Objective To evaluate the clinical importance of doublecontrast CTdiagnosis of traumatic anterior shoulder instability. Methods Forty-eight patients underwent double contrast CT scan. With the guide of CT scan, anterior arthrocentesis of the shoulder was performed and 4 ml of 76% urografin was injected into the joint and then 10 ml of filtrated air was injected. The patients wereexamined by SOMATOM CR Systematic CT. The results of double contrast CT of the 48 patients were divided into Ⅰ, Ⅱ and Ⅲ degree according to the CT results related to their injury history, clinical symptoms, signs and operation findings. Results The patients had no complaint after the CT examination exceptfor 3 patients, who had slight pain within 2 days after CT examination. The results of double contrast CT were as follow:Ⅰ degree: 9 patients, Ⅱ degree: 22 patients, and Ⅲ degree: 17 patients. All patients with Ⅰ degree injuries were treated with rehabilitation program. The patients with Ⅱ degree injuries were mainly treated withrehabilitation program, but took much longer time. The patients with Ⅲ degreeinjuries were suggested to be treated with surgery. Conclusion To divide the results of double contrast CT into Ⅰ，Ⅱ and Ⅲ degree not only reflects the severity of traumatic anterior shoulder instability but provides information for the treatment of the instability.
ObjectiveTo investigate the vaules of multi-slice spiral CT (MSCT) in diagnosing metastatic lymph nodes and judging N stage of resectable gastric cancer. MethodsFifty-nine patients with gastric cancer performed preoperative MSCT plain scan and triple enhanced scans from February 2019 to March 2021 in the First People’s Hospital of Wuhu City were collected. The results of postoperative pathology were taken as the gold standard, the short diameter, long diameter, short to long diameter ratio, CT values of triple enhanced scans and lymphatic hilar blur were compared between the metastatic lymph nodes and the non-metastatic lymph nodes. ResultsThe preoperative MSCT showed that there were 50 cases of metastatic lymph nodes and 9 cases of non-metastatic lymph nodes in 59 patients with gastric cancer. A total of 1 467 lymph nodes were harvested, including 562 metastatic lymph nodes and 905 non-metastatic lymph nodes. The short diameter, long diameter, short to long diameter ratio, and the CT values of plain scan, arterial phase, portal vein phase, and delayed phase of metastatic lymph nodes were higher than those of non-metastatic lymph nodes (P<0.05), and the incidence of lymphatic hilar blur was also higher than that of non-metastatic lymph nodes (P<0.05). Referring to the results of postoperative pathological examination, the accuracies of MSCT in judging of N0, N1, N2, N3a, and N3b stages were 88.9% (8/9), 83.3% (5/6), 85.7% (12/14), 92.3% (12/13), 88.2% (15/17), respectively, and the total accuracy was 88.1% (52/59), the specificity was 96.6% (57/59), and the sensitivity was 91.2% (52/57). ConclusionAccording to this study results, preoperative MSCT has higher specificity, sensitivity, and accuracy in diagnosing metastatic lymph nodes and judging N stage of resectable gastric cancer.
