Preliminary study on the effects of local complications of acute pancreatitis on microcirculation of multiple organs in the upper abdomen / 中华消化杂志

Objective:To investigate the effects of different local complications of acute pancreatitis (AP) on the microcirculation of multiple organs in the upper abdomen.Methods:A dynamic volume perfusion computed tomography (DVPCT) scan in the upper abdomen was prospectively conducted in 101 patients with AP and 24 patients with neither AP nor other obvious upper abnominal lesions diagnosed in People′s Hospital of Deyang City from April 1 to October 31, 2019, 86 patients with AP (AP group) and 21 controls (control group) were enrolled in the study. AP patients were divided into no local complications group (21 cases), acute peripancreatic fluid collection (APFC) group (19 cases), acute necrotic collection (ANC) group (27 cases), walled-off necrosis (WON) group (11 cases) and walled-off necrosis with infection (WONI) group (8 cases). The blood flow (BF) of pancreas, liver, spleen, two kidneys and adrenal glands was measured by deconvolution. The hepatic arterial perfusion (HAP), hepatic portal perfusion (HPP) and hepatic perfusion index (HPI) of each group were calculated by maximum slope. T test was used for statistical analysis. Results:The BF of pancreas, spleen and left adrenal gland of ANC group was (139.89±34.28), (141.42±47.85) and (107.87±26.41) mL·min -1·(100 g) -1, respectively, the BF of pancreas, spleen and left adrenal gland of WON group was (130.00±44.83), (106.12±38.16) and (98.38±41.39) mL·min -1·(100 g) -1 respectively, and the BF of pancreas, spleen and left adrenal gland of WONI group was (127.91±35.86), (102.09±23.73) and (105.66±27.01) mL·min -1·(100 g) -1, respectively, which were all lower than those of control group ((161.22±31.60), (174.00±62.73) and (134.53±36.36) mL·min -1·(100 g) -1), and the differences were statistically significant ( t=2.440, 2.043, 2.943; 2.296, 3.796, 2.548; 2.448, 4.479, 2.154; all P<0.05). The BF of left kidney cortex of WONI group was lower than that of control group ((247.44±39.32) mL·min -1·(100 g) -1 vs. (294.80±39.13) mL·min -1·(100 g) -1), and the difference were statistically significant ( t=2.910, P<0.05). The HAP of ANC group, WON group and WONI group was (18.63±9.54), (19.10±7.47) and (19.51±6.26) mL·min -1·(100 g) -1, respectively, and the HPI was (25.01±15.51)%, (45.98±31.42)% and (35.92±24.95)%, respectively, which were all higher than those of control group ((12.18±5.14) mL·min -1·(100 g) -1 and (13.44±6.49)%), and the differences were statistically significant ( t=2.997, 3.088, 3.235; 3.503, 3.397, 2.517; all P<0.05) . The HPP of ANC group, WON group and WONI group was (72.37±21.76), (48.83±35.10) and (57.55±29.45) mL·min -1·(100 g) -1, respectively, which were all lower than that of control group ((86.43±17.98) mL·min -1·(100 g) -1), and the differences were statistically significant ( t=2.391, 3.331 and 3.226, all P<0.05). The HAP and HPI of APFC group were both higher than those of control group ((18.67±10.24) mL·min -1·(100 g) -1 vs. 12.18±5.14) mL·min -1·(100 g) -1 and (23.75±20.41)% vs. (13.44±6.49)%), and the differences were statistically significant ( t=2.572 and 2.108, both P<0.05) . Conclusions:AP complicated with ANC, WON and WONI can reduce the BF of pancreas, spleen and left adrenal gland, and WONI can induce the decrease of BF of left kindney cortex. AP complicated with ANC, WON and WONI can increase HAP and HPI, but decrease HPP. Furthermore, AP complicated with APFC can increase HAP.

