0.05). Conclusion Treadmill running with low load for 1 week can enhance neurogenesis in the dentate gyrus of young SD rats.

Objective To assess the effects of image fusion of CT spectral monochromatic imaging on image quality in small hepatocellular carcinoma (HCC).Methods Thirty patients with 40 pathologically proven small HCCs (≤3 cm) underwent upper abdominal plain CT and dual-phase enhanced spectral CT scan were analyzed retrospectively.Conventional 140 kVp polychromatic images (group A) and monochromatic images with energy levels from 40 to 140 keV were reconstructed by using spectral imaging viewer.Monochromatic images with highest CNR (group B)and 70 keV images with lowest noise (group C) were fused to generate fused images (group D) with image fusion software.Objective evaluation of 40 HCCs [contrast-to-noise ratio (CNR) of lesion,image noise in HU] and subjective rating score of 30 patients (image noise score,overall image quality score,and lesion conspicuity score) among the four groups were compared by using One-way ANOVA and Kruskal-Wallis H test.Results CNR (1.3±0.6,2.1±0.6,1.5±0.6 and 2.4± 1.3 respectively) and image noise [(20±7),(32±9),(18±3) and (24±6) HU respectively] among group A,B,C and D all had statistical differences (F =5.724 and 13.619,both P values ＜ 0.01).CNR in group D was higher as compared with group A and C (both P values ＜ 0.05),but was similar to group B (P ＞ 0.05).Image noise in group D was lower than group B and higher than group C,but showed no difference from group A (all P values ＞ 0.05).Image noise scores [(3.5±0.5),(3.3±0.4),(3.6±0.5)and(3.5±0.4)point,respectively],overall image quality scores [(3.2 ± 0.4),(3.3 ± 0.3),(3.1 ± 0.3) and (3.7 ± 0.4) point respectively] and lesion conspicuity scores [(3.3 ±0.4),(3.9±0.4),(3.2±0.4) and (3.7 ±0.4) point,respectively] among the four groups all had statistical differences (Z =9.581,37.495 and 43.436,all P values ＜ 0.05).Scores of the four groups were all greater than 3 and met the clinical diagnostic level.Group D was higher than group B in image noise score,higher than the other three groups in overall image quality score,higher than group A in lesion conspicuity score (all P values ＜ 0.05).Conclusion Combined use of CT spectral monochromatic imaging and image fusion can improve overall image quality while maintaining or increasing CNR in small HCC.

Objective To investigate the effects of α_2-adrenergic receptor agonist and k-opioid receptor agonist jointly used on hemodynamics and B-type natriuretic peptide in rabbits,and to explore the effective methods for lessensing post-resuscitation myocardial dysfunction.Method After the establishment of cardiopulmonary resuscitation (CPR) model in rabbits, 30 rabbits were randomly divided into 5 groups, namely epinephrine group(E), vasopressin group(V), U50488H group(U), mivazerol group(M) and mivazerol + U50488H group(M + U). Hemodynamics and B-type natriuretic peptide were examined before ventricular fibrillation and in the early stage of post CPR (30-240 min). Statistical analysis was performed with ANOVA techniques. Results (1)MAP,peak - dp/dt and peak + dp/dt in M + U group were significantly higher than those in other groups, and the increase of LVEDP was less than that in other groups (P<0.05).(2)The concentration of BNP in M + U group was significantly decreased than that in other groups (P <0.01 or P <0.05). Conclusions The α_2-adrenergic receptor agonist (mivazerol) and k-opioid receptor agonist used together can improve post CPR hemodynamics and reduce the concentration of B-type natriuretic peptide, lessening the post CPR myocardial dysfunction.

