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Objective:To investigate the management of patients with intravenous misplacement of nephrostomy tube following percutaneous renal surgery.Methods:The data of 6 patients with intravenous misplacement of nephrostomy tube during percutaneous nephrolithotomy (PCNL) treated in the two hospitals of Chenzhou from January 2006 to December 2020 were retrospectively analyzed. The median age was 41.0(38.5, 53.0) years old. There were 4 males and 2 females. Three patients had undergone contralateral upper urinary tract operation. One patient had undergone ipsilateral upper urinary tract operation. Two patients had not undergone upper urinary tract operation. Two of the 6 patients had a solitary kidney. Two patients were diagnosed with staghorn calculi (combined with mild hydronephrosis in 1 patient, moderate hydronephrosis in 1 patient). Four patients were diagnosed with ureteral calculus (combined with mild hydronephrosis in 2 patients, moderate hydronephrosis in 1 patient, severe hydronephrosis in 1 patient). In all 6 patients, the tract was dilated with fascial dilators. Immediately after dilator removal, brisk venous bleeding was noted. A nephrostomy tube was inserted promptly through the sheath to tamponade the tract and was immediately closed. Five cases were diagnosed by CT after operation, and 1 case was early diagnosed by intraoperative injection of contrast medium through nephrostomy tube. The nephrostomy tube was misplaced in 5 patients with left upper urinary tract calculi, and in 1 patient with right upper urinary tract calculi. The tip of nephrostomy tube was located in ipsilateral renal vein in 3 patients with left upper urinary tract calculus, inferior vena cava in 2 patients with left upper urinary tract calculus, and contralateral renal vein in 1 patient with right upper urinary tract calculus. No venous thrombosis of renal vein or inferior vena cava was founded in the 6 patients. All 6 patients were managed with strict bed rest, intravenous antibiotics, and one-step or two-step tube withdrawal under close monitoring. One step method referred to total removal of nephrostomy tube under ultrasonic monitoring. Two step method referred to retracting the end of nephrostomy tube into the renal sinus under CT monitoring in the first step, then the nephrostomy tube was completely removed under ultrasound monitoring.Results:All 6 patients were successfully managed with strict bed rest, intravenous antibiotics, and one-step or two-step tube withdrawal under close monitoring. The tube was withdrew by one-step method in 1 patient, by two-step method in 5 patients. The original operations were performed successfully under close observation in 4 patients during the same hospitalization and in 1 patient during the next hospitalization. Other type of operation in 1 patient was performed during the next hospitalization. The all 6 patients were discharged uneventfully. The stone was cleared.Conclusions:Intravenous misplacement of a nephrostomy tube is mainly diagnosed by CT. The nephrostomy tube should be sealed immediately after diagnosis. The intravenously misplaced nephrostomy tube can be successfully removed by one-step or two-step withdrawing under close monitoring. Upper urinary tract stones can be successfully treated at the same time or by stages.
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Objective:To explore the setup errors of vacuum pad combined with breast bracket in linear accelerator intensity-modulated radiotherapy for breast cancer.Methods:The clinical data of 72 patients who received linear accelerator intensity-modulated radiotherapy after breast conserving surgery in Hai'an Hospital of Traditional Chinese Medicine from July 2017 to March 2022 were retrospectively analyzed. According to the radiotherapy fixation schemes, they were divided into vacuum pad group (24 patients), breast bracket group (27 patients) and vacuum pad combined with breast bracket group (21 patients). Cone-beam CT was used to analyze the setup errors of the fixation, and the mean value of the overall errors and the standard deviation of the system errors were calculated. The relative factors affecting the fixed setup errors were analyzed.Results:There were statistical differences among vacuum pad group, breast bracket group and vacuum pad combined with breast bracket group in the level of forward and backward (Z) direction translation error (2.11±0.41, 2.67±0.26 and 1.79±0.21) and Z direction rotation error (1.14±0.24, 1.05±0.21 and 0.91±0.22) ( F values were 45.86 and 6.21, both P < 0.05). The level of Z direction translation error in vacuum pad group was higher than that in vacuum pad combined with breast bracket group, and the difference was statistically significant ( t = 12.37, P = 0.001). The level of Z direction rotation error in breast bracket group was higher than that in vacuum pad combined with breast bracket group, and the difference was statistically significant ( t = 3.41, P = 0.001). In the breast bracket group, the planning target volume (PTV) extension boundary values in the left and right (X), up and down (Y), and Z directions were 2.02, 2.09 and 1.97; the PTV release boundary values in X, Y and Z directions of the vacuum pad group were 1.81, 2.07 and 2.25; the external boundary values of PTV in X, Y and Z directions of the vacuum pad combined with breast bracket group were 1.13, 1.51 and 1.49. The result of multifactor analysis showed that body mass index (BMI) ( OR = 4.208, 95% CI 1.438-12.312) and breast volume ( OR = 4.023, 95% CI 1.375-11.769) were the independent influencing factors of fixed setup errors (both P < 0.05). Conclusions:The application of vacuum pad combined with breast bracket in the fixed setup of linear accelerator intensity-modulated radiotherapy of breast cancer is helpful to reduce the fixed setup errors, but at the same time, the fixed setup errors is affected by the patient's BMI, breast volume and other factors.
