Incremental Effect of Mitral Regurgitation on Left Atrial Dysfunction and Atrioventricular Interaction in Hypertensive Patients by MRI.

BACKGROUND: Mitral regurgitation may occur when hypertension causes left ventricular (LV) and left atrial (LA) remodeling. However, its role in LA function in hypertensive patients remains unclear. PURPOSE: To explore how mitral regurgitation affects LA function in hypertension and to investigate atrioventricular interaction in hypertensive patients with mitral regurgitation. STUDY TYPE: Retrospective. POPULATION: A total of 193 hypertensive cases and 64 controls. FIELD STRENGTH/SEQUENCE: A 3.0 T/balanced steady-state free precession. ASSESSMENT: LA volume (LAV), LA strain (reservoir, conduit, and active), LA ejection fraction, and LV strain (global peak longitudinal [GLS], circumferential [GCS], and radial strain [GRS]) were evaluated and compared among groups. Regurgitant fraction (RF) was evaluated in regurgitation patients and used to subdivide patients into mild (RF: 0%-30%), moderate (RF: 30%-50%), and severe (RF: >50%) regurgitation categories. STATISTICAL TESTS: One-way analysis of variance, Spearman and Pearson's correlation coefficients (r), and multivariable linear regression analysis. A P value <0.05 was considered statistically significant. RESULTS: Hypertensive patients without mitral regurgitation showed significantly impaired LA reservoir and conduit functions and significantly decreased LV GLS but preserved pump function and LAV compared to controls (P = 0.193-1.0). Hypertensive cases with mild regurgitation (N = 22) had significantly enlarged LAV and further reduced LA reservoir function, while the group with moderate regurgitation (N = 20) showed significantly reduced LA pump function, further impaired conduit function, and significantly reduced LV strain. The severe regurgitation (N = 13) group demonstrated significantly more severely impaired LA and LV functions and LAV enlargement. Multivariable linear regression showed that regurgitation degree, GRS, GCS, and GLS were independently correlated with the LA reservoir, conduit, and active strain in hypertensive patients with mitral regurgitation. DATA CONCLUSION: Mitral regurgitation may exacerbate LA and LV impairment in hypertension. Regurgitation degree, LV GRS, GCS, and GLS were independent determinants of the LA strain in hypertensive patients with mitral regurgitation, which demonstrated atrioventricular interaction. EVIDENCE LEVEL: 4. TECHNICAL EFFICACY: Stage 3.

Additional Impact of Aortic Regurgitation on Left Ventricular Strain and Remodeling in Essential Hypertension Patients Evaluated Using MRI.

BACKGROUND: Understanding the impact of aortic regurgitation (AR) on hypertensive patients' hearts is important. PURPOSE: To assess left ventricular (LV) strain and structure in hypertensive patients and investigate the relationship with AR severity. STUDY TYPE: Retrospective. POPULATION: 263 hypertensive patients (99 with AR) and 62 controls, with cardiac MRI data. FIELD STRENGTH/SEQUENCE: Balanced steady-state free precession (bSSFP) sequence at 3.0T. ASSESSMENT: AR was classified as mild, moderate, or severe based on echocardiographic findings. LV geometry was classified as normal, concentric remodeling, eccentric hypertrophy, or concentric hypertrophy based on MRI assessment of LV mass/volume ratio and LV Mass index (LVMI). LV global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS) were obtained by post-processing bSSFP cine datasets using commercial software. STATISTICAL TESTS: ANOVA, Kruskal-Wallis test, Spearman's correlation coefficients (r), chi-square test, and multivariable linear regression analysis. A P value <0.05 was considered statistically significant. RESULTS: Hypertensive patients with AR had significantly lower LV myocardial strain and higher LVMI than the group without AR (GRPS 26.25 ± 12.23 vs. 34.53 ± 9.85, GCPS -17.4 ± 5.84 vs. -20.57 ± 3.57, GLPS -9.86 ± 4.08 vs. -12.95 ± 2.94, LVMI 90.56 ± 38.56 vs.58.84 ± 17.55). Of the 99 patients with AR, 56 had mild AR, 26 had moderate AR and 17 had severe AR. The degree of AR was significantly negatively correlated to the absolute values of LV GRPS, GCPS and GLPS (r = -0.284 - -0.416). LV eccentric hypertrophy increased significantly with AR severity (no AR 21.3%, mild AR 42.9%, moderate AR 73.1%, severe AR 82.4%). In multivariable analysis, the degree of AR was an independent factor affecting LV global strain and LVMI even after considering confounding factors (ß values for global myocardial strain were -0.431 to -0.484, for LVMI was 0.646). DATA CONCLUSION: Increasing AR severity leads to decreased cardiac function and worse ventricular geometric phenotypes in hypertensive patients. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.

