Objective To investigate the feasibility of double low scanning technique using the gem spectrum CT coronary artery angiography among the patients at low heart rate≤ 65 beats per minute.Methods This prospective study was approved by the institutional re-view board with patient informed consent.Ninty patients (heart rate≤65 beats per minute)were randomly devided into 3 groups.Group A un-derwent spectral CCTA with iodixanol (Visipaque,270mg/mL)and low scanning technique,Group B conventional CCTA with iohexol (Omnipaque,370 mg/mL)and Group C conventional CCTA with iodixanol (Visipaque,270 mg/mL),Routine scan mode was used in Group B and Group C.Prospective ECG gating mode was used in all groups.120kVp polychromatic images with FBP algorithm (Group B and Group C)were reconstructed for conventional CCTA,60 keV monochromatic images with FBP algorithm (Group A) or with a fixed blending level (40%)of ASiR (Group A1 )were reconstructed for spectral CCTA.Compared the image quality of four groups and ED in three groups.Results The difference was ststistically significant between four groups with the CT value,im-age noise,SNR and CNR of coronary (each P<0.001.Group A1 has the highest SNR and CNR.Group C has the lowest image noise.There were no significant difference of coronary score between group A1 and group B(χ2=0.01,P=1.000)).There was significant difference of coronary score between group A and group B (χ2=22.428,P<0.001),group B and group C (χ2=39.005,P<0.001), group A1 and group A (χ2=21.854,P<0.001).Effective radiation dose in the group A(ED2.60±0.26 mSv)was lower than that of group B (ED3.02±0.36 mSv)(t=3.738,P=0.001)and group C (ED3.11±0.23)(t=3.725,P=0.001).Conclusion Double low scan-ning technique using the gem spectrum CT coronary artery angiography with 40% blending level of ASiR is able to provide better im-age quality than using conventional CCTA and to reduce the effective radiation dose and contrast dose.

Objective To discuss the indication , feasibility and curative effect of endovascular treatment for vascular injuries. Methods 7 patients with vascular injuries were treated by endovascular treatment, including 1 cases of pseudoaneurysm ,2 arteriovenous fistula , 3 closed arteriorrhexis and 1 arterial stenosis after vascular operation . All of the patients were treated by twelve stent - grafts and one introcoil stent. Results All cases were technically successful during follow - up for about 3 to 30 months. The blood flow was rebuild and the diseased region was removed effectively after stent operations. There was no extremity ischemia , hemorrhage , engorgement , stent shift ,fragmentation, angiostegnosis and reinjury appeared in these cases during follow - up. Conclusion Endovascular intervention is a new therapeutic approach with advantages of safety , efectiveness and minimal invasiveness. Its long - term eficacy needs to be further evaluated.

Objective To analysis the effect of stem cell transplantation on serum homocysteine ( Hcy ) , C reactive protein ( CRP ) and brain derived neurotrophic factor( BDNF) in patients with ischemic stroke.Methods 42 patients who were diagnosed with ischemic stroke in Yichang First People's Hospital were collected.All patients were randomly divided into experimental group and control group, 21 cases in each group.The control group was treated with conventional therapy, and the experimental group was treated with autologous bone marrow mesenchymal stem cell transplantation for treatment on the basis of conventional therapy, after treatment, the serum levels of serum homocysteine, CRP, BDNF and clinical curative effect were detected in all patients.Results After treatment, compared with control group, the serum Hcy level was lower in the experimental group(P<0.05);the serum CRP level was lower in the experimental group (P<0.05); the serum BDNF level was higher in the experimental group (P<0.05); the FIM, ADL and Fugl-Meyer score were higher in the experimental group(P <0.05).Conclusions The stem cell transplantation can significantly reduce the serum Hcy and CRP levels in patients with ischemic stroke, increase the content of BDNF in serum, improve the therapeutic effect, and have a guiding significance for clinical.

Objective To investigate the correlation between the insertion torque values and primary stability of dental implants using different insertion torque values ,and search for the best insertion torque values that can acquire good primary stability. Methods Six male pure beagles were selected, and the first molars and four premolars of bilateral mandibulars were extracted. Three months later, a total of 48 XIVE dental implants were inserted. All implants were divided into group A, group B, group C, and group D based on the insertion torque value (ITV): group A, 0 < ITV < 20Ncm; group B, 20 ≤ ITV < 40Ncm; group C,40Ncm ≤ ITV < 60Ncm;group D,ITV≥60Ncm The dental implant stability was measured by Resonance frequency analysis when implanrs were placed immediately. Results No complications occured.There was significant difference between group A and grop B (P=0.012), group A and grop C (P=0.037), group A and grop D (P=0.001). There are no ignificant difference among group B,group C and grop D(P>0.05). Conclusion With the limitations of the study, it was concluded the primary stability does not simply depend on the insertion torque;When the insertion torque value was no less than 20Ncm, the dental implant can acquire good primary stability.

