Objective:The clinical features, risk factors, and outcomes of coma were analyzed in patients treated with bevacizum-ab combined with chemotherapy This study also aims to increase the awareness on the toxicity of this regimen. Methods:Two cases of coma induced by bevacizumab combined with chemotherapy were reported. Diagnosis, treatment, and relevant literature were reviewed and discussed. Results:Inadequate blood pressure (BP) control was one of the risk factors leading to coma in patients treated with this therapy. The clinical feature of these patients was reversible posterior leukoencephalopathy syndrome (RLPS). Imaging results showed no typical finding. Reinforced supportive treatment including intensive BP control showed satisfactory outcomes. Conclusion:Coma is common in patients treated with bevacizumab combined with chemotherapy. This regimen should be used cautiously in patients with a history of hypertension. BP should be monitored closely and managed promptly during the combination therapy to prevent coma. RLPS-related coma is reversible after appropriate treatment.

Objective To evaluate the diagnostic value of contrast enhanced ultrasonogrphy(CEUS) and quantitative analysis in differentiating between thyroid solid malignant masses and solid benign masses.Methods 40 patients with thyroid solid mass were enrolled into this prospective study between March 2012 and June 2012.A total of 45 thyroid solid masses were evaluated by CEUS,and the final pathology diagnosis was confirmed by core biopsy or thyroidectomy.The diagnostic yield of enhancement patterns and quantitative parameters were assessed for differentiating between the solid malignant and benign masses.Results Enhancement patterns were classified into five types (nonenhancement,early hypo enhancement,hypo enhancement,isoenhancement,hyperenhancement).Two malignant masses had nonenhancement pattern,and 6 malignant masses had early hypoenhancement pattern,and 14 malignant and 4 benign masses had the hypo enhancement pattern,and 5 malignant and 7 benign masses had the isoenhancement pattern,and 1 malignant and 6 benign masses had the hyperenhancement pattern.There was a significant difference between malignant and benign enhancement patterns of thyroid solid masses (x2 =12.184,P =0.016).Nonenhancement,early hypoenhancement and whole phase hypoenhancement pattern predict thyroid solid malignant masses with sensitivity of 78.5 ％ and specificity of 76.5 ％.Among seven quantitative parameters used to predict thyroid malignant mass,the relative maximum intensity (IMAX％) of lesions had highest value in differentiating between the malignant and benign masses with sensitivity of 80.8 ％ and specificity of 82.6％,and area under receiver operating curve (AUC) of the IMAX％ was 0.878.RT (rising time),TTP (time to peak intensity),mTT (mean transit time) had almost non differentiation value with AUC of 0.619,0.601,0.656 separately.And mTT-Ratio (mTT of lesion/mTT of parametric area),RT-Ratio (RT of lesion/RT of parametric area),TTP-Ratio (TTP of lesion/TTP of parametric area) had less differential diagnostic value with AUC of 0.749,0.744,0.704 comparing with IMAX％.Conclusions Nonenhancement and early or whole phase hypoenhancement could be characteristic enhancement pattern of malignant thyroid solid masses,and IMAX％ had good diagnostic value in differentiating between malignant and benign masses among the quantitative parameters.

Objective To summarize the manifestation of autoimmune pancreatitis (AIP) on ultrasound and contrast-enhanced ultrasonography (CEUS).MethodsThe 2D ultrasound and CEUS images of 16 patients With AIP were retrospectively analyzed.Results On 2D ultrasound,AIP presented as diffusely(15 cases) or focally (1 case)swelling with low echo.13 cases revealed dilatation of the biliary tract.The choledochal wall showed thickening with a sandwich-pattern in 9 cases,which was also shown in 3 intrahepatic bile ducts and 3 gall bladders.On CEUS,6 AlP of diffuse form enhanced simultaneously and homogeneously.1 AIP with enlarged pancreatic head enhanced simultaneously,the enhanced degree in pancreatic head was higher than that of the surrounding pancreatic tissue in the vascular phase and equal to that in the parenchymatous perfusion phase.1 AIP of focal form enhanced slightly late compared with normal pancreatic tissue and the enhanced degree was lower in the vascular phase,while in parenchymatous perfusion phase.the pancreatic tissue enhanced homogeneously.ConclusionsThe manifestation of AIP on ultrasound and CEUS had some features which were helpful in diagnosis of AIP.

