Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCO rapid system can improve well-being of both HDP parturient and their babies.</p><p><b>METHODS</b>Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer's solution (LR), parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume (ΔSV) provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events.</p><p><b>RESULTS</b>The severity of HDP was similar between two groups. The total LR infusion (P < 0.01) and urine output (P < 0.05) were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01). There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05), and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05) than in the GDFT group.</p><p><b>CONCLUSIONS</b>Dynamic responsiveness guided fluid therapy with the LiDCO rapid system may provide potential benefits to stable HDP parturient and their babies.</p>

Magnetic resonance imaging of eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis following eating freshwater snails / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Angiostrongyliasis cantonensis is a worldwide-existing parasitic disease. However, the relevant reports on its radiological appearances are limited. In this study, we investigated magnetic resonance imaging (MRI) features of eosinophilic meningoencephalitis in a group of consecutive patients caused by human infection with Angiostrongylus cantonensis after eating freshwater snails.</p><p><b>METHODS</b>We performed brain MR imaging on 74 patients with angiostrongyliasis cantonensis. The scanner was a 0.5T unit. For each patient MR pulse sequences of SE T1-weighted image (T1WI) and FSE T2-weighted image (T2WI) were used. After intravenous administration of gadolinium chelate (Gd-DTPA) repeated T1-weighted images were obtained. MRI features of the lesions in the brain and meninges were analyzed and recorded after observing initial and follow-up MR images. The classification of the types of angiostrongyliasis cantonensis infection was done on the basis of locations of the disorders.</p><p><b>RESULTS</b>Forty-one (55%) normal and 33 (45%) abnormal MRI appearances in the brain were found. According to locations of the disorders, the types of angiostrongyliasis cantonensis infection were determined as follows: seventeen cases of type meningitis, three of type myeloencephalitis, one of type neuritis and twelve of mixed type (eight of type ventriculitis and five of type pneumonitis were among them). In type meningitis, abnormal leptomeningeal enhancement was visualized. In type myeloencephalitis, lesions in the brain parenchyma may have iso- or slightly low signal intensity on T1WI and high signal intensity on T2WI. Enhanced nodules in various shapes were shown on gadolinium-enhanced T1WI, a few lesions appeared as crescent enhancements and some lesions did not reveal abnormal enhancement. Other than brain lesions, an enhanced nodule was seen in the cervical spinal cord in one patient. In type ventriculitis, brain ventricular enlargement was demonstrated. In type neuritis, a nodule and abnormal enhancement in the right optic nerve was revealed. In type pneumonitis, patchy ground-glass opacity and consolidative lesions at the periphery of the lungs were seen. Follow-up results indicated that most lesions in the brain could resolve in 2 to 8 weeks.</p><p><b>CONCLUSIONS</b>Angiostrongyliasis cantonensis presented as both single type and mixed type. Nodular enhancing lesions in the brain and/or linear enhancement in the leptomeninges were the main findings, while crescent enhancement would be the characteristic sign of the disease on gadolinium-enhanced T1WI. Focal edematous changes without contrast enhancement in the brain could be seen on MRI in some cases.</p>

