64层螺旋CT脑血管造影在颅内动脉瘤诊断中的应用

目的:探讨64层螺旋CT血管造影(CTA)对颅内动脉瘤的诊断价值。方法:回顾性分析54例临床怀疑为颅内动脉瘤,并同时行64层CTA和DSA检查的病例,其中47例疑诊动脉瘤患者行动脉瘤夹闭手术,将MSCTA,DSA与手术结果对照。结果:54患者中经MSCTA检出57个动脉瘤,DSA检出55个动脉瘤,另7例MSCTA和DSA均未检出动脉瘤,余47例接受手术并检出58个动脉瘤。64层CTA发现动脉瘤的敏感性为96.6%,特异性为87.5%,准确性为96.5%,阳性预测值为98.2,阴性预测值为77.7。MIP和VR技术对动脉瘤的形态、分支血管、血栓和钙化方面的显示优于DSA。结论:64层CTA诊断颅内动脉瘤具有较好的异性、敏感性及三维显示能力,具有较高的临床应用价值。。     

三维DSA在颅内动脉瘤中的应用

目的探讨三维数字减影血管造影(3D DSA)在颅内动脉瘤中的应用价值。方法使用GE Innova 3100平板血管造影机对40例疑似颅内动脉瘤患者行双侧颈内、外动脉和双侧椎动脉正、侧位2D DSA,进一步对感兴趣血管行3D DSA,通过容积再现(VR)进行颅内血管重建。结果 3D DSA检出39例动脉瘤患者,47枚动脉瘤,2D DSA检出31例动脉瘤患者,35枚动脉瘤,二者检出动脉瘤的长、短径无统计学差异(P>0.05),图像质量有统计学差异(P<0.05)。2D DSA出现假阳性动脉瘤3枚,假阴性动脉瘤15枚,评估颅内动脉瘤的灵敏度为78.9%,特异性为85.2%;3D DSA没有出现假阳性、假阴性动脉瘤,评估颅内动脉瘤的灵敏度为100%,特异性为100%。在动脉瘤形态、瘤颈尺寸及与相邻血管间的关系的显示上,3D DSA明显优于2D DSA。结论 3D DSA作为脑动脉造影中2D DSA的进一步补充,对颅内动脉瘤的诊断与治疗具有重要价值。     

头颅电子计算机断层扫描血管造影和头颅磁共振血管成像在颅内动脉瘤中诊断价值比较的回顾性研究

摘要 目的：研究对比头颅电子计算机断层扫描血管造影（CTA）和头颅磁共振血管成像（MRA）在颅内动脉瘤中诊断价值。方法：回顾性分析医院2019年1月2日～2020年12月15日收治的60例疑似颅内动脉瘤患者资料,所有受试者均开展头颅CTA检查、MRA检查以及数字减影血管造影（DSA）检查。以DSA检查结果为金标准,比较头颅CTA和头颅MRA诊断颅内动脉瘤的效能。此外,对比头颅CTA和头颅MRA诊断不同分级、不同部位颅内动脉瘤的符合率。结果：DAS检查结果显示确诊动脉瘤患者48例,共检出动脉瘤74个,CTA检出动脉瘤65个,MRA检出动脉瘤51个,CTA动脉瘤检出率高于MRA检出率（均P＜0.05）。以DSA结果为金标准,CTA诊断颅内动脉瘤的灵敏度、特异度以及准确度分别为94.20%（65/69）、60.00%（3/5）、91.89%（68/74）,均高于MRA的82.26%（51/62）、41.67%（5/12）、75.68%（56/74）（均P＜0.05）。CTA诊断1级颅内动脉瘤的符合率为13.85%（9/65）,高于MRA的7.84%（4/51）（P＜0.05）。各种检查方式诊断不同部位颅内动脉瘤的符合率对比均无明显差异（均P＞0.05）。结论：CTA诊断颅内动脉瘤的灵敏度、特异度以及准确度均高于MRA,可提高对小直径肿瘤的检出率。然而,MRA具有无辐射、检测费用少、安全性高等优势,临床实际工作中可综合选择合理的检查方式。     