Objective To analyze the application value of high risk human papillomavirus (HR HPV) DNA and thinprep cytolo-gy test(TCT ) detection in screening cervical cancer and to evaluate the clinical significance of their combined detection .Methods A total of 402 cases conducting cervical cancer screening in our hospital from March to May 2016 were selected and performed the HR HPV DNA and TCT detection .Those of suspected cervical lesions were performed the histopathological examination .Then the effects of HR HPV DNA and TCT combined detection were compared according to the pathological results .Results The detection positive rate of female HR HPV DNA was 27 .1% (109/402);abnormal and benign inflammation reaction were detected out in 46 cases of female TCT ,the positive rate was 11 .4% (46/402);in 123 cases of suspected cervical malignant lesion ,32 .5% females(40/123) appeared CIN Ⅰgrade or more lesions by histopathological examination ;the sensitivity of HR HPV DNA and TCT combined detection was higher than that of single detection ,the difference was statistically significant (P<0 .05);the specificity of HR HPV DNA and TCT combined detection was higher than that of HR HPV DNA single detection ,the difference was statistically signifi-cant(P<0 .05) ,but the difference was not statistically significant compared with TCT single detection (P>0 .05) .Conclusion The detection of HR HPV DNA and TCT is a good method for screening of cervical cancer ,the combined detection of HR HPV DNA and TCT can improve the detection rate of cervical precancerous lesion .

Objective To study the application value of preoperative medical adhesive locating in performing thoracoscopy for small pulmonary nodules (SPN).Methods The clinical data of 41 patients with solitary SPN,who received thoracoscopy with the help of preoperative locating procedure,were retrospective analyzed.The preoperative locating methods included medical adhesive locating (n=22,medical adhesive group) and Hook-wire locating (n=19,Hook-wire group).The locating effects,complications,the time of engagement stage and the time used for pulmonary wedge resection were determined,and the results were compared between the two groups.Results The locating of SPN was successfully accomplished in all patients of both groups.The incidences of pneumothorax,pulmonary hemorrhage and chest pain in the medical adhesive group were 18.2％,9.1％ and 4.5％ respectively,which were lower than those in the Hook-wire group;among them the difference in the incidence of pulmonary hemorrhage between the two groups was statistically significant (P＜0.01).No-complication rate in the medical adhesive group (63.6％) was higher than that in the Hook-wire group (21.1％),and the difference was statistically significant (P＜0.05).The time of engagement stage for patients in the medical adhesive group was (16.32±8.83) hours,which was longer than (3.29±4.21) hours in the Hook-wire group,the difference between the two groups was statistically significant (P＜0.01).The time used for puhnonary wedge resection in the medical adhesive group and in the Hook-wire group was (21.14±7.01) min and (18.58±5.22) min respectively,the difference between the two groups was not statistically significant (P＞0.05).Conclusion Preoperative medical adhesive locating for the performance of thoracoscopy for SPN is safe and effective,it carries less complications when compared with Hook-wirelocating method and can obtain a longer interwal period,therefore,this technique has high application valuein clinical practice.

Objective To evaluate the clinical effect of transcatheter closure with Amplatzer duct occluder offers in infants with patent ductus arteriosus(PDA).Methods Thirty-seven PDA infants underwent transcatheter closure of PDA at(8.7 ? 3.3)months and weight of(8.6 ? 3.5)kg.A lateral view aortogram was made to determine the morphology and the narrowest diameter of the ductus and selected the size of the device.Occluder was implanted using the anterograde venous approach.Follow-up evaluations were made with chest X-ray and echocardiogram at 24 hours and 1,6 and 12 months after implantation.Results The narrowest diameter of the ducts measured by angiographically was(3.3 ? 1.5)mm.Ninteen patients(54.29%) achieved immediate complete occlusion.On color Doppler the closure rates at 1 month after implant were 34 cases(97.14%).No residual shunt exsisted in all implanted patients at 6 and 12 months follow-up.Procedure time at(57 ? 43)minutes and fluoroscopy time(23.0?14.9)minutes.Conclusions Percutaneous PDA closure with the Amplatzer duct occluder decice is an safety and effective method for the treatment of PDA in infants,but caution shall be exercised to the anatomic characteristics in the infant age group in solving clinical complications.