[Epidemiological Analysis of Carbapenem-Resistant Enterobacteriaceae Strains in the Clinical Specimens of a Hospital].

Objective: To analyze the detection rate, in vitro susceptibility to antibiotics, and carbapenemase types of carbapenem-resistant Enterobacteriaceae (CRE) strains in the clinical samples of a hospital and to provide support for the prevention, control and treatment of CRE-related infections. Methods: Clinical specimens were examined according to the operating procedures of bacteriological tests. Species identification and in vitro drug susceptibility testing were performed on the isolated strains. Carbapenemase inhibitor enhancement testing, which combined the use of 3-aminobenzeneboronic acid and ethylenediaminetetraacetic acid, was conducted to identify the types of carbapenemase in the CRE strains. Results: In 2021, 2215 CRE strains were isolated from 157196 clinical samples collected in this hospital, presenting a detection rate of 1.4% (2215/157196). A total of 1134 non-repetitive strains of CRE were isolated from 903 patients. The main sources of samples were respiratory tract (494/1134, 43.6%), secretion (191/1134, 16.8%) and blood (173/1134, 15.3%) samples. The cases with the same CRE strain isolated from the samples of two, three and four sites accounted for 12.5%, 4.9%, and 1.1%, respectively. The most common species was Klebsiella pneumoniae (883/1134, 77.9%), followed by Enterobacter cloacae complex (107/1134, 9.4%) and Escherichia coli (96/1134, 8.5%). The rates of resistance to polymyxin B and tigecycline of different species of CRE strains were not significantly different ( P<0.05). Serine carbapenemase-producing strains, metallo-ß-lactamase-producing strains, and those producing both enzymes accounted for 82.6% (809/979), 17.2% (168/979), and 0.2% (2/979), respectively. Conclusion: CRE strains are frequently isolated from samples collected from the respiratory tract, secretion, and blood. The most common strain is serine carbapenemase-producing K. pneumoniae, which has a high resistance rate to various antimicrobial drugs, and risk factors of its associated infections deserve more attention.

Comparison of Silicosis and Tuberculosis Involving Mediastinal Lymph Nodes Based on Contrast-Enhanced Multidetector-Row Computed Tomography.

PURPOSE: To investigate the different imaging features of contrast-enhanced multidetector-row-computed tomography (MDCT) for distinguishing between silicosis and tuberculosis involving the mediastinal lymph nodes. METHODS: 86 silicosis patients and 61 tuberculosis patients with mediastinal lymphadenopathy based on contrast-enhanced MDCT were included. The enhanced patterns, anatomical distribution and calcification features of the enlarged lymph nodes were retrospectively compared between the groups using the Pearson chi-square test or Fisher's exact test. RESULTS: Homogeneous enhancement of the mediastinal lymph nodes was more commonly observed in silicosis (94.2%, 81/86) than in tuberculosis (19.7%, 12/61). Peripheral enhancement was more frequent in tuberculosis (n = 44, 72.1%) than in silicosis involving the mediastinal lymph nodes (n = 1, 1.2%), and multilocular appearance was more frequent in TB than in silicosis. Tuberculosis was more likely to affect regions 1R, 2R, 2L, 3A, 5 and 6 than silicosis (all p < 0.05), especially region 2R. Calcification of the lymph nodes was more common in the silicosis group than in tuberculosis group. The sensitivity, specificity, and accuracy of silicosis with lymphadenopathy with homogeneous enhanced pattern were 94.2%, 80.3% and 88.4%, respectively. The sensitivity, specificity, and accuracy of tuberculosis lymphadenopathy with peripheral enhanced pattern were 72.1%, 98.8%, and 87.7%, respectively. CONCLUSION: The predominant enhanced patterns, anatomical distribution, and calcification features of mediastinal lymph nodes were different between tuberculosis and silicosis. These radiographic features might help differentiate tuberculosis from silicosis, which provides imaging information for the differential diagnosis of the two diseases in a clinical setting.

[The Transmission of KPC-2 Gene in Klebsiella Species].

