ABSTRACT
Objective:To investigate the application effect of the blended teaching model of "intelligent teaching" and "wisdom learning" in the practice teaching of integrated traditional Chinese and Western medicine in internal medicine.Methods:According to the principle of randomization, 54 interns in Class 1 of integrated traditional Chinese and Western medicine in the grade of 2019 were selected as control group and received traditional teaching, and 56 interns in Class 2 were selected as observation group and received blended teaching with "intelligent teaching" and "wisdom learning". After 6 months of internship, the two groups were compared in terms of the scores of theoretical assessment (basic theoretical knowledge and professional theoretical knowledge), clinical practice ability [Leicester Assessment Package (LAP)], and degree of satisfaction with teaching. SPSS 17.0 was used to perform the t-test and the chi-square test. Results:At the end of internship, compared with the control group, the observation group had significantly higher score of basic theoretical knowledge (41.53±3.42 vs. 38.71±3.38, P<0.05), score of professional theoretical knowledge (39.49±3.14 vs. 37.85±3.07, P<0.05), LAP score (84.32±6.65 vs. 78.46±6.17, P<0.05), and degree of satisfaction with teaching ( P<0.05). Conclusion:For interns majoring in integrated traditional Chinese and Western medicine, the blended teaching model of "intelligent teaching" and "wisdom learning" can strengthen their mastery of theoretical knowledge, enhance their clinical practice ability, and improve their degree of satisfaction with teaching.
ABSTRACT
Objective:To investigate the characteristics and risk factors of infection in newly diagnosed patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods:The clinical data of AAV patients (followed up for at least 6 months) in Affiliated Hospital of Qingdao University from September 2012 to September 2020 were retrospectively collected. According to whether infection occurred during follow-up, the patients were divided into infection group and non-infection group. The clinical characteristics and infection status of the two groups were analyzed, and the Cox regression analysis model was used to explore the influencing factors of infection.Results:A total of 236 AAV patients were enrolled in this study, including 128 females (54.2%) and 108 males (45.8%), with a median age of 66.00 (59.76, 71.99) years. There were 202 patients (85.6%) with positive myeloperoxidase (MPO)-ANCA and 34 patients (14.4%) with positive protease 3 (PR3) -ANCA. There were 77 cases in the infection group and 159 cases in the non-infection group. A total of 121 infections occurred in 77 patients, and 54 infections (44.6%) occurred within 6 months after initial diagnosis. In the infection group the proportion of patients with hypertension history, pulmonary underlying diseases and patients who received hormone pulse therapy or plasma exchange, the incidence of lung, kidney, heart and gastrointestinal involvement, the level of serum creatinine and five factors score (FFS) at initial diagnosis were significantly higher than those in the non-infection group (all P<0.05), while the estimated glomerular filtration rate (eGFR) was significantly lower ( P<0.05). Lung (73.6%) was the main infection organ of AAV patients. The most common pathogenic microorganisms were bacteria (64.0%), mainly Pseudomonas aeruginosa and Staphylococcus aureus, followed by fungi (33.7%, mainly Candida albicans). Multivariate Cox regression analysis showed that lung involvement ( HR=1.682, 95% CI 1.034-2.734, P=0.036) and gastrointestinal involvement ( HR=2.976, 95% CI 1.219-7.267, P=0.017) were the independent influencing factors for infection in AAV patients. Conclusions:AAV patients have a higher incidence of infection within 6 months after initial diagnosis. The most common organ of infection in AAV patients is the lung, and the common pathogens are Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans. Lung involvement and gastrointestinal involvement are the independent risk factors for infection in AAV patients.
ABSTRACT
Objective:To explore the effect of the application of hierarchical and special quality control in the quality control management of an ultrasound department.Methods:The hierarchical and special quality control method was used to control ultrasonic reports that were related to four quality control areas: basic quality control, deep quality control, obstetrical quality control, and critical value quality control. Changes in the qualified reporting and comprehensive clinical satisfaction rates before and after the implementation of hierarchical and special quality control were examined.Results:After the implementation of hierarchical and special quality control, the qualified rates of basic quality control, deep quality control, obstetrical quality control, and critical value quality control increased significantly. The comprehensive clinical satisfaction score was (90.58±1.79) points, which was higher than before the model was applied [(80.37±2.72) points], and the difference was statistically significant ( P<0.01). Conclusion:The implementation of hierarchical and special quality control measure can effectively improve the quality of ultrasonic diagnoses and comprehensive clinical satisfaction.
