复发性肛瘘的MR影像学特征

目的 探讨复发性肛瘘的MR影像学特征及规律。方法 将本研究29例患者首次手术前、二次手术前所行磁共振平扫+增强扫描检查影像资料分别设定为对照组、研究组,分别与首次及二次手术结果对照其瘘口、瘘管显示的准确率,肛瘘分型的一致性,并回顾性对比分析MR的影像特点。结果 对照组、研究组的内口、主瘘管及支管的显示准确率均较高,分别为91.1%、95.2%、90.3%,95.0%、97.3%、88.0%。对照组、研究组MR术前分型与手术分型的一致性均良好,Kappa值分别为0.891、0.929(按Parks分型),0.946、0.949(按瘘管数目和位置高低分型)。与对照组对比,研究组中:内口位置均不高于原内口位置,均无明显肛周脓肿形成;大多数瘘管形态变细、周围炎性浸润范围变小、瘢痕形成、无明显肛门括约肌功能受损;部分瘘管支数变少、长度变短、分型趋于简单化。结论 MR能较好完成初诊及复发性肛瘘的术前评估,本研究中大部分复发性肛瘘的MR观察项目呈不同程度向好趋势,具有一定的MR影像学特征及规律。

MRI在克罗恩病肛瘘活动性评价与随诊中的研究进展

克罗恩病(Crohn’s disease, CD)是一种病因不明的慢性非特异性炎症性肠病。CD肛瘘(perianal fistulizing CD,pfCD)作为CD最常见的并发症,常发生在成人和儿童CD中。随着医学技术的不断发展,多种辅助检查方法应运而生,如内镜、瘘管造影、麻醉下探查、腔内超声、MRI等皆可辅助诊断。其中MRI具有无创、快速、准确等特点,已经成为pfCD影像学诊断的金标准。本文就盆腔MRI在pfCD的诊断价值、鉴别诊断与疗效评估进行综述。同时考虑到pfCD的复杂性,本文还探讨了CD的MRI炎症活动评分、影像学指标和基于MRI的新技术,以期为pfCD患者诊治策略的进一步优化提供理论依据。

挤压膨化处理对酶解小米粉蛋白结构和功能特性的影响

本研究以小米为原材料,通过添加高温α-淀粉酶挤压膨化的加工方式对小米粉进行处理,比较不同处理对清蛋白、谷蛋白、醇溶蛋白、球蛋白性质及结构的变化。结果表明,挤压处理使小米蛋白组分的持水性提高,起泡能力下降,部分氨基酸含量发生损失。经过加酶挤压处理后,四种蛋白组分含量均呈下降趋势,各组分蛋白的乳化稳定性提高,其中醇溶蛋白的乳化性显著提高,醇溶蛋白和谷蛋白的泡沫稳定性增强。加酶挤压膨化处理清蛋白和球蛋白的谱带减少。小米蛋白的二三级结构没有改变,发生微弱蓝移现象。因此,加酶挤压处理可以有效改善小米蛋白的功能特性,且会对小米蛋白结构产生一定程度的影响。这些结果表明,采用酶促挤压加工技术制备的预糊化谷子粉可作为一种理想的功能性食品资源。