Objective To survey the prevalence of Hyperuricemia (HUA) in elder population of Changchun city,and to detect the correlation between cardiovascular risk factors and the HUA.Methods 900 residents older than 55 years were selected randomly for this questionnaire survey.Physical and laboratory examinations were performed.Results The HUA prevalence rate elder people in Xixin District of Changchun was 16.0％(144/900),while the rates were 13.7％(50/365),15.2％(47/309) and 20.8％(47/226) (P＜0.05) in the elder group (55-65 years),the aged group (66-75 years),and the advanced aged group (older than 76 years) respectively;there was no statistical significant difference in the prevalences between male and female (x2=0.023 5,P＞0.05).The HUA prevalence rate was significantly different between people who had different level of blood pressure,cholesterol,hypersensitive C-reactive protein (hs-CRP),body mass index (BMI),waisthip ratio (WHR).The level of uric acid (UA),total cholesterol (TC) and hs-CRP was significantly different in people with high uric acid when compared with those of normal patients (P＜0.05).There was positive correlation between UA level and TC,triglyceride (TG) level (r=0.364,P＜0.05;r=0.479,P＜0.05).Conclusion The HUA prevalence rate increases significantly as people getting older.There is positive correlation between the increase of uric acid level and the major cardiovascular risk factor.People with hypertension,hyperlipidemia,overweight and obese have high risk for HUA,so change life style and dietary habits may prevent or reduce the occurrence of HUA.

Objective To evaluate the role and mechanism of ifenprodil, which is the selective antagonist of N-methyl-D-aspartic acid subtype receptor NR2B, in soflurane-induced cognitive dysfunction in neonatal rats.Methods Twenty-eight 7-day-old Sprague Dawley rats, weighing 15-18 g, were randomly divided into 4 groups (n=7 each): control group (group C), ifenprodil group (group I), sevoflurane group (group S) and ifenprodil+sevoflurane group (group IS).Normal saline 0.2 ml was injected intraperitoneally in group C.Specific NR2B receptor antagonist ifenprodil 5 mg/kg was injected intraperitoneally at the corresponding time points in group I.Normal saline 0.2 ml was injected intraperitoneally and 2.0% sevoflurane was inhaled for 4 h in group S.Ifenprodil 5 mg/kg was injected intraperitoneally 2 h before sevoflurance inhalation, and 2.0% sevoflurance was inhaled for 4 h in group IS.The rats were then sacrificed 3 weeks after administration, their brains were immediately removed and hippocampal slices were prepared for electrophyisological experiments.The value of population spike amplitude (PSA) and long-term potentiation (LTP) were measured every 10 minutes.Induced LTP was recorded.Results Compared with group C, the values of PSA and rates of induced LTP were significantly decreased in group S (P＜0.01).The values of PSA and rates of induced LTP were significantly increased in group IS than those in group S (P＜0.01).Conclusion NR2B receptor is involved in sevoflurance-induced cognitive dysfunction in the neonatal rats.Pretreatment with ifenprodil 5.0 mg/kg can improve the neurotoxicity and protect the brain.

Objective To observe the effects of ultrasound-guided laryngeal nerve block combined with intratracheal surface anesthesia on the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients.Methods Sixty elderly hypertensive patients,including 37 males and 23 females, with ASA physical statusⅡor Ⅲ,aged 65-85 years,scheduled for thoracic surgery under general anesthesia requiring one-lung ventilation,were equally and randomly divided into either laryngeal nerve block combined with intratracheal surface anesthesia group (group S)or general anesthesia group (group C).Internal jugular vein blood samples were taken to measure the plasma concentrations of epinephrine (E)and norepinephrine (NE) when patients entering the operating room (T0 ),before intubation (T1 ),immediately after intubation (T2 ),at 1 min (T3 ),3 min (T4 ),5 min (T5 )and 10 min (T6 )after intubation.Adverse e-vents,such us hypertension and tachycardia,were recorded during induction and intubation.Results Com-pared with T0 ,the plasma concentrations of E and NE were significantly increased at T2-T5 in group C (P<0.05 or P <0.01),while there were no such significant changes in group S.The plasma concentration of E and NE at T2-T5 in group S were significantly lower than that in group C (P <0.05 or P <0.01).The incidence of hypertension in group S was significantly lower than that in group C during induction of intuba-tion (0% vs 37%,P <0.01).There were no hypotension,tachycardia and bradycardia during induction and intubation in both groups.Conclusion Ultrasound-guided laryngeal nerve block combined with intratra-cheal surface anesthesia can effectively inhibit the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients,which is helpful for maintaining the hemodynamic stability during anesthesia induction.

Objective To study the effect of levosimendan on cardiomyocyte apoptosis after coronary microembolization (CME) in swine,Methods Fifteen healthy swines were randomly divided into sham operation group,CME group and levosimendan treatment group (5 in each group).Their cardiac function was assessed by echocardiography,their cardiomyocyte apoptosis was assyed with TUNEL staining,and Caspase-3 expression was detected by Western blot at 12 h after operation.Results The LVEF was lower,the left ventricular minor axis was shorter and the cardiac output volume was smaller while the LVEDD was longer in CME group than sham operation group (P＜0.05).The cardiac function was significantly better in CME group than in sham operation group (P＜0.05).The cardiomyocyte apoptosis rate and Caspase-3 expression level were significantly higher in CME group than in sham operation group (P＜0.05).The cardiomyocyte apoptosis rate was significantly higher while the Caspase-3 expression level was significantly lower in levosimendan treatment group than in CME group (6.820％±-1.974 ％ vs 10.558％±2.425％,P＜0.05).Conclusion Pretreatment with levosimendan can effecively reduce the cardiomyocyte apoptosis and improve the cardiac function after CME by inhibiting the Caspase-3 expression in cardiomyocytes.

