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Objective:To compare the safety and efficacy of the " step-up approach" versus the " step-jump approach" in treatment of infected pancreatic necrosis (IPN).Method:The clinical data of IPN patients who underwent step-up strategy or step-jump strategy treatment at the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from December 2018 to November 2022 were analyzed retrospectively. Propensity score matching (PSM) was done based on the nearest neighbor matching method (1: 1 ratio). After matching the baseline data (the caliper value was 0.01), a total of 62 patients with IPN were included, including 41 males and 21 females, aged (41.1±13.1) years old. Patients who were treated with the step-up strategy were included in the step-up group, while patients who were treated with the step-jump strategy were included in the step-jump group. There were 31 patients in each group after PSM, and the treatment effect of the two groups were compared.Results:Of the 62 patients with IPN, 43 received surgical intervention, and 19 were managed successfully using symptomatic anti-inflammatory treatment or percutaneous catheter drainage. The total hospitalization cost of patients in the step-jump group was significantly higher than that in the step-up group [122 000 (73 000, 179 000) yuan vs. 88 000 (46 000, 144 000) yuan, P=0.034]. The overall cure rate of IPN patients in the step-jump group was 93.5%(29/31). The 2 patients who died had type Ⅲ IPN. In the IPN patients in the step-up group were all cured, and the overall cure rate was 100%(31/31), with no death. There were no statistical differences between the two groups in the rates of death, postoperative complications, residual infection, debridement ≥2 times, and positive bacterial culture in blood or drainage fluid (all P>0.05). A total of 19.4% (12/62) patients had postoperative complications, including 4 patients with abdominal bleeding, 3 patients with new organ dysfunction, 2 patients with gastrointestinal bleeding, 2 patients with gastrointestinal fistula, and 1 patient with venous thrombosis in both lower limbs. Conclusion:Both the step-up treatment strategy and the step-jump treatment strategy were safe and effective for treatment of IPN patients.
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Objective:To evaluate the effect of resveratrol on radiation-induced myocardial injury in mice.Methods:A total of 80 C57BL/6 mice were randomly divided into the control group, resveratrol (Res) group, radiation (RT) group and radiation+resveratrol (RT+Res) group. In the RT group, mice were given with heart radiation and mice in the Res group were given with resveratrol by gavage for 3 months. Cardiac ultrasound was used to evaluate cardiac function at 3 months after cardiac radiation. The hearts of mice were collected for HE staining, immunofluorescence, TUNEL staining, Masson staining and Western blot to evaluate the expression of silent information regulator 1 (SIRT1), the level of oxidative stress, inflammatory response, apoptosis and the degree of fibrosis in myocardial tissues. Experimental data were expressed as Mean ± SD. Continous data were statistically analyzed by t-test. Results:After 3 months of irradiation, compared with the control group, the ejection fraction (EF) and fractional shortening (FS) of cardiac function were decreased, and myocardial degeneration and disorder, reactive oxygen species (ROS) and inflammatory levels (interleukin-1β, interleukin-6, tumor necrosis factor-α), myocardial apoptosis (TUNEL positive cell rate) and fibrosis were increased in the RT group. In the RT+Res group, the cardiac function was improved, the expression of SIRT1 was increased, and the levels of oxidative stress, inflammation, myocardial apoptosis and fibrosis were decreased.Conclusions:Resveratrol can reduce oxidative stress, inflammatory infiltration, apoptosis and fibrosis of myocardium in mice with radiation-induced myocardial injury, thereby improving cardiac structural abnormalities and cardiac dysfunction. This protective effect can be mediated by upregulation of SIRT1 expression.
