Diagnostic value of 4-dimensional computed tomography in preoperative localization in patients with primary hyperparathyroidism / 中华内科杂志

Objective:To provide more options for preoperative localization diagnosis in patients with primary hyperparathyroidism (PHPT), the diagnostic efficacy of parathyroid 4-dimensional computed tomography (4D-CT) in patients with PHPT was evaluated.Methods:This was a single-center retrospective study including 57 patients with surgical proved PHPT. All of the patients underwent 4D-CT, 99Tc m -sestamibi parathyroid imaging (MIBI), and ultrasonography (US) preoperatively. The reference standard for correct localization was based on operation reports and pathology confirmation. The patients were grouped according to the preoperative serum calcium levels, tumor diameter, or ectopic lesions (yes/no), respectively. The sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of 4D-CT, MIBI and US, alone or in combination, were analyzed in total and each subgroup patients. Results:Fifty-seven patients (39 women, 18 men; mean age of 56.5 years) were evaluated, including four cases with multi-gland disease and thirteen cases with ectopic parathyroid lesions. In all the patients, similar diagnostic efficacy was found in 4D-CT (AUC: 0.943) and MIBI (AUC: 0.927), both of which were higher than that of US (AUC: 0.847) ( P = 0.01 for 4D-CT vs. US; P = 0.04 for MIBI vs. US). In a subset analysis for ectopic quadrants, the diagnostic efficacy of 4D-CT was significantly higher than that of MIBI ( P = 0.04) or US ( P = 0.01), with the sensitivity of 100%, 69.2%, and 61.5%, and AUC of 0.989, 0.846, and 0.808 for 4D-CT, MIBI and US, respectively. Conclusions:4D-CT has similar diagnostic efficacy for preoperative localization to MIBI in patients with PHPT, and it is superior to MIBI and US in identifying the ectopic parathyroid gland. 4D-CT can be recommended as an alternative preoperative localization method, especially when parathyroid lesions could not be precisely located by US and MIBI.

Third-generation Dual-source CT for Head and Neck CT Angiography with 70 kV Tube Voltage and 20-25 ml Contrast Medium in Patients With Body Weight Lower than 75 kg / 中国医学科学院学报

Objective To investigate the image quality of head and neck CT angiography (CTA)using the third-generation dual-source CT combined with 70 kV tube voltage and 20-25 ml contrast medium (CM),and evaluate the effects of venous artifacts arising from the CM on the ipsilateral side of injection. Methods Totally 40 consecutive patients with suspected vascular diseases and body weight lower than 75 kg prospectively underwent head and neck CTA examination using the third-generation dual-source CT. CTA was performed with a third-generation dual-source CT system. Patients were randomly divived into 70 kV group (n=20)and 100 kV group (n=20). The 70 kV group used 20-25 ml CM and advanced modeled iterative reconstruction technique,and the 100 kV group used 40 ml CM and filtered back projection. Venous artifacts and CM residues were evaluated by a 3-point scale (1=excellent,3=poor),respectively. Results The effective dose of 70 kV group decreased 58% compared to 100 kV group (t=-18.14,P<0.001).In the 70 kV group,16 patients (80.0%)presented with venous artifacts and six of them (37.5%,6/16)affected the adjacent arteries. In the 100 kV group,19 patients (95.0%)presented with venous artifacts,and seven of them (36.8%,7/19)affected the adjacent arteries (Z=-0.878,P=0.380). In the 70 kV group,13 patients (65.0%)presented with obvious CM residues and two of them (15.3%,2/13)prolonged into the superior vena cava (SVC). In the 100 kV group,19 patients(95.0%)presented with obvious CM residues,and thirteen of them(68.4%,13/19)prolonged into the SVC (Z=-3.654,P<0.001). Conclusion Compared with the 100 kV,the third-generation dual-source CT for head and neck CTA,combined with 70 kV and 20-25 ml CM,can remarkably decrease the radiation dose,along with reduced CM residues and comparable venous artifacts.

