DCE-MRI参数联合IFIT1基因对腰椎间盘突出患者椎间盘退变程度的评估价值

探讨DCE-MRI参数及IFIT1基因对腰椎间盘突出症(LDH)患者椎间盘退变(IDD)程度的评估价值。随机选取确诊的66例LDH患者作为研究对象,根据改良Pfirrmann分级法将患者分为2组:轻中度IDD(Ⅰ~Ⅲ级)组(46例)和重度IDD(Ⅳ~Ⅴ级)组20例。通过DCE-MRI检查考察患者的K-trans值,采用日本骨科学会评分(JOA)评估腰椎功能,采用视觉模拟评分法(VAS)评估腰部疼痛,采用RT-PCR检测外周血单个核细胞(PBMC)中IFIT1的mRNA表达。轻中度IDD组的K-trans值显著低于重度IDD组。轻中度IDD组患者PBMC中的IFIT1 mRNA相对表达量显著低于重度IDD组。K-trans值与PBMC中的IFIT1 mRNA水平和VAS评分正相关,与JOA评分负相关(P<0.05)。PBMC中的IFIT1 mRNA水平与VAS评分正相关,与JOA评分负相关(P<0.05)。K-trans值和PBMC中的IFIT1 mRNA水平联合诊断重度IDD的AUC值、敏感性和特异性分别为0.991、91.3%和100.0%,AUC值和特异性均高于单独诊断。DCE-MRI检查中的K-trans值联合PBMC中的IFIT1 mRNA水平可用于LDH患者IDD程度的诊断。     

腰椎CT矢状面屈曲角、终板屈曲深度和双侧腰大肌横断面积差值诊断腰椎间盘突出症(LDH)的价值及与退变程度的关系

本研究的目的是探讨腰椎矢状面屈曲角、终板屈曲深度和双侧腰大肌横断面积差值诊断腰椎间盘突出症(LDH)的价值及与椎间盘退变程度的关系。选取LDH患者120例作为观察组,同时选取体检健康者100例作为对照组,均给予腰椎CT检查。实验结果显示,观察组L_3～S_1平均终板屈曲深度、平均矢状面屈曲角、平均腰大肌横断面积与对照组比较,差异有统计学意义(P0.05);观察组Pfirrmann分级Ⅳ～Ⅴ级的患者L_3～S_1平均终板屈曲深度、平均矢状面屈曲角、平均腰大肌横断面积差值与Ⅱ～Ⅲ级患者比较,差异有统计学意义(P0.05);L_3～S_1平均终板屈曲深度、矢状面屈曲角、腰大肌横断面积差值诊断Pfirrmann分级Ⅳ～Ⅴ级的ROC曲线下面积分别为0.601、0.890和0.771。本研究证实矢状面屈曲角、终板屈曲深度、双侧腰大肌横断面积差值与LDH患者椎间盘退变程度有一定关系,诊断椎间盘退变程度有一定价值。     

基于MRI的绝经后女性腰椎退行性病变程度与骨质疏松的相关性研究

本研究探讨基于磁共振成像(MRI)的绝经后女性腰椎退行性病变程度与骨质疏松的关系。选取经骨密度检查确诊的骨质疏松绝经后女性患者50例为骨质疏松组、非骨质疏松症绝经后妇女50例作为对照组,两组妇女均接受MRI检查。结果显示,骨质疏松组的L1/L2、L2/L3、L3/L4、L4/L5、L1~S1椎间盘Pfirrmann分级评分均高于对照组,差异均具有统计学意义(P<0.05);骨质疏松组患者的腰椎L1/L2、L2/L3、L3/L4、L4/L5、L1~S1之间的BMD与椎间盘Pfirrmann分级评分呈显著的正相关关系(P<0.05);多元线性回归模型结果显示:绝经时间、年龄、腰椎BMD值与患者椎间盘Pfirrmann分级评分呈显著的正相关关系(P<0.05)。绝经后女性采用MRI检查评估的腰椎退行性病变程度Pfirrmann分级评分与骨质疏松程度有关,同时与患者的年龄、绝经时间长度有关。     