Objective To evaluate the CT spectral imaging in assessing the therapeutic efficacy of axitinib in rabbit VX2 liver tumors. Methods Thirty-two VX2 liver tumor-bearing rabbits (diameter 1.0 to 2.5 cm) were prospectively and randomly assigned into the study group (axitinib treated group, n=16) or the control group (pseudo-therapy group, n=16). They were treated with axitinib or saline by using the gastric tube respectively. All the rabbits underwent unenhanced, arterial-phase (AP) and portal-phase (PP) contrast enhanced CT examinations by using spectral CT at different time points (baseline, 2, 4, 7, 10 and 14 days after treatment). Tumor size (TS) at each time point was recorded to calculate the percentage change (ΔTS)after treatment relative to baseline. Iodine concentration (IC) of the entire tumor, the peripheral hypervascular region and the center of the tumor were measured and normalized to aorta (NIC) to generate the difference for the NIC (NICD) between a given time and baseline. The tumorΔTS and NICD between the control and treated groups were compared by using Mann-Whitney U test. Serial changes in NICD at different time points were evaluated by using Wilcoxon signed rank test. Correlations between the NICD andΔTS, between NIC and microvessel density (MVD) were analyzed. Results The tumorΔTS after treatment in the control group and study group increased continuously. The tumorΔTS was significantly smaller in the treated group than that in the control group at day 7, 10 and 14. At day 2 , 4 and 10 after treatment, each tumor NICD in the study group was smaller compared with the control group(P<0.05)except the NICD in the entire tumor and the center of the tumor in AP at day 4 , in the entire tumor in PP and the peripheral hypervascular region of the tumor in AP at day 10; no significant differences were found between the two groups at day 7 and day 14 except the NICD in the entire tumor in PP. The tumor ΔTS at day 14 after treatment was (41.44 ± 5.48) %. The tumor NICD in the entire tumor at day 2 in the two phases and the peripheral hypervascular region of the tumor in AP were positively correlated with ΔTS at day 14 (r=0.692, 0.521 and 0.639, P=0.002, 0.032 and 0.005, respectively). The tumor NICD in the peripheral hypervascular region of the tumor in AP were positively correlated with ΔTS at day 14(r=0.673,P=0.003). The tumor NIC values in the entire tumor, peripheral hypervascular region and the center of the tumor in the two phases at day 7 and day 14 had positive correlations with MVD (r=-0.69 to 0.72, all P values<0.05) except the NICD in the center of the tumor in PP (P>0.05).Conclusion CT spectral imaging allows the evaluation and early prediction of tumor response to axitinib in rabbit VX2 liver tumors.

Objective To explore the effect of puncture the left or right branch of portal vein on the incidence of postoperative hepatic encephalopathy in transjugular intrahepatic portosystemic shunt (TIPS). Methods A literature search was conducted through investigating PubMed, Cochrane Library, CNKI digital library and Wanfang databases. Randomized controlled trials and cohort studies related to the effect of puncture the left or right branch of portal vein on the incidence of postoperative hepatic encephalopathy in TIPS were included in this review. According to the methods for Cochrane systematic review, the data were extracted, the quality of the literatures was evaluated, statistical analysis was conducted and the data were analyzed with RevMan 5.0. Results One randomized controlled trial and four cohort studies, including 552 patients with liver cirrhosis received TIPS, were finally included in this review. Random-effects model meta-analysis showed that puncture of the left branch of portal vein in TIPS caused lower incidence of postoperative hepatic encephalopathy than puncture of the right branch of portal vein (RR=0.51, 95%CI was 0.39 to 0.66, P<0.01). Conclusion Puncture of the left branch of portal vein in TIPS can significantly reduce the incidence of postoperative hepatic encephalopathy in comparison with puncture of the right branch of portal vein.

Objective To investigate the impact of automatic tube voltage selection ( ATVS) and sinogram-affirmed iterative reconstruction ( SAFIRE) on image quality and radiation dose in the arterial phase (AP) and portal venous phase (PVP) abdominal dual-source CT imaging.Methods Abdomen contrast-enhanced computed tomography ( CECTs ) in 70 patients were scanned with dual-source CT.Patients were divided into study group and control group based on the scanning date.In the first 35 patients ( study group) , ATVS mode was applied; in the second 35 patients ( control group ) , the conventional fixed at 120 kVp mode was used.The imaging of the study group was reconstructed with FBP ( protocol A ) or SAFIRE ( protocol B ) respectively; the imaging of the control group was reconstructed with FBP ( protocol C).Image quality scores of the 3 protocols were assessed and compared with Rank-sum test.Analysis of variance was used to compare mean signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image noise among the 3 protocols.Two sample t tests were used to compare the radiation dose difference.Results The effective radiation dose in the study group ( 3.9 ±0.4 ) mSv was much lower than that in the control group (4.9 ±0.4) mSv, dropped by 20.41% (t =2.315, P=0.021).The subjective rating scores in protocol A, B, C in arterial were (3.65 ±0.08), (4.41 ±0.10) and (3.79 ±0.10) point, while the subjective rating scores in venous phase were (3.57 ±0.08), (4.41 ±0.10) and (3.95 ±0.11) point.The differences were statistically significant (Z value were 27.587 and 27.436, P<0.01).The image noise of protocol A , B, C in dual-phase were ( 11.96 ±0.33 ) , ( 8.45 ±0.26 ) , ( 10.38 ±0.26 ) HU and (12.79 ±0.39),(9.14 ±0.36), (11.13 ±0.18) HU.The differences were statistically significant (F value were 39.235 and 29.846, P<0.01).Compared to protocol A and C, SNR and CNR in protocol B were much higher (P<0.01).No statistically significant differences were shown between protocol A and C in SNR and CNR ( P>0.05).Conclusion Use of ATVS and SAFIRE could reduce the radiation dose and provide better quality images compared with conventional abdominal CECT and FBP .