DCE-MRI和高b值DWI对卵巢囊腺瘤和囊腺癌的诊断价值初探

目的探讨MRI动态增强(DCE-MRI)结合高b值弥散加权成像(DWI)对卵巢囊腺瘤和囊腺癌的诊断价值。方法回顾性分析34例经手术及病理证实的卵巢囊腺瘤和囊腺癌患者的MRI检查资料,包括:常规MRI平扫、DCE-MRI及DWI(b=800mm^2/s)检查。观察肿瘤的形态学特点;测量肿瘤实性成份的时间密度曲线(TIC)、相应定量参数值及表观扩散系数(ADC)值,利用受试者工作特征曲线(ROC)分析得出诊断卵巢囊腺瘤与囊腺癌的最优参数和最佳诊断阈值及相应的敏感性、特异性、阳性预测值、阴性预测值。结果(1)囊腺瘤22例:单囊7例,双囊1例,多囊14例(其中3例见彩色玻璃征);7例见单发或多发壁结节,结节可见强化或不强化。交界性肿瘤3例,囊腺癌9例:均见明显实性成份,以囊腺癌为著;(2)卵巢囊腺瘤与囊腺癌实性部分的容量转移常数(K trans)及ADC值差异有统计学意义(P<0.01),而速率常数(K ep)值、血管外细胞外间隙容积比(V e)值无统计学意义(P>0.05)。利用ROC曲线得出K trans值的最佳诊断阈值为0.206min-1,敏感性50%、特异性95.5%、阳性预测值(PPV)91.7、阴性预测值(NPV)50%。ADC值鉴别卵巢囊腺瘤与囊腺癌的最佳诊断阈值为1.208×10^-3 mm^2/s,敏感性75%、特异性100%、PPV 100%、NPV 80%。结论DCE-MRI结合高b值DWI能为卵巢囊腺瘤与囊腺癌的定性诊断提供重要依据。

高分辨率磁共振联合质子密度成像对肛瘘分类及分级的价值研究

目的探讨高分辨率磁共振联合质子密度加权成像对肛瘘分类及分级的价值。方法经手术证实的肛瘘患者500例,全部进行肛管区域小视野薄层高分辨率磁共振和质子密度成像检查,观察肛瘘的内口、外口、瘘道及肛周脓肿,并评价与肛管肌肉、肛周间隙及周围组织结构的关系,对肛瘘进行分类及分级,并与手术所见相对照。结果 500例肛瘘中,MRI诊断出肛瘘患者为492例,与术后证实对比,MRI诊断准确率为98.40%(492/500)。MRI检查中有8例(1.60%)肛瘘未发现,故无法分类,其余492例中,可分为四类六级,括约肌间型83例(16.60.%),经括约肌型159例(31.80%),括约肌上型189例(37.80%),括约肌外型61例(12.20%)。与术后证实对比,本研究MRI对肛瘘的分类准确率为96.00%(480/500)。500例病例中,手术发现并证实肛瘘内口、外口、瘘道及肛周脓肿数目分别为552个、568个、676支及280个,MRI诊断出肛瘘内口、外口、瘘道及肛周脓肿的数目分别为520个、568个、640支及280个,MRI对肛瘘外口数目、位置、瘘管的走行及肛周脓肿范围的诊断与手术所见基本一致,MRI对肛瘘内口及瘘道诊断的准确性分别为94.20%、94.67%。结论肛区小视野薄层高分辨磁共振联合质子密度加权成像可以较细致全面的观察肛瘘并进行准确的分类及分级,术前肛区磁共振检查有助于临床治疗、手术方案的选择及预后评估。

磁共振多模态成像在直肠癌诊断和术前分期的应用价值

目的探讨多模态磁共振(T2WI+双b值DWI)在直肠癌诊断和术前分期中的应用价值。方法回顾性分析2017年9月~2019年12月在广元市第一人民医院经手术病理证实的43例原发性直肠癌患者的MRI影像和结肠镜检资料,通过MRI资料分析直肠癌T分期、N分期、MRF状态、EMVI状态和肿瘤下缘到肛缘距离并获得DISTANCE报告,对比治疗前磁共振DISTANCE评估报告的TN评估结果与术后病理TN分期的一致性,计算MRI检查的准确率、灵敏性及特异性。结果多模态磁共振共正确评估T分期直肠癌患者38例,总体准确率为88.37%,对T1-2期、T3期、T4期的诊断准确性、灵敏度、特异度分别为T1-2期:93.02%、100%、92.11%,T3期:88.37%、88.57%、87.50%,T4期:95.35%、66.67%、97.50%,表明MRI对直肠癌患者的T分期结果与病理结果的一致性较高。MRI正确评估N分期直肠癌患者32例,总体准确率为74.42%,对NO期、N1期、N2期的诊断准确性、灵敏度、特异度分别为N0期:88.37%、78.95%、95.83%,N1期:74.42%、72.20%、76.00%,N2期:86.05%、66.67%、89.19%,表明两者相关程度中等。结论多模态磁共振成像可以实现对直肠癌患者的术前分期诊断,且对T分期的诊断准确性优于N分期,尤其体现在对T1-T2分期的诊断效果,对临床直肠癌患者的术前诊断具有重要指导价值。