Neural network-based computer-aided diagnosis in distinguishing malignant from benign solitary pulmonary nodules by computed tomography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Computer-aided diagnosis (CAD) of lung cancer is the subject of many current researches. Statistical methods and artificial neural networks have been applied to more quantitatively characterize solitary pulmonary nodules (SPNs). In this study, we developed a CAD scheme based on an artificial neural network to distinguish malignant from benign SPNs on thin-section computed tomography (CT) images, and investigated how the CAD scheme can help radiologists with different levels of experience make diagnostic decisions.</p><p><b>METHODS</b>Two hundred thin-section CT images of SPNs with proven diagnoses (135 small peripheral lung cancers and 65 benign nodules) were analyzed. Three clinical features and nine CT signs of each case were studied by radiologists, and the indices of qualitative diagnosis were quantified. One hundred and forty nodules were selected randomly to form training samples, on which the neural network model was built. The remaining 60 nodules, forming test samples, were presented to 9 radiologists with 3 - 20 years of clinical experience, accompanied by standard reference images. The radiologists were asked to determine whether a nodule was malignant or benign first without and then with CAD output. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis.</p><p><b>RESULTS</b>CAD outputs on test samples had higher agreement with pathological diagnoses (Kappa = 0.841, P < 0.001). Compared with diagnostic results without CAD output, the average area under the ROC curve with CAD output was 0.96 (P < 0.001) for junior radiologists, 0.94 (P = 0.014) for secondary radiologists and 0.96 (P = 0.221) for senior radiologists, respectively. The differences in diagnostic performance with CAD output among the three levels of radiologists were not statistically significant (P = 0.584, 0.920 and 0.707, respectively).</p><p><b>CONCLUSIONS</b>This CAD scheme based on an artificial neural network could improve diagnostic performance and assist radiologists in distinguishing malignant from benign SPNs on thin-section CT images.</p>

HRCT and pathology for nodules in cadaveric lung with coal workers' pneumoconiosis / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To evaluate imaging of high-resolution computed tomography (HRCT) for nodules of cadaveric lungs of coal workers' or coal workers with coal workers' pneumoconiosis (CWP) and to determine types of small nodules of CWP and dust speckle based on CT-pathologic correlation.</p><p><b>METHODS</b>Thirty-two entire lung specimens were available from autopsy of the patients with CWP and coal workers occupationally exposed to coal dusts. They comprised 25 workers without CWP, 3 patients with 0+ stage and 4 patients with I stage. Thirty-two lung specimens were inflated and fixed by Heitzman's method, and underwent coronal single slice computed tomography (SSCT)/multi-slice computed tomography (MSCT) and HRCT scans. Gross specimens section (50 approximately 100 microm of slice thickness) and histological section (5 approximately 8 microm of slice thickness) were performed on seventeen pieces of 10 mm-thickness slices of lung specimen in thirteen cases. The nodules were divided into round, ill defined and stellate-shaped, and their distributions and relationships with pulmonary lobule were analyzed.</p><p><b>RESULTS</b>The findings were as follows (1) 14 cases without CWP and 18 cases with CWP (including 5 cases with I stage 11 cases with II stage and 2 cases with III stage) were diagnosed by pathology. (2) Nodules were displayed on HRCT in 32 cases, among which 29 cases were verified by pathology. There was no significant difference between HRCT and pathology (chi2 = 0.5, 0.25 < P < 0.5). (3) Nodules of CWP on HRCT included well-defined round nodules, ill defined nodules and stellate-shape nodules. Twelve of fourteen round nodules on HRCT were pathologically typical ones. Twenty-six ill defined nodules on HRCT included 14 atypical ones, 11 dust macules and 1 typical one by pathology. Six dust macules and 3 atypical nodules were found by pathology in nine stellate-shape nodules on HRCT. (4) HRCT accurately displayed nodular distributions including nodules adjacent to small artery, thickened septa and subpleural regions.</p><p><b>CONCLUSION</b>HRCT could display typical, atypical nodules and some dust macules presenting pathologic changes, as well as relationship between nodules and structure of pulmonary lobule.</p>

Significance of ~(99m)Tc-Diethyl Iminodiacetic Acid Hepatobliliary Planar and Tomographic Scintigraphy in Diagnosis on Biliary Atresia / 实用儿科临床杂志

