Objective To evaluate the value of whole body 18F-FDG PET/CT in detecting small intestine adenocarcinoma (SIA).Methods A retrospective study of 18F-FDG PET/CT was performed on 29 cases (male 17,female 12) of SIA,21 cases of small intestine lymphoma (SIL) (male 15,female 6) and 10 cases of small intestine tuberculosis (SIT) (male 4,female 6).Visual and semi-quantitative methods (SUVmax) were used to summarize and analyse the 18F-FDG PET/CT resutls.One-way analysis of variance and x2 test were used to analyze the data.Results (1) 18F-FDG PET/CT for SIA showed a partially conglomerate pattern of hypermetabolic small bowel masses with nodular configurations.A typical SIL showed a partially annular abnormal growth with aggregated foci of radioactivity.SIT lesions were usually in form of stripes and/or nodules with high metabolic foci or lesions withskipped distribution.The SUVmax of SIA (8.44±3.82) was significantly lower than that of SIL (11.54±4.02; F=86.96,t=2.77,both P＜0.01),but not significantly different when compared with SIT (8.61±2.99; t=0.11,P＞0.05).(2) The incidence rates of peri-lesion lymph node enlargement in SIA,SIL and SIT were 72.41％ (21/29),85.71％ (18/21) and 70.00％ (7/10),respectively (x2 =1.50,P＞0.05).The SUVmax of peri-lesion lymph nodes in SIA (5.59±2.86) was significantly lower than that of SIL (11.10±5.72; F=56.56,t=3.85,both P＜0.01),but was not significantly different when compared with SIT (5.63± 3.36; t =0.30,P＞ 0.05).The detection rate of PET/CT on pefi-lesion lymph node enlargement of SIA was higher than CT (41.38％,12/29; x2 =5.69,P＜0.05).(3) The incidence rate of extra-intestinal metastases was 55.17％ (16/29) in SIA,and the most common metastatic sites were liver,bone and adrenal gland.The incidence rate of extra-intestinal lesions was 66.67％ (14/21) in SIL,most commonly presented as widespread multifocal nodal permeation.Extra abdominal tuberculous loci were found in 80.00％ (8/10) of SIT.The incidence rates of extra-intestinal involvement were not significantly different among SIA,SIL and SIT (x2=2.13,P＞0.05).(4) Among the 29 SIA cases,15 (51.72％) involved the ileum,8 (27.59％) jejunum,4 (13.79％) both jejunum and ileum,and 2 (6.90％) both jejunum and duodenum (x2 =18.16,P＜0.01).(5) Among the 29 SIA cases,primary SIA was found in 8 cases (27.59％),double primary in 7 cases (24.14％) and metastatic SIA in 14 eases (48.28％).(6) Based on the clinical data,pathological results and clinical follow-up,the diagnosis of SIA by 18F-FDG PET/CT had a sensitivity and specificity of 93.10％ (27/29) and 80.00％ (8/10),respectively.Conclusions 18F-FDG PET/CT is useful for the differential diagnosis of S1A and for supporting the diagnosis of single primary,multi-primary and metastatic SIA.

