Age-related changes in the surface morphology of the central sulcus

We utilized a sulcus-based computational approach to investigate the relationship between the three-dimensional (3D) morphology of the central sulcus (CS) and age. The anterior and posterior walls of the CS were manually outlined using high-resolution magnetic resonance images of 295 right-handed healthy participants (age range: 18~94years). Surface reconstruction and parameterization methods were employed to create anatomical correspondence of surface locations across participants. Four surface metrics, including average sulcal length (SL), surface area, fractal dimension (FD) and sulcal span, were used to represent the 3D morphology of the CS. We found significant age-related decreases in the surface area for all walls of the CS, the SL for posterior walls of the CS and the FD for posterior wall of right CS. Age-related increases were found in the sulcal spans between the anterior and posterior walls. These surface metrics (except FD) exhibited leftward asymmetries. Specifically, age-related changes in surface morphology progressed more rapidly in the posterior than in the anterior walls. Finally, sex differences were found only in the FD of the right anterior wall of the CS. Taken together, our results show age-related changes in the surface morphology of the CS and therefore provide insights into the normal aging process.     

超声对肝纤维化和肝硬化半定量诊断探讨--肝被膜形态及肝内韧带观察

目的 探讨高频超声及超声附加方法观察肝表面被膜形态的异常程度及半定量化分级对肝纤维化、肝硬化的诊断价值。方法 经手术及病理证实的肝硬化患者127例为病变组，以因其他肿瘤行手术治疗而临床无阳性发现并经手术肉眼观察判断非肝硬化患者56例为对照组，采用高频探头、二次谐波成像、局部放大图像、调节聚焦和适当降低增益等5种超声附加方法观察肝被膜形态及厚度等。评价标准分为5个等级：肝被膜细而平整为0级；肝被膜轻度增厚、回声增强为I级；肝被膜增厚、呈细水纹状欠平整为Ⅱ级；肝被膜明显增厚、呈小结节状或节段状不连续为Ⅲ级；肝被膜明显增厚，呈波浪状凹凸不平为Ⅳ级。对本组病例肝圆韧带结构形态的观察：细而平整、厚度≤2mm为正常；增厚、不平整、回声增强等为异常表现。结果 病变组127例中，肝被膜显示0级11例，Ⅰ级21例，Ⅱ级27例，Ⅲ级32例，Ⅳ级36例。对照组56例中显示O级48例，Ⅰ～Ⅱ级8例。依据此分级评价标准检测肝被膜形态异常程度，敏感性91．3％，特异性85．7％，正确率89．6％。病变组肝内韧带异常者，肝纤维化占75．0％(9／12例)，肝硬化占95．5％(64／67例)；而正常组仅4例(8．9％)异常。结论对肝被膜结构细微变化的分级，可较灵敏反映肝纤维化和肝硬化病理学异常改变，对提高肝纤维化及早期肝硬化的诊断有参考价值，为肝弥漫性病变进展程度的判断提供半定量化诊断依据。     

Beyond grasping: representation of action in human anterior intraparietal sulcus

The fronto-parietal network has been implicated in the processing of multisensory information for motor control. Recent methodological advances with both fMRI and TMS provide the opportunity to dissect the functionality of this extensive network in humans and may identify distinct contributions of local neural populations within this circuit that are not only related to motor planning, but to goal oriented behavior as a whole. Herein, we review and make parallels between experiments in monkeys and humans on a broad array of motor as well as non-motor tasks in order to characterize the specific contribution of a region in the parietal lobe, the anterior intraparietal sulcus (aIPS). The intent of this article is to review: (1) the historical perspectives on the parietal lobe, particularly the aIPS; (2) extend and update these perspectives based on recent empirical data; and (3) discuss the potential implications of the revised functionality of the aIPS in relationship to complex goal oriented behavior and social interaction. Our contention is that aIPS is a critical node within a network involved in the higher order dynamic control of action, including representation of intended action goals. These findings may be important not only for guiding the design of future experiments investigating related issues but may also have valuable utility in other fields, such social neuroscience and biomedical engineering.     

