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The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.
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Objective:To screen plasma exosomal protein molecular markers in patients with spinal cord injury (SCI) by applying Label-Free quantification and bioinformatics analysis.Methods:Fifty plasma specimens from the First Affiliated Hospital of Nanjing Medical University (from January 2021 to June 2022) were collected from SCI patients and healthy people, respectively. Plasma exosomes were isolated using ultracentrifugation and identified by transmission electron microscopy, nanoparticle tracking analysis and western blot. Plasma exosomal differentially expressed proteins (DEPs) were analyzed using Label-Free quantitative proteomics, and DEPs were characterized, annotated, and enriched based on Gene Ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) databases. The screened DEPs were validated by western blot and enzyme linked immunosorbent assay (ELISA) using plasma exosomal specimens.Results:According to the spinal cord injury classification of the American Spinal Injury Association, 14 cases were grade A, 19 cases were grade B, 12 cases were grade C, and 5 cases were grade D. Plasma exosomes of SCI patients and control groups showed typical cup-like morphology, with diameters mainly ranging from 30-200 nm. A total of 493 exosomal proteins were identified by Label-Free quantification, and 126 proteins were screened for differential expression, of which 38 were up-regulated and 88 were down-regulated. GO annotation revealed that DEPs were mainly involved in functions such as protein activation cascade, complement activation and immune response. KEGG pathway analysis revealed that DEPs were involved in biological pathways such as complement and coagulation cascade reactions, proteasome and neurodegenerative disease pathways. Two candidate proteins, APOB and S100A9, were initially screened based on quantitative results from proteomics and bioinformatics analyses. Western blot results showed that the relative expression of S100A9 protein in plasma exosomes of 30 SCI patients (1.62±0.19) was elevated compared with that of 30 control groups (0.86±0.24), and the difference was statistically significant ( t=8.55, P<0.001), while the relative expression of APOB protein (1.06±0.13 and 1.02±0.23) were not statistically significant ( t=0.46, P=0.653). The results of ELISA analysis showed that the expression of S100A9 in plasma exosomes of patients with different degrees of SCI (grade A 197.7±11.7 pg/ml, grade B 151.7±15.2 pg/ml, grade C 136.3±14.7 pg/ml) had statistical significance ( F=69.94, P<0.001), the higher the severity of SCI, the higher the expression of S100A9 in plasma exosomes (A vs. B, q=13.11, P<0.001; A vs. C, q=15.66, P<0.001; B vs. C, q=4.19, P=0.005). Conclusion:S100A9 is a potentially valid plasma exosomal molecular marker for assessing the severity of SCI.
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OBJECTIVE To prepare and evalu ate doxorubicin-loaded red blood cell membrane chitosan-targeted nanoparticles of targeting tumor cell folate acid （FA）receptor（FA-RBC-DOX-CS-NPs）. METHODS Doxorubicin-loaded chitosan nanoparticles （DOX-CS-NPs） were prepared by ion cross-linking method. FA and amino polyethylene glycol phospholithin （NH2- PEG2000-DSPE）were covalently linked to modify the red blood cell membrane to construct FA-RBC-DOX-CS-NPS. FA-RBC- DOX-CS-NPs were characterized and investigated on in vitro drug release characteristics ，antitumor activity and endocytosis ability （investigation with human breast cancer MCF- 7 cells）. RESULTS Average particle size of FA-RBC-DOX-CS-NPs was （254.200± 2.651）nm，and polydispersity index was 0.199±0.031；Zeta potential was （－10.100±0.213）mV. FA-RBC-DOX-CS-NPs released fast in the tumor microenvironment （pH6.5）. Cellular experiments showed that ，the nanoparticles could inhibit the activity of MCF- 7 cell proliferation and improve the efficiency of endocytosis. CONCLUSIONS FA-RBC-DOX-CS-NPs are prepared successfully. The nanoparticles have good tumor cell targeting and endocytosis ability ，and can realize the enrichment of drugs in tumor cells.
