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Objective:To investigate the value of 18F-FDG PET/CT myocardial inflammation imaging in evaluating the functional prognosis of left ventricle (LV) in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods:Thirty-one patients (26 males, 5 females, age: (55.4±10.1) years) with acute ST-elevation myocardial infarction (STEMI) referred for PCI in Beijing Chaoyang Hospital between January 2016 and December 2016 were prospectively included. All patients underwent 18F-FDG PET/CT following 99Tc m-methoxyisobutylisonitrile (MIBI) rest myocardial perfusion imaging (MPI) on the fifth day after PCI. A comprehensive strategy recommended by guideline was followed to suppress myocardial uptake. 18F-FDG uptake in infarcted and remote myocardium were quantitatively analyzed by measuring SUV max, and that in superior vena cava was quantitatively analyzed by measuring SUV mean. Target-to-background ratios (TBRs) in infarcted and remote area were calculated. In addition, the following parameters were obtained: 18F-FDG uptake volume of LV (Vol-FDG), percentage of 18F-FDG uptake size of LV (F/LV%) , percentage of myocardial perfusion defect size of LV (def/LV%). According to the left ventricular ejection fraction (EF) at baseline and 6 months after AMI, the changing rate of EF (ΔEF) was calculated, and data of patients in improvement group (ΔEF≥10%) and no improvement group (ΔEF<10%) were compared. Independent-sample t test or Mann-Whitney U test, and Pearson correlation analysis or Spearman rank correlation analysis were used for data analysis. Results:TBR was significantly higher in infarcted myocardium than that in remote area (2.8±1.0 vs 1.1±0.3; t=11.03, P<0.001). F/LV% was greater than def/LV% (33.7%(25.8%, 43.3%) vs 8.8%(2.3%, 20.7%); z=-4.72, P<0.001). TBR in both infarcted and remote areas showed positive correlations with peripheral blood monocyte counts ( r=0.44, P=0.014; r=0.37, P=0.042). Vol-FDG had positive correlations with the myocardial injury markers (creatine kinase (CK), CK isoenzyme (CK-MB), cardiac troponin I (cTnI); r values: 0.46, 0.41, 0.68, all P<0.05). Of the 31 patients, 26(83.9%) completed the 6-month follow-up. Vol-FDG in no improvement group ( n=11) was significantly greater than that in improvement group ( n=15; (104.5±47.2) vs (70.1±26.3) cm 3;t=2.38, P=0.026). There was a negative correlation between Vol-FDG and ΔEF ( rs=-0.41, P=0.038). Conclusion:18F-FDG PET/CT imaging can evaluate the intensity and size of myocardial inflammation, and estimate the functional prognosis of LV in patients with AMI undergoing PCI.
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Objective@#To assess the superiority of 99Tcm-3SPboroxime (99Tcm-3SP for short) as a fast-myocardial perfusion imaging (MPI) tracer in normal and acute myocardial infarction (AMI) mini-swine.@*Methods@#99Tcm-3SP and 99Tcm-Teboroxime (99Tcm-TEBO for short) were prepared. Approximately 370 MBq 99Tcm-3SP or 99Tcm-TEBO was injected intravenously in 2 healthy mini-swine separately. Dynamic planar images were acquired immediately after injection and continued for 20 min using a standard SPECT camera. The radioactivity uptakes in the heart, liver, and lungs were measured, and heart/liver and heart/lung ratios over time were calculated. Dynamic SPECT studies were performed in 4 normal swine and 1 AMI-swine using cadmium zinc telluride-SPECT (CZT-SPECT). List mode acquisitions were immediately started and continued for 15 min after intravenous injection of approximately 370 MBq 99Tcm-TEBO and 99Tcm-3SP. The injection of two radiotracers in the same swine was completed within 2 d. The radioactivity uptakes in heart and liver were measured, and heart/liver ratio was calculated. Image quality was also evaluated. Paired t test was used to analyze the data.