Objective To evaluate MRI diagnostic accuracy and clinical value on the pancreatic carcinoma.Methods 79 patients with suspected pancreatic carcinoma were imaged by T1-weighted spin-echo pulse sequences and T2-weighted fast spin-echo pulse sequences in axial,sagittal and coronal planes with a pelvic phased-array coils.Results 43 patients were diagnosed as pancreatic carcinoma using MR imaging,in which 39 patients were proved pathologically by biopsy.Conclusion MRI is effective diagnostic modality in localizing and staging pancreatic carcinoma and guiding for the choice of pancreatic carcinoma treatment.

Objective To investigate the optimal mild hypothermia course and cerebral temperature of the neonatal rats after hypoxic-ischemic brain injury. Methods The posthypoxic-ischemic rats of experimental group (n=60) were placed in the glass jars immeresd in water bath held constaut at either 29 C or 3l C for 24h, 48h or 72h. While the rats of room temperature group (n=22) were stayed in room air. Blood glucose, blood gases and neuropathology findings were studied to determine the therapeutic effects. Results The brain temperature droped 3C or 5C when enviro ment temperature was 31C or 29C respectively. The blood glucose remained normal. Neuropathology findings reveled that the brain damage of experimental rats reduced 46%～86% compared to the room temperature group. Conclusion Reducing the cerebral temperature by 4～5 C for 72 hours after hypoxic-ischemic brain injury can lead to superior protective effect.

Objective To investigate the accuracy of high-resolution magnetic resonance imaging (MRI) in diagnosis of the lymph nodes metastases (LNMs) and stage of rectal cancer (RC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 65 patients with RC who were admitted to the Peking University People's Hospital between April 2014 and April 2016 were collected.The results of postoperative pathological examination:of 65 patients with RC,24 had positive LNMs and 41 had negative LNMs;N0,N1 and N2 were respectively detected in 41,14 and 10 patients.Imaging data were captured using 3.0-Tesla MRI and body phased-array coil.Diagnostic criteria for LNMs of RC:criterion 1:irregular lymph node boundaries and signal characteristics were not considered;criterion 2:heterogeneous signal of lymph nodes and boundary characteristics were not considered;criterion 3:irregular lymph node boundaries and / or heterogeneous signal of lymph nodes.The American Joint Committee on Cancer (AJCC) cancer staging manual (7th edition) have established the N staging scheme for RC.Lymph nodes distribution according to the rectal lymphatic drainage:D1was located in fascia of the mesorectum;D1a above the level of tumor;D1b at the level of tumor;D1c under the level of tumor;D2 around the superior rectal artery and root of inferior mesenteric artery;D3 on the side of pelvic cavity.Observation indicators:(1) Efficiency and comparison of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria (postoperative pathological result as a gold standard).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRIaccording to the 3 criteria (postoperative pathological result as a gold standard).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC;②sensitivity,specificity,accuracy and consistency of LNMs diagnosed using different maximum short diameter of lymph nodes as a threshold (postoperative pathological result as a gold standard);③ comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold and using the 3 criteria;④ sensitivity,specificity,accuracy and consistency (postoperative pathological result as a gold standard) of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold combined with the highest efficiency in the (1),and its comparison in accuracy of LNMs with highest diagnostic accuracy as a threshold.(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria.(5) Follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' postoperative survival up to October 2016.The sensitivity,specificity,accuracy and comparison of ratio were respectively done by the chi-square test.Kappa test was used for consistency,tκ ≤ 0.40was used as low consistency,0.40＜κ≤0.60 as moderate consistency,0.60＜κ≤0.80 as higher consistency,and κ＞ 0.80 very high consistency.Results (1) Efficiency and comparison of LNMs of RC diagnosed by highresolution MRIaccording to the 3 criteria:accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 93.8％,87.7％ and 90.8％,showing very.high,higher and very high consistencies compared with postoperative pathological results (κ =0.87,0.74,0.81,P＜0.05),and with no statistically significant difference in diagnostic accuracy among them (x2=1.495,P＞0.05).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRI according to the 3 criteria:accuracies of N stage of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 87.7％,83.1％ and 84.6％,showing the same higher consistencies compared with postoperative pathological result (κ =0.77,0.68,0.72,P＜0.05),and with no statistically significant difference in N stage among them (x2=0.567,P＞0.05).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC:maximum short diameter ranges were respectively 3-18 mm in positive LNMs and 1-9 mm in negative LNMs,and maximum short diameter ＜3 mm and ≥ 10 mm were respectively negative and positive LNMs.② Efficiency of LNMs of RC diagnosed using different maximum short diameter of lymph nodes as a threshold:diagnostic accuracy of 70.8％was the highest when maximum short diameter ＞7 mm was used as a standard of positive LNMs,showing a low consistency compared with postoperative pathological result (κ =0.29,P＜0.05).③ Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold and using the 3 criteria:there was a statistically significant difference among them (x2 =15.637,P＜0.05);accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were higher than that diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold (x2 =10.354,5.656,6.923,P＜0.05).④Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm combined with the criterion 3 as a threshold and using maximum short diameter ＞7 mm as a threshold:the criterion 3 was used as a threshold because there was no statistically significant difference in diagnostic accuracy among the 3 criteria (P＞ 0.05).Diagnostic accuracy was 78.5％ when maximum short diameter ＞7 mm combined with the criterion 3 as a threshold,showing a low consistency compared with postoperative pathological result (κ =0.36,P＜0.05),with no statistically significant difference in diagnostic accuracy compared with maximum short diameter ＞ 7 mm as a threshold (x2=0.154,P＞0.05).(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria:positive LNMs of RC diagnosed by high-resolution MRI located mostly in D1 (76.1％-83.1％)and D1b(77.8％-81.4％).(5) Follow-up situations:of 65 patients,54 were followed up for 6-25 months,with a median time of 14 months.During the follow-up,7 patients had distant metastases and 47 had tumor-free survival.Conclusions There are higher accuracies of LNMs and N stage of RC diagnosed using preoperative highresolution MRI.Diagnostic accuracy of LNMs of RC cannot be improved when characteristics of lymph node morphology and size are used as a diagnostic standard.The positive LNMs of RC locate mostly in D1 and Dib.

