Objective To investigate the effects of different therapeutic strategies on recurrence of postoperative Crohn's disease (CD) patients.Methods From September 2009 to September 2014,85 CD patients with intestinal resection were enrolled.The clinical features and maintenance therapeutic medication were retrospectively analyzed.The patients were divided into non-treatment group (induding continuously or cumulatively taking medicine less than three months),5-aminosalicylic acid (5-ASA) group and immunosuppressant agents group (including azathioprine,methotrexate and thalidomide).Kaplan-Meier method was performed to compare the recurrence rate in postoperative CD with different therapeutic medication and the risk factors of postoperative recurrence were also analyzed.Results Among 85 CD patients,there were 32,21 and 32 patients in non-treatment group,5-ASA group and immunosuppressive agents group,respectively.After surgery,the one year accumulated clinical recurrence rate of immunosuppressant agents group was 12.5％ (4/32),which was significantly lower than that of non-treatment group (56.3％,18/32) and 5-ASA group (38.1％,8/21),and the differences were statistically significant (x2 =12.250,P＜0.01;x2 =4.102,P =0.043).After surgery,the two years accumulated clinical recurrence rate of immunosuppressant agents group was 12.9 ％ (4/31),which was significantly lower than that of non-treatment group (75.9％,22/29) and 5-ASA group (47.6％,10/21),and the differences were statisitcally significant (x2 =17.840,P＜0.01;x2 =6.597,P=0.010).After operation,the one year accumulated endoscopic recurrences rates of non-treatment group,5-ASA group and immunosuppressant agents group were 39.1％ (9/23),5/16 and 34.6％ (9/26),respectively;while the two year accumulated endoscopic recurrence rates were 59.1％ (13/22),6/16 and 44.0％ (11/25),respectively.However,there was no statistically significant difference among the groups (all P＞0.05).Penetrating lesion was an risk factor of postoperative clinical recurrence in CD patients (x2 =4.963,P=0.026,oddsratio (OR) =2.221,95 ％ confidence interval (CI) 1.121 to 5.775).Conclusions Immunosuppressive agents rather than 5-ASA have remarkable effects in preventing postoperative clinical recurrence in CD patients.Postoperative clinical recurrence is more likely to happen in patients with penetrating lesions.

The extrarenal effects of mineralocorticoid receptor (MR) activation are closely related to the regulation of blood pressure. The activation ability of MR varied with age and gender in blood pressure regulation. MR of different types of cells play an important role in the pathogenesis of hypertension by increasing the expressions of osteogenic transcription factors, epithelial sodium channels, fibrotic substances and fibrogenic factors, change of vascular L-type calcium channels, aggravation of inflammation and oxidative stress, etc., leading to arterial elasticity weakened, myocardial fibrosis, and water sodium retention. Cell-specific MR block provides a theoretical basis for the development of targeted drugs for treatment of hypertension in the future. The effect of cell-specific MR on the regulation of blood pressure has been reviewed in present paper.

Objective To compare the virtual non-enhanced chest CT (VNCT)generated from spectral CT with conventional non-enhanced chest CT in patients with lung disease in terms of CT number accuracy and image quality.Methods A total of 30 patients with lung disease proved by pathology underwent the conventional non-enhanced thoracic CT and contrast enhanced CT with spectral imaging mode in arterial phase (AP)and venous phase (VP).The VNCT images were reconstructed based on the enhanced spectral CT imaging data.The mean CT number,signal to noise ratio (SNR)for the lesions and image quality score were obtained and compared between the true non-contrast CT (TNCT)and the VNCT (including AP and VP)with paired t test.Results The mean±standard deviation for CT number were (38.74±5.17)HU,(39.08±5.07)HU and (38.96± 5.18)HU for TNCT,VNCT at AP and VNCT at VP,respectively, with no statistical difference (P>0.05).All 3 sets of images demonstrated acceptable image quality,even though there were statistically significant differences in the SNR value and image quality score.The mean ± standard deviation values for SNR were 4.74±0.42 with TNCT, 3.79 ± 0.5 1 with VNCT at AP and 3.77 ± 0.39 with VNCT at VP (P <0.05),and the image quality scores were 5.00 ±0.00 with TNCT,4.17±0.65 with VNCT at AP and 4.17±0.53 with VNCT at VP (P<0.05).Conclusion In patients with lung disease,the vir-tual non-enhanced CT images generated from spectral CT provide accurate CT numbers for lesions and acceptable image quality com-pared with the true non-contrast CT.VNCT may be used to replace TNCT to improve work flow and reduce radiation dose.

