Multimodal magnetic resonance imaging for assessing lacunar infarction after proximal middle cerebral artery occlusion in a canine model

Background  A new lacunar infarction model was recently established in beagle dogs through proximal middle cerebral artery (MCA) occlusion by thrombus. This study aimed to characterize the model by multimodal magnetic resonance imaging (MRI) and to investigate its potential role for the future stroke research.

Methods  The left proximal MCA was embolized with an autologous thrombus in six beagles. Diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) were performed every half hour during the first six hours after occlusion, followed by three time points at 12 hours, 24 hours, and one week. Perfusion-weighted imaging (PWI) and magnetic resonance angiography (MRA) were carried out at six hours, 24 hours and one week. The PWI-DWI mismatch ratio was defined as (PWI-DWI)/DWI ischemic volume.

Results  Lacunar infarcts induced by MCA occlusion were located in the left caudate nucleus and internal capsule. All the lesions could be detected within two hours by DWI. Lesion volume on DWI increased in a time dependent manner, from (87.19±67.16) mm³ at one hour up to (368.98±217.05) mm³ at 24 hours (P=0.009), while that on PWI gradually decreased from (7315.00±2054.38) mm³ at six hours to (4900.33±1319.71) mm³ at 24 hours and (3334.33±1195.11) mm³ at one week (P=0.002). The mismatch ratio was 41.93±22.75 at six hours after ischemia, showing “extensive mismatch”, and decreased to 18.10±13.74 at 24 hours (P=0.002). No MCA recanalization was observed within 24 hours after MCA occlusion.

Conclusions  Lacunar infarction induced by proximal MCA occlusion could be detected early by DWI and was characterized by extensive PWI-DWI mismatch. Multimodal MRI is useful to demonstrate the natural evolution of PWI-DWI mismatch. This ischemic model could be further used for investigating early thrombolysis in lacunar stroke showing extensive mismatch.

     

连续回顾性研究对比粘小管切开术和小梁切除术治疗先天性青光眼的疗效

Background Surgical interventions are the main treatment for primary congenital glaucoma (PCG).This study aimed to compare the efficacy and safety between viscocanalostomy and mitomycin C (MMC)-trabecu...     

A modified tricuspid valve annuloplasty technique for functional tricuspid regurgitation

Background Functional tricuspid regurgitation often occurs in patients with concomitant left sided, valve disease. Several types of tricuspid valve annuloplasty have been described, but there is no consensus on the management of functional tricuspid regurgitation. We report a modified annuloplasty technique and compare its efficacy with the conventional Kay technique. Methods A retrospective review was made of 60 patients who received tricuspid valve annuloplasty （group A, modified method; group B, Kay technique） and the early and midterm outcomes of modified method and Kay technique were compared. Results Three patients underwent ring annuloplasty using a semirigid Carpentier-Edwards ring due to failing suture annuloplasty. All patients were completely cured when they left the hospital. The follow-up time was （32＋7） months in group A and （30＋7） months in group B. After three years, tricuspid regurgitation decreased by more than two grades in 13 patients in group A and 11 in group B. The mean postoperative regurgitation grade in group A was lower than group B at 12, 24 and 36 months but not significantly. Three of 28 patients developed recurrent tricuspid regurgitation in group A and five of 26 patients in group B during the follow-up period （three deaths and three ring annuloplasties excluded）. Freedom from recurrent tricuspid regurgitation in group A was higher than that group B at all follow-up points. Postoperative right atrium diameter, right ventricle endodiastolic dimension and tricuspid regurgitation area decreased obviously in both groups. The right ventricle endodiastolic dimension and tricuspid regurgitation area improved more significantly in group A than group B over three years of follow-up, Conclusions The modified annuloplasty technique achieved the same outcomes as the conventional Kay annuloplasty over the first three years postoperation. As this modified technique is simple and less expensive, it is another option for correction of functional tricuspid regurgitation.     

