Short-term effects of different PM2.5 ranges on daily all-cause mortality in Jinan, China.

To examine the effects of different PM2.5 concentration ranges on daily all-cause mortality, 8768 all-cause deaths were recorded in the database of the Shandong Provincial Hospital Affiliated to Shandong First Medical University. Data of air pollutants (PM2.5 and O3) concentration were provided by the Jinan Environment Monitoring Center. The relative risk of all-cause mortality was assessed using a quasi-Poisson regression model after adjusting for confounding factors. The concentrations of PM2.5 were divided into four ranges 0-35 µg/m3; 35-75 µg/m3; 75-115 µg/m3; 115-150 µg/m3. There was no significant relationship between PM2.5 exposure and all-cause deaths in individuals aged < 60 years. However, for individuals aged ≥ 60 years, there was a significant positive association between exposure concentrations and all-cause deaths within the ranges 0-35 µg/m3, 35-75 µg/m3, and 115-150 µg/m3 with a mortality increase of 1.07 (1.01, 1.13), 1.03 (1.00, 1.05), and 1.05 (1.01, 1.08), respectively. When the population aged ≥ 60 years was stratified into gender groups, exposure to PM2.5 in the range 0-35 µg/m3 increased the mortality risk in men but not women. All-cause mortality in women, but not men, increased significantly with exposure to PM2.5 in the ranges of 35-75, 75-115, and 115-150 µg/m3.

Middle lobe preservation and fixation after right upper and lower lobectomy for synchronous lung cancer.

The incidence of multiple lung cancer has been steadily increasing worldwide. Although cases of patients with lung cancers in the right upper and lower lobe have also become more frequently reported in clinical work, simultaneous right upper and lower lobectomy reports with the middle lobe preservation are still quite rare. A total of three patients with lung cancers in the right upper and lower lobe were included in the study. The patients underwent simultaneous right upper and lower lobectomy, whereas the remaining middle lobe was sutured and fixed to the intercostal muscle of the incision to prevent postoperative lobe torsion. There was no procedure to reduce residual space，such as phrenic nerve crush or thoracoplasty. All patients were discharged from the hospital 7 days after the operation. The chest tube was removed 5 days after the operation in two patients. One patient was discharged with the tube because of slight pulmonary leakage, and the tube was removed 2 weeks after the operation. Six months after the operation, the chest computer tomography showed that the middle lobe expanded well and no obvious cavity or pleural effusion was found. The suture of the remaining middle lobe and intercostal muscle of the incision is a simple and effective method that can be used to successfully avoid middle lobe torsion. This strategy is safe and can be used as the first choice for eligible patients.

Specific genomic alterations and prognostic analysis of perihilar cholangiocarcinoma and distal cholangiocarcinoma.

BACKGROUND: Cholangiocarcinoma (CCA), which consists of intrahepatic CCA (iCCA), perihilar CCA (pCCA), and distal CCA (dCCA), is an aggressive malignancy worldwide. PCCA and dCCA are often classified as extrahepatic CCA (exCCA). However, the differences in mutational characteristics between pCCA and dCCA remain unclear. METHODS: Deep sequencing targeting of 450 cancer genes was performed for genomic alteration detection. The tumor mutational burden (TMB) was measured by an algorithm developed in-house. Correlation analysis was conducted using Fisher's exact test. RESULTS: FGFR2 and ERBB2 mutations mainly occurred in iCCA and exCCA, respectively. In exCCA, the frequencies of PIK3CA, FAT4, KDM6A, MDM2, and TCF7L2 mutations were significantly higher in pCCA compared to dCCA, while the frequencies of TP53 and KRAS mutations were markedly lower in pCCA than those in dCCA. The prognosis-related mutations were different among the CCA subtypes. NF1 mutation was associated with short disease-free survival (DFS) and overall survival (OS), and ERBB2 mutation was associated with short DFS in dCCA patients. Meanwhile, MAP2K4 mutation was associated with long DFS and OS, and TERT mutation was associated with short DFS in pCCA. A series of mutations in genes, including ARID1A, ARID2, SMAD4, TERT, TP53, and KRAS, were found to be associated with the TMB. CONCLUSIONS: In this study, we investigated the comprehensive genomic characterizations of CCA patients, identified the significant alterations in each subtype, and identified potential biomarkers for prognosis prediction. These results provide molecular evidence for the heterogeneity of CCA subtypes and evidence for further precision targeted therapy of CCA patients.