Application of Third-generation Dual-source CT for Ultra-high Resolution Temporal Bone Imaging Using Automated Tube Voltage Adaptation in Children with Hearing Impairment / 中国医学科学院学报

Objective To evaluate the radiation dose and image quality of the third-generation dual-source CT using automated tube voltage adaptation (CARE kV) in temporal bone scanning in pediatric patients with hearing impairment. Methods Totally 27 children with hearing impairment less than 18 years old were randomly divided into two groups:Group A (n=14),examined with CARE kV (reference with 100 kV and 214 mA)and sinogram-affirmed iterative reconstruction;and Group B (n=13),examined with CARE kV (reference with 100 kV and 171 mA)and advanced modeled iterative reconstruction. The scan range was from eyebrow to the end of the mastoid process. CT values and image noise were measured.The signal to noise ratio (SNR)was calculated. Subjective image quality was assessed by two radiologists and later in a consensus reading. Results There was no significant difference in CT value,image noise,and SNR between these two groups (all P>0.05). Also,the subjective scores of the 10 anatomical structures showed no significant difference (all P>0.05). The CT dose index volume and dose-length product were (11.62+1.92)mGy and (106.92+37.48)mGy·cm,respectively,in group B and (21.28+2.19)mGy (t=12.15,P<0.001)and (229.65+56.26)mGy·cm (t=6.62,P<0.001)in group A,decreased by 45% and 53%. Conclusion Compared with the second-generation dual-source CT,the third-generation dual-source CT for the scanning of temporal bone with CARE kV can ensure image quality and reduce radiation dose.

Laryngeal endoscopic cricopharyngeal myotomy for cricopharyngeal achalasia post stroke / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia.@*Methods@#A total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy(CPM) group and endoscopic CPM (ECPM) group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data.@*Results@#The swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study(VFSS)-swallowing score, VFSS-aspiration score and drinking test score were (3.1±1.1), (3.4±0.8) and (2.0±0.6)in post-ECPM, (3.4±1.4), (3.0±0.9) and (2.2±0.6)in post-CPM. No statistical difference was found in validity between CPM group and ECPM group(t=-0.435, t=1.086, t=-0.607, P>0.05). No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM.@*Conclusions@#New surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.

Effects of Tangbikang on the Expressions of p38 MAPK of Sciatic Nerve and Plasma TNF-αin Diabetic Rats / 中国中医药信息杂志

Objective To explore the effects of Chinese herbal compound Tangbikang on the expressions of p38 MAPK of sciatic nerve and plasma TNF-α in diabetic rats. Methods Ten of the sixty male SD rats were selected randomly as normal group, and the rest were fed with high-fat diet and low-dosage STZ was used to induce type Ⅱdiabetic rat models. Model rats were randomly divided into model group, mecobalamine group and Tangbikang low-, medium-, and high-dosage groups, 10 rats in each group. Each medication group was intervened with relevant medicine. Rat unilaterals sciatic nerves were taken after 16 weeks. The content of TNF-α in plasma was determined by radioimmunoassay. Western blot method was used to detect the expressions of p38 and p-p38 MAPK protein of sciatic nerve. Results Compared with normal group, the expressions of p38 and p-p38 protein and content of TNF-αin model group significantly increase (P<0.05, P<0.01). Compared with the model group, the expressions of p-p38 protein and the content of TNF-α significantly decreased after medicine intervention in different doses Tangbikang groups and mecobalamin group (P<0.05, P<0.01). The expression of p38 protein in Tangbikang high-dose group significantly decreased (P<0.05), with statistical significance (P<0.05). Conclusion Tangbikang can reduce the expression of p38 and p-p38 MAPK protein of the rat sciatic nerve, and reduce the content of TNF-α protein in rat plasma, which may be one of the effective targets of neuroprotection and abirritation of diabetic peripheral neuropathy.

