Objective To assess the clinical walue of 3D retroperitoneal laparoscopic renal pedicle disconnection by comparing its clinical effects with those of traditional 2D laparoscopic.Methods Clinical data about 49 cases from our department with chyluria respectively treated by 3D retroperitoneal laparoscopic and 2D laparoscopic renal pedicle disconnection were analyzed retrospectively.They were divided into 3D group(26 cases)and 2D group(23 cases),and operated by the same salty doctor.The operation time,intraoperative blood loss,postoperation hospital stay and recurrence rate of the two group were compared.Results The operation time in 3D group[(95.2±30.3)min] was shorter than 2D group[(120.4±25.8)min,P<0.05].The intraoperative blood loss in 3D group[(30.0±12.7)ml] was less than 2D group[(55.0±21.7)ml,P<0.05].There were no difference in postoperation hospital stay between the two groups.All of the cases were not recurred.Conclusion 3D Retroperitoneoscopic renal pedicle lymphatic disconnection for treatment of chyluria is safty and feasible.3D laparoscopy provides high-quality 3D endoscopic view and facilitates precise manipulation during surgery,resulting in shorter operation time and intraoperative blood loss compared with 2D laparoscopy.

Objective To evaluate the clin ical value of Multi-slice helical CT three dimensional angiography (3D-MSCTA) as first method for diagnosing intracr anial aneurysms. Methods We studied patients with clinical suspected intracranial aneurysms (13 patients with subarachnoid hemorrhage among cases). All these patients under went 3D-MSCTA and Digital Subtraction Angiography (DSA), 16 patients of them accepte d operation treatment. Row data was acquired by Multi-slice helical CT-AQUILION (Toshiba): scan speed 0.5 s/rot, image slice thickness 1.0 mm, helical pitch 3 .0/5.0. Contrast media (Angiografin) was injected intravenously (1.0-2.0 ml/kg) at spee d of 2.5-3.0 ml/s, delay time was 15-23 sec, reconstruction interval 0.5 mm, recons truction slice thickness 1.0 mm. Source images were processed using a workstation SGI-O2 , images post-processing software was ALATOVIEW,Version 1.21. The reconstructed images were then processed into shaded volume rendering (SVR) and maximal intensity projection (M IP) and Fly-through images. Entire brain DSA was performed obtaining anterioposteri or, lateral, and oblique images. Images of 3D-MSCTA and DSA were analysed by 3 radiologists and 2 neurosurgeons. Results 25 aneurysms were d etected by 3D-MSCTA. Aneurysms′s body, neck, source vessel and the relationship between the aneurysm and surrounding structures was clearly and surely displayed. 22 of 25 aneurysms were detected by DSA,another 3 were (1 anterior communicating artery aneurysm and 2 left middle cerebral artery aneurysm) was not detected. Sixteen of patients un derwent operation treatment, and the results of 3D-MSCTA corresponded very well to those of operation. Maximal diameter of aneurysms body was 14.0 mm and minimal diameter w as 1.7 mm. Conclusion 3D-MSCTA is a high sensitivity and rapid and no ninvasive method for detecting intracranial aneurysms. We suggest that 3D-MSCTA may be the first cho ice for diagnosing intracranial aneurysms.

