Objective:To investigate the predictive value for major adverse cardiovascular events (MACE) occurring within 1 year in patients with old myocardial infarction(OMI) using characteristics of myocardial scar derive from dual-energy CT (DECT) post-processing technique.Methods:OMI patients who received coronary CT angiography following dual-energy CT with late iodine enhancement (LIE-DECT) in the Second Affiliated Hospital of Nantong University from November 2019 to October 2022 were continuously included, and the images of all enrolled patients were reconstructed using 40 keV monoenergetic plus (Mono+) map, LIE (representing myocardial scar) was quantified on left ventricular short-axis images, including the LIE segments, the LIE score, and the LIE degree. All enrolled patients were followed up for MACE, defined as hospitalization for heart failure, malignant arrhythmia, and cardiac death. Regression analysis was used to investigate the relationship between the quantified value of myocardial scar and the occurrence of MACE, and receiver operating characteristic curve (ROC) was used to evaluate the efficacy of quantified value of myocardial scar in predicting MACE. The area under the curve (AUC) was compared using the DeLong test.Results:Finally, 231 patients with OMI were included, and MACE occurred in 37 cases (16.0%) within 1 year after LIE-DECT examination. The LIE segments 5 (4, 7), the LIE score 27 (13, 49) and the LIE degree 9.4%(7.5%, 15.5%) in the MACE group were higher than those in the non-MACE group 3 (2, 5), 9 (6, 15) and 6.7%(6.3%, 7.9%) (all P<0.001). Multivariable logistic regression analysis showed that after adjusting for confounders, the LIE segments ( OR=2.118, P<0.001), the LIE score ( OR=3.168, P<0.001), and the LIE degree ( OR=3.092, P<0.001) remained risk factors for the development of MACE. On ROC analysis, AUC of LIE segments, LIE score and LIE degree were 0.715, 0.822 and 0.806 (all P<0.001), with sensitivities of 81.1%, 86.5%, and 91.9%, and specificities of 53.6%, 69.6%, and 60.8%, respectively. DeLong′s test showed that the predictive efficacy of LIE score and LIE degree was higher than that of LIE segments ( Z=2.63, P=0.008; Z=1.96, P=0.049), and there were no significant differences in the predictive efficacy of LIE score and LIE degree ( Z=0.60, P=0.551). Conclusion:The LIE segments, the LIE score and the LIE degree detected by LIE-DECT 40 keV Mono+maps are risk factors for the occurrence of MACE in patients with OMI and have good efficacy in predicting the occurrence of MACE, which can be used as important indicators for assessing the clinical prognosis of OMI.

Objective:To assess the changes of selenium nutrition of school-age children in Kashin-Beck disease (KBD) areas of Linzhou County, Lhasa City and Xietongmen County, Shigatse City in Tibet Autonomous Region (referred to as Tibet), and provide a scientific basis for evaluating the effectiveness of prevention and control measures.Methods:According to the historical condition of KBD, a total of 344 children's hair samples were collected to determine the content of selenium in Kazi (KBD area) and Jiangxia townships (non-KBD area) of Linzhou County in 2013 and 2021, Renqinze (KBD area) and Tongmen townships (non-KBD area) of Xietongmen County in 2015 and 2021.Results:Compared to 2013/2015, in 2021, the hair selenium level of children in the four townships increased ( P < 0.001). The selenium nutritional level of more than 90% of the children reached medium or above (hair selenium > 0.25 μg/g) in 2021. The hair selenium levels of girls in the two KBD areas (Kazi and Renqinze townships) were lower than those of boys ( Z = - 2.83, - 2.83, P < 0.05). Conclusions:The selenium nutrition level of school-age children in KBD areas in Linzhou and Xietongmen counties has increased rapidly in recent years. However, the selenium nutrition level of girls is significantly lower than that of boys. It is necessary to strengthen prevention, controlling and monitoring, and to further improve the dietary structure of school-age children through the joint efforts of families and schools, to increase the proportion of exogenous high selenium food intake.

