Research Status and Prospect of Living Wills / 中国医学伦理学

This paper analyzed the research status of living wills at home and abroad from three aspects: the status of living wills knowledge-attitude-practice, the influencing factors of the living wills development, and the effects of living wills. It also provided some suggestions for promoting the development of living wills in China. In foreign countries, a large number of quantitative and qualitative studies have been carried out in this regard, and the research contents were relatively in-depth. However, China initiated late in this field, and the research contents and methods were relatively simple. Living wills not only protect patients’ decision-making right, but also promote the rational distribution of medical resources, as well as ensure the fairness of health services. For China, with a large population and uneven distribution of health resources, living wills have broad implementation prospects.

Clinical effect of minimally invasive duodenum preserving pancreatic head resection for benign and pre-malignant lesions of pancreatic head / 中华外科杂志

Objective: To examine the clinical effect of minimally invasive duodenum preserving pancreatic head resection(DPPHR) for benign and pre-malignant lesions of pancreatic head. Methods: The clinical data of patients with diagnosis of benign or pre-malignant pancreatic head tumor were retrospectively collected and analyzed,all of them underwent laparoscopic or robotic DPPHR between October 2015 and September 2021 at Division of Gastrointestinal and Pancreatic surgery,Zhejiang Provincial People's Hospital. Thirty-three patients were enrolled with 10 males and 23 females. The age(M(IQR)) was 54(32) years old(range: 11 to 77 years old) and the body mass index was 21.9(2.9)kg/m2(range: 18.1 to 30.1 kg/m2). The presenting symptoms included abdominal pain(n=12), Whipple triad(n=2), and asymptomatic(n=19). There were 7 patients with hypertension and 1 patient with diabetes mellitus. There were 19 patients who were diagnosed as American Society of Anesthesiologists class Ⅰ and 14 patients who were diagnosed as class Ⅱ. The student t test,U test, χ2 test or Fisher exact test was used to compare continuous data or categorized data,respectively. All the perioperative data and metabolic morbidity were analyzed and experiences on minimally invasive DPPHR were concluded. Results: Fourteen patients underwent laparoscopic DPPHR,while the rest of 19 patients received robotic DPPHR. Indocyanine green fluorescence imaging was used in 19 patients to guide operation. Five patients were performed pancreatico-gastrostomy and the rest 28 patients underwent pancreaticojejunostomy. Pathological outcomes confirmed 9 solid pseudo-papillary neoplasms, 9 intraductal papillary mucinous neoplasms, 7 serous cystic neoplasms, 6 pancreatic neuroendocrine tumors, 1 mucous cystic neoplasm, 1 chronic pancreatitis. The operative time was (309.4±50.3) minutes(range:180 to 420 minutes),and the blood loss was (97.9±48.3)ml(range:20 to 200 ml). Eighteen patients suffered from postoperative complications,including 3 patients experienced severe complications(Clavien-Dindo Grade ≥Ⅲ). Pancreatic fistula occurred in 16 patients,including 8 patients with biochemical leak,7 patients with grade B pancreatic fistula and 1 patient with grade C pancreatic fistula. No one suffered from the duodenal necrosis and none perioperative death was occurred. The length of hospital stay was 14(7) days (range:6 to 87 days). The follow-up was 22.6(24.5)months(range:2 to 74 months). None suffered from recurrence or metastasis. During the follow-up,all the patients were free of refractory cholangitis. Moreover,in the term of endocrine dysfunction,no postoperative new onset of diabetes mellitus were observed in the long-term follow-up. However,in the view of exocrine insufficiency,pancreatic exocrine insufficiency and non-alcoholic fatty liver disease (NAFLD) was complicated in 2 and 1 patient,respectively,with the supplement of pancreatic enzyme,steatorrhea and weight loss relieved,but NAFLD was awaited to be seen. Conclusions: Minimally invasive DPPHR is feasible and safe for benign or pre-malignant lesions of pancreatic head. Moreover,it is oncological equivalent to pancreaticoduodenectomy with preservation of metabolic function without refractory cholangitis.

