Clinical Focus

Early diagnosis of lung cancer with new bronchoscopy techniques

Jin Faguang

2016, 31(11): 1161-1166. doi:10.3969/j.issn.1004-583X.2016.11.001

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The staging of lung cancer is one of the main factors that affects the prognosis of patients with lung cancer. Here， we review some new bronchoscopy techniques in early diagonis of lung cancer， such as fluorescence bronchoscope， narrow spectrum bronchoscope， ultrasonic bronchoscope， electromagnetic navigation bronchoscopy， virtual bronchoscopic navigation， confocal laser endomicroscopy， endocytoscopy system and optical coherence tomography imaging. These techniques overcome the defects of traditional methods and have greatly improved the early diagnostic rate of lung cancer.

New classification system of eight regions in central airway and therapy strategy of malignant airway noeplasma

Wang Hongwu

2016, 31(11): 1167-1169. doi:10.3969/j.issn.1004-583X.2016.11.002

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New classification system of eight regions in the central airway was suggested according to the author′s experience in recent years. Bronchial tumor could be divided into four types of introluminal，mural， extrinsic compression and mixed corresponding to the location between the tumor and the bronchial wall. Debarlking of the tumor was frequently used in the introluminal and mural types， then the stent was not necessary to be placed if airway was unimpeded. Stent should be implanted in the extrinsic compression and mixed types so as to relieve the strictures. The new classification and diagnosis system are helpful to guide the interventional bronchoscopy.

Clinical progress in medical thoracoscopy

Zhai Congcong， Lin Dianjie

2016, 31(11): 1170-1173. doi:10.3969/j.issn.1004-583X.2016.11.003

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Medical thoracoscopy， a manageable， highly safe and less expensive technology， has been mainly used for the diagnosis of pleural effusion and treatment of pleural diseases. With the development of video camera technology and electronic endoscope， the technology of medical thoracoscopy has been widely spread and developed. This article summed up essays in recent years and summarized clinical progress and prospects of medical thoracoscopy.

Advance in diagnosis of mediastium lesion

Duan Zheng， Yuan Yadong

2016, 31(11): 1174-1177. doi:10.3969/j.issn.1004-583X.2016.11.004

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Mediastium lesion is a very common group of diseases in clinical work， such as thymoma， sarcoidosis，lymphoma， metastases of mediastinal lymph nodes， and so on. The diagnosis of mediastium lesion is diffcult. The diagnosis of patients with mediastium lesions in recent decades has increasingly relied on minimally invasive tissue sampling techniques， such as endobronchial ultrasoundguided transbronchial needle aspiration， endoscopic ultrasoundguided fineneedle aspiration and mediastinoscopy.

Endoscopic diagnosis in peripheral pulmonary lesions

Pan Wensen， Yuan Yadong

2016, 31(11): 1178-1183. doi:10.3969/j.issn.1004-583X.2016.11.005

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Peripheral pulmonary lesions (PPL) is very common in clinical work， and the diagnosis of PPL is a challenging task for pulmonologists. PPL includes a variety of diseases with similar Xray findings， such as bronchial lung cancer， lung metastases， tuberculosis and so on. Diagnostic yield of routine bronchoscopy in PPL is very low， and CT guided percutaneous cutting needle lung biopsy may result in more complications in the lesions far from the chest wall. Multiple approaches may be undertaken to establish a tissue diagnosis， including thin (or) ultrathin bronchoscopy， transbronchial lung biopsy， endobronchial ultrasound transbronchial lung biopsy with guidesheath，bronchoalveolar lavage and bronchoscopic navigation system. A suitable method or combination of two methods matter much to improve the diagnostic the accuracy of PPL.

