Background and purpose: Magnetic resonance spectroscopy is currently the only non-invasive magnetic resonance imaging technique which can detect metabolite composition of live organ and tissue and also conduct semi-quantitative or quantitative analysis. We analyzed the characteristics of metabolic changes among normal liver, cirrhosis regenerative nodule and liver cancer on the background of cirrhosis by voxel proton MR spectroscopy at 1.5 Tesla. Methods: 20 healthy volunteers (control group), 25 cirrhosis (cirrhosis group) and 23 hepatocellular carcinoma after cirrhosis (HCC group) patients were our candidates. The characteristics of spectra of ~1H-MRS were observed. The height and ratio of choline complex (Cbo) and lipid methylene (Lip2) were recorded and the results were compared among the groups. Results: The success rate of ~1H-MRS was about 88.2% (60/68). There were statistically significant differences among the heights of Lip2 peak of the three groups, and also between that of the control group and the group of liver cancer. But there were no significant differences between that of control group and cirrhosis group, cirrhosis group and liver cancer group. The comparison of the height of Cho peak and the ratio of Cho/Lip2 showed statistically significances both among the three groups and between each other. Conclusion: The metabolic changes of the liver could be shown non-invasively by ~1H-MRS, which could be useful for differential diagnosis or diagnosis of cirrhosis regenerative nodule and HCC.

Objective To evaluate the clinical value of dual-energy CT in the detection of monosodium urate crystals in patients with gout.Methods One hundred and eight patients who experienced unilateral arthrocele and (or) joint pain in the past two weeks were enrolled into our study.DECT were performed for the upper or lower extremity.Ninety-five patients were enrolled into the gout study group based on the American rheumatism association (ACR) classification standard;The 0.3 linear blended images group were regarded as conventional CT group,DE (80 kV and 140 kV) datasets were reconstructed via gout-recognition software,the pseudo-color images group as the postprocessed group.Imagings were reviewed independently by two senior radiologists.Chi-square test were used for statistical analysis with the SPSS 13.0software.Results In the conventional CT group,DECT scans revealed a total of 298 areas of urate deposition in 51 patients;The sensitivity,specificity,and accuracy were 53.7％,84.6％,and 57.4％.In the postprocessed group,401 areas of green urate deposition were detected in 69 patients,the sensitivity,specificity,and accuracy were 72.6％,100.0％,75.9％ respectively,the differences had statistical significance (x2 =7.329 and 8.333,P ＜ 0.05).Conclusions DECT gout recognition technology can detect smaller amount of monosodium urate in the other parts of the body,with a great potential in early diagnosis and treatment monitoring of patients with gout.

Objective To study the effect of modified air bag deflation lubrication by Sengstaken-Blakemore tube on voluntary dysphagia induced by esophageal variceal bleeding.Method Twenty seven patients with voluntary dysphagia induced by esophageal and gastric variceal bleeding were managed with modified air bag deflation lubrication with Sengstaken-Blakemore tube.Results The indwelling time for the Sengstaken-Blakemore tube was 3~6 d.There was no complication of gastrointestinal mucosal injury and aspiration complications.Conclusion The modified air bag deflation lubrication by Sengstaken-Blakemore tube may effectively avoid the complications by hemostasis with Sengstaken-Blakemore tube.

Objective To retrospectively analyze CT and MR appearances of hepatic adenoma,and to study the causes of misdiagnosis with review of relative literatures.Methods CT and MRI data of 8 patients with pathologically confirmed hepatic adenoma were retrospectively analyzed.Pre-and post-contrast tri-phase (arterial,portal venous and delayed) CT scans and routine MR .scan were performed in all 8 patients,and proton magnetic resonance spectroscopy (~1H-MRS) was performed in 2 patients.Results Typical demonstrations were found in 4 patients who were correctly diagnosed.Among the others with atypical findings,3 patients were misdiagnosed as liver cancer and 1 as focal nodular hyperplasia (FNH) .The ~1H-MRS curves of 2 adenoma tumor showed that the peak of choline of tumor tissue had no significant difference comparing with that of normal liver tissue around the tumor tissue.Conclusion CT and MRI findings of hepatic adenomas have some characteristics,but atypical manifestations lead to misdiagnose.~1H-MRS may be helpful for the differential diagnosis of hepatic adenoma.

