Volume 93  ·   Issue 19  ·  2013

To investigate the feasibility of identifying the vulnerable plaque and predicting plague rupture and thrombus using by positron emission tomography/computed tomography angiography (PET/CTA).

Twenty-eight male New Zealand white rabbits were fed with hyper-lipid diet for 2 weeks before the balloon injury of the abdominal aorta.Then these rabbit were intermittently fed withhyper-lipid diet for 14 weeks, in order to trigger pharmaceuticly the plague rupture and thrombus.PET/CTA scans of abdominal aorta were performed before and after the drug triggering,FDG uptake (standardized uptake value, SUV) was measured.Rabbits were euthanized to obtain data of pathology and histology.The parameters obtained by PET/CTA, pathology and histology were compared and the correclations were performed.

The thrombosis was identified in 13 of 20 rabbits.Before the drug triggering, ¹⁸F-FDG mean standardized uptake value (SUVmean) washigher in thrombotic arterial segments (defined as vulnerable plaque)(1.10±0.19 vs 0.77±0.11,P=0.000); after the drug triggering,SUVmean was higher in thrombotic arterial segments,too (1.15±0.26 vs 0.85±0.17,P=0.000).We use the ROC curve for SUVmean to predict plaque rupture and thrombosis.The areaunder the curve (AUC) was 0.898 (P=0.000).The cutoff value was 0.882.

Our findings indicated that 18 F-FDG PET/CTA,as a noninvasive imaging method,could be used toidentify vulnerable plaques and predict thrombosis events.

To assess for preoperative evaluation of 64-slice spiral computed tomographical angiography (64-SCTA) to predict vascular involvement and general resectability of pancreatic malignant tumors.

The material of 64-SCTA in 34 cases were retrospectively analyzed.Preoperative imaging findings were correlated with intraoperative and histopathologic results.

For the arterial tumor invasion based on 64-SCTA findings, 1 grade was in 8 cases; 2 grade, 6 cases; 3 grade, 8 cases; 4 grade, 10 cases;5 grade, 2 cases.Regarding respectability, the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) were 92.9%, 95.0%,94.1%, 92.9%, 95.0%.Kappa value was 0.879 (P<0.01).Receiver operator characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.943 (P<0.01).For the venous tumor infiltration, 1grade was in 0 case; 2 grade, 6cases; 3 grade, 6 cases; 4 grade, 13 cases; 5 grade, 9 cases.Regarding respectability, these values for those tumors with vein invasion were 78.6%, 95.0%, 88.2%, 91.7%, 86.4%.Kappa value was 0.752 (P<0.01).ROC analysis showed an AUC of 0.927 (P<0.01).

64-SCTA can provide reliable information for vascular involvement and general resectability of pancreatic malignant tumors.64-SCTA has high value in clinical application.

This study is to investigate the clinical role of 18 F-FDG PET/CT in detecting the recurrence and metastases of patients with breast cancer post treatment, compared to the conventional imaging technology, such as CT, MRI, and ultrasound.

The reports of FDG PET/CT whole body scans and conventional imaging technology, such as CT, MRI, and ultrasound, performed from Jan to Aug 2011 on 70 patients with breast cancer post treatment were retrospectively reviewed.The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 2 groups in detecting the recurrence and metastases were calculated and compared.

The accuracy, sensitivity, specificity, PPV and NPV of FDG PET/CT were 84.3%, 95.6%, 64.0%, 82.7% and 88.9%.The conventional imaging technology was 70.0%, 68.9%, 72.0%,81.6% and 56.3% respectively.FDG PET/CT had altered the medical management of 20% of patients and detected 3 second primary malignancies.

FDG PET/CT is superior to conventional imaging in detecting the recurrence and metastases of patients with breast cancer post therapy.

To evaluate MR accuracy for staging endometrial carcinoma with different FIGO staging systems.

Between August 2006 and July 2010, 95 women underwent surgery for endometrial carcinoma.In each patient, endometrial carcinoma was staged with magnetic resonance (MR) findings based on the old FIGO staging system and then repeated according to the new FIGO staging system for comparisons.Histopathologic findings were used as a golden standard to compare the sensitivity, specificity, accuracy, positive predictive value and negative predictive value.

