甲状腺及乳腺多原发癌临床及超声特征

目的 　分析甲状腺及乳腺多原发癌的临床和超声特征。方法 　回顾性分析1990年1月至2013年3月在北京协和医院接受诊治且手术病理证实的甲状腺及乳腺多原发癌24例，比较这些患者的甲状腺癌及乳腺癌临床和超声特征。结果 　24例患者中9例（37.5%）以甲状腺癌首发，其中2例（22.2%）在1年内出现乳腺癌；15例（62.5%）以乳腺癌首发，其中6例（40.0%）在1年内出现甲状腺癌。甲状腺癌和乳腺癌超声表现均多为实性（86.4%和84.2%）、形态不规则（63.6%和94.7%）、纵横比大于1（50.0%和57.9%）、边界不清（63.6%和78.9%）、低回声或极低回声（90.9%和100%）、点状钙化（50.0%和47.4%）、局部丰富血流（50.0%和68.4%）。结论 　甲状腺及乳腺多原发癌的临床和超声特征与单发甲状腺癌及乳腺癌人群相近，超声可有效地筛查甲状腺及乳腺多原发癌，尤其在首发乳腺癌后1年内。     

Short communication: Repeat breeder cows with fluid in the uterine lumen had poorer fertility

The objective of the present study was to test the association between the presence of fluid in uterine lumen and the fertility of repeat breeder cows (RBC). Grazing Holstein cows that were clinically normal and were not pregnant after at least 3 consecutive inseminations were defined as RBC and included in the study (n = 358). A cut-point ≥2 mm of uterine lumen visible by ultrasonography was used as indicative of the presence of fluid in the uterus. The effect of this fluid on the fertility of RBC was assessed by mixed logistic regression. Twenty percent of the RBC had ≥2 mm of fluid in their uterus, and this finding was associated with a marked reduction in the odds of conception (odds ratio = 0.46). Additional intrauterine sampling revealed that 24.0% of RBC showed signs of subclinical endometritis [≥5% neutrophils in endometrial cytology (SCE)]. However, we found no agreement between the finding of uterine fluid and the diagnosis of SCE (kappa coefficient = 0.03, 95% confidence interval = ?0.07 to 0.14). In conclusion, the presence of fluid (≥2 mm) in uterine lumen, detected by ultrasonography, was associated with lower fertility in RBC, but was not related to the diagnosis of SCE. Thus, ultrasonographic evaluation is an important tool to assist in assessment of RBC.     

直肠腔内超声对直肠癌术前新辅助放化疗疗效评估

目的评估直肠腔内超声（ERUS）对直肠癌新辅助放化疗后分期的应用价值。方法 回顾性分析 2011年9月至2012年9月间我院收治的直肠癌患者62例。所有患者在放化疗前后均完成ERUS检查并分期，最终经直肠全系膜切除术（TME）切除肿瘤，并进行病理分期。将ERUS分期结果与手术病理分期相对照。结果 放化疗后，有8例患者肿瘤消失，达到病理完全缓解（pT0N0），ERUS均未准确诊断；30例肿瘤对放化疗反应较好的患者中，只有7例患者的uT分期准确诊断。ERUS的uT分期总准确性只有40%（25/62）, 过高分期36例（58%），过低分期1例（2%）。ERUS诊断转移淋巴结的敏感性、特异性、阳性预测值、阴性预测值分别为60%、84.6%、43%、92%。结论 ERUS对直肠癌放化疗后肿瘤浸润深度分期（T分期），尤其是对放化疗反应较好的肿瘤分期准确性偏低，且无法诊断肿瘤完全病理缓解。ERUS对淋巴结转移诊断的特异性和阴性预测值较高，可对直肠癌的预后作出很好的预判。     

Fetal metacarpal/metatarsal bone thickness as possible predictor of dystocia in Holstein cows

