ObjectiveTo evaluate the late-phase enhancement of carotid artery in patients with cerebral infarction by contrast-enhanced ultrasonography.MethodsSixty-eight patients whose bilateral carotid artery plaques were both wider than 1.5 mm with treatment in Zhejiang Provincial People?s Hospital from April to July in 2013 were enrolled in this study. Among the enrolled patients, there are 50 patients with cerebral infarction including 30 patients with unilateral cerebral infarction and 20 patients with bilateral cerebral infarction, and 18 patients without cerebral infarction. The enrolled patients underwent conventional and contrast-enhanced ultrasonography. The time-intension curve was obtained till 6 minutes after the injection of contrast agent. The late-phase enhancement intensity and relative intensity of maximal carotid plaque was measured and calculated. The differences of late-phase enhancement intensity and relative intensity between patients with cerebral infarction and patients without cerebral infarction, and between ipsilateral and contralateral side of cerebral infarction in patients with cerebral infarction were compared using two samplet test.ResultsThe late-phase enhancement intensity of carotid plaque in patients with cerebral infarction and in patients without cerebral infarction was (6.0±1.5) and (4.9±1.2) dB, respectively, and the relative late-phase enhancement intensity of carotid plaque was 0.9±0.2 and 0.8±0.2, respectively. The late-phase enhancement intensity and the relative intensity of carotid plaque was higher in patients with cerebral infarction compared with patients without cerebral infarction, and the differences had statistical significance (value oft was 2.132 and 2.258 respectively, value ofP were both less than 0.05). The late-phase enhancement intensity of carotid plaque in ipsilateral and contralateral side of cerebral infarction was (7.1±1.8) and (4.9±1.2) dB, respectively, and the relative late-phase enhancement intensity of carotid plaque was 1.2±0.3 and 0.8±0.2, respectively. The late-phase enhancement intensity and the relative intensity of carotid plaque was higher in ipsilateral side of cerebral infarction compared with contralateral side of cerebral infarction in patients with cerebral infarction, and the differences had statistical signiifcance (value oft was 3.132 and 2.953 respectively, value ofP were both less than 0.01).ConclusionThe late-phase enhancement of carotid plaque in patients with cerebral infarction is significantly different from that in patients without cerebral infarction.

Objective To evaluate the correlation between multi-slice spiral CT(MSCT)perfusion imaging parameters and gastric carcinoma differentiation.Methods MSCT perfusion parameters including blood flow(BF),patlak blood volume(PBV),time to peak (TTP)and patlak permeability surface(PPS)were obtained in 44 patients with pathologically confirmed gastric carcinoma before sur-gery.Patients were divided into two groups;26 well differentiated and 18 poorly differentiated.According to the extent of cell differ-entiation ,BF,PBV,TTP and PPS were investigated in two groups.Results Parameters in the well differentiated gastric carcinoma group BF 101.8±6.7 (mL·min-1 ·100 mL-1 ),PBV 85.9±3.4 (mL/1 000 mL ),TTP 121.6±1 1.5(0.1 s),PPS 82.7±1 1.0 (0.5 mL·min-1 ·100 mL-1 )respectivily,Parameters in the poorly differentiated gastric carcinoma group,BF 105.3 ±7.7,PBV 92.1±7.1,TTP 113.0±10.5,PPS 94.3±22.9 respectivily.There was no statistic difference in BF value between the two groups(P >0.05). There were statistic differences in TTP、PBV and PPS between the two groups(P <0.05).Conclusion MSCT perfusion parameters may reflect the degree of differentiation of gastric carcinoma or a certain extent in vivo.

Objective To investigate the mechanism of carbapenem-resistant in Enterobacteriaceae strains isolated from Fuyang First People′s Hospital and to analyze their epidemiological features. Methods The Enterobacteriaceae strains with reduced ertapenem susceptibility were isolated from the Fuy-ang First People′s Hospital during January 2013 to August 2014.K-B disk diffusion and E-test were per-formed to detect the antimicrobial susceptibilities of those strains.The modified Hodge test, ethylenediami-netetraacetic acid ( EDTA) disk synergy test and extended-spectrumβ-lactamases ( ESBLs) confirmation test were used to screen out the carbapenem-resistant phenotypes.PCR analysis and gene sequencing were used to analyze drug resistance genes, genetic structures surrounding the blaKPC-2 gene and seven house-keeping genes of Klebsiella pneumonia ( K.pneumoniae) strains.The sequences of the seven house-keeping genes were analyzed with multilocus sequence typing ( MLST) .Pulsed field gel electrophoresis ( PFGE) was per-formed for homology analysis within the same species.S1-PFGE in combination with Southern blot analysis was used to determine the location of carbapenem resistance genes.Results A total of 19 Enterobacteriace-ae isolates with reduced susceptibility to ertapenem were screened out.Each of them was resistant to multiple antibiotics and harbored several resistance genes.Seven genes including the blaKPC-2 , blaIMP-4 , blaSHV-1 , blaCTX-M-65 , blaCTX-M-15 , blaTEM-1 and rmtB genes were the prevalent drug resistance genes.Fourteen out of the nineteen strains were identified as K.pneumoniae strains, mainly belonged to the ST11 type according to the results of MLST.Among the nineteen strains, eleven K.pneumoniae isolates and one Escherichia coli isolate carried the blaKPC-2 gene, located on plasmids varying in size (95 kb, 140 kb, 200 kb and 240 kb) .The ge-netic structures of all isolates were ISKpn8, blaKPC-2 and ISKpn6-like from upstream to downstream.The blaIMP-4 gene was detected in one Klebsiella oxytoca isolate and one K.pneumoniae isolate, located on a plas-mid about 300 kb in size.Conclusion Carbapenemases KPC-2 and IMP-4 were closely related to the car-bapenem resistance in carbapenem-resistant Enterobacteriaceae strains isolated form the Fuyang First People′s Hospital.No predominant clone was found in those carbapenem-resistant K.pneumoniae isolates.