ABSTRACT
Objective:To investigate the clinicopathological features and prognosis of IgA nephropathy (IgAN) patients with gross hematuria.Methods:The clinical and pathological data of 490 primary IgAN patients admitted in the Affiliated Hospital of Qingdao University from January 2010 to June 2019 were analyzed. Patients were divided into gross hematuria group and non-gross hematuria group. The clinical and pathological features and prognosis were compared between the two groups. All patients were diagnosed by kidney biopsy, and followed up until June 30, 2020. Kaplan-Meier survival curve was used to examine the renal survival,and Cox regression model was used to analyze the risk factors affecting renal survival in two groups.Results:Among 490 patients there were 111 patients (22.7%) in the gross hematuria group and 379 patients (77.3%) in the non-gross hematuria group. Age, hypertension, 24-h urine protein, serum creatinine, blood uric acid, blood triglycerides, total blood cholesterol level, mesangial cell hyperplasia (M1), the proportion of renal tubular atrophy or renal interstitial fibrosis (T1/2) in gross hematuria group were lower than those in non-gross hematuria group ( P<0.05), while the estimated glomerular filtration rate (eGFR) in gross hematuria group was higher than those in non-gross hematuria group ( P<0.05). Four hundred and twenty six patients (86.9%) were followed up for at least 6 months, including 93 patients in gross hematuria group and 333 patients in non-gross hematuria group. There was no statistically significant difference in treatment method between the two groups ( P>0.05). The incidence of end-point events in non-gross hematuria group was higher than that in gross hematuria group [18.6%(62/333) vs. 6.5%(6/93), χ2=8.023, P<0.05]. Kaplan-Meier survival analysis showed that the cumulative renal survival rate of the gross hematuria group was higher than that of the non gross hematuria group (χ2=11.44, P<0.001). Multivariate Cox regression analysis showed that urine protein>1 g/24 h, eGFR<60 ml·min -1·(1.73 m 2) -1, hypertension, hyperuricemia and the elevated serum IgA/C3 were risk factors for renal survival [ HR(95% CI)=3.457(1.137-10.514),2.736(1.073-6.977),2.720(1.144-6.465),2.789(1.102-7.060),1.070(1.009-1.135), all P<0.05]. Conclusions:IgAN patients with gross hematuria has less severe kidney damage and higher cumulative renal survival rate than non-gross hematuria patients. Urinary protein>1.0 g/d, hypertension, hyperuricemia and the elevated serum IgA/C3 are risk factors for adverse end-point events, to which timely attention and corresponding treatment should be given.
ABSTRACT
Objective:To explore the development and clinical application value of Nomogram model, a noninvasive early diagnosis model, in IgA nephropathy.Methods:The clinical data of 712 patients with primary glomerular disease diagnosed by renal histopathological examination in Affiliated Hospital of Qingdao University during October 1, 2010 to August 31, 2019 were collected retrospectively, including 241 cases of IgA nephropathy and 471 cases of non-IgA nephropathy. According to the time of case inclusion, the patients were divided into the training set ( n=426, 156 cases of IgA nephropathy and 270 cases of non-IgA nephropathy) and the validation set ( n=286, 85 cases of IgA nephropathy and 201 cases of non-IgA nephropathy). Univariate and multivariate logistic regression equations were used to analyze the risk factors for diagnosing IgA nephropathy in patients of training set. Nomogram model for noninvasive diagnosis of IgA nephropathy was established according to the akichi information criteria (AIC) and applied to the validation set for validation. The discriminant degree, calibration degree and clinical practicability of the model were verified and evaluated by receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA), respectively. Results:Multivariate logistic regression results showed that the age ( OR=0.966, 95% CI 0.947-0.985, P=0.001), IgA/C3 ratio ( OR=1.889, 95% CI 1.468-2.432, P<0.001), serum albumin ( OR=1.091, 95% CI 1.047-1.136, P<0.001), total cholesterol ( OR=0.810, 95% CI 0.694-0.946, P=0.008), and gross hematuria ( OR=6.858, 95% CI 1.867-25.189, P=0.004) of patients with primary glomerular disease were independent factors for the diagnosis of IgA nephropathy. Nomogram diagnostic model was constructed based on the above indicators, and the areas under ROC curve were 0.880 and 0.887 respectively in the training set and the validation set. The calibration curve showed that the predicted probability of the model was in good agreement with the actual probability. DCA showed that the safety and clinical net benefit of the model were higher. Conclusions:The Nomogram model has high accuracy and clinical practicality in diagnosing IgA nephropathy, and can be used for noninvasive and early diagnosis of IgA nephropathy to enable patients to receive early treatment.
