Objective To investigate the clinical utility of dual-energy virtual non-contrast CT(VNCT)of dual source CT in the di-agnosis and differential diagnosis of solitary pulmonary nodule(SPN).Methods Thirty-six patients with suspected SPN underwent chest plain single energy CT and dual-phase contrast enhanced CT (DECT)(25 and 90 s).The images of dual energy were sent to a commercial workstation for VNC image generation.CT values of SPN on VNC and true non-contrast(TNC),as well as signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were compared.The accuracy of calcification detection was compared according to the diameter and density of the calcification.The TNC images were used as the reference.Results CT values,SNR and CNR of VNC had no statistical difference among TNC and VNC at 25 s and 90 s(P >0.05).DECT VNC(5mm slice)could accurate detected calci-fication(diameter>2 mm,CT value>1 50 HU)in SPN.The 2 mm slice performed significantly better than 5 mm slice VNC images. Conclusion The VNC could provide consistent diagnostic information with TNC.The thin slice DECT VNC images can be used in clinical practice to replace TNC without losing small calcification in SPN,which has potential to reduce the patient radiation dose.

Objective To explore the correlation between left atrial diameter(LAD)and renal function in patients with atrial fibrillation.Methods A total of 364 patients with atrial fibrillation were selected as study subjects.Clinical data of the patients were collected,including gender,age,height,body weight,smoking history,drinking history,atrial fibrillation type,history of hyperten-sion,coronary heart disease,diabetes,heart failure,medication history,high-sensitivity troponin I,brain natriuretic peptide,C-reactive protein,creatinine,urea nitrogen,LAD,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDd),left ventricular posterior wall thick-ness(LVPWTd),and interventricular septal thickness(IVSTd).Estimated glomerular filtration rate(eGFR)and body mass index were calculated.Spearman correlation analysis was used to explore the correlations of LAD with creatinine,urea nitrogen,and eGFR.With eGFR＜60 mL/(min·1.73 m2)setting as renal insufficiency,univariate Logistic regression analysis was used to explore the influencing factors of renal insufficiency in patients with atrial fibrillation.Binary Logistic regression analysis was used to explore the relationship between LAD and renal insufficiency in patients with atrial fibrillation.Results Spearman correlation analysis showed that LAD was positively correlated with creatinine(r=0.279,P＜0.001)and urea nitrogen(r=0.190,P＜0.001)in patients with atrial fibrillation,and negatively correlated with eGFR(r=-0.263,P＜0.001).Univariate Logistic regression analysis showed that gender,history of diabetes,hypertension,coronary heart disease,heart failure,atrial fibrillation type,sodium-glucose cotransporter 2 inhibitor medication history,diuretic medication history,LAD,LVEF,LVDd,and IVSTd were all influencing factors of renal insufficiency in pa-tients with atrial fibrillation(P＜0.05).Binary Logistic regression analysis showed that compared with the first quartile of LAD(LAD ≤38 mm),the risk of renal insufficiency in patients with atrial fibrillation in the fourth quartile of LAD(LAD＞47 mm)increased by 5.199 times(OR=5.199;95％CI,1.210 to 22.337;P=0.027).Conclusion LAD of patients with atrial fibrillation is sig-nificantly related to renal function,and LAD is an influencing factor of renal insufficiency in patients with atrial fibrillation.

