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Objective To explore the imaging features of brucellar spondylitis (BS).Methods The imaging data of 49 cases who were diagnosed as brucellar spondylitis by a positive standard tube agglutination titer test (≥1:100) and (or) the isolation of brucella species from blood or other tissue at our institution between September 2012 and October 2016 were retrospectively reviewed.X-ray,CT scan and MRI examination was performed in 49,28 and 42 cases,respectively,of which 19 cases underwent both CT scan and MRI examination.The imaging manifestations of the spine were analyzed.The x2 test or Fisher's exact test were applied to compare the imaging manifestations of the patients who underwent both CT scan and MRI examination.Results Of the 49 patients,34 patients (69.4％) had involvement of the lumbar vertebra.Forty-five patients (91.8％) had contiguous involvement at adjacent 2 vertebral bodies.There were 10 cases (20.4％) with bony spur or bone bridge,3 cases (6.1％) with spondylolisthesis and 3 cases (6.1％)with slightly kyphosis deformity.There were 8 cases (28.6％) showing bone destruction of more than half of the vertebral body and 6 cases (21.4％) with sequestra on CT.There were 14 cases (33.3％) with psoas abscesses,of which 2 (4.8％) had migrating abscess.Epidural abscesses with dural sac compression were found in 17 cases (40.5％) and 3 cases (7.1％) showed nerve roots compression.There were statistically significant differences in the detection of vertebral bone destruction,bone marrow edema,hyperosteogeny,intervertebral disc changes,abscess formation and sequestrum between CT and MRI (P＜0.05).Conclusion BS has characteristic imaging features.The presence of bone destruction,sequestrum,and migrating abscess should warrant the possibility of BS.
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Objective To investigate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA) on malignant lesions in gastrointestinal adjacent tissue, and further to analyze the risk factors influencing positive rate of EUS-FNA. Methods The clinical data of 171 patients undergoing EUS-FNA from January 2009 to May 2016 were collected. The lesion location, size and characteristics, the number of needle passes, puncture suction negative pressure, size of puncture needle, and years of operator experience in EUS were retrospectively analyzed. Results The overall sensitivity, specificity, and accuracy of EUS-FNA in the diagnosis of malignant lesions were 78. 3％ ( 83/106) , 100. 0％ ( 65/65) , and 86. 5％( 148/171) , respectively. The univariable logistic regression analysis demonstrated that the risk factors of EUS-FNA were lesion location, lesion characteristics, and lesion size. In multivariate analysis, larger lesion size ( OR=1. 029, 95％CI: 1. 011-1. 047, P=0. 001) and lesion characteristics of solid ( OR=5. 098, 95％CI:1. 324-19. 633, P=0. 018) were independent factors affecting the positive rate of EUS-FNA. Among 171 cases performed by EUS-FNA, the incidence of postoperative complications was 1. 75％ ( 3/171 ) included 2 cases of fever and 1 case of acute pancreatitis, which were improved after conservative treatment. Conclusion EUS-FNA is a safe and effective method of cytological and histological diagnosis with high accuracy and sensitivity, importantly in distinguish malignancy from benign lesion in gastrointestinal adjacenttissue. Positive rate of diagnosis on malignant lesions by EUS-FNA is positively correlated with lesion size, and EUS-FNA positive rate of solid malignant lesions is significantly higher than that of cystic lesions.
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Objective To investigate the clinical value of eynovial membrane volume measurement by MRI in patients with hemophilic arthropathy receiving radionuclide synoviectomy. Methods Forty two patients,total 63 diseased joint,who hospitalized in the hemophilia diagnosis and treatment center of Henan Province People's Hospital were enrolled in the study after receiving both enhanced an non enhanded MRI, from May 2011 to January 2015.Sixteen patients(21 joints)were treated with 32P radionuclide synoviectomy (PRS)and followed up.The synovial membrane volume were evaluated by enhanced and non enhanded MRI before and after PRS. All data were analyzed by t test. Results The synovial membrane volume had no statistical difference by using the non enhanced(3 104.38±60.19)mm3and enhanced(2 995.19±59.14)mm3 MRI scans (t=-1.369, P=0.191). The synovial membrane volume post PRS (2 479.45 ± 46.48)mm3much lower than that before PRS (2 983.30 ± 42.87) mm3(t=7.831,P=0.000). The magnetic resonance enhanced range after PRS (0.92 ± 0.06) was significantly lower than that before treatment (1.17 ± 0.07) (t=2.108, P=0.048). Conclusion Synovial membrane volume and magnetic resonance enhanced range are important index to predict clinical efficacy of PRS.
