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Glucagonoma is a rare neuroendocrine tumor of α cells of the pancreas. The tumor excessively secretes glucagon and causes glucagonoma syndrome.70%-90% of patients with glucagonoma will develop necrolytic migratory erythema (NME). We reported a patient of glucagonoma syndrome who was presented to the dermatology outpatient clinic with a 2-year-history of recurrent erythema and scaling on the skin migrating throughout the body. A skin biopsy was performed and resulting features matched with NME, whilst imaging examinations suggested a soft tissue density tumor present in the tail of the pancreas with somatostatin receptor expression and laboratory tests found an elevated levels of serum glucagon. After the diagnosis was confirmed, the patient was treated with surgical resection of the glucagonoma and the skin eruptions resolved rapidly in 4 days. Meanwhile, we reviewed relevant literature published in recent years and summarized its clinical characteristics in order to improve its understanding by clinicians, including clinical manifestations, laboratory and imaging examinations, diagnosis and treatments.
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6-[18F]fluoro-L-dopa (18F-DOPA) is a levodopa analogue.18F-DOPA PET/CT imaging is considered as an ideal tool in the diagnosis and evaluation of Parkinson's disease,brain tumors,pheochromocytoma/paraganglioma,neuroblastoma,gastrointestinal carcinoid,medullary thyroid cancer and congenital hyperinsulinemia.This paper reviews the synthesis,mechanism of localization,imaging procedures,clinical indications and research advances of 18F-DOPA.
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6-[18F]fluoro-L-dopa (18F-DOPA) is a levodopa analogue. 18F-DOPA PET/CT imaging is considered as an ideal tool in the diagnosis and evaluation of Parkinson′s disease, brain tumors, pheochromocytoma/paraganglioma, neuroblastoma, gastrointestinal carcinoid, medullary thyroid cancer and congenital hyperinsulinemia. This paper reviews the synthesis, mechanism of localization, imaging procedures, clinical indications and research advances of 18F-DOPA.
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A 60-year-old man presented with severe watery diarrhea for 2 months complicated with weight loss and acute kidney injury.He did not respond well to antidiarrheal medicines,empirical antibiotics and dietary exclusion of gluten or even complete bowel rest.The final diagnosis of autoimmune enteropathy (AIE) was made based on histopathologic findings of endoscopic biopsy from duodenal mucosa after excluding neoplastic disease,inflammatory bowel disease,and infectious diarrhea,etc.Chronic diarrhea and oliguria alleviated after the administration of corticosteroids.
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Objective To study the effect of moxibustion acupuncture and Chinese medicine external treatment for the severe knee osteoarthritis. Methods A total of 86 severe knee osteoarthritis patients were enrolled between December 2014 and December 2016, in Department of Integrated TCM & Western Medicine, Shijiazhuang first hospital. According to the enrolled sequency, patients were divided into observation group and control group, 43 in each group. The control group was treated with intra-articular injection of sodium hyaluronate of 2ml, and the observation group was treated with the combined acupuncture moxibustion and traditional Chinese medicine external treatment on the basis of the control group. Two groups were performed for 3 months of follow-up. The clinical effect, WOMAC values, VAS score and Lysholm scale, and the serum high sensitivity C reactive protein (hs-CRP), interleukin 1 (IL-1) and tumor necrosis factor a (TNF-a) changes before and after the treatment were observed and compared. Results The total effective rate of observation group was 93.0％ (40/43), while control group total effective rate was 76.7％ (33/43), and the differences between two groups was statistically significant (χ2=4.441, P=0.035). After treatment, the WOMAC joint stiffness scores (3.2 ± 1.2 vs. 4.8 ± 2.1, t=4.338), joint pain (4.2 ± 1.3 vs. 5.9 ± 1.7, t=4.903), daily activities (14.5 ± 2.8 vs. 18.7 ± 2.9, t=6.832) in observation group were significantly lower than those in the control group. The VAS score (2.5 ± 0.8 vs. 4.1 ± 1.2, t=7.275) in observation group was significantly lower than the control group, while the Lysholm score (74.2 ± 3.7 vs. 67.4 ± 3.9, t=8.295) was significantly higher than the control group (P<0.05). The serum hs-CRP (8.34 ± 2.24 mg/L vs. 13.67 ± 2.54 mg/L, t=10.321), IL-1 (0.85 ± 0.11 ng/L vs. 1.32 ± 0.42 ng/L, t=7.099), TNF-a (98.67 ± 15.74 ng/L vs. 178.44 ± 26.53 ng/L, t=16.955) in the observation group patients were significantly lower than those in the control group (P<0.05). Conclusions The acupuncture combined moxibustion and traditional Chinese medicine external treatment could treat severe knee osteoarthritis, improve the function of knee joint.
