Objective To investigate the depiction rate of normal cisterna chyli and thoracic duct by nonenhanced MR lymphography and to describe their appearances on MR imaging.Methods Special MR hydrography sequence was added to the MR imaging protocols of 112 patients undergoing MR examination of the thorax and upper abdomen.MR imaging sequences included:①Respiratory-gated HASTE T2W sequence;②Breath-hold FLASH T1W sequence;③Respiratory-gated TSE 3D T2W sequence(3D MR hydrography sequence)in coronal plane.One hundred cases who met the inclusion criteria were included into the study for observation of the depiction rate,location and morphology of cisterna chyli and thoracic duct.Results On TSE 3D T2W imaging:①Cisterna chyli was visualized in 71/100(depiction rate 71.0%),morphologically including single-tube type 43.7%(31/71),bifurcation type(2-3 tubes)23.9%(17/71),plexus type 32.4%(23/71).Average length of the cisterna chyli was 4.5 cm.②The depiction rate of the lower segment of thoracic duct was 57.0%(57/100),average ductal diameter was 0.23 cm.③The depiction rate of upper segment of the thoracic duct was 31.0%(31/100).Conclusion As a noninvasive method for depicting the lymphatic system,nonenhaced MR lymphography(TSE 3D T2W sequence)demonstrated a high depiction rate for cisterna chyli and lower thoracic duct.Combined with axial images of HASTE and FLASH sequences,the location and morphology of these larger lymphatic ducts can be defined.

Objective To explore the use of magnetic resonance imaging (MRI) in the display of detailed anatomical structures at the pancreaticobiliary junction. Methods 112 patients who received enhanced MRI of upper abdomen were included in the study. Patients with pancreatic and/or biliary diseases diagnosed clinically and with laboratory tests were excluded. The types of junction between the terminal common bile duct and the pancreatic duct, and the location of the major duodenal papilla were studied on MRI. We measured the angle between the duodenum and the common pancreaticobiliary duct or the common bile duct. Results Of the 112 patients, the duodenal papillas were located at the upper, middle, and lower segment of the duodenum in 17. 0%, 66. 0% and 17. 0%, respectively.The angle between the common pancreaticobiliary duct or the distal common bile duct and the descending duodenum was 44. 4°±17. 3°. The pancreatic duct and the common bile duct opened separately in 9 patients (8. 0%). The confluence of the two ducts was present inside and outside of the duodenum wall in 13 (11. 6%) and 90 patients (80. 4%), respectively. The angle between the distal common bile duct and the pancreatic duct was 37. 8°±15.1°. Conclusion MRI was able to display detailed anatomical structures of the pancreaticobiliary junction, including the angle of the junction between the two ducts and the location of the duodenal papilla. It has the ability to provide meticulous anatomical data for the diagnosis and treatment of diseases at the pancreaticobiliary junction and to help surgeons formulate operative plans.

Objective To explore the optimal protocol of lower-extremity contrast-enhanced MRA (CE-MRA) in the evaluation of diabetic foot.Methods Twenty eight healthy volunteers were scanned by CE-MRA in crus twice with parellel imaging factor (PIF) of 3 or 4.The signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR) and image quality of popliteal artery,posterior tibial artery,anterior tibial artery and peroneal artery were compared.Twenty patients with diabetic foot underwent CE-MRA by both of protocol 1 and 2 in leg,crus and foot.Protocol 1 was the traditional Care-bolus protocol and protocol 2 was the optimized K-space center filling delay-time protocol.The difference of two protocols in venous aliasing and in display of femoral artery,popliteal artery,posterior tibial artery,anterior tibial artery,peroneal artery,dorsalis pedis artery,medial plantar artery and lateral plantar artery were compared.The SNR,CNR of two different PIF sequences were compared by paired t test,and the display of artery of crus was compared by Wilcoxon.The display of vessels and venous aliasing of 2 protocols of diabetic foot patients were compared by Wilcoxon.Results In the images of healthy volunteers with PIF of 3,the SNR were 267±84,174±51,147±42;and the CNR were 232 ±83,139±51,108±39 at popliteal artery,posterior tibial artery and peroneal artery.However,in the images with PIF of 4,the SNR were 239±73,157±53,132±35;and CNR were 206±71,124±50,103±33,respectively.Both the SNR and CNR were higher in the former than in the latter(t values were 2.31 to 4.11,P＜0.05).There was no significant difference in the vessel display between the different PIF volunteers (P＞0.05).In the protocol 1 of patients with diabetic foot,the display of popliteal artery,posterior tibial artery,anterior tibial artery,peroneal artery,dorsalis pedis artery,medial plantar artery and lateral plantar artery,the venous aliasing in crus and foot were 3.40±0.82,2.70±0.80,2.50±1.00,2.20±0.77,2.30±0.92,2.15± 1.04,1.45±0.60,2.20± 1.01,2.20± 1.06.And in the protocol 2,they were 3.85±0.37,3.55± 0.69,3.30±0.92,2.90±0.79,3.30±0.92,3.25±0.79,1.95±1.10,3.70±0.47,3.65±0.49,respectively(P＜0.05).All of these parameters of protocol 2 were superior to protocol 1.Conclusion Using a higher PIF properly,setting the personalized K-space center filling delay-time can contribute to improving the image quality of whole lower-extremity MRA in patients with diabetic foot.

