Objective To investigate the diagnosis of intracranial artery fenestration and its other vascular anomalies with CT angiography ( CTA ) . Methods The image data of 653 patients examined with head CTA and 39 patients diagnosed as intracranial artery fenestration in Zhongshan Hospital Affiliated to Sun Yat-sen University from January 2013 to January 2014 were analyzed retrospectively. The incidence, location,morphology of intracranial artery fenestration, and other vascular anomalies were analyzed. Results (1) In 653 patients,39 (5. 97%) with 41 artery fenestrations were detected. The detection rates of basilar artery fenestration was 3. 37% (n=22),vertebral artery fenestration was 0. 31% (n=2),anterior cerebral artery fenestration was 1. 22% (n =8),anterior communicating artery fenestration was 0. 61%(n=4),and middle cerebral artery fenestration was 0. 76% (n=5),respectively. The post-circulation fenestration was mainly convex lens type (66. 67%,n =17),the anterior-circulation fenestration was mainly fissure type (76. 47%,n=24),and there was significant difference (χ2=7. 411,P<0. 05). (2) In the 39 patients,22 complicated other vascular anomalies. Most of them were unilateral or bilateral fetal-type posterior cerebral arteries (n=10),and followed by aneurysms (n=5). The locations of 5 aneurysms were far from the fenestration,3 located in the communicating segment of internal carotid artery,1 in the top of basilar artery,and 1 in the M2 segment of bilateral middle cerebral arteries. Conclusion CTA can intuitively and clearly reveal the intracranial artery fenestration and other vascular anomalies. But there is no significant correlation between arterial fenestration and vascular anomalies.

Objective To assess the displaying of the cystic artery and the cystic duct in calculus cholecystitis patients using MSCT.Methods One hundred and three patients with calculus cholecystitis (the experimental group)and 71 patients with non-gallbladder disease (the control group)performed the cystic artery and the cystic duct imaging using MSCT.The data in two groups were recorded and statistical analyzed.Results (1)The display rate of the cystic duct were 93.2% (96/103)in the experimental group and 100% (71/71)in the control group with the significant difference between the two groups (P <0.05).7 cases whose cystic ducts could not displayed in the experimental group were all the acute cholecystitis,and the display rate of the cystic duct in the acute cholecystitis was 77.4%(24/31).The display rate of the cystic artery were 100% in both the experimental and control group.(2)The variation rate of the cystic duct running were 10.4% (10/96)in the experimental group and 18.3% (13/71 )in the control group with no significant difference between the groups (P >0.05).The variation rate of the cystic artery running were 13.5% (13/96)in the experimental group and 1 5.5% (1 1/71)in the control group.There was no significant difference between the groups (P >0.05).Conclusion The cystic duct and the cystic artery could be evaluted well in calculus cholecystitis using CT.The displaying of the cystic duct is relatively poor in acute cholecystitis.

Objective To explore the relationship between fetal heart size and gestational weeks (GW). Methods The size of left atrium (LA), right atrium (RA), left ventricle (LV), right ventricle (RV), aorta (AO), pulmonary artery (PA), foramen ovale (FO), heart area (HA), thoracic area (TA), heart circumference (HC) and thoracic circumference (TC) were measured for 512 fetal hearts at 14-39 GW. The relationship between GW and the measurement was evaluated. Results The size of fetal heart chambers, AO, PA and ventricular septum (IVS) increased with the development of GW. The PA/AO, LA/RA, LV/RV, HC/TC and HA/TA were stable compared with different GW. Conclusion Fetal heart chambers increase with the development of GW. HA is correlated well with GW.

Objective To investigate the CT findings of histocyticnecrotizing lymphadenitis(HNL)in the neck.Methods CT data of 10 patients with pathologically confirmed HNL in the neck were retrospectively analyzed,7 males and 3 females,aged from 4 to 75 years old(median age 26 years old).Nine patients had plain CT scans and 5 of them had contrast scans.One case had only contrast CT scan.Results Totally,127 lymph nodes were identified in the neck,mainly located in the area of Ⅱ,Ⅲ,Ⅳ and Ⅴ.The maximum diameter of the involved lymph nodes ranged from 0.5-3.6 cm,1.3 cm in average.One hundred and eight lymph nodes were homogeneous and 8 were heterogeneous in plain CT images.Seventy nine lymph nodes had homogeneous enhancement and 27 had heterogeneous enhancement One hundred and ten lymph nodes had unclear margins and the surrounding fat was blurred.Conclusion CT findings of HNL of the neck are variable and non-specific.Clinical findings and laboratory examination may be helpful for the diagnosis and differential diagnosis.