Image quality and radiation dose of different scanning protocols in DSCT cardiothoracic angiography for children with tetralogy of fallot.

The aim of this study was to investigate the image quality and radiation dose of different scanning protocols in dual-source CT cardiothoracic angiography for children with tetralogy of Fallot (TOF). Seventy-five consecutive children with known or suspected TOF were enrolled to undergo prospective ECG-triggering sequential dual-source CT (DSCT) cardiothoracic angiography. According to the scanning protocols, these patients were randomly divided into 3 groups: fixed delay time (FDT, n = 25, group A), automatic bolus-tracking (ABT, n = 25, group B) and manual bolus-tracking (MBT, n = 25, group C). Subjective and objective image quality were evaluated. The radiation doses were recorded. The image quality scores of group C were significantly higher than those of group A and B. The absolute value of difference (D-value) on CT attenuation between left (CTLV) and right ventricle (CTRV) in group C was significantly lower than that in group A and B. The total effective dose of groups A, B and C were 0.39 ± 0.06 mSv, 0.40 ± 0.07 mSv and 0.40 ± 0.08 mSv, respectively. There was no significant difference among 3 groups (P = 0.722). Scanning protocol has significantly impacts on the image quality of cardiovascular structures for TOF patients. Compared with the conventional scanning protocols FDT and ABT, the MBT technique provides high image quality and achieves more homogenous attenuation among different patients with TOF.

Splenosis in gastric fundus mimicking gastrointestinal stromal tumor: a report of two cases and review of the literature.

Splenosis refers to heterotopic autotransplantation and implantation of splenic tissue following splenic trauma or surgery. Splenosis in gastric fundus is rare and difficult to diagnose, since splenosis has similar manifestation with gastrointestinal stromal tumor (GIST) under routine endoscopy examination. In this report, we present two quite rare case of splenosis. Both of their pre-operative diagnose under endoscopic ultrasonography was considered as GIST. Finally, one in the abdominal cavity, adhering closely to the gastric fundus, measuring 20 mm × 15 mm, was resected by surgical operation, and one in the gastric fundus, measuring 20 mm × 20 mm, was resected by endoscopic surgery. The precise diagnosis of splenosis was distinct by post-operative histopathologic examination. In addition, we also made a mini review of previously published articles, in order to provide indication to solve future doubts in diagnosing and treating splenosis.

Abdominal aortic intimal flap motion characterization in acute aortic dissection: assessed with retrospective ECG-gated thoracoabdominal aorta dual-source CT angiography.

OBJECTIVES: To evaluate the feasibility of dose-modulated retrospective ECG-gated thoracoabdominal aorta CT angiography (CTA) assessing abdominal aortic intimal flap motion and investigate the motion characteristics of intimal flap in acute aortic dissection (AAD). MATERIALS AND METHODS: 49 patients who had thoracoabdominal aorta retrospective ECG-gated CTA scan were enrolled. 20 datasets were reconstructed in 5% steps between 0 and 95% of the R-R interval in each case. The aortic intimal flap motion was assessed by measuring the short axis diameters of the true lumen and false lumen 2 cm above of celiac trunk ostium in different R-R intervals. Intimal flap motion and configuration was assessed by two independent observers. RESULTS: In these 49 patients, 37 had AAD, 7 had intramural hematoma, and 5 had negative result for acute aortic disorder. 620 datasets of 31 patients who showed double lumens in abdominal aorta were enrolled in evaluating intimal flap motion. The maximum and minimum true lumen diameter were 12.2 ± 4.1 mm (range 2.6 ∼ 17.4) and 6.7 ± 4.1 mm (range 0 ∼ 15.3) respectively. The range of intimal flap motion in all patients was 5.5 ± 2.6 mm (range 1.8 ∼ 10.2). The extent of maximum true lumen diameter decreased during a cardiac cycle was 49.5% ± 23.5% (range 12% ∼ 100%). The maximum motion phase of true lumen diameter was in systolic phase (5% ∼ 40% of R-R interval). Maximum and minimum intimal flap motion was at 15% and 75% of the R-R interval respectively. Intimal flap configuration had correlation with the phase of cardiac cycle. CONCLUSIONS: Abdominal intimal flap position and configuration varied greatly during a cardiac cycle. Retrospective ECG-gated thoracoabdominal aorta CTA can reflect the actual status of the true lumen and provide more information about true lumen collapse. This information may be helpful to diagnosis and differential diagnosis of dynamic abstraction.