Efficacy analysis of ruptured posterior communicating artery aneurysms with stent-assisted vs.non-stent-assisted coil embolization / 中国脑血管病杂志

Objective To compare the safety and efficacy of stent-assisted coil and non-stent-assisted coil for the treatment of ruptured posterior communicating artery aneurysms.Methods A total of 121 consecutive patients with ruptured posterior communicating artery aneurysm treated at the Department of Neurosurgery,Heze Municipal Hospital between June 2014 and June 2017 were enrolled retrospectively.They divided into either a stent group (n =63) or non-stent group (n =58) according to whether they used stent treatment or not.The two groups were compared,and their clinical data,surgical related complications,the degree of embolism immediately after aneurysm surgery,and the follow-up results of clinical and imaging were analyzed.Results Interventional embolization therapy was successfully performed in all the patients.(1) The proportion of wide-necked aneurysms of the stent group was higher than that of the non-stent group.There was significant difference (92.1％ [58/63] vs.8.6％ [5/58],x2 =84.249,P ＜ 0.01).There were no significant differences in age,aneurysm size,sex,and HuntHess grade (all P ＞ 0.05).(2) The incidences of intraoperative aneurysm rupture of the stent group and non-stent group were 4.8％ (3/63) and 3.4％ (2/58) respectively.There was no significant difference (x2 =0.132,P =0.717).The incidence of thromboembolie complication was 12.7％ (8/63) and 5.2％ (3/58)respectively.There was no significant difference (x2 =2.070,P =0.150).In the stent group,1 patient disabled and 1 died,and in the non-stent group,there were no cases with surgical related disability,and 1 died.(3) The comparison of immediate results after procedure between the stent group and non-stent group:there were no significant differences in the complete embolic rate (39.7％ [25/63] vs.37.9％[22/58],x2 =0.039),aneurysm neck residual rate (25.4％ [16/63] vs.39.7％ [23/58],x2 =2.811],and residual rate of aneurysm (34.9％ [22/63] vs.22.4％ [13/58],x2 =2.298,all P ＞ 0.05).(4) The recurrence rate of aneurysms (4.3％ [2/46]) of the stent group was lower than that of the non-stent group (31.8％ [14/44]).There was significant difference between the two groups (x2 =112.610,P =0.01).No rebleeding occurred in all aneurysms after procedure.Conclusion Compared with the non-stent-assisted coil embolization,the stent assisted embolization of ruptured posterior communicating artery aneurysms in acute phase may reduce the recurrence rate of aneurysms and without significantly increasing the incidence of surgery-related complications.

MSCT diagnosis of adhesive abdominal internal hernias and its complication of strangulated intestinal necrosis / 实用放射学杂志

Objective To explore the MSCT characteristics of adhesive abdominal internal hernias and its complication of strangulated intestinal necrosis.Methods The CT data of 21 cases with adhesive abdominal internal hernias proved by operation were analyzed retrospectively.Raw data of CT images were reconstructed with MPR and/or CTA procedure for visualizing the hernia ring, intestinal mesentery and ansa interstinalis.Results Adhesive bands (hernia ring), crowding of distended and fluid-filled bowel loops with an abnormal location was visualized in 19 cases, among which the transitional segment from stenosis to dilation of the intestine was visualized in 17 cases.The crowded and engorged mesenteric vessels, edematous mesentery were visualized in 17 cases,among which mesenteric torsion was visualized in 11 cases.Varying amounts of ascites was visualized in 15 cases.All adhesive abdominal internal hernias in our study were classified according to their image manifestation.Dilated intestinal loop with thickened bowel wall was classified to type Ⅰ (7 cases).Dilated intestinal loop with normal bowel wall was classified to type Ⅱ (9 cases).Normal size of the intestinal loop with thickened bowel wall was classified to type Ⅲ (5 cases).The difference of CT values of the intestinal wall on non-contrast CT,enhancement CT values in arterial and portal phase of contrast-enhanced CT among three types of adhesive abdominal internal hernias showed statistical significance (P0.05).8 cases of adhesive abdominal internal hernias were accompanied by intestinal necrosis (5 cases for type Ⅰ,3 cases for type Ⅲ).The necrotic intestine loop manifested as markedly thickened and blurred bowel wall with reduced enhancement, while thrombosis embolism of SMV was visualized in 4 cases and thrombosis embolism of SMA in 3 cases,respectively.Massive ascites was visualized in 8 cases.Conclusion The adhesion bands,transitional segment of small intestine,gathered and translocated intestinal loops are the clue to the diagnosis of adhesive abdominal internal hernias.Edema of mesentery, gathered and engorged mesenteric vessels, occlusion of SMV or SMA and the conspicuously thickened bowel wall with reduced enhancement are the image characteristics of intestinal necrosis.

