Objective To investigate the 16-slice spiral CT perfusion imaging features of liver cirrhosis.Methods CT perfusion imaging of liver was performed in 37 participants, including 25 patients with liver cirrhosis and 12 healthy adults as control group.The hepatic blood flow parameters were obtained and compared with Child classifications.Results As comparing to control group,blood flow(BF),blood volume(BV)decreased,and hepatic arterial fraction(HAF) increased gradually,but mean transit time(MTT) changed little with cirrhosis from Child A to C.Conclusion CT perfusion imaging is valuable in evaluating and grading liver cirrhosis early.

ObjectiveTo observe the dynamic change of mtDNA in rats with lung ischemiareperfusion (IR) injury and the implications.MethodsThe rat model of lung IR injury was made.Thirty-two male SD rats were divided into IR group and control group.Each group was sub-divided into two subgroups.Thirty and 60 min after reperfusion,8 rats of each group were sacrificed; left lungs and whole blood were collected.Histopathological study of lung tissues were performed; wet weight/dry (W/D) weight ratio of the lung was detected; DNA was extracted from whole blood,and mtDNA level in circulation was detected by using real-time PCR; the protein levels of MMP-9 and MCP-1were examined by ELISA.Results(1) As compared with control group,the edema and PMN emigration were more serious in IR group; besides,the W/D ratio was increased progressively in IR groups as compared with control groups respectively (P＜0.01); (2) As compared with control group,the mtDNA in circulation was significantly increased 30 min after reperfusion (P＜0.01),and the same trend was detected 60 min after reperfusion (P＜0.01):(3) There was no significant difference between the two groups in the content of MMP-9 and MCP-1in the lungs 30 min after reperfusion (P＞0.05),but the MMP-9 and MCP-1expression levels were increased 60 min after reperfusion (P＜0.01).ConclusionThe mtDNA expression in circulation was increased in the early stage of lung IR,and the increased expression of mtDNA was earlier than the up-regulation of MMP-9 and MCP-1.Our results indicated that mtDNA may aggravate lung injury through increasing MMP-9 and MCP-1in the lung IR.

Objective To explore the epidemiology,etiology and prevention strategy of early respiratory infections (≤1 month) in lung transplantation recipients with donation after cardiac death donors.Method The clinical data of donors and recipients,particularly on early respiratory infections,were retrospectively analyzed in 17 lung transplantations.Result From Jan.2015 to Apr.2015,12 episodes of early respiratory infections (≤ 1 month) in 17 lung transplantation recipients occurred (12/17,70.6％).The organisms most frequently involved were bacteria:Pseudomonas aeruginosa (4/26,15.4％),Klebsiella pneumoniae (4/26,15.4％),Staphylococcus aureus (3/26,11.5％),and Acinetobacter baumannii (3/26,11.5％).Of 26 bacterial strains,3 were Methecillin resistant Staphlococcus aureus,3 were carbapenem resistant Acinetobacter baumanni,2 were carbapenem resistant Pseudomonas cepacia,2 were extended spectrum b-lactamase-producing Klebsiella pneumoniae,and one was carbapenem and quinolone resistant Pseudomonas aeruginosa.Conclusion The morbidity of early infections is high in lung transplantation recipients.In our experience,bacterial respiratory infections are most common in the early post-transplant period (≤ 1 month).Incidence of Aspergillus spp.and Cytomegalovirus pneumonia is lower than before lung transplantation,probably due to the spread of universal prophylaxis.

ObjectiveTo investigate the treatment effects of comprehensive nursing intervention on patients with chronic obstructive pulmonary disease(COPD) treated by non-invasive mechanical ventilation with BiPAP mode.Methods96 patients with diagnosed COPD and using non-invasive mechanical ven- tilation with BiPAP mode were randomly divided into the control group(46 cases) which was treated with routine measures and the comprehensive nursing intervention group (50 cases) which adopted comprehen- sive nursing intervention according to experimental design. The frightening degree, incidence rate of com- plications and clinical treatment effect by ventilator were compared between the two groups.ResultsPa- tients compliance with treatment and clinical treatment effect by ventilator in the comprehensive nursing in- tervention group was better than that of the control group. The frightening degree and incidence rate ofcomplications were lower than those of the control group (P < 0.01 ).ConclusionsComprehensive nurs-ing intervention with non-invasive mechanical ventilation with BiPAP mode can improve the treatmentcompliance of COPD patients,reduce complications followed by non-invasive mechanical ventilation andreach the prospective treatment effect.

