改良式供肝获取在原位肝移植中的临床应用

目的 介绍改良式供肝获取的方法及经验,完善供肝获取技术,提高供肝质量.方法 自1999年1月～2006年8月共在35例次新鲜尸体上采用改进的方法获取供肝,其中26例次为模拟实验,灌洗液全部应用0～4℃乳酸林格氏液.5例次实施背驮式肝移植术,4例次实施经典式肝移植术.腹主动脉插管灌洗后,立即结扎肠系膜上血管,减少灌洗液的分流;根据不同时限调整门静脉灌注UW液的速度,延长灌注时间;修肝过程中再缓慢灌注0～4℃UW液1000ml.结果 35例次所获取的供肝均颜色苍白,质地柔软,各种管道均满足手术吻合需要.热缺血时间为5～8min.9例肝移植病人无手术死亡,供肝功能发挥良好,节约UW液用量约1000ml.结论 供肝获取的改良式方法较常用的经典式方法有明显优越性.     

脑缺血梗死前期的CT灌注成像

缺血性脑血管病具有高发病率、高致残率、高病死率的特点,及时干预、适当的干预措施对预后有很大影响。利用CT灌注成像技术,研究脑梗死超急性期的脑血流变化规律,根据脑局部血液动力学指标确定合适的治疗时间窗,制定个性化的治疗方案,预测治疗结果具有实际的临床意义。CT灌注成像成为近期研究的热点。     

用不灌洗法保存犬肝的电镜观察

本实验证明,用不灌洗法在25℃、15℃保存犬肝的有效时限分别是3小时和4小时,用Sacks液低温灌洗在4℃保存犬肝的有效时限至少是6小时。这表明用不灌洗法进行立即肝移植是可行的。     

循证医学用于膀胱癌灌注化疗患者护理的效果观察

目的 探讨循证医学用于膀胱癌灌注化疗患者护理的临床效果.方法 选取2015年10月至2019年10月间山东省立第三医院收治的60例膀胱癌灌注化疗患者,采用双盲选法抽签分为观察组和对照组,每组30例.对照组患者采用常规护理,观察组患者采用循证医学护理,比较两组患者总体健康状况得分、各功能评分及功能子量表得分.结果 干预前...     

Saccharic acid 1.4-lactone protects against CPT-11-induced mucosa damage in rats

Purpose To evaluate the ability of D-saccharic acid 1.4-lactone (SAL), a -glucuronidase inhibitor, to prevent irinotecan hydrochloride (CPT-11) from inducing mucosal damage as a cause of diarrhea in rats.Methods Wistar rats were divided into six groups of three animals each, administered 1.0 ml isotonic solution intraperitoneally once daily for up to three consecutive days, respectively for up to six days. The series were as follows: (1) On days 1–3: saline; (2). On days 1–3: 200 mg CPT-11/m²; (3) On days –3 to –1 relative to the first administration of CPT-11: 10 mg/ml SAL; on days 1–3: 200 mg CPT-11/m²; (4) On days –3 to +3 relative to the first administration of CPT-11: 10 mg/ml SAL, and on days 1–3: additional 200 mg CPT-11/m²; (5) On days 1–3: 200 mg CPT-11/m² (0.5 ml) + 10 mg/0.5 ml SAL; (6) On days –3 to –1 relative to the first administration of CPT-11: 3 mg/ml SAL, and on days 1–3: 200 mg CPT-11/m². Luminal mucosa damage of the small intestine was detected by histology 24 h after the last intraperitoneal application. Peptidase activities of the proximal jejunum were measured by using an in situ perfusion model.Results Following intraperitoneal CPT-11 treatment, using conventional histology of paraffin sections, we observed severe mucosal damage. This was reflected by a decrease of the villi/crypt ratio, an increase of apoptotic cells, as well as an increase of mitotic figures in the crypt region. There was a concomitant increased lymphatic infiltration in mucosa of CPT-11 treated rats. This damage pattern could be clearly reduced by co-treatment with the -glucuronidase inhibitor, SAL, independent of the treatment schedule. In contrast to our expectations based on previous reports, the intraperitoneal application of CPT-11 alone or in combination with SAL did not cause significant differences in luminal enzyme liberation in comparison with controls in the in situ perfusion assay.Conclusions The -glucuronidase inhibitor SAL is able to significantly reduce CPT-11-induced mucosal damage in the small intestine of rats. This observation might soon have a clinical impact for the treatment of patients with CPT-11.     