Imaging features and curative effect monitoring of IgG4-related disease / 实用放射学杂志

Objective To explore imaging features of IgG4-related diseases (IgG4-RD)and to evaluate curative effect after treatment with steroid.Methods Imaging data were reviewed retrospectively in thirteen patients with pathologically proved IgG4-RD.CT scans were performed in all patients,while MR scans in five of them.Six patients were examined before and after steroid treatment in 3-6 months. Imaging data were analyzed with regard to the shape,distribution and characteristics of the lesions.The image changes between pre-and post-treatment with steroid were analyzed as well.Results The IgG4-RD occurred in the lacrimal gland in 1 case,submandibular glands in 1 case,biliary duct in 1 case,pancreas in 3 cases,kidney in 4 cases,retroperitoneum in 2 cases and lung in 1 case.Multiple organs including the retroperitoneum,kidney and pancreas were involved in two patients.Diffusely swelling organ or soft tissue mass, which manifested as low density on CT and low signal intensity on T2-weighted images on MR,were characteristics of IgG4-RD.All lesions mildly enhanced with contrast media administration.The lesions decreased in size accompanied by raised signal intensity on T2 WI after treatment with steroid in six patients.Conclusion Diffusely swelling organ,low density and low signal intensity on T2 WI with mildly homogenous enhancement are characteristics of IgG4-RD.CT and MR plays a vital role in diagnosis of IgG4-RD and monitoring the curative effect with steroid treatment.

Risk factors of nosocomial infections in patients with head and neck cancer during radiotherapy / 中华临床感染病杂志

Objective To investigate the risk factors of nosocomial infections in patients with head and neck cancer during radiotherapy .Methods Clinical data of 189 patients with head and neck cancer receiving radiotherapy in Huzhou Central Hospital during August 2011 and December 2014 were retrospectively studied .Chi-square test and multivariate Logistic regression analysis were performed to explore the risk factors of nosocomial infections in patients during radiotherapy .Results Among 189 patients with head and neck cancer receiving radiotherapy , nosocomial infection was observed in 64 (33.86%) patients.Univariate analysis showed that radiation-induced oral mucositis (χ2 =11.47, P<0.01), underlying disease (χ2 =6.59, P<0.05), stage of tumor Ⅲ-Ⅳ (χ2 =4.36, P<0.05), whole-neck radiation (χ2 =7.64, P <0.05), dose of radiation ≥50 Gy(χ2 =8.92, P <0.05), combined chemotherapy (χ2 =6.53, P<0.01), invasive operation (χ2 =4.21, P<0.05), PS score=1 (χ2 =3.58, P<0.05) and low body mass index (χ2 =9.56, P <0.05) were risk factors of nosocomial infections . Multivariate Logistic regression analysis indicated that radiation-induced oral mucositis ( OR=3.46, χ2 =8.72, P<0.01),underlying disease (OR=1.91, χ2 =4.66, P<0.05), stage of tumor Ⅲ-Ⅳ (OR=2.01,χ2 =5.22, P<0.05), whole-neck radiation (OR=1.78,χ2 =4.89, P<0.05), dose of radiation ≥50 Gy (OR=1.69,χ2 =3.25, P<0.05), combined chemotherapy (OR=1.84, χ2 =6.91, P<0.05) and low body mass index (OR=1.53, χ2 =2.59, P<0.05) were independent risk factors of nosocomial infection.Conclusions Nosocomial infections are popular in patients with head and neck cancer during radiotherapy.Radiation-induced oral mucositis, underlying disease, stage of tumor, radiation field, dose of radiation, combined chemotherapy and body mass index are associated with the occurrence of nosocomial infections in these patients .

Efficacy observation of glutathione on prevention of acute radiation enteritis in pelvic radiation therapy / 中国基层医药

Objective To observe the prevention effect of glutathione on acute radiation enteritis in pelvic radiation therapy.Methods All 80 pelvic tumor patients treated with radiotherapy were randomly assigned to the control group (40 patients)and the treatment group (40 patients)by the number table method.40 cases in the con-trol group treated with radiation were not treated with preventive drugs,but the patients in the treatment group were treated with glutathione.The occurrence time of acute radiation enteritis and the severity of acute radiation enteritis after treatment were evaluated.Results 15.0% of the treatment group suffered from acute radiation enteritis in the second week and 72.5% in the third week.however,62.5% of the control group were suffered from acute radiation enteritis in the second week and 27.5% in the third week.The difference was statistically significant (χ2 =18.775, 15.998,all P <0.001).Glutathione delayed the occurrence time of acute radiation enteritis.The grade 1 and grade 2 acute radiation enteritis effective rate in the treatment group were 77.5% and 17.5%,and that in the control group were 20.0% and 72.5%,the difference between the two groups was significant(χ2 =26.136,24.139,all P <0.001).The glutathione could reduce the incidence of acute radiation enteritis extent.Conclusion Glutathione could delay the occurrence time of acute radiation enteritis and reduce the incidence of acute radiation enteritis extent.It is worth clinical application.