OBJECTIVES: To explore the mechanisms of imipenem resistance inKlebsiella spp. and the transmission of Klebsiella pneumoniae Carbapenemase-2(KPC-2) gene in Klebsiella species. METHODS: The imipenem resistant Klebsiella pneumoniae and Klebsiella oxytoca were isolated in the West China Hospital of Sichuan University in 2009/2010 and 2012/2013. Their minimal inhibitory concentration (MIC) was determined by agar dilution method. CARB ChromID plate and improved Hodge test were undertaken to detect carbapenemases resistant phenotype. PCR method was used for detecting KPC-2 gene. Plasmid transmission was detected by plasmid conjugation tests. The homology of the plasmids and the strains was analyzed using random amplified polymorphic DNA (RAPD) and enterobacterial repetitive intergenic consensus PCR(ERIC-PCR) methods. RESULTS: Three strains of Klebsiella oxytoca collected in 2009/2010 and 7 Klebsiella pneumoniae collected in 2012/2013 developed carbapenemases resistance, all of which carried KPC-2 gene. The 3 KPC-2 positive plasmids isolated from Klebsiella oxytoca transited to recipient organisms and showed homology with the 7 KPC-2 gene positive plasmids isolated from Klebsiella pneumoniae. The ERIC-PCR showed homology of the 7 KPC positive Klebsiella pneumoniae. CONCLUSIONS: Carbapenemases inKlebsiella spp with expressed KPC-2 gene contribute to the development of resistance in this hospital. The transmission of KPC-2 plasmid in Klebsiella oxytoca may cause imipenem resistance in Klebsiella pneumonia. The horizontal transmission may be the main mechanism in the spread of imipenem resistance inKlebsiella spp.

[FLT3 Gene Expression and Its Clinical Significance in Acute Myeloid Leukemia.]

OBJECTIVES: To determine the correlation between fms-like tyrosine kinase 3 gene (FLT3) expression and FLT3-internal tandem duplication (ITD) mutations in acute myeloid leukemia patients,and the association between expression of FLT3 gene and clinical and laboratory features of patients. METHODS: The expression of FLT3 mRNA in bone marrow (BM) leukemic cells of 128 acute myeloid leukemia (AML) patients was measured by real-time PCR.The patients were divided into two groups using the 35% FLT3 expression as a cut-off point.The associations between the expression level of FLT3 and clinical and laboratory features of patients were analyzed. RESULTS: The patients had a FLT3 gene expression level of 0.01-180.68 (mean 14.65) at the initial diagnosis,with AML-M1 the most expressed and AML-M6 the least expressed,but without statistical significance.The patients with a high level of FLT3 gene expression had higher peripheral blood white blood cell count (WBC) (P<0.01) and were more likely to become anemic and febrile (P<0.05).WBC [regression coefficient (B)=1.508,odds ratio (OR)=4.518,95% confidence interval(CI):1.465-13.390,P=0.009] and anemia (B=2.142,OR=8.513,95%CI:3.201-22.644,P<0.001)were predictors of higher expression of FLT3.The patients with high levels of FLT3 gene expression had lower complete remission rate (32/83),compared with those (36/44) with low levels of FLT3 gene expression (P<0.05).The Cox regression analysis showed that the patients with higher levels of FLT3 gene expression had a higher risk of death (B=1.338, relative risk=3.810, 95%CI:1.820-7.947,P<0.001).The Kaplan-Meier analysis showed that the patients with higher levels of FLT3 gene expression had lower survival time (56.63%) than those with lower levels of FLT3 expression (70.45%,P<0.05). CONCLUSIONS: FLT3 gene has adverse impacts on complete remission of AML.High expression of FLT3 gene is associated with poor prognosis of patients with AML.

[Molecular Features of SMA-related Genes in Spinal Muscular Atrophy Patients of Han Nationality in Southwest China.]

