Diverticulum ; diagnosis ; diagnostic imaging ; Heart Defects, Congenital ; diagnosis ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

Objective To evaluate the value of energy spectrum CT with multimodal quantitative parameters in diagnosis of the metastatic lymph nodes of gastric adenocarcinoma compared with the conventional CT.Methods 37 patients with gastric adenocarcinoma diagnosed by gastroscopy underwent enhanced CT scan with gemstone spectral imaging mode.We positioned and marked the stomach lymph nodes on CT images and compared with postoperative pathologic results one to one.ROC was used to identify the critical quantitative index of energy spectrum CT in distinguishing the metastasis from benign lymph node,and to evaluate the diagnostic effect compared with CT features.Results The 40-80 keV single energy spectrum curve slope (λHU )and normalized iodine concentration (NIC)in metastasis group were lower than those in the benign one in the arterial phase with statistical differences (P <0.05 ),but without statistical differences in venous phase.The combination of arterialλHU and NIC showed significant advantages compared with CT features(P <0.01), with the sensitivity,specificity and accuracy of 84.3% vs 61.4 %,88.4% vs 81.3 % and 86.8% vs 73.6 %.Conclusion The energy spectrum CT can provide quantitative analysis for differential diagnosis of gastric cancer metastasis from benign lymph nodes,and significantly improve the diagnostic accuracy of lymph node metastasis of the cancer.

OBJECTIVE: To explore the treatment and possible prognostic factor of nasal sinuses adenoid cystic carcinoma. METHOD: Retrospectively analysed the records of 18 patients with complete clinical and pathological data,which including 4 patients given up treatment, 5 patients taken surgical treatment and 9 patients taken surgical treatment as well as radiotherapy and chemotherapy. RESULT: Fifty percent of the patients got 2-year survival and 3 cases of death due to intracranial tumor invasion and 2 patients died of the disease distant metastasis. CONCLUSION If patients got Nasal sinuses adenoid cystic carcinoma, they should take comprehensive treatment based on surgery, in order to improve the survival rate. The prognosis depends on the tumor early detection and early treatment, the sooner the treatment, the better.
Adult ; Aged ; Carcinoma, Adenoid Cystic ; therapy ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Paranasal Sinus Neoplasms ; therapy ; Prognosis ; Retrospective Studies

Background Epidemiological investigation showed that 15％-29％ of patients with cataract have preexisting astigmatism of ＞ 1.50 D.So to control astigmatism is very important to the improvement of visual function after cataract surgery.The implantation of Toric intraocular lens (IOL) is a new option for the correction of preexisting astigmatism during cataract surgery,now.Short-term clinical studies of cataract patients with AcrySof Toric IOL implantation have revealed a good stability.However,the evaluation of long-term clinical result is seldom.Objective This study was to evaluate the long-term clinical results of Toric intraocular lens(IOL) implantation.Methods A serial case-observational study was designed.One hundred and twenty eyes of 78 cataract patients were included in this study.Phacoemulsification combined with AcrySof Toric IOL implantation was performed and the patients received a 2-year follow-up.Uncorrected distance visual acuity (UCDVA),best corrected distance visual acuity(BCDVA),residual cylinder,IOL rotation,vector analysis and accuracy of astigmatic correction were clinically evaluated in 1 day,1 month,3 months,6 months,1 year and 2 years,respectively.Comparison of these results of different follow-up periods were made.Results Sixty-seven patients (101 eyes)finished the follow-up and 19patients(19 eyes)lost visit due to other diseases affected.At 2 years visit after AcrySof SN60TT implantation,UCDVA,BCDVA,residual cylinder,absolute value of IOL rotation degree,vector magnitude of surgically induced astigmatism (SIA) was 0.16 (0.20),0 (0.1),0.75 (0.5) D,(2.9± 1.8) °,(1.2 ± 0.6) D,and the correction index (CI)was 0.90±0.41.A positive correlation was found between SIA and TIA(r=0.74,P =0.000).Compared to 1 month,3,6 months and 1 year,there was a mild tendency of decrease in accuracy of astigmatism correction and CI.Residual cylinder and degree of IOL rotation at 2 years after surgery were also slightly higher.However these changes were not statistically significant (P＞0.05).Conclusions After 2 years of follow-up,patients with AcrySof Toric implantation remain good visual acuity.AcrySof Toric IOL presents excellent long-term rotational stability and accuracy of astigmatism correction.