Objective To investigate the value of color Doppler ultrasonography in the differential diagnosis of benign and malignant testicular tumors in children. Methods The sonographic findings of 63 children pathologically confirmed testicular tumors were retrospectively analyzed.All children were divided into benign group and malignant group according to pathologic diagnosis. The tumor size,shape,border, echo texture,calcification and color blood flow were compared between two groups. Logistic regression analysis was employed to predict sonographic features of benign and malignant testicular tumors.Receiver operating curve (ROC) was employed to assess the diagnostic performance of sonographic features. Results Among the 63 cases of pediatric testicular tumors,42 cases were histologically confirmed as benign testicular tumors (66.7% ),and the rest 21 cases were malignant testicular tumors (33.3% ). The maximum diameter of tumor in benign tumors was significantly smaller than that in malignant tumors[(1.75 ± 0.75) cm vs (2.90 ± 1.22)cm,P =0.000].In the sonographic features,malignant testicular tumors were more likely to present with solid masses,and benign testicular tumors were more likely to be cystic or cystic-solid ( P =0.024).Calcification was more common in benign tumors than that in malignant tumors ( P =0.000).Compared with benign tumors,malignant tumors had increased blood flow on color Doppler images ( P =0.000).Logistic regression analysis indicated that flow grade was the independent prognostic factors for malignant tumor. By using Alder grade of 2 or above as threshold,the sensitivity,specificity and accuracy were 95.2%,78.6% and 84.1%,respectively. Conclusions The sonographic features vary between benign and malignant testicular tumors. Blood flow is the independent factors for predicting malignant tumor. Color Doppler ultrasonography is an important method for differential diagnosis of testicular tumors in children.

OBJECTIVETo compare the clinical efficacy of robotic and laparoscopic radical surgery in the treatment of middle-low rectal cancers.

METHODSFrom January 2015 to March 2016, intra-operative and postoperative follow-up data of 30 patients with middle-low rectal cancers who underwent robotic radical resection(robot group) and 32 patients with middle-low rectal cancers who underwent laparoscopic radical resection (laparoscopy group)n in our department were retrospectively collected. The distance from cancer to anal margin was less than 10 cm in both two groups and advanced rectal cancers were confirmed by preoperative colonoscopy biopsy. Associated data were compared between two groups.

RESULTSThere were 13 males and 17 females in robot group with age of 27 to 85 (mean 59.7) years, disease course of 3 to 12 (mean 6.2) months and clinical stage T2-3N0-1. There were 16 males and 16 females in laparoscopic group with age of 32 to 79 (mean 60.3) years, disease course of 2 to 10(mean 5.9) months and clinical stage T2-3N0-1. The baseline data of two groups were not significantly different (all P>0.05). All the patients in two groups completed operations successfully without conversion to open operation. Compared with laparoscopic group, the blood loss was less [(100.3±43.7) ml vs. (150.3±68.2) ml, t=3.413, P=0.001], the first flatus time [(49.3±12.4) h vs. (58.6±12.5) h, t=2.838, P=0.006] and urinary catheter removal time [(3.0±0.7) d vs. (4.8±0.9) d, t=5.491, P=0.000] were shorter, while the operation time [(217.3±57.8) min vs. (187.9±23.1) min, t=2.772, P=0.009] was longer in robot group. No cancer tissue was observed in resection margin of two groups. Number of harvested lymph node per case (15.2±7.4 vs. 13.9±4.9, t=-0.764, P=0.448), distance from anal margin to tumor distal edge [(7±3) cm vs. (6.5±3) cm, t=-1.952, P=0.056] and postoperative hospital stay [(13.6±1.3) d vs. (13.8±1.8) d, t=0.925, P=0.359] were not significantly different between two groups. No serious complications occurred in two groups during intra-operative and postoperative period. During following up of 3 to 12 (average 8.7) months, 1 case of anastomotic fistula occurred in each group and was cured by conservative treatment without significant difference [3.3%(1/30) vs. 3.1%(1/32), P=1.000]. No sexual dysfunction was found in either groups. Two cases in laparoscopic group presented relapse and metastasis, but no recurrence and metastasis was observed in robot group. There was no death in two groups.

CONCLUSIONRobotic radical surgery in the treatment of middle-low rectal cancers is safe and effective with the advantages of less trauma, less bleeding, rapid recovery of intestinal function and urinary function.

Adult ; Aged ; Blood Loss, Surgical ; Comparative Effectiveness Research ; Defecation ; Digestive System Surgical Procedures ; adverse effects ; methods ; Female ; Fistula ; etiology ; surgery ; Humans ; Laparoscopy ; adverse effects ; Length of Stay ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Operative Time ; Postoperative Period ; Recovery of Function ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Robotic Surgical Procedures ; adverse effects ; Treatment Outcome ; Urination

OBJECTIVETo investigate the characteristics of gastrointestinal transit in chronic constipation patients depending on a small amount barium(SAB) gastrointestinal transit test.