Objective:To evaluate the role of spinal mammlian target of rapamycin (mTOR)/ribosomal S6 kinase 1 (S6K1)/glioma associated oncogene homolog 1 (Gli1) signaling pathway in chronic morphine tolerance in mice.Methods:Healthy male Kunming mice, aged 8-10 weeks, weighing 23-25 g, were used in the study.The experiment was performed in two parts.Experiment I Fifty mice were randomly assigned into 2 groups: normal saline group (group S, n=10) and morphine group (group M, n=40). In M and S groups, morphine and normal saline 10 mg/kg were injected subcutaneously, respectively, twice a day for 7 consecutive days.The thermal pain threshold (TPT) was measured and the maximum analgesic effect percentage (MPE) was calculated at 1 day before administration and 30 min after the last administration every day.Ten mice in each group were randomly selected and sacrificed after measurement of TPT at 1, 3, 5 and 7 days after administration in group M and after the last measurement of TPT in group S, and the lumbar segment (L 4-6) of the spinal cord was removed.Experiment Ⅱ Forty mice were randomly divided into 4 groups ( n=10 each): KU-0063794+ morphine group (group KU+ M), dimethyl sulfoxide (DMSO)+ morphine group (group DM+ M), morphine+ KU-0063794 group (group M+ KU) and morphine + DMSO group (group M+ DM). Morphine 10 mg/kg was injected subcutaneously twice a day for 7 consecutive days in 4 groups.At 1-3 days of morphine injection, mTOR specific inhibitor KU-0063794 200μl (1 μg/μl) and 10% DMSO 200 μl was injected intraperitoneally in KU+ M group and DM+ M group at 30 min before administration twice a day.At 5-7 days of morphine injection, KU-0063794 200μl (1 μg/μl) or 10% DMSO 200 μl was injected intraperitoneally in group M+ KU or group M+ DM at 30min before administration, respectively, twice a day.TPT was measured and MPE was calculated at 1 day before morphine injection and at 30 min after the last administration every day.The animals were sacrificed after the last measurement of TPT, and the lumbar segment (L 4-6) of the spinal cord was removed for determination of the expression of spinal mTOR, phosphorylated mTOR (p-mTOR), S6K1, phosphorylated S6K1 (p-S6K1) and Gli1 (using Western blot). Results:Experiment Ⅰ Compared with group S, MPE was significantly increased at each time point after administration at 3, 5 and 7 days after administration, expression of spinal p-mTOR, p-S6K1 and Gli1 was significantly down-regulated ( P<0.05), and no significant change was found in mTOR and S6K1 in group M ( P>0.05). Experiment Ⅱ Compared with group DM+ M, MPE was significantly decreased at 3-7 days after morphine injection, expression of p-mTOR, p-S6K1 and Gli1 in spinal cord was down-regulated ( P<0.05), and no significant change was found in expression of mTOR and S6K1 in group KU+ M ( P>0.05). Compared with group M+ DM, MPE was significantly increased at 6-7 days after morphine injection, expression of p-mTOR, p-S6K1 and Gli1 in spinal cord was down-regulated ( P<0.05), and no significant change was found in mTOR and S6K1 in group M+ KU ( P>0.05). Conclution:Spinal mTOR/S6K1/Gli1 signaling pathway is involved in the development and maintenance of chronic morphine tolerance in mice.