Objective To investigate the expression and clinical significance of H1 receptor in kidney and bladder tissue of rats after long term ketamine intraperitoneal injection.Methods This study was conducted from May 2012 to December 2012.Sixty male 2-month-old SD rats,weighted (200±10) g,were randomly divided into Group A and Group B.Each group concluded 30 rats.In the Group A,Ketamine (100 mg/kg) was given as intraperitoneal injection every other day,while normal saline (100 mg/kg) was given in Group B.The dosage was adjusted every week according to the weight of rats.After 2,4 and 6 months,10 rats from each group were randomly chosen.First,the micturition number during 2 h was recorded.Then,urine samples over a 24 h period were collected and the content of Na+ and K+ were determined.Finally,the blood samples were obtained from the apex of heart for the creatinine determination.The kidneys and bladders were harvested after the rats were sacrificed.HE staining was conducted on all the tissues.Immunohistochemical S-P method was used to detect the expression of H1 receptor in the bladder and kidney tissues from Group A and Group B.The average optical density (A Value) in each group was separately calculated by Imagepro-plus 6.0 software.All the parameters,mentioned above,were carefully compared.Results The successive rate of establishing rats model was 90％ (9/10),according to the pathological result after 6 months injection.The urine volume of 24 h in group A and B were (15.9±1.3) and (10.1±0.8) ml,respectively.Micturition frequency during 2 hours in group A and B were (6.9±1.4) and (3.0±0.5) times.The urine volume of 24 h and micturition frequency during 2 hours were significantly increased in group A (P＜ 0.05).The urine sodium within 24 h in group A was (1.7±0.1) mmol,which is increased significantly than that in group B (1.0±0.1 mmol).While the urine potassium was less in group A (1.1±0.1 mmol/d) than in group B (2.6±0.1 mmol/d) (P＜0.05).But the serum creatinine level were (60.5±6.8) and (58.1± 3.9) μmol/L in group A and B,which had no difference between the two groups (P＜0.05).The expression of H1 receptor in kidneys and bladder in group A was significantly raised compared with group B (P＜0.05).In the group A,the expression of H1 receptor level in kidney was 0.008±0.001,0.016±0.001,0.023±0.004 after 2,4 and 6 months drug used.The expression level in group A were significantly difference than that in group B (0.003±0.001,0.004±0.002,0.003±0.001) (P＜0.05) and goes up with prolonging the drug using.While in the bladder tissue,the level of H1 receptor expression was 0.017±0.006,0.031±0.012,0.036±0.007 in group A and 0.015±0.007,0.016±0.005,0.016±0.004 in group B,which could be noticed a significantly increasing in group A (P＜0.05).In 4 and 6 months,the H1 receptor expression level significantly raised than that in 2 months (P＜0.05).Conclusions Long term ketamine addiction exerts toxicity not only on the bladder but also on the kidney.The increased expression of H1 receptor in rats' kidney and bladder tissues of group A indicates that H1 receptor may be related to the ketamine-associated urinary system dysfunction.The urine sodium and potassium within 24 h may be a sensitive index for the assessment of degree of kidney damage in the early stage of ketamine-induced dysfunction than serum creatinine.

Objective To investigate the expression and clinical significance of four histamine receptors:H1R, H2R, H3R and H4R in urinary bladder of patients with ketamine-induced cystitis. Methods Immunohistochemical S-P method was used to detect the expression levels of histamine receptors:H1R, H2R, H3R and H4R in bladder tissues of 10 patients with ketamine-induced cystitis (experimental group) and distal tissue away from bladder tumors of 10 patients with cystectomy (control group). The average optical density (OD) values of four kinds of different histamine receptors were separately calcu-lated by Imagepro-plus 6.0 in two groups. At the same time, mast cells were marked by toluidine blue special dyeing and were counted. Results Comparing with control group, the expression levels of H1R, H2R, and H4R were significantly in-creased in experimental group (P＜0.05). Mast cells diffused interstitial bladder infiltrates (P＜0.05). There was no signifi-cant difference in the expression of H3R in two groups. Conclusion Mast cells, H1R, H2R, and H4R are closely related to the ketamine-induced cystitis, which may be new diagnostic indicators and new treatment targets of ketamine-induced cysti-tis.

Objective To evaluate the effect of early enteral nutrition (EN) on the pancreatic exocrine secretion in dogs with acute necrotizing panereatitis (ANP). Methods ANP model was induced by injection of mixtured solution of 5% sodium tanrecholate and trypsin into the pancreatic duct. Thirty dogs were randomly divided into total parenteral nutrition (TPN) group (n=5), duodenal PEPTI-2000VARIENT (DP) group (n=5), duodenal Nutrison MuhiFibre (DN) group (n=5), jejunal PEPTI-2000VARIENT (JP) group (n=5), jejunal Nutrison MuhiFibre (JN) group (n=5). The dogs were treated by either TPN or EN 24 hours after ANP model induction and the nutrition support lasted for 5 days. Serum amylase, LDH, lipase, secretin (SEC), cholecystokinin (CCK) and gastrin were measured at 1, 2, 3, 4, 5 d. Pancreatic juice was collected for 3 hours after TPN or EN started, and the amount of pancreatic juice and levels of proteinase, amylase, lipase, HCO3-, K+, Cl-, Na+ were determined. Dogs in each group were sacrificed at day 7. Histological and ultra-structure changes of the pancreatic tissues were evaluated pathologically. Results The levels of serum amylase, LDH, lipase, CCK, amount of pancreatic secretion and K+, Cl+, Na+ were not significantly different among these groups. The levels of plasma SEC and gastrin, HCO3-, proteinase, amylase, lipase in the duodenal nutrition groups were significantly higher than those in TPN group (P<0.05). The above mentioned parameters in the jejunal nutrition group were significantly lower than those in the duodenal group (P<0.05) and higher than those in the TPN group without significant difference. Among the 2 jejunal nutrition groups, the levels of plasma gastrin, HCO3- in pancreatic juice, proteinase, amylase, lipase in the JP group were significantly higher than those in the JN group (P<0.05). The above mentioned parameters in the DP group were significantly lower than those in the DN group (P<0.05). The amount of pancreatic secretion, HCO3-,K+, Cl+, Na+ were not significantly different among these groups. The pathological changes were similar among these groups, and the extent of pathological changes was relatively better in the JP group. The amount and density of intracytoplasm zymogen granules of pancreatic acinar cell were not significantly lower than those in the TPN group. Conclusions The delivery of nutrients to the proximal jejunum with elemental low-fat diets did not increase the pancreatic exacrine activity.

