Objective To evaluate the value in following up the patients with clipped aneurysms with the subtraction CT angiography technique.Methods 30 consecutive patients with clipped aneurysms were followed up with 64-slice spiral CT angiography (CTA) and DS angiography 10 d later postoperatively.CT images were reconstructed with volume rendering (VR) and maximum intensity projection(MIP) techniques to display the vessels.The site of the clip and patency of the parent vessel on both CT and DSA were studies independently by two radiologists.Results The clips in 27 patients were showed clearly by the subtraction CTA.Subtraction CTA demonstrated a partial remnant of aneurysm in 2,28 cases were complete occlusion.The loading vessels were free in passing in 28 cases,occlusion and narrowing of a parent vessel were seen in one respectively.The sensitivity and specificity in detecting neck remnants on MSCT angiography were 67% and 100%,and the sensitivity and specificity in evaluating vessel patency were 100% and 100%,Inter-observer agreements were 0.78 and 1.00,respectively.Conclusion Subtraction CT angiography can be used as the mainly method in following up the patients with clipped aneurysms.

Objective To evaluate the value of MSCT scores on surgery method selection and its difficulty estimation for hepatic cystic echinococcosis. Methods Based on the CT features of hepatic cystic echinococcosis ( HCE), an integral system including 7 items wasestablished. Images of preoperative CT examination performed on 71 cases of hepatic cystic echnococcosis were retrospectively analyzed by the integral system and compared with actual surgical. Total 93 cystic lesions were divided into 3 groups based on CT scores: Group A suitable for total cystectom (0 to 5 score), Group B suitable for subtotal cystectom (6 to 10 score), and Group C suitable forendocystectomy ( ≥11 scores, or4 score in one item). Spearman rank correlation was used to analyze the relationship between WHO classification of cystic echinococcosis and actual surgery methods, the relationship between operation mode forecasted by CT scores and actual surgery methods, the relationship between vessel scores of cyst and actual surgery methods, and that between biliary score of cyst and actual surgery methods. Fisher exact test and Chi-square test were used to evaluate the incidence of residual cavity in patients with different biliary scores. Results Thirty nine cysts got 0 to 5 scores, 45 cysts got 6 to 10 scores and 9 cysts got more than 10 scores. Total cystectom was performed on 30 cysts, subtotal cystectomy on 40 cysts and performed endocystectomy on 23 cysts, actually. Actual operation methods were correlated with that predicated by CT scores ( r = 0. 741, P ＜ 0. 01 ), and with vessels score and biliary score (r = 0. 587,0. 327 respectively,P ＜ 0. 01 ). The higher the biliary score, the higher the incidence of postoperative biliary tract complications. Conclusions Preoperative CT scoring was an easy and objective way to accurately predict the surgery methods and its difficulty for hepatic cystic cnechnococosis.

Objective To investigate the effects and underlying mechanism of the scavenger receptor CD36 in high glucose-induced rat glomerular mesangial cells apoptosis.Methods The mesangial cells of rats were divided into 4 groups:control group (5.6 mmol/L glucose),mannitol group (24.2 mmol/L mannitol+5.6 mmo]/L glucose),high glucose group (30 mmol/L glucose),CD36 monoantibody group (30 mmol/L glucose+CD36 mono-antibody).The intracellular ROS level was detected by confocal microscopy with fluorescent probe CM-H2DCFDA.MDA,GSH-PX,8-OHDGA in cell supernatant were detected.Apoptosis was determined by flow cytometry followed by Annexin V-FITC/PI double stains.The expression of CD36,Bax and Bcl-2 were detected by RT-PCR and Western blotting.Results The expression of CD36 was detected in glomerular mesangial cells.The highest level was found in high glucose group in 24 hours.There was no significant difference found between control group and mannitol group with respect to intracellular ROS generation,MDA,8-OHDG,GSH-PX level,apoptosis rate,expression of CD36,Bax and Bcl-2 (all P ＞ 0.05).There was no significant difference in the expression of CD36 between CD36 mono-antibody group and high glucose group (P ＞ 0.05).Compared to control group,the intracellular ROS generation,MDA and 8-OHDG levels,apoptosis rate,the expression of CD36 and Bax were significantly increased,the GSH-PX level and the expression of Bcl-2 were significantly lower in high glucose group (all P ＜ 0.05).Compared to the high glucose group,the intracellular ROS generation,MDA and 8-OHDG levels,apoptosis rate,the expression of Bax were suppressed but the GSH-PX level and the expression of Bcl-2 increased in CD36 mono-antibody group (all P ＜ 0.05).The intracellular ROS level was positively correlated with apoptosis rate,protein expression of CD36 and Bax gene,was negatively correlated with Bcl-2 protein expression.Conclusions CD36 was involved in the high glucose induced apoptosis of mesangial cells which was potentially mediated by an increased level of oxidative stress.

