Perfusion computed tomography could be a new tool for single-session imaging of ureteric obstructive pathology: an experimental study in rats

Background/Purpose

Perfusion imaging redefines computed tomography (CT) as a technique that can now depict vascular physiology in addition to detailed anatomy. The major clinical applications of perfusion CT are in acute stroke and oncology. Currently, there are very limited data on the application of perfusion CT in urology. The aim of the present study is to investigate the potential value of perfusion CT in anatomic and functional evaluation of obstruction in a single session on experimental hydronephrosis model in rats. Thus, we evaluate the perfusion CT in a new clinical application.

Methods

Twenty-eight rats were randomly allocated into 4 groups each consisting of 7 rats. At the third week of experimental intervention, postoperative renogram curves and perfusion parameters of the right kidneys' cortex and pelvis were assessed by CT. The right ureter was sutured as proximal complete obstruction in group 1, as distal complete obstruction in group 2, and as proximal partial obstruction in group 3. Group 4 served as the sham control group. Computed tomography was performed with single-slice tomography. Dynamic examination was performed with the help of perfusion software through contrast-enhanced tomography examination.

Results

In all study groups, the aorta time/density curves showed a rapid increase after a rapid decrease, and the duration to reach peak concentration in the normal kidney cortex was observed to be later than the aorta as expected. In groups 1, 2, and 3, the duration to reach peak concentration lengthened and the peak concentration values decreased. The time/density curves gradually increased as a result of the accumulation of the contrast agent in the pelvis, and a peak was observed at the end of the procedure in all study groups. In groups 1, 2, and 3, a statistically significant decrease (P = .01, P = .01, and P = .01, respectively) was observed in the peak concentration values of the contrast agent in comparison to group 4. The flow and blood volume values gradually decreased as the grade of the obstruction increased and the localization of the obstruction or grade of obstruction moved closer to the kidney.

Conclusion

In conclusion, perfusion CT technique, performed in a single session, is a useful method for anatomic visualization, together with functional evaluation, in the diagnosis of ureteric obstructive pathology of experimental hydronephrosis model.     

Arthrodèses lombaires par voie antérieure dans le traitement des lombalgies et lomboradiculalgies récidivantes postchirurgicales : étude rétrospective de 46 cas

Background and purpose

Anterior lumbar interbody fusion (ALIF) has gained popularity for the treatment of degenerative disease of the lumbar spine. In this report, we present our experience with the ALIF procedure for treatment of failed back surgery syndrome following lumbar discectomy in a noncontrolled retrospective cohort.

Methods

From 1st January to 31 December 2005, we performed an ALIF in 46 patients presenting with low back pain with or without radiculopathy. All patients had a history of intractable pain resistant to conventional medical treatment and failed posterior lumbar surgery. Clinical and radiological outcomes were recorded. Neurological pain and functional outcomes were measured postoperatively (at 1, 3 and 12 months). Operative data, intraoperative complications, and the fusion rate were recorded.

Results

Forty-six patients with a preoperative diagnosis of failed back surgery syndrome underwent ALIF. The mean follow-up was 21 months. Back pain and leg pain completely disappeared in 60.9% of patients, decreased but required occasional medication in 28.3%, and 10.8% declared no benefit from ALIF surgery.

Conclusion

On the basis of our results, we found ALIF to be a safe and effective procedure for the treatment of failed back surgery syndrome.     

壤塘县藏区成人大骨节病多个大关节受累与分度的关系研究

目的研究阿坝州壤塘县藏区大骨节病（Kashin-Beck disease,KBD）多个大关节受累与分度之间的相关关系,探索成人大骨节病的合理分级标准,指导临床治疗的可行性。方法由骨科、风湿免疫科和地方病专家联合研究组设计专用调查表,采用现场流行病学调查法,包括一般情况、关节疼痛、视觉模拟疼痛评分（visual analoguescale,VAS）、关节畸形和功能障碍等,随机调查阿坝州壤塘县6个村24～93岁藏族成人大骨节病患者81例,按我国关于成人大骨节病分度标准：Ⅰ度30例,Ⅱ度30例,Ⅲ度21例。大关节定义为肩、肘、腕、髋、膝、踝共12个关节,其中任何一个关节出现疼痛、畸形或功能障碍即为大关节受累。分别统计Ⅰ、Ⅱ、Ⅲ度大骨节病患者大关节受累关节数和VAS评分。结果全部患者均存在2个以上大关节受累,其中肘关节和膝关节受累最多见,9～12个大关节受累在成人大骨节病Ⅱ度患者中比例最高,肘关节和膝关节疼痛VAS评分在成人大骨节病Ⅱ度患者中最高,踝关节受累和疼痛在Ⅲ度成人大骨节病患者中最重,肩、腕、髋关节受累及VAS评分在Ⅰ、Ⅱ、Ⅲ度成人大骨节病患者间无统计学差异,4个以上大关节受累人数在Ⅰ、Ⅱ、Ⅲ度成人大骨节病患者间无统计学差异。结论壤塘县藏区成人大骨节病患者常存在多个大关节受累,大关节受累的比例和程度与目前大骨节病分度之间无统一性;有必要对目前成人大骨节病分度进行合理的修订或改进、完善,使之更符合临床诊治并合理指导成人大骨节病的临床治疗。     

