Objective To investigate the value of 18F-FDG PET-CT in the diagnosis of adrenal metastasis.Methods 88 patients (107 adrenal lesions) with adrenal metastasis and benign tumor underwent 18F-FDG PET-CT,all adrenal lesions' short diameter,CT value and 18F-FDG maximum standardized uptake values (SUVmax) were measured.The t test,chi-square test and Pearson correlation test were used for data analysis.Meanwhile,receiver operating characteristic (ROC) curve was used to determine the ability of CT value and SUV~x to differentiate the adrenal metastasis and benign tumor.Results There were 73 adrenal metastases and 34 adrenal benign tumors of 107 adrenal lesions.The short diameter of adrenal metastasis was (2.17±1.14) cm,benign tumor was (1.76±1.00) cm,there was no statistical significant difference between the two groups (t =1.817,P =0.072).The CT value of adrenal metastasis and benign tumor were (29.65±10.29) Hu and (14.83±14.42) Hu (t =5.389,P =0.000),respectively.The SUVmax of adrenal metastasis was 9.28±5.33,while benign tumor was 2.81±1.14,statistical significant difference was found between the two groups (t =9.890,P =0.000).For adrenal metastasis,a significant positive correlation was found between short diameter and SUV~ (r =0.620,P =0.000),and it was also found between CT value and SUVmax (r =0.561,P =0.000).Among all patients with adrenal metastasis,32 (58.2 ％) patients' lesions were found in the left adrenal gland,and 5 (9.1％) in the right side (x2 =29.689,P =0.000).ROC curve analysis showed that using lesion' s SUVmax ＞ 4.1 and CT value ＞ 20 Hu as diagnostic criteria,the sensitivity,specificity,accuracy,PPV and NPV were 91.3 ％ (63/69),94.7 ％ (36/38),92.5 ％ (99/107),96.9 ％ (63/65) and 85.7 ％ (36/42),respectively.Conclusion 18F-FDG PET-CT has high sensitivity,specificity and accuracy in diagnosis of adrenal metastasis,and the adrenal lesion' s SUVmax ＞ 4.1 and CT value ＞ 20 Hu is a better diagnostic criteria.

Myocardial infarction is one of the main factors causing heart failure and is associated with a high rate of morbidity and mortality in the developing countries.Due to infracted cardiac muscles,heart function will aggravate and myocardium will remodel leading to exacerbation of the disease.Current treatment modalities may not be adequate to prevent myocardial remodeling.It is necessary to explore a new approach to restore the damaged myocardium.Stem cell-based therapy is developing rapidly and has been used in the field of cardiovascular disease.There are many problems still to be solved.

Objective To apply the hydrocolloid dressings and hydrocolloid dressings combined GreenCream Dressing for central venous catheterization fixing, and to explore the effect of hydrocolloid dressings combined GreenCream Dressing in the prevention of venous catheter bacterial colonization and bacterial infection. Methods 470 patients who underwent the Inferior vena cava catheter were divided into 230 patients in the control group and 240 patients in the experimental group. The control group was fixed with hydrocolloid dressings after central venous catheter, and the experimental group was fixed with hydrocolloid dressings combined GreenCream Dressing after central vein catheter. The measurements included catheter bacterial colonization, catheter-related infections (CRIs) and catheter related blood stream infections (CR-BSIs), pathogenic bacteria colonization of the skin. At the same time, the skin safety was also confirmed. Results In the control group, 230 cases were retained for 1 419 catheter-days, and 240 cases in the experimental group were retained for 1 675 catheter-days. Compared with hydrocolloid dressings, hydrocolloid dressing combined GreenCream Dressing could reduce the incidence of CRIs from 1.8‰(3/1 675) to 0.7‰(1/1 675), and CR-BSIs from 2.4‰(4/1 675) to 0.7‰(1/1 675) respectively, with the statistically significant (χ2=6.39, 95%CI 1.30-31.41, andχ2=6.21, 95%CI 1.56-40.82;P<0.05). The results of bacterial colonization, CRIs and CR-BSIs showed that the most common bacteria were Staphylococcus and fungi. At the same time, compared with the hydrocolloid dressing, hydrocolloid dressing combined GreenCream dressing could reduce the incidence of skin pathogenic bacteria colonization, from 41.74%(96/230) to 28.33%(68/230),with the statistically significant (χ2=9.29,P=0.00);There was no difference between the two groups in the field of the incidence of abnormal skin manifestation (χ2=1.23, P=0.30), showing a good safety. Conclusions Hydrocolloid dressing combined GreenCream Dressing would be more effective to prevent bacterial colonization and bacterial infection of central venous catheter in department of neurosurgery.

