Chinese expert consensus on emergency surgery for severe trauma and infection prevention during corona virus disease 2019 epidemic (version 2023) / 中华创伤杂志

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Analysis of the negative rate of D-dimer and its influencing factors in patients with acute aortic dissection / 中华急诊医学杂志

Objective:To determine the epidemiological characteristics of acute aortic dissectionand the negative rate of D-dimer of type A and B acute aortic dissection, and to explore the factors related to the negative rate of D-dimer with onset time≤ 24 h.Methods:The study retrospectively analyzed the age, sex, clinical manifestations, medical history, and laboratory test data of patients with acute aortic dissection in the Emergency Department of Xiangya Hospital of Central South University from September 1, 2017 to August 31, 2020. Exclusion criteria included 1) aortic aneurysm, 2) intermural aortic hematoma, 3) penetrating aortic ulcer, and 4) patients with prior aortic dissection, but no new hairclip was shown on this CTA. Stanford typing was used for aortic dissection. The patients were divided into two groups for analysis: onset time ≤ 24 h and onset time in 1-14 days. All statistical analyses were performed using GraphPad Prism 9. Student t-test was used for normal distribution and Mann-Whitney U test for non-normally distributed continuous variables. Comparisons of ratios between groups were performed using the χ2 test or Fisher's exact test. Binary logistic regression analysis was performed to identify independent factors related to the negative rate of D-dimer. A P<0.05 was considered statistically significant. Results:A total of 352 patients with acute aortic dissection were included in this study. Male patients accounted for 79.26%, patients with a history of hypertension accounted for 70.45%, and the ratio of patients with type A:B acute aortic dissection was 2:3. The overall negative rate of D-dimer was 13.64%. The negative rate of D-dimer of type A acute aortic dissection (7.09%) was significantly lower than that of type B acute aortic dissection (7.09% vs. 18.01%, P=0.004). A total of 17 patients died in the emergency department, with an overall mortality rate of 4.83%. The mortality rate of type A acute aortic dissection patients was significantly higher than that of type B acute aortic dissection ( P<0.05). A total of 235 patients (66.76%) with acute aortic dissection had an onset time of ≤24 h. In the hyperacute phase of ≤24 h, there were no statistically significant differences in sex, age, underlying diseases, and vital signs between the normal and elevated D-dimer groups ( P>0.05). In the laboratory test results, the levels of platelet, blood urea nitrogen, creatinine, lactate dehydrogenase, myoglobin, fibrin degradation product, prothrombin time and international normalized ratio of patients in the normal D-dimer group were significantly lower than those in the elevated D-dimer group ( P<0.05). Binary logistic regression analysis showed that the level of FDP was closely related to D-dimer ( P<0.001). Conclusions:The negative rate of D-dimer of type A acute aortic dissection was significantly lower than that of type B acute aortic dissection, but the mortality rate of patients with type A acute aortic dissection was significantly higher than that of type B acute aortic dissection, and the level of FDP was closely related to D-dimer.

Levels of D-dimer, fibrinogen, and fibrinogen degradation product in patients with acute chest pain / 中南大学学报(医学版)

To determine the relationship among the levels of D-dimer, fibrinogen (FIB), and fibrin degradation products (FDP) in acute fatal chest pain patients.
 Methods: We retrospectively analyzed the patients with aortic dissection (AD), pulmonary embolism (PE) or acute myocardial infarction (AMI) from May 1, 2017 to April 30, 2018. All the patients had a chest and/or back pain. Levels of D-dimer, FIB, and FDP were examined at the time of admission, and the patients were further diagnosed by computed tomography angiography (CTA) or percutaneous transluminal coronary intervention (PCI). The levels and negative rates of D-dimer, FIB, and FDP in patients with AD, PE, and AMI were compared.
 Results: A total of 234 patients were enrolled, including 95 AD, 98 AMI, and 41 PE. In the AD group, the AMI group and the PE group, the negative ratios of D-dimer were 13.68%, 70.41% and 4.88%, respectively; the negative ratios of FDP were 24.21%, 81.63% and 24.39%, respectively. There was no significant difference in negative rates of D-dimer and FDP between the AD group and the PE group (all P>0.05), but negative rates of D-dimer and FDP were significantly higher in the AMI group than those in the AD group and the PE group (all P0.05). However, there were no significant difference in the FIB levels among 3 groups (all P>0.05). The FDP level in the AMI group was significantly lower than that in the AD group or in the PE group (both P0.05).
 Conclusion: The levels of D-dimer and FDP are increased in AD and PE patients and may be as the useful biomarkers for the high-risk chest pain patients but not for AMI.