Clinical significance of Vaspin， Gas6 and IMA in assessment of coronary heart disease

Li Qing

2016, 31(11): 1184-1187. doi:10.3969/j.issn.1004-583X.2016.11.006

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ObjectiveTo observe the clinical significance of visceral fatspecific serine protease inhibitors (Vaspin)， growth arrestspecific gene product 6 (Gas6) and ischemiamodified protein (IMA) in assessment of coronary heart disease（CHD）. MethodsA total of 121 patients with CHD， were selected as CHD group and 30 healthy people were chosen during the same period as healthy control group. The levels of serum Vaspin， Gas6 and IMA were detected by ELISA. The serum levels of Vaspin， Gas6 and IMA were compared between CHD group and healthy control group， the relationship among Vaspin， Gas6 and IMA， severity CHD， number of coronary artery atherosclerosis and degree of stenosis were observed in patients with CHD， and the mutual relationship was also observed. ResultsThe level of serum Vaspin was significantly lower in CHD group compared with that of healthy control group (P<0.01)， and the level of Vaspin decreased， as CHD raised， the number of coronary artery atherosclerosis and the degree of stenosis increased (P<0.01)， the serum Gas6 and IMA levels were significantly higher in CHD group than those in healthy control group (P<0.01)， and the level of Vaspin increased， as CHD severity， the number of coronary artery atherosclerosis and the degree of stenosis increased (P<0.01) . The level of serum Vaspin was negatively correlated with Gas6 (r=-0.562，P<0.05) and IMA (r=-0.756，P<0.05) in patients with CHD， and the Gas6 level was positively correlated to IMA (r=0.812，P<0.05). ConclusionThe Vaspin， Gas6 and IMA are involved in the development of CHD， the serum Vaspin， Gas6 and IMA are helpful for early diagnosis of CHD， they have important clinical significance to determine CHD severity and guide the treatment.

Clinical therapeutic effect of thrombus aspiration pipe device on noreflow phenomenon in distal end of coronary in emergency PCI patients

Li Yongzhong， Yang Baoping， Yu Yan，Cui Wenjian

2016, 31(11): 1188-1191. doi:10.3969/j.issn.1004-583X.2016.11.007

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ObjectiveTo evaluate the clinical therapeutic effect and safety of thrombus aspiration pipe device on noreflow phenomenon in distal end of coronary in emergency PCI patients. MethodsForty AMI patients of noreflow phenomenon in distal end of coronary during emergency PCI (TIMI grade≤1) AMI were divided into two groups. Both groups were experienced thrombus aspiration before stent implantation， then the stent implanting achived success. Experimental group as thrombus aspiration were operated after noreflow phenomenon by thrombus aspiration pipe device. Control group were bolused tirofiban and sodium nitroprusside by thrombus aspiration pipe device. TIMI flow grade and incidence rate of major adverse cardiovascular events（MACE） and bleeding events were analyzed during hospitalization.ResultsCompared with control group，TIMI flow grade improved better in experimental group (P<0.05).The incidence of major adverse cardiovascular events（MACE） in experimental group decreased(P<0.05). The incidence of bleeding in two groups showed no significant difference（P>0.05）.ConclusionUsing thrombus aspiration pipe device on noreflow phenomenon indistal end of coronary during emergency PCI improved TIMI flow grade and myocardial reperfusion. Moreover，the incidence of major adverse cardiovascular events（MACE） during hospitalization were decreased. The method was safe and available.

Efficacy of myocardial perfusion with intracoronary injection of prourokinase by balloon catheter in STEMI patients

Liu Jingmin1，Geng Wei2，Tian Xiang2，Zhang Qi2，Zhen Libo2，Zhang Bohan2，Zhao Can1

2016, 31(11): 1192-1196. doi:10.3969/j.issn.1004-583X.2016.11.008

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ObjectiveTo evaluate the effect of myocardial perfusion of STEMI (STsegment elevation myocardial infarction) patients who underwent intracoronary injection of prourokinase by balloon catheter. MethodsA total of 135 STEMI patients who underwent primary PCI were enrolled and depending on whether use of prourokinase they were randomly divided into two groups，test group (prourok inase group， n=66) and control group (n=69).The test group got injected prourokinase 10 mg (10 ml) by expanding the balloon at the occlusion， the control group received the same dose of saline. The basic clinical data， corrected TIMI frame count (cTFC)， myocardial tissue perfusion grading (TMPG)， ST resolution ≥50% at 2 hours，wall motion score and score index after seven days and left ventricular ejection fraction (LVEF) on day 7 and 30 were recorded and analyzed. ResultsThe basic clinical data between two groups had no significant differences (P>0.05). cTFC，TMPG， ST resolution ≥50% at 2 hours， wall motion score and wall motion score index， LVEF on day 7 and 30 had significant differences between two groups (P<0.05).ConclusionIntracoronary administration of prourokinase through balloon castheter could improve myocardium perfusionin STEMI patients who underwent emergency PCI.

