背向散射积分评价二甲双胍对糖尿病大鼠肾脏纤维化的干预作用

目的应用超声背向散射积分(IBS)技术评价二甲双胍对糖尿病大鼠肾脏纤维化的干预作用。方法 30只雄性Wistar大鼠,随机抽取20只高脂饲料喂养4周后,腹腔注射链脲佐菌素(STZ,40mg/kg)建立糖尿病大鼠模型。模型成功后,将其随机分成模型对照组(DM组)、二甲双胍干预组(MET组),余下10只作为正常对照组(NC组)。NC和DM组蒸馏水灌胃2ml/d,MET组二甲双胍0.5g.kg-1.d-1)灌胃。8周后,超声测量肾实质标化背向散射积分值(IBS%),对肾组织进行羟脯氨酸浓度(HPC)测定;PAS染色计算肾小球系膜基质指数(Ms/Gs),Masson染色观察肾小球胶原沉积评分(GCDS)、血管周围胶原面积(PVCA)、肾小管间质病变评分(TIDS)。结果与NC组比较,DM组IBS%及纤维化指标(HPC、Ms/Gs、GCDS、TIDS、PVCA)均明显增高(P<0.05);与DM组比较,MET组IBS%减低(P<0.05),纤维化指标减轻,但未达NC组水平。IBS%与纤维化指标呈正相关(P<0.05)。结论糖尿病大鼠存在明显的肾脏纤维化;二甲双胍可以在一定程度上减轻纤维化病变;超声IBS技术可以检测到糖尿病大鼠肾脏纤维化及二甲双胍的干预效果。     

糖尿病大鼠心肌纤维化的病理改变和超声背向散射积分参数评价

目的：观察糖尿病大鼠不同病程心肌纤维化的病理表现及TGF-β1,CTGF在糖尿病心肌病变中的水平,探讨IBS与心肌纤维化程度及心脏功能的关系。方法：腹腔注射链尿佐菌素（65mg／奴）建立sD大鼠糖尿病模型,于第4、12、2,4周测定测定常规心功能参数左室射血分数（LVEF）、左室后壁校正的IBS值（IBS％）、IBS周期性变异幅度（CWB）。Masson胶原染色观察纤维容积分数（CVF）及血管周围胶原面积（PVCA）,心肌胶原蛋白Ⅰ（collagenⅠ）、转化生长因子β1（TGF-β1）和结缔组织生长因子（CTGF）免疫组织化学染色。心肌光镜与透射电镜观察,并与同龄正常大鼠进行比较。结果：①与对照组相比：糖尿病组的IBS％明显增高（P〈0．05）,CVIB第4、12周时尚无明显变化（P〉0．05）,第24周时明显减低（P〈0．05）,EF值各组间无明显变化（P〉0．05）;糖尿病组心肌纤维化指标CVF、PVCA、CollagenⅠ及TGF-β1和CTGF的表达均明显增高（P〈0．05）;②IBS％与CVF、PVCA、CollagenⅠ、TGF-β1、CTGF表达呈正相关（P〈0．05）;TGF-β1和CTGF表达分别与CVF、PVCA、CollagenⅠ呈正相关（P〈0．05）,TGF-β1和CTGF表达呈正相关。电镜发现糖尿病组心肌细胞肌丝稀疏,线粒体肿胀,间质胶原增生。结论：糖尿病大鼠存在明显的心肌纤维化,糖尿病心肌纤维化与TCF-β1、CTGF的表达增强有关。应用IBS技术可以检测到与纤维化指标（CVF、PVCA、CollagenⅠ、TGF-β1、CTGF）有关的IBS％增高。     

