Signal intensity changes of dentate nucleus on plain MR T1WI innasopharyngeal carcinoma patients after radiotherapy andmultiple injections of gadolinium-base contrast agent

Objective To observe changes of plain MR T1WI signal intensity of dentate nucleus in nasopharyngeal carcinoma patients after radiotherapy and multiple times of intravenous injection of gadolinium-based contrast agent(GBCA).Methods Fifty patients with pathologically confirmed nasopharyngeal carcinoma and received intensity-modulated radiotherapy were retrospectively enrolled as the nasopharyngeal carcinoma group,and 50 patients with other malignant tumors and without history of brain radiotherapy were retrospectively enrolled as the control group.All patients received yearly GBCA enhanced MR examinations for the nasopharynx or the head.T1WI signal intensities of the dentate nucleus and the pons on same plane were measured based on images in the year of confirmed diagnosis(recorded as the first year)and in the second to the fifth years.T1WI signal intensity ratio of year i(ranging from 1 to 5)was calculated with values of dentate nucleus divided by values of the pons(ΔSI i),while the percentage of relative changes of year j(ranging from 2 to 5)was calculated withΔSI j compared toΔSI 1(Rchange j).The values of these two parameters were compared,and the correlation ofΔSI and GBCA injection year-time was evaluated within each group.Results No significant difference of gender,age norΔSI 1 was found between groups(all P>0.05).The second to the fifth yearΔSI and Rchange in nasopharyngeal carcinoma group were all higher than those in control group(all P<0.05).Within both groups,ΔSI was positively correlated with GBCA injection year-time(both P<0.05).Conclusion Patients with nasopharyngeal carcinoma who underwent radiotherapy and multiple times of intravenous injection of GBCA tended to be found with gradually worsening GBCA deposition in dentate nucleus,for which radiotherapy might be a risk factor.

超声造影成像对TI-RADS 4类甲状腺囊性皱缩结节诊断的临床应用

目的:探讨超声造影成像(CEUS)对TI-RADS 4类甲状腺囊性皱缩结节性质诊断效果.方法:选取2020年1月至2023年1月于本院就诊甲状腺结节患者中,被诊断为TI-RADS 4类甲状腺囊性皱缩结节的106例患者为研究对象,共112处病灶,纳入甲状腺囊性皱缩结节组(n=112).同期被同一家医院诊断的甲状腺乳头状癌(PTC)患者101例作为对照,共105处病灶,纳入PTC组(n=105).采取回顾性分析法比较两组病灶的超声表现及CEUS特点,分析CEUS特异性指标诊断甲状腺囊性皱缩结节的效能.结果:甲状腺囊性皱缩结节组与PTC组整体、壁增强模式的CEUS结果比较,差异有统计学意义(P<0.05);CEUS无增强模式诊断甲状腺囊性皱缩结节的灵敏度为95.11%,准确度为97.12%;壁增强模式诊断甲状腺囊性皱缩结节的灵敏度为55.26%,准确度为78.31%.结论:TI-RADS 4类甲状腺囊性皱缩结节超声表现与PTC存在一定相似度,但是CEUS鉴别诊断TI-RADS 4类甲状腺囊性皱缩结节可减少误诊,降低分类,避免不需要的手术和穿刺活检,值得临床广泛应用.

Low-field, high-gradient NMR shows diffusion contrast consistent with localization or motional averaging of water near surfaces

