Objective To study CT and MRI appearance of transient hepatic attenuation difference (THAI)) .to reveal the cause of THAD),and to avoid false positive and misdiagnosis.Methods 10 cases appearing THAD in CT and 5 cases appearing THAI) in MRI were reviewed and all were processed with plain scan and dy- namic contrast with CT or MRI.Results 7 cases appeared transienl hypertransfusion of CT,4 cases appeared tran- sient hypertransfusion of MRI;3 cases appeared transient Hypoperfusion of CT,1 case appeared transient hypoperfu- sion of MRI.Conclusion The appearance of THAD in CT and MRI,was related to the quick-scan with CT and MRI only sufficient comprehension of the characteristics of blood supply in normal physiology and pathology of liver, combined with plain scan,could make correct decision possible in the final diagnosis when it occurred regional perfu- sion difference in liver.

Objective To evaluate the efficacy and safety of fully covered self-expandable metal stents (FCSEMS) implanted by endoscopic retrograde cholangiopancreatography (ERCP) for patients with benign biliary stricture (BBS).Methods The clinical data of 38 patients with BBS underwent ERCP and FCSEMS placement between January 2012 and January 2016 were retrospectively recorded.Success rate of BBS,adverse events related to ERCP and stricture recurrence were analyzed.Results A total of 38 patients underwent FCSEMS placement with a mean time of stent in dwelling for 8 months (range:3-13months).During follow-up after the stent was removed,death of 1 patient after liver transplantation was due to unrelated cause.The mean follow-up time was 13 months (range:2-52 months) for other patients.Stricture recurrence occurred in 6 patients,including 2 cases of gallstone-related biliary strictures,1 case of chronic pancreatitis-related biliary strictures,2 cases of liver transplantation-related biliary strictures,and 1 case of post surgical-related biliary strictures.Stricture resolution occurred in 31 cases with 83.8％ (31/37) success rate,including 90.0％ (18/20) gallstone-related biliary strictures,75.0％ (3/4) chronic pancreatitis-related biliary strictures,80.0％ (8/10) liver transplantation-related biliary strictures,and 66.7％ (2/3)post surgical-related biliary strictures.The incidence of post-ERCP complications was 21.1％ (8/38),including mild pancreatitis in 5 case,hyperamylasemia in 2 cases,cholangitis in 1 case.All patients were cured by conservative treatment.Conclusion FCSEMS are effective and safe for BBS.Further studies are needed to assess the indwelling time of FCSEMS,whether FCSEMS are superior to multiple plastic stents and the different efficacy of FCSEMS for BBS caused by different etiology.

Objective To evaluate the validity and reliability of a Chinese version on the Short-Form Health Survey Scale (SF-36) among elderly population. Methods Questionnaire including SF-36 Chinese version was administered in a cross-sectional study from October to December 2007. 4241 elderly people over 60 years old from rural and urban area in Zhejiang province were face-to-face interviewed by welltrained investigators, and then analyses on correlation, reliability, factors, t-test and one-way ANOVA were made to evaluate on reliability and validity of the scale. Results The SF-36 Chinese version had good split-half reliability (r=0.91, P<0.001 ) and all the internal consistency Cronbach's alpha coefficients exceeded 0.8 except for VT (α=0.65), SF(α=0.65) and MH (α=0.40). The correlative coefficients between each item and its domain were all greater than the 0.4 thresholds except item 9-2, and they were greater than the correlation between the item and other domains for all but item 9-8. These results demonstrated that the SF-36 Chinese version had good convergent validity and discriminant validity. The distribution of 35 items in 6 public factors (the cumulative variance=67.04 %) extracted from them was consistent with the basic conceived concept. All domains except MH had good validity to discriminate different categories. Conclusion The SF-36 Chinese version had good reliability and validity. It was acceptable for the evaluation on quality of life in elderly population, but the reliability and validity of MH were relative low and the items such as 9-2, 9-8 in MH and 3-1 in PF were not suitable for Chinese elderly population.

OBJECTIVETo review retrospectively the experience of surgical repair of sinus of valsalva aneurysm (SVA) in 70 patients.

METHODSBetween September, 1988 and October, 2003, Seventy patients with SVA underwent surgical repair by the aid of general anesthesia and cardiopulmonary bypass, comprised 1.4% (70/4960) of all open-heart operation. Forty-five were male and 25 female. Age ranged from 3 to 69 years old [mean (29 +/- 15) years]. The aneurysms ruptured into the right ventricle in 46 patients, right atrium in 23 and left ventricle in 1 respectively. The aneurysms originated from right and noncoronary sinus in 61 patients (87%) and 9 patients (13%) respectively. The most common associated cardiovascular lesions were ventricular septal defect (VSD, n = 34) and aortic valve incompetence (n = 21). Repairs were achieved through an incision in right atriotomy, right ventriculotomy or aortotomy only or both aortotomy and right atriotomy (or right ventriculotomy). The defects in the sinus of valsalva was repaired with either direct sutures (n = 43) or a patch (n = 27). The aortic valve was replaced in 6 patients.

