偏侧帕金森病模型猴脑的质子磁共振波谱研究

目的　探讨质子磁共振波谱 ( 1H -MRS)对帕金森病 (Parkinson’sdisease ,PD)的诊断价值。方法　对 2只恒河猴经左侧颈内动脉注射 1-甲基 4-苯基 1,2 ,3 ,6-四氢吡啶 (MPTP)制备偏侧PD模型前后的双侧基底节区进行 1H -MRS检测 ,对比分析制模术前和术后猴双侧基底节区N -乙酰基天门冬氨酸 (NAA) /肌酸复合物 (Cr)和胆碱复合物 (Cho) /Cr比值的变化 ,并应用透射电镜观察制模术后猴纹状体的超微结构变化。结果　 2只猴均成功制备成偏侧PD模型。偏侧PD模型猴MPTP注射侧对侧基底节区NAA/Cr和Cho/Cr比值较制模术前无明显改变 (Ρ >0 .0 5 ) ;但偏侧PD模型猴MPTP注射侧基底节区NAA/Cr比值较制模术前明显降低 ,也明显低于对侧 (Ρ <0 .0 5 ) ;Cho/Cr比值较制模术前明显增高 ,也明显高于对侧 (Ρ <0 .0 5 )。偏侧PD模型猴MPTP注射侧纹状体的超微结构呈神经元细胞线粒体肿胀和空泡化、粗面内质网和高尔基复合体囊腔扩张、脂褐素增多和星形胶质细胞增生等病理性改变 ,但MPTP注射侧对侧纹状体的超微结构未发现异常改变。结论　1H -MRS是可以为偏侧PD模型猴基底节区的神经细胞病理学改变提供有价值的信息的一种无创技术 ,有助于PD的诊断。     

氢质子磁共振波谱在海马硬化术前评定中的价值

目的　评价氢质子磁共振波谱 ( 1HMRS)在海马硬化术前评定中的价值。资料与方法　应用 3.0T磁共振扫描仪对 10例手术及病理证实为海马硬化的患者术前分别进行单体素MRS和化学位移成像 (CSI)检查。定量分析单体素MRS的N 乙酰天门冬氨酸 (NAA) / (肌酸 胆碱复合物 ) (Cr Cho)、NAA/Cr、Cho/Cr比值的差异。CSI观察NAA代谢图像上双侧海马信号强度的差别 ,并定量测量NAA值。结果　患侧的NAA/ (Cr Cho)、NAA/Cr比值均低于对侧 (P <0 .0 1,P <0 .0 5 )。以NAA/ (Cr Cho)比值为判定指标 ,8例 ( 8/ 10 )可以正确定侧。代谢浓度图显示患侧NAA的信号强度低于对侧 ,患侧NAA值明显低于对侧 (P <0 .0 1)。结论　MRS能够在体无创定量地反映出海马硬化的生化代谢异常 ,是术前评价海马硬化的一种非常有用的辅助检查方法     

肿瘤坏死因子作用于大鼠C6胶质瘤的1H磁共振波谱研究

目的　采用1H磁共振波谱 (MRS)观察大鼠C6胶质瘤在肿瘤坏死因子 (TNF α)治疗后的代谢改变 ,评价1HMRS在肿瘤疗效观察中的有效指标及应用价值。方法　采用立体定向的方法将C6细胞悬液种植于 3 3只SD大鼠脑尾状核部位 ,高场强磁共振波谱仪观察C6胶质瘤大鼠在腹腔给予TNF α后 3、6、9、12、15d的代谢改变 ,比较N 乙酰门冬氨酸 (NAA)、胆碱类化合物 (Cho)、肌酸和磷酸肌酸 (Cr)及乳酸 (Lac)以及Cho/Cr、NAA /Cr、NAA/Cho积分值的变化 ,进行统计学分析。结果　在给予TNF α后第 3天 ,Cho出现降低 ,在第 15天达到治疗前水平 ,其积分值在未治疗组与 3d组 ,3d组与 6d组以及 9d与 12d组间差异有显著性意义 (P <0 0 5 ) ,而NAA及Cr无明显改变。NAA/Cho在治疗后 3、6以及 9、12d组差异有显著性意义 (P <0 0 5 )。Cho/Cr在用药后第 3、6天下降 ,差异有显著性意义 (P <0 0 5 )。而NAA /Cr无明显改变。结论　1HMRS能够早期观察肿瘤治疗的效果 ,Cho是肿瘤疗效观察的有效指标。     