Application of positron emission tomography in detection of myocardial glucose metabolism in rabbit cardiac arrest models / 中南大学学报(医学版)

To investigate the changes of myocardial glucose metabolism in rabbit cardiac arrest models and the effect of hydrogen intervention by 18F-fluroro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) imaging.
 Methods: Fifteen male New Zealand white rabbits were randomly divided into a hydrogen group (n=6), a control group (n=6) and a sham group (n=3). Cardiac arrest (CA) was induced by intravenous injection of potassium chloride. Conventional cardiopulmonary resuscitation (CPR) was initiated after five-minutes CA. The hydrogen group and the control group were mechanically ventilated into mixed gas with 4% hydrogen+96% oxygen and pure oxygen, respectively, for 30 minutes after CPR. Rats in the sham group was performed the same surgical procedure and was injected adrenaline and potassium chloride but did not induce CA. The vital signs at basic state and 30 min after return of spontaneous circulation (ROSC) were recorded in each group. The parameters of CPR were recorded in two CA groups. Myocardial glucose metabolism was assessed by positron emission tomography (PET) at basic state, 2 h and 24 h after ROSC. The maximum standardized uptake value (SUVmax) of 18F-FDG was measured.
 Results: There were no significant differences in the basal body weight and vital signs among the three groups. There was no significant difference in the blood glucose level before PET examination. The 18F-FDG SUVmax in the sham group at three time points was not significantly changed. In the hydrogen group and the control group, the 18F-FDG SUVmax at 2 h after ROSC were significantly higher than the basic level (1.89±0.47 vs 3.47±1.24 and 1.90±0.36 vs 4.26±0.80, respectively). Compared with the control group, the 18F-FDG SUVmax in the hydrogen group was lower at the point at 2 h after ROSC. The 18F-FDG SUVmax in the 2 CA group were down to the basic level at 24 h after ROSC (hydrogen group 2.02±0.64, control group 2.07±0.61).
 Conclusion: Myocardial glucose metabolism in CA rabbits was increased significantly after ROSC, and hydrogen intervention can reduce the degree of glucose metabolism.

Clinical Application of Whole Aorta and Coronary CT Angiography Combined with Low Radiation Dose, Low Contrast Medium Injection Rate and Dose Protocol / 中山大学学报(医学科学版)