Multi?arterial phase MRI of hepatic vessels using gadoxetic acid: intraindividual comparison of CTA / 中华放射学杂志

Objective To investigate the value of multi?arterial phase differential sub?sampling with cartesian ordering (DISCO) technique in the evaluation of hepatic vascular anatomy with gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA). Methods Forty?eight patients with suspected hepatic malignancy were prospectively enrolled and underwent both of Gd?EOB?DTPA enhanced DISCO MRI and CTA within two weeks. The hepatic arterial anatomy of two examination methods were evaluated by four?point scoring method. The arterial scores between DISCO and CTA images were compared by Wilcoxon test. The difference among multiple arterial scores of DISCO and CTA were compared by Kruskal?Wallis H test respectively. Results There was no difference of arterial scores in celiac artery, common hepatic artery, proper hepatic artery, left hepatic artery, right hepatic artery, first branch of right hepatic artery, splenic artery, left gastric artery and gastroduodenal artery between DISCO and CTA (P>0.05), but the arterial score of first branch of left hepatic artery [2 (2,2)] was lower than that of CTA [2 (2,3)] (Z=-3.138,P=0.002). In the multiple comparison among different arteries, there were differences between PHA and LAH (P<0.05), B?LHA and B?RHA (P<0.05) in DISCO, but no difference was found in CTA (P>0.05). Conclusion The DISCO sequence with Gd?EOB?DTPA enhancement MRI can supply comparable image quality to CTA in hepatic artery and its main branches display, which has no ionizing radiation and can also provide more diagnostic information for clinic.

Relationship between the residual in Tianhui medical slips and in / 中国针灸

Except the complete literature of , Tianhui medical slips unearthed in Chengdu also include a part of literature document on meridian, which was seriously damaged. Both of them were found in the same box together with . The title of the document chapter was not found in the residual medical slips. By investigated the textual content, it was discovered that such medical slips were different from the Mawangdui silk books, i.e. and , of Zhangjiashan bamboo slips of Han Dynasty, as well as in Tianhui medical slips. But, the sentences in description are similar to the sentences of in (), therefore, this residual slips was named as () by the collator. In the paper, by the comparison of this residual slip chapter with the unearthed literature document on meridian as well as in , the origin and evolution of meridian theory of traditional Chinese medicine in the Qin and Han dynasties were explained. By taking it as an example, the construction process of classical theory of traditional Chinese medicine was explored.

Multi-arterial phase MRI of hepatic vessels using gadoxetic acid: intraindividual comparison of CTA / 中华放射学杂志

Objective@#To investigate the value of multi-arterial phase differential sub-sampling with cartesian ordering (DISCO) technique in the evaluation of hepatic vascular anatomy with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA).@*Methods@#Forty-eight patients with suspected hepatic malignancy were prospectively enrolled and underwent both of Gd-EOB-DTPA enhanced DISCO MRI and CTA within two weeks. The hepatic arterial anatomy of two examination methods were evaluated by four-point scoring method. The arterial scores between DISCO and CTA images were compared by Wilcoxon test. The difference among multiple arterial scores of DISCO and CTA were compared by Kruskal-Wallis H test respectively.@*Results@#There was no difference of arterial scores in celiac artery, common hepatic artery, proper hepatic artery, left hepatic artery, right hepatic artery, first branch of right hepatic artery, splenic artery, left gastric artery and gastroduodenal artery between DISCO and CTA (P>0.05), but the arterial score of first branch of left hepatic artery [2 (2,2)] was lower than that of CTA [2 (2,3)] (Z=-3.138,P=0.002). In the multiple comparison among different arteries, there were differences between PHA and LAH (P<0.05), B-LHA and B-RHA (P<0.05) in DISCO, but no difference was found in CTA (P>0.05).@*Conclusion@#The DISCO sequence with Gd-EOB-DTPA enhancement MRI can supply comparable image quality to CTA in hepatic artery and its main branches display, which has no ionizing radiation and can also provide more diagnostic information for clinic.

Biocompatibility of porcine small intestinal submucosa and adipose derived mesenchymal stem cells / 中国组织工程研究

