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 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.

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 investigate the correlation between stroke volume variation (SVV) and blood volume during hypovolemia.Methods Twenty ASA Ⅰ or Ⅱ patients,aged 20-64 years,with body mass index (BMI) of 20-30 kg/m2,scheduled for elective orthopedic operation were enrolled in this study.Anesthesia was induced with dexamethasone,midazolam,propofol,fentanyl and cisatracurium,and maintained with sevoflurane,fentanyl and cisatracurium.Then the patients received endotracheal intubation and mechanical ventilation.Heart rate (HR),mean arterial blood pressure (MAP),central venous pressure (CVP),arterial pressure-based cardiac output (APCO),SW,systemic vascular resistance (SVR) and cardiac index (Cl) were recorded 5 minutes after endotracheal intubation.Blood was taken from the central vein at a rate of 30-50 ml/min and the volume was 5％ of the whole blood volume,and then haemodynamic parameters mentioned above were recorded after the haemodynamics were kept stable for 5 minutes.Blood was taken again with the method mentioned above and the haemodynamic parameters were recorded.Then 6％ hydroxyethyl starch (HES) 130/0.4 was infused at 50-70 ml/min via the right internal jugular vein,and the volume was equal to 5％ of the whole blood volume,and then haemodynamic parameters were recorded after the haemodynamics was kept stable for 5 minutes.Fluid replacement was performed again using the method mentioned above and the haemodynamic parameters were recorded.Linear correlation of the changes 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.Results Significant changes were found in SW,APCO and Cl after each change in blood volume (P ＜ 0.05 or 0.01),while no significant changes were found 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).Conclusion There is high correlation between SVV and blood volume during hypovolemia.And SVV can reflect the changes in blood volume accurately and can be used for volume therapy during hypovolemia.

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.

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 investigate and compare the killing effect of photodynamic therapy (PDT)induced by hematoporphyrin derivative (HpD),hematoporphyrin monomethyl ether (HMME) and photocarcinorin (PsD007) on human leukemia cells K562 in vitro.Methods Human leukemia cells were cultured with serial concentrations of photosensitizers followed by irradiation of different dosage of laser light,then MTT colorimetric assay was applied to measure the relative survival rate of PDT for the cells.Results Significant difference in the inhibitory between the PDT group and control group was observed (P＜0.05).The survival rate of PDT for the cells elevated along with the increase in the concentration of sensitizer and dose of laser light.When the photosensitizer concentration was bigger (25 μg/ml) or the energy density was bigger (7.2 J/cm2),the effect of PsD007 was better than HMME,and they were significantly better than HpD (P＜0.05).Conclusion PDT has significant killing effect on human leukemia cells K562,and its relative inhibitory rate appears to be correlated with the dose of sensitizer and laser light irritation.The effect of PDT is related to the photosensitizers.The effect of HpD-PDT is not as effective as PsD007 and HMME.On the conditions of higher energy density and larger photosensitizer concentration,the effect of PsD007-PDT is better than HMME-PDT.

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.