[Objective] To investigate the clinical value of using prospective ECG-gating Helical protocol in whole aorta and coronary arteries CT angiography combined with low tube voltage,low contrast medium injection rate and dose technology.[Methods]A total of 60 patients (heart rate≤ 75 bpm and normal heart rhythm) with suspected aortic disease or post-operation were randomly divided into 2 groups:G1 (n =30;tube voltage:80 kV;contrast medium injection rate:3 mL/s;contrast medium dose:0.65 mL/kg)and G2 (n =30;tube voltage:120 kV;contrast medium injection rate:4 mL/s;contrast medium dose:1.2 mL/kg).The two groups underwent aorta angiography with prospective ECG-gating Helical protocol by using 320-detector CT.The mean CT values and standard deviation of aorta,coronaries and adjacent adipose tissue were measured,signal to noise ratio (signal-to-noise ratio,SNR)and contrast to noise ratio (contrast-to-noise ratio,CNR) were calculated.The subjective quality scoring of 3-d post-processing images were evaluated independently by 2 senior radiologists.The mean CT values and standard deviation of aorta,coronaries and adipose tissue,SNR,CNR,subjective quality scoring,contrast medium dose and radiation dose were compared and analyzed.[Results] The abnormal and normal rate of aorta in two groups were 83.33％ (25/30),16.67％ (5/30) and 86.67％ (26/30),13.33％(4/30);while the abnormal and normal rate of coronary arteries in two groups were 43.33％ (13/30),56.67％ (17/30) and 53.33％(16/30),46.67％ (14/30).SNR values of ascending aorta,descending aorta,abdominal aorta,superior mesenteric artery,bilateral renal artery,left main coronary artery,left anterior descending branch,left circumflex branch,right coronary artery and CNR values of abdominal aorta,superior mesenteric artery,bilateral renal artery,left anterior descending branch,left circumflex branch had no statistical significance,while the other indicators were significant differences between the two groups.The radiation dose and the contrast medium dose of G1 was significantly lower than G2 (P ＜ 0.05).There was no difference in the subjective image quality of 3D post-processing images between the two groups (P ＞ 0.05).[Conclusions] Using prospective ECG-gating Helical protocol in whole aorta and coronary arteries CT angiography combined with low tube voltage,low contrast medium injection rate and low contrast medium dose technology can help to reduce radiation and contrast medium dose without impacting on the imaging quality satisfactorily.

Comparison of national early warning score, rapid emergency medicine score and acute physiology and chronic health evaluation Ⅱ score for predicting outcome among emergency severe patients / 中华危重病急救医学

Objective To analyze the comparation of national early warning score (NEWS), rapid emergency medicine score (REMS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score in predicting prognosis of critically ill patients in emergency department (ED). Methods A retrospective study was conducted. Critically ill patients, aged > 16 years, hospitalized > 24 hours, and admitted to the ED of Nanhua Hospital Affiliated to South China University from January 2016 to June 2017 were enrolled. NEWS, REMS and APACHE Ⅱ score were calculated based on the worst value of each index within 24 hours after emergency admission. The primary endpoint was 28-day mortality. The relationship between the three scoring systems and the prognosis of patients was analyzed. The predictive value of three scoring systems for the prognosis of critically ill patients in ED was analyzed by receiver operating characteristic curve (ROC). Results A total of 119 emergency severe patients were enrolled in the study, and the 28-day mortality was 21.0%. The scores of NEWS, REMS and APACHE Ⅱ in the death group were significantly higher than those in the survival group (NEWS score: 9.40±3.19 vs. 5.72±2.35, REMS score: 12.64±4.46 vs. 7.97±3.28, APACHE Ⅱscore: 26.64±6.92 vs. 16.19±5.48, all P < 0.01). With the increase of NEWS, REMS and APACHE Ⅱ score, the 28-day mortality of patients gradually increased [28-day mortality of NEWS < 5, 5-6, ≥ 7 was 3.03% (1/34), 13.33% (4/34), 64.25% (20/51); 28-day mortality of REMS < 12, 12-16, ≥ 17 was 10.99% (10/91), 50.00% (11/22), 66.67% (4/6); 28-day mortality of APACHE Ⅱ < 15, 15-24, ≥ 25 was 2.33% (1/43), 15.09% (8/59), 69.57% (16/23), respectively, all P < 0.01]. The ROC curve analysis showed that the areas under the ROC curve (AUC)of NEWS, REMS and APACHE Ⅱ score for predicting the prognosis of emergency critically ill patients were 0.830 [95% confidence interval (95%CI) = 0.737-0.923], 0.782 (95%CI = 0.671-0.892) and 0.878 (95%CI = 0.800-0.956), respectively (all P = 0.000), and the accuracy of prediction was 57.4%, 48.6%, 65.4%, respectively. Conclusions The scores of NEWS, REMS and APACHE Ⅱ were useful in predicting prognosis of critically ill patients, with the highest accuracy of APACHE Ⅱ forecast, followed by NEWS, and the lowest of REMS. After comprehensive consideration of cost-effectiveness, NEWS is more reliable in ED.

