Objective To evaluate the CT features of aorto-right atrial fistula after aortic valve replacement(AVR) or ascending aortic replacement.Methods Eighty-seven patients with aortic-right atrial fistula underwent CT after operation.The CT features were retrospectively analyzed.Fistula was measured according to maximum width of the shunt.Results Aorto-right atrial fistula was detected in 87 patients after aortic valve replacement or ascending aortic replacement by CT scan. Among them,25 patients were diagnosed as mild aorto-right atrial fistula,47 patients as moderate,and 15 patients as severe.Thirty-seven patients underwent follow-up CT.Among them,10 patients with mild to moderate aorto-right atrial fistula were considered to have complete regression,8 patients with mild aorto-right atrial fistula considered to have incomplete regression,14 patients with mild to moderate aorto-right atrial fistula considered to have stable condition,and 5 patients with moderate aorto-right atrial fistula considered to have progression at the 3-month follow-up.Conclusion CT is a useful tool for defining aorto-right atrial fistula after AVR or ascending aortic replacement and for evaluating it in follow-up.

Objective To evaluate the computed tomography (CT) characteristics of cardiovascular involvement in Beheet syndrome. Methods Eleven patients with clinically diagnosed Behcet syndrome were studied retrospectively from July 1995 to December 2007. Electron beam CT or 64-slice helical CT scanner was used and CT characteristics were reviewed. Results Eleven patients were diagnosed according to the criteria reported by the international study group for Behcet syndrome. Of them, 4 patients presented with aortic valve prolapse (2 patients with mitral valve prolapse), false aneurysm of right coronary artery was demonstrated in 2 patients, false aneurysm of left subclavian artery, aortic aneurysm and penetrating ulcers, aortic arch false aneurysm, aortic dissection, pulmonary embolism and interatrial scptum aneurysm in 1 case, respectively. Conclusion CT is a very useful method for the diagnosis and foUow-up of Behcet syndrome.

Objective: To explore the imaging and clinical features of Behcet's disease with coronary artery involvement in order to improve the diagnosis and treatment in clinical practice. Methods: A total of 6 Behcet's disease patients with coronary involvement diagnosed and treated in our hospital from 1999-08 to 2016-11 were analyzed. Coronary angiography (CAG) and coronary CTA were performed for diagnosis. There were 5 cases received CAG and 5 cases received CTA examinations. Results: All 6 patients had the first clinical visit by sudden pericardial tapenade, myocardial infarction or cardiac shock. For diagnosis: the imaging presentation included coronary stenosis, occlusion and pseudo aneurysm formation. 3 patients had anterior descending artery involvement, 1 had the far-end of left circumflex involvement and 2 had the middle segment of right coronary involvement; all patients were combining large amount of pericardial effusion. For treatment: there were 3 patients with aneurysm received conservative treatment (1 case had open thoracic exploration), 1/3 lost contact and 2 having long-term normal life; 3 patients received coronary stent implantation without optimal effect. Conclusion: The patients of Behcet's disease with coronary involvement may easily form pseudo aneurysm; CAG/CTA has been helpful for diagnosis. Clear pre-operative diagnosis of etiology is important for treatment.

Objective:To present our initial experience with robot-assisted laparoscopic prostatectomy (RALP) for complicated cases.Methods:Clinical and pathological data from 4 complicated prostate cancer cases,who underwent RALP from October to November in 2015,were analyzed retrospectively.All the cases were conducted transurethral plasmakinetic enucleation of prostate and hormonal therapy before RALP.Results:All surgeries were done successfully.The age,baseline prostatic special antigen,clinical tumor stage,operation time and estimated blood loss were 58-70 years,6.04-70.15 ng/mL,T2bT3b,210-360 min and 50-250 mL,respectively.No blood transfusion was needed.All surgical margin were negative.Conclusion:Although previous transurethral surgeries and hormonal therapies may increase the difficulty for operations,RALP is still appropriate for the complicated cases of prostate cancer.