Study on value of diffusion weighted imaging in differentiation of solid focal liver lesions / 重庆医学

Objective To evaluate diffusion weighted imaging (DWI) sequence and apparent diffusion coefficient (ADC) in dif-ferentiation of various solid focal liver lesions (SFLL )commonly encountered .Methods 142 cases with 158 SFLLs underwent breath-hold diffusion weighted imaging (DWI)(b = 500 s/mm2 ) using a 1 .5 Tesla MR scanner .The cases included 7 cases of imma-tured abscesses ,12 cases of FNHs ,74 cases of hepatic cell cancer ,26 cases of cholangiocarcinomaes and 39 cases of metastasises . The signal intensity on DWI ,ADC value and the difference for each type of SFLLs were measured and analyzed .Results 24 cases of SFLLs were manifested as high signal intensity ,132 cases of SFLLs manifested as slightly high signal intensity and only 2 cases of SFLLs manifested as iso-signal intensity on DWI sequence .The mean ADC value ( × 10 - 3 mm2 /s)for immatured abscesses , FNHs ,HCCs ,cholangiocarcinomaes ,metastasises were (1 .48 ± 0 .23) ,(1 .75 ± 0 .26) ,(1 .23 ± 0 .43) ,(1 .47 ± 0 .35) ,(1 .36 ± 0 .33) ,respectively .The difference in ADC values between FNH patients and other SFLLs patients showed statistically significant (P 0 .05) .Conclusion The signal intensity on DWI and ADC values may be helpful for diagnosing solid focal liver lesions .

Application of three-dimensional reconstruction and virtual surgery for treatment of complex tibial plateau fracture / 中国组织工程研究

BACKGROUND:Treatment of complex tibial plateau fracture is a difficulty in orthopaedic trauma. Comprehensive assessment and appropriate surgical plan before surgery are the key points of surgery. OBJECTIVE:To investigate the application value of three-dimensional reconstruction and virtual surgical techniques in assessing and surgical planning of complex tibial plateau fracture before surgery. METHODS:The CT scan data of 30 patients with tibial plateau fracture were imported into the Mimics 13.0 software to establish the three-dimensional digital models of complex tibial plateau fracture, and three-dimensional measurements and reclassification was performed according to three-column classification were made. Virtual surgeries such as bone window operation, reduction of the fracture and bone grafting were made in these models. RESULTS AND CONCLUSION:Reconstructed three-dimensional digital models of complex tibial plateau fracture could indicate the characteristics of fracture accurately, could be observed at any direction, and could help doctors to reclassify the fracture according to three-column classification. Virtual surgeries of bone window operation, reduction of the fracture and bone grafting made in computer by Mimics 13.0 were confirmed to be vividly simulate the clinical surgery, and helpful in estimating the amount of bone grafting. Three-dimensional reconstruction and virtual surgical techniques play an important role in assessing and surgical planning of complex tibial plateau fracture before surgery, which should be a conventional step in the management of complex tibial plateau fracture.

A Clinical Analysis of Fluoxetine Treatment for 54 Cases with Depressive/Anxiety Symptoms in Cancer Patient / 浙江中医药大学学报

[Objective] To study the effect and reliability of fluoxetine on depression and symptoms in cancer patient,and to assess the overall quality of life before and after treatment.[Methods]We treated 54 cancer patients with depression by Fluxetine for 8 w,at the same time,evaluated their emotion state,change of quality of life and the adverse effect with HAMD,HAMA,TESS and laboratory tests.[Results]After 8 w,patients’ scores of anxiety and depression decreased significantly from the baseline,effective rates were 82.4% and 96.3% respectively.3 domains of quality of life (physiology,psychology and independence) became much better than those of baseline.The side effect of fluxetine was small.[Conclusion]This study shows that fluoxetine can reduce the depression and anxiety symptoms in cancer patients.