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Objective To study the effect of diffusion-weighted magnetic resonance imaging (DW-MRI) in the differential diagnosis of hydronephrosis and pyonephrosis.Methods From March 2015 to October 2017,50 patients with renal stone and highly suspected infectious hydronephrosis underwent renal DW-MRI,and clinical materials were collected and analyzed retrospectively.Seventeen male and 33 female patients were enrolled with a mean age of (49.40 ±-10.51) years.The median maximum diameter of renal stone was 30.30 (17.38,56.01) mm and hydronephrosis was 46.39 (34.33,56.55) mm.No pyonephrosis was diagnosed by preoperative ultrasound or CT,while 29 cases of hydronephrosis and 21 cases of pyonephrosis were reported by preoperative DW-MRI.Final diagnoses of hydronephrosis and pyonephrosis were made according to whether the pelvic urine drainage was purulent or not during the surgery.DW-MRI reports and characteristics of DW images were analyzed retrospectively.Apparent diffusion coefficient (ADC) was calculated and ADC map constructed,which was compared between the two groups.Receiver operating characteristic curve (ROC) was drawn to analyze the area under curve (AUC) and the optimal cutoff of ADC value,with sensitivity and specificity.Results Thirty-three patients of hydronephrosis and 17 pyonephrosis were confirmed intraoperatively.The overall accuracy of diagnosis using DW-MRI was 84.00％ (42/50),with sensitivity of 88.24％ (15/17) and specificity of 81.82％ (27/33).Among 30 patients who underwent CT scan in our hospital,mean CT value of 18 hydronephrosis was (7.03 ± 3.26)HU and that of 12 pyonephrosis was (8.67 ± 3.52) HU,with no statistical significance (P ＞ 0.05).On DW image,when b ≥ 500 s/mm2,hydronephrosis signal intensity was lowered apparently,whereas pyonephrosis signal intensity was intensified.On ADC map,hydronephrosis appeared as hyperintensity,whereas pyonephrosis appeared as hypointensity.The mean ADC value of pyonephrosis group was lower than hydronephrosis group [(1.53 ±0.58) × 10-3 mm2/s vs.(2.86 ±0.56) × 10-3 mm2/s,p ＜0.01].ROC analysis revealed that AUC =0.92 (95％ CI 0.80-0.98),and the cut-off value of ADC for pyonephrosis diagnosis was 1.39 × 10-3 mm2/s,of which the sensitivity and specificity was 94.12％ and 84.85％ respectively.Conclusions Signal of pyonephrosis was enhanced on DW image,while decreased on ADC image.The ADC value of pyonephrosis was much lower than that of hydronephrosis,with which the differential diagnosis between pyonephrosis and hydronephrosis could be made efficiently.
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Objectives To investigate the factors influencing long-term quality of life (QOL)of patients with first-episode ischemic stroke(IS)and partial side limb dysfunction.Methods 126 cases of the first ischemic stroke patients with partial side limb dysfunction admitted to hospital from November 2012 to July 2013 in Shanghai First People's Hospital were selected.General information of patients was collected and evaluated using NIH Stroke Scale(NIHSS)and Modified Rankin Scale(MRS).Following-up was conducted using NIHSS,MRS,stroke specific quality of life (SS-QOL) and Hamilton Depression Scale (HAMD) during 2-3 years after stroke Factors related to long-term QOL were screened by single factor analysis,then factors influencing QOL by multiple stepwise regression analysis.Results The average QOL score of patients with first IS partial side limb dysfunction was(181.5 ± 46.4)points scale.In each single scoring,the scale was(10.4±4.3)points in energy,(10.8±4.2)points in family roles,(21.8±6.2)points in language,(22.5 ±7.6) points in activity,(18.5±6.3)points in mood,(10.1±4.4)in personality,(19.2±5.9)points in self-care ability,(16.1 ± 7.0) points in social roles,(11.65 ± 3.31) points in thinking,(19.1 ± 6.6) points in upper limb function,(14.0 ± 2.0) points in visual acuity,(8.7 ± 4.1) points in work.The multiple regression analysis showed that the influencing factors of life quality included long-term NIHSS evaluation(β=-0.376,P＜0.01),HAMD evaluation(β=-0.375,P＜0.01),hypertension history(β=-0.178,P＜0.05).HAMD evaluation affected 9 fields of QOL,and NIHSS as long-term evaluation affected 6 fields of QOL.Conclusions Predictive factors for declined QOL of first-episode ischemic stroke patients with partial side limb dysfunction include higher NIHSS score,severer depression after long-term stroke and combined hypertension in the early stage.These indicate that recovering of body structure and function injury,control of hypertension,effective prevention and treatment of post-stroke depression maybe important measures for improving life quality of ischemic stroke patients with partial side limb dysfunction.