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<p><b>OBJECTIVE</b>To identify the predictive factors for differentiating pancreatic ductal adenocarcinoma (PDAC) from other neoplastic solid pancreatic lesions and assess the accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of PDAC.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of patients referred for EUS-FNA evaluation of pancreatic lesions in the Digestive Endoscopic Center of Nanfang Hospital between January, 2009 and May, 2016. The cases with unknown diagnosis, missing data, repeated punctures, cystic lesions and benign lesions were excluded from the analysis. The positivity rates of EUS-FNA were compared between patients with PDAC and those with non-PDAC lesions, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS-FNA were assessed in the diagnosis of PDAC. Univariate and multivariate logistic regression analyses were used to identify the factors for differentiating PDAC from non-PDAC lesions based on the demographic characteristics, clinical presentations, laboratory data, and endoscopic ultrasonography imaging features of the patients.</p><p><b>RESULTS</b>Among the 75 patients with solid neoplastic pancreatic lesions, 54 (72.0%) were found to have PDAC and 21 (28.0%) had non-PDAC lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA for the diagnosis of PDAC were 77.8%, 100.0%, 100.0%, 63.6% and 84.0%, respectively. No significant difference was found in the positivity rate of EUS-FNA between patients with PDAC and those with non-PDAC lesions (77.8% 76.2%, > 0.05). Multivariate regression analysis identified abdominal pain (=5.163, 95%: 1.093-24.389, =0.038), lesion size (=0.926, 95%: 0.877-0.978, =0.006), characteristics of the solid lesions (=7.105, 95%: 1.440-35.043, =0.016), and evidence of metastases (=6.165, 95%: 1.332-28.533, =0.020) as the independent factors for predicting PDAC.</p><p><b>CONCLUSIONS</b>The pretest characteristics including abdominal pain, evidence of metastases, and lesion size and lesion characteristics defined by endoscopic ultrasonography findings can reliably predict a diagnosis of PDAC. EUS-FNA has a high sensitivity and a high specificity for the diagnosis of PDAC.</p>
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Objective To study the diagnostic value and clinical efficacy of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for mediastinal and abdominal lymphadenopathy. Methods Thirty patients who underwent EUS-FNA for mediastinal or abdominal lymphadenopathy between May 2009 and December 2015 were reviewed. The clinical efficacy of EUS-FNA was evaluated by pathological results and the follow-up. The EUS-FNA effect on clinical decision was also analyzed. Results Lesions were located in the mediastinum in 10 cases and in the abdomen in 20 cases. The total diagnostic accuracy, sensitivity, specificity, positive predictive value ( PPV) and negative predictive value ( NPV) of EUS-FNA were 96. 7%, 94. 7%, 100. 0%, 100. 0% and 91. 7%, respectively. Of all the 30 cases, 20 lymph glands were of unknown origin. The diagnostic accuracy, sensitivity, specificity, PPV and NPV of EUS-FNA in these lesions were 95. 0%, 88. 9%, 100. 0%, 100. 0% and 91. 7%, respectively. The combination of cytological and histological examination had higher accuracy ( 96. 7% VS 73. 3%, P=0. 026) and sensitivity ( 94. 7%VS 57. 8%, P= 0. 019 ) than cytological examination only. Immunohistochemistry stains were performed in 12 neoplastic cases, and 11 ( 91. 7%) were confirmed. The diagnosis by EUS-FNA had positive impact on clinical decisions in 27 patients ( 90. 0%) . Conclusion EUS-FNA is an effective approach for mediastinal and abdominal lymphadenopathy, and the result has a positive impact on clinical decisions. The combination of cytological and histological examination and application of ancillary techniques, such as immunohistochemistry stains, can improve the diagnostic efficacy of EUS-FNA.
