Objective To analyze pathologic features, therapeutic strategies and prognosis of patients with metastatic solid pseudopapillary tumor of the pancreas (m-SPTP). Methods Twenty five patients with m-SPTP undergoing radical resection between June 1985 and Dec 2005 were retrospectively analyzed. Kaplan-Meier analysis was used to screen out risk factors of the prognosis of m-SPTP patients.Results Twenty-three postoperative patients were followed up until Dec 2007. The follow-up rate was 92% and the median follow up time was 78 months. The 5-year overall survival rate was 82%. Kaplan-Meier analysis showed that five variables including age, tumor size, pathologic features, number of metastatic lesions and lymphatic metastasis were related to overall survival. Conclusions Solid pseudopapillary tumor of the pancreas is low-grade malignant potential with a favorable prognosis, but not for the m-SPTP.Patients of ≥40 years old, tumor size (≥6 cm), pathologic features (including presence of areas with diffuse growth pattern and tumor necrosis), multiple metastatic lesions and lymphatic metastasis have poor prognosis.

Objective:To evaluate the sonographic characteristics of primary lymphoma of the thyroid gland and to analyze histo-pathologic findings and other imaging features to improve the diagnostic accuracy of this disease. Methods: We retrospectively re-viewed the records of 20 patients with histologically proven primary lymphoma of the thyroid gland. The clinical, pathologic, sono-graphic, CT, and MRI features were analyzed. Results:Histology revealed non-Hodgkin lymphoma in 20 patients. Ultrasound revealed lateral thyroid lobe disease in 12 cases and the presence of unilateral masses in 8 cases. The main features seen were diffusely enlarged thyroid gland. The lateral or unilateral thyroid lobe was with hypoechoic masses intermingled with echogenic structures. A total of 16 cases showed enlarged lymph nodes, 5 cases showed invasion of trachea, and 1 case involved the trachea and esophagus. Conclusion:Primary lymphoma of the thyroid gland usually presents with clinical and sonographic findings mimicking a carcinoma or benign tu-mor. If clinical features revealed rapidly enlarging neck masses and sonographic characteristics represented by malignant features of Hashimoto thyroiditis, then we should consider lymphoma. However, the final diagnosis depends on histopathology.

Objective To establish a simple and rapid detection technique for Oncomelania infected with Schistosoma japonicum(SJ), with high sensitivity and good specificity .Methods The gene fragment of SJ was amplified by PCR , and cloned into the T-vector to construct positive-reference.An isothermal nucleic acid amplification reaction system for detecting Oncomelania infected with SJ was set up , and its sensitivity was analyzed by detecting positive-reference diluted according to geometric proportion , and its specificity by detecting the genomic DNA of relative samples .Then, a corresponding means of purifying nucleic acid was designed to assemble a reagent detecting Oncomelania infected with SJ . This reagent was validated by detecting Oncomelania samples.Results The 213 bp amplified products were obtained and used to construct recombination T-vector for positive reference .An isothermal nucleic acid amplification reaction system was set up for detecting Oncomelania infected with SJ , and the amplification results could be simply determined by color change, with better sensitivity and specificity .The reagents for detecting Oncomelania infected with SJ were assembled , which could detect samples containing only 1% infected Oncomelania.Conclusion A visible detection method for Oncomelania infected with SJ is successfully established and validated .

Objective To discuss the treatment of periprosthetic femoral fractures (PFF) with unstable prosthesis by replacement of long-stem femoral prosthesis and internal fixation.Methods From December 2005 to December 2014,15 PFF patients with unstable prosthesis (15 hips) following were treated at our department.They were 10 men and 5 women,aged from 64 to 89 years (mean,76.2 years).Their primary surgeries included total hip arthroplasty in 13 cases and biological bi-polar replacement of femoral head in 2.Two prostheses were cement and 13 biological.By Vancouver classification,9 cases were type B2,and 6 type B3.The unstable prostheses in the 15 cases were replaced by long-stem femoral ones,followed by internal fixation.At the last follow-ups,clinical outcome were evaluated by Harris scoring and images of PFF by Beals & Tower criteria.Complications were documented.Results One died 4 months after operation.The other 14 patients were followed up for an average of 4.5 years (from 6 months to 9 years).Fracture union was achieved in 12 cases after an average of 3.9 months (from 3 to 9 months).Nonunion occurred in 2 cases.Imaging evaluation revealed 9 excellent cases,3 good ones and 2 poor ones.The Harris scores at the last follow-up averaged was 82.3 points (from 50 to 100 points).Deep vein thrombosis occurred preoperatively in one case and posterior tibial vein thrombosis occurred in 2 cases respectively on day 3 and day 10 postoperatively.No such complications occurred as malunion,fixation failure,dislocation or prosthesis loosening.Conclusion Satisfactory outcomes can be achieved by replacement of long-stem femoral prosthesis combined with appropriate fixation for treatment of PFF with unstabrosthesis.

