影像学对原发性甲状旁腺功能亢进骨病的诊断价值

目的研究原发性甲状旁腺功能亢进所致骨骼改变的特殊影像学征象（如好发骨骼影像学改变,特殊的病理学特征,性别差异）,旨在提高对本病影像的诊断。方法对8例患者经手术病理证实为原发性甲状旁腺功能亢进所致骨改变的影像资料进行回顾性分析。结果所有患者均有广泛性骨质疏松改变,多部位受累及多种影像表现共存。其中骨质疏松8例,骨质破坏吸收6例,骨质软化2例,纤维囊性骨炎3例,软组织钙化1例,病理性骨折2例。结论中年女性患原发性甲状旁腺功能亢进机率高;骨质疏松多为发病早期的表现,骨膜下吸收为原发性甲状旁腺功能亢进进展期所特有,棕色瘤的出现标志着该病变已进人中晚期;从影像学角度分析其特有表现有利于正确诊断该病,并进一步确定病变程度,从而减少误诊,提高诊断率,明确病变程度,为临床医生提供正确的治疗方案提供影像学依据。     

腰椎间盘早期退变定量MRI研究的新进展

腰椎间盘退变引起的下腰痛是影响人们健康的重要原因,MRI 技术是诊断腰椎间盘退变的主要手段,特别是MR扩散加权成像、T2 mapping成像、T1ρ加权成像、钠MRI、软骨延迟钆增强MRI 和MR 波谱成像等新技术能够通过对蛋白聚糖、水等椎间盘细胞外基质成分进行检测,从而达到早期诊断腰椎间盘退行性变的目的。从上述几个方面综合论述MRI技术用于定量分析研究早期腰椎间盘退变的新进展,并就各自的优缺点进行比较。     

急进高原高海拔地区高原反应发生情况分析及紧急献血可行性初步探讨

目的：调查185名从平原急进高原地区人员高原反应发生情况,以及海拔约4600 m地区试验性紧急献血人员健康状况,为高原高海拔地区紧急采血的实施提供科学依据。方法依照GJB1098-1991《急性高原反应的诊断和处理原则》测定不同海拔高度高原反应变化,填写调查表,分析海拔约3600 m和4600 m环境下高原反应发生情况以及海拔4600 m地区献血者紧急献血前后身体健康状况。结果不同海拔高度高原反应发生率变化不明显,但高海拔地区中重度高原反应发生率明显增加;航空机动模式（2～5 h）和铁路机动模式（6～9 d）入藏人员高原反应发生率基本一致,分别为70．00％和74．40％;健康者紧急献血后未发生献血反应和高原反应。结论高原海拔4600 m地区在一定条件下可以开展紧急献血,但仍需加大样本量继续进行深入研究。     

小于8mm并引起梗阻及炎性反应的输尿管结石自行排出率的影响因素

目的 探讨输尿管结石引起梗阻从而导致输尿管黏膜层发生炎性反应变化对结石自行排出的影响因素。方法 通过分析小于8 mm的输尿管结石自行排出率与血清C-反应蛋白（C-reactive protein,CRP）水平和中性粒细胞百分比之间的关系,回顾2001-01至2014-01在武警新疆总队医院287例被诊断为输尿管结石且结石小于8 mm的患者。4周后通过影像学复诊判断结石是否排出。根据患者血清CRP水平分成3组,根据中性粒细胞百分比高低分成2组。分析CRP水平和中性粒细胞百分比与输尿管结石自行排出率之间的关联。结果 输尿管结石自行排出率在低血清CRP水平组、中等血清CRP水平组和高血清CRP水平组分别为：94.1%、70.0%和50.0%。输尿管结石自行排出率在正常的中性粒细胞百分比和高中性粒细胞百分比组中的通过率分别为94.5%和83.1%。结论 当输尿管结石患者血清CRP水平和中性粒细胞百分比高时,可及早考虑侵入治疗,如体外冲击波碎石术或输尿管镜碎石术。     