Experimental research of cerebral protective effect of mild hypothermia by semiconductor cooling device on the liver surface in rabbits after cardiac arrest / 中华危重病急救医学

Objective To observe the cerebral protective effect of mild hypothermia by semiconductor cooling device on the liver surface in rabbits after cardiac arrest (CA). Methods Eighteen healthy male New Zealand white rabbits were randomly and equally divided into CA control group, ice saline group and semiconductor group. CA was induced by rapid intravenous injection of potassium chloride. Five minutes after onset of CA, CPR was initiated. Compared to the control group, which was not treated by hypothermia intervention after CPR, the ice saline group was treated by 4 ℃ ice saline infusion and the semiconductor group was treated by the semiconductor refrigeration piece device cooling on the liver surface for hypothermia intervention after CPR. We recorded the changes of temperature (tympanic temperature and anus temperature), heart rate (HR), mean arterial pressure (MAP) of rabbits in each group, neurological deficit scores (NDS) at 24, 48, 72 hours after the return of spontaneous circulation (ROSC) and the changes of serum neuron specific enolase (NSE) by enzyme linked immunosorbent assay (ELISA). Pathological changes of the hippocampus tissue, liver tissue and skin tissue were obtained by HE staining. Results There was no significant difference in ROSC time in each group. Two rabbits died at 55 hours and 67 hours after ROSC respectively in the control group. The remaining rabbits survived to 72 hours after challenge. There was no significant difference in the overall survival time in groups. Two hypothermia intervention groups had significantly lower level of serum NSE at 24 hours after ROSC and lower DNS scores at 24, 48, 72 hours after ROSC than control group. And the level of serum NSE after 24 hours of ROSC in the semiconductor group were significantly lower than the ice saline group (μg/L: 6.916±1.161 vs. 8.615±1.430, P < 0.05). DNS scores at 24, 48, 72 hours after ROSC in the semiconductor group were all significantly lower than the ice saline group (scores: 1.33±0.52 vs. 2.00±0.01, 1.01±0.41 vs. 2.00±0.01, 0.92±0.40 vs. 2.10±0.52 respectively, all P < 0.05). Two hypothermia intervention groups had more minor damage of neuronal cell in hippocampus than the control group. And the semiconductor group had more minor damage than the ice saline group. There were no obvious hepatic and subcutaneous tissue injury through which the semiconductor induced hypothermia was performed at corresponding liver surface skin. Conclusion The hypothermia by semiconductor cooling device on the liver surface is a new safe way of protecting brain tissue after CA, which has better cerebral protective effect than ice saline infusion.

Comparison of the peritoneal dialysis treatment outcome and quality of life on end-stage renal disease patients with high and low clinical compliance / 中华行为医学与脑科学杂志

Objective To analyze the correlation between clinical compliance and peritoneal dialysis treatment outcome and quality of life on end-stage renal disease patients with high and low clinical compliance.Methods Total of 137 continuous ambulatory peritoneal dialysis (CAPD) patients of end-stage renal disease were collected in second-class hospital in Weifang by convenience sampling,and divided into high and low clinical compliance group (68 patients in each)according to ESA score.SF-36,dropout rate,fatality rate,infection rate and rehospitalization rate were used to estimated,and Cox multi-factor regression model was used to analyze correlation between therapy outcome and risk factors.Results 61 CAPD patients (44.52％) were dropout,with 23 cases (37.70％) by death.The dropout rate without death(11.8％,44.12％),fatality rate (7.4％,26.5％) and infection rate(8.8％,38.2％)had significant difference between high and low clinical compliance group (P＜0.05).The SF-36 scores of 8 dimension also had significant difference between the two groups.Cox multi-factor regression model showed that clinical compliance was an important risk factor of therapy outcome and death(HR =1.68,P＜0.05).Conclusion Clinical compliance is an important risk factor of therapy outcome,and should be listed as efficacy monitoring index of peritoneal dialysis and the target of improving the curative effect of the intervention.