The accuracy of MRI in the staging of endometrial carcinoma stageⅠ, Ⅱ and Ⅲ with the old FIGO staging system were 83.2%, 86.3% and 92.6% versus 88.4%, 96.8% and 91.6% respectively with the new FIGO staging criteria.According the old FIGO staging system, the sensitivity of stageⅠA,ⅠB andⅠC were 51.8%, 76.5% and 50.0% and the specificity 85.3%,55.7% and 95.4% respectively; the sensitivity of stageⅡA and ⅡB were merely 12.5% and 20.0% and the specificity 97.7% and 100.0%.With the new FIGO staging criteria, the above indices were 97.1%, 55.6%, 57.7%, 95.3%, 40.0% and 100.0% respectively.

With new FIGO staging system versus the old one, the accuracy of MR imaging in the preoperative staging of endometrial carcinoma increases.

To explore the types of primary trigeminal neuralgia (TN) responsible vessels and curative efficacies of microscopic vascular decompression (MVD).

A total of 162 primary TN patients underwent MVD from August 2004 to the present at our hospital.Their clinical data were collected and analyzed.There were 69 males and 93 females with an age range of 22-88 years.

The most common responsible vessels were superior cerebellar artery (n=65, 40.12%), anterioinferior cerebellar artery (n=45, 27.78%), multiple vessels (n=26, 16.05%), posterioinferior cerebellar artery (n=16, 9.88%), veins (n=6, 3.70%) and vertebral artery (n=4, 2.47%).And the pressure points were at the root of trigeminal nerve (n=139,85.80%), distal part (n=16, 9.88%) and root and distal part (n=7, 4.32%).Postoperatively pain disappeared in all patients (including one case on second surgery).Postoperative follow-ups were conducted for 132 cases.Two cases recurred over 8 years and the recurrence rate was 1.52%.

MVD is preferred method for primary T N non-responsive to pharmacotherapy.Identification and treatment of responsible vessels remain a key.Venous and distal pressure points should be taken care.

Explore the feasibility and superiority about Supreme double-lumen laryngeal mask airway for cesarean section anesthesia.

From March 2011 to March 2012,a total of 300 patients with American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ foot of cesarean section in full-term pregnant women for the first time production of Quanzhou Women′s and Children′s Hospital were recruited, authenticated by Hospital Ethics Committee, they were randomly divided into three groups (Random number table), dual-chamber in the LMA group (A group of 100 cases), tracheal intubation group (B group of 100 cases) and spinal anesthesia group (C group of 100 cases).ECG, SpO₂, MAP, heart rate, Narcotrend and Apgar scores were observed.

Before and after the LMA group inserted laryngeal mask HR,MAP no significant change in the performance of Narcotrend value remained at the level of anesthesia, intubation before and after HR, MAP significantly increased performance of Narcotrend values significantly increased, both compared to the obvious statistical difference (P<0.05).The ventilation indicators of two groups compared to no significant difference (P>0.05).LMA group cover required intubation time was significantly shorter than the time required for intubation of endotracheal intubation group (P<0.01).Three groups of patient administration to the fetus at all times is in 5-10 min.Three groups similar to the Apgar score was no significant difference (P>0.05).

The dual-chamber laryngeal mask airway for caesarean section anesthesia, fetal Apgar scores, feasibility, and its operation is easy, safe and comfortable anesthesia, compared tracheal intubation has obvious superiority.

To explore the reasonable radiotherapy range by analyzing the characteristics of supraclavicular lymph node metastasis in limited-stage small cell lung cancer (LSSCLC).

From January 2005 to December 2011, patients of LS-SCLC were reviewed.Supraclavicular zone was further divided into five subgroups including para-recurrent laryngeal nerve (region Ⅰ and region Ⅱ), para-internal jugular vein (region Ⅲ), supraclavicular region (region Ⅳ),as well as the other regions except for the mentioned above (region Ⅴ).The characteristics of the lymph nodes in each region were analyzed.