The clinical data,endoscopic and CT findings of 39 patients with Crohn's disease(CD) and 24 patients with intestinal tuberculosis (ITB) were retrospectively reviewed.Diarrhea,hematochezia,perianal disease,intestinal obstruction,occurred more frequently in CD than in ITB (P ＜0.05 or ＜0.01).Night sweating,febrility,pulmonary tuberculosis and ascites were more common in ITB than in CD (P ＜0.01).The endoscopic findings showed that longitudinal ulcer,cobblestone sign,intestinal stricture were detected more often in CD than in ITB (P ＜ 0.05 or ＜ 0.01),but transverse ulcer and rodent ulcer were more frequently found in ITB than in CD (P ＜0.05 or ＜0.01).On the CT imaging mural gas,fat,enteric cavity stenosis and layering thickening were more common in CD than in ITB (P ＜ 0.05 or ＜ 0.01),but mural single layer thickening and hollow lymph nodes were discovered more frequently in ITB than in CD (P ＜ 0.01).The degree of intestinal wall thickening,enhancement and lymph nodes enlargement of ITB were more severe than that of CD (P ＜ 0.01).The clinical manifestations combined with endoscopic and CT finding may improve the differential diagnosis between Crohn's disease and intestinal tuberculosis.

Objective To investigate the effect of spectral CT monochromatic images for improving imaging quality in hepatic venography.Methods Thirty patients underwent spectral CT examination on a GE Discovery CT 750 HD scanner.During portal phase,1.25 mm slice thickness polychromatic images and optimal monochromatic images were obtained,and volume rendering and maximum intensity projection were created to show the hepatic veins respectively.The overall imaging quality was evaluated on a five-point scale by two radiologists.Inter-observer agreement in subjective image quality grading was assessed by Kappa statistics.Paired-sample t test were used to compare hepatic vein attenuation,hepatic parenchyma attenuation,CT value difference between the hepatic vein and the liver parenchyma,image noise,vein-to-liver contrast-to-noise ratio (CNR),the image quality score of hepatic venography between the two image data sets.Results The monochromatic images at 50 keV were found to demonstrate the best CNR for hepatic vein.The hepatic vein attenuation[(329 ± 47) HU],hepatic parenchyma attenuation [(178 ± 33) HU],CT value difference between the hepatic vein and the liver parenchyma [(151 ± 33) HU],image noise (17.33 ±4.18),CNR(9.13 ±2.65),the image quality score(4.2 ±0.6) of optimal monochromatic images were significantly higher than those of polychromatic images[(149 ± 18) HU],[(107 ± 14) HU],[(43 ±11) HU],12.55 ± 3.02,3.53 ± 1.03,3.1 ± 0.8 (t values were 24.79,13.95,18.85,9.07,13.25 and 12.04,respectively,P ＜ 0.01).In the comparison of image quality,Kappa value was 0.81 with optimal monochromatic images and 0.69 with polychromatic images.Conclusion Monochromatic images of spectral CT could improve CNR for displaying hepatic vein and improve the image quality compared to the conventional polychromatic images.

Objectives To explore the value of Silenz MRA in the follow-up assessment of intracranial aneurysms embolization. Methods Fifteen patients underwent coiled embolization were prospectively collected. Silenz and time of flight MRA (TOF MRA) were performed on the same day as DSA examination. Two neuro-radiologists scored the structures of peripheral vascular with a 4-score grading system and evaluate embolism status (two-grade montreal scale). The scores of vascular structures were compared using Wilcoxon signed rank tests. Weighted Kappa statistics was used to assess the inter-observer agreement on each MRA scoring, the inter-modality agreement between MRA and DSA, the inter-modality agreement between the MRA methods. Results There were 11 cases with complete occlusion, 4 cases with residual aneurysm revealed by DSA. For depiction, Silenz MRA was significantly better than TOF MRA [(3.50 ± 0.62) vs. (3.00 ± 0.63), Z=-3.12, P=0.002]. Inter-modality agreement of Silenz MRA and DSA was excellent (Kappa=0.82), while the agreement of TOF MRA and DSA was moderate(Kappa=0.60). Inter-modality agreement between Silenz MRA and TOF MRA was good (Kappa=0.76). Conclusions Silenz MRA is superior to TOF MRA for depiction of vascular structures and evaluation of embolism status, which is highly related with DSA. It has the value in the postoperative follow-up evaluation.

