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Objective:To explore the feasibility and value of individualized scheme of dose of iodine contrast medium in enhanced abdominal CT imaging based on liver volume (LV) measurement.Methods:The examination data and technical parameters of 64 patients, who underwent multi-phase dynamic enhanced abdominal CT imaging from February to September 2019 at First People's Hospital of Yunnan Province were retrospectively analyzed. The density of liver on CT pre-contrast images and post-contrast images, LV and average iodine content in the liver (AII) of all subjects were measured. The difference of liver density (ΔHU), total iodine dose of contrast agent injected (IM) and total intrahepatic iodine (TII) were calculated. Pearson correlation analysis was performed to evaluate the association between AII and ΔHU, as well as IM and TII. The difference between the injection volume of contrast agent predicted by the formula and the actual injection volume of contrast agent was tested by paired t test. Results:The ΔHU and AII showed highly positive correlation ( r=0.926, P<0.05). The regression equation was Y AII=0.034X ΔHU+0.296. The TII showed significantly positive correlation with the IM ( r=0.759, P<0.05), and the regression equation was Y IM=3.649X TII+16 486.754. With the liver enhancement ΔHU=50 HU as a reference, the individually dose of contrast medium injection could be deducted based on LV, with Y IM=7.225X LV+ 16 486.754. This formula was introduced into all the subjects to calculate the predicted value of contrast agent application, and the calculated injection volume of contrast agent was (64.27± 4.92) ml. Paired t test was conducted to compare the predicted injection volume of contrast agent with the actual injection volume of contrast agent, and the difference was statistically significant ( t= 6.009, P<0.05). Conclusion:The feasibility of calculating individualized scheme of contrast agent based on LV in enhanced abdominal imaging is verified. This method can be used to predict the enhancement level of liver and to reduce the dosage of iodine contrast agent.
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Objective To design bundle treatment plan in the early stage for severe human infection by avian influenza H7N9, and explore its clinical efficacy and application value. Methods Fifteen patients with severe human infection by avian influenza H7N9 in Guizhou Province from December 29th, 2016 to June 7th, 2017 were enrolled. Patients admitted from March 6th, 2017 to June 7th, 2017 served as a prospective observation period (bundle treatment group), and those from December 29th, 2016 to March 5th, 2017 were selected as a historical control period (conventional treatment group). Conventional treatment group was given conventional treatment such as isolation, anti-virus, symptomatic treatment, and traditional Chinese medicine and so on. Bundle treatment group was given bundle treatment on the basis of conventional treatment, including isolation, anti-virus, respiratory support, restrictive fluid management, immunotherapy, inhibition of inflammation, antibiotic therapy, nutritional support, prevention of hospital acquired infection (HAP), individual sedation, continuous blood purification (CBP) for acute kidney injury (AKI) and severe acute respiratory distress syndrome (ARDS) patients, and intensive care. A cluster of bundle treatment team was set up to ensure that all measures carried out smoothly. The gender, age, onset to diagnosis time, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, oxygenation index (PaO2/FiO2) at admission, the length of intensive care unit (ICU) stay, total hospitalization time and prognosis of the two groups were observed. Correlation analysis between bundle therapy and prognosis was analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was drawn, and the clinical value of bundle treatment was analyzed. Results There was no significant difference in gender, age, onset to diagnosis time, APACHEⅡscore, PaO2/FiO2, the length of ICU stay, or total hospitalization time between bundle treatment group (n = 9) and conventional treatment group (n = 6), but the death patients in the bundle treatment group was significantly fewer than those in conventional treatment group (cases:2 vs. 5, χ2= 3.225, P = 0.041). Correlation analysis showed that there was a significant correlation between the mortality and whether received bundle treatment or not in patients who infected by avian influenza H7N9 (r = -0.875, P = 0.018). ROC curve analysis showed that the area under the ROC curve (AUC) of non-bundle treatment for predicting the death in patients with severe human infection by avian influenza H7N9 was 0.938, 95% confidence interval (95%CI) was 0.795-1.000, the sensitivity was 88.88%, and the specificity was 98.62%. Conclusions Early bundle therapy has a significant effect on severe human infection by avian influenza H7N9, which can improve the prognosis and reduce the mortality of patients. It is worthy for clinical application.