Nuclear magnetic resonance(NMR)measurements of water diffusion have been extensively used to probe microstructure in porous materials,such as biological tissue,however primarily using pulsed gradient spin echo(PGSE)methods.Low-field single-sided NMR systems have built-in static gradients(SG)much stronger than typical PGSE maximum gradient strengths,which allows for the signal attenuation at extremely high b-values to be explored.Here,we perform SG spin echo(SGSE)and SG stimulated echo(SGSTE)diffusion measurements on biological cells,tissues,and gels.Measurements on fixed and live neonatal mouse spinal cord,lobster ventral nerve cord,and starved yeast cells all show multiexponential signal attenuation on a scale of b with significant signal fractions observed at b×Do>1 with b as high as 400 ms/um2.These persistent signal fractions trend with surface-to-volume ratios for these systems,as expected from porous media theory.An exception found for the case of fixed vs.live spinal cords was attributed to faster exchange or permeability in live spinal cords than in fixed spinal cords on the millisecond timescale.Data suggests the existence of multiple exchange processes in neural tissue,which may be relevant to the modeling of time-dependent diffusion in gray matter.The observed multi-exponential attenuation is from protons on water and not macromolecules because it remains proportional to the normalized signal when a specimen is washed with D20.The signal that persists to b×Do>1 is also drastically reduced after delipidation,indicating that it originates from lipid membranes that restrict water diffusion.The multiexponential or stretched exponential character of the signal attenuation at b×Do>1 appears mono-exponential when viewed on a scale of(b×Do)/3,suggesting it may originate from localization or motional averaging of water near membranes on sub-micron length scales.To try to disambiguate these two contributions,signal attenuation curves were compared at varying temperatures.While the curves align when normalizing them using the localization length scale,they separate on a motional averaging length scale.This supports localization as the source of non-Gaussian displacements,but this interpretation is still provisional due to the possible confounds of heterogeneity,exchange,and relaxation.Measurements on two types of gel phantoms designed to mimic extracellular matrix.one with charged functional groups synthesized from polyacrylic acid(PAC)and another with uncharged functional groups synthesized from polyacrylamide(PAM),both exhibit signal at b×Do>1,potentially due to water interacting with macromolecules.These preliminary finding motivate future research into contrast and attenuation mechanisms in tissue with low-field,high-gradient NMR。

An inverse analysis of fluid flow through granular media using differentiable lattice Boltzmann method

This study presents a method for the inverse analysis of fluid flow problems.The focus is put on accurately determining boundary conditions and characterizing the physical properties of granular media,such as permeability,and fluid components,like viscosity.The primary aim is to deduce either constant pressure head or pressure profiles,given the known velocity field at a steady-state flow through a conduit containing obstacles,including walls,spheres,and grains.The lattice Boltzmann method(LBM)combined with automatic differentiation(AD)(AD-LBM)is employed,with the help of the GPU-capable Taichi programming language.A lightweight tape is used to generate gradients for the entire LBM simulation,enabling end-to-end backpropagation.Our AD-LBM approach accurately estimates the boundary conditions for complex flow paths in porous media,leading to observed steady-state velocity fields and deriving macro-scale permeability and fluid viscosity.The method demonstrates significant advantages in terms of prediction accuracy and computational efficiency,making it a powerful tool for solving inverse fluid flow problems in various applications.

Navigating nephrotoxic waters:A comprehensive overview of contrast-induced acute kidney injury prevention

Contrast-induced acute kidney injury(CI-AKI)is the third leading cause of acute kidney injury deriving from the intravascular administration of contrast media in diagnostic and therapeutic procedures and leading to longer in-hospital stay and increased short and long-term mortality.Its pathophysiology,although not well-established,revolves around medullary hypoxia paired with the direct toxicity of the substance to the kidney.Critically ill patients,as well as those with pre-existing renal disease and cardiovascular comorbidities,are more susceptible to CI-AKI.Despite the continuous research in the field of CI-AKI prevention,clinical practice is based mostly on periprocedural hydration.In this review,all the investigated methods of prevention are presented,with an emphasis on the latest evidence regarding the potential of RenalGuard and contrast removal systems for CI-AKI prevention in high-risk individuals.

Protective Effect of Oral Steroid Premedication: Adverse Reactions to Nonionic Iodine Contrast Media for Computed Tomography

This study aimed to investigate the protective effect of oral steroid premedication in terms of adverse reactions to non-ionic contrast media. We investigated the incidence of adverse reactions among patients who underwent contrast-enhanced computed tomography. Patients in the premedication group took 30 mg of prednisolone orally the night before and on the morning of the scheduled computed tomography. Sixty-five patients received the same contrast media. Among them, 56 took prednisolone orally prior to the procedure (premedication without change of contrast media group) and nine without premedication (no premedication and no change of contrast media group). In total, 379 patients received different contrast media. Among them, 340 took prednisolone orally (premedication with change of contrast media group), while 39 did not take the premedication (no premedication with change of contrast media group). The adverse reaction rates in the premedication with change of contrast media and no premedication with change of contrast media groups were 1.8% (6/340 cases) and 2.6% (1/39 cases) (P = 0.54), respectively. The incidence of adverse reaction after the administration of non-ionic iodinated contrast media did not differ significantly based on whether an oral steroid was administered prior to compute tomography. Our evaluation is limited due to the small sample size of the contrast media-changed group. However, even if premedication with steroids is effective, it may only result in an adverse reaction reduction rate of ≤3%.

