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Objective To investigate the effect of different coating methods on production quality of complex and flexible silicone vascular replicas. Methods Based on models of anterior communicating artery aneurysms, several patient-specific models were made by using spray-coating method and brush-spin-coating method respectively, and two methods for making the same vascular structure were quantitatively compared in terms of thickness growth, circumferential uniformity and light transmittance. Results Brush-spin-coating method was better than spray-coating method in the thickness control and coating uniformity for fabrication of vessels with large curvature, variable diameter and straight tube, and the model had preferably light transmittance and surface smoothness. The relative deviation of thickness by brush-spin-coating method was decreased by 8. 9% , 10. 8% and 16. 9% respectively compared with spray-coating method. Conclusions At present stage, the brush-spin coating method has the advantage of thickness uniformity and light transmittance over the spray-coating method in making silicone phantoms, and it has promising application prospects in fluid mechanics field of in vitro experiment on large vessels.
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Objective:To investigate the feasibility of multi-slice spiral CT (MSCT) imaging feature of gastric stromal tumor (GST) in evaluating Ki-67 index expression .Methods:The clinical and CT imaging data of 501 patients with GST confirmed by surgery and pathology were retrospectively studied in Zhongshan Hospital affiliated to Fudan University and the Affiliated TCM Hospital of Southwest Medical University from Nov 2014 to Nov 2021. By immunohistochemical results, tumors were divided into Ki-67 low expression group (Ki-67≤6%, 335 lesions) and high expression group (Ki-67>6%, 168 lesions). Multivariate logistic regression analysis was conducted.Results:Between the two groups,there were statistical differences in the longest and shortest diameter of tumor, CT value on venous phase, CT attenuation value ( Z=4.80, 4.91, 3.21, 3.29, all P<0.01) and tumor location,morphology, necrosis, ulcer, feeding artery, vascular enhancement, positive fat sign around disease, gastrointestinal bleeding ( χ2=10.77, 13.49, 8.59, 22.87, 7.59, 7.23, 7.76, 8.58, all P<0.05). Tumor ulceration positive ( OR=1.88, 95%CI: 1.17-3.03) was independent risk factor of Ki-67 high expression ( P=0.009). Gastric antrum was used as the reference for tumor location, cardia ( OR=5.41, 95% CI:1.25-23.46) was independent risk factor of Ki-67 high expression ( P=0.024). Conclusion:MSCT has a definite predictive value for the expression in Ki-67 index of GST cases.
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Objective:To study the clinical and MRI features of alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis to compare with those of hepatic focal nodular hyperplasia (FNH) to arrive at a correct differential diagnosis.Methods:The data of 105 patients who underwent liver surgery for alpha-fetoprotein-negative hepatocellular carcinomas without cirrhosis at Zhongshan Hospital, Fudan University and the Traditional Chinese Medical Hospital of Nantong from March 2017 to November 2020 were retrospectively studied. There were 109 lesions in 95 males and 10 females. These patients had the age of (60.2±9.9) years. The data of 88 patients who were diagnosed to have hepatic FNH during the study period were collected, and there were 99 lesions in 36 males and 52 females. These patients had the age of (32.8±9.5) years. Variables including age, history of hepatitis B virus infection, T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), enhancement mode, lesion shape, lesion boundary and capsule were compared between the two groups. Results:The age and the proportion of patients with a history of hepatitis B in the alpha-fetoprotein-negative hepatocellular carcinoma and without cirrhosis group were significantly higher than those in the hepatic FNH group (both P<0.05). The proportion of lesions with quasi-circular shape, clear boundary and with capsule in hepatocellular carcinoma group were significantly higher than those in the hepatic FNH group (all P<0.05). There were also significant differences in the T 1WI, T 2WI, enhancement modes, DWI, and ADC map between the two groups of lesions (all P<0.05). The areas under the receiver operating characteristic curve for the alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis by the age >45.5 year, with a history of hepatitis B, with clear lesion boundary, with a "washin and washout" enhanced mode and with lesion encapsulation were 0.97(95% CI: 0.95-0.99), 0.79(95% CI: 0.72-0.85), 0.78(95% CI: 0.72-0.85), 0.94(95% CI: 0.90-0.97), 0.99(95% CI: 0.98-1.00) respectively. Conclusions:The presence of a capsule, clear lesion boundary and "washin and washout" enhanced mode are helpful in differentiating alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis with hepatic FNH.
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Objective:To study the role of the Administration Research Fund in promoting the high-quality development of hospitals.Methods:This study conducted a comprehensive analysis of all projects funded by the Administration Research Fund in terms of the quantity of applying and granting, the specialties or the fields involved, the heads of projects, the outputs of the projects, and the trends and characteristics of the selected topics, further, analyzed and evaluated the role played by the projects in promoting hospital development through questionnaires and in-depth interviews.Results:Since the establishment of the fund, a total of 113 projects have been funded (204 have been declared). Encompassing a wide range of professions or fields. More than 80% of the project leaders were from administrative departments, showing the characteristics of high education and youthfulness.Conclusions:The Administration Research Fund reached its goal at the time of establishment and formed a stable influence. The selection of project topics revolved around the aspects of continuous improvement in hospital development and presented a certain pattern, which can promote the growth of management cadres and is one of the important ways to promote hospital development. It is recommended to further improve the quality of administration research projects by strengthening the whole process of management, setting up project guidelines, and improving the review mechanism.
