Objective To investigate the imaging features of surgical complications of Crohn's disease (CD).Methods The retrospective cross-sectional study was conducted.The clinical data of 128 CD patients with surgical complications who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2015 were collected.All the patients underwent computed tomography enterography (CTE),magnetic resonance enterography (MRE),magnetic resonance imaging (MRI) of anal tube and X-ray examination.The patients underwent surgical therapies after examinations.Observation indicators:(1) clinical characteristics of surgical complications of CD:occurrence of surgical complications of CD,correlation between preoperative complications and Montreal types of CD,(2) diagnostic accuracy of surgical complications and perianal lesions through CTE,MRE and MRI of anal tube,(3) imaging findings of preoperative complications of CD,(4) treatment and follow-up situations.Follow-up using telephone interview and outpatient examination was performed to detect the postoperative recovery and reoperations of patients up to March 2016.Count data were represented as frequency or percentage.The correlation between preoperative complications and Montreal types of CD was represented as the odds ratio (OR) and 95％ confidence interval (CI).The features of diagnostic indexes were described as the sensitivity and specificity.Results (1) Clinical characteristics of preoperative complications of CD:all the 128 patients had preoperative complications,including 71 with anal fistula or anal fistula combined with perianal abscess,26 with intestinal fistula,24 with intestinal obstruction,23 with abdominal abscess,3 with digestive tract perforation,1 with kidney stone and 1 with hydronephrosis.Of 128 patients,12 had intestinal fistula combined with abdominal abscess,1 had intestinal fistula combined with intestinal obstruction,3 had intestinal fistula combined with abdominal abscess and intestinal obstruction,1 had intestinal fistula combined with digestive tract perforation and 1 had intestinal fistula combined with hydronephrosis.There was a correlation between lesion location of CD and type of complications.Thirty-five of 51 patients had strictures or penetrationtype lesions,with a correlation between strictures or penetration-type lesions and ileal CD [OR =6.23,95％ confidence interval (95％ CI):2.86-13.61,P ＜ 0.05].Fifty-six of 77 patients had anal fistula,showing a correlation between combined anal fistula and colonic lesions of CD (OR =6.40,95％ CI:2.92-14.01,P ＜ 0.05).(2) Diagnostic accuracy of CTE,MRE and MRI of anal tube:with intraoperative exploration findings as the standard,the sensitivity and specificity of surgical complications of CD were 84％ and 95％ through CTE or MRE,and the sensitivity and specificity of anal fistula were 100％ and 100％ through MRI of anal tube.(3) Imaging findings of surgical complications of CD.① Of 71 patients with anal fistula,65 had 2 or more internal openings or fistula tract of complex anal fistula.The internal opening was a starting point of the fistula tract,and enhanced scans of MRI displayed punctate,shredded or small round abnormal strengthening signals between under mucous membrane of the anal canal and sphincter.The tubular and striped fistula tract was horizontal or vertical distribution,with a lightly high-high signal on T2 weighted-images (WI).The results of enhanced scans of MRI showed that there was an obvious homogeneous enhancement in the fistula tract or enhancement in the fistula tract wall,and no enhancement in the cavity of fistula tract.MRI findings in 38 patients combined with perianal abscess included a obvious high-signal on T2WI,and enhanced scans of MRI showed circular enhancement and no internal enhancement.② Of 26 patients with intestinal fistula,17 had intestinal fistula,imaging findings included multiple thickened intestinal walls and more obvious enhancement compared with normal intestinal canal.There was gathering and adhesions among intestinal canals,showing mash connections and petal-like changes.Fourteen patients had enterocutaneous fistula (6 combined with intestinal fistula and 1 patient combined with intestinal fistula and intestine-bladder fistula).Four patients had intestine-bladder fistula (2 combined with intestinal fistula and 1 combined with intestinal fistula and enterocutaneous fistula).One patient had intestine-vagina fistula.The results of CTE and MRE examinations showed that thickened intestinal canals and intestinal walls in the lesions,and shadows of intestinal canals communicated with the abdominal,bladder wall and vagina,with a high signal on T2WI and enhancement of intestinal wall by enhanced scan.The partial intestinal canals were physically close to other organs,without a connection between them,and anomalous enhancement or local pneumatosis among the adjacent organs were detected.③ CTE findings of intestinal obstruction included constriction of intestinal canal combined with dilatation of proximal intestinal canal.There were 3 enhancement methods of thickened intestinal wall in 24 patients with intestine obstruction.Imaging findings of 12 patients included enhancement in the intestinal mucosa and no enhancement in the submucosa and muscularis mucosa.Imaging findings of 4 patients included enhancement of intestinal mucosa and muscularis mucosa and no enhancement in the submucosa.Imaging findings of 8 patients included homogenous and heterogeneous enhancements in the intestinal walls.④ Twentythree patients were complicated with abdominal abscess,including 15 combined with intestine fistula.The scans of CTE showed that there was a round-like or oval mass in the abdomen,with a high signal on T2WI,fluid-dominated inflammatory exudation around the mesentery,the enhancement of annular wall of mesentery and no enhancement of pus within the mesentery.⑤ Three patients were combined with digestive tract perforation,including 1 combined with intestine fistula.CTE and X-ray detections showed there was a shadow of free gas in the intestinal mesentery and under abdominal diaphragm.⑥ Two patients were combined with kidney stone and hydronephrosis.X-ray findings of kidney stone included the deposition of multiple and sharp-edged dense shadows within the renal calices.CTE findings of hydronephrosis included inflammatory thickening of ureteric wall with proximal ureter dilatation.(4) Treatment and follow-up situations:128 patients underwent successful operation and were followed up for 4-27 months.Of 10 patients undergoing reoperations due to postoperative complications,MRI detection of 7 patients with recurrence of anal fistula showed fistula tract or abscess located at the previous loci was incompletely healed or progressed,morphous and location of lesions were roughly the same as the preoperative situations.The scans of CTE in 2 patients with anastomotic stricture showed that there were the thickening of intestinal wall and obstruction and dilatation at the proximal anastomotic-site.The enhanced scan of CTE in 1 patient with anastomotic fistula showed that there were irregularly cavity-like lesion beside the metal anastomotic ring,and effusion was seen within the lesions,with an edge enhancement.The other 118 patients recovered well without intestinal fistula or intestinal obstruction on CTE or MRE examination.Conclusions Anal fistula is the most common surgical complication of CD,and intestinal fistula,intestinal obstruction and abdominal abscess are also relatively common.The early postoperative complications consist of the recurrence of anal fistula.Location of lesions in CD is associated with the type of complications.CTE or MRE and anal MRI findings have different imaging characteristics for CD combined with different complications,with a certain value in the assessment of abdominal and perianal complications.