BACKGROUND: Small intestinal submucosa (SIS) has good compatibility with cells and tissues, and has good degradabUity. It is an ideal scaffold for tissue engineering. Inducing adipose derived mesenchymal stem cells (ADSCs) seeded on SIS can construct target tissues, which has the potential to be used in clinical treatment.OBJECTIVE: To prepare decellularized porcina SIS matrix, and testify its biocompatibility with rabbit ADSCs cultured in vitro. METHODS: SIS was processed by enzyme digestion-hypertonic saline decellularization, lyophilized at low temperature, and sterilized by gamma radiation. Paraffin sections were used to observe the effect of decellularization of SIS, and the surface structures of SIS were observed by scanning electron microscope (SEM). Rabbit ADSCs were isolated and cultured, and passage 3 ADSCs were seeded onto one side or both sides of SIS. After one weak of co-culture, the cell-scaffold composites were observed.RESULTS AND CONCLUSION: SIS was white and semi-transparent film. Paraffin sections showed no cells on SIS matrix; electron microscopy showed loose weave structure of serosal surface and dense packing structure of mucosal surface. After one week of co-cultivation, plenty of ADSCs were observed on the surface of SIS. In ADSCs seeded onto one side of SIS group, a large number of cells grew on the superior surface, and few even no cells were observed on inferior surface of SIS. When ADSCs were seeded onto both sides of SIS, cells adhered to SIS in paraffin sections. Results show that enzyme digestion-hypartonic saline decellulariation can decellularize SIS completely, and SIS can support ADSCs growth.

Assessment of disease activity and liver fibrosis in chronic viral hepatitis by magnetic resonance diffusion-weighted imaging / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the diagnostic value of magnetic resonance diffusion-weighted imaging (DWI) technique in assessing the disease activity and liver fibrosis of chronic viral hepatitis.</p><p><b>METHODS</b>A total of 49 patients with chronic viral hepatitis who received liver biopsy and 10 healthy volunteers were included in this study. All of them underwent DWI on a 3.0 T magnetic resonance imaging system. When the gradient factor b value was set at 100, 200, 400, 600, and 800 s/mm2, the apparent diffusion coefficient (ADC) of the liver was measured respectively. Biopsy specimens were scored for necroinflammation and liver fibrosis according to the Knodell histological activity index.</p><p><b>RESULTS</b>The ADC values of the right lobe in both controls and patients were lower than those of the left lobe. When the b value was set at 400, 600, and 800 s/mm2, the differences of the ADC values between the fibrosis group (n = 36) and the non-fibrosis group (n = 23, including 10 cases of normal subjects) were statistically significant (P < 0.01). When the b value was set at 800 s/mm2, the ADC values among the different degrees of necroinflammation and grades of liver fibrosis were also significantly different (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>DWI is a valuable method for in vivo and noninvasive assessment of the disease activity and liver fibrosis of chronic viral hepatitis.</p>

Value of Multi-Detector Row Spiral CT and 3-Dimensional Reconstruction Technique for Intussusception / 中国普外基础与临床杂志

0.05).For following indexes: whether or not having intussusception,the location of intussusception,finding reason caused intussusception,the confidence index of the doctor between original image add MPR image group and original image group had significant difference(5.00 vs.4.24,4.76 vs.4.29,4.29 vs.3.71),and the confidence index of the doctor of original image add MPR image group exceeded that of original image group(P

Value of MR Diffusion-Weighted Imaging for Differentiating Pancreatic Carcinoma from Chronic Focal Pancreatitis on 3.0 T MR System / 中国普外基础与临床杂志

Objective To investigate the value of MR diffusion-weighted imaging (DWI) in differentiating pancreatic carcinoma from chronic focal pancreatitis on 3.0 T MR system. Methods Thirteen patients with proved pancreatic carcinoma, 7 patients with confirmed chronic focal pancreatitis, and 14 healthy volunteers, were included in this study. MR examination including the routine abdomen scanning protocol and DWI was performed for both patients and volunteers. The SE-EPI sequence and ASSET technique were used for DWI. The b values of 400, 600, 800 and 1 000 s/mm2 were selected to acquire the DWI. The corresponding apparent diffusion coefficient (ADC) values were measured in each designated region of interest and statistically analyzed. Results ①DWI of the healthy volunteers showed intermediate signals of pancreas. ②DWI of pancreatic tumor masses showed homogenous high signal intensity relative to the surrounding pancreatic tissue with clear boundary. Under different b values, the tumor ADC values were (1.63?0.235)?10-3 mm2/s, (1.42?0.126)?10-3 mm2/s, (1.36?0.170)?10-3 mm2/s and (1.26?0.178)?10-3 mm2/s respectively, which were significantly lower than those of non-tumor region (2.11?0.444)?10-3 mm2/s, (1.83?0.230)?10-3 mm2/s, (1.81?0.426)?10-3 mm2/s, (1.60?0.230)?10-3 mm2/s and of the normal pancreas (1.85?0.350)?10-3 mm2/s, (1.69?0.290)?10-3 mm2/s, (1.67?0.268)?10-3 mm2/s, (1.42?0.221)?10-3 mm2/s, P