BACKGROUND: Anterior cervical decompression and fusion has been widely used in the treatment of multi-level cervical spondylotic myelopathy, but accompanied with lots of complications.OBJECTIVE: To investigate the efficacy of zero-profile interboby fixation system for multi-level cervical spondylotic myelopathy.METHODS: Seventy-one patients with multi-level cervical spondylotic myelopathy were randomly divided into two groups, and the patients in group A accepted zero-profile interboby fixation system, and group B accepted cage interboby fixation system. The Japanese Orthopaedic Association score, fusion rate, as well as the incidence of dysphagia and esophageal fistula were detected to compare the efficacy between two groups.RESULTS AND CONCLUSION: (1) All cases were followed-up for 3-34 months, average of 17.5 months. The excellent and good rate at the last follow-up showed no significant difference between two groups. (2) The final fusion rate did not differ significantly between two groups, but the fusion rate in the group A was significantly higher than that in the group B at 6 and 9 months postoperatively (P < 0.05). (3) There was one patient with mild dysphagia in the group A (3％), three mild, five medium, and two severe dysphagia in the group B (29％), which showed significant difference between two groups (P < 0.05). No internal fixation loosening occurred in the group A, but three cases in the group B. The blood loss, operation time and radiology times in the group A were significantly lower than those in the group B (P < 0.05). (4) These results suggest that the effect of these two surgical methods in promoting functional recovery of spinal cord and final fusion rate show no significant differences; however, the zero-profile interboby fixation system exhibits better postoperative stability and interim fusion rate, with lower incidence of dysphagia.

Objective To explore the efficacy and safety of conversion from calcineurin inhibitor (CNI) to sirolimus (SRL) as major immunosuppressive therapy in lung transplant recipients.Method Retrospective analyses were conducted for the clinical data of all the patients undergoing lung transplantation in Wuxi People's Hospital between January 2011 and December 2014.Sixteen were given conversion treatment with Sirolimus in the postoperative irnmunosuppressive therapy.We analyzed the opportunity and reasons in the conversion treatment,and the safety,effectiveness and complications of the conversion treatment.Result The follow-up period was 8 to 25 months,and the median time of conversion was 6 months after operation (2-18 months).The indications of conversion concluded:malignant tumor (n =8),renal dysfunction (n =5),lymphangioleiomyomatosis (n =1) and intractable diarrhea caused by CNIs (n =2).Four cases suffered from interstitial pneumonitis associated with Sirolimus and one case suffered from spontaneous pneumothorax,and they all conversed back to CNIs.In those patients,cancer recurrence occurred in 4 cases (of them,there were 3 deaths),and 3 patients developed chronic rejection.Those recipients receiving the conversion treatment due to renal dysfunction showed recovery of renal function to some extent.Conclusion It's effective and safe to converse the immunosuppressive therapy based on Sirolimus.Sirolimus should be reduced or withdrawn when interstitial pneumonitis associated with Sirolimus occurred.

Objective To study the finding and patterns of chronic inflammatory sinonasal disease on CT. Methods All of 93 patients with chronic inflammatory sinonasal disease by clinical observations and operation,the appearances and patterns of chronic inflammatory sinonasal disease were analyszed.Results Six radiological patterns of inflammatory sinonasal disease were identified:( 1) infundibular,16/93 or 17%;( 2) osteaomeatal unit,27/93 or 28% ; (3) sphenoethmoidal recess,5/93 or 6%;(4) sinonasal polyposis,17/93 or 18%;(5) sporadic ( unclassifiabal ) ,13/93 or 14%;(6) mixing pattern,15/93 or 16% .Conclusion Assignment of patients to radiological patterns allows tailored endoscopic sinonasal surgical approach.

