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Obesity is one of the most challenging global public health issues, and more than half of adults in Chia are overweight or obese. Obesity has been shown to be a risk factor for type 2 diabetes, cardiovascular disease, colon cancer and other specific cancers, and has become a serious threat and even a danger to the health and quality of life of the nation. With the mature development of bariatric surgery in the last 20 years, it is now widely recognized for its effectiveness and safety in the treatment of obesity and related metabolic diseases, as well as improving patients′ life expectancy and quality of life. However, previous data from the literatures suggest that some patients require revisional surgery after bariatric surgery, with the incidence of revisional bariatric surgery as 5% to 50%. The main reasons for revisional bariatric surgery are poor post-operative outcomes, including the lack of significant weight loss, weight regain and no significant improvement or even recurrence of associated metabolic disease, and other reasons include the development of anaemia, malnutrition and long-term chronic pain. Currently, there is only the East Asian expert consensus on revised bariatric surgery proposed by Chinese Society for Metabolic & Bariatric Surgery in 2018. However, there are still no uniform standards regarding the indications, contraindications and surgical modalities of revisional bariatric surgery in clinical practice. The authors summarize the latest researches of revisional bariatric surgery, in order to provide the guidance value for clinical practice.
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Bariatric and metabolic surgery is an effective treatment for obesity and its associated diseases. Gastric bypass has been the gold standard surgery, but now sleeve gastrectomy has become the most commonly used procedure, both procedures have certain disadvantages. In recent years, on the basis of sleeve gastrectomy, a variety of derivative procedures have been developed to improve the efficacy of sleeve gastrectomy. They mainly include sleeve gastrectomy with gastric banding, sleeve gastrectomy with jejunal bypass, sleeve gastrectomy with duodenal-jejunal bypass, single-anastomosis duodeno-ileal bypass with sleeve gastrectomy, stomach intestinal pylorus sparing and single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy. The authors summarize the efficacy and safely of these new operations from sleeve gastrectomy and gastric bypass in order to provide certain references for clinical practice.
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Objective:To investigate the predictive value of visceral fat area (VFA) on multiple metabolic risk factors in obese patients undergoing bariatric surgery.Methods:The retrospective case-control study was conducted. The clinical data of 146 obese patients undergoing bariatric surgery in the West China Hospital of Sichuan University from June 2015 to May 2020 were collected. There were 57 males and 89 females, aged (33±9)years, with a range from 15 to 65 years. All patients underwent multi-slice spiral computed tomography (CT) examination, and the total fat area (TFA), VFA and subcutaneous fat area (SFA) were measured. Observation indicators: (1) CT findings of abdominal fat area and patients with multiple metabolic risk factors; (2) receiver operator characteristic(ROC) curve of different clinical indicators for predicting multiple metabolic risk factors; (3) relationship between different VFA and clinicopathological features in patients; (4) analysis of factors influencing multiple metabolic risk factors in patients. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was analyzed by independent sample t test. Measurement data with skewed distribution were expressed as M (range) and comparison between groups was analyzed by nonparametric rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. The ROC curve was used to analyze the predictive value of different clinical indicators for multiple metabolic risk factors in patients. Logistic regression analysis was used for univariate and multivariate analysis. Results:(1) CT findings of abdominal fat area and patients with multiple metabolic risk factors. CT findings of 146 patients showed that VFA was (212±122)cm 2, SFA was (419±147)cm 2, visceral-to-subcutaneous fat ratio (VSR) was 0.60±0.54. The levels of systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose (FBG), triglyceride and highdensity lipoprotein cholesterol (HDL-C) were (131±16)mmHg(1 mmHg=0.133 kPa), (86±12)mmHg, (6.4±2.5)mmol / L, 4.43 mmol /L(range, 1.23-9.99 mmol/L), (1.5±1.3)mmol/L, respectively. Among the 146 patients, 85 had impaired FBG or diabetes, 82 had hypertension, 139 had high triglyceride, 91 had low serum HDL-C; 128 had multiple metabolic risk factors. (2) ROC curve analysis of different clinical indicators for predicting multiple metabolic risk factors: the ROC curve showed that VFA had better ability to predict or diagnose multiple metabolic risk factors in patients ( hazard ratio=0.617, 95% confidence interval as 0.470-0.764, P<0.05). The cutoff value of VFA was 163.52 cm 2 by calculating Yoden index in ROC curve. (3) Relationship between different VFA and clinicopathological features in patients: according to the cutoff value of 163.52 cm 2 in ROC curve, 146 patients were divided into high VFA group (≥163.52 cm 2) and the low VFA group (<163.52 cm 2), with 49 cases and 97 cases respectively. Cases with hypertension, level of SBP, cases with impaired FBG or diabetes, cases with multiple metabolic risk factors were 64, (134±17)mmHg, 63, 90 for the high VFA group, versus 18, (127±13)mmHg, 22, 38 for the low VFA group; there were significant differences in above indicators between the two groups ( χ2=11.309, t=6.916, χ2=5.380, 6.988, P<0.05). (4) Analysis of factors influencing multiple metabolic risk factors in patients: results of univariate analysis showed that VFA was a related factor for multiple metabolic risk factors in patients ( hazard ratio=3.722, 95% confidence interval as 1.341-10.328, P<0.05). Results of multivariate analysis showed that the VFA≥163.52 cm 2 was an independent rsik factcor or multiple metabolic risk factors in patients ( hazard ratio=5.182, 95% confidence interval as 1.441-18.641, P<0.05). Conclusions:VFA is positively correlated with hypertension, systolic blood pressure, impaired FBG and diabetes. VFA≥163.52 cm 2 is an independent predictor for multiple metabolic risk factors in obese patients undergoing bariatric surgery.