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Objective To study the clinical features of hepatic pseudolymphoma.Methods A retrospective study was conducted on 19 patients with hepatic pseudolymphoma who were diagnosed and treated at Zhongshan Hospital in Shanghai from June 2013 to December 2017.Eighteen patients were females and one was a male.The mean age was (55±9) years,range 36 to 68 years.This study mainly analyzed the imaging features,treatment and postoperative results.Results All patients were diagnosed accidentally,and 78.9％ patients did not exhibit any evidence of hepatic B viral infection.A monofocal lesion was found in 14 patients and multifocal lesions in 5 patients.Surgical treatment was performed in all the patients.The lesion size was (1.1±0.4) cm (range 0.5～2.4 cm).Ultrasound revealed hypo-or slightly hypo-echogenicity.On MRI,diffusion weighted imaging showed slight hyperintensity or hyperintensity,all lesions manifested as homogeneous and slightly hyperintensity on T2WI and hypointensity on T1WI.Dynamic enhancement pattern,wash in and wash out,degressive and persistent enhancement were observed in 16(55.2％),12(41.4％),and 1 (3.4％) patients,respectively.More than 70％ of lesions were diagnosed as malignant tumors on preoperative imaging.During a follow-up of 6 ～ 44 months (median:19 months),no patient developed metastasis or recurrence.Conclusions Hepatic pseudolymphoma commonly occurred in women with a small sized lesion.Due to the lack of specific clinical manifestations and imaging findings,preoperative diagnosis was difficult.Surgical resection is still the most optimal treatment.The patients usually have favorable prognosis.
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Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)and multi-phasic enhanced MRI in the classification of clear cell renal cell carcinoma(ccRCC).Methods The data of 91 patients with pathologically confirmed ccRCC who all underwent multi-phasic enhanced MRI and IVIM-DWI examination were analyzed retrospectively. According to Fuhrman classification criteria,grade Ⅰ - Ⅱ were defined as low-grade group(n=73),grade Ⅲ - Ⅳ were defined as high-grade group(n=18).Mann-Whitney U test,independent sample t test and receiver operating characteristic(ROC)analysis were used for statistical analysis.Results The maximal diameter and pathological stage of ccRCC in the low-grade group were lower than those in the high-grade group,and the differences between the two groups were statistically significant(P<0.001 and P=0.003). The signal intensity and enhancement rate of ccRCC in the high-grade group in corticomedullary phase and parenchyma phase were lower than those in the low-grade group,but there was no significant difference between the two groups(all P>0.05).The ADC and D values of ccRCC in the high-grade group were lower than those in the low-grade group,and the differences between the two groups were statistically significant(P=0.007 and P=0.009).However,there was no significant difference of D *and f between the two groups(P=0.604 and P=0.695).Conclusion Multi-phasic enhanced MRI scanning has a limited value in the classification of ccRCC.IVIM-DWI derived diffusion-related parameters(ADC and D)is of great significance for differentiating between high-grade and low-grade ccRCC.