ABSTRACT
Objective@#To estimate the effect of urate-lowering therapy with febuxostat on oxidative stress in chronic kidney disease (CKD) stages 3-5 patients with hyperuricemia (HUA).@*Methods@#The study was a prospective cohort study. The patients of CKD stages 3-5 with HUA between June 2015 and June 2018 in the Affiliated Hospital of Qingdao University were prospectively analyzed. The patients were assigned to febuxostat (A) group, allopurinol (B) group and non-hyperuricemia (C) group according to the level of serum uric acid and the choice of urate-lowering drugs. Serum uric acid, hypersensitive C-reactive protein (hs-CRP), plasma malondialdehyde (MDA), superoxide dismutase (SOD) and endothelin-1 (ET-1) were measured at baseline, 1 month and 3 months after treatment and the changes of the values of inflammation and oxidative stress before or after treatment were compared. According to the level of serum uric acid, patients were divided into attainment group and nonattainment group, and the correlation between uric acid and oxidative stress was analyzed at baseline and 3 months after treatment respectively.@*Results@#There was no significant difference in baseline levels of serum uric acid, inflammation and oxidative stress between group A and group B (P>0.05). The levels of serum uric acid, hs-CRP, MDA and ET-1 of group A and group B were significantly higher than those of group C, but the level of SOD of group A and group B was significantly lower than that of group C at baseline (P<0.001). After treatment for 1 month and 3 months, the values of serum uric acid, hs-CRP, MDA and ET-1 in group A were significantly lower than those in group B, while the level of SOD in group A was significantly higher than that in group B (P<0.001). Compared with pre-treatment period, both the serum uric acid, hs-CRP, MDA and ET-1 levels of group A and group B were declined significantly while SOD had a significant rise after 3 months treatment (P<0.001). The changes of group A were significantly higher than those of group B (P<0.001). At baseline and 3 months after treatment, serum uric acid was positively related to hs-CRP, MDA and ET-1, but negatively related to SOD in nonattainment group (| r|>0.50, P<0.001); serum uric acid was positively related to hs-CRP, MDA and SOD (| r|>0.70, P<0.001), and there was no correlation between serum uric acid and ET-1 in attainment group (P>0.05).@*Conclusions@#Febuxostat performed better than allopurinol in lowering urate and inhibiting oxidative stress in CKD stages 3-5 patients with HUA, thus reducing vascular endothelial injury. Elevated serum uric acid may be one of the important factors that promote oxidative stress and increase endothelial damage in CKD patients.