ObjectiveTo introduce a new bone defect model based on the anatomical measurement of radius and ulna in rabbits for offering a standard model for further tissue engineering research. MethodsFifteen healthy 4-month-old New Zealand rabbits were selected for anatomic measurement and radiological measurement of the radius and ulna. Another 30 healthy 4-month-old New Zealand rabbits were randomly divided into groups A, B, and C (n=10). The radius bone defect was created bilaterally in 3 groups. In group A, the periosteum and interosseous membranes were fully removed with jig-saw by approach between extensor carpi radialis muscle and musculus extensor digitorum. The periosteum and interosseous membranes were fully removed in group B, and only periosteum was removed in group C with electric-saw by approach between extensor carpi radialis muscle and flexor digitorum profundus based on anatomical analysis results of ulnar and radial measurement. The gross observation, X-ray, micro-CT three-dimensional reconstruction, bone mineral density (BMD), and bone mineral content (BMC) were observed and recorded at immediate and 15 weeks after operation. HE staining and Masson staining were performed to observe bone formation in the defect areas. ResultsBlood vessel injury (1 rabbit), tendon injury (2 rabbits), postoperative hematoma (1 rabbit), and infection (1 rabbit) occurred in group A, postoperative infection (1 rabbit) in group C, and no postoperative complications in group B; the complication rate of group A (50%) was significantly higher than that of groups B (0%) and C (10%) (P<0.05). The radiological examination showed bone defects were fully repaired in groups A and B at 15 weeks, but bridging callus formation was observed in group C. There was no significant difference in BMC and BMD among 3 groups (P>0.05). HE staining and Masson staining results showed bone formation in group A, with structure disturbance and sclerosis. New bone formed in groups B and C, cartilage cells were observed in the center of bone cells. ConclusionThe radius bone defect model established by approach between extensor carpi radialis muscle and flexor digitorum profundus is an ideal model because of better exposures, less intra-operative blood loss, less complications. Interosseous membranes play a role in bone tissue repair process, and the mechanism needs further study.
Objective To study the clinical significance of multi-slice spiral CT in portal vein imaging. Methods One hundred and thirty seven cases underwent enhanced scan with GE Light SpeedQX/i4 CT scanner were collected, including 41 cases of liver cancer, 20 cases of hepatic cirrhosis, 21 cases of cavernous hemangioma of liver, 9 cases of hepatic abscess, 6 cases of carcinoma of gallbladder, 14 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 5 cases in normal. The results of portal vein images were reconstructed with three-dimensional software and analyzed. Results In 109 cases, portal vein, cranial mesenteric vein, and splenic vein were demonstrated successfully in the stage of portal vein: volume rendering images were clear in 84 cases, and maximum intensity projection images and multiplanar reconstruction images were clear in 109 cases. Forty-five cases of portal hypertension, 18 cases of opened collateral circulation, 15 cases of portal vein tumor thrombus, 1 case of splenic vein tumor thrombus, and 6 cases of large cavernous hemangioma were demonstrated successfully. Conclusion The portal vein imaging with multi-slice spiral CT can show the dissection and lesions of portal vein and its branches clearly, and can provide the clinical evidence for clinicians to formulate a treatment plan correctly.
Objective To investigate the feasibility of predicting proximal junctional kyphosis (PJK) in adults after spinal deformity surgery based on back-forward Bending CT localization images and related predictive indicators. Methods A retrospective analysis was performed for 31 adult patients with spinal deformity who underwent posterior osteotomy and long-segment fusion fixation between March 2017 and March 2020. There were 5 males and 26 females with an average age of 62.5 years (range, 30-77 years). The upper instrumented vertebrae (UIV) located at T5 in 1 case, T6 in 1 case, T9 in 13 cases, T10 in 12 cases, and T11 in 4 cases. The lowest instrumented vertebrae (LIV) located at L1 in 3 cases, L2 in 3 cases, L3 in 10 cases, L4 in 7 cases, L5 in 5 cases, and S1 in 3 cases. Based on the full-length lateral X-ray film of the spine in the standing position before and after operation and back-forward Bending CT localization images before operation, the sagittal sequence of the spine was obtained, and the relevant indexes were measured, including thoracic kyphosis (TK), lumbar lordosis (LL), local kyphosis Cobb angle (LKCA) [the difference between the different positions before operation (recovery value) was calculated], kyphosis flexibility, hyperextension sagittal vertical axis (hSVA), T2-L5 hyperextension C7-vertebral sagittal offset (hC7-VSO), and pre- and post-operative proximal junctional angle (PJA). At last follow-up, the patients were divided into PJK and non-PJK groups based on PJA to determine whether they had