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Plasmodium falciparum malaria, caused by Plasmodium falciparum infection, is an Anopheles mosquito-transmitted infectious diseases, which predominantly occurs in tropical areas of Africa. P. falciparum malaria is characterized by complex and atypical clinical manifestations, and high likelihood of misdiagnosis and missing diagnosis, and may be life-threatening if treated untimely. This case report presents the diagnosis and treatment of a P. falciparum malaria case with acute abdominal pain as the first symptom.
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Objective:To evaluate the value of dual-energy CT (DECT) mixed images CT in predicting hemorrhagic transformation (HT) after endovascular therapy (EVT) of acute ischemic stroke (AIS).Methods:From October 2018 to January 2020, the immediate dual-energy CT images of intracranial high attenuation (HA) regions in patients with AIS after endovascular treatment in Wuhan No.1 Hospital were retrospectively analyzed. According to the diagnostic criteria of CT or diffusion weighted image in 72 hours of follow-up, they were classified into HT group and non-HT group. The CT value of mixed images, contrast media, and virtual non-enhancement (VNC) and iodine concentration in the highest attenuation areas were measured. Intragroup correlation coefficient was used to evaluate the consistency among the readers; Mann-Whitney U test was used to compare the difference between the two groups of quantitative parameters; Spearman correlation analysis was uesd for evaluating correlation between mixed images CT value and contrast media CT value, VNC CT value, and iodine concentration. The receiver operating characteristic curve was used to analyze the quantitative parameters to predict the diagnostic efficacy of HT. Results:A total of 154 cases were enrolled, with 65 cases in the HT group and 89 cases in the non-HT group. The intraclass correlation coefficient of CT values of mixed images was 0.861 ( P<0.05). Comparing the non-HT group and the HT group,the CT value of mixed images [59.40(54.84, 63.05) HU vs 100.10(79.90, 122.40) HU, Z=-10.87, P<0.001],contrast agent CT value [24.90(20.75, 30.05) HU vs 66.60(47.10, 84.15) HU, Z=-10.85, P<0.001] and iodine concentration [1.10(1.00, 1.30) mg/ml vs 2.90(2.05, 3.65) mg/ml, Z=-10.85, P<0.001] both increased in the HT group, but there was no significant difference in VNC CT values between the two groups [33.60(31.80, 35.70) HU vs 34.30(30.90, 38.00) HU, Z=-0.50, P=0.62]. There was a highly significant correlation between the CT value of mixed images and iodine concentration ( r=0.99, P<0.01). Using CT value>72.60 HU as the diagnostic cutoff value for predicting HT, the sensitivity and specificity were 89.23% and 95.51%, respectively. Conclusions:The CT value of DECT mixed images after EVT can be used to predict HT within 72 hours. When DECT was not available, conventional CT scan′s intracranial HA density over 72.60 HU can be selected as the cutoff value for predicting HT.
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Objective@#To investigate the first chest HRCT imaging manifestations infected with novel coronavirus pneumonia (NCP).@*Method@#A retrospective analysis of the first chest HRCT images of 106 patients with NCP clinically diagnosed in our hospital from January 3 to 25, 2020. Lesion distribution, morphology and surrounding involvement were analyzed.@*Result@#Lesions were found in the first lung HRCT of 106 patients, with unilateral lung distribution in 11 cases (10.4%), bilateral lung distribution in 95 cases (89.6%), and peripheral distribution of lung in 65 cases (61.3%). 41 cases (38.7%) were distributed at the same time; 8 cases (7.5%) were 1 lesion, 5 cases (4.7%) were 2 lesions, 93 cases (87.8%) were multiple lesions, and 12 cases were nodular lesions (11.3%). 94 cases of ground-glass lesions (88.7%), 7 cases of cord-like lesions (6.6%), 15 cases (14.2%) of coexisting lesions of two or more forms; 10 cases (9.4%) involving one lung lobe There were 96 cases (90.6%) involving two or more lung lobes; 24 cases (22.6%) with enlarged mediastinal lymph nodes (19 cases over 60 years old, accounting for 79.2%); 3 cases with pleural effusion (2.8 %), 1 case had pericardial effusion (0.9%), and 2 cases had pleural involvement / thickening (1.9%). Patients over 60 years of age mostly present with multiple lesions, multiple morphology, peripheral and central distribution of lungs, involving multiple lung lobes, and enlarged mediastinal lymph nodes.@*Conclusions@#Lung lesions of NCP patients can be detected for the first time by chest HRCT, which is the preferred imaging method. Thoracic HRCT scans play an important role in the early diagnosis of new coronavirus (NCP). .
