Objective To compare the clinical efficacy of three different methods in treatment of tuberculous pleural effusion.Methods 108 patients with tuberculous pleural effusion were divided into three groups by randomized single blind methods,and each group had 36 cases.Group A was given Chinese medicine formulations and central venous catheter pleural drainage for injection,group B was given minimally invasive thoracic closed drainage,while group C was given conventional pleural puncture.The clinical efficacy,complications and hospitalization corresponding cost were compared in three groups.Results The clinical effective rates of the three groups were 97.2％,83.3％,61.1％ (x2 =12.90,14.17,15.28,all P ＜ 0.05).In group A,the tuberculous pleural effusion disappearedfastest,hospitalization corresponding cost was lowest and less complications,followed by group B,and group C was the worst,there were statistically significant differences (all P ＜ 0.05).Conclusion Chinese medicine formulations combined with central venous catheter drainage in the treatment of tuberculous pleural effusion has good clinical effecacy,and it is an effective treatment method,which is worth to be further promoted in clinical.

Objective: To investigate the effect of Yi Jin Jing (Sinew-transforming Qigong Exercises) plus tuina on scapulohumeral periarthritis (SP). Methods: A total of 30 cases with SP were randomized into an observation group and a control group. Those in the observation group practiced Yi Jin Jing (Sinew-transforming Qigong Exercises) plus tuina therapy; whereas those in the control group received only tuina therapy. Tuina therapy was conducted every other day, 20 min every time for 1 month and Yi Jin Jing (Sinew-transforming Qigong Exercises) was conducted once a day for 1 month. The therapeutic effects were assessed by visual analogue scale (VAS) and Constant-Murley scale. Results: After treatment, the VAS score and Constant-Murley scale were substantially improved, showing statistical significances (P<0.01); the Constant-Murley scale in the observation group was better than that in the control group, showing a statistical significance (P<0.01); the effective rate in the observation group was higher than that in the control group, between-group comparison showed a statistical significance (P<0.01). Conclusion: Yi Jin Jing (Sinew-transforming Qigong Exercises) plus tuina and tuina alone have a verified effect in treating SP, and the former can achieve a better effect than the later.

Objective To investigate the clinical application value of hippocampal volume (HV)measurement with MMSE score in varying different degrees cognitive impairment.Methods 30 Alzheimer’s disease(AD)patients,30 mild cognitive impairment (MCI)patients and 30 normal controls(NC)were recruited,HV was measured by Siemens Tim-avanto 3.0T super conductance magnetic resonance.Standardized HV and MMSE scores of three groups were comprehensive analyzed.Results The left and right sides and the total HV of AD group were lower than the MCI and the NC group,with significant differences by statistical analysis (P <0.05).The HV had no significant differences between the MCI and the NC group.The MMSE scores of AD group were lower than the MCI and the NC group,with significant differences by statistical analysis (P <0.05),the score had no significant differences between the MCI and the NC group.Conclusion HV measurement with MMSE score would be helpful to provide effective basis for the AD diagnosis,the sensitivity in the diagnosis of MCI is not high.

Objective To investigate the diagnosis of value 99mTc-MIBI SPECT and CT fusion imaging in the differential solitary pulmonary nodule ( SPN). Methods Thirty-nine patients with SPN underwent 99mTc-MIBI-SPECT and positioning CT fusion imaging, and the imaging results carried on the qualitative and semi-quantitative analysis. The diagnostic value of the imaging method for SPN was judged according to the results of the final diagnosis. Results Of 39 cases with SPN, 13 cases were malignant and 26 cases were benign. The diagnostic sensitivity, specificity, accuracy, negative predictive value and positive predictive value of 99mTc-MIBI-SPECT positioning CT fusion imaging qualitative analysis in benign and malignant SPN was 92.31%(12/13),88.46%(23/26),89.74%(35/39),80% (12/15) and 95.83% (23/24),respectively. Receiver operating characteristic (ROC) curve analysis showed:using 99mTc-MIBI early uptake ratio (EUR) ≥1.474 as the critical value for identification the benign and malignant SPN, the sensitivity and specificity was 100% and 76.90%, respectively;using 99mTc-MIBI delayed uptake ratio (DUR) ≥ 1.38 as the critical value, the sensitivity and specificity was 100%and 76.90%. Conclusion The method of 99mTc-MIBI-SPECT and positioning CT fusion imaging has a high clinical value in the differential diagnosis of SPN.

To investigate the effects of three classical anti-jaundice formulas Yinchenhao Decoction (YCHD). Yinchen Wuling San (YCWLS) and Zhizi Baipi Decoction (ZZBPD) on liver fibrosis induced by dimethylnitrosamine (DMN) in rats and explore the formula-syndrome relationship.