Objective To investigate the predictive value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) calculated from 18F-FDG PET-CT results for postoperative recurrence and prognosis in patients with resectable pancreatic cancer. Methods From may 2009 to December 2015, 30 patients with pancreatic cancer who underwent curative resection after PET-CT examination were enrolled, and the clinic pathological data and 18F-FDG PET-CT data were retrospectively analyzed. The prognostic value of SUVmax, SUVmean, MTV, TLG and other prognosis factors were analyzed. Results In 30 patients with pancreatic cancer, preoperative 18F-FDG PET-CT detected all primary lesion (10 0%). 29 patients were recurrence or metastasis, and 26 patients were died with median of 17.8 months (2.6-39.6 months) follow-up. The median progression-free survival (PFS) time was 6.5 months and the median overall survival (OS) time was 11.6 months. The multivariate analysis revealed the histological differentiation and MTV were the independent influencing factors for PFS (both P<0.05). The lymph node metastasis, MTV and TLG were the independent influencing factors for OS (all P<0.05). Conclusion The MTV and TLG of PET-CT may be predicting the recurrence and survival of patients with pancreatic cancer after curative resection, suggesting that it can be used to guide the individual treatment.

Objective To investigate the diagnostic value of the combined transeranial Doppler ultrasound and CT for vertebrobasilar insufficiency in elderly patients.Methods Fifty elderly patients with symptoms of vertebrobasilar insufficiency were enrolled and randomly assigned to 4 groups,including examinations of TCD,CTA,DSA,combination of TCD and CTA.The diagnostic accuracy was calculated and compared.Results Among 50 cases,the vertebrobasilar insufficiency was confirmed in 42 patients (84％) by TCD,45 (90％) by CTA,48 (96％) by DSA,49(98％) by combination of TCD and CTA.There was no significant difference in diagnostic rate between TCD combined with CTA and DSA (x2 =0.34,P＞0.05).Conclusions The diagnosis accuracy of the combined CTA and TCD is high,making it worth popularizing.

Objective To evaluate the clinical value of 18F-FDG PET-CT imaging on monitoring recurrence, metastasis and therapeutic decision-making in small intestinal adenocarcinoma patients after radical surgery. Methods Twenty-two patients were enrolled, who underwent surgical operation before received PET-CT scan. PET-CT findings were retrospectively observed to compare with the results of follow-up [postoperative pathology and (or) long-term clinical follow-up]. The roles of PET-CT on therapeutic decision-making were then investigated. Results Among 22 patients, 14 cases were finally diagnosed as recurrence and (or) metastasis, the other 8 cases as disease-free survival after long-term follow-up. According to PET-CT, 13 cases were diagnosed as recurrence and (or) metastasis (including 12 true-positive and 1 false-positive), and 9 cases were negative (including 2 false-negative). The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET-CT were 85.7 % (12/14), 87.5 % (7/8), 86.4 %(19/22), 92.3%(12/13) and 77.8%(7/9), respectively. The therapeutic decisions were changed in 10 patients (10/22, 45.5 % ) based on PET-CT results. Conclusion 18F-FDG PET-CT has an important clinical value on the detection of recurrence and (or) metastasis of small intestinal adenocarcinoma, which is an ideal method of monitoring.

BACKGROUND:The principle of lyophilization is to sublimate the solvent of frozen materials in vacuum and retain the solute, thus making a pore structure. OBJECTIVE: To produce a chitosan tubular scaffold by lyophilization, and to test its physicochemical properties. METHODS: The chitosan tubular material was prepared by lyophilization method, folowed by gross observation and electron microscopic observation. The chitosan tubular material samples were placed into PBS solution and pure water for 50 days, respectively, and then immersed in trypsin liquid for 1 day folowed by embedded into the muscle and dorsal skin of neonatal Sprague-Dawley rats for 30 days. The degradation rate and porosity of the material were observed and calculated. The breaking strength and compressive strength of the material were determined both under drying and soaking conditions using tensile instrument and pressure meter, respectively. RESULTS AND CONCLUSION:The external form of the chitosan tubular material was normaly tubular. Under the electron microscope, it was composited by different size pores, and the pore size was 50-200μm. The degradation rates of the material were (5.33±0.12)% in PBS, (11.26±0.15) in water, 0.012% in the trypsin liquid and (35.2±3.7)in vivo. The porosity rate was (97.5±1.5)%. The breaking strength and compressive strength of the material was higher under the drying state than under the soaking state (P < 0.05). These findings indicate that the lyophilization method can produce the chitosan tubular material with good porosity rate and degradation rate as wel as good tensile ability and compressive capability.