海马硬化MR质子波谱分析与MRI的对比研究

目的　评价MR质子波谱分析 (1HMRS)和MRI对海马硬化的诊断价值。方法　对 8例病理证实的海马硬化病人和 8例健康志愿者分别进行1HMRS和MRI海马体积定量研究。通过计算峰下面积 ,对代谢产物氮 乙酰天门冬氨酸 (NAA)、肌酸 (Cr)及胆碱复合物 (Cho)的浓度进行定量并观察NAA/Cr、NAA/ (Cr Cho)及Cho/Cr各参数的变化 ,同时用右侧海马体积和左侧海马体积差值(DHF)的方法分析形态学的异常。结果　病变组病侧NAA/Cr、NAA/ (Cr Cho)及Cho/Cr值分别为0 5 5、1 77及 1 38,对照组分别为 0 77、1 38及 1 0 6。海马硬化病人NAA/Cr和NAA/ (Cr Cho)值下降 ,统计学上差异有显著性意义 (t值分别为 2 15和 4 83,P值均 <0 0 5 ) ,Cho/Cr值升高 ,统计学上差异有显著性意义 (t值为 2 34 ,P <0 0 5 )。根据NAA/ (Cr Cho)值的不对称降低可对 6例病人进行定侧诊断 ,其中错误 1例 ;根据DHF值的变化可诊断海马萎缩 2例。所有病例均经手术病理证实为海马硬化 ,病变程度与NAA/ (Cr Cho)值的降低相一致。NAA/ (Cr Cho)减低与癫痫发作次数无相关性 (r=- 0 134 ,P >0 0 5 )。结论　1HMRS能够早期发现海马硬化。1HMRS和MRI互相补充有利于海马硬化的术前诊断。     

高级别胶质瘤和转移瘤的磁共振波谱及灌注成像研究

目的通过磁共振波谱(MRS)及灌注成像(PI)研究肿瘤强化区域、肿瘤周围区域的细胞代谢和血管分布特点,探讨MRS及PI对高级别胶质瘤和转移瘤的鉴别诊断价值。资料与方法23例颅内肿瘤患者,包括高级别胶质瘤(Ⅲ～Ⅳ级)13例,转移瘤10例,行常规MRI、PI和单体素MRS检查。MRS检查主要观察的代谢物有:氮-乙酰天门冬氨酸(NAA),胆碱(Cho),肌酸(Cr/PCr),计算NAA/Cr,Cho/Cr,NAA/Cho比值。PI观察指标为相对脑血容量(rCBV)。采用SPSS10.0软件进行统计学分析。结果MRS提示高级别胶质瘤和转移瘤肿瘤强化区域均出现NAA/Cr与NAA/Cho降低,Cho/Cr升高;两种肿瘤强化区域各项比值之间的比较差异均无统计学意义(P>0.05);高级别胶质瘤肿瘤周围组织亦出现NAA/Cr与NAA/Cho降低,Cho/Cr升高,与转移瘤肿瘤周围组织相比差异均有统计学意义(P<0.05)。高级别胶质瘤和转移瘤肿瘤强化区域的rCBV值分别为4.05±2.04,3.84±2.44,两者之间差异无统计学意义(P>0.05),肿瘤周围组织的rCBV值分别为1.31±0.14,0.56±0.22,两者之间差异有统计学意义(P<0.05)。结论结合肿瘤强化区域与肿瘤周围区域的MRS和PI,有助于提高对高级别胶质瘤和转移瘤的鉴别能力。     

