Objective To compare imaging quality and detection capability of bone metastases between Insight NM/CT Pro SPECT/CT(Insight SPECT/CT)and Siemens Symbia T16 SPECT/CT(Symbia T16 SPECT/CT)scanners.Methods Totally 40 patients with diagnosed or suspected bone metastases were prospectively enrolled.Whole-body bone imaging and local tomographic fusion imaging were performed using Symbia T16 and Insight SPECT/CT scanners with same method and parameters,and imaging quality and detection capability were compared between 2 devices.Results Among whole-body bone imaging acquired with Symbia T 16 SPECT/CT,the imaging quality score was 5 in 35 cases and 4 in 5 cases,and detected 118 positive bone lesions,including 36 lesions involved chest,28 involved spinal cord,30 involved pelvic bones,20 involved limbs and 4 involved cranial bones.The imaging quality score of local tomographic fusion imaging obtained with Symbia T16 SPECT/CT was 5 in all 40 cases,and 59 positive lesions involved bone regions were detected,including 14 lesions presented as bone destruction,11 presented as increased bone density and 34 showed uneven bone density on CT.Meanwhile,the whole-body bone imaging quality score acquired with Insight SPECT/CT was 5 in 35 cases,4 in 4 cases and 3 in 1 case,and both the detected positive lesions and the involved bone regions were consistent with those of Symbia T 16 SPECT/CT.Furthermore,the imaging quality,detected positive lesions and their involved regions,as well as CT manifestations on local tomographic fusion imaging obtained with Insight SPECT/CT scanner were all consistent with those of Symbia T 16 scanner.Conclusion The imaging quality of whole-body bone imaging and local tomographic fusion imaging of bone metastases of domestic Insight SPECT/CT were comparable to those of Siemens Symbia T16 SPECT/CT.

ObjectiveTo observe the clinical effectiveness and safety of Dingchan Granule （定颤颗粒） for paroxysmal atrial fibrillation with syndrome of qi stagnation and blood stasis. MethodsUsing a randomised， double-blind， placebo controlled study method， 90 patients with paroxysmal atrial fibrillation with qi stagnation and blood stasis syndrome were divided into 45 cases each in the treatment group and the control group. Both groups were given conventional western medicine treatment， and the treatment group was additionally treated with Dingchan Granule， while the control group was treated with Dingchan Granule placebo， both of which were taken orally for 8 g each time twice a day. Both groups were treated for 8 weeks. We compared the clinical effectiveness， the improvement of traditional Chinese medicine （TCM） symptoms and the recovery rate of atrial fibrillation between the two groups. We compared the number and duration of atrial fibrillation episodes， TCM symptoms score， atrial fibrillation symptom classification， 24-hour average ventricular rate， Pittsburgh Sleep Quality Index （PSQI）， anxiety index， depression index before and after treatment， and evaluated the safety of the two groups. ResultsThe total clinical effectiveness rate in the treatment group was 82.22% （37/45）， which was better than 60.00% （27/45） in the control group （P＜0.05）. The total effective rate of TCM syndrome effectiveness in the treatment group was 88.89% （40/45）， which was better than 66.67% （30/45） in the control group （P＜0.05）； and the rate of atrial fibrillation regression in the treatment group was 26.67% （12/45）， better than 6.67% （3/45） in the control group （P＜0.05）. The number and duration of atrial fibrillation episodes in both groups were significantly decreased （P＜0.01）， and the number and duration of atrial fibrillation episodes in the treatment group were lower than those in the control group （P＜0.01）. The TCM syndrome scores of both groups after treatment were significantly lower than before treatment （P＜0.01）， and the scores of the treatment group was lower than those of the control group （P＜0.05）. The severity of atrial fibrillation symptoms and the grading of atrial fibrillation symptoms in both groups after treatment were improved （P＜0.01）， and the degree of symptom improvement in the treatment group was better than that in the control group （P＜0.01）. The 24-hour average ventricular rate of both groups after treatment was significantly lower （P＜0.01）. The PSQI， anxiety index and depression index of the treatment group were all lower than before treatment （P＜0.01）， while the PSQI and anxiety index of the control group were both lower than before treatment （P＜0.01 or P＜0.05）， the PSQI， anxiety index and depression index of the treatment group being lower than those of the control group （P＜0.05 or P＜0.01）. No adverse events occurred in both groups， and no abnormalities were observed in blood， urine， stool routine， liver and kidney function， and coagulation function indexes. ConclusionDingchan Granule for paroxysmal atrial fibrillation with qi stagnation and blood stasis syndrome can alleviate clinical symptom， improve TCM symptom scores， increase atrial fibrillation recovery rate， stabilise the average ventricular rate， and significantly improve the quality of sleep， alleviate the anxiety and depression， with a good safety profile.