Objective To investigate the prognostic value of interim and post-therapy 18fluorine-fluododeoxyglucose(18F-FDG) PET-CT in patients with T-cell lymphoma.Methods A retrospective analysis was conducted on data from 50 patients diagnosed with T-cell lymphoma(12 patients underwent interim PET-CT only,19 patients underwent interim and post-therapy PET-CT,and the rest 19 patients underwent only post-therapy PET-CT).Interim and post-therapy PET-CT(positive versus negative) were visually interpreted according to the criteria of the International Harmonization Project.The progression-free survival (PFS) and overall survival(OS) of two groups were calculated.We used the Fisher exact test and KaplanMeier testfor data analysis.Results Interim 18F-FDG PET-CT results were positive in 19 cases and negative in 12 cases.The median PFS and OS were 8 months and 16 months,in patients with positive results,versus 30 months and 36 months,in patients with negative results.The 1-year PFS and 3-year OS rates were 21.1％ (4/19) and 10.5％(2/19) in patients with positive results at interim PET/CT versus 100.0％(12/12) and 66.7％ (8/12) in patients with negative results(P＜0.01.Post-therapy 18F-FDG PET-CT results were positive in 16 cases and negative in 22 cases,the median PFS and OS were 10 months and 20 months in patients with positive results versus 32 months and 41 months in patients with negative results.The 1-year PFS and 3-year OS rates were 12.5％(2/16) and 12.5％(2/16),in patients with positive results at post-therapy PET-CT versus 95.5％(21/22) and 54.5％(12/22),in patients with negative results(P＜0.01).Conclusion Both interim PET-CT status and post-therapy PET-CT have significant value in monitoring response to therapy and predicting prognosis for patients with T-cell lymphoma.

Objective To investigate the correlation of clinicopathological features and maximum standardized uptake value (SUVmax) detected by 18F-FDG PET-CT in pulmonary large cell neuroendocrine carcinoma(LCNEC).Methods The clinicopathological data of 43 pulmonary LCNEC patients who underwent 18F-FDG PET-CT and were confirmed by pathology in the First Affiliated Hospital with Nanjing Medical University From October 2009 to May 2017 were retrospectively analyzed.Univariate and multivariate analyses were performed on factors that may affected SUVmax in the primary tumor,including the patient's age,gender,tumor location,tumor type,tumor maximum diameter,T stage,N stage,M stage,and TNM stage.Results The SUVmax and tumor maximum diameter of 43 pulmonary LCNEC patients were 11.9 ±4.9 and (3.2±1.4) cm,and there was a positive relation between SUVmax and tumor maximum diameter (r =0.533,P =0.000).The univariate analysis showed that SUVmax was correlated with tumor maximum diameter,T stage,N stage,M stage and TNM stage (all P ＜ 0.05),but was not correlated with patient's age,gender,tumor location,and tumor type (all P ＞ 0.05).The multivariate analysis showed that tumor location,N stage,M stage and TNM stage were the independent influencing factors of SUVmax (OR =2.087,2.852,2.315,-2.200,all P ＜ 0.05).Primary tumor SUVmax had predictive value for lymph node metastasis,when the cut-off value was 13.5,the diagnostic efficiency was the highest,the sensitivity was 64.7 ％,and the specificity was 92.3 ％.Conclusions The SUVmax detected by 18F-FDG PET-CT in pulmonary LCNEC is correlated with tumor maximum diameter,N stage,M stage and TNM stage.Primary tumor SUVmax has a certain reference value for predicting lymph node metastasis.

Objective:To summarize the 10 year clinical experience of treating tibiafibular fractures with rectangle shaped intramedullary nails(RIN). Methods:From January 1987 to December 1996, 4 682 cases (3 278 male and 1 404 female) of tibiafibular fractures from 9 hospitals were treated with RIN . Three kinds of reduction methods including open reduction, semi open reduction and closed reduction were used during operation. Results:Results showed 2 173 cases (62.89%) got excellent result, 947 got good (27.40%), 214 got moderate (6.19%), 121 got poor (3.50%). The total healing rate was 90.29%. Conclusion:RIN has excellent biological characteristics which can provide a flexible interfixation when treating tibiafibular fractures, and the operation is simple, it also can be used for severe open fractures. RIN is one of the good techniques in treating tibiafibular fractures.