Diagnostic Value of CT and MRI on Acute Cholecystitis / 中国普外基础与临床杂志

Objective To investigate the diagnostic value of CT scanning and MR imaging on acute cholecystitis.Methods The CT or MR imaging data of 21 patients with proved acute cholecystitis were retrospectively reviewed.Eleven patients were examined with contrast-enhanced multi-detector-row spiral CT scanning and other 10 cases underwent contrast-enhanced MR imaging.Results Nineteen patients showed obscure gallbladder outlines(90.5%).The gallbladder wall demonstrated even thickening in 15 patients(71.4%) and irregular thickening in 6 cases(28.6%).All patients showed inhomogeneous enhancement of the gallbladder wall(100%).The bile was hyper-dense or hyper-intense on T1W image in 11 cases(52.4%).Ten cases had free peri-cholecystic effusion(47.6%),and 16 cases had peri-cholecystic adhesive changes or fat swelling(76.2%).Patchy or linear-like transient enhancement of the adjacent hepatic bed in the arterial phase was seen in 16 cases(76.2%).Twelve patients developed pleural effusion,or ascites,or both(57.1%).Gallbladder perforation complicated with peritonitis was seen in one case,micro-abscess formation and pneumocholecystitis was observed in another case,and one case had gallbladder diverticulum.Conclusion Wall blurring,pericholecystic adhesion or fat edema,and transient enhancement of adjacent hepatic bed in the arterial phase are the imaging findings specifically associated with acute cholecystitis,which are readily appreciated on contrast-enhanced multi-phasic CT and MR scanning.

The relationship between 31P magnetic resonance spectroscopy and the histopathology of livers of chronic viral hepatitis patients / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the correlations between 31P-magnetic resonance spectroscopy (MRS) findings and histopathological grading and staging of the livers of chronic viral hepatitis patients.</p><p><b>METHODS</b>Thirty-one patients with chronic viral hepatitis and 18 healthy volunteers were enrolled for this study. All of them underwent routine MRI plain scan and 31P-MRS of their livers. Peak areas of PME, PDE, PCr, Pi, gamma-ATP, beta-ATP and alpha-ATP were calculated. The concentrations of the phosphorus compounds of their livers, including PME, PDE, PCr, Pi, gamma-ATP, beta-ATP and alpha-ATP were measured. Percutaneous liver biopsies were performed on all 31 patients 0 to 7 days after their 31P-MRS examinations. Biopsy specimens were scored for fibrosis and necroinflammation according to the Knodell histological activity index. According to their necroinflammation scores, the 31 patients were divided into groups: slight hepatitis (7 patients), mild hepatitis (11), moderate hepatitis (8) and severe hepatitis (5). According to their fibrosis scores, the patients were divided into groups: no fibrosis (7 patients), portal fibrosis (11), bridging fibrosis (5) and cirrhosis (8).</p><p><b>RESULTS</b>The PME%, PDE% and PME/PDE of the hepatitis patients and of the control volunteers had significant statistical differences. The differences of PME%, PDE% and PME/PDE among different grades and stages also had statistical significance. When PME/PDE=0.78, 0.95 and 1.11 were set as the cut-off points for different grades of necroinflammation, and PME/PDE=0.79, 0.95 and 1.10 were set as the cut-off points for different stages of fibrosis, a sensitivity of 80.0%-87.5% and a specificity of 42.9%-72.7% were achieved.</p><p><b>CONCLUSION</b>PME/PDE is a sensitive marker for diagnosing the severity of chronic viral hepatitis. A rise of PME/PDE in hepatitis patients represents an increase of synthesis and a decrease in the breakdown of hepatocytes.</p>