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Objective To observe image quality and impact factors for single heart beat coronary CTA (CCTA) with prospectively ECG-triggered CT in patients with low,high heart rate (HR) and arrhythmia.Methods Single heart-beat CCTA was performed for 208 patients with prospectively ECG-triggered 256-slice wide-detector CT without drug control of HR.The patients were divided into 3 groups,including low HR group (n=87,HR≤70 bpm),high HR group (n=38,HR＞70 bpm) and arrhythmia group (n=83,HR variation ＞ 10 bpm in 5 cardiac cycles).The normal reconstruction phase was set as 75％ or 45％ in R-R interval,while the optimal phase was that with the least motion artifacts.Univariate linear regression was used to analyze the impact factors for image quality.Results Compared with images of normal phase,the optimal phase of 105 patients (105/208,50.48％) was altered.In the optimal images,imaging quality,SNR and CNR were not significantly different among 3 groups (all P＞0.05).Image quality was significantly influenced by reconstruction phase and artifact type (both P＜0.001).Conclusion During prospectively ECG-triggered 256-slice wide-detector CCTA without drug control of HR,high HR and arrhythmia are not significant impact factors of image quality.
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Objective To observe the targeting function of high affinity anti-EGFR monoclonal antibody (Cetuximab)conjugated superparamagnetic iron oxide-dopamine (anti-EGFR-PEG-SPIO) lung cancer cells via epidermal growth factor receptor (EGFR),as well as the feasibility for surveillance of tumor targeting with MRI.Methods Nanoparticles (NPs)of anti-EGFR-PEG-SPIO and PEG-SPIO were prepared,and the morphology of nanoparticles was observed with transmission electron microscope (TEM).The hydrodynamic diameter and R2 values of nanoparticles before and after conjugation with anti-EGFR were performed with dynamic light scattering (DLS) and MRI.MRI was performed in incubation with anti-EGFR-PEG-SPIO and PEG-SPIO after 2 h in vitro.The cellular uptake of anti-EGFR-PEG-SPIO and PEG-SPIO was further evaluated using Prussian blue staining and TEM.Results Anti-EGFR-PEG-SPIO and PEG-SPIO showed signal intensity of H460 cells on T2WI,decreased significantly compared with PEG-SPIO.The rate of signal intensity change was -58.2％,-82.7％,-94.4％ and-98.3％,respectively,at iron concentrations of (0,10,20,40,80 μg/ml) of antiEGFR-PEG-SPIO.Prussian blue staining and TEM showed that a lot of intracellular irons of anti-EGFR-PEG-SPIO were observed in H460 cells,but few of PEG-SPIO.Conclusion The effect of active targeting via anti-EGFR in EGFR overexpressed cells can be achieved with anti-EGFR-PEG-SPIO in H460 cells in vitro,and the targeting delivery process could be monitored with 3.0T MRI.
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Objective To explore the MSCT findings of occipital condyle fracture (OCF) and improve its diagnostic accuracy. Methods Nineteen patients with OCF, selected from 110 patients suffering high energy injuries at the craniocervical junction, were enrolled into the study. The MSCT appearances of OCFs were retrospectively analyzed by two experienced radiologists. OCF had four types: type Ⅰ was a comminuted fracture, type Ⅱ was a extension of basilar skull fracture, type Ⅲ was an avulsion fracture at the attachment site of alar ligament on occipital condyle, type Ⅳ was a fracture of mixed pattern consisting of two or more above fracture types. Results In 19 patients, the left, right and bilateral OCFs were seen in 7,11 cases, and 1 case, respectively. Type Ⅰ was found in one case, which was a comminution of the left occipital condyle. Type Ⅱ was found in 5 cases, which involved the middle and posterior parts of occipital condyles with 2 on the left and 3 on the right, Type Ⅲ was found in 12 cases which showed various degree of fragment displacement with 3 occuring on the left, 8 on the right, 1 involving bilateral sides, 6 involving articular surfaces and 7 accompaning by enlargment of alar ligaments. Type Ⅳ was found in one case, with coexistence of Type Ⅱ and type Ⅲ. In addition, OCFs were accompanied by head and (or) cervical spine injuries in 14 cases, which included cranial fracture in 8 cases, epidural hematoma in 4 cases, subarachnoid hemorrhage in one case, cerebral contusion and laceration in one case, subfalcial hernia in one case, cervical spine fracture and dislocation in 9 cases, and so on. Conclusion OCFs can be accurately diagnosed by MSCT, which is important for selection of treatment protocols.
