Objective To summarize the features of multi-slice spiral computed tomography (MSCT) examination of acute primary epiploic appendagitis,and investigate the clinical value of MSCT.Methods The clinical data of 19 patients with acute primary epiploic appendagitis who were admitted to the Yangzhou No.1 Hospital from December 2009 to March 2014 were retrospectively analyzed.All the patients received MSCT examination,and the data were transported to the work station for multiplanar reconstruction.The location,shape,size,density,peripheral performance and peritoneal thickening were observed.Results The foci of the 19 patients were located adjacent to the colon.One focus was adjacent to the cecum,4 were adjacent to the ascending colon,1 was adjacent to the hepatic flexure of the colon,6 were adjacent to the descending colon,and 7 were adjacent to the sigmoid colon.The shapes of the foci were similar to the oval or ring in 14 cases and similar to the flame in 5 cases.The diameters of the foci were 0.8-3.7 cm.The results of CT plain scan showed that the density of the foci was similar to that of the fat,and the CT value was-101--34 HU.The central density of the foci was lower,while the limbic density was higher.The results of CT enhanced scan showed a ring-like enhancement region in the foci,and the lesion was surrounded by slightly high-density inflammation.Point or linear slightly high-density shadows were detected at the center of the foci in 9 patients.The peritoneum was locally thickened in 14 patients.The colonic wall was locally thickened in 1 patient,and the pelvic effusion was detected in 5 patients.The results of CT reexamination of 4 patients showed that the inflammatory regions were reduced or disappeared,the mass shrank,nodulized or calcified.Conclusions MSCT examination can provide a specific features of primary epiploic appendagitis.It could accurately diagnose acute primary epiploic appendagitis when combined with multiplanar reconstruction.

Objective To investigate the clinical correlative factors of malignant cystic pancreatic tumors.Methods The clinical data of 45 patients who received cystic pancreatic tumor resection at the General Hospital of Tianjin Medical University from May 2000 to May 2011 were retrospectively analyzed.All patients were divided into benign tumors + precancerous lesions group (35 patients) and malignant tumor group (10 patients).The clinical symptoms and imaging features of cystic pancreatic tumors were analyzed.All data were analyzed by chisquare test or Logistic regression analysis.Results Abdominal pain,jaundice,emaciation,nausea and vomiting were observed in 23 patients (51％),and 22 (49％) patients had no clinical symptoms.The clinical features of benign pancreatic cyst included pancreatic calcification and pancreatic divisum,while the clinical features of malignant pancreatic cystic tumors were nodules,swelling of lymph nodes,dilation of biliary and pancreatic duct.The results of univariate analysis showed that age ≥ 60 years,presence of symptoms,jaundice,emaciation,dilation of pancreatic duct were the correlative factors of malignant cystic pancreatic tumors ( x2 =4.220,4.294,4.645,7.705,4.645,P ＜ 0.05 ).The results of multiple logistic regression analysis found that age ≥60 years,dilation of pancreatic duct and presence of clinical symptoms were the correlative factors of malignant cystic pancreatic tumors ( OR =1.573,2.674,2.723,P ＜ 0.05).Conclusion Age≥60 years,dilation of pancreatic duct and presence of clinical symptoms are the correlative factors of malignant cystic pancreatic tumors.

Objective To investigate the effects of a newly developed health belief model (HBM)on the survival of liver transplant recipients. Methods The most important health concerns and follow-up service expectations were learned from out-patients who received long-term liver transplant follow up, and a new HBM for liver transplant was developed. The impact of the HBM on survival was evaluated in this prospective randomly controlled trial. Results In 374 liver transplant recipients who completed the questionnaire, the most common health concerns were the implication of follow-up service and optimal medications ,etc. Moreover,liver transplant club and improved role and function of health-care providers were expressed by the participants to enhance interactions with the medical staff. After 2 years' follow up, the incidence of abnormal liver function ( 16. 8% vs 21.2% ), infection ( 3.2% vs 10. 3% ) and disease recurrence (2. 6% vs 9. 8% ) were significantly decreased in the study group (n = 190) when compared with the control group ( n = 184) ( all P ＜ O. 05 ). Conclusion Adverse health events could be reduced following the application of HBM for liver transplantation.