脊神经沟与颈神经前支嵌压关系的神经形态学观察

目的:观察脊神经沟及其沟内段脊神经形态学变化,探讨脊神经沟与沟内段脊神经受嵌压的关系。方法:取60具成尸(男28,女32)120侧颈椎,对脊神经沟外口宽度、深度及其沟内段脊神经前支横径进行观察,并统计脊神经前支横径与脊神经沟外口宽度之比。结果:①脊神经沟外口宽度、深度自C3至C6均逐渐增大,其平均值分别为(4.5±1.2)mm和(4.3±1.2)mm;②3到7颈神经前支横径逐渐增大,平均值为(2.9±1.0)mm;③颈神经前支横径与脊神经沟外口宽度之比,C5最小(1:1.54),C4次之(1:1.67),C3最大(1:1.75)。结论:脊神经沟与沟内段脊神经受累关系密切,下颈段(C5,C6)颈神经受累几率可能大于上颈段(C3,C4)。     

Detection of liver and gallbladder calcification

Although abdominal radiographs have been the standard method for demonstrating right upper quadrant calcifications, recent evidence shows that ultrasound and computed tomography are equally sensitive, if not more so. Liver and gallbladder calcifications from many causes have been detected by ultrasound and computed tomography. In some of these cases, plain films of the abdomen have been normal. This observation suggests that the plain radiograph is no longer adequate for evaluating possible calcifications in the upper abdomen.     

Inferior central sulcus: variations of anatomy and function on the example of the motor tongue area

We wanted to define the position of the primary motor tongue area (MTA) by using functional magnetic resonance imaging (fMRI) to display the MTA in relation to the inferolateral segment of the central sulcus (CS). The anatomy of the inferolateral segment was analyzed in 24 healthy subjects, using the magnetization prepared rapid acquisition gradient echo sequence. The position of the MTA was defined in 11 subjects by using fMRI to identify the sites of maximal activation for each subject in relation to that subject's own CS. The MTA was then displayed in three orthogonal planes, and in lateral surface reformations. The inferolateral segment displayed two distinct curves in 33 of 48 (69%) hemispheres, three curves in 6%, and four curves in 23%. Significant paradigm correlated activations were found in every hemisphere. Thereof 89 local maxima were determined, with 84 (94%) located in the region of the CS. Sixty-seven (80%) of the 84 CS activations lay along the two lowest curves of the CS. In 86% of cases, activations situated in the middle and deep portion of the anterior bank of the CS were encompassed within the three axial sections centered on the cella media of the lateral ventricles. In conclusion, the variability of the inferior CS segment precluded the assignment of the MTA to a specific anatomic configuration. However, the position of the MTA could be approximated by the intersection between the CS and the three axial planes through, just above, and just below the cella media of the lateral ventricles.     

Emergencies of the liver, gallbladder, and pancreas

Abdominal pain is a common presenting complaint in today's emergency department (ED). Disorders related to the liver, gallbladder, and pancreas are responsible for many of these presentations. With the increasing prevalence of gallstones, as well as alcohol use and abuse, the numbers of cases are likely to increase. This article examines hepatic emergencies including alcoholic hepatitis, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. In addition, the authors review the presentation, evaluation, and management of acute biliary tract disorders with some emphasis on bedside ultrasonography. Evaluation and treatment of pancreatitis and its complications in the ED are discussed.     

超声内镜在肝胆胰外科的应用进展

胆道系统结构特殊，肝胆管分支深入肝内，解剖变异复杂多样，胆道系统疾病纷繁复杂，既有良性疾病，又有恶性肿瘤。其临床表现变化多端，有的很典型，有的则可以完全没有症状。由于胆道疾病多发生于深在细小的肝胆管管腔之内，给胆道系统疾病的诊断和治疗增加了许多困难，客观上给临床医生处理胆道疾病制造了重重障碍。     

胆囊癌肝脏转移动物模型的实验研究

目的 建立胆囊癌肝脏转移动物模型,并对其进行初步评估.方法 用脾内接种法建立人胆囊癌细胞系(GBC-SD)的裸鼠肝脏转移模型.接种后第45天行肝脏CT检查,并处死裸鼠后取下肝脏行病理检查.结果 CT检查肝转移率为40%(4/10),探查发现肝转移率为50%(5/10),CT检查的阳性率为80%(4/5),组织病理学证实肝脏瘤结节均为转移瘤.结论 脾内接种法可以成功建立胆囊癌肝脏转移动物模型,CT可以作为初步评估该模型的影像学工具.     

