Objective The study the formative causes of low dense area in lung on CT images during expiration.Methods This group included 15 young volunteers,mean age was 22 years.Thin sections of spiral CT at right middle hilum were scanned at suspended deep inspiration and deep expiration on both supine and prone positions.The density and area of lobes on matching structural images in the middle hilum at deep inhalation and exhalation were measured on the supine and prone.The increasing rate in area and absolute increasing value in attenuation as full inhalation comparing to full exhalation were calculated.Results Changes of distention and density in the same section of the right lower lobe on dependent position were greater than that on nondependent one.Correlation between distention and density of the lobes was high(P

Objective To analyze the clinical features of melioidosis spleen abscess.Methods A retrospective analysis of 26 cases with melioidosis spleen abscess at Hainan People′s Hospital between October 2002 and March 2015 was performed.Data with general conditions, clinical characteristics, imaging features, treatment and outcome were all extracted and analyzed.Results High fever (100.0%) and splenomegaly (73.1%) were the main clinical symptoms and signs.Laboratory examinations showed that white blood cell and neutrophil percentage increased, with a mean value of 12.6×10.9/L and 0.86, respectively.88.5% cases had diabetes mellitus which was the main underlying disease.Apart from spleen abscess, pulmonary infection (73.1%) and liver abscess (38.5%) were the majority.Imaging showed multiple small abscess (92.3%).All patients had at least one positive blood culture of Burkholderia pseudomalleiand were treated with imipenem, ceftazidime and sulfamethoxazole alone or in combination.Hospitalization days ranged between 8 to 65 days with the mean of 29.5 days.Twenty-three cases (88.5%) were cured, the remaining 3 cases (11.5%) abandoned treatment and were all lost for follow-up.Conclusions Melioidosis should be suspected in patients from epidemic areas, who have diabetes and imaging shows spleen abscess and other organ infections including pulmonary infection and liver abscess.Microbiological culture is needed immediately.

Objective To study the early diagnostic indices of melioidosis by analyzing 49 cases. Methods Unconditional logistic regression analysis was used to analyze the clinical data of 49 cases of melioidosis and 98 cases of bacterial pneumonia who were admitted in our hospital and Peoples' Hospital of Hainan Province from December 1996 to December 2007. Their social characteristic,background diseases,clinical manifestations,laboratory findings,radiologic examination and complications were studied. Results Background disease (such as diabetes),hepatosplenomegaly,septic shock,sepsis et al were the main causes of melioidosis. Conclusion Chills,fever,hepatosplenomegaly,diabetes mellitus,septic shock and sepsis are all factors that should be considered with melioidosis.

Objective:To study the effects of soybean isoflavone (SI) on metabolism of lipids and lipoprotein (a) [Lp(a)] in ovariectomized rats . Methods:Senventy female Sprague- Dawley (SD) rats were randomly divided into 7 groups according to the levels of total cholesterol (TC) in serum: high-lipid (HF) group, estrogen (EG) group, low-dose SI (L-SI) group, middle-dose SI (M-SI) group, high-dose SI (H-SI) group, sham group and normal control (NC) group. One week after bilateral ovaries were extirpated, except sham and NC group, estrogen, different doses of SI or deionized water were fed i.g. for 12 w. Except NC group, the other groups were fed high fat diet. Body weights were weighed every week and blood and heart were collected at the end of experiment. The serum TC, triglyceride(TG), high or low density lipoprotein-cholesterol (HDL-C, LDL-C), Lp (a), and antioxidative enzymes activities were assayed. Results:After SI intervention, the levels of LDL-C in SI groups were significantly lower than in HF group but higher than in NC group. The levels of Lp (a) were also changed, but there was almost no effect on HDL-C. Persistent intervention with SI can reduce TC, TG , and protect cadiocyte’s actin filament andmitochondrial ultramicrostructure from damage as shown in HF group. The ultramicroscopic pictures in EG and H-SI group almost resembled NC group. Conclusion:Persistent intervention of high-dose SI can reduce the levels of LDL-C, TC, TG and protect the myocardiac damages due to high fat diet in ovariectomized rats.

