Serially evaluation of changes in myocardial perfusion, hibernation myocardium and left ventricular function in the development of chronic coronary artery occlusion by gated SPECT perfusion and gated PET imaging in pigs / 中华核医学与分子影像杂志

Objective:To serially characterize the myocardial perfusion, myocardial hibernation and left ventricular (LV) function as well as LV remodeling in progressive coronary artery stenosis in Chinese mini-pigs.Methods:In 8 Chinese mini-pigs (5 males, 3 females; age: 10 months), chronic progression of coronary stenosis and finally occlusion was established using Ameroid constrictor implantation at the 1 cm below the bifurcation of the first diagonal branch of the left anterior descending (LAD) artery. Serial gated 99Tc m-methoxyisobutylisonitrile(MIBI) SPECT/CT, gated 18F-FDG PET/CT imaging and coronary angiography (CAG) were performed before surgery and at the 1st, 4th and 8th week after surgery. Longitudinally, total perfusion defect (TPD), LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), summed motion score (SMS), summed thickening score (STS) and hibernating myocardium (HM) were analyzed. Repeated measures analysis of variance, Kruskal-Wallis rank sum test and Bonferroni correction method were used to analyze data. Results:One mini-pig died of infection after the Ameroid constrictor implantation. In the remaining 7 mini-pigs, TPD was progressively increased with time prolonged (0, 12.0%(0, 33.0%), (41.1±23.7)% and (49.3±24.5)%; H=17.03, P=0.001); Compared with HM before the surgery (100%), HM was gradually reduced from the 1st (21.0%(6.0%, 100%)) to the 4th (18.0%(3.0%, 33.0%)) week after surgery, and then increased to the 8th week after surgery ((23.0±15.4)%; H=13.09, P=0.004), but there was no significant difference between the 1st and 4th week, or between the 4th and 8th week after surgery (both P>0.05 (Bonferroni correction method)). Accordingly, LVEF gradually decreased ((73.7±8.4)%, (63.7±19.1)%, (53.7±14.6)% and (49.9±15.4)%; F=6.22, P=0.004). LVEDV (9.0(6.0, 21.0), (31.4±16.3), (32.9±17.4) and (36.4±17.5) ml; H=8.58, P=0.035)and LVESV ((3.8±3.2), (15.9±15.3), 12.0(10.0, 17.0)and (19.3±10.9) ml; H=10.51, P=0.015) gradually increased. SMS and STS continuously increased as well ( H values: 16.49, 13.33, P values: 0.001, 0.004). Conclusions:With the progression of coronary artery stenosis to occlusion, myocardial perfusion is gradually decreased, while the global and regional LV function, LV remodeling are gradually aggravated, and HM is gradually reduced. After the chronic coronary artery occlusion, myocardial perfusion has a trend to be improved and HM is gradually recovered.

Research progress on influence factors and treatment of urinary incontinence after radical cystectomy and orthotopic neobladder in male / 中国医师杂志

Radical cystectomy is widely used as a gold standard in the treatment of invasive bladder cancer. Urinary diversion is required after radical cystectomy. In all kinds of urinary diversion procedures, orthotopic neobladder is preferred by its advantages such as spontaneous voiding, avoidance of external ostomy and improvement of body image. After surgery, urinary incontinence is a common complication. In this review, we systematically outline the management of urinary incontinence in men after radical cystectomy and orthotopic neobladder. And we mainly describe the influential factors of urinary incontinence, such as preoperative diabetes, intraoperative intestinal selection and nerve preservation, and postoperative urinary tract infection. The related post-operative management of urinary incontinence that has been conducted previously is also described in detail. The aim of this study is to provide guidance for the systematic treatment of urinary incontinence in clinical practice, and to look forward to the possible future development directions of urinary incontinence treatment, such as bladder neck reconstruction and stem cell therapy.

Clinical value of 18F-FDG PET/CT in distinguishing benign from malignant cardiac tumors / 中华核医学与分子影像杂志