Curved planar reformations in multi-slice spiral CT in pancreatic adenocarcinoma: prediction of invasion of pancreatic and peripancreatic ductal structures / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical values of the curved planar reformation (CPR) in multi-slice spiral CT (MSCT) in determining the malignant invasion of pancreatic carcinoma into the intrapancreatic and peripancreatic ductal structures.</p><p><b>METHODS</b>Thirty-seven patients having documented pancreatic carcinoma with tumor involvement of intrapancreatic or peripancreatic ductal structures were enrolled. All patients received dual-phase MSCT scan of upper abdomen. Images generated by CPR technique were used for evaluating the appearances of intrapancreatic and peripancreatic ductal structures.</p><p><b>RESULTS</b>Malignant invasion of peripancreatic arteries was found in 28 patients and characterized by: obliteration of fat plane between tumor and the artery, with contact surface of more than 180 degrees; stenosis or deformation of the artery; and infarction of the spleen. Invasion of peripancreatic veins was found in 31 patients and characterized by: tumor encasement of the vein, resulting in the narrowing or deformation of the vein; lack of enhancement of the involved venous segment; tumor thrombosis in the venous lumen; and formation of collateral circulation. Invasion of intrapancreatic segment of the common bile duct or pancreatic duct was found in 18 patients and characterized by: sudden interruption of the bile duct or pancreatic duct; narrowing of the bile duct or pancreatic duct; and dilation of the up-stream ducts proximal to the involvement portion. CPR images clearly depicted the direct relationship between tumor mass and the involved ductal structures.</p><p><b>CONCLUSION</b>Invasion of intrapancreatic or peripancreatic ductal structures by pancreatic carcinoma has certain MSCT imaging features. CPR technique is valuable in depicting these imaging findings.</p>

Effect of compound salvia injection on nitrate ester tolerance / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effect and mechanism of Compound Salvia injection (CSI) on nitrate ester tolerance.</p><p><b>METHODS</b>Eighty-four patients with coronary heart disease (CHD) were randomly divided into three groups, Group A treated with isosorbide dinitrate (ISD, 15 mg, 4 times per day) alone, Group B with ISD plus CSI and Group C with ISD plus vitamin C. The therapeutic course for all groups was 10 days. The tolerance to nitrate ester and blood pressure were monitored. Before and after treatment, the color Doppler ultrasonic apparatus was used to detect the baseline value of humeral arterial internal diameters (D0), the humeral arterial dilatory response under compression [D1, that is, the flow-mediated vasodilation (FMD)] and the vasodilatory response after sucking of nitroglycerin (D2). And the blood levels of endothelin-1 (ET-1), endothelial nitric oxide synthase (eNOS) mRNA expression were determined. The endothelial-dependent vasodilation (EDD) was expressed by (D1 - D0)/D0 x 100%, and the endothelial-independent vasodilation (EID) was expressed by (D2 - D0)/D0 x 100%.</p><p><b>RESULTS</b>(1) The occurrence rate of nitrate tolerance in Group B and C (28.57% and 35.7%) was lower than that in Group A (64.29%), but insignificant difference was found between the former two. (2) After treatment, blood pressure increased in Group A to the level of pre-treatment, that in Group C also increased but still lower than that of pre-treatment, while insignificant increase was observed in Group B, comparison between Group B and C showed significant difference (P < 0.05). (3) After treatment, EID lowered in Group A, EDD increased in Group B and C (P < 0.05), EDD and EID in Group B and C were higher than those in Group A (P < 0.05), and EDD was higher in Group B than in Group C (P < 0.05). (4) After treatment, ET-1 mRNA expression lowered in Group B, eNOS mRNA expression increased in Group B and C, with significant difference as compared with those before treatment and those in Group A (P < 0.05), and eNOS mRNA expression in Group C was lower than that in Group B (P < 0.05).</p><p><b>CONCLUSION</b>CSI could partially prevent the occurrence of tolerance to nitrate ester, with the effect better than vitamin C, the mechanism might be related with its regulation on eNOS, ET-1 mRNA expression and protection on vascular endothelial function.</p>

Value of Mult-Slice Spiral CT for Nontumorous Bowel Wall Thickening / 中国普外基础与临床杂志

