肝硬化患者工作记忆任务的fMRI研究

目的：通过n-back语义工作记忆任务的功能磁共振成像（~MRI）技术探讨肝硬化患者语义工作记忆损伤的神经病理学机制。方法：对10例轻微肝性脑病（MHE组）、14例单纯肝硬化（non-HE组）患者及16例正常对照者（对照组）行n-back语义工作记忆任务的fMRI研究。n-back实验采用组块设计,对照状态为0-back,任务状态为1-back和2-back。采用基于MATLAB的SPM8软件对数据进行处理分析。采用单样本t检验分析三组受试者在两种任务状态下的大脑激活情况,采用单因素方差分析观察三组受试者两种任务状态（1和2-back）下脑区激活的差异,采用Pearson相关分析行工作记忆任务脑激活区与任务执行正确率及反应时间之间的相关性。结果：在n-back任务中,三组受试者均表现为额顶叶脑网络的激活,包括双侧前额叶、双侧顶叶、双侧前运动区以及辅助运动区。在1-back任务下,non-HE组及MHE组主要表现为工作记忆部分脑区激活的增加;在2-back任务下,non-HE组及MHE组表现为工作记忆相关脑区激活的减低。肝硬化患者左侧额中回激活与2-back任务执行正确率密切相关。结论：肝硬化患者存在语义工作记忆相关脑区的损害。1-back任务时主要表现为脑区的代偿,但MHE较单纯肝硬化代偿能力减低;2-back任务难度超出代偿限度,主要表现为激活下降,且MHE较单纯肝硬化损伤更明显。     

磁共振引导下兔肝脏血管旁 VX2肿瘤模型制作

目的：探讨1．5T磁共振引导下经皮兔肝脏血管旁 VX2肿瘤模型的制作。方法新西兰大白兔13只,在1.5T磁共振引导下经皮穿刺将VX2肿瘤组织块种植于兔肝大血管旁,接种后2周行磁共振扫描。结果11只兔肝肿瘤均种植成功,其中1只出现针道种植,均无胸腹腔积液等并发症出现。结论磁共振引导下兔肝血管旁肿瘤种植是一种微创、有效的造模方法。     

磁共振扩散加权成像监测不同剂量单次照射兔VX2肝癌的疗效

目的：通过DWI监测单次不同剂量照射下兔VX2肝癌的改变,并与病理比较。方法：40只兔VX2肝癌待肿瘤直径≥1 cm时,随机分为2组行立体定向放疗,放疗剂量分别为10 Gy、20 Gy,单次放疗,放疗后不同时间点1d、5d、10d、15d分别行 MR扫描,测量VX2肿瘤、肝脏感兴趣区（ROI）的ADC值,并计算两者比值。标本采用DNA缺口末端标记（TUNEL）法检测计算凋亡指数,并进行统计学分析。结果：40只肝癌模型共发现48个病灶。放疗后1d、15d 10Gy组与20Gy组ADC比值、凋亡指数的差异无统计学意义（P＞0．05）,放疗后5d、10d 10Gy组与20Gy组ADC比值、凋亡指数有显著性差异（P＜0．05）,认为20Gy组ADC 比值显著高于10Gy组。结论：DWI 可以从分子水平监测不同剂量放疗后VX2肝癌的动态变化,适当提高放疗剂量可以使细胞凋亡增加,细胞坏死、崩解更彻底,但有可能增加了放疗毒性。     

Care Bolus技术在肝癌Gd-EOB-DTPA MRI动态增强中的应用

目的：探讨Carebolus技术在肝癌Gd—EOB-DTPAMR动态增强肝脏动脉期扫描中的价值。方法：纳入本院2012年3月-12月行Gd—EOH_DTPA动态MR增强的72例患者,分为A、B两组,A组行Carebolus技术动态扫描,B组行定时延时动脉期扫描,分析Gd—EOB-DTPA增强后患者胸主动脉下段、腹腔干信号强度、门静脉和肝癌病灶强化情况,采用独立样本t检验,独立样本的Wilcoxon符号秩和检验及KruskalWallisH统计两组问的差别。结果：A、B两组Gd—EOB-DTPA增强后胸主动脉下段信号强度分别为15．5±7．8和21．3±11．3,腹腔干信号强度分别为22．5±8．2和31．0±14．0,两组间差异均有统计学意义（P=0．0065,P=0．0015）。A、B两组动脉期门静脉无强化率分别为53％和4％,差异有统计学意义（P=0．000）。A、B两组动脉期肝癌病灶最优强化率分别为79％和46％,差异有统计学意义（P=0．005）。结论：Carebolus技术对肝癌病灶动脉增强特点的显示明显优于常用的动脉延时扫描技术。Carebolus技术可作为常规扫描技术用于肝癌Gd-E013-DTPAMR动态增强肝脏动脉期扫描。     

Abdominal Actinomycosis Misdiagnosed as a Secondary Bladder Tumor: A Case Report

A 46-year-old woman presented with a hypogastric mass. The preoperative diagnosis was a malignant ovarian tumor involving multiple organs, including the urinary bladder. Surgical exploration was performed with wide resection of the right ovary and uterus, including the affected ileum, sigmoid colon, and omentum. An intraoperative histopathological examination of the paravesical tissue revealed abdominal actinomycosis. Consequently, bladder resection was not done. The cause of abdominal actinomycosis in this patient was probably due to implantation of an intrauterine device 3 years previously.     

