Objective To optimize an integration technique for extracting the liposoluble and water-soluble components of Salvia miltiorrhiza. Methods Salvianolic acid B and Tanshinone ⅡA were selected as marker components and determined by HPLC to optimize the integration extract process of Salvia miltiorrhiza by orthogonal test. Results The liposoluble and water-soluble active components of Salvia miltiorrhiza were efficiently extracted by the optimum integration technique. The integration technique for extracting was obtained:Salvia miltiorrhiza was added with 8 times alcohol of 70% and extracted 1 hour for 2 times. Conclusion The liposoluble and water-soluble active components of Salvia miltiorrhiza can be extracted simultaneously by the novel extraction process which was reasonable and feasible. This new technique can be employed to reduce time, working and energy, and be suitable for the morden production.

Objective:To analyze the genetic test results and ultrasonographic markers of 41 fetuses with short femurs and their relationship.Methods:This study retrospectively analyzed 41 fetuses who were diagnosed with short femurs by ultrasound during 19-37 gestational weeks and underwent prenatal genetic examination at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2019. According to the results of genetic examination, these cases were divided into three groups after excluding three cases of variants of unknown significance: genetically normal group, chromosome variation (including chromosomal aneuploidy and pathogenic or likely pathogenic copy number variations) group, and gene mutation (including pathogenic or likely pathogenic gene mutations) group. According to the head circumference (HC), abdominal circumference (AC) and femur length (FL), Z FL, FL/HC, FL/AC, ΔZ H-F and ΔZ H+A-2F for each fetus were calculated. One-way ANOVA and LSD- t test were used for statistical analysis. Results:(1) Among the 41 fetuses with short femurs, there were 28 in the genetically normal group, five in the chromosome variation group, three with chromosome variations of unknown significance and five in the gene mutation group. (2) In the genetically normal, chromosome variation and gene mutation groups, Z FL values were -2.78±0.77, -4.36±0.69 and -4.69±0.70; FL/HC ratios were 0.178±0.011, 0.170±0.010 and 0.131±0.022; FL/AC ratios were 0.197±0.013, 0.186±0.011 and 0.151±0.017; ΔZ H-F values were 2.49±1.09, 3.53±1.28 and 8.17±1.30; ΔZ H+A-2F values were 4.44±2.00, 6.78±2.20 and 14.28±1.26, respectively. The differences in Z FL values between the genetically normal group and the chromosome variation group as well as the gene mutation group were statistically significant (both P<0.05); so were the differences in FL/HC, FL/AC and ΔZ H-F values between the gene mutation group and the genetically normal group as well as the chromosome variation group (all P<0.05) and in any pairwise comparison of ΔZ H+A-2F among the three groups (all P<0.05). Conclusions:The genetic etiology of fetal short femurs is mainly related to chromosomal variations (including chromosomal aneuploidy and pathogenic or likely pathogenic copy number variations) and gene mutation. In fetuses with chromosome variation and gene mutation, the degree of the femoral development delay relative to the development of HC and AC is worse than that in the normal genetic results group.

