ObjectiveTo compare the effectiveness of T2 weighted image (T2WI) and some compounded MRI techniques, including T2WI combined with magnetic resonance spectroscopy (T2WI+MRS), T2WI combined with diffusion weighted imaging (T2WI+DWI) and T2WI combined with dynamic contrast-enhancement [T2WI+(DCE-MRI)] respectively, with 1.5 T MR scanner in diagnosing prostate cancer through a blinding method. MethodsBetween March 2011 and April 2013, two observers diagnosed 59 cases with a blinding method. The research direction of radiologist A was to diagnose prostate cancer. The observers diagnosed and scored the cases with T2WI, T2WI+(DCE-MRI), T2WI+MRS, T2WI+DWI and compositive method respectively. The data were statistically analyzed with receiver operating characteristic (ROC) curve. ResultsAccording to the ROC curve, both observers got the sequence of area under curve (AUC) as T2WI+DWI > T2WI+(DCE-MRI) > T2WI+MRS > T2WI. On the basis of the result from observer A, the AUC from each technique was similar. The AUC of T2+DWI was slightly bigger than others. The specificity of single T2WI was the lowest; the sensitivity of T2WI was slightly higher. The AUC of the compositive method was marginally larger than T2WI+DWI. According to the result from observer B, the AUC of T2WI+DWI was obviously larger than the others. The AUC of single T2WI was much smaller than the other techniques. The single T2WI method had the lowest sensitivity and the highest specificity. The AUC of T2WI+DWI was slightly larger than the compositive method. The AUC of T2WI+(DCE-MRI), T2WI+MRS, single T2WI methods from observer A was obviously higher than those from the score of observer B. The AUC of T2WI+DWI from the two observers was similar. ConclusionThe method of combined T2WI and functional imaging sequences can improve the diagnosing specificity when a 1.5 T MR scanner is used. T2WI+DWI is the best method in diagnosing prostate cancer with least influence from the experience of observers in this research. The compositive method can improve the diagnosis of prostate cancer effectively, but when there are contradictions between different methods, the T2WI+DWI should be considered as a key factor.
ObjectiveTo evaluate the feasibility and effectiveness of proximal femoral nail anti-rotation (PFNA) combined with curettage and bone graft through Watson-Jones approach in the treatment of proximal femur benign tumors and tumor like lesions.MethodsThe clinical data of 38 patients with benign tumors and tumor like lesions in the proximal femur who were treated through the Watson-Jones approach with PFNA combined with curettage and bone graft between January 2008 and January 2015 were retrospective analysed. There were 24 males and 14 females with an average age of 28 years (range, 15-57 years). Pathological types included 20 cases of fibrous dysplasia, 7 cases of bone cyst, 5 cases of aneurysmal bone cyst, 3 cases of giant cell tumor of bone, 2 cases of enchondroma, and 1 case of non-ossifying fibroma. Before operation, hip pain occurred in 19 patients, pathological fracture occurred in 12 patients, limb shortening and coxa varus deformity was found in 4 patients, and 3 patients received surgery for the local recurrence. The operation time, intraoperative blood loss, and full-weight bearing time after operation were recorded. Patients were followed up to observe union of bone graft and the position of internal fixator on X-ray films and CT images. Visual analogue scale (VAS) score was used to evaluate the level of pain. The Musculoskeletal Tumor Society (MSTS93) score was used to evaluate lower limb function. Harris hip score was used to evaluate hip joint function.ResultsThe operation time was 130-280 minutes (mean, 182 minutes) and the intraoperative blood loss was 300-1 500 mL (mean, 764 mL). After operation, 3 cases of fat liquefaction of incision healed successfully by carefully dressing, and the rest incisions healed by first intention. All patients started partially weight-bearing exercise at 2-4 weeks after operation. The total weight-bearing time was 3-6 months (mean, 4.2 months). All the patients were followed up 24-108 months (median, 60 months). Imaging examination showed that the bone graft fused and the fusion time was 8-18 months (mean, 11.4 months). During the follow-up period, there was no complication such as pathological fracture, femoral head ischemic necrosis, hip joint dislocation, internal fixation loosening and fracture, and no tumor recurrence or distant metastasis occurred. At last follow-up, the VAS score, MSTS93 score, and Harris score were significantly improved when compared with preoperative ones (P<0.05).ConclusionThe treatment of proximal femoral benign lesions by PFNA combined with curettage and bone graft through the Watson-Jones approach is safe and effective, with advantages of better mechanical stability, less residual tumor, and less postoperative complications.