Building and confirming the mathematical model to estimate the occurrence of coronary heart disease in female

Feng Leia，Nian Shiyanb

2016, 31(11): 1197-1201. doi:10.3969/j.issn.1004-583X.2016.11.009

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ObjectiveTo build the mathematical estimation model with multiple physiological and biochemical factors in order to improve the potency in diagnosing coronary heart disease (CHD) in female. MethodsThrough the correlation analysis and ROC curve， the factors which had significant relationship with CHD were confirmed. The mathematical estimation model was built，the diagnostic efficiency was confirmed by ROC curve and the repeatability was performed in patients. Results①There were significant differences between test group and control group except for LDLC， APOB and Lp（a）; ②There were very strong relationship between CHD and age， TG， HCY， GGT， HDLC， APOA; ③In ROC curve，the areas of five indexes such as age，HCY， GGT， HDLC and APOA were more than 0.75; ④A total of six mathematical models were built and the area of the sixth model was 0.955; ⑤The mathematical estimation model can be repeated to validate the patients. ConclusionThe mathematical estimation models with multiple factors can significantly promote the potency in diagnosing CHD in female.

Correlation analysis of serum bilirubin， homocysteine levels and carotid atherosclerotic plaque in elderly CHD patients

Zhang Cuijie，Cui Sheng

2016, 31(11): 1202-1205. doi:10.3969/j.issn.1004-583X.2016.11.010

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ObjectiveTo investigate the relationship between serum bilirubin， homocysteine (Hcy) levels and carotid atherosclerotic plaque in elderly patients with coronary heart disease (CHD). MethodsA sum of 210 cases of elderly patients with coronary heart diseasefrom our hospital were enrolled. The carotid intimamedia thickness(IMT) were observed by the carotid artery ultrasound.According to the value of IMT，all cases were divided into two groups:plaque group (n=82) and non plaque group (n=128)， recording the patient’s age， gender， history of hypertension， history of diabetes， smoking history and other general situation， detection of serum total bilirubin， direct bilirubin， indirect bilirubin， Hcy and lipid laboratory indicators. ResultsThe total bilirubin and indirect bilirubin levels were lower in plaque group than those of non plaque group. However， the plasma Hcy level in plaque group was higher than non plaque group (P<0.05).The total bilirubin， indirect bilirubin was negatively correlated with carotid artery plaqu erespectively(r=-0.447，-0.482，P<0.05) and Hcy level was positively correlated with the carotid plaque(r=0.376，P<0.05).The logistic stepwise regression analysis showed that total bilirubin and indirect bilirubin levels decreased and Hcy increased were risk factors in the progression of carotid artery plaque formation.ConclusionThe intervention of the formation of serum bilirubin and Hcy in patients with carotid atherosclerosis might prevent the occurrence of acute cardiovascular and cerebrovascular events in CHD patients.

Efficacy and safety analysis of paclitaxel liposome and docetaxel for neoadjuvant chemotherapy of breast cancer