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【Objective】 To establish a blood transfusion outcome prediction model for comprehensivel evaluation of coagulation function of patients with upper gastrointestinal bleeding by thrombelastogram (TEG) and blood coagulation indicators. 【Methods】 The data of 101 patients with upper gastrointestinal hemorrhage, admitted to the Department of Gastroenterology of Zhejiang Provincial People′s Hospital and its Chun′an Branch from June 2018 to June 2021, were collected through Tongshuo blood transfusion management system and His system. Those patients were divided into blood transfusion group (n=56) and non-transfusion group (n=45), and into cirrhosis group (n=74) and non-cirrhosis group (n=27), and 40 patients, with non-upper gastrointestinal bleeding, were enrolled as the control. The results of TEG indicators (R, K, α, MA), coagulation function (PT, INR, APTT, TT, Fib), blood routine (Hb, Plt, WBC, NEUT%) and biochemical detection(Alb, SCr, ALT, AST, GGT) before transfusion were compared between groups and the correlation between TEG indicators and traditional coagulation parameters was analyzed. Single-factor and multi-factor analysis were used to screen blood transfusion-related factors to establish a predictive model. 【Results】 The comparisons of paremeters between transfusion and non-transfusion group were as follows, K (min), α (°), and MA (mm) was 3.86±3.12 vs 2.50±1.47, 54.00±14.08 vs 61.05±10.88, and 51.12±13.37 vs 58.26±11.08, respectively (P<0.01); PT (s) and Fib (g) was 16.36±7.45 vs 13.44±1.50 and 1.59±0.87 vs 2.35±1.09 (P<0.01); NEUT% and Hb (g/L) was 0.75 ±0.13 vs 0.66±0.15 and 68.04±14.49 vs 100.73±22.92 (P<0.01); Alb (g/L) and SCr (nmol/L) was 29.73±6.08 vs 33.73±7.19 and 99.50±53.55 vs 76.25±19.28 (P<0.01). Correlation analysis showed that APTT was positively correlated with R and K values, and negatively correlated with α and MA. Fib was negatively correlated with K values, and positively correlated with α and MA. Plt was negatively correlated with K values, and positively correlated with α and MA (P<0.01). Eight pre-transfusion indicators as K, MA, PT, Fib, NEUT%, Hb, Alb, and SCr were subjected to Logistic regression to establish a blood transfusion prediction model. The optimal ROC curve of blood transfusion threshold (blood transfusion predictive value of patients), sensitivity, specificity and AUC were 0.448, 92.9%, 88.9%, and 0.969, respectively. 【Conclusion】 The establishment of Logistic regression model by integrating detection indicators of TEG, coagulation function, blood routine and biochemistry in patients with upper gastrointestinal bleeding have showed significant correlation with blood transfusion prediction, and good clinical practicability.
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Objective To characterize the imaging features of fibroblastic and (or) myofibroblastic benign tumors. Methods The imaging manifestations were analyzed in fourteen patients with fibroblastic and (or) myofibroblastic benign tumors of the breast area confirmed by histopathology from July, 2010 to July, 2017. Independent-samples t test was performed to compare ADC values between lesions and normal breast tissue. Results Thirteen cases were adhered to superficial facia of breasts and 1 case was located in the pectoralis. Five lesions were presented as a mass on MRI, 9 lesions were presented as a non-mass. Twelve cases showed low signal intensity on T1WI, 8 cases showed high signal intensity and 4 cases showed moderately or slightly high signal intensity on T2WI. TIC analysis showed that 10 cases had typeⅠenhancement and 4 cases had typeⅢenhancement. There was no difference between mean ADC values of lesions and normal breast tissue (P>0.05). All the cases showed hypoechoic and spiculated margins on ultrasound. Twelve cases were hypovascular ones. Twelve cases underwent mammography. Five cases were presented as a mass and 7 cases were presented as asymmetric. These cases showed equal density without suspicious calcifications. Conclusion The location, MRI, ultrasound and mammography manifestations of fibroblastic and (or) myofibroblastic benign tumors have some characteristics and these imaging findings may help to establish an accurate preoperative diagnosis.