Background Venous malformation damages the local tissue severely because of the progressive development and often presents with invasive biological behavior.Galectin-3 (Gal-3) is proved to be closely associated with local invasion of malignant tumor.Studying the role of Gal-3 on tissue invasion in venous malformation of ocular region is of important clinical significance.Objective This study was to explore the role of Gal-3 protein and mRNA expression in venous malformation of ocular region.Methods One hundred and eighteen pathological sections were collected from ocular venous malformation patients who received surgery in Department of Hemangioma Surgery,People's Hospital of Henan Province and Henan Eye Institute from June 2009 to June 2014.The specimens were further diagnosed by histopathological examination.Then the expressions of Gal-3 protein and mRNA in venous malformation of ocular region were detected by using immunohistochemistry and in situ hybridization and compared with 20 pieces of distal cutting edge specimens which were evidently normal.The associations of Gal-3 positive expressions with invasion and configuration of lesions were analyzed.Results Pathological examination showed that venous malformations tissues contain many big blood vessels lacuna, lined with fiat endothelial cells.Immunochemistry and in situ hybridization exhibited that Gal-3 protein and mRNA were expressed in the cytoplasm and nuclei.The positive expression rates of Gal-3 protein and mRNA in the venous malformation tissues were 55.93％ (66/118) and 59.32％ (70/118) , but those in the normal tissue were 15.00％ (3/20) and 20.00％ (4/20) ,showing significant differences between them (x2 =11.461, 10.633, both at P＜0.05).No significant differences were seen in the positive expression rates of Gal-3 protein and mRNA between the patients aged ≤ 12 years and ＞12 years or different genders (age: x2 =0.334,0.128;both at P＞0.05.gender:x2 =0.606,1.155;both at P ＞0.05).The incidence rate of invading ocular deep tissues was significantly higher in the Gal-3-positive groups than that in the Gal-3-negative groups of protein and mRNA (protein :x2 =32.688, P＜0.05;mRNA : x2 =23.695, P＜0.05).In the Gal-3-negative groups,96.15％ (Gal-3 protein negative group) and 97.92％ (Gal-3 mRNA negative group) lesions showed the spherical shape with clear boundaries.The lesions texture with the fuzzy boundaries and the incidences of vague structure in lesions were significantly higher in the Gal-3-positive groups than that in the Gal-3-negative groups of protein and mRNA (protein :x2 =28.255, P＜0.05;mRNA : 28.186, P＜0.05).Conclusions Gal-3 expression rate is raised in the deep tissue-invaded and texture disorder ocular venous malformation.These results suggest that invasion and damage of ocular venous malformation are associated with the up-regulation of Gal-3.

AIM: To investigate the effect of ischemia induced by central retinal artery occlusion on retinal microstructure of macula using optical coherence tomography (OCT). METHODS: Fourteen eyes of 14 patients with unilateral central retinal artery occlusion (CRAO) in two to three days without fully recovery of retinal circulation underwent OCT examination with 4.5 mm length horizontal and vertical line scans through foveola to measure the retinal neurosensory layer (RNL) thickness on foveola, 175 ?m (fovea), 750 ?m (macula) to foveola, respectively. The other normal eyes of patients as control group underwent the same examination and measurement. RESULTS: The mean RNL thickness(?m) on foveola, fovea, macula were 169 91?10 96, 176 36?11 74 and 256 45?16 95 respectively in normal control eyes, and 235 64?47 02 , 241 84?49 36 and 401 57?54 53 respectively in CRAO eyes with retinal ischemia. There was a significant difference in thickness between two group ( P

OBJECTIVETo explore the therapeutic effect of radiofrequency ablation for tongue venous malformation( VM).