ABSTRACT
Objective To estimate the effect of urate-lowering therapy with febuxostat on oxidative stress in chronic kidney disease (CKD) stages 3-5 patients with hyperuricemia (HUA). Methods The study was a prospective cohort study. The patients of CKD stages 3-5 with HUA between June 2015 and June 2018 in the Affiliated Hospital of Qingdao University were prospectively analyzed. The patients were assigned to febuxostat (A) group, allopurinol (B) group and non -hyperuricemia (C) group according to the level of serum uric acid and the choice of urate-loweringdrugs. Serum uric acid, hypersensitive C-reactive protein (hs-CRP), plasma malondialdehyde (MDA), superoxide dismutase (SOD) and endothelin-1 (ET-1) were measured at baseline, 1 month and 3 months after treatment and the changes of the values of inflammation and oxidative stress before or after treatment were compared. According to the level of serum uric acid, patients were divided into attainment group and nonattainment group, and the correlation between uric acid and oxidative stress was analyzed at baseline and 3 months after treatment respectively. Results There was no significant difference in baseline levels of serum uric acid, inflammation and oxidative stress between group A and group B (P>0.05). The levels of serum uric acid, hs-CRP, MDA and ET-1 of group A and group B were significantly higher than those of group C, but the level of SOD of group A and group B was significantly lower than that of group C at baseline (P<0.001). After treatment for 1 month and 3 months, the values of serum uric acid, hs-CRP, MDA and ET-1 in group A were significantly lower than those in group B, while the level of SOD in group A was significantly higher than that in group B (P<0.001). Compared with pre-treatment period, both the serum uric acid, hs-CRP, MDA and ET-1 levels of group A and group B were declined significantly while SOD had a significant rise after 3 months treatment (P<0.001). The changes of group A were significantly higher than those of group B (P<0.001). At baseline and 3 months after treatment, serum uric acid was positively related to hs-CRP, MDA and ET-1, but negatively related to SOD in nonattainment group (|r|>0.50, P<0.001);serum uric acid was positively related to hs-CRP, MDA and SOD (|r|>0.70, P<0.001), and there was no correlation between serum uric acid and ET-1 in attainment group (P>0.05). Conclusions Febuxostat performed better than allopurinol in lowering urate and inhibiting oxidative stress in CKD stages 3-5 patients with HUA, thus reducing vascular endothelial injury. Elevated serum uric acid may be one of the important factors that promote oxidative stress and increase endothelial damage in CKD patients.
ABSTRACT
Objective To evaluate the characteristics of arterial elasticity changes of abdominal aorta atherosclerosis in type 2 diabetic rats by using velocity vector imaging(VVI).Methods A rat model of diabetes mellitus(DM)were successfully established by a high-fat diet combined with the streptozotocin injection in thirty healthy male sprague-dawley rats.DM rats were randomly divided into five groups (n =6,each):0-week group (rats before treatment),4-week group (rats treated for 4 weeks),8-week group(rats treated for 8 weeks),the 12-week group(rats treated for 12 weeks),the 16-week group(rats treated for 16 weeks).The intima-media thickness(IMT)of abdominal aorta,the difference of end-systolic and end-diastolic vessel diameter(△D),resistance index(RI),pulsatility index (PI)and peak systolic velocity(Vs)were detected by ultrasound every 4 weeks.Peak radial velocity (PRy),PCs rate (PCs),peak circumferential strain (PCsr) and peak radial displacement (PRd) of abdominal aorta in short axis view were determined by VVI technique.Rats were sacrificed in different stages.Then,the specimens of abdominal aorta were collected,and observed by light microscope and electron microscope for the histopathological and ultrastructural changes in the atherosclerosis,respectively.Results Compared with 0-week group(0.25±0.03) mm and 4-week group(0.26 ±0.02)mm,IMT was thickened in the 16 weeks group(0.30±0.03)mm,(F=3.718,P=0.017).PRv,PCs,PCsr and PRd were lower after 8 weeks of treatment than in 0-week group.PRy,PCs,PCsr and PRd were lower in 16-week group than 0-week,4-week and 8-week groups (F =15.565,14.754,25.015 and 19.326,P＜0.01).Under the light microscope in abdominal aorta of rats in 12-week group and 16-week group,the stromal layer was thickened,smooth muscle cells were deformed and migrated to the tunica intima,and foam cells were formed.And under electron microscope,endothelial cells had a large amount of lipid attachment,and smooth muscle cells had vacuolar degeneration.Conclusions As compared with the two-dimensional ultrasound,velocity vector imaging can earlier find the elasticity change and intimal damage in abdominal aortic wall of diabetic rat,and can better analyze a motor function of the vascular wall.