ObjectiveTo investigate the safety and efficacy of carbon dioxide ( CO2 ) insufflation during ERCP.MethodsBetween January and August 2011,a total of 102 consecutive patients who underwent ERCP were randomized to accept CO2 insufflation ( n =52 ) of air insufflation ( n =50 ) during the procedure.ERCP was carried out with the same instrument by an expert endoscopist who was blinded to the insufflation gas used and the procedure was controlled at 30 minutes to 1 hour.The heart rate,oxygen saturation of the patient was continuously monitored during the procedure.Before the procedure and 1 hour after the end of operation,abdominal X-ray was taken to evaluate the width of intestine,and the degree of intestinal expansion was defined as normal,mild,moderate and severe according to the width increased.A questionnaire with 100 mm visual analogue scale (VAS) was used to quantify the abdominal pain and distention experienced at 1 hour,2 hours,and 6 hours after the procedure.The patients' vital signs,bowel dilatation,the average operating time,abdominal pain score and distention score on VAS,and complications in 2 groups were analyzed.ResultsThe baseline characteristics of 2 groups were comparable.ERCP was successfully performed in all the patients and no complication was observed.In CO2 group,the average operating time,mean heart rate and oxygen saturation were (45.2 ± 10.6) min,( 102.2 ± 10.3 ) bpm and ( 99.5 ± 0.5)％,which were (48.5 ± 11.2) min,( 100.3 ± 11.4) bpm and (98.9 ±0.6)％,respectively,in air group.There were no significant differences on these items between the 2 groups ( P ＞ 0.05 ).Moderate to severe intestinal expansion 1 hour after ERCP was found in 14 patients (26.9％ ) in CO2 group and in 28 patients (56.0％ ) in air group,and the latter was significantly higher than the former (x2 =11.61,P =0.009).Both of the mean abdominal pain and abdominal distention scores at 1 hour post-ERCP in CO2 group were lower than those in air group,but without significant difference (P ＞0.05).However,the mean abdominal pain scores at 2 hours and 6 hours post-ERCP in CO2 group were significantly lower than those of patients in air group (7.4 ±2.2 vs.18.7 ±4.6 at 2 hours post-ERCP,9.6 ±3.7 vs.20.1 ±4.5 at 6 hours post-ERCP,all P ＜ 0.05 ).Similarly,the mean abdominal distention scores at 2 hours and 6 hours post-ERCP in CO2 group were significant lower than those of patients in air group (7.6 ±3.6 vs.18.3 ±4.1 at 2 hours post-ERCP,8.9 ±3.7 vs.19.4 ±4.2 at 6 hours post-ERCP,all P ＜0.05).ConclusionThe use of CO2 insufflation instead of air during ERCP appears to be safe.Insufflation of CO2 during ERCP palliates the intestinal expansion,post-ERCP abdominal pain and distention comparison to insufflation of air.However,because of the single-center clinical observation with limited number of cases,the safety and efficacy of CO2insufflation during ERCP requires to be further evaluated.

Objective To evaluate modified laparoscopic hepatic hemangioma extraction methods during laparoscopic hepatectomy.Methods From May 2009 to June 2013, 25 hepatic hemangioma patients were admitted for laparoscopic hepatectomy.Patients were divided into modified laparoscopic group with modified laparoscopic hepatic hemangioma extraction methods (MLH, n =11) and traditional laparoscopic group (TLH, n =14).Perioperative clinical parameters were compared between the two groups.Results Operative time (148.6 ± 18.0) min, time to removal of the HCH (15.7 ±4.6) min, visual analog scale pain score on the first postoperative day (2.3 ± 0.9), time to off-bed activity (2.5 ± 0.8) d, and postoperative hospital stay (8.5 ± 2.6)d in the MLH group were all less than those in the TLH group [(163.9±13.2)min, (33.9±3.1)min, (3.4±0.9), (3.1±0.8)d, (10.6±1.9)d] (t=-2.451,t =-11.800, t =-2.931, t =-2.156, t =-2.338,P ＜ 0.05).There were one in the MLH group and two cases in the TLH group developing postoperative complications (P =1.000).Conclusions Modified laparoscopic hepatic hemangioma extraction methods during laparoscopic hepatectomy for hepatic hemangioma is safe, feasible and of good therapeutic effect.

Objective To study CT numbers correction of kilo?voltage cone?beam CT (KV?CBCT) images for dose calculation. Method Aligning the CBCT images with plan CT images, then obtain the background scatter by subtracting CT images from CBCT images. The background scatter is then processed by low?pass filter. The final CBCT images are acquired by subtracting the background scatter from the raw CBCT. KV?CBCT images of Catphan600 phantom and four patients with pelvic tumors were obtained with the linac?integrated CBCT system. The CBCT images were modified to correct the CT numbers. Finally, compare HU numbers between corrected CBCT and planning CT by paired T test. Evaluate the image quality and accuracy of dose calculation of the modified CBCT images. Results The proposed method reduces the artifacts of CBCT images significantly. The differences of CT numbers were 232 HU, 89 HU, 29 HU and 66 HU for air, fat, muscle and femoral head between CT and CBCT respectively (P= 0?? 39,0?? 66,0?? 59,1).The differences of CT numbers between CT and CBCT was reduced to within 5 HU. And the error of dose calculation with corrected CBCT images was within 2%. Conclusions The CT numbers of corrected CBCT are similar with plan CT images and dose calculations based on the modified CBCT show good agreement with plan CT.