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Objective To determine the effectiveness and safety of stereotactic body radiotherapy (SBRT)-CyberKnife for oligometastatic prostate cancer.Methods From May 2012 to February 2017,31 patients treated by CyberKnife were retrospectively reviewed,with a median age of 67 years(range 52 to 83 years),including 50 oligometastatic and 2 primary prostate cancer patients.The median PSA level was 8.4 ng/ml(range 0 to 300.0 ng/ml) and PSA test was performed every month.PSA progression-free survival (PSA-PFS),time to initiation of androgen deprivation therapy (ADT) and local control rate (LCR) were measured as the main outcomes.Results SBRT was well tolerated and were performed as planned in all patients.No SBRT related acute or late toxicities were observed.No bone fracture was observed in patients treated by bony targeted radiotherapy.The median follow-up after SBRT was 20.7.months (range 1.2-58.3 months).The median PSA-PFS was 5.3 months (range 0-58.3 months).1-year,2-year,and 4-year PSA-PFS was 52.0％,36.7％ and 36.7％ respe ctively.PSA level decrease was observed in 21 oligometastatic prostate cancer patients after SBRT,with median PSA-PFS of 12.3 months (range 1.2-58.3 months).PSA level increase was observed in 29 oligometastatic prostate cancer patients after SBRT.Six local recurrence were observed resulting in an actuarial 1-year,2-year and 3-year LCR of 90.4％,86.9％ and 82.6％,respectively.Twelve patients treated without ADT after SBRT,with median follow-up of 8.6 months (range 2.9-58.3 months) in this subgroup.Seven patients were added ADT after SBRT,with the median time from SBRT to initiation of ADT of 13.3 months (range 3.0-24.0 months) in this subgroup.Twelve patients were treated with ADT continuously after SBRT.Conclusions CyberKnife seems to be a safe and effective treatment with tolerated adverse events and good local control for patients with oligometastatic prostate cancer.
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<p><b>OBJECTIVES</b>To investigate the feasibility of establishing an individualized navigation template for occipital condyle screws insertion using a fused deposition modeling based three-dimensional printing forming technique, and to evaluate the accuracy and safety of template-assisted condyle screw insertion.</p><p><b>METHODS</b>Thirty adult occipitocervical specimens were selected to take a CT-scan. After original Dicom data imported into the Mimics software, the craniocervical junction models were created, which were used to evaluate anatomic structures and define the screw-related parameters. Design and generate the cavity models of the occipital condyle based on a three-dimensional printing forming technique. After using a free-hand procedure to create a navigation template with a well-established screw path, finish bilateral condyle screws insertion assisted by the navigation template. Anatomy study and CT-scan were taken postoperatively to access the position of the screws.</p><p><b>RESULTS</b>Sixty condyle screws were implanted assisted by 30 individualized navigation templates with an average time cost of (91.4 ± 8.2) s. The axial medial angle, sagittal cranial angle and distance between the entry point to atlantooccipital joint surface were (33.2 ± 6.4)°, (8.9 ± 3.4)°, (3.9 ± 0.9) mm, respectively. The variations due to different sex and sides resulted in a statistically insignificant difference of the parameters. Anatomy study and CT-scan indicated no intrusion of the vertebral artery, hypoglossal canal, condyle emissary vein canal or atlantooccipital joint. Fifty-nine condyle screws were completely contained within the condyle, while only 1 screw perforated lateral condyle wall.