MRI对卵巢颗粒细胞瘤的诊断价值

目的:探讨卵巢颗粒细胞瘤(OGCT)的MRI及DWI特点,以提高对该病的认识。方法:回顾性分析经手术确诊的12例OGCT的临床及MRI资料,并对所有患者行DWI(b=0、800s/mm2)及ADC值测量。结果:12例中,幼年型OGCT3例,成年型OGCT9例。囊性2例,囊实性9例,实性1例。实性成分T1WI呈等或稍高信号,T2WI呈稍高或等信号,DWI呈不同程度高信号,平均ADC值0.612×10^-3mm^2/s;囊性成分T1WI呈低等或稍高信号,T2WI呈高信号,DWI上部分囊液呈等或稍高信号,部分呈低信号,平均ADC值2.207×10^-3mm^2/s;增强扫描实性部分呈中等至明显强化,囊性部分未强化。11例肿瘤囊变区可见数量不等的出血信号。结论:OGCT的临床特点不典型,但其MRI表现具有特征性,有助于作出较为准确的术前诊断。

PTEN对脂多糖攻击RAW264．7细胞核因子-κB转录活性的影响及其意义

目的探讨PTEN(phosphatase and tensin homolog deleted on chromosome ten)全县对脂多糖(IYS)攻击RAW264．7细胞核因子-κB转录活性的影响。方法NF-κB-LUC质粒与PTEN质粒或其突变质粒分别共转染RAW264．7细胞,通过检测NF-κB反应性荧光素酶报告基因表达,观察PTEN在LPS攻击巨噬细胞时对NF-κB转录激活的影响。结果野生型PTEN过表达可促进LPS诱导的NF-κB活性增强,而突变型PTEN则没有明显作用。结论PTEN可正性调控LPS诱导的NF-κB转录因子的激活,从而有可能在内毒素所诱导的炎症反应中发挥重要的调控作用。

表面活性蛋白在病毒性角膜炎中的作用

自体免疫系统在病毒性角膜炎中扮演重要角色,新近发现该系统的表面活性蛋白(SP)A和D在角膜炎中发挥重要作用。SP通过对病毒配体的高度亲和,抑制其黏附宿主细胞,进一步经调理作用促进吞噬细胞吞噬病毒。同时SP调节免疫细胞功能,保持组织在病毒感染早期的非炎症状态,保证组织发挥正常功能。而当病原菌入侵增加,机体呈应激状态时,SP-A和SP-D又能促进炎症反应,杀灭病原菌。在眼部,SP-A和SP-D能在角膜、结膜等部位表达,在腺病毒、单纯疱疹病毒、巨细胞病毒等主要致病病毒感染时,SP-A和SP-D可以通过与病毒结合,阻止病毒进入细胞,促进吞噬细胞吞噬病毒,以及直接中和杀灭病毒发挥抗病毒作用。此外,SP-A和SP-D还展示了作为病毒感染重要临床诊断工具的前景,以及将来有望应用重组SP作为治疗病毒性角膜炎的重要手段。本文就SP-A和SP-D在眼部病毒感染中的作用进行综述。

亚急性甲状腺炎采用核医学与超声检查诊断价值分析

目的研究亚急性甲状腺炎采用核医学与超声检查的临床诊断价值。方法该次研究中的观察对象均选自2018年1月—2019年5月期间在该院接受治疗的亚急性甲状腺炎患者,共便利抽选88例,所有患者均接受核医学与超声检查以及手术病理检查,将手术病理检查作为“金标准”,比较核医学与超声检查方式的诊断准确性,并对比患者甲状腺左叶厚度和右叶厚度。结果88例患者经手术检查均确诊为亚急性甲状腺炎,而经过超声检查确诊人数为41例(93.2%),核医学检查确诊人数为43例(97.7%),其核医学检查的诊断准确率高于超声检查,差异无统计学意义(χ^2=1.048,P=0.306>0.05)。同时,超声检查和核医学检查对于患者甲状腺左叶厚度与右叶厚度方面的数据对比,差异无统计学意义(t=0.300、0.095,P=0.765、0.925>0.05)。结论核医学和超声检查在亚急性甲状腺炎的临床诊断中均具有较好的应用价值,尤其是核医学,其临床诊断确诊率更具优势,为临床治疗提供更为精准和科学的参考依据。