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Objective:To study the magnetic resonance imaging (MRI) features of primary hepatic diffuse large B-cell lymphoma (PDLBCLL) with the aim to improve the diagnosis of this disease.Methods:The clinical data of 15 patients with PDLBCLL confirmed by biopsy or surgical resection specimens at Zhongshan Hospital of Fudan University and Yiwu Central Hospital from May 2015 to August 2021 were retrospectively analyzed. There were 8 males and 7 females, aged (58.3±12.0) years old. Thirteen patients underwent conventional Gd-DTPA enhanced MR examinations, and 2 patients underwent hepatobiliary specific contrast agent (Gd-EOB-DTPA) enhanced MR examinations. Image analysis included the number, location, size, shape, signal intensity and enhancement features of the lesions. Apparent diffusion coefficient (ADC) values of lesions and surrounding liver parenchyma were measured on the ADC map, and paired sample t-test was used to compare the differences between the two groups. Results:In 15 patients, 10 patients had a single, 4 had multiple lesions. In 1 patient, there was diffuse, mild enhancement in the arterial phase, slow decrease in the early portal venous, late portal venous and equilibrium phases, and ring low signal signals were detected in the hepatobiliary specific phase. The average ADC value of the 15 patients was (0.826±0.379)×10 -3 mm 2/s, and the average ADC value of the adjacent liver parenchyma was (1.311±0.236)×10 -3 mm 2/s. The difference was significant ( P<0.05). Uniform signals were detected in lesions in 3 patients, in the scar tissues of 2 patients, moderate enhancement scan lesions were improved in 10 patients, mild aggrandizement in 5 patients, lesions showing a " floating vessels" sign in 6 patients, lesions showing a typical " target" appearance in 7 patients, abnormal perfusion around the lesion in 7 patients, and compression of bile ducts with perifocal bile duct dilatation in 2 patients. Conclusion:The MRI findings of PDLBCLL showed certain characteristics. The lesion boundary was clear and the signal was uneven. Contrast-enhanced scans showed a lack of blood supply, most of which were accompanied by necrosis, and the " vessel floating sign" and " target sign" were characteristic.
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Objective:To investigate the value of multislice spiral computed tomography (MSCT) features in the differential diagnosis of pancreatic solid pseudopapillary neoplasm (pSPN) and hypovascular pancreatic neuroendocrine tumor (hypo-PNET).Methods:From January 2016 to January 2021, at Zhongshan Hospital of Fudan University, the clinical information, pathological results and imaging data of 81 patients with pSPN and 40 patients with hypo-PNET confirmed by surgical pathology were retrospectively analyzed. The tumor location, shape, growth mode, relationship between the long axis of the lesion and pancreas, boundary, whether with calcification, floating cloud sign, ring enhancement, sausage-like enhancement, intratumoral vascular sign, pancreatic duct dilatation, distal pancreatic atrophy, intratumoral cystic change, cystic-solid ratio of tumor, the maximum diameter of the lesion, the plain and enhanced computed tomography (CT) values of the solid part of the tumor of pSPN patients and hypo-PNET patients were compared and analyzed. Chi-square test, independent sample t test and Mann-Whitney U test were used for statistical analysis. The variables with statistical significance in univariate analysis were included in the binary logistic regression model to screen the independent predictors of pSPN and hypo-PNET, and the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficiency of MSCT characteristics in the differential diagnosis of pSPN and hypo-PNET. Results:Compared with hypo-PNET patients, most of pSPN patients were female (71.6%, 58/81 vs. 45.0%, 18/40), younger (36.0 years old (27.0 years old, 46.0 years old) vs. 56.5 years old (48.2 years old, 63.7 years old), the tumors were mostly round or elliptical (76.5%, 62/81 vs. 55.0%, 22/40), most with clear boundaries (70.4%, 57/81 vs. 40.0%, 16/40), with more intratumoral calcification (53.1%, 43/81 vs. 20.0%, 8/40), with more floating cloud sign (65.4%, 53/81 vs. 35.0%, 14/40), more without intratumoral vascular sign (77.8%, 63/81 vs. 32.5%, 13/40), more without pancreatic duct dilatation (79.0%, 64/81 vs. 55.0%, 22/40), more with mixed solid and cystic mass (38.3%, 31/81 vs. 22.5%, 9/40), with longer maximum diameter of tumor (4.0 cm (3.0 cm, 5.6 cm) vs. 3.3 cm (2.6 cm, 4.2 cm), with lower enhanced CT values in the arterial and venous phases ((54.7±13.1) HU vs. (68.2±15.0) HU and (65.9±16.0) HU vs. (79.2±14.2) HU), and the differences were all statistically significant ( χ2=8.11; Z=-6.24; χ2=5.85, 10.32, 12.02, 10.03, 23.50, 7.51, 7.72; Z=-2.53; t=-5.08 and -4.46, all P<0.05). The results of binary logistic regression model indicated that the independent predictive factors for the diagnosis of pSPN and hypo-PNET included age ( OR=0.874, 95% confidence interval (95% CI) 0.827 to 0.923, P<0.001), calcification ( OR=5.412, 95% CI 1.428 to 20.506, P=0.013), intratumoral vascular sign ( OR=0.212, 95% CI 0.055 to 0.817, P=0.024), CT value in the arterial phase ( OR=0.943, 95% CI 0.899 to 0.988, P=0.015). For the combination diagnostic model based on clinical features and MSCT characteristics, area under ROC was 0.944 (95% CI 0.905 to 0.990), sensitivity was 87.7% and specificity was 92.5% ( P<0.001). The results of ROC analysis of the independent predictive factors and combined diagnostic model showed that the areas under the curve (95% CI) of the age, calcification, intratumoral vascular sign, CT value in the arterial phase and the combined diagnostic model was 0.665 (0.565 to 0.765), 0.726 (0.627 to 0.826), 0.850 (0.775 to 0.924), 0.757 (0.660 to 0.853), and 0.944 (0.905 to 0.983), respectively, and the diagnostic efficacy of the combined diagnostic model was higher ( P<0.001). Conclusion:MSCT features such as intratumoral calcification, intratumoral vascular sign, tumor density in the arterial phase combined with age can be used in the differential diagnosis of pSPN and hypo-PNET.