Objective To study the relationship between the 18F-FDG PET/CT whole body imaging characteristics and pathologic features of small intestine primary malignant neoplasms.Methods A retrospective study was carried out on 18F-FDG PET/CT data of patients(n =44)with small intestine disease(25 malignant,19 benign).All results were proved by pathologiy,or diagnostic therapy and/or clinical follow-up.The intestinal wall thickness(IWT)and maxium standardized uptake value(SUVmax)were used to analyze the imaging features under different pathological conditions.Results(1)The incidence rate of local tumor formation for benign and malignant intestinal lesions was 31.6％ and 84.0％(x2 =10.40,P ＜ 0.01),respectively.The IWT was(0.75 ± 0.32)cm and(1.42 ± 0.20)cm(t =2.66,P ＜ 0.01),respectively.The S UVmax was(5.17 ± 3.04)and(9.65 ± 5.48)(t =2.88,P ＜ 0.01),respectively.The incidence rate of enlargement of mesenteric lymph nodes for benign and malignant intestinal lesions was 52.6％ and 72.0％(x2 =1.01,P ＞ 0.05),respectively.The SUVmax was(4.80 ± 1.91)and(7.00 ± 5.61)(t =1.11,P ＞ 0.05),respectively.(2)The metastasis incidence rate of other organs for intestinal malignant lesions was 44.0％.The most common metastasis organs were liver(28.0％),distant lymph nodes(20.0％)and bone (16.0％).The most pathological type of intestinal malignant lesions were malignant lymphoma(44.0％),adenocarcinoma(32.0％).The IWT was(1.41 ± 0.59)cm and(1.36 ± 0.62)cm(t =0.18,P ＞ 0.05),respectively.The SUVmax was(12.49 ± 7.00)and(7.93 ± 2.82)(t =7.55,P ＜ 0.01),respectively.The metastasis incidence rate was 9.1％ and 62.5 ％(x2 =3.89,P ＜ 0.05),respectively.(3)Taking the intestinal local tumor formation and SUVmax andnot less than 4.2 0 wall thickening,and / or metastasis as the main basis of the intestinal malignant lesions,the sensitivity,specificity and accuracy were 96.0％,94.7％ and 95.4％,respectively.The main pathological type of false positive for '8F-FDG PET/CT imaging was intestinal tuberculosis,and false negative was signet(f)ing cell carcinoma.Conclusion 18F-FDG PET/CT imaging has a higher clinical diagnosis value in differentiating small intestine primary malignant carcinoma from benign ones.The size and SUVmax of perifocus lymph nodes could not point out its malignant degree.The 18F-FDG uptake of the lesions is correlated with pathological type.The IWT is not correlated with pathological type.

Objective To evaluate the ability of a synthetic PET/NIRF probe,named 18F-PSVue643,on the apoptosis detection in animal models with the anti-cancer drugs therapy,and compare the advantages and disadvantages between PET and NIRF.Methods Cell apoptosis was detected by MTT and flow cytometry in vitro.Established U87MG glioblastoma xenograft tumors in nude mice were treated with retinol and paclitaxel for nine days (for PET imaging) or eleven days (for NIRF imaging) continuously.The uptake values were recorded by ROI and expressed as ％ID/g.Results The apoptosis ratios in 10 and 100 nmol/L paclitaxel-treated groups were 7.4％ and 7.5％,respectively,and the apoptosis ratio of the control group was 4.3％.The apoptosis could be well detected by both NIRF and PET imaging during the whole process of treatment.However,the amount of probe for PET imaging was only a half of that for optical imaging to get the same apoptosis visualization.Conclusion 18F-PSVue643 is suitable for NIRF and PET imaging in detection of apoptosis,and it may be a promising agent for further clinical studies.

Objective To analyze the clinical effectiveness of using marginal donor kidney in living kidney transplant. Methods From November 2005 to June 2011,274 cases of living kidney transplant were performed in the First Affiliated Hospital of Zhengzhou University.The cases were divided into the marginal donors group ( Donor ages over 60 years old,suboptimal renal anatomy or physiology) of 66 cases and standard donors group of 208 cases.The clinical data were retrospectively analyzed.The criteria of marginal donors were as follows:36 cases of donors with age over 60 yrs (6 cases with renal cysts and 1 case with renal calculus),22 cases of renal cysts ( with diameter range from 4 mm to 40 mm ),4 cases of renal calculus (with diameter range from 3 mm to 6 mm),4 cases of low GFR (under 35 ml/min.The mean recipients' serum creatinine before surgery and after surgery on day 3,day 7,month 1,month 3,month 6,month 12,related complications,the rate of acute rejection and delayed graft function,1 year,3 year recipient/kidney survival were compared between the 2 groups,respectively. Results The serum creatinine levels in the marginal donor group and standard donor group were (242.7 ± 132.2 vs 185.6 ± 148.4) and ( 156.7 ±86.8 vs 122.2 ± 136.8 ) on day 3,day 7 respectively ( P ＜ 0.05 ).Nevertheless,there were no significant differences between the 2 groups in recipients' serum creatinines before surgery and after surgery on month 1,month 3,month 6,month 12,peri-operative complications,the rate of acute rejection and delayed graft function,1 year,3 year recipient/kidney survival (P ＞ 0.05). Conclusions Healthy old donors and donors with renal cyst (the diameter of renal cysts under 40mm) should not be the barriers to organ donation.To those living donors with low GFR,we should consider of donor age,donor/recipient body weight,donor/recipient body surface area and whether we could deal with the problem by surgical operation.Donor with renal calculus should be carefully evaluated.

