[The mediation mechanism of coronary artery lesions in both male and female patients with Kawasaki disease].

Objective: To explore the mediation mechanism of coronary artery lesion among both male and female Kawasaki disease (KD) children. Methods: Children with KD that hospitalized in the Wenzhou Medical University affiliated Yuying Children's Hospital from January 2009 to December 2014, were included in this study. Differences on demographical characteristics, clinical manifestations, laboratory indicators, regimen and time of treatment, results from pre/post echocardiography and treatment between male and female patients, were compared. The independent effect of gender on the risk of coronary artery lesions (CAL) was evaluated, and the mediating effect of BMI, visiting time and KD type on the association between gender and CAL were also studied. Results: The average BMI level of male patients was higher than that of female patients. The difference was statistically significant (P<0.001). The prevalence of overweight among male patients (20.9%) was higher than female (14.1%). The difference was statistically significant (P=0.011). Data from the multivariate logistic regression analysis confirmed that the incidence of CAL in male patients was higher than that in female patients (aOR=1.50, 95%CI: 1.06-2.12) but the CAL was mainly different before on the immunoglobulin therapy. Results from the mediation analysis showed that BMI was an important mediator in the association between gender and CAL, with the indirect effect as 1.05 (95%CI: 1.01- 1.10) and the proportion mediated as 13.0%. Conclusions: Male patients presented higher incidence of CAL but was mainly reflected in the difference of CAL before the treatment. BMI was probably an important mediator related to the association between gender and CAL.

[The impact of hydrogen sulfide on the heme oxygenase-1/carbon monoxide system in Coxsackie virus B3-induced myocarditis in mice].

Objective: To explore the impact of hydrogen sulfide (H(2)S) on the heme oxygenase-1/carbon monoxide pathway in Coxsackie virus B3 (CVB3)-induced murine myocarditis (VMC) model. Method: A total of 70 inbred male Balb/c mouse (4-6 weeks old) were randomized into the following four groups: Normal, VMC, PAG and NaHS (n=10 for Normal, n=20 for VMC, PAG and NaHS groups). Mice in Normal group were non-infected mice treated with intraperitoneal injection of sterile phosphate-buffered saline daily for 10 days.Mice in VMC group received intraperitoneal CVB3 injection (0.1 ml 10(-5.69)TCID(50)m·ml(-1)·d(-1) and PBS for 10 days), and mice in PAG group received additional intraperitoneal DL-proparglygylcine injection (40 mg·kg(-1)·d(-1) for 10 days), mice in NaHS group received additional intraperitoneal NaHS injection (50 µmol·kg(-1)·d(-1) for 10 days). All mice were sacrificed on day 10th, and body weight and heart weight, the ratio of heart weight to body weight were compared among groups.Pathological changes of heart tissues were observed microscopically by HE and the histopathologic scores were valued.The content of COHb was tested after the gathering of blood specimens while reverse transcription-polymerase chain reaction was used to detect myocardial HO-1 mRNA expression. Results: (1) Pathological findings in myocardium: hearts sections in Normal group were normal and no inflammatory cells and necrosis were found.A notable cellular infiltration, interstitial edema, vascular hyperemia and necrosis were observed in heart section of VMC, PAG and NaHS group.Extensive inflammations and larger area of myocardial cells necrosis were evidenced in PAG group and above changes were significantly reduced in NaHS group.(2) Comparison of the ratio of heart weight to body weight and histological scores of myocardium: the ratio was significantly higher in the VMC, PAG, NaHS groups than in Normal group (P<0.05), which was higher in PAG group and lower in NaHS group as compared with VMC group (both P<0.05). The histopathologic scores of all CVB3 innoculation groups were higher than in the Normal group, which was higher in PAG group and lower in NaHS group as compared to VMC group (both P<0.05). (3) The content of blood COHb in VMC, PAG or NaHS group was significantly higher than that in Normal group (P<0.05), which was significantly lower in PAG group, and higher in NaHS group as compared to VMC group (both P<0.05). (4) The mRNA expression of myocardial HO-1 detected by RT-PCR: weak expression was observed in Normal group, which was significantly upregulated in VMC, PAG and NaHS groups (P<0.05), which was downregulated in PAG group and upregulated in NaHS group as compared to VMC group (both P<0.05). (5) Correlation analysis: blood COHb concentration was positively correlated with myocardial HO-1 mRNA expression(r=0.927, P=0.000), negatively correlated with histopathologic scores(r=-0.753, P=0.000)and the histopathologic scores were negatively correlated with the myocardial HO-1 mRNA expression (r=-0.754, P=0.000). Conclusions: H(2)S could play a protective role in murine CVB3 myocarditis model through inducing HO-1 expression and upregulating HO-1/CO pathway.

Clinical evaluation of the normalized metal artefact reduction algorithm caused by dental fillings in CT.

OBJECTIVES: The aim of this study was to evaluate the performance of a normalized metal artefact reduction (NMAR) algorithm in patients with high-density dental fillings in CT images, and compare the results with weighted filtered back-projection (WFBP) and linear interpolation metal artefact reduction (MARli) algorithms. METHODS: A total of 15 patients who had dental fillings were included in this study. The CT raw data sets were processed on an offline workstation. For each data set, one image series was reconstructed with WFBP, one with MARli and one with NMAR. Two observers qualitatively graded the severity of metal artefacts and their impacts on surrounding and distant soft tissue using a five-point scale. Six regions of interest were selected to measure the CT values and the standard deviation (SD) for quantitatively evaluating the effects of artefact reduction. RESULTS: A total of 217 slices with metal artefacts from 15 patients were included in the qualitative analysis. The average score (mean ± SD) with the WFBP and MARli algorithms was 2.24 ± 1.06 and 2.71 ± 0.73, respectively. Image artefacts were significantly reduced using the NMAR algorithm compared with the other two algorithms, with an average score of 1.70 ± 0.83. The mean CT value in the most hypodense streak artefacts around the metal fillings was significantly improved with both MARli and NMAR. The mean SDs of measured CT values from surrounding or distant soft tissues were lower in NMAR images than in WFBP and MARli images. CONCLUSIONS: The NMAR algorithm can significantly reduce the artefacts caused by dental fillings, compared with the WFBP and linear interpolation algorithms.