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Objective To analyse the routes and MRI characteristics of disseminated intracranial gliomas after operation. Methods 10 patients of intracranial gliomas confirmed by pathology and intracranial dissemination after operation underwent MRI examina-tions including T_1 WI, FSE T_2 WI, FLAIR and fat-suppressed T_1 WI after intravenous injection of Gd-DTPA. In addition, 4 cases were also examinated with DWI, 1 case with SWI and DTI. Results In 10 cases,there were glioblastoma in 7 cases,grade Ⅱ astro-cytoma in 2 and grade Ⅲ astrocytoma in one. The disseminated tumors were found by MRI in 4 to 56 months after operation. The le-sions in all patients were confirmed with the comparison of contrast-enhanced MRI positive signs between preoperation and post-operation. Plain MR scanning showed line-like thicking with isointensity in 1/7 case/time (C/T)and multiple noduli in 5/7 (C/T) on T_1 WI respectively;shallowed cortical sulci and cistern in 2/7(C/T) and nodular in 5/7(C/T) on T_2 WI;shaUowed cortical aulci and cistern in 2/7 (C/T) and nodular in 6/7(C/T) on FLAIR. The signal intensity of noduli of disseminated tumors in 7 cases were in complete consistency with that of primary neoplasm , however, in 3 cases, it was inconsistent. Enhanced scanning showed 7 ca-ses with the signs of line-like thicking, 7 cases with noduli , 6 cases with :cast-like shape" sign and 6 cases with different extent of hydrocephalus. Conclusion Enhanced MRI can be used as a most useful and reliable monitoring tools for detecting dissemination of brain glioma.
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Objective To evaluate T2WI sequence and liver acquisition with volume acceleration (LAVA) technique in the diagnosis of early endometrial carcinoma on 3.0 T MR scanner. Methods Twenty-seven patients with endometrial carcinoma confirmed by pathology were retrospectively analyzed. MRI sequences included axial T1WI and sagittal T2WI with fat saturation, axial and sagittal LAVA scanning including four phases: early arterial phase, late arteral phase, parenchymal phase and delayed phase. The tumor location, signal features, and myometrial infiltration by tumor were recorded and preoperative staging was compared with pathologic results. The sensitivity, specificity, accuracy of T2WI and LAVA in diagnosing endometrial carcinoma was assessed. The accuracy of the evaluation of the deep myometrium infiltration was compared between the two sequences using Fisher's exact test. Results According to Federation International of Gynecologie and Obstetrigue (FIGO) standard, 27 patients with endometrial carcinoma were classified as: stage Ⅰ in 22 cases, stage Ⅱ in 5 cases. The sensitivity, specificity, positive and negative predictive values in assessing deep myometrium infiltration were 70.0% (7/10), 94. 1% (16/17), 87. 5% (7/8), 84. 2% (16/19) respectively for T2WI sequence. Its accuracy in assessing myometrium invasion was 85.2% (23/27). The sensitivity, specificity, positive and negative predictive values were 80. 0% (8/10), 94. 1% ( 16/17 ), 88. 9% (8/9), 88. 9% ( 16/18 ) respectively for LAVA sequence, and the accuracy was 88.9% (24/27). There was no statistical difference of accuracy between two techniques( P = 1.00). Conclusion 3.0 T MR T2WI sequence has important role in diagnosing early endometrial carcinoma, and LAVA technique is highly valued in preoperative diagnosis and staging in early endometrial carcinoma for myometrium infiltration.
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The growth of brain metastasis needs appropriate microenvironment, and the change of normal brain microenvironment is the basis for exploring metastasis with MRI. Through the local magnetic field changes and the application of contrast agents for improving the discrepancy of the cerebral tissue, MR can accurately detect brain metastasis in position, number, size, and shape. MR with contrast-enhanced technique is the first choice for screening brain metastasis. The application of all kinds of new MR techniques, sequences and intracellular contrast agents can not only further improve the specificity of detection, but also improve the sensitivity of MRI, which is favorable to formulating reasonable treatment and prolonging the lifetime of the patients. The microenvironment of brain metastasis and advances in the new MR techniques were reviewed in this article.
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In the treatment of 34 cases of radial nerve paralysisby puncturing the acupoints in Yangming meridians of the hand and foot, plus TDP radiation in the local areas after acupuncture, the total effective rate is 97.1%.
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Objective To analyse the detective rate and significance in diagnosis of cerebral and meningeal metastases by MR.Methods 115 cases with cerebral and meningeal metastasis were proved by operation and pathology.There were male 86 and females 29 ranged in age from 17-77 years old,plain MR scan and enhanced MR scan were performed in all cases.Results In this group included 46 cerebral metastases(40.0%),33 meningeal metastasis(28.7%),36 both cerebral and meningeal metastases(31.3%). Different degree of enhancement was showed on enhanced MRI in all cases, "mouse tail signs"or"target signs" were appeared in which cerebral metastasis with the adjoining meninges involved.Conclusion MRI is a good method for diagnosing cerebral and meningeal metastasis.Enhanced MRI has an important value.