ObjectiveTo investigate the value of diffusion tensor imaging (DTI) at high b value for unilateral middle cerebral artery (MCA) occlusive disease in patients without obvious infarct lesions on conventional MR imaging.MethodsDTI at high b value (2200 s/mm2 ) was performed using a 3.0 Tesla MR scanner in 34 patients with unilateral middle cerebral artery occlusion,who had no obvious infarct lesions on conventional MR imaging. Fractional anisotropy (FA),apparent diffusion coefficient (ADC),axial diffusivity (eigenvalue λ1) and radial diffusivity (eigenvalues λ2,λ3) were measured at the ipsilateral and contralateral corona radiata,anterior and posterior limbs of the internal capsule,cerebral peduncle and pons in all subjects.Mean ADC,FA,λ1,λ2 and λ3 values of corona radiata,anterior and posterior limbs of the internal capsule,cerebral peduncle and pons were compared between the ipsilateral and contralateral MCAterritory by t test. Results Among the 34 patients,left MCA occlusion in M1 segment occurred in 16 patients and right MCA occlusion in Ml segment occurred in 18 patients.At the ipsilateral corona radiata,mean FA,ADC,λ1,λ2 and λ3 were 0.419 ±0.032,(5.975 ±0.272) × 10 3,(5.704 ±0.365) ×10-3,(6.412 ±0.368) × 10-3 and (6.605 ±0.343) × 10-3 mm2/s,respectively.At the contralateral corona radiata,mean FA,ADC,λ1,λ2 and λ3 were 0.443 ± 0.033,(5.804 ± 0.282) × 10 -3,(5.651 ±0.350) × 10-3,(6.099 ±0.353) × 10-3 and(6.372 ±0.355) × 10-3 mm2/s,respectively.At the ipsilateral corona radiata,mean FA was significantly decreased(t =11.614,P ＜0.01),and mean ADC (t=12.421,P＜0.01),λ1(t =7.447,P＜0.01),λ2(t=10.244,P＜0.01) and λ3(t=9.890,P＜0.01) were significantly increased.At the ipsilateral anterior and posterior limb of the internal capsule,mean FA were 0.609 ±0.026 and 0.674 ±0.033,λ1 were(5.330 ±0.462) × 10 -3 and(5.171 ±0.456) ×10-3 mm2/s,respectively.At the contralateral anterior and posterior limb of the internal capsule,FA were 0.622 ±0.026 and 0.694 ±0.034,λ1 were(5.064 ± 0.448) × 10 -3 and(4.924 ± 0.365) × 10 -3 mm2/s,respectively.Mean FA was significantly decreased (t =7.823,8.013,all P ＜ 0.01) and mean λ1 was significantly increased (t =7.811,8.800,all P ＜0.01) at the ipsilateral anterior and posterior limbs of the internal capsule.There was no significant difference in ADC,λ2 and λ3 value between the ipsilateral and contralateral sides.And all the DTI parameters,including mean ADC,FA,λ1,λ2 and λ3 values,showed no statistical difference between both sides of cerebral peduncle and pons.ConclusionDTI at high b valuc can provide useful information for visualizing ischemic white matter injury in patients without obvious infarct lesions on conventional MR imaging.