紫杉醇联合顺铂治疗晚期食道癌的临床效果分析

目的 研究紫杉醇联合顺铂治疗晚期食道癌的临床效果.方法 选择浙江省宁波市第二医院心胸外科2010年11月～2012年10月收治的84例晚期食道癌患者作为实验对象.按照1:1的人数比例将其分为实验组和对照组,实验组给予紫杉醇与顺铂联合的方法进行治疗,对照组采用5-氟尿嘧啶与顺铂联合的方法进行治疗,实验期结束后,比较两组患者的治疗效果.结果 实验期结束后,本研究统计了实验组和对照组患者的病灶大小变化情况及其垂直直径情况,实验组完全缓解8例,占19.0％,部分缓解27例,占64.3％,稳定6例,占13.3％,进展1例,占2.4％,总有效率为97.6％;对照组完全缓解1例,占2.4％,部分缓解10例,占23.8％,稳定18例,占42.9％,进展13例,占30.9％,总有效率为69.1％.两组各项指标比较的x2值分别为3.161、3.764、2.957、4.037和2.745,P值分别为0.01、0.04、0.03、0.01和0.04.结论 紫杉醇联合顺铂治疗晚期食道癌相较于其他方法能够有效提高患者的生存质量,延长生存时间,值得临床推广.     

双源CT双能量扫描评价肺癌化疗效果的初步研究

目的 研究西门子双源CT双能量扫描检测肺癌化学治疗的效果.方法 收集苏州市吴江区第一人民医院2012年4月～2013年3月进行化学治疗的肺癌患者40例,对其进行长春瑞滨＋顺铂治疗,分析记录肺癌患者化疗前后肿瘤的能谱曲线、碘含量以及不同单能量下的CT值,并对数据进行分析.结果 40例肺癌患者在不同单能量下（40、60、80、100、120 kV）治疗前后肿瘤的CT值分别为[（145.8±22.7）、（108.1±26.2）HU]、[（94.2±18.6）、（74.7±18.2）HU]、[（74.1±16.8）、（49.9±10.8）HU]、[（58.0±13.4）、（39.8±11.3）HU]、[（48.6±13.7）、（35.6±9.5）HU].治疗前肿瘤内感兴趣区（ROI）的碘含量为（2.5±0.2） mg/mL,治疗后肿瘤内ROI的碘含量为（1.3±0.2）mg/mL.治疗后不同单能量下肿瘤CT值及肿瘤内碘含量均较治疗前降低,差异有统计学意义（P＜0.05）.结论 西门子双源CT为肿瘤检查提供一条准确性高、检测速度快且X射线量大大减少的检测途径,并为使用西门子双源CT双能量扫描检测肺癌化疗效果提供理论依据与实践基础.     

腹腔镜下治疗早期卵巢癌的临床效果分析

目的 探讨腹腔镜下广泛性子宫切除术治疗早期卵巢癌的效果及对患者预后和生命质量的影响.方法 选择2002年1月～2012年1月确诊为临床Ⅰ a、Ⅰb期卵巢癌并接受手术治疗的患者120例,其中60例行腹腔镜手术（腹腔镜组）,60例行开腹手术（开腹组）.采用自制的质量量表对存活患者进行生命质量调查,比较各组患者的疗效及生命质量调查结果.结果 ①腹腔镜组、开腹组手术时间、术中出血量比较,差异有统计学意义（t=2.17、6.38,P＜0.05）.腹腔镜组、开腹组术中损伤脏器例数比较,差异无统计学意义（t=1.02,P＞0.05）.②腹腔镜组、开腹组术后肛门排气时间、72 h下床活动、术后平均住院时间比较,差异均有统计学意义（t/x2=10.12、10.27、4.55,P＜0.05）.两组并发症发生率比较,差异无统计学意义（t=1.23,P＞0.05）.③两组性生活质量、泌尿道症状及植物神经功能失调症状评分差异无统计学意义（t=0.36、0.51、1.05,P＞0.05）.结论 腹腔镜广泛子宫切除术治疗卵巢癌是安全、可行的,远期疗效良好,可以作为子卵巢癌手术治疗的选择方式之一.     