Objective To investigate the protective effect and associated mechanism of PNS in spinal cord hemisection injury.Methods fifty-five adult SD rats were randomly divided into three groups,sham group(n =5),spinal cord injury group(n =25),PNS group(n =25).The rats were evaluated in behavioral test with BBB score,pathology and immunohistochemistry at 1 d,3d,7d,14d,21d after the procedures.Results Motor recovery was significantly better in PNS group than the spinal cord injury group at 3d,7d,14d and 21d.Nissl staining showed less neuron necrosis and more integrated neural cells in morphology.cPLA2 expression was inhabited in PNS group,and less number of positive cells were found in the group.Conclusion PNS can inhibit the expression of cPLA2 after spinal cord injury,which may be one of the mechanisms of its effect on promoting motor recovery.

Objective To investigate the protective effect and cytosolic phospholipase A2 (cPLA2) associated mechanism of panax notoginseng saponins (PNS) in spinal cord hemisection injured rats. Methods 55 adult Sprague-Dawley rats were randomly divided into three groups: sham group (n=5), spinal cord injury group (n=25) and PNS group (n=25). The rats were evaluated with BBB score, pathology and immunohistochemistry 1 d, 3 d, 7 d, 14 d and 21 d after intervention. Results Compared to the spinal cord injury group, motor recovery was significantly better in PNS group 3 d, 7 d, 14 d and 21 d after intervention (P<0.05). Nissl staining showed less neuron necrosis and more integrated neural cells in morphology in PNS group 7 d, 14 d and 21 d after intervention. Cytosolic phospholipase A2 (cPLA2) expression was inhabited, and less number of positive cells were found in PNS group 7 d, 14 d and 21 d after intervention. Conclusion PNS can inhibit the expression of cPLA2 after spinal cord injury, which may be one of the mechanisms of its effect on promoting motor recovery.