Surgical management of refractory dysphagia and aspiration / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the methods and results of surgical management for refractory dysphagia and aspiration.</p><p><b>METHODS</b>The clinical data of 24 refractory dysphagia and aspiration patients who accepted surgical management were retrospectively analysed.</p><p><b>RESULTS</b>Twenty-four refractory dysphagia and aspiration patients accepted 26 operations between 2001 and 2014. Of the 26 operations, 17 were cricopharyngeal myectomy (CPM), 6 were scarectomy, 3 were laryngeal-tracheal separation. No severe complications occurred. Assessments of dysphagia were completed in 18 operations before and after operation. Aspiration scores of videofluoroscopic swallowing study (VFSS) were 4.50 [4.00;7.00] vs 2.00 [1.00; 3.25], P = 0.000; swallow dysfunction scroes of VFSS were 5.00 [4.00; 12.00] vs 1.00 [1.50; 10.00], P = 0.001; aspiration scores of fibroptic endoscopic evaluation of swallowing (FEES) were 4.00 [5.00; 7.00] vs 2.00 [1.75; 3.00], P = 0.000. But the surgical results for post radiotherapy dysphagia were not successful (n = 5): aspiration scores of VFSS were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109;swallow dysfunction scroes of VFSS were 12.00 [10.50; 12.00] vs 12.00 [7.50; 12.00], P = 0.180;aspiration scores of FEES were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109.</p><p><b>CONCLUSION</b>Surgical management was effective for refractory dysphagia and aspiration, but the surgical indication selection should be strict.</p>

Clinical Research on Near-term Quality of Life among Unstable Angina Patients by Shen-Yuan Yi-Qi Huo-Xue Capsule Combined with Early Percutaneous Coronary Intervention / 世界科学技术-中医药现代化

This study was aimed to investigate the effects of Shen-Y uan Y i-Qi Huo-Xue (SYYQHX) capsule com-bined with early percutaneous coronary intervention (PCI) on near-term quality of life (QOL) in unstable angina (UA) patients. Seventy-eight patients diagnosed with UA were selected and randomly divided into the treatment group and control group, with 39 patients in each group. Early PCI was undergone after coronary angiography. Before PCI, the control group was given routine western medication. The treatment group was given routine western medication plus SYYQHX capsule, three pills once, three times daily. The treatment lasted for 30 days. The QOL scores were evalu-ated among patients from both groups before and after treatment in order to determine the efficacy on angina, electro-cardiogram (ECG) and traditional Chinese medicine (TCM) main symptom. The results showed that compared to pre-treatment, the scores of physical limitation (PL), angina stability (AS), angina frequency (AF), and treatment satisfac-tion ( TS ) were significantly increased after treatment ( P < 0 . 05 ) . Compared with the control group , after treat-ment with SYYQHX capsule, the AF, duration time and symptoms of palpitation, fatigue and shortness of breath were obviously improved (P< 0.05). The scores of AS, AF and TS in the treatment group were significantly increased (P < 0.05). It was concluded that SYYQHX capsule combined with early PCI can improve the near-term QOL and TCM main symptoms among UA patients.

Up-regulation of monocyte chemoattractant protein-1 in 3T3-L1 adipocytes by CoCl2 induced hypoxia / 中华内分泌代谢杂志

To investigate the effects of hypoxia chemically induced by CoCl2 on the expression of monocyte chemoattractant protein-1 ( MCP-1 ) in mouse 3T3-L1 adipocytes.3T3-L1 preadipocytes were cultured in vitro and differentiated into the matured adipocytes.Cell differentiation and lipid accumulation was determined by Oil Red O staining.CoCl2 was used as a chemical hypoxia-inducible reagent to mimic hypoxic microenvironment.The effect of CoCl2 on cell viability was estimated by MTT assay.Hypoxia-inducible factor-1α(HIF-1α) expression under hypoxia was detected by realtime fluorescent PCR and Western blot,while MCP-1 expression was detected by real-time fluorescent PCR and ELISA.CoCl2 induced hypoxia led to a marked recruitment of HIF-1α in mouse 3T3-L1adipocytes.Similarly,both mRNA and protein levels of MCP-1 were up-regulated.Exposure of 3T3-L1 adipocytes to CoCl2 induced hypoxic microenvironment in vitro,and hypoxic induction of MCP-1 expression and secretion may be mediated by HIF-1 α and may contribute to chronic low grade inflammation in adipose tissue.