培美曲塞加顺铂治疗晚期非小细胞肺癌的效果

目的探讨培美曲塞联合顺铂治疗晚期非小细胞肺癌的临床疗效。方法将2010年1月～2011年12月在驻马店市中心医院住院的94例晚期非小细胞肺患者分为两组,研究组48例,对照组46例。对照组采用吉西他滨1000mg]m2,d1,联合顺铂25mg／m^2,d1-3研究组采用培美曲塞500mg／m^2,d1,联合顺铂25mg／m^2,d1-3,两组均以21d为1个周期重复。观察并比较两组的疗效、中位疾病进展时间（TTP）、中位生存期（MST）以及生活质量提高率和降低率。治疗期间观察不良反应。结果对照组的总有效率为71．7％,研究组的总有效率为83.3％,差异有统计学意义（P〈0．05）。对照组与研究组中位无疾病进展时间（mPFS）分别为3．8个月和5．2个月,差异有统计学意义（P〈0．05）;对照组与研究组中位生存时间（MST）分别为11．2个月和15．8个月,差异有统计学意义（P〈0．05）。两组生活质量提高率和降低率比较,对照组KPS评分提高18例（39．1％）,稳定18例（39．1％）,降低10例（21．7％）,研究组KPS评分提高为21例（43．8％）,稳定22例（45．8％）,降低5例（10．4％）,两组提高率和降低率比较,差异有统计学意义（P〈0．05）。两组的不良反应主要为骨髓抑制、恶心呕吐、脱发及周身乏力。研究组中骨髓抑制及恶心呕吐发生率明显低于对照组,差异有统计学意义（P〈0．05）,其他不良反应发生率两组相似（P〉0．05）。结论培美曲塞联合顺铂治疗晚期非小细胞肺癌的疗效较顺铂的疗效显著,且毒性反应明显减少,可作为晚期非小细胞肺癌患者的一线治疗用药。     

围绝经期女性患者住院期间焦虑抑郁情绪调查研究

目的探讨围绝经期女性患者焦虑抑郁情绪的检出率和影响因素。方法采用自编问卷、抑郁自评量表（SDS）和焦虑自评量表（SAS）对2011年12月-2012年12月在浙江省金华市中心医院住院治疗的200例围绝经期女性患者进行测评,运用SPSS 18.0统计软件进行描述性统计和二分类Logistic回归分析,探讨围绝经期女性患者焦虑抑郁情绪检出率和影响因素,旨在为采取针对性的干预措施提供参考依据。结果 200例围绝经期女性患者中焦虑情绪检出率为20.50%（41/200）,抑郁情绪检出率为22.50%（45/200）。多因素Logistic回归分析显示,伴侣健康状况好是围绝经期女性患者住院期间焦虑情绪的保护因素（P〈0.05）,经济状况好是围绝经期女性患者住院期间抑郁情绪的保护因素（P〈0.05）,文化程度高和婚姻自我感觉好是围绝经期女性患者住院期间焦虑抑郁情绪的保护因素（P〈0.05）,患者年龄大和所患疾病为恶性是围绝经期女性患者住院期间焦虑、抑郁情绪的危险因素（P〈0.05）。结论围绝经期女性患者抑郁焦虑情绪检出率较高,其发生影响因素众多。在对患者进行干预的过程中,应对高危人群进行重点干预,减少患者焦虑抑郁情绪的出现。     

卵巢癌中医药研究近况

卵巢癌是严重威胁生命健康的一类妇科恶性肿瘤,其在女性生殖器官恶性肿瘤中的发生率占第3位,但病死率却居第1位。积极探索中医药抗肿瘤或辅助抗肿瘤有着重大研究价值,该文通过对卵巢癌古代文献、现代医家辨治经验、方药实验和临床研究等方面分别论述。     

64排CT冠状动脉成像与心血管造影对壁冠状动脉诊断价值的对比

目的比较64排螺旋CT冠状动脉成像(CTCA)与心血管造影(CAG)对壁冠状动脉的诊断价值。方法回顾性分析46例经由CTCA和CTA确诊的心肌桥-壁冠状动脉患者的图像,观察壁冠状动脉的发生部位、长度、埋藏深度及壁冠状动脉狭窄程度,同时分析壁冠状动脉狭窄程度与埋藏深度之间是否存在相关性。结果 46例患者中CTCA与CAG共同发现心肌桥62段,其中LAD心肌桥45段(占72.6%),LCX心肌桥7段(占11.3%),RCA心肌桥10段(占16.1%)。CTCA诊断壁冠状动脉平均长度为(6.8±2.5)mm,平均埋藏深度为(3.2±1.3)mm,平均狭窄程度(47.2±10.1%)。CAG诊断壁冠状动脉平均长度为(5.3±1.9)mm,平均埋藏深度为(2.9±1.4)mm),平均狭窄程度(57.3±11.2%)。两者对比差异有统计学意义(P<0.05)。壁冠状动脉狭窄程度与埋藏深度之间存在相关性,深埋型壁冠状动脉狭窄程度较表浅型壁冠状动脉狭窄程度更严重。结论 64排螺旋CT冠状动脉成像是诊断心肌桥-壁冠状动脉的有力检查方法,可为临床诊断及治疗提供重要参考价值。