多参数MRI对子宫肉瘤与良性子宫肌瘤的鉴别诊断价值及与肿瘤细胞恶性程度的关系

本文选取子宫肉瘤(US)患者103例作为观察组,另选取同期良性子宫肌瘤患者103例作为对照组,探究多参数MRI对US与良性子宫肌瘤的鉴别诊断效果及与肿瘤细胞恶性程度的关系。结果发现,观察组达峰时间(TTP)、扩散系数(ADC)低于对照组;随临床分期增加,TTP、ADC呈下降趋势,TopoⅡα、AgNOR、PDGFα、Matriptase mRNA相对表达量呈升高趋势,TTP、ADC与TopoⅡα、AgNOR、PDGFα、Matriptase mRNA相对表达量呈负相关,且TTP、ADC联合鉴别诊断US和良性子宫肌瘤的AUC值最大,提示US与良性子宫肌瘤MRI参数存在显著差异,且TTP、ADC值与增殖分子、侵袭分子活性直接相关,可为临床鉴别诊断提供数据支持。     

腰椎CT定量参数诊断LDH的价值及与退变程度的关系

回顾性分析130例腰椎间盘突出症(LDH)患者(观察组)的腰椎CT影像学资料,选取同期其他原因行腰椎CT检查的130例患者作为对照组,比较发现,观察组L_4上终板和下终板、L_5上终板和下终板、S_1上终板屈曲角、L_(4～5)和L_5～S_1双侧腰大肌横断面积差值均大于对照组,且与LDH改良Pfirrmann分级呈正相关(P0.05);观察组L_4上终板和下终板、L_5上终板和下终板、S_1上终板的终板屈曲深度均低于对照组,且与LDH改良Pfirrmann分级呈负相关(P0.05);经ROC分析获取各参数截断值敏感度均70%。因此,笔者认为腰椎CT矢状面屈曲角、终板屈曲深度、双侧腰大肌横断面积差值可为LDH诊断及退变程度判断提供有效参考价值。     

食道多普勒超声指导液体治疗在老年肺癌手术中的应用

本研究探讨经食管超声心动图(TEE)指导液体治疗在老年肺癌根治术患者术中的应用价值。选取我院心胸外科实施传统肺癌手术患者98例,采用前瞻性研究方案,依据随机数字将患者分为TEE组(TEE指导下液体治疗)和常规组(传统方法补充液体治疗)各49例,两组患者均采用传统开胸手术治疗,对比两组患者的血流动力学参数、补充液体量、氧合指数、血乳酸水平、术后手术并发症指标。结果显示,TEE组的晶体液用量、胶体液用量均低于常规组(P<0.05);监测对比TEE组和常规组患者在T1~T4时刻的血流动力学参数,TEE组在T2、T3时刻的每搏变异度(SVV)、中心静脉压(CVP)测定值明显低于常规组(P<0.05);TEE组的心排血量(CO)值在T4时刻高于常规组(P<0.05);TEE组的平均动脉压(MAP)值在T3、T4时刻明显低于常规组(P<0.05);术中60 min、术后30 min时,TEE组的氧合指数明显高于常规组,血乳酸明显低于常规组(P<0.05)。老年肺癌根治术患者采用TEE指导液体治疗,有利于维持患者血流动力学指标的稳定性,能更好地维持外周血循环及组织灌流。     

MRI相关定量参数在肩峰下撞击综合征诊断中的价值及与肩关节功能、治疗效果的关系

为分析MRI相关定量参数对肩峰下撞击综合征(SIS)的诊断价值,本研究将56例SIS患者设为SIS组,同期56例健康体检者设为对照组,对比了两组对象的一般资料、肩关节功能评分(Constant评分)及MRI相关定量参数水平,探讨了MRI定量参数与Constant评分、SIS发病相关影响因素、治疗效果的关系及对SIS的诊断价值。结果显示SIS组Constant评分、最短肩肱间距低于对照组,肩峰指数、肩锁关节骨赘高度高于对照组,且SIS组治疗有效患者肩峰指数、肩锁关节骨赘高度低于无效患者,最短肩肱间距高于无效患者(P<0.05);SIS患者肩峰指数、肩锁关节骨赘高度与Constant评分呈负相关,而最短肩肱间距与其呈正相关(P<0.05);各MRI相关定量参数均为SIS发病的重要影响因素(P<0.05)。应用各MRI相关定量参数联合诊断SIS特异度为87.50%,敏感度为80.36%。由此可知MRI相关定量参数对SIS诊断价值较高,且与肩关节功能和治疗效果有关。     