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Objective:To investigate the initial chest high resolution CT (HRCT) manifestations of the patients with COVID-19.Methods:A retrospective analysis of the first chest HRCT images of 106 patients with COVID-19 was performed who were confirmed in our hospital from January 3 to 25, 2020. Lesion distribution, morphology and surrounding involvement were analyzed.Results:The lesions were found on all initial HRCT images of 106 patients, with unilateral lung distribution in 11 cases (10.4%) and bilateral lung distribution in other 95 cases(89.6%), peripheral distribution of lung in 65 cases (61.3%) and peripheral and central distribution in other 41 cases (38.7%). HRCT showed 8 cases (7.5%) with 1 lesion, 5 cases (4.7%) with 2 lesions, and other 93 cases (87.8%) with multiple lesions. HRCT also showed the nodular lesions in 12 cases(11.3%), ground-glass opacities in 94 cases (88.7%), fibrous stripes in 7 cases (6.6%), and mixed lesions in 15 cases (14.2%). Only one lung lobe was involved in 10 cases (9.4%) , while more than two lobes were involved in other 96 cases (90.6%) . In addition, 24 cases (22.6%) with enlarged mediastinal lymph nodes (over 60 years old in 19 cases, accounting for 79.2%), 3 cases with pleural effusion (2.8 %), 1 case with pericardial effusion (0.9%), and 2 cases with pleural involvement/thickening (1.9%) were found. Patients over 60 years old mostly presented with multiple lesions, various appearances, peripheral and central distributions of lungs, involving multiple lobes, and enlarged mediastinal lymph nodes.Conclusions:Lung COVID-19 lesions can be shown by the initial chest HRCT, which is the preferred imaging method. Thoracic HRCT scans play an important role in the early diagnosis of COVID-19.
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Objective TodiscussthevalueofthefusiontechnologyofbronchialarteryCTA with3Dreconstructionoftracheain interventionaltreatmentsforhemoptysis.Methods AretrospectiveanalysiswasconductedinthefusionimagesofthebronchialarteryCTA with 3DreconstructionoftracheaandDSAin58patientswithhemoptysis,therelatedparametersofthebronchialartery(BA)wereobserved (the typeofBA,thebronchialopening,thebronchialoriginandthepositionrelationshipbetweenthebronchus),andthestatisticalanalysiswas performed.Results Inthe58hemoptysispatients,CTArevealed156BAs,including73leftBAs,76rightBAsand7heterotopic BAs.Therewere67BAsresponsibleforhemoptysis,ofwhich64BAswerefromnormaloriginand3BAswerefromheterotopicorigin.Four typesofBAswerefoundandthemostwereR1L1,accountingfor44.8%.BAsaboveandbelowthetrachealcarinaaccountedfor61.5% and 38.5%,respectively.Themeandiameterwas(3.56±1.21)mmforBAsresponsibleforhemoptysisand (1.67±0.32)mmforBAs irresponsibleforhemoptysis.Conclusion ThefusiontechniqueofbronchialarteryCTAandtracheal3Dreconstructionoftracheacan welldetecttheoriginofthesuspectedhemoptysisresponsibilityBA,theposition,andtherelationshipbetweentheshapeandthebifurcation ofthebronchusI.tcanbeusedasthefirstchoiceofroutineexaminationforhemoptysisinterventionaltherapy.
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Objective To summarize the clinical and MSCT manifestations of infectious lesions around the ileocecus.Methods The clinical and CT manifestations of 147 patients with infectious lesions around the ileocecus were analyzed retrospectively.All of patients were confirmed by postoperative pathology or clinical diagnosis.Results Of 147 patients,there were 119 cases of appendicitis, including 2 cases of ileocecal tumor combined with acute appendicitis;1 1 cases of colonic diverticulitis,including 5 cases with bezoars in diverticulum (perforation occurred in 3 cases);14 cases of abdominal abscess (9 cases showed peripheral slightly hyper-density and central hypo-density masses,and 5 cases showed the faveolate inhomogeneous hypo-density,significantly enhanced walls and septum on enhanced CT imaging);3 cases of right tubal abscess showing sausage-like hypo-density.Conclusion CT shows high sensitivity and specificity for the diagnosis of infectious lesions around the ileocecus.MSCT manifestations are more overlapped among different infectious lesions around the ileocecal region,and clinical features of these diseases are similar,which can cause missed diagnosis and misdiagnosis.
