Objective The aim of this study was to explore the clinical value of dual-source CT(DSCT)in the diagnosis of coronary artery fistula(CAF)before and after surgery. Methods A retrospective analysis was performed in 15 cases of patients with CAF,11 cases of which was treated by surgery during extracorporeal circulation. Results CAF arose from right coronary artery in 8 cases and left coronary artery in 7 cases,with the latter including 3 cases of ramus nodi sinuatrialis fistula,2 cases of anterior descending branch fistula,and 2 cases of left circumflex fistula. CAF entered into right atrium(6 cases),right ventricle(5 cases),left ventricle(4 cases)and left atrium(1 case). There were dilatation of coronary artery in 8 cases,localized aneurysm in 4 cases,normal coronary artery in 3 cases,single fistula orifice in 11 cases,and multiple fistula orifice in 4 cases. 11 patients underwent surgery under cardiopulmonary bypass(CPB).The postoperative imaging revealed fistula has been sutured in 10 patients with no residual fistula,including fistula vascular ligation in 3 cases,the proximal imaging and distal occlusion in right coronary artery angioplasty in 1 case,and pseudo diverticulum in 2 cases. Conclusion DSCT examination has significant value in preoperative diagnosis and postoperative follow-up for CAF.

Objective To explore the way to evaluate hemodynamics of posterior circulation distal ischemia with PWI. Methods Thirty-two patients with vertebral basilar artery severe stenosis were reviewed and compared with thirty normal persons. Information and data of PWI and MRA were collected and analyzed. Following parameters were observed, index of vascular stenosis, collateral vessels, cerebral blood flow (rCBF), cerebral blood volume (rCBV), and mean transit time (rMTT). Results All the patients had at least one vertebral basilar artery with more than 70% stenosis. There were 17 cases with severe vertebral artery stenosis , 20 cases with severe basal artery stenosis , 8 cases with severe superior cerebellar artery stenosis , 17 cases with posterior cerebral artery stenosis , 22 cases with after the traffic artery open , 11 cases with soft meningeal arteries show and 12 cases with small artery show. The ratio of ROI with frontal white matter was lower than the rCBF and rCBV in the country group. MTT value was extended and P value of the parameters in both groups was less than 0.05, reflecting the statistical difference. Conclusions PWI combined with MRA can effectively evaluate the posterior circulation distal ischemia area and tissue perfusion , as well as the hemodynamic status of ischemia area.

Objective To analysis the occurrence status of breast disease in married women in Tangshan area,and to provide basis for early prevention of breast cancer in this region.Methods 773 married women in Tangshan area were given mammography examination.The tissue biopsy or surgical treatment was recommended for patients with above grade 3 of breast imaging reporting and data system (BI-RADS) classification to obtain pathological diagnosis.Results In 773 women,482 cases (62.35 ％) were diagnosed as BI-RADS grade 2 or below,256 cases (33.12 ％) were BI-RADS grade 3,33 cases (4.27 ％) were BI-RADS grade 4,2 cases (0.26 ％) were BI-RADS grade 5.The distribution of each BI-RADS grade among different age group was statistically significant (x2 =17.90,P ＜ 0.001),35 cases got pathological diagnosis by biopsy or surgical treatment,including 30 cases of mammary gland hyperplasia,3 cases of breast fibroadenoma,and 2 cases of breast cancer.Conclusion Women's mammography screening is important for the prevention and early detection of mammary gland diseases.

Objective To investigate CT features on increased cerebral vascular density and its pathological mechanism in patients with cyanotic congenital heart disease(CCHD).MethodsPreoperative brain CT scan and clinical data in 82 patients suffering from CCHD were analyzed. According to the increased levels of vascular density,patients were divided into 4 groups:normal,mild,moderate and severe.Relationships between the increased levels of vascular density and Hb,RBC,HCT,as well as the degree of cyanosis,were studied.AVONA was carried out to test blood CT value of cerebral sinuses,Hb,RBC and HCT in different groups. Descriptive analysis and linear regression were adopted to study the correlation between blood CT value and Hb concentration.The relationship of increased vascular density todegrees of cyanosis was analysed by Spearman.Results Among 82 patients,12 patients ( 14.6％ ) werefound in the group of normal vascular density and 70 patients ( 85.4％ ) in the increased vascular density group.Among 70 patients with increased vascular density,22 patients (26.8％ ) with (55.4 ± 2.6) HU,(169 ±6)g/L of Hb,(5.8 ±0.3) × 1012/L of RBC and 0.51 ±0.03 of HCT,29 patients (35.4％) with (61.3 ± 2.9) HU,(209 ± 15 ) g/L,(7.1 ± 0.4) × 1012/L,0.66 ± 0.06 and 19 patients ( 23.2％ ) with ( 68.8 ± 4.2) HU,( 242 ± 23 ) g/L,( 8.3 ± 0.9 ) × 1012/L,0.78 ± 0.08 were observed in the mild,moderateand severe group,respectively.There were significant differences in distribution of blood CT value ( HU),Hb,RBC and HCT in different groups ( F =163.263,134.703,120.974,136.541 ;P ＜ 0.01 ).Blood CT value was positively correlated with Hb concentration ( r =0.98,P ＜ 0.01 ). Vascular density was also positively correlated with the degree of cyanosis ( r =0.86,P ＜ 0.01 ). Conclusions Cerebral vascular density of patients suffering from CCHD presented different levels of increases based on CT scan results due to rise of RBC stimulated by anoxia.The increased level of vascular density was positively correlated with blood Hb concentration,and also associated with RBC accunulation caused by abnormal blood circulation.Moreover,it was positively correlated with the degree of cyanosis.