ABSTRACT
Objective@#To evaluate the effects of CYP2C19 genetic polymorphism on the plasma concentration of voriconazole in patients with hematological disease and the value of serial monitoring plasma concentrations in the treatment and prevention of invasive fungal disease (IFD).@*Methods@#From January 2016 to December 2016, 65 hematological patients who received voriconazole intravenous administration for the treatment of invasive fungal disease were enrolled in this study. The population CYP2C19 polymorphism of voriconazole were performed using PCR-Pyrosequencing. The trough plasma concentrations of vriconazole (Ctrough) was detected by ultra performance liquid chromatography tandem mass spectrometry.@*Results@#Based on the genotype analysis, 65 subjects were identified as extensive metabolizers’ group (30 cases) and poor metabolizers’ group (35 cases). The Ctrough of the 65 patients were detected for 169 times totally, and there was a significant difference of Ctrough values between the two groups [0.98(0.38-2.08) mg/L vs 2.19(1.53-4.27) mg/L, z=10.286, P<0.001]. The medium of Ctrough in 65 hematological patients were described. Lack of response to therapy was more frequent in patients with voriconazole levels <1.5 mg/L (50.0%) than in those with voriconazole levels >1.5 mg/L (20.5%) (P=0.052). And the risk of adverse events was more frequent in patients with voriconazole levels >5.5 mg/L (80.0%) than in those with voriconazole levels ≤5.5 mg/L (8.3%) (χ2=11.689, P=0.020).@*Conclusion@#Patients with CYP2C19 wild-type phenotype are extensive metabolizers, their Ctrough of voriconazole are significantly lower than patients with CYP2C19 non-wild-type phenotype (poor metabolizers). Appropriate concentrations of vriconazole can improve the efficacy and safety during treatment.
ABSTRACT
ObjectiveTo investigate the value of advanced dynamic flow (ADF) versus color Doppler flow imaging (CDFI) in evaluating stent patency after transjugular intrahepatic portosystemic shunt (TIPS). MethodsA total of 60 post-TIPS patients who underwent ADF, CDFI, and contrast-enhanced ultrasound (CEUS) in Shengjing Hospital of China Medical University from September 2016 to May 2018 were enrolled. The grade of the patency of TIPS stent was evaluated according to the results of ADF, CDFI, and CEUS. With the results of CEUS as the gold standard, the Kappa test was used to examine the consistency between ADF and CEUS results, as well as between CDFI and CEUS results, the Z test was used as the hypothesis testing of kappa value. ResultsThere was extremely strong consistency between ADF and CEUS in evaluating stent patency after TIPS (Kappa=0.902, P＜0.05), while there was moderate consistency between CDFI and CEUS in evaluating stent patency after TIPS (Kappa=0423, P＜0.05). The Z test found that the difference was statistically significant (P＜0.05). ConclusionCompared with CDFI, ADF has a higher value in evaluating stent patency after TIPS and has certain clinical significance.
ABSTRACT
Objective To investigate the CT spectral imaging features of benign and malignant ovarian tumors and to assess the value of spectral CT in differentiating between benign and malignant ovarian tumors.Methods This study was granted by the institutional review board with a waiver for informed consent.34 patients with ovarian tumor(11 benign tumors and 23 malignant tumors)underwent preoperative CT scanning that included arterial phase (AP)and venous phase (VP)with GSI mode.Measurements were performed on the GSI viewer.The iodine concentration (IC,100 ug/cm3)was saved,and the normalized iodine concentration (NIC)and the spectral curve(spectral Hounsfield unit curve)were recorded.The slope of the curve was calculated as the formula:(CT attenuation (40 keV)-CT attenuation(100 keV))/60.The CT value was measured at 70 keV in Mono image.CT values,the slope of the spectral curve,the iodine concentration and NIC were compared between the two groups by using independent sample t-test with software SPSS 2 1.0.Receiver operating characteristic (ROC)was used to determine the threshold of slope of the spectral curve,the iodine concentration and NIC for differentiating benign and malignant ovarian tumors in VP.Results The slope of the spectral curve,the iodine concentration and NIC of malignant ovarian tumors in VP were 1.72±0.77,14.50±6.44 (100 μg/cm3),and 0.33±0.12.The slope of the spectral curve,the iodine concentration and NIC of benign ovarian tumors in VP were 1.05±0.48,8.86±4.04 (100 μg/cm3),and 0.22±0.13.Significant differences were found between the slope of spectral curve,the iodine concentration and NIC of the malignant ovarian tumors and those of the benign ovarian tumors in VP (P=0.01).CT values in double phases revealed no difference between these two groups (P>0.05).Conclusion There is a significant difference between the solid component of benign ovarian tumors and that of malignant ovarian tumors in spectral CT.GSI scan mode can provide more information for the differential diagnosis of benign and malignant ovarian tumors.