OBJECTIVETo evaluate the accuracy of 3.0T high-resolution magnetic resonance imaging(MRI) in definition of tumor invasion depth staging (T staging) before operation.

METHODSClinical and radiographic data of 49 rectal cancer patients who underwent radical resection within two weeks after 3.0 T high-resolution MRI examination without preoperative neoadjuvant chemotherapy in Peking University People's Hospital between February 2015 and November 2015 were retrospectively collected. Two radiologists reviewed the MRI imagines and evaluated the location and T staging of rectal cancer independently(radiologist A and B). The kappa statistics was used to evaluate the interobserver agreement, and kappa value greater than 0.81 indicated excellent agreement. The accuracy, sensitivity and specificity of high-resolution MRI in definition of rectal cancer T staging were assessed with pathological result as golden standard.

RESULTSAccording to pathological result of 49 rectal cancer patients, 3 were pT1, 17 were pT2, 22 were pT3, and 7 were pT4a. In 2 cases of mucinous adenocarcinoma, MRI T2WI showed focal or diffuse significantly higher signal close to perirectal fat. And in other 47 patients of non-mucinous adenocarcinoma, MRI T2WI showed equal or higher signal compared with pelvic muscle. Interobserver agreement was excellent in diagnosis of T staging of rectal cancer with 3.0T high-resolution MRI(Kappa=0.87). The accuracy, sensitivity and specificity of both radiologists for T1 staging was 95.9%(47/49), 1/3 and 100%(46/46) respectively, besides, 1 case was both diagnosed correctly and 2 cases were overstaged. For 2 radiologists, the accuracy of T2 staging was 87.8%(43/49) and 91.8%(45/49) respectively, the sensitivity was both 88.2%(15/17), and the specificity was 87.5%(28/32) and 93.5%(30/32) respectively, besides, 15 cases were both diagnosed correctly and 2 cases were overstaged. The accuracy for T3 staging was 89.8%(44/49) and 93.9%(46/49) respectively, the sensitivity was 86.4%(19/22) and 95.5%(21/22) respectively, and the specificity was both 92.6%(25/27). Radiologist A made correct diagnosis for 19 cases, understaged 2 cases and overstaged 1 case. Radiologist B made correct diagnosis for 21 cases and only overstaged 1 case. The accuracy, sensitivity and specificity of both radiologists for T4a staging was 98.0%(48/49), 7/7 and 97.6%(41/42) respectively, besides, 7 cases were both diagnosed correctly. The overall accuracy of T staging was 85.7%(42/49) and 89.8%(44/49) by two radiologists respectively. The accuracy for differentiating T1/T2 from T3/T4 was 91.8%(45/49) and 95.9%(47/49) by two radiologists respectively. Radiologist A overstaged 2 cases and understaged 2 cases, and radiologist B overstaged 2 cases.

CONCLUSIONHigh-resolution MRI can accurately evaluate preoperative T staging of rectal cancer and help select the high-risk rectal cancer patients with over T3 to receive neoadjuvant treatment.

OBJECTIVE: To discuss the application of spiral CT imaging of temporal bone in diagnosing the chronic otitis media with cholesteatoma. METHOD: The clinical data and spiral CT manifestation of 104 cases of chronic otitis media with cholesteatoma were retrospectively analyzed. All the diagnoses were confirmed by operation and pathology. RESULT: Spiral CT imaging could accurately show the signs of soft-tissue occupancy and bony-erosion of by cholesteatoma in middle ear which originated from various sites and of various sizes. Comparing the CT imaging before surgery and the findings during the operation, the consistency in bone erosion was 89.1%, in soft-tissue occupancy was 94.4% and in invasion of ossicle chain was 89.3%. CONCLUSION Spiral CT imaging plays an important role in diagnosing cholesteatoma and especially the bony-erosion and the soft-tissue occupancy, which can provide crucial information for the surgery.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Cholesteatoma, Middle Ear ; diagnosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Spiral Computed ; Young Adult

