Predictive value of CT in surgical treatment of acute closed intestinal and mesenteric inj uries / 实用放射学杂志

Objective To explore the predictive value of different CT signs in surgical treatment in patients with acute closed intestinal and mesenteric injury.Methods The CT data and follow-up results of 120 patients with acute closed intestinal and mesenteric injury(including 58 cases of surgical treatment and 62 cases of conservative treatment)were analyzed retrospectively.The diagnostic value and prognostic value in surgical treatment of different CT signs were analyzed.Results There were significant differences between the operation group and the conservative treatment group in mesenteric vascular amputation,mesenteric hematoma,vascular contrast agent extravasation, intestinal wall defect,pneumoperitoneum and peritoneal effusion (χ2＝4.69,P＝0.03;χ2＝21.40,P＜0.001;χ2＝13.95,P＜0.001 ;χ2＝11.34,P＝0.001;χ2＝80.65,P＜0.001).The CT signs of intraperitoneal effusion had the highest sensitivity for intestinal and mesenteric injury,and vascular contrast agent extravasation and intestinal wall defect had the highest specificity for surgical predictability of intestinal and mesenteric injury.ROC curves showed that abdominal gas accumulation had the highest predictive value for intestinal and mesenteric injuries (AUC＝0.92,95%CI:0.87－0.97),followed by mesenteric hematoma (AUC＝0.73,95%CI:0.64－0.82).Conclusion Intraperitoneal effusion has the highest sensitivity for intestinal and mesenteric inj ury,and vascular contrast agent extravasation and intestinal wall defect have the highest specificity for surgical predictability of intestinal and mesenteric injury.The overall value of intraperitoneal gas in predicting intestinal and mesenteric injury is highest.Combining different CT signs can improve the accuracy of clinical intervention for acute closed intestinal and mesenteric injury.

Analysis of risk factors for adverse cardiac events in adults with acute myocarditis during hospitalization / 中华急诊医学杂志

Objective To analyze the risk factors of adverse cardiac events in adults with acute myocarditis during hospitalization and provide reference for clinical diagnosis and treatment.Methods A restrospective study was conducted in 80 patients (54 males and 26 females) with acute myocarditis over 18 years old admitted to our hospital between January 2007 and December 2016.Major adverse cardiac events (MACE) were defined as death,cardiac arrest,cardiogenic shock and ventricular fibrillation.According to whether MACE occurred during hospitalization,patients were divided into two groups:the MACE group and the non-MACE group.The differences between the two groups were compared,and the risk factors were analyzed by logistic regression.Results There were 12 patients in the MACE group and 68 patients in the non-MACE group.The age of patients in the two groups was similar.Compared with the non-MACE group,the proportion of female patient in the MACE group was higher (66.7％ vs 26.5％,P=0.015),and the systolic pressure (mmHg) was lower at admission (89.75±17.63 vs 112.49±16.35,P＜0.01),and the heart rate (beats/min) was faster (106.42±24.39 vs 82.66±20.92,P=0.001);ALT and creatinine levels in the MACE group were higher (P＜0.01),while the levels of TnI,CK-MB,CK and LDH were significantly higher (P＜0.05).The LVEF value of the MACE group was significantly lower at admission (45％ vs 60％,P=0.022),and the proportion of LVEF ＜ 50％ was also higher (58.3％ vs 19.1％,P=0.008) The proportion of prolonged QRS wave (＞120 ms) was significantly higher in the MACE group (75％ vs 17.6％,P＜0.01).In the MACE group,the proportion of diuretics and vasoactive drugs (dopamine,norepinephrine,and adrenaline) was higher (66.7％ vs 25％,91.7％ vs 4.4％,66.7％ vs 0,75％ vs 0％,all P＜0.01);the proportion of glucocorticoids and immunoglobulin was higher (33.3％ vs 8.8％,P=0.038;33.3％ vs 4.4％,P=0.008),and the proportion of ventilator,CRRT,ECMO and IABP were also higher (50％vs 1.5％,33.3％ vs 0,25％ vs 0％,25％ vs 0％,all P＜0.01).Logistic regression analysis showed that the OR value of MACE in female patients during hospitalization was 5.56 (95％CI:1.49-20.71,P=0.011).The OR value of MACE in patients with reduced LVEF at admission was 5.92 (95％CI:1.62-21.67,P=0.007).The OR value of MACE in patients with prolonged QRS wave was 14.00 (95％CI:3.29-59.55,P＜0.01).Conclusions Female patients,LVEF＜50％ at admission,and prolonged QRS wave (QRS＞120 ms) are independent risk factors for MACE in adult patients with acute myocarditis during hospitalization.