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Objective@#To explore the accuracy in localizing occult insulinomas with Glucagon-like peptide-1 receptor(GLP-1R) PET-CT with 68Ga-exendin-4.@*Methods@#In this prospective cohort study, patients with biochemically proven endogenous hyperinsulinemic hypoglycemia and negative contrast-enhanced CT with pancreatic perfusion scans were enrolled consecutively at Department of Nuclear Medicine, Peking Union Medical College Hospital from February 2014 to June 2018.There were 37 males and 32 females, with age of (43.2±17.9)years. 68Ga-exendin-4 PET-CT, MRI and endoscopic ultrasound(EUS) were done before elective surgery. Sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of the above imaging modalities were calculated.@*Results@#A total of 69 patients were recruited. Thirty-two patients were diagnosed with insulinomas at histology. Four patients with positive 68Ga-exendin-4 PET-CT findings did not undergo surgery so far. Twenty-eight patients were proven to be noninsulinoma induced hyperinsulinemic hypoglycemia. Five patients were unknown of etiology of hypoglycemia. The sensitivity, specificity, accuracy, PPV and NPV of 68Ga-exendin-4 in localizing occult insulinomas were 96.9%(31/32), 100%(30/30), 98.3%(59/60), 100%(29/29), 96.8%(30/31), respectively.The sensitivity, specificity, accuracy, PPV and NPV of MRI were 74.1%(20/27), 9/11, 76.3%(29/38), 90.9%(20/22), 9/16, respectively. The sensitivity, specificity, accuracy, PPV and NPV of EUS were 75.0% (15/20), 2/2, 77.3%(17/22), 15/15, and 2/7.@*Conclusion@#68Ga-exendin-4 PET-CT has a high sensitivity, specificity and accuracy for detection of occult insulinoma, which shows superiority to MRI and EUS.
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Objective To determine whether glucagon-like peptide-1 (GLP-1) receptor PET/CT with 68Ga-exendin-4 is accurate in localizing insulinomas,by comparing with conventional imaging techniques.Methods In this prospective cohort study,patients with biochemically proven endogenous hyperinsulinemic hypoglycemia from March 2014 to November 2016 were recruited consecutively.68Ga-exendiri-4 PET/CT,CT,MRI,endoscopic ultrasound (EUS),and SSTR imaging were performed before elective surgery.Surgical pathology results were considered as the gold standard.Sensitivity based on patient-analysis and positive predictive value (PPV) based on lesion-analysis were calculated and compared using x2 test and generalized score test.Results A total of 109 patients were recruited (47 males,62 females;average age (45.1±14.8) years),and 96 of them with insulinomas proved pathologically were included in the main assessment.Thirteen patients with positive 68Ga-exendin-4 PET/CT findings did not undergo surgical intervention.Based on patient-analysis,the sensitivities of 68Ga-exendin-4 PET/CT,CT,MRI,EUS and SSTR imaging for detecting insulinomas were 98.96％ (95/96),81.25％ (78/96),79.41％ (54/68),81.40％ (35/43) and 21.84％ (19/87),respectively.Based on lesion-analysis,the PPV of the above 5 methods were 100％ (102/102),97.56％ (80/82),95.16％ (59/62),83.72％ (36/43) and 90.48％ (19/21),respectively.68 Gaexendin-4 PET/CT showed the highest diagnostic sensitivity than others (all P＜0.01) and higher PPV than MRI,EUS and SSTR imaging (all P＜0.05).Conclusion 68Ga-exendin-4 PET/CT is a highly sensitive imaging technique for detection of insulinoma.
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Objective To investigate the technical requirements for the 3.0T multi-modal quantitative MR imaging of the rabbit liver.Methods A total of 8 rabbits were scanned and T1 mapping,T2 mapping,MT and Gd EOB-DTPA dynamic enhancement images were acquired.For the dynamic enhanced scanning,injecting contrast medium was followed by saline flush with different combinations of injection flow rate (1.5 mL/s and 2 mL/s) and injection volume(6 mL and 8 mL).The quality of the images was assessed and analyzed statistically.Results The total scanning time was about 20-25 min.High-quality images were acquired by T1 mapping,T2 mapping and MT sequences.There was no significant difference in image quality among different groups in Gd-EOB-DTPA dynamic enhanced scanning(P＞0.05).Two rabbits died when the combination of injection flow rate of 2 mL/s and injection volume of 8 mL was used.Conclusion 3.0 T multi-modal quantitative MR scanning of rabbit liver can be achieved successfully if scanning parameters are properly chosen.
