ObjectiveTo investigate the morphologic features of coronary sinus (CS)-left atrium muscle connections,and evaluate the function and anatomical features of coronary sinus on dual-source CT coronary angiography (DSCTCA).MethodsImages of DSCTCA of 144 patients [ control group consisted of 96 patients,and atrial fibrillation (AF) group consisted of 48 patients] were reviewed.The existence of coronary sinus-right atrium muscle connections was indirectly evaluated by measuring the cross-sectional area changes of the CS during atrial systole and atrial diastolic.The number,location,length of the CS-left atrium muscle connections andthe relationship between CS-left atrium muscle connections and CS morphological characteristics were studied.The t test for continuous variables and Chi-square test for categorical variables were used in statistical analysis.Results( 1 )The anatomic course of the CS in relation to the mitral ring was straight,mild curvature and high riding of 62,16 and 18 cases in control group and 10,8 and 30 cases in AF group,respectively.There was not statistical significance between the 2 group (x2 =0.093,P=0.954). (2)The CS length was (34.1 ±9.1),(33.8 ±8.9)mm in Control group and AF group,respectively.There was no statistical significance between the 2 group ( t =- 0.486,P =0.628 ).(3) Coronary sinus-left atrium muscle connections were seen in 131 of the 144 patients (91.0％).A single connection was seen in 103 of the 144 patients,with a mean length of (22.6 ± 12.7)mm within (6.3 ± 5.8 ) mm of the coronary sinus ostium.28 patients had two connections; distal connections measured ( 13.2 ± 6.2)mm in length within (16.7 ± 6.8 ) mm of the coronary sinus ostium,and proximal connections measured ( 11.1 ± 3.6 ) mm in length within (2.1 ± 1.9) mm of the coronary sinus ostium.And there was no statistical difference the number and length of CS-left atrium connections in between Control group and AF group (P ＞ 0.05 ).(4)The CS narrowed 22.4％ (44.5/198.8 )in cross-sectional area from atrial diastolic to atrial systole in control group( t =- 21.076,P ＜ 0.01 ),while the CS had no obvious contraction in AF group(t =0.374,P ＞ 0.05).The cross-sectional area of the coronary sinus during diastole was obviously larger in the AF group than in the control group[( 230.4 ±77.0) mm2 vs (198.8 ±65.4) mm2,respectively,t =- 2.579,P =0.01 ].In control group ( n =9 ),the coronary sinus-left atrium connection was not seen,however,all showed a CS constriction during atrial systole,indicating that coronary sinus-left atrium muscle continuity is not likely the primary cause for coronary sinus contractions. Conclusions DSCTCA can clearly show the anatomical characteristics of CS,it can help to understand the length,number and location of the CS-left atrium muscle connection.

Objective To evaluate abdominal CT scan in predicting complications and mortality of acute pancreatitis patients. Methods CT imaging data of 606 AP patients from June 2010 to October 2011 were analyzed retrospectively. Fatty liver, pleural effusion, suprahepatic space effusion, biliary tract disease,gastric bare area involvement (GBAI),adrenal gland involvement (AGI) and perirenal space involvement (PSI) were evaluated,and the relationship between CT findings and complications and mortality was analyzed. Results (1) The Logistic regression analysis showed six risk factors for complications of AP,including obesity,fatty liver,PSI,AGI,GBAI and suprahepatic space effusion.The sensitivity,specificity and accuracy of Logistic regression model for predicting complications were 81.3％,89.1％ and 85.3 ％,respectively. (2) The Logistic regression analysis showed four risk factors for mortality of AP,including obesity,AGI,GBA and suprahepatic space effusion.The sensitivity,specificity and accuracy of Logistic regression model for predicting mortality were 33.3％, 98.6％, 96.0％, respectively.Conclusions Abdominal CT scan effectively indicates the signs of tissue and organ involvement in AP.These CT findings relate with the prognosis of AP.

