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Chemotherapy is currently the main clinical treatment method for malignant tumors， and chemotherapy resistance is the main factor leading to chemotherapy failure and malignant tumor recurrence and metastasis. The cha-racteristics of malignant tumors formation were regarded as similar to the “Yin Fire” theory， manifested that deficiency of original qi as the foundation of malignant tumors， imbalance of original qi and yin fire as the internal cause of malignant tumor progression， and the internal environment of phlegm-blood stasis-toxicity-deficiency caused by yin fire promoted the formation of chemoresistance. In the treatment of chemoresistance of malignant tumors， traditional Chinese medicine should focus on treating disease before its onset by tonifying the spleen and strengthening the middle， nou-rishing the original qi， and reinforcing healthy qi and anti-cancer； during the treatment， the clinicians should regulate the qi and detoxify to clear yin fire， and improve the internal environment. Summarily， the strategies were adjusting the balance of internal environment of original qi and yin fire， and conducting a comprehensive treatment during the whole process， to provide new ideas for the treatment of chemoresistance of malignant tumors with traditional Chinese medicine.
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Objective:To investigate the feasibility of reducing radiation dose in coronary CT angiography for patients with arrhythmia with absolute phase and narrow window in prospective electrocardiogram-gating.Methods:200 patients with arrhythmia underwent coronary CT angiography procedure with prospective electrocardiogram-gating adaptive sequence in dual source CT were randomly divided into 2 groups according to the scan mode. Group A was scanned with absolute phase and narrow window(250-450 ms) and group B uesd relative phase and wide window (30%-75%). The other parameters and injection protocol of contrast media were the same in 2 groups. Both image quality and radiation dose of the 2 groups were analyzed.Results:No significant difference of image quality was found between the 2 groups. CTDI vol, DLP, E of group A were all lower than those in group B [CTDI vol : (16.71±8.35) vs.(29.35±17.90)mGy , DLP: (231.04±114.86) vs.(398.27±238.40)mGy·cm , E: (3.23±1.60) vs.(5.57±3.33)mSv, t=-6.40, -6.32、-6.32, P<0.05] . The patients with repeat scan cycles in group A and group B were 81 vs. 22 for 0 cycle , 17 vs. 62 for 1 cycle, 2 vs. 10 for 2 cycles, 0 vs. 6 for 3 cycles( χ2=70.76, P<0.05). Conclusions:The prospective electrocardiogram-gating adaptive CCTA sequence with absolute phase and narrow window can reduce radiation dose while the image quality meets the requirementsfor patients with arrhythmia.
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OBJECTIVE： To study the efficacy and economics of cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with multidrug-resistant Acinetobacter baumannii （MDRAB）. METHODS： By prospective study， 150 MDRAB pneumonia patients were selected from Jingmen Second People’s Hospital during Jan. 1st， 2016-Aug. 31st， 2019， and then randomly divided into control group and observation group， with 75 cases in each group. Control group was given Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Tigecycline for injection （first dose 100 mg， maintenance dose 50 mg， q12 h， ivgtt）. Observation group was give Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Moxifloxacin hydrochloride and sodium chloride injection （400 mg， qd， ivgtt） and Amikacin sulfate injection （0.6 g， qd， ivgtt）. The treatment lasted for 14 days in both groups. The time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal， clinical efficacy， bacterial clearance rate and the occurrence of ADR were compared between 2 groups. Cost-effectiveness analysis was used to evaluate the cost- effectiveness ratio （C/E） and incremental cost-effectiveness ratio （ΔC/ΔE） of 2 groups using antibiotics cost as cost. Sensitivity analysis was performed by reducing drug cost by 15％. RESULTS： There was no statistical significance in the time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal between control group and observation group （P＞0.05）. Clinical response rates of 2 groups were 85.33％ and 81.33％， and bacterial clearance rate were 89.33％ and 82.67％， with statistical significance （P＞0.05）. No serious ADR occurred in either group. The antibacterial cost of control group and observation group were 32 371.49 yuan/person and 9 367.82 yuan/person. C/E of clinical response rate were 379.37 and 115.18， and C/E of bacterial clearance rate were 362.38 and 113.32 in 2 groups， respectively. ΔC/ΔE of clinical response rate and bacterial clearance rate between control group and observation group were 5 750.92 and 3 454.00. Sensitivity analysis supported cost-effectiveness analysis results. CONCLUSIONS： Cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with MDRAB has similar efficacy， but cefoperazone/sulbactam combined with moxifloxacin and amikacin has economic and social benefits.