Objective:To evaluate the clinical value of 18F-fluorodexoyglucose (FDG) PET/CT in distinguishing benign from malignant tumors in patients with cardiac tumors. Methods:Between January 2015 and September 2018, 18F-FDG PET/CT was performed in 3 678 patents in Beijing Anzhen Hospital, and 51 of them (51/3 678, 1.39%) were diagnosed as cardiac tumors. Finally, 28 patients (10 males, 18 females; mean age (52±14) years, age range: 18-84 years) with pathological results were included. According to pathological results, patients were divided into 4 groups: group 1 with primary benign cardiac tumor ( n=9), group 2 with primary malignant cardiac tumor ( n=9), group 3 with lymphoma ( n=6) and group 4 with secondary malignant cardiac tumor ( n=4). All patients underwent early (60 min) 18F-FDG PET/CT imaging and 22 patients (6, 7, 6, 3 patients in group 1, group 2, group 3, group 4 respectively) underwent delayed (120 min) imaging. The maximum standardized uptake value (SUV max) and target/backgroud ratio (TBR) of 4 groups in early imaging and delayed imaging were calculated and compared with one-way analysis of viariace and Scheffe Post-hoc test. TBR were calcualted as SUV max/mean standardized uptake value (SUV mean) in the liver. Receiver operating characteristic (ROC) curve analysis was also performed. Results:SUV max during early imaging, defined SUV max(early), was 2.6±1.5, 9.9±4.0, 20.5±6.1, 9.2±5.8 in group 1-4 respectively ( F=21.39, P<0.01), the value of group 1 was lower than that of group 2 and 3, and the value of group 3 was the highest (all P<0.005). TBR early was 1.1±0.6, 4.1±1.6, 9.4±2.6, 3.7±2.0 in the 4 groups ( F=29.15, P<0.01), the value of group 1 was lower than that of group 2 and 3, and the value of group 3 was the highest (all P<0.005). SUV max in delayed imaging (SUV max(delay)) was 2.4±1.2, 11.0±5.9, 25.8±7.7, 13.7±7.7 respectively in the 4 groups ( F=16.01, P<0.01). TBR delay was also significantly different among the 4 groups (1.3±0.7, 5.5±2.9, 14.4±4.9, 7.9±5.0; F=14.78, P<0.01), the value of group 3 was higher than that of group 1 and 2 (all P<0.05). ROC curve analysis showed optimal cut-off values for indicating malignancy were: SUV max(early)=4.2, TBR early=1.6, SUV max(delay)=4.6, TBR delay=1.9. The corresponding sensitivities, specificities, accuracies were 19/19, 8/9, 96.4%(27/28); 19/19, 7/9, 92.9%(26/28); 16/16, 6/6, 100%(22/22); 16/16, 5/6, 95.5%(21/22), respectively. Conclusions:18F-FDG PET/CT imaging can accurately diagnose malignant cardiac tumors. Delayed imaging can further improve the accuracy for diagnosis of malignant cardiac tumors.

18F-FDG PET/CT images quality and its impact factors in diabetic and non-diabetic patients with coronary artery disease / 中华核医学与分子影像杂志

Objective:To evaluate the image quality (IQ) of 18F-fluorodeoxyglucose (FDG) PET/CT imaging and identify its influenfial factors in diabetes mellitus (DM) and non-DM patients with coronary artery disease (CAD). Methods:A total of 196 consecutive CAD patients (174 males, 22 females, 68 DM; age: (57±10) years) in Beijing Anzhen Hospital between June 2016 and February 2018 were retrospectively analyzed. All patients underwent 18F-FDG myocardial PET/CT imaging. The standardized fasting+ oral glucose loading (OGL) and intravenously injection of insulin protocol was performed. According to the FDG uptake by myocardium, background activity in blood and other visceral organ nearby the heart, the IQ was visually evaluated and scored by 0-4. Zero-two was considered as good IQ, 3-4 was regarded as poor IQ. Patients were divided into three groups: group 1 (non-DM+ good IQ), group 2 (DM+ good IQ), group 3 (DM+ poor IQ). Factors which may affect IQ were analyzed, which including OGL, the injection dose of insulin, fasting blood glucose (FBG), peak blood glucose (PBG), blood glucose (BG) level at 18F-FDG injection (BG injnection), BG increasing rate ((PBG-FBG)/FBG, %), and BG decreasing rate ((PBG-BG injection)/PBG, %). One-way analysis of variance, Spearman correlation analysis and logistic regression analysis were used for data analysis. Results:There were significant differences ( F values: 13.074-38.371, all P<0.05) of FBG, PBG, OGL, BG decreasing rate and the injection dose of insulin among group 1 ( n=132, 67.3%), group 2 ( n=53, 27.1%), group 3 ( n=11, 5.6%). All those parameters, except for OGL, were positively correlated with FDG PET/CT IQ ( r s values: 0.142-0.262, all P<0.05). OGL was negatively correlated with IQ ( r s=-0.324, P<0.05). Logistic regression analysis showed that FBG (odds ratio ( OR)=0.687, 95% CI: 0.633-0.746), PBG( OR=0.786, 95% CI: 0.746~0.829), BG injection( OR=0.631, 95% CI: 0.595-0.716), OGL( OR=0.897, 95% CI: 0.873-0.922), the injection dose of insulin( OR=0.680, 95% CI: 0.618-0.748) were predictive factors (all P<0.01) for good IQ in all patients. For DM patients, OGL was the only predictive factor for good IQ( OR =0.940, 95% CI: 0.904-0.960; P<0.01). Conclusions:FBG, PBG, BG injection, OGL, the injection dose of insulin can predict IQ for all patients with CAD. For DM patients with CAD, OGL is the only predictive factor for good IQ. A good IQ of 18F-FDG PET/CT could be obtained in majority of CAD patients, with the standardized fasting + OGL and intravenously injection of insulin protocol and adjust according to the personal status, and prevent the hypoglycemia from happening.