Objective To compare the image quality and patient radiation dose of coronary computed tomography angiography (CCTA) received by prospectively-gated step-and-shoot (SAS) technique with those obtained by retrospectively-gated spiral (RGS) technique on a 256-slice CT scanner. Methods A total of 200 patients were enrolled in this study. One hundred patients underwent CCTA with SAS mode were subdivided into two groups: ( 1 ) 50 patients with an average heart rate (HR) ≤70 bpm were scanned with a data acquisition time window centered at the 75％ of the R-R cycle ( group A) and (2) 50 patients with HR ＞ 70 bpm were scanned with the data acquisition time window centered at the 45％ of the R-R cycle, including a phase tolerance of ±％ (group B). Other 100 patients underwent CCTA with RGS mode and ECG-based tube current modulation were also subdivided into two groups: (3) 50 patients with HR ≤70 bpm were scanned with cardiac dose right set to phase of 75％ (group C) and (4) 50 patients with HR ＞ 70 bpm were scanned with cardiac ose Rdight set to phases of 45％ and 75％ (group D). All patients were grouped in randomized order. The image quality of CCTA were evaluated using a rank scale from 1 to 4 ( 1 : excellent ; 4 : non-assessable ) .Radiation dose of the four groups received was also estimated. The image quality between groups was compared by Mann-Whitney U test.The radiation dose between groups was compared by t test. For the 100 patients received by prospective ECG-gated CCTA, the receiver operating characteristic curve (ROC) was used to analyze the CCTA image quality and average heart rate to determine the uppercutoff of HR for obtaining diagnostic coronary images with SAS mode. A spearman correlation analysis was also performed to analyze the correlation of HR and image quality in patients underwent CCTA with SAS mode.Results Of 2338 coronary artery segments, excellent or good image quality( score of 1 or 2) was achieved in 96. 5％ (585 of 606) in group A, 77.7％ (445 of 573 ) in B,96. 1％ (548 of 570) in C, and 85. 7％ (505/589) in D, with no significant difference for A vs C(Z ＝- 1. 351 ,P ＞0. 05) and with significant differenceS for B vs D (Z＝ -2. 236,P ＜0. 05). Linear correlation analysis indicated a significant degradation of image quality with the increase of heart rate using SAS mode (Spearman correlation, r ＝ 0. 577, P ＜0. 01 ). ROC analysis established an upper HR threshold of 78 bpm for obtaining diagnostic image quality using SAS mode( AUC ＝ 0. 827, P ＜ 0. 05 ). The average radiation dose in group A [ ( 2. 6 ± 0. 5 ) mSv]reduced 75 ％ comparing with that in group C [ ( 10. 6 ± 2. 3 ) mSy], and the average radiation dose in group B [ ( 4.0 ± 0. 7 ) mSy]reduced 69％ comparing with that in group D [ ( 13.0 ± 1. 4) mSv]. ConclusionUsing SAS mode to perform low-dose CCTA with 256-slice helical CT could keep the image quality and reduce radiation dose significantly. Our preliminary experience suggests a good promise of this technique which could be applied to a wider group of patients such as with higher heart rates.