Role of MRI in the diagnosis and evaluation of diabetic foot ulcer / 实用放射学杂志

Objective To study the value of MRI in the diagnosis of diabetic foot(DF)ulcer.Methods MRI data of 29 cases with DF ulcer were analyzed retrospectively,among which 8 showed neuropathic osteoarthropathy (Charcot’s joint)on X-ray radiographs. To analyze the correlation of MRI features and MRA results of DF ulcer patients.Results All patients displayed with soft tissue cellulitis,and 1 6 cases suffered with osteomyelitis as well.8 cases were Charcot’s joint,and 2 cases were confirmed by biopsy for false positive osteomyelitis.8 cases of MRA could not meet the diagnostic requirements due to the contamination of the inferior genicular vein.There were no obvious difference among the incidence of Charcot’s joint,sinus,abscess and tenosynovitis between lower extremity artery stenosis and not(P=0.06;χ2=0.07, P=0.79;χ2=2.15,P=0.14;χ2=2.29,P=0.13),but the difference of incidence of osteomyelitis was obvious(χ2=4.88,P=0.03). Conclusion MRI can display osteomyelitis,neuropathic osteoarthropathy,cellulitis of the tissue,sinus,abscess,tenosynovitis and lower extremities arterial disease (LEAD)of the DF ulcer patients,and the incidence of osteomyelitis was associated with LEAD.

Correlation analysis between lower extremity CTA and ABI about diabetic lower extremity disease / 实用放射学杂志

Objective To investigate the correlation between lower extremity CTA and ankle brachial index (ABI) of the diabetic lower extremity arterial disease (LEAD),and to study the difference of the examination methods.Methods 80 patients of clinical diagnosed with diabetic LEAD that underwent CTA check were enrolled.The indexes of ABImax,ABImin,ABIave and lower limb atherosclerosis integral (LEAI) of the 80 patients were calculated respectively,and the relationship and correlation were analyzed between ABI and LEAI in different degree of lower extremity arterial calcification.Results ABI index of 58 (58/80) cases could be determined,with an average of 0.87.CTA results displayed that below-the-knee artery had a high incidence of atherosclerosis.According to the degree of arterial calcification,non-calcified in 4(4/58) cases,mild in 20(20/58),moderate in 10(10/58),and severe in 24(24/58).The patients with moderate and severe calcification,means the arterial calcification,had lower ABI (P =0.001),higher LEAI (P ＜ 0.001),and higher pressure of brachial artery(P =0.03).There was weak correlation between ABImax and LEAI(r =-0.48) and the best correlation between ABIave and LEAI(r=-0.59).The correlations between ABI and LEAI of non calcified cases were better than that of calcified ones.Conclusion ABI monitoring of diabetic LEAD has some limitations.Diabetic lower extremity artery CTA has important clinical value that can accurately assess the degree of arterial calcification and occlusion.

