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Objective@#To compare the reproducibility and performance of quantitative metrics between ZOOMit and conventional intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in the diagnosis of early- and mid-stage Sjögren’s syndrome (SS). @*Materials and Methods@#Twenty-two patients (mean age ± standard deviation, 52.0 ± 10.8 years; male:female, 2:20) with early- or mid-stage SS and 20 healthy controls (46.9 ± 14.6 years; male:female, 7:13) were prospectively enrolled in our study.ZOOMit IVIM and conventional IVIM MRI were performed simultaneously in all individuals using a 3T scanner. Quantitative IVIM parameters - including tissue diffusivity (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) - inter- and intra-observer reproducibility in measuring these parameters, and their ability to distinguish patients with SS from healthy individuals were assessed and compared between ZOOMit IVIM and conventional IVIM methods, appropriately. MR gland nodular grade (MRG) was also examined. @*Results@#Inter- and intra-observer reproducibility was better with ZOOMit imaging than with conventional IVIM imaging (ZOOMit vs. conventional, intraclass correlation coefficient of 0.897–0.941 vs. 0.667–0.782 for inter-observer reproducibility and 0.891–0.968 vs. 0.814–0.853 for intra-observer reproducibility). Significant differences in ZOOMit f, ZOOMit D*, conventional D*, and MRG between patients with SS and healthy individuals (all p < 0.05) were observed. ZOOMit D* outperformed conventional D* in diagnosing early- and mid-stage SS (area under receiver operating curve, 0.867 and 0.658, respectively; p = 0.002). The combination of ZOOMit D*, MRG, and ZOOMit f as a new diagnostic index for SS, increased diagnostic area under the curve to 0.961, which was higher than that of any single parameter (all p < 0.01). @*Conclusion@#Considering its better reproducibility and performance, ZOOMit IVIM may be preferred over conventional IVIM MRI, and may subsequently improve the ability to diagnose early- and mid-stage SS.
ABSTRACT
<p><b>BACKGROUND</b>A multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis (PD) solutions. Some researchers believe that 6 L/d is enough for adequate dialysis, but there is no multi-center prospective study on Chinese population to confirm this. In this study, we evaluated the efficacy and safety of domestic PD solution (Changfu) and its difference between 6 L and 8 L dosage.</p><p><b>METHODS</b>Adult PD patients who had taken PD therapy for at least one month were selected and divided into four groups according to two dialysis solution brands and two dialysis dosages, i.e., 6 L dose with Changfu dialysis solution, 6 L dose with Baxter dialysis solution, 8 L dose with Changfu dialysis solution, and 8 L dose with Baxter dialysis solution. After 48 weeks, the changes of primary and secondary efficacy indices were compared between different types and different dosages. We also analyzed the changes of safety indices.</p><p><b>RESULTS</b>Changes of Kt/V from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of creatinine clearance rate (Ccr). Normalized protein catabolic rate (nPCR) from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of net ultrafiltration volume (nUF) and estimated glomerular filtration rate (eGFR). Changes of nPCR from baseline to 48 weeks between 6 L and 8 L showed no statistical differences; so did those of nUF and eGFR. The decline of Kt/V from baseline to 48 weeks in 6 L group was more than that in 8 L group. Change of Ccr was similar. During the 48-week period, the mean Kt/V was above 1.7/w, and mean Ccr was above 50 L×1.73 m(-2)×w(-1). More adverse events were found in Changfu group before Changfu Corporation commenced technology optimization, and the statistical differences disappeared after that.</p><p><b>CONCLUSIONS</b>The domestic PD solution (Changfu) was proven to be as effective as Baxter dialysis solution. During 48-week period, a dosage of 6 L/d was enough for these patients to reach adequate PD. Clinical study promotes technological optimization, further helps to improve the safety indices of the medical products.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Dialysis Solutions , Therapeutic Uses , Peritoneal Dialysis , MethodsABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical application of TRAM-RPAS flap in the one-stage breast reconstruction for patients with breast cancer, and to discuss the method to reduce the incidence of abdominal hernia and abdominal bulging.</p><p><b>METHODS</b>From 2002 to 2004, 16 cases of breast cancer (9 cases in stage I or II and 7 in stage III) received radical resection and breast reconstruction with TRAM-RPAS flaps at the same stage.</p><p><b>RESULTS</b>Good symmetry was achieved in 12 cases. In the other 4 cases, 3 cases had moderate breast poptosis and one case had breast hypoplasia on the unaffected side. All the flaps survived with only one case of abdominal bulging.</p><p><b>CONCLUSIONS</b>TRAM-RPAS flap can achieve the same result as traditional TRAM-RPAS flap in the one-stage breast reconstruction, while the incidence of abdominal complication is lower for TRAM-RPAS flap.</p>
Subject(s)
Adult , Female , Humans , Middle Aged , Breast Neoplasms , General Surgery , Mammaplasty , Methods , Rectus Abdominis , Transplantation , Surgical FlapsABSTRACT