Objective To explore the correlation between left atrial diameter(LAD)and renal function in patients with atrial fibrillation.Methods A total of 364 patients with atrial fibrillation were selected as study subjects.Clinical data of the patients were collected,including gender,age,height,body weight,smoking history,drinking history,atrial fibrillation type,history of hyperten-sion,coronary heart disease,diabetes,heart failure,medication history,high-sensitivity troponin I,brain natriuretic peptide,C-reactive protein,creatinine,urea nitrogen,LAD,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDd),left ventricular posterior wall thick-ness(LVPWTd),and interventricular septal thickness(IVSTd).Estimated glomerular filtration rate(eGFR)and body mass index were calculated.Spearman correlation analysis was used to explore the correlations of LAD with creatinine,urea nitrogen,and eGFR.With eGFR＜60 mL/(min·1.73 m2)setting as renal insufficiency,univariate Logistic regression analysis was used to explore the influencing factors of renal insufficiency in patients with atrial fibrillation.Binary Logistic regression analysis was used to explore the relationship between LAD and renal insufficiency in patients with atrial fibrillation.Results Spearman correlation analysis showed that LAD was positively correlated with creatinine(r=0.279,P＜0.001)and urea nitrogen(r=0.190,P＜0.001)in patients with atrial fibrillation,and negatively correlated with eGFR(r=-0.263,P＜0.001).Univariate Logistic regression analysis showed that gender,history of diabetes,hypertension,coronary heart disease,heart failure,atrial fibrillation type,sodium-glucose cotransporter 2 inhibitor medication history,diuretic medication history,LAD,LVEF,LVDd,and IVSTd were all influencing factors of renal insufficiency in pa-tients with atrial fibrillation(P＜0.05).Binary Logistic regression analysis showed that compared with the first quartile of LAD(LAD ≤38 mm),the risk of renal insufficiency in patients with atrial fibrillation in the fourth quartile of LAD(LAD＞47 mm)increased by 5.199 times(OR=5.199;95％CI,1.210 to 22.337;P=0.027).Conclusion LAD of patients with atrial fibrillation is sig-nificantly related to renal function,and LAD is an influencing factor of renal insufficiency in patients with atrial fibrillation.

Objective: To observe the clinical efficacy of self-made one-fourth tubular hook plate used in the fixation of comminuted fractures of acetabular posterior wall. Methods: The clinical data of 21 patients with comminuted fracture of acetabular posterior wall were retrospectively analyzed who had been treated by fixation with our self-made one-fourth tubular hook plate from June 2015 to September 2017 at Deparment I of Orhthopaedics, The Second People's Hospital of Anhui Province. They were 12 males and 9 females, aged from 20 to 59 years (mean, 38.5 years). The time from injury to surgery ranged from 3 to 6 days (average, 4.5 days). All the fractures were fixated with our self-made one-fourth tubular hook plate via the Kocher-langenbeck approach. Depending on the fracture fragments, the hook plate was cut out obliquely through the 3rd or 4th hole and the sharp end of the plate was bent into a small hook to hold the fragments. Only the hook plate was used in 6 cases and an additional construction plate in the other 15 cases. The postoperative reduction, functional recovery of the affected hip and complications were recorded. Results: The follow-up averaged 13 months (from 8 to 32 months). Intermuscular venous thrombosis occurred in one patient and sciatic nerve contusion was observed intraoperatively in one patient with sciatic nerve injury. According to the improved Matta criteria, the fracture reduction was rated as excellent in 16 cases, as good in 4 and as poor in one, giving a good to excellent rate of 95.2%. The fractures united after an average of 7.5 months (from 6 to 12 months). According to the improved Merle d'Aubigné and Postel scoring system, the hip function at the final follow-up was excellent in 14 cases, good in 3, fair in 2 and poor in 2, giving a good to excellent rate of 81.0%. Follow-ups revealed traumatic arthritis in 3 cases, femoral head necrosis in 2 cases and ectopic ossification in one. Conclusion Our self-made one-fourth tubular hook plate is simple, economical and effective because it can provide easy and rigid fixation of the comminuted fractures of acetabular posterior wall, leading to fine therapeutic effects.

