Objective To investigate whether the perfusion of the solitary pulmonary nodules (SPNs) is homogeneous derived with 16-slice spiral CT and 64-sliee spiral CT. Methods Eight-five patients with. SPNs (diameter≤4 cm; 57 maliagnant;15 active inflammatory; 13 benign)underwent multi- location dynamic contrast material-enhanced serial CT. One scan was obtained every 1 seconds during 11- 41 seconds without scanning interval after injection, one scan was obtained at 90 seconds. TOSHIBA AquilionMerconi 16 : The section thickness was 8.0 mm for lesions 3.0-4.0 cm, 6. 0 mm for 2.0- 3.0 cm,4.0 mm for 1.5-2.0 cm,3.0 mm for 1.0-1.5 cm and 2.0 mm for lesions <1.0 cm. GE Lightspeed 64:The section thickness was 8.0 mm for lesions3.0-4.0 cm and 2.5 mm for <3.0 cm. Precontrast and posteontrast attenuation on every scan was recorded. The peak height , perfusion, ratio of peak height of the SPNs to that of the aorta and mean transit time of three central valid sections were calculated. The significance of the difference among groups was analyzed by means of ANOVA. Results The peak heights in three sections were ( 30.95±14.53 ), ( 25.10±13.32), (32.37±15.85) HU, respectively, the perfusions (33.01±21.35), (23.70±12.87), ( 29.00±15.47) ml·min-1·100 g-1, the ratios of peak height of the SPN to that of the aorta (13.58±6.41) %, (10.95±5.76) %, (13.64± 6.20)% and the mean transit times (11.61±5.74),(11.97±3.55), (13.44±3.74) s. Statistically significant differences were found among three sections in the peak height(F= 5.913,P=0.003), perfusion (F=6.464, P=0.002), ratio of peak height of the SPN to that of the aorta (F=5.333, P=0.005) and mean transit time (F= 3.837, P = 0.023). No statistically significant differences were found among three sections in precontrast attenuation ( F =0.032, P = 0.968). Conclusion The volume perfusion of the SPNs is inhomogeneous,it is suggested to evaluate blood flow patterns of the solitary pulmonary nodules with CT volume perfusion imaging.

Objective:To optimize the injection protocol of contrast medium for contrast-enhanced MRA (CEMRA) of pulmonary artery and to evaluate the diagnostic value of CEMRA and pulmonary perfusion imaging (PPI) in an experimental model of acute pulmonary embolism. Methods:CEMRA and PPI were performed in 6 normal pigs with different doses of gadolinium contrast agent (5ml, 10ml, 15ml, 20ml and 25ml) at an injection rate of 3ml/s, and 3 pulmonary embolism models were injected with 20 ml contrast agent at 3 ml/s. DSA was also performed for comparison. Results:The signal intensities and the signal to noise ratios of the pulmonary arteries kept increasing with the dose increase of the contrast agent, but the best angio-pulmonary contrast dose was 10-15ml (0.25-0.375mmol/kg), while the optimal dose for PPI was 15-20ml (0.375-0.5mmol/kg). Although CEMRA demonstrated less obstructed pulmonary arteries than DSA (5/10 vs 8/10)did, it detected all obstructions when combined with PPI. The pulmonary infarction zones showed wedge-shaped perfusion defects on the PPI images, with the signal intensities lower than those of the normal areas (137.86±45.32 vs 330.14±46.52, P<0.001). Conclusion:It is suggested that the optimal dose of the contrast agent is 0.25mmol/kg to 0.375mmol/kg for CEMRA, and 0.375mmol/kg to 0.5mmol/kg for lung perfusion. CEMRA combined with PPI may be better than DSA in demonstrating pulmonary embolism.