组织工程骨-软骨修复兔膝关节缺损术后功能恢复效果

目的制备具备关节解剖形态的组织工程骨软骨,行原位移植修复兔关节大面积缺损,评价修复后效果。方法制备具有解剖形态的明胶-硫酸软骨素-透明质酸钠-胶原-陶瓷化骨软骨支架。分为复合细胞组,无细胞组和不修复组。进行体内原位移植,术后不同时间进行大体观、运动功能检查、HE染色观察,并进行O’Driscoll评分。结果复合细胞组与其他两组相比,运动功能基本无障碍,前行时双下肢运动对称,大体观可见与正常关节外形接近,表面软骨层呈现略透明白色,与正常组织界限不明显,HE染色可见组织结构逐步改建与正常关节组织结构类似。结论复合组织在功能恢复中起到了相当大的作用,但与正常关节还有较大差距。     

A comparison of low-dose and normal-dose gadobutrol in MR renography and renal angiography.

OBJECTIVE: It has been advocated that a reduced injection volume with highly concentrated (1 M) contrast material can produce a sharper bolus peak and an increased intravascular first-pass gadolinium concentration when compared with the use of a lower concentration (0.5 M). A higher concentration would also cause a reduction in dose. The purpose of our study was to test the use of a low dose (0.05 mmol/kg) of gadobutrol in magnetic resonance renography and angiography and compare the findings with a dose of 0.1 mmol/kg. MATERIALS AND METHODS: One-hundred-thirty-four patients referred for magnetic resonance angiography for suspected renovascular disease participated in the study. Contrast enhanced MR renography and angiography were performed after administration of a bolus of 0.1 mmol/kg or 0.05 mmol/kg gadobutrol in randomized patients. The relative signal intensity-time curves of the aorta, peripheral cortex and parenchyma, were obtained. Two radiologists evaluated the angiographic images and evaluated the quality of angiography. RESULTS: The signal intensity with a low dose of gadobutrol was significantly lower in early phases, in the peripheral cortex (for 36, 54, 72 and 90 seconds), the parenchyma (for 36, 54, 72 seconds) and the aorta (for 18, 36, 54, 72 seconds). The decreases in the early phase obtained with a low dose of gadobutrol caused blunter time intensity curves. The difference in the quality scores of the readers for the angiographic images for the use of the two different doses was not statistically significant (p > 0.05). CONCLUSION: A lower dose of gadobutrol can be used for MR renal angiography, but for MR renography the normal dose should be used.     

中西医结合治疗功能性消化不良的临床应用分析

目的:分析中西医结合疗法在功能性消化不良治疗中的应用效果. 方法:使用随机数字表法,将我院收治的110例功能性消化不良患者分为中西医组和对照组,各55例 ,对照组患者口服多潘立酮片,中西医组在口服多潘立酮片的同时,应用疏肝健脾方剂. 结果:中西医组患者的总有效率为92.73 %,显著高于对照组的74.55%,组间比较,差异具有统计学意义( P<0. 05);治疗过程中,中西医组有6例(10.91%)出现不良反应,对照组有8例(14.55%)发生不良反应,组间比较,差异不具有统计学意义(P>0.05). 结论:采用中西医结合疗法治疗功能性消化不良,可有效改善临床症状,临床疗效确切,且不会增加不良反应风险,安全性好.     

