Objective:To implement rapid acquisition gradient echo(RAGE)pulse sequence in clinical MRI scaner.Methods:Pascal language is engaged to edit source code.Number of slice excited,order of phase encoded,phase recycle of RF pulse,NEX,on/off of the gradients,and so on are all controlled by sequence parameters.SI×N_(phase)×N_(slice) data of 32 bctys were allocated to restore the k space.Source code of sequence was compiled with executable file and is loaded to RINMR software.Image of human brain are acquired.The experiment has been conducted on 0.36T permanent MRI system.Resuits:In the case of 256×256 matrix acquisition,time of single slice is 4 seconds.The resolution and SNR of the image are all adquately satisfy the clinical application.

Objective To detective the carcinogenesis and operation principle of cyst canceration after internal drainage(ID) operation for congenital choledocal cyst (CCC).Methods The clinical data of 25 patients with cyst carcinoma after ID operation for CCC in the past 28 years were analysed retrospectively.Results The total canceration rate after internal drainage of CCC were 30.49%(25/82); after cystoduodenostomy was 35.29%(14/51),after cystojejunostomy was 22.58%(11/31), respectively. In the 25 cases, three of them were operated with Wipple operation , 4 with tumour resection plus biliary reconstrustion operation, 4 local resection with external drainage ,14 with external drainage only. Conclusions Internal drainage of CCC should be aborted becaus of the high canceration rate after the operation.

Objective To investigate expression differences of neutrophil and mononuclear phagocyte related gene mRNAs among acute myocar-dial infarction (AMI), stable angina (SA) and control groups, and then discuss their expression characteristics in the stable angina pectoris (SAP) and AMI stages of coronary artery disease (CAD). Methods Whole Human Genome Oligo Microarrays were applied to assess the differential expression characteristics of neutrophil and mononuclear phagocyte related mRNAs in patients with AMI (n=20), SA (n=20) and controls (n=20). Results (1) Almost all colony-stimulating factors (CSF) and their receptors related mRNAs was up-regulated in AMI and SA groups compared with the control group, and the expression of granulocyte-macrophage colony stimulating factor receptor (GM-CSFR) and granulocyte colony stimulating factor receptor (G-CSFR) mRNAs in the AMI group was significantly up-regulated com-pared with the other two groups (P<0.01). (2) The expression of mRNAs related to monocyte chemoattractant protein-1 (MCP-1), CCR2 (MCP-1 receptor) and CXCR2 (IL-8 receptor) was significantly up-regulated (P<0.01) in AMI group compared with SA and control groups. IL-8 mRNA expression in the AMI group was clearly higher than the controls (P<0.05). (3) All mRNAs expression related to opsonic re-ceptors (IgG FcR and C3bR/C4bR) was significantly up-regulated in AMI group compared with SA and control group (P<0.01), and the SA group showed an upward trend compared with controls. (4) Most pattern recognition receptor (PRR)-related mRNAs expression was up-regulated in AMI group compared with SA and control groups. Most toll-like receptor (TLR) mRNAs expression was significantly up-regulated (P<0.01) than the SA and control groups;macrophage scavenger receptor (MSR) mRNA was significantly up-regulated in AMI group compared with the control group (P<0.01), and the SA group showed an upward trend compared with the controls. Conclusions The expression of most neutrophil and mononuclear-macrophage function related genes mRNAs was significantly up-regulated by stages during the progression of CAD, suggesting that the adhesive, chemotactic and phagocytic functions of neutrophil and mononuclear-ma-crophage were strengthened in the occurrence and development of coronary atherosclerosis and AMI. This also showed a stepped up-ward trend as the disease progressed.

OBJECTIVETo establish a clinical classification of pulmonary embolism (PE), and to evaluate the optional treatment strategies for different types of PE.

METHODSFrom December 1995 to July 2001, 45 patients with acute PE were hospitalized, of which 33 received intravenous thrombolytic therapy or interventional treatment.

RESULTSMisdiagnostic rate in the 45 patients with acute PE during first visit was 62.2% and mortality rate was 28.9%. Misdiagnostic rate in acute PE patients who had undergone surgery was 82% and mortality rate was 73%. The effective rate of thrombolytic therapy was 77.7%. Clinical symptoms rapidly disappeared in massive PE patients treated with interventional therapies.

CONCLUSIONSIntravenous thrombolytic therapy is one of the most effective methods for treating acute PE. Application of interventional therapy for severe acute PE is also promising.