Objective To investigate image quality and radiation dose of prospective ECG-gated coronary combined with carotid and cerebrovascular angiography and compare it with common coronary CTA and carotid-cerebrovascular CTA at a 256-slice spiral CT.Methods Fifty-seven patients were included in the study.The data was analyzed retrospectively and divided into 3 groups.Group 1 underwent coronary combined with carotid CTA ( n =17 ),which included a wide range of prospective ECG-gated coronary,carotid and cerebral vascular one-stop angiography.Group 2 underwent coronary CTA ( n =20),which was routine prospective ECG-gated coronary angiography.Group 3 underwent routine carotid and cerebrovascular CTA (n =20).Mean CT image attenuation and image noise were measured in the ascending aorta root,proximal parts of the bilateral common carotid artery and vertebral artery,and in the internal carotid artery at sellae level in the axial plane.Coronary artery image quality was rated using a four-point ordinal scale and carotid cerebral vascular image quality was rated using a three-point ordinal scale.Radiation dose were calculated.Mean CT image attenuation,image noise and radiation dose were compared among the 3 groups using t test.Using Mann-Whitney U,the coronary artery imaging quality was compared between group 1 and 2,and image quality of cerebral vessels was compared between group 1 and 3.Results Mean CT image attenuation [ (427 ±50) HU in group 1 and (426 ±86) HU in group 2] and image noise of the ascending aorta root [ (30 ± 9) HU in group 1 and (31 ± 9) HU in group 2 ] showed no statistical difference between group 1 and 2 (t =0.058,-0.325,P ＞0.05).There were no non-diagnosis coronary segments in group 1 and 2.And coronary segments with excellent or good image quality reached 98.1％ (202/206) in group 1 and 99.6％ ( 244/245 ) in group 2.It showed no significant difference between group 1 and 2 ( Z =-0.572,P ＞ 0.05 ).There were significant differences of mean CT image attenuation in the common carotid artery between group 1 [ ( 474 ± 70 ) HU ] and group 3 [ ( 348 ± 81 ) HU ],and in the vertebral artery between group 1 [(447 ±83)HU] and group 3 [(328 +66) HU] (t =5.043,4.869,P＜0.05).However,there was no significant difference of mean CT image attenuation in the internal carotid artery [ (370 ± 92) HU in group 1 and ( 367 ± 97 ) HU in group 3 ] ( t =0.111,P ＞ 0.05 ).There was a significant difference of image quality scores of carotid and cerebrovascular arteries between group 1 and 3 (Z =- 3.306,P ＜ 0.05 ).Effective radiation dose of groups 1,2,3 were ( 7.0 ± 0.8 ),( 3.1 ± 0.4 ) and (5.0 ± 0.3) mSv respectively.Conclusion The prospective ECG-gated coronary combined with carotid and cerebrovascular angiography is able to obtain diagnostic image quality of coronary,carotid and cerebral vascular at the 256-slice spiral CT.It is a simple,fast,noninvasive way to assess coronary and carotid cerebrovascular arteries,with advantages of less contrast medium and low radiation dose.

Objective To investigate the effect of depression symptoms on surgical outcome of posterior decompression among cervical spondylotic myelopathy (CSM) patients. Methods Between October 2006 and October 2011 in our hospital, lami?nectomy or laminoplasty was performed in 396 cases that were enrolled in the study. There were 132 males and 264 females with an average age of 60.2 years(ranged,39-84 years). All patients were divided into depression group and non?depressed group by the 21?item Beck Depression Inventory (BDI). There were no statistically significant differences between groups in age, sex, smok?ing status, duration of symptoms, and employment status (whether in the current working). The Japanese Orthopedic Association (JOA) scores, Neck disability index (NDI) and visual analogue scale (VAS) were compared after 1.5 months postoperatively. Re?sults All of 396 cases were followed up. The mean follow up duration was 32 months (range,24-50 months). There were no statistically significant differences in the CCI decline (7.1%±2.1% versus 6.8%±1.5%), expansion degree[(130.9±7.0) mm2 versus (150.8 ± 5.2) mm2] and the drift?back distance of the spinal cord [(5.7 ± 1.2) mm versus (6.2 ± 0.8) mm]. However, pa?tients with continuous depression showed poorer improvement than non?depressed patients in the surgery outcome: JOA im?proved (1.42±0.56 versus 6.76±3.12); NDI declined (7.31±2.18 versus 21.11±11.36); and VAS lightened (16.08±19.76 versus 23.85±20.79). Conclusion Depression contributed a dissatisfied surgery outcome after posterior decompression on functional re?covery, disability index and pain scores among patients of the cervical spondylotic myelopathy.

