Objective To investigate the value of 64-slice spiral computed tomography(CT)angiography in preoperative evaluation of spinal vascular intervention.Methods Seventeen patients with segmental injury of the spinal cord underwent the enhanced 64-slice CT scan of the spine.Thin-slice reconstruction was done,with the slice thickness of 0.625 mm and interval of 0.625 mm.The data were transferred to the work station ADW4.2 in DICM format.Image postprocessing technologies such as volume rendering(VR),maximum intensity projection(MIP)and multi-planar reformat(MPR)were used to conduct three-dimensional reconstruction and analyze the anatomical characteristics of radiculomedullary artery.Results Radiculomedullary artery could be found in the thoracolumbar segment of 16 patients(16/17,94%).Among them,one artery(1/17,6%)went into the vertebral canal through the left intervertebral foramen of T4/5,two(2/17,12%)through the left intervertebral foramen of T10/11,one (1/17,6%)through the left intervertebral foramen of T11/12,four(4/17,24%)through the left intervertebral foramen of L1/2,two(2/17,12%)through the left intervertebral foramen of L2/3,two (2/17,12%)through the right intervertebral foramen of T11/12,two(2/17,12%)through the right intervertebral foramen of T12/L1,two(2/17,12%)through the right foramen of L2/3 andl0(10/17,59%)through the left intervertebral foramen.Either CT scan or DSA examination found no radiculomedullary artery in one patient.All the above findings were in accordance with the results of DSA examination.Conclusions Spiral 64-slice CT scan can provide significant preoperative evaluation information for spinal vascular intervention,for it can accurately and visually show the anatomical features of the radiculomedullary artery such as open position,flow tendency,caliber size and spatial relationship with the surrounding vessels.

Objective To explore the feasibility of laparoscopically intracorporeal delta-shaped anastomosis in distal gastrectomy.Methods 82 consecutive patients with distal gastric cancer received laparoscopic distal gastrectomy, including intracorporeal delta-shaped anastomosis in 39 cases, and handassisted Billroth-Ⅰ anastomosis in 43 cases.The operative time, blood loss, anastomosis time were compared between the two groups.Results There were no differences between the two groups with regard to the operative time [(215 ± 24) min vs.(207 ± 13) min, t =0.406, P ＞ 0.05] and blood loss [(56 ±21)ml vs.(65 ± 26)ml, t =1.441, P ＞ 0.05], although the intracorporeal Delta-shaped anastomosis was more time-consuming than the extracorporeal Billroth-Ⅰ anastomosis [(17 ± 8) min vs.(12 ± 3) min, t =2.529, P ＜ 0.05].Conclusions Demanding expertise and some skills, totally laparoscopic distal gastrectomy with intracorporeal delta-shaped anastomosis is safe and feasible.

Objective To discuss the surgical therapy of primary leiomyosarcoma of the inferior vena cava(PIVCLS).Methods Retrospective analysis of was made 5 patients of PIVCLS from Oct 2009 to May 2011 hospitalized in Department of Vascular Surgery,Provincial Hospital Affiliated to Shandong University.All patients underwent surgical resection,combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft.Results Surgical resection was performed successfully in all patients.The mean operation time was 166.6 min,with mean blood loss 1 560 mL.Leiomyosarcoma intruding the inferior vena cava and right renal vein were observed in all patients during operation.The mean size was 12 cm × 10 cm× 8 cm.The diagnosis of PIVCLS in 5 patients was confirmed by postoperative pathologic examination.All patients did not present lower extremity swelling after surgery and discharged from hospital with normal blood (BUN) and (CREA).All patients were administrated with oral warfarin therapy after discharge.No clinical relapse and pulmonary embolism was observed during the follow-up (range 3 months to 12 months).The ultrasound revealed the patency of artificial vascular grafts in all patients.Conclusions Surgical resection combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft is an effective and feasible treatment of PIVCLS.Leiomyosarcoma is completely eliminated and important abdominal viscera are protected well during the procedure because of minimal impact on hemodynamics.The incidence of postoperative pulmonary embolism also decreases obviously.

