CTP与DWI检查在急性脑梗死缺血半暗带中的应用价值

[目的]探讨全脑CT灌注成像(CTP)与弥散加权成像(DWI)检查在急性脑梗死(ACI)患者缺血半暗带(Ischemic penumbra,IP)中的应用价值.[方法]回顾性分析2019年2月至2020年7月在本院诊治的154例ACI患者,所有患者均进行CTP、DWI检查,对比不同区域的CTP脑灌注参数值、DWI参数值,采用Spearman法分析不同区域病变与DWI参数值、CTP脑灌注参数值相关性,采用ROC曲线分析各项参数值对ACI患者IP的预测价值.[结果]梗死中心区的平均扩散系数(Diffusion Coefficient Average,DCavg)值、各项异性指数(Fractional Anisotropy,FA)值、表面扩散系数(Apparent diffusion coefficient,ADC)值、脑血流量(Regional cerebral bloodflow,rCBF)低于IP区和对侧镜像区参数值(P<0.05),达峰时间(Transit time to the peak,TTP)、平均通过时间(Mean transit time,MTT)长于IP区、对侧镜像区(P<0.05),IP区的DCavg值、FA值、ADC值低于对侧镜像区参数值,TTP、MTT长于对侧镜像区,rCBF低于对侧镜像区,局部血容量(regional cerebral blood volume,rCBV)高于梗死中心区、对侧镜像区.经相关性分析,不同区域病变与TTP、MTT呈正相关(P<0.05),与rCBV、rCBF、DCavg值、FA值、ADC值呈负相关(P<0.05),ROC曲线分析显示:TTP、MTT、rCBV、rCBF、DCavg值、FA值、ADC值、七项联合早期预测ACI患者IP的AUC分别为0.622、0.778、0.941、0.955、0.943、0.944、0.952、0.997.[结论]CTP联合DWI对ACI患者IP有较高诊断效能.     

Study of the morphology and biomechanics of sacral fracture

Objective:To observe the morphological characteristics of sacral fracture under different impact loads. Method: Ten fresh pelvic specimens were loaded in dynamic or static state. A series of mechanical parameters including the pressure strain and velocity were recorded. Morphological characteristics were observed under scanning electron microscope. Results: The form of sacral fracture was related to the impact energy. Under low-energy impact loads, ilium fracture, acetabulum fracture and crista iliaca fracture were found. Under high-energy impact loads, three types of sacral fracture occurred according to the classification of Denis: sacral ala fracture, Type I fracture; sacral foramen cataclasm fracture, Type II fracture; central vertebral canal fracture, Type III fracture. Nerve injury of one or two sides was involved in all three types of sacral fracture. The fracture mechanism of sacrum between the dynamic impact and static compression was significantly different. When the impact energy was above 25 J, sacral foramen cataclasm fracture occurred, involving nerve root injury. When it was below 20 J, ilium and sacral fracture was most likely to occur. When it was 20 - 25 J, Type I fracture would occur. While in the static test, most of the fracture belonged to ilium or acetabulum fracture. The cross section of sacrum was crackly and the bone board of Haversian system was brittle, which could lead to separation of bone boards and malposition of a few of cross bone boards. Conclusions: In dynamic state, sacrum fracture mostly belongs to Type I and Type n , and usually involves the nerve roots. Sacrum fracture is relevant to the microstructures, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of sacrum. The fracture of ilium and acetabulum more frequently appears in static state, with slight wound of peripheral tissues.     

应用硝普钠,多巴胺治疗急性心肌梗塞合并心源性休克14例临床分析

本文就应用硝普钠、多巴胺治疗14例急性心肌梗塞合并心源性休克的临床体会总结如下。1 临床资料1.1 一般资料本组14例,其中男8例,女6例,年龄40～82岁。其中冠心病9例,高血压动脉硬化性心脏病4例,先天性心脏病1例。1.2 病情及治疗入院时,病人血压均在10.6/6.6kPa以下,神志恍惚,四肢湿冷,脉细弱,额部冷     