METHODSFrom July 2013 to July 2014, 30 cases with tongue VM (local or diffuse) were retrospectively analyzed. 23 cases underwent radiofrequency ablation treatment. The radiofrequency electrode tip(0. 5 mm in diameter) was inserted into the lesion 1 mm below the bottom with 25 W in power and 15-30 s of pulse. The treatment was repeated when the electrode tip was removed back every 1 mm. Multi-point treatment was performed.

RESULTS15 cases with unilateral VM were completely healed after one-stage radiofrequency ablation. 8 cases with bilateral VM received two-stage radiofrequency ablation with a 3-6 months of interval. Among the 8 cases, completely healing was achieved in 5 cases, partial VM residue happened in 3 cases due to its diffuse lesion and reservation of tongue function. 23 cases were followed up for 3 month to 1.5 years. Good cosmetic and functional results was achieved in 20 cases with no relapse. Partial VM residue was left in 3 cases.

CONCLUSIONSRadiofrequency ablation can effectively treat tongue VM with minimal morbidity and good cosmetic appearance. It also avoids the disadvantages of surgery.

Catheter Ablation ; instrumentation ; methods ; Electrodes ; Humans ; Retrospective Studies ; Tongue ; blood supply ; Treatment Outcome ; Vascular Malformations ; surgery ; Veins ; abnormalities

Objective To evaluate the efficacy and safety of photodynamic therapy(PDT)combined with intravitreaIinjection of bevacizumab for choroidal neovascularization(CNV)caused by agerelated macular degeneration(AMD). Methods A total of 21 eyes of 21 patients with AMD,which was diagnosed by examination of visual acuity,intraocular pressure,ocular fundus,fundus color photography,fundus fluoreseein angiography(FFA),indocyanine green angiography(ICGA)and optic coherence tomography(OCT),were underwent PDT combined with intravitreal injection of Bevacizumab.The patients,15 males(15 eyes)and 6 females(6 eyes),aged from 56 to 78 years,with the average of 68.6years.The best corrected visual acuity:counting fingers/10cm-0.9,logMAR was 1.04±0.41.CNV located in below or side central fovea of macula.There was obvious leakage of fluorescein which examined by FFA and ICGA.The average of retinal thickness of macular foveal was(258.91±78.66)μm.The treatment method of PDT has to according to the way of PDT for TAP and Verteporfin PDT for VIP.Intravitreal infeetion with 1.5mg bevacizumab was performed after three days under surface anesthesia.Follow-up time was 1,3,6,12 months after the treatment. Resuits At last visit,the best corrected visual acuity:counting fingers/10 cm-1.5,logMAR was 1.04±0.41,and the differences are statistically significant compared with before.The BCVA improved four or more lines in 6 eyes(28.57%),improved two to four lines in 9 eyes(42.86%),stabilized(±1 line or no change)in 6 eyes(28.57%)and decreased in none.The average intraocular pressure was(15.20±2.41)mmHg after surgery,and the differences was not statistically significant compared with before(P＞0.05).FFA and lCGA showed CNV complete closure in 13 eyes(61.90%).partial closure in 8 eyes(38.10%).The average of retinal thickness of macular foveal was(127.38±20.14)μm(P＜0.01). Conclusion Combining treatment with PDT and intravitreal injection of Bevacizumab is safe and effective for CNV which caused by AMD.It has significant improvement in BCVA.1eakage of CNV and retinal edema.

Objective: This study aims (1) to evaluate the surgical outcome of intramuscular venous malformations, and associated nerve and tendon encapsulated; (2) to summarize the surgical procedure, with the purpose of providing individualized surgical treatment. Methods: This is a retrospective study of 114 patients of intramuscular venous malformations with associated nerve and tendon encapsulated. All the patients were admitted in the Henan Provincial People′s Hospital from January 2012 to December 2014. The surgeries were produced, according to the patient′s condition. The surgical outcome was evaluated after 1-3 years follow up, by the overall evaluation of radiological imaging, symptoms and functions of limbs. The evaluation criteria: (1) Invalid: clinical symptoms or radiological imaging showed no improvement or even worsen; (2) Improvement: clinical symptoms or radiological imaging was significantly improved; (3) Cure: clinical symptoms were gone or the radiological imaging was normal. Results: All the 114 patients were followed up for 1-3 years, with the average of 1.8 years. Three cases were evaluated as invalid, 26 cases were improved, and 85 cases were cured. The effective rate was 97%, and the cure rate was 75% on 1 year after surgery. Conclusions It is difficult to treat intramuscular venous malformations as it often involves nerve and tendon. Universal treatment is few. Therefore, an individualized surgical plan is recommendable.