PJK. The gender, age, body mass index (BMI), number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, osteotomy grading, and related imaging indicators were compared between the two groups. The hC7-VSO of the vertebral body with significant differences between groups was taken, and the receiver operating characteristic curve (ROC) was used to evaluate its accuracy in predicting the occurrence of PJK. Results All 31 patients were followed up 13-52 months, with an average of 30.0 months. The patient’s PJA was 1.4°-29.0° at last follow-up, with an average of 10.4°; PJK occurred in 8 cases (25.8%). There was no significant difference in gender, age, BMI, number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, and osteotomy grading between the two groups (P>0.05). Imaging measurements showed that the LL recovery value and T8-L3 vertebral hC7-VSO in the PJK group were significantly higher than those in the non-PJK group (P>0.05). There was no significant difference in hyperextension TK, hyperextension LL, hyperextension LKCA, TK recovery value, LL recovery value, kyphosis flexibility, hSVA, and T2-T7, L4, L5 vertebral hC7-VSO (P>0.05). T8-L3 vertebral hC7-VSO was analyzed for ROC curve, and combined with the area under curve and the comprehensive evaluation of sensitivity and specificity, the best predictive index was hC7-L2, the cut-off value was 2.54 cm, the sensitivity was 100%, and the specificity was 60.9%. Conclusion Preoperative back-forward Bending CT localization image can be used to predict the occurrence of PJK after posterior osteotomy and long-segment fusion fixation in adult spinal deformity. If the patient’s T8-L2 vertebral hC7-VSO is too large, it indicates a higher risk of postoperative PJK. The best predictive index is hC7-L2, and the cut-off value is 2.54 cm.
Objective To explore the feasibility of mean temporal phase images calculated from perfusion CT datasets by using CT perfusion (CTP) of liver on the third-generation dual-source CT. Methods Twenty-two consecutive patients with suspected hepatocellular carcinoma were enrolled, we retrospectively compared objective and subjective image quality, leson detectability, and radiation dose between mean temporal arterial (mTA) and mean temporal portal venous (mTPV) images which calculated from perfusion CT datasets with conventional enhanced arterial and portal venous datasets. Results ① Image quality: compared with the conventional enhancement image, the standard deviation (SD) values of CTP images on liver (arterial phase), portal vein (arterial phase), and liver (portal vein phase) were lower (P<0.05); the signal-to-noise ratio (SNR) values of CTP images on aorta (arterial phase), portal vein (arterial phase), aorta (portal vein phase), and portal vein (portal vein phase) were all higher (P<0.05), the contrast-to-noise ratio (CNR) value of CTP images on aorta (arterial phase) was higher (P<0.05). ② The subjective image quality: the subjective image quality scores of CTP images (mTA and mTPV images) were higher when compared to responding conventional enhanced arterial and portal venous datasets (P<0.05). ③ The diagnostic efficiency: the CTP images and conventional enhancement images showed all the lesions, but the diagnostic efficiency images of CTP images was better than the conventional enhancement images, both on lesions of blood supply and lack of blood supply (P<0.05). Conclusions The image quality of mTA and mTPV datasets calculated from CTP datasets are non-inferior when compared to conventional enhanced arterial and portal venous acquisitions in patients with suspected hepatic lesions. Thus, CTP could be used as a stand-alone imaging technique without additionally performed conventional arterial and portal venous CT acquisitions.
Objective To evaluate the value of MRI and MDCT in detecting both inferior vena cava tumor thrombus and vena cava wall invasion in renal cell carcinoma. Methods Databases including PubMed, EMbase, The Cochrane Library, MEDLINE (Ovid), CBM, CNKI, VIP and WanFang Data were searched from January 2000 to February 2012. Relevant studies were screened on the basis of the inclusion and exclusion criteria, and then quality assessment and data extraction were conducted. Then heterogeneity test and meta-analysis were conducted using RevMan 5 and Meta-disc 1.4. Results A total of 6 trials involving 244 patients and 246 cases of renal cell carcinoma were included. The results of meta-analysis showed that, for the MRI group and the MDCT group, the sensitivity was 0.963 and 0.952, the specificity was 0.969 and 0.979, the value of +LR was 9.759 and 15.57, the value of −LR was 0.091 and 0.108, and the dOR was 198.71 and 251.54, respectively. There were no significant differences in pooled effect-size among groups (Pgt;0.05). The area under curve (AUC) of summary ROC curve analysis as well as Q index of the MDCT group were 0.981 8 and 0.940 7, respectively. Conclusion There is no significant difference in the value of MRI and MDCT in detecting inferior vena cava tumor thrombus induced by renal cell carcinoma. More original studies on vena cava wall invasion by tumor thrombus should be conducted in the future due to the limitation of current materials.