Objective:To investigate the relationship between propofol anesthesia maintenance and cerebral tissue edema after craniotomy and its protective effect on the brain.Methods:A total of 98 patients who received craniotomy in the Second Affiliated Hospital of Air Force Medical University from June 2022 to June 2023 were selected and divided into control group and observation group according to random number table method, with 49 cases in each group. Sevoflurane was inhaled to maintain anesthesia in the control group after tracheal intubation, and propofol was injected intravenously into the observation group after tracheal intubation. The indexes were compared between the two groups in terms of dynamic changes of cerebral tissue edema, intracranial pressure, brain injury factors [S100 calcified protein β (S100-β), neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP)], cerebral oxygen metabolism indexes [arterial blood oxygen content (AVDO 2), arterial blood lactic acid (AVDL), cerebral oxygen metabolism rate (CMRO 2)], oxidative stress indicators [malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px)]. Results:There were no significant differences in the degree of cerebral tissue edema, intracranial pressure, brain injury factors, cerebral oxygen metabolism indexes and oxidative stress indexes between the two groups (all P>0.05). There were significant differences in the degree of cerebral tissue edema, intracranial pressure, brain injury factors, cerebral oxygen metabolism indexes and oxidative stress indexes between the two groups after surgery (all P<0.05). The degree of cerebral edema in the observation group at 24 h and 72 h after operation was less than that in the control group, and the difference was statistically significant (all P<0.05). The intracranial pressure after craniotomy, before skull reduction and after operation in the observation group was lower than that in the control group, with statistical significance (all P<0.05). The serum levels of S100-β, NSE, GFAP in observation group were lower than those in the control group after craniotomy, before skull reduction and after operation, and the difference was statistically significant ( P<0.05). AVDO 2, AVDL, CMRO 2 of the observation group after craniotomy, before skull reduction and after surgery were better than those of the control group, with statistical significance (all P<0.05). In terms of oxidative stress indexes after craniotomy, before skull reduction and after surgery, MDA levels in observation group were lower than those in control group, while SOD and GSH-Px levels were higher than those in control group, the differences were statistically significant (all P<0.05). Conclusions:Propofol anesthesia maintenance can alleviate cerebral tissue edema after craniotomy, reduce intracranial pressure, reduce the release of brain injury factors, improve cerebral oxygen metabolism, enhance antioxidant capacity, and significantly protect the brain of patients.

Objective:To summarize and investigate the ultrasound manifestations, clinical characteristics, causes, and prognosis of hepatic portal vein gas (HPVG) after liver transplantation in children.Methods:A case series study. Clinical data of 9 pediatric recipients diagnosed with HPVG by ultrasound after liver transplantation between January 2012 and August 2023 were collected, and the ultrasound manifestations, causes, clinical features, and prognosis of HPVG were analyzed.Results:A total of 1,850 pediatric liver transplantations were performed during the same period in Tianjin First Central Hospital, among which 9 cases (0.48%) developed HPVG; 6 cases occurred within 1 month after surgery, and 3 cases occurred more than 1 month after surgery; the duration ranged from 2 to 15 days, with a median of 7 (4.5, 9.0) days. HPVG was first detected by ultrasound in all cases, with common ultrasound manifestations including bubble-like or punctate strong echoes flowing with blood in the portal vein, and patchy strong echoes with unclear borders in the liver parenchyma. Among the 9 patients, 3 had diarrhea with intestinal flora imbalance, 2 had abdominal distension with incomplete intestinal obstruction, 1 had colonic fistula with repeated replacement of Li's tube and concurrent abdominal distension, 1 was experiencing acute T-cell-mediated rejection of the transplanted liver, and the remaining 2 were asymptomatic. Patients with diarrhea and intestinal dysbiosis were treated with Bifidobacterium Lactobacillus triple viable tablets to regulate flora and montmorillonite powder to relieve diarrhea, which gradually subsided. Patients with abdominal distension and incomplete intestinal obstruction were treated with fasting, intravenous nutrition, and enema, and the obstruction gradually resolved, along with disappearance of HPVG.Conclusion:HPVG after liver transplantation has characteristic ultrasound manifestations, and its occurrence may be related to intestinal gas, obstruction, dysbiosis, or mucosal damage. Treatment may be conservative or surgical depending on the underlying cause and severity.