MR扩散加权成像和波谱联合应用诊断肝豆状核变性

目的通过MR扩散加权成像(diffusionweightedimaging,DWI)和MR波谱(MRspectroscopy,MRS)分析肝豆状核变性的表观扩散值(apparentdiffusioncoefficient,ADC)和不同代谢物的变化,探讨病变不同时期铜沉积过程出现的病理改变与MR功能成像改变之间的关系。方法对12例临床确诊并行驱铜治疗的肝豆状核变性患儿行MR常规扫描、DWI和波谱分析,比较扩散信号、ADC值和不同区域的N乙酰天门冬氨酸(Nacetylaspartate,NAA)/肌酸(Creatine,Cr)、胆碱复合物(Choline,Cho)/Cr比值的变化。结果根据DWI信号,分高、等、低3组,ADC值差异有统计学意义(F=2444,P<0001),DWI呈低信号的ADC值最高[(150±018)×10-3mm2/s],与其他两组差异有统计学意义(P1,3=000057;P2,3=000058)。MRS示NAA/Cr均值降低(108±065),Cho/Cr均值升高(133±094)。3组在基底节的NAA/Cr、Cho/Cr的比值差异没有统计学意义(F=02,11;P=08,03)。但NAA/Cr较丘脑有显著降低(t=-474,P<0001),Cho/Cr差异无统计学意义(t=145,P=016)。结论ADC值增高反映出铜沉积后局部结构疏松,海绵状变性和坏死伴随的髓鞘脱失引起的水分子扩散加快,MRS同时反映出该区神经细胞消失(NAA的降低)和星形胶质细胞广泛增生(Cho的升高)。二者的结合应用反映了肝豆状核变性过程中的微观结构变化和     

家犬脑挫裂伤1H-MR波谱研究

目的 探讨家犬脑挫裂伤MR波谱(MRS)表现及其应用价值.方法 家犬10只,200 g砝码1.3 m高以自由坠落方式复制脑挫裂伤动物模型,分6个时间点(1 h、24h、72 h、5 d、8 d和14 d)行常规MR及MRS检查.各时段检查结束后处死家犬,取挫裂伤处脑组织行病理检查.结果 伤后1～24h,N-乙酰天冬胺酸/肌酸(NAA/Cr)、胆碱类化合物(Cho)/Cr及NAA/Cho下降,NAA/Cr分别为0.843±0.214,0.862±0.204,对侧 1.069±0.284,1.048±0.232,t=-7.227,-6.718;Cho/Cr1.181±0.224,1.243±0.134,对侧 1.415±0.305,1.455±0.159,t=-4.332,-4.489;NAA/Cho0.701±0.147,0.536±0.136,对侧 0.832±0.245,0.613±0.165,t=-2.652,-2.665(P值均＜0.05);病理示挫伤处见局部点状出血、灶性坏死、神经轴突肿胀、小胶质细胞轻度增生.伤后72 h至5 d,NAA/Cr开始升高,Cho/Cr于5 d时为1.517±0.197,高于对侧,对侧为1.387±0.214(t=3.758,P＜0.05);镜下示炎性细胞浸润明显,血管周围炎、肉芽及纤维瘢痕形成.伤后8～14 d,NAA/Cr与对侧相比差异无统计学意义(0.895±0.105,0.875±0.153,对侧0.989±0.169,0.990±0.173,t=-2.909,-2.471;P值均＞0.05),Cho/Cr高于对侧(1.457±0.168,1.572±0.374,对侧1.334±0.174,1.366 ±0.352,t=7.312,3.201;P值均＜0.05);病理示炎性反应及胶质增生更加显著,14 d时肉芽肿形成.各时段均未见异常乳酸峰及脂质峰.结论 MRS能无创性检测脑挫裂伤后神经元受损及修复情况,了解其脑组织生化代谢改变,反映损伤的程度,为早期治疗和预后的评价提供理论依据.     

实验性缺氧缺血性脑病的~1H-MRS及病理学研究

目的:探讨早期新生猪缺氧缺血性脑病(HIE)的1H-MRS波峰变化规律及其与病理学改变的关系。方法:选取40只7日龄健康新生猪,随机分为:正常对照组(n=5只)、假手术组(n=5只)及缺氧缺血组(n=30只)。1.5T磁共振1H MRS测定脑内代谢产物。观察每组新生猪脑组织的病理变化情况。结果:①造模后0~24h,NAA峰明显下降,Lac峰呈典型的双峰状显著升高,NAA/Cho、Lac/NAA、Lac/Cr、Lac/Cho和Lac/(Cr Cho)比值逐渐降低,HI后3h,NAA/Cr、NAA/(Cr Cho)比值升高,然后逐渐降低,Glx峰和mI峰无明显变化。②造模后0~24h随着时间延长脑水肿逐渐加重,24h出现坏死灶。结论:①NAA/Cho、Lac/NAA、Lac/Cr、Lac/Cho和Lac/(Cr Cho)是定量反映脑缺氧缺血生化改变的最敏感指标;②早期缺氧缺血后脑NAA、Lac与病理学的变化一致。     

