Application value of double-layer spectral detector CT in differentiating central lung cancer from atelectasis.

BACKGROUND: Central lung cancer with obstructive atelectasis is very common in clinical practice. Determination of the tumor borderline is important. Conventional computed tomography (CT) alone may not be sufficiently accurate to distinguish central lung cancer from obstructive atelectasis. Spectral CT can improve the soft-tissue resolution greatly. In this study, we evaluated the application value of double-layer spectral detector CT in differentiating central lung cancer from atelectasis. METHODS: A total of 51 patients (37 males) with pathologically confirmed central lung cancer accompanied by atelectasis were enrolled. The rates of differentiation between tumors and atelectasis were retrospectively analyzed using conventional CT and three types of spectral images (40 keV virtual monoenergetic imaging, iodine density map, and their fusion image) of unenhanced scans as well as arterial and venous phases. Cochran's Q test and Friedman test were used to compare the differentiation rates and the maximal diameters of the tumors in each image. RESULTS: Among the 51 cases, conventional CT, 40 keV monoenergetic, iodine density, and their fusion images of the venous phase were successful in differentiating tumors from atelectasis in 17 (33.33%), 35 (68.63%), 39 (76.47%), and 38 (74.51%) cases, respectively. The differentiation rates of the 40 keV monoenergetic, iodine density, and fusion images were significantly higher than those of conventional images (χ2=-0.35, -0.43, and -0.41, respectively, all P<0.001). There were no significant differences in the differentiation rates among the 40 keV monoenergetic, iodine density, and fusion images (χ2=-0.06, -0.08, 0.02, respectively, all P=1.00). The maximal tumor diameters in the four images did not significantly differ (χ2=3.61, P=0.31). Conventional and spectral images of unenhanced and arterial phases could not/barely identify the tumor borderlines. CONCLUSIONS: Venous-phase spectral images of double-layer spectral detector CT can differentiate most central lung cancers from atelectasis, and the maximal diameter measurement of the tumor is reliable. Double-layer spectral detector CT can accurately identify the borderlines of most central lung cancers through spectral images during routine CT examinations without requiring other imaging modalities. Therefore, this method has considerable clinical value for applications in tumor staging, efficacy evaluation, and radiotherapy.

Prediction of early recurrence of hepatocellular carcinoma after resection based on Gd-EOB-DTPA enhanced magnetic resonance imaging: a preliminary study.

Background: Early recurrence (ER) after radical resection of hepatocellular carcinoma (HCC) affects the prognosis of patients. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) can improve the detection rate of small HCC. This study innovatively introduces a new quantitative index combined with qualitative index to compare the differences in clinical and imaging characteristics between ER and non-ER groups and evaluate the feasibility of Gd-EOB-DTPA-enhanced MRI in predicting ER. Methods: A total of 68 patients with HCC confirmed by operation and pathology in the Shandong Cancer Hospital and Institute were included retrospectively. All participants were examined by Gd-EOB-DTPA-enhanced MRI within 3 weeks before surgery. Regular follow-up was performed every 2 months within 1 year after operation. Among them, 18 cases with new lesions were in ER group, and 50 cases without new lesions were in non-ER group. The clinical and imaging data of the 2 groups were collected, and the differences of clinical data and preoperative MRI signs between the ER group and non-ER group were compared. The predictive factors of ER after HCC were analyzed by multivariate logistic regression. Results: The quantitative parameter lesion-to-liver contrast enhancement ratio (LLCER) can predict the pathological grade of HCC (P=0.023). The results of univariate analysis between the ER group and non-ER group showed that there were significant differences in pathological grade (P=0.008), lesion morphology (P=0.011), peritumoral low signal intensity in hepatobiliary phase (HBP) (P<0.001), satellite nodules (P<0.001), and LLCER (P<0.001) between the 2 groups. Multivariate logistic regression analysis showed that HBP peritumoral low signal intensity [odds ratio (OR) =7.214, 95% confidence interval (CI): 1.230-42.312, P=0.029], satellite nodules (OR =9.198, 95% CI: 1.402-60.339, P=0.021), and parameter LLCER value (OR =0.906, 95% CI: 0.826-0.995, P=0.039) were independent predictors of ER of HCC after resection. Conclusions: Preoperative Gd-EOB-DTPA enhanced MRI has important predictive value for early recurrence after radical resection of hepatocellular carcinoma.