Objective To investigate the morphologic features of Bachmann bundle (BB) and its vascular supply on dual-source CT coronary angiography(DSCTCA) in healthy volunteers and patients with coronary artery lesion (CAL). Methods Clinical histories, electrocardiograms (ECGs), and images of DSCTCA of 106 patients ( CAL group) and 100 healthy volunteers ( Control group) were reviewed. All 106 patients underwent conventional coronary angiography ( CCA ). The Gensini scoring system was used to assess the results of CCA. The patients were divided into three groups according to their Gensini scores. The length, width and superoinferior diameter, CT value, and vascular supply of BB were studied. Rank sum test for continuous variables and Chi-square test for categorical variables were used in statistical analysis.Results ( 1 ) BB visualization rate of control group was higher than CAL group [86.0% (86/100) vs 51.9%(55/106), x2 = 27.726, P ＜ 0.01]. The higher the Gensini score of CAL subgroup, the lower the visualization rate of its BB [80.0% ( 28/35 ), 55.6% ( 20/36 ), 20.0% ( 7/35 ), x2 = 25.530, P ＜ 0.01].(2)The median of measurements of length,width and superoinferior diameter of control and CAL group were 13.0 vs 13.8,5.0 vs 5.2 and 5.9 vs 6.2 mm, respectively ( P ＞ 0.05 ). (3) The CT value of the BB region in control group( median :42.6 HU ) was higher than that of CAL group( median: 13.0 HU) ( Z = - 7.061, P ＜0.01). The CT values of BB regions in patients with nonvisualized BB (median: -16.0 HU) were lower. The CT values of the BB regions in CAL group were negatively-correlated with Gensini scores( median:19.0) (r = -0.553, P ＜0.01 ). (4)The blood supply of BB and BB region was provided by right sinuatrial node artery ( SNA, 58.7%, 121/206 ), left SNA ( 35.9%, 74/206 ) or both SNAs ( 5.3%, 11/206 ).Conclusions DSCTCA could can show the anatomical characteristics of BB and its arterial supply. The serious the degree of CAL , the lower the BB display rate, and the higher the abnormal ECG incidence,which indicate that the occurrence of BB lesions is probably related to ischemia.

Objective: To explore the value of dual energy CT lung perfusion imaging (DEPI) for diagnosing pulmonary embolism (PE) in comparison with CT pulmonary angiography (CTPA). Methods: There were 49 patients with suspected PE received DEPI scanning and 19 with CTPA conifrmed diagnosis were enrolled in this study. CTPA image was obtained by 80 kv data, and DEPI image was obtained by PBV software. The location, type of PE in CTPA image, and the location, shape of perfusion defect in DEPI were observed and compared by segment basis. The correlation and agreement of CTPA and DEPI for diagnosing PE were calculated and the un-agreement was analyzed. Results: A total of 380 segments were included for analysis. CTPA detected 162 segments of PE and DEPI detected 155 segments of perfusion defect or reduction, partial PE were mainly presented by perfusion defects as speckles, patches or without perfusion defect, and complete PE were mainly showed segmental or sub-segmental perfusion defects. CTPA and DEPI were correlated for PE diagnosis (χ2=305.5,P=0.000), the diagnostic agreement was 83.42% and KAPPA value was 0.659. Conclusion: The perfusion defect in DEPI is related to the degree and type of PE presented in CTPA, their combination is helpful for diagnosing PE.

BACKGROUNDObstructive sleep apnea syndrome (OSAS) is strongly associated with obesity and with cardiovascular disease. Ghrelin and obestatin are two peptides from the same source but have opposite roles. Both of them can affect feeding and regulate vascular tune. The aim of this study was to investigate the relationship between plasma ghrelin, obestatin, the ratio of ghrelin and obestatin (G/O) and sleep parameters and blood pressure circadian rhythms in patients with OSAS.

METHODSThis study enrolled 95 newly diagnosed over-weight OSAS patients (OSAS group), 30 body mass index (BMI)-match non-OSAS adults (over-weight group) and 30 non-OSAS normal weight adults (control group). Polysomnography (PSG) was performed in the OSAS group and over-weight group. Blood pressure of all subjects was monitored by means of 24-hour ambulatory blood pressure monitoring. The concentration of plasma ghrelin and obestatin was detected by enzyme-linked immunosorbent assay (ELISA).