Objective To explore the correlation between serum growth differentiation factor‐15(GDF‐15) level and acute myocardial infarction(AMI) to provide a basis for the prognostic evaluation of AMI .Methods Totally 192 Han patients with AMI (AMI group) and non‐coronary heart disease (NCHD ,NCHD group) diagnosed in Chengde Municipal Central Hospital from Sep‐tember 2013 to January 2015 ,were selected and their clinical data were collected .The biochemical markers and serum GDF‐15 level were detected .Results Comparing the AMI group with the NCHD group ,differences in the patients′age ,smoking ,blood glucose (Glu) ,TC ,TG ,LDL‐C levels had statistical significance (P<0 .05);the serum GDF‐15 level in the AMI group was significantly higher than that in the NCHD ;serum GDF‐15 level was positively correlated with TC ,LDL‐C ,hs‐CRP and Glu in the AMI group . Conclusion The increase of serum GDF‐15 level is obviously correlated AMI ,therefore GDF‐15 can serve as an indicator for moni‐toring myocardial infarction .

Objective To develop an ultrasmall superparamagnetic iron oxide(USPIO)based MR probe targeting CD40 mutant and investigate its biological and chemical properties and its targeting effect on ovarian cancer cells in vitro.Methods To prepare immunologically competent probe,the monoclonal antibody was conjugated with USPIO particles modified by DMSA based on chemical crosslinking method.The USPIO labeled anti-human CD40 mutant monoclonal antibody 5H6(5H6-USPIO)was the experimental probe,and the USPIO labeled anti-human CD40 monoclonal antibody 5C11(5C11-USPIO)and USPIO served as control agents.The flow cytometry,confocal microscopy and Prussian blue staining were employed to assess the magnetic performance and analyze its bioactivity of the probe.The probe's cell MR imaging in vitro was carried out using ovarian caner cells(HO8910)with high CD40 mutant expression.The analysis of signal data of different groups was conducted by using one-way ANOVA andLSD test.The probe's effect on ovarian caner cells' growth was measured by CCK-8 kit.Results The stable molecular probe carrying nanoparticles and CD40 mutant antibody was built and purified successfully.The probe had similar magnetic property compared with original USPIO.Immunofluorescence and Prussian blue staining confirmed that the molecular probe could recognize CD40 mutant on ovarian cancer cells(HO8910)with high specificity.The probe had no effect on the growth of HO8910 cells.MR cell imaging in vitro showed that the value of T2 and T2 * decreased significantly after the probe binding with HO8910 cells and T2WI became darker than control groups.The T2 and T2* relaxation time of 5H6-USPIO group was(40.05 ± 1.62)ms and(3.08 ± 0.11)ms,respectively.The T2 and T2 * relaxation time of 5H6-USPIO group was shorter than 5C11-USPIO [(85.38 ± 4.74)and(11.82 ± 1.00)ms,respectively]and USPIO[(91.62 ± 3.35)and(13.60 ± 1.92)ms,respectively]groups with statistical significance(F =196.29,60.73,P ＜0.01).The difference of T2 and T2* relaxation time between 5C11-USPIO and USPIO groups showed no statistical significance (P ＞0.05).Conclusions CD40 mutant antibody can conjugate with ultrasmall superparamagnetic iron oxide particles to form MR molecular probe using chemical crosslinking method.The probe has good magnetic characters and high bioactivity.The probe can specifically bind with HO8910 cells.

Traumatic myocardial injury is a rare complication after blunt chest injury.The most common symptom is nonspecific chest pain, followed by ventricular premature beat and bundle branch block, with slight elevation of myocardial necrosis markers, which should be differentiated from acute myocardial infarction.One case of traumatic myocardial injury misdiagnosed as acute myocardial infarction was received in our hospital, except for acute myocardial infarction after corresponding examination.This kind of patients should be concerned by professional doctors, especially the elderly patients, who are more complicated with basic cardiovascular diseases, should be paid more attention in clinical work.