The supraclavicular lymph node metastasis was found in 60 patients, with a positive rate of 34.5%.In multivariate Logistic regression analysis,intrathoracic lymph node metastasis in the lymph node stations of level 2 and 3 were found to be the risk factors of supraclavicular lymph node metastasis (P=0.006,P=0.000).Our data suggests that the frequencies of metastasis in region Ⅰ and Ⅲ were much higher than those in the other areas.Among the sixty patients with supraclavicular lymph node metastasis, 95.0% were found at region Ⅰ or Ⅲ while the incidence of skip metastasis was only 5.0%.

It is advisable to contain the bilateral supraclavicular nodes in patients with mediastinal lymph nodes metastasis to the level 2 or 3 for elective radiation target volume.The clinical target volume (CTV) exterior margin containing the outer margin of internal jugular vein may be suitable.

To explore the correlations between the serum levels of hypoxia inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and computed tomography (CT) perfusion parameters at pre- and post-transcatheter arterial chemoembolization (TACE) in patients with primary hepatic carcinoma (PHC).

A total of 22 PHC patients were recruited.Their serum levels of HIF-1α and VEGF were measured and CT perfusion imaging (CTPI) was performed at Day 1 pre- and Days 32-40 post-TACE to compare and analyze the relevance of the changes of serum levels of HIF-1α, VEGF, tumor′s hepatic artery perfusion (HAP), portal vein perfusion (PVP) and hepatic artery perfusion index (HPI) at pre- and post-TACE.

They were divided into stable and tumor residual/recurrent groups according to the efficacy of TACE.No significant differences existed between two groups with respects to serum levels of HIF-1α, VEGF, tumor′sHAP, PVP and HPI pre-TACE.The serum levels of HIF-1α and VEGF decreased in stable group and there was significant difference in serum level of VEGF at Days 32-40 post-TACE (P<0.05).There was no perfusion signal of HAP or PVP in tumor tissue.The serum levels of HIF-1α and VEGF were significantly higher while HAP and HPI were significantly lower than that pre-TACE in tumor residual/recurrent group and had statistical significance (P<0.05), but PVP had no change.Positive correlations existed between serum levels of HIF-1α, VEGF and tumor′s HAP, HPI at 32-40 days post-TACE.

Serum levels of HIF-1α and VEGF may indirectly reflect the status of neovascularization and CTPI acts as the intuitive and quantitative responses of hemodynamic changes at post-TACE.Positive correlations exist between serum levels of HIF-1α, VEGF, HAP and HPI.In short, a combination of serum levels of HIF-1α, VEGF and CTPI contributes to the efficacy evaluation of TACE and has great reference significance of determining timing of a second therapy.

To retrospectively evaluate early and mid-term results of thoracic endovascular repair (TEVAR) of type B aortic dissection by the second generation of stent graft.

From January 2009 to January 2013, 383 acute, 43 sub-acute and 152 chronic patients with type B aortic dissection underwent TEVAR in our aortic center.The mean follow-up period was (27±14) months.All clinical data were analyzed with SPSS 17.0.

The 30-day mortality and morbidity were 0.35% and 1.2% respectively.The mid-term mortality and morbidity were 0.35% and 5.5%.Serious complications included retrograde type A dissection (n=3), new tear at the distal end of stent (n=26),endoleak (n=3) and paraplegia (n=0).The retreatment rate was 5.2% (6 patients were transformed to open operation and 24 patients underwent re-intervention).

The early and mid-term results of thoracic endovascular repair (TEVAR) of type B aortic dissection by the second generation of stent graft showed lower mortality, no paraplegia and significant reduced endoleaks in comparison with the first generation stent graft.The new distal tear caused by the stent graft became the major complication.The design of the stent graft still need improvement.

To collect the clinical data of non-cardiac inpatients with coronary heart disease risk factors and analyze the pathogenic factors and prognosis features of these inpatients with acute myocardial infarction.

Retrospective analyses were performed for 650 cases of consecutive non-cardiac inpatients with coronary heart disease risk factors at Tianjin Union Medical Center between January 2009 and January 2012.They were divided into non myocardial infarction (Un AMI, n=551) and myocardial infarction groups (AMI, n=99).Firstly the method of single factor analysis was employed to screen some significant influencing factors of acute myocardial infarction.Secondly multivariate Logistic regression analysis was performed to analyze the risk factors associated with the onset of AMI.Also the cardiovascular death event rates during hospitalization were compared between two groups.Cox regression analysis was performed to analyze independent risk factors for cardiovascular death of two group during hospitalization.