Objective To investigate the feasibility and safety,and short-term therapeutic effect of laparoscopic azygoportal disconnection without splenectomy for cirrhotic portal hypertension (PLT count ＞ 50 × 109/L).Methods Clinical data of 48 patients with bleeding portal hypertension and secondary hypersplenism (PLT count ＞ 50 × 109/L) undergoing laparoscopic splenectomy and azygoportal disconnection (LSD,n =26) vs.laparoscopic azygoportal disconnection (LD,n =22) between January 2014 and August 2015 were analyzed.Results Operative time (82 ± 29) min,intraoperative blood loss 20(10-50) ml,days of postoperative fever 0(0-3) d,rate of postoperative fever 10/22,postoperative hospital stay (7.0 ± 1.3) d,and WBC counts (3.8 ± 1.6) × 109/L,PLT counts 64 (49-88) × 109/L,and the incidence of portal vein thrombosis on POD 7 (14％),were significantly less in LD group than in LSD group [(180±41) min,80(20-500) ml,2(0-4) d,(22/26),(10.8 ±3.0) d,(9.1 ±3.1) × 109/L,156 (78-630) × 109/L,(42％)],(t =9.637,Z =-4.746,Z =-2.314,x2 =8.224,t =5.794,t =7.785,Z=-5.508,x2 =4.742,all P ＜ 0.05).Immune function was better in LD group than in splenectomy group at postoperative month 3.The serum proportion of CD4 + (58 ± 11) and the CD4 +/CD8 + ratio (1.9 ±0.7) at postoperative month 3 were significantly higher after LD than after LSD [(43 ± 14),(1.2 ± 0.9)],(t =-3.755,t =-2.509,all P ＜ 0.05).Conclusion Laparoscopic azygoportal disconnection without splenectomy is safe and effective for esophagogastric variceal hemorrhage and moderate hypersplenism (PLT ＞ 50 × 109/L) secondary to portal hypertension.

Some patients who have neck tumor but cannot tolerate the thermoplastic immobilization may be supported by simple cushions, and are marked on the neck skin during CT simulation. We therefore set 5 mm as the spinal cord-planning risk volume margin in the intensity-modulated radiotherapy plans in our Centre. Cone beam CT (CBCT) scans were acquired for three times, and matched with the simulation CT images in each radiotherapy. The mean and the standard deviation of the individual, the root mean-square and the standard deviation of the individual were calculated. The matched results of the third CBCT were used to calculate the spinal cord- planning risk volume margin. The results showed that the interfraction error was significantly reduced and the intrafraction error was stable by CBCT guiding. CBCT and 5 mm spinal cord-planning organ is feasible and safe without threatening volume margin to high dose radiotherapy for the patients with neck tumor and not able to tolerate thermoplastic immobilization.
Cone-Beam Computed Tomography ; Head and Neck Neoplasms ; diagnostic imaging ; radiotherapy ; Humans ; Patient Positioning ; methods ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy Setup Errors ; prevention & control ; Radiotherapy, Image-Guided ; methods ; Radiotherapy, Intensity-Modulated ; instrumentation ; methods

This paper is aimed to acquire high Geometric similar Subject-specific three-dimensional (3D) finite element mesh model of hip joint containing necrotic femoral head according to individual patient's X-ray, CT and MRI by using the image registration and fusion technology. We selected a middle-aged female patient with osteonecrosis of femoral head, obtained the X-ray, CT and MRI images respectively. Then we established 3D solid model separately based on these image data by using Mimics 13. 1 and Pro/E 5.1 software. We confirmed the match points and then proceed the 2D image registration after image projection conversion. Finally we showed the 3D finite element mesh model. A highly geometric similar subject-specific 3D finite element mesh model for osteonecrosis of femoral head has been established, which included normal cortical bone, cancellous bone, articular cartilage and necrotic zone, fractured trabecular bone within the femoral head. The model truly reflects the morphological characteristics and relationship of hip joint with osteonecrosis of femoral head, provides a relatively ideal research platform for further biomechanical analysis and surgical simulation.
Female ; Femur Head Necrosis ; diagnostic imaging ; pathology ; Finite Element Analysis ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Middle Aged ; Models, Anatomic ; Tomography, X-Ray Computed