@*Results@#The radiochemical purity of 99Tcm-TEBO or 99Tcm-3SP were both above 95%. The initial heart uptake of 99Tcm-3SP was very close to that of 99Tcm-TEBO (planar image, 2 min postinjection: 309.32×103 vs 314.13×103 counts/MBq; SPECT image, 2 min postinjection (corrected): 7.96±0.87 vs 8.24±1.53, t=0.277, P>0.05), but the myocardial retention time was much longer than that of 99Tcm-TEBO (planar image, 20 min postinjection: 218.67×103 vs 143.19×103 counts/MBq; SPECT image, 15 min postinjection (corrected): 6.76±0.45 vs 5.06±0.33, t=-12.412, P=0.001). The uptake of liver and heart/liver ratio between 99Tcm-TEBO and 99Tcm-3SP were similar (t values: -1.332-1.101, all P>0.05 within 15 min). SPECT MPI images demonstrated uniform tracer distribution with clearly visualizable myocardial boundary in normal myocardium and intense perfusion defect in infarct myocardium. High quality SPECT images could be obtained in any of the 5 min imaging windows over the first 15 min after injection of 99Tcm-3SP in normal swine and AMI-swine.@*Conclusion@#99Tcm-3SP is a promising 99Tcm-labeled radiotracer for fast-MPI considering its high heart uptake, long myocardial retention time (20 min postinjection) and superior SPECT image quality.
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Objective To assess the superiority of 99Tcm-3SPboroxime (99Tcm-3SP for short) as a fast-myocardial perfusion imaging (MPI) tracer in normal and acute myocardial infarction (AMI) mini-swine.Methods 99Tcm-3SP and 99Tcm-Teboroxime (99Tcm-TEBO for short) were prepared.Approximately 370 MBq 99Tcm-3SP or 99Tcm-TEBO was injected intravenously in 2 healthy mini-swine separately.Dynamic planar images were acquired immediately after injection and continued for 20 min using a standard SPECT camera.The radioactivity uptakes in the heart,liver,and lungs were measured,and heart/liver and heart/lung ratios over time were calculated.Dynamic SPECT studies were performed in 4 normal swine and 1 AMI-swine using cadmium zinc telluride-SPECT (CZT-SPECT).List mode acquisitions were immediately started and continued for 15 min after intravenous injection of approximately 370 MBq 99Tcm-TEBO and 99Tcm-3SP.The injection of two radiotracers in the same swine was completed within 2 d.The radioactivity uptakes in heart and liver were measured,and heart/liver ratio was calculated.Image quality was also evaluated.Paired t test was used to analyze the data.Results The radiochemical purity of 99Tcm-TEBO or 99Tcm-3SP were both above 95％.The initial heart uptake of 99Tcm-3SP was very close to that of 99Tcm-TEBO (planar image,2 min postinjection:309.32× 103 vs 314.13 × 103 counts/MBq;SPECT image,2 min postinjection (corrected):7.96±0.87 vs 8.24± 1.53,t =0.277,P＞0.05),but the myocardial retention time was much longer than that of 99Tcm-TEBO (planar image,20 min postinjection:218.67× 103 vs 143.19× 103 counts/MBq;SPECT image,15 min postinjection (corrected):6.76±0.45 vs 5.06±0.33,t =-12.412,P =0.001).The uptake of liver and heart/liver ratio between 99Tcm-TEBO and 99Tcm-3SP were similar (t values:-1.332-1.101,all P＞0.05 within 15 min).SPECT MPI images demonstrated uniform tracer distribution with clearly visualizable myocardial boundary in normal myocardium and intense perfusion defect in infarct myocardium.High quality SPECT images could be obtained in any of the 5 min imaging windows over the first 15 min after injection of 99Tcm-3SP in normal swine and AMI-swine.Conclusion 99Tcm-3SP is a promising 99 Tcm-labeled radiotracer for fast-MPI considering its high heart uptake,long myocardial retention time (20 min postinjection) and superior SPECT image quality.