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Objective:To explore the effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapies (CBT) on the cognitive function and alcohol craving in patients with alcohol dependence.Methods:From March 2019 to September 2021, a total of 150 patients with alcohol dependence were enrolled and randomly divided into rTMS treatment group (rTMS+ sham CBT, n=41), CBT treatment group (CBT+ sham rTMS, n=34), rTMS+ CBT treatment group( n=36) and control group (sham rTMS+ sham CBT, n=39). At baseline (before treatment), 2nd week, 8th week, 12th week and 24th week, alcohol dependence scale (ADS) was used to evaluate the degree of alcohol dependence, the obsessive compulsive drinking scale (OCDS) was used to assess patients' drinking craving, and Montreal cognitive assessment scale (MoCA) was used to assess the overall cognitive level of patients.SPSS 23.0 statistical software was used to compare the differences of ADS, OCDS and MoCA scale scores of the four groups by repeated measure ANOVA and simple effect analysis. Results:(1)The patients in the four groups were evaluated with ADS scale at baseline, 12th week and 24th week respectively.The interaction of group×time( F=1.279, P=0.279) and the main effect of group were not significant ( F=0.882, P=0.454), and the main effect of time was significant ( F=12.925, P<0.001) .Further simple effect analysis showed that the ADS score of rTMS+ CBT group was lower than that of baseline(14.48±5.70, 10.00±6.51) ( P=0.01) at 24th week.(2)Patients in the four groups were assessed with OCDs scale at baseline, 2nd week, 8th week, 12th week and 24th week, and the interaction of group×time was significant ( F=2.015, P=0.042). Further simple effect analysis showed that the OCDs scores of rTMS group and rTMS+ CBT group at each follow-up time node were lower than those at baseline period (all P<0.05). (3)Patients in the four groups were assessed with MoCA scale at baseline, 8th week, 12th week and 24th week, and the interaction of group×time was not significant ( F=1.660, P=0.106), and the main effect of group and the main effect of time were significant ( F=2.964, P=0.038; F=14.239, P<0.001). Further simple effect analysis showed that the score of MoCA scale in CBT group at the 24th week was higher than that at baseline (21.73±5.81, 24.60±3.98)( P=0.029), the score of MoCA scale in rTMS+ CBT group at the 24th week was higher than that at the 8th week (23.50±6.01, 25.95±2.87) ( P=0.006), and the score of MoCA scale in rTMS group at the 12th week was higher than that in control group (22.08±6.64, 26.64±2.46)( P=0.009). Conclusion:rTMS combined with CBT can be effective in improving alcohol craving and cognitive function in patients with alcohol dependence, and has a good long-term effect.
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Invasive neural electrodes promote human understanding of neuroscience to the micrometer and millisecond scale. Due to the large mechanical mismatch between traditional rigid electrodes and soft brain tissues, flexible electrodes have become the new trend of neural electrodes. The flexibility of the neural electrode reduces the immune response while losing the implantation stiffness. The implantation mechanism of the neural electrode was reviewed and current researches on the implantation strategies of the flexible electrodes were summarized, so as to help solve the loss of implantation ability of flexible electrode and acute implantation injury. Based on the characteristics of various implantation strategies, the prospect of flexible electrode implantation strategies was proposed.
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Objective To evaluate mechanical comprehensive performance of the flexible neural electrode with coating modification, so as to provide references for optimal design of the electrode and coating parameters. Methods Simplified mechanical models were established for the contact phase, implantation phase and micromotion phase. The electrode material was polyimide, the coating material was PEG, and PDMS mold injection method was selected as the coating method. The coating thickness gradients were set as 40, 80, 120, 160 and 200 μm, respectively, and the three factors (the critical load, the maximum total deformation and the maximum strain of brain tissues) were comprehensively evaluated. Results As the thickness increased, the critical load increased, the maximum total deformation and the maximum strain of brain tissues decreased, but meanwhile, the strain area of brain tissues increased. For consideration of equilibrium for three factors, 200 μm was chosen as optimal thickness of the coating. At this thickness, the critical load was 17.9 mN, the maximum total deformation was 10.1 μm, and the maximum strain of brain tissues was 0.011 4. Conclusions The coating thickness had a great influence on mechanical properties of the neural electrode. The optimal parameters could be selected by setting influencing factors from the mechanical performance factors under specific case. The optimal parameter selection of coating can improve the electrode performance, which is of great significance for clinical application of the neural electrode.
