Objective To study the half quantitative diagnostic method of the high-risk gastrointestinal stromal tumors (GISTs) with analyzing the characteristic of high-risk and lower risk GISTs with multi-slice spiral CT (MSCT). Methods CT findings of 46 patients with 51 GIST lesions were retrospectively analyzed. The location, size, shape, boundary, growth pattern and other specialties of the tumors in high-risk and lower risk GISTs were studied, moreover statistical analysis was conducted, logistic regression equation was obtained. Results Significant difference was found in tumors' location, size, shape, boundary and distant metastasis between the two types of GISTs. There were obvious correlation between the risk level and tumors' size and boundary which could be used to build the diagnostic equation of high-risk GISTs. Conclusion The equation ln [P/(1-P)]=-2.612X_3+0.371X_5 (X_3:tumors' boundary, X_5:tumors' size) is valuable in the diagnosis of high-risk GISTs.

Objective To analyze the application value of digital radiography (DR) on healthy population.Methods 1449 cases of health examination on chest by DR were retrospectively studied,the physical examination results were analyzed.Results The medical examination of positive rate was 4.9％.The positive rate of women was higher than men ( x2 =11.493,P =0.001 ).the top 5 detection rate of diseases were lung old lesions,pneumonia,suspicious tumor,thickening and adhesion of pleural,senile pulmonary.Conclusion The DR examination was selected according to symptoms,medical history of participate in the examination,the check frequency was selected according to age.

Objective To probe the cause,clinical and imaging findings of children's congenital pyriform sinus fistula (CPSF). Methods Clinical and radiographic data in 23 patients with children’s CPSF were analyzed retrospectively which were confirmed by pathology.Results 1 6 patients represented repeated swelling and pain in left anterior neck,6 of whom were misdiagnosed as thyroid abscess and suffered surgery.7 patients represented masses in left anterior neck.Ultrasound showed all patients with diffuse en-larged thyroid gland with uneven mass and separated liquid dark space or infection in deep neck soft tissue,and no CPSF was identi-fied.The subsequent esophageal barium meal confirmed the fistula in 8 patients,and other patients underwent further CT scan with image post-processing.CT showed clear fistula in 4,suspicious fistula in 7 and no fistula in 4,All fistulas were confirmed by the pa-thology.Conclusion The combination of ultrasound,esophagogram and CT with image post-processing can improve the diagnostic sensitivity and accuracy of CPSF.

Objective To examine the epidemiological and clinical features of the adults with Henoch Schonlein Purpura (HSP),and improve the diagnosis and therapeutic efficacy of HSP.Methods Thirty five adults with HSP from the hematological department of Tianjin Medical University General Hospital between 1993.9 to 2005.12 were enrolled in this study.Epidemiological,clinical and laboratory data,therapeutic methods and efficacy were investigated.Results Most patients with HSP in our department were male and adolescent.HSP occurred more commonly in the winter.The important predisposing factors were infection and having specific food.Purpuric lesions were the most common presenting signs.Multiple organ involvement was more common.Purpura was present in all case,lower extremities were more commonly involved.Joint involvement was observed in 15 cases(42.9%),abdominal involvement in 20 cases(57.1%),renal involvement in 20 cases(57.1%).Conclusion The adult patients with HSP had more tendenecy to have severe renal damage and multiple organ involvement.

Objective To establish and clinically evaluate a method to adjust tube current(mA)individually for obtaining images with consistent noise and optimized radiation dose in 64-slice spiral helical CT coronary angiography.Methods (1)80 patients,as a control group,were underwent CT coronary angiography(CTCA)using 64-muhislice spiral helical CT with fixed mA(650 mA).Two radiologists first assessed image quality of the fixed mA group by scoring from 1 to 5.A minimal dose requirement for meeting clinical diagnosis with the desired noise level(standard deviation SD0)were decided.By analyzing the images of the control group,we also established correlation between the image noises of timing bolus(TB)scans and cardiac(CA)scans and set up a formula to predict the required mA value for obtaining the desired cardiac image noise for individual patient.(2)Subsequently,another group of 80 patients(study group)wero scanned with individually adjusted mA using the established formula and the practicability of this method was then evaluated.The independent sample t test was used to compare the values of the two groups.Results (1)The noise of TB and CTCA scans was linearly correlated with r2=0.994. (2)A cardiac image noise level of 28 HU was found to be adequate for clinical diagnostic purpose based on the image quality analysis.(3)The average noise for the acquired cardiac images was found to be 28.97 HU for the study group with individually adapted mA using the established formula.The standard deviation of the image noisein study group was 1.93,which was much smaller than 5.14 in the fixed mA group,but the average image scores for the study group(4.27±0.68)and fixed group mA(4.03 4-0.93)were not statistically different.(4)In the study group,63 out of 80 patients required tube currents below the standard 650 mA,yielding an average CTDIvol of58.32 mGy,which was about 32.1%dose reduction than that of fixed mA(85.94 mGy).The lowest CTDIvol was 19.27 mGy with 160 mA which was 22.4%of the average CTDIvol in control group.Conclusion Adjusting mA individually based on timing bolus scan noise analysis is an accurate and practical method to obtain consistent image quality for different cardiac pailents and to minimize the radiation dose for individuals compared to the fixed mA.