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Objective:To investigate the imaging characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of undifferentiated carcinoma with pancreatic osteoclast-like giant cell (UPC-OGC).Methods:From April 2015 to November 2019, at Zhongshan Hospital, Fudan University, 11 pathologically confirmed UPC-OGC patients who received upper abdominal CT or MRI before surgery and with complete clinical and pathological data were retrospectively included. The imaging characteristics of CT and MRI were analyzed, which included lesion location, number, shape, size, boundary, plain scan and enhancement features, adjacent tissue invasion and metastasis. Independent sample t test was used for statistical analysis. Results:The tumor lesions of 11 patients with UPC-OGC were all single, and the maximum diameter of lesion was (4.84±2.96) cm (ranged from 2.00 to 12.80 cm). The lesions of 7 patients with UPC-OGC were located in the head of pancreas, 2 located in the body of pancreas, 1 located in the tail of pancreas and 1 located in the junction of body and tail of pancreas. The lesion shapes of 3 patients with UPC-OGC were round, and the lesion shapes of 8 patients were oval with lobulation. The lesion boundaries of 8 patients with UPC-OGC were clear and the lesion boundaries of 3 patients were unclear. Seven patients with UPC-OGC were examined by plain and enhanced CT scan. Plain CT scan showed that the density of solid area of the tumor was similar to that of normal pancreatic parenchyma ((37.14±6.10) HU vs. (43.14±4.55) HU), and the difference was not significant ( t=-2.85, P=0.097). Contrast-enhanced CT scan in arterial phase showed that the degree of enhancement in solid area of the tumor was weaker than that of normal pancreatic parenchyma ((67.29±12.79) HU vs. (90.43±9.81) HU), and the difference was statistical significant ( t=-4.10, P=0.004), while contrast-enhanced CT scan showed that in venous phase the solid area of the tumor continued to strengthen and the degree of enhancement was similar to that of normal pancreatic parenchyma ((84.71±15.30) HU vs. (79.57±10.73) HU), and the difference was not significant ( t=0.38, P=0.535). Both CT and MRI enhanced scans showed uneven enhancement of the lesions, the degree of enhancement of solid component in arterial phase was slightly weaker than that of normal pancreatic parenchyma and the marginal and internal separation were progressively enhanced, and the degree of enhancement in the venous phase and balanced phase was slightly higher than that of the normal pancreatic parenchyma or similar to that of the normal pancreas. Conclusions:The imaging of CT and MRI of UPC-OGC have certain characteristics, which are helpful for the diagnosis and identification of the disease.
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Objective:To investigate the value of imaging features of contrast-enhanced computed tomography (CT) of pancreatic neuroendocrine neoplasm (panNEN) in predicting preoperative pathological grade.Methods:From February 2009 to August 2020, at Zhongshan Hospital affiliated to Fudan University, the CT data of 136 patients with panNEN diagnosed by surgery and pathology were retrospectively analyzed. According to World Health Organization classification of digestive tumors (5th edition, 2019), panNEN was classified into G1, G2, G3 neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC). The differences in CT values and correlative parameters of solid part of lesions with different pathological grades were compared. The receiver operator characteristic curve was drawn and the area under the curve (AUC) was calculated to evaluate the CT value and related parameters in the differential diagnosis of panNEN of different pathological grades. The Kruskal-Wallis test and chi-square test were used for statistical analysis.Results:A total of 142 tumor lesions were detected in 136 panNEN patients, of which the numbers of G1, G2, G3 NET and NEC were 58, 73, 7 and 4, respectively. Along with the increase of pathological grade, the degree of CT enhancement in the solid part of panNEN lesions gradually decreased. The CT value, CT value difference and relative density of arterial phase and venous phase of patients with G2 NET were all lower than those of patients with G1 NET (Arterial phase: 105 HU, 46 to 251 HU vs. 126 HU, 57 to 195 HU; 62 HU, 6 to 212 HU vs. 81 HU, 23 to 166 HU; 1.1, 0.4 to 2.5 vs. 1.4, 0.7 to 2.0. Venous phase: 90 HU, 49 to 159 HU vs. 107 HU, 63 to 162 HU; 49 HU, 9 to 134 HU vs. 62 HU, 24 to 128 HU; 1.1, 0.5 to 2.0 vs. 1.4, 0.9 to 2.0), and the differences were statistically significant ( Harterial phase=2.880, 2.607 and 3.482, Hvenous phase=3.426, 3.323 and 3.891, all P<0.05). The CT value difference, the percentage of lesion enhancement, the index of lesion enhancement in arterial phase, and the CT value difference and the index of lesion enhancement in venous phase of patients with G3 NET were all lower than those of patients with G2 NET (31 HU, 27 to 52 HU vs. 62 HU, 6 to 212 HU; 67%, 59% to 153% vs. 151%, 15% to 705%; 0.6 HU, 0.5 to 0.9 HU vs. 1.3 HU, 0.1 to 5.8 HU; 40 HU, 36 to 52 HU vs. 49 HU, 9 to 134 HU; 0.9, 0.7 to 1.6 vs. 1.5, 0.2 to 5.4), and the differences were statistically significant ( H=2.634, 2.801, 3.267, 2.264 and 2.882, all P<0.05). The relative density index of arterial phase and venous phase to identify G1 and G2 NET received maximum AUC value of 0.679 (95% confidence interval ( CI) 0.587 to 0.771, P<0.01) and 0.701 (95% CI 0.609 to 0.793, P<0.01), respectively. The index of lesion enhancement in arterial phase and venous phase to identify G2 and G3 NET received maximum AUC value of 0.875 (95% CI 0.793 to 0.956, P=0.001) and 0.828 (95% CI 0.700 to 0.956, P=0.004), respectively. Conclusion:The enhanced CT parameters of panNEN can be used to predict the pathological grade before operation.