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Objective To determine whether glucagon-like peptide-1 (GLP-1) receptor PET/CT with 68Ga-exendin-4 is accurate in localizing insulinomas, by comparing with conventional imaging techniques.Methods In this prospective cohort study, patients with biochemically proven endogenous hyperinsulinemic hypoglycemia from March 2014 to November 2016 were recruited consecutively.68Ga-exendin-4 PET/CT, CT, MRI, endoscopic ultrasound (EUS), and SSTR imaging were performed before elective surgery.Surgical pathology results were considered as the gold standard.Sensitivity based on patient-analysis and positive predictive value (PPV) based on lesion-analysis were calculated and compared using χ2 test and generalized score test.Results A total of 109 patients were recruited (47 males, 62 females;average age (45.1±14.8) years), and 96 of them with insulinomas proved pathologically were included in the main assessment.Thirteen patients with positive 68Ga-exendin-4 PET/CT findings did not undergo surgical intervention.Based on patient-analysis, the sensitivities of 68Ga-exendin-4 PET/CT, CT, MRI, EUS and SSTR imaging for detecting insulinomas were 98.96%(95/96), 81.25%(78/96), 79.41%(54/68), 81.40%(35/43) and 21.84%(19/87), respectively.Based on lesion-analysis, the PPV of the above 5 methods were 100%(102/102), 97.56%(80/82), 95.16%(59/62), 83.72%(36/43) and 90.48%(19/21), respectively.68Ga-exendin-4 PET/CT showed the highest diagnostic sensitivity than others (all P<0.01) and higher PPV than MRI, EUS and SSTR imaging (all P<0.05).Conclusion 68Ga-exendin-4 PET/CT is a highly sensitive imaging technique for detection of insulinoma.
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Objective To investigate the clinical effect of mifepristone in treatment of perimenopausal dysfunctional uterine bleeding.Methods 80 cases of patients with perimenopausal dysfunctional uterine bleeding were selected and randomly divided into control group and research group,with 40 cases in each group.The control group was in the diagnosis of curettage after 10 days of oral provera 10mg every night before going to bed,stopped drug application in 14 days,15 days to retreat hemorrhages oral provera 10mg/day,stayed for 10 days,repeated drug use 5 months.The research group was treated with oral mifepristone every night before going to bed since cleaning up the uterus,12.5mg,for 6 months.Outpatient follow -up for 6 months,the recent curative effect,long -term curative effect,hormone level changes,anemia and adverse drug reactions were observed.Results The total effective rate of the research group was 95.0%,which of the control group was 82.5%,there was statistically significant difference(χ2 =7.82, P =0.005);The recurrence rate of the research group was 5.0%,which of the control group was 15.0%,there was statistically significant difference(χ2 =5.56,P =0.018).The FSH,LH,E2 and P of the two groups were decreased, but which of the research group were lower significantly than those of control group,the differences were statistically significant (all P <0.05).The decreased degree of endometrium in the research group was larger than that of the control group,the difference was statistically significant(P =0.0001).Conclusion Treatment of mifepristone perimenopausal dysfunctional uterine bleeding is significant,safe and convenient,which is worthy of clinical application.
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BACKGROUND:There are currently various surgical methods of patel a fracture, and they have advantages and disadvantages, thus cannot wel meet the requirements of patients. OBJECTIVE:To evaluate biomechanical properties of internal fixation plate to treat patel ar fracture and to provide theoretical evidence for clinical application. METHODS:According to the statistics of patel a in the Chinese population, a titanium al oy spider internal fixation plate was designed and manufactured for the treatment of patel ar fractures. Knee joint specimens in six fresh cadavers were randomly divided into two groups and the comminuted fracture model of patel a were established. The models were fixed with internal fixation plate of patel a and NiTi patel ar concentrator. Biomechanical tests were carried out to compare the biomechanical properties. RESULTS AND CONCLUSION:Both the two fixation methods could meet the 1-kN quadriceps femoris contraction. The internal fixation plate of patel a was superior to NiTi patel ar concentrator in the patel ar isolation shift, muscle strength and joint strength, as wel as mechanical properties of patel a-point surface. There were significant differences between the two groups (P<0.05). The internal fixation plate of patel a is designed in accordance with the anatomical and biomechanical properties of the patel a, the fixation strength can completely meet clinical requirement and deserve further application.