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Objective To study the feasibility of reducing radiation dose in aorto-iliac and lower extremity arteries CT angiography (CTA) with low tube voltage (100 kV) and automatic tube current modulation(ATCM).Methods Totally 61 patients requiting aorto-iliac and lower extremity arteries CTA for clinical reasons were prospectively enrolled in study.The patients were randomly assigned to 3 groups:Group A(120 kV),Group B (100 kV) and Group C (100 kV with automatic tube current modulation).Both quantitative and qualitative analysis were included in this research.Group C was divided into obese group(BMI≥ 24.9 kg/m2) and normal group(BMI ＜ 24.9 kg/m2).The radiation doses were analyzed respectively among two groups.Results The subjective evaluations of image quality for axial,MIP and VR were good.There were no significant differences among group A,B and C in SNR and CNR (P ＞0.05).The effective dose of group A,B and C was 8.20 mSv,5.36 mSv,and was 7.48 mSv,respectively Group B was 34.6％ less than group A.Group C was 39.5％ more than group B,and there was no significant differences between group A and C (P ＞ 0.05).The effective dose of group C1 was 7.11mSv,group C2 was 9.69 mSv,the E with group C1 were significantly less than group C2 (t =-3.163,P ＜0.05),the effective dose of group C1 was 13.3％ less than group A (Z =-2.822,P ＜ 0.05),but the group C2 was more than group A (P ＞ 0.05) and group B (Z =-3.426,P ＜ 0.05).Conclusions Lowkilovoltage (100 kV) CT scanning protocol is feasible in multi-detector CT angiography for aortoiliac and lower extremity arteries.Automatic low tube voltage (100 kV) with automatic tube current modulation (ATCM) scanning protocol can be used for someone with BMI less than 24.9 kg/m2.
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Objective To assess the feasibility of low-dose MDCT pulmonary angiography (MDCTPA) by using low kVp combined with individual-adapted low tube current protocol and noise reduction filter algorithms.Methods Fifty-six consecutively patients with MDCTPA were enrolled in the study.The patients were randomly divided into group A (120 kVp,100 mAs) and group B (100 kVp,individual-adapted tube current about 1.0 mAs/kg).Two series of images were reconstructed in group B:B1 with standard filter algorithms (FC13,B1) and B2 with noise reduction filter algorithms (FC11,B2).The image noise,quality and radiation dose in two groups were compared.Results The CTDIvol,DLP and E of group B were 5.1 mGy,83.3 mGy· cm and 1.4 mSv respectively,which were reduced by 64.3％,66.4％ and 66.7％,respectively (F =32.57,12.32,11.98,P ＜ 0.05) when compared with those in group A.Compared with group A,the image noise in B1 was increased by 118.2％ (t =10.05 P ＜0.05),the central and peripheral SNR and CNR and scores were increased by 51.5％,46.6％,50.8％,45.3％and 20.4％,respectively(t =7.20,6.30,6.58,5.54,8.35,P ＜ 0.05).Compared with B1,the image noise in B2 was reduced by 32.5％ (t =6.12,P ＜0.05),the central and peripheral SNR and CNR and scores were increased by 46.2％,46.2％,45.9％,46.9％ and 18.4％ (t =3.19,3.55,2.95,3.37,5.42,P ＜0.05).Compared with group A,the image noise in B2 group was increased by 47.3％ (t =4.03,P ＜0.05),the central and peripheral SNR and CNR and scores were reduced by 29.1％,21.8％,28.2％,19.6％ and 8.2％(t =4.06,2.82,3.68,2.22,3.02,P＜0.05).Conclusions Keeping effective diagnostic image quality,the protocol with low kVp and individual-adapted low tube current for low-dose MDCT pulmonary angiography would be effective and feasible,and the radiation dose would be significantly reduced.
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Objectives To explore the brain white matter integrity among the patients with buprenorphine tables,scopolamine and promethazine solution(BSP) dependence after abstinence.Methods BSP-dependent patients( n=16)and age/eduction-matched healthy control subjects ( n=18) were assessed by diffusion tensor imaging (DTI) after 3 days,1 month and 2 months of abstinence.White matter (WM) integrity was measured with DTI as fractional anisotropy ( FA),an index of intravoxel orientational coherence of white matter fibers.Results Compared with health controls,FA values were significantly lower in frontal,parietal,temporal and corpus callosum in the BSP addicts after 3-day withdrawal (P＜0.001,uncorrected).Increased FA values in left superior frontal cortex,right medial frontal gyms and fight inferior parietal gyrus were found in BSP users after 2 months of abstinence (P ＜0.001,uncorrected).However,no significant difference was found between these BSP addicts after 1-month abstince.Compared with health controls,BSP dependent subjects still exhibited significantly lower FA in the corpus callosum,frontal,parietal and temporal WM after 2-month withdrawal (P ＜ 0.001,uncorrected ).Conclusion The abnormalities showed less recovery in BSP dependent individuals with abstinence in white matter that suggests that rehabilitation time should be further prolonged for BSP addicts and emphasis cognitive-behavioral therapy to assist BSP abusers rebuild social functions.