Biological characteristics of the cerebral venous system and its hemodynamic response to intracranial hypertension.

BACKGROUND: The role of the cerebral venous system (CVS) in intracranial pressure (ICP) regulation remains largely unclear. In the present study, the interaction between ICP and the cerebral venous system and its possible mechanism were investigated with respect to the biological characteristics of the cerebral venous system and its hemodynamic response under increased ICP. METHODS: We created intracranial hypertension animal model, measured and calculated the venous flow velocity and diameter of the outflow terminal of the CVS with color ultrasonic system and recorded the vascular morphology by 3-dimensional anatomical microscopy. Patients who suffered from raised ICP underwent MRI and digital subtraction angiography (DSA) examination to show the length in the vertical direction of the wall of the bridging vein representing the diameter value. Pathological autopsy was performed from bodies of patients who had died from non-cerebral causes to observe the juncture part between the venous sinuses and tributary vertical brain veins. RESULTS: Under increased ICP conditions, venous drainage through the outlet cuff segment, a unique structure between the bridge vein and sinus, was obstructed and in turn venous blood became congested. Therefore, the increased blood volume worsened the pre-existing ICP according to the well-accepted theory regarding volume-pressure relationship. This phenomenon was described as concurrent "venogenic intracranial hypertension", which is characterized by intracranial venous blood stasis responsive to and together with the original increased ICP. CONCLUSIONS: The existence of this special pathophysiological process is prevalent, rather than rare, in various intracranial disorders. This finding would definitely provide new insight into the area of cerebral venous system research.

Low-dose prospective ECG-triggering dual-source CT angiography in infants and children with complex congenital heart disease: first experience.

OBJECTIVE: To explore the clinical value of low-dose prospective ECG-triggering dual-source CT (DSCT) angiography in infants and children with complex congenital heart disease (CHD) compared with transthoracic echocardiography (TTE). METHODS: Thirty-five patients (mean age: 16 months, range: 2 months to 6 years; male 15; mean weight: 12 kg) underwent low-dose prospective ECG-triggering DSCT angiography and TTE. Surgeries were performed in 29 patients, and conventional cardiac angiography (CCA) was performed in 8 patients. The accuracy was calculated based on the surgical and/or CCA findings. The overall imaging quality was evaluated on a five-point scale. RESULTS: A total of 146 separate cardiovascular deformities were confirmed. DSCT missed three atrial septal defects and a patent ductus arteriosus. The accuracy of DSCT angiography and TTE was 97.3% (142/146) and 92.5% (135/146), respectively. Overall test parameters for DSCT angiography and TTE were similar (sensitivity, 97.3% vs 92.5%; specificity, 99.8% vs 99.8%). The average subjective image quality score was 4.3 ± 0.7. The mean effective dose was 0.38 ± 0.09 mSv. CONCLUSIONS: Prospective ECG-triggering DSCT angiography with a very low effective radiation dose allows the accurate diagnosis of anomalies in infants and children with complex CHD compared with TTE. It has great promise to become a commonly used second-line technique for complex CHD.

Diagnostic value of dual-source CT in Kawasaki disease.

BACKGROUND: Doppler color echocardiography is a common method for detecting coronary artery lesions in patients with Kawasaki disease (KD). However, the diagnostic accuracy for the whole coronary artery lesions is limited. The purpose of this study was to compare the diagnostic value of dual-source computed tomography (DSCT) and Doppler color echocardiography for the assessment of coronary artery lesions caused by KD. METHODS: Sixteen patients, 12 with typical KD and 4 with atypical KD, underwent DSCT and Doppler color echocardiography. The position and internal diameter of each coronary artery lesion was measured. Correlation analysis was used to compare the diagnostic value of the two imaging modalities. RESULTS: In the typical KD group, seven patients did not have any coronary artery lesion as confirmed by both DSCT scans and Doppler color echocardiography; in four patients proximal coronary artery injuries were identified by both modalities; in one patient an aneurysm in the middle and distal segments of the coronary artery was detected by DSCT but was negative in Doppler color echocardiography. In the atypical KD group, three cases showed the same results with both modalities, while one case with coronary artery stenosis in the middle segment was identified by DSCT but not detected by Doppler color echocardiography. There was a good correlation between the two imaging modalities (Kappa value, 0.768 (>or= 0.75)). CONCLUSION: DSCT coronary artery angiography is an accurate, non-invasive, and valuable technique for detecting and following up coronary artery lesions in patients with KD.