Objective To explore clinical value of serum carcinoembryonic antigen (CEA) rate in early evaluation of imaging tumor efficacy and prognosis of disease control for advanced non-small cell lung cancer (NSCLC) before and after the second course of chemotherapy, and provide the basis for clinical adjustment chemotherapy regimens.Methods Patients in the Third Affiliated Hospital of Sun Yat-sen University were randomly collected in January 2007-September 2014 during the pathological diagnosis of 130 cases for advanced NSCLC, who had an elevated serum CEA level, including pre-chemotherapy and prochemotherapy, were collected.Receiver operating characteristic (ROC) was used to evaluate efficacy of CEA change in evaluation of early disease control (DC).SPSS 18.0 was used to analyze the relationship between CEA change and prognosis.Results After two chemotherapy cycles, the area under the ROC curve was 70.6％.When the cut-point of the change rates of CEA levels was 2.05％ , the Youden index reaches the maximum.Adenocarcinoma group and squamous cell carcinoma patients after 2 courses of CEA change rate evaluation, which area under the ROC curve was 72.0％ (95％ CI :61.4％ ～ 82.5％), and 70.1％ (95％ CI:45.8％ ～94.5％).Survival was analyzed with the Kaplan-Meier method, which showed the change rates of CEA levels were all the influencing factors of progression-free survival (PFS) in patients with advanced NSCLC(P ＜ 0.05).While the change rates of CEA levels were not predictive overall survival (OS) (P =0.715).Conclusions It prompts effective chemotherapy, and patients have the extended PFS, when CEA levels before and after chemotherapy dropped to a certain degree.

BACKGROUND:The magnetic resonance molecular imaging used in the research of lumbar disc degeneration includes T2 mapping and T1ρtechnologies at present.
OBJECTIVE:To evaluate the feasibility of 1.5 T MR equipment on T2 mapping of New Zealand white rabbits lumbar disc.
METHODS:T2 mapping images of New Zealand white rabbit lumbar discs were obtained on 1.5 T MR equipment. The regions of interest T2 values of lumbar discs were measured with post-processing workstation.
RESULTS AND CONCLUSION:Sagittal and coronal T2 maps of 3-month rabbit discs were obtained
satisfactorily on 1.5 T MR equipment. The regions of interest T2 values of nucleus pulposus in L 4/5 , L 5/6 and L 6/7 discs were (104.6±14.0) ms, (109.1±13.8) ms and (109.5±15.1) ms respectively at Pfirrmann
regions of interest T2 values of anterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs were (82.1±9.5) ms, (80.4± 11.2) ms and (79.9±10.6) ms respectively, and T2 values of posterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs were (85.8±11.9) ms, (85.1±12.1) ms and (85.3±9.3) ms respectively. There were no significant differences in T2 values of nucleus pulposus, anterior annulus fibrosus and posterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs at PfirrmannⅠP>g 0ra.0d5e).( However, the T2 values of nucleus pulposus were higher than those of annulus
fibrosus in the same discs (P<0.01), and there were no significant differences in T2 values between the anterior and posterior annulus fibrosus (P>0.05). The T2 values of rabbit lumbar discs obtained on 1.5 T MR equipment can be used for quantitative assessment of intervertebral disc signal.

Objective To establish a off-pump leukocyte depletion method in canines.Methods Twenty-one healthy adult mongrel dogs of both sexes, weighing 10-12 kg, were randomized into 2 groups: control group (group C, n = 9) and leukocyte depletion group (group LD, n = 12) . An extracorporeal leukocyte filtration end was constructed by aseptic puncture of the bilateral external jugular veins via a blood transfusion line and the leukocyte filter for extracorporeal leukocyte depletion. In group LD, blood was filtered with a MP-300 blood line and a SQ40S leucocyte depletion filter one end placed in the right external jugular vein (artery end) and the other end placed in the left external jugular vein (venous end). After heparin anticoagulation, a MP-300 blood line pump was used as the power. Blood was filtered at a rate of 75 ml/min and it was maintained for 60 min. The artery end was then closed, normal saline injected into the closed circuit, the remaining blood pumped into the body, and then the venous end closed. In group C, aseptic puncture of the bilateral external jugular veins was performed. Arterial blood samples were taken immediately before leukodepletion (baseline, T_0 ) , at 10, 20, 30, 40, 50 and 60 min of leukodepletion (T_(1-6) , depletion period), and at 10, 20, 30, 40, 50, 60, 120, 180 and 270 min after leukodepletion (T_(7-15) , recovery period) for determination of blood routine. MAP, HR, RBC.Plt and body temperature were recorded at T_0 , T_6 , T_(12) and T_(15) . Results There were no significant difference in MAP and RBC between the two groups ( P > 0.05 ) . HR, body temperature, and Plt were significantly lower in group LD than in group C (P < 0.05) .The leukocyte concentration was lower during depletion period in group LD than in group C ( P < 0.05) , while there was no significant difference in leukocyte concentration during recovery period between the two groups (P > 0.05 ). Conclusion The off-pump leukocyte depletion method is successfully established and has exact efficacy with less adverse effects in this study.