Radiation dose of non-enhanced chest CT can be reduced 40% by using iterative reconstruction in image space.

AIM: To evaluate the image quality and dose reduction capability of non-enhanced chest computed tomography (CT) examinations using iterative reconstruction in image space (IRIS). MATERIALS AND METHODS: A CT water phantom was scanned at 120 kV/150 mAs and 100 kV/270 mAs as the reference, and the tube current was decreased in 10% intervals down to 40% of the reference value. Image noise was evaluated and compared between filtered back-projection (FBP) and IRIS reconstructed data. In the patient study, 90 patients underwent non-enhanced chest CT examinations; the patients were randomly assigned into three groups: group A (n=30) standard dose protocol, 120 kV/110 mAs; group B (n=30) low dose, 100 kV/110 mAs; group C (n=30) low dose, 120 kV/67 mAs. All images were reconstructed by FBP and IRIS algorithm using matched kernels of B30 and I30. The objective image noise (OIN), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the aorta and latissimus dorsi were measured. The subjective image quality and noise were scored using a three-point scale by two experienced radiologists. The results of the subjective and objective image assessment were compared between groups B and C (low dose) IRIS and group A (standard dose) FBP. RESULTS: The phantom study showed comparable image noise between the scans using 60% dose with IRIS and 100% dose with FBP for both 120 and 100 kV. In the patient study, groups A, B, and C had effective dose of 3.81 ± 0.43, 2.40 ± 0.19, and 2.41 ± 0.15 mSv. IRIS significantly improved the OIN, SNR, and CNR compared with FBP for the same patient. The OIN, SNR, and CNR using IRIS in group B and C were improved or comparable to those in group A using FBP. No significant difference was found in subjective image quality and noise between groups B and C using IRIS and group A using FBP. CONCLUSION: Compared with FBP, IRIS can maintain or improve image quality on unenhanced chest CT image reconstruction while saving 40% radiation dose.

[Clinical study on conducting physical exercise in lowering blood pressure of hypertensive patients and influencing their endocrine hormones].

OBJECTIVE: To explore the mechanism of conducting physical exercise to lower blood pressure of hypertensive patients, relieve their symptoms and influence the cardiovascular endocrine hormone. METHODS: One hundred and twenty-five patients with II or III stage hypertension were divided into the experimental group and the control group and observed. The comparison of conditions before and after treatment, and between experimental and control groups was carried out. RESULTS: The effect in lowering blood pressure and relieving symptoms in the experimental group were obviously better than those in the control group, P < 0.05. Angiotensin-II (AT-II) level much reduced after the exercise experiment, P < 0.05. Peripheral renin activity (PRA) level had a tendency of reduction, but atrial natriuetic factor (ANF) and 6-keto-prostaglandin F1 alpha (6-k-PGF1 alpha) showed a tendency of increasing. CONCLUSION: Physical exercise combined with medical treatment could control the symptoms of hypertensive patients, in some of them could gradually using the way of doing physical exercise to replace the hypotensive medicament, the effect of the combined treatment can be obtained within a month. The change of cardiovascular endocrine hormone indicated that the physical exercise can be helpful in lowering blood pressure and improving blood circulation in hypertensive patients.

[Bacteriological investigation of burn blister fluid].

Under a sterilized technique the fluid of the unbroken blister was obtained for bacterial culture in 73 burned patients with different ages (5 months-67 Y) and extent of injury (1.5%-96% TBSA). Bacterial count was carried out if a positive result is obtained. Among the 73 patients, positive cultures were observed in 12, an incidence of 16.4%. Patients suffering from serious or extremely serious thermal injuries showed a positive culture rate of 15%. Bacterial count of the blister fluid appeared to be higher in patients with extensive burns. Most of the bacteria were common resident organisms of the human body. Of the 4 patients with their blister fluid bacteria counts over 2000 CFU/ml, 2 died from sepsis, while 8 patients with lower than 2000 CFU/ml bacteria in their blister fluid survived. The results suggested that large number of bacteria in the blister fluid might further depress local immunity, so that the patient is more susceptible to infections. It is therefore suggested that culture of blister fluid and bacterial count should be done immediately in the extensively burned patient just after admission.

[Anomalies of the lumbosacral nerve roots with low backache and sciatica].

Nine patients with lumbosacral nerve root anomalies (NRA) were reported. 36 cases were collected from reported papers in addition, seven types of NRA were classified by the author. They were: conjoined root (with the incidence of 31.11%), near roots (26.66%), two roots in same foreman (20%), anastomosis between roots (11.11%), double roots (4.44%), branch root and combined type (6.66%). The rate of finding of NRA by operation was 0.34%, that was far lower than by myelography and autopsy. Careful exploration can increase the finding rate. NRA can induce backache and sciatica by itself. Its clinical distinguishing features were severe symptoms, compression of multiple nerve roots slight or negative Lasegue sign. The principle of treatment of NRA was adequate decompression, but should be careful to avoid injury of displaced and tensile nerve roots. In this paper, the matters needing attention in operation was discussed as well.