Objective To investigate the value of screening bridge vessels before coronary artery bypass graft(CABG) by ultrasonic examination. Methods To analyze the ultrasonic result of internal mammary arteries,carotid arteries,and radial arteries before CABG. Results Among the 140 cases,11 internal mammary arteries were not qualified,14 of 74 radial arteries were not qualified. And the stenosis of carotid arteries were present in 28 cases. Conclusions It is valuable to examine the bridge vessels before CABG.

Objective To access the left internal thoracic artery (LITA) graft late postoperative patency after coronary artery bypass grafting (CABG) by peripheral blood vessel ultrasound combined with color Doppler coronary flow imaging (CDCFI).In contrast with angiography,try to find available flow parameter to access graft patency.MethodsForty-six patients with CABG more than 1 year postoperatively followed-by angiography were detected by ultrasound.The LITA graft and left anterior descending artery were examined.Systolic and diastolic peak velocity(Smax,Dmax),velocity time integral(VTIs,VTId)of each segment were measured separately.The ratio of diastolic and systolic peak velocity (D/S),and diastolic velocity time integral fraction(DVTIF) were calculated.All patients were divided into groups according to angiography results.ResultsThirty -one LITA grafts were patent,11 were dysfunctional,4 were occlusive.According to the angiography results,the flow parameters of the proximal segment of LITA graft were significant.The D/S and DVTIF of patent group was higher than that of dysfunctional group.The diastolic peak velocity of distal segment of LAD of patent group was higher than that of dysfunctional group.ConclusionsPeripheral blood vessel ultrasound combined with CDCFI could provide the evidence to access the patency of the graft.It was an effective method for the clinical follow-up.

Objective To evaluate the function of peripheral vessels, the change of ankle-brachial Index (ABI) and toe-brachial Index (TBI), and its related risk factors in elderly type 2 diabetic patients were observed. Methods Doppler frequency spectrum was used on lower limb of 128 type 2 diabetic patients and 103 non-diabetic people. ABI and TBI were calculated, other indexes including body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), hypersensitivity C-reactive protein(hs-CRP), triglyceride (TG), total cholesterol (TC), high density lipopretein (HDL), low density lipoprotein (LDL), fasting blood glucose(FBG), postprandial blood glucose (PPBG) and glycosylated hemoglobin (HbAlC) were measured. Results ABI and TBI were decreased in T2DM group as compared with control group (P<0.05), and hs-CRP was increased in T2DM group. With multiple stepwise regression, it showed that ABI and TBI was negatively related with age, SBP and T2DM duration, while ABI was positively correlated with HDL. In multiple logistic regression, cigarette, age, high blood pressure(HBP) and T2DM duration were independent risk factors with respective odds ratios of 1.94 (P<0.05), 2.12(P<0.01), 2.74(P<0.05) and 1.59(P<0.05), respectively. Conclusion Older age, T2DM duration, ciga-rette, hyperglycosema, HBP, low HDL and high bs-CRP play important roles in the occurrence and development of peripheral vascular dis-ease (PVD) in elderly type 2 diabetic patients. PVD of type 2 diabetic patients can be found earlier with Doppler diagnostic instrument.

Objective To investigate CT features on increased cerebral vascular density and its pathological mechanism in patients with cyanotic congenital heart disease(CCHD).MethodsPreoperative brain CT scan and clinical data in 82 patients suffering from CCHD were analyzed. According to the increased levels of vascular density,patients were divided into 4 groups:normal,mild,moderate and severe.Relationships between the increased levels of vascular density and Hb,RBC,HCT,as well as the degree of cyanosis,were studied.AVONA was carried out to test blood CT value of cerebral sinuses,Hb,RBC and HCT in different groups. Descriptive analysis and linear regression were adopted to study the correlation between blood CT value and Hb concentration.The relationship of increased vascular density todegrees of cyanosis was analysed by Spearman.Results Among 82 patients,12 patients ( 14.6％ ) werefound in the group of normal vascular density and 70 patients ( 85.4％ ) in the increased vascular density group.Among 70 patients with increased vascular density,22 patients (26.8％ ) with (55.4 ± 2.6) HU,(169 ±6)g/L of Hb,(5.8 ±0.3) × 1012/L of RBC and 0.51 ±0.03 of HCT,29 patients (35.4％) with (61.3 ± 2.9) HU,(209 ± 15 ) g/L,(7.1 ± 0.4) × 1012/L,0.66 ± 0.06 and 19 patients ( 23.2％ ) with ( 68.8 ± 4.2) HU,( 242 ± 23 ) g/L,( 8.3 ± 0.9 ) × 1012/L,0.78 ± 0.08 were observed in the mild,moderateand severe group,respectively.There were significant differences in distribution of blood CT value ( HU),Hb,RBC and HCT in different groups ( F =163.263,134.703,120.974,136.541 ;P ＜ 0.01 ).Blood CT value was positively correlated with Hb concentration ( r =0.98,P ＜ 0.01 ). Vascular density was also positively correlated with the degree of cyanosis ( r =0.86,P ＜ 0.01 ). Conclusions Cerebral vascular density of patients suffering from CCHD presented different levels of increases based on CT scan results due to rise of RBC stimulated by anoxia.The increased level of vascular density was positively correlated with blood Hb concentration,and also associated with RBC accunulation caused by abnormal blood circulation.Moreover,it was positively correlated with the degree of cyanosis.