Acute Disease ; Adolescent ; Adult ; Aged ; Anticoagulants ; therapeutic use ; Diagnostic Errors ; Humans ; Middle Aged ; Pulmonary Embolism ; diagnosis ; therapy ; Thrombolytic Therapy

Objective:To analyze the value of minute ventilation to carbon dioxide production slope (VE/VCO 2 slope) combined with peak systolic blood pressure (SBP) in predicting prognosis for patients with chronic heart failure (CHF). Methods:A total of 170 patients with CHF who visited the Cardiac Rehabilitation Center of Tongji Hospital Affiliated to Tongji University and completed cardiopulmonary exercise test from March 2007 to December 2018 were enrolled in the study. The clinical data, cardiopulmonary exercise testing results and follow-up information of patients were collected to explore the predictors of all-cause mortality in patients with CHF.Results:The median follow-up time was 647 (182-1 764) days. All-cause death occurred in 34 patients. Compared with surviving patients, the proportion of diabetes and angiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor blocker (ACEI/ARB) use in fatal patients was significantly higher ( P<0.01). The VE/VCO 2 slope and peak SBP*VE/VCO 2 in the fatal patients were significantly higher, and the peak oxygen consumption (peak VO 2) was lower than those in the surviving patients ( P<0.01). The areas under the receiver operating characteristic curve (AUC) of VE/VCO 2 slope and peak SBP*VE/VCO 2 in predicting all-cause mortality in patients with CHF were 0.648 ( P=0.008) and 0.681 ( P=0.001), respectively; the optimal thresholds were >40.95 ( P=0.008) and > 5 423.50 mmHg (1 mmHg=0.133 kPa, P=0.006), the sensitivity was 0.559 and 0.588, and the specificity was 0.728 and 0.735, respectively. Multivariate Cox regression analysis showed that after adjusting for age, gender, diabetes and ACEI/ARB use, VE/VCO 2 slope ( HR=2.12, P=0.036) and peak SBP*VE/VCO 2 ( HR=2.42, P=0.016) were independent risk factors for all-cause mortality in patients with CHF. Conclusion:Compared to the traditional index VE/VCO 2 slope, a novel index peak SBP* VE/VCO 2 provides a relatively better predictive value for all-cause death of CHF patients.

Objective: To compare the dosimetric parameters of target volumes and organs at risk between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for left sided breast cancer after breast-conserving surgery by a meta-analysis. Methods: Literature search was performed to include related studies to analyze the dosimetric parameters of target volumes and organs at risk. Results: A total of 11 studies involving 154 patients were included in meta-analysis. There were no significant differences in D_mean, HI of PTV-Whole breast and PTV-Boost. Comparing to IMRT, VMAT increased the conformity index (CI) of PTV-Whole breast (P=0.000) and PTV-Boost (P=0.002). When the mean volume of target volumes was≤634 cm³, there were no significant differences in D_mean, V₅, V₂₀ of the heart and left sided lung, V₃₀ of the heart, D_mean of the right sided lung and breast between VMAT and IMRT.When the mean volume of target volumes was>634 cm³, the D_mean(P=0.037), V₅(P=0.005) and V₂₀(P=0.030) of the heart in IMRT was lower than VMAT, but the V₃₀(P=0.001) of heart in VMAT was lower than IMRT.IMRT showed significantly lower D_mean(P=0.013), V₅(P=0.000), V₂₀(P=0.000) of the left sided lung, and D_mean(P=0.001) of the right sided lung than VMAT.There were no significant differences in D_mean of the right sided breast. Conclusions There were no significant differences in dosimetric parameters of target volumes between VMAT and IMRT.When the mean volume of target volumes was≤634 cm³, there were no significant differences in dosimetric parameters of organs at risk. When the mean volume of target volumes was>634 cm³, IMRT has some advantages in protection of the heart and lung.

The association among plasma trimethylamine-N-oxide (TMAO), FMO3 polymorphisms, and chronic heart failure (CHF) remains to be elucidated. TMAO is a microbiota-dependent metabolite from dietary choline and carnitine. A prospective study was performed including 955 consecutively diagnosed CHF patients with reduced ejection fraction, with the longest follow-up of 7 years. The concentrations of plasma TMAO and its precursors, namely, choline and carnitine, were determined by liquid chromatography-mass spectrometry, and the FMO3 E158K polymorphisms (rs2266782) were genotyped. The top tertile of plasma TMAO was associated with a significant increment in hazard ratio (HR) for the composite outcome of cardiovascular death or heart transplantation (HR = 1.47, 95% CI = 1.13-1.91, P = 0.004) compared with the lowest tertile. After adjustments of the potential confounders, higher TMAO could still be used to predict the risk of the primary endpoint (adjusted HR = 1.33, 95% CI = 1.01-1.74, P = 0.039). This result was also obtained after further adjustment for carnitine (adjusted HR = 1.33, 95% CI = 1.01-1.74, P = 0.039). The FMO3 rs2266782 polymorphism was associated with the plasma TMAO concentrations in our cohort, and lower TMAO levels were found in the AA-genotype. Thus, higher plasma TMAO levels indicated increased risk of the composite outcome of cardiovascular death or heart transplantation independent of potential confounders, and the FMO3 AA-genotype in rs2266782 was related to lower plasma TMAO levels.
Carnitine ; Choline/metabolism* ; Chronic Disease ; Heart Failure/genetics* ; Humans ; Methylamines ; Oxygenases ; Prospective Studies