聚焦超声联合程序性死亡蛋白1单克隆抗体治疗大鼠脑胶质瘤

目的 观察聚焦超声(FUS)联合程序性死亡蛋白1(PD-1)单克隆抗体药物治疗大鼠脑胶质瘤的效果.方法 建立SD大鼠脑胶质瘤模型,随机分为FUS组、PD-1单抗组、联合治疗组及对照组,每组8只.于造模后第9天始对前3组分别给予干预,隔天1次,共4次:FUS组经尾静脉注入微泡后行FUS辐照,PD-1单抗组予腹腔注射PD-...     

心力衰竭对门静脉频谱形态的影响

目的探讨心力衰竭对门静脉频谱形态的影响,摸索超声检查评价心功能的新途径。方法选取临床Ⅰ～Ⅲ度心力衰竭患者60例,按心衰竭程度分组,每组各20例;健康对照组20例。排除肝脏及门静脉、下腔静脉病变。经右侧肋间及剑突下探查门静脉,在取得门静脉清晰二维切面图像后,记录1～3个呼吸周期中的门静脉频谱,观察频谱形态,记录各组不同门静脉频谱形态的例数,所获资料采用统计软件SPSS11.0处理。结果健康对照组门静脉频谱均表现为单向连续频谱,各心力衰竭组出现不同程度的门静脉收缩末期反向血流,Ⅲ度心力衰竭组门静脉频谱多出现恒定的收缩末期反向血流。结论心力衰竭可导致门静脉频谱形态异常,观察门静脉频谱形态,可作为判断心力衰竭程度的辅助依据。     

经颅多普勒超声在儿童颅内压增高性疾病中的应用

经颅多普勒超声(transcranial doppler ultrasonography,TCD)是一种非侵入性评价颅内动脉的检测手段,自上世纪80年代问世以来,已被广泛性应用于临床工作的各个领域.由于其操作简便、重复性好,可以对患者进行床旁连续、动态观察,尤其适用于监测危重症患者.颅内压增高是儿童致病致死的再要原因之一,它可使脑血流灌注下降,造成脑功能障碍等严重后果,因此颅内压监测有重要临床意义.TCD作为一种无创性监测工具,可根据其血流速度、相关参数及血流频谱的变化对颅内压增高患者脑血流动力学进行动态监测与评估,从而达到监测颅内压改变的目的.本文着重阐述TCD在几种常见的儿童颅内高压性疾病中的应用进展.     

Validation of the Proximal Isovelocity Surface Area Method for Assessing Mitral Regurgitation in Children

The proximal isovelocity surface area (PISA) method for calculating volume flow through the regurgitant orifice has attracted significant attention. A number of in vitro studies and clinical studies in adults suggest that the method is accurate. However, when applying the method to children it must be noted that the absolute regurgitation volume is small, and the range of body sizes is wide. This study investigated the accuracy of the PISA method for quantitative assessment of the severity of mitral regurgitation in children. Twenty children aged 7 months to 12 years (average 4.7 years) with mitral regurgitation but without interventricular shunt or aortic stenosis were selected for this study. Underlying cardiac diseases included atrioventricular septal defects in nine, isolated mitral regurgitation in five, and association with other heart defects in six. The PISA radius (r) and the duration of regurgitation (T) were measured on color M-mode recordings, with the M line passing through the center of the PISA. Assuming that the PISA is a hemisphere, maximal regurgitant flow rate (MFR: ml/s) was calculated as MFR = 2π×~ r ²×~ V (r= maximal radius, V= aliasing velocity), and regurgitant stroke volume (RSVpisa) as RSVpisa = 2π×~ MSR ×~ V×~ T (MSR = mean square of the PISA radius during regurgitation). As a validating standard, total stroke volume (TSV) using two-dimensional echocardiography determined by the area–length volumetry method and forward stroke volume (FSV) by the pulsed Doppler method were measured, and regurgitant stroke volume (RSV_D: RSV_D= TSV − FSV) and regurgitant fraction (RF: RF = RSV_D/TSV) were calculated. A linear correlation was found between MFR, RSVpisa, and RSV_D (X) (MFR = 4.2X + 54.0, r= 0.84. RSVpisa = 1.0X + 9.8, r= 0.90), and both RSVpisa and MFR divided by body surface area (BSA: m²) revealed a significant correlation with regurgitant fraction (X) by nonlinear regression analysis (RSVpisa/BSA = 26.2 ×~ X/(1 − X) + 16.8, r= 0.85. MFR/BSA = 121.8 ×~ X/(1 − X) + 92.2, r= 0.79). It is concluded that maximal regurgitant flow rate, regurgitant stroke volume, and regurgitant fraction can be accurately predicted in children using the PISA method by Doppler echocardiography.     