Chen Han1，Wang Juan2，Zhang Jing2

2016, 31(11): 1206-1208. doi:10.3969/j.issn.1004-583X.2016.11.011

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ObjectiveTo analyze the efficacy and safety of paclitaxel liposomal and docetaxel for the neoadjuvant chemotherapy of breast cancer. MethodsThe clinical data of 174 operable patients with breast cancer who received the neoadjuvant chemotherapy were analyzed. According to the treatment regimens， all patients were divided into the group of paclitaxel liposome (n=87) and group of docetaxel (n=87). All the patients received a combination therapy with epirubicin and cyclophosphamide， neoadjuvant chemotherapy for 6 cycles with 21 days as a course. Surgery was carried out three weeks after the end of chemotherapy， and the chemotherapy efficacy and adverse reaction of two groups were evaluated. ResultsPathological complete remission in paclitaxel liposome group and docetaxel group was 10.3％（9/87） and 9.2％（8/87）， respectively; the objective response rate was 80.5％（70/87） and 79.3％（69/87）， respectively; and the disease control rate was 95.4％（83/87）and 93.1％（81/87）， respectively; there was no significant difference in therapy efficacy between two groups (P＞0.05). Safety analysis indicated that all the occurrence rates of skin and nail toxic reaction， body fluid retention， oral mucositis， allergic reaction (such as facial blushing chest distress， palpitation and dyspnea)， grade ⅢⅣ leukopenia and neutropenia in paclitaxel liposome group were significantly lower than those of docetaxel group (P＜0.05). ConclusionCompared with docetaxel， paclitaxel liposome has the same antitumor efficacy with fewer and milder adverse reactions and a higher safety in the neoadjuvant chemotherapy for breast cancer.

Quantitative relationship between inflammatory markers and sepsis severity

Zhou Xiaofeng1，Jia Jinhu2

2016, 31(11): 1209-1212. doi:10.3969/j.issn.1004-583X.2016.11.012

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ObjectiveTo investigate the quantitative relationship between the concentration of ultra sensitive C response protein (hsCRP) in all kinds of sepsis patients’ blood and the severity of sepsis. MethodsEightythree sepsis patients were selected， then grouped according to the severity of the disease and scored according to basic information of each patient. The blood sample 8 ml was extracted and CRP，hsCRP， WBC， N(%) were measured and coefficient of death risk was calculated. ResultsLogistic regression model showed that hsCRP，PCT concentration， erythrocyte sedimentation rate (ESR) were associated with sepsis severity of patients. ConclusionThe concentration of inflammatory cytokines，hsCRP， ESR， PCT have certain guiding significance on sepsis severity evaluation.

Noninvasive markers in patients with stable chronic obstructive pulmonary disease

Ju Junqiang， Zhu Zhengtai， Li Hua， Teng Maorong

2016, 31(11): 1213-1217. doi:10.3969/j.issn.1004-583X.2016.11.013

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ObjectiveTo compare the noninvasive markers between chronic obstructive pulmonary disease (COPD) patients and healthy subjects and to assess their relationship with smoking. MethodsThe subjects included 52 COPD exsmoking patients (COPD EX group，n=52) and 36 smoking patients (COPD S group，n=36) treated in our hospital， 23 healthy exsmokers (HE EX group，n=23) and 23 healthy smokers (HE S group，n=23) medically examined in our hospital. Prostaglandin E2 (PGE2)， and prostaglandin isomers 15F2tisoprostane (15F2tIsoP) concentrations in sputum， exhaled breath condensate (EBC)， fraction of exhaled nitric oxide， sputum cell counts and pulmonary function test were detected and compared. ResultsCompared with COPD S group， FeNO values in COPD EX group increased significantly (P<0.01); Compared with healthy group， the EBC 15F2tIsoP concentrations in two groups with COPD increased significantly (P<0.05); Compared with smokers who had equal health status， the urine 15F2tIsoP concentration in both smokers groups increased significantly (P<0.05).ConclusionThe combination of different types of inflammatory markers can be used for a comprehensive assessment of COPD respiratory inflammation.