加酶挤压膨化对小米膳食纤维的影响

以小米为原材料,通过加酶挤压膨化的加工方式对小米粉进行熟化处理,对比研究小米生粉、加酶小米粉、挤压小米粉及加酶挤压粉的营养成分和冲调性的变化;采用酶解法提取膳食纤维,比较其性质及结构的变化。结果显示:小米粉在加工过程中,蛋白质含量无显著变化,WSI(水溶性指数)显著提高(P<0.05),结块率显著降低(P<0.05),WAI(吸水性指数)下降,极大改善了小米粉冲调性。提取小米膳食纤维后,持水、持油能力和溶解度均显著提高(P<0.05),扫描电镜结构疏松多孔,润湿性提高,胆固醇吸附能力、亚硝酸根离子吸附力显著增强,红外光谱相似,主要官能团没有改变,存在不同的吸收峰强度。

Value of ^(18)F-FDG PET/CT and MRI in diagnosing primary endometrial small cell carcinoma

Primary small cell carcinoma（SCC） is a group of aggressive neoplasms that mainly arise from the lung and digestive tract. Endometrial small cell carcinoma（ESCC） is extremely rare. To our knowledge, less than 90 cases have been reported, and most of these reports were dedicated to describing the clinicopathologic or immunochemical features of ESCC. Herein, we present a new case of ESCC involving a 51-year-old woman and mainly focus on the magnetic resonance imaging（MRI） and positron emission tomography/computed tomography（PET/CT） findings. MRI showed that the uterus was significantly enlarged（11.6 cm × 11.1 cm × 14.4 cm）, and a giant irregular mass（7.5 cm × 8.4 cm × 8.5 cm） was observed in the uterine cavity. The lesion demonstrated an extremely low apparent diffusion coefficient（ADC） value [（0.553±0.088）×10^–3 mm^2/s] and a high FDG uptake value（22.7）. Multiple metastatic lymph nodes（LNs） were identified at different positions, with diameters ranging from 0.3 to 2.8 cm and a maximum standardized uptake value（SUV max） ranging from 6.9 to 19.3.

Three dimensional nano-LiMn_(0.6)Fe_(0.4)PO_4@C/CNT as cathode materials for high-rate lithium-ion batteries

Three dimensional（3D） nano-LiMn0.6Fe0.4PO4@C/CNT composite was successfully synthesized by an oleylamine-assisted solvothermal method. The prepared composite showed excellent electrochemical performance, especially superior high rate capability. It could deliver a specific discharge capacity of103.1 mAh/g, even at 80 C. The superior high rate performance of the as-prepared LiMn0.6Fe0.4PO4@C/CNT electrode is attributed to its unique 3D conducting network：（1） the prepared LiMn0.6Fe0.4PO4@C active particles were in nano-scale with a size of 30-50 nm;（2） LiMn0.6Fe0.4PO4 nanoparticles were uniformly coated by amorphous carbon with a thickness of 3 nm;（3） the graphitized conductive CNTs were dispersed homogenously among the LiMn0.6Fe0.4PO4@C active particles. The synergistic effect of the nanoscale amorphous carbon coated LiMn0.6Fe0.4PO4@C active particles and the graphitized CNTs reduces the diffusion path of the lithium ions and benefits the transference ability of electron.

