Objective To evaluate beam-hardening (BH) artifact reduction of myocardium in coronary computed tomography angiography(CCTA)with single-source dual-energy CT. Methods Thirty patients received CCTA on single-source dual-energy CT with findings of coronary artery stenosis<50%were enrolled in this study prospectively. Scanning mode was gemstone spectral imaging (GSI), single-source instantaneous(0.5 ms)kVp(140 kVp and 80 kVp)switch. The original images acquired by scanning were
reconstructed into monochromatic energy (60,70,80,90,100,110,120,130,140 keV) left vertical short-axis images via 40% ASIR and the polychromatic left vertical short-axis images were conventionally reconstructed. CT values were measured across multiple segments (basal anterior, basal lateral, basal inferior , basal septal, mid anterior, mid lateral, mid inferior , mid septal, apical anterior, apical lateral, apical inferior , apical septal and apex)of left ventricle wall at varying monochromatic energy levels and polychromatic images, and then the left ventricular myocardial average CT value and BH objective value were calculated retrospectively:BH1=CT value of mid inferior wall-CT value of basal inferior wall ,BH2=CT value of mid septal wall-CT value of mid inferior wall. BH subjective rating were evaluated by two radiologists independently. Single sample t test was used to compare the difference of myocardial CT values among 13 segments with the left ventricular myocardial average CT value on polychromatic images ;Kruskal-Wallis test was used to compare the difference of CT values among thirteen different segments of myocardium on fixed monochromatic energy images; Wilcoxon rank test was used to compare the difference of BH objective value and subjective rating between monochromatic images with polychromatic images. Results On polychromatic images, the mean myocardial CT value was(73 ± 25)HU, the CT value of basic inferior[(58±23)HU], basic septal[(85±21)HU], mid septal[(89±24)HU], apical anterior[(64±23)HU]and apex [(61 ± 24)HU ] were different from the mean myocardial CT value(t value were -3.76,2.89,3.50,-2.30, -2.86,P all<0.05),the differences of CT value between other myocardial segments and the mean myocardial CT value had no statistical significance(P all>0.05). The differences of CT value of different myocardial segments had statistical significance at 60 to 80 keV images(P all<0.05), the differences of CT value of different myocardial segments had no statistical significance at 90 to 140 keV images(P all>0.05), suggesting that the non-uniformity of CT value among different segments was improved. On polychromatic images,BH1 M(P25,P75)was 11(6,28),BH2 M(P25,P75)was 19(1,29) HU. BH1 was improved on 90 to 140 keV images while BH2 was improved on 70 to 140 keV images, the difference had statistical significance compared with the polychromatic images(P all<0.05). BH1,BH2 decreased with the increasing of monochromatic energy level on 60 to 100 keV images, then increased a little on 110,120 keV images, and hit bottom on 130 keV images with the value of 5.20,0.34 HU ,finally exist a slight increase on 140 keV images again. On polychromatic images,BH1,BH2 subjective rating M(P25,P75)both were 1(1,2), BH1 subjective rating was improved on 70 to 140 keV images while BH2 subjective rating was improved on 90 to 140 keV , the difference had statistical significance compared with the polychromatic images(P all<0.05). Conclusion Compared with the polychromatic images,monochromatic energy images of CCTA with dual-energy CT resulted in significant BH artifact reduction and improvements in the uniformity in the myocardium, and 130 keV is the optimal Monochromatic energy.

PurposeTo evaluate the motion correction algorithm (snapshot freeze, SSF) and multi-cycle reconstruction on the imaging quality and interpretation of coronary CT angiography (CCTA).Materials and Methods Sixty patients with suspected coronary heart disease were divided into two groups according to the heart rate. Twenty-ifve patients with heart rate ≤65 beats per minute underwent prospectively ECG-gated CCTA on gemstone CT. Image quality and interpretability of standard (STD) and SSF reconstructions at 75% R-R interval were compared. Thirty-five patients with heart rate>65 beats per minute underwent retrospective ECG-gated CCTA. Image quality and interpretability of STD and SSF reconstructions at 45% and 75% R-R interval were compared. The image qualities and interpretability were assessed based on coronary artery segment, coronary artery bifurcation and overall coronary artery.Results For 25 patients with prospectively ECG gated CCTA, SSF reconstructions showed higher interpretability than STD reconstructions on per-segment level [96.3% (341/354)vs 90.7% (321/354),P<0.01]. Image qualities with SSF were higher than that with STD reconstructions for left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA). There was no statistic significance for left main coronary artery (P>0.05). For 35 patients with retrospective ECG-gate CCTA, SSF reconstructions at 45% R-R interval showed higher interpretability (P<0.01,P<0.001). But there were no signiifcant difference for 75% R-R interval images (P>0.05). Image qualities with SSF were higher than that with single and double sector STD reconstructions (P<0.001). The image qualities were signiifcant different among SSF, single and double sector STD reconstructions for 45% R-R interval images of LM (P<0.01), but it was similar for 75% R-R interval images (P>0.05). There were signiifcant different for LAD, LCX and RCA on both 45% and 75% R-R interval images (P<0.01,P<0.001). Conclusion SSF may improve the image quality and interpretability of CCTA images using prospectively and retrospective ECG-gated techniques, especially for improving the image quality.