Effect of mild to moderate hypothermia on casepase-3, Bcl-2 and Bax expressions in brain tissue of rats after cardiopulmonary resuscitation / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the effect of mild to moderate hypothermia on the expressions of apoptosis-related genes in the brain tissue of rats after cardiopulmonary resuscitation (CPR).</p><p><b>METHODS</b>CPR models were established by asphyxia in 15 male SD rats, which were randomized equally into normal temperature group, 34 degrees celsius hypothermia group and 32 degrees celsius hypothermia group. The brain tissues of the rats were obtained after treatment for 12 h to observe the pathological changes. The expression of caspase-3 in cerebral cortex neurons was determined with immunohistochemistry, and the expressions of Bcl-2 and Bax were detected by Western blotting.</p><p><b>RESULTS</b>Compared with normal temperature group, the two hypothermia groups (especially 32 degrees celsius group) showed significantly decreased expression of caspase-3 in the cortical neurons (P<0.05). Bcl-2 protein expression was significantly increased in the hypothermia groups, especially in 32 degrees celsius hypothermia group (P<0.05). There was no significant difference in Bax protein expression among the 3 groups.</p><p><b>CONCLUSION</b>Mild hypothermia can relieve brain injury by down-regulating caspase-3 expression and up-regulating Bcl-2 protein expression to inhibit apoptosis of the brain neurons. Hypothermia at 32 degrees celsius offers better protection of the brain tissue than hypothermia at 34 degrees celsius.</p>

Effect of valsartan on ultrastructure in the brain tissue and expression of Klotho gene in spontaneously hypertensive rats / 中南大学学报(医学版)

Objective To observe the effect of valsartan on brian ultrastructure, Klotho gene and micro-inflammatory factor [intercellular adhesion molecule-1(ICAM-1) and vascular cell adhesion molecule-l(VCAM-1)] expression in spontaneously hypertensive rat models. Methods Ten male spontaneously hypertensive rats of 22 weeks age were selected and randomly divided into a hypertension group and a valsartan intervention group, while another 5 Wistar-kyoto rats were set as a normal contrast group. The brain ultrastructure of the 2 groups was observed by electron microscope. The expression of micro-inflammatory factor (ICAM-1 and VCAM-1)and Klotho gene was detected with RT-PCR, immunohistochemistry, and Western blot, respectively. Results The cerebral neuron damage of spontaneously hypertensive rats whose ultrastructure showed cell-pyknosis, chromatin margination and typical apoptotic body formation were alleviated after the intervention of valsartan. RT-PCR showed that the gene expression of Klotho increased while ICAM-1 and VCAM-1 decreased after valsartan intervention. Immunohistochemistry and Western blot also showed that the protein expression of Klotho increased, while ICAM-1 and VCAM-1 decreased after valsartan intervention. ConclusionValsartan can improve the brain ultrastructure of spontaneously hypertensive rats by increasing the expression of Klotho.

CT diagnosis of criss-cross heart / 中华放射学杂志

Objective To probe the clinical application of CT in the diagnosis of criss-cross heart(CCH).Methods Five patients with CCH confirmed by operation were retrospectively analyzed.Enhanced 64-slice spiral CT was performed in 2 patients and enhanced single-slice electron beam CT was performed in 3 patients.Three dimensional reconstructions were applied for the fully display of anatomic malformations,and the results were compared with that of echocardiogram and angiocardiogram with Chi-square test Results(1)Visceroatrial situs solitus,twisted and concordant atrioventricular connection,horizontally oriented ventricular septum,ventricular septum defect and pulmonary stenosis were found in all patients on CT.The ventriculoarterial connection was discordant,including double-outlet right ventricle in 4 patients and complete transposition of great arteries in 1 patient In addition,associated anomalies including persistent left superior vena cava(n=2),coarctation of the aorta(n=1)and right aortic arch with right descending aorta(n=1)were detected as well.(2)Total 33 anomalies in 5 cases were found during operation.The diagnostic accuracy of CT,angiocardiogram and echocardiogram was 93.9%(31/33),81.8%(27/33)and 54.5%(18/33)respectively.There was a significant difference between CT and echocardiogram(X~2=13.39,P＜0.01),and no significant difference between CT and angiocardiogram(X~2=1.29,P＞0.05).Conclusion CT is an excellent imaging technique for the diagnosis of CCH.