Objective To investigate the mult-slice spiral CT(MSCT)imaging manifestations of bowel wall thickening due to nontumorous causes,and to address the value of MSCT scanning in assessing nontumorous bowel wall thickening.MethodsThe MSCT findings of 284 patients with bowel wall thickening due to nontumorous causes confirmed by surgery,biopsy,or clinical follow-up were retrospectively analyzed.The location,range,symmetric or asymmetric,degree,attenuation,presence or absence of enhancement and associated perienteric abnormalities of thickened bowel wall were involved.ResultsAll nontumorous disease caused bowel wall thickening include liver cirrhosis(109 cases),acute pancreatitis(54 cases),bowel obstruction(36 cases),inflammatory bowel disease(14 cases),ischemic bowel disease(12 cases),radiation enterocolitis(13 cases),tuberculosis(12 cases),immune reaction(10 cases),infective enteritis(3 cases),acute appendicitis(3 cases),hypoproteinemia(5 cases),non-common disease(8 cases)and normal variants(5 cases).The attenuation pattern of the thickened bowel wall include high attenuation(1 case),iso-attenuation(144 cases),low attenuation(127 cases),fat deposition(5 cases)and pneumatosis(7 cases).The enhancement pattern of the thickened bowel wall included gentle enhancement(249 cases),notable enhancement(32 cases)and unenhancement(3 cases).Degree of bowel wall thickening included mild thinckening(279 cases)and marked thickening(5 cases).The range of bowel wall thickening was focal(8 cases),segmental(64 cases)and diffuse(212 cases).The associated perienteric abnormalities of thickened bowel wall included swelling of fat(218 cases),ascites(189 cases),lymphadenopathy(5 cases),peirenteirc abscess(2 cases),mesenteric vascular lesion(25 cases)and involvement of solid abdominal organs(169 cases).ConclusionMSCT has an invaluable role in the diagnostic evaluation of nontumorous bowel wall thickening.A wide variety of nontumorous diseases may manifest with bowel wall thickening at MSCT.Paying attention to the characteristics of thickening of bowel wall will benefit the diagnosis and differential diagnosis of various intestinal diseases.

Differentiation of Chronic Mass-Forming Type Pancreatitis from Pancreatic Carcinoma by Functional Magnetic Resonance Imaging / 中国普外基础与临床杂志

Objective To summarize the principle and application of functional MR imaging of pancreatic carcinoma and chronic mass-forming type pancreatitis.Methods Articles about diffusion-weighted imaging(DWI),magnetic resonance spectrum imaging(MRSI) and dynamic contrast-enhanced MR imaging of pancreatic carcinoma and chronic pancreatitis were reviewed and analyzed.Results Functional MR imaging could reflected the differences in molecules diffusion,metabolism and tissue perfusion between pancreatic carcinoma and chronic pancreatitis.Conclusion As a non-invasive protocol,functional MR imaging can provide useful information in differential diagnosis between chronic mass-forming type pancreatitis and pancreatic carcinoma.

Imaging of Cisterna Chyli and Thoracic Duct by Nonenhanced MR Lymphography / 中国普外基础与临床杂志

Objective To investigate the depiction rate of normal cisterna chyli and thoracic duct by nonenhanced MR lymphography and to describe their appearances on MR imaging.Methods Special MR hydrography sequence was added to the MR imaging protocols of 112 patients undergoing MR examination of the thorax and upper abdomen.MR imaging sequences included:①Respiratory-gated HASTE T2W sequence;②Breath-hold FLASH T1W sequence;③Respiratory-gated TSE 3D T2W sequence(3D MR hydrography sequence)in coronal plane.One hundred cases who met the inclusion criteria were included into the study for observation of the depiction rate,location and morphology of cisterna chyli and thoracic duct.Results On TSE 3D T2W imaging:①Cisterna chyli was visualized in 71/100(depiction rate 71.0%),morphologically including single-tube type 43.7%(31/71),bifurcation type(2-3 tubes)23.9%(17/71),plexus type 32.4%(23/71).Average length of the cisterna chyli was 4.5 cm.②The depiction rate of the lower segment of thoracic duct was 57.0%(57/100),average ductal diameter was 0.23 cm.③The depiction rate of upper segment of the thoracic duct was 31.0%(31/100).Conclusion As a noninvasive method for depicting the lymphatic system,nonenhaced MR lymphography(TSE 3D T2W sequence)demonstrated a high depiction rate for cisterna chyli and lower thoracic duct.Combined with axial images of HASTE and FLASH sequences,the location and morphology of these larger lymphatic ducts can be defined.