三维CT血管造影在颅内动脉瘤夹闭术后复查中的应用

目的:评价三维CT血管造影(3D-CTA)在颅内动脉瘤夹闭术后复查中的应用价值.方法:选取我院神经外科2010年8月至2012年1月间,共42例颅内动脉瘤夹闭术后患者(45个动脉瘤),分别于动脉瘤夹闭术后5-7天,5-6个月,12个月接受三维CT血管造影(3D-CTA)和数字减影血管造影(DSA)检查,以DSA为金标准,判断CTA对动脉瘤术后残留、血管闭塞狭窄等检出的灵敏度和特异度.结果:3D-CTA发现4例瘤颈残留,1例吻合血管闭塞,28例载瘤动脉通畅,6例术中阻断的载瘤动脉不显影,61个动脉瘤夹均可清晰辨识,与DSA结果一致.3D-CTA评价瘤颈残留与载瘤动脉、吻合血管通畅的灵敏度和特异度均为100％,一致性为1.0.结论:3D-CTA检查操作简便,结果真实可靠,临床应用价值极高,能够很好的显示动脉瘤夹闭术后改变,可作为颅内动脉瘤夹闭术后长期多次随访的主要方法.     

16层螺旋CT血管成像诊断颅内动脉瘤的价值

目的:探讨16层螺旋CT血管成像(16SCTA)诊断颅内动脉瘤的价值.方法:对33例16SCTA诊断的颅内动脉瘤进行回顾性分析.其中4例经手术证实,13例经数字减影血管造影(DSA)证实.结果:16SCTA在33例患者中,共发现40个动脉瘤.其中3例为两个动脉瘤,2例为三个动脉瘤.40个动脉瘤中大脑中动脉瘤9个,大脑前动脉瘤8个,大脑后动脉瘤2个,后交通动脉瘤4个,颈内动脉瘤12个,基底动脉瘤3个,胼周动脉瘤1个,小脑上动脉瘤1个.16SCTA均清晰显示瘤体的大小、位置、形态及瘤颈宽度、瘤轴指向、载瘤动脉、动脉瘤与周围重要解剖结构的关系.有DSA资料对照的13例中,16SCTA发现16个动脉瘤中DSA只发现13个,另外DSA发现1个动脉瘤而16SCTA漏诊.16SCTA诊断颅内动脉瘤的敏感度、特异度、阳性预测值、阴性预测值分别为92.9%、97.1%、81.3%、99%.结论:16SCTA在颅内动脉瘤临床诊断和术后随访中有较高的应用价值.     

Interlock可解脱弹簧圈在脾动脉瘤腔内治疗中的应用

目的:探究Interlock可解脱弹簧圈在脾动脉瘤的腔内治疗中的应用价值。方法:回顾性分析2016年2月至2019年2月于本中心使用Interlock可解脱弹簧圈治疗的36例脾动脉瘤患者的临床资料,包括10例男性,26例女性,31例真性动脉瘤,5例假性脾动脉瘤,术前均行超声或CTA明确诊断。术中栓塞后,立即血管造影以明确技术成功率。围手术期及术后2周、3个月和6个月监测血常规、胰淀粉酶和主动脉CTA,观察并发症的发生情况。结果:6例患者弹簧圈栓塞动脉瘤远近端及瘤腔,其余仅栓塞脾动脉瘤瘤腔。术中DSA血管造影提示即刻脾动脉瘤栓塞闭塞率为97%以上,术中共使用128枚Interlock弹簧圈,其中104枚为钻石型,24枚为普通2D型。弹簧圈平均直径为6.3±4.2(2-12)mm,平均长度为16±13.5(3-32)mm,瘤体平均尺寸为40.6±12.5(15-70) mm。围手术期无并发症发生。平均随访10.0±3.2(6-15)个月,1月后2例出现脾梗死,7例发生轻微腹痛及低热等症状,所有病例均未见瘤腔再通和瘤体增大。结论:Interlock可解脱弹簧圈可以安全有效地治疗脾动脉瘤,但其远期疗效需长期随访观察。     