磁共振T2WI、DWI对直肠癌新辅助治疗疗效的评估价值

本研究探讨磁共振成像T2WI、弥散加权成像(DWI)在直肠癌新辅助治疗疗效的评估价值。选取直肠癌患者92例,给予新辅助治疗,比较治疗前后T2WI、DWI参数变化。治疗无效患者治疗后肿瘤绝对信号值(SIT)明显高于治疗有效患者(P<0.05),而肿瘤绝对信号值减低率(SITRR)、治疗后肿瘤相对信号值(SIT/M)、肿瘤相对信号值减低率(SIT/MRR)明显低于治疗有效患者(P<0.05);治疗无效患者治疗后表观扩散系数(ADC)值、ADC变化值明显低于治疗有效患者(P<0.05);治疗后SIT、SITRR、SIT/MRR预测治疗有效的ROC曲线下面积分别为0.671、0.950和0.879(P<0.05);治疗后ADC值、ADC变化值预测治疗有效的ROC曲线下面积分别为0.717和0.977(P<0.05)。磁共振T2WI图像参数、ADC在预测直肠癌新辅助治疗疗效中有较高的应用价值。     

超声弹性成像参数联合血清MK和VEGF对分化型甲状腺癌的诊断价值及与肿瘤恶性程度关系研究

本研究选取了分化型甲状腺癌(DTC)患者106例为甲状腺癌组,同期106例甲状腺腺瘤患者为甲状腺腺瘤组,检测比较了两组患者的超声弹性成像参数(弹性比值、蓝色面积比值)、血清中期因子(midkine,MK)、血管内皮生长因子(VEGF)水平。研究结果发现,弹性比值、蓝色面积比值、血清MK和VEGF水平与DTC患者淋巴结转移、包膜侵犯、临床分期相关(P<0.05);弹性比值、蓝色面积比值、血清MK和VEGF水平联合诊断DTC的曲线下面积(AUC)为0.888;弹性比值、蓝色面积比值、血清MK及VEGF水平与DTC患者组织中趋化因子受体(CXCR)4、解聚素金属蛋白酶(ADAM)9、靶向Xklp2靶蛋白(TPX2)基因表达量呈正相关,与程序性细胞死亡因子(PDCD)4基因表达量呈负相关。这些结果提示超声弹性成像参数、血清MK及VEGF水平上调可能用来评估DTC患者病情程度及肿瘤恶性程度,三者联合对DTC具有可靠诊断价值,可为临床诊治提供参考。     

MR弥散张量成像及弥散张量纤维束示踪成像在不同级别脑胶质瘤诊断中的应用

本文探讨不同级别脑胶质瘤诊断中应用MR弥散张量成像(DTI)及弥散张量纤维束示踪成像(DTT)的价值。选取脑胶质瘤患者84例,比较低级别和高级别脑胶质瘤DTI、DTT参数差异。实验结果显示:高级别瘤周白质纤维束破坏比例明显高于低级别(P0.05);高级别病灶实质区部分各向异性(FA)值明显高于低级别脑胶质瘤(P0.05),而表观扩散系数(ADC)值明显低于低级别(P0.05);高级别瘤周水肿区纤维密度指数(FDi)值明显低于低级别(P0.05);瘤周白质纤维束破坏,病灶实质区FA值和ADC值,瘤周水肿区FDi值鉴别诊断高级别脑胶质瘤的ROC曲线下面积分别为0.857、0.877、0.965和0.828(P0.05)。研究证实:同级别脑胶质瘤中,DTI及DTT参数有所差异,在鉴别诊断中有一定应用价值。     

射频热凝联合臭氧消融治疗腰椎间盘突出症的临床观察

目的 观察射频热凝术联合臭氧消融术治疗腰椎间盘突出症的临床效果。方法 选取2013年3月到2016年3月珠江医院康复科收治的腰椎间盘突出症患者220例为研究对象,随机分为A组和B组,各110例,A组采用射频热凝术治疗,B组采用射频热凝术联合臭氧消融术治疗,采用VAS、Mac Nab标准评价治疗效果。结果 A组和B组术后1 d、术后一周、术后两周VAS评分均较术前明显下降(P0.05);B组术后1 d的VAS评分与A组比较均没有统计学意义(P0.05)。B组术后一周、术后两周的VAS评分均比A组明显降低(P0.05)。A组和B组术后两周Mac Nab有效率均较术后1 d明显提高(P0.05)。B组术后1 d的Mac Nab有效率与A组比较没有统计学意义(P0.05)。B组术后两周的Mac Nab有效率与A组比较有统计学意义(P0.05)。结论 射频热凝术和射频热凝术联合臭氧消融术治疗腰椎间盘突出症都有明显的疗效,射频热凝术联合臭氧消融术治疗腰椎间盘突出症的效果明显比单纯用射频热凝术好。     