Dystocia and perinatal calf mortality cause significant economic losses in the dairy cattle industry. Despite advanced ultrasound examination procedures, there is no reliable method to estimate the birth weight of calves in order to predict, prepartum, the risk of dystocia. The aim of this study was to predict calf birth weight and dystocia based on transrectal ultrasonographic (TRUS) examinations in late-term Holstein heifers and cows. Therefore, TRUS examination was performed on 128 animals that were between 265 and 282 d of gestation to measure the bone thickness of the fetal metacarpus (MC) or metatarsus (MT). Fetal TRUS measurements were successful in 104 cases. Excluding twin deliveries, 97 fetal MC/MT bone thicknesses were measured and the mean (±SD) MC/MT thickness was 2.54 ± 0.37 cm. A novel index, the metacarpal/metatarsal index [MCTI = maternal body weight (kg)/fetal MC or MT thickness (cm)], was also calculated to study its association with calving ease. The average MCTI was 257.3 kg/cm in the studied population. A lower MCTI was associated with the risk of dystocia with an odds ratio of 2.074 that was not significantly different from 1 (95% confidence interval: 0.002–11.104). Fetal presentation, fetal age, fetal sex, body condition score of the dam, age of dam, and intercoxal and interischiadic distances were not related to dystocia. A fair phenotypic correlation (0.226) was found between MC/MT thickness and calf birth weight. The genetic correlation between MC/MT thickness and calf birth weight was 0.235. Our results indicate that late-term measurement of the fetal MC/MT bone thickness by means of TRUS examination augmented with the MCTI may have clinical significance in the prediction of dystocia in Holstein cattle. Because the odds ratio for dystocia based on MCTI determination was not significant, the applied technique should be improved based on further studies on prepartum TRUS examinations combined with dam pelvic measurements.     

大鼠C6脑胶质细胞移植瘤肿瘤模型动态生长核磁共振表现

目的: 建立大鼠C6脑胶质瘤模型。在不同时段以磁共振平扫、增强扫描、DWI和MRS多种技术对大鼠脑组织进行扫描成像分析, 动态观察接种后大鼠脑组织内胶质瘤的生长情况, 测量肿瘤体积变化, 细胞的凋亡情况以及肿瘤细胞密集区域, 无创性检测活体组织器官能量代谢、生化改变和特定化合物定量分析。建立大鼠C6脑胶质瘤模型MRI肿瘤动态生长数据库。方法: 建立大鼠C6脑胶质瘤模型。大鼠接种C6脑胶质瘤细胞的不同时段(接种前、接种后第7天、第14天、第21天)在活体无创状态下, 在不同时段分别运用MRI常规、增强扫描, DWI和MRS多种技术对大鼠脑组织进行扫描成像分析, 建立大鼠C6脑胶质瘤模型MRI肿瘤动态生长数据库, 最后将大鼠处死取脑组织进行肉眼、病理和电镜验证。结果: 肿瘤体积生长第14天与第7天均值比是5.010 0±0.450 0倍, 第21天与7天均值比是17.990 0±0.910 0倍, 解剖肉眼、病理、电镜均可见肿瘤及肿瘤细胞。正常脑组织DWI弥散成像ADC值测定, 平均值(B＝1 000)420.183 3±75.598 0)明显低于各时间肿瘤组, 接种肿瘤后7、14、21天ADC均值为738.598 0±219.568 0、660.645 0±105.322 0、551.366 7±103.578 0均高于正常脑组织, ADC均值T检验正常脑组织与7天及14天肿瘤组比, P值＜0.05, 有显著差异。 肿瘤生长的第14、21天ADC值不断的降低。大鼠C6脑胶质瘤移植瘤模型接种不同时间MRS测定cho/NAA均值, 正常脑在第1、7、14、21天在0.5左右, 而接种后的大鼠C6脑胶质瘤7、14、21天测定cho/NAA均值为5.532 0±4.066 4、6.560 0±3.440 0、8.938 0±4.079 4, 随着肿瘤的长大比值均值在不断加大。结论: 磁共振平扫、增强扫描、DWI和MRS多种技术对大鼠脑组织进行扫描成像分析, 能在无创情况下动态观察接种后大鼠脑组织内胶质瘤的生长情况, 测量肿瘤体积变化, 细胞的凋亡情况以及肿瘤细胞密集区域, 无创性检测活体组织器官能量代谢、生化改变和特定化合物定量分析。     

超声造影在兔VX2肝肿瘤模型的早期检测中的应用价值

目的:研究兔VX2早期肝癌常规超声与低机械指数超声造影的图像特点,对比探讨两者在早期肝癌诊断方面的应用价值。方法:25只新西兰大白兔开腹种植VX2肿瘤,造模后14天分别行常规彩色多普勒超声检查及经耳缘静脉注射声诺维实时超声造影检查,观察记录图像二维特征及血供情况,进行对比研究。结果:在24例25个病灶中,常规超声检出23个病灶,病灶大小(0.92±0.15)cm,5个病灶边界显示清晰,18个病灶与周边分界不清;彩色多普勒检出17个结节有不同程度的血流信号,超声造影检出25个病灶,病灶大小(1.13±0.24)cm,25个病灶与周边分界显示清楚,10个病灶内部出现坏死。结论:超声造影较常规超声能更敏感地检出早期肝癌病灶,显示病灶内部坏死区域,病灶周边的浸润范围以及病灶内部血供情况。     