急性一氧化碳中毒迟发脑病的磁共振波谱特征及其临床意义

目的 研究急性一氧化碳中毒迟发脑病(delayed encephalopathy following acute carbon monoxide poisoning,DEACOP)患者的质子磁共振波谱(1H magnetic resonance spectroscopy,1H MRS)特征及临床意义.方法 对38例DEACOP患者和30例正常志愿者分别进行常规核磁及质子磁共振波谱检查,对比分析DEACOP患者与正常志愿者的额叶、脑室旁、枕叶的N-乙酰天门冬氨酸(NAA)、肌酸/磷酸肌酸(Cr)、含胆碱代谢物(Cho)含量的变化,对以Cr为参照的代谢产物比值(Cho/Cr,Cho/NAA,NAA/Cr)进行比较,并分析NAA/Cr、Cho/Cr、Cho/NAA与患者简易智能状态检查量表(MMSE)和患者日常生活能力量表(ADL)的相关性.结果 获取的DEACOP组患者波谱数据显示不同部位的NAA/Cr同对照组比较降低,差异有统计学意义(P＜0.01),Cho/Cr、Cho/NAA同对照组比较增高,差异有统计学意义(P＜0.01);Cho/Cr与MMSE、ADL评分呈明显负相关,Cho/NAA与MMSE、ADL评分呈明显负相关,NAA/Cr与MMSE、ADL评分呈明显正相关.中、重度DEACOP患者NAA/Cr同轻度患者比较降低,差异有统计学意义(P＜0.05),Cho/Cr、Cho/NAA同对照组比较增高,差异有统计学意义(P＜0.05).结论 通过1H MRS检测DEACOP患者脑部病灶的代谢异常可显示神经元损伤程度,代谢物比值异常变化提示预后不佳.

Abstract：

Objective To study the characteristics of proton magnetic resonance spectroscopy (1H magnetic resonance spectroscopy, 1H MRS) in patients with delayed encephalopathy following acute carbon monoxide poisoning (DEACOP) and its significance in the early diagnosis of the disease. Methods MRI and 1H MRS were performed in 38 DEACOP patients and 30 healthy volunteers. The ratios of N-acetylaspartate ( NAA), Creatine ( Cr), Choline (Cho) peaks were measured in each volume of interest, and the correlation of Activity of Daily Living Scale (ADL) and Mini-Mental State Examination (MMSE) with NAA/Cr, Cho/Cr,Cho/NAA were analyzed. Results Compared with those of the control group, the NAA/Cr ratio in different parts decreased with very significant statistical differences ( P ＜ 0. 01 ), while Cho/Cr and Cho/NAA ratio increased also with very significant statistical difference ( P ＜ 0. 01 ). Negative correlation was found in the assessment scores between Cho/Cr and MMSE, ADL. Cho/NAA was also negatively correlated in the assessment scores with MMSE and ADL, and NAA/Cr was positively correlated in the assessment scores with MMSE and ADL. The NAA/Cr ratio in moderate and serious DEACOP patients decreased, when it was compared with that of the mild DEACOP patients, with statistical differences (P ＜ 0. 05 ). Cho/Cr and Cho/NAA ratio increased, when it was compared with that of the control group, with statistical differences ( P ＜0. 05). Conclusions 11 MRS could detect metabolic abnormalities in DEACOP patients with brain lesion.Abnormal changes in the ratio of metabolites might indicate poor prognosis.     