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Objective:To investigate the correlation between endothelial dysfunction and cardiomyocyte apoptosis during myocardial ischemia-reperfusion.Methods:A total of 63 male rats were selected to establish the rat model of myocardial ischemia-reperfusion by the ligation of the left anterior descending(LAD)coronary artery to simulate myocardial ischemia.Rats were divided into the control group and group Ⅰb, group Ⅰa, group Ⅱb, group Ⅱa, group Ⅲb and group Ⅲa.Control rats were treated only with LAD threading without ligation.In observation group, at 30, 90, 120 min after LAD ligation(marked as Ⅰ, Ⅱ, Ⅲ group respectively), loosen the ligation to simulate ischemia-reperfusion.In the observation group, captopril sublingual injection of 0.25 mg/kg before ligation were marked as group b, and as group a with no captopril injection.The circulating endothelial cells(CEC), endothelin(ET), nitric oxide(NO)and the apoptosis rate of cardiomyocytes in each group were measured.Results:The CEC and ET levels showed a continuous upward trend, and a NO level showed a continuous downward trend from group Ⅰa to Ⅱa to Ⅲa as compared with the control group( P<0.05). After using preventive intervention of captopril, the CEC and ET levels were lower and NO levels were higher in group Ⅱb and Ⅲb than in group Ⅱa and Ⅲa, respectively( P<0.05). The apoptotic rate of cardiomyocytes was higher in group Ⅰa than in the control group, and the apoptotic rate from high to low were from group Ⅲa[(235.71±40.25)%]to group Ⅱa[(197.28±43.56)%]to group Ⅰa[(138.55±32.87)%]and to the control group[(5.81±2.02)%]( P<0.05). The apoptotic rate of cardiomyocytes was lower in group Ⅱb[(125.67±26.51)%]and Ⅲb[(124.91±33.28)%]than in group Ⅱa and Ⅲa, respectively( P<0.05). Conclusions:The ischemia-reperfusion can cause endothelial dysfunction and the apoptosis of cardiomyocytes, and there is a close relationship between the degree of this lesions and the duration of ischemia-reperfusion.While, the appropriate application of angiotensin converting enzyme inhibitor can inhibit the damage of cardiomyocytes to a some extent.
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Objective:To explore the predictors of recovery of normal left ventricular ejection fraction (LVEF) in patients with chronic Keshan disease (CKD) after standard anti-heart failure treatment.Methods:From June 2013 to October 2017, CKD patients were selected as the research subjects in 8 Keshan disease counties (cities) in Shandong Province. Demographic data and clinical indicators related to the recovery of normal LVEF were collected at the initial diagnosis, and the patients were given standard anti-heart failure treatment. Follow-up was carried out until October 2019 or until all-cause death. Patients were divided into recovery group and non-recovery group according to whether LVEF returned to normal (LVEF≥50% was normal) by group design, and multi-factor logistic regression was used to analyze the predictors of recovery of normal LVEF.Results:A total of 98 CKD patients were included in this study, their average age was (47.51 ± 12.84) years old; body mass index (BMI) was (23.18 ± 4.92) kg/m 2; LVEF was (39.54 ± 8.26)%; male accounted for 65.31% (64/98); the New York Heart Association (NYHA) heart function grade Ⅱ and grade Ⅲ accounted for 46.94% (46/98) and 53.06% (52/98), respectively. The median follow-up time was 26 months, the LVEF of 28 patients (28.57%) returned to normal, and the LVEF increased from (43.27 ± 7.85)% of the baseline to (58.74 ± 6.07)%, the difference was statistically significant ( t=8.25, P < 0.01); LVEF did not return to normal in 70 patients (71.43%), and the LVEF increased from (37.84 ± 6.93)% of the baseline to (42.94 ± 7.31)%, the difference was statistically significant ( t=4.24, P < 0.01). The median recovery time of 28 patients with normal LVEF recovery was 14 months, of which 4 patients (14.29%), 6 patients (21.43%) and 15 patients (53.57%) recovered at follow-up of 6, 12 and 18 months, respectively, and 27 patients (96.43%) recovered within 3 years. The results of multivariate logistic regression analysis showed that disease course [odds ratio ( OR)=0.81, 95% confidence interval ( CI): 0.70-0.95, P < 0.05], electrocardiogram QRS wave duration ( OR=0.88, 95% CI: 0.79-0.98, P < 0.05), LVEF ( OR=1.26, 95% CI: 1.13-1.42, P < 0.01), and left ventricular end-diastolic diameter (LVEDD, OR=0.79, 95% CI: 0.66-0.90, P < 0.01) were independent predictors of recovery of normal LVEF. Conclusions:LVEF can return to normal after anti-heart failure treatment in some CKD patients. Patients with shorter disease course, shorter electrocardiogram QRS wave duration, higher baseline LVEF and lower LVEDD are more likely to recover from LVEF.