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Objective To study the diagnostic value and clinical efficacy of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for mediastinal and abdominal lymphadenopathy. Methods Thirty patients who underwent EUS-FNA for mediastinal or abdominal lymphadenopathy between May 2009 and December 2015 were reviewed. The clinical efficacy of EUS-FNA was evaluated by pathological results and the follow-up. The EUS-FNA effect on clinical decision was also analyzed. Results Lesions were located in the mediastinum in 10 cases and in the abdomen in 20 cases. The total diagnostic accuracy, sensitivity, specificity, positive predictive value ( PPV) and negative predictive value ( NPV) of EUS-FNA were 96. 7%, 94. 7%, 100. 0%, 100. 0% and 91. 7%, respectively. Of all the 30 cases, 20 lymph glands were of unknown origin. The diagnostic accuracy, sensitivity, specificity, PPV and NPV of EUS-FNA in these lesions were 95. 0%, 88. 9%, 100. 0%, 100. 0% and 91. 7%, respectively. The combination of cytological and histological examination had higher accuracy ( 96. 7% VS 73. 3%, P=0. 026) and sensitivity ( 94. 7%VS 57. 8%, P= 0. 019 ) than cytological examination only. Immunohistochemistry stains were performed in 12 neoplastic cases, and 11 ( 91. 7%) were confirmed. The diagnosis by EUS-FNA had positive impact on clinical decisions in 27 patients ( 90. 0%) . Conclusion EUS-FNA is an effective approach for mediastinal and abdominal lymphadenopathy, and the result has a positive impact on clinical decisions. The combination of cytological and histological examination and application of ancillary techniques, such as immunohistochemistry stains, can improve the diagnostic efficacy of EUS-FNA.
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Objective To evaluate the value of endoscopic ultrasonography (EUS) in the diagnosis of Crohn's Disease (CD).Methods A total of 436 patients with endoscopically suspected CD underwent EUS and the clinical data of these patients were analyzed retrospectively.Changes of gastrointestinal wall stratification and perienteric complications detected by EUS were documented systematically.The consistency between the diagnosis of EUS and the results of pathology were recorded.Results A total of 297 cases of CD and 139 cases of non-CD were clinically diagnosed,while 277 CDs (including 17 non-CDs clinically diagnosed) and 159 non-CDs (including 37 CDs clinically diagnosed) were diagnosed by EUS.The sensitivity,specificity and accuracy rate of EUS in diagnosing CD were 87.5％ (260/297),87.8％ (122/139) and 87.6％ (382/436),respectively.Dilated vessels in submucosa were detected in 40 patients,fistulae in 13,abscesses in 5 and enlarged lymph nodes in 75.Conclusion EUS can show gastrointestinal wall stratification of CD clearly with high diagnostic accuracy.Meanwhile,EUS can detect extraluminal complications well to help in providing useful information for surgery.
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Gastrointestinal stromal tumors (GISTs) are common mesenchymal neoplasms in the gastrointestinal tract.The results of computed tomography play important roles in the diagnosis,treatment planning and follow up of GISTs. From August 2007 to January 2012,28 patients with GISTs were admitted to the Henan Provincial People's Hospital. Sixteen tumors showed extra-luminal growth,4 showed intra-luminal growth,7 involved both intra- and extra-luminal growth,and 1 showed extra-gastrointestinal growth.After administration of contrast media,9 tumors demonstrated homogeneous enhancement,18 showed heterogeneous enhancement and 1 showed non-obvious enhancement.The enhancement of tumors in arterial and venous phase was 20 Hu higher than that in plain scan.Angiogenesis was displayed in 6 tumors,and feeding arteries were observed in 3 tumors.