Objective To explore the diagnostic value of tumor markers of CEA,CA153,TPS,Fer and CYFRA21-1 level in postoperative metastasis of breast cancer.Methods After 3-year follow-up for 578 patients with primary breast cancer from 2012 to 2014,we chose 42 patients with metastasis as metastasis group,and another 42 cases without as non-metastasis group.Level of CEA,CA153,TPS,Fer and CYFRA21-1 was detected using chemiluminescence and the difference of CEA,CA153,TPS,Fer and CYFRA21-1 level in 2 groups was compared.Pearson correlation test analysis and ROC curve test were performed for data analysis.Results Serum CEA,CA153,TPS,Fer and CYFRA21-1 levelq6.11 ± 1.87)ng/mL,(26.97 ± 9.52) U/mL,(155.95 ± 22.03)U/L,(173.08 ± 19.87)ng/mL and (18.98 ± 7.33)ng/mL respectively increased in metastasis group when compared with those in non-metastasis group (5.33 ± 1.85)ng/mL,(23.34 ± 8.30)U/mL、(133.22 ± 19.09)U/L,(142.29 ± 22.59) ng/mL and (6.76 ± 1.59)ng/mLrespectively and the change of TPS,Fer and CYFRA21-1 was more obvious and the difference was statistically significant (P ＜ 0.05).There was no significant correlation among serum TPS,Fer and CYFRA21-lin metastasis group.The area under ROC curve of CYFRA21-1 was 0.903,followed by Fer (0.849) and TPS (0.791) and in the diagnosis of metastasis of breast cancer,CYFRA21-1 has great diagnostic value.Conclusions The increase of serum TPS,Fer and CYFRA21-1 level is closely associated with postoperative metastasis of breast cancer and CYFRA21-1 has great diagnostic value for monitoring postoperative metastasis of breast cancer.

OBJECTIVE：To reference for the rational use of sodium va lproate in clinic. METHODS ：By retrospective analysis，blood concentration monitoring results of sodium valproate and medical record data in 856 patients were collected from the Affiliated Tianyou Hospital of Wuhan University of Science and Technology during Jan. 2016-Dec. 2018. The dosage form of sodium valproate ，monitoring times of therapeutic drugs ，monitoring results of steady-state blood concentration of sodium valproate up to the standard ，dosage adjustment and the combination with carbamazepin ，fluconazol and carbapenem drugs were analyzed. Fisher exact test was used to analyze the factors influencing the steady-state blood concentration of sodium valproate up to the standard. RESULTS ：A total of 1 270 cases of sodium valproate were monitored in 856 patients，involving 407 males and 449 females，with age of （38.2±13.8）years and body mass of （52.3±10.0）kg. Among 1 270 cases of monitoring ，steady-state blood concentration of sodium valproate in 554 cases were in the range of 50-100 µg/mL，and 43.6％ of which reached the standard. The rate of reaching the standard in patients with multiple monitoring was higher than patients with single monitoring ；the dosage of patients with last monitoring reaching the standard was higher than that of patients with the first monitoring reaching the standard. The rate of reaching the standard in Sodium valproate sustained-release tablet group was higher than general Sodium valproate tablet group；the carbamazepin/fluconazol free group was higher than the carbamazepin combination group and fluconazol combination group；the carbapenem free group was higher than the carbapenem combination group （all P＜0.05）. CONCLUSIONS ：Clinical pharmacists should pay attention to the monitoring of sodium valproate treatment drugs ， strengthen the publicity and 3551851542@qq.com education of patients and their families ，and try to use Sodium valproate sustained-release tablets. When patients additionally receive carbapenem drugs like carbamazepin or fluconazol ， the standard level of sodium valproate will be reduced ，then the dosage of sodium valproate should be adjusted.