Objective To evaluate the diagnostic accuracy and integrity of two-dimension ultrasound (2DUS)assisted with spatio-temporal image correlation (STIC)for cardiac and vascular abnormalities in fetal heterotaxy syndrome (HS).Methods The retrospective study was conducted from Nov 2007 to Feb 2013.Forty-five fetuses with suspected heterotaxy syndrome on routine prenatal ultrasonic screening underwent STIC volume sweep.The diagnosis was confirmed by pathological or echocardiographic examination.STIC volume data sets of fetal hearts were off-line analyzed blindly by one doctor who had practiced fetal echocardiography for more than five years.The concordance and integrity levels of diagnosis with 2DUS or assisted with STIC were compared according with pathological results.Results There were 397 cardiac and vascular defects in 37 cases of right isomerism.The overall concordance of various defects in right isomerism diagnosed assisted with STIC (96.5%)was significantly higher than that of 2DUS (60.2%) (P <0.05).The concordance rates of right atria and ventricle isomerism,anomalies of ventriculo-arterial junction,arterial arch,systematic and pulmonary veins diagnosed assisted with STIC (78.9%,96.7%, 100%,100%,100%)were higher(P <0.05)than those of 2DUS (49.1 %,60%,34.7%,23.2%,62.2%). Percentages of diagnostic integrity levels (0 ~3)on 2DUS+STIC (8% on level 2,92% on level 3 )were significantly different(P <0.05)with those on 2DUS (1 1 % on level 0,21 % on level 1 ,57% on level 2, 1 1 % on level 3).There were 59 cardiac and vascular defects in 8 cases of left isomerism with the overall concordance of defects diagnosed assisted with STIC (89.8%)and 2DUS (81 .4%)being no difference (P >0.05).There was no significant difference in concordance rates of various defects of left isomerism diagnosed between two methods,except that the concordance rate of left atria isomerism diagnosed assisted with STIC was higher(P <0.05).There was no difference in percentages of diagnostic integrity levels (0-3)in left isomerism between two methods.Conclusions STIC technology may provide considerable diagnostic information for ultrasonic diagnosis of fetal heterotaxy syndrome,especially in abnormalities of atria and ventricle isomerism,ventriculo-arterial junction,arterial arches,systematic and pulmonary veins in right isomerism.

Objective To evaluate the efficacy of eszopiclone for patients with acute insomnia and the impact of premedication with eszopiclone on sleep structure of patients with acute insomnia.Methods In an open-label,self-control trial was conducted at Changzheng Hospital Sleep Centers,and patients (n =32) with acute insomnia (12 men,20 women; mean age,36.2 years) were administered eszopiclone 3 mg for three consecutive nights.Sleep was monitored via polysomnography.The insomnia severity index (ISI),and mini-mental state examination (MMSE) were used to assess the degree of insomnia and impact of drugs on cognitive function during the day.Results Eszopiclone can shorten sleep latency ( before treatment:(52.92 ± 11.71 ) min,after treatment:(28.2 ± 10.11 ) min; t =-4.376,P ＜0.01 ),prolong total sleep time(before treatment:(365.22 ±30.13) min,after treatment:(429.18 ±26.93 ) min; t =4.102,P ＜ 0.01 ),decrease wake up times( before treatment:( 5.00 ± 1.92 ) times,after treatment:( 2.73 ± 0.91 )times; t =- 4.592,P ＜ 0.01 ),improve sleep efficiency ( before treatment:72.69％ ± 6.32％,after treatment:82.67％ ± 4.16％ ; t =3.371,P ＜ 0.01 ),reduce awake time ( before treatment:( 88.51 ±17.48) min,after treatment:(65.93 ±21.l0)min; t =-4.592,P ＜0.01 ),decrease light sleep ( NREM1 period) the percentage of time ( before treatment:12.54％ ± 2.10％,after treatment:7.30％ ± 2.90％ ;t=-3.155,P ＜ 0.01 ),and increase the percentage of slow wave sleep (before treatment:8.03％ ±5.37％,after treatment:9.31％ ±5.29％; t =4.228,P ＜0.01).No effect was observed on the percentage of NERM2 period (t =0.731,P ＞0.05) and REM period (t =-0.813,P ＞0.05).Eszopiclone can improve the quality of subjective assessment of sleep ( ISI score decreased,t =- 2.551,P ＜ 0.05) and has no significant effect on cognitive function on first the morning after patients taking the medication.Conclusion Eszopiclone can positively regulate the sleep structure in patients with acute insomnia and improve subjective assessment of sleep quality.It is safe and has no significant effect on cognitive function.