Objective To explore clinical effect of repairing soft tissue defect in forearm, hand and foot with free super-thin anterolateral thigh perforator flaps. Methods At first the site of perforator vessels were determined by Doppler, then the flaps were designed and harvested with the site as center; the fascia lata and subcutaneous fat were removed by sandhill-likely only the 4.0 cm × 3.0 cm - 3.0 cm×2.5 cm disc-like fascia lata and dermis layer were reserved. 15 traumatic soft tissue defects including forearm, hand and foot were repaired with the ree super-thin antemlateral thigh perforator flaps. Results No vascular crisis happened and all skin grafts survived in donor sites. 2.0 cm×1.2 cm of the distal of flap was necrosis in 1 case and it was healed by dress changing. 15 cases were followed up 3 months-2 years and the average is 6 months. The contour and texture of all flaps were good and two point discrimination (2-PD) was about 8-10 mm of. Conclusions The contour and texture of free super-thin anterolateral thigh perforator flap are good, the feeling of recipient site recovered well, it's less injury for donor site and there is no reshaping for flap. It is a fineness donor site for repairing soft tissue defects in hand and foot.

OBJECTIVEThis study aimed to explore the differences of membrane thickness and pressure on the paranasal sinus membrane in goats and analyze their causes. The results can provide theoretical basis and guidance for the issues of the maxillary sinus floor augmentation related to the membrane.

METHODSThe membrane was cut into two sizes from every sinus membrane. The membrane was fixed in formalin to obtain tissue specimens for the membrane thickness study and pressure study. The correlation between the two parameters was then analyzed, and appropriate statistical methods and software were selected.

RESULTSThe top of maxillary sinus, the bottom of maxillary sinus and the frontal sinus membrane thickness were (410.03 ± 65.97), (461.33 ± 91.37), (216.90 ± 46.47) µm. The pressure were (260.08 ± 80.12), (306.90 ± 94.37), (121.72 ± 31.72) kPa. The mean differences of the membrane thickness between the top of the maxillary sinus and the frontal sinus, bottom and frontal, and top and bottom were statistically significant (P < 0.05). The mean differences in membrane pressure were also statistically significant (P < 0.05).

CONCLUSIONThe membrane thickness and pressure of the top and bottom of the maxillary sinus are higher than those of the frontal sinus membrane. However, the thickness and pressure of the bottom membrane are slightly higher than those of the top membrane. Pressure and membrane thickness are positively correlated in the sinus membrane.

Objective To explore the value of DWI and ADC in evaluation the pathologic characteristics of hepatic alveolar echinococcosis (HAE).Methods Twenty six patients with HAE underwent routine MRI and DWI ( b =500,800 s/mm2 ) scan,ADC values of different part including the center,peripheral area and surrounding zone of the lesion were measured,respectively.One-way ANOVA was used for comparing the ADC values of two groups.HE staining specimens and MVD of peripheral area of the lesion were analyzed by different pathological staining methods.The correlation between MVD and ADC values of the peripheral area was analyzed by using the Pearson rank correlation analysis.ResultsTotally 32 lesions were detected in 26 HAE patients.The ADC values of the center,the peripheral zone and the surrounding area of the lesions were (1.3 ±0.3) × 10-3,(1.1 ±0.4) × 10-3 and (1.8 ±0.5) ×10 -3 mm2/s when b =500 s/mm2,but when b =800 s/mm2,the ADC values were ( 1.2 ± 0.4) × 10 -3,(1.1 ± 0.3) × 10-3 and (1.9 ± 0.4) × 10-3 mm2/s,respectively.There were significant difference of the ADC values between two groups(P ＜0.01 ).The significant differences of the ADC values were also found in different area of the lesion (P ＜ 0.05 ).There were no correlation was found between ADC value and MVD [(12.9 ± 3.7)/HP] in the peripheral area of HAE(r =-0.042 and -0.077,P ＞ 0.05).ConclusionsDWI reflected the heteromorphism of peripheral zone and help to identify the infiltration area and biological boundary.No relationship was found between the ADC values of peripheral zone of lesion and MVD.