术前MRI定位技术对于复杂性肛瘘手术效果的评估

目的:分析研究术前MRI定位技术对于复杂性肛瘘手术的临床效果.方法:选取80例2017年2月-2018年5月笔者所在医院收治的复杂性肛瘘患者,随机分为对照组和研究组,两组均40例.对照组采用亚甲蓝染色技术进行手术,研究组采用MRI定位技术确定瘘管相关情况,然后根据瘘管走向和内口进行手术,比较分析两组术中发现内口数量、手术次数、愈合时间和治疗效果.结果:研究组发现的内口数量显著多于对照组,手术次数显著少于对照组,且差异均有统计学意义(P<0.05);虽然研究组的愈合时间较对照组短,但两组比较差异无统计学意义(P>0.05).研究组的治疗率高达92.50%,显著高于对照组的72.50%,差异有统计学意义(P<0.05).结论:术前MRI定位技术应用于复杂性肛瘘手术的临床效果显著,值得推广.

The efficacy and tolerability of lamotrigine adjunctive/monotherapy in patients with partial seizures refractory to poly-AEDs

Objective： This study was designed as an open-label trial to assess the effects of changing the antiepileptic drugs （AEDs） regimen to lamotrigine （LTG） as adjunctive/monotherapy in patients with partial seizures who were dissatisfied with their drug regimen because of intractable seizures. Methods： The patients were recruited from mulficenters using the following criteria： age≥ 18 years; at least 3 seizures per month during the last 16 weeks; previous use of at least 3 AEDs. The study involved a baseline phase and 2 experimental phases： LTG was first added to the regimen, and then patients could gradually change to LTG monotherapy if their seizures were reduced by at least 50 percent/month. Tolerability, the primary end point, was assessed using the Liverpool Adverse Experience Profile （LAEP）. Secondary end points included quality of life, as measured with the Quality of Life in Epilepsy-31 inventory. Reductions in seizures from baseline throughout each phase were also analyzed. Results： One hundred and fourteen patients aged between 18 and 52 years （age 27.8___ 13.2 years; 71 men and 43 women） were enrolled. After adding LTG, 105 patients （92.11%） Completed adjunctive therapy. Upon completion of the adjunctive phase, mean improvement from baseline was 2.6 points on the LAEP （p=0.037）. The overall score on the QOLIE-31 improved by 8.49 points from baseline （p=0.023）. At the end of the trial, 26 （22.81%） of patients completed LTG monotherapy, and 65 patients （57.02%） experienced at least 50% reduction in seizure frequency compared to baseline, The mean improvement from baseline was 5.1 points on the LAEP （p=0.0059）, and the overall score on the QOLIE-31 score improved by 12,72 points from baseline（p=0,0071）. Twenty-two （19.30%） patients reported adverse effects and 9 patients discontinued participation in the trial because of adverse effects. Conclusion： For patients with partial seizures who were dissatisfied with their AED regimen because of intractable seizures, adding LTG to the drug regimen was well tolerated and effective in improving the quality of life and controlling seizures. Furthermore, switching to LTG monotherapy was associated with further improvement.

卵巢子宫内膜样癌MRI诊断

目的:探讨卵巢子宫内膜样癌(ovarian endometsrioid adenocarcnoma,OEC)的MRI表现及病理基础。方法:回顾性分析经手术病理证实的8例OEC的MRI表现,并与手术和组织病理学结果进行对照分析。结果:8例OEC中位于左侧2例,右侧4例,双侧2例。肿瘤最大者直径20.1cm,最小者直径约1.8cm,平均(9.19±5.58)cm,共10个病灶,均为囊实性,9个呈圆形或卵圆形,1例呈分叶状,肿瘤边界清楚6例,部分模糊2例。MR平扫:T1WI实性成分呈等信号,囊性成分7例呈低信号,1例呈高信号,T2WI实性成分呈稍高信号,囊性成分呈高信号,增强后肿瘤实性部分明显强化。8例OEC中合并子宫体内膜癌2例,巧克力囊肿2例,子宫肌瘤5例,子宫内膜增生4例。结论:卵巢子宫内膜样腺癌的MRI表现有一定特征,能清晰显示肿瘤的大小、形态、内部成分、血供及邻近组织器官的侵犯等情况,具有重要的术前诊断价值,并为临床制定治疗方案及预后评估提供帮助。

Reduced irreversible capacities of graphene oxide-based anodes used for lithium ion batteries via alkali treatment