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Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the staging of chronic kidney disease(CKD).Methods From May 2016 to April 2017,seventy-two patients diagnosed as CKD according to the criteria of clinical diagnostic and 20 healthy volunteers (control group) underwent routine MRI and IVIM-DWI ( 8 b values, 0 to 800 s/mm2).CKD patients were divided into two groups based on their estimated glomerular filtration rate (eGFR): mild CKD group(45 cases,eGFR≥60 ml·min-1·1.73m-2)and moderate to severe CKD group(27 cases,eGFR<60 ml·min-1·1.73 m-2).The ADC,true diffusion coefficient(D),pseudo-diffusion coefficient(D*),perfusion fraction (f) were measured on both cortex and medulla. The paired-samples t test was used to compare the cortico-medullary difference of the ADC,D,D*and f values in three groups.Differences of the ADC,D, D*and f values among three groups were compared using the one-way analysis of variance (ANOVA). Correlations between eGFR and the IVIM-DWI parameters in CKD were evaluated by using Pearson correlation analysis. ROC was performed to evaluate the diagnostic efficiency of using IVIM-DWI parameters to distinguish CKD with moderate to severe renal impairment from mild renal impairment, as well as distinguish CKD with mild renal impairment from healthy volunteers.Results The cortical ADC,D, D*and f values were significantly higher than that in the medulla in healthy volunteers(all P<0.05). The cortical ADC,D*and f values were significantly higher than that in the medulla in mild CKD group(all P<0.05). The cortical ADC,D and f values were significantly higher than that in the medulla in moderate to severe CKD group (all P<0.05). The ADC,D,D*and f values of cortex and medulla showed significantly differences among three groups(all P<0.05).In CKD patients,no significant correlation was found between medullary D*,f values and eGFR, there was a significant positive correlation between eGFR and cortical ADC,D,D*and f values(r=0.475,0.362,0.625,0.276;all P<0.05),as well as between eGFR and medullary ADC,D values(r=0.427,0.615;P<0.05). The results of the ROC analysis for distinguishing the mild CKD group from the moderate to severe CKD group revealed that the cortical D*value had the highest area under the ROC curve (AUC=0.965), cortical f value showed high sensitivity(92.6%) to distinguish CKD with different degree of renal impairment, with the threshold of 32.99%, and cortical D*value showed high specificity(97.8%)with the threshold of 17.07×10-3mm2/s;the results of the ROC analysis for distinguishing the mild CKD group from healthy volunteers revealed that the cortical D*value had the highest AUC(0.885), medullary ADC value showed high sensitivity (82.2%) to distinguish mild CKD group from healthy volunteers,with the threshold of 1.83×10-3mm2/s,and medullary f value showed high specificity(100.0%)with the threshold of 21.70%,as well as medullary D value showed high specificity(100.0%)with the threshold of 1.75× 10-3mm2/s.Conclusion IVIM-DWI may be useful for CKD early diagnosis and assessing renal function.
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Objective To observe the impact of heterogeneous echo in endometrial region on pregnancy rate after fertilization in vitro/intracytoplasmic sperm injection (IVF/ICSI).Methods Totally 334 patients who underwent IVF/ICSI therapy were enrolled.According to results of B-mode ultrasound in the course of promoting drainage,the patients were divided into heterogeneous echo group (n=88) and normal echo group (n=246).Pregnancy conditions were compared between the two groups.Results Heterogeneous echo group showed significant lower pregnant rate than normal echo group (68.18％ [60/88] vs 78.86 ％ [194/246],P=0.01),while the ectopic pregnancy rate of heterogeneous echo group was higher than that of the normal echo group (5.00％ [3/60] vs 1.03％ [2/194],P=0.01).Pregnancy rate of endometrial thickness patients were higher than that of patients without endometrial thickness in two groups (all P＜0.05).Conclusion Pregnant rate reduced and ectopic pregnancy rate increased in infertility patients with endometrial heterogeneous echo,while higher 10 mm endometrial thickness could contribute to increase pregnant rate.