<p><b>OBJECTIVE</b>To study the effect of the fixation on skull and thorough mobilization of the brow area on the results of the endoscopically assisted subperiosteal forehead lift.</p><p><b>METHODS</b>The operation procedure included adequate subperiosteal dissection, especially at the frontotemporal transition area; complete mobilization of the brow area and fixation of the incised scalp to the skull through a cortical tunnel without tension. 19 patients received the operation.</p><p><b>RESULTS</b>Long-term follow-up showed that all the 19 patients were satisfied with the surgical results. A transient frontal branch paresis happened in one case, which resolved in 3 months spontaneously without sequelae.</p><p><b>CONCLUSIONS</b>Cortical tunnel fixation well keeps the brows at a lifted position and achieves persistent rejuvenation of the forehead.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Blepharoplasty , Methods , Endoscopy , Follow-Up Studies , Forehead , General Surgery , Periosteum , General Surgery , Rhytidoplasty , MethodsABSTRACT
<p><b>OBJECTIVE</b>In order to facilitate psychological rehabilitation of the women who underwent modified radical mastectomy for breast cancer, the DIEP free flap was used for immediate breast reconstruction in a series of patients. We present a review of the surgical outcomes.</p><p><b>METHODS</b>From December 2001 to January 2003, unilateral breast reconstruction was performed in 12 patients using the DIEP free flap at the same time of modified radical mastectomy in our department. The recipient vessels were the thoracodorsal artery and vein or the internal mammary artery and its venae concomitants.</p><p><b>RESULTS</b>Of the 12 DIEP flaps, 1 was vascularized by a single perforator, 3 were vascularized by two perforators, 6 by three perforators, 1 by four an 1 by five perforators. One flap failed totally, likely due to previous multiple lower abdominal operations. The eleven reconstructed breasts achieved almost the same size and shape as the healthy sides. The time of patient getting out of bed ranged from 3 to 7 days and the mean hospital stay was 8.8 days. All patients were satisfied with the outcome. No complications were observed in the abdominal wall, including weakness, abdominal bulge or hernia.</p><p><b>CONCLUSION</b>Immediate breast reconstruction facilitates the psychological rehabilitation and helps to avoid the dressing inconveniences resulted from total mastectomy. Free DIEP flap is a new and reliable technique for immediate breast reconstruction with autologous tissue. This flap offers the patients the same advantages as the TRAM flap and avoids its most important disadvantage of potential abdominal wall weakness, by preserving the continuity of the rectus abdominis muscle. The donor site morbidity is thus reduced and recovery is faster. The more complex nature of this procedure leads to increased operating time and requires more demanding surgical skills.</p>
Subject(s)
Adult , Female , Humans , Breast Implantation , Methods , Mammaplasty , Methods , Skin Transplantation , Methods , Surgical Flaps , Transplantation, Autologous , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To establish a stable ischemic TRAM flap model in rats and observe the effects of rhVEGF gene on the ischemic flap.</p><p><b>METHODS</b>Materials were administrated via subcutaneous injection 5 days before the TRAM flap procedure. 32 animals were divided into four groups. The first group was treated with PcDNA3.1 VEGF; the second group with PcDNA3.1 as the negative control; the third group with normal saline as the frank control, and the fourth group with VEGF as the positive control. The material was given while the procedures were performed. The serum levels of VEGF before and after the operation were measured with ELISA kit. The flap was harvested for immunohistological evidence of VEGF protein expression. The viable area of the flap was calculated with AutoCAD software. The microvessel density(MVD) of the subcutaneous tissue of the flap was counted.</p><p><b>RESULTS</b>The average viable area of the TRAM flap in model animals was (3.61 +/- 1.06) cm2 [(16.04 +/- 4.71)%]. Comparing the mean viable area of the flap in the PcDNA3.1 VEGF group[(7.98 +/- 2.64) cm2] with that in the normal saline group [(4.13 +/- 1.77) cm2], the difference was significant(P < 0.05). There was no significant difference between the PcDNA3.1 VEGF group and the VEGF group[(7.31 +/- 1.22)cm2] in terms of mean viable flap area. The difference of mean MVD values between the PcDNA3.1 VEGF group and the negative control group was significant(P < 0.05), but was not significant between the gene treatment group and the positive control group. The serum level of VEGF did not increase significantly up to 9 days after the administration of PcDNA3.1 VEGF(P > 0.05). Immunohistochemical staining documented the increased deposition of VEGF protein in the plasma of endothelial cells of the flap that was injected with PcDNA3.1 VEGF.</p><p><b>CONCLUSION</b>The unilateral inferior-pedicled TRAM flap as an ischemic flap model is stable and suitable for statistic treatment. Subcutaneous injection of rhVEGF gene can express biologically active VEGF at the site, increase MVD and the viable area of the TRAM flap.</p>