Objective To explore the best keV conditions of show hepatocellular carcinoma lesions with the best contrast-to-noise ratio (CNR)and image quality,and evaluate the effect of monochromatic energy imaging on the detection of hepatocellular carcinomas.Methods The dual-energy CT imaging of 30 patients with hepatocellular carcinoma were analyzed retrospectively.Monochromatic energy images (40 to 140 keV,interval 10 keV)were produced by the dual-engery software.CNR and image noise of monochromatic energy,100 keV and 140 keV images were measured respectively.The CNR and the imaging noise were optimized.The results between the monochromatic energy images and the mixed energy images were compared by using the two related samples of non-parameter rank test.Results In the arterial phase, the monochromatic energy level with the highest CNR was concentrated at 70 keV,and the lowest level of the image noises was at 70 and 80 keV.The images at 70 keV were chosen to be compared with the fusion images.The CNR values of the monochromatic images at 70 keV were similar as those at 100 keV (1 .68 ± 1 .04 vs 1 .88 ± 1 .59 ,P =0 .149 ),and significantly higher than those at 140 keV (1 .68 ± 1 .04 vs 0.62±0.92,P =0.000).The image noises at 70 keV were similar as those at 140 keV (6.52±1.53 vs 7.60±2.73,P =0.050), and significantly lower than those at 100 keV (6.52±1.53 vs 8.55±1.11,P =0.000).Conclusion The monochromatic energy imaging at 70 keV can improve the CNR of the hepatocellular carcinoma lesions without reducing the image quality,which will help the lesion detection.

Objective To explore the clinical effects of sequential flap of thigh perforator for closure of the anterolateral thigh free flap donor site.Methods From March,2014 to May,2015,8 consecutive patients underwent elective anterolateral thigh free flap reconstruction for limb soft tissue defect.To design a sequential flap of thigh perforator to achieve primary closure of the anterolateral thigh free flap donor site.The area of anterolateral thigh free flap ranged from 9.0 cm×6.0 cm to 20.0 cm×1 1.0 cm,respectively.The area of thigh perforator flap ranged from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm.Results All flaps healed uneventfully.Distal skin flap necrosis appeared in 1 flap which was healed after local transposition flap.All the patients were followed up for 1 to 6 months,with mean time of 4 months.The color,texture and appearance of flaps were satisfactory.Conclusion Sequential flap of thigh perforator,with reliable blood supply and constant position,represents an ideal model to close the anterolateral thigh free flap donor site of small defect.

Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG)positron-emission temography/computed tomography (PET/CT) examination to predict microvascular invasion (MVI) of hepatocellular carcinoma (HCC).Methods The retrospective cohort study was conducted.The clinicopathological data of 51 HCC patients who were admitted to Changhai Hospital of the Second Military Medical University (32 patients) and Universal Medical Imaging Diagnostic Center (19 patients) from January 2013 to October 2017 were collected.Of 51 patients receiving postoperative pathological examination,21 diagnosed with positive MVI and 30 diagnosed with negative MVI were respectively allocated into the positive and negative MVI groups.All the patients received preoperative 1s F-FDG PET/CT examination and underwent surgery after related examinations.Two imaging doctors independently read films and made a semi-quantitative analysis.Observation indicators:(1) results of 18F-FDG PET/CT examination;(2) multivariate analysis and diagnostic value affecting MVI of HCC;(3) treatment and follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative patients' survival up to November 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with the independent-sample t test.Measurement data with skewed distribution were described as M (Qn),and comparisons between groups were analyzed using the independent-sample rank sum test.Comparisons of count data were analyzed using the chisquare test.Logistic regression analysis was performed in variables with statistical significance.The inclusion criteria was 0.05 and exclusion criteria was 0.10 according to Backward (LR) method for screening variables.Receiver Operating Characeristic (ROC) curve analysis was used to evaluate the diagnostic value using MVI as a diagnostic standard.Results (1) Results of 18F-FDG PET/CT examination:of 51 HCC patients,tumors located in the right lobe,left lobe and caudate lobe of the liver were respectively detected in 37,12 and 2 patients.CT examinations of 51 HCC patients:HCCs showed the hypodense shadow or slightly hypodense shadow in liver and were round-like,and some of the larger lesions were irregularly conglomerate,with a relatively clear tumor-liver boundary;tumor necrosis area showed patchy and irregular lower density,with small lesions around the port of tumors.Of 51 patients,34 were positive on PET and 17 were negative on PET,and some necrotic areas showed no uptake and located in the center of tumors.There was no abnormal 18 F-FDG uptake in other parts of the whole body.The maximum diameter of tumor was (6± 3)cm.The maximum standardized uptake value (SUVmax),and ratio of SUVmax of tumor to SUVmax of liver (SUVmax T/L) in all the lesions were 6.38±4.91 and 2.42±1.93,respectively.The mean standardized uptake value (SUVmean),metabolism of volume (MTV),total lesion of glycolysis (TLG) of 40 patients were 4.30± 2.46,43.82 cm3 (8.97 cm3,219.13 cm3) and 165.73 (28.26,794.50),respectively,and software could not automatically delineate lesions in other 11 patients due to low metabolism.Delayed imaging was found in 21 patients,and the delayed SUVmax and retention index (RI) were 7.22±6.26,19.66％ (-7.10％,50.84％),respectively.The cases with positive and negative on PET were 18,3 in the positive MVI group and 16,14 in the negative MVI group,respectively,with a statistically significant difference between groups (x2=5.829,P＜0.05).The maximum diameter of tumor in the positive MVI group and negative MVI group was respectively (7.7±2.9)cm and (5.2±3.1)cm,with a statistically significant difference between groups (t=-2.930,P＜0.05).(2) Multivariate analysis and diagnostic value affecting MVI of HCC:the results of multivariate analysis showed that maximum diameter of tumor was an independent factor affecting MVI of HCC (OR=1.276,95％ confidence interval:1.028-1.585,P＜0.05).The area under the ROC curve of the maximum diameter of tumor was 0.723 using MVI as a diagnostic standard.The sensitivity,specificity and Youden index were respectively 90.5％,50.0％ and 0.405,with 4.55 cm as the critical value.(3) Treatment and followup:all 51 patients underwent tumor resection.Twenty-two patients were followed up for 25 months (range,12-46 months).The 1-and 2-year overall survival rates were 81.8％ (18/22) and 63.6％ (14/22),respectively.The 1-and 2-year tumor-free survival rates were 59.1％ (13/22) and 45.5％ (10/22),respectively.Conclusion The positive rate on PET of 18F-FDG PET/CT examination in HCC patients with positive MVI is higher than that in HCC patients with negative MVI,and the maximum diameter of tumor is an independent factor predicting MVI of HCC,with a certainly reference value.