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Purpose To evaluate the application value of volume CT perfusion (CTP) protocol with 128-slice CT scanner in patients with unilateral middle cerebral artery (MCA) stenosis or occlusion.Materials and Methods Thirty-five patients with severe unilateral MCA stenosis or occlusion who underwent cerebral volume CTP examination in Wuhan No.1 Hospital between July 2013 and December 2014 were evaluated.The volume CTP parameter maps of cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT) and time to peak (TTP) were analyzed.Meanwhile,the dynamic CT angiography (4D-CTA) images were obtained.Results In three patients,CBF,CBV and MTT were observed normal but TTP was delayed.In the other thirty-two patients,CBF in the affected side was lower than that in the contralateral side (but difference without significance:P＞0.05).The increased CBV,prolonged TTP and MTT were also detected in the affected side compared with the contralateral side (difference with significance:P＜0.05).McNemar test showed 4D-CTA and DSA diagnosis of middle cerebral artery occlusion were not significantly different (P＞0.05),and they had better consistency (Kappa=0.861,P＜0.05).Conclusion Brain volume CTP protocol with 128-slice CT scanner provides valuable information about cerebral artery abnormalities and hemodynamic changes in patients with severe stenosis or occlusion of MCA.It has great value for clinical application.
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Objective To compare the value of the coronary angiography by dual source CT (DSCT)and the transthoracic echo-cardiography (TTE)in the diagnosis of patent foramen ovale(PFO).Methods Recruiting total 476 cases,those who had both of the coronary angiography by DSCT and TTE within 24 hours,collecting the diagnosis cases number and related data for analysis.Results There were 101 out of 476 cases(21.2%)that were diagnosed PFO by coronary angiography DSCT.There were 68 out of 101 cases (67.3%)combined with left right shunt in atrium and there were 33 of 101 cases (32.7%)had no findings in diagnosis of left right shunt(LRS).There were also 5 out of 101 cases combined with atrial septal aneurysm.Meanwhile,there were 71 out of 476 cases (14.94%)that were diagnosed PFO by TTE.5 out of them were combined with atrial septal aneurysm.The diagnosis rate of PFO by TTE combined with CDFI was less than coronary angiography DSCT(P0.05).Con-clusion Coronary angiography DSCT is better than TEE in diagnosis rate and anatomical structures displing in PFO.
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Objective To explore the availability and safety of conducting low-pressure TURP assisted by a home-made cystometry and warning system.Methods 167 benign prostatic hyperplasia (BPH) patients admitted from Jan 2014 to Jan 2016 were randomly assigned into cystostomy group (group A) and non-cystostomy group (group B). In group A (n = 85), 42 patients (group A1) were performed percutaneous cystostomy + TURP, and 43 (group A2) were performed continuous flushing sheath TURP. In group B (n = 82), 42 patients (group B1) were received percutaneous cystostomy + TURP, and 40 (group B2) were received continuous lfushing sheath TURP. In group A, bladder pressure was monitored in real time with a cystometry and was monitored by bladder puncture using a home-made siphon, ensuring low bladder pressure throughout TURP. Serum Na+ levels were measured before and after operation in all four groups. The operation time, the intraoperative bleeding, the weight of resected prostates and the time before which urine turned clear were recorded. The IPSS, maximum lfow rate (Qmax), postvoid residual volume (PVR) and life quality score (QOL) were evaluated.Results While no significant differences were found between group A1 and A2, there were significant differences between group B1 and B2, indicating cystostomy group was safer than non-cystostomy group. When compared group A1 with B1, or group A2 with B2, it showed that the safe operation time to perform prostate tissue resection was longer in cystostomy group; the weight of the resected prostates was heavier; the time before which urine turned clear were shorter; and the IPSS improvement was better. These findings presented better therapeutic effects in cystostomy group than in non-cystostomy group.Conclusions This home-made cystometry and warning system could timely detect high bladder pressure state during TURP, making it possible to avoid of high pressure, ensuring low bladder pressure lfushing during the operation, lengthening the safe operation time, increasing tissue resection ratio, reducing transurethral resection syndrome, thus helping TURP to be safer.
