Objective:To observe the diagnosis effect about the MRI and CT examination for the patients with lacunar cerebral infarction(LAC).Methods: 82 cases early LAC patients during April 2014- June 2016 were diagnosed by two methods, MRI and CT, respectively. And the application effect of the two methods were compared based on image result.Results: In 82 cases of LAC 742 lesions confirmed by MRI and only 145 lesions confirmed by CT, and there was statistical significant between the two methods; especially in front lobe and thalamic, lesions detection rate using MRI was higher than CT, and there was statistical significant between the two methods(x2=6.59,x2=5.64,x2=6.42;P<0.05); the difference of detection rate in capsula internal also was statistical significant(x2=7.43,P<0.05); the number of lesion diameter less than 5mm was 256 using MRI and it was 3 using CT, the difference also was statistical significant(x2=6.39,P<0.05).However, in parietal lobe, basal ganglia and brainstem, all of the difference were not statistical significant (x2=0.18,x2=1.25,x2=0.81;P>0.05);Conclusion: Both of CT and MRI can be used in early diagnosis of LAC, and MRI examination is more accurate for early or micro lesions and lesions happened in the frontal lobe, thalamus, capsula internal than CT. Therefore, MRI can be used as first choice eximination method in early diagnosis of LAC.

Objective To study the risk factors for perioperative heart failure in the elderly patients with femoral intertrochanteric fracture so as to provide guide information for prevention of the perioperative heart failure.Methods Included in this retrospective study were 175 elderly patients with femoral intertrochanteric fracture who had undergone closed reduction and intramedullary nail fixation in our hospital from May 2013 to August 2016.They were divided into 2 groups.In the heart failure group of 31 cases,there were 12 males and 19 females,with an age of 73.5 ± 7.8 years;in the non heart failure group of 144 cases,there were 61 males and 83 females,with an age of 69.8 ± 6.9 years.The 2 groups were compared in terms of age,early surgery,hypertension history,respiratory disease history,heart disease history,disturbance of consciousness,preoperative renal function,operation time,anesthesia method,operation time,perioperative fluid volume difference,perioperative pain score,and postoperative hemoglobin.After univariate analysis of these factors,the risk factors were determined through the multivariate regression analysis.Results The univariate analysis showed that age,heart disease history,perioperative fluid volume difference and perioperative pain score were statistically different between the 2 groups (P ＜ 0.05).By the multivariate analysis,the risk factors for perioperative heart failure were age [P =0.014,OR =1.063 (1.012,1.116)],heart disease history [P =0.008,OR =4.977 (1.526,16.230)],perioperative fluid volume difference [P =0.025,OR=2.421 (1.117,5.249)],and perioperativepain score [P=0.040,OR=2.292(1.040,5.050)].Conclusions Age,heart disease history,perioperative fluid volume difference and perioperative pain score may be the risk factors for perioperative heart failure in elderly patients with femoral intertrochanteric fracture.We should pay attention to these factors and evaluate their influences on the patient so as to take appropriate perioperative prevention and treatment measures to reduce the incidence of perioperative heart failure.

OBJECTIVETo investigate the predictive value of hepatic venous pressure gradient (HVPG) for early bleeding after esophageal variceal ligation (EVL) by analyzing the differences in HVPG in patients with and without post-EVL bleeding.

METHODSThe medical records of patients who had been diagnosed with cirrhosis and esophageal varices and who had pre-EVL HVPG measurement data were surveyed. The study population included 105 patients from October 2010 to March 2014. Data of HVPG value, previous treatment history, endoscopic manifestation, and whether bleeding and serious complications occurred within 2 weeks after the ligation procedure were investigated as independent risk factors.

STATISTICAL METHODSincluded the chi-square test and Wilcoxon test, logistic regression modeling and receiver operating characteristic (ROC) analysis using the SPSS software version 16.

RESULTSOnly HVPG value was identified as an independent risk factor of early bleeding after EVL.According to the ROC analysis, the area under the curve (AUC) of HVPG for early bleeding after EVL was 0.866; when HVPG was more than or equal to 16 mmHg, AUC was 0.838. The sensitivity was 90.9% and the specificity was 76.4%.

CONCLUSIONHVPG is an independent factor of early bleeding after EVL and when HVPG cut-off value of more than or equal to 16 mmHg is used the predictive ability has certain accuracy and high sensitivity and specificity.

Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage ; Humans ; Hypertension, Portal ; Ligation ; Liver Cirrhosis ; Portal Pressure ; ROC Curve ; Risk Factors