宝石能谱CT评估冠状动脉介入治疗术后支架内成像质量的研究

目的:探讨宝石能谱CT用于冠状动脉支架内成像质量评估的应用价值。方法:回顾分析56例冠状动脉支架植入后患者,按照支架厚度及直径分成四组。采用宝石能谱CT对冠状动脉成像及同时进行冠状动脉造影患者的影像学资料,通过分析宝石能谱CT的冠状动脉的成像质量,与冠状动脉造影进行对比,得出宝石能谱CT用于冠状动脉介入治疗术后支架内成像质量评估的价值。结果:宝石能谱CT显示支架内再狭窄的敏感度为100%,特异度为98.6%,阴性预测值为100%。直径≥3 mm的支架内成像质量优于直径3 mm的支架。但支架直径和厚度对宝石能谱CT支架内成像质量的可评估率没有差异。结论:宝石能谱CT均能提供优秀的冠状动脉支架内成像质量,采用宝石能谱CT替代冠状动脉造影术可对冠脉支架术后支架内影像进行评估。     

冠状动脉CTA和DSA对冠心病患者的临床诊断价值比较

目的:比较冠状动脉CT血管成像(CT angiography,CTA)以及数字减影血管造影(digital subtraction angiography,DSA)诊断冠心病的临床价值差异。方法:选择2013年12月至2020年3月安徽医科大学第三附属医院、安徽医科大学第四附属医院收治的60例冠心病患者为研究对象,首先对其实施多排螺旋CT冠状动脉血管造影检测(CTA),而后2 w内再对其实施DSA检测,比较两种检测方式对不同血管狭窄程度、不同性质斑块检出率的差异,最后以DSA检测结果为金标准,评估CTA对冠状动脉狭窄诊断的一致性、灵敏度、特异度、阳性预测值和阴性预测值。结果:(1)CTA检测狭窄血管共计387支,轻度狭窄152支(39.28%),中度狭窄118支(30.49%),重度狭窄105支(27.13%),闭塞12支(3.10%);DSA检测狭窄血管392支,轻度狭窄150支(38.27%),中度狭窄124支(31.63%),重度狭窄112支(28.57%),闭塞6支(1.53%),两组各血管狭窄类型比较差异无统计学意义(P0.05);(2)CTA检测斑块69个,其中钙化斑43个(62.32%),非钙化斑26个(37.68%),DSA检测斑块61个,其中钙化斑33个(54.10%),非钙化斑28个(45.50%),两种检测方式差异无统计学意义(P0.05);(3)以DSA检测为金标准,CTA对重度及以上血管狭窄诊断一致性为99.23%,特异度为98.31%,灵敏度为99.64%,阳性预测值为99.15%,阴性预测值为99.27%。结论:与DSA相比,CTA对冠心病患者血管狭窄的诊断价值相当,且属于无创检测,在冠心病早期筛查中临床应用价值更高。     

使用320排CT评价冠状动脉钙化斑块狭窄程度的准确性

目的:研究使用320排容积CT评价冠状动脉钙化斑块造成管腔狭窄的精确程度。方法:搜集320排冠状动脉CTA的受检者200例,均有中度以上狭窄程度的钙化斑块,并近期进行过冠状动脉造影检查(CAG),根据钙化斑块的平均CT值及斑块面积占管腔百分比程度进行分组,A组平均CT值120Hu-400Hu、B组400-500Hu、C组500Hu以上,三组内又根据钙化斑块占管腔的面积百分比分为1、2两个亚组。使用测量软件对钙化部位狭窄程度进行测量并与冠状动脉造影进行对比。结果:A、B、C三组中第1亚组高估程度分别为21.4±8.7%、23.1±7.7%、23.9±9.8%,第2亚组高估程度分别为30.1±13.4%、32.5±15.4%、33.5±16.4%。每组的三个亚组中,随着钙化斑块平均CT值的增高,高估程度略有增高,而同组中两个亚组间的比较,高估程度明显增高。结论:320排冠状动脉CTA钙化平均CT值对管腔的遮盖程度有影响,促使CTA高估了管腔的狭窄程度,两者呈正比相关。但影响程度不如钙化占管腔面积百分比明显。     