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Objective: To explore the imaging findings of mediastinal hemangiomas (MH) on multi-slice spiral CT. Methods: CT findings of 13 patients with MH were analyzed retrospectively. The location, shape, size, margin, density and enhancement pattern, mass-cardiovascular interface (MCI), mass-pulmonary interface (MPI) and other appearances of MH were observed. Results: Single mass with obscure margin was found in all 13 patients, located at anterior-middle mediastinum in 6 cases, at anterior-middle-posterior in 4 cases, while at posterior mediastinum in 3 cases. Diffuse pampiniform growth mass was found in 10 cases, with irregular-shape and obscure MCI, while mild and significant mass effect were observed in 9 cases mass and 1 case, respectively. Mild pampiniform growth and dumbbell-shape mass were observed in 2 cases, extended into spinal canal and compressed the spinal cord, and 1 mass showed expansive growth and oval-shape. MPI were clear in 12 cases and obscure in 1 case. Eight masses showed mixed density with stripe-like soft tissue in peripheral area, 2 masses showed homogenous density, 3 masses showed predominant fatty tissue with nodular or stripe-like soft tissue, among which the phleboliths were seen in 5 cases. All 13 masses showed heterogeneously nodular or stripe-like enhancement with delayed-enhancement, while significant draining veins were simultaneously seen in 12 cases, blood supply arteries in 7 cases and splenic hemangioma in 4 cases. Conclusion: CT findings of MH are relatively specific. Enhanced CT is valuable for preoperative evaluation and accurate diagnosis of MH.
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Objective To study and analyze the CT and MRI findings of hepatic eosinophilic infiltration. Methods Twenty nine patients of hepatic eosinophilic infiltration who were confirmed by biopsy or clinical diagnosis were retrospectively analyzed. All the patients underwent CT and/or MRI scan. Twenty seven cases underwent upper abdominal CT plain scan and three phase enhanced scan, and 5 cases underwent upper abdominal MR plain scan and three phase enhanced scan, of which 3 cases underwent CT and MRI scan. Evaluations were made regarding to the numbers of lesion, distribution, size, shape, margin, density or signal characteristic, enhancement parttern and other special features. Pearson correlation analysis was used to analyze the correlation between the number of hepatic lesions and the number of eosinophils in peripheral blood. Results A total of 108 lesions of eosinophilic hepatic infiltration were observed in 29 cases, including 2 cases with single lesion and 27 cases with multiple lesions. Ninety five of the lesions were located in subcapsular parenchyma or surrounding the portal vein. Most subcapsular lesions were wedge-shaped(n=28). Lesions surrounding portal vein were round-shaped(n=32), while the hepatic parenchymal lesions were irregular or round-shaped(n=13). The mean size of lesion was 34 mm, ranging from 3 to 61 mm. The margin of all the lesions were obscure. The lesions showed slightly low density or isodensity on CT pre-contrast images. On MR pre-contrast images, lesions showed slightly low signal or isointense on T1WI, and hyperintense on T2WI. Branches of portal vein were found infilrated by all lesions. Tueleve cases showed“stripe sign”along the portal vein branches, 16 cases showed“halo ring sign”around the portal vein. Pearson analysis indicated a significant correlation between the number of eosinophilic hepatic infiltrated lesions and the increase of eosinophils in peripheral blood (r=0.783, P<0.05). Conclusion The imaging features of EHI had certain characteristics, especially in the three phase dynamic enhanced scanning, from which we can mainly find“progressive enhancement”,“portal vein sign”,“stripe sign”and“halo ring sign”.