Objective To investigate the clinical experience and associated factors of extracorporeal membrane oxygenation(ECMO)for adult patients with severe acute respiratory distress syndrome(ARDS).Methods The clinical data of 22 adult patients with severe ARDS,which met the criteria for ECMO,were retrospectively collected and analyzed.The ECMO team all receiving VV-ECMO treatment (Veno-venous extracorporeal membrane oxygenation),data collection including the patients,general data,blood gas analysis,hemodynamics,mechanical ventilation parameter before and after the ECMO treatment and the auxiliary complications,etc.The control group were 14 cases of patients with severe ARDS which receiving conventional treatment;We collected the same data as the research team.Results In the research,8 patients treated with VV-ECMO,There were 5 males and 3 females,with an average age of (46.3 ± 14.1)years.Compared with the factors at the same time point in the control group,those of the ECMO group,except MAP (t =-0.872,P =0.357),Respiratory rate (t =-1.670,P =0.357),Heart rate (t =-1.973,P =0.042),PH (t =-1.432,P =0.033),PaCO2 (t =-2.564,P =0.024),PO2 (t =-4.955,P ＜ 0.001),PO2/FiO2 (t =-3.654,P ＜ 0.01),PEEP (t =-1.382,P =0.031),Pplateau (t =-2.785,P ＜ 0.01),Blood lactate (t =-2.564,P =0.024) were significantly improved after ECMO running 24 hours (all P ＜ 0.05).And also the factors such as the length of ICU stay (t =-2.452,P =0.027),the times of mechanical ventilation (t =-1.478,P =0.038),number of organ failure(t =-1.963,P =0.047),the hospital mortality rates(t =-1.970,P =0.045) and treatment costs(t =-1.667,P =0.035) between the ECMO group and the control group were significantly different (P ＜0.05).In the end,we divided the ECMO group into survival group and death group,and compare the time of Mechanical Ventilation before ECMO(P =0.031) the total time of Mechanical Ventilation(P =0.038),the time of ECMO adjutant (P =0.047),the length of ICU stay (P =0.043) and the cost of treatment (P =0.037) between the two groups;and there were also statistically significant difference (P ＜ 0.05).Conclusion ECMO can significantly improve the patients,oxygenation and respiratory physiology indexes which can not sustain under the conventional mechanical ventilation therapy and win the time for rest and repair of lung.Indexes such as age,time of mechanical ventilation before ECMO therapy,the primary cause of ARDS are the important factors influencing the efficacy of ECMO treatment in the patients with severe ARDS.

Behcet′s disease is a chronic, multisystemic, inflammatory disease characterized by recurrent episodes of mucous membranes, eyes, musculoskeletal, blood vessels, central nervous system, and gastrointestinal tract.The treatment of Behcet′s disease varies according to the degree of organ involvement, gender and age of the patient, and there is no standard treatment. Behcet′s disease can be divided into vascular type, gastrointestinal type and neural type. Vascular type often leads to high mortality and disability rate.Glucocorticoids, azathioprine and cyclophosphamide are still recommended as first-line treatments for vascular Behcet′s disease.However, with the use of tumor necrosis factor inhibitors, they are an acceptable option for the treatment of refractory vascular Bezier′s disease.This article reviews the current treatment of vascular Behcet′s disease.

Objective To analyze the differences in the initial stability of an acetabular cup with a Voronoi polyhedral porous structure and a solid acetabular cup and to explore the impact of the Voronoi polyhedral porous layer on the initial stability of the acetabular cup,as well as its role in preventing loosening and dislocation.Methods Voronoi polyhedral porous scaffold structures with 60％and 70％porosities were designed using the Grasshopper software.Specimens of porous acetabular cups with 60％and 70％porosities and solid acetabular cups were manufactured using selective laser melting technology.Lever tests on the acetabular cups were conducted using polyurethane block models under identical conditions,and the maximum lever-out moment,angular displacement,and interface stiffness of the three groups of specimens were analyzed and compared.Results Under the condition of no significant differences in the compression force,for porous acetabular cups with porosities of 60％and 70％,the maximum lever-out moment increased by 278.82％and 320.56％,the angular displacement increased by 194.04％and 269.23％,respectively,and the interface stiffness increased by 18.58％and 7.88％,respectively,compared with that of solid acetabular cups.After the lever-out tests were completed,significant wear was observed within the polyurethane block hemisphere cavity using the porous acetabular cups.Conclusions The initial stability indicators of acetabular cups with a Voronoi polyhedral porous structure were higher than those of solid acetabular cups,indicating that the Voronoi polyhedral porous layer can enhance the initial stability of the acetabular cup.These results provide a reference for designing and selecting acetabular components.