Objective To analyze the image quality of coronary arteries by dual-source computed tomography (DSCT) in children with congenital heart disease(CHD). Methods Image quality of coronary arteries were scored by two radiologists with an ordinal grading system. Score 3 or 4 was considered to be good image quality and diagnostic. Score differences among 3 groups of various baseline heart rate levels, 3 groups of various age levels and 4 coronary branches were analyzed by using ANOVA. Multiple linear regression analysis was used to test the effects of age, heart rate, tube voltage, tube current, pitch, contrast volume, contrast injection rate on the coronary image scores. Results A total of 72 consecutive patients were enrolled. 71.2% (205/288) of coronary artery branches was good enough for diagnosis. Image quality of left main coronary artery (LM, score 3.64±0.49), left anterior descending (LAD, score 2.97±0.40), right coronary artery (RCA, score of 2.82±0.70), left circumflex (LCX, score 2.76±0.73) were in a descending order (F=29.00, P<0.01). Image scores of age groups of 0--1 years old (2.80±0.65), >1--3 years old (2.81±0.74), >3--14 years old (3.58±0.52) were in an ascending order (F= 20.16,P<0.01). Image scores of heart rate groups of<100 bpm (3.54±0.56),100--150 bpm (2.86± 0.70) and >150 bpm (2.81±0.63) were in a descending order (F=16.72, P<0.01). Multiple linearregression analysis demonstrated that multiple impact factors affected image quality of LM, LAD, LCX and RCA. Age(r=0.013 ,P<0.01)and contrast volume(r=0.292, P<0.01)had positive correlation with LM score. Age(r=0.509, P<0.01) and voltage (r=0.292, P=0.011) had positive correlation with LAD score. Heart rate(r= -0.179, P<0.05) had negative correlation with LAD score. Age (r=0.063, P< 0.01) had negative correlation with LCX score. Age (r=0.486,P<0.01) and voltage (r=0.220, P<0.05) had positive correlation with RCA score. Conclusions Dual-source CT could clearly shows coronary arteries of children with CHD over the age of 3 or with heart rate less than 100 bpm. Limitations of Dual-source CT coronary angiography for CHD children included young age and fast heart rate.

Objective To investigate the clinical safety and value of sequential therapy combining laparoscopic splenectomy and azygoportal disconnection with postoperative endoscopic variceal ligation (EVL) for portal hypertensive variceal bleeding.Methods From February 2012 to March 2016,114 patients underwent sequential laparoscopic splenectomy plus azygoportal disconnection and periodical postoperative endoscopic variceal ligation.Results were compared with those who underwent laparoscopic splenectomy and azygoportal disconnection without postoperative endoscopic variceal ligation in a group of 105 cases.Results Between the two groups oesophageal variceal re-bleeding (EVR) rates during first postoperative 3 months was not significantly different (P ＞ 0.05),however,sequential therapy group was associated with lower EVR rates during the periods ranging from 1 to 12 months,and 4 to 12 months compared with non-sequential therapy group (all P ＜ 0.05).Dynamic changes in the diameter of oesophageal varices and EVL rates in sequential therapy group both decreased gradually and significantly over the 12-month follow-up period (all P ＜0.01).No one in sequential therapy group suffered EVR from 6th month onward.No patient required EVL at the 12th month in sequential therapy group.Conclusion Sequential laparoscopic splenectomy plus azygoportal disconnection and postoperative EVL for portal hypertensive variceal bleeding is safe,feasible and effective in decreasing postoperative EVR rates.