RESULTSThere were no deaths in early time after repair. Postoperative hospital stay was 8 approximately 33 days [mean +/- standard deviation, (14.3 +/- 6.4) days] before 1997 and 6 approximately 15 days [mean +/- standard deviation, (9.1 +/- 2.6) days] after 1997 respectively. Complications included infection (n = 4), hemorrhage (n = 4), pneumothorax (n = 1), arrhythmia (n = 4) and residual shunt (n = 1) of VSD. Fifty-three (76%) patients (2 months approximately 13 years) were followed-up [mean +/- standard deviation, (6.6 +/- 3.8) years]. All patients survived except that one died of rupture of dissecting aortic aneurysm 7 years after operation.

CONCLUSIONSThe ruptured sinus of valsalva aneurysm and unruptured sinus of valsalva aneurysm with ventricle septal defect or(and) aortic valve regurgitation should be repaired surgically as soon as the diagnosis was confirmed. Long-term results are associated with preoperative aortic valve regurgitation.

Adolescent ; Adult ; Aged ; Aortic Aneurysm ; complications ; surgery ; Aortic Rupture ; surgery ; Aortic Valve Insufficiency ; complications ; surgery ; Child ; Child, Preschool ; Female ; Heart Septal Defects, Ventricular ; complications ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sinus of Valsalva ; surgery ; Treatment Outcome

Objective To describe the epidemic status of hepatitis B along the Yangzi River area,ill Anhui province.Methods A croSS-sectional seroepidemiological survey was conducted and the samples were collected by stratified cluster sampling.Serological biomarkers to hepatitis B virus were tested using enzyme-linked immunosorbent assay(ELISA)reagents.Results Among 2282 people.the prevalence rates of HBsAg,HBsAb,HBeAg.HBeAb,HBeAb and hepatitis B virus infection were 9.8%,43.5%.1.0%,7.8%,10.3%and 40.6%respectively.The prevalence rate of HBsAg among males was higllel"than that offemales(P＜0.05).The vaccination rate was 24.7%,higher in urban than in taral areas.The vaccination rate was high in children younger than ten years old and in students.The prevalence rates of HBsAg and HBV among people who had received vaccines were lower than those who had not.Conclusion The standardized prevalence rates of HBsAg(9.3%)Was high in the area along the Yangzi River in Althai province.The vaccinate rate Was low in the country side.Expanded vaccinate which can obviously reduce the prevalence rate of HBsAg should be enhanced.

Objective To study the surgical treatment and effects of the lesions in the third ventricle. Methods The data of 15 patients with third ventricular lesion, accepted surgical treatment were retrospectively analyzed. The lesions were removed through transcallosal approach in 11 patients, frontal trans-cortical approach in 2 and trans-terminalis approach in 2,respectively. Postoperative radiotherapy was performed in 5 and chemotherapy in 2. VP shunt was performed in 1. Results The lesions were total-resected in 8 (53.3%), subtotal-resected in 5 (33.3%) and partial-resected in 2 (13.3%) with 1 postoperative death. The hydrocephalus were resolved in all cases. With a follow-up of 3 to 12 months, all the 14 patients recovered without obvious neurological deficits. Conclusion Proper microsurgical approach and perfect surgical skills are the keys to high resection and good prognosis. And postoperative radiotherapy or chemotherapy may be helpful in improving the outcome

INTRODUCTIONAkt, a serine/threonine protein kinase, mediates growth factor-associated cell survival. In several human cancers, including pancreatic cancer, constitutive activation of Akt (phosphorylated Akt, p-Akt) has been observed and may be associated with chemotherapy and radiotherapy resistance. However, there are contradictory viewpoints in p-Akt in pancreatic cancer on prognosis, and the clinical relevance of p-Akt in pancreatic cancer is not well understood. This study aims to investigate the expressions and relevance of Akt and p-Akt1 in pancreatic cancer tissues and their clinical significance.

MATERIALS AND METHODSThe expressions of Akt and p-Akt in 74 surgically resected paraffin-embedded pancreatic ductal adenocarcinoma samples and 10 normal pancreatic tissue samples were examined by immunohistochemistry. The associations of their expression with clinicopathological and survival data were analysed.