To evaluate bioequivalence and safety of two kinds of metformin hydrochloride sustained-release tablets (test preparation vs reference preparation) under the condition of fed and single administration.A single center, randomized, open, single-dose, two-period, two-sequence, and double-crossover design was used.32 healthy subjects took 0.5 g of test preparation or reference preparation under fed and single-dose administration.4 mL of venous blood was collected from before administration (0 h) to 1, 3, 4, 4.5, 5, 5.5, 6, 7, 8, 9, 10, 12, 15, 24, 36 and 48 h after administration.The concentration of metformin in plasma samples was detected, and then the pharmacokinetic parameters were calculated by WinNonlin 7.0 software.When the 90% confidence intervals of cmax, AUC0-t and AUC0-∞ geometric mean ratio of test preparation and reference preparation were within 80.00%-125.00% equivalent intervals respectively, the bioequivalence of the two preparations was proved.One subject fell off due to adverse events.The main pharmacokinetic parameters of test preparation and reference preparation as follows: cmax were (0.68 ± 0.14) and (0.65 ± 0.11) mg/L, AUC0-t were (7.33 ± 1.65) and (7.00 ± 1.89) h·mg/L, AUC0-∞ were (7.39 ± 1.67) and (7.06 ± 1.91) h·mg/L, respectively.The 90% confidence intervals of the geometric mean ratio of the two main pharmacokinetic parameters were 101.45%-109.14%, 100.08%-112.32% and 100.24%-112.28%, respectively, which fell within the bioequivalence interval of 80.00%-125.00%.There were no serious adverse events and unexpected adverse events during the trial.The results show that test preparation and reference preparation are bioequivalent under fed and single-dose administration, safe and well tolerated in healthy subjects.

Objective To improve the understanding of deep venous thrombosis (DVT),the present study was conducted to investigate the difference of DVT onset in hospitalized patients with different underlying diseases.Methods This is a single-center retrospective study from Beijing Shijitan Hospital.Clinical data from hospital onset DVT patients from 2007 to 2016 were collected.DVT was confirmed with compression ultrasonography (CUS),color Doppler flow imaging (CDFI),CT venography (CTV),magnetic resonance venography (MRV),lower extremities radionuclide venography(RDV) or conventional venography (CV).The risk factors of DVT in hospital were analyzed with a Chi-square analysis.Results A total of 5 063 patients (1.65％) with DVT involving 5 024 veins were identified from 305 922 inpatients admitted without DVT during ten years.Among DVT patients,2 752 were males (54.36％) and 2 311 were females (45.64％) with age of (74.1±15.9) years (range from 1 to 103 years).Patients with DVT were elder and longer inhospital than those without DVT (P＜ 0.001).Patients with respiratory diseases had higher incidence of DVT (6.83％,OR=5.498,95％CI 5.151-5.868) than those with other system diseases,in which patients with respiratory failure had the highest incidence of DVT (9.53％,95％CI 6.912-8.018) among all patients.The risks of having DVT were higher in patients with serious internal medicine diseases than those in patients with trauma,or cataclasis / operations,or invasive manipulations.Among all DVT patients,71.54％ of them were with inflammation diseases,55.56％ were with hypertension and 54.93％ were with structural heart disease.DVT often occurred in inferior extremities (83.78％,4 360/5 063) in patients irrespective of underlying diseases.Conclusions There is an association between underlying diseases of hospitalized patients and the development of DVT.Patients with internal medicine diseases had higher risk to develop DVT than those with trauma or cataclasis / operations or invasive manipulations.To prevent the development of DVT,its screening should be emphasized in patients with serious internal diseases.

Objective To evaluate the effect of parasternal intercostal plane block(PIB)on postopera-tive fatigue in elderly patients undergoing off-pump coronary artery bypass grafting(CABG).Methods A to-tal of 111 elderly patients undergoing elective off-pump CABG in Xuzhou Municipal Central Hospital from May 2021 to January 2023 were selected as the study subjects.The patients were divided into the control group(group C,n=55)and PIB group(group P,n=56)by adopting the random number table method.After induction of anesthesia,the patients in the group P received the ultrasound-guided bilateral PIB,and the group C received the equal volume of normal saline at the same site.The incidence rate of postoperative fatigue syn-drome(POFS)on postoperative 1,3,5,7 d and postoperative 8 weeks,NRS scores immediately after extuba-tion and at postoperative 12,24,48 h,postoperative opioid drugs consumption,ICU stay duration,hospitaliza-tion duration and adverse events occurrence were compared between the two groups.Results Compared with the group C,the incidence rates of POFS on postoperative 1,3,5,7 d and postoperative 8 weeks in the group P were significantly decreased,the NRS scores immediately after extubation and at postoperative 12,24 h in the group P were lower,the postoperative opioid drugs consumption were smaller,the ICU stay duration was shorter,and the differences were statistically significant(P＜0.05).The NRS score at postoperative 48 h and hospitalization duration had no statistical differences between the two groups(P＞0.05).No nerve block re-lated adverse events in the patients appeared during the study period.Conclusion The ultrasound guided PIB could effectively reduce the incidence rate of POFS in elderly patients undergoing off-pump CABG,promote the patients'prognosis and improve the recovery quality of the patients.