Clinical analysis of 23 cases with candidemia in ICU

Jin Wei，Zhang Xiaoyan，Du Jiang，Wang Ruilan

2016, 31(11): 1218-1221. doi:10.3969/j.issn.1004-583X.2016.11.014

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ObjectiveTo study the clinical characteristics， prevention strategy and treatment of candidemia in critical patients. MethodsA retrospective analysis was made in the clinical data of ICU for patients with candidemia. ResultsCandida was found in 23 blood strains culture from hospital acquired infected patients， including 11 cases(52.2%) of Candida albicans and 12 cases(47.8%) of non Candida albicans. In all 23 cases， broadspectrum antibiotics use were found in 18 cases， center venous catheterization in 16 cases， aged in 15 cases， abdominal surgery in 10 cases， prolonged ICU stay (> 7 days) in 19 cases， tracheal intubation in 13 cases， and elevated Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) ≥20 in 14 cases. The levels of serum procalcitonin(PCT) and 1， 3Dbetaglucan (G test) were (0.58±0.25) μg/L and (210.1±147.9) ng/L.15 patients were treated by Caspofungin. The total mortality was 47.8%. ConclusionCandida albicans infection was the highest reason of candidemia in patients with multiple risk factors. For highrisk patients， more attention should be payed in the levels of serum PCT and G test， etiology examination and timely choice of antifungal drug to improve the prognosis.

Analysis of pathogen distribution and drug resistance in liver cirrhosis patient with spontaneous bacterial peritonitis

Zhao Zhengbin1a，Fan Wenhai1b， Chen Qingfeng2，Yao Liqiong1a

2016, 31(11): 1222-1224,1228. doi:10.3969/j.issn.1004-583X.2016.11.015

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ObjectiveTo analyze pathogen distribution and drug resistance in liver cirrhosis patients with spontaneous bacterial peritonitis for the basis for clinical rational drug use. MethodsRetrospective analysis was made in the positive bacterial culture results of liver cirrhosis patients（534 cases） with spontaneous bacterial peritonitis in our hospital. Depending on the kind of bacteria， we grouped the patients， and compared the percentage of each group of bacteria， at the same time for the dominant strains (Escherichia coli， Enterococcus feces)， we analyzed resistance rate. ResultsBacterial culture positive cases was 61 cases and 78 strains of pathogenic bacteria were isolated， in which 45 patients as a single infection(73.8%)，16 patients a composite infection(26.2%) and 15 cases of complex infection(93.8%). In 78 strains of bacteria， gramnegative bacteria were 40 strains(51.3%)， and Escherichia coli accounted for 37.5% of gramnegative bacteria; grampositive bacteria was 32(41.0%)，of which Enterococcus Faecium accounted for 59.4% of gramnegative bacteria， meanwhile the total number of Enterococcus Faecium(19) was more than Escherichia coli(15); Fungi was 6 strains，accounting for 7.7%. E. coli was highly resistant to ampicillin and levofloxacin，trimethoprimsulfamethoxazole，cefuroxime，respectively，accounted for 93.3%，80.0% and 73.3%. Enterococcus Faecium was highly resistant to Feces enterococci to ampicillin， penicillin， levofloxacin， norfloxacin， respectively，68.4%，63.2%，57.9% and 42.1%; Discovery of one case of vancomycinresistant strains was Enterococcus Faecium. No strains resistant to linezolid were discovered. ConclusionIn liver cirrhosis patients with spontaneous bacterial peritonitis infected mainly in Enterococcus Faecium and Escherichia coli，the phenomenon of resistance has been very serious. Clinicians should be based on the type of pathogen and make reasonable choice for antibiotic use.

Analysis on drug sensitivity of Mycobacterium tuberculosis in 350 sputum specimens and drug resistant of initial treatment and retreatment tuberculosis patients in Huai’an area

Ji Xiaoting， Sun Lihua， Zeng Dongxiao，Wang Lijuan

2016, 31(11): 1225-1228. doi:10.3969/j.issn.1004-583X.2016.11.016

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ObjectiveDrug resistance of Mycobacterium tuberculosis to four common antituberculosis drugs in sputum of tuberculosis patients was analyzed; difference in sensitivity of four common antituberculosis drugs was compared between initial treatment and retreatment tuberculosis patients， which all provide a reference for clinic treatment to reduce the incidence of multidrug resistance of Mycobacterium tuberculosis. MethodsUsing the ratio method， 350 strains of Mycobacterium tuberculosis were tested for the susceptibilities to two firstline antituberculosis drugs (isoniazid and rifampicin) and two secondline antituberculosis drugs (ofloxacin and kanamycin). ResultsThe total resistant rate of 350 strains was 37.7% (131/350)， while that of initial treatment patients and retreatment patients was 30.4%(71/233) and 51.3%(60/117). Furthermore， the total rate of multidrug resistance was 15.4%(54/350)， the multidrug resistance rate of initial treatment was 11.2%(26/233)， while that of retreatment patients was 23.9% (28/117). Compared with the results of the fifth national epidemiological survey of tuberculosis， the drug and multidrug resistance rate both increased. ConclusionThe drug and multidrug resistance rate of Mycobacterium tuberculosis from the retreatment tuberculosis patients were higher than the strain from initial treatment tuberculosis patients. It is crucial for the initial treatment patients to strengthen the standard treatment management.