血肌酐与胱抑素C比值在非酒精性脂肪性肝病中的临床意义

目的: 评估血肌酐与胱抑素C比值（CCR）作为筛查非酒精性脂肪性肝病（NAFLD）高危人群血清标志物的临床价值。方法： 本研究共纳入超重或肥胖患者162例及正常体重指数（BMI）受试者64例,按照CCR水平将受试者三分位数分组,使用Spearman相关分析、Logistic回归分析及受试者工作特征（ROC）曲线等确定CCR在NAFLD中的临床应用价值。结果: 根据CCR进行三分位分组后,BMI、腰围、血压、空腹血糖、餐后2 h血糖、糖化血红蛋白（HbA1c）、空腹C肽、胰岛素抵抗指数（HOMA-IR）、三酰甘油、AST、ALT、γ-GT、HDL-C、NAFLD患病率等表现出显著差异(P<0.05)。NAFLD受试者的CCR值显著低于非NAFLD受试者(P<0.01)。CCR与空腹血糖、HbA1c、AST、γ GT、HOMA IR、三酰甘油、BMI及腰围显著负相关。在调整年龄、性别、糖脂代谢指标后,CCR低分位和中分位数组NAFLD发生风险分别为5.096倍和2.722倍（P<0.05）。ROC分析显示CCR在男性组和女性组的曲线下面积分别为0.865(95%CI:0.769~0.932)和0.806(95%CI:0.733~0.866),切点分别是94.44和91.43。结论： CCR与NAFLD相关的多种风险因素密切相关,可作为早期筛查NAFLD高风险人群的简易新指标。     

减重手术后身体成分影响骨代谢的研究进展

减重手术(bariatric surgery, BS)是近年来治疗肥胖症及肥胖相关并发症新型有效的技术。虽然术后体重降低及糖脂代谢得到改善,但部分患者出现骨密度(bone mineral density, BMD)降低甚至骨质疏松。减重手术后肌肉、内脏脂肪(visceral adipose tissue,VAT)、皮下脂肪(subcutaneous adipose tissue, SAT)等身体成分变化明显。其相关细胞因子或激素的变化可能参与术后骨代谢的调节。本文综述肥胖人群减重手术前后骨密度及骨转换标志物的特征,并探讨身体成分对骨代谢的影响及可能的作用机制。     

夏季养生重在“养心”

正中医养生强调"春夏养阳",夏季在五行中对应"心",因此夏季养生重在养心。而夏季阳气极旺,烈日炎炎,人体新陈代谢旺盛,阳气外发,伏阴于内,气机宣畅,通泄自如,精神饱满,情绪向外,使得"人与天地相应";因此,在炎热的夏季要注意保护体内阳气,远离暑邪侵袭,避免热毒积于体内,建议可以适当多用些具有清热解毒功效的食材,或煲汤或泡茶,让自己清爽度过夏天。最养心的夏季作息早起晨练养阳养心。晨练促进阳气升     

餐桌上常见10种最营养的食物

正随着健康意识的提高,人们挑选食物时不仅考虑满足口腹之欲,而且越来越注重营养。近日,英国广播公司和美国《国家地理》等媒体纷纷报道了"全世界最有营养的100种食物排行榜",引起广泛关注。该排行榜来自美国《影响因子》杂志刊发的一项研究。亚太理论物理中心对1000种食物的营养成分进行分析,评出营养最全面的100种食物。研究以一名20岁成年男性的每日营养物质需求为标准,将1000种食物进行组合,并     

血压身高比筛查青春期儿童青少年血压偏高效果评价

分析血压身高比性别分类法、年龄分类法和年龄性别分类法筛查青春期血压偏高的效果,为预防儿童青少年高血压提供依据.方法 对参与黑龙江省佳木斯市中小学常规体检的10~17岁汉族学生26 068名进行生长发育指标测量,采用受试者工作特征曲线确定3种方法筛查血压偏高的最佳临界值,计算曲线下面积(AUC)、灵敏度、特异度、阳性似然比(+LR)、阴性似然比(-LR)、阳性预测值(PPV)、阴性预测值(NPV)、Kappa值用于评价.结果 儿童青少年血压偏高检出率为22.7%.筛查青春期血压偏高时,性别分类法的AUC、灵敏度、特异度、+LR、-LR、PPV、NPV、Kappa值分别为0.87,95.0%,79.1%,4.56,0.06,57.2%,98.2%,0.60;年龄分类法分别为0.89,93.3%,84.5%,6.04,0.08,64.0%,97.7%,0.67;年龄性别分类法分别为0.90,94.3%,85.5%,6.52,0.07,65.7%,98.1%,0.69.3种方法灵敏度、特异度及阴性预测值较高,但阳性预测值较低.年龄性别分类法的AUC和Kappa值最高,性别分类法最低.结论 年龄性别分类法筛查效果最好,但相对复杂;年龄分类法筛查效果良好且更加简便.推荐采用2种方法筛查青春期血压偏高.     

