氨甾酮及其五种衍生物的药理研究

氨甾酮(Org6001或Amafalone)于1968年合成,为一抗心律失常药,无激素样副作用。对动物多种实验性心律失常都有治疗和预防作用,如对乌头碱引起大鼠的室性心律失常具有良好的作用,对哇巴因、结扎冠脉所引起的狗室性心律失常也     

Perfusion MR Imaging Using a 3D Pulsed Continuous Arterial Spin-Labeling Method for Acute Cerebral Infarction Classified as Branch Atheromatous Disease Involving the Lenticulostriate Artery Territory

BACKGROUND AND PURPOSE:Branch atheromatous disease is a stroke subtype considered a risk factor for early neurologic deterioration. Meanwhile, crossed cerebellar diaschisis is thought to be influenced by the degree and location of supratentorial perfusion abnormalities and is associated with the clinical outcome in the case of an ischemic stroke. In this article, our aim was to clarify the utility of using a whole-brain 3D pulsed continuous arterial spin-labeling method as an imaging biomarker for predicting neurologic severity in branch atheromatous disease.MATERIALS AND METHODS:Twenty-three patients with branch atheromatous disease in the lenticulostriate artery territory were enrolled. All patients underwent MR imaging, including DWI, 3D-TOF-MRA, and 3D-arterial spin-labeling. We measured the asymmetry index of CBF in the affected area (branch atheromatous disease), the asymmetry index of the contralateral cerebellar hemisphere (crossed cerebellar diaschisis), and the DWI infarct volume in the lenticulostriate artery territory. We also compared each parameter with the initial NIHSS score with the Pearson correlation coefficient.RESULTS:Among the 23 patients, we found no correlation between NIHSS score and the asymmetry index of CBF in the affected area (branch atheromatous disease) (r = −0.027, P = .724), whereas the asymmetry index of the contralateral cerebellar hemisphere (crossed cerebellar diaschisis) and DWI infarct volumes were significantly correlated with NIHSS score (r = 0.515, P = .012; r = 0.664, P = .001, respectively).CONCLUSIONS:In patients with branch atheromatous disease, 3D-arterial spin-labeling can detect crossed cerebellar diaschisis, which is correlated with the degree of neurologic severity.

Intracranial branch atheromatous disease (BAD) is a stroke subtype that was first described in 1989.¹ BAD was originally determined on the basis of pathologic findings of occlusion or stenosis at the origin of a deep penetrating artery due to the presence of a microatheroma or a junctional plaque.^2,3 Representative vascular territories of BAD include the lenticulostriate artery (LSA), the pontine paramedian artery, and sometimes the anterior choroidal artery.^4,5 Previous studies have mentioned that BAD is strongly associated with early neurologic deterioration (END), and some patients with BAD may experience a worsening of neurologic deficits despite intensive medical treatment, resulting in a worse functional outcome.^6–10 Although few pathologic studies for BAD have been reported, some articles have investigated its neuroradiologic characteristics, with MR imaging in particular.^7–10Arterial spin-labeling (ASL) is a noninvasive MR perfusion imaging technique that uses magnetically labeled blood as an intrinsic tracer.^11–13 ASL permits a quantitative measurement of cerebral perfusion and repetitive acquisitions with independent labeling because it requires neither an injection of a contrast medium nor radiation exposure.^11–13 3D-ASL is considered an advanced method for ASL and uses pulsed continuous arterial spin-labeling with a volumetric spiral fast spin-echo readout, which enables the acquisition of high signal-to-noise ratio and quantitative whole-brain perfusion images.^13,14Previous articles have suggested that 3D-ASL is useful for evaluating cerebral ischemia.^12,15 To the best of our knowledge, no report has used ASL imaging findings to assess BAD, and a few articles have examined the neuroradiologic features of BAD that are related to END.^6–8 In addition, some studies using ¹⁵O-positron-emission tomography and perfusion CT imaging have indicated that crossed cerebellar diaschisis (CCD) occurrence is influenced by the degree and location of the supratentorial perfusion abnormalities and is associated with the clinical outcome.^16,17 Therefore, we hypothesized that perfusion abnormalities detected with 3D-ASL, including CCD, might be correlated with the degree of neurologic deterioration despite the small lesions found with BAD. The aim of our study is to clarify the utility of whole-brain 3D-ASL as an imaging biomarker for predicting the neurologic severity in BAD.     

