Objective To evaluate the multi-detector CT (MDCT) on pulmonary changes in post-operative adult receptor of liver transplantation complicated with acute respiratory distress syndrome (ARDS).Methods Nineteen adult patients admitted into Tianjin First Center Hospital from January to December 2016 to perform the first time liver transplantation were enrolled in this study. Before operation, the CT showed no significant abnormality in the patients' lungs, after operation MDCT was applied to observe the pulmonary changes of ARDS post-operative complication in the adult receiver of liver transplantation, and the pulmonary changes in different gender of patients were analyzed and compared.Results MDCT showed that after liver transplantation all the 19 patients (100%) had lung pathological changes, of whom 18 cases (94.7%) manifested 2 or more than 2 kinds of pulmonary changes, including consolidation shadows (12 cases, 63.2%), patchy shadows (2 cases, 10.5%), ground glass opacity (6 cases, 31.5%) and pleural effusion (18 cases, 94.7%). In the comparisons between male and female patients with post-operative ARDS after liver transplantation, there were no significant differences in the lung pathological changes shown in MDCT (allP > 0.05) statistically.Conclusion The application of MDCT has great potential value in the evaluation of the disease situation after liver transplantation, that might providehelp to the postoperative treatment.

Objective To observe the location of pelvic organs, the morphology and function of levator ani muscle (LAM) in primiparous women post vaginal delivery at 6 months postpartum using static and dynamic MRI, and investigate the correlation between LAM injury and pelvic organ prolapse (POP). Methods A perspective analysis of static and dynamic MRI was performed in fifty-one primiparous women post vaginal delivery at 6 months postpartum and thirty-five nulliparous women without experience of pregnancy and delivery as control group from June 2014 to January 2015. Previous pregnancy and abortion history, previous pelvic surgery and pelvic mass diseases were excluded. Cases with pelvic floor dysfunction symptoms were excluded from the control group. All of the women underwent static and dynamic MRI. The primiparous group was divided into two groups on presence or absence of POP on MRI findings:primiparous POP group and primiparous control group. The levatorani scoring system based on static MRI was used to characterize morphological changes of LAM into none, minor and major injury by the total score of bilateral LAM. A series of parameters including H line (the distance between the inferior margin of pubic symphysis to anorectal junction), M line (the perpendicular distance between the distal end of H line to pubococcygeal line), levator plate angle (LPA), iliococcygeal angle (ICA), and levator hiatus length and area were measured on static and dynamic MR images. Fisher exact test was performed to compare difference in distribution of the LAM injury between the primiparous group and control group, as well as the primiparous POP group and primiparous control group. Independent sample t test or Mann-Whitney test was used to compare difference in LAM parameters between the primiparous POP group and primiparous control group. Results In the 51 cases primiparous group, 44 cases showed none injury, whilst 5 cases with minor and 2 cases with major injury in the puborectal muscle. Thirty two cases showed none injury, whilst 10 cases with minor and 9 cases with major injury in the iliococcygeal muscle. In the 35 cases control group, none injury was shown in puborectal muscle, whilst 32 cases with none, 2 cases with minor and 1 case with major injury in the iliococcygeal muscle. There was no significant difference in the puborectal muscle injury between the two groups (P=0.203), and there was significant difference in the iliococcygeal muscle injury between the two groups (P<0.05). In the 24 cases primiparous POP group, 20 cases showed none injury, whilst 2 cases with minor and 2 cases with major injury in the puborectal muscle. Fourteen cases showed none injury, whilst 6 cases with minor and 4 cases with major injury in the iliococcygeal muscle. In the 27 cases primiparous control group, 24 cases showed none and 3 cases with minor injury in the puborectal muscle, whilst 18 cases with none, 4 cases with minor and 5 cases with major injury in the iliococcygeal muscle. There was no significant difference in the puborectal muscle injury and iliococcygeal muscle injury between the two groups (P=0.588 and 0.559, respectively). The LH during Valsalva status in primiparous POP group and primiparous control group were (6.7 ± 1.1) and (5.0 ± 0.6) cm, respectively, whilst the LHA was (41.6 ± 12.6) and (24.2 ± 5.5) cm2. There were significant difference between the corresponding groups (P=0.042 and 0.004, respectively). There was no significant difference between the corresponding groups of the other LAM parameters on static and dynamic MRI (all P>0.05). Conclusion Vaginal delivery may cause various degrees of LAM injury, the LAM functional deficiency were observed in primiparous women combined with POP.

