Objective To analyze the diagnostic accuracy and safety of adenosine stress 99mTc-MIBI myocardial perfusion single photon emission computed tomography(SPECT)for assessing coronary artery disease(CAD)in the elderly. Methods 63 elderly patients(≥65 years old)without myocardial infarction were enrolled in the research.They were admitted into hospital because of suspected CAD or suffering from acute coronary syndrome.Adenosine was infused intravenously at a rate of 140μg·kg-1·min-1 for 6 minutes.During the period.all patients were given electrocardiogram monitor and blood pressure detection,the uncomfortable symptoms were recorded.At the end of 3 minutes of adenosine infusion,925MBq of 99mTc-MIBI was injected intravenously.Then adenosine stress SPECT myocardial imaging acquisition was obtained.If the results were abnormal.the rest SPECT myocardial imaging would be performed next day.All patients underwentcoronary angiography(CAG)within 1 week before or after SPECT. Results In the 53 CAD patients diagnosed by CAG,there were 51 cases with positive adenosine 99mTC-MIBI myocardial perfusion SPECT.In 10 cases with normal CAG there were 7 cases with negative adenosine myocardial imaging.The results showed the sensitivity,specificity and accuracy of adenosine stress SPECT in detection of CAD in comparison with CAG were 96.2%,70.0%,92.1%respectively.The results of CAG also showed that 74 coronary arteries had been affected(defined as≥50%coronary vessel lumen reduction).There were 44 cases with affection in left anterior descending(LAD),18 eases in left circumflex(LCX)and 25 cases in right coronary artery(RCA).Correspondingly,there were 42 patients with lowering myocardial perfusion in anterior wall territory,10 patients in lateral wall territory and 21 patients in inferior wall territory.The sensitivity of adenosine 99mTc-MIBI myocardial perfusion SPECT for diagnosing LAD lesion was 95.5%,which was higher than for the other 2 coronary arteries,but the specificity for detecting LCX lesion was 100%.The adverse effects during the adenosine stress test were found in 50%patients,no serious events occurred.Conclusions Adenosine stress 99mTc-MIBI myocardial perfusion SPECT is a good noninvasive method with high diagnostic accuracy and safety in detection of CAD in the elderly,especially.highly accurate for detection and localization of significant CA D.

OBJECTIVETo observe the status of iron deposition in patient with β thalassemia major, and to formulate appropriate treatment strategies.

METHODThe data of status of transfusion and chelation in 135 patients aged from 6 years and 4 months to 17 years and 11 months with β thalassemia major were collected and analyzed. Serum ferritin levels were determined and cardiac and hepatic iron deposition was determined using MRI T2(*) technology.

RESULTOf the 135 cases studied, 66 were male, and 69 were female, their average age was 12.1 years. Serum ferritin (SF) was determined for 111 cases, it varied from 1 086.8 µg/L to 15 011.5 µg/L. Among them, 16 cases had SF level <2 000 µg/L (14.5%) , in 41 cases SF were between 2 000 and 4 000 µg/L (36.0%) ;in 54 cases SF >4 000 µg/L (48.7%) . Liver MRI T2(*) results showed that in only 8 cases (5.9%) iron content in the liver was in normal range, 19 cases (14.9%) showed mild liver iron deposition;34 (25.2%) moderate and 74 (54.8%, the youngest one was only 6 years and 4 months of age) had severe iron deposition respectively. Cardiac MRI T2(*) showed that in 89 cases (65.9%) iron content in the heart was in normal range;19 cases (14.1%) had mild cardiac iron deposition and 27 (20.0%) presented severe iron deposition (the youngest one was only 9 years and 3 months of age) . SF level was obviously related to liver and cardiac iron deposition (MRI T2(*)) r and P value were -0.284, 0.003 and -0.374, 0.000 respectively. In 108 cases regular transfusion and chelation were delayed due to financial problem. The late and insufficient dosage administered and irregular chelation caused the higher SF level and the severe iron deposition.

CONCLUSIONThe survival status of β thalassemia major in China is worrisome. Majority of them had not received regular transfusion and chelation. Liver and cardiac iron deposition occur early and had a high incidence.

Adolescent ; Child ; Female ; Ferritins ; blood ; Humans ; Iron ; metabolism ; Iron Chelating Agents ; adverse effects ; therapeutic use ; Iron Overload ; epidemiology ; etiology ; Liver ; metabolism ; Magnetic Resonance Imaging ; Male ; Myocardium ; metabolism ; Radiography ; Retrospective Studies ; Transfusion Reaction ; beta-Thalassemia ; diagnostic imaging ; metabolism ; therapy

Objective: To explore the effect of ambient fine particulate matters (PM_2.5) and temperature interaction on schizophrenia admission. Methods: All admission data were retrieved from the Psychiatric Hospital and Municipal Hospital of TongLing from January 1, 2014 to December 31, 2017. Daily air pollution and meteorological data were collected from the Tongling Environmental Protection Agency and Meteorological Bureau, respectively. A distributed lag non-linear model combined with the generalized additive model were applied to explore the effects of PM_2.5, multi-pollutants, and the interaction between temperature and PM_2.5 on schizophrenia admission. The stratification of temperature was divided by three criteria. The low temperature layer was defined as <P₅ or <P₁₀ or <P₂₀; P₅-P₉₅ or P₁₀-P₉₀ or P₂₀-P₈₀ was defined as the middle temperature layer; >P₉₅ or >P₉₀ or >P₈₀ was defined as the high temperature layer. Results: From 2014 to 2017, 6 642 patients were admitted for schizophrenia in Tongling, and the median of PM_2.5 and temperature were 47.0 μg/m³ and 17.5 ℃, respectively. The median concentration of PM_2.5 (P₅₀) was taken as a reference. When the exposure concentration of PM_2.5 was P₉₀, the lagged effect appeared in the first day with RR=1.03 (95%CI: 1.00-1.07) and reached the maximum in the fifth day with RR=1.16 (95%CI: 1.13-1.19). In the multi-pollutant models, it was found that the simultaneous inclusion of PM_2.5 and NO₂ had higher risk of schizophrenia admission, with the RR=1.18 (95%CI: 1.15-1.22), P<0.001. The risk of schizophrenia admission caused by PM_2.5 exposure at high temperature was greatest under the three temperature stratification standards, which were 12.1% (8.5%-15.7%), 9.7% (6.9%-12.6%) and 17.1% (11.6%-22.8%), all P values <0.001. Conclusion With the increase of PM_2.5 concentration, the risk of schizophrenia admission is increased, and the risk effect of PM_2.5 is stronger at high temperature.