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We report a case of cushing's syndrome caused by ectopic adreocortical adenoma. The patient is a 37 years old woman, she was admitted to our hospital for " 2 years history of hypertension and weakness in both lower extremities for 2 months". Physical examination revealed: blood pressure 160/116 mmHg(1 mmHg＝0.133 kPa), body mass index 27.47 kg/m2, moon-face, increased fat in the neck and back, purple marks on abdominal skin, withⅡdegree edema of both lower extremities. Laboratory examination revealed that serum cortisol levels were elevated, loss of normal circadian rhythm, and serum adrenocorticotropic hormone (ACTH) was suppressed, the level of cortisol could not be suppressed in low dose desamethasone suppression test. Adrenal computed tomography ( CT) revealed a nodule in the right retroperitoneum, compression of the renal hilum, no bilateral adrenal adenoma and hyperplasia were found. This patient was diagnosed as corticotropin-independent Cushing's syndrome unequivocally. The clinical symptoms were relieved after successful laparoscopic retroperitoneum resection of the nodule. Pathological exam confirmed adrenocortical adenoma in ectopic adrenal tissue. Thus, we should consider the ectopic corticosteroid-secreting tumor in the context of corticotropin-independent Cushing's syndrome, especially when the imaging studies of adrenal revealed bilateral adrenal glands were normal or atrophic, which helped to make an appropriate strategy treatment.
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Objective To compare the two-dimensional (2D) and three-dimensional (3D) shear wave elastography (SWE) technology in the diagnosis of early stage breast cancer.Methods 84 patients (94 breast lesions) with breast disease confirmed by pathological examination were enrolled from December 2014 to December 2016.All patients underwent 2D and 3D color Doppler ultrasound and the relevant SWE examinations.The optimal maximum and mean elastic modulus of 2D and 3D SWE for diagnosing the benign and malignant breast lesions were obtained by the receiver operating characteristic curve (ROC).Based on the results of pathological examinations,the sensitivity,specificity and accuracy of 2D SWE and 3D SWE in benign and malignant breast lesions diagnosis were evaluated and compared.Results The optimal maximum and mean elastic modulus of 2D SWE for diagnosing the benign and malignant breast lesions were 98.82 kPa and 43.88 kPa respectively,while the corresponding modulus of 3D SWE were 102.54 kPa and 53.87 kPa.The sensitivity of 2D SWE and 3D SWE in breast cancer diagnosis was 89.5％ and 86.3％ respectively,and the difference was not statistically significant (P＞0.05).The specificity and the accuracy of 2D SWE in breast cancer diagnosis were 95.3％ and 92.7％ respectively,which was significant higher than 83.9％ and 85.1％ of 3D SWE,and the differences were statistically significant (all P＜O.05).Conclusions The efficiency of 2D SWE examination is significantly higher than the 3D SWE in benign and malignant breast lesions diagnosis,which can provide a reliable diagnostic basis and is worthy for clinical application.
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Objective To investigate two-dimensional color Doppler commissure real-time shear wave elastrography (SWE) examination and its application value in the diagnosis of breast diseases.Methods One hundred and thirty patients (158 breast lesions) confirmed with breast disease were chosen from September 2013 to September 2014,and all patients underwent two-dimensional color Doppler ultrasound and SWE examination.The receiver operating characteristic (ROC) curve was examined to obtain maximum elasticity modulus value,average elastic modulus value and the corresponding critical value for the diagnosis of benign and malignant breast lesions.According to the results of pathological examination,sensitivity,specificity and accuracy of two-dimensional ultrasound and SWE for the diagnosis of breast lesions were evaluated and compared.Results Of all 158 breast lesions in 130 patients,90 were malignant lesions and 68 were benign lesions.The sensitivities of two-dimensional ultrasound and SWE in diagnosis of breast cancer were 89.7％ and 89.5％,the specificities were 85.6％ and 95.3％ and the accuracy were 87.3％ and 91.4％,respectively.The sensitivity,specificity and accuracy in the diagnosis of breast cancer by combination of two-dimensional ultrasound and SWE were 98.5％,93.3％,95.6％,respectively.Conclusions Although two-dimensional color Doppler ultrasound is a commonly used method in the diagnosis of breast lesions,it has certain limitation.The specificity of diagnosis can be improved by SWE,which is a useful complement to traditional two-dimensional ultrasound technology.Combination of the two methods can significantly increase the sensitivity and accuracy of the diagnosis and provide a reliable basis for the differential diagnosis,reduce the rate of misdiagnosis,missed diagnosis and unnecessary biopsy,which has important clinical application value.