ObjectiveTo study the value of magnetic resonance multiple sequence examination in the diagnosis of biliary sludges. MethodsThe display rates of biliary sludges were obtained from 56 cases of biliary sludges between February 2011 and March 2013 examined with trans T1 weighted imaging (T1WI), T2 weighted imaging with fat suppression (T2WI-FS), true fast imaging with steady-state precession (True FISP), and MR cholangiopancreatography (MRCP) proved by operations or endoscopic retrograde cholangio-pancreatography. Then we carried out a statistical comparison study. ResultsThe display rate combined with trans T1WI, T2WI-FS, True FISP, and MRCP sequence was statistically higher than any other single sequence (P<0.005). Diagnostic sensitivity, specificity and accuracy of MRI for biliary sludges were 85.7%, 84.1% and 84.5%, respectively. ConclusionTo improve the display rate of biliary sludges on MRI, multiple sequences including trans T1WI, T2WI-FS, True FISP, and MRCP should be used.
Objective To summarize the research progress of rehabilitation after autologous chondrocyte implantation (ACI). Methods The literature related to basic science and clinical practice about rehabilitation after ACI in recent years was searched, selected, and analyzed. Results Based on the included literature, the progress of the graft maturation consists of proliferation phase (0-6 weeks), transition phase (6-12 weeks), remodeling phase (12-26 weeks), and maturation phase (26 weeks-2 years). To achieve early protection, stimulate the maturation, and promote the graft-bone integrity, rehabilitation protocol ought to be based on the biomechanical properties at different phases. Weight-bearing program, range of motion (ROM), and options or facilities of exercise are importance when considering a rehabilitation program. Conclusion It has been proved that the patients need a program with an increasingly progressive weight-bearing and ROM in principles of rehabilitation after ACI. Specific facilities can be taken at a certain phase. Evidences extracted in the present work are rather low and the high-quality and controlled trials still need to improve the rehabilitation protocol.
Objective To investigate the evaluation, diagnosis, and surgical treatment of knee joint diagonal lesion and to observe its effectiveness. Methods A retrospective analysis was performed on 9 patients with knee joint diagonal lesion admitted between November 2011 and November 2019, including 7 males and 2 females, aged 18-61 years, with an average age of 38.3 years. According to the clinical staging criteria of multiple ligament injury of knee joint, 6 patients with acute stage injury (≤3 weeks), the time from injury to operation was 5-16 days, with an average of 9.3 days; 3 patients with old stage injury (>3 weeks), the time from injury to operation was 7, 12, 144 months, respectively. Posterolateral complex injuries were all type C according to Fanelli classification, and the posterior cruciate ligament injury was grade 3 according to American Medical Association (AMA) classification. According to the three columns classification of tibial plateau fracture, there were 2 cases of zero column fracture and 7 cases of medial column fracture. Patients with acute injury were treated with posterior cruciate ligament reconstruction, posterolateral complex repair and/or reinforcement reconstruction, and tibial plateau fracture was treated with conservative treatment or internal fixation. Patients with malunion of tibial plateau in old stage were treated with limited osteotomy, bone grafting, and internal fixation; the stability of the knee joint was further evaluated during operation, then the posterior cruciate ligament reconstruction and/or posterolateral complex repair and reconstruction were performed as needed. Lysholm score and the International Knee Documentation Committee (IKDC) score before and after operation were used to evaluate knee function and effectiveness. Results All patients were followed up 24-119 months, with an average of 51.7 months. All the incisions healed by first intention, and no complication such as incision infection, deep venous thrombosis of lower extremities occurred, and there was no reoperation during follow-up. The full-length X-ray films of both lower extremities at 6 months and 1, 2 years after operation showed that the alignment of both lower extremities returned to normal, and the stress position X-ray films showed that the stability in all directions recovered well. The X-ray films of the knee joint at 6 months after operation showed that the fracture of the tibial plateau healed well. At 1 year after operation, MRI showed that the signal of the repaired and reconstructed ligament was good, and there was no reconstruction failure such as ligament absorption or rupture occurred. At 1 year after operation, the muscle strength of the affected limbs was all rated as grade Ⅴ, and the active and passive range of motion of the knee joint recovered to 0°-130°. At 2 years after operation, the Lysholm score and IKDC score significantly improved when compared with those before operation (P<0.05). Conclusion Knee joint diagonal lesion is a special type of posterior cruciate ligament and posterolateral complex injury with anteromedial split and collapse fracture of tibial plateau, which requires correct evaluation and diagnosis of the injured structure, and detailed surgical and rehabilitation programs to achieve better effectiveness.