Objective To investigate the expression and the effects of tissue inhibitor of metalloproteinases-1 (TIMP-1) on lungs of rats with sepsis.Methods Forty Sprague-Dawley (SD) rats were randomly divided into two groups,namely sham group (n =8) and sepsis model group (n =32).The rats of model group were modeled by cecal ligation and puncture (CLP),and were further divided into four subgroups as per the time after modeling,namely 6 h (n =8),12 h (n =8),24 h (n =8),48 h (n =8)subgroups.Blood and lung samples were taken 6 h,12 h,24 h and 48 h after modeling.The histological changes in lungs of the rats were observed under light microscope.Expressions of TIMP-1 mRNA,Bax mRNA and Bcl-2 mRNA in lungs were measured by RT-PCR.The immunohistochemistry was used to label the CD18 in lungs during different phases of sepsis.The data were processed by t test.Results Compared with sham group,the lung tissues of rats in model group were injured to a certain extent after CLP.The expression of TIMP-1 mRNA and the number of CD18 positive cells increased at the same time (P ＜ 0.01),and peaked 24 hours later (P ＜ 0.01).While the expression of Bax mRNA in model group decreased markedly 12-48 hours after modeling (P ＜ 0.01-0.05),and reached minimum 48 hours later (P ＜ 0.01).The expression of Bcl-2 mRNA in model group changed unnoticeable.The positive correlation between variations in number of CD18 positive cells and expression of TIMP-1 mRNA was found in model group (r =0.426,P ＜ 0.01).Conclusions The increase in expression of TIMP-1 mRNA in lungs is closely associated with the lung injury of sepsis.The mechanism of lung injury is likely attributed to the preservation of inflammatory cells from apoptosis,and the persistent inflammation response causes tissue damage,leading to organ dysfunction.

Objective:To investigate the imaging manifestations and diagnosis of hepatic hereditary hemorrhagic telangiectasia (HHHT). Methods:The imaging features and clinical data of three HHHT patients were analysed and the related data were reviewed. B-type ultra-sonography, contrast enhanced CT and DSA were utilized to show the changes of the involved liver and the vessels. Results:B-type ultra-sonic graph showed abnormal blood vessels in hepatic hila. CT or DSA demonstrated intra-and extra-hepatic abnormal ectatic arteries, intrahepatic telangiectasia, cirrhosis and hepatic enlargement. Conclusion:CT might be used as one of the key measures for the diagnosis of HHHT.

OBJECTIVE To recognize the frontal recess cells and analyze their distributional characteristics during image navigation assisted endoscopic sinus surgery. METHODS 20 cases(39 sides)of chronic sinusitis with nasal polyps were observed in this study. The fontal recess cells and frontal sinus were opened under the endoscope and the distributional characteristics were observed and recorded, and then confirmed by the image navigation system. RESULTS Centred on frontal sinus ostium, frontal recess cells were divided into three areas: the agger nasi cell(ANC)and frontal cells(FC)are located in front of frontal sinus ostium(FS); frontal septum cells(IFSSC)and terminal cells(RT)are located at the same plane of FS; supra-ethmoidal bulla recess(SBR), frontal bulla cell(FBC)and super-obital cells(SOEC)are in the posterior area. The coincidence of identification for ANC, FCI and II, SBR, FBC and IFSSC under endoscope and image navigation is 100%, the coincidence of identification for FS is 89.7%, SOEC 80%, RT 71.4% and FC III and IV 60%. CONCLUSION The distribution of the frontal recess cells around the frontal ostium showed a fixed pattern.It would well benefit the orientation of frontal ostium and the opening of frontal sinus. Furthermore, it is significant for the orientation and opening of the frontal recess cells.