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Objective To evaluate the diagnostic value of multi-slice spiral CT (MSCT) in classifying coronary arteries of complete transposition of great arteries (D-TGA). Methods The clinical and imaging data of 367 patients with D-TGA who had undergone MSCT examination from March 2005 to June 2015 were retrospectively analyzed. The origin and course of the coronary arteries of the patients were classified according to the Marie Lannelongue classification. There were four patterns of courses: normal, looping, intramural and miscellaneous. And the four patterns were subdivided into eleven subgroups. The anatomic classification of coronary arteries in D?TGA were recorded, and the ratio of descriptive statistics was used according to categorical variable data. Results All the origin and course of the coronary arteries could be clearly displayed on MSCT. Of 367 patients with D-TGA, 209 cases (56.95%) were normal course (typeⅠ), 138 cases (37.60%) were looping course (typeⅡ), 16 cases (4.36%) were intramural course (typeⅢ), and 4 cases (1.09%) were miscellaneous course (typeⅣ). In looping course, the posterior looping (typeⅡA), anterior looping (typeⅡB) and double looping (typeⅡC) were found in 63 cases (17.17%), 30 cases (8.17%) and 45 cases (12.26%), respectively. The ratios of the anatomic classification of looping courses wereⅡA-1 44(11.99%),ⅡA-2 19(5.18%),ⅡB-1 12(3.27%),ⅡB-2 8(2.18%),ⅡB-3 10(2.72%),ⅡC-1 25 (6.81%),ⅡC-2 17(4.63%),ⅡC-3 3(0.82%). Conclusions MSCT is an effective technique to visualize and classify the coronary arteries in patients with D-TGA. And it is helpful for successful transfer of the coronary arteries and reducing the rate of coronary events after operation.
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Objective To investigate the CT and MRI features of desmoid-type fibromatoses(DF).Methods The images of 29 ca-ses with DF proved by pathology were reviewed retrospectively.CT and MRI examinations were performed in 1 5 cases respectively, and both in 1 case.Results The median age was 33.0 years with a male-to-female sex ratio of 1 ︰ 2.2.36 lesions were discovered,among which 26 cases were solitary while 3 cases had multiple focus.1 9 lesions were extra-abdominal,14 ones in the abdominal wall and 3 ones intra-abdominal.The largest diameter of tumors was 13 -1 75 mm.27 lesions displayed ovoid or elongated shape while 9 ones were irregular .The boundary could be clear or unclear.25 lesions extended along muscle planes with consistent long axis.23 focuses grew aggressively,1 6 of which crossed the muscle clearance,while 13 lesions grew expansively.On CT,20 lesions appeared iso-den-sity or slightly hypo-density compared with normal muscles,mostly homogeneous(1 5/20).Most lesions exhibited gadually moderate or obvious enhancement on post-contrast CT,and the enhancement was homogeneous or heterogeneous.1 7 lesions were found on MRI,which presented signal intensity similar to or slightly higher than that of muscles on T1 WI and most were homogeneous(12/1 7);on T2 WI,all were heterogenous with slightly high or high intensity.All lesions demonstrated obvious enhancement on MRI after contrast administration ,and most were heterogeneous(12/1 7).Sheets or bands of low signal were detected within 1 1 lesions with no enhancement.Conclusion DF has some characteristics on CT and MRI,which are valuable for accurate pre-operative diagnosis,and for evaluation of the lesion extent and involvement of adjacent structures.
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Objective To evaluate the value of iterative modal reconstruction (IMR) for reducing radiation dose and controlling image quality in cardiac CT. Methods Ten pigs were included. All pigs were scanned on a 256?slice prospectively ECG?gated cardiac CT utilizing routine dose (group A) and tube current reduced by 30%(group B), 50%(group C) and 70%(group D), respectively. Filtered back projection (FBP), hybrid iterative reconstruction (iDose4) and IMR were used for all data, respectively. Image noise and contrast?to?noise ratio (CNR) of ascending aortic root were measured, while overall image quality and coronary artery image quality was rated (five point scale). All results reconstructed by FBP, iDose 4 and IMR were compared. Objective measurements were compared with one?way analysis of variance, and subjective assessments were compared with Kruskal?Wallis H test andχ2 test. Results Compared with that of FBP and iDose4, image noise of IMR was(15.1 ± 6.1),(18.8 ± 5.5),(22.1 ± 4.8)and(33.0 ± 4.0)HU, respectively in group A, B, C and D with significant reduction (F=82.77, 90.71, 96.59, 95.51 respectively, all P0.05) in the diagnosis rates of proximal coronary arteries compared with that using FBP and iDose4, while group C (100%, 40/40) and group D(92%, 37/40) had significantly increased diagnosis rates (χ2=20.05, 45.72, both P<0.01). The diagnosis rates of distal coronary arteries of IMR reconstruction which were 100%(50/50), 98%(49/50), 90%(45/50), 78%(39/50), respectively in groups A, B, C, D had significant increase compared with that of FBP and iDose4 reconstruction (χ2=7.39, 16.75, 34.62, 81.33, all P<0.05). Conclusions IMR can significantly reduce image noise, improve CNR and image quality compared with iDose4. Application of IMR can reduce radiation dose but without compromising image quality.