Objective The purpose of this study was to evaluate the effect of patient’s body mass index on applications of auto-matic tube voltage selection (ATVS)for contrast-enhanced abdominal CT.Methods 1 60 patients underwent contrast-enhanced ab-dominal CT scan were assigned into the study group (ATVS technique)and the control group (120 kVp)with equal size (both n =80)according to the scanning mode.The two groups were both divided into four subgroups according to BMI (A:BMI <18.5 kg/m2 ;B:BMI 18.5~23.9 kg/m2 ;C:BMI 24~28.9 kg/m2 ;D:BMI ≥29 kg/m2 ).Image quality were assessed and compared with Rank-sum test.Analysis of variance was used to compare differences in mean contrast-to-noise ratio (CNR)and image noise a-mong the two groups.Two sample t tests were used to compare the radiation dose.Results In the study group,tube voltage of 100 kVp were selected highest(78.75%)and distributed from subgroups A to D,accounting for 60%,80%,90% and 60% respectively, with average BMI of (23.71±3.1 9)kg/m2 .Compared to control group,the effective dose of study group from subgroups A to C re-duced by 35.09%,27.61% and 1 9.08% respectively(t=3.829,4.389,2.238,P =0.005,<0.001,0.025).Despite the higher image noise in study group,the overall image quality was acceptable.Conclusion The contrast-enhanced abdominal CT with AVTS technique can reduce radiation dose in patients with BMI smaller than 28.9 kg/m2 .

Objective To investigate the image quality and radiation dose of automatic spectral imaging mode selection and adaptive statistical iterative reconstruction (ASIR) at abdominal CT with low contrast agent dose. Methods One hundred cases with the arterial-phase (AP) and portal venous phase (PVP) contrast-enhanced abdominal CT scanning were analyzed prospectively. Patients were randomly assigned to the study group and control group (n=50 each). In the study group, automatic spectral imaging mode selection and contrast agent dose of 300 mg/kg were used and spectral monochromatic images(40 to 60 keV) were reconstructed using either filtered back-projection (FBP) (group A) or ASIR (group B). In the control group, the fixed tube potential of 120 kVp and contrast agent dose of 450 mg/kg were used with images reconstructed using FBP (group C). Quantitative parameters (image noise and contrast-to-noise ratio of the liver, pancreas, aorta and portal vein) and qualitative visual parameters (overall image quality as graded on a 5-point scale) were compared among the groups by using One-way ANOVA or Kruskal-Wallis H test. Two sample t tests were used compare the radiation dose difference. Results There had no significant difference in CTDIvol[both (12±5) mGy] and DLP[(364±142) mGy·cm versus (377±131) mGy·cm] between the study group and control group(t=-0.408 and-0.428,P>0.05). During the AP and PVP, at the energy level of 40 keV, group B showed higher CNRs than group A and group C, lower image noise[ (29±6) HU in AP, (24±6) HU in PVP] than group A[(43±11) HU, (44±10) HU] but higher image noise than group C[ (18± 4) HU, (18±4) HU], lower overall image quality scores[(3.0±0.2) point, (2.9±0.3) point] than group C[(3.6± 0.4) point , (3.6±0.5) point] but similar scores to group A[(2.9±0.4) point,(2.8±0.4)point]. At the energy level of 50 keV, group B showed higher CNRs than group A but higher than or similar CNRs to group C, lower image noise[ (20±5) HU, (20±4) HU] than group A[(31±8) HU, (31±7) HU] but similar image noise to group C, higher overall image quality scores[(3.6±0.4) point, (3.5±0.4) point]than group A[(3.3±0.3) point,(3.3±0.3) point] but similar scores to group C. At the energy level of 60 keV, group B showed lower image noise[(14±4) HU, (14±3) HU], higher CNRs and overall image quality scores[(3.9±0.4) point,(3.9±0.3) point] than group A[(19 ± 5) and (20 ± 5)HU in image noise, (3.7 ± 0.4) and (3.7 ± 0.3) point in overall image quality scores ]and group C. Except for monochromatic images at 40 keV, the overall image quality scores in group B were all greater than 3 point and met the clinical diagnostic level. Conclusions The radiation dose of CT spectral imaging and conventional 120 kVp CT scan is equivalent with the use of automatic spectral imaging mode selection. By combining ASIR technique, monochromatic images at 50 and 60 keV can improve CNR and reduce contrast agent dose while maintain or improve overall image quality.