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Objective To study the current status of personality characteristics of the left-behind rural junior middle school students in Chongqing Three Gorges reservoir area,and to analyze the influence of different left-behind status on the development of junior high school students' personality.Methods The stratified cluster sampling method was adopted to extract the left-behind rural junior middle school students aged 12-15 years old from 1 vocational middle school and 2 junior middle school in Wuxi,Yunyang and Wanzhou of the Chongqing Three Gorges reservoir area.A questionnaire survey was conducted by using the Eysenck Personality Questionnaire (EPQ) children's edition and self-compiled questionnaires.The original scores were converted into the standard scores (T) for conducting the comparative analysis.Results A total of 438 questionnaires were issued and 380 effective questionnaires were recycled with the effective rate of 86.8 ％,including 204 left-behind junior middle school students and 176 nonleft-behind junior middle school students.The typical neuroticism (T≥61.5) in the left-behind rural junior middle school students accounted for 31.4％,the typical introversion type and extroversion type respectively accounted for 7.8％ and 7.4％.The scores in the dimensions of nervouness and neuroticism had statistical difference between the left-behind junior middle school students and non-left-behind junior middle school students (P＜0.05).The family income and age had a significant impact on the concealed personality of left-behind junior high school students (P＜0.05);grandparents as caregivers had a significant impact on introversion and extroversion in different genders of left-behind junior high school students (P＜0.05).The introversion and extroversion scores of father caring students were lower than those of non-father caring students (P＜0.05).The concealing scores of father caring students were lower than those of non-father caring students(P＜0.05).Conclsion The family factor and school factor are main causes affecting the personality characteristics of the left-behind junior middle school students.
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Objective To investigate the prevalence rates of healthcare-associated infection (HAI) and antimicrobial use in a psychiatric hospital.Methods The annual cross-sectional survey on HAI among all hospitalized psychiatric patients from 0:00 to 24:00 of June 20, 2012-2015 were conducted, HAI during 4 years were analyzed.Results A total of 2 584 hospitalized patients were surveyed, 47 patients had 48 episodes of HAI, the prevalence rate and case prevalence rate of HAI were 1.82% and 1.86% respectively;prevalence rates in 2012-2015 were 2.09%, 1.56%, 1.48%, and 2.11% respectively(x2=1.23, P=0.75).The top three departments of high prevalence rates were male section of medical rescue department(3.80%), male section of acute intervention department(3.31%), and department of geriatric psychiatry(2.78%).The top three infection sites were upper respiratory tract (31.91%), lower respiratory tract (29.79%), and gastrointestinal tract(14.89%);28 strains of pathogenic bacteria were detected, the top three pathogens were Escherichia coli (28.58%), Klebsiella pneumoniae (17.86%), and Staphylococcus aureus (14.29%);antimicrobial use rates in 2012-2015 were 10.91%, 5.78%, 5.41%, and 5.06% respectively, which decreased year by year(x2=23.13,P<0.01).Conclusion Prevalence rates of HAI in four consecutive years maintained a low level in this hospital, antimicrobial usage rates decreased year by year.
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Objective To identify the imaging performance and differences between type] and type Ⅱ papillary renal cell carcinoma (PRCC).Methods Data of 21 lesions of type Ⅰ,27 lesions of type Ⅱ (1 patient had 2 lesions) in 47 patients was retrospectively analyxed.All patients with pathologically proven PRCC were examined by contrast CT or MRI preoperatively.The morphological features,outside invasion signs and performance on contrast-enhanced CT were compared by qualitative and quantitative studies.The maximum diameter of tumors and CT values,△CT values in corticomedullary and nephrographic phase were analyzed by two-sample t-test,classified variable were compared by the Pearson X2 test or the Fisher exact test.Results On morphological behaviors,type Ⅱ PRCC were significantly larger than type Ⅰ PRCC (t =-2.604,P =0.013),more heterogeneous (X2 =14.928,P =0.000),greater probability to show cystic degeneration or necrosis (X2 =5.598,P =0.018) with more severity (X2 =4.769,P =0.029).There was no significant difference in hemorrhage and calcification between the two types observed by contrast-enhanced CT.Respectively,66.7 ％ of type Ⅱ PRCC and 23.8％ of type Ⅰ PRCC had papillary nodule,with obviously significant difference (X2 =8.694,P =0.003).In outside invasion signs,except for margins,type Ⅱ had more easily invaded peripheral fat,renal sinus and distant metastasis compared with type Ⅰ (P＜0.05).On contrast enhanced CT,there were significant differences in CT values and △CT values in corticomedullary phase between the two types (t =-2.674,P =0.012;t =-3.109,P =0.005).And there were no significant difference in unenhanced and nephrographic phase.Conclusions There were certain difference in morphological features,outside invasion signs and enhancement degree between type Ⅰ and type Ⅱ PRCC,and part of type Ⅱ PRCC had aggressive biological behaviors with worse prognosis.