ABSTRACT
Objective@#To investigate the association between single nucleotide polymorphisms (SNPs) of rs3130542 and rs4821116 in the HLA-C and UBE2L3 genes and the effect of telbivudine antiviral therapy during pregnancy in HBeAg-positive mothers through a large-sample control study, and to provide a basis for the development of individualized blocking strategies for pregnant women with a high viral load.@*Methods@#The genotypes of rs3130542 and rs4821116 were determined for 312 pregnant women with a high viral load who received telbivudine antiviral therapy during the second or third trimester of pregnancy, and the dominant model, recessive model, and additive model were used to analyze the association between the genotypes of these two loci and the reduction in HBV DNA load. The Shapiro-Wilk test and the Levene test were used to evaluate data normality and homogeneity of variances, and the t-test or the non-parametric Mann-Whitney U test was selected based on data type and was used for the comparison of means between groups. The Hardy-Weinberg equilibrium was used to determine the genotype of SNPs, and the dominant model, recessive model, and additive model were used for analysis.@*Results@#Mothers with an AA/AG genotype of rs3130542 in the HLA-C gene had a significantly higher probability of HBV DNA load ≥103 IU/ml at the time of delivery (P < 0.05) and a significantly higher risk of failure in the prevention of mother-to-child transmission, no matter whether they started to take telbivudine at week 24 or 28 of pregnancy. The association between the genotype of rs4821116 in the UBE2L3 gene and the reduction in viral load in pregnant women needed to be confirmed by studies with a larger sample size.@*Conclusion@#Pregnant women with a high viral load and an AA/AG genotype of rs3130542 in the HLA-C gene tend to have poor response to antiviral therapy during pregnancy, and early antiviral intervention is recommended for such patients.
ABSTRACT
<p><b>OBJECTIVE</b>To detect potential mutation of immunoglobulin μ -binding protein 2 (IGHMBP2) gene in a two-year-old patient with spinal muscular atrophy with respiratory distress type 1 (SMARD1).</p><p><b>METHODS</b>Genomic DNA was extracted from peripheral blood sample from the patient and her parents, as well as cord blood sample from the fetus. Potential mutations of the coding region of the IGHMBP2 gene was detected with PCR and Sanger sequencing.</p><p><b>RESULTS</b>A heterozygous missense mutation c.1060G>A and a frameshift mutation c.2356delG was detected in the patient. The mutations were respectively inherited from her father and mother. Neither mutation was found in DNA derived from the cord blood sample.</p><p><b>CONCLUSION</b>The missense mutation c.1060G>A and frameshift mutation c.2356delG were probably causative for the disease. Analysis of the IGHMBP2 gene has provided an important clue for the etiology and prenatal diagnosis of SMARD1.</p>
Subject(s)
Adult , Child, Preschool , Female , Humans , Infant , Male , Pregnancy , Base Sequence , DNA Mutational Analysis , DNA-Binding Proteins , Genetics , Molecular Sequence Data , Muscular Atrophy, Spinal , Genetics , Prenatal Diagnosis , Respiratory Distress Syndrome, Newborn , Genetics , Transcription Factors , GeneticsABSTRACT
Gitelman syndrome is a rare disease.It is easy to be misdiagnosed and missed diagnosis due to the diverse clinical symptoms.A girl with long-term hypokalemia,who presented with intermittent pain of lower limb muscle and physical retardation,was treated in Xiangya Hospital,Central South University.Laboratory examination confirmed the severe hypokalemia and metabolic alkalosis.Gene sequencing indicated SLC12A3 gene mutation and the patient was finally diagnosed as Gitelman syndrome.Patients with chronic hypokalemia and metabolic alkalosis need to conduct gene sequencing to confirm the diagnosis.Gene therapy is expected to be the most effective treatment for this disease.