Objective To explore the relationship between clinical and histological features in children with immunoglobulin A(IgA) nephropathy(IgAN).Method Twenty-one children with IgAN were classified by clinical features,histological and immunological changes.The relationships among them were analyzed.Results IgAN occurred in boys more than girls with the ratio of 2.5∶1.Clinical feature manifested by asymptomatic hematuria(66.7%),hematuria with proteinuria(19.1%),nephrotic syndrome(4.7%),nephritic syndrome(9.5%).The grade Ⅲ(Hass M.classification) in pathological changes was commonly seen with more combined immunoglobulin deposit.Conclusions The incidence of IgAN increased followed by more renal biopsies in asymptomatic hematuria and proteinuria.Clinical features varied and involved all the kinds of glomerulonephritis.There are some relations between clinical and pathological features.Asymptomatic hematuria presented with mild histological changes achieved better outcome.The more proteinuria is always with more severity of histological changes,which should be diagnosed and treated early.

Gastrointestinal Transit ; Humans ; Medicine, Chinese Traditional ; Postoperative Period

Objective To explore the diagnosis, treatment strategies and clinical outcomes of spontaneous subarachnoid hemorrhage in elderly patients. Methods A total of 68 patients aged over 60 years presenting with spontaneous subarachnoid hemorrhage underwent cerebral angiography. And 72 intracranial aneurysms were detected in 60 patients, among whom 47 patients with 59 aneurysms underwent endovascular coil embolization, 6 aneurysms in 6 patients were clipped in microneurosurgery operation, and 7 patients chose conservative treatment. Results A total of 57 aneurysms (96.6%) were embolized successfully, among which 40 aneurysms (70.2%) reached dense occlusion and 17 aneurysms (29.8%) reached incomplete occlusion. Among 47 patients undergoing endovascular treatment, 39 patients (83.0%) were evaluated as good, 7 patients (14.9%) were moderately to seriously disabled according to Glasgow Outcome Scale when they were discharged, and one patient died. Conclusions Active treatment such as endovascular coil embolization can acquire good outcome in elderly patients with spontaneous subarachnoid hemorrhage, especially in elderly patients detected with aneurysms.

Objective To evaluate the clinical application of automated urine formed elements analyzer and/or urine dipstick analyzer for examination of urinary formed elements in screening urinary tract infection (UTI). Methods 148 fresh midstream clear-catch urine samples from the UTI patients and 284 fresh midstream clear-catch urine samples from non-UTI subjects were selected. Bacteria culture was performed for bacterial colony counting and identification. Bacteria counts ( BACT), yeast-like fungus and WBC were performed by UF-looOi automated urine formed elements analyzer. Leukocyte esterase test (LEU) and nitrite test (NIT) were performed by URISYS 2400 urine dipstick analyzer. We evaluated data obtained from urine dipstick analyzer, UF-1000i and combination of UF-1000i with urine dipstick analyzer and the results was compared with those obtained from quantitative bacterial culture. Then we evaluated the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Among the 148 patients with UTI, the positive rate of the quantitative bacterial culture was 73.6% (109/148), the positive rate of LEU and NIT detected by dipstick test 26. 4% (39/148).There was significantly statistical difference between bacterial culture and strip test(χ2 = 55.68 ,P < 0. 05 ). The positive rate of urine flow cytometry by UF-1000i with either positive of BACT and WBC was 91.2%(135/148), which was higher than the positive rate of the quantitative bacterial culture. There was significant difference between two methods (χ2 = 14. 70, P < 0. 05 ). The positive rate of anyone positive among BACT, WBC, LEU and NIT was 94. 6% (140/148) when detected with combination of dipstick test and UF-1000i, which was higher than the positive rate of the quantitative bacterial culture. And there was significant difference between two methods (χ2 = 20. 45, P < 0. 05 ). The sensitivity of dipstick test was low (26. 4% ,39/148 ), and specificity was high ( 99. 3%, 282/284 ) . The sensitivity, specificity, positive predictive value, negative predictive value of BACT detected by UF-1000i in diagnosing urinary tract infection were 92. 6% ( 137/148 ), 39. 8% ( 113/284 ). 44. 5% ( 137/308 ) and 91.1% ( 113/124 ), respectively. If the dipstick test was combined with UF-1000i, the sensitivity, negative predictive value, specificity, positive predictive value and accuracy were 98.0% ( 145/148 ), 97.1% ( 100/103 ). 35.2% (100/284) ,44. 1% (145/329) and 56. 7% (245/432), respectively. Conclusions The combination of urine dipstick test and automated urine formed elements analyzer UF-1000i plays an important role in early diagnosis of UTI. And it has significant value in diagnosis of UTI, especially for the patients with negative bacterial cultures of urine sample.