Role of contrast-enhanced ultrasonography in percutaneous radiofrequency ablation of liver metastases and efficacy evaluation

Objective： To retrospectively investigate the role of contrast-enhanced ultrasonography （CEUS） in percutaneous radiofrequency ablation （RFA） in patients with liver metastases and evaluate the therapeutic efficacy of RFA assisted by CEUS. Methods： From May 2004 to September 2010, 136 patients with 219 liver metastatic lesions received CEUS examination 1 h before RFA （CEUS group）, and other 126 patients with 216 lesions without CEUS examination in the earlier period were served as a historical control group. The mean tumor size was 3.2 cm and the mean tumor number was 1.6 in the CEUS group, while 3.4 cm and 1.7 in the control group, respectively （P〉0.05）. The clinical characteristics, recurrence results and survival outcomes were compared between two groups. Results： In the CEUS group, two isoechoic tumors were not demonstrated on unenhanced ultrasonography （US）, and 63 （47%） of 134 tumors examined with CEUS were 0.3 cm larger than with unenhanced US. Furthermore, in 18.4% of 136 patients, additional 1-3 tumors were detected on CEUS. The CEUS group showed higher early tumor necrosis and lower intrahepatic recurrence than the control group. The 3-year overall survival （OS） rate and the 3-year local recurrence-free survival （LRFS） rate in the CEUS group were 50.1% and 38.3%, in contrast to 25.3% and 19.3% in the control group, respectively （P=0.002 and P〈0.001）. Conclusions： CEUS provides important information for RFA treatment in patients with liver metastases and better therapeutic effect could be attained.

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Radiocontrast-induced nephropathy(RCIN) is an acute and severe complication after coronary angiography,particularly for patients with pre-existing chronic kidney disease(CKD).It has been associated with both short-and long-term adverse outcomes,including the need for renal replacement therapy,increased length of hospital stay,major cardiac adverse events,and mortality.RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25%above baseline within 48 h after contrast administration.There is no effective therapy once injury has occurred,therefore,prevention is the cornerstone for all patients at risk for acute kidney injury(AKI).There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes.The optimal strategy for preventing RCIN has not yet been established.This review discusses the principal risk factors for RCIN,evaluates and summarizes the evidence for RCIN prophylaxis,and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.

Evolution of gastrointestinal double contrast radiography in China:researches,application and popularization

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Shellfish allergy and relation to iodinated contrast media: United Kingdom survey

AIM: To assess current practice of United Kingdom cardiologists with respect to patients with reported shellfish/iodine allergy, and in particular the use of iodinated contrast for elective coronary angiography.Moreover we have reviewed the current evidence-base and guidelines available in this area.METHODS: A questionnaire survey was send to 500senior United Kingdom cardiologists(almost 50% cardiologists registered with British Cardiovascular Society)using email and first 100 responses used to analyze practise. We involved cardiologists performing coronary angiograms routinely both at secondary and tertiary centres. Three specific questions relating to allergy were asked:(1) History of shellfish/iodine allergy in pre-angiography assessment;(2) Treatments offeredfor shellfish/iodine allergy individuals; and(3) Any specific treatment protocol for shellfish/iodine allergy cases. We aimed to establish routine practice in United Kingdom for patients undergoing elective coronary angiography. We also performed comprehensive PubMed search for the available evidence of relationship between shellfish/iodine allergy and contrast media.RESULTS: A total of 100 responses were received, representing 20% of all United Kingdom cardiologists. Ninety-three replies were received from consultant cardiologists, 4 from non-consultant grades and 3 from cardiology specialist nurses. Amongst the respondents, 66% routinely asked about a previous history of shellfish/iodine allergy. Fifty-six percent would pre-treat these patients with steroids and anti-histamines. The other 44% do nothing, or do nonspecific testing based on their personal experience as following:(1) Skin test with 1 mL of subcutaneous contrast before intravenous contrast;(2) Test dose 2 mL contrast before coronary injection;(3) Close observation for shellfish allergy patients; and(4) Minimal evidence that the steroid and anti-histamine regime is effective but it makes us feel better.CONCLUSION: There is no evidence that allergy to shellfish alters the risk of reaction to intravenous contrast more than any other allergy and asking about such allergies in pre-angiogram assessment will not provide any additional information except propagating the myth.