[Objective] The present study was to evaluate the association of serum total cholesterol level and prognosis in patients with acute left heart failure and associated mechanisms.[Methods] Sixty-eight patients due to acute episode of left heart failure prospectively enrolled,and baseline data and biochemical parameters were collected.After discharge,patients were follow-up for 1 month and they were divided into two groups (with and without cardiovascular events).Differences between groups were evaluated and the association of serum total cholesterol level and cardiovascular events were analyzed by logistic regression analysis.[Results] The mean age was 57.3 ± 12.6 years old and 52 cases were male patients accounting for 76.5 ％.Among these patients,46 had a diagnosis of coronary heart disease (67.6 ％),10 rheumatic heart disease (14.7 ％),12 dilated cardiomyopathy (17.7％),38hypertension (55.9％) and 24 diabetes mellitus (35.3％).After 1 month's follow up,39 patients (57.4％) had experienced cardiovascular events,36 cases were re-hospitalized,and 3 died from heart failure.Compared to those with cardiovascular events,event free individuals were younger and were less likely smokers (P ＜ 0.05).In addition,event free group had lower serum levels of N-terminal pro-BNP and C-reactive protein (P ＜ 0.05) while serum levels of total cholesterol and albumin were significantly higher (P ＜ 0.05).There was no significant difference in medication between these two groups.After adjusted for age,gender,smoking,systolic blood pressure,serum albumin level,diabetes,hypertension and medications,increased total cholesterol level was independently associated with better prognosis with odds ratio of 0.91 (95 ％ confidence interval 0.80-0.96).Further adjusted for C-reactive protein,the association was attenuated to non-significance,with odds ratio of 0.97 (95 ％ confidence interval 0.87-1.09).[Conclusion] Adequate serum total cholesterol level was beneficial for improving short-term cardiovascular outcomes in patients with left heart failure and the potential mechanisms might be related to cholesterol effects on improving nutritional status and anti-inflammation.

Objective: To explore correlation among clinic blood pressure (CBP), ambulatory blood pressure (ABP) and cardiovascular diseases in diabetic populations.Methods: A total of 336 patients complicated with type 2 diabetes mellitus, who received 24h ambulatory blood pressure monitoring, were selected.According to complicated with coronary heart disease or stroke or not, they were divided into cardiovascular disease group (CVD group, n=122) and no cardiovascular disease group (NCVD group, n=214).Blood lipids, blood pressure, CBP and ABP etc.were compared between two groups;according to median of 24h mean SBP (122mmHg), they were divided into <122mmHg group (n=168) and ≥122mmHg group (n=168), incidence of cardiovascular diseases was compared between these two groups.Results: (1) Compared with NCVD group, there were significant rise in age, percentages of smoking and hypertension, and plasma hsCRP level in CVD group (P<0.05 or <0.01);for ambulatory blood pressure,there were significant rise in levels of 24h mean SBP(mSBP) [(119.8±8.7)mmHg vs.(124.4±9.6) mmHg], daytime SBP (dSBP)[(121.4±9.3) mmHg vs.(128.0±10.3) mmHg] and nighttime SBP(nSBP) [(114.4±4.2) mmHg vs.(120.8±4.7) mmHg] in CVD group, P<0.01 all;there was no significant difference in CBP between two groups;(2) compared with <122mmHg group, there were significant rise in percentages of stroke (20.2% vs.25.0%) and total cardiovascular diseases (32.7% vs.39.9%) in ≥122mmHg group, P<0.01 both;(3) Logistic regression analysis indicated that diabetic patients no matter complicated with hypertension or not, 24h mean SBP was always an independent risk factors of diabetic patients complicated cardiovascular diseases (OR=1.83, 1.36, P<0.05 all).Conclusion: ABP is superior to CBP in predicting cardiovascular risk in patients with diabetes, and 24h mean SBP may be a good ABP index to predict cardiovascular risk.