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Objective To explore the appropriate treatment according to the grading system of adolescent idiopathic cervical kyphosis.Methods A retrospective study was performed in 115 adolescent patients with idiopathic cervical kyphosis.The patients were divided into 4 groups according to the magnitude of kyphosis.The initial Cobb angle of 4 groups were 12.7°±1.4° 25.4°±4.8°,47.2°±4.4° and 62.6°±5.7° respectively.The patients in group I were treated with the collar support for 4-8 weeks.The patients in group Ⅱ were treated with skull traction (3-5 kg) and then fixed by cranio-cervical-thoracic plaster.According to the angles between the tangents of posterior vertebral body at each level on lateral cervical radiograph in extension,the anterior fusion levels of the group Ⅲ and angles and range of osteotomy in the group Ⅳ were decided.In group Ⅳ,the patients were treated by two steps.The anterior release and posterior osteotomy were performed firstly.Then skull traction (1/10 body weight) was maintained in order to correct the deformity for 7-10 days,fusion and anterior fusion with autologous bone graft and internal fixation was completed.Results Post-operative radiograph showed that Cobb angle were -5.5°±2.0°,-8.2°±6.1°,-4.5°±6.6° and -2.9°±7.9° in Ⅰ-Ⅳ group after treatment.The deformed appearance of the patients improved significantly.A improvement neck pain and neurologic function were found in all patients.Post-operative MRI showed that physiological curve of the cervical spine was restored,and the cerebrospinal fluid line was clear in the previous kyphosis area.Conclusion Adolescent idiopathic cervical kyphosis has specific characteristics.Surgical strategy is determined by the severity of deformity.
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Objective To explore what brain regions are modulated by heroin addiction and withdrawal.MethodsWe used functional magnetic resonance imaging to investigate the brain function in 15 heroin-dependent patients 3 days (acute) and 1 month (protracted) after heroin abstinence.Sixteen normal controls were included.Results The blood oxygen level-dependent signal in the orbitofrontal cortex of the brain of heroin-dependent patients was significantly elevated 3 days after the withdrawal.Hyperfunction of the orbitofrontal cortex declined 1 month after the withdrawal.Conclusion Heroin-dependent subjects at both 3 days and 1 month abstinence have persistent abnormalities in the brain function.Although some tangible beneficial effects are noted following 1month of detoxification,possible permanent damage to the brain caused by heroin use is suggested.
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Objective To examine white matter integrity in heroin-dependent patients and matched normal controls with diffusion tensor imaging (DTI).Methods The fractional anisotropy was compared between 15 heroin-dependent patients and 15 controls.Results We found the fractional anisotropy was significantly decreased in specific brain regions of the heroin-dependent patients (P ＜ 0.001 uncorrected),including the frontal gyrus,the parietal lobule,the insula,and the corpus callosum.Conclusion The presence of microstructural abnormality is found in the white matter of several brain regions of heroin-dependent patients.
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Objective To evaluate the diagnostic accuracy of coronary artery stenosis caused by calcified coronary artery plaques with 64-detector row CT under different conditions. Methods Totally 165 patients with coronary artery calcification accompanied by one or more branches stenosis more than 50% detected with computed tomography coronary angiography (CTCA) were collected. The Agatston calcium score (ACS) and stenosis rate were calculated based on per-patient, per-vessel, per-segment, various stenosis degree and different morphology of calcification as the analysis object, respectively. The measurement results of coronary angiography (CAG) were taken as the gold standard. The diagnostic accuracy was evaluated with receiver operating characteristic (ROC) curves which were created to assess the diagnostic value and to determine the diagnostic cutoff level (threshold). Results When per-patient analyzed, the greatest diagnostic accuracy rate was obtained with ACS threshold of 113.5, and the area under curve (AUC) value of ROC was 0.791. With the analysis object of per-vessel, the greatest diagnostic accuracy rate was found in right coronary artery and its sub-branches, and the AUC value was 0.897. Per-segment analyzed, the highest accuracy rate was obtained in RCA1 segment, and the AUC value was 0.894. When the analysis object was the morphology of calcification, the range of AUC value was merely 0.601-0.667, while the diagnostic value was rather low. The highest accuracy of CTCA was obtained in stenosis less than 50%, and the AUC value was 0.856. Conclusion Coronary artery calcification has different influence on the diagnostic accuracy rate of coronary artery stenosis with CTCA in various situations. Moreover, the morphology of the calcification may not be the main impact factors of the diagnostic accuracy.