Value of MR contrast media in image-guided body interventions

In the past few years,there have been multiple advances in magnetic resonance (MR) instrumentation,in vivo devices,real-time imaging sequences and interventional procedures with new therapies.More recently,interventionists have started to use minimally invasive image-guided procedures and local therapies,which reduce the pain from conventional surgery and increase drug effectiveness,respectively.Local therapy also reduces the systemic dose and eliminates the toxic side effects of some drugs to other organs.The success of MR-guided procedures depends on visualization of the targets in 3D and precise deployment of ablation catheters,local therapies and devices.MR contrast media provide a wealth of tissue contrast and allows 3D and 4D image acquisitions.After the development of fast imaging sequences,the clinical applications of MR contrast media have been substantially expanded to include pre-during-and post-interventions.Prior to intervention,MR contrast media have the potential to localize and delineate pathologic tissues of vital organs,such as the brain,heart,breast,kidney,prostate,liver and uterus.They also offer other options such as labeling therapeutic agents or cells.During intervention,these agents have the capability to map blood vessels and enhance the contrast between the endovascular guidewire/catheters/devices,blood and tissues as well as direct therapies to the target.Furthermore,labeling therapeutic agents or cells aids in visualizing their delivery sites and tracking their tissue distribution.After intervention,MR contrast media have been used for assessing the efficacy of ablation and therapies.It should be noted that most image-guided procedures are under preclinical research and development.It can be concluded that MR contrast media have great value in preclinical and some clinical interventional procedures.Future applications of MR contrast media in image-guided procedures depend on their safety,tolerability,tissue specificity and effectiveness in demonstrating success of the interventions and therapies.

Transient small bowel angioedema due to intravenous iodinated contrast media

Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good under-standing of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.

Studies on Hepatocyte-Targeting Magnetic Resonance Imaging Macromolecular Contrast Media

DTPA was covalently conjugated to the copolymer of L lysine and L tyrosine, then transchelated with Gd EDTA,the resultant polymer chelates were further reacted with 6 O bromoacetyl D galactose or methyl lactobionyloxyacetate to give PLT(Gd DTPA) with galactose moiety as liver targeting group.These macromolecular MRI contrast agents were characterized by means of FT IR, ICP AES, elementary analyses and UV Vis spectrophotometry. Their in vitro relaxivity and liver targeting property in mice were also investigated.

Effects of contrast media on the hepato-pancreato-biliary system

AIM： To determine the effects of high osmolarity contrast media （HOCM） and iso-osmolar contrast media （CM） application, with or without pressure, on hepato-pancreato-biliary （HPB） system. METHODS： Sixty rats were divided into six equal groups as follows： Group i： （0.9% NaCl, control）, Group 2： （diatrizoate meglumine Na, ionic HOCM, Urographin）, Group 3： （iodixanol, iso-osmolar nonionic CM, Visipaque）; each of which was applied without pressure, whereas the animals of the remaining three groups （1p, 2p, 3p） were subjected to the same CM with pressure. We performed a duodenal puncture and introduced a catheter into the ampulla. After the catheterization, 0.2 mL CM or 0.9% NaCI was injected with or without pressure. Blood samples were taken for biochemical evaluations. The histopathological examinations of liver, common bile duct, and pancreas were performed. RESULTS： There were no significant differences between the six groups for blood amylase, alanine aminotransferases, aspartate aminotransferases, bilirubin levels （P 〉 0.05）. Alkaline phosphatase and γ glutamyl transaminase levels were higher （P 〈 0.05） in the Urographin groups （2, 2p） than the Visipaque groups （3, 3p）, or control groups （1, 1p）. Hepatocyte necrosis, portal area inflammation, and Kupffer＇s cell hyperplasia were higher （P 〈 0.05） in the study groups than the control group. However, there were no significant differences （P 〉 0.05） between HOCM （2, 2p） and iso-osmolar CM （3, 3p） groups. Bile duct proliferation and regeneration in the Urographin groups （2, 2p） were significantly higher （P 〈 0.05） than the Visipaque~ groups （3, 3p） or the control groups （1, lp）. Although CM caused minor damage to the pancreas, there were no statistically significant differences （P 〉 0.05） between the groups. Application of the CM with pressure did not cause additional damage to the HPB system. CONCLUSION： Iso-osmolar, non-ionic CM could be more reliable than the ionic HOCM, whereas the application of pressure during the CM application had no effect on the HPB system.