OBJECTIVES: To investigate the molecular features of spinal muscular atrophy (SMA) related genes in SMA patients of Han nationality of southwest of China. METHODS: We collected 62 unrelated patients of SMA and 50 unrelated healthy individuals in this study.The copy numbers of survival motor neuron gene (SMN) and uronal-apoptosis inhibitory protein gene (NAIP) were measured by using multiplex ligation-dependent probe amplification (MLPA). RESULTS: Of 62 patients,the copy number of SMA1-4 were 30.65% (19/62),41.94%(26/62),16.13% (10/62),11.29% (7/62),respectively.The deletion of SMN1 exon 7 accounts for 98.38% (61/62).The deletion of SMN1 exon 8 accounts for 82.26% (51/62).Among SMA 1 patients,the homozygous deletion of NAIP exon 5 accounts for 68.42% (13/19) and heterzygous deletion accounts for 26.32% (5/19).Among SMA2-4patients,the homozygous deletion of NAIP exon 5 accounts for 13.95% (6/43) and heterzygous deletion accounts for 62.79% (27/43).Furthermore,68.42% (13/19) patients of SMA1have 1 copy and 2 copies of SMN2 gene,84.62% (22/26) patients of SMA 2 have more than 2 copies of SMN2 gene,90.00% (9/10) SMA3 and 85.71% (6/7) SMA4 have over 2 copies of SMN2 gene and even have 5 and 6 copy of SMN2 gene. CONCLUSIONS: The deletion of SMN1 gene is the main cause of SMA,and the change of SMN2 and NAIP copy number can affect the severity of SMA.

[Characteristics of mediastinal lymph nodes enlargement determined by contrast-enhanced multi-detector CT in patients with sarcoidosis].

OBJECTIVE: To determine the enhancement patterns and anatomic distribution of enlarged mediastinal lymph nodes using contrast-enhanced multi-detector CT (MDCT) in patients with sarcoidosis. METHODS: We reviewed the contrast-enhanced MDCT features of 39 patients with pathologically or clinically diagnosed sarcoidosis, including the size, morphology, attenuation, enhancement patterns, and anatomic distribution of the enlarged mediastinal lymph nodes. RESULTS: Of the 39 patients, 85% showed homogenous enhancement and 15% showed homogenous mixed with peripheral enhancement. The enlarged lymph nodes were predominantly distributed in the regions of 10R (95%), 10L (90%), 2R (69%), 7 (69%), and 5 (58%). CONCLUSION: Contrast-enhanced MDCT can detect the enhancement patterns and predominant anatomic distribution of enlarged mediastinal lymph nodes, which is of great value for the diagnosis of sarcoidosis.

Additive effects of mitral regurgitation on left ventricular strain in essential hypertensive patients as evaluated by cardiac magnetic resonance feature tracking.

Objectives: Hypertension is one of the leading risk factors for cardiovascular disease. Mitral regurgitation (MR) is a heart valve disease commonly seen in hypertensive cases. This study aims to assess the effect of MR on left ventricle (LV) strain impairment among essential hypertensive cases and determine factors that independently impact the global peak strain of the LV. Materials and methods: We enrolled 184 essential hypertensive patients, of which 53 were patients with MR [HTN (MR +) group] and 131 were without MR [HTN (MR-) group]. Another group of 61 age-and gender-matched controls was also included in the study. All participants had received cardiac magnetic resonance examination. The HTN (MR +) group was classified into three subsets based on regurgitation fraction, comprising mild MR (n = 22), moderate MR (n = 19), and severe MR (n = 12). We compared the LV function and strain parameters across different groups. Moreover, we performed multivariate linear regression to determine the independent factors affecting LV global radial peak strain (GRS), circumferential peak strain (GCS), and global longitudinal peak strain (GLS). Results: HTN (MR-) cases exhibited markedly impaired GLS and peak diastolic strain rate (PDSR) but preserved LV ejection fraction (LVEF) compared to the controls. However, HTN (MR +) patients showed a decrease in LVEF and further deteriorated GRS, GCS, GLS, PDSR, and the peak systolic strain rate (PSSR) compared to the HTN (MR-) group and controls. With increasing degrees of regurgitation, the LV strain parameters were gradually reduced in HTN (MR +) patients. Even the mild MR group showed impaired GCS, GLS, PDSR, and PSSR compared to the HTN (MR-) group. Multiple regression analyses indicated that the degree of regurgitation was independently associated with GRS (ß = -0.348), GCS (ß = -0.339), and GLS (ß = -0.344) in HTN (MR +) patients. Conclusion: GLS was significantly impaired in HTN (MR-) patients. MR may further exacerbate the deterioration of LV strain among essential hypertensive cases. Besides, the degree of regurgitation was independently correlated with GRS, GCS, and GLS in HTN (MR +) patients.

Earthquake-related crush injury versus non-earthquake injury in abdominal trauma patients on emergency multidetector computed tomography: a comparative study.