Relationship between Serum Osteocalcin Levels and Non-Alcoholic Fatty Liver Disease in Adult Males,South China

AIM

To determine serum osteocalcin levels in South Chinese males with non-alcoholic fatty liver disease (NAFLD) and to examine the relation between serum osteocalcin and NAFLD.

METHODS

Data were collected from 1683 men attending the Fangchenggang Area Male Healthy and Examination Survey (FAMHES) from September 2009 to December 2009. Serum osteocalcin was measured with electrochemiluminescence immunoassay. An abdominal ultrasonographic examination for all individuals was performed by two experienced ultrasonographers. The associations of serum osteocalcin with NAFLD were evaluated.

RESULTS

The levels of serum osteocalcin were lower in 364 NAFLD participants than in 1319 non-NAFLD participants (24.51 ± 1.38 ng/mL vs. 20.81 ± 1.33 ng/mL, p < 0.001). Serum osteocalin level was associated with the scale of NAFLD (r = −0.150, p < 0.01). Serum osteocalin level tended to decrease with the scale of NAFLD. Binary logistic regression analysis showed that decreased ORs for NAFLD were observed from the first to the fourth osteocalcin quartiles.

CONCLUSIONS

Our findings suggest that a lower serum osteocalcin level is associated with the presence of NAFLD.     

宫腔镜对阴道超声发现子宫内膜异常的诊治价值

目的：研究阴道超声发现子宫内膜异常患者的宫腔镜诊治价值。方法：对827例经阴道超声检查发现子宫内膜异常的患者行官腔镜检查,并行诊断性刮宫或宫腔内病变电切,组织物送病检。结果：以病检结果为诊断标准,宫腔镜检查对子宫内膜息肉、子宫粘膜下肌瘤、正常子宫内膜、宫颈管息肉及子宫内膜癌的诊断符合率均明显高于阴道超声检查（P〈0．01）;宫腔镜检查对子宫内膜病变诊断的敏感性和特异性分别是95．23％和86,82％,而阴道超声检查对子宫内膜病变诊断的敏感性和特异性分别是83．99％和41．23％。结论：对阴道超声检查发现子宫内膜异常的患者应常规行宫腔镜检查并取组织活检,才能提高诊断符合率,减少误诊和漏诊。     

Gadolinium-enhanced magnetic resonance angiography of the pelvis in patients with erectile impotence

This study evaluted the potential of contrast-enhanced digital-subtraction magnetic resonance angiography (CE-DS-MRA) for noninvasive angiographic delineation of the arterial supply of the penis in patients with erectile dysfunction. After induction of an erection with prostaglandin E, a three-dimensional fast imaging with steady-state precision (FISP) sequence with TE of 1.8–2 milliseconds, TR of 4.4–5 milliseconds, and flip angle of 40°–60° was used to obtain high-resolution angiograms of the pelvis and penis during the injection of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) 0.3 mmol/kg body weight, within 30–50 seconds. DS maximum intensity projections (MIPs) and multiplanar reconstructions (MPRs) were compared with clinical work-up and directional Doppler ultrasound in 11 patients. In all 11 patients (100%), the arterial supply of the penis could be delineated from the aortic bifurcation via the iliac and internal pudendal arteries to the dorsal and deep penile arteries. Of the 22 internal pudendal arteries, 6 (27%) were occluded on CE-DS-MRA and 5 (23%) had stenoses, of which 4 (18%) were greater than 50%. In 7 patients (64%) good correlation between CE-DS-MRA and clinical findings and/or Doppler ultrasound was found; in 2 patients (18%), the correlation was moderate, and in 2 patients (18%) results were discrepant. In 6 patients (55%), MRA provided additional information to the clinical and Doppler ultrasound work-up. CE-DS-MRA can delineate small sessels such as the internal pudendal and penile arteries and thus has the potential to become a noninvasive angiography method in the work-up of erectile impotence. Supported by Siemens Medical Systems, Erlangen; Schering AG, Berlin; and Agfa-Gevaert AG, Leverkusen.