Objective To explore the effect and compare the relapse rates of 1-desamino-8-D-Arginine Vasopressin(DDAVP) different withdrawal ways after initial 3 months in primary monosymptomatic nocturnal enuresis(PMNE) patients,in order to provide some evidences and references to use DDAVP to cure PMNE preferably.Methods Two hundred and fifty-six cases PMNE patients who were treated in Hubei Maternal and Child Health Hospital from November 2014 to June 2016 were selected and randomly divided into group A (DDAVP immediate withdrawal group,65 cases),group B(DDAVP day reduction group,58 cases) and group C (DDAVP step reduction group,60 cases).All patients were given DDAVP tables for 3 months.After 3 months for DDAVP,patients who were effective (full respond and partial respond) to DDAVP continued to undergo a withdrawal stage,those in group A underwent immediate cessation,those in group B continued to receive the effective dose every other day for 2 months and those in group C were step by step tapered by 0.05-0.10 mg every 2-4 weeks until completely stopped,the period was not more than 3 months.All patients had a follow-up visit for 3 months after cessation of DDAVP.Results A total of 183 patients completed the study finally,there were 65 patients in group A,58 patients in group B and 60 patients in group C.Initial 3 months the effective rates of group A,B and C were respectively 89.23％ (58/65),89.66％ (52/58) and 86.67％ (52/60),there were not statistically significant difference(x2 =0.309,P =0.857).There were 58 patients in group A,52 patients in group B and 52 patients in group C continued to undergo the withdrawal stage.One month after cessation of DDAVP,the effective rates of group B (88.46％,46/52) and group C (92.31％,48/52) were significantly higher than group A(67.24％,39/58) (x2 =7.030,P=0.008;x2 =10.417,P=0.001),while the relapse rates of group B(19.23％,10/52) and group C(17.31％,9/52) were significantly less than group A(36.21％,21/58) (x2=3.904,P=0.048;x2=4.937,P =0.026).Three months after cessation of DDAVP,the effective rates of group C (78.85％,41/52) were significantly higher than group A (50.00％,29/58) and group B (57.69％,30/52) (x2 =9.859,P=0.002;x2 =5.371,P=0.020),and the relapse rates of group C(32.69％,17/52) were significantly less than group A (55.17％,32/58) and group B (51.92％,27/52) (x2 =5.609,P =0.018;x2 =3.939,P =0.047),while the effective rates and relapse rates were not statistically significant difference between group A and group B(x2 =0.652,P =0.419;x2 =0.116,P =0.733).Severe adverse events related to DDAVP were not observed in any patients.Conclusion Gradual withdrawal after initial 3 months of DDAVP may improve the effect and reduce the relapse rates,the short-term and long-term curative effects of step-by-step withdrawal treatment are both well,while long-term curative effects of every other day withdrawal treatment is not obviously well.

Systemic juvenile idiopathic arthritis is one of the common rheumatic and immune diseases in children. It has a sudden onset, obvious systemic symptoms, and lung involvement. However, systemic juvenile idiopathic arthritis with an early manifestation of pulmonary ground-glass opacities combined with macrophage activation syndrome is rare. The clinical data of a child with systemic juvenile idiopathic arthritis with pulmonary ground-glass shadow and macrophage activation syndrome who was admitted to Hubei Maternal and Child Health Care Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology in December 2021 were analyzed retrospectively in order to improve the understanding of rheumatic diseases and pulmonary lesions. The child was admitted to the hospital for 10 days due to rash and fever. Thoracic CT showed scattered ground glass like shadows in both lungs due to the prevention and control screening of COVID-19 pneumonia epidemic situation. After admission, the child was still repeatedly flaccid with high fever, accompanied by dysfunction of both lower limbs. The knee joint MRI found that there was synovitis in the knee joint, and various laboratory indicators suggested macrophage activation syndrome. After that, systemic juvenile idiopathic arthritis was diagnosed. After being treated with methylprednisolone, cyclosporine and topzumab, the clinical remission and the ground-glass shadow of the lung basically disappeared. Through the analysis of this case, it is suggested that clinicians should not ignore other diseases that cause ground glass shadow in the lung during the current epidemic of COVID-19.