重型颅脑外伤术后颅内感染患者脑脊液高迁移率族蛋白-1和RAGE水平的变化及意义

目的:观察重型颅脑外伤(sever traumatic brain injury,s TBI)术后发生颅内感染的患者高迁移率族蛋白-1(High mobility group box 1,HMGB-1)和晚期糖基化终产物受体(receptor for advanced glycosylation end products,RAGE)的脑脊液(cerebrospinal fluid,CSF)水平,探讨其对诊断颅内感染的价值。方法:54例s TBI术后拟诊发生颅内感染的患者根据最后诊断分为颅内感染组(n=12)和非颅内感染组(n=42)。酶联免疫法吸附法(enzyme-linked immunosorbent assay,ELISA)检测拟诊颅内感染时CSF中的HMGB-1和RAGE蛋白水平。受试者工作曲线(receiver operating characteristic,ROC)分析其对颅内感染的诊断意义。结果:脑脊液的HMGB-1和RAGE水平在颅内染组和非颅内感染组之间比较差异具有统计学意义(t=6.711,P=0.000;t=2.683,P=0.008)。脑脊液HMGB-1和RAGE水平诊断颅内感染的ROC的曲线下面积分别为:0.899(95%CI:0.822~0.975)、0.682(95%CI:0.555~0.809)。HMGB-1的cut-off值分别为209.50 ng/m L(敏感度:0.75,特异性:0.93);RAGE的cut-off值为108.50 ng/m L(敏感度:1.00,特异性:0.43)。结论:联合检测脑脊液HMGB-1和RAGE水平对s TBI术后是否发生颅内感染具有重要的诊断价值。     

高迁移率蛋白B1对血管平滑肌细胞迁移的影响及分子机制研究

目的：探讨高迁移率蛋白B1（HMGB1）对血管平滑肌细胞（VSMCs）迁移的影响及 TLR4依赖的 TLR4／PI3K／Akt信号通路介导的分子机制。方法体外分离培养大鼠胸主动脉VSMCs ,采用不同浓度 HMGB1（0．1～1000．0 ng ／mL）处理,分为对照组（未经任何处理）、HMGB1组、HMGB1＋ TLR4 siRNA转染组、Control siRNA转染组和磷脂酰肌醇3‐激酶（PI3K）抑制剂（LY294002）干预组,观察各组细胞活性及 HMGB1对 VSMCs 迁移的影响;实时定量 RT‐PCR与 Western blot 分别检测TLR4、Akt、p‐Akt、PI3K mRNA和蛋白的表达;ELISA测定PI3K的活性。结果 HMGB1（0．1～1000．0 ng／mL）呈剂量依赖性促进VSMCs迁移（P＜ 0．05）;经细胞活性测定,HMGB1在使用的浓度范围内对 VSMCs未造成细胞毒性作用（P＜ 0．05）;HMGB1（100 ng／mL）处理的 VSMCs细胞组 PI3K 活性及 Akt磷酸化水平明显增加（P＜ 0．05）;经 TLR4 siRNA 转染发现, HMGB1引起的VSMCs迁移明显减弱（P＜0．05）,同样在PI3k抑制剂干预组,PI3K／Akt途径活化和HMGB1介导的VSMCs迁移也被明显抑制（P＜0．05）。结论 HMGB1呈剂量依赖性促进VSMCs迁移,TLR4依赖的 TLR4／PI3K／Akt信号通路参与了此过程,提示以TLR4依赖的PI3K／Akt途径为靶点,可为阻塞性血管疾病的治疗提供新思路。     

功能锻炼在非小细胞肺癌胸腔镜术后康复治疗中的应用

目的 探讨功能锻炼在非小细胞肺癌(NSCLC)胸腔镜术后康复治疗中的应用效果.方法 选取2015年6月至2016年6月中国医科大学附属盛京医院胸外科收治并经细胞学或组织学确诊为NSCLC拟行胸腔镜手术治疗的患者120例,按随机数表法将患者分为观察组和对照组,每组60例.住院期间对照组仅接受常规围术期护理,观察组在此基础上接受综合功能锻炼,统计并比较两组患者的拔管时间、住院时间、6 min步行实验(6MWK)距离、Karnofsky功能状态评分(KPS评分)和术后并发症.结果 观察组和对照组患者术后总并发症发生率分别为3.33%和18.33%,差异有统计学意义(P<0.05);观察组患者的拔管时间、术后住院时间分别为(4.52±1.14)d、(6.91±1.80)d,均明显短于对照组的(5.33±2.25)d、(8.81±2.17)d,差异均有统计学意义(P<0.05);观察组患者的6 MWK距离、KPS评分分别为(576.43±101.99)m、(90.2±7.5)分,均明显高于对照组的(467.82±116.37)m、(81.4±8.0)分,差异均有统计学意义(P<0.05).结论 功能锻炼可促进非小细胞肺癌术后康复,改善其生存质量.