ABSTRACT
Objective To investigate the value of automatic spectral imaging mode selection and adaptive statistical iterative reconstruction(ASIR) in upper abdominal enhanced CT with low contrast agent dose, and to optimize the combination of monochromatic energy level and ASIR percentage.Methods 100 patients underwent upper abdominal enhancement CT were randomly assigned into control group (n=50) and study group (n=50).In the control group, tube voltage of 120 kVp and contrast medium of 450 mg I/kg were used with the images reconstructed using 40% ASIR.In the study group, CT spectral imaging with automatic spectral imaging mode selection and contrast medium of 300 mg I/kg were used,and monochromatic images (40-65 keV,intervals of 5 keV) were reconstructed using 40%-60% ASIR (intervals of 10%), respectively.CT value, image noise and contrast-to-noise ratio of the liver, pancreas, aorta and portal vein and radiation dose were compared using two independent samples t test.Overall image quality was assessed by Mann-Whitney U test.Results All image quality indexes in 60 keV with 40% ASIR, 55-60 keV with 50% ASIR in the study group were equal to or better than the control group.There was no significant difference in radiation dose between control group and study group.Conclusion Combined automatic spectral imaging mode selection with ASIR, upper abdominal enhanced CT with low contrast agent dose could improve image quality compared to 120 kVp with 40% ASIR, without increasing radiation dose.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the value of CT perfusion imaging in differential diagnosis between Borrmann types II( and III( gastric cancer.</p><p><b>METHODS</b>All the patients were proven as ulcerated gastric cancer by preoperative gastroscopy and underwent CT perfusion scanning with Aquilion ONE 320 spiral CT from October 2013 to June 2014 in The First Affiliated Hospital of Zhengzhou University, including 19 patients as Borrmann type II( gastric cancer and 23 patients as Borrmann type III( gastric cancer by pathology. Lesions were divided into three parts by two tangent lines perpendicular to the gastric wall of the ulcer edge, including proximal part (close to cardia), ulcer part and distal part (close to pylorus). All the perfusion images were analyzed in the Toshiba 4.7 post processing workstation. Blood flow (BF), blood volume (BV), and clearance (CL) were measured according to Patlak-plot mode, and arterial flow (AF) was measured according to Single-input maximum mode. Differences in all the parameters between Borrmann type II( and III( groups were analyzed. Receiver operating characteristic (ROC) curve was used to determine the threshold of perfusion parameters for differentiating Borrmann type II( and III( gastric cancer.</p><p><b>RESULTS</b>There were no significant differences in AF, BV and BF of ulcer part between the two groups (all P>0.05). While the CL of ulcer part in Borrmann type III( group was (7.17±2.41) L/s, which was significantly higher than (4.82±2.26) L/s in Borrmann type II( group (P=0.00). There were no significant differences for all the parameters at proximal part and distal part between the two types (all P>0.05). According to the ROC curve, area under the curve of CL was 0.78. Taking 0.59 L/s as the threshold of CL value, the corresponding sensitivity and specificity for diagnosing Borrmann type III( were 70% and 80%, respectively.</p><p><b>CONCLUSION</b>The CL value has certain diagnostic value in differential diagnosis between Borrmann types II( and III( gastric cancer.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Diagnosis, Differential , Gastroscopy , Perfusion Imaging , ROC Curve , Sensitivity and Specificity , Stomach Neoplasms , Diagnostic Imaging , Tomography, Spiral Computed , Tomography, X-Ray ComputedABSTRACT
Objective To evaluate the efficacy and safety of the conscious analgesia/sedation scheme with remifentanil and propofol on the elderly patients under gastroenterological endoscopic procedure. Methods Retrospective analysis was performed on 3 500 cases with remifentanil and small?dose propofol under gastroenterological endoscopic procedures, and the procedure achievement, effects of the narcotic, adverse reactions and satisfactory results were summarized. Results All procedures were completed successfully. The ratio of the patients whose intended sedation depth arrived at referential induction was up to 91?3%(3 196/3 500).Hemodynamic change was slight and almost all patients could open eyes in no time, with short hospital stay. No serious adverse effects were observed except several patients complaining about mild bucking, abdominal distension and stomachache. The degree of patients′ satisfaction was high. Conclusion The conscious analgesia/sedation scheme with remifentanil and propofol can be effectively and safely used on gastroenterological endoscopic procedure among the elderly, but precise monitor and timely treatment of complications are still needed.