Objective To evaluate the clinical value of 6 h 99mTc-diethyl iminodiacetic acid (99mTc-EHIDA) planar hepatobiliary scintigraphy (HBS),6 h tomographic HBS and 24 h planar HBS in diagnosis on biliary atresia(BA).Methods Seventy cases(32 male,38 female) with continuous jaundice received planar and tomographic HBS in Beijing Friendship Hospital from Jan.2005 to Dec.2007.The mean age was 48.7 d (29 d-4 months).According to final diagnosis,all cases were divided into BA group (45 cases) and non-BA group (25 cases).All cases fasted at least 4 hours before HBS.The equipment was 3 head IRIX from Philips company with low energy high resolution collimator.The tracer was 99mTc-EHIDA and the radiochemistry purity was more than 95 percent.The dosage was 7.4 MBq/kg.All diagnosis demonstrated by operation pathology and clinical follow-up.All cases received HBS at 5,10,15,20,30 min and 1,6 h after tracer injection.HBS would ended if radioactivity appeared in gallbladder or intestine.These cases would received tomographic HBS and 24 h HBS if radioactivity did not appear in gallbladder or intestine at 6 h post injection.All these images were analyzed by 2 or more nuclear medicine physicians.Results There were not radioactivity appearing in gallbladder and intestine on planar and tomographic HBS of 27 cases,which suggested the BA.There were radioactivity appearing in gallbladder and intestine on planar and tomographic HBS of 30 cases,which suggested the non-BA.Positive rate of 6 h tomographic HBS was significantly higher than that of 6 h planar HBS and there was significantly difference between the 2 methods.Positive rate of 6 h tomographic HBS was significantly higher than that of 24 h planar HBS and there was significant difference between the 2 methods.Conclusions 99mTc-EHIDA HBS is a noninvasive,safety,valuable examing method and has definitely clinical value in the diagnosis on BA.The clinical value of 6 h tomographic HBS is significantly higher than that of 6 h planar HBS and 24 h planar HBS.

Abdominal imaging in AIDS patients / 中华放射学杂志

Objective To evaluate abdominal imaging in AIDS.Methods The imaging examinations(including US,CT and MR)of 6 patients with AIDS associated abdominal foci were analysed retrospectively.All the cases were performed US,and CT scan,of which 4 performed enhanced CT scan and 1 with MR.Results Abdominal tuberculosis were found in 4 patients,including abdominal lymph nodes tuberculosis(3 cases)and pancreatic tuberculosis(1 case).The imaging of lymph nodes tuberculosis typically showed enlarged peripheral rim enhancement with central low-attenuation on contrast-enhanced CT. Pancreatic tuberculosis demonstrated low-attenuation area in pancreatic head and slightly peripheral enhancement.Disseminated Kaposi's sarcoma was seen in 1 case:CT and MRI scan demonstrated tumour infiltrated along hepatic portal vein and bronchovascular bundles.Pelvic tumor was observed in 1 case:CT scan showed large mass with thick and irregular wall and central low attenuation liquefacient necrotic area in the pelvic cavity.Conclusion The imaging findings of AIDS with abdominal foci is extraordinarily helpful to the diagnosis of such disease.Tissue biopsy is needed to confirm the diagnosis.

Feasibility of computer-aided nodule detection system in digital chest radiographs / 中华放射学杂志

Objective To assess the usefulness of a computer-aided detection(CAD)system on detecting the pulmonary nodules in digital chest radiography.Methods Three hundred and twenty-eight digital chest radiographies along with corresponding chest computed tomography were selected for this study. Two senior chest radiologists interpreted these cases using the CAD system and marked the locations and sizes of all nodules with consensus,which were stored in a computer system as Gold Standard to evaluate the performance of the CAD system.Eight radiologists of various experience read these selected cases without and with the aid of CAD system and their results were stored in a computer system.The radiologists' performance was evaluated by using the receiver operating characteristic analysis.Comparison is made regarding the difference in Az values when CAD was not used versus when CAD was used by using the paired-samples t test.Results For small nodules,the sensitivity of this computer system used by the two senior chest radiologists in 100 digital radiographs was 78.1%(118.0/151).Without and with the assistance of CAD system,the nodule detection sensitivity of the radiology residents was 62.4% (94.2/151),77.4%(116.8/151)respectively,and the area under the curve of radiology residents was 0.769,0.836 respectively.Statistical analysis showed there was statistically significant difference between interpretation without and with the CAD system(P0.05).Conclusions This CAD system can help to enhance the radiologists' ability to detect small pulmonary nodules.This is especially helpful for radiology residents.