Objective To explore the clinical value of cardiac magnetic resonance imaging (CMRI) in assessment of right ventricular function in patients with pulmonary arterial hypertension (PAH).Methods The PubMed/MEDLINE,Wanfang data,CNKI (from January 2001 to April 2015) were searched.The search terms were pulmonary arterial hypertension,right ventricular function,and cardiac magnetic resonance imaging.An inclusion criterion was the patients suffering from PAH,and the healthy volunteers were served as controls.The study was designed as randomized controlled trial.All the subjects investigated had received CMRI.The end of the trial included right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF).Meta analysis was conducted by RevMan 5.0 software provided by Cochrane Collaboration,and the publication bias was analyzed by the funnel plot analysis.Results Five papers involving 381 patients met the criteria.It was showed by Meta-analysis that compared with healthy control group,RVEDV was increase in PAH group [weighted mean difference (WMD) =33.96,95％ confidence interval (95％CI) =20.80-47.12,P ＜ 0.000 01],RVESV was increased (WMD =41.91,95％ CI =29.63-54.19,P ＜ 0.0O0 01),and RVEF was decrease (WMD =-20.09,95％CI =-22.65 to-17.52,P ＜ 0.000 01).Conclusion CMRI can be used to evaluate the right ventricular function of patients with PAH,and it has important significance in the evaluation of right ventricular function in patients with PAH.

Objective To investigate the status and influencing factors of cooperation of doctors and nurses in the nutritional support of critically ill patients, and provide the basis for future improve the physician-nurse collaboration in the nutritional support. Methods Doctors and nurses who from ICU in Soochow were investigated by the Nurse-Physician Collaboration Scale (NPCS). Results The doctors′score of physician-nurse collaboration in the nutritional support of critically ill patients was 87.42 ±15.73, which was significantly higher than 80.97 ± 13.80 the nurses′(t=3.279, P= 0.001).In addition, under the item 1, 3, 5 in the dimension one as well as the total items in the dimensions two and three, the doctors′score was similarly higher than the nurses, and the differences are also statistically significant (Z=-3.894--1.964, all P<0.01 or 0.05). Technical titles, educational level and age was significantly related to the cooperative level between doctors and nurses respectively (χ2=11.037, P=0.012;F=3.488, P=0.037; F=3.499, P=0.016). Conclusions Doctors have higher levels of perceived collaboration than nurses in the nutritional support of critically ill patients, while both require further improvement. We should highlight the physician-nurse collaboration in feeding critically ill patients, and should improve the nutrition quality through standardized process management and active team cooperation.

Objective To investigate the consistency and stability of two types of pubococcygeal line (PCL) determined by dynamic MRI used in evaluating pelvic organ prolapse (anterior and apical compartments).The first type of PCL was measured from the inferior pubic symphysis to the tip of coccyx (PCLtip) and the second was to the sacrococcygeal joint (PCLjnt).Methods Dynamic MRI changes of 50 female patients who were diagnosed with pelvic organ prolapse by pelvic organ prolapse quantification were retrospective reviewed.Chi-square test was used to compare the staging of each pelvic compartment (anterior,apical) with the two PCLs.The lengths and the degree of the oblique angle of the two PCLs during the rest and straining were compared using a paried t test.Results Agreement of PCLjnt with PCLtip was 96％ (48/50) for anterior compartment and 94％ (47/50) for apical compartment.There was no difference between the two PCLs in staging of each pelvic compartment (anterior,apical)(x2 values were 2.000 and 3.000,P values were 0.368 and 0.223).The length of the PCLtip at rest and straining was (10.1±0.8),(10.2± 0.8) cm respectively and the result was statistical significance (t=-2.339,P=0.023).Twenty patients (40％) in the 50 pelvic organ prolapse patients demonstrated a shortening of the PCLtip,while the rest including 30 patients (60％) was longer.The oblique angle of the PCLtip at rest and straining was 22°±6° and 18°±11° respectively(t=3.490,P=0.001).The length of the PCLjnt at rest and straining were (11.2±0.8) and (11.2± 0.8)cm respectively(t=-1.845,P=0.071).The oblique angle of the PCLjnt at rest and straining were 29°±6° and 26°± 10° (t=2.836,P=0.007),but the degree of PCLjnt's oblique angle had a mild fluctuate compared with the PCLtip.Conclusions PCLjnt and PCLtip have the equal level in staging of anterior and apical pelvic organ prolapse.Meanwhile the oblique angle and the length of PCLjnt illustrated the better the stability.