This study evaluated the clinical value of three-dimensional computed tomography (3D-CT) images in the knees following arthroscopic anterior cruciate ligament (ACL) reconstruction. Sixty-five consecutive patients underwent arthroscopic ACL reconstruction with single-incision and single-tunnel techniques. Preoperative and postoperative (12 months in between) clinical evaluation were performed using the Lysholm knee score and a KT-1000 arthrometer (side to side). Computed tomography (CT) of the knees was performed in a week after operation in all cases and at mean follow-up of 12 months. All of the clinical evaluation scales performed showed an overall improvement. 3D-CT images can display not only the bone tunnels of the knees including femoral and tibia very distinctly, but also the contour of the reconstructed ACL including adjacent structures. The average femoral tunnel diameter increased significantly (3%) from (9.15 +/- 0.03) mm postoperatively to (9.48 +/- 0.5) mm after 12 months; tibial tunnel increased significantly (12%) from (9.11 +/- 0.09) mm to (10.2 +/- 0.3) mm. There was no statistical difference between tunnel enlargements. So multi-slices spiral CT can evaluate the contour and changes of contour and changes of the knee after ACL reconstruction, which will be helpful in the intraoperative location and postoperative assessment of the knees.
Adult ; Anterior Cruciate Ligament ; diagnostic imaging ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; methods ; Arthroscopy ; Female ; Humans ; Imaging, Three-Dimensional ; Knee Injuries ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Postoperative Period ; Tomography, X-Ray Computed ; methods ; Young Adult

Objective To learn the needs of family physicians for tertiary hospital support in the hierarchical medical system. Methods In July 2017 cluster sampling was made to 135 family physicians of Changning district of Shanghai for a " Family physicians needs questionnaire" . It covered such aspects as their demographic characteristics and their needs. The data so acquired were subject to descriptive and logical analysis. Results 99.3% of them need preferential appointment of specialists at tertiary hospitals;93.3% of them need preferential appointment of examinations; 82.2% of them need preferential outpatient visits; while 83.7% of them need preferential hospitalization and surgery scheduling. In terms of the approaches for preferential appointment of specialists, 84.4% of them prefer specialist appointment at short notice, and 73.3% of them need direct online appointment for large-scale device examinations at tertiary hospitals. In terms of mentoring scenarios, 62.2% of them prefer mentoring during outpatient rounds at fixed schedules of specialists in their community. Conclusions Tertiary hospitals are recommended to establish green pathways for referrals and priority measures in order to improve capabilities of family physicians and the shared platform in the hierarchical medical network. They are also expected to guide family physicians in their research paper writing, thus fully supporting the hierarchical medical system.

Objective:To explore the value of metal artifact reduction in oblique sagittal multi-acquisition with variable resonance image combination slab selectivity (MAVRIC-SL) inversion recovery (IR) sequence compared with conventional fast spin-echo (FSE) fat saturation (FS)-T 2WI and proton density weighted imaging (PDWI) on the postoperative review of patients with metal-fixed anterior cruciate ligament reconstruction (ACLR) at 3.0 T MR. Methods:From June to November 2018, 27 patients with metal fixtures in ACLR were prospectively recruited in the First Hospital of China Medical University. The FSE sequences (FS-T 2WI and PDWI) and the MAVRIC-SL IR were performed at 3.0 T MRI system. The maximum artifact slice was selected and ROI was drawn, then the implant and artifact area and the number of artifact-influence slices were recorded. Image signal-to-noise ratio (SNR) was calculated. The degree of image artifacts (artifact degree of spiked ligament staple and its influence on the diagnosis of surrounding structures), measurability (measurability of distance between the upper edge of the staple and the lower edge of the graft entrance on tibia), and other degree of artifacts (whether there were metal artifacts other than implants that affect the observation of other structures within the scanning range) were scored. The Friedman M test and pairwise comparison were used to compare and analyze the quantitative and qualitative data. Results:The differences in artifact area, the number of artifact-influence slices and SNR among FS-T 2WI, PDWI and MAVRIC-SL IR images were statistically significant (all P<0.001). Pairwise comparison analysis suggested that the metal implant artifact area and the number of artifact-influence slices in the MAVRIC-SL IR image were smaller, and the SNR was higher than those of FS-T 2WI and PDWI (all P<0.05 after correction). The differences of the three scores among FS-T 2WI, PDWI and MAVRIC-SL IR were statistically significant (all P<0.001). Pairwise comparison analysis suggested that the degree of image artifacts score of MAVRIC-SL IR sequence was lower, and the measurability and other degree of artifacts scores were higher than FS-T 2WI and PDWI (all P<0.05 after correction). Conclusion:MAVRIC-SL can significantly reduce the metal artifacts and improve image quality in the postoperative MRI review of the patients with metal-fixed ACLR. Therefore, oblique sagittal MAVRIC-SL IR sequence can be used for assisting the diagnosis of conventional FS-T 2WI and PDWI.