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Objective To establish and validate the ascites volume forecast model of ascites puncture drainage operation with ultrasound measuring for 6 positions in patients with ovarian hyperstimulation syndrome (OHSS),including front of the uterus,Douglas pouch,right iliac fossa,left iliac fossa,hepatorenal recess and spleen kidney fossa.Methods Fifty patients received ultrasonographic measurement (measurement group) and then underwent ascites puncture drainage operation within 6 h.Three scatter diagrams of actual ascites volume (Y;ml) and key position ascites depth summation (X;mm),height correlation coefficient and surface area correlation coefficient were drawn.The simple and practical regression equation with better correlation was used to be the one verified.Then 100 subsequently HSS patients were enrolled in verrification group.Forecast ascites volume calculated with above-mentioned regression equation and actual ascites volume was analyzed with Bland-Altm an method and paired t test.Results Regression equation obtained with the scatter diagram was Y=-256.554 + 10.452X (R2 =0.577),which could be simplified as Y=10.5X-250.0.The limit of consistency between forecast ascites volume and actual ascites volume was (-1 314.02,1 560.48) ml,and the bias was 123.23 ml.The difference between forecast ascites volume and actual ascites volume was not statistically significant (t=-1.684,P=0.096).Conclusion The simplified equation is Y=10.5X-250.0 to forecast ascites volume caused by OHSS,therefore guiding clinical work.
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Objective To observe the muscles and skeleton involvement surrounding sacroiliac joint (SIJ) of axial seronegative spondyloarthropathy (SPA) patients with magnetic resonance imaging (MRI),and to analyze the relationship between them.Methods A prospective study of 38 patients who meet the 2009 axial SpA diagnostic criteria was conducted.We carried out MRI of the SIJ for these patients to evaluate the muscles and skeleton involvement.Those cases were divided into muscles differences between the two groups of image scores,including Spondyloarthritis Research Consortium of Canada (SPARCC) scores and Spondyloarthritis Research Consortium of Canada MRI Sacroiliac Joint Structural Score (SPARCC SSS).The extent of muscles edema in patients with sacroiliac joints was ranked into twelve grades from 0-12,and we did Spearman rank correlation test of muscles edema scope and two indexes.Results We found that 28 cases (73.68％) of the 38 patients had significant muscle involvement by analyzing the STIR sequence,and found erector spinae in 22 cases (57.89 ％)gluteal muscles in 13 cases (34.21 ％),iliacus muscle in 11 cases (28.95 ％),obturator muscle in 5 cases (13.16％),piriform muscle in 5 cases (13.16％) and other 4 cases (10.53％).SPARCC (t =2.28,P =0.03) and SPARCC SSS (t =3.37,P =0.00) were statistically different between the two groups.SPARCC (P =0.00,r =0.67) and SPARCC SSS (P-0.01,r =0.47) were positively correlated with the extent of muscles edema.Conclusions The muscles edema around sacroiliac joint is an important sign of axial SpA magnetic resonance imaging.Patients who had muscles edema tended to have more serious skeleton changes.
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Objective: To understand the medication compliance of inpatients with essential hypertension, analyze the influencing factors in medication compliance of the patients and perform the targeted medication education and pharmaceutical care.Methods: Medication education and guide were conducted in 50 cases of patients with essential hypertension based on the main contents in guidelines for prevention of hypertension.Every patient completed regular follow-ups in two months after being recruited.The relevant information about the treatment and medication were collected and analyzed.Results: Through the medication education and pharmaceutical care, the patients had a better understanding on the relevant knowledge of hypertension, rational drug use and treatment.Among the 50 patients, the percentage of completely following the doctor's advice on the hypertension medication was 86%, that of quitting smoking and limiting alcohol was 82%, and that of optimized life way was 78%, and totally 82% of the patients effectively controlled blood pressure or improved markedly when compared with the situation on admission.Conclusion: Medication education and pharmaceutical care conducted by clinical pharmacists is very important for the patients with high blood pressure.It can help patients build a good lifestyle or improve the quality of life by improving the medication compliance of patients, alleviating complications and reducing adverse drug reactions.