1 H-MRS对低级别和高级别脑胶质瘤鉴别诊断的作用及病理级别相关性的研究

目的 分析脑胶质瘤的氢质子磁共振波谱（proton magnetic resonance spectroscopy，^1H—MRS）表现及其临床意义；探讨脑胶质瘤的^1H—MRS特点与其病理级别相关性。资料与方法 搜集经临床手术、病理证实的脑胶质瘤36例，按照WHO诊断标准分成两组：低级别脑胶质瘤组、高级别脑胶质瘤组。所有患者在术前行^1H—MRS检查。均在MR非增强成像的基础上获得。使用Siemens Sonata 1．5T超导磁共振扫描仪，多体素扫描，点分辨表面线圈法，检测不同区域代谢物变化。结果 脑胶质瘤的^1H—MRS表现：肌酸（Cr）轻度下降，N-乙酰天门冬氨酸（NAA）显著下降。胆碱（Cho）显著增高。低级别、高级别脑胶质瘤的肿瘤组织分别和对侧正常脑组织的NAA／Cr、Cho／Cr、NAA／Cho比值存在非常显著性差异（P〈0．01）；低级别脑胶质瘤和高级别脑胶质瘤的肿瘤组织的NAA／Cr、Cho／Cr、NAA／Cho比值存在显著性差异（P〈0．05）。脑胶质瘤的NAA／Cho、Cho／Cr、NAA／Cr比值与病理级别相关，其中NAA／Cho和Cho／cr比值反映肿瘤级别较稳定；NAA／Cr、NAA／Cho比值存在负相关关系（相关系数rs分别为-0．663，-0．851），Cho／Cr比值存在正相关关系（相关系数rs为0．858）。结论 ^1H—MRS与MRI相结合能提高脑胶质瘤术前诊断的准确性。^1H-MRS可评价脑胶质瘤的分级，反映脑胶质瘤代谢特性以及肿瘤生长潜能。     

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.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Treatment of intrahepatic arteriovenous fistula in hepatocellular carcinoma with N-butyl-2-cyanoacrylate

Primary hepatocellular carcinoma (HCC) continues to be one of the most common malignancies with an incidence of approximately one million cases per year and a dismal prognosis; some authors have reported a median survival of 1 ～ 2 months after diagnosis. Although surgery remains the only hope for cure, few patients are candidates[1,2].     

U50,488H对正常及缺氧心肌细胞L型钙电流的作用

目的 探讨心脏阿片受体和β-受体相互作用的机制。方法 采用全细胞膜片钳技术，观察U50，488H(β-阿片受体选择性激动剂)对正常和缺氧心肌细胞L型钙电流的作用。结果 U50，488H剂量依赖性(0．1～100μmol／L)抑制正常心肌细胞的L型钙电流及异丙肾上腺素(0．1μmol／L)激动的钙电流，而细胞缺氧后，这一抑制作用减弱；U50，488H对Forskolin(10μmol／L)激动的L型钙电流无明显影响。结论 β-阿片受体对β-受体信号的负性调节作用在细胞缺氧后减弱，其作用位点可能发生于β-受体与腺苷酸环化酶环节之间。     

Overtraining syndrome : la piste de la suractivité ?

Introduction

Overtraining is clearly a multifactorial disturbance. We aimed at evaluating the relative importance of overactivity and nutritional imbalances.

Methods

A comparison of 17 footballers with seven subjects with a diagnosis of overtraining evidenced that the two groups differ by energy expenditure resulting from physical activity (1573 ± 378.6 kcal/d from 804.7 ± 184.7 kcal/d) while food intake does not exhibit significant differences.

Conclusion

In this sample of subjects, inadequate food intake is found in both groups, so that overtraining appears rather characterized by a higher level of physical activity. Therefore, a relative energy deficit resulting from overactivity rather than dietary mistakes appears to explain the syndrome in these athletes, who are thus truly “overtrained”.     

Prenatal detection of brain anomalies with ultrasonography

Ultrasound is the first-line imaging study of the fetal brain performed at 12, 22 and 32 weeks of gestation. The very structured evaluation of biometric and morphological data, facilitated by the use of a checklist, ensures a high quality examination. All patients where an anomaly of any key element is suspected should be referred to a center dedicated to prenatal diagnosis for confirmation irrespective of the gestational age. Prenatal diagnosis plays a significant role in France since medical interruption of pregnancy until term is authorized.     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.