Objective To investigate the preoperative evaluation of pulmonary function and protocol for scoliotic patients with respiratory failure. Methods From September 2000 to June 2008, sixteen patients suffered from respiratory failure were recruited into this study. There were two males and three females who were diagnosed as idiopathic scoliosis with a mean age of 13.5 years (range, 10-16 years). The other eleven patients were diagnosed as congenital scoliosis, including five males and six females with a mean age of 12.4 years (range, 10-14 years). The mean preoperative Cobb angle was 126.6°±15.5° with a mean height of 137.6 cm (range, 120-160 cm) and a mean weight of 32.5 kg (range, 18-40 kg). Decision was made depending on the severity of pulmonary impairment and spinal deformity. Preoperative treatment included respiratory training, noninvasive positive pressure ventilation therapy and halo-gravity traction. Results All patients received corrective surgery; ten patients were extubated tracheal tubes successfully 1 hour after surgery and six patients had to stay in intensive care unit (ICU) for 24 hours. Pulmonaryedema occurred in two cases and pneumonia in one case. The Cobb angle had improved to 72.0°±13.2° after surgery with a correction rate of 43%. All patients recovered well after surgery with no major cardiac or pulmonary complications.Conclusion Patients with preexisting respiratory failure can tolerate deformity correction operation with few complications after receiving a set of preoperative respiratory training modalities.

Objective To prospectively explore the techniques and correction results of the method of vertebral coplanar alignment (VCA) in posterior correction for thoracic scoliosis. Methods Between June 2008 to March 2009, 27 patients with idiopathic thoracic scoliosis were selected to undergo posterior pedicle screw fixation with assistance of Coplanar system. There were 26 females and 1 male with the average age of 15.9 years(ranged 11-23 years). There were type 1 in 25 cases and type 2 in two cases. The levels of fusion were established according to the Lenke criteria. The average preoperative coronal Cobb angle was 49°(ranged 40°-70° ). During the procedure, the pedicle screws were inserted in each involved levels on the convex side, an extended Coplanar tube was screwed in line with screw axis to each screws. Then two rigid bars were inserted through the uppermost part of the slotted tube sequentially. As the bar was gently driven down toward the bottom end, the pedicle screws axis started to converge in the straight line, correcting translation and rotation. Spacers were inserted into the slots of the tubes to achieve the ideal physiologic thoracic kyphosis. Once the rod was fixated in the concave side of the main curve, the Coplanar system could be removed. Results The mean postoperative Cobb angle was 14° (ranged 6°-25°), representing the correction rate of 70.7%. The average duration of surgery was 245 min (ranged 210-300 min) and a mean estimated blood loss was 1500 ml (ranged 600-2100 ml). The duration of follow-up averaged 15 (12-18) months. The loss of correction at last follow-up was 3° with the loss of correction rate of 6.1%. In the sagittal plane, the thoracic kyphosis was restored from 18° to 25°. No coronal or sagittal plane decompensation occurred. No thoraeoplasties were necessary to correct the residual rib hump. There was no death, infection and neurological complications. Conclusion The Coplanar is a new technique for the correction of scoliosis, its advantage lies in excellent and modulatable three-dimensional correction with a single and standardized maneuver.

Objective To explore the value of CT venography in the surgical treatment of falcotentorial junction meningiomas. Methods CT venography was carried out in 25 patients with falcotentorial junction meningiomas. 2-D and 3-D images were reformatted at the workstation. The classification and relationship between the tumors and veins were determined, and the degree of venous stenosis and collateral were assessed. The safe surgical pathway was chosen to avoid the injury of main draining vein. Results Falcotentorial junction meningiomas were divided into 5 types according to the relationship between the tumors and veins and the direction of the tumors. There were 5 cases of forward type, 4 cases of backward type, 3 cases of inferior type, 6 cases of superior type and 7 cases of lateral type in this group. The relationship between tumors and veins was accordant with the findings in surgery. Of all 25 cases, 19 underwent total removal, 6 underwent subtotal removal and all of the main driving veins were reserved. There were 3 cases of quadrantanopsia or hemianopsia after the operation, and all of them recovered after 3 months of follow-up. Conclusion CTV technique can classify the falcotentorial junction meningioma and is helpful for choosing the appropriate surgical approaches.