Objective To investigate the risk factors of slow coronary flow (SCF) phenomenon; To study the prognosis of SCF patients and analyze the high risk factors of adverse events by follow-up.Methods 17930 patients were analyzed retrospectively who had undergone routine coronary angiography because of suspected coronary artery disease at TEDA International Cardiovascular Hospital from January 2006 to December 2010.By Thrombolysis in myocardial infarction Frame Count method,236 patients with normal coronary artery but slow coronary flow were enrolled in the SCF group and 240 patients with normal coronary artery and normal coronary flow (40-50patients per year) were enrolled in the control group.After that,the risk factors leading to SCF were analyzed by the multivariate logistic regression analysis and all patients were followed up from March 2012 to April 2012 to know about the incidence of adverse events (acute coronary syndrome,malignant arrhythmia and sudden cardiac death) and the high risk factors leading to the adverse events.Results (1) Compared to the patients in the control group,the patients in SCF group have higher percentage of male (76.69％ vs.42.08％,P =0.000) 、rate of smokers (58.48％ vs.27.50％,P =0.000) 、BMI (26.78 ±3.75 vs.26.13 ±3.20,P =0.043) 、serum uric acid (344.90 ± 86.18 vs.304.43 ±76.44,P =0.000) 、serum creatinine (68.27 ± 15.10 vs.60.92 ± 13.17,P =0.000)、triglyceride (1.85 ± 1.23 vs.1.65 ± 0.81,P =0.037) but younger age and lower high density lipoprotein cholesterol (1.14 ± 0.28 vs.1.19 ± 0.30,P =0.048).(2) By multivariate logistic regression analysis,male,smoking status,hiah BMI and serum uric acid are all independent factors for SCF.(3) The SCF phenomenon noted in lvessel,2 vessels and 3 vessels accounted for 7.29％,26.04％,66.67％,respectively.(4) During the follow-up,2 patients with malignant arrhythmia and 1 patients with ACS were found in SCF group,no sudden cardiac death took place.None of the adverse events happened in the control group.Conclusions Younger male smokers are prone to have SCF,high BMI and serum uric acid are also independent factors for SCF; The SCF phenomenon is most common in three coronary arteries.Both malignant arrhythmia and acute coronary syndrome took place in the SCF group in the follow-up.

Skin aging principles play important roles in skin disease diagnosis, the evaluation of skin cosmetic effect, forensic identification and age identification in sports competition, etc. This paper proposes a new method to evaluate the skin aging objectively and quantitatively by skin texture area. Firstly, the enlarged skin image was acquired. Then, the skin texture image was segmented by using the iterative threshold method, and the skin ridge image was extracted according to the watershed algorithm. Finally, the skin ridge areas of the skin texture were extracted. The experiment data showed that the average areas of skin ridges, of both men and women, had a good correlation with age (the correlation coefficient r of male was 0.938, and the correlation coefficient r of female was 0.922), and skin texture area and age regression curve showed that the skin texture area increased with age. Therefore, it is effective to evaluate skin aging objectively by the new method presented in this paper.
Algorithms ; Female ; Humans ; Male ; Skin ; Skin Aging

Purpose To detect the expression of Raptor,Rictor,angiogenesis-related factors HIF-lα,HIF-2α and VEGF and to investigate their relationship and significance in eolorectal cancer (CRC).Methods Immunohistochemistry,Western blot and RT-PCR were employed to detect the expression of Raptor,Rictor,HIF-lα,HIF-2α and VEGF in 120 cases of CRC and 60 cases of normal colorectal mucosa.CD34 labeled microvascular density (MVD) was also observed.The correlations between Raptor,Rictor,HIF-1α,HIF-2c,VEGF expression and the patients' clinicopathological features were analyzed.Results The positive rates of Raptor,Rictor,HIF-1c,HIF-2α and VEGF in CRC were significantly higher than those in normal colorectal mucosa (P ＜ 0.05).Raptor and Rictor expression was correlated with the degree of tumor diffcrentiation and lymph node metastasis,respectively.The expression of HIF-1α,HIF2α and VEGF was higher in patients with lymph node metastasis than those in patients without lymph node metastasis (P ＜0.05).The MVD was higher in patients with Raptor or Rictor positive than that in patients with Raptor or Rictor negative (P ＜0.05).The expression of Raptor was positively correlated with HIF-1α and VEGF (P ＜ 0.01),the expression of Rictor was positively correlated with HIF-2o and VEGF (P ＜ 0.01),but the expression of Raptor was negatively correlated with Rictor (P＜0.01).Conclusion The expression of mTOR core molecules Raptor and Rictor is related to the initiation and development of colorectal cancer and angiogenesis,and they promote angiogenesis in colorectal cancer by different ways.

Objective To investigate the safety and efficacy of endoscopic submucosal dissection (ESD) in elderly patients (age ≥ 65 years) with early gastric cancer.Methods The retrospective cohort study was adopted.The clinical data of 145 patients with early gastric cancer who underwent ESD at the Peking University Cancer Hospital between January 2011 and June 2014 were collected.Of 145 patients,57 (age≥65 years) were allocated into the elderly group and 88 (age ＜ 65 years) were allocated into the non-elderly group.ESD was performed to all the patients after the multidisciplinary discussion and evaluation.Observation indicators included operation time,volume of intraoperative blood loss,duration of hospital stay,complications,integrity of resected specimens,negative resection margin,tumor cure and follow-up (survival,tumor recurrence and metastasis).The follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis till June 2015.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using t test.Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using nonparametric U test.Count data were analyzed using the chi-square test.Results Operation time,volume of intraoperative blood loss,duration of hospital stay,numbers of patients with postoperative perforation,bleeding,en bloc resection of tumor,piecemeal resection of tumor,negative resection margins,positive resection margins,curative resection,extended curative resection and non-curative resection were 100 minutes (range,20-470 minutes),25 mL (range,5-200 mL),5 days (range,2-10 days),1,2,52,5,50,7,30,17,10 in the elderly group and 110 minutes (range,25-480 minutes),25 mL (range,5-600 mL),4 days (range,2-29 days),3,3,85,3,83,5,47,24,17 in the non-elderly group,respectively,with no significant differences between the 2 groups (U =2 451.000,2 183.500,2 116.500,x2=1.544,1.018,1.210,0.142,P ＞ 0.05).Patients with complications were improved after symptomatic treatment.Of 145 patients,135 were followed up for a median time of 26 months (range,12-53 months).Tumor recurrence rates in the elderly and non-elderly groups were 1.8％ (1/57) and 2.3％ (2/88),showing no significant difference between the 2 groups (x2=0.000,P ＞ 0.05).No tumor recurrence and metastasis and death were occurred in other patients.Conclusion ESD is safe and feasible in the treatment of elderly patients with early gastric cancer,and it is equivalent to short-and long-term efficacies of ESD in non-elderly patients.