BACKGROUND/AIMS: The relationship between C-peptide levels and gastrointestinal (GI) symptoms in type 2 diabetic patients is not clear. The purpose of this study is to examine the association between fasting C-peptide and GI symptoms of gastroparesis in type 2 diabetic patients. METHODS: We recruited 333 type 2 diabetic patients into the present study. All patients filled out questionnaires of gastroparesis cardinal symptom index (GCSI) to evaluate GI symptoms. Hospital anxiety and depression scale were adopted to define anxiety and depression. Patients with GCSI scores ≥ 1.9 were regarded as having symptoms of gastroparesis. RESULTS: In our study, 71 (21.3%) type 2 diabetic patients had GCSI scores ≥ 1.9. In comparison to patients with scores < 1.9, those with scores ≥ 1.9 had significantly lower fasting c-peptide levels (1.49 ng/mL vs 1.94 ng/mL, P < 0.001), higher prevalence of depression (40.9% vs 18.3%, P < 0.001) and anxiety (28.2% vs 13.0%, P = 0.002). Multivariate logistic regression revealed that fasting C-peptide was still significantly associated with symptoms of gastroparesis (odds ratio, 0.67; 95% confidence intervals, 0.48–0.94; P = 0.021), even after adjustments for age, sex, body mass index, HbA1c, current smoking and drinking status, anxiety, and depression. Furthermore, linear regressions showed that fasting C-peptide was independently and negatively related to GCSI scores (standardized regression coefficient, −0.29; P < 0.001) in patients with at least one GI symptom. CONCLUSION: GI symptoms of diabetic gastroparesis affect approximately 20% of type 2 diabetes patients and are associated with lower fasting C-peptide levels independent of depression and anxiety status.
Anxiety ; Anxiety Disorders ; Body Mass Index ; C-Peptide* ; Depression ; Depressive Disorder ; Diabetes Mellitus ; Drinking ; Fasting* ; Gastroparesis* ; Humans ; Linear Models ; Logistic Models ; Prevalence ; Smoke ; Smoking

Objective To investigate the calcification characteristics and biological activity of hepatic alveolar echinococcosis(HAE). Methods Retrospective analysis of 60 patients in the First Affiliated Hospital of Xinjiang Medical University from June 2016 to April 2017 with hydatid positive or surgical pathology confirmed HAE.All patients underwent abdominal CT scan and double-phase enhanced PET-CT examination were confirmed with single lesion.The CT and PET-CT features were analysed,and the maximum standard uptake value (SUVmax) of the focal lesion on the PET-CT was measured. According to the calcification,HAE patients were divided into A,B,C type.Kruskal-Wallis H test was used to compare the difference of SUVmax between lesions of different HAE types. Results Sixty patients with hepatic alveolar echinococcosis were evenly divided into A,B and C by different calcifications.The median SUVmax of A,B and C were 3.41(2.17 to 3.75),7.45(6.77 to 9.01)and 6.67(6.28 to 9.01),respectively.The median SUVmax within three types was statistically significant (χ2=4.429, P<0.05). Conclusion The biological activity of different HAE calcifications is different.

Objective This study aimed to explore the differences of membrane thickness and pressure on the paranasal sinus membrane in goats and analyze their causes. The results can provide theoretical basis and guidance for the issues of the maxillary sinus floor augmentation related to the membrane. Methods The membrane was cut into two sizes from every sinus membrane. The membrane was fixed in formalin to obtain tissue specimens for the membrane thickness study and pressure study. The correlation between the two parameters was then analyzed, and appropriate statistical methods and software were selected. Results The top of maxillary sinus, the bottom of maxillary sinus and the frontal sinus membrane thickness were (410.03±65.97), (461.33±91.37), (216.90±46.47) μm. The pressure were (260.08±80.12), (306.90±94.37),(121.72±31.72) kPa. The mean differences of the membrane thickness between the top of the maxillary sinus and the frontal sinus, bottom and frontal, and top and bottom were statistically significant (P<0.05). The mean differences in membrane pressure were also statistically significant (P<0.05). Conclusion The membrane thickness and pressure of the top and bottom of the maxillary sinus are higher than those of the frontal sinus membrane. However, the thickness and pressure of the bottom membrane are slightly higher than those of the top membrane. Pressure and membrane thickness are positively correlated in the sinus membrane.