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Objective:To investigate CT imaging appearance of pancreatic solid pseudopapillary neoplasm (pSPN) in predicting pathological invasive behaviors.Methods:The clinical data and CT data of 103 patients with solid pseudopapillary neoplasm confirmed by surgical resection and pathology were retrospectively analyzed. According to the pathological results, all cases were divided into two groups: invasive group with 38 cases and non-invasive group with 65 cases. All 103 cases of pSPN had a single lesion. Image analysis included tumor location, size, shape, capsule,calcification, hemorrhage and proportion of cystic or solid component, etc. The density of solid components in all lesions was measured in plain scan, arterial phase and venous phase of CT images. Enhancement degree in arterial phase, enhancement degree in venous phase and enhancement degree between venous phase and arterial phase were calculated, and the differences between the two groups were statistically analyzed. For data analysis, the comparison of continuous variables between two groups was done with Student′s t-test. Categorical variables were tested using the χ 2 test or Fisher′s exact test. Diagnostic accuracy of density in arterial phase, density in venous phase, enhancement degree in arterial phase and enhancement degree in venous phase were assessed as the area under the receiver-operating characteristic (ROC) curve. Results:There were statistically significant differences in tumor capsule and proportion of cystic or solid component between the two groups ( P<0.05). There were no significant differences in neoplasm maximum diameter, location, morphology, calcification, hemorrhage, pancreaticobiliary dilatation and pancreatic atrophy between the two groups ( P>0.05). The density[(76.65±16.71) HU] and enhancement degree[(41.04±17.02) HU] in venous phase in invasive group were higher than those in non-invasive group [respectively (70.09±12.02),(34.55±11.41) HU] and the differences were statistically significant ( P<0.05). There were no statistically significant differences in the density in plain scan, density in arterial phase, enhancement degree in arterial phase and enhancement degree between venous phase and arterial phase ( P>0.05). The area under the ROC curve of density in arterial phase, density in venous phase, enhancement degree in arterial phase and enhancement degree in venous phase were respectively 0.598, 0.634, 0.613, and 0.617, among which only density in venous phase had the discriminant efficacy, and the optimal critical value was 78.65 HU. Conclusion:The pSPN has no capsule or incomplete capsule, more solid components, and obvious enhancement of the solid components in the tumor in venous phase may suggest that the tumor has more invasive behavior.
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Objective:To analyse the MRI features of hilar schwannomas and pathology.Methods:The MRI and pathological features of 5 patients with hilar schwannomas which were confirmed histopathologically at Zhongshan Hospital, Fudan University from January 2012 to August 2019 were retrospectively analyzed. There were 3 males and 2 females, with age ranging from 47 to 67 years (median age 59 years). Contrast-enhanced MRI scans were performed in these 5 patients. The site, shape, size, edge, signal and enhancement pattern of these lesions and pathologicl findings were analysed.Results:All the lesions were single, located in and around the perihilar region. Four lesions were oval or roundish, and 1 lesion was sausage-shaped. Two lesions were solid while 3 lesions were cystic solid. All lesions had clear borders with intact capsules. The solid parts in all the lesions showed isointensity or slightly hypointensity on T 1 weighted imaging, hyperintensity on fat-suppression T 2 weighted imaging (T 2WI), hyperintensity on diffusion weighted imaging, slightly hyperintensity / isointensity / slightly hypointensity on apparent diffusion coefficient maping with progressive mild to moderate enhancement. Thick septum was observed in the cystic part. The septum and capsule showed mild to moderate delayed enhancement. Fluid-fluid level was seen in one lesion. The cystic solid lesion in one patient showed the " target sign" on fat-suppression T 2WI. All the 5 tumors were close to blood vessels, and their long axes followed the shape of the portal vein. In 1 patient, the lesion slightly compressed the adjacent bile ducts. Pathological examination showed that all the tumors in the 5 patients had complete fibrous envelopes, and the solid parts of the tumor showed mainly spindle cells. Conclusions:The MRI features of hilar schwannomas were oval or sausage-shaped lesions, with the long axis along the portal vein. They were prone to develop cystic changes, and a"target sign"could be shown on fat-suppression T 2WI. The solid parts, septa and capsules of the lesions showed mild to moderate progressive enhancement after contrast-injection.
