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Objective To investigate the predictive value of diffusion-weighted (DW) magnetic resonance imaging (MRI) for invasiveness of hilar cholangiocarcinoma (HC).Methods The retrospective casecontrol study was conducted.The clinicopathological data of 65 HC patients who were admitted to the Sun Yat-sen Memorial Hospital from January 2012 to November 2017 were collected.Patients received DW MRI before treatment,and 2 senior imaging doctors analyzed imaging data and measured the apparent diffusion coefficient (ADC) for the primary lesions of HC.Observation indicators:(1) MRI situations of HC;(2) relationship between ADC and clinicopathological factors;(3) receiver operator characteristic (ROC) curve analysis;(4) treatment and follow-up situations.According to patients' conditions,treatment plans were done within 2 weeks after MRI and patients underwent radical resection of HC.Follow-up using telephone interview was performed to detect tumor recurrence up to December 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between group and among group were respectively analyzed using the t test and one-way ANOVA.Spearman's rank correlation was performed to analyze the relationship between ADC and clinicopathological factors.ROC curves assessed the diagnostic efficiency of ADC.Results (1) MRI situations of HC:MRI and magnetic resonanced cholangio-pancreatography (MRCP) in 65 patients showed varying degrees of soft rattan-like dilations of intrahepatic bile ducts and truncation signs of bile tracts in hepatic port.Of 65 patients,tumors in 23,7 and 35 patients were respectively pedunculated type,polypoid type and infiltrating type.The pedunculated-type lesions of 23 patients presented as low signal on T1WI and slightly high signal on T2WI;after enhanced scans of MRI,pedunculated-type lesions of 7 patients demonstrated moderate homogenous enhancement in 3 patients,ring-like enhancement with internal liquefaction necrosis in 10 patients and moderate heterogeneous enhancement in 10 patients,respectively.The polypoid-type lesions presented as low signal on T1WI and high signal on T2WI,and moderate homogenous enhancement by enhanced scans of MRI.There were varying degrees of bile duct wall thickness and irregular nodules in the infiltrating-type lesions of 35 patients,showing moderate enhancement by enhanced scans of MRI.All the lesions of 65 patients using DW MRI demonstrated restricted diffusion,showing a clear boundary between lesions and normal surrounding bile ducts or liver tissues;heterogeneous enhancement lesions by MRI scans presented as heterogeneously high signal on DWI and heterogeneously low signal on ADC map,and necrotic area of lesions showed low signal on DWI;homogenous enhancement by MRI scans presented as homogenously high signal on DWI and homogenously low signal on ADC map.(2) Relationship between ADC and clinicopathological factors:ADC was respectively (1.382±0.165)× 10-3 mm2/s,(1.343±0.138)× 10-3 mm2/s,(1.291-±0.226)×10-3 mm2/s,(1.111±0.243)×10-3 mm2/s in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ (TNM staging) and (1.441± 0.355) × 10-3 mm2/s,(1.226 ± 0.177) × 10-3 mm2/s,(1.061 ± 0.228) × 10-3 mm2/s in highdifferentiated,moderate-differentiated and low-differentiated tumors (pathological grading) and (1.403±0.176)× 10-3 mm2/s,(1.121±0.238)× 10-3 mm2/s in Ki-67 score ≤ 10％ and ＞ 10％ and (1.115±0.241)× 10-3 mm2/s,(1.347±0.174)× 10-3 mm2/s in HC patients with and without lymph node metastasis,with statistically significant differences in the above indicators (F =4.158,9.866,t =11.607,13.464,P＜0.05).Results of Spearman's rank correlation analysis showed that ADC had a negative correlation with TNM staging,pathological grading and Ki-67 score (r=-0.532,-0.522,-0.409,P＜0.05).(3) ROC curve analysis:using 1.225×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of stage Ⅰ-Ⅱ HC and stage Ⅲ-Ⅳ HC were 70.5％ and 81.0％,and area under ROC curve was 0.705 (95％CI:0.62-0.84,P＜0.05).Using 1.100×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of lowdifferentiated HC and moderate-and high-differentiated HC were 88.2％ and 64.3％,and area under ROC curve was 0.814 [95％ confidence interval (CI):0.69-0.90,P＜0.05].Using 1.243×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of Ki-67 score ≤ 10％ and ＞ 10％ were 66.7％ and 75.0％,and area under ROC curve was 0.783 (95％CI:0.62-0.90,P＜0.05).Using 1.222×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of lymph node metastasis were 91.3％ and 71.4％,and area under ROC curve was 0.873 (95％CI:0.76-0.94,P＜0.05).(4) Treatment and followup situations:65 patients underwent successful radical resection of HC.Thirty-three patients were followed up for 1-24 months.Of 33 patients,5 had tumor recurrence within 6 months postoperatively,including 4 with ADC ＜ 1.100× 10-3 mm2/s,13 had tumor recurrence after 6 months postoperatively,and 15 didn't have tumor recurrence or metastasis,including 1 with ADC ＜ 1.100× 10-3 mm2/s.Conclusions There are different ADC in differentTNM staging,pathological grading,Ki-67 score and with or without lymph node metastasis of HC.ADC of DWMRI can be used as a preoperative imaging predictor for invasiveness of HC.
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Objective To develop a gas dynamic exposure device with a simple structure.Methods The device was composed of a water tank, an gas chest, an exposure kit and an gas-out bottle. The chest body was made of organic glass pane, drainage method was used to distribute the gas properly, and airflow was regulated with the gravity and valve.Results The device was proved to have simple structure and high effects.Conclusion The device has low cost, simple structure and properly distributed gas, and can be reused for exposure test.