糖尿病早期NOS亚型的蛋白表达及其在血流变化中作用的实验研究

目的探讨在糖尿病早期,3种亚型一氧化氮合酶(NOS)在大鼠视网膜不同组织细胞中蛋白表达的变化,及其与视网膜血流变化的关系。方法将Wistar大鼠随机分成正常对照组与链脲佐菌素(STZ)腹腔注射诱导的糖尿病组各10只,采用彩色多谱勒对大鼠视网膜中央动脉(CRA)进行血流参数的测量,运用免疫组织化学技术观察视网膜eNOS、iNOS、nNOS蛋白表达的变化。结果8wk糖尿病大鼠视网膜尚未出现病变,但血流参数已显著异常,表现为糖尿病组大鼠CRA的血流速度较对照组显著降低(P<0.05),而阻力指数则显著增高(P<0.05),搏动指数高于对照组,但尚未有显著意义。3种亚型NOS在糖尿病与正常对照组视网膜中表达部位一致;但与正常对照组比较,iNOS免疫反应的强度在糖尿病大鼠视网膜中的内核层显著增强,而eNOS与nNOS的免疫反应强度则未见显著变化。结论在糖尿病早期,大鼠视网膜已开始出现血流灌注不良,此时NOS亚型中iNOS在视网膜中的表达上调可能与之相关。     

超声微血管成像技术的研究进展

超声微血管成像技术是在多普勒血流成像基础上发展起来的新型多普勒成像模式,对微细血管结构及深部血管的显示存在极大的优势。研究显示,超声微血管成像技术在乳腺、甲状腺、肝脏、颈动脉斑块、肌骨、肾脏以及淋巴结疾病中有较好的应用,在疾病活动分级及监测治疗反应中也显示出特殊的应用价值。本文将从以下三个方面对超声微血管成像技术展开综述：超声微血管成像技术的原理、超声微血管成像技术的临床应用以及超声微血管成像技术的现状和展望。     

Endoscopic Reintervention for Recurrence of Malignant Biliary Obstruction: Developing the Best Strategy

Drainage therapy for malignant biliary obstruction (MBO) includes trans-papillary endoscopic retrograde biliary drainage (ERBD), percutaneous transhepatic biliary drainage (PTBD), and trans-gastrointestinal endoscopic ultrasound-guided biliary drainage (EUS-BD). With the development of chemotherapy, many MBO cases end up needing endoscopic reintervention (E-RI) for recurrent biliary obstruction. To achieve a successful E-RI, it is necessary to understand the various findings regarding E-RI in MBO cases reported to date. Therefore, in this review, we focus on E-RI for ERBD of distal MBO, ERBD of hilar MBO, and EUS-BD. To plan an appropriate E-RI strategy for biliary stent occlusion for MBO, the following must be considered on a case-by-case basis: the urgency of the drainage, the cause of the occlusion, the original route of drainage (PTBD/ERBD/EUS-BD), the initial stent used (plastic stent or self-expandable metallic stent), and in the case of self-expandable metallic stents, the type used (fully covered or uncovered). Regardless of the original method of stent placement, if the inflammation caused by obstructive cholangitis is severe and/or the patient is in shock, PTBD should be considered as the first choice. Finally, it is important to keep in mind that in many cases, performing E-RI will be difficult.     

药物性阴茎双功能超声检测在外伤性勃起功能障碍中的应用

目的 探讨阴茎双功能超声诊断尿道外伤患者勃起功能障碍的价值.方法 尿道外伤后经IIEF-5评分诊断为勃起功能障碍的患者35例分别于注射罂粟碱及酚妥拉明前后应用多普勒超声测量阴茎背动脉和背深动脉的动脉血流收缩期峰速(peak systolic velocity ,PSV),舒张末期流速(end diastolic velocity,EDV),阻力指数(resistance index,RI);背深静脉流速(V),并进行组间分析.依据骨盆耻骨联合有无分离分为两组,分离组13例,未分离组22例.结果 35例勃起功能障碍的患者中,经超声诊断为血管性勃起功能障碍(erectile dysfunction,ED)的有11例,耻骨联合分离组与未分离组在注射血管活性药物后背深动脉收缩期流速有统计学意义(P《0.05).结论 阴茎血流超声检测在诊断尿道外伤患者勃起功能障碍时可对血管性ED作出诊断,后尿道损伤患者尤其是合并骨盆耻骨联合分离者可能存在较大的血管性ED的风险.     

Comparison of the background echotexture between automated breast ultrasound and handheld breast ultrasound

This study aimed to compare the background echotexture (BE) between automated breast ultrasound (ABUS) and handheld breast ultrasound (HHUS) and evaluate the correlation of BE with mammographic (MG) density and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI). A total of 212 women with newly diagnosed breast cancer who had undergone preoperative ABUS, HHUS, MG, and MRI were included. Two breast radiologists blinded to the menopausal status analyzed the BE of the contralateral breasts of the patients with breast cancer in consensus. The MG density and BPE of breast MRI on the radiologic reports were compared with the BE in the ultrasound. We used the cumulative link mixed model to compare the BE and Spearman rank correlation to evaluate the association between BE with MG density and BPE. BE was more heterogeneous in ABUS than in HHUS (P < .001) and in the premenopausal group than in the postmenopausal group (P < .001). The heterogeneity of BE in the premenopausal group was higher with ABUS than with HHUS (P = .013). BE and MG density showed a moderate correlation in the postmenopausal group, but a weak correlation in the premenopausal group. BE and BPE showed moderate correlations only in the premenopausal group. ABUS showed a more heterogeneous BE, especially in the premenopausal group. Therefore, more attention is required to interpret ABUS screening in premenopausal women.