The feasibility of quantitative MRI of extra‐ocular muscles in myasthenia gravis and Graves' orbitopathy

Although quantitative MRI can be instrumental in the diagnosis and assessment of disease progression in orbital diseases involving the extra‐ocular muscles (EOM), acquisition can be challenging as EOM are small and prone to eye‐motion artefacts. We explored the feasibility of assessing fat fractions (FF), muscle volumes and water T2 (T2_water) of EOM in healthy controls (HC), myasthenia gravis (MG) and Graves' orbitopathy (GO) patients. FF, EOM volumes and T2_water values were determined in 12 HC (aged 22‐65 years), 11 MG (aged 28‐71 years) and six GO (aged 28‐64 years) patients at 7 T using Dixon and multi‐echo spin‐echo sequences. The EOM were semi‐automatically 3D‐segmented by two independent observers. MANOVA and t‐tests were used to assess differences in FF, T2_water and volume of EOM between groups (P < .05). Bland–Altman limits of agreement (LoA) were used to assess the reproducibility of segmentations and Dixon scans. The scans were well tolerated by all subjects. The bias in FF between the repeated Dixon scans was ?0.7% (LoA: ±2.1%) for the different observers; the bias in FF was ?0.3% (LoA: ±2.8%) and 0.03 cm³ (LoA: ± 0.36 cm³) for volume. Mean FF of EOM in MG (14.1% ± 1.6%) was higher than in HC (10.4% ± 2.5%). Mean muscle volume was higher in both GO (1.2 ± 0.4 cm³) and MG (0.8 ± 0.2 cm³) compared with HC (0.6 ± 0.2 cm³). The average T2_water for all EOM was 24.6 ± 4.0 ms for HC, 24.0 ± 4.7 ms for MG patients and 27.4 ± 4.2 ms for the GO patient. Quantitative MRI at 7 T is feasible for measuring FF and muscle volumes of EOM in HC, MG and GO patients. The measured T2_water was on average comparable with skeletal muscle, although with higher variation between subjects. The increased FF in the EOM in MG patients suggests that EOM involvement in MG is accompanied by fat replacement. The unexpected EOM volume increase in MG may provide novel insights into underlying pathophysiological processes.     

静脉腔内激光手术治疗下肢大隐静脉曲张的临床效果

目的观察采用静脉腔内激光手术治疗下肢大隐静脉曲张的临床效果。方法选取2016年1~12月我院收治的102例下肢大隐静脉曲张患者为研究对象,随机分为观察组与对照组,每组51例,观察组采取静脉腔内激光手术治疗,对照组采取高位结扎抽剥术治疗。对比两组患者住院时间、手术时间、切口长度、切口数量;对比两组患者治疗后临床疗效、不良症状发生率、治疗前后生活质量。结果观察组住院时间、手术时间、切口长度及切口数量、不良症状发生率均低于对照组,差异有统计学意义(P0.05);两组患者术后临床症状以及体征的改善情况无明显差异(P0.05);观察组临床治疗有效率、生活质量均高于对照组,差异有统计学意义(P0.05)。结论静脉腔内激光手术治疗效果好,可以有效节省住院、手术时间,术后并发症少,能有效提高患者生活质量,且患者满意度高,值得临床推广。     

心脏移植患者磺胺甲噁唑血药浓度快速检测分析方法的构建及临床应用

目的 探索建立心脏移植患者磺胺甲噁唑血药浓度分析方法,以指导临床合理用药。方法 采用柱切换技术的新型二维液相色谱仪(2D-LC-UV),使用一维色谱柱Aston SC2(3.5 mm×25 mm,5 μm)对血浆中磺胺甲噁唑进行在线固相萃取,然后经中间柱Aston SBR(3.5 mm×10 mm,5 μm)截取保留,随后转移至第二维色谱柱Aston SNX4(4.6 mm×130 mm,5 μm)对目标分析物进行完全分离检测。色谱条件:一维流动相为乙腈-甲醇-水(10:10:70),流速0.8 mL·min^-1;二维流动相比例为BPI-1碱性移动相-API-3酸性移动相-甲醇(20:40:40),流速为1.2 mL·min^-1;紫外检测波长为240 nm。结果 磺胺甲噁唑浓度在9.96~200.04 μg·mL^-1内与峰面积呈良好的线性关系(相关系数R²=0.999 6);低、中、高3个浓度的日内和日间精密度RSD均<15%、相对回收率为85%~115%。对在院56例患者血药浓度进行测定,仅有30例(53.57%)患者血样磺胺甲噁唑浓度为100~150 μg·mL^-1,其余均不满足浓度治疗窗;泌尿系统/血液系统/肝脏等发生III~IV级不良反应为0例。结论 本方法前处理简单,自动化程度高,可大体积进样,准确度、灵敏度高,能够满足临床应用,研究结果可为临床治疗药物监测提供方法学参考。     

生理性大视杯的遗传规律

目的探讨生理性大视杯的遗传规律.方法由同一人用眼底镜检测生理性大视杯家族其他成员的眼底C/D值,分析生理性大视杯的发生率,并用系谱分析法推断生理性大视杯的遗传模式.结果共调查165人,其中生理性大视杯占69.7%.对56个生理性大视杯者家系调查,发现其一级亲中生理性大视杯占53.9%;二级亲中生理性大视杯占57.1%.对有完整双亲的46个生理性大视杯者的父母进行调查,结果发现46个家系中,父母均为生理性大视杯有6个家系,父母均非生理性大视杯有6个家系,仅父亲是生理性大视杯有15个家系,仅母亲是生理性大视杯有19个家系.结论生理性大视杯的发生与遗传有关,可能为常染色体显性遗传.     