The aim of this study was to investigate features of abdominal earthquake-related crush traumas in comparison with non-earthquake injury. A cross sectional survey was conducted with 51 survivors with abdominal crush injury in the 2008 Sichuan earthquake, and 41 with abdominal non-earthquake injury, undergoing non-enhanced computed tomography (CT) scans, serving as earthquake trauma and control group, respectively. Data were analyzed between groups focusing on CT appearance. We found that injury of abdominal-wall soft tissue and fractures of lumbar vertebrae were more common in earthquake trauma group than in control group (28 vs 13 victims, and 24 vs 9, respectively; all P < 0.05); and fractures were predominantly in transverse process of 1-2 vertebrae among L1-3 vertebrae. Retroperitoneal injury in the kidney occurred more frequently in earthquake trauma group than in control group (29 vs 14 victims, P < 0.05). Abdominal injury in combination with thoracic and pelvic injury occurred more frequently in earthquake trauma group than in control group (43 vs 29 victims, P < 0.05). In conclusion, abdominal earthquake-related crush injury might be characteristic of high incidence in injury of abdominal-wall soft tissue, fractures of lumbar vertebrae in transverse process of 1-2 vertebrae among L1-3 vertebrae, retroperitoneal injury in the kidney, and in combination with injury in the thorax and pelvis.

Carotid and cerebrovascular disease in symptomatic patients with type 2 diabetes: assessment of prevalence and plaque morphology by dual-source computed tomography angiography.

BACKGROUND: Plaque morphology directly correlates with risk of embolism and the recently developed dual-source computed tomography angiography (DSCTA) may help to detect plaques more precisely. The aim of our study was to evaluate the prevalence and morphology of carotid and cerebrovascular atherosclerotic plaques in patients with symptomatic type 2 diabetes mellitus (DM) by DSCTA. METHODS: From July 2009 to August 2010, DSCTA was prospectively performed in 125 consecutive patients with symptomatic type 2 DM. We retrospectively analyzed plaque type, distribution, and extensive and obstructive natures were determined for each segment for all patients. RESULTS: Atherosclerotic plaques were detected in 114 (91.2%) patients. Relatively more noncalcified (45%) and calcified (39%) plaques and less mixed (16%) plaques were observed (p < 0.001). Noncalcified plaques were found mainly in the intracranial arteries (81.8%), mixed plaques in the intracranial arteries (25.2%) and intracranial internal carotid artery (ICA) (56.1%). Calcified plaques were found mainly in the intracranial ICA (65.9%) and extracranial arteries (28.2%) (for all, p < 0.001). Extension of plaques from the 1(st) to 5(th) segments was observed in 67 (58.8%) patients and from the 6(th) to 10(th) segments in 35 (30.7%) patients. The most common site of all detected plaques was the cavernous segment. Regarding stenosis, there were significantly more nonobstructive than obstructive stenosis (91% vs. 9%, p < 0.001). CONCLUSION: DSCTA detected a high prevalence of plaques in patients with symptomatic type 2 DM. A relatively high proportion of plaques were noncalcified, as well as with nonobstructive stenosis. The distribution of plaques was extensive, with the cavernous portion of ICA being the most common site.

Characteristics of coronary artery disease in symptomatic type 2 diabetic patients: evaluation with CT angiography.

BACKGROUND: Coronary artery disease (CAD) is a common and severe complication of type 2 diabetes mellitus (DM). The aim of this study is to identify the features of CAD in diabetic patients using coronary CT angiography (CTA). METHODS: From 1 July 2009 to 20 March 2010, 113 consecutive patients (70 men, 43 women; mean age, 68 ± 10 years) with type 2 DM were found to have coronary plaques on coronary CTA. Their CTA data were reviewed, and extent, distribution and types of plaques and luminal narrowing were evaluated and compared between different sexes. RESULTS: In total, 287 coronary vessels (2.5 ± 1.1 per patient) and 470 segments (4.2 ± 2.8 per patient) were found to have plaques, respectively. Multi-vessel disease was more common than single vessel disease (p < 0.001), and the left anterior descending (LAD) artery (35.8%) and its proximal segment (19.1%) were most frequently involved (all p < 0.001). Calcified plaques (48.8%) were the most common type (p < 0.001) followed by mixed plaques (38.1%). Regarding the different degrees of stenosis, mild narrowing (36.9%) was most common (p < 0.001); however, a significant difference was not observed between non-obstructive and obstructive stenosis (50.4% vs. 49.6%, p = 0.855). Extent of CAD, types of plaques and luminal narrowing were not significantly different between male and female diabetic patients. CONCLUSIONS: Coronary CTA depicted a high plaque burden in patients with type 2 DM. Plaques, which were mainly calcified, were more frequently detected in the proximal segment of the LAD artery, and increased attention should be paid to the significant prevalence of obstructive stenosis. In addition, DM reduced the sex differential in CT findings of CAD.