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Objective To establish a function model to modulate the tube current according to the chest circumference at Coronary CTA scan,and to evaluate the feasibility of using the function model individually.Methods Sixty-eight consecutive patients who underwent thoracic scan with automatic current modulation were studied to establish a function model of tube current and chest circumference.The other 64 consecutive patients underwent coronary CTA scan using the new function model.The image quality was scored,and the noise,tube current and radiation dose were recorded and statistically evaluated.Results The POW function model was the best one to adjust tuber current to the chest circumference (R2 =0.691,P ＜ 0.05).The mean image quality score,noise,tube current,radiation dose (CTDIvol) and dose-length product (DLP) were (3.38±0.72) scores,(31.02 ±3.97) HU,(390.63± 89.30) mA,(34.83±10.72) mGy,(751.67 ±175.16) mGy·cm,respectively.Conclusions Tube current modulation based on the chest circumference would be feasible to reduce the radiation dose individually in coronary CT angiography.
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Purpose To explore the CT findings of gastric stromal tumor (GST) and primary gastric lymphoma (PGL) for differential diagnosis. Materials and Methods The CT findings of 26 patients with GST confirmed pathologically and 21 patients with PGL confirmed pathologically were retrospectively analyzed with regards to location of lesion, number, range, relation between lesion and gastric wall, density, enhancement pattern, change of gastric mucoma and serous layer, and encroachment of perigastric lymph nodes and other organs. Results CT scans demonstrated that all 26 GST cases had single localized mass with relatively well-defined margin (17 cases located in gastric fundus, 9 cases inside stomach body) and that all 21 PGL cases showed single irregular diffused thickening of gastric wall, and most of which located in 2 or 3 parts with ill-defined margin. On plain CT scan, all lesions of GST appeared slightly hypo-density or iso-density, or heterogeneous density [mean CT value (32±11) Hu];while all lesions of PGL presented homogeneous iso-density [mean CT value (52±9) Hu] with statistical difference (t=12.37, P<0.05). On contrast enhanced scan, GST showed obvious homogeneous or heterogeneous delayed enhancement whereas PGL displayed slightly homogeneous delayed enhancement with statistical difference (t=5.35, P<0.05). Smooth and clear gastric mucosa was found in 26 GST cases without any perigastric lymph node enlargement. Two PGL cases had obscure gastric mucosa and the other 19 PGL cases showed smooth and clear gastric mucosa, 6 PGL cases with lymph node enlargement. Conclusion On CT scan, lesions of GST are limited, with heterogeneous density and obviously heterogeneous enhancement; whilst PGL has diffuse lesions, associated with homogenous density and slightly homogeneous enhancement. The different features are helpful in the diagnosis for both diseases.
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Objective To assess the MRI features of cerebrum in idiopathic hypoparathyroidism (IHP). Methods MR images of 27 IHP patients were analyzed retrospectively emphasized on the location, appearance and signal intensity of the lesions. Results MRI showed symmetric abnormal signals in basal ganglia in 27 patients, in thalami and dentate nucleus in 21 patients, and in corona radiata-centrum ovale in 9 patients. All the lesions were hyperintensity on T1WI. Local hypointensity in basal ganglia was found in 4 patients, while hyperintensity or slight hyperintensity on both T2WI and T2-FLAIR were found in 26 patients, and slight hyperintensity with hypointensity on both T2WI and T2-FLAIR in 1 patient. Conclusion MRI of IHP has some features. Symmetric high signals on both T1WI and T2WI in basal ganglia, thalami and dentate nucleus have important diagnostic value for IHP.