The large irreversible capacities of graphene oxide-based anodes hinder commercial applications of GO materials although the high specific capacity of it has been universally accepted. In this paper, GO was treated under alkaline condition and the composite consisting of the modified GO and graphite was used as anode for lithium ion batteries (LIBs), resulting in an improved initial coulombic efficiency. Electrochemical tests also showed that the modified GO/graphite electrode possessed 86.0% of initial coulombic efficiency, which was 15% higher than that of pristine GO/graphite electrode. The species and the content of functional groups were investigated via XPS, FTIR characterizations in detail, which certified that the ring-opening reaction of epoxides under alkaline condition could greatly reduce the irreversible capacity of GO/graphite anode, in addition, the reversible capacity was guaranteed at the same time. This modified GO/graphite electrodes in the LIBs exhibit superior rate capability and long cycle life. The uniqueness of this electrode lied in its chemical stability, which benefits from the transition of epoxide group and unstable functional groups removal.

Na^+/HCO_3^- cotransporter is expressed on β and α cells during rat pancreatic development

AIM To determine the expression and localization of the electrogenic Na^+/HCO_3^- cotransporter(NBC1) in rat pancreas during development. METHODS The rat pancreas from postnatal and embryos removed from the uterus of pregnant rats that had been sacrificed by CO2 asphyxiation were used. Rat pancreas from embryonic day(E) 15.5 and E18.5 rat embryos was isolated under a stereomicroscope. Rat pancreas from postnatal(P) days 0, 7, 14, 21 and adult was directly isolated by the unaided eye. The RT-PCR analysis of the NBC1 specific region on rat pancreastissues from different developmental stages. The two antibodies which target the NBC1 common COOHterminal region and NH2-terminal region detected a clear band of about 145 k Da in the Western blot analysis. The localization of NBC1 was examined by immuno-fluorescence detection. RESULTS The results revealed the first peak of NBC1 expression at E18.5 and the second peak at P14. Meanwhile, the low NBC1 expression occurred at P7 and adult stages. Our results demonstrated, for the first time, the presence of NBC1 in the plasma membrane of β and α cells, as well as in the basolateral membrane of acinar cells of the rat pancreas at different stages of development. CONCLUSION The data strongly suggests that NBC1 is diversely expressed in the pancreas at different developmental stages, where it may exert its functions in pancreatic development especially islet cell growth through HCO_3^- transport and pH regulation.

Perinatal outcomes of frozen-thawed embryo transfer following blastocyst-stage embryo transfer compared to those of cleavage-stage embryo transfer:analysis of 9408 singleton newborns using propensity score analysis

Objective:Regarding frozen-thawed embryo transfer(FET),there is limited consensus on whether extending embryo culture from the cleavage stage to the blastocyst stage affects perinatal outcomes.This study aimed to compare perinatal outcomes of singletons between blastocyst-stage embryo transfer(BT)and cleavage-stage embryo transfer(CT)in FET.Methods:A total of 9408 FET cycles that met the inclusion criteria were included in this retrospective cohort study between 2019 and 2022.Blastocyst-stage embryo transfers were performed in the BT group,and cleavage-stage embryo transfers were performed in the CT group.Multivariate logistic regression analyses were performed,as well as propensity score matching(PSM)to adjust for confounders.Results:After PSM,a higher risk of pre-term birth(PTB;odds ratio[OR]:1.23,95%confidence interval[CI]:1.00-1.50,P=0.048)and being large for gestational age(LGA;OR:1.16,95%CI:1.00-1.35,P=0.050)was observed in the BT group compared to that in the CT group.After stratified PSM,in the subgroup under 35 years of age,only an increased risk of LGA was observed in the BT group compared to the CT group.Perinatal outcomes in the double-embryo transfer subgroup were similar to those in the unstratified group.However,in the subgroup beyond 35 years of age and the single embryo transfer subgroup,perinatal outcomes were not statistically different between the BT and CT groups(P>0.05).Conclusions:In FET,prolonged embryo culture to the blastocyst stage increased the risk of PTB and LGA in single fetuses.However,stratified analysis based on age and the number of transferred embryos yielded different results,necessitating further mechanistic studies.