Earthquake-related crush fractures and non-earthquake-related fractures of the extremities: a comparative radiological study.

OBJECTIVE: To determine the features that differentiate earthquake-related crush extremity fractures from non-earthquake-related extremity fractures by using digital radiography (DR) and multidetector row computed tomography (MDCT). METHODS: Six hundred and twenty-three consecutive victims with crush extremity fractures arising from the 2008 Sichuan earthquake, including 611 undergoing DR and 12 undergoing MDCT, entered the test group, and 316 consecutive victims with non-earthquake-related extremity fractures, including 301 undergoing DR and 15 undergoing MDCT, were enrolled in the control group. Image data were reviewed retrospectively and statistically between groups focusing on the anatomic distributions, numbers and types of extremity fractures. RESULTS: Fractures involving multiple extremities were more likely in the test group than the control group (88/623 vs 27/316 victims, P < 0.05). Fractures involving multiple bones (336/623 vs 112/316 victims) and comminuted fractures (324/623 vs 78/316 victims) were seen more frequently in the test group than the control group with both occurring predominantly in the tibia and fibula (all P < 0.05). CONCLUSION: Earthquake-related crush fractures of extremities are more likely than non-earthquake-related extremity fractures to involve multiple extremities, multiple bones and to be comminuted. The lower extremities, predominantly the tibia and fibula, are more likely to be involved. This has implications for emergency and disaster planning in earthquake-prone regions.

Tuberculosis versus lymphoma in the abdominal lymph nodes: a comparative study using contrast-enhanced MRI.

PURPOSE: The purpose of this study was to determine the differential characteristics on MRI between tuberculosis and lymphoma in abdominal lymph nodes. MATERIALS AND METHODS: We conducted a retrospective analysis for the counter, size, signal intensity, enhancement patterns, and anatomic distribution of lymph nodes in 57 consecutive patients with documented tuberculosis (28 patients; 49.1%) and newly diagnosed, untreated lymphoma (29 patients; 50.9%). RESULTS: Twenty-four cases (85.7%) in the tuberculosis group were hyperintense on T2-weighted images and either hypointense or isointense on T1-weighted images with respect to the abdominal wall muscle. All cases in the lymphoma group were hyperintense on T2-weighted images and isointense on T1-weighted images with respect to the abdominal wall muscle. Concerning the main anatomic distribution of lymph nodes, the lymph nodes in the lower paraaortic region were more frequently involved in the lymphoma group (48.3%) than in tuberculosis (17.9%, p<0.05). Moreover, mesenteric lymph nodes were more often involved in tuberculosis (32.1%) than in lymphoma (6.9%, p<0.05). Tuberculous lymphadenopathy showed predominantly peripheral enhancement, frequently with a multilocular appearance; whereas lymphomatous adenopathy often demonstrated uniform homogeneous enhancement (all p<0.001). CONCLUSION: Contrast-enhanced MRI can be useful in differentiation between these two entities.

Earthquake-related injuries: evaluation with multidetector computed tomography and digital radiography of 1491 patients.

PURPOSE: The aim of this study was to evaluate the common features of earthquake-related injuries using radiography and computed tomography. MATERIALS AND METHODS: We retrospectively reviewed the radiography and multidetector computed tomography features of 1491 patients injured in 2008 Sichuan earthquake. We categorized patients by age group (<35, 35-64, and ≥ 65 years) and time to imaging. Injuries were categorized by anatomical distribution. RESULTS: We detected earthquake-related trauma in 1197 patients (80.28%), including head injuries, facial fractures, thoracic injuries, abdominal injuries, pelvic fractures, spinal injuries, and extremity fractures in 91, 41, 354, 30, 204, 299, and 732 (61.15%) patients, respectively (χ(2) = 1844.747, P < .001). Injuries in 2 or more anatomical locations occurred in 384 cases. We discovered significant difference in the anatomical distribution of injuries among the 3 age groups (χ(2) = 104.113, P < .001) and among the time-to-imaging categories (χ(2) = 64.420, P < .001). Twenty-two patients (1.48%) eventually died. Abdominal injuries (B = 2.285, P = .004), head injuries (B = 2.194, P < .001), thoracic injuries (B = 1.989, P < .001), and age (B = 1.539, P < .001) were all associated with patient death. CONCLUSIONS: The Sichuan earthquake most commonly resulted in extremity fractures, but there was a high incidence of injuries to multiple body areas. Head, abdominal, and thoracic injuries and age older than 64 years all were significant risk factors for earthquake mortality.