Objective To explore the imaging appearances and the value of multi-slice CT (MSCT)with post-processing tech-niques in diagnosis and treatment of lumbar hernia (LH).Methods The imaging and clinical data of 1 6 patients with LH which were confirmed by surgery were analyzed retrospectively.Results In 1 6 patients,1 7 lesions of LH were revealed by MSCT.There were superior lumbar hernias in 13 (76.5%),inferior lumbar hernias in 3 (1 7.6%)and diffuse lumbar hernia in 1 (5.9%).Hernia ring in diameter ranged from 1.5 to 9.3 cm,and the hernia sac size ranged from 1.8 cm×2.4 cm to 1 1.3 cm× 6.2 cm.MSCT showed oval or flask shaped mass of extraperitioneal fat with or without peritoneum and visceral contents protruded through the de-fecting fascia floor into lumbar triangle.Superior lumbar hernia was bounded by the 12th rib superiorly,the erector spine muscle medially and the internal oblique muscle laterally.Inferior lumbar hernia was bounded by latissimus dorsi muscle medially,the ex-ternal oblique muscle laterally and the iliac crest inferiorly.Hernia contents included colon in 3 patients and small bowel in 2 with in-carcerated hernia with small bowel obstruction in 1,and adipose tissue and mesentery in other 12.All patients received surgery treatment,and the appropriate surgical methods were selected according to the MSCT findings.The surgical findings were consistent with MSCT results.No recurrence was found during follow-up.Conclusion LH has characteristic CT manifestations.MSCT volu-metric scanning with post-processing techniques can clearly display the type of LH,the size of abdominal wall defect,hernia contents and their complications.It is helpful for diagnosis of the LH and differentiation from other diseases,which may provide important information for clinical surgery.

This study is to investigate the effects of indirubin on ATP-induced immune responses of macrophages. For this, neutral red dye uptake method was used to test phagocytosis, MTT assay was used for measuring cell death, and reactive oxygen species (ROS) was tested with fluorescent probe DHE. The data showed that extracellular ATP attenuated phagocytosis, induced cell death and increased ROS production, and these effects were restored by pre-treating with indirubin. This result suggested that indirubin blockade the effects of ATP on macrophages, because extracellular ATP-induced effects are dependent on P2 receptors, in particular P2X7 receptors. Furthermore, the effects of indirubin on the activation of P2 receptors were tested, in particular P2X7 receptors. The data showed that indirubin significantly decreased ATP-induced, P2 receptors mediated intracellular Ca2+ concentration ([Ca2+]i) rise and inhibited P2X7 receptor-based ethidium bromide (EB) dye uptake. These results suggested the inhibitory effects of indirubin on the activation of P2X7 receptors, which may underlying the effects on ATP induced ROS production, phagocytosis attenuation and cell death of macrophages.

Adolescent ; Catheter Ablation ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Tachycardia, Supraventricular ; surgery

Objective To investigate the application of alpha-fetoprotein (AFP),α-L-fucosidase(AFU),5'-nucleotidase(5'-NT) and γ-glutamyltransferase (GGT) in diagnosis of hepatocellular carcinoma(HCC),and to provide the basis for its early and rapid diagnosis.Methods The clinical data of 120 cases with initial diagnosis as hepatocellular carcinoma,150 cases with liver cirrhosis,200 cases with hepatitis were analyzed retrospectively from June 2013 to August 2014,meanwhile,100 healthy people were selected as control group.The serum AFP,AFU,5'-NT and GGT levels were measured by electrochemiluminescence immunoassay,rate method,peroxidase method and enzymatic colorimetric assay,respectively.The results were analyzed by receiver operating characteristic (ROC) curve,while the sensitivity,specificity,AUC were calculated at the same time.Results The levels of serum AFP,AFU,5'-NT and GGT were significantly different among HCC group,liver cirrhosis group,hepatitis group and control group (all P＜0.05).When tested alone,the sensitivities of AFP,AFU,5'-NT and GGT were 58.33 ％(70/120),82.50 ％(99/120),85.00 ％(102/120),78.33 ％(94/120),the specificities were 88.33 ％(106/120),73.33 ％(88/120),88.33 ％(106/120),71.67 ％(86/120),and AUC were 0.655,0.702,0.814,0.754.When four indexes were performed with combined test,the sensitivity was 98.33 ％(118/120),specificity was 96.67 ％(116/120),AUC was 0.975,which were higher than the single detection (all P＜0.05).Conclusion The combined detection of serum AFP,AFU,5'-NT and GGT can greatly increase the sensitivity and specificity for diagnosing HCC and will gain mutual complement advantages,which is of great clinical value for early and rapid diagnosis.