The value of intravoxel incoherent motion diffusion-weighted MRI in differentiating benign breast lesions from malignant lesions / 中华内分泌外科杂志

Objective To study the diagnostic value of intravoxel incoherent motion (IVIM) diffusion-weighted MRI in differentiating benign from malignant breast lesions.Methods 50 female patients with lesions verified by pathology were included in this study,all of them underwent multi-b value (b=0-2000s/mm2) DWI scanning.Tissue diffusivity (D),pseudo-diffusivity (D*),perfusion fraction (f) and apparent diffusion coefficient (ADC) were acquired using IVIM model.The difference of these parameters in benign and malignant breast lesions was analyzed statistically.The diagnostic performance of these parameters was evaluated by ROC analysis.Results In benign lesions,D,D*,f and ADC value was (1.31±-0.47) ×10-3 mm2/s,(26.47±13.81) ×10-3 mm2/s,(17.35±3.78)％,(1.37±0.37)×10-3 mm2/s,respectively.In malignant lesions,D,D*,f and ADC value was(0.95±0.28)×10-3 mm2/s,(24.58±14.62)×10-3 mm2/s,(23.69±4.35)％,(1.03±0.14)×10-3 mm2/s,respectively.There were statistically significant differences between benign and malignant lesions in D,f and ADC value (t=3.203,-5.139,3.991,P＜0.05).There was no statisticaly significant difference in D* value (P＞0.05).ROC analysis showed that AUC of D value was 0.866,which was the highest one.AUC was increased to 0.934 by combining D with f value for diagnosis.Condusions The parameters acquired from IVIM model are useful to differentiate benign from malignant breast lesions.D value obtained from IVIM model may have relatively high sensitivity and specificity,D Combined with f value can obtain the best diagnostic performance.

Clinical and radiologic comparison of dynamic cervical implant arthroplasty and cervical total disc replacement for single-level cervical degenerative disc disease.

Anterior cervical discectomy and fusion, to date the most successful spine procedure for the surgical treatment of cervical radiculopathy, has limitations that have led to the development of non-fusion cervical procedures, such as cervical total disc replacement (TDR) and dynamic cervical implant (DCI) arthroplasty. We compared the clinical and radiological results of DCI and cervical TDR for the treatment of single-level cervical degenerative disc disease in Chinese patients. A retrospective review of 179 patients with cervical spondylotic myelopathy who underwent DCI or TDR between April 2010 and October 2012 was conducted, and 152 consecutive patients (67 patients single-level DCI and 85 single-level TDR) who completed at least 2years of follow-up were included. Clinical and radiological assessments were performed preoperatively and at 1week and 3, 6, 12, and 24months postoperatively. The most common operative level was C5/C6 (49.3%). The differences in blood loss, duration of surgery, and duration of hospitalization were not statistically significant. The Japanese Orthopaedic Association scale, Visual Analog Scale, Neck Disability Index, and Short Form-36 scores improved significantly after surgery in both the DCI and TDR groups (P<0.05), but the differences were not statistically significant at the final follow-up. The rate of occurrence of heterotopic ossification was 22.4% and 28.2% in the DCI and TDR groups, respectively. As an effective non-fusion technique, DCI is a more economical procedure. Further prospective, randomized studies with long-term follow-up periods are needed to determine the long-term effects.

Surgical treatment of L5S1 tuberculosis by debridement, fusion and internal fixation via a medial edge of rectus abdomi-nal muscle and retroperitoneal approach / 中华骨科杂志