ObjectiveTo investigate the CT and MR imaging features and distribution characteristics of lymphatic nodal involvement in patients with gallbladder carcinoma. MethodsThirtyseven histopathologically proven cases of gallbladder carcinoma with regional lymphatic nodal enlargement in upper abdomen were included into the study. The lymph nodal short diameter of equal to or larger than 10 mm was used as the criteria for positive lymphadenopathy. Thirtyone cases underwent contrastenhanced spiral CT scanning, 6 cases had MR imaging studies. CT and MR images were jointly evaluated by three radiologists with especial attention to the size and location of enlarged lymph nodes in upper abdomen.ResultsThe enlarged lymph nodes were observed in four anatomic locations in the upper abdominal region. ①The retroportal and retropancreatic group in which lymph nodes were located along the cystic duct and common bile duct, in the portocaval space and behind the pancreatic head. ②The celiac group in which enlarged nodes distributed along the common hepatic artery and surrounded the celiac trunk. ③The mesenteric group in which lymph nodes assembled at the mesenteric root and around the superior mesenteric vessels. ④The abdominal aorta group in which lymph nodes scattered at the left side of abdominal aorta and in the aortocaval space at the level of the left renal vein. The spiral CT visualization rates for the above 4 groups of lymphadenopathy were 89.1%(33/37), 78.3%(29/37), 29.8%(11/37) and 51.3%(19/37) respectively.ConclusionCT and MR can clearly depict the four location sites of lymphadenopathy in patients with gallbladder carcinoma, which closely reflects the three major lymphatic spreading pathways of gallbladder carcinoma, namely, the cholecystoretropancreatic, cholecystoceliac and cholecystomesenteric routes.
目的 比较磁共振胰胆管成像（MRCP）三维质子加权快速自旋回波（SPACE）序列和半傅立叶采集单次激发快速自旋回波（HASTE）序列对胆囊管的显示情况，优选最佳的磁共振检查序列。 方法 2012年5月-2013年3月265例连续性患者同时采用SPACE序列和HASTE序列行MRCP检查，比较两种序列对胆囊管显示的图像质量和显示率，并进行统计学分析。 结果 SPACE序列对胆囊管显示的图像质量评分及显示率均优于HASTE序列 （P＜0.05）。 结论 SPACE序列是目前显示胆囊管较为理想的MRCP成像方法。
【Abstract】Objective To establish animal model of orthotopic liver transplantation(OLT) in miniature pigs with high standardization, reproducibility and stability. Methods OLTs were performed without venovenous bypass in Bama miniature pigs. The survival rates and the changes of hemodynamics and metabolism were investigated. Results Twenty OLTs were performed between pairs of miniature pigs. The mean operative time and anhepatic phase were (181±25.8) min and (28.4±3.2) min respectively. During the anhepatic phase, dramatic hemodynamics and metabolism changes accompanied hyperkalemia identified. MAP and CVP decreased from (14.59±1.68) kPa and (0.66±0.11) kPa to (5.87±0.91) kPa and (0.27±0.10) kPa respectively, while temperature, pH, BE and HCO3- were significantly reduced (P＜0.05) and HR and K+ in serum were remarkable increased. After reperfusion, the disorder of hemodynamics and metabolism described above recovered gradually. 1week survival rate was 90%. Sixteen animals survived more than 2 weeks. AST, ALT and TBIL were significantly increased and reached the peak level on postoperative 1 day. From postoperative 2 day, AST, ALT and TBIL began to decrease and reached postanaesthesia level on postoperative 7 day. Conclusion The animal model of OLT without venovenous bypass in miniature pig, with its high standardization, reproducibility and stability, is an ideal one for series studies related to liver transplantation.
【Abstract】Objective To observe concentration changes of substances including hepatocyte growth factor(HGF),interleukin-6(IL-6),nitric oxide(NO),nitric oxide synthase(NOS) that were secreted by sinusoidal endothelial cells(SECs) in different shear stress and study the effects of shear stress on the secretions of SECs.Methods To establish a hemodynamics equipment and to set up a way to separate and culture SEC. The rats were divided into two groups: the control group (shear stress was 0 dyn/cm2) and study group. Study group was divided into three subgroups according to shear stress (12, 24 and 48 dyn/cm2). Sinusoidal endothelial cell culture mediums were examined in different shear stress and phases.Results HGF, IL-6, NO and NOS secreted by sinusoidal endothelial cells in different shear stress were distinctive and had positive correlation with shear stress and action time. Conclusion In vitro, the secretion of HGF,IL-6,NO and NOS of sinusoidal endothelial cells are increased along with shear stress rising, which suggests that the rising pressure in portal vein after hepatectomy may result in SECs activated．Activated SECs then secret many cytokines and medias to trigger the regeneration of liver.