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Objective To probe the clinical application of CT in the diagnosis of criss-cross heart(CCH).Methods Five patients with CCH confirmed by operation were retrospectively analyzed.Enhanced 64-slice spiral CT was performed in 2 patients and enhanced single-slice electron beam CT was performed in 3 patients.Three dimensional reconstructions were applied for the fully display of anatomic malformations,and the results were compared with that of echocardiogram and angiocardiogram with Chi-square test Results(1)Visceroatrial situs solitus,twisted and concordant atrioventricular connection,horizontally oriented ventricular septum,ventricular septum defect and pulmonary stenosis were found in all patients on CT.The ventriculoarterial connection was discordant,including double-outlet right ventricle in 4 patients and complete transposition of great arteries in 1 patient In addition,associated anomalies including persistent left superior vena cava(n=2),coarctation of the aorta(n=1)and right aortic arch with right descending aorta(n=1)were detected as well.(2)Total 33 anomalies in 5 cases were found during operation.The diagnostic accuracy of CT,angiocardiogram and echocardiogram was 93.9%(31/33),81.8%(27/33)and 54.5%(18/33)respectively.There was a significant difference between CT and echocardiogram(X~2=13.39,P＜0.01),and no significant difference between CT and angiocardiogram(X~2=1.29,P＞0.05).Conclusion CT is an excellent imaging technique for the diagnosis of CCH.
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OBJECTIVE To study mechanisms of terguride on the treatment of herion dependence. METHODS Adult male SD rats were randomly assigned into 5 groups: normal control group, saline treatment during heroin use period group, terguride treatment during heroin use period group, saline treatment during heroin reinstatement period group, terguride treatment during heroin reinstatement period group, the last 4 groups established heroin intravenous self administration and cue induced reinstatement models, and after interfernce and perfusion to get the following five brain regions [including ventral tegmental area (VTA)]sections. The expression of dopamine D2 receptor protein and mRNA, prodynorphin protein and preprodynorphin mRNA was detected by immunohistochemistry and hybridization in situ. RESULTS The expression of dopamine D2 receptor was downregulated during heroin use period and upregulated during heroin reinstatement period in nucleus accumbens shell (AcbSH) region, the expression of dopamine D2 receptor mRNA was parallelled with the protein expression approximately, terguride could downregulate the high expression of receptor protein during reinstatement. The expression of dopamine D2 receptor protein and mRNA was upregulated during heroin reinstatement period in central nucleus amygdalae (CeA) region, and terguride could downregulate this high expression. The expression of dopamine D2 receptor protein and mRNA was upregulated during heroin use period and downregulated during heroin reinstatement period in CA1 region of hippocampus and prefrontal cortex (PFC), terguride could downregulate the high expression of mRNA during heroin reinstatement period. The expression of dynorphin protein and mRNA was upregulated during heroin reinstatement period, terguride could downregulate this high expression. The expression of dynorphin protein was upregulated during heroin reinstatement period, and terguride could downregulate this high expression. CONCLUSION The activity of mesolimbic dopamine is boosted up during heroin use period and depressed during reinstatement period, terguride can regulate this dysregulation. The activity of dynorphin is boosted up during cue induced reinstatement, and terguride has the downregulation effect. So the preclinic study demonstrated that terguride has the potential benefit in heroin dependence.