基于GS筛选系统的动物细胞高效表达载体的构建及应用

目的：通过插入GS筛选系统和替换启动子改造载体以获得高效表达细胞系。方法将pIRES2-EGFP多克隆位点上的BamHⅠ位点突变,构建一个新的载体pIRES2-EGFP-B,通过AseⅠ和NheⅠ双酶切其上的巨细胞病毒（CMV）启动子,加入谷氨酰胺合成酶（ GS）基因筛选标志,再通过PacⅠ和NheⅠ双酶切,插入人巨细胞病毒（hCMV）启动子,构建载体pHGS1．0。将目的基因分别插入载体pHGS1．0和pIRES2-EGFP中,通过比较重组蛋白TEM8（1-227）-VEGFR1domain2-IgG2（TV-IgG2）表达来分析新构建载体的优越性。结果成功插入GS筛选标志,并加入hCMV启动子,人免疫球蛋白定量试剂盒分析发现,重组蛋白表达量提高了5倍。结论通过GS系统筛选,得到高效表达目的蛋白载体系统,为后续的高效表达细胞系筛选奠定了基础。     

纤维胆道镜联合钬激光治疗肝胆管结石的体会

目的总结分析纤维胆道镜联合钬激光治疗肝胆管结石的临床经验。方法2009年1月至2013年6月,肝内外胆管结石76例,采用纤维胆道镜联合钬激光治疗。结果76例患者手术均取石成功。术后并发症9例,其中切口感染4例,肺部感染3例,胆漏2例,均治愈。术后随访6个月至3年,平均17个月,经B超或“T”管造影检查,未发现结石复发、残留及胆管狭窄。结论纤维胆道镜联合钬激光治疗肝胆管结石具有创伤小、并发症少、取石率高、残石率低等优点,可同时发现并处理胆管狭窄。     

Cortical Thinning Correlates with Cognitive Change in Multiple Sclerosis but not in Neuromyelitis Optica

Objectives

To compare spatial patterns of cortical thickness alterations in neuromyelitis optica (NMO) and multiple sclerosis (MS); and to investigate the correlations between cortical thinning and clinical variables in NMO and MS.

Methods

We studied 23 patients with NMO, 27 patients with MS and 26 healthy controls (HCs). The global, brain region and vertex-based cortical thickness (CTh) were analysed and compared among the three groups. A general linear model was used to investigate the correlations between cortical thinning and clinical measures.

Results

A limited number of cortical regions in visual cortex were found to be significantly thinner in NMO patients than in HCs. The MS patients exhibited more widespread cortical thinning compared with HCs, and significantly greater cortical thinning in the insula and the parahippocampus compared with NMO. The extent of cortical thinning in several brain regions correlated with cognitive measures in MS, but not in NMO.

Conclusions

Neocortical thinning in NMO mainly affects visual cortex, while MS patients show much more extensive cortical thinning. Cognitive changes are correlated with cortical atrophy in MS not in NMO. The substrates of cognitive changes in MS and NMO could therefore be different.

Key Points

? MS patients show much more extensive cortical thinning than NMO. ? Cortical thinning of insula and parahippocampus particularly distinguishes MS from NMO. ? Cognitive changes are correlated with cortical atrophy in MS but not in NMO.     

Sagittal and coronal plane location of the popliteal artery in the open-wedge high tibial osteotomy

Purpose

The objectives of this study were (1) to evaluate the sagittal and coronal plane location of the popliteal artery during the advancement of open-wedge high tibial osteotomy and (2) to confirm the effect of osteoarthritis if it changes the relationship between the popliteal artery and posterior cortex.

Methods

Two hundred consecutive patients were enrolled, and we divided patients into two subgroups according to age and cartilage status in the radiologic report of magnetic resonance imaging (group I: 100 non-arthritic knees; group II: 100 arthritic knees). For prediction of the location of the popliteal artery during the operation, sagittal and coronal plane location along the osteotomy plane was evaluated.