Utility of anthropometric parameters for prediction of metabolic syndrome in the elderly

Xu Lihuaa，Yan Yinglina，Yu Kaia，Yang Hongnaa，Li Fang，He Yanb，Yin Xiaofanga

2016, 31(11): 1229-1232. doi:10.3969/j.issn.1004-583X.2016.11.017

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ObjectiveTo screen summary anthropometry index of each composition for the elderly in predicting metabolic syndrome in Renqiu. MethodsA cluster random sampling method was used to study Renqiu permanent residents the age 60 to 70 years， including 4 412 cases， using face to face health questionnaire， anthropometric measurements， and laboratory test. Gender grouping according， ROC curve analysis was used to determine the boundary value of neck circumference， body mass index and waistheight ratio. ResultsNeck circumference， body mass index and waistheight ratio had significant potential for predicting metabolic syndrome in the elderly（P<0.01）.In the male，the neck circumference 37.75 cm，body mass index 24.95 kg/m2 and waistheight ratio 0.56 were the optimal cutoff points for screening and predicting the presence of metabolic syndrome. The area under the AUC was 0.779，0.797，0.817. In the female， the neck circumference 34.15 cm，body mass index 24.55 kg/m2 and waistheight ratio 0.56 were the optimal cutoff points for screening and predicting the presence of metabolic syndrome. The area under ROC curve (AUC) was 0.769，0.766，0.775. Waistheight ratio showed the highest AUC in all the parameters in men and women. ConclusionNeck circumference， body mass index and waistheight ratio play important roles in the prediction of metabolic syndrome， and waistheight ratio seems to be the best parameter in the prediction of metabolic syndrome in the elderly.

Comparative study of conventional and contrastenhanced ultrasound in diagnosis of carotid atherosclerotic plaques

Zhang Xueqiana，Tian Huib，Jia Lijinga，Wei Jingmeib

2016, 31(11): 1233-1236. doi:10.3969/j.issn.1004-583X.2016.11.018

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ObjectiveTo explore the value of conventional ultrasonic in diagnosis of carotid atherosclerotic plaques comparing with contrastenhanced ultrasound. MethodsThe clinical data included conventional and contrastenhanced ultrasound image of 54 cerebrovascular patients with carotid atherosclerotic plaques which confirmed by conventional ultrasonic. ResultsThe conventional ultrasound in seven patients showed low echo plaques confirmed by contrastenhanced ultrasound plaque only for grade Ⅰ; conventional ultrasound in five patients showed high echo plaques confirmed by contrastenhanced ultrasound plaque for grade ⅢⅣ; contrastenhanced ultrasound imaging in three patients showed the plaque of internal carotid lateral wall that conventional ultrasonic failed to clearly find. Carotid artery stenosis was confirmed by conventional ultrasonic and contrastenhanced ultrasound in two patients， stenosis rate was estimated for 50%69%. ConclusionContrastenhanced ultrasound is better than conventional ultrasonic in diagnosis of carotid atherosclerotic plaques， especially finding the lateral wall plaque of carotid artery， observing the angiogenesis in atherosclerosis plaque and assessment of plaque stability.