A 10.46 Mb 12p11.1-12.1 interstitial deletion coincident with a 0.19 Mb NRXN1 deletion detected by array CGH in a girl with scoliosis and autism

We present a 12-year-old girl with de novo karyotype 46,XX,del(12)(p11.1p12.1). Array CGH revealed in addition to a 10.466 Mb interstitial deletion on 12p11.1→12p12.1 a 0.191 Mb deletion on 2p16.3. The girl presented with mild facial dysmorphism consisting of microcephaly, hypertelorism, downslanting palpebral fissures, strabismus, broad nasal base, bulbous nose, short philtrum, micro/retrognathia, irregular tooth arrangement, phalangeal deformity in distal phalanges of hands, 5th finger camptodactyly, brachydactyly in feet, history of joint hypermobility, and scoliosis. She was considered to have mild to moderate mental retardation and ascertained for an autism spectrum disorder(ASD). Short arm of chromosome 12 interstitial deletions are rarely reported whereas point mutations and deletions of NRXN1, which is located on chromosome 2p16.3, are associated with ASDs. In this article we present and discuss the phenotypic consequences of a patient who was affected by deletions of two different chromosomal regions.     

Sequential motion of the ossicular chain measured by laser Doppler vibrometry

Objective: In order to help a surgeon make the best decision, a more objective method of measuring ossicular motion is required.

Methods: A laser Doppler vibrometer was mounted on a surgical microscope. To measure ossicular chain vibrations, eight patients with cochlear implants were investigated. To assess the motions of the ossicular chain, velocities at five points were measured with tonal stimuli of 1 and 3?kHz, which yielded reproducible results. The sequential amplitude change at each point was calculated with phase shifting from the tonal stimulus. Motion of the ossicular chain was visualized from the averaged results using the graphics application.

Results: The head of the malleus and the body of the incus showed synchronized movement as one unit. In contrast, the stapes (incudostapedial joint and posterior crus) moved synchronously in opposite phase to the malleus and incus. The amplitudes at 1?kHz were almost twice those at 3?kHz.

Conclusions: Our results show that the malleus and incus unit and the stapes move with a phase difference.     

A case of acute encephalopathy with biphasic seizures and late reduced diffusion: Utility of arterial spin labeling sequence

A 1-year-old boy was admitted because of febrile status epilepticus (FSE). A secondary cluster of seizures was seen on day 5 after onset, and the patient eventually displayed developmental delay. Conventional magnetic resonance imaging (MRI) showed no abnormal findings on day 1 after onset, but showed reduced diffusion in the subcortical regions of bilateral frontal lobes on day 5 after onset. Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) was diagnosed. Arterial spin labeling (ASL) revealed reduced cerebral blood flow (CBF) in bilateral frontal lobes on day 1 after onset and showed increased CBF in the corresponding region in the subacute phase. Outcomes after prolonged febrile seizures are usually good, but mental deficit and/or epilepsy often remain in AESD. Discriminating between these syndromes is difficult, because no useful biomarkers have been identified. Reduced CBF in bilateral frontal lobes was observed on ASL on day 1 of FSE in the present case, and this finding may be predictive of developing AESD.     

卡托普利对高血压高胰岛素血症的干预

通过对42例原发性高血压患者（EH）、26例正常人测定口服葡萄糖耐量试验（OGTT）前后血糖（GS）、血胰岛素（IS）及其反应曲线下面积，发现EH组空腹GS与对照组之间无统计学差异；空腹IS和服糖后EH组GS、IS及其曲线下面积显著高于对照组，提示EH患者存在糖耐量降低、IS抵抗（IR）。EH组中21例患者单纯接受卡托普利有效降压4～8周后，OGTT显示糖负荷1h、2h的IS和GS水平均显著低于治疗前水平，结果提示卡托普利可以改善EH患者IR。     

Reduction of metal artifacts due to dental hardware in computed tomography angiography: assessment of the utility of model-based iterative reconstruction

Purpose

The aim of this study is to assess the value of adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR) for reduction of metal artifacts due to dental hardware in carotid CT angiography (CTA).

Methods

Thirty-seven patients with dental hardware who underwent carotid CTA were included. CTA was performed with a GE Discovery CT750 HD scanner and reconstructed with filtered back projection (FBP), ASIR, and MBIR. We measured the standard deviation at the cervical segment of the internal carotid artery that was affected most by dental metal artifacts (SD₁) and the standard deviation at the common carotid artery that was not affected by the artifact (SD₂). We calculated the artifact index (AI) as follows: AI = [(SD₁)2 ? (SD₂)2]1/2 and compared each AI for FBP, ASIR, and MBIR. Visual assessment of the internal carotid artery was also performed by two neuroradiologists using a five-point scale for each axial and reconstructed sagittal image. The inter-observer agreement was analyzed using weighted kappa analysis.

Results

MBIR significantly improved AI compared with FBP and ASIR (p < 0.001, each). We found no significant difference in AI between FBP and ASIR (p = 0.502). The visual score of MBIR was significantly better than those of FBP and ASIR (p < 0.001, each), whereas the scores of ASIR were the same as those of FBP. Kappa values indicated good inter-observer agreements in all reconstructed images (0.747–0.778).

Conclusions

MBIR resulted in a significant reduction in artifact from dental hardware in carotid CTA.