METHODSImaging data of 1890 cases with chronic constipation diagnosed with Rome III( criteria undergoing the SAB gastrointestinal transit test at Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University from January 2009 to March 2015 were retrospectively analyzed. All the patients took 20 g medical barium sulfate diluted in porridge and erect position abdominal X-ray photographs were then taken at 4, 8, 12, 24 hours after meal and once in every 24 hour sequentially. Transit characteristics of whole gut and various segments, including stomach, small intestine, right hemicolon, left hemicolon and rectum were assessed according to the predetermined criteria.

RESULTSAll the 1890 patients showed good compliance with the complete test. Among these patients, 794 cases(42%) were diagnosed as normal transit and 1096 cases(58%) as gastrointestinal slow transit. Classified by the site of slow transit, 151 cases(8%) were abnormal gastric transit, 175(9%) cases were abnormal small intestinal transit, 986(52%) cases were slow right hemicolon transit, 1039 cases(55%) were slow left hemicolon transit, 139 cases(7%) were outlet obstruction. Among the 1096 patients with slow gut transit, 907 cases(83%) were multiple segments slow transit and 189 cases(17%) were single segment slow transit. Among 907 patients with multiple segmental slow transit, 668 cases(74%) were total colon slow transit, 61 cases(7%) were colonic slow transit combined with outlet obstruction, 138 cases(15%) were small intestine slow transit coincided with colon slow transit, 40 cases(4%) were total segments slow transit in the whole gut. Of 189 cases of single segment slow transit, 17 cases(9%) were unique gastric delayed empting, 37 cases(20%) were unitary small intestine transit dysfunction, 19 cases(10%) were right hemicolon transit defect, 78 cases(41%) were left hemicolon transit deterioration, 38 cases(20%) were outlet obstruction.

CONCLUSIONSThe characteristics of gastrointestinal transit test in patients with chronic constipation varied from each other. Majority presents multi-segment slow transit combined with colon slow transit. SAB gastrointestinal transit test is helpful for surveying the transit characteristics of each segment of gut and worth clinical generalization and application.

Colon ; Constipation ; Gastrointestinal Tract ; Gastrointestinal Transit ; Humans ; Rectum ; Retrospective Studies ; Stomach

BACKGROUND:Mechanical, inflammatory, and biochemical factors, particularly matrix metaloproteinases and reactive oxygen lead to chondrocyte degeneration in osteoarthritis. Curcumin has been shown to be a potent antioxidant; however, its protective effects against chondrocyte degeneration in osteoarthritis remain unclear.
OBJECTIVE:To investigate the potential molecular mechanisms underlying the protective effects of curcumin on articular cartilage of osteoarthritis in rats.
METHODS:A total of 30 Sprague-Dawley rats were used and randomly divided into model group (positive control,n=15) and normal group (negative control,n=15). Rat models of traumatic osteoarthritis were established, and then cartilage cels were isolated from articular cartilage and culturedin vitro. Chondrocytes were treated with curcumin (curcumin group) or PDTC (an inhibitor of nuclear factor-kappa B) for 24 hours. The expression level of nuclear factor-kappa B P65 in nucleus and cytoplasm in chondrocytes were determined by western blot assay and immunofluorescence. Moreover, mRNA expressions of type II colagen, matrix metaloproteinase-1 and -13 were analyzed using RT-qPCR.
RESULTS AND CONCLUSION: Nuclear factor-kappa B P65 protein was mainly expressed in nucleus, but few in cytoplasm in positive control group; the reversed results were found in the curcumin group. Nuclear translocation of nuclear factor-kappa B P65 was observed mainly in nucleus in the positive control group; however, that was observed mainly in cytoplasm in the negative control, curcumin, and PDTC groups. Matrix metaloproteinase-1 and -13 mRNA expressions were significantly decreased, while type II colagen mRNA expression was significantly increased in the curcumin group compared with the positive control group. These findings indicated that curcumin protect chondrocytes against degeneration through inhibiting the activation of nuclear factor-kappa B signaling pathway, suppressing nuclear translocation of nuclear factor-kappa B P65 and inhibiting the expressions of matrix metaloproteinase-1 and -13, which are responsible for upregulation of type II colagen expression.

Objective To compare the effects of expectoration by high frequency back tapping with both hands and traditional expectoration by tapping back with a single hand on pulmonary complications in esophageal cancer patients having undergone radical resection with video-assisted thoracoscopic surgery (VATS). Methods Sixty patients after radical resection for esophageal cancer with VATS from May 2013 to January 2014 were set as the control group, in which expectoration by tapping the back with a single hand. Another 60 patients after radical resection for esophageal cancer with VATS from February 2014 to July 2014 were set as the observation group, in which the expectoration by high frequency tapping the back with both hands. The two groups were compared in terms of pulmonary complications. Result The incidence of atelectasis and pulmonary infection in the observation group were lower than those with a single hand in the control group (all P<0.05). Conclusion For the patients having undergone radical resection of esophageal carcinoma with VATS, the expectoration with high frequency back tapping with both hands is more effective in lowering atelectasis rate than that with a single hand.

BACKGROUND:Intra-articular injection of sodium hyaluronate or dexamethasone can relieve pain and increase range of motion after traumatic arthritis. OBJECTIVE:To observe the effect of dexamethasone combined with sodium hyaluronate on traumatic arthritis of rat knees. METHODS:Forty-eight Sprague-Dawley rats were randomly divided into four groups. The anterior ligament of the left knee was resected and the medial meniscus was removed to establish models of traumatic arthritis in al the rats. After 3 weeks, the four groups were respectively injected dexamethasone+sodium hyaluronate (combined group), dexamethasone, sodium hyaluronate, and nothing (control group). After 4, 8, 12 weeks of injection, the samples were obtained for gross observation, anteroposterior and lateral X-ray films and hematoxylin-eosin staining. RESULTS AND CONCLUSION:At 12 weeks after injection, X-ray films showed that there was no stenosis in the combined group, mild stenosis in the dexamethasone and sodium hyaluronate groups, and obvious stenosis in the control group (indicating severe osteoarthritis);hematoxylin-eosin staining exhibited the fibrous cartilage-like tissue grew wel in the combined group, varying degrees of proliferation of fibrous cartilage-like cells were visible in the dexamethasone and sodium hyaluronate groups, and there was a smal amount of fibrosis in the control group. These findings suggest that the combination of dexamethasone and sodium hyaluronate can improve the cartilage repair and restore the joint function.

Objective To analyze the relationship between plasma lipoprotein-associated phospholipase A2,lipoprotein(a)and atherosclerotic cerebral infraction(ACI).Methods The carotid plaque stability of 60 cerebral infraction patients were determined by cervical vascular color Doppler ultrasound.Plasma Lp-PLA2 and Lp(a)levels were detected by enzyme linked immunosor-bent assay(ELISL).Scores of neurological impairment were assessed by the National Institute of Health Stroke Scale (NIHSS).Results 44 patients with ACI showed unstable carotid plaques, while 16 patients with ACI showed stable carotid plaques.Compared with control group,the levels of plasma Lp-PLA2 and Lp(a)were higher in ACI group (P <0.05).The levels of plasma Lp-PLA2 and Lp (a )in unstable plaque group were higher than those in stable plaque group (P <0.05).The plasma level of Lp-PLA2 was negatively correlated with neurological impairment (P >0.05).Conclusion Increasing of Lp-PLA2 and Lp(a)are closely related with atherosclerotic cere-bral infarction.In clinic,the risk of cerebral infarction can be predicted by detecting the levels of Lp-PLA2 and LP(a),and it can play an important role in preventing and reducing the recurrence of cerebral infarction.

Objective To analyze the relationship between plasma lipoprotein-associated phospholipase A2,lipoprotein(a)and atherosclerotic cerebral infraction(ACI).Methods The carotid plaque stability of 60 cerebral infraction patients were determined by cervical vascular color Doppler ultrasound.Plasma Lp-PLA2 and Lp(a)levels were detected by enzyme linked immunosor-bent assay(ELISL).Scores of neurological impairment were assessed by the National Institute of Health Stroke Scale (NIHSS).Results 44 patients with ACI showed unstable carotid plaques, while 16 patients with ACI showed stable carotid plaques.Compared with control group,the levels of plasma Lp-PLA2 and Lp(a)were higher in ACI group (P <0.05).The levels of plasma Lp-PLA2 and Lp (a )in unstable plaque group were higher than those in stable plaque group (P <0.05).The plasma level of Lp-PLA2 was negatively correlated with neurological impairment (P >0.05).Conclusion Increasing of Lp-PLA2 and Lp(a)are closely related with atherosclerotic cere-bral infarction.In clinic,the risk of cerebral infarction can be predicted by detecting the levels of Lp-PLA2 and LP(a),and it can play an important role in preventing and reducing the recurrence of cerebral infarction.