Comparison of highfrequency color Doppler ultrasonography and hepatobiliary seintigraphy in early diagnosis of biliary atresia

Ju Hongjuana， Hao Lupingb，Li Yingchaoc

2016, 31(11): 1237-1239,1243. doi:10.3969/j.issn.1004-583X.2016.11.019

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ObjectiveTo analyze the diagnostic value of highfrequency color Doppler ultrasonography and hepatobiliary seintigraphy in early diagnosis of biliary atresia. MethodsThe study involved 56 neonates and infants with cholestatic jaundice who were confirmed with cholangiography by operation or abdominoscopy. Preoperative highfrequency color Doppler ultrasonography and hepatobiliary seintigraphy were performed. Two diagnostic methods were compared with the gold standards.The sensitivity， specificity， accuracy， positive predictive value and negative predictive value were calculated. ResultsIn 56 consecutive cholestatic infants(32 boys，24 girs)， there were 34 infants with biliary atresia (60.7%) and 22 infants with nonbiliary atresia (39.3%). The sensitivity， specificity， accuracy， positive predictive value and negative predictive value of biliary atresia diagnosis by highfrequency color Doppler ultrasonography were 88.2%，77.3%，83.93%，85.71%，80.95%， and those of biliary atresia diagnosis by hepatobiliary seintigraphy were 100.0%，63.6%，85.7%，81.0% and 100.0%，respectively. ConclusionHighfrequency color Doppler ultrasonography diagnosis of biliary atresia with high specificity，superior to that of hepatobiliary seintigraphy; Hepatobiliary seintigraphy diagnosis of biliary atresia with high sensitivity， superior to that of highfrequency color Doppler ultrasonography. The combination of two methos can distinguish between biliary atresia and other causes of neonates and infants cholestasis with high accuracy，and unnecessary surgery may be avoided， improved clinic prognostic.

Value of virtual touch tissue quantification technique in systemic lupus nephritis

Nan Cailing， Zhang Weiyang， Yao Yaning

2016, 31(11): 1240-1243. doi:10.3969/j.issn.1004-583X.2016.11.020

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ObjectiveTo investigate the value of virtual touch tissue quantification technique in systemic lupus nephritis(LN). Methods108 cases of LN were divided into four groups: type Ⅰ （normal glomerular group）， type Ⅱ（mesangial proliferation group）， type Ⅲ（focal group）， type Ⅳ（diffuse group）. And 30 health participants were enrolled as control group．The shears wave velocity (SWV) was measured. The SWV values were compared among different groups. Activity index(AI) and chronic index(CI) were scored for each group， and the correlation between the score and SWV was analyzed. ResultsThe diagnostic cutoff points of Ⅰ， Ⅱ， Ⅲ and Ⅳ were 2.13 m/s (sensitivity 75%， specificity 87%)， 2.37 m/s (sensitivity 89%， specificity 90%)，2.56 m/s (sensitivity 93%， specificity 94%) and 2.91 m/s (sensitivity 80%， specificity 87%) respectively. There was significant differences between each type in LN groups vs control group. Moreover， there were also statistically significant differences between each groups in LN group. With the severity of pathological degree， the AI and CI scores of each LN group increased . Furthermore， the AI of type Ⅳ was more than 10 points and CI scores were more than 6 points. ConclusionVirtual touch tissues quantification technique could reflect the renal tissue elasticity. It has clinical value in the diagnosis of LN.

Effect of GdDTPA to liver parenchyma and intrahepatic common malignant lesions on T2weighted imaging

Zhao Baohong，Xu Qian，Zeng Yanhong， Guo Zhojun，Lin Qiang， Zhang Yuhuan

2016, 31(11): 1244-1247. doi:10.3969/j.issn.1004-583X.2016.11.021

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ObjectiveTo explore the possibility of optimizing liver MRI enhancement scanning process， the changes of T2WI signal of hepatic parenchyma and intrahepatic common malignancy were studied before and after using contrast agent gadolinium diethylenetriamine pentaacid(GdDTPA.) MethodsEightynine cases were collected normally in the control group and 42 cases which were clinically diagnosed as intrahepatic common malignancy (19 cases of liver cancer and 23 cases of liver metastases)， the changes of T2WI signal were measured and analyzed comparatively. ResultsContrast agent GdDTPA was used to scan normal liver， liver cancer and liver metastases， T2WI signal reduced slightly. The difference was statistically significant (P<0.01). The difference of T2WI signal before enhancement and after enhancement were compared among groups of normal liver and liver cancer and liver metastases， there were statistically significant difference (P<0.05). However， there was no significant difference on the percentage of signal reduction (P>0.05). By comparing the signal difference before and after enhancement，T2WI signal difference between common malignant lesions in liver and its surrounding normal liver parenchyma was not significantly different (P>0.05). ConclusionHepatic parenchyma and intrahepatic common malignancy were affected by contrast agent， the enhanced degree of T2WI signal was decreased after the enhancement， but it had little effect on the detection of common malignant lesions in liver. Therefore， it is feasible to perform T2WI after enhancement.