CT diagnosis of cardiac rhabdomyoma in childhood / 中华放射学杂志

Objective To investigate the CT findings of cardiac rhabdomyoma in childhood. Methods Five children with cardiac rhabdomyoma confirmed by operation was retrospectively analysed. Enhanced electron beam CT (EBCT) was performed in 4 children and enhanced 64-slice helical CT (MSCT) scan was performed in 1 infant. Three dimensional reconstruction was applied for the full display of the lesions based on the transverse section images. Results ( 1 ) Multiple masses or nodules originated from atrioventricular septum were observed in 4 children including 1 nodule from the anterior walls of the left and right ventricles. A mass was derived from the mitral valve in 1 infant (2) The CT value of the lesions after enhancement ranged from 80 to 180 HU and was similar to neighbouring left ventricular myocardium. (3) The ventricular outlet obstruction was found in 3 children including 1 infant with pericardial effusion and pulmonary inflamation of the right lower lobe. Conclusion The rhabdomyoma should be considered first when masses or nodules originated from atrioventricular septum and with the enhancement similar to neigbouring left ventricular myocardium in children.

CT diagnosis of cardiac lipoma / 中华放射学杂志

Objective To investigate the application of CT in the diagnosis of cardiac lipoma.Methods Retrospective analysis of 6 patients with cardiac lipoma confirmed by operation and pathology was done. Four patients had singles slice electron beam CT plain and contrast and movie scan. Two patients had 64-slice CT plain and enhanced scan. Results (1) One patient was isolated intracavitary lipoma in the right artium, 1 patient was isolated intrapericardial lipoma and 4 patients were intramural lipomas. Of the 4 intramural lipoma, 2 were infiltrative lipomas located in the left ventricle wall or the right ventricle and septum, 2 patients were isolated in the atrio-ventricular septums. (2) CT and three-dimensional reconstruction could depict the location, shape, size, margin and characteristic fat density of lipoma,indicating the diagnosis and classifications. The displacement of coronary artery, pulmonary inflammation and effusions of pericardium and pleural cavity could also be revealed. Conclusion Cardiac lipoma can be accurately diagnosed and classified by CT.

Expression and its relationship of PRL-3 and RhoC in non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>Phosphatase of regenerating liver-3 (PRL-3) is a newly identified protein-tyrosine phosphatase, which belongs to phosphatase of regenerating liver family, and plays a role in promoting tumor metastasis; Ras homologue C (RhoC) belongs to Rho subfamily of small-molecule G protein superfamily. However, the mechanisms of PRL-3 and RhoC are unknown. The aim of this study is to investigate the expressions of PRL-3 and RhoC proteins and their correlation to invasion and metastasis of non-small cell lung cancer (NSCLC), which may provide experiment evidence of the mechanism of PRL-3 in tumorigenesis and tumor-development.</p><p><b>METHODS</b>Immunohistochemical staining was used to detect the expressions of PRL-3 and RhoC in NSCLC in 92 cases, and statistical methods were used to analyse statistical significances of their expressions in different groups and their correlation.</p><p><b>RESULTS</b>The positive rates of PRL-3 and RhoC expressions in NSCLC were 69.6% (64/92) and 73.9% (68/92), respectively, and the expressions of PRL-3 and RhoC were closely correlated with TNM stage and lymphatic metastasis and pleural metastasis (P < 0.01), and they were correlated with each other (r = 0.754, P < 0.001).</p><p><b>CONCLUSION</b>The expressions of PRL-3 and RhoC are higher in the higher TNM stage and lymphatic metastasis and pleural metastasis cases, and closely correlate with each other in NSCLC, which suggests that PRL-3 and RhoC might be in the same signal pathway and PRL-3 might promote the distant metastasis of cancer cell by RhoC and downstream factors.</p>