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Objective To evaluate the diagnostic value of multi-slice computed tomography (MSCT)for incisional hernia of ab-dominal wall before operations.Methods Thirty patients with incisional hernia in abdominal wall confirmed by the pathology were enrolled in this study.All patients underwent MSCT examination with sagittal and coronal MPRs,and 21 cases underwent ultra-sound (US)examinations.The value of transverse scan and MPRs & MSCT and US on demonstrating the number,location,con-tents of incisional hernia,and accompanying intestinal obstruction or other complications were retrospectively evaluated and com-paired.Results Of 30 cases,there were 40 hernias,the rate of MSCT and US in detecting incisional hernias were 97.5% and 56.0%, respectively.MSCT performed better than US on demonstrating the incisional hernias (P =0.000).On MSCT,there was no signif-icant difference in the detection for isolated incisional hernia between the MPRs and axial scans (P = 1.000 ).However,MPR showed a more accurate rate for two or multiple incisional hernias diagnosis (P =0.006),and the sagittal reconstruction displayed more correct than coronal reconstruction on two or multiple incisional hernias (P =0.01 9).Furthermore,MSCT can exactly reveal the complications of incisional hernias (7 cases of intestinal obstruction,5 cases of intestinal ischemia and edema,and 1 case of me-tastasis in incisional hernia),which were not detected by US.Conclusion MSCT can correctly demonstrate the incisional hernia of abdominal wall and its complication,it can provide important imaging reference for clinical therapy.
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Objective To investigate the feasibility of ADC values in the evaluation of normal fetal brain development by measuring ADC values changes in specific regions with advancing gestational age.Methods Forty fetuses(gestational age:24 to 41 weeks) with normal brain underwent DWI(b value were 0 and 600 s/mm2).ADC values of the frontal white matter(WM),occipital WM,thalamus,basal ganglia,and cerebellum were measured by post-processing software.The differences among different regions' ADC values were calculated by repeated measurements of ANOVA,and simple linear regression was used to evaluate the relationship between ADC values and gestational age.Results The mean ADC valuesof 40 fetuses were(1 800±214) ×10-6mm2/s in frontal WM,(1 400±100) ×10-6mm2/s in basal ganglia,(1 300±126) ×10-6mm2/s in thalamus,(1 700±133) ×10-6mm2/s in occipital WM and(1 400± 155) × 10-6mm2/s in cerebellum,respectively.There was significant difference in the ADC values among the five regions(F=80.813,P＜0.01).In pair-wise comparison,ADC values of basal ganglia,thalamus and cerebellum had no significant difference; however,others had significant difference between each other.With the increasing gestational age,ADC values of basal ganglia,thalamus,occipital WM and cerebellum decreased,and had significant negative correlations with gestational age(Pearson correlation coefficient were-0.568,-0.716,-0.830 and-0.700,respectively,all P＜0.01).In terms of ADC value,occipital WM declined fastest with gestational age,followed by cerebellum and thalamus,and the slowest was basal ganglia.Frontal ADC values showed no correlation with gestational age(P＞0.05).Conclusions Specific regions of fetal brain have specific ADC values,and ADC values of the region undergo regular change with advancing gestational age.ADC value is a specific quantitative parameter that could help to evaluate normal brain development and early diagnosis of fetal brain lesions.
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Objective To observe whether electroacupuncture (EA) is protective to the blood-brain barrier (BBB) in rabbits with acute cerebral infarction and explore the underlying mechanisms. Methods Eighty rabbits were used in this study. After establishing the acute cerebral infarction rabbit model,all the animals were randomly allocated to a model group and an EA group. The acupoint "Bai Hui" and "Shui Gou" in Du meridian in the rabbits of the experimental group were stimulated by EA. The content of ANP,cAMP and cGMP was examined. Results Compared with the model group,the content of ANP in blood plasma and cAMP in brain tissue of the EA group significantly increased,while the content of cGMP decreased,the ratio cAMP/cGMP increased nearly to the normal level. Conclusion The EA exerted protective effect and promoted repair of BBB in rabbits with acute cerebral infarction,which might be modulated by the changes of the content of ANP in blood plasma and cAMP,cGMP in brain tissue.