Clinical features comparison of ST segment elevation and non ST segment elevation in adult patients with acute myocarditis / 中华急诊医学杂志

Objective ST segment elevation in adult patients with acute myocarditis is rare in adult.The purpose of this study was to report the outcome of ST segment elevation in adult patients with acute myocarditis in our hospital,in order to provide reference for clinical diagnosis and treatment.Methods A retrospective analysis of Beijing Anzhen Hospital during January 2002 to December 2015 for the diagnosis of acute myocarditis were 105 cases,divided into two groups,one group of ST elevation (ST elevation group) total 57 cases,another group of non ST elevation (non ST elevation group) total 48 cases.The clinical features,laboratory examination,treatment and prognosis were compared between the two groups.The composite primary endpoint of major cardiovascular events (MACE) during hospitalization included:mortality,cardiac shock and ventricular fibrillation.Results The average onset age of patients with ST segment elevation group and non ST segment elevation group were similar [(27.7 ± 10.1) years vs.(28.7 ± 10.0) years,P =0.603].There was a significant difference between the two group in patients of heart rate [(89 ± 22) beats/min vs.(80 ± 23) beats/min,P =0.028],systolic blood pressure on admission [(105 ± 17) mmHg vs.(115 ± 17) mmHg,P =0.003],diastolic blood pressure on admission [(66 ± 11) mmHg vs.(74 ± 11) mmHg,P =0.000],and total number of acute fulminant myocarditis [20 (35.1％) vs.7 (14.6％),P =0.024)].ST segment elevation acute myocarditis patients were significantly more at risk for MACE than non ST segment elevation acute myocarditis patients during hospitalization (P =0.04).Conclusion ST segment elevation acute myocarditis has acute onset and rapid progression.The incidence of MACE during hospitalization was significantly high.Mechanical support can be ve,ry favourable.ST segment elevation acute myocarditis is associated with excellent short-term prognosis.

The clinical value of MSCTA in diagnosing lower extremity arterial disease of diabetic foot ulcers / 实用放射学杂志

Objective To study the value of MSCT angiography(MSCTA)in diagnosing lower extremities arterial disease (LEAD) of diabetic foot ulcers and analyze the possible influential factors on the onset of diabetic foot ulcers.Methods 80 diabetic patients for MSCTA examination were divided into two groups by whether combined with foot ulcers.The tibial artery calcification score (TACS) and peripheral arterial occlusion index (PAOI) were calculated and the possible risk factors of diabetic foot ulcer were analyzed.Results There were 30 cases suffered with foot ulcer and 18 cases occurred lower extremity arterial occlusion (LEAO), the average PAOI was 4.40(3.60, 5.75).Non-foot ulcer cases were 50, and there were 8 cases suffered with LEAO, the average PAOI was 2.05(1.43, 3.10).Compared to patients without foot ulcer, patients with foot ulcer were older, had a lower BMI, and were more likely to have a history of tobacco use.They usually had higher TACS and severer peripheral arterial occlusive disease (PAOD).Stepwise regression model showed that foot ulcers had significant correlation with TACS and PAOI.Partial correlation analysis showed TACS was independent from PAOI in impacting diabetic foot ulcer.Conclusion MSCTA has important clinical value in diagnosing and valuing diabetic foot ulcer LEAD.Age, smoking history,BMI,TACS and PAOI affect the incidence of diabetic foot ulcers, and TACS and PAOI are the independent risk factors for diabetic foot ulcers.

CTA characteristics of diabetic lower extremities arterial disease in different Fontaine stage / 中国介入影像与治疗学