Objective To investigate the effect of bone cement distribution near fracture line after percutaneous vertebroplasty (PVP) on patients with osteoporotic vertebral compression fractures (OVCF). Methods One hundred and twenty OVCF patients who had underwent PVP from September 2015 to August 2017 were selected. The range of fracture line was determined by magnetic resonance lipid suppressor sequence imaging before operation, and the three-dimensional modeling was carried out by computer aided design software. Three dimensional imaging of CT bone cement was performed after PVP. The patients were divided into 2 groups according to the bone cement distribution near fracture line. The bone cement distribution near fracture line area was not good in 52 cases (group A), and the bone cement distribution near fracture line was good in 68 cases (group B). The pain visual analogue score (VAS) and the Oswestry dysfunction index (ODI) were measured before operation, second day after operation and 3 months after operation. Results All the patients completed the operation successfully, and the postoperative pain was significantly relieved. In group A, there were 3 cases of with postoperative bone cement leakage, and 4 cases in group B. There were no obvious clinical symptoms, no serious complications such as nerve injury and infection. There was no significant difference in the amount of bone cement between group A and group B: (4.08 ± 0.74) ml vs. (4.03 ± 1.03) ml, P＞0.05. There were no significant differences in VAS and ODI before operation between 2 groups (P>0.05). The VAS and ODI second day and 3 months after operation were significantly lower than those before operation in 2 groups, VAS: (4.54 ± 0.81) and (1.46 ± 0.51) scores vs. (7.38 ± 0.94) scores, (2.68 ± 0.88) and (1.18 ± 0.58) scores vs. (7.21 ± 1.12) scores; ODI: (70.23 ± 2.70) and (19.42 ± 2.21) scores vs. (90.46 ± 1.79) scores, (48.85 ± 2.23) and (18.85 ± 1.84) scores vs. (90.50 ± 2.02) scores, and there were statistical differences (P＜0.05). The VAS and ODI second day after operation in group B were significantly lower than those in group A, and there were statistical differences (P＜0.01). There were no significant differences in VAS and ODI 3 months after operation between 2 groups (P>0.05). Conclusions PVP can obviously relieve the pain of OVCF patients. The bone cement is well distributed near the fracture line, and the early effect is obvious.

BACKGROUNDTo improve the differential diagnosis accuracy for solitary pulmonary nodules (SPNs), and to study the basis and mechanisms of enhancement by comparing with the microvessel constructions (microvessel density and basement membrane of microvessels) in SPNs.

METHODSDynamic contrast enhancement CT scanning were performed in 38 peripheral lung cancer, 5 hamartoma and 10 inflammatory lesions which were less than 3 cm in diameter with Siemens Plus S or Marconi MX 8000 spiral CT scanner. The CT time-attenuation curves were interpreted. The microvessel density (MVD) and the basement membrane of microvessels of the resected specimens were observed with the ABC immuno-histochemical method in all patients.

RESULTSThe CT contrasted value of lung cancer [(49.05±16.08) HU] and inflammatory lesions [(49.59±21.30) HU] were significantly higher than that of hamartoma [(8.98±4.56) HU] (t=7.48, P < 0.05; t=8.35, P < 0.05), but the enhancement of lung cancer was similar to that of inflammatory lesions (t=0.76, P > 0.05). The time-attenuation curve of inflammatory lesions tended to increase faster and reach a higher peak value than that of lung cancer, and both of them maintained a high plateau after crossing. The hamartoma showed a slight increase and demonstrated a low plateau curve. The MVD of SPNs was positively related to CT enhancement (r=0.805 1). The microvessel counts of peripheral lung cancer (48.45±10.09) and inflammatory lesions (49.60±19.94) were significantly higher than that of hamartoma (8.70±7.30) (t=11.64, P < 0.001; t=6.09, P < 0.001), but no significant difference was found between lung cancer and inflammatory lesions (t=-0.26, P=0.799). There was no any difference in continuity of basement membrane between nodules with enhanced CT less than 30 HU and higher than 30 U (Chi-square=3.13, P > 0.05).

CONCLUSIONSThe microvessel counts mainly contribute to the enhancement of SPNs. The basement membrane is not related to nodule enhancement, but it might influence the pattern of time-attenuation curve.

BACKGROUNDTo investigate the methods of dynamic enhanced multi-slice spiral CT in the evaluation of blood flow patterns of malignant solitary pulmonary nodules (SPNs).