Objective:To investigate the application value of real-time ultrasound elastography in the treatment of fibroids radiofrequency ablation (RFA).Methods:Transvaginal ultrasonography,Real-time ultrasound elastography (RTE) and contrast-enhanced ultrasonography (CEUS) were performed on 34 patients with a total of 38 uterine fibroids who had the treatment of RFA before,1 hour and 3 months after the treatment of RFA.Detected the diameters of the lesions with the three methods of CEUS,RTE and 2D.Analysed the elastic image features and divided into groups,Measured the elastic strain ratio and compared the E/E0 in and between the group.The difference of lesion diameter between 2D,RTE and CEUS was compared.When the image of lesions showed blue and green was taken as the cirterion of incomplete ablation after RFA,conpared with CEUS,analysed the consistency of RTE and CEUS in evaluating the degree of ablation.Results:The lesions were divided into 3 groups according to the preoperative elastic image,with 8 (21.1％) in the blue group,20 (52.6％) in blue-based and 10 (26.3％) in green-based group.The difference was obvious in E/E0 between the 3 groups before RFA.There was no significant difference in E/E0 between 1 hour and 3 months after RFA (P ＞ 0.05).In each group the E/E0 of lesions were significantly increased at 1 hour and 3 months after the treatment of FRA,and the hardness of 3 months after RFA was harder than that of 1 hour after RFA(P＜0.05).The diameter measured by RTE was larger than that by 2D and CEUS before RFA(P＞0.05).The diameter measured by 2D was larger than that by RTE and CEUS at 1 hour after RFA (P＜0.05).No statistically significant difference was found in the lesion diameters among the three methods of2D,RTE and CEUS at 3 months after the treatment ofRFA (P＞0.05).CEUS and RTE had the basic consistent in the evaluation of lesions ablation degree at 1 hour (kappa=0.46) and 3 months (kappa=0.54) after the treatment of RFA.Conclusions:After RFA,the myoma gradually hardens,and RTE can reflect the change of the hardness,RTE can clearly show the boundary of uterine ftbroids especially after the treatment of RFA,can be used in the prediction of lesions ablation degree,so there was a certain application value of RTE used in RFA.

OBJECTIVE: To observe the gasification of the maxillary sinus which might affect the vision of the maxillary sinus surgery with endoscope. METHOD: The diameters of 2 000 maxillary sinus were observed and measured hy normal sinus CT scan. The maxillary sinus were then genotyped with the data. RESULT: Morphology of the medial wall of maxillary sinus played an important role in maxillary sinus surgery. According to the horizontal position CT data, the middle part of maxillary sinus medial wall included two shapes: 857 triangle (85.7%) and 143 semicircular (14.3%). According to the coronal CT data, the middle part of maxillary sinus medial wall varied a lot, there were also two shapes of them: 341 convex type (31.1%) and 659 straight type (65.9%). In contrast, the former and back parts varied a little. Therefore, we genotyped the maxillary sinus according to the morphology of maxillary sinus medial wall and the gasification level. There were 3 types of our genotyping: 662 of I type (66.2%), 265 of II type (26.5%), 73 of III type (7.3%). CONCLUSION The medial wall of maxillary sinus should be considered before the surgery of nasal endoscopy because of the great affections of which to endoscopy version.
Adolescent ; Adult ; Aged ; Endoscopy ; Female ; Humans ; Male ; Maxillary Sinus ; anatomy & histology ; surgery ; Middle Aged ; Paranasal Sinuses ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult

Objective To summarize the clinical experience of harvesting and using the lungs of cardiac death donor.Methods The lungs from donation after cardiac death (DCD) were harvested and used for lung transplantation.The donors suffered from severe craniocerebral trauma or brain neoplasms and were identified after cardiac death post declaration of brain death.Written consent about DCD was obtained from the consanguinities.The donor lungs were harvested after clinical evaluation of donors with considerable function and after the determination of DCD.The preoperative lymphocytotoxic cross match test was negative,ABO blood type was compatible,and the donors were all suitable for the transplant procedure.Results Two bilateral lung transplantations and one single lung transplantation were performed,with the warm ischemic time being 23,27,and 32 min,respectively.The operative course was uneventful The ICU stay was 31,18,and 26 days respectively,with dramatic improvement of pulmonary function postoperatively.Acute rejection occurred in two cases,which was treated with bolus of corticoids.There were no infection in our 3 patients,and the life quality was satisfactory during the follow-up period.Conclusion The lung from DCD may be one of the available resources used for lung transplantation on the basis of efficient management of the potential donors and clear evaluation of the donors.