Objective To study the effects of soybean isoflavone(SI) on lipid peroxidation and liver ultrastructure in ovariectomized rats. Methods Seventy female Sprague-Dawley(SD) rats were randomly divided into 7 groups according to the levels of total cholesterol(TC) in serum: hyper-lipoid group,estrogen group,low-dose SI group,middle-dose SI group,high-dose SI group,sham group and normal control group.After bilateral ovaries were extirpated except sham and normal control groups for a week,the estrogen,different doses of SI or deionized water were fed with intragastric administration for 12 weeks.The rat body weight was weighted once per week and blood samples were collected at the time of ovariectomization,the 4th and 8th weeks after administeration at the time of being killed.The serum TC,triglyceride(TG),high or low density lipoprotein-cholesterol(HDL-C,LDL-C),lipoprotein(a) and antioxygen enzyme were assayed. Results LDL-C levels in SI intervention groups were significantly lower than that in hyper-lipoid groups but higher than that in normal control group;the levels of lipoprotein(a) were changed;there was almost no effect on HDL-C in serum.SI could retain integrity and ultrastructure of hepatocyte;there was similar structure in high dose SI group and normal control group.An obvious damage was detected in hyper-lipoid group.Conclusion SI can improve lipoprotein(a) and lipid peroxidation in ovariectomized rats.A continuous intervention with high-SI can reduce LDL-C to normal lever and retain integrity and ultrastructure of hepatocyte.

Objective To investigate the feasibility and efficacy of iliofemoral endovascular therapy for the treatment of chronic ischemia of lower extremities due to arterial atherosclerosis. Methods During the period of September 2005-January 2009 percutaneous endovascular angioplasty and stent implantation were performed in 15 consecutive patients with CTA-proved chronic occlusive iliofemoral artery disease. The patients included 11 males and 4 females with a mean age of (72.1 ± 5.9) years (ranged from 61 to 82 years). Before the procedure, all patients underwent clinical and imaging assessments, including Fontaine classification, ankle-brachial pressure index (ABI), and lower limb computed tomography angiography (CTA). According to the length, morphology and location of the occlusive segment, different types of stents were employed together with pereutaneous transluminal angioplasty (PTA) to treat the occluded lilac or superficial femoral artery. At the end of the procedure, distal angiogram was performed to assess the success of the procedure and to exclude thromboembolism or dissection complications. After PTA, the residual stenosis < 30% and/or pressure gradient < 10 mmHg were defined as technical success. Clinical success was identified when patient's clinical symptoms were improved by one or more grade according to Fontaine classification. Results Technical success was totally achieved in all patients with no occurrence of complication. Recanalization of the occluded artery was performed preferably by retrograde ipsilateral femoral artery approach in 5 patients and by contralateral access using the crossover aorta technique in 10 patients. PTA was performed in all patients after stent release to open the occluded vessel to its normal diameter. The mean length of the lilac arterial segment covered with 8 stents was (7.6 ± 1.4) cm (ranged from 6 cm to 10 cm). The mean diameter ± SD of the iliac stents was 9.5 mm ± 1.4 mm (ranged from 8 mm to 12 mm). The mean length of 5 superficial artery implanted stents was (4.5 ± 1.1) cm (ranged from 4 cm to 6 cm). The mean ABI before treatment and six months after treatment was 0.64 (range 0.41 to 0.89) and 0.76 (range 0.50 to 0.95), respectively. The difference in ABI between pre-interventional and post-interventional procedure was statistically significant (t = -4.64, P < 0.01). Clinical improvements according to Fontaine classification were obtained in all patients, in whom technical success was achieved (100%). Conclusion Endovascular interventional procedure is a safe and effective treatment for iliofemoral arterial occlusive disease due to arterial atherosclerosis. PTA combined with subsequent stent implantation can well improve the patient's quality of life as well as the hemodynamics of lower extremities, which is very important for preserving the diseased limb for a long period of time.