优化低剂量一站式全脑CT灌注成像联合CTA扫描方案

目的 探讨优化一站式全脑CT灌注成像（CTP）联合CTA扫描方案。方法 对45例受检者行一站式全脑CTP联合CTA,共进行22期相扫描,并采用3种扫描方案,选取第10期相灌注图像重建CTA图像,其中A组为自动管电流调制（ATCM）技术及低噪声指数（噪声指数=2）,B组为管电流325 mA,C组为ATCM及稍低噪声指数（噪声指数=2.5）;3组其余各期相均采用ATCM技术且噪声指数设定为8;3组扫描方案的管电压均为100 kV。记录辐射剂量相关参数,比较CTA、CTP图像的噪声（SD）、SNR、CNR及不同部位脑实质各灌注参数值及CTA、CTP图像的主观评分。结果 3组有效剂量（ED）差异有统计学意义（P<0.05）,其中A组ED明显高于B、C组（P=0.043、0.001）;3组CTA图像噪声、SNR、CNR及主观评分差异无统计学意义（P=0.218、0.545、0.575、0.900）,CTP图像相应部位图像噪声、SNR、各灌注参数值及主观评分差异均无统计学意义（P均>0.05）。结论 采用ATCM技术一站式全脑CTP联合CTA检查可通过适当增加噪声指数减低患者辐射剂量。     

Dipeptidyl peptidase IV in mammalian lungs

Endothelial cells of the pulmonary circulation are equipped with an ectoenzyme protease system on their luminal surface. The membrane-bound proteases act on the circulating polypeptides and cleave certain peptide bonds in their structure, thus modifying their biological properties. We studied the enzyme dipeptidyl peptidase IV (DP-IV) in mammalian lungs in order to elucidate its contribution to the aforementioned proteolytic processing. We have found that lungs of mammalian species posses DP-IV with different levels of specific activity. In rat lungs the specific activity of DP-IV progressively increased during development between the 18th fetal and the 70th postnatal days. Human embryonal and fetal lungs had significantly higher specific activity of DP-IV compared with the lungs of adult individuals. The enzyme in lungs was mainly membrane bound and was solubilized by some detergents, but not with papain and trypsin. The Triton X-100-solubilized DP-IV from rat lung lysosomal-microsomal membranes migrated during electrophoresis on continuous 4–30% gradient polyacrylamide gel at native apparent M_r values of 260 000 and 490 000. Using a histochemical technique we found the enzyme activity of DP-IV in the capillary bed of the lung alveolar septa only. Four aminoacyl-L-proline-4-nitroanilide substrates for DP-IV were cleaved rapidly during one passage through isolated perfused blood-free rat lungs. The perfusion profiles of cleavage of these substrates were largely coincident with that of Blue Dextran 2 000, a compound, which is unlikely to leave the intravascular space. Taken together, the data suggest that DP-IV operates in vivo as a membrane-bound ectoenzyme on the luminal surface of pulmonary endothelial cells and that it may cleave certain circulating polypeptides.     

Validation of histologic bone analysis following Microfil vessel perfusion

Abstract

The ability to examine bone vascularity using micro-computed tomography following vessel perfusion with Microfil^® and to subsequently perform histologic bone analysis in the same specimen would provide an efficient method by which the vascular and cellular environment of bone can be examined simultaneously. The purpose of this report is to determine if the administration of Microfil precludes accurate histologic assessment of bone quality via osteocyte count and empty lacunae count. Sprague–Dawley rats (n?=?6) underwent perfusion with Microfil. Left hemi-mandibles were harvested, decalcified, and underwent vascular analysis via micro-computed tomography prior to sectioning and staining with Gomori’s trichrome. Quantitative histomorphometric evaluation was performed. Ninety-five percent confidence intervals (CIs) were used to determine statistical differences from an established set of controls (n?=?12). Histologic analyses were successfully performed on specimens that had been perfused. Quantitative measures of bone cellularity of perfused versus control specimens revealed no statistical difference in osteocyte count per high-power field (95·33 versus 94·66; 95% CI: ?7·64 to 6·30) or empty lacunae per high-power field (2·73 versus 1·89; 95% CI: ?1·81 to 0·13). A statistical validation is reported that allows histologic analysis of cell counts in specimens which had been perfused with Microfil.     

UMMPerfusion: an Open Source Software Tool Towards Quantitative MRI Perfusion Analysis in Clinical Routine

To develop a generic Open Source MRI perfusion analysis tool for quantitative parameter mapping to be used in a clinical workflow and methods for quality management of perfusion data. We implemented a classic, pixel-by-pixel deconvolution approach to quantify T1-weighted contrast-enhanced dynamic MR imaging (DCE-MRI) perfusion data as an OsiriX plug-in. It features parallel computing capabilities and an automated reporting scheme for quality management. Furthermore, by our implementation design, it could be easily extendable to other perfusion algorithms. Obtained results are saved as DICOM objects and directly added to the patient study. The plug-in was evaluated on ten MR perfusion data sets of the prostate and a calibration data set by comparing obtained parametric maps (plasma flow, volume of distribution, and mean transit time) to a widely used reference implementation in IDL. For all data, parametric maps could be calculated and the plug-in worked correctly and stable. On average, a deviation of 0.032 ± 0.02 ml/100 ml/min for the plasma flow, 0.004 ± 0.0007 ml/100 ml for the volume of distribution, and 0.037 ± 0.03 s for the mean transit time between our implementation and a reference implementation was observed. By using computer hardware with eight CPU cores, calculation time could be reduced by a factor of 2.5. We developed successfully an Open Source OsiriX plug-in for T1-DCE-MRI perfusion analysis in a routine quality managed clinical environment. Using model-free deconvolution, it allows for perfusion analysis in various clinical applications. By our plug-in, information about measured physiological processes can be obtained and transferred into clinical practice.