(1) The significant influencing factors of AMI included total cholesterol (TC), low-density lipoprotein (LDL), advanced age, discontinuation of antiplatelet drug, recent episodes of angina above Ⅱ grade, arrhythmia, 5 years of PCI or CABG history, blood glucose control or not, cardiac dysfunction (NYHA Ⅱ-Ⅳ), dehydration, severe inflammatory response, infection, peroperative period, emergency operation and without cardiological consultation. (2) Multivariate Logistic regression analysis showed that LDL (OR (odds ratio):2.047, 95% CI (confidence interval):1.066-3.930, P=0.031), discontinuation of antiplatelet drug therapy (OR:15.213, 95% CI:5.746-40.281, P=0.000), recent episodes of angina aboveⅡgrade (OR:1.990, 95% CI:1.155-3.430, P=0.013), glucose non-control (OR: 2.991, 95% CI:1.485-6.026, P=0.002), advanced age (OR:2.499, 95% CI:1.299-4.808, P=0.006), severe inflammation (OR:4.425, 95% CI:2.984-6.561, P=0.000), infection (OR: 2.405, 95% CI:1.058-5.464, P=0.036), emergency operation (OR:4.365, 95% CI:1.580-12.060, P=0.004) were all AMI-related occurring factors.And cardiologic consultation (OR: 0.011, 95% CI:0.003-0.040, P=0.000) was a favorable factors to reduce AMI; (3) AMI group during hospitalization for cardiovascular death event rate was higher than the Un AMI group; (4) Advanced age (β=0.776,OR=0.460,95% CI:0.217-0.974, P=0.042) and without consultation of cardiology department (β=1.366, OR=3.918, 95% CI:1.549-9.912, P=0.004) were cardiovascular death independent risk factors.

(1) Non cardiac inpatients during hospitalization LDL, discontinuation antiplatelet drug therapy, recent episodes of angina above Ⅱ grade, blood sugar non-control, advanced age, severe inflammatory response, infection and without cardiologic consultations were significant risk factors for AMI. (2) The treatment of Department of Cardiology specialist for non cardiac inpatients with coronary heart disease risk factors to improve the prognosis of them.

To investigate the characteristics of high density lipoprotein cholesterol and the relationship between high density lipoprotein cholesterol and the severity of coronary artery lesions in young men with acute myocardial infarction (AMI).

We retrospectively studied 278 young men with acute myocardial infarction and compared with 208 non-CHD young men,137 old men with AMI.All patients were admitted to hospital from Jan 2009 to Dec 2011 and undergone coronary angiography, and the clinic and coronary angiographic features were assessed.According to the result of coronary angiography, the patients were divided into three groups:the single, double and triple vessel lesions.The relation between systolic body mass index (BMI), hemoglobin (Hb), serum uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDL-C), smoking history, essential hypertension, type 2 diabetes mellitus, familial history of early coronary artery disease with acute myocardial infarction and severity of coronary artery disease are observed.And observe the characteristics of HDL-C in the obesity group and the smoking group in young men based on body mass index and smoking history.