Objective To investigate the effects of propofol on the changes in myocardial Toll-like receptor 4 (TLR-4)and TNF-αand NF-κb protein expressions in ischemia-reperfusion injury (I/R).Methods Thirty healthy male SD rats weighing 250-320 g were randomly divided into 3 groups (n=10 for each):Group A,sham operation;Group B,I/R;and Group C,propofol + I/R.In Groups B and C myocardial I/R was induced by occlusion of the left anterior descending artery (LAD)for 30 min,followed by 120 min reperfusion.In Group C propofol was given intravenously 1 0 min before myocardial ischemia,followed by continuous infusion of propofol at 5 mg/(kg·h)until the end of 120 min reperfusion.In Groups A and B normal saline instead of propofol was given. The myocardial tissues were taken at the end of 120 min;ultrastructural changes of myocardial cells were observed under X-ray electron microscope and the expressions of TLR-4 mRNA as well as TNF-αand NF-κb protein were determined.Results Ultrastructural observation under electron microscope showed significantly worsened damage in myocardial tissue structure and mitochondria in Groups B and C compared with Group A.The myocardial expressions of TLR-4 and TNF-αand NF-κb protein were significantly higher in Groups B and C than in control Group A.The myocardial expressions of TLR-4 and TNF-αand NF-κb protein were down-regulated in Group C compared with Group B.Conclusion Intravenous injection of propofol can protect against myocardial damage.Propofol can suppress the increase in myocardial TLR-4 and TNF-αand NF-κb protein expressions induced by I/R.

Accidents, Occupational ; Humans ; Work Schedule Tolerance

Objective To evaluate the feasibility of dual energy spectral CT with 270 mg/ml iodixanol in coronary CT angiography (CCTA).Methods A total of 60 patients with suspected coronary heart disease underwent CCTA.They were randomly divided into 3 groups.Prospectively ECG gated CCTA with 120 kVp were performed on the controlgroup (Group A,n=20).In group B (n=20) and group C (n=20),gemstone spectral imaging(GSI) technique were used and monochromatic images from 60 to 80 keV with increment of 5 keV were obtained to divide into 5 subgroups(B1-B5,C1-C5).Group A and group B used the same contrast medium (iodixanol 350 mg/ml) while Group C used low concentration contrast medium (iodixanol 270 mg/ml).One-way ANOVA analysis was used to compare objective evaluation indices (CT values,image noise,signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the left main coronary artery,proximal segment of left anterior descending branch,proximal segment of left circumflex branch and proximal segment of right coronary artery) of group A and B1-B5.Statistical t-test was performed between group A and C2(with optimal keV).Results CNR of the group B1-B5[(21.2± 3.4),(21.5 ±4.0),(21.5 ±4.0),(21.8 ±4.2),(20.7 ± 3.5)]were increased significantly than group A(16.6± 3.8).No significant differences were found among groups B 1-B4 (P＞0.05).Compared withgroup A,group B2 showed higher CT values of the vessels [(481.4±43.2),(466.7±69.3),(434.1±48.8),(436.3±42.5),(427.4±48.6)HU] and decreased image noise[(28.2±7.3)HU versus (31.1±9.9) HU,P＜0.01].The optimal keV was 65 keV.Compared with group A,group C2 showed no significant differences in CT values[(396.3± 76.3),(390.4 ± 74.4),(359.5±83.1),(358.3±67.7),(365.4±68.2)HU)],image noise[(29.1±5.6)HU],SNR(14.6±4.2) and CNR [(18.4±4.8),t=-1.29-1.40,P＞ 0.05].Conclusion Dual-energy spectral CT with monochromatic reconstruction at 65 keV can provide same good image quality as the routine method while reduce iodine concentration to 270 mg/ml.

Objective To study the value of CT scan in diagnosis and clinical therapy of thyroid diseases.Methods CT findings in 61 cases with various thyroid diseases confirmed pathologically were analyzed retrospectively.Results ① 9 patients were Hashimoto’s thyroiditis.Of them,5 cases were diffuse lesions and 4 localized at one enlarged lobe and 1 with calcification.② 28 cases with hyperplasia included 2 Graves disease of diffuse lesions with enlargement and 26 nodular hyperplasia.There were calcification in 8 and cystic change in 13.③ 24 cases of thyroid tumor included 14 thyroid adenomas with complete circumscribed enhanced ring around the lesion,10 of them were in company with cystic change and 4 with calcification.13 cases were single lesion and one case was mattiple lesions.10 thyroid carcinoma,3 cases were in company with cystic change and 7 with calcification.Metastasis of cervical lymph nodus was found by CT in 7 cases.Metastatic lymph nodes presented marked enhancement,cystic change and calcification.Conclusion CT scan both plain and contrast-enhanced are beneficial for the detection of thyroid diseases,and is also important for planning the management and predicting the prognosis of this disease.