Association between TNFα1031 T>C polymorphisms and helicobacter pylori infection: a metaanalysis

Pu Ning1a， Wang Jing2， Ka Shiquan1b， Tang Zhigang1c

2016, 31(11): 1248-1253. doi:10.3969/j.issn.1004-583X.2016.11.022

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ObjectiveTo investigate the association between TNFα 1031 T>C polymorphisms and helicobacter pylori(H.pylori) infection. MethodsPublished literatures within CNKI， VIP Database， Wanfang Database， PubMed， Embase， and the Cochrane Library were searched. Data were analyzed with the Stata12.0 software package using pooled odds ratios (ORs) with 95% confidence intervals (CI).ResultsA total of ten studies involving 2 328 patients were included in this study. The results of metaanalysis showed that TNFα 1031 T>C polymorphisms was associated with decreasing H.plylori infection（TT vs CC，OR=0.61，95%CI=0.440.85，P=0.003; TT+CT vs CC，OR=0.61，95%CI=0.440.84，P=0.002）. However， there was no significant difference between allele model（T vs C， OR=0.92，95%CI=0.821.02，P=0.106） and recessive model（TT vs CC+CT，OR=0.96，95%CI=0.841.09，P=0.504）.ConclusionTNFα 1031 T>C polymorphisms may be associated with a decreasing risk of H. pylori infection. Further studies with different ethnicities and larger sample size are required to validate the results.

Curative effects and safety of zotarolimuseluting stents and sirolimuseluting stents on coronary heart disease: a metaanalysis

Wu Yuqiong1a， Yang Lining1a， Shi Youqin1a， Luo Zhaojun1b， Wang Junchen1c， Meng Min2

2016, 31(11): 1254-1260. doi:10.3969/j.issn.1004-583X.2016.11.023

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ObjectiveTo compare the curative effects and safety of zotarolimuseluting stents (ZES) and sirolimuseluting stents (SES) after percutaneous coronary intervention(PCI). MethodsThe databases of Pubmed， Embase， Chocorane library， Science Direct， CNKI，Chinese Biological Medical Disc and related website such as http://scholar.google.com/ were retrieved with computer for collecting randomized controlled trials (RCTs) about the comparison in the curative effects and safety of ZES and SES published from inception to Jan 31， 2016. After critical appraisal for the literature quality using the Cochrane Reviewers Handbook， the eligible data of RCTs were extracted and given a metaanalysis by applying RevMen 5.3 software. ResultsThere were nine RCTs identified (a total of 6 672 patients)， the treatment group had 3 434 cases and the control group had 3 238 cases. Metaanalysis showed that there was no statistical difference between ZES group and SES group in the incidence of mortality (RR=0.99，95%CI=0.831.19，P=0.93)， cardiac mortality (RR=0.86，95%CI=0.631.19，P=0.37)， MACE (RR=1.05，95%CI=0.931.20，P=0.43)， myocardial infarction (RR=0.84， 95%CI=0.681.02，P=0.08)， target vessel revascularization (RR=1.19，95%CI=0.991.42，P=0.06) and stent thrombosis (RR=0.82，95%CI=0.461.46，P=0.50). There was statistically significant difference between two groups in the rate of target lesion revascularization (RR=1.49，95%CI=1.181.89，P=0.0008). ConclusionData showed that two kinds of drugeluting stents were similar in the incidence of mortality， cardiac mortality， MACE， MI， TVR and ST in the treatment of CHD. SES could significantly reduce the incidence of target lesion revascularization compared with ZES， but sensitivity analysis showed that above mentioned results were instable.

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