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Objective To investigate the relationship among the spinous process open degree,the relative displacement of the lumbar facet joints(LFJ),and the morphologic change of the intervertebral foramina.Methods From Nov 2010 to Jun 2012,a total of 6 human fresh cadaveric spines was used in this study.All the ligaments were kept.The relative displacement of the corresponding segments LFJ,and the change of height and width of intervertebral foramen were measured through the corresponding open L3-4 and L4-5 spinous process,respectively.Results Lumbar degeneration was described with the following indices including the proliferation and displacement of LFJ,deformation of the intervertebral foramen morphogenesis,nerve root oppression,and lumbar intervertebral stenosis.When the interspinous process spacer was opened up to 2 mm,lumbar intervertebral foramen heights at the L3-4 and L4-5 [(15.62 ± 0.73) mm,(14.67 ± 0.75) mm] were significantly increased (t =26.00,16.02,P ＜ 0.01) compared to the original state [(13.89 ± 0.77) mm,(12.48 ± 0.80)mm].When the interspinous process spacer was opened up to 4mm,lumbar intervertebral foramen heights at the L3-4 and L4-5 [(17.13 ± 0.78) mm,(16.74 ± 0.76) mm] were significantly increased (t =36.15,30.69,P ＜ 0.01) compared to the original state.The foraminal height with a 4 mm distraction was significantly greater than the 2 mm distraction (t =20.82,21.72,P ＜0.01).When the interspinous distraction was 2 mm,L FJ displacement at the L3-4and L4-5 [(0.31 ±0.04) mm,(0.34 ± 0.07) mm] was significantly better than the original state [(0.63 ± 0.03) mm,(0.56±0.05)mm] (t =61.97,58.91,P ＜0.01).When the interspinous distraction was 4 mm,LFJ displacement at the L3-4 and L4-5 [(0.10 ±0.04) mm,(0.12 ±0.06) mm] was significantly better than the original state (t =18.69,18.88,P ＜0.01).No significant difference was found in the change of the intervertebral foramen width [(8.65 ± 0.38) mm,(7.78 ± 0.37) mm] at the 2 mm interspinous distraction compared to the original state(P ＞ 0.05),but a statistically significant difference was found at the 4 mm interspinous distraction compared to the original state [(9.03 ± 0.41) mm,(8.05 ± 0.32) mm] (t =7.78,7.97,P ＜ 0.01).Conclusions Spinous process shove off can effectively improve LFJ displacement,and increase the intervertebral foramen height,but the increase of its width needs to shove off enough distance.
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BACKGROUND:The traditional surgical method have large trauma in the treatment of tibiofibular syndesmosis injury, and cannot wel complete the repair of ligament. But the suture anchor has clear effect for ligament repair, ligament reconstruction and bone connection. OBJECTIVE:To investigate the biomechanical properties of the suture anchor in the treatment of tibiofibular syndesmotic injury, and to compare with lag screw internal fixation. METHODS:Eight ankle joint specimens were col ected, and the biomechanical experiment was performed for stress analysis. The suture anchor technology and lag screw internal fixation were used respectively to treat the tibiofibular syndesmotic injury. The biomechanical properties of the stress strength, stiffness and stability were compared. RESULTS AND CONCLUSION:The biomechanical properties of the stress strength, stiffness and stability of suture anchor technology for the treatment of tibiofibular syndesmotic injury were better than those of lag screw internal fixation, and there were significant differences in the strength and stiffness between two methods (P<0.05);the stress shielding rate of suture anchor technology was lower than that of lag screw internal fixation, and the difference was significant (P<0.05);the tibiofibular syndesmosis separated displacement of suture anchor technology was lower than that of lag screw internal fixation, and the difference was significant (P<0.05). The results indicate that the suture anchor technology is a minimal invasion and good method to realize physiological reconstruction and elastic fixation with stable fixation strength and less trauma, and without secondary operation.
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Objective To determine the human milk insulin(HMI) concentrations of healthy,gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) lactating mothers and their correlative factors and to explore the effect of HMI on growth and development of neonates. Methods HMI of colostrum and mature milk collected from 148 healthy lactating mothers and 46 GDM/GIGT mothers were determined by radioimmnuoassay. The intergroup HMI levels were compared by Wilcoxon test. Results (1) In the GDM/GIGT group, colostrum HMI was 28.81 μU/ml(13. 84-43.14 μU/ml), significantly lower than that of mature milk which was 57.50 μU/ml(36. 70-82. 73 μU/ml) (Z=-4. 828,P=0. 000). HMI of mature milk in the healthy group was 35.88 μU/ml(25.91-46.85 μU/ml), lower than in the GDM/GIGT group (Z=-2.874,P=0.004). ( 2 ) The colostrum HMI of the mothers underwent cesarean section was 23.64 μU/ml (14.90-38.51 μU/ml) lower than in the vaginal delivery ones which was 38.89 μU/ml(23.14-65.54 μU/ml)(Z= -4. 510, P= 0. 000). (3) HMI of mature milk in mixed feeding cases was 42.58 μU/ml (26.60-73.06 μU/ml),significantly higher than that of breast feeding ones which was 36.32 μU/ml(26.00-46.16 μU/ml)(Z=-2. 377,P=0.019). (4) Both HMI in colostrum and mature milk were positively correlated with maternal BMI (P＜0.05). Conclusions The mode of delivery significantly affects the HMI in colostrum. GDM/GIGT and the feeding patterns have some effects on HMI levels in mature breast milk. The HMI level is positively correlated with maternal BMI.