Role of multidimensional assessment in refractory asthma of children / 中华实用儿科临床杂志

Refractory asthma is an inevitable clinical difficulty that is often faced by pediatricians in the promotion of standardized diagnosis and treatment of asthma.In this paper, the important role of multidimensional assessment (MDA) in the diagnosis of refractory asthma is emphasized, and the method of MDA is described in detail at first.Then foreign and domestic research on the internal mechanism of truly refractory asthma in recent years is syste-matically reviewed, which shows the progress of research on the internal phenotypes, biomarkers and targeted treatment of refractory asthma to the readers, with a view to developing the pediatricians′ ideas and further improving the diagnosis and treatment level of asthma by taking precision medical treatment as the goal.

Research Progress and Joint Evaluation on Center of Rotation for Lumbar Vertebrae / 医用生物力学

In recent years, with the growth of social development, the incidence of lumbar vertebrae diseases has increased year by year, and many surgical methods have been developed. These treatment methods mark the accumulation of surgical experience and the development of medical technology. However, a new issue appears, i.e. how to evaluate the degree of lumbar disease and postoperative rehabilitation. There is an urgent need to establish a quantitative index of preoperative examination and postoperative rehabilitation criteria for lumbar disease from both doctors’ and patients’ perspectives. The current studies show that the measurement of the center of rotation (COR) for lumbar vertebrae and surface electromyography (sEMG) can reduce the error in the evaluation of clinical curative effect for treating lumbar disease and can be applied widely. This review summarizes the relationship between COR and lumbar disease, as well as the role of COR and sEMG joint evaluation in clinical operation and postoperative rehabilitation.

Kinematic Differences Between Patients with Lumbar Disc Herniation and Healthy People in Three Daily Activities Based on Refined Trunk Model / 医用生物力学

Objective To establish a refined model of trunk composed of different lumbar segments, lumped thoracic spine and pelvis, analyze the kinematic differences between patients with lumbar disc herniation (LDH) and healthy people during three daily activities, and to compare the refined trunk model with the simplified trunk model adopting the whole lumbar segment, and discuss the necessity of using the refined trunk model for kinematic analysis of LDH patients. Methods Motion capture system NDI was used to collect kinematic parameters of each segment from 15 healthy people and 7 male LDH patients during level walking, trunk flexion and contralateral pickup, then the kinematic differences between patients and healthy people by the two models were compared respectively. Results During level walking, the rotation of the thoracic segment and pelvis for LDH patients increased, while no significant change was found in motion angle of the whole lumbar segment, and the rotation angle of L4-5 segment significantly reduced. During trunk flexion, the flexion angles of all lumbar segments for LDH patients were reduced by varying degrees, and the flexion angle of L3-4 segment was significantly different from that of healthy people. During contralateral pickup, the performance on the sagittal plane was similar to that during flexion. However, the lateral bending angles of L3-4 segment and L4-5 segment for LDH patients were significantly lower than those for healthy people. ConclusionsLDH patients mainly restrict the motion of injured lumbar segments in daily activities. During some motions, only refined model can discover the abnormal motion of injured lumbar segments. Therefore, it is necessary to subdivide the lumbar spine into 5 independent segments for analyzing the kinematic characteristics of LDH patients.