Objective:To investigate the clinical efficacy and prognosis of transjugular intrahepatic portosystemic shunt (TIPS) and drug combined with endoscopic treatment in patients with liver cirrhosis and esophagogastric variceal bleeding (EGVB).Methods:From January 2012 to December 2013, at the First Affiliated Hospital of Xi′an Jiaotong University, the data of 147 patients with liver cirrhosis and EGVB undergoing TIPS or drug combined with endoscopic treatment were retrospectively collected, with 87 cases in TIPS treatment group and 60 in drug combined with endoscopic treatment group.The 5 years follow-up data were analyzed, and the overall survival rates, rebleeding-free survival rates and hepatic encephalopathy-free survival rates at 6 weeks, 1 year, 2 years and 5 years after treatment of two groups were compared. Independent sample t test, Mann-Whitney U test, chi-square test, Fisher exact test, Z test, log-rank test and trend test were used for statistical analysis. Results:There were no significant differences in age, gender, etiology, Child-Pugh classification, initial liver function, coagulation function, liver ascites, previous history of hepatic encephalopathy, blood pressure and preoperative blood transfusion history between the TIPS treatment group and combination of drugs and endoscopy treatment group (all P>0.05). Forty-one patients died within 5 years, of which 20 (48.8%) died of rebleeding and 6 (14.6%) died of hepatic encephalopathy. There were no significant differences in 6-week, 1-year and 2-year overall survival rates between the TIPS group and drug combined with endoscopic treatment group (all P>0.05), however the 5-year overall survival rate of the TIPS treatment group was higher than that of the drug combined with endoscopic treatment group (78.4% vs. 63.2%), and the difference was statistically significant ( Z=2.06, P=0.048). The 6-week, 1-year, 2-year, 5-year rebleeding-free survival rates of the TIPS group were 97.7%, 96.5%, 88.9% and 70.9%, respectively, which were all higher than those of the drug combined with endoscopic treatment group (86.7%, 53.3%, 43.3% and 27.1%), and the differences were statistically significant ( Z=2.35, 6.39, 6.26 and 4.80, all P<0.05). There were no significant differences in hepatic encephalopathy-free survival rates at 6 weeks, 1 year and 2 years after treatment between the TIPS group and drug combined with endoscopic treatment group (all P>0.05), however the 5-year hepatic encephalopathy-free survival rate of the TIPS treatment group was lower than that of the drug combined with endoscopic treatment group (67.7% vs. 86.7%), and the difference was statistically significant ( Z=2.28, P=0.030). The lower the Child-Pugh classification, the higher the cumulative 5-year survival rate ( χ2=6.75, P<0.01). There was no statistically significant difference in the 5-year overall survival rate in patients with the same Child-Pugh classification between the TIPS group and the drug combined with endoscopic treatment group (all P>0.05). Conclusions:The efficacy of TIPS is better than that of the drug combined with endoscopic treatment in treating EGVB. Even the long-term risk of hepatic encephalopathy of TIPS is higher, the short-term, middle-term and long-term rebleeding rate are decreased. Patients with Child-Pugh grade C do not need to avoid TIPS when choosing the treatment, the earlier the TIPS used, the better survival benefit will be obtained.