ABSTRACT
Objective To investigate the clinical effect of acupuncture therapy for ascending and descending Qi for the treatment of insomnia with the syndrome of liver stagnation. Methods Sixty quantified patients were randomized into 2 groups, 30 cases in each group. The patients in the treatment group were treated by acupuncture therapy for ascending and descending Qi, and the control group was given conventional acupuncture therapy. The polysomnography ( PSG) results and Pittsburgh sleep quality index ( PSQI) were compared before and after treatment, and the clinical efficacy was evaluated after treatment in the two groups. Results ( 1) The parameters of total sleep time, deep sleep time and rapid eye movement ( REM) time were prolonged, and the sleep latency and waking-up frequency in both groups were reduced after treatment (P<0.05 compared with those before treatment), and the improvement of total sleep time, deep sleep time and REM time in the treatment group was significantly superior to that in the control group (P<0.05). (2) PSQI scores in both groups were reduced after treatment ( P<0.01 compared with those before treatment) , and the reduction in the treatment group was more significant than that in the control group (P<0.01). (3) The total effective rate in the treatment group was 93.33%and was 76.67%in the control group. The efficacy in the treatment group was better than that in the control group (P<0.01). Conclusion Acupuncture therapy for ascending and descending Qi has better effect on insomnia with liver stagnation than conventional acupuncture therapy, being practical and innovative.
ABSTRACT
Objective To evaluate the diagnostic efficacy of shear wave elastography and ultrasound weighted score in differentiating benign and malignant thyroid nodules.Methods Ninety-two patients with 1 13 thyroid nodules (72 benign and 41 malignant)underwent ultrasound weighted score.The items and scores were as follow:hypoechogenicity(2),irregular margin(2),no well-defined border(1),no uniform and complete acoustic halo (1 ),microcalcification (2 ),anteroposterior to transverse diameter ratio ≥ 1 with irregular margin(6 ),nodules with cystic components which had an diameter larger than 5 mm (- 6 ), posterior enhanced echo(-2),metastasis of neck lymph nodes(6).Shear wave velocity(SWV)of thyroid nodules were measured by virtual touch tissue quantification and the mean SWV of five data was calculated. The diagnostic efficacy of shear wave elastography,ultrasound weighted score,and their combination in differentiating benign and malignant thyroid nodules were calculated by ROC curves.The diagnostic sensitivity,specificity,and accuracy of ultrasound scores,SWV,and their combination in differentiating malignant and benign thyroid nodules were compared.Results The ultrasound score cut-off for the diagnosis of malignant lesions was 4.5 with a sensitivity of 80.5%,specificity of 86.1 %,and accuracy of 84.1 %.The SWV cut-off for the diagnosis of malignant lesions was 2.55 m/s with a sensitivity of 70.7%, specificity of 88.9%,and accuracy of 82.3%.When two methods were combined,the diagnostic sensitivity, specificity,and accuracy were 95.1 %,80.6% and 85.8%,respectively.Comparing the sensitivity,specificity and accuracy of the three methods,there were no significant difference between any two methods (P >0.016 7),except that the sensitivity of combination was significantly higher than that of SWV (P <0.016 7).Conclusions Shear wave elastography and ultrasound weighted score both have high value in differentiating benign and malignant thyroid nodules.Combining two methods can not improve diagnosis value comparing with conventional ultrasonography.
ABSTRACT
The safflower floret is a traditional Chinese medicine used to promote blood circulation and remove obstruction in the channels. The spines on its bracts are considered a handicap when manual harvest is involved. In this study, cDNA-SRAP was used to systematically investigate which genes are associated with the spines. Sixty pairs of possible primer combinations were used on two cDNA pools representing spininess and spinelessness. Six transcript-derived fragments were identified, of which two with low recombination were sequenced successfully and named as GPY-1 and GPY-2. By using the RACE method, the full-length cDNA of GPY-2 is cloned and named as CTL-spn. The full-length cDNA of CTL-spn was 1 679 bp long with a 1 524 bp ORF encoding a 508 aminoacid protein. The deduced amino acid sequence of the CTL-spn gene shared a high homology (97%) with other known ATP synthase CF1 alpha subunits. Semiquantitative RT-PCR analysis revealed that the mRNA of GPY-1 and GPY-2 accumulated in only spiny lines. Considering the important role of ATP synthase CF1 alpha subunit in plants, it may directly take part in the formation process of spininess and enhancing resistance reaction of spiny safflower. Also, our results provide the important insights for breeding spineless cultivars of safflower.