经颅多普勒超声对脑梗死患者颅内动脉狭窄中的诊断价值研究

目的:研究经颅多普勒超声(TCD)对脑梗死患者颅内动脉狭窄中的诊断价值。方法:选择2014年10月至2016年10月新疆心脑血管病医院神经内科收治的急性脑梗死患者、短暂性脑缺血发作患者及后循环缺血发作患者共140例作为研究对象,对所有患者进行CT血管造影(CTA)及TCD检测。以CTA检查结果为金标准,对比两组颅内动脉狭窄的检测结果,分析TCD的诊断价值以及TCD对双侧大脑的中动脉(MCA)狭窄程度的诊断结果。结果:CTA诊断结果显示140例患者总共检出105例有颅内动脉狭窄,在1155条颅内段的前、后循环血管内,经CTA检测显示狭窄血管249条,TCD检测显示狭窄血管236条。与CTA相比,TCD对患者的诊断一致性较好(Kappa值0.75)。其中TCD对MCA的诊断敏感度和阳性预测值最高,分别为91.26%和93.07%,一致性最好(Kappa值=0.917)。210条MCA血管经CTA诊断结果显示狭窄103条,其中轻度狭窄17条,中度狭窄41条,重度狭窄45条,TCD诊断结果显示狭窄101条,其中轻度狭窄16条,中度狭窄40条,重度狭窄45条。经Kappa检验发现,TCD对MCA狭窄程度的诊断结果与CTA的一致性较好(Kappa值=0.884)。结论:TCD对于脑梗死患者的颅内动脉狭窄具有较高的诊断价值,且与CTA的诊断一致性较好。     

冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠状动脉硬化性心脏病的价值研究

摘要 目的：探讨冠状动脉CTA结合动态心电图夜间ST段趋势图对冠状动脉硬化性心脏病（冠心病）的诊断价值。方法：回顾性分析2022年1月-2023年2月在我院疑似冠心病的患者104例,所有患者均行冠状动脉造影、冠状动脉CTA、动态心电图及临床相关实验室检查。以冠状动脉造影结果作为诊断冠心病的金标准,分析比较冠状动脉CTA、动态心电图夜间ST段趋势图及两者联合诊断冠心病的诊断效能和一致性。结果：104例疑似冠心病的患者确诊93例（89.42%）。冠状动脉CTA诊断冠心病的敏感性为90.32%,特异性为72.73%,阳性预测值为96.55%,阴性预测值为47.06%,准确率为88.46%,与冠状动脉造影的Kappa值为0.813,一致性好。动态心电图夜间ST段趋势图诊断冠心病的敏感性为84.95%,特异性为63.64%,阳性预测值为95.18%,阴性预测值为33.33%,准确率为82.69%,与冠状动脉造影的Kappa值为0.724,一致性较好。有夜间ST段动态改变的冠心病检出率（84.95%,79/93）明显高于无夜间ST段动态改变的冠心病检出率（15.05%,14/93）,差异有统计学意义（P＜0.001）。冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠心病的敏感性为96.77%,特异性为90.91%,阳性预测值为98.90%,阴性预测值为76.92%,准确率为96.15%,与冠状动脉造影的Kappa值为0.923,一致性好。结论：冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠心病的临床价值优于冠状动脉CTA或动态心电图夜间ST段趋势图单独检查。     

64排螺旋CT在老年冠心病患者中的应用研究

目的:探讨64排螺旋CT在老年冠心病患者中的应用价值方法:选择60例老年冠心病患者行64排螺旋CT冠状动脉成像,并与传统的冠状动脉造影进行比较结论:以冠状动脉造影作为对照,64-MSCTA诊断冠状动脉狭窄的灵敏度为86.41%、特异度为94.01%、阳性预测值为78.26%、阴性预测值为96.52%、诊断符合率为92.49%。研究结果表明对于老年冠心病患者的诊断而言,64排螺旋CT可以作为冠脉动脉造影的有效替代检查。     

血管内支架成形术治疗大脑中动脉狭窄

目的:探讨血管内支架成形术治疗大脑中动脉狭窄的疗效及安全性.方法:对22例大脑中动脉狭窄患者行血管内支架成形术,回顾性分析其临床特点、疗效及治疗经验.结果:22例患者共植入22枚支架,均获得成功.术后即刻造影狭窄率为(11.2±4.5)%,较术前(79±15)%明显改善.术后残余狭窄程度均小于20%.临床随访无TIA发作或脑卒中再发,DSA随访除1例外均无再狭窄发生.结论:血管内支架成形术治疗大脑中动脉狭窄安全有效,但远期疗效还需进一步观察.     