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Objective@#To compare the MRI features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.@*Methods@#The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed. Of the 26 males and 7 females aged (56.0±9.8) years, there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients. All patients underwent contrast-enhanced abdominal MRI scans. The differences in the MRI features, including morphology, margin, signal intensity on plain scanning and enhancement patterns were compared statistically. The apparent diffusion coefficient (ADC) values of peliosis hepatis, hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.@*Results@#In 14 lesions of the 11 patients with peliosis hepatis, 10 lesions were ill-defined and 4 lesions were well-defined. In 31 lesions of the 22 patients with hepatic metastases, 5 lesions were ill-defined and 26 lesions were well-defined. Significant differences existed between peliosis hepatis and hepatic metastases in the margin (P<0.05). The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma (P<0.05). In all the 14 lesions of peliosis hepatis, 10 lesions showed gradual filling enhancement, and 4 lesions showed marked and persistent enhancement. In all the 31 lesions of hepatic metastases, 28 lesions showed a ring-shaped enhancement, and 3 lesions showed "quick in and quick out" enhancement.@*Conclusions@#The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined, with no restriction of water diffusion in the diffusion weighted imagings, and with progressive enhancement. The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma.
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Objective To compare the MR] features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.Methods The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed.Of the 26 males and 7 females aged (56.0 ± 9.8) years,there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients.All patients underwent contrast-enhanced abdominal MRI scans.The differences in the MRI features,including morphology,margin,signal intensity on plain scanning and enhancement patterns were compared statistically.The apparent diffusion coefficient (ADC) values of peliosis hepatis,hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.Results In 14 lesions of the 11 patients with peliosis hepatis,10 lesions were ill-defined and 4 lesions were well-defined.In 31 lesions of the 22 patients with hepatic metastases,5 lesions were ill-defined and 26 lesions were well-defined.Significant differences existed between peliosis hepatis and hepatic metastases in the margin (P ＜ 0.05).The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma (P ＜ 0.05).In all the 14 lesions of peliosis hepatis,10 lesions showed gradual filling enhancement,and 4 lesions showed marked and persistent enhancement.In all the 31 lesions of hepatic metastases,28 lesions showed a ring-shaped enhancement,and 3 lesions showed "quick in and quick out" enhancement.Conclusions The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined,with no restriction of water diffusion in the diffusion weighted imagings,and with progressive enhancement.The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma.
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Objective To analyze the difference of echocardiography in patients with chronic Keshan disease (CKD) at different altitudes areas,explore the effects of altitude on the structure and functional of right heart in CKD patients,and provide a reference for imaging diagnosis of CKD.Methods According to the three step distribution of the terrain in China,30 cases of CKD patients in the first step (altitude ＞ 4 000 m) of Tibet autonomous region were randomly selected as the Tibetan plateau group.In the second step (altitude:1 000-2 000 m),31 cases were randomly selected in Gansu Province as the Loess plateau group.In the third step (altitude ＜ 500 m),42 cases were randomly selected in Shandong Province as the plain group.Echocardiography was used to analyze the morphology,hemodynamics and function of right heart.Results Right atrial transverse diameter (RATD),right ventricular transverse diameter (RVTD),right ventricular lateral wall thickness (RVWT) and main pulmonary artery diameter (MPAD) of the Tibetan plateau group,the Loess plateau group and the plain group (mm:49.75 ± 8.40,45.64 ± 7.63,43.56 ± 7.34;50.89 ± 7.13,46.56 ± 5.62,43.27 ± 6.01;4.75 ± 1.02,3.53 ± 0.61,3.37 ± 0.51;32.87 ± 3.62,28.93 ± 2.12,28.44 ± 2.71) were significant differences among the three groups (F =5.36,12.91,37.08,23.33,P ＜ 0.01).The above indexes of the Tibetan plateau group were higher than those of the Loess plateau group and the plain group (P ＜ 0.05).RVTD of Loess plateau group was higher than that of plain group (P ＜ 0.05).The fractional area change [FAC,(24.85 ± 2.75)％,(26.26 ± 3.42)％,(26.73 ± 3.14)％],tricuspid annular plane systolic excursion [TAPSE,(12.87 ± 1.12),(14.59 ± 1.63),(14.13 ± 1.31) mm] of the Tibetan plateau group,the Loess plateau group and the plain group were significant differences among the three groups (F =3.36,13.47,P ＜ 0.05 or ＜ 0.01);the above indexes of the Tibetan plateau group were lower than those of the Loess plateau group and the plain group (P ＜ 0.05).Tei index (0.87 ± 0.18,0.78 ± 0.16,0.71 ± 0.14),tricuspid flap diastolic maximum filling speed/tricuspid annulus early diastolic peak velocity (E/E',9.48 ± 1.22,8.64 ± 0.91,8.12 ± 1.13),systolic pulmonary artery pressure [SPAP,(49.58 ± 11.76),(44.35 ± 11.41),(42.67 ± 12.13) mmHg,1 mmHg =0.133 kPa] of the Tibetan plateau group,the Loess plateau group and the plain group were significant differences among the three groups (F =12.89,13.99,3.12,P ＜ 0.01 or ＜ 0.05);the Tei index and E/E'of the Tibetan plateau group were higher than those of the Loess plateau group and the plain group (P ＜ 0.05).Tei index,E/E'of the Loess plateau group were higher than those of the plain group (P ＜ 0.05).Conclusions The right heart structure and function of CKD patients are affected by the altitude of their residence.With the increase of altitude,the right heart is enlarged,the right ventricular systolic and diastolic functions are decreased,and SPAP is increased in CKD patients.