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Objective To evaluate the efficacy of pulmonary thromboendarterectomy (PTE) in treatment of chronic thromboembolic pulmonary hypertension (CTEPH) using 99Tcm-macroaggregated albumin (99 Tcm-MAA) pulmonary perfusion tomography.Methods Sixteen patients with CTEPH underwent 99Tcm-MAA pulmonary perfusion tomography before and 6-12 months after PTE.The perfusion defects and improvement both in pulmonary lobe and segment were observed pre-and post-PTE.Percentage of perfusion defect scores (PPDs％) were calculated and the change of systolic pulmonary artery pressure (SPAP) measured by echocardiography was also recorded.Results The postoperative SPAP was significantly lower than that before surgery ([36.56±8.47] mmHg vs [90.52±14.55] mmHg,t=14.14,P＜0.001).Before PTE,perfusion abnormalities were identified in 86 (86/96,89.58％) pulmonary lobes of 16 patients.In all of the 86 abnormal lobes,21 (21/86,24.42％) became normal,and the remaining 65 (65/86,75.58％) were improved after PTE.Perfusion defects were confirmed in 230 (230/304,75.66％) pulmonary segments of 16 patients before surgery.In all of the 230 abnormal segments,73 (73/230,31.74％) became normal,74 (74/230,32.17％) were improved and 83 (83/230,36.09％) remained unchanged after PTE.The mean PPDs％ decreased from (56.79±14.54)％ pre PTE to (28.20±15.24)％ at 6 12 months after PTE.The PPDs％ was positively correlated with homochronous SPAP (r=0.68,P＜0.001).Conclusion PTE can significantly reduce SPAP and improve the pulmonary perfusion in CTEPH patients.Pulmonary perfusion imaging can evaluate the curative effect of PTE.
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Objective To investigate ht e clinical characteristics and treatment of children with acute laryn gitis comlp icated with negative pressure pulmno ary edema(NPPE),and the changes of inflammatory factosr w ere monitored.Methods Data of 9 cases with acute laryngitis complicated with NPPE in pediatric intensive care unit from August 2010 to March 2015 we re analyzde .The levelso f TNF -αand IL-6 of 8 cases were detected at admission and checked agani forty-eihg t horu s after therapy.Ten children of acute laryngitis wi thotu NPPE were selected as disease cotn rol group, and ten healthy children as normal control group. Results (1)The onset of NPPE varied from 8 minutes to 2 hours following relief of obstruction,and presen-ted with acute respiratory disrt ess, decreased xo ygen saturation, tachycardai , rales on chest auscultation.All thees patients received therapeutic measures icn luding mechna ical ventilation,limiting the fluid input volume. The disappearance of rales on chest auscultation varied from 6 hours to 30 hours.Duration of mechanical ven-tilation was lse s than 48 hours,and all the children were cured.(2) Compared with the children of disease control group and normal control group,in acute phase the plasma levels fo TNF-αand IL-6 in children with NPPE were significantly higher ( P<0.01 ) .The indicators of NPPE group significantly decreased after 48 hours therapy( P<0.01 ) .Conclusion NPPE is manifested by rapid onset of respiratory distress after relief of the airway obstruction.The symptoms resolve rapidly if early support of breath and limiting the fluid input volume are applied properly.The inflammatory response is one of the possible mechanisms of NPPE.