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The psychiatric problem has become a global public health issue. The model of mental health service advocate that“Treatment of disease occurred in the hospital, but rehabilitation and management in the community”. This brings great challenge to the community health service center. By comparing the domestic and foreign mental health service system, this paper discusses the necessity of carrying out the standardized training of general practitioners in psychiatry and psychology.
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Objective To analyze quantitatively intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI)of normal adult kidney and to evaluate the effects of the location of the kidney,gender and age on IVIM-DWI parameters.Methods Thirty healthy adult volunteers were recruited to undergo IVIM-DWI examination.Two radiologists measured the D ,D? and f values of renal parenchyma in both the upper pole,middle part and lower pole of the kidneys separately.Results The D ,D? and f values of the middle part of kidneys in healthy adult were(1.61±0.1 6)×10 -3 mm2/s,(1 7.45 ±3.78)×10 -3 mm2/s and (26.88 ±5.1 9)%, respectively.The D values of right kidney were higher than that of left kidney (P 50 years group were lower than that of ≤50 years group (t = 3.548,P=0.001).D value of the kidney and age was negatively correlated (r=-0.406).Intraclass correlation coefficient of D,D? and f values between two observers were 0.881,0.56 and 0.741,respectively.The consistency of two observers in measurement of IVIM-DWI parameters in the middle part of kidneys was higher than that of the upper pole and lower pole of the kidneys.Conclusion The IVIM-DWI parameters of adult normal kidneys are influenced by different parts of the kidney,gender and age.
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OBJECTIVE: To compare the diagnostic accuracy of intravoxel incoherent motion (IVIM)-derived parameters and apparent diffusion coefficient (ADC) in distinguishing between renal cell carcinoma (RCC) and fat poor angiomyolipoma (AML). MATERIALS AND METHODS: Eighty-three patients with pathologically confirmed renal tumors were included in the study. All patients underwent renal 1.5T MRI, including IVIM protocol with 8 b values (0–800 s/mm²). The ADC, diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were calculated. One-way ANOVA was used for comparing ADC and IVIM-derived parameters among clear cell RCC (ccRCC), non-ccRCC and fat poor AML. The diagnostic performance of these parameters was evaluated by using receiver operating characteristic (ROC) analysis. RESULTS: The ADC were significantly greater in ccRCCs than that of non-ccRCCs and fat poor AMLs (each p 0.97 × 10⁻³ mm²/s, D* < 28.03 × 10⁻³ mm²/s, and f < 13.61% maximized the diagnostic sensitivity for distinguishing non-ccRCCs from fat poor AMLs. The final estimates of AUC (95% confidence interval), sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the entire cohort were 0.875 (0.719–0.962), 100% (23/23), 75% (9/12), 88.5% (23/26), 100% (9/9), and 91.4% (32/35), respectively. CONCLUSION: The ADC and D showed similar diagnostic accuracy in distinguishing between ccRCCs and fat poor AMLs. The IVIM-derived parameters were better than ADC in discriminating non-ccRCCs from fat poor AMLs.