Objective To explore the optimal acupuncture scheme in intervening hypermyotonia of the affected limbs in stroke.Method Eighty eligible stroke patients were randomly grouped by using the orthogonal experimental design, by adopting electroacupuncture (A), daily acupuncture frequency (B), and acupoint (C) as three factors, and two levels. A total of 20 treatment sessions were conducted. Each group was scored by using the Modified Ashworth Scale (MAS) before and after the treatment, and the safety was also evaluated.Result There was a significant difference in comparing the MAS score between the two different levels of factor A (P<0.05), while there were no significant differences in comparing the MAS scores between different levels of factor B and factor C (P<0.05). Concerning the improvement of the MAS scores of wrist, elbow, knee, and ankle joints, A2B1C1(i.e. electroacupuncture twice a day with acupoints from yin meridians) was the optimal treatment scheme.Conclusion Electroacupuncture twice a day is the optimal treatment scheme for hypermyotonia of the affected limbs in stroke, as it can effectively ease the hypermyotonia, improve the function and symptoms of the limbs, and has a satisfactory security evaluation.

Objective To evaluate the role of necroptosis in liver injury induced by intestinal ischemia-reperfusion (I/R) in rats.Methods Thirty-two healthy adult male Sprague-Dawley rats,weighing 250-300 g,were divided into 4 groups (n=8 each) using a random number table:sham operation group (S group),I/R group,specific necroptosis inhibitor necrostatin-1 group (N group) and dimethyl sulfoxide (DMSO) group (D group).Intestinal I/R was produced by occlusion of the superior mesenteric artery for 1.5 h followed by 6 h of reperfusion.The superior mesenteric artery was only isolated but not ligated in group S.At 30 min before ischemia,necrostatin-1 1 mg/kg (diluted to 200 μl in DMSO) was intraperitoneally injected in group N,while the equal volume of DMSO was given instead in group D.The animals were sacrificed at the end of reperfusion,livers were removed for examination of the pathological changes with a light microscope,and the severity of liver injury was evaluated using the Eckhoff's scale score.Blood samples were collected from the cardiac apex for determination of serum alanine transaminase (ALT) concentrations by enzyme-linked immunosorbent assay.The expression of receptor-interacting protein kinase 1 (RIP1),RIP3 and high-mobility group box 1 protein (HMGB1) in cytoplasm of hepatocytes was detected by Western blot.The location of RIP1 and RIP3 in liver tissues was determined by immunohistochemistry,and the translocation of HMGB1 from nucleus to cytoplasm was tested by immunofluorescence.Results Compared with group S,the Eckhoff's scale score of liver tissues and serum ALT concentration were significantly increased,the expression of RIP1,RIP3 and HMGB1 in liver tissues was up-regulated (P＜0.05),and the hepatocytes in which RIP1 and RIP3 were highly expressed in the portal area were increased in group I/R.Compared with group I/R,the Eckhoff's scale score of liver tissues and serum ALT concentration were significantly decreased,the expression of RIP1,RIP3 and HMGB1 in liver tissues was down-regulated (P＜0.05),and the hepatocytes in which RIP1 and RIP3 were highly expressed in the portal area were decreased in group N,and no significant changes were found in the variables mentioned above in group D (P＞0.05).HMGB1 was expressed in the nucleus of hepatocytes in the portal area in group S;a large number of HMGB1 in hepatocytes in the portal area was translocated to cytoplasm in I/R and D groups;a small number of HMGB1 in hepatocytes in the portal area was translocated to cytoplasm in group N.Conclusion Necroptosis is involved in intestinal I/R-induced liver injury in rats.