</p><p><b>CONCLUSIONS</b>Using the Mimics software for establishing the occipital condyle and related cavity model based on CT-scan images proves to be a feasible and precise method.Occipital condyle screws insertion assisted by a three-dimensional printing model is highly accurate and simple, which could be a new alternative to conventional technique.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Bone Screws , Cadaver , Occipital Bone , General Surgery , Printing, Three-Dimensional , Surgery, Computer-AssistedABSTRACT
Objective To evaluate the effects of Taoist cognitive psychotherapy on depression of aged patients with cerebral stroke hemiplegia convalescence. Methods Seventy-seven hemiplegia convalescence patients with depression were divided into general treatment group (38 patients, received general back-up psychology therapy) and combined treatment group (39 patients, received general back-up psychology therapy and Taoist cognitive psychotherapy) by random digits table. All patients were treated for 8 weeks and followed up for 6 months. Two groups were evaluated with HAMD and SS-QOL before treatment and at the end of the 2 weeks,4 weeks, 8 weeks and 6 months after treatment. The results were analyzed with statistics. Results In general treatment group, the HAMD scores were gradually decreased, and the HAMD scores of patients after 8 weeks' treatment were significantly lower than those before treatment[(22.35 ± 4.69)scores vs. (29.62 ± 5.95 ) scores,t = 6.425 ,P ＜ 0.01]. At the end of 6 months after treatment, the scores increased [(24.48 ± 4.12 ) scores vs. (22.35 ± 4.69 ) scores, t = 2.014, P ＜ 0.05], but they were lower than those before treatment(t = 4.836, P ＜ 0.01 ). At the end of 6 months after treatment, the SS-QOL scores were lower than those after 8 weeks' treatment (t =2.543,P ＜0.05),but they were higher than those before treatment (t = 2.790,P ＜ 0.05 ). In combined treatment group, the HAMD scores decreased continuously,and the scores after 8 weeks' treatment [(20.08 ± 4.60) scores] and 6 months' treatment [( 15.21 ± 3.42)scores] were significantly lower than those before treatment [( 30.14 ± 4.92 ) scores] (t = 8.341,15.443, P ＜0.01). Meanwhile,the HAMD scores after 6 months'treatment were significantly Iower than those after 8 weeks' treatment (t =4.724,P ＜ 0.01 ). The SS-QOL scores after 8 weeks' treatment [( 117.56 ± 26.22)scores] and 6 months' treatment [(126.57 ±21.82) scores] were significantly higher than those before treatment[(86.54 ± 23.90) scores] (t = 6.716,8.916,P ＜ 0.01 ) ,and there was significantly difference(t=2.378,P ＜ 0.05). The HAMD scores of combined treatment group after 8 weeks' and 6 months' treatment were significantly lower than those of general treatment group at the same time(t = 2.118, P ＜ 0.05 ;t = 8.405,P＜ 0.01 ) ,and SS-QOL scores were significantly higher than those of general treatment group at the same time (t = 3.123,P ＜ 0.05 ;t = 6.580,P ＜ 0.01 ). Conclusions General back-up psychology therapy combined with Taoist cognitive psychotherapy can improve depression and life quality of cerebral stroke hemiplegia convalescence in aged patients. The effects of Taoist cognitive psychotherapy is slower, but it is more beneficial in the long time.
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Protease activated receptor-2(PAR-2)is a G-protein-coupled receptor.Recent studies indicate that PAR-2 is mainly expressed in leukocytes and activated by pancreatin and(or)tryptase,which subsequently induces inflammation through degranulation of leukocytes.Activation of PAR-2 in leukocytes is possibly involved in the pathogenesis of rheumatoid arthritis.