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Humans , Angiomyolipoma , Area Under Curve , Carcinoma, Renal Cell , Cohort Studies , Diffusion , Diffusion Magnetic Resonance Imaging , Magnetic Resonance Imaging , Perfusion , ROC Curve , Sensitivity and SpecificityABSTRACT
<p><b>OBJECTIVE</b>To analyze the value of MR imaging in diagnosis of intraductal papillary neoplasm of the bile duct (IPN-B).</p><p><b>METHODS</b>Fourteen patients with intraductal papillary neoplasms of the bile duct confirmed by surgical pathology were included in this study. The patients underwent MR routine plain scanning and enhancement scanning (including T1WI, T2WI with fat suppression, FALSH T1WI, and three-phase enhancement scanning), diffusion weighted imaging(DWI) and magnetic resonance cholangiopancreatography (MRCP) before operation. The imaging data were reviewed and analyzed retrospectively in comparison with the surgical and pathological results.</p><p><b>RESULTS</b>In these patients, 7 cases had tumors located in the left lobe, 2 cases had tumors in both the left and right lobes, 2 cases in the hepatic hilum, 2 cases in the common bile duct, and 1 case in both the right lobe and the common bile duct. Solitary or multiple intraductal masses could be found in 12 cases, with 11 cases appeared as papillary masses and one case as flat mass. In the other two cases the tumor was not visible (one case had too many stones, and in another case the tumor was too small). The tumors in the 12 cases showed hypointensity on T1WI and hyperintensity on T2WI. On the dynamic contrast-enhanced MRI, 11 cases showed mild and one showed moderate enhancement in arterial phase, and all the cases showed mildly and gradually delayed enhancement. On DWI, the lesion areas showed high signal intensity in all the cases, and the ADC value of the tumor area (1.697×10(-3)mm(2)/s) was significantly lower than that of the normal bile (3.973×10(-3)mm(2)/s) (t = -10.94, P < 0.05). Twelve cases demonstrated filling defects on primary MRCP coronary thin section images. On 3D-reconstruction MRCP images, 7 cases exhibited diffuse bile duct dilatation with the tumor areas more prominent, 3 cases exhibited aneurysmal bile dilatation, while the rest 4 cases exhibited segmental or lobar bile duct dilatation ( including 2 with invisible tumors ). In the 3 cases with aneurysmal bile dilatation, the multiple directions of MRCP images helped to find the communication between the aneurysmal dilatation and the bile duct. All the cases showed significant proximal bile duct dilatation (the extent of dilatation >100%), and 9 cases also showed distal bile duct dilatation. Bile duct stones were noted in 6 cases, 4 at the tumor area, and the other 2 away from the tumor area. No adjacent tissue invasion and no distal tissue or lymph node metastasis were observed.</p><p><b>CONCLUSION</b>Intraductal papillary neoplasms of the bile ducts have characteristic imaging appearances on MRI, and MRI is an important method helpful to making correct diagnosis.</p>
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Humans , Bile Duct Neoplasms , Diagnosis , Bile Ducts , Cholangiopancreatography, Magnetic Resonance , Common Bile Duct , Diagnostic Imaging , Diffusion Magnetic Resonance Imaging , Magnetic Resonance Imaging , Retrospective StudiesABSTRACT
Objective The status quo of multidimensional life satisfaction of college medical students understanding and its influ‐ence on mental health and to provide the scientific basis for the implementation of school mental health education .Methods 810 medical science college level students were measured with satisfaction status and mental health survey with self‐designed question‐naire and life satisfaction scale (MSLSS) ,mental health assessment scale (SCL‐90);Use SPSS19 .0 to establish a database for t test ,variance analysis ,correlation analysis and regression analysis ,descriptive etc .Results College level medical students in differ‐ent gender ,native place (birthplace) ,parents′educational level ,family economic status ,and whether the only child ,whether there are differences in the student cadre ,whether or not to participate in social practice life have different satisfaction score ;life satisfac‐tion scores and symptom self evaluation scale (SCL‐90) score of each factor were negatively related (P<0 .01) .Conclusion The current status of life satisfaction of medical students directly affect their psychological health .The intervention of medical students life satisfaction is an important means to promote mental health .