Objective:To investigate the application value of transanal endoscopic partial intersphincteric resection for ultra-low rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 9 ultra-low rectal cancer patients undergoing transanal endoscopic partial intersphincteric resection at the First Affiliated Hospital of Xiamen University from December 2017 to August 2020 were collected. There were 8 males and 1 female, aged from 39 to 62 years, with a median age of 58 years. Observation indicators: (1) surgical and postoperative situations; (2) postoperative pathological examination; (3) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative tumor local recurrence and distant metastasis, survival of patients, ileostomy closure, anus function at 3 months after ileostomy closure, male urinary and sexual function and female sexual function at 6 months after rectal surgery. The follow-up was up to February 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1)Surgical and postoperative situations: all 9 patients underwent surgery successfully, without conversion to open surgery. Seven of the 9 patients underwent transanal endoscopic partial intersphincteric resection and the rest of 2 patients with tumor close to the dentate line underwent transanal endoscopic modified partial intersphincteric resection. The operation time and volume of intraoperative blood loss of 9 patients were (267±48)minutes and 50 mL(range, 30?60 mL), respectively. Five of the 9 patients underwent transanal specimen extraction, and 4 patients underwent specimen extraction by an abdominal incision. All 9 patients underwent transanal hand-sewn coloanal anastomosis and protective ileostomy, and two pelvic drainage tubes were indwelled. Transanal drainage tube was placed after anastomosis in 3 of 9 patients. Three cases had intraoperative adverse events and there were no intraoperative adverse event reported in the remaining 6 cases. The time to postoperative initial stoma exhausting and time to postoperative first semi-liquid food intake of 9 patients were 3 days(range, 2?4 days) and 5 days(range, 4?7 days), respectively. One case had Clavien-Dindo grade Ⅰ complication and 2 cases had Clavien-Dindo grade Ⅱ complication during postoperative 30 days and the rest of 6 cases had no postoperative complication. No anastomotic stricture, hemorrhage or urinary retention occurred in 9 patients. The duration of postoperative hospital stay and cost of hospitalization of 9 patients were 11 days(range, 9?23 days) and (6.8±1.3)×10 4 yuan, respectively. (2) Postoperative pathological examination: the diameter of tumor, the distance of distal resection margin, the number of lymph node dissected and the number of positive lymph node of 9 patients were (3.2±1.4)cm, 0.6 cm(range, 0.5?1.5 cm), 17±7 and 0(range, 0?7), respectively. The tumor histopathological type was adenocarcinoma with negative tumor nodule and nerve infiltration in all 9 patients. Only 1 case of 9 patients was found vascular tumor thrombus. The surgical specimens of all 9 patients showed negative for distal and circumferential margins and complete mesorectum. Results of postoperative pathological TNM staging showed that of 6 cases with preoperative T1-T2 staging tumors, 3 cases were classified as pT2N0M0 stage, and 3 cases were classified as pT2N1M0 stage, pT2N2M0 stage or pT3N1M0 stage, respectively. Three cases with preoperative T3 staging tumors were classified as ypT0N0M0 stage, ypT2N0M0 stage or ypT3N0M0 stage, respectively. (3) Follow-up: all 9 patients were followed up for 6 to 13 months, with a median follow-up time of 9 months. No local recurrence, distant metastasis or tumor-related death was found during follow-up. Of the 9 patients, only 1 case did not receive stoma closure and undergo anus function assessment, and the rest of 8 cases underwent stoma closure. Results of postoperative anus function assessment showed 5 cases of accessibility, 2 cases of mild impairment and 1 case of severe impairment. Results of urogenital function assessment showed 6 cases of the 8 male patients of mild impairment, 1 case of moderate impairment and 1 case of severe impairment in micturition function, respectively, and 3 cases of accessibility, 2 cases of mild impairment and 3 cases of moderate impairment in sexual function, respectively. The female patient underwent accessibility of sexual function and the six-item version of the female sexual function index was 25. Conclusion:Transanal endoscopic partial intersphincteric resection can be used for the treatment of ultra-low rectal cancer.