Cardiac involvement in amyloidosis has a relatively poor prognosis, and early diagnosis and treatment is very important to the prognosis of such involved patients. "One stop type" cardiac examination can be carried out by the cardiac magnetic resonance imaging (CMRI) and the evaluation of cardiac morphology and function can be complete. "One stop type" CMRI may show the thickness of myocardium in left ventricle, cardiac diastolic dysfunction, sub-endocardial enhancement (patch, diffuse and transmural types), rising of T1 value, too fast clarifying rate of contrast agent in blood pool, pericardial and/or pleural cavity effusion, that may help to elevate the efficiency of diagnosis. The CMRI presents myocardial tissue characteristics quite well, that may help for early diagnosis of myocardial amyloidosis, and clearly demonstrate the situation of heart involvement; to follow-up patients with repeat CMRI examinations can monitor drug therapeutic effect, direct and regulate treatment, judge prognosis, etc. so that CMRI possesses very high clinical application value.

Objective To observe the post-systolic shortening (PSS) during isovolumic relaxation phase and its clinical significance in regional myocardium in chronic heart failure (CHF) patients.MethodsLeft ventricular regional myocardium movement in 60 CHF patients (CHF group) and 30 healthy volunteers (control group) were assessed with tissue velocity imaging (TVI). QLAB software was used to measure the systolic peak velocity (V_s), regional systolic time (T_s), post-systolic shortening velocity (V_(pss)) and post-systolic shortening time (T_(pss)) at the basal and middle levels of left ventricle. Results In CHF patients, the rate of isovolumic relaxation phase PSS was 34.44% both in basal and mid segments, the rate of pathological PSS was 29.44% and 29.72%, respectively. The rate of isovolumic relaxation phase PSS in control group was 26.11% and 20.56%, respectively; none pathological PPS occured. Compared with the physiological PSS of control group, the pathological PSS of CHF group had a higher peak velocity and a longer time (P<0.05). Conclusion The pathological PSS of CHF patients has high peak velocity and long duration, which may be one of the causes leading to the asynchronous movement of left ventricle in CHF.

Objective: To explore the role of late gadolinium enhancement (LGE) and T1 mapping for detection of cardiac amyloidosis. Methods: Nine cases of cardiac amyloidosis who had diagnosed by renal biopsy diagnosed type light-chain (AL) amyloidosis and acute heart failure suspected involvement of the heart in Tianjin First Central Hospital from May 2018 to March 2019 were enrolled, and at the same time 14 cases of non-obstructive hypertrophic cardiomyopathy patients, 12 cases of healthy physical examination at the same period were enrolled as the control. All patients underwent Philips 3.0-T including plain scan as cine, T2WI, native T1 mapping and enhanced scan as perfusion, LGE imaging, post T1 mapping. For LGE cardiac magnetic resonance imaging (CMRI), a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered. After a 7-minutes delay, ECG-gated images were acquired in 3 long-axis and a stack of short-axis slices identical to those of cine images using a breath-hold gradient recalled echo phase-sensitive or magnitude only inversion recovery sequence. LGE and T1 mapping CMRI observation, including cardiac function index [left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), valvular regurgitation], cardiac morphological index [including left ventricular wall thickness, left ventricular weight (LVM)], myocardial histological characteristics and markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and accompanying signs (including pericardial effusion, pleural effusion) were performed. Results: The predominant LGE pattern in amyloidosis was diffuse left ventricular sub endocardial enhancement (3/9), diffuse in left ventricular wall enhancement (3/9), and transmural delayed enhancement in left ventricular (2/9) and non-typical delayed enhancement (1/9). Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 1 497.3±22.0 vs. 1 273.3±30.1, 1 329.3±42.6, both P < 0.05). Myocardial T1 was increased in AL amyloid before LGE. A post-contrast myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 476.7±44.2 vs. 516.1±41.5, 569.9±12.3, both P > 0.05). Three of 9 amyloidosis patients with review images showing T1 value and cardiac function was no significantly different with the first check (ms: 1 484.8±6.5 vs. 1 497.3±22.0, P = 0.11). Conclusions One-stop CMRI can improve the diagnosis of cardiac amyloidosis, LGE can display the myocardial scarring and fibrosis, and T1 mapping is sensitive to myocardial edema and diffuse fibrosis. LGE and T1 mapping can improve the diagnostic accuracy, which is very meaningful for diagnosis and follow-up of patients.