高压氧对疲劳大鼠肾损伤的保护作用研究

目的:探讨高压氧暴露对疲劳大鼠肾脏损伤的保护作用及机制.方法:4周龄健康雄性(Sprague Dawley,SD)大鼠30只,随机分为对照组、疲劳模型组和疲劳高压氧暴露组3组,每组10只.建立大鼠游泳致力竭疲劳模型并通过高压氧暴露进行恢复;8周后检测各组动物血清尿素氮(BUN)和肌酐(Cre);采用光镜观察肾脏组织形态结构,取0.5 g肾组织制备成10％肾组织匀浆,检测匀浆液丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性.结果:①疲劳高压氧暴露组大鼠游泳时间明显长于疲劳模型组(P＜0.05).②三组大鼠血清BUN和Cre含量存在显著性差异(P＜0.01),两两比较,疲劳模型组BUN和Cre含量均显著高于其他两组(P＜0.05).③三组大鼠肾脏组织MDA含量存在显著性差异(P＜0.01),两两比较,疲劳模型组MDA含量显著高于其他两组(P＜0.01);三组肾脏组织SOD活性存在显著性差异(P＜0.01),两两比较,疲劳模型组SOD活性显著低于其他两组(P＜0.01).④肾脏组织形态结构显示:对照组肾小管结构完整,基底膜保留完好,间质无充血现象.疲劳组肾小管结构紊乱,排列稀疏,肾小管和肾小球严重变性,细胞核固缩,髓质间质疏松.疲劳高压氧暴露组肾脏组织形态更接近对照组,虽然髓质间质疏松现象无明显改变,但肾小管和肾小球紊乱均有所改善.结论:高压氧暴露有效提高大鼠游泳时间,改善肾脏功能,降低疲劳大鼠肾脏MDA含量,提高SOD活性,改善肾脏组织病理变化,对疲劳大鼠肾脏损伤起到保护作用.     

磁共振体素内不相干运动成像和扩散峰度成像在正常肾脏成像中的初步研究

目的:探讨正常人肾脏磁共振体素内不相干运动成像(IVIM)和扩散峰度成像(DKI)的定量参数指标特点.方法:对27名健康志愿者行肾脏IVIM和DKI检查,通过后处理分析,获得双肾皮髓质IVIM相关参数ADC、Dffast、Dslow、fp以及DKI相关参数MD、MK的测量值.分析同一测量者前后2次测得数据的一致性,比较正常肾脏左右侧以及同侧肾脏不同部位IVIM、DKI各参数间的差异,比较正常肾脏皮质、髓质各参数均值间的差异.结果:IVIM序列的ADC值、Dslow值、fp值和DKI序列的MD值、MK值前后两次测量总体一致性较好,Dfast值一致性一般;IVIM、DKI各参数测量值在双侧肾脏间均没有统计学差异(P值为0.058～0.954),同侧肾脏皮髓质不同部位各参数测量值间亦均没有统计学差异(P值为0.171～0.995);正常肾脏皮质ADC值、Dslow值高于髓质(t=7.072,P＜0.05;t=10.057,P＜0.05),皮髓质Dfast值、fp值差异不具有统计学意义(P＞0.05);正常肾脏皮质MD值高于髓质(t=10.268,P＜0.05),髓质MK值高于肾皮质(t=-10.228,P＜0.05).结论:正常肾脏IVIM和DKI成像能显示皮髓质间差异,反映肾脏生理功能,提示在评估肾脏疾病具有潜在应用价值,整体检查结果具有一定稳定性.     

实时剪切波弹性成像检测肾脏弹性模量与原发性肾小球肾炎病理相关性研究

目的探究实时剪切波弹性成像检测肾脏弹性模量与原发性肾小球肾炎病理的相关性。方法选择200例原发性肾小球肾炎患者作为观察组,同时选择50例健康体检者为对照组。取观察组肾活体组织进行病理检查,使用实时剪切波弹性成像技术检测观察组和对照组的肾脏弹性模量。结果观察组的杨氏模量显著性的高于对照组(P0.05);随着观察组肾小球硬化程度和肾间质纤维化程度的增加,杨氏模量显著性增加(P0.05);杨氏模量与肾小球硬化和肾间质纤维化程度呈正相关(P0.05)。结论实时剪切波弹性成像检测肾脏弹性模量与原发性肾小球肾炎的病理有相关性,该检测技术可以应用于原发性肾小球肾炎的检查。     