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Objective To assess the enhancement characteristic of breast lesions of contrast-enhanced ultrasound (CEUS) in comparison with contrast-enhanced magnetic resonance imaging (MRI).Methods Between August 2011 and March 2013,72 women with 72 lesions were enrolled.All patients underwent ultrasound,CEUS and MRI.The histopathologic results obtained from ultrasound-guided core biopsy or operation excisions were used as the reference standard.CEUS section evaluations were made similar with MRI regarding the size and shape of lesions.Different contrast enhancement patterns including homogeneous/heterogeneous,the tumor areas,the perfusion defect areas,and modality of time-intensity curve were evaluated.Pearson's correlation coefficient,Student's t-tests,and the concordance test were used for evaluation.Results Of the 72 lesions,pathologic examination revealed 56 (77.8％) malignant lesions and 16 (22.2％) benign lesions.The tumor areas measured by CEUS and MRI agreed well,with a correlation of r =0.894,P =0.000.The difference between the two measurements was not significant according to a paired t test (P =0.886).The concordance tests gave a value of the coefficient Kappa =-0.153 (P =0.061),indicating a low concordance between the results obtained with CEUS and those obtained with MRI regarding the enhanced uniformity.There were statistically significant differences in the perfusion defect areas as measured by CEUS and MRI (P =0.01).The CEUS estimates [(0.837 ± 0.827)cm2] were consistently higher than the MRI estimates [(0.576 ± 0.524)cm2].The time-intensity curve patterns between the two groups showed no correlation.Conclusions The enhancement patterns evaluated by CEUS and MRI partly agreed well.There was no direct association between the two methods regarding the enhancement patterns because of the different contrast agent.
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Objective:This study aims to evaluate the sonographic features of phyllodes tumors of the breast (PTBs) and the cor-relation between sonographic and pathologic findings to improve the understanding of the disease. Methods:Sonographic findings of 85 PTBs from 83 patients were reviewed. The sonographic findings included the results of two-dimensional ultrasound and color Dop-pler flow imaging, elastographic features, and pathologic data. Results:Of the 85 lesions, 33 were the benign tumors, 28 were border-line, and 24 were malignant according to the pathologic diagnosis. Tumor morphology revealed that most masses were lobulated, with a clear-cut boundary, smooth verge, and inhomogeneous internal echo. Clear boundary was more common in the benign phyllodes tumors (χ2=12.721, P=0.002), and a cystic echo-free area was more commonly observed in these malignant tumors (χ2=9.677, P=0.046). LevelⅡandⅢsignals of the blood flow were observed in 75.3%of PTB cases. Of all lesions, only 26 were subjected to elasticity imaging, and the elastographic scores ranged from 2 to 3 in 88.5%of the cases (23/26). Conclusion:Conventional ultrasound and elastographic findings on PTBs exhibited definite characteristics. The border and cystic areas in the tumors can be used to differentiate between be-nign and malignant PTBs.
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Objective To explore the effects of CD4+CD25+Treg cell on the allograft after infusion of dendritic cells (DCs) with low expression of CD40 from donor in mouse heart transplantation.Methods In vitro,mouse bone marrow-derived DCs were infected by CD40-RNAi lentiviral vector,and tolerogenic DCs (Tol-DCs) with low expression of CD40 were prepared.A heterotopic abdominal heart transplantation model was established in mice,and the other three groups that were control group,noninfected DC group and lentivirus infected DC group were designed correspondingly.Cardiac allograft survival time was recorded and pathological grading for acute rejection was assessed on the 7 d after heterotopic abdominal heart transplantation.Concentrations of CD4+CD25+Treg cells in peripheral blood were analyzed before and after transplantation by flow cytometry.Results After 48 h infection of DCs by CD40-RNAi lentiviral vector in vitro,the expression of CD40 mRNA was down-regulated significantly,whose inhibition rate was 80.9％.The expression of CD40 was decreased from 74.37％ ±4.08％ to 40.07％ ± 4.03％ (P＜0.05) after 48 h infection.Compared with the control group and the noninfected DC group,the cardiac allograft survival time was significantly prolonged in the CD40-RNAi lentivirus infected DC group,which was (14 ± 4) d(P＜0.01) ; concentrations of CD4+CD25+Treg cells in peripheral blood were increased both on the 3 d and the 7 d after transplantation (P＜0.05) ; the pathological grading for acute rejection was decreased on the 7 d after transplantation (P＜0.05).Conclusion The CD4+CD25+Treg cell in peripheral blood was protective to cardiac allograft in prolonging its survival time in mouse heart transplantation.