Objective To investigate the intra- and interobserver repeatability of coronary artery disease (CAD) diagnosis based on invasive coronary angiography (ICA) and CT coronary angiography (CTCA).Methods Two readers with comparable experience ( over 10 years) independently evaluated ICA results of 42 consecutive patients with a blind method. After 30 days,one of them reviewed the same patients again.Another two comparable-experience (over 10 years) readers evaluated the results of CTCA (prospectively ECG-triggering) from the same 42 patients in the same way.The inter-reader and intra-reader repeatability of ICA and CTCA were analyzed by performing Kappa test and calculating the percentage of the segments with agreement on stenotic degree.Using ICA as reference,the accuracy of CTCA in diagnosing CAD was studied by comparing the area under ROC. Results The Kappa between readers for ICA and CTCA were 0.91 and 0.81.Intra-reader Kappa were 0.92 and 0.83 respectively (x2 =509.4 and 432.5,all P ＜0.01 ).The percentage of the segments with agreement between readers on the degree of stenosis were 80.8％ (494/611) in ICA and 75.2％ (469/624) in CTCA ( x2 =2.75,P =0.10),and within the same reader,86.9％ (531/611)in ICA and 81.9％ (511/624) in CTCA(x2 =3.76,P =0.053).With≥ 50％narrowing as a CAD diagnosis criterion,the agreement rates for two readers were 96.6％ (590/611 ) in ICA and 94.4％ (589/624) in CTCA( x2 =3.36,P =0.07),and for the same reader,97.4％ (595/611) in ICA,95.4％ (595/624) in CTCA ( x2 =3.62,P =0.06).Using ICA as reference,two readers of CTCA results achieved a sensitivity and specificity of 84.9％ (530/624)and 98.1％ (612/624).The area under ROC was 0.94 (95％ CI 0.91-0.97).Conclusions Both ICA and CTCA demonstrate good repeatability in diagnosing CAD.The repeatability of ICA is superior to that of CTCA.A certain discrepancy exists in two readings from the same reader or two readers.

Objective:To investigate the effect of Stigma Maydis Palysaccharide(SMPS)on ATP synthesis in kidney mitochondria of D-galactose-induced aging mice, and to clarify its possible mechanism.Methods:The aging mouse model was established by subcutaneous injection of D-galactose solution in the back of the neck.The 48 SPF male mice were randomly divided into normal control group(control group), D-galactose model group(D-Gal group), SMPS low-dose group and SMPS high-dose group(n=12 for each). The control group was subcutaneously injected with 150 mg/kg normal saline on the back of the neck every day, while the other three groups were subcutaneously injected with 150 mg/kg of D-gal solution on the back of the neck every day.SMPS-L and-H dose groups were given 30 mg/kg and 60 mg/kg of SMPS solution by gavage at the same day of D-Gal injection.The control group and D-GAL group were given the same volume of normal saline daily by gavage for 42 days.Blood samples were collected from the eyeball under general anesthesia after 42 days of intervention for the detection of serum levels of superoxide dismutase(SOD), glutathione peroxidase(GSH-Px)and MDA.After harvesting the kidney tissue, various tests were used to detect ATP content, the mRNA expression levels and protein expression levels in kidney.Luciferase assay was used to detect ATP content in renal tissue.Real-time fluorescent quantitative PCR was used to detect the mRNA expression levels of succinate dehydrogenase(SDH)of complex Ⅱ, cytochrome C reductase(Cycs)of complex Ⅲ, complex Ⅳ(COXⅣ)and ATP5b in ATP synthase in mitochondrial oxidative respiratory chain.Western blot was used to detect the expression levels of mitochondrial fusion protein 2(MFN2), dynamin-related protein1(DRP1)and mitochondrial autophagy related protein P62 in renal tissues of each group.Results:Compared with control group, the activities of serum of SOD(116.53±10.01)U/mg and GSH-Px(127.58±8.74)μmol/L were significantly decreased in D-GAL group(both P< 0.01), and serum MDA content(15.42±0.91)μmol/L increased significantly in D-GAL group( P<0.01). Compared with D-GAL group, the activities of SOD(152.80±9.29)U/mg and GSH-Px(274.07±10.73)μmol/L were significantly increased in SMPS intervention group( P< 0.01), while the MDA content(8.10±0.66)μmol/L decreased significantly in SMPS intervention group( P< 0.01). Compared with control group, the content of ATP(178±4)10 -4 μmol in D-gal group was significantly decreased( P<0.01), the mRNA expression levels of SDH, Cycs and COXⅣ were not significantly changed in D-gal group, and the mRNA expression level of ATP5b(0.67±0.01)was down-regulated in D-gal group( P<0.01), the expression of MFN2 protein(0.29±0.02)was significantly decreased in D-gal group( P<0.01), and the expression of DRP1 and P62 protein(0.31±0.02 and 0.21±0.01)was significantly increased in D-gal group(both P<0.01). Compared with the D-gal group, the ATP content(193±1)10 -4 μmol in the kidney tissue of the mice was significantly increased in SMPS intervention group( P< 0.01), and the ATP5b mRNA expression and MFN2 protein expression(0.87±0.05 and 0.71±0.08)were significantly increased in SMPS intervention group(both P< 0.01), DRP1 and P62 protein expressions(0.20±0.01 and 0.10±0.01)were significantly down-regulated in in SMPS intervention group(both P< 0.01). Conclusions:SMPS can improve the mitochondrial dynamic homeostasis disorder in aging mice by increasing the activity of antioxidant enzymes, up-regulating the expression of ATP5b mRNA and MFN2 protein, down-regulating the expression of DRP1 and P62 protein, and promoting the generation of mitochondrial ATP in D-gal-induced aging mice kidney tissue.