METHODSFifty-seven patients with malignant SPNs (≤4 cm) underwent dynamic multi-slice spiral CT (Marconi Mx8000) scan before and after contrast enhancement by injecting 90 ml contrast material with a rate of 4 ml/s. Twenty-nine patients in protocol one were scanned every 2 seconds during 15-45 seconds and 75-105 seconds after injection, while 28 patients in protocol two were scanned every 2 seconds during 11-41 seconds and 71-101 seconds. All patients were then scanned every 30 seconds during 2-9 minutes. The collimation was 2.5 mm for lesions of ≤3 cm and 5 mm for lesions of 3-4 cm. Standard algorithm was used in the image reconstruction. The perfusion, peak height, ratio of peak height of the SPN to that of the aorta and mean transit time were calculated.

RESULTSThe enhancement value, perfusion, ratio of peak height of the SPN to that of the aorta and mean transit time were (34.61±11.37) HU, (31.17±11.18) ml/(min*100 g), 13.90%±4.15%, (13.96±5.86) s separately in protocol one, and (36.54±10.89) HU, (29.80±8.80) ml/(min*100 g), 15.01%±4.83%, (13.34±5.12) s respectively in protocol two. No statistically significant difference was found between the two groups. In addition, mean transit time from all 28 patients in protocol two were obtained, but only part of them were measured in protocol one (22/29).

CONCLUSIONSDynamic enhanced multi-slice spiral CT is a kind of non-invasive method for quantitative evaluation of blood flow patterns of malignant solitary pulmonary nodules. It might have potential significance in angiogenesis research for lung cancer.

OBJECTIVEBody plethysmography is a typical method to measure functional residual capacity (FRC) and airway resistance (Raw). The aim of the study was to test the feasibility of measuring lung function with the body plethysmography in young children with acute lower respiratory tract infection (ALRI) by evaluating changes and prognosis of lung function for infants with ALRI with or without wheezing via body plethysmograph.

METHODPulmonary function tests (PFTs) were performed by using body plethysmography in 444 children with ALRI, aged 1-36 months, to assess their tidal breathing parameters such as ratio of time to peak tidal expiratory flow to total expiratory time (TPTEF/TE), ratio of volume to peak tidal expiratory flow to total expiratory volume (VPTEF/VE), plethysmographic functional residual capacity (FRCP), FRCP per kilogram (FRCP/kg), specific effective airway resistance (sReff), effective airway resistance (Reff), Reff per kilogram (Reff/kg), etc. According to whether there was wheezing or not, children who had ALRI with wheezing were classified as Group-W, or without wheezing as Group-N. Changes or correlations of tidal breathing parameters and plethysmographic parameters were compared.One hundred and three contemporaneous healthy controls aged 1-36 months underwent the same tests for comparison. And 36 wheezing children accepted PFTs at follow-up in recovery phase.

RESULTMean values of TPTEF/TE in Group-W,Group-N and the Control respectively were (20.5 ± 6.7)%,(22.8 ± 6.5)%,(34.6 ± 5.0)% (F = 110.500, P < 0.001), while VPTEF/VE respectively were (23.0 ± 6.3)%,(25.2 ± 6.8)%,(34.5 ± 4.2)% (F = 107.800, P < 0.001). Compared to the Control,Group-W and Group-N had significantly higher values of FRCP (226 vs. 176 vs. 172 ml, χ(2) = 64.870, P < 0.001), FRCP/kg(24.40 vs.17.80 vs.17.60 ml/kg,χ(2) = 68.890, P < 0.001), sReff(1.00 vs. 0.52 vs. 0.46 kPa·s,χ(2) = 75.240, P < 0.001), Reff (3.90 vs.2.74 vs.2.20 kPa·s/L, χ(2) = 36.480, P < 0.001) and Reff/kg [0.42 vs. 0.29 vs.0.22 kPa·s/(L·kg), χ(2) = 29.460, P < 0.001]. Although 25 (12.8%) wheezing children with ALRI had normal values of tidal breathing parameters, they already had increased FRCP, FRCP /kg, sReff, Reff and Reff/kg (t = 2.221, 1.997, 2.502, 2.587, 2.539, all P < 0.05). Values of FRCP and Reff in infants caught ALRI were inversely correlated to that of TPTEF/TE and VPTEF/VE (P < 0.05); 36 children with wheezing who accepted PFTs at follow-up had shown significant decline in the specific parameters of plethysmography such as FRCP, FRCP/kg, sReff, Reff and Reff/kg (Z = -1.999, -2.195, -2.038, -1.823, -2.054, all P < 0.05), while no improvement in the main parameters of tidal breathing such as TPTEF/TE.

