内镜下切除胃肠道息肉及癌前病变方法的选择

目的;比较不同方法切除胃肠道息肉和癌前病变的疗效。方法：本文采用高频电和其它不同方法对胃肠道息肉和癌前病变切除和切割。结果：对小的扁平息肉用高频电灼除或热活检安全有效。一次的灼除达100％。圈套适应胃结肠有蒂息肉。对大的有蒂或分叶状息肉需分次圈套切除,圈套和烧灼或热活检结合可避免肠穿孔发生。双胃镜代替双腔治疗胃镜行粘膜切除胃内平坦和扁平隆起性非典型增生灶操作容易,病灶切除彻底。息肉切除后常于局部形成溃疡,术后应常规给予酸抑制剂和粘膜保护剂治疗。结论：内镜－高频电是切除胃肠道有蒂和无蒂息肉的有效方法,粘膜染色后,双胃镜行粘膜和术治疗胃内癌前病变切实可行。     

食管粘膜活检取样误差的发生机制及对策

目的：探讨食管粘膜活检取样误差的发生机制及对策。方法：对来自河南食管癌高发区２８例患者行食管内镜检查和中、下段粘膜活检组织病理检查,１０天短期随访后对同一人群作重复检查;并对８８位无症状受检者进行碘染与活检相结合的方法。结果：第二次粘膜活检组织中,食管中段２４％的患者病变减轻,２８％的患者病变加重,４８％的患者病变维持不变。食管下段粘膜活检中,４８％的患者病变减轻,１６％的患者病变加重,３２％的患者病变维持不变;碘染受检者的食管粘膜中染色正常和染色异常的粘膜组织在癌前病变各阶段的构成比无明显差异。组织形态学测量显示：各级癌前组织与正常上皮组织的厚度无明显差异。结论：粘膜活检取样误差可严重影响组织病理学检查随访结果。食管粘膜癌前病变,特别是较轻度病变的厚度与同期正常上皮无明显改变,造成内镜下识别困难,是造成取样误差的重要因素。碘染可明显提高内镜下病变与同期正常组织的识别,但对小范围病变的活检准确度仍需改进。肿瘤抑制基因ｐ５３蛋白聚集的重复性检出率较高,可能是食管癌变过程中的有效指标。     

基于多尺度特征融合与反向注意力的COVID-19病灶分割

针对新型冠状病毒肺炎（COVID-19）分割问题中感染区域具有高变异性以及病灶与背景对比度低等问题,提出一种基于多尺度特征融合与反向注意力的COVID-19感染分割网络。首先,利用残差网络作为主干网络进行特征提取,并使用全局上下文聚合策略对不同层次特征进行融合得到粗略的分割结果;其次,在网络瓶颈处添加多尺度特征融合模块,利用空洞卷积与多核池化增强网络分割不同尺度病变的能力;最后,设计一种级联结构的反向注意力模块,利用互补区域的细节特征增强背景与目标的对比度。本文方法在COVID-19 CT分割测试集上的准确率、特异性、灵敏度分别达到0.714、0.700和0.958,误检和漏检区域明显减少,细小病灶的分割能力显著提升。     

MRI of the Stener lesion

Objective. To assess the utility of MR in detecting surgically induced Stener lesions (displaced thumb ulnar collateral ligaments) in cadaveric models. Design. Six cadaver thumbs had ulnar collateral ligament (UCL) tears created surgically. MR examinations (2D STIR and 3D GRASS) were performed identically on all specimens both before displacement (non-Stener) and after displacement (Stener lesion) of the UCL. The MR images were then randomly numbered. Each image was evaluated separately in blinded fashion by four musculoskeletal radiologists for the presence or absence of a Stener lesion. Each radiologist reinterpreted the images after an interval of several days. The interpretation was based on previously published criteria for Stener lesion diagnosis by MR. Results. The sensitivity of GRASS ranged from 0.17 to 0.67 with the most experienced reader scoring the lowest. The specificity of GRASS ranged from 0.33 to 1.0 (most experienced reader 0.67, 0.83). STIR had a sensitivity of 0.00–0.17 and a specificity of 0.53–0.83. The values for inter- and intraobserver agreement were measured. The intraobserver for GRASS was 0.27–0.75 (most experienced reader 0.75). Conclusions. 2D imaging is probably inadequate for the evaluation of Stener lesions. The most likely reason is that the STIR slice thickness of 3 mm limits resolution of small UCLs. The poor sensitivity and specificity of GRASS as well as poor interobserver agreement suggest that MR may not be sufficiently accurate for Stener lesion evaluation.     