Objective To investigate the clinical efficacy and prognostic factors of radical hepatectomy of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 760 HCC patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from August 2003 to June 2015 were collected.Surgical procedures were determined according to the location,number and size of tumors and anatomical relations among vessels.Observation indicators included:(1)intra-and post-operative situations:surgical procedures,operation time,volume of intraoperative blood loss,cases of intraoperative blood transfusion,postoperative complications,duration of postoperative hospital stay and pathological examination;(2) follow-up:1-,3-,5-year overall and tumor-free survival situations;(3) prognostic factors analysis of HCC patients.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to January 2016.Measurement data with normal distribution were represented as-x±s.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Intra-and post-operative situations:all the 760 patients underwent successful operations,including 419 undergoing anatomical hepatectomy and 341 undergoing non-anatomical hepatectomy.R0 and R1 resections were respectively applied to 742 and 18 patients.Two patients were combined with portal vein resection and reconstruction and 1 was combined with resection and reconstruction of inferior vena cava.Operation time,volume of intraoperative blood loss and cases of intraoperative blood transfusion were (226± 115) minutes,(714±706) mL and 88,respectively.Fifty-five patients had postoperative complications,including 20 with abdominal effusion or abscess,16 with pleural effusion,9 with recurrent fever,8 with incisional infection,7 with intra-abdominal hemorrhage,6 with liver failure,3 with pyloric or intestinal obstruction and 2 with renal failure (some patients with multiple complications).Of the 55 patients with postoperative complications,7 with hemorrhage underwent reoperation or interventional therapy and other patients underwent conventional symptomatic treatment.Of 55 patients,5 patients died and other 50 patients were improved.Duration of postoperative hospital stay was (14±6) days.There were 457 patients with minimum margin of tumors ≤ 1.0 cm and 303 with minimum margin of tumors ＞ 1.0 cm.(2) Followup:all the 760 patients were followed up for 1-139 months,with a median time of 25 months.The overall and tumor-free median survival times were 59 months and 31 months,respectively.The 1-,3-,5-year overall and tumor-free survival rates were 81.7％,63.4％,47.9％ and 68.7％,44.9％,29.6％,respectively.(3) Prognostic factors analysis of HCC patients:results of univariate analysis showed that clinical symptoms,alpha-fetoprotein (AFP),Barcelona clinic liver cancer staging,surgical procedures,intraoperative blood transfusion,minimum margin of tumors,number and diameter of tumors,tumor capsule,tumor differentiation,vascular cancer embolus,macrovascular invasion and tumor staging of American Joint Committee on Cancer (AJCC) were related factors affecting prognosis of HCC patients after radical hepatectomy [HR =1.39,1.50,1.92,0.65,1.45,1.68,1.96,1.66,2.26,1.50,2.68,3.37,2.00,95％ confidence interval (CI):1.08-1.79,1.16-1.94,1.68-2.20,0.50-0.84,1.04-2.02,1.28-2.20,1.54-2.49,1.42-1.94,1.69-3.02,1.22-1.85,1.99-3.60,2.61-4.36,1.77-2.27,P＜0.05].Results of multivariate analysis showed that AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC were independent factors affecting prognosis of HCC patients after radical hepatectomy (HR=1.61,1.62,1.31,1.40,1.78,95％CI:1.14-2.26,1.22-2.14,1.06-1.63,1.10-1.79,1.27-2.51,P ＜ 0.05).Conclusions The anatomical and non-anatomical hepatectomies are safe and feasible for optional HCC patients,with a good long-term outcome.AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC are independent factors affecting prognosis of HCC patients after radical hepatectomy.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China.It has high malignancy,strong invasion and metastasis,and a poor prognosis.It seriously threatens the life and health of people.With the development of modem medical technology,the treatment of HCC has developed into a comprehensive treatment mode based on surgical resection.At present,surgery is still the best cure for liver cancer.The treatment plan should be formulated according to different individuals,such as surgical treatment,ablation,embolization,chemotherapy,molecular targeted therapy,immunotherapy treatment and sequential application of that comprehensive treatment,to improve the overall efficacy of HCC and prolong the survival period and improve the quality of life of patients.The present situation of comprehensive treatment of HCC was discussed in this paper.