血管内皮生长因子对尾吊大鼠后肢胫骨骨丢失的影响

目的探究血管内皮生长因子(vascular endothelial growth factor,VEGF)对废用性骨丢失的影响。方法建立尾吊大鼠的动物模型,并随机平均分为尾吊盐水组、尾吊VEGF组、对照盐水组、对照VEGF组。实验过程中,每周两次对大鼠右腓肠肌注射VEGF或者等量的生理盐水,4周后通过micro-CT对大鼠胫骨近端进行扫描,以松质骨和皮质骨骨密度(bone mineral density,BMD)、骨体积分数(BV/TV)、骨小梁数量(Tb.N)、骨小梁间距(Tb.Sp)和结构模型指数(SMI)等松质骨微结构参数以及皮质骨厚度作为评价指标,探讨VEGF对尾吊大鼠后肢胫骨骨丢失的影响。结果与对照组大鼠相比,尾吊组大鼠松质骨表观BMD、BV/TV、Tb.N以及皮质骨厚度均显著降低,Tb.Sp与SMI显著升高,尾吊会造成大鼠的骨丢失,而注射VEGF能够缓解尾吊大鼠松质骨的骨丢失。结论血供的改变可能与骨重建之间存在着一定的联系,改善血供有助于对抗废用性的骨丢失。     

肝内胆管细胞癌的形态学CT分型及临床意义

目的对肝内胆管细胞癌的形态学CT分型以及临床意义进行评价分析,为今后的临床治疗工作提供可靠的理论依据。方法抽取在2013年1月~2014年6月我院收治的临床确诊肝内胆管细胞癌患者24例,对其CT扫描情况展开回顾性分析,评价形态学CT分型以及临床诊断价值。结果本组24例患者中,包括有肿块型者10例,CT表现为肝内结节状肿瘤,未出现周围胆管扩张现象;管周围浸润型者5例,CT表现为沿着胆管纵轴生长的树枝状肿瘤,合并有周围胆管扩张;肿块合并管周浸润型者7例,CT表现出肝内结节状肿瘤,并且合并有胆管扩张;管内生长型2例,CT表现为单发、多发肿瘤结节位于扩张的胆管内。结论经CT检查可以对肝内胆管细胞癌展开准确的形态学分型,为临床治疗方案的选择提供了可靠的参考依据,临床价值显著,值得关注。     

Lipoprotein(a) and Oxidized Phospholipids Promote Valve Calcification in Patients With Aortic Stenosis

Background

Lipoprotein(a) [Lp(a)], a major carrier of oxidized phospholipids (OxPL), is associated with an increased incidence of aortic stenosis (AS). However, it remains unclear whether elevated Lp(a) and OxPL drive disease progression and are therefore targets for therapeutic intervention.

肝硬变患者肝脏体积改变与肝功能的关系

本文应用放免法检测３４例肝炎后肝硬变血清ＨＡ、ＣＧ等肝功能指标结合测量ＣＴ片上肝脾体积改变以探讨两者的关系。结果显示随着肝硬变患者Ｃｈｉｌｄ分级增加，肝功能损害加重，表现为ＨＡ和ＣＧ浓度逐渐上升，ＰＴ时间延长和白蛋白浓度降低。肝脏体积缩小，与ＨＡ、ＣＧ及ＰＴ时间呈负相关（分别为ｒ＝－０．８０４、－０．８９３、－０．８７４、Ｐ＜０．０１）及与白蛋白呈正相关（ｒ＝０．７２２、Ｐ＜０．００１），而脾脏体积改变与上述指标相反，即与ＨＡ、ＣＧ呈正相关，与白蛋白呈负相关，且ＣｈｉｌｄＡ、Ｂ、Ｃ三级之间差异显著（Ｐ＜０．００１）。结果表明，在检测肝功能的同时测量肝脏及脾脏体积可能有助于对肝硬变患者判断预后及指导治疗。     

Massive mesenteric edema in a patient with type I hereditary angioedema

We report a patient with hereditary angioedema (HAE) presenting with skin edema and abdominal pain. Laboratory examination showed reduced levels of CH50, C2, C4, and C1 inhibitor (C1-INH). Abdominal computed tomography (CT) showed marked mesenteric edema and wall thickening of the duodenum and transverse colon. Acute abdominal pain is common in HAE and is difficult to distinguish from surgical emergency. Massive mesenteric edema on CT is a rare, but specific, sign suggesting HAE.     