Study on coronary artery imaging with dual source computed tomography in senile people / 中华老年医学杂志

Objective To explore the image quality of coronary artery imaging with dual source computed tomography (DSCT) and analyze the coronary artery lesions. Methods Two hundred cases with clinically suspected coronary heart disease, who underwent plain and enhanced DSCT coronary artery imaging without oral Betaloc preparation were retrospectively analyzed. The patients were divided into two groups: the senile group of 126 cases with the average age of (71.3±7.7) years old and the control group of 74 cases with the average age of (50.4±6.2) years old. The clinical characteristics, the average heart rate and breath-holding time for plain and enhanced scan, the average calcium score, the image quality evaluation and the coronary stenosis were compared between the two groups. Results Compared with the control group, the incidences of chest pain or discomfort, hypertension, diabetes mellitus, hypercholesterolemia and old myocardial infarction were significantly higher in the senile group. The average calcium score and the numbers of <50% and ≥50% stenosis were also significantly higher in the senile group than those in the control group (364.9±442.6)points vs. (44.8±106.9)points, 159 vs. 45 branches, 212 vs. 32 branches, respectively, all P<0.01). The average heart rate and breath-holding time of plain and enhanced scan had no significant differences compared with the control group. The proportion of the coronary segments with grade 1 ,grade 2 and grade 3 image quality also had no significant difference compared with the control group (96.5%,2.3% and 1.2% vs. 97.1%, 2.0% and 0.9%, P>0.05). Conclusions DSCT coronary artery imaging in senile patients is noninvasive, safe and simple, and excellent coronary artery image can be obtained without oral Betaloc preparation. It can be used as a routine examination in the clinical diagnosis of coronary heart disease.

Dual-source CT coronary angiography in patients with premature heart-beats:initial experience / 中华放射学杂志

Objective To evaluate the feasibility of dual-source computed tomography(DSCT)coronary angiography in a population with premature heart-beats.Methods Seventy patients with suspected coronary artery disease and premature heart-beats were routinely imaged on a DSCT scanner(Somatom Definition,Siemens AG,Germany).The images were reconstructed before and after ECG editing.Two readers independently assessed image quality of all coronary segments using a four-point grading scale from excellent(1)to non-assessable(4).The results ofthe two groups were compared with a paired t-test,and a P value of less than 0.05 Was considered significant.Results The mean heart rate during examination ranged from 49 to 111 bpm[mean(70.7±12.4)bpm].Twenty-eight of 70 patients with relatively small variability of the heart rate[(41.0±18.4)bpm]got diagnostic image quality without ECG editing.In other 42 patients with larger variability of the heart rate[(71.4±28.7)bpm],the meal image quality scores were 2.09±1.27 and 1.50±0.79 before and after ECG editing,there Was a significant difference(t=13.764,P＜0.01).The proportion of non-assessable segments Was reduced from 24.8%(154/620)to 3.4%(21/620)through ECG editing(X2=121.846,P＜0.01).Finally,the diagnostic image accounted 98.0%(1014/1035)in all segments of 70 patients.Conclusion DSCT can provide diagnostic images for patients with premature heart-beats.The image quality in patients with larger variability of the heart rate can be significantly improved through ECG editing.