Objective To investigate the clinical efficacy and indication of surgical treatment of L5S1 tuberculosis us?ing a medial edge of rectus abdominal muscle and retroperitoneal approach. Methods From Jan. 2010 to Nov. 2014, totally 18 cases of L5S1 tuberculosis were surgically cured by debridement, fusion and internal fixation via a medial edge of rectus ab?dominal muscle and retroperitoneal approach. There were 10 males and 8 females, with an average age of 35.6±10.1 years (21 to 55). The mean course of disease was 5.3±2.2 months. The primary destruction lesions were located at L5S1, and one patient of whom L4 was also involved, three cases S2 involved, and one S3 involved. Abscess pre sacrum was noticed in all cases. Six patients were combined with abscess in vertebral canal. Neural deficiency was detected in 3 patients, all grading as Frankel D. Dubousset's lumbosacral angle was 104°-126°, mean 114.6°±6.0°. Formal anti?tuberculosis medicine treatment was given for at least 2-3 weeks. All patients were treated using a medial edge of rectus abdominal muscle and retroperitoneal approach. Af?ter debridement, a tri?cortical iliac bone was used for structural inter?vertebrae fusion. The iliac bone was fixed to the sacrum by one cortical screw. Operation time, volume of blood loss, and surgery complications, including wound infection, looseness and shift of internal fixation, sinus occurrence, vascular injury, retrograde ejaculation in male patients were evaluated. The X?ray and 3D CT of lumbosacral spine, together with ESR and CRP were used to evaluate the control of tuberculosis during fol?low?up. The Dubousset's lumbosacral angle, visual analogue score, and the Frankel grade were compared between preoperative and postoperative. The bone graft fusion were also observed. Results The operation time was 147±16 min in average. The mean blood lose was 275 ± 77 ml. No vascular or neurological injury was noticed. There was also no retrograde ejaculation happened in this group. All patients were followed up from 18 to 28 months. Dubousset's lumbosacral angle was 122.4°±3.8° post?operatively and 121.4°±3.7° at the final follow?up. There was a significant difference between the lumbosacral angles pre and post operation, whereas no statistical difference between the post operation and the final follow?up. Bone fusion was noticed in all cases. All pa? tients have intact neurological function at the final follow?up. No screw breakage or graft bone migration occurred. VAS was 5.6± 1.09 pre?operation and 0.83±0.71 at the 3rd month's follow?up, and there was a significant difference between them. Conclusion Surgical treatment of L5S1 tuberculosis by debridement, fusion and internal fixation via a medial edge of rectus abdominal muscle and retroperitoneal approach is an effective method in terms of minimal trauma, low rate of modality, good ability in restore and maintenance of lumbosacral junction alignment and high fusion rate.

Helicobacter pylori negative peptic ulcer and ulcer bleeding:a multi-center case-control study in China mainland / 中华消化内镜杂志

Objective The primary aim of this study was to examine the proportion and natural history of Helicobacter pylori (Hp) negative bleeding peptic ulcers. Methods The study was designed as a multiple-center, case-control study conducted in 14 endoscopy centers in China from April 2006 to March 2007. Each center was expected to recruit 30 peptic ulcer patients with bleeding ( PUB group) and 30 without (PU group). All screened patients with upper gastrointestinal bleeding received endoscopy within 24 hours of admission. Biopsy specimens were taken from the antrum to determine Hp infection by rapid urease test and pathology. Patients with negative Hp infection at first examination were asked to receive urease breathe test (UBT) one month later. Results A total of 617 patients were enrolled with 263 in PUB group and 354 in PU group. There is no significant difference in demographic characters between 2 groups ( P ＞0. 05). The rate of Hp infection in PUB group ( 161/263, 61.2% ) was significantly lower than that in PUgroup (311/354, 87. 9%, P ＜0. 001 ). The incidence of complex ulcer in Hp positive PUB patients was 7.5% ( 12/161 ), which is significantly higher than that in Hp negative PUB patients ( 1/102, 1.0% , P =0. 018). In PUB group, no significant differences were found between Hp positive and negative patients in regarding of age, sex, rates of haematemesis, duodenal ulcer and gastric ulcer, and size of ulcer ( P ＞0. 05 ). Among 102 Hp negative cases in PUB, no positive case was found in UBT one month later. Conclusion We have demonstrated a rise in the incidence of Hp negative bleeding ulcers in China. The idiopathic ulcer was not rare, and might have a higher tendency to cause bleed.

Lumbosacral MR Study in the Neurogenic Bladder / 实用放射学杂志

Objective To evaluate the lumbosacral features and diagnostic value of MRI in the neurogenic bladder .Methods Lumbosarcral MR scans were performed in 90 patients with neurogenic bladder.MRI images were reviewed and the abnormal appearances of lumbosacrum on MRI were analysed.Results Of 90 cases,61 cases showed abnormal appearances,the positive rate was 68% and 60 cases were accurately diagnosed by MRI(98.5%).These positive cases were mostly composed of follow three kinds of diseases:spinal deformations,tumors of spinal canal and lumber disc herniations.Conclusion MRI has significant value in lumbosacral examination of patients with neurogenic bladder.