Traditional Chinese medicine shows good hypoglycemic effect with mild efficacy, long duration and few adverse reac-tions. In recent years, the researches on the hypoglycemic effect of Ruikang Hospital Affilliated to traditional Chinese medicine mainly started from the mechanism of new target protein and pathway, for example, Chinese medicine monomers or compounds including as-tragalus polysaccharide, curcumin, berberine, emodin, total saponins of momordicacharantia, total saponins of momordicacharantia, Yitangkang, Jiangtang Sanhuang tablets, Jianpixiaokefang and Tangnaikang granule can activate Adenosine monophosphate ( AMP)-activated protein kinase ( AMPK) to play hypoglycemic effect.

Objective To assess the diagnostic accuracy of preoperative endoscopic ultrasonography (EUS) for tumor size and invasion of non-ampullary duodenal neuroendocrine tumors (NA-DETs) and to compare the efficacy and safety of endoscopic submucosal dissection ( ESD ) and modified ESD for the treatment of NA-DETs. Methods Data of 22 patients with 22 NAD-NETs confirmed by histopathological examinations from January 2007 to January 2018 were retrospectively analyzed. ESD was performed on 13 tumors, and modified ESD was performed on 9 tumors. R0 resection rate, procedure time and incidence of procedure-related complications in the ESD group and the modified ESD group were compared. The postoperative pathological results were used as the gold standard to assess the accuracy of preoperative EUS in diagnosing tumor size and invasion of NA-DETs. Results The mean size of NA-DETs was 6. 9 ± 1. 5 mm. The accuracy in assessing the invasion depth by EUS was 95. 5％ ( 21/22 ) compared with histological results. R0 resection was achieved in 13/13 ( 100. 0％) of the ESD group and in 7/9 ( 77. 8％) of the modified ESD group (P=1. 000). The procedure time was significantly shorter in the modified ESD group than that in the ESD group ( 16. 0 ± 2. 2 min VS 29. 8 ± 4. 9 min, P<0. 001 ) . Intraoperative perforation occurred in one patient and delayed perforation occurred in one patient in the ESD group. Delayed bleeding occurred in one patient in the modified ESD group. Follow-up data were available in all cases with a mean period of 30. 0±24. 8 months. No cases of local recurrence or distant metastasis were detected in the follow-up period. Conclusion EUS can accurately assess the size and depth of NAD-NETs. Modified ESD can provide comparable clinical outcomes to ESD for NAD-NETs ≤10 mm in diameter that are confined to the submucosa.

AIM:To investigate the effects of astragalin(AST)on activation status of astrocytes and the ex-pression level of autophagy-related proteins in the cortex of the anterior cingulate cortex of mice with a complete Freund's adjuvant(CFA)-induced inflammatory pain model.METHODS:Twenty-four 6-month-old male C57BL/6 mice were ran-domly divided into four groups:control group,saline group,CFA model group and CFA+60 mg/kg AST administration group,and six mice in each group.Mice in the AST administration group received 60 mg/kg AST by intraperitoneal injec-tion on a body weight basis for 21 d.The paw withdrawal threshold in each group of mice was evaluated by the von Frey test.The expression levels of autophagy-related factors LC3,p62,ATG12 and beclin-1,and astrocyte activation were de-tected by multiplex immunofluorescence staining in the anterior cingulate cortex of mice in each group.Western blot was used to measure the levels of autophagy-related proteins LC3,p62,ATG12 and beclin-1 in the anterior cingulate cortex of mice in each group.RESULTS:Behavioural tests showed that AST significantly increased mechanical pain thresholds in CFA mice(P＜0.05).The results from multiple immunofluorescent staining showed that AST significantly increased the fluorescence intensity of LC3(P＜0.01),ATG12(P＜0.01)and beclin-1(P＜0.05),attenuated the fluorescence intensi-ty of p62(P＜0.05),and inhibited the activation of astrocytes in the anterior cingulate cortex of CFA mice.Western blot results further confirmed that AST significantly increased the expressions of LC3(P＜0.01),ATG12(P＜0.01),beclin-1(P＜0.01),and decreased the expression of p62(P＜0.05)in the anterior cingulate cortex of CFA mice.CONCLU-SION:AST relieves CFA-induced inflammatory pain of mice,and its analgesic mechanism may be related to the inhibi-tion of activation of cortical astrocytes in the anterior cingulate cortex and the promotion of autophagy in CFA mice.