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Objective To explore the risk factors and interventional strategies of bleeding caused by brain arteriovenous malformations associated with aneurysms.Methods Clinical and imaging data of 42 cases of brain arteriovenous malformations associated with aneurysms were collected and analyzed.According to the results of intraoperative angiography and the architectural characteristics of vessels,the therapeutic schedule was formulated.Three months,6 months and 1 year after interventional management,all patients were followed with DSA to observe whether arteriovenous malformations recurred or not.Results The risk factors of hemorrhage caused by brain arteriovenous malformations associated with aneurysms included lesions located in subtentorium,deep vein or mixed venous drainage,Spetzler-Martin grade Ⅲ-Ⅳ,as well as type Ⅰ and type Ⅱ a aneurysms of Redekop classification.Glasgow outcome score of 38 postoperative patients were more than 4 points,visual impaired happened in 1 patient,whereas 2 patients had different degree of limb dysfunction and 1 patient died.DSA follow-up found no recurrence of arteriovenous malformation in 37 patients.Conclusion Understanding the vessel architectural characteristics and substantial hemorrhage risk factors before intervention,therefore formulating individualized therapeutic schedules are benefit to improving safety and efficacy for the treatment of brain arteriovenous malformations associated with aneurysms.
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Objective To analyze risk factors of hemorrhagic brain arteriovenous malformation (BAVM).Methods Totally 105 BAVM patients confirmed with DSA were collected,and corresponding risk factors were analyzed.Results Univariate analysis suggested that factors were correlated to hemorrhagic presentation including the site and size of the lesions,the type and number of feeding arteries,the number,type and form of draining veins and co-existing arteriovenous fistula.Multiple factors Logistic analysis showed that the location,size,the type and amount of supplying arteries,the number of the draining vein and combined with arteriovenous fistula were the risk factors for hemorrhagic presentation,and drainage vein dilation might be a protective factor.Conclusion Infratentorial and deep cerebral lesions,arteriovenous malformation with diameter ＜3 cm,single draining vein,pure perforating artery,multiple feeding arteries and combined with arteriovenous fistula are risk factors for hemorrhagic BAVM.
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ObjectiveTo evaluate the expression of endothelial differentiation gene/lysophosphatidic acid (LPA) receptors (Edg/LPA) and its clinical significance in human pancreatic cancer.MethodsFifty cases of pancreatic cancer and adjacent normal tissues were collected,and Real-time PCR,Western blot and immunohistochemistry was used to determine the expression of Edg-2/LPA1,Edg-4/LPA2 and Edg-7/LPA3 receptors mRNA and protein,and its relationship with clinicopathological parameters was analyzed.Results The expressions of Edg-2/LPA1,Edg-4/LPA2,Edg-7/LPA3 receptor mRNA were (0.142 ± 0.042 ) ％,(0.471 ±0.064)％,(0.231 ±0.043)％ in pancreatic cancer,and the corresponding values were (0.132 ±0.029)％,(0.027 ±0.015)％,(0.163 ±0.046)％ in adjacent normal tissues.The expressions of Edg-4/LPA2 receptor mRNA in pancreatic cancer were significantly lower than that in adjacent normal tissues ( P ＜0.05 ).The expressions of Edg-4/LPA2 receptor protein in pancreatic cancer were significantly lower than that in adjacent normal tissues ( P ＜ 0.05 ).The expressions of three types of Edg /LPA receptor mRNA in pancreatic cancer were parallel to serum CA19-9 levels.The expressions of Edg-4/LPA2 receptor mRNA were associated with tumor size,differentiation degree,and invasive ability and metastasis.While the expressions of Edg-2/LPA1,Edg-7/LPA3 receptor mRNA was associated with invasive ability and metastasis only.ConclusionsEdg-4/LPA2 receptor is highly expressed in pancreatic cancer,which suggesting the malignant biological behavior of pancreatic cancer.