Objective To compare imaging quality and detection capability of bone metastases between Insight NM/CT Pro SPECT/CT(Insight SPECT/CT)and Siemens Symbia T16 SPECT/CT(Symbia T16 SPECT/CT)scanners.Methods Totally 40 patients with diagnosed or suspected bone metastases were prospectively enrolled.Whole-body bone imaging and local tomographic fusion imaging were performed using Symbia T16 and Insight SPECT/CT scanners with same method and parameters,and imaging quality and detection capability were compared between 2 devices.Results Among whole-body bone imaging acquired with Symbia T 16 SPECT/CT,the imaging quality score was 5 in 35 cases and 4 in 5 cases,and detected 118 positive bone lesions,including 36 lesions involved chest,28 involved spinal cord,30 involved pelvic bones,20 involved limbs and 4 involved cranial bones.The imaging quality score of local tomographic fusion imaging obtained with Symbia T16 SPECT/CT was 5 in all 40 cases,and 59 positive lesions involved bone regions were detected,including 14 lesions presented as bone destruction,11 presented as increased bone density and 34 showed uneven bone density on CT.Meanwhile,the whole-body bone imaging quality score acquired with Insight SPECT/CT was 5 in 35 cases,4 in 4 cases and 3 in 1 case,and both the detected positive lesions and the involved bone regions were consistent with those of Symbia T 16 SPECT/CT.Furthermore,the imaging quality,detected positive lesions and their involved regions,as well as CT manifestations on local tomographic fusion imaging obtained with Insight SPECT/CT scanner were all consistent with those of Symbia T 16 scanner.Conclusion The imaging quality of whole-body bone imaging and local tomographic fusion imaging of bone metastases of domestic Insight SPECT/CT were comparable to those of Siemens Symbia T16 SPECT/CT.

Objective:To investigate the relationship between propofol anesthesia maintenance and cerebral tissue edema after craniotomy and its protective effect on the brain.Methods:A total of 98 patients who received craniotomy in the Second Affiliated Hospital of Air Force Medical University from June 2022 to June 2023 were selected and divided into control group and observation group according to random number table method, with 49 cases in each group. Sevoflurane was inhaled to maintain anesthesia in the control group after tracheal intubation, and propofol was injected intravenously into the observation group after tracheal intubation. The indexes were compared between the two groups in terms of dynamic changes of cerebral tissue edema, intracranial pressure, brain injury factors [S100 calcified protein β (S100-β), neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP)], cerebral oxygen metabolism indexes [arterial blood oxygen content (AVDO 2), arterial blood lactic acid (AVDL), cerebral oxygen metabolism rate (CMRO 2)], oxidative stress indicators [malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px)]. Results:There were no significant differences in the degree of cerebral tissue edema, intracranial pressure, brain injury factors, cerebral oxygen metabolism indexes and oxidative stress indexes between the two groups (all P>0.05). There were significant differences in the degree of cerebral tissue edema, intracranial pressure, brain injury factors, cerebral oxygen metabolism indexes and oxidative stress indexes between the two groups after surgery (all P<0.05). The degree of cerebral edema in the observation group at 24 h and 72 h after operation was less than that in the control group, and the difference was statistically significant (all P<0.05). The intracranial pressure after craniotomy, before skull reduction and after operation in the observation group was lower than that in the control group, with statistical significance (all P<0.05). The serum levels of S100-β, NSE, GFAP in observation group were lower than those in the control group after craniotomy, before skull reduction and after operation, and the difference was statistically significant ( P<0.05). AVDO 2, AVDL, CMRO 2 of the observation group after craniotomy, before skull reduction and after surgery were better than those of the control group, with statistical significance (all P<0.05). In terms of oxidative stress indexes after craniotomy, before skull reduction and after surgery, MDA levels in observation group were lower than those in control group, while SOD and GSH-Px levels were higher than those in control group, the differences were statistically significant (all P<0.05). Conclusions:Propofol anesthesia maintenance can alleviate cerebral tissue edema after craniotomy, reduce intracranial pressure, reduce the release of brain injury factors, improve cerebral oxygen metabolism, enhance antioxidant capacity, and significantly protect the brain of patients.