Differential sacnning calorimetric examination of the human intervertebral disc: establishment of calorimetric standards of different stages of degeneration

Intervertebral disc (IVD) degeneration is a common orthopaedic disorder with significant social and economic impact. The major pathological changes occur in the structure of anulus fibrosus (AF) and nucleus pulposus (NP). According to previous reports differential sacnning calorimetric (DSC) proved to be a suitable method for the demonstration of thermal consequences of local and global conformational changes in the structure of the human intervertebral discs. According to the present study, the DSC results clearly proved that definitive differences are present between the stages of disc degeneration in calorimetric measures. The structural differences between the stages could be also demonstrated by histology.     

MRI检查神经根沉降征诊断LSS患者的价值及其危险因素分析

本研究探讨磁共振成像(MRI)检查神经根沉降征(NRS)在腰椎管狭窄症(LSS)患者发生中的相关因素及其诊断学价值。选取接受腰椎MRI检查的262例(511个腰椎节段)患者进行研究,根据MRI结果患者腰椎节段分为狭窄组(172例患者,348个腰椎节段)和非狭窄组(90例患者,163个腰椎节段)。狭窄组硬膜囊面积(CSA)<100 mm²患者占比、椎管正中矢状径(PDA)≤15 mm患者占比、侧隐窝矢状径≤5 mm患者占比、神经根沉降征(NRS)阳性率均显著高于非狭窄组(P<0.05);NRS诊断LSS的曲线下面积(AUC)值为0.714;172例LSS患者,NRS阳性患者108例、NRS阴性患者64例,NRS阳性组的糖尿病率、硬膜囊CSA<100 mm²患者占比、椎管PDA≤15 mm患者占比、侧隐窝矢状径≤5 mm患者占比均高于阴性组患者,差异均具有统计学意义(P<0.05);硬膜囊CSA<100 mm²、椎管PDA≤15 mm、侧隐窝矢状径≤5 mm是LSS患者发生NRS的独立危险因素(P<0.05)。NRS对于诊断LSS具有较高的特异度,但是灵敏度一般,患者椎管狭窄越严重,其NRS发生的风险越高。     

Pharmacokinetic study of eight bioactive components following oral administration of Zhiqiao Gancao decoction and observation of its clinical efficacy

Zhiqiao Gancao (ZQGC) decoction is widely used in China due to its therapeutic effect on lumbar disc herniation (LDH). In this study, we compared the clinical therapeutic effects among oral ZQGC decoction treatment, bed rest, and oral anti-inflammatory drug celecoxib treatment using visual analog scale, Oswestry Disability Index, and MacNab scores. The results showed that ZQGC decoction can significantly improve the symptoms of patients with LDH. A selective, sensitive, and rapid ultra-performance liquid chromatography–tandem mass spectrometry method was developed and validated for the determination of eight bioactive components in rat plasma. The plasma samples were extracted by simple protein precipitation with methanol. The protonated analytes were quantitated simultaneously in positive and negative ion modes by multiple reaction monitoring with a mass spectrometer. The calibration curve of eight components in plasma showed good linearity (r > .996) and the extraction recovery was 81.19% ± 2.15% − 100.39 ± 3.36 (relative standard deviation: 1.21%–10.70%). The accuracy of all the lower limit of quantitation values was quantified within 80%–120%, and the precision was less than 15%. This validated method was successfully applied to the pharmacokinetics study in rat plasma after ZQGC decoction oral treatment. Our research can provide experimental basis for the rational clinical application of ZQGC decoction in the treatment of LDH.     