CONCLUSIONMeasuring lung function with the body plethysmography in young children with ALRI is feasible. FRC and Raw, as special lung function testing parameters of body plethysmography, were sensitive indicators reflecting impairment of lung function in infants with ALRI (especially for children caught ALRI with wheezing) and shows significant correlation with parameters from lung function testing via tidal breathing. Therefore plethysmography is worthy of clinical promotion.

Airway Resistance ; physiology ; Case-Control Studies ; Child, Preschool ; Female ; Functional Residual Capacity ; physiology ; Humans ; Infant ; Lung ; physiopathology ; Male ; Plethysmography, Whole Body ; Respiratory Function Tests ; Respiratory Sounds ; diagnosis ; physiopathology ; Respiratory Tract Diseases ; diagnosis ; physiopathology ; Tidal Volume

BACKGROUNDTo investigate the methods of dynamic enhanced multi-slice spiral CT in evaluation of blood flow patterns of solitary pulmonary nodules (SPNs) with enhancement.

METHODSSeventy-eight patients with SPNs (≤4 cm) with strong enhancement underwent dynamic multi-slice spiral CT (Marconi Mx8000) scan before and after contrast enhancement by injecting contrast material with a rate of 4 mL/s. For the 40 patients in protocol one, one scan was obtained every 2 seconds during 15-45 and 75-105 seconds after injection, while for the 38 patients in protocol two, one scan was obtained every 2 seconds during 11-41 and 71-101 seconds. For all the patients, one scan was obtained every 30 seconds during 2-9 minutes. The section thickness was 2.5 mm for lesions ≤3 cm and 5 mm for lesions > 3 cm. Standard algorithm was used in the image reconstruction. Precontrast and postcontrast attenuation on every scan was recorded. The perfusion, peak height, ratio of peak height of the SPN to that of the aorta and mean transit time were calculated.

RESULTSThe peak height, perfusion, ratio of peak height of the SPN to that of the aorta and mean transit time in malignant SPNs were 34.85 Hu±10.87 Hu, 30.37 ml/(min*100 g)±11.14 ml/(min*100 g), 13.78%± 3.96% , 14.19 s±6.19 s respectively in protocol one, while those in protocol two were 36.62 Hu±10.75 Hu, 30.01 ml/(min*100 g)±8.10 ml/(min*100 g), 14.70 %±4.71%, 13.91 s±4.82 s respectively. No statistically significant differences were found between the peak height (t= 0.673, P=0.503), perfusion (t= 0.152 , P=0.880), ratio of peak height of the SPN to that of the aorta (t= 0.861, P=0.393) and mean transit time (t= 0.199, P=0.843) in malignant SPNs measured in protocol one and those measured in protocol two. All mean transit time in protocol two (36/36) were obtained, but only part of them (25/32) were obtained in protocol one.

CONCLUSIONSDynamic enhanced multi-slice spiral CT is a non-invasive method for quantitative evaluation of blood flow patterns of SPNs with enhancement and scans beginning at 11 seconds after injection of contrast material is suggested.