Hybrid ants-like search algorithms for P2P media streaming distribution in ad hoc networks

Media streaming delivery in wireless ad hoc networks is challenging due to the stringent resource restrictions,po-tential high loss rate and the decentralized architecture. To support long and high-quality streams,one viable approach is that a media stream is partitioned into segments,and then the segments are replicated in a network and served in a peer-to-peer(P2P) fashion. However,the searching strategy for segments is one key problem with the approach. This paper proposes a hybrid ants-like search algorithm(HASA) for P2P media streaming distribution in ad hoc networks. It takes the advantages of random walks and ants-like algorithms for searching in unstructured P2P networks,such as low transmitting latency,less jitter times,and low unnecessary traffic. We quantify the performance of our scheme in terms of response time,jitter times,and network messages for media streaming distribution. Simulation results showed that it can effectively improve the search efficiency for P2P media streaming distribution in ad hoc networks.

Thyroid Dysfunction in Children Exposed to Iodinated Contrast Media:A Meta-Analysis and Systematic Review

Iodinated contrast media(ICM)has the potential to cause thyroid dysfunction in some patients.However,it is unclear whether this relationship exists in children.We conducted a systematic review and meta-analysis aim to obtain a general overview of the relationship between ICM exposure and the risk of thyroid dysfunction in children.Methods:Computer search of Web of Science,EMbase,PubMed,Cochrane Library,collection of relevant literature on ICM and thyroid dysfunction in children,the search period was from the establishment of the database to July 2021.Meta-analysis was performed using Stata 14.0 software.Results:A total of 8 literatures with 3497 children.The incidence of hypothyroidism in children with ICM exposure was 0.05(95%CI:0.05,0.12),P<0.0001.Subgroup analysis showed that the incidence of hypothyroidism in ICM exposed children in the European region was 0.21(95%CI:0.13,0.30),P<0.0001,a statistically significant difference.Conclusion:The current evidence shows that children exposed to ICM are at risk for hypothyroidism,with a higher risk in neonates,especially children with congenital heart disease.

乌司他丁防治老年冠心病合并慢性肾脏病患者对比剂诱导的急性肾损伤的临床研究

目的探究乌司他丁对老年冠心病合并慢性肾脏病(CKD)患者发生对比剂诱导的急性肾损伤(CIAKI)的防治作用。方法连续入选2021年11月至2022年11月解放军总医院第一医学中心收治的老年冠心病合并CKD并拟行冠状动脉造影的患者321例,分为乌司他丁组161例,水化组160例。比较2组术前及术后2 d心、肾功能指标,观察2组心、肾功能变化差异及CIAKI发生情况。结果乌司他丁组术后2 d血清肌酐、尿素、胱抑素C、同型半胱氨酸、N末端B型钠尿肽前体水平显著低于水化组,估算肾小球滤过率水平显著高于水化组(P<0.01)。321例中有62例(19.3%)符合CIAKI诊断,乌司他丁组17例,水化组45例,乌司他丁组与水化组比较有显著差异(10.6%vs 28.1%,P<0.01)。乌司他丁组合并高血压、糖尿病、高脂血症及高尿酸血症的患者CIAKI发生率较水化组显著降低(P<0.01)。多因素logistic回归分析显示,乌司他丁是发生CIAKI的保护因素(OR=0.348,95%CI:0.180~0.673,P=0.001)。结论乌司他丁可改善老年冠心病合并CKD患者的肾功能,降低CIAKI发生风险。