由门静脉高压症患者脾内血管病变再谈脾脏功能

目的　探讨门脉高压状态下脾脏的功能及其在门脉高压发展中的作用。方法　研究２８ 例门脉高压症患者和１０ 例外伤性脾破裂患者脾脏的血管病变,采用常规ＨＥ 染色和ＭＡＳＳＯＮ 三色染色,光镜下观察其血管的病理改变。结果　与外伤性脾破裂脾脏比较,门脉高压脾内血管发生多种改变如：硬化性血管内膜炎病变,均发生内皮细胞受损、胶原纤维细胞外基质增多、弹力纤维断裂和管壁纤维化。结论　①门脉高压时脾脏微循环发生改变,免疫功能处于紊乱状态;存在保脾和切脾的争论的主要原因是脾脏的病理进展时期不一致;②脾脏在尤其是中重度门脉高压发展中起促进作用;脾内血管病变是门静脉高压症血管病变的一部分     

Effect of dopamine denervation and dopamine agonist administration on serine phosphorylation of striatal NMDA receptor subunits

Sensitization of striatal N-methyl-d-aspartate (NMDA) receptors has been implicated in the pathogenesis of the response alterations associated with dopaminomimetic treatment of parkinsonian animals and patients. To determine whether serine phosphorylation of NMDA receptor subunits by activation of Ca2+/calmodulin-dependent protein-kinase II (CaMKII) contributes to this process, we examined the effects of unilateral nigrostriatal ablation with 6-hydroxydopamine and subsequent treatment with levodopa, SKF 38393 (D1-preferring dopamine agonist), or quinpirole (D2-preferring agonist) on motor responses and phosphorylation states. Three weeks of twice-daily levodopa administration to rats shortened the duration of their rotational response to levodopa or SKF 38393 challenge, but prolonged the duration of quinpirole-induced rotation. At the same time, levodopa treatment elevated serine phosphorylation of striatal NR2A (p<0.02), but not that of NR2B subunits, without associated changes in subunit protein levels. Chronic treatment with SKF 38393 increased NR2A (p<0.0001) but decreased NR2B (p<0.004) serine phosphorylation. In contrast, chronic quinpirole treatment had no effect on NR2A but increased NR2B phosphorylation (p<0.0001). The acute intrastriatal injection of the CaMKII inhibitor KN93 (1.0 micrograms) not only normalized the levodopa-induced motor response alterations but also attenuated the D1 and D2 receptor-mediated serine phosphorylation of NR2A and NR2B subunits, respectively (p<0.02). These results suggest that a CaMKII-mediated rise in serine phosphorylation of NMDA receptor subunits induced by intermittent stimulation of D1 or D2 dopaminergic receptors contributes to the apparent enhancement in striatal NMDA receptor sensitivity and thus to the dopaminergic response plasticity in levodopa-treated parkinsonian rats.     

Neurological prognosis correlated with variations over time in the number of subependymal nodules in tuberous sclerosis

In tuberous sclerosis (TS), brain CT reveals subependymal nodules, cortical tubers and white matter lesions. This study is a retrospective analysis of the relationship between the variations over time in the number of subependymal nodules and the clinical course in cases of tuberous sclerosis. Twenty-four children with tuberous sclerosis, who attended the National Children's Hospital as outpatients, were followed by means of brain CT examinations for 7 years and 1 month on average. Cranial MRI was also performed in 22 cases. Brain CT disclosed subependymal nodules already in early infancy. In almost all cases, the number of subependymal nodules gradually increased with age, especially around the frontal horn of the lateral ventricle. The increase stopped at around age 10. The cases with five or more subependymal nodules at the initial or subsequent CT examination (17 patients; Group A) exhibited a significantly greater number of cortical tubers than those with less than five (five patients; Group B) and had white matter lesions unlike Group B. In addition, the number of cases with either infantile spasms or mental retardation was significantly higher in Group A than Group B (P<0.005). In conclusion, the number of ventricular subependymal nodules may allow prediction of the severity of the cerebral dysfunction in TS. Our results suggest that its variation may reflect the degree of the embryologic disorder when neuronal cells grow in the early gestational period.     

Selective drawing disorders after right subcortical stroke: a neuropsychological premorbid and follow-up case study

We report the case of a patient affected by a subcortical lesion of the right non-dominant hemisphere, and demonstrate that he had selective constructional disorders by comparing his post-stroke performances with those assessed 18 months before the stroke. A detailed analysis was made of the visuospatial, perceptual, representational and executive competences involved in drawing tasks at one, two and six months post-stroke. Neuropsychological follow-up revealed the progressive recovery of all visuospatial abilities. This study provides some interpretative elements for constructional disorders and, in particular, for the closing-in phenomenon observed only during the subacute phase.

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Sommario Descriviamo un paziente affetto da una lesione sottocorticale dell'emisfero destro. Le prestazioni del paziente dopo l'ictus cerebrale, confrontate con quelle osservate prima dell'evento patologico, hanno dimostrato la presenza di selettivi disturbi costruttivi. Abbiamo effettuato un approfondito esame delle prestazioni costruttive, con prove visuospaziali che esplorano i livelli percettivo, rappresentazionale ed esecutivo, esaminando il paziente fino a sei mesi dopo l'ictus. Il follow-up neuropsicologico ha dimostrato un progressivo recupero di tutte le competenze visuospaziali. Questo studio fornisce dunque alcuni elementi interpretativi per i disordini costruttivi ed, in particolare, per il fenomeno del closing-in osservato nelle prime fasi dello studio longitudinale.

     

Primary cranial vault lymphoma mimicking meningioma

Primary lymphomas of the cranial vault are rare; only six patients have been described in the literature. We report a 75-year-old woman who was admitted to our hospital after a focal seizure. CT showed a homogeneous mass which, on contrast enhancement, was similar to a meningioma. The tumour was excised and found to be a centroblastic, centrocytic non-Hodgkin's lymphoma. Treatment was completed with radiotherapy and chemotherapy.