Objective To study the clinical application of self-expanding nitinol stent in benign and malignant esophageal obstruction as well as in postoperative anastomotic stenosis and anastomotic leakage. Methods 22 cases of benign or malignant esophageal stenosis were treated by placing metallic stents inserted into the stenosis segment through per-oral intubation under the fluoroscopic guidance. Results The degreee of dysphagia was improved, Stooler′s staging of dysphagia was down from 3.1 preoperatively to 1.2 postoperatively. 2 cases of anastomotic leakage and 1 case of esophagorespiratory fistula were cured. All have been followed up for one to twelve months. 3 cases died with carcinoma cachexia and one succumbed to severe hemorrahage of digestive tract. The other 18 cases are still followed up. Conclusions Placement of esophageal expandable stent is one of the ideal methods to treat benign and malignant esophageal stenosis and anastomotic leakage. It can also play an important role in the improvement of the patients' life quality and prolongation of life.

Objective To discuss the nursing points for patients with malignant obstructive jaundice who are receiving biliary stenting combined with linear 125I seeds strand implantation. Methods A total of 41 patients with malignant obstructive jaundice were enrolled in this study. Biliary stenting combined with linear 125I seeds strand implantation was performed in all the 41 patients. Sufficient preoperative preparation and psychological intervention were carefully implemented. During the operation, active cooperation with the surgical procedures and close observation of patient’s vital signs as well as adverse reactions such as nausea and vomiting were strictly carried out. After the treatment the management of PTCD drainage tube, the protection of radiation and the early detection of complications were further emphasized. Results The technical success rate of biliary stenting together with linear 125I seeds strand implantation was 100%. The serum total bilirubin levels, determined at one week, one and 3 months after the treatment, were significantly decreased when compared with the preoperative data. Clinically, the jaundice basically subsided. Bile-cardiac reflex occurred in one case and displacement of PTCD drainage tube in 2 cases. Twelve patients developed chills and fever after operation. Acute renal insufficiency occurred in one patient, which was relieved after effective management. The median survival time was 10.9 months. Conclusion Careful and comprehensive preoperative preparation can ensure a successful operation. Intraoperative close observation of patient’s condition and skilled cooperation with the operator, and high quality postoperative nursing measures and close observation for early signs of complications are essential nursing points to ensure that the patients can safely get over the rehabilitation period.

Objective To determine the correlation between coronary artery calcium score (CACS) and carotid calcification, and their risk factors. Methods 162 cases underwent coronary and carotid pre-contrast CT scan with dual-source CT scanner within 2 weeks. The reconstructed parameters were the same. The calcifications of coronary and carotid arteriae were quantified by calculating the Agatston score. The main risk factors such as age, sex, hypertension, total cholesterol, low-density-lipoprotein cholesterol (LDL), high-density-lipoprotein cholesterol (HDL), diabetes, smoking and coronary heart disease history were recorded. The CACS and carotid calcium scores were comparatively analyzed using Spearman's correlative analysis. The relativity between the risk factors and CACS scores, carotid calcium scores. Results In 162 subjects, there was positive relativity between CACS and carotid cal-cium score(r=0.690, P<0.01). Logistic regression analysis showed that CACS were of relativity with age, diabetes, total cholesterol and LDL cholesterol,otherwise, carotid calcium scores only with age and diabetes. Conclusion There is significant correlation be-tween CACS and carotid calcium score, but their risk factors are not same.