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Objective The echocardiography of patients with chronic Keshan disease (CKD) in the plateau and plain areas was compared,to analyze the specific manifestations of echocardiography in patients with high altitude CKD,to provide a reference for imaging diagnosis.Methods From October 2014 to December 2016,34 patients with CKD were selected in the Tibet Autonomous Region [18 males,16 females,aged (44.5 ± 5.6) years old] as plateau group;45 patients with CKD were selected in Shandong Province [21 males,24 females,age (47.3 ± 6.9) years old] as a plain group.Echocardiography was performed on the observed subjects,and cardiac morphology,hemodynamics and cardiac function were analyzed.Results The left atrial diameter (LAD),left ventricular end diastolic diameter (LVEDD),and left ventricular mass (LVM) of the plateau group were (39.2 ± 4.8),(56.5 ± 6.3) mm and (232.4 ± 40.2) g,respectively,which were lower than those of the plain group [(48.3 ± 5.7),(65.2 ± 7.8) mm,(283.7 ± 38.3) g,t =-7.52,-5.30,-5.74,P ＜ 0.01].The right atrial transverse diameter (RATD),right ventricular transverse diameter (RVTD) and right ventricular lateral wall thickness (RVWT) of the plateau group were (47.6 ± 8.5),(50.4 ± 7.3) and (4.8 ± 1.1) mm,respectively,which were higher than those of the plain group [(42.3 ± 7.2),(42.7 ± 6.8),(3.3 ± 0.7) mm,t =2.99,4.81,7.36,P ＜ 0.01].The early diastolic filling velocity (E),the early diastolic peak velocity of the mitral annular (Em) of the plateau group were lower than those of the plain group,E/Em of the plateau group was higher than that of the plain group (t =-2.64,-2.35,2.07,P ＜ 0.05).The fractional area change (FAC) of right ventricular,tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S') of the plateau group [(24.9 ± 2.8)％,(13.2 ± 1.2) mm,(6.8 ± 1.0) cm/s] were lower than those of the plain group [(26.3 ± 3.2)％,(14.5 ± 1.3) rmm,(7.5 ± 1.2) cm/s,t =-2.02,-4.53,-2.74,P ＜ 0.05 or ＜ 0.01].The tricuspid annular diastolic velocity (e') of the plateau group was lower than that of the plain group,and tricuspid annular blood flow early diastolic filling velocity maximum (e)/e'was higher than that of the plain group (t =-2.07,2.09,P ＜ 0.05).The systolic pulmonary artery pressure (SPAP) of the plateau group [(48.5 ± 12.3) mmHg,1 mmHg =0.133 kPa] was higher than that of the plain group [(41.6 ± 13.3) mmHg,t =2.34,P ＜ 0.05].Conclusion Compared with CKD patients in plain area,CKD patients in plateau area have showed more obvious right heart enlargement and right ventricular failure,and combined with higher SPAP.
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Objective To investigate the safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure (LARP-PPC) for low rectal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 132 patients with low rectal cancer who were admitted to Ruijin Hospital of Shanghai JiaoTong University School of Medicine from January 2014 to December 2017 were collected.There were 81 males and 51 females,aged from 45 to 83 years,with an average age of 62 years.Among the 132 patients,60 undergoing LARP-PPC were allocated into LARP-PPC group,and 72 patients undergoing conventional LARP were allocated into LARP group.All the patients received standardized preoperative and postoperative treatments.Observation indicators:(1) surgical and postoperative conditions;(2) postoperative pathological examination;(3) postoperative complications.The measurement data with normal distribution were expressed as Mean±SD,and the t test was used for comparison between groups.The measurement data with skewed distribution were expressed as M (range),and the Mann-Whitney U test was used for comparison between groups.The count data were expressed as absolute numbers,and the chi-square test or the Fisher exact probability was used for comparison between groups.Mann-Whitney U test was used for comparison of ordinal data between groups.Results (1) Surgery and postoperative conditions:all the patients in the two groups underwent successful surgery without conversion to open surgery.The operation time,volume of intraoperative blood loss,time to first flatus,and time to first liquid intake of the LARP-PPC group were (163±45) minutes,168 mL(range,85-280 mL),2 days(range,1-5 days),3 days(range,2-6 days),versus (155±39) minutes,160 mL(range,100-305 mL),3 days(range,1-7 days),4 days(range,2-7 days) of the LARP group;there was no differencebetween the two group (t =1.113,Z =-1.623,-1.468,-0.321,P＞0.05).The duration of postoperative hospital stay in the LARP-PPC group and the LARP group were 16 days (range,11-21 days) and 19 days (14-24 days),respectively,with a significant difference between the two groups (Z =-5.888,P＜0.05)].In the LARP-PPC group,time of PPC was (13± 3) minutes.(2) Postoperative pathological examination:the length of specimen,the number of lymph node dissection,tumor diameter,cases with high-,middle-,and low-differentiated tumor in the LARP-PPC group was (18±4)cm,16±t5,(3.7±1.4)cm,10,34,16 in the LARP-PPC group,and (18±4)cm,16±5,(3.9±1.5) cm,13,41,18 in the LARP group,showing no significant difference between the two groups (t =0.779,0.390,0.703,Z=-0.267,P＞0.05).(3) Postoperative complications:cases with perineal wound infection,delayed perineal wound healing,intestinal obstruction,and perineal hernia were 2,1,1,0 in the LARP-PPC group,and 12,10,8,6 in the LARP group,showing significant differences between the two groups (x2 =6.137,6.400,P＜0.05).There were 2 and 4 patients with urinary tract infection in the LARP-PPC group and the LARP group,respectively,showing no significant difference between the two groups (P ＞ 0.05).Conclusion LARP-PPC is safe and feasible for the treatment of low rectal cancer,which can significantly reduce postoperative perineal-related complications and consequently shorten postoperative hospital stay.