Objective To identify the clinical and imaging characteristics in neonatal refractory purulent meningitis. Methods Clinical data of 70 cases of neonatal purulent meningitis admitted to the neonatal intensive care unit at Children's Hospital of Fudan University from January, 2009 to December, 2014 were reviewed retrospectively. The patients were divided into refractory group (n=28) and non-refractory group (n=42) according to the course of antimicrobial therapy.The clinical and brain MRI characteristics of neonatal refractory purulent meningitis were analyzed. Parameters were compared between the two groups using Chi-square or Fisher's exact tests, and Wilcoxon tests where appropriate. Risk factors of neonatal refractory purulent meningitis were investigated by univariate and multivariate Logistic regression analysis. Results Among the 70 cases, 31(44.3%) were positive for cerebrospinal fluid (CSF)/blood culture. The positive rate was higher in the refractory group than in the non-refractory group [75.0%(21/28) vs 23.8%(10/42),χ2=17.843, P<0.01]. The most common pathogenic bacteria isolated in the refractory group were Escherichia coli [8 cases (38.1%)] and group B streptococci [5 cases (23.8%)]. Compared to the non-refractory group, patients in the refractory group were more likely to have seizure, higher CSF white blood cell count, higher CSF protein concentration and lower CSF glucose concentration [53.6%(15/28) vs 7.1% (3/42), 965.0 (463.0-2 200.0)×106/L vs 116.5 (61.0-327.5)×106/L, 3 221.1(2 354.3-4 633.5) mg/L vs 1 487.6(988.2-1 924.1) mg/L, and 0.2 (0.1-0.8) mmol/L vs 1.5 (1.2-1.8) mmol/L; all P<0.01]. Multivariate Logistic regression analysis showed that seizure, low CSF glucose concentration on admission, and a positive CSF/blood culture result neonatal refractory purulent meningitis (OR=9.6, 95%CI: 1.2-76.0; OR=15.0, 95%CI: 5.6-63.3; and OR=7.3, 95%CI: 1.5-36.0, respectively). Abnormal brain MRI findings, including intracranial extracerebral space abnormality, ventricular dilatation and periventricular white matter injury, were more common in the refractory group [100.0%(28/28) vs 61.9%(26/42), χ2=13.827 totally; 64.3%(18/28) vs 21.4%(9/42), χ2=13.023 for intracranial extracerebral space abnormality; 60.7%(17/28) vs 19.0%(8/42), χ2=12.704 for ventricular dilation and 28.6%(8/28) vs 2.4%(1/42) for periventricular white matter injury; all P <0.01]. Compared with the non-refractory group, the refractory group had a longer hospital stay [(48.0±17.4) d vs (26.0±10.2) d, t=6.016, P<0.01] and more adverse events [67.9%(19/28) vs 31.0%(13/42), χ2=9.220, P=0.002], including hearing impairment and requirement of neurosurgical intervention [14/18 ears vs 10/46 ears (21.7%), χ2=4.292, P=0.038]. There was no death in both groups during hospitalization. Conclusions Neonates with seizure, low CSF glucose concentration and positive CSF/blood culture results are more likely to have refractory purulent meningitis. Brain MRI abnormalities are more common in neonatal refractory purulent meningitis.

Zinc oxide nanowires were hydrothermally synthesized on the surface of an Au cylindrical spiral formed by manually spiraling an Au fiber around an optical fiber core, glucose oxidase was immobilized on these nanowires by physical adsorption, and then a spirally hierarchical structure-based glucose enzymatic electrode was obtained. The surface morphologies of the spirally hierarchical structures and corresponding enzymatic electrodes were extracted, and the electrochemical performances of the enzymatic electrodes were characterized. It was concluded that the synthesizing parameters of zinc oxide nanowires significantly affected the surface morphologies and glucose oxidase immobilization on the spirally hierarchical structures, and further the performances of related glucose sensors. With Zn2﹢concentration of the growth solution set at 25 mmol/L, the roughness of surface morphology was determined to be 0. 10 μm and correlation length 0. 29 μm, resulting in a better immobilization of glucose oxidase upon zinc oxide nanowires. In this case the sensitivity of the glucose sensor was determined to be 2. 15 μA/(mmol/L·cm2), the linear range was 0-4. 50 mmol/L, the low detection limit was 9. 20 μmol/L and Michaelis-Menten constant was 3. 68 mmol/L. The results not only benefit the batch production of the spirally hierarchical structure-based enzymatic electrodes, but also significantly improve the performances of the glucose sensors.