Coronary artery imaging with 64-slice spiral CT in atrial fibrillation patients:initial experience / 中华放射学杂志

Objective To discuss the clinical value of coronary artery imaging using 64-slice spiral CT in patient with atrial fibrillation.Methods The images of 31 patients with atrial fibrillation who underwent contrast-enhanced CT coronary angiography were evaluated.The presence of stenosis on each segment of coronary arteries was recorded and their degree of stenosis was measured using the vessel analysis software.Ten patients additionally underwent conventional coronary angiography.The results of conventional coronary angiography were compared with CT coronary angiography of the 10 patients.Results Image reconstruction was based on absolute timing.The image quality of 364 coronary vessel segments on the images from 31 patients was evaluated and defined as excellent,fine,moderate or poor.The image quality was excellent,fine,moderate and poor in 85,41,5,and 8 vessel segments respectively in patient group with heart rate between 47 beat per minent(bpm)and 69 bpm;and in 63,16,13,and 15 vessel segments respectively in patent group with heart rate between 70 bpm and 79 bpm;and in 46,25,23,and 24 vessel segments in patient group with heart rate between 80 bpm and 105 bpm.There was significant difference among the three patient groups(H=22.08,P＜0.01).Comparison was carried out between CT angiographic findings and conventional angiographic findings of the 125 segments of the coronary arteries in the 10 patients who underwent conventional coronary angiography.The sensitivity and specificity of CT angiography for diagnosing vessel with significant coronary stenosis(≥50% narrowing)was 85.0%(17/20)and 95.2%(100/105),respectively.Positive predictive value was 77.3%(17/22),and negative predictive value was 97.1%(100/103).Coronary CTA underestimated the lesions of 3 vessel segments and overestimated the lesions of 5 vessel segments.Conclusion Coronary artery imaging with 64-slice row CT had clinical value for patients with atrial fibrillation.

Clinical application of 64-slice spiral CT for apical hypertrophic cardiomyopathy / 中华放射学杂志

Objective To evaluate the clinical application values of 64-row MSCT for apical hypertrophic cardiomyopathy(AHCM).Methods Twenty-one patients with AHCM were included in this study,14 patients were diagnosed by echocardiography(UCG),and 7 patients were diagnosed by MRL AU patients underwent MSCT exam,and 5 patients also had ventriculography and coronary angiography.The left ventricular wall thickness in end-systole and end-diastole phases were measured at MSCT workstation,the left ventricular apex thickening rate(LVAT)and the ratio of maximum wall thickness of the left ventrieular apex(LVA)to the left ventricular posterior wall thickness(LVA/LVPW)in end-diastole phase were calcdated.The left ventricular end-diastolie volume(LVEDV)and left venueular ejection fraction (LVEF)were quantitively evaluated with cardiac functional analysis software.The results were compared with the measurement results from the normal control group(30 volunteers).The independent-samples t test was used for the statistics.At the same time.the coronary stenosis was measured.Results Diffuse or partial thickening of the LV apical myocardium were found in the four-chamber view and two-chamber view of MSCT images.which leaded to the deformation of the left ventricle chamber.The LVEDV were(82.6±11.4)and(108.5±10.6)ml in the AHCM group and the control group,respectively;the LVA were (20.6±3.4)and(9.9±1.5)mm;LVA/LVPW were 2.1±0.5 and 1.1±0.2;the LVAT were(25.6±4.7)%and(81.5±8.5)%.There were significant differences in LVEDV,LVA,LVA/LVPW and LVAT between the two groups(t=8.32 and 15.29,P＜0.05;t=9.91 and 27.30,P＜0.05;respectively),but there were no statistical differences in LVPW and LVEF between the two groups(t=0.26 and 1.13.P＞0.05).Five patients had myocardium bridging and 4 patients had coronary stenosis.Conclusion AHCM can be diagnosed accurately with MSCT,and the cardiac anatomy.function and coronary artery are also assessed simultaneously.