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Objective To analyze the predictive factors of clinically relevant pancreatic fistula after distal pancreatectomy.Methods The perioperative data of 154 patients undergoing distal pancreatectomy at Anhui Provincial Hospital from Jan 2013 to Jan 2018 were retrospectively analyzed.29 clinical factors were analyzed using SPSS 22.0.Results The univariate analysis of clinically relevant pancreatic fistula after distal pancreatectomy showed:body mass index,preoperative ALT level,pre-operation and first day after operation pre-albumin level,drain fluid volume on the first postoperative day,first postoperative day blood glucose level,combined with diabetes and ASA score were risk factors for clinically relevant pancreatic leakage (P ＜ 0.05).Multivariate analysis indicated that drain fluid volume on the first postoperative day and the preoperative ALT level were independent risk factors for clinically relevant pancreatic leakage (P ＜ 0.05).Conclusion The drainage volume on the first postoperative day can predict the occurrence of clinically relevant pancreatic fistula after distal pancreatectomy.
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Objective To analyze magnetic resonance imaging (MRI) features of adenosquamous carcinoma of the pancreas and to summarize MRI signs with diagnostic value.Methods From August 2010 to June 2017,at Zhongshan Hospital Affiliated to Fudan University,the MRI data of 20 patients with pathologically diagnosed adenosquamous carcinoma of pancreas were retrospectively analyzed.The image analysis included tumor location,size,morphology,lesion borders,signal intensity,enhancement pattern,bile duct and main pancreatic duct dilatation,pancreatic atrophy,extrapancreatic invasion,lymph node metastasis and liver metastasis.Results The lesions of all the 20 patients with pancreatic adenosquamous carcinoma were single,and the diameter was (3.39 ± 1.17) cm (1.37 to 5.87 cm).The lesions of 12 patients were located in the head of pancreas,and eight cases were located in body and (or)tail.Eleven lesions were round and nine lesions were irregular.Eight lesions had clear lesion boundaries,and 12 lesions had blurred lesion boundaries.The imagines of 20 lesions showed slightly lower or hypointensity signal on T1 weighted imaging (T1WI),and equal or slightly higher signal on T2 weighted imaging (T2WI).There were different sizes of necrosis or cystic areas in 18 lesions,and two lesions were complete solid masses.The imagines of 19 lesions showed uneven enhancement during dynamic enhanced scan,which were ring-shaped or separated.The enhancement started from the periphery of tumors,and the signal intensity of the enhanced areas within the lesions approached or exceeded the signal intensity of the normal pancreatic tissue.Conclusion Pancreatic adenosquamous carcinoma is prone to cystic necrosis,and its enhanced MRI imaging has certain characteristics.
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Objective To compare the incidence of postoperative complications and long-term survival rates in pancreatic head cancer with extended and standard lymphadenectomy,and conclude an appropriate cleaning range.Methods Published randomized controlled trials about pancreatoduonectomy with extended lymphadenectomy (ELPD) vs standard lymphadenectomy (SLPD)in pancreatic cancer patients on Pubmed,Embase and the Cochrane library were retrieved from database building to October 1st 2017 with the keywords including "pancreatoduonectomy " " pancreatic adenocarcinoma whipple lymphadenectomy extended " and "standard".Obtained literatures were screened independently by two researchers(the PRISMA statement).After included literatures reviewed and data extracted,a meta-analysis was carried out using Revman 5.3 software.Results A total of 7 RCTs were included in the analysis,and the total number of cases was 850,of which 426 cases were extended lymph node dissection and 424 were standard.The results showed that the ELPD group had longer operation time (373.1 min and 318.4 min,respectively,P =0.003),increased intraoperative bleeding and blood transfusion (681.5 ml and 556.2 ml,respectively,P =0.03).The incidence rate of postoperative complications (40.8％ and 28.9％,respectively,P =0.0006) and the delayed gastric emptying (16.2％ and 10.0％,P =0.02),postoperative hospitalization time (19.7 d and 15.0 d,P ＜ 0.05) also increased in ELPD group.At the same time,the 1-、3-、5-year survival rate (66.0％ and 70.8％,P =0.17;24.7％ and 27.5％,P=0.41;16.6％ and 14.3％,respectively,P=0.45) was not improved in pancreatic cancer patients.Condusion ELPD increase the postoperative complications and prolong the hospital stay of pancreatic cancer patients and did not improve postoperative survival rate at the same time,SLPD should be preferred during the operation.By summarizing the latest research progress.