不同海拔高度正常肾脏多层螺旋CT灌注成像的研究

目的 探讨不同海拔高度正常肾脏多层螺旋CT(MSCT)灌注成像的表现.方法 采用16排螺旋CT机对35例3组高海拔地区(A组20例2 260～2 500 m;B组7例3 000～3 500 m;C组8例4 000～4 500 m)的健康志愿者行肾脏灌注扫描,应用工作站上Perfusion分析软件测定正常肾脏的各项灌注参数值,并分别比较左右侧之间、不同海拔高度之间各灌注参数有无显著性差异,从而分析海拔高度、侧别是否对各灌注参数产生影响.结果 高海拔地区的正常35例(70个肾)肾皮质平均灌注量为(171.09±48.39) ml·100 ml-1·min-1,髓质平均灌注量为(57.70±28.25) ml·100 ml-1·min-1.肾皮质和髓质的峰值增强值(peak enhancement,PEI)、达峰值时间(time to peak,TTP)、血容量值(blood volume,BV)分别为(96.54±24.92) HU、(16.61±3.85) s、(55.45±11.46) ml/100 g和 (43.88±17.15) HU、(22.67±5.54) s、(22.53±6.90) ml/100 g.35例双侧肾脏各自的皮质或髓质的同一灌注指标无明显差异(P＞0.05);但同侧肾脏皮质和髓质的同一灌注指标明显不同(P＜0.05).不同海拔高度对肾脏皮髓质灌注参数值有影响,3组间比较肾皮质A组与B组的肾脏血流灌注(Per)、PEI、TTP组间差异有统计学意义(P＜0.05);B组与C组的Per、TTP组间差异有统计学意义(P＜0.05).肾髓质A组与C组的Per、PEI、TTP组间差异有统计学意义(P＜0.05).结论 MSCT灌注成像显示肾脏皮、髓质的灌注值与海拔高度有关,而与左右侧无关.     

卡托普利对放射性肾损伤中血管性血友病因子的影响

目的 探索卡托普利对放射性肾损伤大鼠血浆和肾小球中血管性血友病因子(vWF)的影响.方法 体重为280～300 g的雄性SD大鼠96只,采用随机数字表法分为3组:健康对照组20只、单纯照射组38只和卡托普利+照射组38只.其中后两组大鼠双肾接受5 MeV电子线一次性局部照射,剂量为12 Gy.照射前24 h,卡托普利+照射组大鼠开始接受浓度为0.38 ～0.50 mg/ml的卡托普利处理.照后48 h,1、2、4、8、16、24周,单纯照射组和卡托普利+照射组的大鼠被留取尿和血样本,其中除照射后2周外,其余时间点均取肾脏(每次每组6只).照射后48 h,4和24周,健康对照组大鼠被留取尿、血和肾脏样本(每次每组6只).用免疫组织化学染色法检测肾小球中vWF的改变,苦味酸-天狼猩红染色观察肾小球中胶原的沉积,酶联免疫吸附试验(ELISA)法检测大鼠血浆中胱抑素C和vWF的水平.检测尿蛋白和尿肌酐,计算尿蛋白清除率,HE染色方法检测大鼠肾脏组织的病理变化.结果 单纯照射组照射后16和24周,肾小球中vWF逐渐增加(t=3.53～6.95,5.71～12.66,P＜0.05);照射后8、16和24周,肾小球中的胶原沉积逐渐增加(t=3.03 ～5.13,3.48～4.68,4.68～9.03,P＜0.05),且vWF和胶原沉积之间有明显的正相关(r=0.819,P＜0.05).照射后2、4和16周,血浆vWF出现增加(t=3.93 ～ 5.03,4.04～5.15,3.48～ 4.58,P＜0.05);照射后24周,血浆胱抑素C(t=5.10～6.17,P＜0.05)和尿蛋白清除率(t=14.59 ～16.34,P ＜0.05)开始增加,而此时肾组织病理显示肾脏出现了轻度的肾小球系膜的增生.在卡托普利+照射组中,照射后2周,卡托普利未明显地降低血浆vWF,但在其余时间点中,卡托普利均明显地降低了肾小球中的vWF(F=15.60,t=9.82,P＜0.05)、肾小球中的胶原沉积(F=10.24,16.08,t=8.63,P＜0.05)、血浆vWF(t=3.77,P＜0.05;F=4.16,P＜0.05)、血浆胱抑素C(t =6.68,P＜0.05)和尿蛋白清除率(t=13.01,P＜0.05).且卡托普利+照射组的大鼠肾脏未出现明显的病理变化.结论 卡托普利能够降低放射性肾损伤大鼠血浆和肾小球中的vWF,并有效地保护了肾脏.     