RESULTSThe positive expression rate of Akt and p-Akt1 were 87.8% and 83.8%, respectively, which were remarkably higher then those in normal pancreatic tissue (P <0.05). There was a positive correlation between the expression of Akt and p-Akt1. High p-Akt1 expression correlated with lower T stage (P = 0.004), while Akt was not associated with any clinicopathologic variables. Kaplan-Meier survival analysis revealed that higher expression of Akt, p-Akt1 were respectively correlated with favourable prognosis (16.0[4.7-27.3] vs 9.3[9.0-9.6] months, P = 0.007, and 23.0[12.2-33.8] vs 11.1[7.5-14.7] months, P = 0.004, respectively). Multivariate analysis identified p-Akt1 as a significant independent favourable prognostic factor (HR=0.421, P = 0.010).

CONCLUSIONSThese results suggest that high p-Akt1 expression may be a favourable prognostic factor in pancreatic cancer.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Pancreatic Ductal ; metabolism ; Female ; Humans ; Immunohistochemistry ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pancreatic Neoplasms ; metabolism ; Prognosis ; Proto-Oncogene Proteins c-akt ; metabolism

OBJECTIVETo evaluate four candidate variable number tandem repeat (VNTR) loci for genotyping Mycobacterium tuberculosis complex strains.

METHODSGenomic sequences for two M. tuberculosis strains (CCDC5079 and CCDC5180) were generated, and using published sequence data, four candidate VNTR loci were identified. The VNTRs were used to genotype 225 Chinese clinical M. tuberculosis complex strains. The discriminatory power of the VNTRs was evaluated using BioNumerics 5.0 software.

RESULTSThe Hunter-Gaston Index (HGI) for BJ1, BJ2, BJ3, and BJ4 loci was 0.634, 0.917, 0.697, and 0.910, respectively. Combining all four loci gave an HGI value of 0.995, thus confirming that the genotyping had good discriminatory power. The HGI values for BJ1, BJ2, BJ3, and BJ4, obtained from Beijing family strain genotyping, were 0.447, 0.878, 0.315, and 0.850, respectively. Combining all four loci produced an HGI value of 0.988 for genotyping the Beijing family strains. We observed unique patterns for M. bovis and M. africanum strains from the four loci.

CONCLUSIONWe have shown that the four VNTR loci can be successfully used for genotyping M. tuberculosis complex strains. Notably, these new loci may provide additional information about Chinese M. tuberculosis isolates than that currently afforded by established VNTR loci typing.

Cluster Analysis ; Genotyping Techniques ; Humans ; Minisatellite Repeats ; Mycobacterium bovis ; genetics ; Mycobacterium tuberculosis ; genetics

BACKGROUNDThe diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities.

METHODSTwo hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE (under anesthesia with propofol) first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed.

RESULTSFailure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carried out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases. The overall detection rate of small bowel diseases using CE (72.0%, 118/164) was superior to that with DBE (41.2%, 21/51); chi(2) = 16.1218, P < 0.0001. The diagnostic rate (51.8%, 85/164) was also higher than that with the latter procedure (39.2%, 20/51), but was not significantly different (chi(2) = 2.4771, P > 0.05). Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE (88.0%, 88/100) was superior to that of DBE (60.0%, 9/15); chi(2) = 7.7457, P = 0.0054. Lesions were detected by DBE in 1 out of 4 patients in whom CE had a negative result. Suspected findings by CE were confirmed by DBE combined with biopsy in 12 out of 15 patients. On the other hand, small bowel lesions were identified by CE in all 3 patients after negative evaluations by DBE. There were no severe complications during or after either of the two procedures.

CONCLUSIONSThe detection rate of small bowel diseases by CE is very high. CE should be selected for the initial diagnosis in patients with suspected small bowel diseases, especially in patients with obscure gastrointestinal bleeding. DBE appears to be inferior to CE in the diagnosis of small bowel diseases. However, it was shown that abnormalities could still be identified by DBE in patients with normal images or used to confirm suspected findings from CE. DBE can also serve as a good complementary approach after an initial diagnostic imaging using CE.

Abdominal Pain ; diagnosis ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Capsule Endoscopy ; adverse effects ; methods ; Diarrhea ; diagnosis ; Endoscopy, Gastrointestinal ; adverse effects ; methods ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; Humans ; Intestinal Diseases ; diagnosis ; Intestine, Small ; pathology ; Male ; Middle Aged

Child, Preschool ; China ; Female ; Hepatitis A ; immunology ; prevention & control ; Hepatitis A Antibodies ; blood ; Hepatitis A Vaccines ; adverse effects ; immunology ; Humans ; Infant ; Male ; Safety ; Sampling Studies ; Vaccination ; Vaccines, Inactivated ; adverse effects ; immunology