Adrenomedullin in the rostral ventrolateral medulla is involved in the regulation of cardiovascular component of defensive responses induced by electrical stimulation of dorsal periaquaductal gray of the midbrain.

In this study, we used techniques of in situ hybridization, immunohistochemistry, electric stimulation of the dorsal periaquaductal gray of the midbrain (dPAG) and microinjection to investigate the changes of preproadrenomedullin (ppADM) gene expression encoding adrenomedullin (ADM) and ADM-like immunoreactivity (ADM-IR) in the medulla oblongata, especially in the rostral ventrolateral medulla (rVLM) of the rats receiving foot-shock and noise stress for 5 d, and the potential role of ADM in cardiovascular component of defense response in the rVLM. The results showed that ppADM mRNA and ADM-IR were widely distributed throughout the medulla oblongata. Highly labeled neurons were found in the ventrolateral reticular nucleus and hypoglossal nucleus. Moderately labeled neurons were seen in the facial, ambiguus, lateral reticular, paragigantocellular reticular, and inferior olivary nuclei. Weak signal was present over neurons of nucleus of the solitary tract. The expression of ppADM mRNA and ADM-IR increased significantly after foot shock and noise stress for 5 d as compared with that in control group (P<0.01). On the other hand, stimulation of the right dPAG raised the artery pressure (AP) rapidly from (116.4+/-8.9) mmHg to (140.0+/-9.8) mmHg, and heart rate (HR) from (378.0+/-7.5) beats/min to (413.0+/-8.2) beats/min, respectively, in the normotensive rats. After unilaterally microinjection of hADM(22-52) (a specific antagonist of ADM receptor, 1 pmol) into the right rVLM of the normotensive rats for 10 min, the rats received the stimulation of the dPAG again. Then we found that the DeltaAP and DeltaHR were lowered significantly within 60 min compared with those without hADM(22-52) application (P<0.05). After unilaterally microinjection of 0.1 pmol rat ADM (rADM) into the rVLM, dPAG stimulation caused no significant changes in DeltaAP and DeltaHR. Our results that foot-shock and noise stress induced significant increases of ppADM mRNA and ADM-IR in the rVLM, and microinjection of ADM receptor antagonist hADM(22-52) into the rVLM partly blocked the cardiovascular component of stress-defensive response induced by stimulation of the dPAG, suggest that ADM in the rVLM might be an important neurotransmitter or neuroregulator in the regulation of cardiovascular function in the stress-related defensive response.

Differential expressions of nNOS and iNOS in the rostral ventrolateral medulla induced by electroacupuncture in acute myocardial ischemia rats.

Increasing lines of evidence has been accumulated that nitric oxide (NO) and nitric oxide synthase (NOS) distribute plentifully in the rostral ventrolateral medulla (RVLM) and contribute to cardiovascular regulation. In the present study, the expressions of neuronal and inducible isoform of NOS (nNOS and iNOS) were observed in the RVLM of acute myocardial ischemia (AMI) Wistar rats experienced electroacupuncture (EA) treatment, thereby the cardiovascular effects of NO in the RVLM were investigated and the mechanism of acupuncture effect on AMI was inferred. The results indicated that in the AMI rats, cardiac functions were markedly attenuated with high serum level of brain natriuretic peptide (BNP) and norepinephine (NE), the number of nNOS-immunoreactive cells and nNOS mRNA exprossion in the RVLM area were increased, while those of iNOS were lowered. EA at "Neiguan" acupoints (Pe 6) 30 min daily for successive 5 d resulted in an improvement of the cardiac functions, decreases in NE and BNP levels; it also increased the expression of iNOS and decreased the expression of nNOS in the RVLM. These results suggest that the curative effect of acupuncture on AMI is possibly attributable to the differential regulation of NOS/NO in the RVLM, leading to decreased sympathetic outflow and improvement of cardiac functions.