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Objective To study the characteristics of heterotopic pancreas (HP) in upper gastrointestinal tract (UGIT) under endoscopy and endoscopic sonography ( EUS), and its endoscopic managements. Methods Data of 67 patients with pathologically confirmed HP in our hospital from March 2004 to November 2009, including clinical and endoscopic manifestations and sequelae after endoscopic resection,were retrospectively studied. Results Heterotopic pancreas were most commonly found as a single lesion in gastric antrum (62/67, 92. 5% ) and in gastric angle and duodenum as well, which were characterized by protrusion, with intact mucous membrane and centrally umbilicated. Of the 67 patients, 59 underwent EUS before endoscopic resection. Findings were heterogeneous and mixed echogenic lesions with indistinct borders involving both the second and third layers of the gastrointestinal wall, sometimes even involving the first and fourth layers. Most lesions (n =60) were removed by endoscopic mucosal resection (EMR), with basal residues in 25 cases, in which fourth layer involvement was observed in 23 cases (92. 0% ). Delayed bleeding occurred in 1 case at 3rd day after the procedure, and no other complications were observed. Complete removal was achieved in 8 cases ( including one receiving EMR previously ) with endoscopic submucosal dissection (ESD) , and there was no such severe complications as perforation. Postoperative pathological examinations revealed that the consistent rate of preoperative diagnosis with EUS was 91.5% (54/59). Conclusion Endoscopy combined with EUS is critical in diagnosis of HP in UGIT. EMR, especially with cap assistance, is the best method for those without involvement of muscularis propria, while ESD or endoscopic surveillance is a better alternative for those with 4th layer involvement.
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Objective To evaluate the endoscopic features and treatment of gastrointestinal carciholds. Methods Data of 44 patients diagnosed as gastrointestinal carcinoid from 2002 to 2009, including clinical manifestation, endoscopic findings, treatment and follow-up, were analyzed retrospectively. Results Most common presentations were abdominal pain and changes in bowel habits, while some patients (n = 7 ) did not have any symptoms. Most lesions were elevated submucosal ones with normal mucosal pit pattern of type Ⅰ . Larger lesions appeared as polyps with mucosal pit pattern of type Ⅲ and 1 malignant carcinoid as type Ⅴ. Endoscopic ultrasonography were performed in 29 patients and all lesions were presented as submucosal hypoechoic masses with distinct borders. Endoscopic fulguration with high frequency current was applied in 12 patients and endoscopic mucosal resection (EMR) in 32. One patient with malignant carcinoid accepted multiple EMRs and died from lung and liver metastasis 6 months after last procedure. No recurrence was observed in other 43 patients during the follow-up visit of 3 months to 5 years. Conclusion Gastrointestinal carcinoid is lack of specific symptoms, and the diagnosis is made by endoscopic and pathologic findings.
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Objective To investigate the feasibility of achieving consistent image quality with dose reduction technology in lumber spine MSCT examination with Z-axis automatic tube current modulation (ATCM). Methods Forty-eight patients diagnosed as lumber intervertebral disc protrution scanned twice by MSCT before and after interventional operations with the same coverage from third lumbar vertebra to first sacral vertebra. The first scan (FM) was with fixed tube current of 320 mAs. The follow-up scan was with ATCM with noise index (NI) of 12.0 HU. At the levels of L3-4, L4-5 and 15-S1, image quality, image noise and radiation dose were measured and analyzed. Image quality and radiation dose were compared by paired t-test and the image noise was compared by ANOVA test. Results The dosage of the ATCM had a 31.3% reduction compared with FM, the average DLP was(187.9±66.4)mGy·cm and(273.4±45.4) mGy·cm respectively, where t = 8.205, P < 0.05. The average noise and their deviations for the FM group were (9.8±2.4) HU,(9.9±2.4) HU, and (11.5±3.2) HU at level of L3-4, L4-5, 15-S1, respectively. With ATCM, the average noise was(12.0±0.8) HU, (11.7±0.6) HU, and (11.7±1.4) HU, respectively. There was statistical difference between the two groups (F = 23.31, P < 0.05). The image quality scores for the FM group were (4.7±0.3), (4.5±0.2), (4.5±0.2) and showed no statistical difference to ATCM group (4.6±0.3), (4.5±0.2), (4.5±0.2) at level of L3-4, L4-5, L5-S1, respectively, where t = 1.000, P > 0.050 Conclusion ATCM technique with the noise index setting at 12.0 HU can achieved a 31.3% dose reduction while keep the consistent image quality for lumbar spine MSCT study.