Objective To investigate the efficacy and safety of triple anti-platelet therapy (low-dose tirofiban plus aspirin and clopidogrel) comparing to dual anti-platelet therapy (aspirin and clopidogrel) in preventing stent thrombosis (ST) and major adverse cardiac events (MACE) within 30 days after implantation of drug-eluting stent (DES) in ACS patients.Methods A total of 2904 ACS patients treated with DES from March 2004 to November 2010 were enrolled for retrospective study.Of them,1145 patients were treated with dual anti-platelet therapy (DAT) and 1759 patients with triple anti-platelet therapy (TAT).The incidences of ST,MACE (cardiac death,urgent target vessel revasculanization and myocardial infarction) and side effects occurred within 30 days after PCI were compared between two groups by Fisher' s exact test.Results (1)Although there were significant differences in age,the degree of coronary stenosis,the number of smokers,diabetes,hyperlipidemia and coronary diffuse lesion between two groups,but these differences did not impact on the end point events showed by Cox analysis.The rest of the general condition of patients between two groups was no difference.(2) The incidence of ST as primary end point was lower in TAT group than that in DAT group (0.11％ vs.1.05％,P =0.0036),reducing the relative risk by 89.52％.In addition,the incidence of MACT as secondary end point was also lower in TAT group than that in DAT group (0.17％ vs.1.48％,P =0.0005),reducing the relative risk by 88.51％.Among the total,the incidences of cardiac death and urgent target vessel re-vascularization in TAT group were lower than those in DAT group with significant differences.However,there was no difference in the incidence of myocardial infarction between two groups.(3) Both two groups had no severe hemorrhage complication,the incidence of mild hemorrhage was similar in two groups (0.45％ vs.0.35％,P =0.6720).Nesides,the incidence of acute thrombocytopenia between two groups was also similar (0.45％ vs.0.09％,P =0.083).Conclusions The patients with ACS in the TAT group have significant lower incidence of ST and MACE than those in the DAT group within 30 days after PCI.While the risk of bleeding and the incidence of acute thrombocytopenia do not increase.

We reviewed the clinical data of 24 patients with postpartum hemorrhage undergoing transcatheter arterial embolism from March 2009 to September 2011.Twenty out of 24 patients underwent uterine artery embolism,while other 4 underwent internal iliac artery embolism.The hemorrhage reduced markedly 2 to 9 min after arterial embolism in all patients,except 2 who underwent secondary embolism due to the intermittent postoperative hemorrhage. The postoperative complications included low fever and discomfort in lower abdomen.Nineteen patients were followed up for a mean period of ( 17.3 ± 1.1 ) months,no recurrent hemorrhage was observed after discharge.The normal menstrual cycle recovered 4 to 6 months after operation.Three patients underwent pregnancy successfully after discharge.The results indicate that transcatheter arterial embolism is safe and effective in the treatment of postpartum hemorrhage and it should be recommended as a feasible choice in clinical practice.

Objective To evaluate the clinical value of mini-probe endoscopic ultrasonography (EUS) in determin-ing the therapeutic strategy for early gastric cancer (EGC) before surgery. Methods 151 EGC lesions were enrolled in the study. The accuracy of EUS-determined depths were compared with histopathologic results, and the effects of EUS-based therapeutic decision-making plan was evaluated. Results The overall accuracy of EUS-determined T staging was 74.8%. Multivariate analysis revealed that tumor size larger than 2 cm, endoscopic ulceration and tumor located at upper two thirds of the stomach were associated with EUS misdiagnosis ( < 0.05). 75.3 %(107/142) of the EGC patients received proper treatment according to EUS-based therapeutic selection. Conclusions Mini-probe EUS is a useful utility in T-staging and therapeutic strategy selection for EGC. Special attention should be paid when tumor diameter exceeds 2 cm, co-existence of ulcer or tumor located in the upper two-thirds portion of the stomach.