Objective:To investigate the application value of spectral computed tomo-graphy (CT) multi-parameter imaging in predicting gastric cancer lymph node metastasis.Methods:The retrospective case-control study was conducted. The clinicopathological data of 86 patients with gastric cancer who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2017 were collected. There were 53 males and 33 females, aged from 22 to 87 years, with a median age of 53 years. All patients received abdominal plain scan and arterial and venous phase contrast spectral scan. Images of plain scan, 70 keV monochromatic and iodine-based images in arterial and venous phase were analyzed on post-processing working station. Observation indicators: (1) gastric cancer lymph node metastasis; (2) analysis of influencing factors for lymph node metastasis in gastric cancer; (3) introduction of special cases. Count data were described as absolute numbers. Univariate analysis was performed using the chi-square test or rank sum test. Multivariate analysis was conducted using the Logistic regression model.Results:(1) Gastric cancer lymph node metastasis: of the 86 patients, 64 cases had lymph nodes metastasis and 22 had no lymph nodes metastasis. (2) Analysis of influencing factors for lymph node metastasis in gastric cancer: results of univariate analysis showed that tumor growth pattern, tumor diameter, infiltration of peritumor fat, CT value in arterial phase, CT value in venous phase, iodine value in venous phase were related factors affecting lymph nodes metastasis in gastric cancer ( χ2=6.753, Z=-3.180, χ2=7.649, Z=-2.051, -2.971, -2.547, P<0.05). Results of multivariate analysis showed that infiltration of peritumor fat and the iodine value in venous phase were greater than 12(100 μg/cm 3) and not greater than 16(100 μg/cm 3), or greater than 16(100 μg/cm 3) were independent risk factors affecting lymph nodes metastasis in gastric cancer ( odds ratio=13.154, 3.761, 7.583, 95% confidence interval as 2.597-66.620, 1.893-8.572, 4.769-16.692, P<0.05). (3) Introduction of special cases: case 1 was male, aged 46 years. Results of preoperative spectral CT enhanced scan showed gastric antrum space occupying lesion combined with enlarged lymph nodes. During enhancement arterial phase, spectral CT 70 keV monochromatic images and corresponding iodine-based images of primary lesion layer in the transverse view showed gastric wall thickening with mild to moderate enhancement, clear fat space in serosa and enlarged lymph nodes in lesser curvature. The spectral CT 70 keV monochromatic images and corresponding iodine-based images below pylorus level in the transverse view showed subpyloric enlarged lymph nodes. During enhancement venous phase, the 70 keV monochromatic images and corresponding iodine-based images of primary lesion layer in the transverse view showed layered enhancement of gastric antrum lesions and mucosal enhancement, with a high iodine value. The patient was diagnosed as gastric antrum cancer with lymph node metastasis, no serosal or peritumoral fat invasion. Results of postoperative pathological examination showed moderately differentiated adenocarcinoma of gastric antrum with serosal invasion and lymph node metastasis. Case 2 was male, aged 53 years. Results of preoperative spectral CT enhanced scan showed gastric cancer of lesser curvature combined with enlarged lymph nodes. During enhancement arterial phase, 70 keV monochromatic images and corresponding iodine-based images of primary lesion layer in the transverse view showed gastric wall heterogeneous thickening of lesser curvature, with moderate enhancement, obscure peritumor fat space, unclear serosa, and multiple enlarged lymph nodes in lesser curvature. During enhancement venous phase, 70 keV monochromatic images in the transverse view showed unclear boundary between lesions and enlarged lymph nodes in lesser curvature, obscure peritumor fat. During enhancement arterial phase, 70 keV monochromatic images of celiac trunk layer in the transverse view showed parasplenic artery lymph nodes, with circular enhancement and no enhancement in central necrotic elements. The patient was diagnosed as gastric cancer of lesser curvature with lymph node metastasis, serosal and peritumor fat invasion. Results of postoperative pathological examination showed poorly differentiated adenocarcinoma of gastric antrum with serosal invasion and lymph node metastasis. Conclusion:The infiltration of peritumor fat and iodine value in venous phase are independent factors affecting gastric cancer lymph node metastasis.