Objective To evaluate the value of radiofrequency ablation (RFA) combined with percutaneous vertebroplasty (PVP) in the treatment of metastatic spinal tumor. Methods The clinical data of 94 hospitalized patients with metastatic spinal tumor from January 2013 to January 2017 were retrospectively analyzed.The patients were divided into PVP group(43 cases)and RFA+PVP(51 cases) according to the different treatment methods. The visual analogue scores (VAS) before operation and 1 month after operation were observed.The serum levels of N-telopeptide of typeⅠcollagen(NTx),carboxy terminal telopeptide typeⅠcollagen(ICTP)and bone alkaline phosphatase(BAP)before operation and 1 month after operation were monitored.The recurrence rate of tumor 6 months after operation was record. Results The VAS before operation in PVP group was (7.67 ± 1.12) scores, in RFA + PVP group was (7.71 ± 1.04) scores, and there was no statistical difference (P>0.05). The VAS of 2 groups after operation was significantly lower than that before operation:PVP group(3.17 ± 0.26)scores,RFA+PVP group (2.66 ± 0.31) scores, and there were statistical differences (P<0.05). The VAS in RFA + PVP group was significantly lower than that in PVP group(P<0.05).The serum levels of NTx,ICTP and BAP before operation in PVP group were(25.39 ± 9.77)nmol/L,(36.71 ± 8.77)μg/L,(73.66 ± 14.60)μg/L;after operation were (19.34 ± 6.32) nmol/L, (21.14 ± 6.66) μg/L, (33.63 ± 7.50) μg/L, and there were statistical differences before and after operation (P<0.05). The serum levels of NTx, ICTP and BAP before operation in RFA+PVP group were(26.63 ± 10.53)nmol/L,(35.37 ± 9.42)μg/L,(75.24 ± 13.01) μg/L; those after operation were (12.10 ± 5.17) nmol/L, (15.14 ± 5.08) μg/L, (27.19 ± 8.22) μg/L, and there were statistical differences before and after operation(P<0.05).The serum levels of NTx,ICTP and BAP after operation in RFA + PVP group were significantly lower than those in PVP group (P < 0.05). The recurrence rate of tumor 6 months after operation in RFA+PVP group was significantly lower than that in PVP group: 3.92% (2/51) vs. 16.28% (7/43), and there was statistical difference (P<0.05). Conclusions Compared with simple PVP, RFA combined with PVP can reduce the pain symptoms, reduce the recurrence rate and improve the quality of life in patients with metastatic spinal tumor.

The pathophysiological process of immune inflammatory response after severe trauma is extremely complex, especially manifested in the dynamic changes. In the physiological response state, the inflammatory and anti-inflammatory conditions are in a dynamic balance. The immune inflammatory response is relatively stable, avoiding excessive inflammatory reactions or immunosuppression and reducing further damage to the body. In the pathological response state, the dynamic balance between inflammatory and anti-inflammatory is broken, and it can also lead to persistent inflammatory-immunosuppression-catabolism syndrome (PICS). As a result, it increases serious complications such as uncontrolled inflammatory reactions, sepsis, multiple organ dysfunction syndrome (MODS), and multiple organ failure (MOF). Current researches on post-traumatic immune inflammatory response have also expanded to the genetic level, indicating that the over-expression of genes and the generation and increase of immune response media are likely to be the key reasons for the disorder of immune inflammatory response. The author reviews the research progress of immune inflammatory response mechanism and related clinical intervention after severe trauma, in order to summarize the previous research results and explore the future research direction.

OBJECTIVE To investigate the ameliorative effects and mechanism of Sanwei ganlu on hepatic fibrosis in rats. METHODS The rats were randomly divided into normal group， model group， silibinin group （positive control， 50 mg/kg）， and Sanwei ganlu low-dose， medium-dose， and high-dose groups （80， 250， 800 mg/kg）. Except for normal group， hepatic fibrosis rat models were established by intraperitoneal injection of CCl4 in the other groups of rats. Starting from the 6th week of modeling administration， they were given normal saline or corresponding drugs intragastrically at the same time. At the end of the ninth-week experiment， liver and spleen indexes of rats were calculated； the pathological structure and fibrosis changes of liver tissue were observed by HE， Masson and Sirus Red staining. The contents of alanine transaminase （ALT）， aspartate transaminase （AST）， procollagen type Ⅲ （PC Ⅲ）， collagen type Ⅳ （COL-Ⅳ）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α） and IL-1β in serum， and hyaluronic acid （HA） and laminin （LN） in liver tissue were all detected. RESULTS Compared with the model group， the liver injury and collagen fiber deposition of rats were improved to different extents in Sanwei ganlu groups and silibinin group； the contents of ALT， AST， PC Ⅲ， COL-Ⅳ， IL-6， TNF-α and IL-1β in serum as well as the contents of HA and LN in liver tissue significantly decreased （P＜0.05 or P＜0.01）. CONCLUSIONS Sanwei ganlu can alleviate the progression of hepatic fibrosis in rats， possibly by inhibiting the synthesis of collagen fiber， reducing transaminase content， down-regulating the levels of HA， LN， PC Ⅲ and COL-Ⅳ， and reducing the inflammatory response.