This is a report of a complex defects in the right upper extremity treated in the Department of Hand and Microsurgery, 521 Hospital of Norinco Group, in October 2016. The patient received multi-transfers of flaps for one-stage reconstruction, including a double-paddled ALTPF and a compound flap of the great toe and the second toe. Vascular compromises occurred in flaps on the 2nd day after surgery. All the flaps were rescued and survived completely after surgical exploration. Followed-up at 3 year after surgery showed that the appearance and function of the affected limb recovered well. The flexion and extension of elbow and wrist were normal. The pinch function of the reconstructed thumb and index finger recovered well.

OBJECTIVETo compare the diagnostic value of ⁹⁹Tc(m)-MIBI SPECT/localizable CT and ¹⁸FDG-PET/CT in patients with indeterminate solitary pulmonary nodules (SPNs) and assess the feasibility of using ⁹⁹Tc(m)-MIBI SPECT/localizable CT as an alternative when ¹⁸FDG-PET/CT is not available.

METHODSThirty-nine patients with indeterminate SPNs were examined by ⁹⁹Tc(m)-MIBI SPECT/localizable CT, and another 46 patients by ¹⁸FDG-PET/CT. The findings of the two modalities were analyzed qualitatively and semiquantitatively to assess their efficacy for a definitive diagnosis of SNPs.

RESULTSOf the 39 patients examined by ⁹⁹Tc(m)-MIBI SPECT/localizable CT, 13 were identified to have malignant SPNs and 26 had benign SPNs; the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the examination were 92.31% (12/13), 88.46% (23/26), 89.74% (35/39), 80% (12/15) and 95.83% (23/24), respectively. Of the 46 patients receiving ¹⁸FDG-PET/CT examination, 29 malignant cases and 17 benign cases were identified with a diagnostic sensitivity, specificity, accuracy, PPV and NPV of 96.55% (28/29), 76.47% (13/17), 89.13% (41/46), 87.50% (28/32) and 92.86% (13/14), respectively. The two modalities showed no significant differences in the diagnostic sensitivity (χ² =0.356, P=0.55), specificity (χ² =1.084, P=0.298), accuracy (χ² = 0.008, P=0.927), PPV (χ² = 0.453, P=0.501) or NPV (χ² =0.157, P=0.692). The ROC curve showed that with the early uptake ratio (EUR) of ⁹⁹Tc(m)-MIBI ≥ 1.474 and ≥ 1.38 as the cutoff values, the sensitivity of ⁹⁹Tc(m)-MIBI SPECT/localizable CT was both 100% and the specificity both 76.90%; with the maximum standard uptake value (SUVmax) of ¹⁸FDG ≥ 2.40 as the cutoff value, the sensitivity of ¹⁸FDG-PET/CT was 96.60% and the specificity was 76.50%, showing no significant differences between the two modalities in the diagnostic efficacy.

CONCLUSION⁹⁹Tc(m)-MIBI-SPECT/localizable CT may be a useful and practical modality for early diagnosis of SNPs for patients with a medium or low income in small and medium-sized cities.

Diagnosis, Differential ; Fluorodeoxyglucose F18 ; Humans ; Lung Neoplasms ; diagnosis ; Positron-Emission Tomography ; ROC Curve ; Radiopharmaceuticals ; Sensitivity and Specificity ; Solitary Pulmonary Nodule ; diagnosis ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed