Objective To explore the application value of multidetector computed tomography(MDCT),computed tomography cholangiography(CTC)and computed tomography angiography(CTA)reconstruction technology in the diagnosis and classification and the evaluation of the efficacy of biliary drainage in advanced hilar cholangiocarcinoma(HCCA).Methods A total of 44 patients of inoperable advanced HCCA were collected.Conventional CT plain scan and enhanced multi-phase scan were performed before treat-ment.Minimum intensity projection(MinIP)combined with curve planar reformation(CPR)was used to perform CTC.CTA of the portal vein,hepatic artery and hepatic vein were performed by maximum intensity projection(MIP),volume rendering(VR)or CPR,respectively.CT was reexamined after biliary drainage treatment.The study included the comparison between reconstruction technology of CTC and CTA and conventional CT scanning technology,CTC in the classification and diagnosis of HCCA,CTA in the evaluation of vascular invasion,and the evaluation of the effect of jaundice drainage by biliary imaging before and after biliary drain-age treatment.Results All HCCA cases obtained clear location diagnosis,including 39 cases of Bismuth-Corlette type Ⅳ and 5 cases of type Ⅲ.There were 40 cases of hepatic vascular involvement,including 15 cases of bilateral portal vein invasion by tumor,12 cases of portal vein constriction,8 cases of portal vein tumor thrombosis,4 cases of bilateral hepatic arteries involvement,and 1 case of hepatic vein involvement.CTC and CTA could better display a full view of the bile duct and blood vessel than conventional CT scanning ima-ges,and provided more accurate analysis of tumor classification and degree of vascular invasion.Before treatment,CT showed severe dila-tion of bile duct in 21 cases and moderate dilation in 20 cases,severe dilation of the intrahepatic bile duct in the left lobe but mild dilation of the intrahepatic bile duct in the right lobe in 3 cases.After drainage treatment,the contraction rate of intrahepatic bile duct dilation was＜25％in 4 cases,25％to 49％in 13 cases,50％to 74％in 18 cases,and ≥75％in 9 cases.The bile duct contraction rate was positively correlated with the decrease in total bilirubin(TBIL).Conclusion MDCT,CTC and CT A reconstruction technology can well complete the diagnosis of advanced HCCA,Bismuth-Corlette typing,and vascular evaluation.Observing the contraction rate of the intrahepatic bile duct after biliary drainage treatment can evaluate the efficacy of jaundice drainage.

A 68-year-old male patient with advanced lung squamous cell carcinoma received intravenous infusion of pembrolizumab 200 mg once every 3 weeks. One week after the 4th IV infusion of pembrolizumab, the patient developed nausea and vomiting. Laboratory tests showed blood potassium 7.39 mmol/L, fasting blood glucose 28.1 mmol/L, β-hydroxybutyric acid 3.23 mmol/L, arterial blood pH 7.16, and bicarbonate 7.5 mmol/L. The patient was diagnosed as diabetic ketoacidosis, which was considered to be associated with pembrolizumab. After 8 days of treatments such as lowering blood sugar and correcting electrolyte disorder, his nausea and vomiting disappeared. Laboratory tests showed blood potassium 3.65 mmol/L, fasting blood glucose 7.5 mmol/L, β-hydroxybutyric acid 0.38 mmol/L, and bicarbonate 25.2 mmol/L.

A 68-year-old male patient with advanced lung squamous cell carcinoma received intravenous infusion of pembrolizumab 200 mg once every 3 weeks. One week after the 4th IV infusion of pembrolizumab, the patient developed nausea and vomiting. Laboratory tests showed blood potassium 7.39 mmol/L, fasting blood glucose 28.1 mmol/L, β-hydroxybutyric acid 3.23 mmol/L, arterial blood pH 7.16, and bicarbonate 7.5 mmol/L. The patient was diagnosed as diabetic ketoacidosis, which was considered to be associated with pembrolizumab. After 8 days of treatments such as lowering blood sugar and correcting electrolyte disorder, his nausea and vomiting disappeared. Laboratory tests showed blood potassium 3.65 mmol/L, fasting blood glucose 7.5 mmol/L, β-hydroxybutyric acid 0.38 mmol/L, and bicarbonate 25.2 mmol/L.

Objective:To observe the clinical curative effect of compound glycyrrhizin tablets and tacrolimus ointmenta combined with photon therapy on hormone dependence facial dermatitis and the safety.Methods:80 cases were randomly divided into two groups: treatment group and control group, 40 each; compound glycyrrhizin tablets and tacrolimus ointmenta were administrated to all the cases in both groups while photon therapy was added to cases in treatment group; a comparative study was made to observe the clinical effect 4 weeks after treatment between the two groups.Results:Four weeks after treatment, the effective rate was 86.67% in treatment group and 63.33% in control group, the difference was of statistical significance ( χ2=4.36, P<0.05); the total scores of symptoms and signs decreased obviously in both groups while the difference between the groups was of statistical significance ( t=3.10, P<0.05); topical medication led to drug adverse reaction in 4 cases in treatment group and 3 cases in control group with the manifestation of tolerable aggravated facial erythema and twinge while the adverse reaction disappeared gradually with the drug application keeping on for about 1 week. Conclusions:Compound glycyrrhizin tablets and tacrolimus ointmenta combined with photon therapy is of definite curative effect on hormone dependence facial dermatitis with good safety.

Objective To explore the feasibility,reproducibility and reliability of the T 2* MRI technique in quantifying different concentrations of MnCl2water phantoms at 3.0T.Methods The water phantoms with different concentrations of MnCl2underwent T2* imaging at both 1.5T and 3.0T MRI,and repeated imaging at 3.0T MRI after 1 month.A Spearman correlation was used to determine the relationship of T2* values and Mn concentrations,and established the linear regression equations by using the simple linear regression.W ilcoxon signed-rank sum test and Bland-Altman method were used to evaluate the reproducibility of twice T 2* measurements at 3.0T,and the interclass correlation coefficient(ICC)was calculated.Results T2* values of the phantoms were negatively correlated to Mn concentrations(r= -1.000,P<0.001),and R2* values of the phantoms were positively correlated to Mn concentrations(r=1.000,P<0.001). T2* values of the phantoms measured at 3.0T were positively correlated to that measured at 1.5T(r=1.000,P<0.001).The linear regression equation was T2* 3.0T =0.651T2* 1.5T +0.041.There was no statistical difference of T2* values between the two measurements at 3.0T (Z= -1.732,P=0.083),and ICC was 1.000.Conclusion 3.0T MRI is feasible to quantify cardiac iron deposition.

Objective To evaluate the therapeutic effects of thymectomy in myasthenia gravis (MG) patients with thymoma.Methods A total of 178 MG patients with thymectomy between July 2008 and December 2010 were included.All the subjects were received either cyclophosphamide alone or in combination with radiotherapeutic treatment after surgery.The MG absolute and relative clinical scores were used to assess the effectiveness of long-term trcatments.Clinical evaluations were conducted before,and at 1,6,12 and 24 months after operation.A comparative analysis on the inter-relationships among MG clinical presentation,WHO histology aud Masaoka stage was also conducted.Results (1) Of the 178 thymomapatients,103 were male and 75 were female,with a mean age of (43.7 ± 12.5)-years old.One hundred and twelve cases were taken cyclophosphamide,and 58 cases with invasive thymoma (stages Ⅱ,Ⅲ and Ⅳ or WHO type B3) were taken cyclophosphamide in combination with radiotherapy.Five patients refused cyclophosphamide or radiotherapy and 3 did not finish treatment.(2) The muscular strength improved obviously in 32.8％ (58/177) of the patients after 1 month after thymectomy,and 59.8％ (101/169),69.7％ (115/165) and 81.5％ (132/162) after 6 months,1 year and 2 years,respectively with MG score for disease severity decreased significantly with time.(3) No significant differences of the improvement rates were observed in patients within different WHO histology category.However,the rates were much higher in patients with Masaoka stage Ⅰ (91.4％) and stage Ⅱ (89.8％) than those in patients with stage Ⅲ (45.5％) and Ⅳ(28.6％) (all P＜0.001).Conclusions The remission rate of MG patients with thymomas increase after thymectomy plus cyclophosphamide or in combination with radiotherapy and reached 81.5％ after 2 years.The remission rate is associated with Masaoka stagc,but not with WHO histology.

PURPOSE5.12 Wenchuan earthquake and 4.25 Nepal earthquake are of the similar magnitude, but the climate and geographic environment are totally different. Our team carried out medical rescue in both disasters, so we would like to compare the different traumatic conditions of the wounded in two earthquakes.

METHODSThe clinical data of the wounded respectively in 5.12 Wenchuan earthquake and 4.25 Nepal earthquake rescued by Chengdu Military General Hospital were retrospectively analyzed. Then a contrast study between the wounded was conducted in terms of age, sex, injury mechanisms, traumatic conditions, complications and prognosis.

RESULTSThree days after 5.12 Wenchuan earthquake, 465 cases of the wounded were hospitalized in Chengdu Military General Hospital, including 245 males (52.7%) and 220 females (47.3%) with the average age of (47.6±22.7) years. Our team carried out humanitarian relief in Katmandu after 4.25 Nepal earthquake. Three days after this disaster, 71 cases were treated in our field hospital, including 37 males (52.1%) and 34 females (47.9%) with the mean age of (44.8±22.9) years. There was no obvious difference in sex and mean age between two groups, but the age distribution was a little different: there were more wounded people at the age over 60 years in 4.25 Nepal earthquake (p<0.01) while more wounded people at the age between 21 and 60 years in 5.12 Wenchuan earthquake (p<0.05). The main cause of injury in both disasters was bruise by heavy drops but 5.12 Wenchuan earthquake had a higher rate of bruise injury and crush injury (p<0.05) while 4.25 Nepal earthquake had a higher rate of falling injury (p<0.01). Limb fracture was the most common injury type in both disasters. However, compared with 5.12 Wenchuan earthquake, 4.25 Nepal earthquake has a much higher incidence of limb fractures (p<0.01), lung infection (p<0.01) and malnutrition (p<0.05), but a lower incidence of thoracic injury (p<0.05) and multiple injury (p<0.05). The other complications and death rate showed no significant differences.

CONCLUSIONMajor earthquakes of the similar magnitude can cause different injury mechanisms, traumatic conditions and complications in the wounded under different climate and geographic environment.When an earthquake occurs in a poor traffic area of high altitude and large temperature difference, early medical rescue, injury control and wounded evacuation as well as sufficient warmth retention and food supply are of vital significance.

Adult ; Aged ; Earthquakes ; Female ; Humans ; Male ; Middle Aged ; Nepal ; Prognosis ; Wounds and Injuries ; epidemiology

Objective To explore the value of MRI-R2 * and to compare clinical effect of two iron chelators(deferasirox and deferoxamine) in iron-overloaded patients.Methods By completely randomized balanced design,24 iron-overloaded patients were randomly divided into 2 groups,which consisted of 12 patients treated with deferasirox and 12 patients treated with deferoxamine.The planned deferasirox dose was 40 mg· kg-1 · d-1,and the deferoxamine dose was no less than 50 mg · kg-1 · d-1 All patients underwent quantitative MRI at the time points of the primary screening,6 months and 12 months.Pair Wilcoxon rank sum test was used to compare the differences of liver R2 * values of the 2 groups at various time points respectively.Wilcoxon rank sum test was used to compare the differences of change rate of liver R2 * values between the two groups at the time point of 6 months,12 months,respectively.Results Deferasirox group's liver R2 * values of primary screening,6 months and 12 months were 1081,889 and 712 Hz,while deferoxamine group's liver R2 * values were 1042,838 and 488 Hz.There was no statistically significant difference between liver R2 * values of two groups at primary screening (Z =-0.029,P ＞ 0.05).The change rate of liver R2 * of deferasirox group at 12 month was-32％,while it was-58％ for the deferoxamine group,and there was statistically significant difference between the two groups (Z =-3.060,P ＜0.01).The change rate of serum ferritin of deferasirox group at 12 month was-15％,while it was -55％ for the deferoxamine group,and there was statistically significant difference between the two groups (Z =-2.945,P ＜ 0.01).Conclusion By using MRI-R2*,it suggest that both deferasirox and deferoxamine can effectively remove liver iron and deferoxamine is superior to deferasirox.

Objective To evaluate the efficacy and safety of tacrolimus in patients with generalized myasthenia gravis (MG).Methods A total of 69 cases admitted to our hospital were given 2-6 mg/day tacrolimus (FK506) for 12 months.The MG absolute and relative clinical scores were used to monitor the efficacy of tacrolimus.Clinical evaluation was conducted at month 1,3,6,and 12,while the serum concentration of FK506 was measured at one month after administration of tacromus for one month.Results The therapeutic response presenting as improved muscular strength showed within one month after administration of tacrolimus.The overall response rates (MG relative clinical score≥25％) at month 1,3,6 were 81.2％,87.6％,92.2％ respectively.It reached 93.8％ by the final visit at month 12.MG score to evaluate disease severity decreased significantly as the subjects continued to take tacrolimus.Statistic analysis suggested that the serum concentration of FK506 was correlated with its therapeutic effect.Serum trough levels in remission and response groups [(7.1 ± 3.9) μg/L and (6.3 ± 3.8) pg/L,respectively] were significantly higher than that of no response group [(3.4 ± 1.3) μg/L].The most common adverse effects included hyperglycemia (5 cases),myelosuppression (3 cases),and dizziness tinnitus (3 cases),majority of which were temporary and manageable.Conclusions Our study has shown that tacrolimus significantly improved muscular strength of generalized MG patients.The treatment is well tolerated.The therapeutic effect of tacrolimus is observed within 1 month after initial use.Adverse events were manageable and not common.

Objective To study the clinical characteristics which are related to malignancy in pancreatic intraductal papillary mucinous neoplasm (IPMN) with an aim to provide evidence for clinical practice.Methods Using PubMed,all pancreatic IPMN related articles with positive pathologic results before July 30th,2011 were studied.A pooled analysis was carried out on the morphological features of the disease.The analysis included gender,diameter of main pancreatic duct,diameter of cystic lesion,mural nodules and histological types (benign/malignant) of the neoplasm.Results 98 articles (including 1902 cases) were collected and analyzed.1025 cases were benign (53.89％) and 877 cases (46.11 ％) were malignant.Morphologically,there were a correlation between main pancreatic duct dilatation (≥5 mm),cystic lesion of large size (≥30 mm),presence of mural nodules and malignancy.The OR (95％ CI) were 5.591 (3.657-8.548),3.633 (2.626-5.027) and 4.983 (3.872-6.412) respectively.Conclusions A main pancreatic duct dilatation (≥5 mm),cystic lesions of large size (≥30 mm) and presence of mural nodules prompt the tumor to be malignant.In clinical work,the management of pancreatic IPMN should be made prudently based on comprehensive analysis of clinical features and the patient's status and intent.