64 排螺旋CTA 在下肢动脉闭塞及狭窄性病变中应用价值

目的:评价64排螺旋CT血管造影在下肢动脉闭塞性及狭窄性病变中应用价值。方法:采用美国GE公司生产LightSpeedVCT对52例患者进行下肢血管造影检查。扫描层厚0.625 mm,管电压120 KV、管电流130-205 mAs,扫描时间约为10秒。图像后处理技术多采用VR、MIP、MPR、cMPR,图像分析密切结合原始轴位图像。结果:67支血管未见明确病变,CTA显示狭窄血管共77支,5支血管闭塞;狭窄≥50%,≤75%共21支;狭窄≤50%共51支。结论:64排CTA图像在发现闭塞远端血管方面优于DSA,可以清晰显示闭塞远端侧枝供血血管。随着64排螺旋CT临床广泛应用,在下肢血管疾病诊断方面的优势会得到长足发展。     

320排CT冠脉造影检查对冠状动脉斑块成分分析可行性初探

目的:研究320排CT冠脉造影对分析冠状动脉轻度及重度狭窄患者斑块成分的价值。方法:2011年4月-2012年5月间我院1132例(62±12岁,42%女性)冠心病患者行320排CT冠状动脉造影检查,依据美国心脏协会16分段标准,分析每一例患者每一节段血管狭窄程度及斑块性质,CT斑块分型如下:Ⅰ型为钙化斑块,Ⅱ型为钙化为主的混合斑块,Ⅲ型为非钙化为主的混合斑块,Ⅳ型为非钙化斑块。比较不同狭窄程度组斑块类型差别。结果:共363例为冠脉血管正常人群,冠状动脉狭窄患者共769例,其中管腔狭窄程度<50%的轻度人群为367例,重度狭窄组(≥50%)为402例。重度狭窄患者组冠脉血管混合斑块数量较多,而非钙化斑块相对较少(Ⅰ～Ⅳ型斑块所占比例分别为22%,,39%,21%,18%),轻度狭窄患者组各斑块所占比例分别为29%,29%,26%,16%(p=0.006)。结论:随着冠状动脉狭窄程度的不同,冠状动脉粥样硬化斑块的类型也不尽相同,重度狭窄人群组中混合斑块较多而非钙化斑块较少。320排CT冠脉造影可对冠状动脉斑块成分进行分析。     

血管超声与64排螺旋CT血管造影在评价颈动脉狭窄中的对比研究

目的:比较血管超声与64排螺旋CT血管造影(CTA)对颈动脉狭窄的诊断价值。方法:选取2014年12月到2015年12月我院收治的疑似颈动脉狭窄患者70例(278节段),所有患者入院1周内均行血管超声、64排螺旋CTA检查,以数字减影血管造影(DSA)为金标准,比较血管超声与64排螺旋CTA对颈动脉狭窄诊断的符合率、特异度和灵敏度。结果:血管超声和64排螺旋CTA对不同程度颈动脉狭窄诊断的符合率比较,差异均无统计学意义(P0.05);血管超声和64排螺旋CTA对颈动脉狭窄诊断的灵敏度和特异度分别为87.28%、85.71%和85.55%、90.48%,比较差异无统计学意义(P0.05)。结论:血管超声和64排螺旋CTA对颈动脉狭窄均具有较高的诊断价值。     

On the origin of the Hirudinea and the demise of the Oligochaeta

The phylogenetic relationships of the Clitellata were investigated with a data set of published and new complete 18S rRNA gene sequences of 51 species representing 41 families. Sequences were aligned on the basis of a secondary structure model and analysed with maximum parsimony and maximum likelihood. In contrast to the latter method, parsimony did not recover the monophyly of Clitellata. However, a close scrutiny of the data suggested a spurious attraction between some polychaetes and clitellates. As a rule, molecular trees are closely aligned with morphology-based phylogenies. Acanthobdellida and Euhirudinea were reconciled in their traditional Hirudinea clade and were included in the Oligochaeta with the Branchiobdellida via the Lumbriculidae as a possible link between the two assemblages. While the 18S gene yielded a meaningful historical signal for determining relationships within clitellates, the exact position of Hirudinea and Branchiobdellida within oligochaetes remained unresolved. The lack of phylogenetic signal is interpreted as evidence for a rapid radiation of these taxa. The placement of Clitellata within the Polychaeta remained unresolved. The biological reality of polytomies within annelids is suggested and supports the hypothesis of an extremely ancient radiation of polychaetes and emergence of clitellates.     