Results

The distance between the posterior cortex of the osteotomy and popliteal artery was 13–14 mm on the sagittal plane, and the popliteal artery was located at an approximately 35 ± 5.5 mm portion from the starting point of the osteotomy on the coronal plane. The distance at the starting point of osteotomy was larger than at the end portion and prominent area. In comparison between groups I and II, group II showed a larger distance on the sagittal planes [osteotomy–vascular: 13.6 vs 14.4 (p = 0.01), fibula–vascular: 4.88 vs 6.5 (p < 0.01), and prominence–vascular: 4.3 vs 5.3 (p < 0.01)] compared to the group I.

Conclusions

Special caution and some protection should be given until the approximately 35 mm portion from the starting point of the posteromedial cortex with consideration for the approximity on the sagittal plane. In comparison between the non-arthritic and arthritic knee, differences were observed on the sagittal plane. However, the value was minimal, and the clinical relevance was questionable.

Level of evidence

Case series, Level IV.     

Comparison of anatomic ACL reconstruction between selective bundle reconstruction and double-bundle reconstruction

Purpose

The objective of this study was to compare the clinical and radiologic results of preserved ligament remnants in the selective bundle anterior cruciate ligament (ACL) reconstruction and totally sacrificed ligament remnant in the double-bundle ACL reconstruction in order to confirm the evidence of selective bundle reconstruction.

Methods

This retrospective comparative study was conducted for comparison between preserved ligament remnants in the selective bundle ACL reconstruction and totally sacrificed ligament remnant in the double-bundle ACL reconstruction. From 2008 to 2010, 16 patients (group I) underwent selective bundle ACL reconstruction and 30 patients (group II) underwent double-bundle ACL reconstruction. Clinical, stability and radiologic results (tunnel locations of femoral tunnels using 3-D computed tomography and graft signal intensity using magnetic resonance imaging) were compared.

Results

In comparison with functional results, no statistical differences in the Lysholm, Tegner and International Knee Documentation Committee scores were observed between the two groups (n.s.). In comparison with stability results between the two groups, no statistical differences were observed in the Lachman, pivot shift and anterior drawer stress tests using a Telos^® device at 30° and 90° flexed positions (n.s.). In evaluation of the femoral tunnel location, no statistical significant differences in the tunnel position were observed between the groups (n.s.). No statistically significant differences in signal intensity were observed between the two groups (n.s.).

Conclusions

Compared to the double-bundle ACL reconstruction, selective bundle ACL reconstruction produced comparable clinical and radiologic results. Selective bundle ACL reconstruction could be performed instead of double-bundle ACL reconstruction if some intact bundle exists.

Level of evidence

Comparative study, Level III.     

内质网应激预处理对肝毒性药物导致原代大鼠肝细胞损伤的保护作用研究简

目的探讨大鼠肝细胞的内质网应激预处理对临床相关肝毒性药物肝细胞损伤的保护作用。方法（1）将培养的原代大鼠肝细胞分为8组,分别予以不同浓度的衣霉素和毒胡萝卜素进行干预,尔后检测葡萄糖调节蛋白78GRP78、葡萄糖调节蛋白94GRP78。（2）衣霉素和毒胡萝卜素干预作用24h后,可造成50％～75％的细胞死亡。对肝细胞进行预处理后,再使用顺铂、百草枯和利福平对细胞进行干预,检测细胞生存率。结果内质网应激诱导剂（毒胡萝卜素、衣霉素）对于GRP78和GRP94的表达表现出剂量相关的诱导作用．随着浓度的增加其表达量也逐渐增加,其变化具有明显的统计学意义（P〈0．05）。而临床相关的毒性药物（顺铂、利福平、百草枯）对细胞的损伤可明显地因毒胡萝卜素和衣霉素的内质网应激预处理而减轻,其结果具有统计学意义。结论内质网应激预处理对临床相关肝毒性药物导致原代大鼠肝细胞损伤具有保护作用。这些结果提示在药物导致的肝损伤中内质网应激或许起到了一定作用。