十六排螺旋CT血管造影在颅内疾病中应用初探

脑血管疾病是危及人体生命的危险疾病。传统的血管造影虽然是诊断该类疾病的最佳方法,但属于有创伤检查,且有1．5％-2．0％的合并症或死亡危险的报导^[1]。CT血管造影(computed tomographic angiography cTA)的应用给传统的血管造影带来了极大的挑战。1998年问世的多层螺旋CT(MSCT)以亚秒级的扫描速度具有更长的解剖覆盖、更薄的层厚、多种后处理能力、更简单方便等优势。2002年7月,我院引进GE公司Lightspeed十六排螺旋CT机,并进行了几十例颅内CTA检查,现对其应用情况进行分析。目的：初讨十六排螺旋CT血管造影在颅内病变中的应用及其技术优势。材料与方法：使用GE公司的十六排螺旋CT对自发性脑内出血、动脉瘤、脑肿瘤等几十例病人进行CTA检查,对血管显示情况进行评价;其中AVM和动脉瘤进行DSA检查并与CTA结果比较;另外颜面部AVM及脑肿瘤病人与手术结果比较。结果：CTA检查结果如下,脑血管主干及其1-3级分支显示率为100％,大脑中动脉4—5级分支显示率为94．7％。发现动脉瘤并清晰显示了瘤体、瘤颈、载瘤动脉及其详细关系;AVM清楚地显示了AVM的畸形团及其供血动脉和引流静脉;脑肿瘤显示了肿瘤与周围血管、颅骨间的三维关系。结论：十六排螺旋CT血管造影重建图像质量显著提高,它对颅内各种血管性病变以及血管与颅内其他病变三维空间关系,对各类疾病的诊断具有重要价值,它能显示更细小分支,具备作为动脉瘤等其他血管性病变筛选的首选方法。     

64层螺旋CT血管成像诊断胚胎型大脑后动脉及与DSA诊断的比较研究

目的:探讨64层螺旋CT血管成像(CTA)诊断胚胎型大脑后动脉(FTF)的准确性及其临床价值.方法:回顾性分析62例同时做了64层螺旋CTA和DSA脑血管检查患者的影像学资料,将CTA诊断FTP的结果与DSA检查结果进行比较,分析CTA诊断FTP的准确性.结果:62例中,DSA诊断FTP10例,CTA诊断FTP13例,CTA诊断FTP的敏感性为100%,特异性为96.40%,准确性为96.77%.经Kappa一致性检验,CTA与DSA诊断FTA的结果高度一致(P<0.001).结论:64层螺旋CTA能够无创性准确判断FTP的存在,对筛选FTP患者具有重要意义,能为脑血管疾病的诊断与治疗提供重要信息.     

VCTDSA联合CT灌注成像在急性缺血性卒中诊断运用探究

目的：探讨64层容积CT数字减影血管造影（Volume computed tomography digital subtraction angiography, VCTDSA）联合CT灌注成像在急性缺血性卒中诊断价值。方法：回顾性分析45例临床确诊为急性缺血性卒中患者的临床资料,分别给予VCTDSA与CT灌注成像处理,分析这两种技术对急性缺血性卒中患者的诊断敏感性和特异性。结果：45例患者检查有颅内有不同部位出血灶,多见于脑室,均伴有不同程度的异常血管网形成,其中VCTDSA图像质量优于CT灌注成像,VCTDSA较DSA可准确显示和测量动静脉瘘口大小,VCTDSA与MRA在瘤体长轴、瘤颈的比较中无显著性差异。结论：与其他减影CTA比较,VCTDSA联合CT灌注成像在急性缺血性卒中患者的诊断中具有优势。     