The diagnosis and treatment of complex anal fistula has been a significant challenge. Unwise incision and excessive exploration will lead to the secondary branch, sinus and perforation. A simple fistula may become a surgical problem and result in disastrous consequences. Preoperative accurate diagnosis of anal fistula, including in the internal opening, primary track and location of the fistula, extensions and abscess, is important for anal fistula treatment. In the diagnosis of anal fistula, imaging examination, especially MRI plays a crucial role. Localization and demarcation of anal fistula and the relationship with sphincter are important. MRI has been an indispensable confirmatory imaging examination.
Abscess ; Attention ; Humans ; Magnetic Resonance Imaging ; Rectal Fistula

Objective To explore the relationship between ileocolonic lesions and perianal fistulas of Crohn's disease as sessed by CT enterography (CTE).Methods Totally 28 patients with initial diagnosis of active ileocolonic lesions of Crohn 's disease were collected,16 with perianal fistula and 11 without perianal fistulas.All patients underwent CTE and pelvic MRI.Total number of lesions,minimum length between every two lesions in colon wall and maximum length of colonic le sions were calculated.The rank sum test was performed respectively.Results Lesions of 14 patients (14/16,87.50％) in perianal fistulas group located in left colon or rectum,while lesions of 6 patients (6/12,50.00 ％) in non-perianal fistulas group located in left colon or rectum,the difference was statistically significant (Z=-2.135,P＜0.05).The mean number of lesions in patients with perianal fistulas was 3.06,while in patients without perianal fistulas was 2.91,there was no statistical difference (P＞0.05).The maximum length of colonic lesions in patients with perianal fistulas was (12.79± 8.30)cm,while in patients without perianal fistulas was (7.04± 3.09)cm,and there was no statistical difference(P＞ 0.05).The minimum length hetween every two lesions in patients with perianal fistulas was (5.23±2.98)cm,while in pa tients without perianal fistulas was (8.44 ± 2.87) cm,the difference was statistically significant (Z =-2.095,P＜ 0.05).Conclusion Crohn's disease complicated with perianal fistulas has relationship with lesion location and smaller length intervals between two lesions in colon wall,and has no relationship with total number of lesions and maximum length of colon lesions.

Objective To study the academic level of randomized control trials(RCTs)published from 2004 to 2009 in Chinese Journal of Hepatobiliary Surgery.Methods Published work about RCTs in 72 issues of Chinese Journal of Hepatobiliary Surgery was searched by finding relevant articles published during 2004-2009.Correlated indexes including literature received time, literature publishing time, the total number of citations, number of citations in Chinese, number of citations in English, research funding situations, the number of authors, article affiliations in all RCTs, together with single(or multiple)center study situation, positive conclusions, the starting time, the end time,and number of patients recruited in clinical RCTs were extracted for aggregate analysis.Results During the past six years, a total of 135 articles of RCT were published in Chinese Journal of Hepatobiliary Surgery, accounting for 8.7% in all clinical studies.The average number of RCTs in each issue was 1.88.The average time for publishing time delay was 450 days.The total number of citations in RCTs was 1252 and the average number of RCTs for citations was 9.3.53 RCT studies were financed, accounting for 39% of the total number of research papers.Beijing Friendship Hospital attached to the Capital University of Medical Sciences had published 8 papers of RCT and it is the institution of publishing the largest number of such papers in the journal.The number of multi-center study for RCTs was one and all RCT studies had significant conclusions.The average research duraton in RCTs was 45 months.The total number of patients in 33 clinical RCTs was 2705 and the average number of patients recruited in each RCT was 82.Conclusion Chinese Journal of Hepatobiliary Surgery put emphasis on the strongest evidence and the most valuable RCT researches that have great significance in the field of domestic hepatobiliary surgery for clinical treatment and experimental research.

Anal fistula is the most common perianal lesion in Crohn disease (CD), which usually is complicated and difficult to treat, and has a high recurrence rate and serious influence on the quality of life of patients. Inaccurate or incomplete intervention may result in irreversible damage. In order to achieve the best outcome, an optimal disease assessment is crucial. Many imaging modalities are useful for the evaluation of perianal fistulas in CD, which may help confirm the diagnosis, accurately classify the disease, plan the most suitable treatment, and monitor the efficacy. Magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) and anal endosonography (AES) are considered to be the suitable options for evaluation of the initial perianal fistula, both in terms of sensitivity and specificity, while MRI is more suitable for monitoring the curative efficacy. Fistulography (by X ray or CT) is generally less applied due to inferior soft tissue performance, radiation exposure, etc. This paper reviews the various imaging modalities, analyzes their advantages and disadvantages in order to assist clinicians in selecting the most appropriate examination individually.
Crohn Disease ; complications ; Endosonography ; Humans ; Magnetic Resonance Imaging ; Multimodal Imaging ; Quality of Life ; Rectal Fistula ; diagnosis ; etiology ; Sensitivity and Specificity