Electron-beam CT diagnosis of congenital cardiovascular diverticula / 中华放射学杂志

Objective To investigate the clinical application of electron-beam CT(EBCT)in the diagnosis of congenital cardiovascular diverticula. Methotis Retrospective analysis of 9 patients with congenital cardiovascular diverticula confirmed by operation and pathology was done.Of them,enhanced continuous volume scan was performed on 8 patients and enhanced single slice scan was performed on one patient with an Imatron C-150 scanner.Results The group of 9 pailents included one patient with diverticulum of the left ventricle.3 patients with diverticulum of the atria and 5 patients with diverticulum of the aorta.EBCT scan and three dimensional reconstruction could demonstrate not only the origin,size,shape,Location and adjacent structure of diverticula,but also other important complicated abnormalities such as ventrieuloarterial connection disorder,cardiac sepud defect,aortic coarctation and even dissection.Conclusion EBCT is an ideal noninvasive technique in the diagnosis of congenital cardiovascular diverticula

Serum Klotho protein in hypertensive patient with brain harm and analysis of associated risk factors / 第三军医大学学报

Objective To explore the changes of the Klotho protein expression in blood serum of hypertensive patients with brain harm,so as to investigate the incidence mechanism of brain harm caused by hypertension and the associated risk factors.Methods The research objects were recruited from the hypertensive in-patients and healthy individuals from health examination during September 2007 to March 2008 in our hospital.There were 56 hypertensive patients without syndrome,104 hypertensive patients with brain harm,and 30 normal control individuals,They all were marched in sex and age.Klotho protein concentration of blood serum,cholesterin,creatinine,blood glucose and blood pressure of these 3 groups were tested.And correlation analysis of the above factors and the patients' ages and hypertension medical records was performed.Results The Klotho protein concentration of blood serum in the normal control group was obviously higher than that of the hypertensive patients without syndrome and those with brain harm(P

Analysis on correlated clinical factors of upper gastrointestinal tract bleeding induced by acute organophosphorus pesticide poisoning / 中国实用内科杂志

Objective To investigate the correlated clinical factors of upper gastrointestinal hemorrhage induced by acute organophosphorus pesticide poisoning(AOPP) and look for effective method for the prevention and treatment of upper gastrointestinal tract bleeding(UGTB).Methods 49 patients with severe AOPP were divided into UGTB group(group A,26 cases)and non-UGTB group(group B,23 cases).The time,frequency and causes of UGTB were observed.We also observed the differences in acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),blood glucose and cholinesterase in serum.Results The causes of UGTB induced by AOPP were poison damage of stomach mucous membrane,gastric lavage damage and irritability ulcer;APACHE Ⅱ scores of group A were more than those of group B obviously;the level of cholinesterase was lower in group A.Correlation analysis showed that the APACHE Ⅱ scores had positive correlation and the level of cholinesterase had negative correlation with UGTB induced by AOPP.Conclusion Both the APACHE Ⅱ scores and level of cholinesterase can reflect the UGTB induced by AOPP.Active treatment of the primary disease and stress status and often the operation of gastric lavage are important ways to prevent and treat UGTB induced by AOPP.

Influence of ulinastain on tumor necrosis factor and interleukin-6 in patients after cardiopulmonary resuscitation / 中国实用内科杂志

Objective To investigate the incidence of systemic inflammatory response syndrome(SIRS)after cardiopulmonary resuscitation(CPR)and to observe the effect of ulinastain in inhibition of inflammatory mediator.Methods Thirty-two patients surviving more than 72 hours after CPR were divided into ulinastain group and control group randomly.Activity of TNF-? and IL-6 of these patients was detected.In the meantime,all patients were evaluated by SIRS diagnosis and all data were compared between two groups.Results Activities of TNF-? and IL-6 in patients after CPR were significantly higher than that of normal people(P