数字减影CTA诊断破裂颅内动脉瘤和预测动脉瘤破裂的价值

目的:评价数字减影CTA诊断破裂颅内动脉瘤和预测动脉瘤破裂效用。方法:对72例后期确诊为动脉瘤破裂引起的蛛网膜下腔出血患者行数字减影CTA(DSCTA)、数字减影血管成像(Digital subtraction angiography,DSA),对比多发动脉瘤患者破裂动脉瘤、未破裂动脉瘤DSCTA参数。结果:DSCTA发现动脉瘤86个,DSA检查发现89个;15例患者多发动脉瘤,破裂动脉瘤L、AR、SR均高于未破裂者,有子囊者L、AR、SR均高于无子囊者,差异具有统计学意义(P0.05)。结论:DSCTA可诊断绝大多数破裂动脉瘤、未破裂动脉瘤检出率较高,对比相关参数可初步预测破裂风险,但DSCTA、DSA使用均有一定风险,且诊断效用受患者、医师技术水平、病理因素影响,医师应积极总结应用经验。     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

Comparative morphology of the carpel in the Liliaceae: Hewardieae, Petrosavieae, and Tricyrteae

The young pistils in the melanthioid tribes, Hewardieae, Petrosavieae and Tricyrteae, are uniformly tricarpellate and syncarpous. They lack raphide idioblasts. All are multiovulate, with bitegmic ovules. The Petrosavieae are marked by the presence of septal glands and incomplete syncarpy. Tepals and stamens adhere to the ovary in the Hewardieae and the Petrosavieae but not in the Tricyrteae. Two vascular bundles occur in the stamens of the Hewartlieae and Tricyrtis latifolia. Ventral bundles in the upper part of the ovary of the Hewardieae are continuous with compound septal bundles and placental bundles in the lower part. Putative ventral bundles occur in the alternate position in the Tricyrteae and putative placental bundles in the opposite. position in the Petrosavieae. The dichtomously branched stigma in each carpel of the Tricyrteae is supplied by a bifurcated dorsal bundle.     

Selection with two alleles and complete dominance

For a plant selection model with frequency-independent viabilities, fertilities and selfing rates, it is shown that apart from global fixation, for certain parameter combinations a protected polymorphism and facultative fixation (either allele may become fixed according to initial frequencies) may both occur. Facultative fixation requires different selling rates for the dominant and recessive type. Protection of the polymorphism requires resource allocation for male and female function. In this connection the problem of purely genetically caused population extinction is discussed.
For general frequency dependence and regular segregation, the chances for establishment of a completely recessive gene are compared to those of a completely dominant gene. It is proven that the process of establishment of the recessive gene, despite a fitness advantage, may be considerably endangered by drift effects if random mating prevails. The recessive gene may reach the same effectivity in establishment as a dominant gene, only if the recessive homozygote mates exclusively with its own type during the period of establishment.     

Perinatal Vertical Transmission of Chikungunya Virus in Ruili,a Town on the Border between China and Myanmar

正Dear Editor,Chikungunya virus (CHIKV), an arbovirus in the family of Togaviridae, genus Alphavirus, is transmitted by the A.aegyptii or A. albopictus mosquito, and causes disease in humans characterized by fever, rash, and arthralgia (Silva and Dermody 2017; Suhrbier 2019). It was first reported in 1953 in Tanzania, and caused only a few outbreaks and sporadic cases in Africa and Asia in last century. However, in the epidemic in 2004, CHIKV acquired mutations that conferred enhanced transmission by the A. albopictus mosquito(Schuffenecker et al. 2006). Since then, it has successively caused outbreaks in Africa, the Indian Ocean, South East Asia, the South America, and Europe (Zeller et al. 2016).