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Objective To characterize the MR features of intraductal papilloma of the breast.Methods The MRI data of 24 patients with intraductal papillomas of the breast verified by histopathology were analyzed.The MRI features analyzed included morphology,signal intensity on pre-enhanced T1 WI and FE T2 WI,the patterns of dynamic enhancement,and the mean ADC on DWI.The ADC values for intraductal papilloma and normal breast tissue were compared using paired t test.Results The maximum diameter of the tumors ranged from 0.3 cm to 2.0 cm.Of the 24 tumors,17 were round or oval and 7 were irregular in shape:the margins were well-defined in 18 cases,and ill-defined in 6 cases.AII tumors were isointensity or hypointensity on T1 WI,and slight hyperintensity on T2 WI.On dynamic enhanced images,all the 24 tumors showed rapid initial enhancement.and the mean early phase enhancement rate was(156.50±19.67)%.In the early phase.homogenous enhancement was shown in 15 cases and heterogeneous enhancement in 9 cases.In the delayed phases,the most tumors(18/24)had ring-like enhancement pattern in which signal intensity in peripheral is higher than that in center.The patterns of time-signal intensitycurves were type Ⅲ(washout)in 19 cases and type Ⅱ(plateau)in 5 cases.With b=1000 s/mm2,the mean ADC value for intraductal papilloma[(1.14±0.29)×10-3mm2/s]was significantly lower than that of the normal breast tissue [(1.83±0.32)x 10-3mm2/s (t=5.53,P=0.000).Conclusions MRI features of intraductal papilloma are similar to breast cancer in washout pattern on DCE-MRI and lower ADC value on DWL However,relative lower early enhancement rate and dynamic signal intensity course on DCE-MRI are characteristic clues to differentiating intraductal papilloma from breast eancer.
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Objective To evaluate the role of breast MRI in detecting the primary malignancy in patients presenting solely with axillary lymph node metastases. Methods Thirty-three patients with axillary lynph node metastases but negative findings on either physical examination or mammography underwent breast MRI to identify occult breast carcinoma. MRI of the breast was assessed according to BI-RADS criteria. The pathologic diagnosis was made according to the standard criteria by the WHO Classification of Tumor. Results Among 33 patients presenting solely with axillary metastases, 30 patients underwent modified radical mastectomy. Primary breast carcinoma was proven in 17 patients. MRI detected lesions in 16 patients, including 10 masses and 6 non-mass lesions. Size of the masses ranged from 0. 5 to 2. 6 cm (mean 1.5 cm). Six lesions were smaller than 1.5 cm in size. Non-mass lesions showed ductal enhancement in 4 cases and segmental enhancement in 2 cases. One patient with tumor detected by histopathology showed no abnormal enhancement on MRI. No tumor was found at mastectomy in the other 13 womeu, and negative MR findings were revealed in 9. Four cases with suspicious enhancement on MRI had no corresponding primary foci on pathology. Three patients didn't undergo surgical procedure. The sensitivity, specificity, and accuracy of MRI in the diagnosis of the primary malignancy were 94. 1%,69. 2%, and 83.3%, respectively. Conclusions Small size of mass and ductal or segmental enhancement of non-mass lesion were common MR features of occult malignancy. MRI showed high sensitivity and accuracy in diagnosing occult breast carcinoma. Breast MRI should be taken in search of occult malignancy in patients with axillary metastases.