Objective To investigate the clinical efficacy of Qishen Xiaodian Decoction combined with laser acupoint irradiation for treatment of recurrent Hen?ch-Sch?nlein purpura (HSP) in children. Methods Totally 120 cases of children with recurrent HSP were divided into treatment group and control group according to the digital random table method, with 60 cases in each group. The control group was given anti-allergy, hormones, immunosuppressive agents and other conventional treatment for 4 weeks, while the treatment group was treated with Qishen Xiaodian Decoction based on conventional treatment, 1 dose each day, morning and night (age 4–5 take 1/3 dose, age >5–10 take the half dose, and age >10–14 take the whole dose), for 4 weeks. Zusanli, Xuehai, and Sanyinjiao acupoints were under laser vertical irradiation, 12 min for each time, once a day for 2 weeks. The disappearing time of the main symptoms and the total effective rate of the two groups were compared. Peripheral blood contents of Th17 and Treg cells and serum interleukin-17 (IL-17), and transforming growth factor β1 (TGF-β1) level before and after the treatment were observed. The recurrence rate in 6 months and in 12 months of the two groups were compared. Results The disappearing time of rash, abdominal pain and joint swelling pain and kidney damage of the treatment group were less than those of the control group (P<0.01). The total effective rate was 95％(57/60) in treatment group, significantly higher than control group 80％ (48/60), with statistical significance (P<0.05). Compared with before treatment, Th17 cell content, serum IL-17 and TGF-β1 decreased, and Treg cell content increased after treatment of the two groups (P<0.01). Compared with the control group, contents of Th17 cell and serum IL-17 of the treatment group decreased (P<0.01). The recurrence rate was lower than that of the control group in 6 and 12 months after treatment, with statistical significance (P<0.05). Conclusion Based on the conventional western medicine treatment, Qishen Xiaodian Decoction combined with laser acupoint irradiation on recurrent HSP in children can quickly relieve symptoms and reduce the recurrence rate.

Objective To analyze the clinical characteristics of patients with acute myocardial infarction(AMI) complicated by free wall rupture (FWR) and to define the independent risk factors for FWR. Methods Clinical and angiographic data of 6192 AMI patients admitted to our department between January 1995 and January 2010 were retrospectively reviewed, FWR was confirmed in 43 patients by postmortem examination. Multivariate logistic regression analysis was performed to identify risk factors for FWR Results Rupture occurred at a median of 3. 58 days after symptom onset. Risk factors associated with FWR were older age, female gender, delayed hospital admission, hypertension at admission and increased serum creatine level。 Although patients with FWR had more single-vessel disease, their in-hospital mortality was very high (97.7％) .Undue physical efforts were documented in 41.9％ patients with FWR. Conclusion Old age, female gender and prolonged time from the onset of symptoms to hospital,hypertension and high level of serum creatine at admission are independent factors of FWR.

Objective To analyze the clinical characteristics of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD).Methods Clinical data of 3911 SLE patients were retrospectively analyzed and CAD was diagnosed by coronary angiography in 26 (0.7％ ) SLE patients (10 stable angina pectoris,5 unstable angina pectoris,8 STEMI and 3 non-STEMI).The tradition risk factors,first onset of cardiac events,blood biochemistry index,treatment and activity of SLE,coronary angiographic features were compared with 552 CAD patients without SLE.Results Compared with CAD patients without SLE,CAD patients with SLE were younger [ (50.4 ± 15.2) years vs.(60.6 ± 11.6 ) years,P＜0.01 ],the mean number per patient of Framingham tradition risk factors was less ( 1.11 ± 1.18 vs.2.50 ± 1.28,P ＜0.05 ).CAD patients with SLE were prone to premature coronary artery disease [ 76.9％ (20/26) ],and ACS was the most common manifestation in SLE patients with premature coronary artery disease [ 65.0％ ( 13/20 ) ],the duration of steroid use was significantly longer [ 24.00 ( 3.75,57.00 )months vs.1.00 (0.00,2.00 ) months,P ＜ 0.05 ] and 24 hours total urine protein [ ( 1.93 ± 1.97 ) g vs.(0.76 ±0.75 )g,P ＜0.05] was significantly higher in the ACS patients with SLE than non-ACS patients with SLE.Coronary stenosis was evidenced in most of the SLE patients with CAD [ 76.9％ ( 20/26 ) ] and incidence of coronary thrombotic occlusion was significantly higher in SLE patients with CAD than CAD patients without SLE [ 30.8％ ( 8/26 ) vs.11.8％ ( 65/552 ),P ＜ 0.05 ].Conclusion The incidence of CAD in SLE patients is low and the major form of CAD in SLE patients is premature coronary artery disease and mostly induced by coronary thrombotic occlusion.