Objective To analyze clinical outcome of kidney transplantation from elderly livingrelated donors. Methods The clinical data of living-related kidney transplantation between November 2005 to June 2011 in the First Affiliated Hospital of Zhengzhou University were retrospectively analysed.The patients were divided into elderly donor kidney transplantation group (elderly group,36 cases) and non-elderly living related donor kidney transplantation group (nonelderly group,208 cases).The mean recipients' serum creatinines before and 3 days,7 days,1 month,3 month,6 month,12 month,24 month,36 month after surgery,peri-operation complications,the incidence rate of acute rejection,calcineurin inhibitor (CNI)-induced renal toxicity,delayed graft function(DGF),1 year and 3 year recipient/kidney survival were compared respectively between the two groups. Results The serum creatinine levels were higher in elderly group than in non-elderly group at 3 days,7 days,1 month after surgery [(245.2±135.2)μmol/L vs.(185.6±148.4)μmol/L,(150.5±86.8)μmol/L vs.(122.2± 136.8)μmol/L,(140.6±42.5)μmol/L vs.(117.8±33.2)μmol/L,t =84.07,31.90,21.54; all P =0.000].In addition,the incidence rate of CNI induced renal toxicity was higher in the elderly group than in non-elderly group [22.2％(8/36)vs.1.9％(4/208),x2=27.04,P=0.000].Nevertheless,there were no significant differences between the two groups in recipients' serum creatinines before and 3 month,6 month,12 month,24 month,36 month after surgery,in peri-operation complications,the incidence rate of acute rejection,delayed graft function,and in 1 year and 3 year recipient/kidney survival (all P ＞ 0.05). Conclusions With stringent screening and overall assessment of elderly donors,healthy elderly donors should not be barriers to organ donation.Renal toxicity of CNI agents should be carefully monitored in recipients of elderly donor.

Objective To investigate the effect of icariin on renal ischemia-reperfusion injury (IRI) and the action mechanism.Methods SD rats were divided into 3 groups.The model of unilateral renal IRI was established in SD rats,and Icariin (100 mg/kg) was orally administrated by gavage daily from 2 days before operation to 12 days after operation (icariin group).The vehicle of icariin was administrated to IRI model rats as control group,while in the sham-operation group the renal pedicel was only dissociated without treatment.Body weight and kidney function were monitored within 14 days after reperfusion.The kidney was harvested at 24 h after reperfusion,and then malonaldehyde (MDA) and activity of reactive oxygen species (ROS) scavenger enzymes were examined.Histopathological changes were observed at postoperative day (POD) 3 and 14.Results At POD 3,7,11 and 14,the creatinine clearance rate was significantly higher in icariin group than in control group (P＜0.01). Icariin group had significantly lower Paller scores which indicated tubules injury than in control group at day 3 after reperfusion (P＜0.01 ).In icariin group,MDA level was obviously decreased at 24 h after operation.Compared to control group,icariin group had statistically higher activity of glutathion reductase (GR),catalase and superoxide dismutase (SOD),as well as higher level of reduced glutathione (GSH) (P＜0.05).Conclusion Icariin has protective effects on renal IRI,and can promote recovery of kidney function. Icariin can reduce oxidative stress through increasing activity of ROS scavengers.

Objective To report surgical outcomes of managing comminuted fractures of the inferior patellar pole with separate vertical wiring plus anchor suture fixation.Methods From January 2010 to January 2015,37 patients with comminuted fractures of the inferior patellar pole were treated with separate vertical wiring and anchor suture fixation.They were 15 men and 22 women,from 32 to 76 years of age (average,55.1 years).The intervals from fracture to surgery ranged from 2 to 3 days (average,2.1 days).According to the AO classification,all the fractures were type 34-A1.The visual analogue scale (VAS) scores,ranges of motion (ROM) of the knee,Bostman scores and postoperative complications were recorded at 6 weeks,3,6 and 12 months and the final follow-up postoperatively.Results The follow-up time for the 37 patients averaged 16 months (range,from 12 to 23 months).The fracture union time averaged 10 weeks after surgery (range,from 8 to 13 weeks).At postoperative 6 weeks,3,6 and 12 months and the final follow-up,respectively,the average VAS scores were 2.5,1.1,0.3,0.2 and 0.2 points,the average ranges of motion 109.5°,123.7°,128.6°,129.1° and 132.5°,and the average Bostman scores 23.7,26.9,29.1,29.4 and 29.6 points.No patient reported delayed union,nonunion,loss of reduction,wire breakage,wound problem or irritation from the implant.Conclusion Separate vertical wiring combined with anchor suture fixation is a useful technique for comminuted fractures of the inferior patellar pole,for it is easy to perform,allows early functional exercise and leads to fine curative outcomes.