Snapshot of degenerative aging of porcine intervertebral disc: a model to unravel the molecular mechanisms

Larger animal models, such as porcine, have been validated as appropriate models of the human disc with respect to biomechanics and biochemistry. They are advantageous for research as the models are relatively straightforward to prepare and easily obtainable for research to perform surgical techniques. The intention of this study was to quantitatively analyze gene expression for collagen and proteoglycan components of the extracellular matrix and for collagenase (MMP-1) in porcine discs of varying ages (Newborn; 2-3weeks, Mature; 6-9 month, Older; 2-3 years). In this study, we observed that the cell number and GAG (glycosaminoglycan) formation dramatically decreased with aging. Also, gene expression in the annulus fibrosus (AF) and nucleus pulposus (NP) cells changed with aging. The level of MMP-1 mRNA increased with age and both type I, II collagens decreased with age. The level of aggrecan mRNA was highest in the mature group and decreased significantly with aging. In the mature group, MMP-1 expression was minimal compared to the newborn group. In AF cells, type II collagen was expressed at a high level in the mature group with a higher level of aggrecan, when aged NP showed a decrease in type II collagen. The model of IVD degeneration in the porcine disc shows many changes in gene expression with age that have been previously documented for human and may serve as a model for studying changes in IVD metabolism with age. We concluded that the porcine model is excellent to test hypotheses related to disc degeneration while permitting time-course study in biologically active systems.     

不同手术方法治疗腰椎滑脱合并腰椎管狭窄的临床疗效对比

目的比较分析采用两种不同手术方式对合并腰椎管狭窄的腰椎滑脱疾病患者实施治疗的临床效果。方法抽取过去一段时间内江西省信丰县人民医院收治的88例合并腰椎管狭窄的腰椎滑脱疾病患者,采用随机分组方式将其分为对照组和治疗组,平均每组44例。对照组采用颈后路之间融合术进行治疗;治疗组采用改良的颈椎间孔椎间融合术进行治疗。结果治疗组患者在手术治疗前后VAS评分的改善幅度大于对照组;腰椎滑脱合并腰椎管狭窄疾病手术治疗及格率达到90.9%,高于对照组的70.5%;围术期仅有1例出现不良反应,少于对照组的8例。结论合并腰椎管狭窄的腰椎滑脱疾病患者采用改良的颈椎间孔椎间融合术进行治疗,可以有效控制疼痛,减少不良反应,缩短治疗时间。     

CT检查参数对腰椎管狭窄症的诊断价值及与疗效、腰椎功能改善的相关性分析

选取我院60例腰椎管狭窄症(LSS)患者作为研究组,同期健康者60例作为对照组,探究CT检查参数对LSS的诊断价值及与疗效、腰椎功能改善的相关性。结果显示,研究组椎管面积、硬膜囊面积、椎管矢径、椎管横径、侧隐窝矢径、侧隐窝角小于对照组(P<0.05);CT各参数联合诊断LSS的AUC值大于任一参数单独诊断;疗效优良患者术后3个月椎管面积、硬膜囊面积、椎管矢径、侧隐窝矢径、侧隐窝角大于治疗前及非优良患者(P<0.05);经偏相关性分析发现,CT检查参数与疗效显著相关(P<0.05)。说明LSS疗效、腰椎功能改善情况与椎管面积、硬膜囊面积、椎管矢径等关系密切,CT检查对指导临床完善手术方案有重要意义。     

Synergistic effects of layered double hydroxide with phosphorus-nitrogen intumescent flame retardant in PP/EPDM/IFR/LDH nanocomposites

<正>Synergistic effects of layered double hydroxide(LDH) with intumescent flame retardanct(IFR) of phosphorus-nitrogen (NP) compound in the polypropylene/ethylene-propylene-diene/IFR/LDH(PP/EPDM/IFR/LDH) nanocomposites and related properties were studied by X-ray diffraction(XRD),transmission electron microscopy(TEM),scanning electron microscopy(SEM),limiting oxygen index(LOI),UL-94 test,cone calorimeter test(CCT) and thermo-gravimetric analysis (TGA).The XRD and TEM results show that the intercalated and/or exfoliated nanocomposites can be obtained by direct melt-intercalation of PP/EPDM into modified LDH and that LDH can promote the IFR additive NP to disperse more homogeneously in the polymer matrix.The SEM results provide positive evidence that more compact charred layers can be obtained from the PP/EPDM/NP/LDH sample than those from the PP/EPDM/LDH and PP/EPDM/NP samples during burning.The LOI and UL-94 rating tests show that the synergetic effects of LDH with NP can effectively increase the flame retardant properties of the PP/EPDM/NP/LDH samples.The data from the CCT and TGA tests indicate that the PP/EPDM/NP/LDH samples apparently decrease the HRR and MLR values and thus enhance the flame retardant properties and have better thermal stability than the PP/EPDM/LDH and PP/EPDM/NP samples.