Objective To investigate the effects of intervention of information literacy education on the feeling of uncertainty of patients with percutaneous coronary intervention.Methods A total of 228 cases of patients with percutaneous coronary intervention who were hospitalized during July 2010 to June 2012 were selected.The patients were divided into two groups by means of random numbers table:the experimental group (including 119 cases) and the control group (including 109 cases).The patients of the control group received traditional nursing intervention,while the patients of the experimental group received additional information literacy education intervention besides the traditional nursing.The change of feeling of uncertainty and state anxiety level of patients under two kinds of nursing interventions was analyzed and compared.Results The patients of the experimental group had high uncertainty level on the day of admission,(99.17-4.46) points.It was obviously higher than the total score (80) by 50％.Compared with that on the day of admission,the uncertainty level on the night before surgery and on the day of patient discharge significantly declined.The state anxiety level of the patients of the experimental group was (52.97±5.91) points,higher than the normative level of Chinese normal people.Compared with that on the day of admission,the state anxiety level on the night before surgery and on the day of patient discharge significantly declined,and it was lower than the normative level.Compared with those of the control group,the MUIS and SAI assessment of the experimental group on the night before surgery and the day of patient discharge obviously declined.Conclusions The information literacy education intervention was able to reduce the uncertainty level and state anxiety level of patients with percutaneous coronary intervention.Therefore,the nursing quality of patients was enhanced.

Purpose To analyze the correlation of pulmonary artery obstruction index (PAOI) and the cardiovascular parameters in patients with massive pulmonary embolism (MPE), and to explore the CT pulmonary angiography (CTPA) significant in radiological massive pulmonary embolism. Materials and Methods Sixty-two patients with massive pulmonary embolism confirmed by CTPA were divided into two groups according to the severity with 17 cases in high-risk group and 45 cases in non-risk group. The correlation between pulmonary artery obstruction index and cardiovascular parameters of all subjects was analyzed. Parameters in the two groups were compared including PAOI, ratio of main pulmonary artery diameter (MPAd) to the ascending main artery diameter (AAd) named rPA, and ratio of right ventricular diameter (RVd) to the left ventricular diameter (LVd) named RVd/LVd. Results Pulmonary artery obstruction index had positive correlation with the cardiovascular parameters (r=0.504, 0.543, 0.629 and 0.657, P<0.05), but negative correlation with LVd (r=-0.500, P<0.05). PAOI, MPAd, rPA, RVd/LVd and RVd were higher in the high-risk group than those in the non-high-risk group (P<0.05). LVd was lower in the high-risk group than that in the non-high-risk group (P<0.05). Conclusion CTPA can not only effectively diagnose pulmonary embolism but also assess the severity of the radiologic massive pulmonary embolism, which contributes to the clinical prognosis and treatment options.

Objective To evaluate the impact of respiratory motion on lung dosimetry using 4D-CT during lung cancer radiotherapy.Methods Ten cases were randomly selected from non-small cell lung cancer (NSCLC) patients treated in our department.The 4D-CT machine was adopted for simulation before treatment and 10 respiratory phases were obtained for each patient.Target volumes were delineated on the maximum intensity projection (MIP) images,and plans were generated on average intensity projection (ALP) images.Plans were transferred to CT images of each respiratory phase,and we calculated the dosage on lungs and subsequently evaluated the volume dosage to lungs and the entire body.Results The mean dosage to lungs are greatly affected by the respiratory phase.This difference also depended on tumor location.When it was inside the lung,the average dosage shows the same trend as the respiratory motion,with the change rate of 2.18％,which was less than the change of lung volume 4.49％ (t =4.189,P ＜ 0.05).When the tumor was located nearby the lung,the mean dosage showed the opposite trend with respiratory motion,with the change rate of 3.76％,which was also less than the change of lung volume 4.49％ (t =25.007,P ＜ 0.05).The effect of respiratory motion on V5,V10,V20 of body was small,and the magnitude of change for whole body dosages were 0.47％,0.28％,0.17％ respectively,which was smaller than the change of lung volume 4.49％ (t =11.371,11.188,11.377,P ＜ 0.05).Volume dose of lung V5,V10,V20 and lung volume change trends were the same,and the magnitude of change for lung volume dosages were 2.39％,1.91％,1.80％ respectively,and were smaller than the change of lung volume 4.49％ (t =2.279,2.298,2.485,P ＜ 0.05).Conclusions The mean dosage to lungs shows a great difference between different respiratory phases.More attention should be paid when evaluating the lung volume during treatment planning.