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Objective To observe the imaging features of primary lymphoma of bone (PLB) on MRI and PET, and to assess the value of MRI combined with PET for PLB. Methods Sixteen patients with pathologically confirmed PLB were collected, and the MRI and PET appearances were analyzed retrospectively. Results Single bone infiltration was detected in 15 patients (5 in femurs, 3 in vertebro, 3 in right iliums, 2 in tibias, 1 in radius and 1 in maxillae), while multiple bones infiltration were noticed in 1 patient (lesion located in manubrium sterni and the 7th right rib). MRI demonstrated heterogeneous focal-lamellar or diffuse signal intensity within marrow, isointense or hypointense on T1WI and slightly hyperintense on T2WI with homogeneous or heterogeneous enhancement. Severe soft tissue mass was seen in all 16 patients, the range of soft tissue mass was larger than osseous lesion in 15 patients and equal to osseous lesion in 1. Most PLB were homogeneous isointense or slightly hypointense on T1WI and homogeneous or heterogeneous slight-hyperintense on T2WI with slightly or moderately homogeneous or heterogeneous enhancement, while in 3 patients showed single vertebral compression fracture with local epidural- and/or paravertebral-soft tissue, and the range of soft tissue larger than the pathologic vertebrae. PET was performed before operation in 13 patients, showing local increasement of glycometabolism and uptake of radioactive nuclide without abnormality for other sites. For three patients of primary lymphoma of vertebrae underwent PET after operation, and recurrence was detected in 1 patient after 2 months. Conclusion Large soft mass with small osseous destruction and relatively hypointensity on T2WI is somehow characteristic for PLB. PET features of PLB are not specific, but has some advantages in determining the nature of lesion, differentiating lesions and follow-up after operation. MRI combined with PET is an appropriate imaging method for PLB.
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Objective To explore the value of 64-slice CT coronary artery angiography in detecting anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) in infants. Methods Ten children aged from 5 months to 2 years and weighed from 5.5 to 10.0 kilograms with surgical confirmed ALCAPA were underwent contrast-enhanced retrospective ECG-gated 64-slice CT, and the data were retrospectively analyezd. Scanning were performed with 80 kV tube voltage, 150 mA tube current, 0.35 s rotation time, 0.625 mm slice thickness and 0.2 pitch. Results The heart rate ranged from 110 to 150 beats per minute. All images were good enough for diagnosis. The radiation dose was 1.11-1.62 mSv. The left coronary arteries were found to originate from the posterior-right sinuse in 4 patients, from posterior-left sinuse in 4 parients, from posterior-right wall and inferior wall above the pulmonary sinuses in 1 patient, respectively. Conclusion The 64-slice CT coronary artery angiography can reveal the location of the ectopic ostium and the course of left coronary artery in ALCAPA infants with low radiation dose.
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ranches of portal vein were found in 3 cases. Conclusion The multi-slice spiral CT findings of eosinophilie hepatic infiltration are relatively specific, and three-phase dynamic CT studies can be a valuable tool for the diagnosis of this disease.
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Objective To analyze the epidemiologieal characteristics of the pre-hospital care cases in Shanghai in the year 2007. Method Based the demographic records in the year 2007, the cases which from the database of Shanghai pre-hospital care center with full items were analyzed. Chi-square test and exact probabilities were used to compete the consfituent ratio; and the method of circular distribution was used to calculate the peak time, date and month. Results There were 86 815 patients with pre-hospital care well documented from the ur-ban districts of Shanghai. The ratio of male to female was 3.89: 1. The senile patients accounted for 84.95% of all the pre-hospital care ones. The major causes of disease in patients with pre-hospital care were trauma, eere-brovascular disease,cardiac diseases, coma, high fever, tumor emergency, acute abodomen emergency,OB/GYN emergency and upper G1 tract bleeding in turn. During the daytime, the occurrence of those emergency patients with pre-hospital care usually peaked at 2:15 o' clock with the high frequency in the period of 5:45 to 17:45 o' clock.The top nine diseases had their own peak time and high frequency period, respectively. Within a year, no peak date occurrence of patients with prehospital care, in tolal, was found. Howerer, the occurrence of patients with high fever, acute abdomen and upper GI bleeding had specific peak dates within a year, respectively. Conclusioes The pre-hospital care eases in the urban of Shanghai have own epidemiologieal characteristics. Perfect the construc-tion of pre-hospital emergency care system, improving the professional training, and thereby meeting the require-ments are factors in the fundamental guarantee of improving the rescue full success rate of severe patients.