Predictive value of magnetic resonance imaging characteristics before and after radiotherapy for the occurrence of severe radiation-induced late rectal injury in patients with rectal cancer / 中华胃肠外科杂志

Objective: Severe radiation-induced late rectal injury (sRLRI) directly affects the quality of life of patients with rectal cancer. Effective prediction of sRLRI before surgery may provide important information for the selection of surgical strategies and perioperative managements. The purpose of this study is to evaluate the feasibility of predicting sRLRI based on magnetic resonance imaging (MRI) features before and after radiotherapy for rectal cancer. Methods: This was a diagnostic study. Clinical and imaging data of 90 patients with rectal cancer receiving long-term radiotherapy from June 2013 to July 2018 in the Sixth Affiliated Hospital of Sun Yat-sen University were collected retrospectively. Case inclusion criteria: (1) rectal cancer was diagnosed by pathology and age of ≥ 18 years old; (2) patients received neoadjuvant chemoradiotherapy and anterior rectal resection; (3) follow up time ≥ 3 years; (4) patients had no history of other neoplasm. Exclusion criteria: (1) patients did not receive MRI examination in our hospital within 2 weeks before and/or 8 weeks after radiotherapy; (2) images were not good enough for evaluation; (3) medical records were incomplete; (4) patients had severe gastrointestinal diseases. According to the RTOG/EORTC classification criteria for radiation reactions, severe complications of grade 3-4 requiring surgical management were defined as sRLRI. T2WI and DWI images before and after radiotherapy were evaluated. The rectal wall thickness, bladder wall thickness, rectal sacral spacing and apparent diffusion coefficient (ADC) were measured. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above indicators for sRLRI. Results: Among the 90 patients with rectal cancer, 34 (37.8%) developed sRLRI. Before radiotherapy, the median rectal wall thickness of sRLRI and non-sRLRI patients was 4.530 mm and 4.355 mm, respectively; the median bladder wall thickness was 3.962 mm and 3.868 mm, respectively; the median rectal sacral spacing was 15.557 mm and 12.433 mm, respectively; the median ADC value of rectal wall was 1.620 ×10(-3) mm(2)/s and 1.653 ×10(-3) mm(2)/s, respectively. There were no significant differences in above indicators between sRLRI and non-sRLRI patients (all P>0.05). After radiotherapy, compared with non-sRLRI patients, sRLRI patients had increased rectal wall thickness (median: 8.239 mm vs. 6.223 mm, Z=-3.512, P=0.001), rectal sacral spacing (median: 17.728 mm vs. 13.885 mm, Z=-2.247, P=0.025), and change of rectal wall thickness after radiotherapy (median: 98.106% vs. 49.584%, Z=-4.169, P<0.001). After radiotherapy, there were no significant differences in the bladder wall thickness and its change value, the ADC value of rectal wall and its change rate before and after radiotherapy between the two groups (all P>0.05). The area under the curve (AUC) of the change rates of rectal wall thickness after radiotherapy, rectal wall thickness and rectal sacral spacing after radiotherapy for predicting sRLRI was 0.763, 0.722 and 0.642, respectively, while the sensitivity was 85.3%, 70.6% and 76.5%, respectively, and the specificity was 64.3%, 71.4% and 57.1%, respectively. Conclusion: Based on MRI examinations, assessments of rectal wall thickness after radiotherapy, the change rate of rectal wall thickness after radiotherapy, and rectal sacral spacing after radiotherapy are helpful for evaluating the risk of sRLRI after radiotherapy for patients with rectal cancer.

Correlation of adiponectin, monocyte chemoattractant protein-1, and endothelial function to vascular remodeling in coronary in-stent restenosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the correlation between vascular remodeling index (RI) and serum adiponectin, plasma monocyte chemoattractant protein-1 (MCP-1), endothelial function and evaluate the mechanism of coronary in-stent restenosis.</p><p><b>METHODS</b>RI 6 months after percutaneous coronary intervention (PCI), serum adiponectin, plasma MCP-1 and flow-mediated dilation (FMD) before and 3 days,6 months after PCI were measured in 30 patients with and 30 without coronary in-stent restenosis.</p><p><b>RESULTS</b>Compared with patients without restenosis and those with restenosis before PCI, the patients with coronary in-stent restenosis showed significantly increased plasma MCP-1 3 days and 6 months after PCI (P<0.05) and reduced RI 6 months after PCI, serum adiponectin and FMD 3 days and 6 months after PCI (P<0.05). RI was positively correlated to serum adiponectin and FMD and inversely to MCP-1.</p><p><b>CONCLUSION</b>The occurrence of coronary in-stent restenosis is the result of the interrelations between multiple factors.</p>

Clinical value of dual-source CT in evaluating coronary artery disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the clinical value of dual-source CT (DSCT) in the diagnosis of coronary artery disease.</p><p><b>METHODS</b>Fifty-five patients with suspected coronary heart disease underwent both DSCT coronary angiography (DSCTCA) and selective coronary angiography (CAG) examination, and the diagnostic sensitivity, specificity and accuracy of the DSCTCA was evaluated.</p><p><b>RESULTS</b>The sensitivity, specificity, positive and negative predictive value, and accuracy of DSCT in the diagnosis of coronary heart disease were 97.7%, 72.6%, 93.5%, 88.9% and 92.7% by the number of patients, respectively; by calculating the coronary arteries, the sensitivity, specificity, positive and negative predictive value, accuracy were 94.9%, 95.8%, 92.5%, 97.1%, 95.5%, respectively. According to the lesion segment, these values were 88.2%, 96.9%, 90.5%, 96.1%, 94.7%, respectively. DSCTCA showed no significant difference from CAG for a diagnostic purpose, nor did their vessel sensitivity, specificity, positive and negative predictive value, and accuracy in different coronaries differ significantly.</p><p><b>CONCLUSION</b>DSCT has a diagnostic accuracy of coronary heart disease close to that CAG and can on some occasion serve as an alternative to CAG in the screening of coronary artery disease.</p>

Effect of combination of Chinese and Western medicines on sinus rhythm maintenance in patients with auricular fibrillation after conversion / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the curative effects of irbesartan, amiodarone and Wenxin Granule (WG), applied alone or in combination, on sinus rhythm maintenance in patients with auricular fibrillation (AF) after conversion.</p><p><b>METHODS</b>Forty-one patients of persistent AF, after their fibrillation being converted, were divided into three groups randomly, and treated with amiodarone (group A, n=14), irbesartan and amiodarone (group B, n=15), and WG plus irbesartan and amiodarone (group C, n=12) respectively for 6 months.</p><p><b>RESULTS</b>Compared with that before treatment, the inner diameter of atria sinistrum reduced in group B and C, and the reduction in the latter was superior to that in the former (P < 0.05); the diameter of left ventricle also reduced in group C (P < 0.05); and the maintenance rate of sinus rhythm was higher in group C than that in group A (P < 0.05).</p><p><b>CONCLUSION</b>Combined therapy of Chinese and Western medicines shows synergistic effect of anti-arrhythmia.</p>