(1) In young men with AMI group, the HDL-C levels was significantly lower than those in non-CHD young men group ((1.00±0.28) mmol/L vs (1.05±0.23) mmol/L,P<0.05).In young men with AMI group, the HDL-C levels was significantly lower than those in old men group with AMI ((1.00±0.28) mmol/L vs (1.07±0.30) mmol/L, P<0.05);the HDL-C level in young AMI men with smoking history was significantly lower than those in young AMI men without smoking history ((0.98±0.25) mmol/L vs (1.09±0.40) mmol/L, P<0.05);the HDL-C level in normal weight group is significantly higher than those in overweight and obesity groups in young AMI men ((1.30±0.55) mmol/L vs (0.99±0.22) mmol/L, (0.98±0.29) mmol/L, P<0.05). (2) The HDL-C level in the single lesions group was significantly lower than those in the double and triple vessel lesions groups ((1.06±0.29) mmol/L vs (0.92±0.20) mmol/L, (0.91±0.26) mmol/L,P<0.05). (3) Applying Logistic regression analysis, type 2 diabetes mellitus (OR=35.784), essential hypertension (OR=7.782), familial history of early coronary artery disease (OR=4.613), low density lipoprotein cholesterol (OR=2.496), smoking history (OR=2.241), hemoglobin (OR=1.042) and serum uric acid (OR=1.005) are independent risk factors (P<0.05) for young men with AMI, while high density lipoprotein cholesterol (OR=0.147, P<0.05) is a protective factor; low density lipoprotein cholesterol (OR=2.095) and essential hypertension (OR=1.042) are independent risk factors (P<0.05) for young men with multiple vessel lesions in AMI, while high density lipoprotein cholesterol (OR=0.071, P<0.05) is a protective factor.

High density lipoprotein cholesterol are protective factors for young men with AMI and multiple vessel lesions in young men with AMI.

To explore the possible roles of KCC2 and NKCC1 in the pathological mechanism of acute insomnia in rats.

A total of 18 Sprague-Dawley rats were randomly selected into model, interference and normal control groups.The expressions of KCC2 and NKCC1 in brainstem were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.The concentration of intracellular Cl^- ([Cl^-]i) in brainstem was detected by fluorescence probe MQAE with laser confocal microscopy.

(1) Comparing with the control group, both KCC2 mRNA and protein expression were down-regulated in the model and interference groups (mRNA:0.196±0.021 vs 0.939±0.109, P<0.05; 0.485±0.026 vs 0.939±0.109, P<0.05; protein expression:0.363±0.058 vs 0.967±0.155, P<0.05; 0.663±0.106 vs 0.967±0.155, P<0.05).However they became up-regulated in the interference group versus the model group (mRNA:0.485±0.026 vs 0.196±0.021, P<0.05; protein expression: 0.663±0.106 vs 0.363±0.058, P<0.05). (2) Comparing with the control group, both NKCC1 mRNA and protein expression in the model group were slightly up-regulated.But statistical difference was insignificant (mRNA:0.344±0.026 vs 0.320±0.019, P>0.05; protein expression:0.244±0.010 vs 0.230±0.021, P>0.05).There was down-regulation in the interference group versus the model and control groups (mRNA:0.066±0.031 vs 0.320±0.019,P<0.05;0.066±0.031 vs 0.344±0.026,P<0.05; protein expression:0.131±0.012 vs 0.230±0.021, P<0.05; 0.131±0.012 vs 0.244±0.010, P<0.05). (3) Comparing with the control group,[Cl^-]i became up-regulated in the model group (0.0315±0.0039 vs 0.0164±0.0019,P<0.05).It was down-regulated in the interference group versus the model group (0.0182±0.0013 vs 0.0315±0.0039, P<0.05), but higher than control group without statistical difference (0.0182±0.0013 vs 0.0164±0.0019, P>0.05).

The down-regulation of KCC2 and rise of[Cl^-]i in brainstem may participate in the pathological mechanism of acute insomnia in rats.And the mechanism of sedative-hypnotic diazepam may be operate through an up-regulation of KCC2, a downregulation of NKCC1 and decreased[Cl^-]i.

To explore the histological outcomes of tendon-bone healing in anterior cruciate ligament (ACL) reconstruction with cortical press-fit bolt (CPB).

Twenty-four healthy female or male New Zealand White rabbits (2-3 months old) underwent bilateral ACL reconstruction with extensor digitorum longus tendon.A random method was used to decide one knee would receive the routine ACL reconstruction (control group) and another cortical press-fit bolt fixation (experimental group).After general anesthesia, extensor digitorum longus tendon was harvested and ACL reconstruction performed.All animals were sacrificed at 4, 8 and 12 weeks postoperation.Radiological and histological examinations were made at each timepoint.The specimens were stained with different methods to observe the pathological changes of tendon graft, bone tunnel and cortical press-fit bolt.