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Objective To evaluate the clinical application value of multi-slice helical CT volumetric (VH) scanning in lumber spine. Methods One thousand of patients with back and leg pain who underwent CT examinations were selected as subjects. We simulated the traditional protocol of single-slice(SS) discrete scanning for L3/4, L4/5, and LS/S1 intervertebral discs. The VH scanning mode was performed with 120 kV, 210 mAs,pitch of 1.5 and coverage of 97. 5 mm. The simulated SS scanning mode was performed with 120 kV, 240 mAs and coverage of 45.0 mm. The diagnostic outcomes and the radiation doses were compared between the two scanning modes. Two groups doctors observed ten terms, including the osseous spinal stenosis,narrowed intervertebral space and so on in two scanning modes respectively. Then consistency analysis of the data was carried out. Results The VH scanning mode showed far more features than the SS mode. The detection rates of the VH mode in the osseous spinal stenosis, narrowed intervertebral space,herniated nucleus pulposus, narrowed lateral recess, vertebral lesion, hypertrophy of L5 transverse process,abnormal direction of facet, facet degeneration, lumbar spondyloschisis, and paraspinal soft tissue were 11.8% (n =118), 38. 5% (n =385), 9. 3% (n =93), 46. 8% (n =468), 31.4% (n =314), 5.7% (n =57), 25.4% (n = 254), 49. 7% (n = 497), 9.9% (n = 99), and 0. 6% (n = 6) respectively, while the detection rates of the SS mode in ten terms were 5.6% (n = 56), 0, 0. 6% (n = 6), 27. 9% (n = 279),22.4% (n =224), 1.2% (n = 12), 16.7% (n = 167), 37.2% (n =372), 0.5% (n =5), and 0.2%(n = 2) respectively. The difference between the two groups had statistically significance (average P <0.05), except the paraspinal soft tissue abnormal (P > 0.05). The detection rates of the VH mode were higher than the SS mode in the osseous spinal stenosis, narrowed intervertebral space, herniated nucleus pulposus, lumbar spondyloschisis, being 6.2% (n = 62) , 38. 5% (n = 385) , 8.7% (n = 87), and 9.4%(n =94), respectively. In addition, VH mode only partially showed the articular facets, narrowed lateral recess, hypertrophy of L.5 transverse process, and paraspinal soft tissue. We could not acquire the imaging slices paralleling to intervertebral discs in SS mode in 467 patients (46.7%) with lumbosacral angle greater than 35°. The radiation dose of VH mode (164.9 mGy/em) was slightly higher than SS mode (147.0 mGy/cm) Conclusion MSCT VH scanning mode can significantly improve the diagnostic rate of lumbar spine diseases compared with SS mode, and was not restricted by the lumbosacral angle with slightly increasing radiation dosage.
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Objective To evaluate diagnostic value of CT coronal scan to foreign body in bronchus of children.Methods 30 cases appearances of CT coronal scan to foreign body in bronchus of children were analysed.The appearances between CT coronal scan and axial scan,X-ray examination of chest were contrasted in some cases.Results Foreign body in bronchus or granuloma around part of foreign body were shown clearly by CT coronal scan in 30 cases,28 cases obstructive emphysema,13 cases obstructive pneumonia and 3 cases obstructive atelectasis were also shown clearly.Another,CT coronal scan showed the double margin sign of 16 cases diaphragm and 11 cases mediastinum.Conclusion CT coronal scan could show direct and indirect signs of the most foreign body in bronchus of children and it may be acte as primary examintion.