术前Sonazoid超声造影评估肝细胞癌病理分化程度的价值

目的分析肝细胞癌(HCC)Sonazoid超声造影(CEUS)的特点与病理分化程度的相关性。方法纳入行CEUS检查并经病理确诊为HCC的患者64例,共64个病灶,根据病理分化程度将其分为高、中、低分化组,分别为6、48和10例。比较不同病理分化程度HCC的CEUS动脉期增强形态、增强水平和增强模式。结果动脉期增强形态分为均匀增强和不均匀增强2种,低分化组所有病灶及58.3%中分化组病灶呈不均匀高增强;高分化组病灶可呈均匀高增强、均匀等增强和不均匀高增强3种表现。动脉期,所有中、低分组病灶和66.7%高分化组病灶呈高增强,不同分化程度HCC的增强水平差异有统计学意义(P<0.01);门脉期,高、中、低分化组分别有16.7%、25.0%和70.0%的病灶消退成低增强,不同分化程度HCC的增强水平差异有统计学意义(P<0.05);延迟期,75%中分化组病灶和所有低分化组病灶呈低增强,66.7%高分化组病灶呈等增强,不同分化程度HCC的增强水平差异有统计学意义(P<0.01);Kupffer期,所有低分化组和95.8%中分化组病灶呈低增强,高分化组中仍有50%的病灶呈等增强,不同分化程度HCC的增强水平差异有统计学意义(P<0.01)。高分化组病灶表现为多种CEUS模式,中分化组病灶以“快进快退”、“快进慢退”为主,90.0%低分化组病灶呈“快进快退”模式,不同分化程度HCC的CEUS模式差异有统计学意义(P<0.01)。结论Sonazoid-CEUS在评估HCC病理分化程度方面具有一定价值。

利拉鲁肽对老年2型糖尿病患者经皮冠状动脉介入治疗后造影剂肾病及预后的影响

目的 探讨利拉鲁肽对老年2型糖尿病(T2DM)患者经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)及预后的影响。方法 回顾性分析2021年1月至2022年6月于天津市胸科医院心内科行PCI的老年T2DM患者364例,根据既往是否使用利拉鲁肽分为利拉鲁肽组145例和对照组219例。收集2组患者一般临床资料并使用倾向性评分匹配法校正混杂因素,倾向性评分匹配后,共纳入患者220例,每组110例。比较匹配后2组PCI术前及术后48 h血清肌酐(Scr)、尿素(BUN)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、高敏C反应蛋白(hs-CRP)、丙二醛(MDA)、超氧化物歧化酶(SOD)、B淋巴细胞瘤-2相关X蛋白/B淋巴细胞瘤2基因比值、半胱氨酸天冬氨酸蛋白酶9及CIN发病率的差异,并在出院后随访18个月。采用多因素logistic回归分析利拉鲁肽对CIN发生的影响,采用Kaplan-Meier生存曲线分析和log rank检验比较2组主要不良心血管事件(MACE)发生的差异。结果 利拉鲁肽组术后48 h Scr、BUN、NGAL、hs-CRP、MDA水平显著低于对照组,SOD水平显著高于对照组(P<0.05,P<0.01)。利拉鲁肽组术后48 h CIN发病率显著低于对照组(7.27%vs 16.36%,P<0.05)。多因素logistic回归分析显示,利拉鲁肽是老年T2DM患者发生CIN的独立保护因素(OR=0.341,95%CI:0.128~0.906,P=0.031)。中位随访时间14.75(12.60,16.33)个月,利拉鲁肽组MACE发生率显著低于对照组(log rank χ^(2)=5.656,P=0.017)。结论 利拉鲁肽可以减少老年T2DM患者PCI术后CIN及MACE的发生,可能与其抗炎、抗氧化应激作用有关。

超声造影诊断经皮肝穿刺胆管引流置管滑脱后胆瘘1例

患者女,69岁,胰头癌伴梗阻性黄疸,房间隔缺损、三尖瓣中度关闭不全,肺动脉高压;接受经皮肝穿刺胆管引流(percutaneous transhepatic cholangial drainage,PTCD)后置管滑脱伴轻微腹痛2天。查体:上腹部压痛阳性,无反跳痛及肌紧张,移动性浊音阴性。