MRI-based visualization of iron-labeled CD133+ human endothelial progenitor cells.

UNLABELLED: The objective of this study is to build up a kind of effective approach to multiply CD133+ endothelial progenitor cells (EPCs) and visualize cells by labeling with two FDA-approved agents based on MRI technique. CD133+ cells were separated by immunomagnetic microbeads selection and grew with serum-free medium. Seven days later, CD133+ cell production was collected and co-incubated with iron complex for 24 h for labeling. The iron-labeled cells were suspended into agarose gel and scanned by MRI for visualization. Labeled cells were also analyzed for cell viability. Iron can be effectively introduced into CD133+ EPCs plasma in culture and visualized by changing the MRI signal intensity. Iron had no influence on cell viability. CONCLUSION: Iron substance can be applied to label CD133+ cells without cytotoxicity and iron-labeled cells can be visualized by MRI image. Due to the non-invasive property and repeatability of MRI technology and this kind of method could be used for tracing in vivo stem cells in the future.

Clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot.

OBJECTIVE: To explore the clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. METHODS: Eighteen patients with diagnosed Tetralogy of Fallot underwent cardiac CT angiography with 64-slice CT (CTA). Two- and three-dimensional images were used for diagnosing in all cases by means of MPR (coronal, sagital and oblique), cMPR, MIP and VRT. RESULTS: All patients had ventricular septal defect, pulmonary stenosis and hypertrophy of right ventricle. The morphologic features of Tetralogy of Fallot were equal to echocardiography. Patent ductus arteriosus (PDA) were detected on eight patients. Main coronary artery branches and partial sub-branches were visualized in all patients. Abnormal coronary arteries were found in seven cases: both left and right main coronary artery arising from the right aortic sinus one case, right main coronary artery and circumflex (CX) arising from the right aortic sinus one case, left anterior descending (LAD) and CX arising from left aortic sinus directly one case, left and right coronary artery arising from back and front of the aortic sinus, respectively, three cases. Pulmonary artery branch stenosis was found in 12 cases and branch pulmonary artery dilation noticed in 1 case. Double superior vena cava was also found in one case. According to the surgery the diagnostic accuracy of CT and Echocardiography was 95.45 and 83.33%, respectively. CONCLUSION: Two- and three-dimensional 64-slice CTA not only show the overall anatomical structure of the heart, but also show coronary and pulmonary arteries. With these results, evaluation of coronary anomalies and pulmonary artery stenosis with 64-MSCT is extremely valuable for planning the operative procedure on the patients with Tetralogy of Fallot.

[CT multiplan reconstruction images of disorder of stapes].

OBJECTIVE: To evaluate the clinical application of multi-planar reformation (MPR) for the stapes with multi-slice spinal thin-section CT in the patients with disorder of stapes before prosthetic ossicular reconstruction and their impact on surgical decision. METHODS: Axial CT scanning of temporal bone was undergone in 50 volunteers. Multiplan reformatted images included coronal, sagittal and oblique MPR, were made. All the MPR images were compared with each other in order to show which one could reveal the whole structures of stapes better. The height of stapes was measured with the oblique MPR. CT findings were evaluated in 102 cases with disorder of stapes. Prosthetic ossicular reconstruction was made in 65 cases. RESULTS: The full stapes cannot be shown in axial, coronal and sagittal MPR images, however, it was shown in oblique MPR in all the cases. The highness of stapes was (3.3 +/- 0.4) mm in the abnormal group. There was chronic otitis media in 69 cases (90 ears) and congenital abnormalities of the stapes in 33 cases (47 ears) which included the dispart of incudostapedial joint in 5 cases (7 ears), defect of head and crus of stapes in 9 cases (13 ears), defect of one side of crus in 3 cases (4 ears) and absence of the oval window in 16 cases (23 ears). CONCLUSIONS: Coronal and oblique MPR images from Axial Spiral CT Data are essential for the pre-operative planning of prosthetic ossicular reconstruction. The ship, structure or defect of stapes can be shown in the oblique MPR images. It is important for the patient to choose the type of operation.