Plastic and Aesthetic surgery is a science which creates beauty by combining know-ledge and art. Combined with the professional characteristics of plastic surgery, we reformed the cur-riculum content and teaching mode of continuous education, including a established interactive theoret-ical learning model based on Journal club, the strengthening of clinical practice integrated with multiple related disciplines, the expanding the knowledge of Sociology, Psychology and Ethics, and the construc-tion of a long-term platform of network resources. Therefore, a comprehensive and specialized continu-ous education model in the department of plastic and aesthetic surgery was ultimately formed, whose preliminary assessment was favorable, and could be helpful in the cultivation of high-quality plastic and aesthetic surgeons in the future.

Objective To carry out further analysis and assessment of the radiation risk from DSA examinations and related factors.Methods All the online radiation dose values and associated parameters of the 107 patients examined were collected for purpose of statistical analyses according to their classification.Results The analyses of DSA examinations indicated:for coronary angiography,DAP was (22 285.5±18 682.7)μGy·m2,ESD was (2 942.1 ±2 557.3) mGy;for head angiography,DAP (25 929.6±8 302.7) μGy·m2,ESD (1 288.8 ±682.3) mGy;for abdominal angiography,DAP (12 129.7 ± 10 646.1) μGy· m2,ESD (730.1 ± 584.7) mGy.Conclusions Among total accumulated radiation dose,the dose arising form coronary angiography is the highest,followed by the head angiography,and the dose from abdominal angiography is the lowest.

Objective To study the diagnosis and treatment of non-anastomotic biliary stricture (NABS) after liver transplantation.Methods The clinical data of 403 patients who underwent liver transplantation in the past 10 years in our department were analyzed retrospectively,compared different methods to find out the most appropriate method in the diagnosis and management of NABS.Results NABS occurred in 13 out of 403 patients (3.2％),almost the same incidence as in patients who received DCD donor livers (4.16％,2/48).The clinical signs of NABS were frequent cholangitis and high TBil,r-GT and AKP (P ＜0.01).All these cases were finally diagnosed by cholangiography and they could be classified into 3 types:hepatic bile duct stricture (4 patients,type Ⅰ),multiple extrahepatic and intrahepatic biliary strictures (7 patients,type Ⅱ),intrahepatic biliary strictures (2 patients,type Ⅲ).NABS were mainly treated by interventional therapy,Roux-en-Y anastomosis and retransplantation in our centre.All type Ⅰ patients were successfully managed with interventional therapy/ERCP and Roux-en-Y anastomosis,but 44.4％ (4/9) of type Ⅱ and Ⅲ patients required retransplantation.The TBIL,r-GT and AKP decreased significantly in 12 patients (P ＜ 0.05) and the total curative rate of NABS was 92.3％ (12/13) with one patient who died after retransplantation.Conclusions Cholangiography was an effective way to diagnose NABS which is common among patients after liver transplantation.Interventional therapy/ERCP,Roux-en-Y anastomosis and retransplantation were our 3 ways to treat this problem.We proceeded from easy to difficult and chose a suitable way to deal with NABS according to the different types of biliary stricture from cholangiography.Type Ⅰ patients had much better prognosis than Type Ⅱ and Ⅲ patients who should receive retransplantation if interventional therapy/ERCP failed.

Objective To evaluate the prevalence rate of pulmonary malignant disease in people at high risk of lung cancer through low-dose multi-slice spiral CT. Methods 1 200 symptom-free volunteers were under low-dose spiral CT scans in an on-going screening study. The people tested aged 40 or older regardless of their gender or smoking history. Low-dose CT scans were performed with Iightspeed Plus multi-slice scanner using spiral mode, 120 kV,30 mAs. Results Calcified nodules were detected in 32 participants and non-calcified nodules were detected in 18 participants by low-dose CT,in which 3 were vicious ones,including 1 non-solid lesion and 2 solid lesions. The detection rate of lung cancer was 0. 25%. Conclusion Low-dose multi-slice spiral CT was effective in detecting, classifying and defining lung nodules,and furthermore would make it possible to find lung cancer at earlier stage.