Objective To summarize the methods and applications for quantitative measurement of iron in human.Methods The methods and applications for quantitative measurement of iron in human were analyzed retrospectively via reviewing the literatures domesticly and abroad， and summarized the advantages and disadvantages respectively. Results The methods for quantitative measurement of iron included laboratory tests， pathology examinations， CT， superconducting quantum interference device investigation （SQUID）， and MRI. Conclusions Laboratory test is the most simple and economic method for quantitative measurement of iron in human. Percutaneous liver biopsy is the gold standardmethod. Radiologic examinations， especially MRI， may be main methods of measuring liver iron content in future.
Objective To investigate the controlled release effect and the anti-cancer cell ability of a 5-FU loaded poly-L-lactic acid （PLLA） nanofibers membrane blending with keratin. Methods Making PLLA and keratin mix together and crosslinking to generate blending solution. Then the anti-cancer drug 5-FU was added into the solution to fabricate nanofibers membrane by high voltage electrospinning method. The micro morphology was observed by scanning electron microscope （SEM）. The controlled release effect of 5-FU from the nanofibers membrane was measured by high performance liquid chromatography （HPLC）. The cytotoxicity of 5-FU/PLLA keratin nanofibers membrane was evaluated by using 3-（4, 5-dimethylthiazol-2-yl）-2, 5-diphenyltetrazolium bromide （MTT） assay on HCT116 cell lines. At the meantime, cell growth morphology of HCT116 in experiment group were observed by microscope and transmission electron microscope. Results 5-FU could be dispersed homogeneous in the PLLA/keratin nanofibers membrane through SEM. HPLC suggested that 5-FU could be diffused out from the fibers slowly and uniformly, which corresponded the zero order kinetics basically. After different treatment, the longer time the 5-FU/PLLA keratin nanofibers （experiment group） immerse in the medium, the much more swelling, apoptosis, and necrocytosis of the cells were observed. The cell viability for experiment group was （47.5±2.8）% by MTT, while the PLLA keratin nanofibers without 5-FU had no significant impact on cell viability （93.9±2.8）%, which was statistic significance （P＜0.01）. Conclusion 5-FU/PLLA keratin nanofibers membrane owns good controlled release effect and satisfies cell inhibitory effect against HCT116 cells in vitro，which suggested that it has a promising prospect for clinical therapy.
Objective To observe the expressions of P53 and CD34 in rectal cancer and distal mucosa and to explore the safe distal margin of radical surgery for rectal cancer at molecular pathologic level. Methods Forty-five cases of rectal cancer were marked before operation， and then the cases were detected by PET/CT. P53 and CD34 expressions in rectal tissues were detected by immunohistochemistry technique. Results P53 expression and microvessel density (MVD) in rectal cancer were significantly higher than those in distal mucosa， which in distal mucosa were decreased along the anal direction. P53 and CD34 were still found in the normal rectal tissue. P53 expression and MVD were not significantly different between in more than 1.5 cm distal rectal mucosa and in normal rectal tissue. Besides MVD was related to size of tumor in rectal cancer and distal 0.5 cm rectal mucosa tissue, P53 and CD34 in rectal cancer and distal mucosa rectal tissue were not associated with tumor diameter, stage and differentiation of rectal cancer. Conclusion From the molecular pathologic view, the resection of 2.0 cm rectal distal tissue should be safe for excision of rectal cancer.