RESULTSPlasma ghrelin levels in the OSAS group and over-weight group were significantly lower than that of the control group (P < 0.05). Plasma obestatin levels were lower in the over-weight group and OSAS group, but there was no significant difference among the three groups. The blood pressure in OSAS patients was higher, and there was a significant difference in all blood pressure parameters compared to the control group, and in the daytime average diastolic blood pressure (DBP), nocturnal average systolic blood pressure (SBP) and DBP, DBP variability values as compared to over-weight subjects. Furthermore, there were significantly more non-dipper patterns of blood pressure (including hypertension and normotension) in the OSAS group than in the other two groups (P < 0.01). Correlation analysis showed that ghrelin levels had a significant correlation with BMI and nocturnal average DBP but not with PSG parameters. In contrast, the G/O ratio had a negative correlation with apnea-hypopnea index (AHI) (P < 0.05), as well as a strong positive correlation with the blood pressure variability values (P < 0.01). In multivariate analyses, AHI (P < 0.05) and G/O (P < 0.05) were independently related to SBP variability changes, while AHI (P < 0.05), G/O (P < 0.01) and BMI (P < 0.05) were independently related to DBP variability changes.

CONCLUSIONSOur data show plasma ghrelin and obestatin levels were related to obesity in OSAS. Sleep apnea in OSAS patients could have led to an imbalance in G/O in the basis of obesity. Moreover, the imbalance may promote nighttime blood pressure elevation and affect blood pressure circadian disorder.

Adolescent ; Adult ; Aged ; Blood Pressure ; physiology ; Circadian Rhythm ; physiology ; Enzyme-Linked Immunosorbent Assay ; Female ; Ghrelin ; blood ; Humans ; Male ; Middle Aged ; Obesity ; blood ; physiopathology ; Pancreatic Neoplasms ; blood ; physiopathology ; Prognosis ; Repressor Proteins ; metabolism ; Sleep Apnea, Obstructive ; blood ; physiopathology ; Young Adult

【Objective】 To investigate and summarize the clinical and imaging features of a few patients with coronavirus disease 2019 (COVID-19) in Lanzhou City. 【Methods】 We carried out a retrospective analysis of the epidemiological data, laboratory results and clinical imaging features of eight hospitalized patients with confirmed COVID-19 in The First Hospital of Lanzhou University from January 23 to February 23, 2020. 【Results】 The sex ratio (men to women) of the 8 patients was 5∶3 while their age ranged from 24 to 57 years old. The incubation period was 1-10 days. Of the 8 patients, 7(87.5%) had COVID-19 brought in from other places in China and 1(12.5%) was a secondary infection case. The main clinical manifestations included cough in 6 cases (75%), fever in 4 cases (50%), expectoration in 3 cases (37.5%), and fatigue in 2 cases (25%). All the 8 cases indicated abnormal manifestations in blood routine examinations, 4 cases (50%) decreased in WBC, 7 cases (87.5%) decreased in Lym count, 5 cases (62.5%) increased in LDH, 1 case (12.5%) increased in CK, 1 case(12.5%) increased in CK-MB, 4 cases (50%) increased in CRP, 2 cases (25%) increased in PCT, and 1 case (12.5%) increased in D-dimer. Of the 2 patients examined by chest digital radiography (DR), one DR finding was not typical and the other one suggested increased bilateral lung markings. Six patients were examined by HRCT, of whom four (50%) showed multiple ground glass opacities on both lobes and two (25%) showed multiple ground glass opacities only on the right lobe; none of the 6 imaging findings suggested pleural effusion. Six patients were discharged from hospital after being cured and 1 patient still underwent treatment. 【Conclusion】 Most of these 8 patients had COVID-19 imported from outside the city, and the patients were relatively young with few underlying diseases. Their major symptoms were fever, cough, and expectoration. All of them exhibited abnormal findings in blood routine examinations; half of them suggested increased CRP while a few ones showed abnormal CK and Ddimer values. The imaging manifestations of most patients were multiple ground glass opacities near the peripheral pleura.