Abnormal left ventricular filling in patients with sustained myocardial relaxation: Assessment of diastolic parameters using radionuclide angiography and echocardiography

Parameters of left ventricular filling obtained from time-activity curves of radionuclide angiograms were compared with parameters of myocardial relaxation from digitized M-mode curves of the free wall endocardium in 25 consecutive patients. Eight patients had normal left ventricular systolic and diastolic function. Five patients with low ejection fraction (EF < 50%) also had abnormal values of peak filling rate (PFR), time to peak filling rate (T_r), and/or time constant of endocardial retraction (T_e). Twelve patients with normal EF had three (40%), two (40%), or one (20%) of the diastolic parameters within the pathological range. T_r correlated significantly with T_e (r=0.88, p<0.001), and patients with T_e prolongation always had high values of T_r. One of the diastolic parameters (PFR) correlated significantly with EF (r=0.60, p<0.01). Parameters of left ventricular filling and myocardial relaxation are thus abnormal in many patients with normal systolic function, indicating that diastolic parameters may be more sensitive to myocardial deterioration.     

Zinc chloride (smoke bomb) inhalation lung injury: clinical presentations, high-resolution CT findings, and pulmonary function test results

STUDY OBJECTIVES: Zinc chloride smoke inhalation injury (ZCSII) is uncommon and has been rarely described in previous studies. We hypothesized that structural changes of the lung might correlate with pulmonary function. To answer this question, we correlated findings from high-resolution CT (HRCT) scan and the results of pulmonary function tests (PFTs) in patients with ZCSII. DESIGN: Retrospective cohort study. SETTING: University hospital. PATIENTS: Twenty patients who had been hospitalized with ZCSII-related conditions. MEASUREMENTS: The study included HRCT scan scores (0 to 100), static and dynamic lung volumes, and diffusing capacity of the lung for carbon monoxide (D(LCO)). RESULTS: HRCT scans and PFTs were performed initially after injury (range, 3 to 21 days) in all patients and during the follow-up period (range, 27 to 66 days) in 10 patients. The predominant CT scan findings were patchy or diffuse ground-glass opacities with or without consolidation. The majority of patients showed a significant reduction of FVC, FEV1, total lung capacity, and D(LCO), but normal FEV1/FVC ratio values. Changes of functional parameters correlated well with HRCT scan scores. Substantial improvements in CT scan abnormalities and pulmonary function were observed at follow-up. CONCLUSIONS: The majority of our patients with ZCSII presented with a predominant parenchymal injury of the lung that was consistent with a restrictive type of functional impairment and a reduction in Dlco rather than with obstructive disease. Our results suggest that HRCT scanning and pulmonary function testing may reliably predict the severity of ZCSII.     

Hyperacute Management of Ischemic Strokes: JACC Focus Seminar

Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide. Intravenous tissue plasminogen activator has been a cornerstone for treatment of acute ischemic stroke for more than 20 years; however, its use is limited due to a narrow therapeutic window, several contraindications, and low efficacy to recanalize the artery in large vessel occlusion. Recently, the addition of endovascular mechanical thrombectomy of large artery occlusion has revolutionized the stroke treatment for most disabling strokes. The paper reviews updates to the thrombolytic treatment as well as catheter-based treatment, and results from recent trials in the selection of patients in an extended time window using perfusion imaging.     

心肌桥诊治研究进展

随着冠脉造影等技术的普及,心肌桥的发现并非罕见,被认为是良性变异的心肌桥也可以导致心绞痛、心肌梗死、甚至猝死,其引起心肌缺血的机制是多方面的。有症状的心肌桥需要处理,包括药物治疗,介入治疗,手术治疗。心肌桥严重程度不同, 预后不同。     

Epidermoid cyst in intrapancreatic accessory spleen: A systematic review

Background/Objectives

Due to its rarity, epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) is still a diagnostic dilemma during clinical practice. The aim of this review was to summarize the epidemiologic features and management of ECIPAS.