原发性肝及胆囊神经内分泌肿瘤

收集了1例经尸体解剖证实的肝及2例外科手术切除胆囊的神经内分泌肿瘤。应用组织学、免疫组织化学和电子显微镜对其肿瘤病理特点进行了观察。免疫组化第一抗体包括抗－嗜铬蛋白A、胃泌素、五羟色氨、胰岛素、生长抑素、胰多肽、肾上腺皮质激素（ACTH）、降钙素、蛙皮素、β绒毛膜促性腺激素（β－HCG）。结果发现1例发生在胆囊的为典型类癌；另两侧诊断为神经内分泌癌分别发生在肝和胆囊。在免疫组织化学中，3例肿瘤大部分细胞（50％以上）对嗜铬蛋白A呈阳性反应。并在肿瘤细胞中分别发现胃泌素、五羟色氨、胰岛素和胰多肽阳性细胞。电子显微镜显示胞浆内含有电子致密圆颗粒。结合文献对肝及胆囊的神经内分泌癌的临床病理特点、神经内分泌癌的分类命名及组织来源进行了探讨。     

Handedness-dependent and -independent cerebral asymmetries in the anterior intraparietal sulcus and ventral premotor cortex during grasp planning

When planning grasping actions, right-handers show left-lateralized responses in the anterior intraparietal sulcus (aIPS) and ventral premotor cortex (vPMC), two areas that are also implicated in sensorimotor control of grasp. We investigated whether a similar cerebral asymmetry is evident in strongly left-handed individuals. Fourteen participants were trained to grasp an object appearing in a variety of orientations with their left and right hands and with a novel mechanical tool (operated with either hand). BOLD fMRI data were then acquired while they decided prospectively whether an over- or under-hand grip would be most comfortable for grasping the same stimulus set while remaining still. Behavioral performances were equivalent to those recorded previously in right-handers and indicated reliance on effector-specific internal representations. In left-handers, however, grip selection decisions for both sides (left, right) and effectors (hand, tool) were associated with bilateral increases in activity within aIPS and vPMC. A direct comparison between left- and right-handers did reveal equivalent increases in left vPMC regardless of hand dominance. By contrast, aIPS and right vPMC activity were dependent on handedness, showing greater activity in the motor-dominant hemisphere. Though showing bilateral increases in both left- and right-handers, greater increases in the motor dominant hemisphere were also detected in the caudal IPS (cIPS), superior parietal lobule (SPL) and dorsal premotor cortex (dPMC). These findings provide further evidence that regions involved in the sensorimotor control of grasp also participate in grasp planning, and that for certain areas hand dominance is a predictor of the cerebral organization of motor cognitive functions.     

Sonographic evaluation of the anterior liver surface in chronic liver diseases using a 7.5-MHz annular-array transducer: correlation with laparoscopic and histopathologic findings

PURPOSE: We studied the sonographic appearance of the anterior liver surface using an ultrasound scanner equipped with a 7.5-MHz annular-array transducer to determine the accuracy of this imaging modality in monitoring the course of chronic liver diseases. METHODS: We prospectively evaluated patterns of the liver surface in the sonograms of 77 consecutive patients with chronic liver diseases who had undergone sonographic examination with a 7.5-MHz annular-array transducer and a 3.75-MHz convex-array transducer over a 2-year period and compared these findings with those of laparoscopy (using previously described categories) and histopathology. RESULTS: Histopathologically confirmed disease prevalences for inactive chronic hepatitis, active chronic hepatitis, liver cirrhosis, and others were 10% (8/77), 56% (43/77), 29% (22/77), and 5% (4/77), respectively. The sonographic appearance of the liver surface with the 3.75-MHz transducer was classified as either a regular or an irregular pattern. The regular pattern corresponded to 69% (34/50) of the cases in laparoscopic category 200 or 300 and the irregular pattern with 85% (23/27) of the cases in category 400 or 500. The sonographic appearance of the liver surface with the 7.5-MHz transducer was classified as regular, unevenly irregular, diffusely irregular, or nodular. These 4 patterns detected 75% (24/32), 78% (14/18), 52% (12/23), and 75% (3/4) of the cases of laparoscopic categories 200, 300, 400, and 500, respectively. In a comparison of the sonographic patterns of the liver surface with the differential histopathologic findings, the regular sonographic pattern corresponded to 88% (7/8) of the cases of inactive chronic hepatitis, the unevenly irregular pattern with 35% (15/43) of the cases of active chronic hepatitis, and the diffusely irregular and nodular patterns (considered as 1 group) with 68% (15/22) of the cases of liver cirrhosis. CONCLUSIONS: Our results suggest that sonographic evaluation of the liver surface with a 7.5-MHz annular-array transducer using this classification provides detailed information on the evolution of chronic liver diseases that correlates with the laparoscopic and histopathologic findings and thus is a useful noninvasive method for monitoring the disease course to cirrhosis.     