X-ray and high resolution CT Findings in pulmonary alveolar proteinosis and their relationship with pulmonary function / 中华放射学杂志

ObjectiveTo study X-ray and high resolution computed tomograghy(HRCT)features and tIleir relationship with pulmonary function test in pulmonary alveolar proteinosis(PAP).MethodsThe findings of X-ray and HRCT and the Resultsof pulmonary function tests in 19 patients with PAP were reviewed retrospectively.X-ray and HRCT scores were rated in the aspects of opacity density,extent,and severity.The relationship between the imaging scores and pulmonary function tests were determined.ResultsX-ray showed a symmetrical perihilar predominance appearance in patients with PAP.HRCT scan showed bilateral clear-defined pathchy areas of ground-glass opacity and interlobular septal thickening,a pattern commonly characterized as"crazy paving".Nineteen PAP respiratory function Resultswere:DLCO/Pred=(54.49±16.78)%,FEV1/FVC=(86.00±6.70)%.Chest radiographic extent score and severity score correlated with diffusing capacity(r=-0.661,P＜0.01,r=-0.475,P＜0.05).HRCT severity score was 16.47±5.26.Among all the HRCT scores,severity score correlated significantly with the presence of restrictive ventilatory defect and diffusing capacity defect(DLCO/Pred,r=-0.809,P＜0.01;FEV1/FVC,r=0.573,P＜0.05).ConclusionsIn patients with PAP,there Is close relationship between X-ray,HRCT findings and pulmonary function.HRCT correlates more closely with pulmonary function.

The impact of heart rate on image quality and reconstruction timing of dual-source CT coronary angiography / 中华放射学杂志

ObjectiveTo evaluate the impact of patient's heart rate(HR)on coronary CT angiography(CTA)image quality(IQ)and reconstruction timing in dual-source CT(DSCT).Methods Ninety-five patients with suspicion of coronary artery disease were examined with a DSCT scanner(Somatom Definition.Siemens)using 32×0.6 mm collimation.All patients were divided three groups according to the heart rate(HR):group 1,HR≤70 beats per minute(bpm),n=26;group 2,HR＞70 bpm to≤90 bpm, n=37;group 3,HR＞90 bpm,n=32. No beta-blockers were taken before CT scan.50-60 ml of nonionic contrast agent were injected with a rate of 5 ml/s. Images were reconstructed from 10%to 100% of the R-R interval using single-segment reconstruction. Two readers independently assessed IQ of all coronary segments using a 3-point scale from excellent(1)to non-assessable(3)for coronary segments and the relationshiD between IQ and the HR. ResuitsOverall mean IQ score was 1.31 ±0.55 for all patients with 1.08±0.27 for group 1,1.32±0.58 for group 2 and 1.47±0.61 for group 3. The IQ was better in the LAD than the RCA and LCX(P＜0.01).Only 1.4%(19/1386)of coronary artery segments were considered non-assessable due to the motion artifacts.Optimal image quality of all coronary segments in 74 patients(77.9%)can be achieved with one reconstruction data set.The best IQ was predominately in diastote(88.5%)in group 1,while the best IQ was in systole(84.4%)in group 3. ConclusionsDSCT can achieve the optimal IQ with a wide range of HR using single-segment reconstruction. With the increasing of HR,the timing of data reconstruction for the best IQ shifts from mid-diastole to systole.

Coronary Artery Imaging in Patients with High Heart Rate by Dual-source CT:The Initial Experience / 实用放射学杂志

Objective To explore the scanning technique and image quality of coronary artery imaging with dual-source CT without oral Betaloc preparation in the patients with high heart rate.Methods 412 cases were undergone coronary imaging with dual-source CT (including plain and enhanced scans) ,among them,there were 30 cases with heart rate more than 100 bpm.Multi-planar reconstruction(MPR),maximum intensity projection(MIP) and volume rendering (VR) were performed using contrast-enhanced images.The image quality was classified into 3 grades, and coronary segments named according to AHA standard were evaluated.Results The average heart rate during enhanced scan in the 30 cases was (115.6?11.8)(101～139)bpm,the average breath hold time was (5.7?1.2) s.The best reconstruction phase was in the systolic phase. Altogether 424 coronary segments were evaluated, among them 93.9%(398/424)belonged to the first grade,5.0%(21/424)belonged to the second grade,and 1.2%(5/424) belonged to the third grade. Conclusion Without oral administration of Betaloc preparation, good coronary artery images can be obtained in the patients with high heart rate by dual-source CT.