Background: Lhasa is the main residence of Tibetans and one of the highest cities in the world. Its unique geography and ethnic population provide the chance to investigate the interactions among high altitude, ethnicity, and cardiac adaptation. Meanwhile, echocardiographic data about healthy Tibetans on a large scale are not available. This study aimed to analyze physiological factors related to ventricular size and valvular function in healthy Tibetans in Lhasa. Methods: A representative sample of residents in Tibet was recruited using a multistage cluster random sampling method. Two?dimensional echocardiographic measurements and Doppler evaluation for valvular function were performed. Healthy Tibetans in Lhasa constituted the study population. Associations between physiological parameters and ventricular dimensions in healthy Tibetans were analyzed by canonical correlation analysis. Factors related to valvular regurgitations were determined by logistic regression analysis. Results: The 454 healthy Tibetans (340 females and 114 male) in Lhasa were included in the final analysis. Canonical correlation analysis revealed that weight was positively correlated with the proximal right ventricular outflow diameter and the basal left ventricular linear dimension in both genders. Weight and pulse were negatively related to mild tricuspid regurgitation. Age was a positive factor for pulmonary and aortic regurgitations. The same was found between systolic blood pressure and mitral regurgitation. Conclusions: Weight is associated with ventricular size and valvular regurgitation in healthy Tibetans. It should be of more concern in research of high altitude population.

Objective To investigate the effect of Rivastaban tablet combined with psychological intervention after radiofrequency ablation of paroxysmal atrial fibrillation. Methods According to the random number table method, 86 patients of paroxysmal atrial fibrillation ablation were divided into the control group and the observation group. The control group was treated with Rivastaban table and routine nursing. The observation group was given psychological intervention on the basis treatment of the control group. The quality of life of two groups was evaluated by SF-36 quality of life scale, anxiety and depression symptoms of two groups were evaluated before and after the intervention. Recurrence of two groups were observed by followed-up of 6 to 12 months. Results The anxiety and depression scores of the observation group were significantly lower than those of the control group. The anxiety and depression scores of the two groups were significantly lower than those before treatment (P<0.05). The body function, physical character, social function, body pain, body emotion, vitality, mental health and overall health score of the observation group were significantly higher than those of the control group (P<0.05). The recurrence rate was 4.65% (2/43) in the observation group, which was significantly lower than (18.60%, 8/43) in the control group (χ2=4.07, P=0.04). Conclusion Radiotherapy with radiofrequency ablation of paroxysmal atrial fibrillation combined with Rivastaban tablet plus psychological intervention could help improve the mental state of patients, reduce their recurrence and improve their quality of life.

OBJECTIVETo evaluate the blood supply of low density viable area of primary heptocellular carcinoma after transcatheter hepatic artery chemoembolization using lipiodol (LP-TACE), by helical dual-phase CT scanning and three dimensional CT (3DCT).

METHODSThirty-four patients with primary heptocellular carcinoma after LP-TACE were examined by hepatic helical dual-phase CT. 3DCT model of the maximum intensity projection (MIP), surface shaded display (SSD) reconstruction of the hepatic artery and portal vein were simultaneously done in 5 cases.

RESULTSViable tumor areas of 34 cases of primary heptocellular carcinoma after LP-TACE were divided into four types: peripheral, lateral, central and diffused types. Enhanced tumor vessel or tissue in viable tumor area was found during hepatic dual-phase in 17 cases, during hepatic artery-phase only in 8 and hepatic portal vein-phase only in 3. The viable tumor areas were found to have blood supply from the hepatic vein in 2 cases. The viable tumor area unenhanced during hepatic dual-phase was found in 6 cases. In 5 cases, the relation between the viable tumor area and branches of hepatic artery and portal vein was showed by MIP and SSD of hepatic artery and portal vein.

CONCLUSIONHepatic helical dual-phase CT scan with 3DCT is effective in evaluating the blood supply of viable tumor areas and the therapeutic effect of primary heptocellular carcinoma after LP-TACE.

Adult ; Aged ; Carcinoma, Hepatocellular ; Catheterization ; Chemoembolization, Therapeutic ; Contrast Media ; Female ; Hepatic Artery ; Humans ; Iodized Oil ; Liver Neoplasms ; diagnostic imaging ; therapy ; Male ; Middle Aged ; Tomography, Spiral Computed