超声对急性有机磷中毒兔肾脏二维及背向散射积分的研究

目的：探讨二维超声、背向散射积分技术描述急性有机磷中毒兔肾脏改变的价值.方法：12只兔建立急性有机磷中毒动物模型,分别于染毒前（T0）、染毒后（T1……T9） 10个时间点行二维超声及IBS检查.二维超声观察肾脏的回声、大小.IBS定量分析肾实质的改变.结果：肾皮质回声给药前后未见明显变化.两侧肾体积与T0相比从T6开始差异有显著性意义（P〈0.05）,肾脏的长径从T7开始与T0相比差异有显著性意义（P〈0.05）,体积的变化早于长径;肾皮质IBS%从T5开始与T0相比差异有显著性意义（P〈0.05）,髓质IBS%从T6开始与T0相比差异有显著性意义（P〈0.05）,皮质的IBS%改变早于髓质.结论：急性有机磷中毒兔肾脏IBS%的改变可以为临床提供更多有意义的信息.     

缬沙坦对糖尿病大鼠肾皮质中肾上腺髓质素受体(ADMR)表达的影响

目的 探讨缬沙坦对糖尿病大鼠肾脏的保护作用.方法 30只SD大鼠随机均分为正常对照组(N组)、糖尿病未干预组、糖尿病大鼠缬沙坦干预组.采用腹腔注射链脲佐菌素(STZ)制备糖尿病动物模型,缬沙坦干预组以缬沙坦10mg/(kg·d)灌胃.8周后通过RT-PCR和Western blot方法,以GAPDH为内参照,检测肾皮质中肾上腺髓质素受体(ADMR) mRNA和蛋白的表达. 结果缬沙坦干预组较糖尿病未干预组大鼠体重明显增加(P＜0.01), 24h尿白蛋白排泄率显著降低,两组糖化血红蛋白及血糖比较无显著性差异;缬沙坦干预组大鼠肾皮质中ADMR mRNA和蛋白的表达显著高于糖尿病未干预组.结论 缬纱坦可上调糖尿病大鼠肾皮质中ADMR基因和蛋白的表达;ADMR可能参与了缬沙坦对肾脏的保护作用.     

肾脏皮髓质的分界、对比度及CT峰值与单肾功能相关性的64层螺旋CT研究

组肾皮质为(91±29)HU,肾髓质为(76±25)HU;重度肾功能减退组肾皮质为(68±24)HU,肾髓质为(57±21)HU.3组问差异均有统计学意义(F值分别为42.76和32.68,P值均<0.05).肾皮质、髓质CT峰值均与GFR呈正相关(r值分别为0.672和0.623,P值均<0.05).结论 梗阻性肾积水肾功能减退时CMD与CMC及肾皮髓质CT峰值均降低;肾脏CMC与肾皮质及髓质CT峰值改变与GFR具有正相关关系,对预测单侧肾脏功能有一定临床价值.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.