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Objective: To investigate the changes of gallbadder motive function in diabetics. Method: The size of gnllbadder,recovering rate,echo and half-empty time after fat food were compared and statistically analyzed between 22 healthy individuals and 20 diabetics with ultrssonograph. Results:The gallbadder recovering rate was similar between the healthy individuals and diabetics (P>0.05), but the rate of cholecystitis (30%) and choletethiasis (35%) of diabetics were higher than those in healthy individuals, the gallbadder half-empty time after fat food was obviously slower in diabetics (46.1+12.9 min)than those healthy individuals (27+4.4 mmin). Conclusions: The diabetics had obvious gallbadder motive funciion obstruction and higher rates of chronic cholecystitis and choletethiasis with ultrasonograph observations.
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Objective This study was to investigate the relation of nitric oxide synthase with cell proliferation and apoptosis in hepatocellular carcinoma (HCC). Methods The expression and localization of inducible nitric oxide synthase (iNOS) and PCNA in 21 patients with HCC were studied by immunohistochemistry. Apoptotic cell in tissue section was detected by TUNEL (terminal deoxynucleotidyl transferase [TdT] mediated desoxyuridinetriphosphate [dUTP] nick end labeling). Results The iNOS protein was markedly expressed in the liver tissue of hepatic cirrhosis or chronic liver hepatitis, which was close to tumor edge. Meanwhile it was weakly or undetectable in the liver tissue localized beyond 1.5 cm from the tumor edge. The iNOS protein was markedly expressed at the invasive tumor edge and HCC cells that invased into stroma, but it was weakly or undetectable at the most tumor core. The expression of iNOS was correlated with the proliferative activity of cells, and the number of apoptotic cells was correlated to the number of PCNA positive cells ( P
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Objective:To construct the yeast expressive vector of rmFⅦ, in which mFⅦ was mutated to inhibit coagulation without affecting the affinity for TF, and express it in Pichia pastoris. Methods:The full length cDNA encoding mFⅦ was amplified from a mouse liver by RT-PCR method, site-direct mutated and restriction enzyme digested as design. Cloning into pPIC9K, electroporation of Gs115, in vivo screen of multiple inserts by G418 resistance, BMGY/BMMY are used for induction and expression of rmFⅦ in pichia pastoris. These proteins were also screened for functional activity. Results: Three different rmFⅦ-pPIC9K yeast expression vectors and it's aim protein were obtained,two kinds of proteins were found to be functional active as design. Conclusion:rmFⅦ protein can be expressed in pichia pastoris and it might facilitate the development of tumor-target molecule, and novel anti-agiogenesis drug study.
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AIM: To observe the effects of Egr-1 gene knockout on the expression of inflammatory-related factors in pancreatic tissue in a mouse acute pancreatitis model.METHODS: The experimental pancreatitis was induced by high-dose of cearulein in wildtype mice and Egr-1 knockout mice.The pancreatitis indexes,such as serum amylase,pancreata edema,and myeloperoxidase(MPO) levels in pancreata and lungs were recorded.The mRNA levels of tissue factor(TF),plasminogen activator inhibitor(PAI-1),monocyte chemoattractant protein(MCP-1),Gro-1,IL-6 and ICAM-1 were measured by quantitative PCR.RESULTS: Contrary to wildtype mice,typical pancreatitis was not induced by high-dose cearulein in the Egr-1 knockout mice,not only markedly reduced edema in pancreata and lungs,but decreased MPO levels in lungs as well were found.Furthermore,the mRNA of TF,PAI,MCAP,ICAM-1 and IL-6 in pancreata were significantly decreased in Egr-1 knockout mice.CONCLUSION: The severity of pancreatitis and lung damage is ameliorated in Egr-1 knockout mice stimulated by high-dosage of cearulein,which was probably mediated by decreasing expression of inflammatory-related factors in pancreata,such as TF,PAI,MCP-1,ICAM-1 and IL-6.