Establishment of chimerism in donor liver with recipient-type bone marrow cells prior to liver transplantation produces marked suppression of allograft rejection in rats

Abstract In this study, we investigated whether establishment of chimerism in donor liver with recipient-type bone marrow cells (BMCs) prior to liver transplantation could prolong the liver allograft survival. Donor female ACI rats were inoculated with recipient-type BMCs of male LEW rats via the portal vein, with or without irradiation as cytoablation, followed by intramuscular administration of FK506 for 5 days. At 1–2 months later, livers were harvested and transplanted into naive female LEW rats. No immunosuppressants were used. Chimerism in donor rats was confirmed by primers specific for the sex determinant Y chromosome of rats. With livers from rats pretreated with recipient-type BMCs, survival of liver allografts was significantly extended, irrespective of irradiation. These results showed that modification of the donor liver by intraportal injection of recipient-type BMCs and concomitant administration of FK506 prior to liver transplantation prolonged liver allograft survival in rats.     

Role of the bcl-2/bax pathway in hepatocyte apoptosis during acute rejection after rat liver transplantation

Abstract It is well established that hepatocytes undergo apoptotic cell death in the course of rejection of liver grafts. The present study was designed to investigate the role of the bcl-2/bax pathway in liver allograft tissue. Orthotopic liver transplantation was performed in three groups of rats: group 1, a syngeneic combination (Lewis to Lewis), group 2, an allogeneic combination (ACI to Lewis), and group 3, an allogeneic combination (ACI to Lewis) treated with 15-deoxyspergualin. The number of apoptotic cells identified by the TUNEL method in the grafted liver reflected the severity of acute rejection. In group 1, both bcl-2 mRNA and bax mRNA were expressed in trace amounts. In group 2, bcl-2 mRNA was slightly expressed while the expression of bax mRNA rose steadily. In group 3, bcl-2 mRNA expression levels remained similar to group 1, while bax expression levels exceeded those in group 1, but were less than in group 2. Expression of bcl-2 mRNA was stationary in comparison with expression of bax mRNA. Significantly higher levels of bax mRNA were expressed from day 4 in group 2 than in group 1 (on postoperative days 4, 6, and 8, P < 0.05, group 2 vs group 1). We also investigated bax protein and results consistent with the mRNA analysis data were obtained. These findings suggest that apoptotic cell death in liver allograft rejection is regulated, at least in part, by bax.     

Expression of bcl-2 homologue mRNAs in rat liver allograft: rejection-induced cell apoptosis is associated with upregulation of bax and bcl-xs expression

Abstract Apoptosis is considered to play an important role in rejection of organ transplants, although the precise mechanism has not been elucidated. In this study, we screened for the expression of bcl-2 homologues (bcl-2, bax, bcl-xl, and bcl-xs) and Fas ligand (FasL) by RT-PCR method in grafts during acute rejection in rats following liver transplantation. Both bax and bcl-xs (inducers of apoptosis) mRNA levels increased steadily in the allografted group from postoperative day (POD) 2 to 8, while no remarkable changes of bcl-2 and bcl-xl expression (inhibitors of apoptosis) were recognized. Significant induction of FasL gene expression was observed in the allografted group on POD 4 and expression gradually decreased thereafter, although minimal FasL mRNA expression was seen in isografts. Our results indicated, for the first time, that rejection-induced cell apoptosis is closely associated with upregulation of bax and bcl-xs expression besides FasL, but not with down-regulation of bcl-xl.     

The effect of recurrence of HCV infection of life after liver transplantation

Abstract The present study evaluated the quality of life (QOL) of adult cirrhotic patients before orthotopic liver transplantation (OLT), the effect of OLT on QOL in the long-term and the effect of HCV recurrence within medical complications on QOL. Three groups of patients were studied: 19 pre-OLT, 33 during the first year post-OLT and 41 1 to 5 years post-OLT. The patients completed questionnaires on QOL and underwent liver function tests, immunosuppressive drug blood level determinations and medical complications evaluation. Somatization and depression and anxiety scores improved significantly during the first year post-OLT compared with pre-OLT, but they worsened again during the 1–5-year period post-OLT. Physical functioning and life satisfaction scores improved significantly during the first year post-OLT compared with pre-OLT and the improvement persisted 1–5-year during the period post- OLT. Patients with HCV recurrence compared with patients without HCV recurrence during the first year post-OLT showed a significant worsening of most of the domains of QOL. In conclusion, OLT improved most of the domains of QOL by the end of the first post-transplant year, though the improvements did not all persist in the long-term. Recurrence of HCV infection plays a major role in the impairment of QOL after OLT.     

Fine Needle Aspiration Biopsy of the Penis: Transitional Cell Carcinoma of the Urinary Bladder with Mucinous Differentiation

We report a case of transitional cell carcinoma of the urinary bladder metastatic to the penis. The diagnosis was established by fine needle aspiration biopsy (FNAB). Malignant cells showed mucinous differentiation. Ancillary studies carried out in the FNA material as well as in the primary bladder carcinoma suggested transitional cell carcinoma with mucinous differentiation. FNAB proved to be effective in diagnosing a secondary neoplasm to the penis. Mucoid differentiation of urothelial cells can be seen in FNAB specimens and might pose a problem in differential diagnosis.