Objective:To summarize and investigate the ultrasound manifestations, clinical characteristics, causes, and prognosis of hepatic portal vein gas (HPVG) after liver transplantation in children.Methods:A case series study. Clinical data of 9 pediatric recipients diagnosed with HPVG by ultrasound after liver transplantation between January 2012 and August 2023 were collected, and the ultrasound manifestations, causes, clinical features, and prognosis of HPVG were analyzed.Results:A total of 1,850 pediatric liver transplantations were performed during the same period in Tianjin First Central Hospital, among which 9 cases (0.48%) developed HPVG; 6 cases occurred within 1 month after surgery, and 3 cases occurred more than 1 month after surgery; the duration ranged from 2 to 15 days, with a median of 7 (4.5, 9.0) days. HPVG was first detected by ultrasound in all cases, with common ultrasound manifestations including bubble-like or punctate strong echoes flowing with blood in the portal vein, and patchy strong echoes with unclear borders in the liver parenchyma. Among the 9 patients, 3 had diarrhea with intestinal flora imbalance, 2 had abdominal distension with incomplete intestinal obstruction, 1 had colonic fistula with repeated replacement of Li's tube and concurrent abdominal distension, 1 was experiencing acute T-cell-mediated rejection of the transplanted liver, and the remaining 2 were asymptomatic. Patients with diarrhea and intestinal dysbiosis were treated with Bifidobacterium Lactobacillus triple viable tablets to regulate flora and montmorillonite powder to relieve diarrhea, which gradually subsided. Patients with abdominal distension and incomplete intestinal obstruction were treated with fasting, intravenous nutrition, and enema, and the obstruction gradually resolved, along with disappearance of HPVG.Conclusion:HPVG after liver transplantation has characteristic ultrasound manifestations, and its occurrence may be related to intestinal gas, obstruction, dysbiosis, or mucosal damage. Treatment may be conservative or surgical depending on the underlying cause and severity.

Objective:To obtain the normal reference range of hemodynamic ultrasound parameters after pediatric liver transplantation through big data query and statistical analysis, and compare their changes with age.Methods:The clinical liver transplantation ultrasound imaging database software V1.0 independently developed by Tianjin First Central Hospital was used to query the ultrasound hemodynamic parameters of 0-14 years old pediatric patients after parental liver transplantation from December 2012 to December 2022, including portal vein diameter (PVD) on the 1st day, 7th day, 1st month, 6th month, 1st year, 5th year, and 10th year after surgery. The changes in ultrasound blood flow parameters such as portal vein velocity (PVV), hepatic artery peak velocity (S), hepatic artery end diastolic velocity (D), and left hepatic vein velocity (LHVV) with postoperative time in different age groups were analyzed, the differences between age groups were compared, and statistical analysis was perform to obtain the 95% reference value range for each parameter.Results:A total of 731 pediatric patients aged 0-14 years who underwent parental liver transplantation were included in this study, with a total of 5 283 monitoring results. The ultrasound hemodynamic parameters PVV, hepatic artery S, D, and LHVV were highest at 7th day after surgery, and gradually showed a sustained and slightly decreasing trend with the prolongation of postoperative time. At the same time, there was no statistically significant difference in PVV, hepatic artery S, D, and LHVV among different age groups (all P>0.05). Conclusions:This study obtains the trend of ultrasound hemodynamic parameters after pediatric liver transplantation with prolonged follow-up time, and compared them among different age groups.After pediatric liver transplantation, there is no significant change in liver hemodynamic parameters with increasing age. Obtaining reference value ranges for various parameters in different age groups is of great clinical significance for early detection and diagnosis of postoperative vascular complications. Pediatric liver transplantation is more complex than adult liver transplantation, and in clinical monitoring, more attention should be paid to the dynamic changes of transplanted liver blood flow, combining with individual patient status, to provide imaging support for clinical diagnosis.