Objective To evaluate the clinical effect of intervertional devascularization and surgical devascularization in treatment of patients with upper gastrointestinal hemorrhage .Methods Ninety-nine cases treated with intervertional devaacularization or surgical devascularization were retrospectively studied including 48 cases in intervertional group and 51 cases in surgical group.The postoperative resection, complications and rebleeding time were compared by X2 test and t test between two methods.Results The 12 months, 24 months and 36 months cumulative rebleeding rates after intervertional devascularization were 12.5% (6/47) ,24.5% (11/45), 27.9% (12/43) respectively.The rate after surgical devaacularization were 29.2% (14/48) ,44.7% (21/47), 48.9% (22/45) respectively.There were statistically significant differences between the intervertional and surgical groups (X2=3.843,4.150,4.083, P < 0.05).The complications of intervertional devascularization included fever 85.4% (41/48), bellyache 81.3% (39/48), portalvein thrombosis 4.2% (2/48), intraabdominal hemorrhage 2.1% (1/48), infection 2.1% (1/48) and death 2.1% (1/48).The complications of surgical devaacularization included fever 68.6% (35/51), bellyache 62.7% (32/51), generous hydroperitoneum 25.5% (13/51), portalvein thrombosis 37.3% (19/51), splenic vein thrombosis 11.8% (6/51), hepatic encephalopathy 3.9% (2/51), hepatorenal syndrome 2.0% (1/51), intraabdominal hemorrhage 2.0% (1/51), death 3.9% (2/51) and infection 15.7% (8/51).There were statistically significant differences of fever, bellyache, generous hydroperitoneum, portalvein thrombosis, splenic vein thrombosis between the intervertional and surgical groups(X2=4.174,3.098,16.199,6.011,5.536,14.085,P <0.05).Conclusions The intervertional devascularization procedure is simple, safe and effective method for treating upper gastrointestinal hemorrhage for portal hypertensive.The clinical effect is better than that of surgical devascularization.

ObjectiveTo investigate the characteristics of spontaneous activities throughout the whole brain with Alzheimer's disease (AD) by resting state functional magnetic resonance imaging ( fMRI ).Methods The subjects included 23 AD patients and 21 normal controls (NC),who underwent a neuropsychological test battery including MMSE and Auditory Verbal Learning Test (AVLT) and restingstate fMRI using GE Signa 3.0 T MR scanner.The neuropsychological scores were compared between two groups.Regional homogeneity (ReHo) method was used to explore the different regional spontaneous activities throughout the brain between normal controls and patients with AD.Results In AD group,clinical variables (MMSE scores:20 ±4,AVLT-Immediate Recall:2.6 ± 1.6,AVLT-Delay Recall:0.4 ±0.7,AVLT-Recognition:5.8 ± 3.7 ) were lower than NC group( 29 ± 1,5.9 ± 1.2,5.5 ± 2.0,9.2 ± 1.1,T =10.58,7.21,10.99,3.96,all P ＜ 0.01 ).With the threshold of P ＜ 0.01 for each voxel and a cluster size of at least 100 voxels,decreased ReHo indexes were found in default mode network (DMN) including the medial prefrontal cortex,posterior cingulate gyrus/precuneus,right superior temporal gyrus and bilateral superior parietal lobule/inferior parietal lobule in AD,while increased ReHo indexes were found in left putamen and thalamus compared with controls.ConclusionThe DMN are damaged in AD and spontaneous activities of putamen and thalamus are reinforced as compensation response of subcortical structures.

Objective To assess the capability of monochromatic energy images of Gemstone spectral imaging(GSI) in reducing artifacts caused by metallic implants. Methods Twelve subjects with metallic implants underwent GSI (Discovery CT750 HD, GE Healthcare, Milwaukee ). The metallic orthopedic implants included 3 patients of dentures, 2 patients of cervical spinal vertebraplasty, one clavicle fracture fixation, one lumbar spinal vertehraplasty, 3 patients of artificial femoral head, one iliac fracture fixation and one tibial fracture fixation. GSI was performed by using a single source ultra-fast dual energy X-ray switching (80 kVp and 140 kVp). Following GSI scanning, thin slice images were reconstructed into 1.25 mm slice thickness. The monochromatic energy images were set to the same window width and level (window width 1500 HU,window level 500 HU). The artifact indexes (AI) at different kiloelectronvolts (keV) images were measured and compared. 3D reconstruction was performed using images with minimal AI. Result The artifacts index on monochromatic energy images varied with the change of keV. Of the images from 12 subjects, the maximal AI ranged between 145-225 at 40 keV, and minimal AI ranged between 15-90 at the 95-140 keV. The artifacts are clearly visible on polychromatic energy images and the artifacts are reduced markedly on the monochromatic energy images with minimal AI. Conclusion The artifacts caused by metallic implants can be reduced significantly by GSI with high keV monochromatic energy images.