Favourable outcomes of poor prognosis diffuse large B‐cell lymphoma patients treated with dose‐dense Rituximab,high‐dose Methotrexate and six cycles of CHOP‐14 compared to first‐line autologous transplantation

The optimal therapeutic approach for young diffuse large B‐cell lymphoma (DLBCL) patients with high‐intermediate and high‐risk age‐adjusted international prognostic index (aaIPI) remains unknown. Hereby we report a 10‐year single‐centre study of 63 consecutively treated patients. To optimize outcome, two approaches were carried out: Cohort 1 patients received four cycles R‐CHOP‐21 (rituximab, cyclophosphamide, daunorubicin, vincristine, prednisolone over 21 days) followed by first‐line high‐dose chemotherapy with autologous stem‐cell support (HDCT‐ASCT), resulting in 2‐year progression‐free (PFS) and overall survival (OS) of 60·6% and 67·9%. 39·4% of those patients were not transplanted upfront, mainly due to early progressive disease (24·2%). Cohort 2 patients received an early intensified protocol of six cycles of CHOP‐14 (cyclophosphamide, daunorubicin, vincristine, prednisolone over 14 days) with dose‐dense rituximab and high‐dose methotrexate resulting in promising overall response‐ (93·3%) and complete remission (90%) rates and sustained survival (2‐year PFS and OS: 93·3%). In an intention‐to‐treat analysis, 2‐year PFS (60·6% vs. 93·3%, hazard ratio [HR] 7·2, P = 0·009) and OS (69·7% vs. 93·3%, HR 4·95, P = 0·038) differed significantly, in favour of the early intensified protocol (Cohort 2). In a multivariate Cox‐regression model, PFS (HR 8·12, 95% confidence interval [CI] 1·83–35·9, P = 0·006) and OS (HR 5·86, 95% CI 1·28–26·8, P = 0·02) remained superior for Cohort 2 when adjusted for aaIPI3 as the most important prognostic factor. Survival of young poor‐prognosis DLBCL patients appears superior after early therapy intensification.     

The anti-hypertensive effect of Danshen (Salvia miltiorrhiza) and Gegen (Pueraria lobata) formula in rats and its underlying mechanisms of vasorelaxation

Ethnopharmacological relevance

Radix Salviae miltiorrhizae (Danshen) and Radix Puerariae lobatae (Gegen) have long been used in traditional Chinese Medicine and serve as the principal herbs in treating cardiovascular disease.

Aims of the study

In the present study, an aqueous extract comprising Danshen and Gegen in the ratio of 7:3 (DG) was investigated for its anti-hypertension in vivo and vasodilative activities ex vivo.

Materials and methods

The anti-hypertensive effect of DG extract was investigated in spontaneously hypertensive rat (SHR) by measuring systolic blood pressure (SBP). Oral administration of DG extract was started at age of 6 weeks and 14 weeks for the preventive and therapeutic studies, respectively. Blood pressure was measured by tail-cuff method biweekly for 12 weeks. The ex vivo vasodilative activities of DG extract, its dependency on endothelium and the involvement of nitric oxide, prostacyclin and potassium channels were investigated using isolated rat aorta ring in organ bath.

Results

For in vivo study, systolic blood pressure was significantly reduced in DG extract-treated groups (90.2 and 300 mg/kg) as compared with the SHR control in both preventive and therapeutic studies. However, DG extract was unable to suppress or delay the onset of hypertension in the preventive study. For ex vivo study, the results showed that DG extract induced a concentration-dependent relaxation in aorta and persisted response was observed with the removal of endothelium. Besides, pretreatment with a non-selective potassium channel inhibitor tetraethylammonium (TEA) also significantly inhibited DG extract-induced vasodilation. Further investigations on specific potassium channel blockers revealed that ATP-sensitive potassium (K_ATP) channel inhibitor glibenclamide, inward rectifier potassium (Kir) inhibitor barium chloride and voltage-dependent potassium (K_v) channel inhibitor 4-aminopyridine, but not BK_Ca channel inhibitor iberiotoxin, exerted significant inhibition on DG extract-induced vasodilation.

Conclusions

The results of in vivo SHR animal model suggested that DG aqueous extract possessed blood pressure lowering effect on both pre- and post-hypertensive rats, which could be explained by its endothelium-independent vasodilation via the opening of K_ATP, Kir and K_v channels.