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Objective To investigate the MDCT and dual-energy CT (DECT)features of chromophobe renal cell carcinoma (chRCC)and to improve the diagnostic accuracy before operation.Methods The data of MDCT(46 cases of 47 lesions)and DECT (10 cases )of 56 patients with pathologically confirmed 57 chRCC were retrospectively analyzed.All of them underwent plain scan-ning,corticomedullary phase and parenchymal phase scanning after contrast material injection.The lesions were divided into ≤4 cm group and > 4 cm group according to its maximum diameter.Qualitative and quantitative analysis were compared between the groups.Results 64.9% of chRCCs were round and oval,87.7% of chRCCs were solid or mainly solid tumors.The incidence of hemorrhage,necrosis,calcification,cystic degeneration of the tumors was approximately 38.6%,36.8%,10.5% and 12.3%,respec-tively.Central scar(1 7.5%)and vascular sign (24.6% )were seen in part of chRCCs.The tumors showed iso and high attenuation on plain CT scanning in 47.4% and 45.6% of the lesions,respectively.The enhancement pattern of wash-in and wash-out,prolonged enhancement and delayed enhancement were seen in approximately 24.6%,66.7% and 8.8% of the lesions,respectively.The shape, necrosis and cystic degeneration,vascular sign and density uniformity between the two groups were statistically different.The CT value of the lesions were 37.29 HU,82.58 HU and 78.97 HU on unenhanced,corticomedullary phase and parenchymal phase CT scanning.The lesion-kidney ratio on the three phases was 1.29,0.62 and 0.55,respectively.There was no significant difference be-tween CT values and LKR values.The lesions and its subtle signs were much clearer on the 80 kV images of DECT after contrast in-jection.Conclusion The MDCT and DECT findings of chRCC have certain characteristics.However,when the lesions showed atypi-cal CT findings because of its different degree of enhancement and variable enhancement pattern,it would be very difficult to get an accurate diagnosis and the final results depend on pathological diagnosis.
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<p><b>OBJECTIVE</b>To analyze the CT and MRI findings and pathological characteristics of retroperitoneal localized Castleman's disease and discuss the diagnostic and differential value of CT and MRI.</p><p><b>METHODS</b>CT, MRI and clinical data of retroperitoneal localized Castleman's disease, proved by surgery and pathology, of 13 patients were reviewed. Among them, all the 13 cases received CT, and 4 cases received MRI examination.</p><p><b>RESULTS</b>Among the 13 cases, 12 cases were of hyaline vascular type, and one was of mixed type. All foci were single mass and most foci located in the periphery of the kidney. The maximum diameter was 4.2 cm to 8.6 cm and the mean diameter of all tumors was 5.9 cm. The outline of most tumors was clear and kidney-shaped. On unenhanced CT, 10 cases showed low density and 3 cases showed isodensity. On plain MRI, four cases showed iso-signal on T1WI, three cases showed slightly high signal on T2WI and one showed moderately high signal. The CT and MRI findings were similar on contrast enhanced scan. In arterial phase, 10 cases showed moderate enhancement, 2 cases showed significant enhancement and one case showed moderate enhancement. Five cases showed rather homogeneous enhancement and 8 cases showed heterogeneous enhancement.In venous phase, all the 13 tumors showed continuous enhancement. Eight cases showing heterogeneous enhancement in arterial phase showed expanded range, and among them two cases showed tending to be homogeneous enhancement. Six cases showed areas of low density without enhancement, and 9 cases were accompanied with single or multi-satellite punctuate or striped foci around the tumors.</p><p><b>CONCLUSION</b>Dynamic contrast-enhanced CT and MRI combined with MR T2WI fat-suppression are of great importance in the diagnosis and identification of retroperitoneal localized Castleman's disease.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Castleman Disease , Diagnostic Imaging , Pathology , General Surgery , Image Enhancement , Magnetic Resonance Imaging , Radiographic Image Enhancement , Retroperitoneal Space , Diagnostic Imaging , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective To explore the effect of transcription factor E2F1 on the apoptosis of small cell cancer line H446. Methods Plamid vector- mediated E2F1 small hairpin RNA (shRNA) was used to silence E2F1 in H446 cell. RT-PCR and western-blot assay were used to detect the expressions of E2F1 and Bcl-2. The apoptosis rate in H446 cell line was detected by flow cytometry assay. Result E2F1 protein was suppressed in shRNA1-modified H446 cell. Sgnificant difference of the apoptosis was shown between E2F1 shRNA1 group and the other two groups. Additionaly, the expression of Bcl-2 protein increased in E2F1 shRNA1-modified cell line. Conclusions E2F1 is highly expressed in H446 small cell lung cancer cell line. E2F1 promotes apoptosis of H446 through upregulating Bcl-2 expression.