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Objective To investigate the application value of multifunctional dynamic flat panel X-ray detector in intravenous pyelography.Methods Total 540 patients with intravenous pyelography were divided into multifunctional dynamic flat panel X-ray detector group (300 cases) and conventional flat panel X-ray detector group (240 cases) by random digits table method.Image quality,radiation dosage and examination time were analyzed and compared between the two groups.Results There was no statistical difference between the two groups in image quality (P ＞ 0.05).The examination time and radiation dosage was (25.5 ± 8.2) min and (12.5 ± 6.8) mAs respectively in multifunctional dynamic flat panel X-ray detector group and (39.2 ± 12.1) min and (23.6 ± 7.6) mAs in conventional flat panel X-ray detector group.The differences had statistical significance (P ＜ 0.01).Conclusions Multifunctional dynamic flat panel X-ray detector in intravenous pyelography can provide lower radiation dose,shorter examination time and higher image quality.It has obvious advantages in urography.
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Recently, the incidence of both diabetes mellitus and diabetic foot has been increasing.Ischemia, neuropathy, and infection are major causes of diabetic foot ulcer. In addition to other conventional treatments, hyperbaric oxygen is an effective adjunctive therapy with less side-effects. Hyperbaric oxygen may play a role through different mechanisms in improving the prognosis of diabetic foot.
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Objective To discuss the apparatus of inspired oxygen in hyperbaric oxygen(HBO)chamber for patients after tracheotomy.Methods Many kinds of apparatus of inspired oxygen were analyzed,including composition,usage and characteristics.Results The apparatus of inspired oxygen play an active role in treating patients.But in the above apparatus,there are great differences in serving range,efficiency of inspired oxygen,curative effect,reliability and so on.Conclusions When serious patients after tracheotomy are treated in HBO chamber earlier,it is very important to select reasonable apparatus.
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Objective To investigate the application and administration of hyperbaric oxygen chambers in Beijing.Methods Forty-eight hospitals with hyperbaric oxygen chambers in Beijing were investigated by field investigation,letter investigation or telephone investigation.The investigation includes grades of hospital,personnel,equipment,therapy of severe cases,time of therapy and treatment plans in questionnaire.Results Hyperbaric oxygen was popular in Beijing,which ensured emergency treatments.But the scale was little relatively and the number of full-time technicians was less,besides,the therapeutic system and plans were diversified,which should be standardized.Conclusions Something must be done to improve the conditions of hyperbaric oxygen medicine in Beijing,such as cultivating personnel,standardizing therapeutic system,standardizing treatment plans,realizing computer control and so on.
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Objective:To observe the effect of partial liquid ventilation (PLV) on gas exchange,pulmonary compliance and blood dynamics in the pulmonary edema rabbits after seawater drowning(PE-SWD). Methods:Totally 42 healthy male New Zealand rabbits were randomly allocated into 3 groups (n=14);each group was treated with various methods after PE-SWD model was established:PE group with no treatment,CMV group with conventional mechanical ventilation and positive end-expiratory pressure(PEEP),PLV group with CMV,PEEP and FDC.After being treated for 3 h,blood gases,pulmonary mechanics,hemodynamics,pulmonary histopathology and survival time were observed.Results:In PLV group,PaO 2 increased obviously and reached (262.84?64.33) mmHg (1 mmHg=0.133 kPa), airway pressure decreased by 23.4%,pulmonary static compliance increased by 31.3% and TNF-? decreased by 24.9%.HR and MAP showed no significant changes after treatment compared with PE group.Conclusion: Pulmonary gas exchange and compliance are improved significantly during PLV in the PE-SWD rabbits without obvious influence on hemodynamic status, although the survival time of PLV group is less than that of CMV group.
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Objective To evaluate the application of mobile ultrasonoscope in earthquake rescue. Methods According to the characteristic of environment and traumatic conditions in earthquake area, the mobile ultrasonoscope was used to diagnose for clinicians, and the advantages and disadvantages were evaluated. Results The mobile ultrasonoscope played an important role in routine diagnosis, such as organic injury and calculus, superficial organellae injury, soft tissue injury, injury of limbs and blood vessels, gynaecology and obstetrics and so on. As far as certain conditions were conferred in which the mobile ultrasonoscope was seldom used to diagnose in common practice, it played a dramatic role too in bone fracture, joint damage, craniocerebral injury and foreign objects. Conclusion In routine diagnosis or certain conditions, the mobile ultrasonoscope is very practical, especially in earthquake rescue.
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This paper introduces the current situation of hyperbaric oxygen (HBO) therapy, the environment characteristics in HBO chamber and the qualification of sputum aspirators. What's more, this paper also describes the construction, principles and characteristics of all kinds of sputum aspirators in HBO chamber. When critical patients are treated in HBO chamber, it is very important to select reasonable sputum aspirators.
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When the tracheotomy and tracheal intubation patients were treated in hyperbaric oxygen chamber,not ordi-nary facemask but specially made therapeutic facilities should be used.To select a more reasonable therapeutic facility for patients treatment in HBO chamber,all kinds of hyperbaric oxygen therapeutic facilities for the tracheotomy and tracheal intubation patients of our country in recent years are introduced from the aspects of material,facility,impermeability,ther-apeutic efficiency,influences on oxygen concentration in chamber,the advantages and disadvantages of each kind were demonstrated.