Objective To explore CTA characteristics of diabetic lower extremities arterial disease (LEAD) with different Fontaine stage.Methods Data of 100 patients clinically diagnosed as diabetic LEAD and underwent lower limbs arterial CTA were analyzed retrospectively.The patients were classified into grade Ⅰ-Ⅳ according to Fontaine classifications.Lower extremities arteries were graded according to CTA.Stenosis degree of lower extremity arteries in different Fontaine stages were analyzed.Results The grades of lower extremity arteries stenosis in different Fontaine stages had statistically significant difference (x2 =186.24,P＜0.001).There had statistically significant difference of stenosis degree in different lower extremity arterial levels among different Fontaine stages (superior genicular artery:x2 =69.24,P＜0.001;inferior genicular artery:x2 =111.59,P＜0.001;dorsalis pedis and arteriae plantaris:x2 =94.15,P＜0.001).Grades of stenosis between superior genicular arteries and inferior genicular arteries,superior genicular arteries and dorsalis pedis and arteriae plantaris had statistically significant differences (Z=12.59,P＜0.001;Z=10.47,P＜0.001).There was statistically significant difference of stenosis grades between inferior genicular artery and dorsalis pedis and arteriae plantaris (Z=12.66,P＜0.001).Occluded inferior genicular arteries usually associated with collateral vessels.Conclusion CTA can reflect the clinical stages of LEAD,which is the ideal method in diagnosing of diabetic LEAD.

Value of natural position of cervical vertebra using MRI in diagnosis of Hirayama disease / 实用放射学杂志

Objective To analyze the MRI features of Hirayama disease(HD)with cervical natural position and its diagnostic val-ue.Methods The natural position of cervical vertebra with MRI examination was used in 1 5 patients and 40 normal people.The spe-cificity and sensitivity of MRI features were analyzed and the ratio of cervical sagittal diameter/cervical transverse diameter (CSD/CTD)of the lower cervical cord was measured.Results CSD/CTD of the patients and control group had a significant difference (t=7.99,P =0.00).The sensitivity of LOA was 86.7%,and its specificity was 88.4%.The sensitivity of atrophy of the lower cervical cord was 80.0%,and its specificity was 79.5%.The sensitivity of the cervical spine curvature abnormalities was 40.0%,and its spe-cificity was 65.2%.The sensitivity of abnormal signal in the spinal cord was 46.7%,and its specificity was 87.5%.The sensitivity of abnormal signal in the epidural outer cavity was 20.0%,and its specificity was 96.8%.Conclusion MRI features of lower cervical cord in combination with clinical symptoms and signs can be helpful for the accurate diagnosis of HD.

Sesquiterpenoids from gorgonian Muriceides collaris / 药学学报

Seven guaiane-type sesquiterpenoids, a new compound 6-formyl-5-isopropyl-3-hydroxymethyl-7-methyl-1H-indene (1), a new natural product 5-isopropyl-3, 7-dimethyl-1H-indene-1-one (2), along with five known compounds: guaiazulene (3), 4-formyl-7-isopropyl-10-methylazulene (4), sesquiterpene ketolactone (5), alismoxide (6) and guaia-1 (5), 6-diene (7), were isolated from gorgonian Muriceides collaris collected in South China Sea. Their structures were elucidated on the basis of extensive spectroscopic analysis [MS, IR, 1H NMR, 13C NMR (DEPT), HMQC, HMBC, NOESY] and by comparison of the spectral data with those of the literatures.

The clinical value of Sharp-van der Heijde score in rheumatoid arthritis / 实用放射学杂志

Objective To evaluate the clinical value of Sharp-van der Heijde score (SHS)in rheumatoid arthritis (RA).Methods Clinical and X-ray of hands data in 200 patients with RA met the ACR criteria were collected in this study.Clinical DAS28,anti-cyclic citrullinated peptide antibody (aCCP)and imaging SHS were used to evaluate the activity of RA quantitatively before and after treatment.Results A moderate correlation existed between SHS and DAS28 (r s =0.61,P =0.00),but there was no significant cor-relation either between SHS and aCCP (r s = -0.1 5,P =0.03)or between aCCP and DAS28 (r s =0.14,P =0.05 ).Significant differences before and after treatment was existed in SHS (t=24.27,P =0.00)and DAS28 (t=1 5.98,P =0.00)respectively.And there was a moderate correlation between the difference in SHS before and after treatment and aCCP (r s =0.66,P =0.00).Conclu-sion The SHS,DAS28 and the aCCP in RA are closely related.Combination of three methods will help to develop the clinical pro-grams,evaluate the efficacy and prognosis.