Objective:To develop an diagnostic equipment with artificial intelligence (AI) real-time assistance under endoscopy (endoscopic AI equipment) for the detection of gastrointestinal protruding lesions, and to evaluate its performance and safety.Methods:From January to December 2017, at Endoscopy Center of West China Hospital, Sichuan University, the endoscopic images of individuals who underwent routine gastroscopy and colonoscopy were collected. The model was established based on convolutional neural network and the endoscopic AI equipment was developed. From June to December 2019, a prospective, single center, blinded and parallel controlled study was conducted to compare the differences in evaluation of protruding lesions of the same patient under gastroscopy or colonoscopy between endoscopist and the endoscopic AI equipment and to evaluated the impact of lesion size (lesions <5 mm and ≥5 mm) on the detection of endoscopic AI equipment. The main outcome measure was the detection time difference in reporting the protruding lesion between endoscopic AI equipment and endoscopist; and the secondary indicator was the accuracy of endoscopic AI equipment in detecting the protruding lesion. Wilcoxon rank sum test and chi-square test were used for statistical analysis.Results:A total of 71 582 white light endoscopy images were used for endoscopic AI equipment training, which included 41 376 images of protruding lesions. The endoscopic AI equipment was successfully developed and obtained the registration certificate of medical devices of the People′s Republic of China (Sichuan Instrument Standard, 20202060049). The accuracy, sensitivity, and specificity of endoscopic AI equipment in detecting protruding lesions were 96.4%, 95.1% and 92.8%, respectively. The detection time of each protruding lesions under gastroscopy of endoscopic AI equipment was 1.524 seconds faster than that of endoscopist; but the detection time of each protruding lesions under colonoscopy was 0.070 seconds slower than that of endoscopist, and the differences were statistically significant ( Z=-5.505 and -4.394, both P<0.01). The detection time of each protruding lesions under gastroscopy or colonoscopy of endoscopic AI equipment was not inferior to that of endoscopist. The detection rate of protruding lesions under colonoscopy by endoscopic AI equipment was 89.9% (249/277) and the sensitivity was 89.9%; the detection rate of protruding lesions under colonoscopy was 87.0% (450/517) and the sensitivity was 86.9%. There were no statistically significant differences in the detection time difference, sensitivity and missed diagnostic rate between the lesions <5 mm and ≥5 mm detected by endoscopic AI equipment under gastroscopy (all P>0.05). The sensitivity of endoscopic AI equipment in detecting the lesions ≥5 mm under colonoscopy was higher than that of lesions <5 mm (96.8% vs. 84.9%), and the missed diagnostic rate was lower than that of lesions <5 mm (3.2%, 3/94 vs. 15.1%, 61/405), and the differences were statistically significant ( χ2=9.615 and 9.612, both P=0.002). No adverse events on patients and medical staffs occurred, and there were no cases of equipment electricity leakage, and abnormal work reported during the use of endoscopic AI equipment. Conclusions:The endoscopic AI equipment can report the protruding lesions simultaneously with endoscopists, and the accuracy is close to 90%, which is expected to be a practical assistant for endoscopists to avoid missed detection of protruding lesions.

OBJECTIVE: To explore the application of the"five-line division method "in selecting the surgical approach for occupying lesions in the saddle area and its adjacent areas. METHODS: Based on the natural anatomic structures, 5 lines (alpha, beta, theta line and lambda, epsilon line) were drawn on the images of the craniocerebral axial plane crossing the middle of the saddle area and the craniocerebral median sagittal plane, thus dividing the saddle area and its adjacent areas into 6 regions in the axial plane (1, 2, 3, 1', 2', and 3' regions) and into 4 regions in the sagittal plane (I, II, III, and IV regions). Based on these divisions, the large space-occupying lesions in the saddle area and adjacent areas were classified and their respective surgical approaches were determined after reviewing the commonly used approaches in the saddle area and clinical experiences. We collected the data of 116 patients undergoing surgeries for space-occupying lesions involving the saddle and the adjacent areas in our hospital between September, 2014 and August, 2017, and analyzed their classifications and the corresponding surgical approaches based on the "five- line division method " to compare the consistency between the hypothetic approaches and the approaches adopted in the actual surgeries. RESULTS: The actual surgical approaches adopted in the 116 cases were all selected under the guidance of experts in our hospital. The hypothetic surgical approaches selected based on the"five- line division method "showed a good consistency with the actually adopted approaches. CONCLUSIONS The"five-line division method "can spatially classify the commonly seen space-occupying lesions involving the saddle area and its adjacent area to provide assistance in the selection of surgical approaches for such lesions.
General Surgery/methods* ; Humans