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Objective To investigate the clinical characteristics and treatment of negative pressure pulmonary edema (NPPE) with acute laryngitis in children,and to monitor the change of inflammatory factors.Methods The data of 9 cases with NPPE and acute laryngitis in Pediatric Intensive Care Unit of Xuzhou Children's Hospital from August 2010 to March 2015 were analyzed.Ten children of acute laryngitis without NPPE in our hospital were selected as the control group.The changes of the TNF-α and IL-6 between the 2 groups were compared before and after treatment.Results (1) All the 9 children in NPPE group were associated with third degree laryngeal obstruction.The onset of NPPE in 8 cases varied from 8 minutes to half an hour following relief of obstruction,and 1 child with NPPE occurred 2hours after relief of obstruction.Four of the 9 children had pink frothy pulmonary secretions but the other 5 children did not.NPPE chest radiograph showed diffuse interstitial and alveolar infiltrates.All these patients received these therapeutic measures including mechanical ventilation,retaining high positive end expiratory pressure (PEEP) (5-8 cmH2O,1 cmH2O =0.098 kPa),glucocorticoids,limiting the fluid input volume to 60-80 mL/(kg · d).Three of the 9 cases were treated with diuretics.The disappearance of rales on chest auscultation varied from 6 hours to 30 hours.Duration of mechanical ventilation was less than 48 hours,and all the children were cured.(2) The levels of TNF-α and IL-6 in NPPE group were significantly higher than those in the control group before treatment [(369.16 ± 48.19) ng/L vs(281.77 ± 45.59) ng/L,(30.39 ± 9.60) ng/L vs (20.43 ± 4.80) ng/L,P ＜ 0.05].After 48-hour treatment,the levels of TNF-α and IL-6 in both groups significantly decreased compared with before treatment (all P ＜ 0.01);and the levels of TNF-α and IL-6 in NPPE group were (281.10 ±47.45) ng/L and (20.04 ±5.87) ng/L,respectively,which were also significantly higher than those in the control group(P ＜ 0.05).Conclusions NPPE is manifested by rapid onset of respiratory distress rapidly after relief of the airway obstruction.Imaging suggested edema change.The prognosis will be good if early support of breath and limiting the fluid input volume are applied properly.The inflammatory response is one of the possible mechanisms of NPPE.
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Objective To investigate the expression of Toll-like receptor 4 ( TLR4 ) and nuclear factor-κB ( NF-κB) in patients with critically severe hand, foot and mouth disease ( HFMD) and to evaluate the effects of esmolol intervention on those patients.Methods Fifty-two hospitalized children with critically severe HFMD in the Intensive Care Unit of Xuzhou Children′s Hospital were enrolled in the study from May 2014 to May 2015 and randomly divided into two groups, represented as group A and group B.Children in the group A were given routine treatment, while those in the group B were treated with esmolol in addition to the routine therapy.Thirty children with common HFMD were selected as disease control, and thirty healthy children were set up as normal control.Differences in the expression of TLR4, NF-κB, TNF-αand IL-6 among all children were comparatively analyzed.The levels of TLR4, NF-κB, TNF-αand IL-6 in children from groups A and B were detected after 24 hours, 72 hours and five days of treatment and the differences betweenthetwogroupswereanalyzed.Results (1)Comparedwiththechildrenfromdiseasecontroland normal control groups, those with critically severe HFMD showed significantly increased expression of TLR4, NF-κB, TNF-αand IL-6 (P0.05).The expression of TLR4, NF-κB, TNF-αand IL-6 in children from both subgroups were significantly decreased after receiving corresponding treatments for 24 hours, 72 hours and five days (all P0.05).No significant differences in those observed indicators were found between the two subgroups after five days of treatments (all P>0.05).Conclusion The TLR4/NF-κB/proinflammatory factor pathway might play an important role in the development of critically severe HFMD.Treatment with esmolol could inhibit the expression of NF-κB, reduce the secretion of inflammatory factors and alleviate the inflammatory reaction during critically severe HFMD.
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We have investigated the situation about recent interdisciplinary construction for medical subject from several 985-project universities in China as well as the well-known overseas universities via internet. We also have analyzed the results and in mean time, put forward some related suggestions in order to probe an available strategy of interdisciplinary construction for medical subject in the universities of China.
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In this article some ideas on the discipline construction and development in the school of medicine of Shahghai Jiao Tong University were put forward based on the results analysis of state key discipline application in 2007 and comparison between approval and failure disciplines from team,research,graduates education and lab construction.It will be meaningful for the sustainable development of the school of medicine of Shahghai Jiao Tong University in future.