室内外PM_(2.5)污染水平对慢性阻塞性肺疾病患者呼出气炎症指标的影响

目的探讨冬季室内外PM_(2.5)污染水平对慢性阻塞性肺疾病(简称慢阻肺)患者呼出气炎症指标的影响。方法以18名某三甲医院诊断的稳定期慢阻肺患者为研究对象,于2014年1月2日—2月18日,对研究对象室内PM_(2.5)水平进行实时监测,同步收集研究对象居室附近北京市固定监测点PM_(2.5)、气温和相对湿度数据,并采集研究对象呼出气一氧化氮(e NO)和呼出气硫化氢(e H2S)样品,采用Spearman相关分析和多元线性回归分析探讨室内外PM_(2.5)对研究对象呼出气指标的影响。结果调查地区冬季室内、外PM_(2.5)污染水平较高,x±s分别为(94.09±46.87)μg/m3和(119.27±54.78)μg/m3。室外PM_(2.5)暴露与e NO呈正相关关系(rs=0.311,P0.05),PM_(2.5)每上升1个四分位数间距(74.80μg/m3),可使e NO增加13.13μg/m3(P0.05),控制室外气温和相对湿度后,该相关关系仍然存在。未观察到室内PM_(2.5)与e NO以及室内、外PM_(2.5)与e H2S的相关关系。结论本次调查地区的冬季室内、外PM_(2.5)污染严重,室外PM_(2.5)可对慢阻肺患者e NO产生影响。     

健侧骶神经根移位修复大鼠骶丛撕脱伤

目的 探讨采用健侧骶神经根移位修复骶丛撕脱伤的可行性.方法 选用体重200～300 g的成年SD大鼠30只,随机分为不吻合组、健侧L6-患侧L6吻合组和健侧L6-患侧L5吻合组,每组10只.大鼠右侧为实验侧,左侧为对照侧.术后观察各组大鼠的存活情况,对受试大鼠进行BBB评分.双侧股二头肌、小腿三头肌及胫骨前肌称重并进行肌肉横截而HE染色的埘比研究;电镜观察吻合口远端神经牛长情况;坐骨神经功能指数(SFI)、肌电图检查评价吻合的可行性.结果 术后12周吻合组BBB评分比不吻合组高(P<0.01).吻合组右侧的股二头肌、小腿三头肌、胫前肌与不吻合组相比均有不同程度恢复.其中L6-L5吻合组效果较L6-L6吻合组好.三组肌群恢复速度在L6-L6吻合组内有差异,其中近侧股二头肌恢复效果相对较好,吻合口远端神经电镜观察可见大量再生有髓神经纤维.肌电图显示于三组肌肉可记录到波幅,其中以近侧股二头肌及小腿三头肌峰值较大,远侧胫前肌峰值较小.结论 健侧骶神经根移位加自体神经移植或健侧骶神经移位与患侧神经根直接吻合均能蕈建截瘫大鼠骶丛神经的部分功能,其中健侧骶神经移位与患侧神经根直接吻合组效果优于健侧骶神经根移位加自体神经移植组.

Abstract：

Objective To evaluate the efficiency of normal sacral nerve root transposition in repair of the sacral plexus root avulsion. Methods A total of 30 adult SD rats were chosen and divided into three groups,ie,group A(the sciatic nerve received no repair),group B(the autologous sacral plexus root nerve was bridged with the right L6 nerve root by the translocation of the left L6)and group C (the right L5 nerve root nerve was bridged by the translocation of the left L6),10 rats per group.The left side of the rats was used as the control side and the right one as the experimental side.Twelve weeks after operation,the rats in each group were selected for the histomorphological observation of the nerves under the microscope and the electron microscope.The models were evaluated by observing the survival rates of the rats,BBB scores,electron microscope weight and muscle fiber CSA(cross section area)of double biceps femoris,triceps surae and tibial muscle. Results Twelve weeks after operation,the BBB scores in groups B and C was higher than that in group A,with statistical difference(P<0.01)between three groups.A remarkable improvement was found in the ratio of weight and muscle fiber CSA of double biceps femoris,triceps surse and tibial muscle.The repair efficiency in the group C was better than that in the group B.In the group B,the biceps femoris,triceps surae and tibial muscle recovered at different degrees.The biceps femoris recovered the best,when a great deal of myelinated nerve fiber regeneration was observed under the microscope and the electromicroscope.Electromyography revealed the volatility in the muscles of three groups,with larger peak value for the proximal biceps femoris and the triceps muscle but smaller peak value for the distal anterior tibial muscle. Conclusions L6 transposition combined with auto-graft of nerve root or without the auto-graft can reconstruct the partial function of the sciatic nerve in the paraplegia rats,when the latter has the better effect.