Left atrial diverticula in patients referred for radiofrequency ablation of atrial fibrillation: assessment of prevalence and morphologic characteristics by dual-source computed tomography.

BACKGROUND: The anatomic features of left atrial diverticula (LAD) are still unclear in patients with atrial fibrillation (AF). The purpose of this study was to evaluate the prevalence and morphological characteristics of LAD in patients referred for radiofrequency transcatheter ablation of AF with dual-source computed tomography. METHODS AND RESULTS: Dual-source computed tomography images were obtained in 214 patients referred for AF catheter ablation and 214 sex- and age-matched control subjects. Images were analyzed to determine the prevalence and morphological characteristics of LAD and their relationship with adjacent pulmonary veins and left atrial appendage. In AF patients 77 (36.0%) (95% confidence interval, 29.6-42.4%) had 90 LAD, whereas in control subjects 70 (32.7%) (95% confidence interval, 26.4-39.0%) had 81 LAD (P=0.551). In patients with AF, LAD locations were right anterosuperior (47.8%), left anterosuperior (8.9%), left lateral (32.2%), interatrial septum (4.4%), right inferior (5.6%), and posterosuperior (1.1%) walls, respectively. The mean size of LAD was 5.3±2.9×5.6±3.3 mm. The wall of the LAD was much thinner than that of adjacent left atrium (0.89±0.46 versus 2.39±0.83 mm). Most LAD were located close to a pulmonary vein or atrial appendage ostium, with a mean distance of 8.7-13.1 mm. CONCLUSIONS: LAD are common, with a prevalence of 36.0% in patients with AF, which is not statistically greater than that in patients without AF. Thin-walled LAD are more commonly located on the superior anterior wall of left atrium and close to common ablation sites.

Earthquake-related pelvic crush fracture vs. non-earthquake fracture on digital radiography and MDCT: a comparative study.

OBJECTIVE: To determine the features of earthquake-related pelvic crush fractures versus non-earthquake fractures with digital radiography and multidetector row computed tomography. METHODS: One hundred and sixty-seven survivors with pelvic crush fractures in the 2008 Sichuan earthquake were entered in our study as the earthquake-related group (139 underwent digital radiography, 28 underwent multidetector row computed tomography); 70 victims with non-earthquake pelvic fractures were enrolled into this study as the non-earthquake group (54 underwent digital radiography, 16 underwent multidetector row computed tomography). Data were reviewed retrospectively between groups, focusing on anatomic distributions, status of pelvic bone fractures, numbers of pelvic bones involved, and classification of pelvic ring fractures according to the Tile classification system. RESULTS: Pelvic fractures occurred more frequently in the pubis in the earthquake-related group than in the non-earthquake group (135/167, 81% vs. 48/70, 69%). In addition, comminuted fractures were more common in the earthquake-related group than in the non-earthquake group (55/167, 33% vs. 10/70, 14%). Multiple fractures were less common in the earthquake-related group than in the non-earthquake group (81/167, 49% vs. 46/70, 66%). Regarding the classification of pelvic ring fractures, Type C predominantly composed of subtype C3 occurred more frequently (64/167, 38% vs. 12/70, 17%), and Type A was less common in the earthquake-related group than in the non-earthquake group (31/167, 19% vs. 23/70, 32%). All differences were statistically significant (p<0.05). No difference was found in Type B fractures between the groups (72/167, 43% vs. 35/70, 50%). CONCLUSION: Earthquake-related pelvic crush fractures can be characterized by a high incidence of pelvic fractures occurring in the pubis, comminuted fractures, and Type C fractures predominantly composed by subtype C3, despite a low incidence of multiple fractures.