Objective To evaluate the dose reduction technology using in CT-guided percutaneous lung biopsy of pulmonary lesions using automated core needle biopsies (ACNB).Methods 412 ACNB cases included 146 consecutive conventional patients (group A,120 kV/100 mA) and 266 consecutive patients (group B,120 kV/20 mA,low-dose scanning,reduce scanning width and scanning frequency).The quality of images was compared by grain homogeneity,fine structure,clearness of tissue interface and artifacts.The total diagnostic accuracy rate,the examination time and radiation dose between group A and group B were compared.Results The fine structure of group B was significantly lower (X~2 ＝7.0508,P ＜ 0.05).The total diagnostic accuracy rate was 95.9% vs 95.1% (X~2 ＝0.1296,P ＜ 0.05).The examination time for biopsy procedure was (16 ±2.2)min vs (15.9 ±2.0)min (t ＝ 1.3579,P ＜ 0.05) ,and the mean effective dose (E) was (1.74 ± 0.7) mSv vs (0.59 ± 0.14) mSv (t ＝ 19.3415 ,P ＜ 0.05) .The E of group B decreased by 66%.Conclusions ACNB is a feasible and accurate method for diagnosing pulmonary lesions,and the E can significantly reduce the dose received in low-dose scanning.

Objective To investigate the role of nitric oxide (NO) in the protective effects of morphine postconditioning against ischemia-reperfusion (I/R)-induced myocardial apoptoais. Methods Sixty pathogen-free SD rats were randomly divided into 4 groups ( n = 15 each) : group Ⅰ sham operation (S) ; group Ⅱ I/R; group Ⅲ morphine postconditioning ( M ) and group Ⅳ M + L-NAME ( non-selective NOS inhibitor). The animals were anesthetized with intraperitoneal pentobarbital 60 mg/kg, tracheostomized and mechanically ventilated. ECG was monitored. Right carotid artery was cannulated for BP monitoring and left jugular vein was cannulated for drug and fluid administration. Myocardial ischemia was induced by 45 min occlusion of left anterior descending coronary artery (LAD) followed by 120 min reperfusion. In group S LAD was exposed but not occluded; in group M morphine 1.25 mg/kg was injected iv over 5 min from 3 min before reperfuaion to 2 min of repeffuaion and in group M + L-NAME L-NAME 10 mg/kg was injected iv at 20 min before myocardial ischemia. Hemodynamic changes were monitored. The animals were killed at the end of 120 min reperfusion and their hearts removed. Myocardial apoptosis was determined by TUNEL technique. The expression of Akt phosphorylation was assessed by Western blotting. The NO content in myocardium was measured by a chemiluminescence detector.Results A large number of TUNEL positive cells (18.4 ± 1.1 ) % were observed in group I/R. Morphine postconditioning exerted a significant anti-apoptotic effect. The number of TUNEL positive cells was reduced to (10.8 ± 1.2)%. The myocardial eNOS phosphorylation expression and NO content were significantly increased in group M as compared with group I/R. The anti-apoptofie effect and increased NO production were significantly reversed by L-NAME. However, pretreatment with L-NAME did not inhibit the phosphorylation of eNOS in group L + M. Conclusion In vivo, morphine postconditioning can significantly reduce I/R-induced myocardial apoptosis through phosphorylation of eNOS and increase in NO production.