Ⅱ型糖尿病患者胆囊与肝脏CT改变的探讨

目的评价Ⅱ型糖尿病患者胆囊和肝脏的CT改变,并探讨Ⅱ型糖尿病、胆囊改变、肝脏改变三者的关系。方法回顾性分析586例Ⅱ型糖尿病的肝脏和胆囊的CT改变。结果Ⅱ型糖尿病患者胆囊炎胆囊结石的发生率为33.45%,肝脏改变的发生率20.48%。胆囊炎胆囊结石组肝脏改变发生率58.67%,无胆囊炎胆囊结石组肝脏改变发生率仅为1.28%,胆囊炎胆囊结石与肝脏改变有显著相关性。结论H型糖尿病的肝脏病变是胆囊炎胆囊结石的后续改变。     

利用CT三维重建分析肝硬化伴胆囊窝积液对胆囊壁超声成像的影响

目的：探讨肝硬化伴胆囊窝积液病者胆囊壁超声与CT三维重建在影像成像以及胆囊壁厚度测量的方面上对比差异。方法：对比39例患者于空腹状态同时行超声以及多层螺旋CT检查的影像图像, B超和CT测量胆囊厚度情况,绘制散点图,并进行Pearson相关性分析,应用配对样本t检验比较胆囊壁厚度情况。结果：①与CT三维重建图像对比,发现其中31例出现胆囊窝积液超声漏诊情况,并且发现胆囊壁厚度的超声测量值,存在高估情况的16例,低估情况2例。②B超与CT胆囊壁厚度的测量值相关系数为0.648（P<0.000）。③B超测量胆囊壁厚度（（6.2±2.6）mm）较CT测量胆囊壁厚度（（4.5±2.0）mm）平均值更大,测量差异具有统计学意义（t=4.465,P<0.000）,变异系数分别为0.42、0.44。结论：局限性胆囊窝积液在CT检查中检出率较超声高, 对肝硬化患者胆囊壁增厚与局限性胆囊窝积液能够更准确地进行鉴别诊断。     

血清总胆汁酸与传统肝功能酶学指标在肝胆疾病中的比较

目的探讨血清总胆汁酸(TBA)水平在肝硬化、肝癌和梗阻性黄疸中的临床价值。方法采用酶循环法对120例肝胆疾病患者(病例组)和80例健康体检者(健康对照组)进行TBA水平检测,同时检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)的活性,并对检测结果进行比较分析。结果肝硬化组、肝癌组、梗阻性黄疸组血清TBA水平均明显高于健康对照组,差异有统计学意义(P<0.01);并且肝硬化组和梗阻性黄疸组的TBA水平明显高于肝癌组,差异有统计学意义(P<0.01);血清TBA在肝硬化、肝癌及梗阻性黄疸中的阳性率分别为100%、80%、100%,并且明显高于传统肝功能酶学指标,差异有统计学意义(P<0.01)。结论 TBA是反映肝细胞损伤、胆道梗阻的良好指标,其灵敏度、特异性都优于常规肝功能酶学检测项目,对肝胆疾病早期诊断、病情监测具有重要的临床价值。