On the ontogeny of the haptor and the evolution of the Monogenea

Data on the ontogeny of the posterior haptor of monogeneans were obtained from more than 150 publications and summarised. These data were plotted into diagrams showing evolutionary capacity levels based on the theory of a progressive evolution of marginal hooks, anchors and other attachment components of the posterior haptor in the Monogenea (Malmberg, 1986). 5 + 5 unhinged marginal hooks are assumed to be the most primitive monogenean haptoral condition. Thus the diagrams were founded on a 5 + 5 unhinged marginal hook evolutionary capacity level, and the evolutionary capacity levels of anchors and other haptoral attachement components were arranged according to haptoral ontogenetical sequences. In the final plotting diagram data on hosts, type of spermatozoa, oncomiracidial ciliation, sensilla pattern and protonephridial systems were also included. In this way a number of correlations were revealed. Thus, for example, the number of 5 + 5 marginal hooks correlates with the most primitive monogenean type of spermatozoon and with few sensillae, many ciliated cells and a simple protonephridial system in the oncomiracidium. On the basis of the reviewed data it is concluded that the ancient monogeneans with 5 + 5 unhinged marginal hooks were divided into two main lines, one retaining unhinged marginal hooks and the other evolving hinged marginal hooks. Both main lines have recent representatives at different marginal hook evolutionary capacity levels, i.e. monogeneans retaining a haptor with only marginal hooks. For the main line with hinged marginal hooks the name Articulon-choinea n. subclass is proposed. Members with 8 + 8 hinged marginal hooks only are here called Proanchorea n. superord. Monogeneans with unhinged marginal hooks only are here called Ananchorea n. superord. and three new families are erected for its recent members: Anonchohapteridae n. fam., Acolpentronidae n. fam. and Anacanthoridae n. fam. (with 7 + 7, 8 + 8 and 9 + 9 unhinged marginal hooks, respectively). Except for the families of Articulonchoinea (e.g. Acanthocotylidae, Gyrodactylidae, Tetraonchoididae) Bychowsky's (1957) division of the Monogenea into the Oligonchoinea and Polyonchoinea fits the proposed scheme, i.e. monogeneans with unhinged marginal hooks form one old group, the Oligonchoinea, which have 5 + 5 unhinged marginal hooks, and the other group form the Polyonchoinea, which (with the exception of the Hexabothriidae) has a greater number (7 + 7, 8 + 8 or 9 + 9) of unhinged marginal hooks. It is proposed that both these names, Oligonchoinea (sensu mihi) and Polyonchoinea (sensu mihi), will be retained on one side and Articulonchoinea placed on the other side, which reflects the early monogenean evolution. Except for the members of Ananchorea [Polyonchoinea], all members of the Oligonchoinea and Polyonchoinea have anchors, which imply that they are further evolved, i.e. have passed the 5 + 5 marginal hook evolutionary capacity level (Malmberg, 1986). There are two main types of anchors in the Monogenea: haptoral anchors, with anlages appearing in the haptor, and peduncular anchors, with anlages in the peduncle. There are two types of haptoral anchors: peripheral haptoral anchors, ontogenetically the oldest, and central haptoral anchors. Peduncular anchors, in turn, are ontogenetically younger than peripheral haptoral anchors. There may be two pairs of peduncular anchors: medial peduncular anchors, ontogentically the oldest, and lateral peduncular anchors. Only peduncular (not haptoral) anchors have anchor bars. Monogeneans with haptoral anchors are here called Mediohaptanchorea n. superord. and Laterohaptanchorea n. superord. or haptanchoreans. All oligonchoineans and the oldest polyonchoineans are haptanchoreans. Certain members of Calceostomatidae [Polyonchoinea] are the only monogeneans with both (peripheral) haptoral and peduncular anchors (one pair). These monogeneans are here called Mixanchorea n. superord. Polyonchoineans with peduncular anchors and unhinged marginal hooks are here called the Pedunculanchorea n. superord. The most primitive pedunculanchoreans have only one pair of peduncular anchors with an anchor bar, while the most advanced have both medial and lateral peduncular anchors; each pair having an anchor bar. Certain families of the Articulonchoinea, the Anchorea n. superord., also have peduncular anchors (parallel evolution): only one family, the Sundanonchidae n. fam., has both medial and lateral peduncular anchors, each anchor pair with an anchor bar. Evolutionary lines from different monogenean evolutionary capacity levels are discussed and a new system of classification for the Monogenea is proposed.In agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. EditorIn agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. Editor