Effect of adrenomedullin on the activity of barosensitive neurons in the rostral ventrolateral medulla of rats.

To investigate the eletrophysiological effect of rat adrenomedullin (rADM) on barosensitive neurons in the rostral ventrolateral medulla (rVLM) and its potential mechanisms, the extracellular recording and multi-barrel iontophoresis methods were used. Of the 29 barosensitive neurons in the rVLM, 20 neurons demonstrated excitatory response to iontophoretically applied rADM and increased the firing rate from (10.8 +/- 2.7) spikes/s to (14.6 +/- 3.6), (19.8 +/- 4.7) and (31.9 +/- 6.4) spikes/s (P<0.05, n=20) at the current of 30, 60 and 90 nA, respectively. Application of human adrenomedullin (22-52) [hADM (22-52)], a specific antagonist of rADM receptor, distinctly attenuated the augmentation of firing rate induced by rADMjthe firing rate was increased by 15.4% [(11.4 +/- 2.5) spikes/s, P<0.05, n=10]. Another antagonist, human calcitonin gene-related peptide (8-37) [hCGRP (8-37)] had no significant effect on rADM-induced excitation. Other 23 barosensitive neurons were recorded to test the influence of nitric oxide synthase (NOS) inhibitors on the excitatory effect of rADM. In 10 neurons, 7-NiNa (neuronal NOS inhibitor) decreased the firing rate from (10.1 +/- 3.5) spikes/s to (7.5 +/- 2.5), (5.3 +/- 2.1) and (3.1 +/- 1.4) spikes/s (P<0.05, n=10) at the current of 10, 20 and 40 nA, respectively. The excitatory effect of rADM (60 nA, 30 s) during 7-NiNa application was nearly eliminated and the magnitude of firing rate was increased only by 17% of the basal level (6.2 +/- 1.9) spikes/s (P<0.05, n=7). While aminoguanidine (AG, iNOS inhibitor) increased the firing rate at the resting level from (11.5 +/- 5.1) spikes/s to (17.8 +/- 5.6), (22.5 +/- 6.3) and (29.1 +/- 6.4) spikes/s (P<0.05, n=8) at the current of 10, 20 and 40 nA in 8 barosensitive neurons, respectively. When rADM (60 nA, 30 s) was delivered during AG iontophoresis period, the firing rate significantly increased by 60% of the basal level [(22.5 +/- 6.3) spikes/s, n=5]. These results indicate that rADM activates the barosensitive neurons in the rVLM directly and acts as a cardiovascular regulator, and that this function might be mediated by its specific receptor. NO, mainly neuronal NOS-originated might be involved in the excitatory effect of rADM in the rVLM.

Effects of acupuncture on nNOS and iNOS expression in the rostral ventrolateral medulla of stress-induced hypertensive rats.

This study was to observe the changes of the neuronal and inducible nitric oxide synthase (nNOS & iNOS) as well as their mRNAs in the rostral ventrolateral medulla (RVLM) of stress-induced hypertensive rats before and after acupuncture, and thereby to infer the curative mechanism of acupuncture on hypertension. The result indicated that the systolic blood pressure (SBP) of stress group rats was increased significantly (P < 0.01), it was accompanied that the expression of nNOS in the RVLM, including the immunoreactive neuron number (P < 0.05), the optical density (OD) (P < 0.01), and the mRNA (P < 0.01) were obviously elevated, while those of iNOS (P < 0.05, P < 0.01 and P < 0.01) were evidently lowered in the stress-induced hypertensive rats. Electroacupuncture (EA) points at "Zusanli" (St. 36) and "Lanwei" (Extra 37) on the same hindlimb were stimulated by an EA apparatus (Type G6805-2) with dense sparse wave (4-20Hz) and 4mA intensity. EA application could return the SBP (P < 0.05), and the changes on the expression of both nNOS and iNOS (P < 0.05, P < 0.01 and P < 0.01). These results suggest that the curative mechanism of acupuncture on stress-induced hypertension is related to the changes of nNOS and iNOS in the RVLM of rats.