Objective To investigate the status of living relative kidney transplantation, and the clinical effects and social significances of kidney transplantation between spouses. Methods We retrospectively collected the clinical data of the department of kidney transplant of the First Affiliated Hospital of Zhengzhou University, from January 2011 to December 2013. The spouse group as group 1, the age and sex of doners were taken into account,the siblings with the similar age of the same period were enrolled in group 2. Then the postoperative recoveries of the two groups were compared. Considering the current social status, particularly the shortage of donor kidneys, the clinical, social and family significances of kidney transplantation between spouses were analyzed. Results Twelve cases of spouses in group 1, 8 cases of siblings in group 2 , the differences of donor and recipient age of the two groups were 0.33 ± 0.98 years and 2.29 ± 7.23 years, respectively. The human major histocompatibility complex antigens (HLA) was less than three in group 1, and was greater than or equal to three in group 2. The changes of serum creatinine and urea nitrogen were analyzed. No significant differences of serum creatinine and downward trend of blood urea nitrogen were observed between two groups (P = 0.84, P = 0.79). Conclusion The kidney transplantation between spouses has good clinical efficacy and great social significance, improving the status of the shortage of donor kidney and contributing to family harmony. The renal transplantation between spouses has obvious advantages and need further promotion.

Objective To dynamically monitor the changes of peripheral blood lymphocyte subsets of renal transplant recipients and investigate the relationship between lymphocyte subsets with infection and rejection.Methods The clinical data of allogenic kidney transplantation recipients and living relative donors in the Department of Kidney Transplantation of the First Affiliated Hospital of Zhengzhou University were prospectively collected from June 2015 to December 2016.The data of lymphocyte subsets and other related indexes were obtained from renal transplant recipients and relatives of the same period.Results Sixty-four cases of living-relative donors and 351 cases of renal transplant recipients were enrolled in this study,and the recipients were divided into 3 groups:infection group (67 cases),acute rejection group (46 cases),and stable group (238 cases),according to the diagnostic criteria.There was significant difference in the concentration distribution of lymphocytes between the stable group and the control group (P<0.05).The stable frequency distribution range of the stable group was as follows (cells/μL):Lym (1 000-1 500),T (<1 500),CD4+ (<1 000),CD8+ (<1 000),B (<300),NK (100-300),CD4+/CD8+ (0.5-1.0).The number of Lym,T,CD4+,CD8+,NK and B cells in the preoperative patients was less than that in the healthy population (P<0.05);The number of Lym,T,CD4+, CD8+,B and NK cells was gradually decreased in the postoperative infection group,which was less than that in the stable group (P<0.05).After treatment the indicators gradually restored to the level in the stable group level;the number of T,CD4+,CD8+,B cells was highly correlated with infection.The number of T and CD4+ cells,and CD4+/CD8+ ratio were significantly increased in acute rejection group as compared with the stable group,and gradually decreased after the rejection was reversed.The number of T,CD4+,CD8+ cells was highly correlated with rejection.Lymphocyte subsets had a predictive effect on infection and rejection of recipients,and CD4+ cell count and CD4+/CD8+ ratio were independent risk factors.Conclusion The monitoring of lymphocyte subsets has an important clinical value in the evaluation of immune status and individual treatment of renal recipients.

Objective To evaluate the characteristics and efficacy of microscope-assisted bilateral decompression via unilateral approach for the treatment of lumbar stenosis. Methods From June 2007 to June 2010, Sixty case lumbar stenosis with bilateral decompression were treated via unilateral approach under microscopy. Patients were followed up from 6 to 24 months, average (12 ± 4.7) months. Results The pain level of each patient was assessed both before and after the opeartion, using a visual analogue scale (VAS). Intermittent claudication was completely relieved in 57 out of 60 cases, moderately relieved in 3 cases. VAS score decreased from pre-operational 9.08 ± 0.76 to post-operational 2.33 ± 1.43, and there was significantly difference between them. There was no recurrent case during the whole follow-up. Conclusion Bilateral decompression via unilateral approach under microscope is proved to be an effective and safe procedure for the treatment of lumbar stenosis, and have the advantages of minimal invasion, less pain, quick recovery, better effect, little influence on the spinal stability.