Objective To evaluate the outcomes of liver transplant recipients who received liver grafts from HBsAg positive donors in patients with hepatocellular carcinoma beyond UCSF (University of California,San Francisco) Criteria.Method The medical records of patients who underwent HBsAg-positive donor liver transplantation for hepatocellular carcinoma beyond UCSF Criteria from October 2008 to December 2012 at our hospital were analyzed retrospectively,including the existence status of HBV,graft function,tumor recurrence,and the survival after transplantation.Result A total of 20 patients were enrolled in the study.One patient lost follow-up while the remaining 19 patients had complete follow-up data.All the patients were followed up until June 2013,with a median follow-up duration of 12 months (range 2-57 months).One patient died from postoperative abdominal bleeding and multiple organ failure at post-transplantative day 21.Five patients survived up to now,including 4 cases with disease-free survival,who has been surviving for 57,35,26 and 12 months respectively.The remaining all 14 patients died from tumor recurrence at different time points after transplantation.Entecavir was used alone in 19 patients and Entecavir combined with Adefovir dipivoxilalone were used as anti-HBV therapy in the recipients.At posttransplant day 45,all the recipients were positive for serum HBsAg and negative for serum HBVDNA,and the liver enzymatic criteria,coagulation criteria and the serum bilirubin restored to normal levels or within twice the upper limit of normal levels.Throughout the follow-up period,recipients were all positive for serum HBsAg,but there was no recurrence of hepatitis B.The 1-,2-,3-and 4-year cumulative survival rate was 48.0％,35.0％,18.7％ and 18.7％ respectively.Conclusion The HBsAg positive liver may be used as a donor in liver transplantation and the graft probably works well after the operation.Liver transplantation may prolong the survival and improve the quality of life,even achieve long-term disease-free survival in patients with hepatocellular carcinoma beyond UCSF Criteria.The use of nucleotide analogue only,instead of combination with hepatitis B immune globulin,can also bring HBV well under control in liver transplant recipients with HBsAg positive donors.

Objective To evaluate the efficacy and safety of glargine combined with repaglinide in the treatment of post-transplantation diabetes mellitus(PTDM).Methods PTDM patients who were treated in our hospital from Jan 1,2010 to Dec 31,2010 were enrolled in this study.They were administrated with glargine combined with repaglinide for 6 months,and their glucose level,hepatic and renal function indicators,and tacrolimus concentration were examined at baseline and 1,3,and 6 months after treatment.Results Totally 44 patients were included and given dietary control.Three cases were not given any hypoglycemic drugs,7 were administrated with glargine only,30 cases received glargine combined with repaglinide therapy,and 4 cases required intensive insulin therapy.All the patients achieved satisfactory glycemic control.The hepatic function,renal function,and serum tacrolimus concentration showed no significant change before and after repaglinide therapy(P ＞ 0.05).Five hypoglycemic events were recorded during the treatment,in which the lowest blood glucose level was 3.7 mmol/L.No severe hypoglycemia happened.Conclusion On the basis of dietary control,glargine combined with repaglinide provides a safe and effective therapy for PTDM.

Objective:To explore the efficacy of total sternotomy or partial sternotomy for the treatment of isolated plasmacytoma of the sternum, and the feasibility of the chest wall reconstruction using 3D printed polyether ether ketone(PEEK) implants.Methods:In this study, a total of 6 patients with isolated plasmacytoma of sternum was enrolled, including 5 males and 1 female, aged (57.7±9.4) years old (42-71 years old). All patients received total sternotomy or partial sternotomy, and the chest wall was reconstructed using 3D-printed PEEK implant. The perioperative data and demographic characteristics of the patients were collected for statistical analysis.Results:All patients in this study had isolated plasmacytoma of sternum. Chest wall defects with mean area of (102.7±18.8)cm 2 were anatomically repaired using 3D-printed PEEK implants. No postoperative complications such as abnormal respiration was found. All 6 patients were discharged from hospital successfully, and no complications during the perioperative period were found. During the average follow-up period of(31.2±15.4)months, no implant fracture, displacement, rejection and other phenomena occurred, and no recurrence, metastasis or death occurred in postoperative patients. Conclusion:Total or partial sternotomy was an effective treatment for isolated sternum plasmocytoma . The chest wall reconstruction using 3D-printed PEEK implant was a reliable clinical treatment method.