Objective Explore the impact of long-term blood glucose fluctuations and blood glucose control on the stroke incidence in patients with type 2 diabetes mellitus(T2DM).Methods An observa-tional cohort of patients with T2DM was established based on"Shanghai Community Chronic Disease Health Management Service Objects"on October 1st,2018.Follow-ups were conducted every three months,and fasting blood glucose(FBG)were tested at each visit.Basic epidemiological data were collected via the Shanghai Community Health Management Information Platform or survey questionnaires,and stroke incidents were gathered via the"Shanghai Cardio-Cerebrovascular Event Monitoring System".The first reported stroke incident within the observation period was considered.The observational deadline was December 31st,2021.Standard deviation of FBG was used to evaluate blood glucose fluctuation and FBG control rate was used to reflect blood glucose control status.Cox Proportional Hazards Model was utilized to analyze the impacts.Results The cumulative observation time was 91,826.1 person-years for the study,in which there were 1785 cases of stroke events observed,implying a cumulative incidence of 5.73%and incidence rate of 1943.9/100000 person-years.The mean number of follow-ups(10.29±3.07)per patient was recorded.The details of the stroke cases were as follows:transient ischemic attacks(n=111,6.22%),non-lacunar brain infarctions(n=754,42.24%),lacunar brain infarctions(n=798,44.71%),intracerebral hemorrhages(n=80,4.48%),non-intracerebral hemorrhages(n=8,0.45%),subarachnoid hemorrhages(n=12,0.67%),and unclassified strokes(n=22,1.23%).After excluding subjects with less than five follow-ups,the Cox Proportional Hazards Model suggested that increased standard deviation of FBG was an independent risk factor for the first stroke incident,and an increased blood glucose control rate was an independent protective factor.Both the standard deviation of FBG and the blood glucose control rate were not correlated with stroke recurrence.Conclusion Long-term blood glucose fluctuations and blood glucose control can predict the risk of a first stroke in patients with T2DM.The relationship between blood glucose fluctuations,blood glucose management,and stroke recurrence requires further studies.

Objective To investigate the clinical efficacy of thoracoscopic and laparoscopic radical resection for adenocarcinoma of the esophagogastric junction (AEG) with side-to-side tubular gastroesophagostomy.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 4 patients with AEG who were admitted to the First Affiliated Hospital of Xiamen University between November 2017 and June 2018 were collected.All the patients underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy and received 6 cycles of postoperative adjuvant chemotherapy with SOX regimen.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy situations and survival of patients up to Semptember 2018.Results (1) Surgical and postoperative recovery situations:4 patients successfully underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy,without conversion to thoracotomy,open surgery or perioperative death.Operation time,volume of intraoperative blood loss,time for postoperative fluid diet intake and postoperative drainage-tube removal time of case 1,2,3,4 were respectively 420 minutes,400 minutes,320 minutes,300 minutes and 100 mL,100 mL,150 mL,100 mL and 9 days,8 days,8 days,8 days and 11 days,10 days,10 days,10 days.Case 1 with mild pneumonia and hiccup and case 2 with mild pneumonia were improved by symptomatic treatment,case 3 and 4 didn't have complication.All the patients had postoperative patent anastomosis.Duration of postoperative hospital stay of case 1,2,3,4 were respectively 12 days,11 days,11 days,11 days.(2) Postoperative pathological examination:all the 4 patients had negative surgical margin.Number of lymph node dissected,number of positive lymph node,tumor diameter,Siewert type,depth of tumor infiltration,tumor histopathologic stage of case 1,2,3,4 were respectively 32,31,17,23 and 0,4,2,6 and 3.5 cm,5.0 cm,5.0 cm,4.0 cm and type Ⅱ,Ⅰ,Ⅱ,Ⅰ and subserosa,entire wall of the esophagogastric junction,subserosa,entire wall of the esophagogastric junction and Ⅱ A staging,Ⅲ B staging,Ⅱ B staging,Ⅲ A staging.Degree of tumor differentiation and pathological type were moderately differentiated adenocarcinoma in the 4 patients.(3) Follow-up and survival situations:4 patients were followed up for 3-10 months,with a median time of 5 months.During the follow-up,4 patients underwent chemotherapy and achieved disease-free survival.Conclusion Thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy is safe and feasible.