Objective To evaluate the utility of neovascularization grade of carotid plaque using contrast enhanced ultrasonography in the prediction of recurrent cerebral infarction by Logistic regression model analysis. Methods Eight-nine patients with first cerebral infarction were studied by conventional and contrast enhanced ultrasonography, then the two-dimensional echoic grade and neovascularization grade of carotid plaque was assessed. The condition of recurrent cerebral infarction in next year was followed up. The independent risk and predictive factors of recurrent cerebral infarction were analyzed by Logistic regression model and the utility of the independent risk and predictive factors in the prediction of recurrent cerebral infarction was evaluated by ROC curve. Results Both two-dimensional echoic grade of carotid plaque (P=0.028) and neovascularization grade of carotid plaque (P=0.006) were the risk and predictive factors of recurrent cerebral infarction in single-factor Logistic regression model. However, only the neovascularization grade of carotid plaque was the independent risk and predictive factor in multiple-factor Logistic regression model (P=0.043) with an OR value of 1.916. The sensitivity and specificity of the neovascularization grade of carotid plaque in prediction of recurrent cerebral infarction (cut-off value>Ⅱ) were 67.74% and 70.69% respectively and the area under ROC curve was 0.684(95%CI:0.577~0.779,P=0.0017).Conclusion The neovascularization grade of carotid plaques on contrast enhanced ultrasonography is the independent risk and predictive factor in prediction of recurrent cerebral infarction.

Cervical cancer is a common female reproductive system malignant in developing countries. Radiotherapy plays a very important role in the treatment of cervical cancer, and brachytherapy is an essential part of cervical cancer radiotherapy. With the rapid development of CT and MRI imaging technology, brachytherapy cervical cancer has gradually developed from the traditional two-dimensional image-guided technology to three-dimensional image-guided technology. There are more and more treatment methods, including intracavitary brachytherapy, interstitial brachytherapy and intracavitary/interstitial brachytherapy. This paper reviews several common techniques of three-dimensional brachytherapy for cervical cancer, and discusses the dosimetric feasibility of internal and external integration irradiation.

Objective: To investigate histopathological characteristics, and differential diagnoses of childhood synovial sarcoma. Methods: HE staining, immunohistochemical staining and fusion gene detection by FISH were performed in 12 cases of synovial sarcoma in childhood at Beijing Children′s Hospital from 2016 to 2018. Results: There were 6 cases of biphasic type, 1 case of monophasic epithelial type, 3 cases of monophasic spindle cell type and 2 cases of poorly differentiated synovial sarcomas. EMA, CKpan, bcl-2, CD99, TLE1 and CD34 immunostain positivities were observed in 10/12, 9/12, 12/12, 10/12, 10/12 and 0/12 cases respectively. Unique INI1 immunohistochemical staining was observed in 9/12 cases. SS18-SSX gene fusion was detected in 8 of 11 cases by FISH. Conclusions Synovial sarcoma is rare in children. Histological morphology combined with immunohistochemistry and FISH SS18-SSX fusion gene detection are important for the diagnosis and differential diagnosis of synovial sarcoma in children.

BACKGROUNDBalloon release pressure may increase the incidence of no reflow after direct percutaneous coronary intervention (PCI). This randomized controlled study was designed to analyze the correlation between balloon release pressure and no-reflow in patients with acute myocardial infarction (AMI) undergoing direct PCI.

METHODSThere were 156 AMI patients who underwent PCI from January 1, 2010 to December 31, 2012, and were divided into two groups according to the stent inflation pressure: a conventional pressure group and a high pressure group. After PCI, angiography was conducted to assess the thrombolysis in myocardial infarction (TIMI) grade with related artery. Examinations were undertaken on all patients before and after the operation including cardiac enzymes, total cholesterol, low-density lipoprotein, blood glucose, homocysteine , β-thromboglobulin (β-TG), Hamilton depression scale (HAMD) and self-rating anxiety scale (SAS). After interventional therapy, the afore-mentioned parameters in both the conventional pressure group and high pressure group were again analyzed.

RESULTSThe results showed that CK-MB, HAMD, SAS were significantly different (P < 0.05) in all patients after PCI, especially the CK-MB in the high pressure group ((25.7 ± 7.6) U/L vs. (76.7 ± 11.8) U/L). CK-MB, HAMD, SAS, and β-TG were comparative before PCI but they were significantly changed (P < 0.05) after intervention. No-reflow phenomenon occurred in 13 patients in the high pressure group, which was significantly higher than in the conventional pressure group (17.11% vs. 6.25%, P < 0.05).

CONCLUSIONIn stent implantation, using a pressure less than 1823.4 kPa balloon to release pressure may be the better choice to reduce the occurrence of no-reflow following direct PCI.

Adult ; Aged ; Blood Glucose ; metabolism ; Cholesterol ; blood ; Female ; Homocysteine ; metabolism ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; blood ; surgery ; Percutaneous Coronary Intervention ; methods