Objective:To explore the ultrasonic hemodynamic characteristics of early allograft dysfunction after left lateral lobe liver transplantation in children with biliary atresia.Methods:A total of 546 children with biliary atresia who underwent related left lateral lobe liver transplantation at Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, according to the early functional recovery of the transplanted liver, it was divided into a normal function recovery group (non-EAD group) and an early allograft dysfunction group (EAD group). The hepatic artery peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), resistance index (RI), portal vein diameter (PVD), portal vein flow velocity (PVV), portal vein flow (PVF), left hepatic vein diameter (LHVD) and left hepatic vein velocity (LHVV) were measured 1 to 7 days after surgery (a total of 3 703 ultrasound examination results), and the differences in ultrasound hemodynamic parameters between the two groups were compared. Binary logistic regression analysis was used to determine the correlation between hepatic artery RI=1.0, PSV<25 cm/s, PVV<15 cm/s, LHVV<15 cm/s and the occurrence of EAD within 7 days after surgery.Results:① Among the 546 children with biliary atresia, 262 children developed EAD after liver transplantation, and 284 children did not develop EAD. ②The portal vein flow of children in the EAD group was lower than that of the non-EAD group on 3 days, 4 days, 6 days and 7 days after surgery [3 days: 783 (560, 1 170) ml/(min·100 g) vs 942 (597, 1 381) ml/(min·100 g), P=0.006; 4 d: 862(594, 1 443) ml/(min·100 g) vs 1 068(748, 1 606) ml/(min·100 g), P=0.001; 6 d: 1 024 (631, 1 447) ml/(min·100 g) vs 1 141 (777, 1 709) ml/(min·100 g), P=0.005; 7 d: 937 (619, 1 408) ml/(min·100 g) vs 1 066 (670, 1 557) ml/(min·100 g), P=0.018]. The hepatic artery blood flow parameter RI was higher than that in the non-EAD group 7 days after surgery [0.72 (0.65, 0.79) vs 0.70 (0.63, 0.76), P=0.025]. There were no statistically significant differences in hepatic venous blood flow parameters between the two groups from 1 to 7 days (all P>0.05). ③Both the PVV and PVF in the EAD group and the non-EAD group showed an overall upward trend over time from 1 to 7 days after surgery, but compared with the non-EAD group, the portal vein flow in the EAD group increased more slowly from 3 to 7 days [PVF change rate: 0.01 (-0.25, 0.62)% vs 0.06 (-0.41, 0.41)%, P=0.003], while PSV, EDV and LHVV had no significant fluctuations. ④In the ultrasound hemodynamic abnormality index, the EAD group has a higher probability of transplanted hepatic artery RI=1.0 than the non-EAD group. Binary logistic regression analysis showed that hepatic artery RI=1.0 within 7 days after surgery was correlated with the occurrence of EAD [Exp(B)=2.413, P=0.005]. Conclusions:After left lateral lobe liver transplantation in children with biliary atresia, the portal vein of children with EAD showed a relatively low flow state.Abnormal ultrasound hemodynamic index hepatic artery RI=1.0 in children within 7 days after surgery can indicate the occurrence of EAD. Ultrasound examination can provide hemodynamic basis for early clinical detection of the presence of EAD.

Objective To investigate the analgesic effect of multi-site multiple paravertebral nerve blocks on patients undergoing radical lung cancer surgery and the impact on their serum indices and prognosis.Methods Ninety-eight cases of patients undergoing thoracoscopic radical lung cancer surgery in our hospital were selected from March 2021 to January 2023 and divided into 2 groups according to the difference in anaesthesia.Among them,42 patients in the study group were treated with preoperative and postoperative multipoint paravertebral nerve block combined with general anaesthesia,while 56 patients in the control group were treated with preoperative multipoint paravertebral nerve block combined with general anaesthesia,and the analgesic effect and other differences between the two groups were compared.Results In the study group,extubation time,recovery time,propofol dosage and postoperative VAS score were(150.2±15.2)min,(19.1±5.1)min,(738.2±36.5)mg and(4.2±0.7)points,respectively.The control group was(151.9±12.6)min,(22.6±7.3)min,(902.1±49.0)mg and(2.3±0.3)min,respectively,and the difference between the two groups was statistically significant(P＜0.05).The differences of heart rate,mean arterial pressure and before and after half an hour after surgery in control group were higher than those in study group,and the differences of norepinephrine,epinephrine and before and after surgery were higher than those in study group,with statistical significance(P＜0.05).The total complication rate of the study group was 7.2％,and that of the control group was 23.2％.The QoR score of the control group was lower than that of the study group,and the difference between the two groups was statistically significant(P＜0.05).Conclusion Preoperative and postoperative multi-point paravertebral nerve block combined with general anaesthesia has a better analgesic effect on patients undergoing radical lung cancer surgery,which can not only reduce the inflammatory reaction of the patients,but also have less impact on their haemodynamic indexes and lower rate of postoperative adverse reactions,and ultimately improve the quality of life of the patients.