Clinical effects of upper eyelid blepharoplasty using the dermis orbicularis muscle flap technique / 中华医学美学美容杂志

Objective To develop a new technique of upper eyelid blepharoplasty for reducing surgical complications and improving cosmetic results.Methods In this study,721 cases (9 males and 712 females,range in age 17-32 years) with single eyelid were performed with double eyelid blepharoplasty using this method (dermis orbicularis muscle flap technique,DOMF),698 cases of which were simultaneously operated with epicanthoplastic surgery.In the operation,DOMF was harvested in the dermis edge in lower incision margin.The flap was sutured to levatoraponeuros at the superior border of the tarsus.Patients were followed up for three months to three years.Results It was concluded that unfavorable results included low fold in 12 cases,relapse in 3 cases,asymmetric crease in 4 cases,puffy eyelids in 5 cases,and sunken appearance in 4 cases.The physicians and patients were satified with the results.The eyelid appeared smooth without fold depression on downward gaze or eyes closed,and it was gentle and not overly puff as eyes opening.Conclusions The DOMF technique mimics the movement of congenital crease fold,which is easy to perform,creating a delicate,firm and smooth upper lid orientation.

Directional laminar resection of retro-orbicularis oculus fat: a method for upper eyelid heaviness correction / 中华整形外科杂志

Objective@#To apply an operative method of directional laminar resection of retro-orbicularis oculus fat(ROOF) for correction of upper eyelid heaviness.@*Methods@#From June 2017 to May 2018, 87 cases with preoperative diagnosis of puffy eyes were operated on the technique. In order to guide the resection of ROOF and orbital septum fat(OF), the upper eyelid was marked by three areas before the operation: lateral superior orbital region, orbital blepharoculi, and inferior orbital blepharoculi.Blepharoplasty was performed by septoaponeurosis junctional thickening technique. The epicanthoplasty was completed by inverted L-type technique. Drainage skin plate was placed in the incision and postoperative compression bandage was applied.@*Results@#Two patients developed postoperative hematoma in the right eye. The incisions healed well after debridement. Two cases of which developed superior sulcus in the left eye was improved after one months. The patients was followed 6 months to 12 months after surgery. All the patients were satisfied with the effect.@*Conclusions@#The technique was effective in reducing the heaviness of upper eyelid. In the operation, anatomical positioning of ROOF resection, complete retention of orbital septum and the release and anchorage of OF were the key steps to prevent complications.

Effects of flavonoids from Cuscuta chinensis on intestinal calcium-binding protein mRNA expression in ovariectomized osteoporosis model rats / 中国组织工程研究

BACKGROUND:Cuscuta chinensis is a mature seed of Cuscutachinensis Lam., can warm kidney. Previous studies demonstrated that kidney compound composed of Cuscuta chinensis could apparently inhibit bone loss and improve bone density. OBJECTIVE:To explore the influence of flavonoids from Cuscuta chinensis on bone mineral density of femur, 1,25(OH)2D3 levels of serum and kidney, the expression of smal intestine CaBp-D9K mRNA in model rats with ovariectomized osteoporosis. METHODS:A total of 72 Sprague-Dawley female rats were equal y and randomly divided into six groups (n=12):sham surgery group, model group, vitamin D3 group and low-, moderate-and high-dose flavonoids groups. The sham surgery group only received sham operation and the other five groups were ovariectomized respectively. One week after ovariectomy, the rats were given flavonoids from low-, moderate-and high-dose Cuscuta chinensis and vitamin D3 (2 mg/kg) by intragastric administration for 3 consecutive months. Blood was obtained from the abdominal aorta. Serum was isolated. The kidney was obtained. Enzyme linked immunosorbent assay was used to determine 1,25(OH)2D3 contents of renal and serum. Rats were sacrificed at the end of experiment. The thighbone was taken out to determine bone mineral density. The second lumbar vertebra was taken out to measure the expression of lumbar vertebra and renal vitamin D receptor mRNA using real-time fluorescent reverse transcription-polymerase chain reaction. The smal intestine was taken out to measure the expression of smal intestine CaBp-D9K mRNA using real-time fluorescent reverse transcription-polymerase chain reaction. RESULTS AND CONCLUSION:Compared with the sham operation group, bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney and the expression of lumbar vertebra vitamin D receptor mRNA significantly decreased in model group, and the expression of smal intestine CaBp-D9K mRNA significantly decreased in model group. Compared with the model group, bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney, and the expression of the second lumbar vertebra vitamin D receptor mRNA, and the expression of smal intestine CaBp-D9K mRNA were increased in moderate-and high-dose flavonoids groups and vitamin D3 group. Results indicated that flavonoids from Cuscuta chinensis could significantly raise bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney and the expression of lumbar vertebra vitamin D receptor mRNA and the expression of smal intestine CaBp-D9K mRNA, accelerate intestinal calcium absorption and osteoblast activity, and reinforce quality of the bone.