To study the dynamic changes of CT perfusion parameters during the first 12 h in the embolic cerebral ischemia models. Local cerebral ischemia model were established in 7 New Zealand white rabbits. All CT scans were performed with a GE Lightspeed 16 multislice CT. Following the baseline scan, further CT perfusion scans were performed at the same locations 20 min, 1-6 h and 8, 10 and 12 h after the embolus delivery. Maps of all parameters were obtained by CT perfusion software at each time point. The brains, taken 12 h after the scan, were sliced corresponding to the positions of the CT slices and stained by 2,3,5-triphenyltetrazolium chloride (TTC). On the basis of the TTC results, the ischemic sides were divided into 3 regions: core, penumbra and the relatively normal region. The changes of all parameters were then divided into 3 stages. In the first two hours (the first stage), the CBV dropped more remarkably in the core than in the penumbra but rose slightly in the relatively normal region while the CBF decreased and MTT, TTP extended in all regions to varying degrees. In the 2nd-5th h (the second stage), all the parameters fluctuated slightly around a certain level. In the 5th-12th h (the third stage), the CBV and CBF dropped, and MTT and TTP were prolonged or shortened slightly in the core and penumbra though much notably in the former while the CBV, CBF rose and MTT, TTP were shortened remarkably in the relatively normal region. We experimentally demonstrated that the location and extent of cerebral ischemia could be accurately assessed by CT perfusion imaging. The pathophysiology of the ischemia could be reflected by the CT perfusion to varying degrees.
Blood Flow Velocity ; Brain Ischemia/physiopathology ; Brain Ischemia/*radiography ; Cerebrovascular Circulation ; Stroke/physiopathology ; Tomography, X-Ray Computed

ObjectiveTo determine the allele frequency and genotypic distribution of plateletactivating factor acetylhydrolase (PAF-AH) gene polymorphism in the patients with sepsis. Methods Ala379Val,Val279Phe site genotypes were determined in patients (n=66) and healthy controls(n=68) by means of restriction fragment length polymorphism analysis of polymerase chain reaction products,DNA sequencing was used to detect the PCR product containing allele gene polymorphism.SPSS13.0 statistical software was use to analyze.Results All the samples by PCR-RFLP analysis of the PAF-AH gene in the Ala379Val site have three kinds of genotypes: in 66 cases of sepsis group there were 1 homozygous Val/Val type,19 heterozygous Val/Ala type,46 homozygous Ala/Ala type.In 68 cases of control group there were 2 Val/Val type,22 Val/Ala type,44 Ala/Ala type.The Ala379Val allele frequency and genotypic distribution in the patients with sepsis was not significantly different from those in the healthy controls.No statistically significant difference was observed between the survival group and the death group ( P＞0.05 ).PAFAH gene of Va1279Phe polymorphism could have three kinds of genotypes.All 66 patients in the sepsis group were the homozygous Val/Val type.Control group 68 cases,only one case was homozygous Phe/Phe type,and the others were homozygous Val/Val type,not found heterozygous Val/Phe type.The Val279Phe genotypic distribution and allele gene frequency in the patients with sepsis was not significantly different from those in the healthy controls; no statistically significant difference was observed no statistically significant difference was observed between the survival group and the death group ( P＞0.05 ).ConclusionNo associations were found between PAF-AH gene Ala379Val and Val279Phe polymorphisms and sepsis susceptibility,prognosis and severity.