Objective:To observe the effect of CoCl2on the cisplatin sensitivity of human ovarian cancer SKOV3cells, and to clarify the possible mechanism.Methods:The SKOV3cells were cultured in vitro and randomly divided into control group, CoCl2 group, cisplatin (DDP) group and CoCl2 combined with DDP (combination) group.The cells in CoCl2group were cultured in normal cell medium for 20hafter cultured in 200μmol·L-1 CoCl2for 4h, the cells in DDP group were cultured in normal cell medium containing 10mg·L-1 DDP for 24h, and the cells in combination group were cultured in 10mg·L-1 DDP for 20hafter cultured in 200μmol·L-1 CoCl2for 4h.The survival rates of SKOV3cells in various groups were detected by MTT method, and the positive expression intensities of hypoxia-inducible factor-1α (HIF-1α) and inducible nitric oxide synthase (iNOS) in the cells in various groups were detected by immunofluorescence method.Rhod 2-AM fluorescence probe was used to observe the levels of Ca2+in mitochondria in the cells in various groups.Western blotting method was used to observe the expression levels of cytochrome C (cyto C) , cysteinyl aspartase 3 (caspase 3) and cleaved cysteinyl aspartase 3 (cleaved caspase 3) .Muse○R apoptosis assay kit was used to detect the apoptotic rates of cells in various groups.Results:Compared with control group, the survival rate of the cells in CoCl2group had no significant change (P＞0.05) , and the survival rates of the cells in DDP and combination groups were decreased (P＜0.05) ;the survival rate in combination group was higher than that in DDP group (P＜0.05) .Compared with control group, the positive expression intensities of HIF-1αin CoCl2and combination groups were increased (P＜0.05) .Compared with control group, the positive expressions of iNOS in DDP and combination groups were increased (P＜0.05) .The Ca2+levels in the cells in DDP group and combination groups were higher than that in control group (P＜0.05) and the Ca2+level in DDP group was higher than that in combination group (P＜0.05) .Compared with control group, the expression levels of cyto C, caspase 3and cleaved caspase 3proteins in the SKOV3cells in CoCl2group had no significant changes (P＞0.05) , and the expression levels of cyto C, caspase 3and cleaved caspase 3in DDP group were increased significantly (P＜0.05) ;compared with DDP group, they were lower than those in combination group (P＜0.05) .Compared with control group, the apoptotic rate of SKOV3cells in DDP group was increased significantly (P＜0.05) ;the apoptotic rate of SKOV3cells in combination group was lower than that in DDP group (P＜0.05) .Conclusion:CoCl2can redece the mitochondrial apoptosis of human ovarian cancer SKOV3cells by inhibiting the DDP-induced enhancement of iNOS expression and decrease the sensitivity of SKOV3cells to cisplatin.