Objective To study the functional connectivity (FC) pattern of thalamus in patients with Alzheimer' s disease (AD).Methods In the present study,resting state functional magnetic resonance imaging (MRI) data were obtained from 30 patients with AD and 26 subjects with normal cognition (NC).The altered functional connectivity pattern in AD was evaluated by comparing to NC.Then a correlation analysis was performed between the strength of FC of the identified regions and various clinical variables for evaluating the relationships between the strength of FC and the cognitive abilities (MMSE,immediate recall and delayed recall of Auditory Verbal Learning Test) of the AD patients.Results The MMSE(19.7 ± 4.1),immediate recall (2.8 ± 1.7) and delayed recall (0.7 ± 1.3) of Auditory Verbal Learning Test in AD patients were lower than NC group (28.8 ± 1.0,5.9 ± 1.2,5.7 ± 2.2 ; t =11.09,8.09,10.51,all P ＜0.05).Compared to NC,AD patients showed decreased FC between the left thalamus and several regions of brain including right posterior/middle cingulate cortex (PCC/MCC.R),left medial prefrontal cortex (MPFC.L) and right superior frontal gyms/medial prefrontal cortex (SFG/MPFC.R).For the right thalamus,decreased FC was found in SFG/MPFC.R,PCC/MCC.R and right hippocampus.We also found increased FC between the bilateral thalamus and many regions of brain including inferior temporal gyrus,medial temporal gyrus,SFG,postcentral gyrus,paracentral lobule,inferior frontal gyms and insula.Significant correlations between the fitted FC strength and clinical variables were also detected.Conclusions FC pattern of thalamus in AD group is impaired.Increased FC in AD may indicate the presence of a compensatory mechanism.The alteration is related with cognitive function in AD.

Objective To study the expression of adhesion molecule glycoprotein(CD_(44)) in children with primary nephrotic syndrome(NS) and its clinical significance.Methods The expression of CD_(44) in peripheral blood was detected in 28 children with NS by flow cytometry,controlled by 20 cases of healthy children.Results The CD_(44) expression level of NS in active stage was significantly higher than that of the control(P

Objective To evaluate the value of interventional embolism therapy for metastatic carcinoma of adrenal gland.Methods Fifty four patients with metastatic carcinoma of adrenal gland were treated with interventional catheterization perfusion and embolism therapy.Results Except one case with failure of finding the feeding artery, totally 76 sessions of interventional therapy were performed on 53 patients. Technical successful rate was 98.1% with 100% of complete release of clinical sign in 14 patients. Good deposition of iodized oil in tumor area reached 75.4% in three months after the procedure. Severe complication rate ocurred in 1.88%. Conclusion Interventional therapy seemed to be safe and effective for patients with metastatic carcinoma of adrenal gland.

Objective To investigate the incidence and influencing factors of postoperative infection in patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods A retrospective study was conducted on the HCC patients who received TACE during the period from January 2016 to December 2016. The possible risk factors that might induce postoperative infection after TACE were evaluated by using univariate analysis and multivariate logistic regression analysis. The risk factors were further stratified into very high risk factors, high risk factors, moderate risk factors and low risk factors. Results Among 386 HCC patients who showed effective response to TACE, postoperative infection occurred in 17 patients, the incidence rate was 4.4％. Ascites, history of hepatobiliary resection surgery or preoperative liver cancer rupture with bleeding, history of liver abscess or previous postoperative infection after TACE were the very high risk factors of infection after TACE. Preoperative serum total protein value <60 g/L was a high risk factor. The presence of tumor thrombus in portal vein or in vena cava was a moderate risk factor. Conclusion Ascites, previous hepatobiliary surgery, preoperative liver cancer rupture with bleeding, history of liver abscess and history of infection after TACE are significantly correlated with the occurrence of infection after TACE.