Objective To investigate epidemiological and clinical features of human ehrlichiosis.Methods The epidemiological, clinical, laboratory, therapeutic and prognostic data of 21 clinically diagnosed cases of human ehrlichiosis were retrospectively analyzed. Results The epidemic regions where the ticks' activity was high located at the boundary between Hubei and Henan Provinces. All cases were farmers. The median age was 50 years ranged from 19 to 69 years. The male female ratio evident history of tick bite 1 week before the onset. The common symptoms included fever, diarrhea,cough, nausea and vomiting, abdominal pain and expectoration. The complications included hemorrhage, toxic encephalopathy, acute renal insufficiency, secondary infection and respiratory failure. The common abnormalities of routine lab data were thrombocytopenia, hypoeosinophilia,elevated lactate dehydrogenase, creatine kinase and aminotransferases, leucopenia and proteinuria.Nine cases were tested with peripheral blood smear and intracytoplasmic inclusions in neutrophils were found in one case. Seventeen cases were tested with serological assay and antibodies against Ehrlichia were positive in five cases. After doxycycline, symptomatic and supportive treatments, 14 cases were recovered and seven died. The average age of the deaths was 56 years. Conclusions Human ehrlichiosis is an acute tick-borne zoonosis and multiorgan could be involved. The older cases prone to develop complications and the prognosis is poor.

Objective:To search for a method for radical resection of pancreatic and duodenal malignancy involving the mesentery root and for the long post-operation survival of patients.Methods:From Jan.2004 to Aug.2006,a total of 26(16 male and 10 female. aged 27-70)patients with pancreatic and duodenal malignancy involving the mesentery root were treated in our department.The patients included 3 with duodenal malignancy and 23 with pancreatic malignancy.Curative resection was performed by the extended pancreaticoduodenetomy(Whipple procedure)combined with mesentery root resection(MRR)for all patients.The outcomes,safety and the post-operation survival rate were analyzed retrospectively.Results:Thirteen patients were treated with Whipple procedures combined with MRR,9 were treated with partial portal vein/superior mesenteric vein(PV/SMV)and reconstruction of the vessel,and 4 patients received pre-shunt between PV and SMV with artificial vessel graft before the extended Whipple and MRR procedures.The operation time was 2.5 to 7(4.4?1.1)hour,and blood loss was 300 to 5 000(1892?1414)ml with the blood transfusion of 0 to 5 600(2 100?1 586)ml.There was no death in our group and 7(27%)had post-operation complication.The post-operation hospital stay was 10 to 30 days.The pathologic examination showed negative surgical margins for all specimens.The tumor size was 4 to 10 (6.17?2.03)cm.After a follow-up of 9 to 38 months,the pain was relieved in all patients.One of the 3 patients with duodenal adenocarcinoma had liver metastasis at 10 months after operation,and the other 2 survived 10 months and 27 months without evidence of tumor reccurence.The patient with pancreatic micro-adenocarcinoma died of local reccurence 9 months after operation.The patient with neuroendocrine carcinoma died of organ failure 24 months after operation.The patient with lymphoma have survived for 24 months after operation.The 1-year and 2-year accumulated survival rates in the 20 cases with pancreatic ductal cancer were 86.6% and 45.6%. respectively.Conclusion:The extended Whipple procedure with MRR is safe and effective.It can obtain R0 resection in patients with malignant tumors(over 5 cm in diameter)in the head,neck and uncinate process of the pancreas and duodenal.

Cells, Cultured ; Enzyme-Linked Immunosorbent Assay ; Female ; Fetal Blood ; Humans ; Infant, Newborn ; Lipopolysaccharides ; Lymphocytes ; metabolism ; Male ; RNA, Messenger ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Suppressor of Cytokine Signaling 1 Protein ; Suppressor of Cytokine Signaling 3 Protein ; Suppressor of Cytokine Signaling Proteins ; genetics ; metabolism ; Time Factors ; Toll-Like Receptor 2 ; genetics ; metabolism ; Toll-Like Receptor 4 ; genetics ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism

Objective To explore the value of fluid-attenuated inversion recovery (FLAIR)sequence and gradient echo T2 ?weighted image (GRE-T2 ? WI)in diagnosis of acute traumatic extra-axial hemorrhage.Methods 50 patients who were diagnosed as acute traumatic extra-axial hemorrhage by plain CT underwent FLAIR and GRE-T2 ? WI in acute stage.The diagnosis consistency (Kappa ),detection rate of subarachnoid hemorrhage(SAH),epidural hemorrhage(EDH)and subdural hemorrhage(SDH)were compared.The detection rates of SAH in 8 locations among FLAIR,GRE-T2 ? WI and combination of two sequences were analyzed by Chi-square test.Results 48 patients were enrolled in the study.The diagnosis consistency of SAH between FLAIR and GRE-T2 ? WI was high (k =1.0).The detection rate of SAH was 100% for both FLAIR and GRE-T2 ? WI.Comparing with GRE-T2 ? WI and combi-nation of two sequences,FLAIR tended to misdiagnose SAH in perimesencephalic cistern (P <0.05).The diagnosis consistency of EDH between FLAIR and GRE-T2 ? WI was high (k =1.0).3 patients with EDH were all detected by FLAIR and GRE-T2 ? WI. The diagnosis consistency of SDH between FLAIR and GRE-T2 ? WI was high (k =0.943).The detection rate of 12 patients with SDH was 100% in FLAIR,and 1 patient with SDH was missed by GRE-T2 ? WI.Conclusion The detection rate of acute traumatic extra-axial hemorrhage is high for both FLAIR and GRE-T2 ? WI.Combination of two sequences can improve the accuracy of acute traumatic extra-axial hemorrhage in clinic.

SUMMARY To explore the clinical pathological characteristics and improve the recognition in the diag-nosis and treatment of basal cell carcinoma (BCC)of prostate.Three cases of BCC of prostate were re-ported and the relevant literature was reviewed to investigate the diagnosis and treatment of this disease. We analyzed three cases of prostatic BCC.Their ages were within a range of 57 to 83 years.One of them complained of hematuria and two complained of dysuria.All of them presented with prostatic hyperplasia. Two of them presented with high prostate specific antigen (PSA)and one with normal PSA.Case 1 had prostate cancer invasion of bladder,rectal fascia,with lymph node metastasis,bone metastasis and lung metastases.The patient received bladder resection +bilateral ureteral cutaneous ureterostomy +lymph node dissection on November 2,2014 .Postoperative pathological diagnosis showed BCC.Reexamination of pelvic enhanced MRI in January 8,2015 suggested pelvic recurrence.Abdominal enhanced CT showed multiple liver metastases and pancreatic metastasis on July 11,2015.Prostate cancer specific death occurred in October 2015.Case 2 was diagnosed as BCC in prostate biopsy on March 27,2015. Positron emission tomography and computed tomography (PET-CT)showed pulmonary metastasis and bone metastasis.Then the patient received chemotherapy,endocrine therapy and local radiation therapy. Reexamination of PET-CT on January 11,2016 showed that the lung metastase tumors and bone metas-tase tumors were larger than before.Up to January 10,2016,the patient was still alive.Postoperative pathological changes of transurethral resection of prostate (TURP)in case 3 showed BCC might be con-sidered.The PET-CT suggested residual prostate cancer,which might be associated with bilateral pelvic lymph node metastasis.In April 20,2016,the review of PET-CT showed pelvic huge irregular hybrid density shadow,about 14.5 cm ×10.0 cm ×12.9 cm in size,and tumor recurrence was considered. Then the patient received local radiation therapy.The patient survived in the followed upon January 10, 2016.BCC of prostate is a rare subtype.Due to the local infiltrative and distant metastatic potentiality, active management is preferred and a life-long follow-up is necessary.

Objective:To assess the anatomy of superficial circumflex iliac artery perforator (SCIP) and its feasibility for tongue re-construction after tumor resection. Methods:From January 2014 to January 2015, a total of 15 patients with oral maxillofacial defects underwent SCIP flap surgery. Perforator identification and SCIA course were performed intra-operatively. The relationships among the SCIA, deep circumflex iliac artery (DCIA), and superficial inferior epigastric artery (SIEA) were determined intra-operatively. Surgical procedures, measurement of vessel's caliber and pedicle's length, SCIP flap anatomy, and their outcomes were described. Results:Flap mean thickness was approximately 1.2±0.3 cm. The mean diameter of the SCIA was 0.7±0.2 cm, and that of the superficial circumflex iliac vein was 1.2±0.2 cm. The relationships among SCIA, DCIA, and SIEA were described and subdivided into typeⅠ(8/15), typeⅡ(2/15), typeⅢ(2/15), typeⅣ(2/15), and typeⅤ(1/15) in intra-operative dissection. The flap sizes were in the range from 6 cm × 4.5 cm to 11 cm × 10 cm. A total of 14 SCIP flaps survived, and 1 SCIP flap underwent necrosis. Conclusion:The SCIP flap is a reliable, thin, and pliable flap with long vascular pedicles and hidden donor site morbidity. Its texture is a perfect match for tongue defect reconstruc-tion.