Objective To investigate the effect of morphine postconditioning on myocardial ischemiarepedusion(I/R)injury and the role of PI3K/Akt signaling pathway in the effect.Methods Seventy male SD rats weighing 280-330 g aged 16-17 weeks Were randomly divided into 5 groups(n=14 each):group Ⅰ sham operation(S);group Ⅱ I/R;group Ⅲ morphine postconditioning(M);group Ⅳ morphine postconditioning+ wortmannin(W+M);groupV wortmannin(W).Myocardial I/R injury wa.g produced by occlusion of anterior descending branch of left coronary artery for 45 min followed by 120 min reperfusion.In group M and W+M (groupⅢ,Ⅳ)morphine 1.25 mCkg was given iv at 3 min before and 2 min after reperfusion.In group W+M and W(groupⅣ,Ⅴ)wortmannin(a specific PDK inhibitor)15μ/gkg Was given iv at 20 min before ischemia. The animals were sacrificed at the end of 120 min repedusion for assessment of ischemic and infarct area and determination of total and phosphorylated Akt expression in myocardium by Western blot.Results There were no significant differences in the size of ischemic area and total Akt expression among the 5 groups. The infarct area was significantly smaller in group M than in group I/R. The were no significant differenees in the size of infarct area between group 1/R, W + M and W (group Ⅱ , Ⅳ,Ⅴ ). The phosphorylated Akt expression was significantly upregulated in group I/R and M as compared with group S, and was significantly higher in group M than in group I/R.Conclusion The PI3K/Akt signaling pathway activation is involved in the protective effect of morphine posteondifioning on myocardium against I/R injury.

ObjectiveTo investigate the correlation between stroke volume variation (SVV) and blood volume during hypovolemia.MethodsTwenty ASA Ⅰ or Ⅱ patients,aged 20-64 yr,with body mass index 20-30 kg/m2,scheduled for elective orthopedic operation,were studied.Anesthesia was induced with dexamethasone,midazolam,propofol,fentanyl and cisatracurium and maintained with sevoflurane,fentanyl and cisatracurium.The patients were tracheal intubated and mechanically ventilated.HR,MAP,CVP,arterial pressure-based cardiac output (APCO),SVV,systemic vascular resistance (SVR) and cardiac index (CI) were recorded 5 min after tracheal intubation.Blood was taken from central vein at a rate of 30-50 ml/min,the volume was 5％ of the whole blood volume and the haemodynamic parameters mentioned above were recorded after the haemodynamics was kept stable for 5 min.Blood was taken again as the method mentioned above and the haemodynamic parameters were recorded.6％ HES 130/0.4 was then infused at 50-70 ml/min via right internal jugular vein,the volume was equal to 5 ％ of the whole blood volume and the haemodynamic parameters were recorded after the haemodynamics was kept stable for 5 min.Fluid replacement was performed again using the method mentioned above and the haemodynamic parameters were recorded.Linear correlation of the change in blood volume (difference between the blood volume at each time point and the baseline value) with dSVV (difference between the value monitored at each time point and the baseline value) was analyzed.ResultsThere was significant change in SVV,APCO and CI after each change in blood volume ( P ＜ 0.05 or 0.01),while there was not always significant change in HR,MAP,CVP and SVR after each change in blood volume.The change in blood volume was negatively correlated with dSVV ( r =- 0.875,P ＜ 0.01 ).ConclusionThere is high correlation between SVV and blood volume during hypovolemia and SVV can reflect the change in blood volume accurately and be used for volume therapy during hypovolemia.