Relationship of Magnetic Resonance Diffusion-Weighted Imaging to Histology in Chronic Viral Hepatitis / 中国普外基础与临床杂志

Objective To investigate the relationship of magnetic resonance diffusion-weighted imaging (DWI) to histology in the patients of chronic viral hepatitis. Methods Thirty-five patients of chronic viral hepatitis who received liver biopsy and 10 healthy volunteers were included in this study. All of them underwent DWI on a 3.0T MRI device. Apparent diffusion coefficient (ADC) of the liver were measured respectively when b value were set as 100, 400, 600 and 800 s/mm~2. Biopsy specimens were scored for fibrosis and necroinflammation according to the Knodell histology activity index (HAI). Results When b value was set as 800 s/mm~2, statistical difference was showed between the fibrosis group and the non-fibrosis group, statistical difference was also shown among the different degrees of necroinflammation and fibrosis. Conclusion DWI is a valuable method for grading and staging of chronic viral hepatitis.

Clinical Applications of Hepatic ~(31)P-MR Spectrocscopy / 中国普外基础与临床杂志

Objective To summarize the principle and clinical applications of ~(31)phosphorus MR spectroscopy(~(31)p-MRS).Methods Literatures about ~(31)P-MRS in liver were reviewed and analyzed.Results Abnormalities of ~(31)P-MRS were found in patients of hepatitis,liver cirrhosis,liver tumor,obstructive jaundice and patients after liver transplantation.Evaluation of ~(31)P-MRS is important in diagnosis and treatment of many hepatic diseases.(Conclusion As a) non-invasive protocol for analyzing the energetic metabolism and biomedical changes in cellular level of living liver,~(31)P-MRS has a wide clinical application.

Multi-Detector-Row Helical CT Features of Hepatic Metastases from Adenocarcinoma of Digestive Tract / 中国普外基础与临床杂志

Objective To investigate the CT imaging features of metastatic hepatic adenocarcinomas from the digestive tract by using multi-detector-row helical CT (MDCT) with pathological correlation. Methods CT and clinical data of 36 patients with pathologically proven metastatic hepatic adenocarcinomas from the digestive tract were retrospectively reviewed. The primary tumors included 10 cases of gastric cancer, 1 duodenal cancer, 18 colo- nic carcinoma, 7 rectal cancer. All patients underwent MDCT plain scan and contrast-enhanced dual-phase scanning of upper or whole abdomen. The appearances of hepatic metastatic lesions on MDCT images at various enhancement phases were carefully observed. Results On plain CT scan 32 cases (88.9%) presented multiple nodules of low density at different sizes, 3 cases (8.3%) showed a single low-density nodule, and 1 case presented with a cystic mass. On contrast-enhanced scan, 4 cases (11.1%) showed faintly enhanced rim around the nodules on arterial phase; on portal venous phase 29 cases (80.6%) presented slight ring-like enhancement at the periphery of the nodule while the nodule core was markedly hypodense with intermediate soft tissue density area in between, giving rise to the typical appearance of “bull’s-eye” sign. Three cases (8.3%) showed no enhancement on either phase images. Conclusion The ring-like enhancement and the appearance of “bull’s-eye” on portal venous phase was characteristic CT features of metastatic hepatic adenocarcinoma from digestive tract.

Spiral CT Manifestations of Blunt Liver Trauma / 中国普外基础与临床杂志

Objective To investigate the spectrum of spiral CT imaging findings of blunt liver trauma.Methods Clinical data of 17 patients with blunt liver trauma were retrospectively collected. All patients underwent standardized spiral CT examination of the upper abdomen, which include plain scan, arterial phase and portal venous phase acquisition. The morphology, density and integrity of liver parenchyma and intrahepatic venous structures were carefully observed, as well as regions of porta hepatis, peritoneal cavity and retroperitoneal space.Results Twelve cases (70.6%) developed hepatic parenchymal laceration. There were 9 cases (52.9%) of traumatic hematoma, among which 5 were intraparenchymal and 4 were subcapsular. One case (5.9%) showed active bleeding within an intrahepatic hematoma, while two cases (11.8%) had injury (laceration) of hepatic veins. There were 7 patients (41.2%) who demonstrated the so-called “halo sign” around the intrahepatic portal branches. Thirteen patients were associated with peritoneal fluid (blood) collection, 3 with hematoma or hemorrhage of the right adrenal gland, 8 with plural effusion and 3 cases with rib fractures of right lower chest. Conclusion CT imaging findings of blunt liver trauma include parenchymal laceration, intraparenchymal and /or subcapsular hematomas, active hemorrhage, and tear of hepatic veins. Plain CT scan and contrast-enhanced dual-phase acquisition is very important for the comprehensive evaluation of patients with blunt liver trauma.