ObjectiveTo observe the efficacy of L-carnitine in prevention and treatment of toxicity of LFP chemotherapy with gastrointestinal cancer. Methods60 cases of gastrointestinal cancer were divided into 2 groups according to the admission date. The treatment groups received LFP chemotherapy and L-carnitine, while the control group received LFP chemotherapy alone.Both groups received 3 cycles chemotherapy. The gastrointestinal toxicity, neurotoxicity, hematologic toxicity and physical state were compared.ResultsThere were 12 cases of peripheral neurotoxicity in treatment group,the incidence rate was 40.0 ％;but in control group there were 21 patients, and the incidence rate was 70.0 ％. There was a significant difference between the two groups(x2=5.4545,P =0.0195). Anemia in the treatment group was 56.7 ％ (17/30); in the control group the rate was 86.7 ％ (26/30).There was a significant difference between the two groups (x2 =6.698,P =0.0351).After chemotherapy,in the treatment group,there were 4 cases with increasing Karnofsky score ≥ 10,19 patients whose Karnofsky score did not change,and 7 cases with reduced Karnofsky score ≥ 10; in the control group,there was 1 case with increasing Karnofsky score ≥ 10,13 cases with Karnofsky score no changing,and 16 cases with reduced Karnofsky score ≥ 10.The changes in physical state of two groups had a significant difference(x2 =5.711,P =0.0169).The gastrointestinal toxicity,thrombocytopenia,and neutropenia of two groups had no significant difference.ConclusionL-carnitine can reduce peripheral neurotoxicity and hematologic toxicity,improve the patient's physical state in patients received LFP chemotherapy.

A description of the intervention measures of the reform program for integrated care and payment in pilot areas,covering such diseases as chronic obstructive pulmonary disease and cerbral stroke.The reform aims at exploring impacts on both medical behaviors and medical costs.Authors of the paper hold that the practice of packaged ceiling payment for a single disease is a two-edged sword for clinical pathway management,and joint efforts by the government,medical insurers,medical workers and patients at large are required to regulate medical behaviors over time.They also see the total growth of medical costs as an objective rule,and the correct way out for optimal use of medical insurance funds is to focus on makeup of such costs.

Objective:To explore influence of probucol combined atorvastatin on blood viscosity ,transcranial Doppler (TCD) indexes and carotid plaque stability in patients with large artery‐derived cerebral infarction .Methods :A total of 100 patients with large artery‐derived cerebral infarction treated in our hospital from Apr 2014 to Apr 2016 were selected .According to random number table ,patients were randomly and equally divided into atorvastatin group (received atorvastatin based on routine treatment ) and combined treatment group (received probucol based on atorv‐astatin group) ,both groups were treated for six months .Related indexes before and after treatment were compared between two groups .Results :Compared with atorvastatin group after treatment ,there were significant reductions in levels of TC ,TG and LDL‐C ,and significant rise in HDL‐C level (P<0.01 all);significant reductions in whole blood high shear viscosity [(6.23 ± 0.38) mPa/s vs .(4.20 ± 0.42) mPa/s] ,whole blood low shear viscosity [(21.17 ± 5.83) mPa/s vs .(18.10 ± 4.44) mPa/s] ,plasma viscosity [ (2.10 ± 0.45) mPa/s vs .(1.72 ± 0.34) mPa/s] and fibrinogen (Fg) level [(4.35 ± 1.36) g/L vs .(3.30 ± 1.38) g/L] ,P<0.01 all;significant rise in systolic blood flow velocity (Vs) [left :(87.43 ± 14.56) cm/s vs .(95.45 ± 18.37) cm/s]and mean blood flow velocity (Vm) [left :(60.89 ± 16.03) cm/s vs .(75.38 ± 19.36) cm/s]of left and right MCA ,significant reduction in pulsatility index(PI) [(0.85 ± 0.22) vs .(0.75 ± 0.12)] , P<0.05 or <0.01;significant reductions in unstable plaque score [(4.93 ± 0.40) scores vs .(4.12 ± 0.35) scores]and recurrence rate of cerebral infarction (16.00% vs .2.00% ) in combined treatment group ,respectiely P=0.001 ,0.014. Conclusion:Probucol combined atorvastatin can significantly reduce blood viscosity ,significantly improve hemodynamics in patients with large artery‐derived cerebral infarction .Its an‐ti‐atherosclerosis effect is obvious ,therefore it can be used to prevent or reduce recurrence of cerebral infarction .