Abdominal crush injury in the Sichuan earthquake evaluated by multidetector computed tomography.

AIM: To investigate the features of abdominal crush injuries resulting from an earthquake using multidetector computed tomography (MDCT). METHODS: Fifty-one survivors with abdominal crush injuries due to the 2008 Sichuan earthquake underwent emergency non-enhanced scans with 16-row MDCT. Data were reviewed focusing on anatomic regions including lumbar vertebrae, abdominal wall soft tissue, retroperitoneum and intraperitoneal space; and types of traumatic lesions. RESULTS: Fractures of lumbar vertebrae and abdominal wall soft tissue injuries were more common than retro- and intraperitoneal injuries (P < 0.05). With regard to the 49 lumbar vertebral fractures in 24 patients, these occurred predominantly in the transverse process (P < 0.05), and 66.67% of patients (16/24) had fractures of multiple vertebrae, predominantly two vertebrae in 62.5% of patients (10/16), mainly in L1-3 vertebrae in 81.63% of the vertebrae (40/49). Retroperitoneal injuries occurred more frequently than intraperitoneal injuries (P < 0.05), and renal and liver injuries were most often seen in the retroperitoneum and in the intraperitoneal space, respectively (all P < 0.05). CONCLUSION: Transverse process fractures in two vertebrae among L1-3 vertebrae, injury of abdominal wall soft tissue, and renal injury might be features of earthquake-related crush abdominal injury.

Digital radiography of crush thoracic trauma in the Sichuan earthquake.

AIM: To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography (CDR). METHODS: We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake. Patient age ranged from 0.5 to 103 years. CDR was performed between May 12, 2008 and June 7, 2008. We looked for injury to the thoracic cage, pulmonary parenchyma and the pleura. RESULTS: Antero-posterior (AP) and lateral CDR were obtained in 349 patients, the remaining 423 patients underwent only AP CDR. Thoracic cage fractures, pulmonary contusion and pleural injuries were noted in 331 (42.9%; 95% CI: 39.4%-46.4%), 67 and 135 patients, respectively. Of the 256 patients with rib fractures, the mean number of fractured ribs per patient was 3. Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib. Rib fractures had a significant positive association with non-rib thoracic fractures, pulmonary contusion and pleural injuries (P < 0.001). The number of rib fractures and pulmonary contusions were significant factors associated with patient death. CONCLUSION: Earthquake-related crush thoracic trauma has the potential for multiple fractures. The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment.

Earthquake-related pelvic crush fracture vs. non-earthquake fracture on digital radiography and MDCT: a comparative study

OBJECTIVE: To determine the features of earthquake-related pelvic crush fractures versus non-earthquake fractures with digital radiography and multidetector row computed tomography. METHODS: One hundred and sixty-seven survivors with pelvic crush fractures in the 2008 Sichuan earthquake were entered in our study as the earthquake-related group (139 underwent digital radiography, 28 underwent multidetector row computed tomography); 70 victims with non-earthquake pelvic fractures were enrolled into this study as the non-earthquake group (54 underwent digital radiography, 16 underwent multidetector row computed tomography). Data were reviewed retrospectively between groups, focusing on anatomic distributions, status of pelvic bone fractures, numbers of pelvic bones involved, and classification of pelvic ring fractures according to the Tile classification system. RESULTS: Pelvic fractures occurred more frequently in the pubis in the earthquake-related group than in the non-earthquake group (135/167, 81 percent vs. 48/70, 69 percent). In addition, comminuted fractures were more common in the earthquake-related group than in the non-earthquake group (55/167, 33 percent vs. 10/70, 14 percent). Multiple fractures were less common in the earthquake-related group than in the non-earthquake group (81/167, 49 percent vs. 46/70, 66 percent). Regarding the classification of pelvic ring fractures, Type C predominantly composed of subtype C3 occurred more frequently (64/167, 38 percent vs. 12/70, 17 percent), and Type A was less common in the earthquake-related group than in the non-earthquake group (31/167, 19 percent vs. 23/70, 32 percent). All differences were statistically significant (p<0.05). No difference was found in Type B fractures between the groups (72/167, 43 percent vs. 35/70, 50 percent). CONCLUSION: Earthquake-related pelvic crush fractures can be characterized by a high incidence of pelvic fractures occurring in the pubis, comminuted fractures, and Type C fractures predominantly composed by subtype C3, despite a low incidence of multiple fractures.