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BACKGROUND: The middle ear is a little aerated cavity with a complex anatomy and a deep location. Computed tomagraphy virtual endoscopy (CTVE) can be used to reconstruct the stereoscopic images of internal surface of hollow organs using spiral CT volumetric data, providing findings similar to fiberendoscope.OBJECTIVE: To vedfy the ability to show the normal middle ear and the clinical application of virtual endoscopy based on 64-detector CT data.DESIGN, TIME AND SETTING: A confirmatory controlled observation was performed at Department of Radiology, First Affiliated Hospital of Sun Yat-sen University between October 2005 and March 2006.PARTICIPANTS: A total of 33 patients (66 ears) with suspected middle ear disease who underwent spiral CT examination were included in this study. Among included ears, 35 were normal, and 31 were impaired, including 24 ears presenting with chronic suppurative otitis media (10 simple otitis media, 5 granulomatous otitis media, and 9 middle ear cholesteatoma), 2 ears with post-operative recurred suppurative otitis media, 2 ears with carcinoma of middle ear, and 2 ears with temporal bone fracture, and lear with foreign body granuloma.METHODS: CT images of the temporal bone were obtained using 0.5 mm thick axis slices with a soft reconstruction kemel at 0.3 mm intervals. Virtual endoscopic images of middle ear on CT were generated from volumetric data using the Navigator software. CTVE images were observed from multiple directions using the Fly Through software, and compared with the axial and coronal images and surgery findings.MAIN OUTCOME MEASURES: The following structures were observed: auditory ossicle and joints, superior, middle, and inferior tympanum, sinus tympani, external acoustic meatus, tympanum, facial recess, tegmental wall, anterior and superior ligaments of malleus, posterior ligament of incus, and retrotympanum.RESULTS: A series of images were acquired as the virtual endoscope moved from the extemal auditory canal to the middle ear cavity. CTVE displayed the structures of normal middle ear with high details in 100%, except the anterior and posterior limbs of stapes in 68.6% (24/35) and 74.3 %(26/35), respectively. In the ears with supperative otitis media, the destruction of bone of handle, head of malleus, long and short limbs of incus, and limbs of stapes was found on CTVE in 91.7%(22/24), 95.8%(23/24), 95.8%(23124), 100%(24/24), and 87.5%(21/24), respectively. CTVE clearly showed the destruction of promontory, tegmental wall and facial nerve tube in one ear with carcinoma. CTVE showed the dislocation of incudomallear joint in one ear with temporal bone fracture. It took about 10-15 minutes to perform CTVE.CONCLUSION: CTVE can be used as a noninvasive and reliable method in displaying normal and pathologic middle ears. In cases of suspected bony destruction and confirmed trauma, it is helpful for diagnosis and surgical planning. CTVE of the middle ear can currently be considered as a complementary technique to conventional CT, and it is time-saving and reserves clinical generalization.
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Objective To investigate the feasibility of the low tube voltage setting and personalized contrast agent application in 64-row multi-slice spiral CT pulmonary angiography.Methods Ninety patients with high risk of pulmonary artery embolism were sequentially enrolled in the study and divided into 3 groups employing completely randomized design: (1) Regular group included 30 patients using 120 kV and fixed dose of 70 ml contrast agent, (2)Another 30 patients were in 120 kV group, using 120 kV and the contrast amount was determined according to the patient weight (1.0 ml/kg), (3) The remaining 30 patients were included in 100 kV group, using 100 kV and the contrast amount was also determined according to the patient weight(1.0 ml/kg).Administration of contrast agent was completed within 20 seconds for all the patients, followed by 20 ml of saline.The objective and subjective indexes for assessing CT image quality, CT dose index volume (CTDIvol) and effective received dose (ERD) were compared between 120 kV group and 100 kV group; then the contrast media volume, injection rate, objective CT image indexes and subjective indexes for image quality was compared between the 100 kV group and regular group.The variance analysis and post hoc test were employed for the statistical analysis.Results Compared with 120 kV group(3.4± 0.7), the image quality of 100 kV group(5.2±1.8)had higher noise(52.9%), but subjective index for the image quality demonstrated no differences(q=0.272 ,P=0.063)in mediastinum window while CTDIvol and ERD decreased for 34.9%[(9.5±0.0) vs (14.6±0.0) mGy]and 36.8%[(3.8±0.6) vs (2.4± 0.4) mSv].The mean CT values on pulmonary artery of 100 kV group[(269.2±54.7) HU]were 13.4% (31.8/237.4) higher than the 120 kV group[(237.4±62.9) HU], but there was no statistical differences eornpared to normal group(q=0.172,P=0.260).Conclusion Using low kV setting (100 kV) to reduce radiation dose is proved to be effective and feasible in 64-MSCT pulmonary angiography.Personalized contrast agent injection has clinical application value for specific patient group.