More revascularization and massive new bone were found in tendon-bone junction of experimental group at 4,8 and 12 weeks postoperation.The circum-graft new vessel proportion of the experimental and control groups were 0.48±0.12 and 0.26±0.05 respectively (P<0.05).In the experimental group, more cartilage cells were present in tendon-bone junction at 12 weeks and the circum-graft new bone areas in two groups were 0.41±0.11 and 0.21±0.10 mm² respectively (P<0.05).

Cortical press-fit blot may improve tendon-bone healing after ACL reconstruction in rabbits.The application prospects of this procedure are promising.

To explore the inhibitory effects of human umbilical cord-derived mesenchymal stem cells (hUCMSC) on the proliferation of peripheral blood mononuclear cells (PBMC) from spondyloarthritis (SpA) patients.

A total of 12 SpA patients at Chinese PLA General Hospital were recruited from May 2012 to October 2012.Information on demographic characteristics, disease and functional activity was collected.Isolated PBMC were stimulated by phytohemagglutinin (PHA,1μg/ml) in the presence or absence of hUCMSC.The proliferation of hUCMSC was suppressed by irradiation with Co60 (30 Gy) before co-culturing with PBMC.The proliferation of PBMC was determined by Cell Counting Kit-8 (CCK-8).Cell cycle profiles of PBMC were analyzed by flow cytometry.The association of inhibitory effect of hUCMSC with the disease and functional activity of SpA patients was examined.

After coculturing with hUCMSC by cell-to-cell contact for 5 days, the proliferation of PBMC stimulated by PHA (1μg/ml) was significantly inhibited by hUCMSC in a dose-dependent manner.The inhibition rate of the proliferation of PBMC cocultured with hUCMSC by cell-to-cell contact was higher than that by Transwell culture (57%±17% vs 32%±12%,P<0.01).Compared to PBMC cultured alone,a larger number of PBMC cocultured with hUCMSCwerein phase G1 (86%±3% vs 68%±5%,P<0.01) while a lower number of cells in phases Sand G2 (8%±3% vs 26%±5%,P<0.01).No association was found between the inhibitory effect of hUCMSC and the disease and functional activity.

The proliferation of PBMC from SpA patients may be inhibited by hUCMSC.And hUCMSC have therapeutic potentials for Sp A patients.

To explore the osteogenetic capacity of cross-linked adjustable antituberculosis drug sustained-release artificial composite (TPB/SA-RFP/PLA).

The model of femur bone defect was established in rabbits.TPB/SA-RFP/PLA complex was implanted into defect parts in the experimental group while TPB/SA/PLA in the blank control group.At Weeks 4, 8 and 12, gross specimens received radiographic, histological and immunohistochemical examinations to determine the osteogenetic performance of TPB/SA-RFP/PLA.

As compared with the control group, TPB/SA-RFP/PLA complex had excellent osteogenic capacities while the TPB/SA/PLA group had no obvious osteogenic difference.Lane-sandhu histological and radiographic ratings demonstrated significant difference between TPB/SA-RFP/PLA (8.3±0.3) and blank groups (2.2±0.4)(P<0.05).And TPB/SA/PLA showed no significant intragroup significance (P>0.05).Two groups immunohistochemical Alkaline phosphatase was strongly positive in two test groups and weakly positive in the control group.

TPB/SA-RFP/PLA has excellent profiles of bone conductivity and regeneration.And the incorporation of rifapin does not affect its osteogenetic capacity.

To discuss the role of sonic hedgehog (SHH) pathway in PDGF-induced vascular smooth muscle cell proliferation.

Human vein VSMC were cultued in vitro.Laser confocal microscopy and Western blot were used to detect the expression of SHH pathway related proteins.The cell proliferation was evaluated by Ki-67 staining and BrdU incorporation after treatment by siRNA of Gli2 or shh pathway inhibitor cyclopamine.

The results of laser confocal microscopy and Western blot showed that SHH pathway protein which including shh, Patched1 and Gli2 were activated in the PDGF-induced VSMC proliferation.BrdU incorporation assay and Ki-67 stianing showed that the cell proliferation which induced by PDGF was inhibited by Gli2-siRNA and cyclopamine which can both block SHH pathway.

SHH pathway play an important role in PDGF-induced VSMC proliferation.