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Objective To investigate the clinical application of electron-beam CT(EBCT)in the diagnosis of congenital cardiovascular diverticula. Methotis Retrospective analysis of 9 patients with congenital cardiovascular diverticula confirmed by operation and pathology was done.Of them,enhanced continuous volume scan was performed on 8 patients and enhanced single slice scan was performed on one patient with an Imatron C-150 scanner.Results The group of 9 pailents included one patient with diverticulum of the left ventricle.3 patients with diverticulum of the atria and 5 patients with diverticulum of the aorta.EBCT scan and three dimensional reconstruction could demonstrate not only the origin,size,shape,Location and adjacent structure of diverticula,but also other important complicated abnormalities such as ventrieuloarterial connection disorder,cardiac sepud defect,aortic coarctation and even dissection.Conclusion EBCT is an ideal noninvasive technique in the diagnosis of congenital cardiovascular diverticula
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Objective To evaluate the clinical application values of 64-row MSCT for apical hypertrophic cardiomyopathy(AHCM).Methods Twenty-one patients with AHCM were included in this study,14 patients were diagnosed by echocardiography(UCG),and 7 patients were diagnosed by MRL AU patients underwent MSCT exam,and 5 patients also had ventriculography and coronary angiography.The left ventricular wall thickness in end-systole and end-diastole phases were measured at MSCT workstation,the left ventricular apex thickening rate(LVAT)and the ratio of maximum wall thickness of the left ventrieular apex(LVA)to the left ventricular posterior wall thickness(LVA/LVPW)in end-diastole phase were calcdated.The left ventricular end-diastolie volume(LVEDV)and left venueular ejection fraction (LVEF)were quantitively evaluated with cardiac functional analysis software.The results were compared with the measurement results from the normal control group(30 volunteers).The independent-samples t test was used for the statistics.At the same time.the coronary stenosis was measured.Results Diffuse or partial thickening of the LV apical myocardium were found in the four-chamber view and two-chamber view of MSCT images.which leaded to the deformation of the left ventricle chamber.The LVEDV were(82.6±11.4)and(108.5±10.6)ml in the AHCM group and the control group,respectively;the LVA were (20.6±3.4)and(9.9±1.5)mm;LVA/LVPW were 2.1±0.5 and 1.1±0.2;the LVAT were(25.6±4.7)%and(81.5±8.5)%.There were significant differences in LVEDV,LVA,LVA/LVPW and LVAT between the two groups(t=8.32 and 15.29,P＜0.05;t=9.91 and 27.30,P＜0.05;respectively),but there were no statistical differences in LVPW and LVEF between the two groups(t=0.26 and 1.13.P＞0.05).Five patients had myocardium bridging and 4 patients had coronary stenosis.Conclusion AHCM can be diagnosed accurately with MSCT,and the cardiac anatomy.function and coronary artery are also assessed simultaneously.
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Objective To discuss the clinical value of coronary artery imaging using 64-slice spiral CT in patient with atrial fibrillation.Methods The images of 31 patients with atrial fibrillation who underwent contrast-enhanced CT coronary angiography were evaluated.The presence of stenosis on each segment of coronary arteries was recorded and their degree of stenosis was measured using the vessel analysis software.Ten patients additionally underwent conventional coronary angiography.The results of conventional coronary angiography were compared with CT coronary angiography of the 10 patients.Results Image reconstruction was based on absolute timing.The image quality of 364 coronary vessel segments on the images from 31 patients was evaluated and defined as excellent,fine,moderate or poor.The image quality was excellent,fine,moderate and poor in 85,41,5,and 8 vessel segments respectively in patient group with heart rate between 47 beat per minent(bpm)and 69 bpm;and in 63,16,13,and 15 vessel segments respectively in patent group with heart rate between 70 bpm and 79 bpm;and in 46,25,23,and 24 vessel segments in patient group with heart rate between 80 bpm and 105 bpm.There was significant difference among the three patient groups(H=22.08,P＜0.01).Comparison was carried out between CT angiographic findings and conventional angiographic findings of the 125 segments of the coronary arteries in the 10 patients who underwent conventional coronary angiography.The sensitivity and specificity of CT angiography for diagnosing vessel with significant coronary stenosis(≥50% narrowing)was 85.0%(17/20)and 95.2%(100/105),respectively.Positive predictive value was 77.3%(17/22),and negative predictive value was 97.1%(100/103).Coronary CTA underestimated the lesions of 3 vessel segments and overestimated the lesions of 5 vessel segments.Conclusion Coronary artery imaging with 64-slice row CT had clinical value for patients with atrial fibrillation.