[Dyspnea with multiple bilateral lung opacities on CT scan].

A 58-year-old man was admitted with a typical presentation of acute left heart failure. However, the patient showed a partial response to the anti-heart failure therapy. Following admission, a continuous fever was monitored, and a CT scan revealed that multiple opacities on bilateral lungs had progressed. Bronchoscopy was performed, and Coxiella burnetii was detected by Metagenomic next-generation sequencing (mNGS) in bronchoalveolar lavage (BALF), and transbronchial lung biopsy showed organizing pneumonia. Considering that the patient had a history of rabbit breeding and delivery, with some newborn rabbits dying before he became ill, organizing pneumonia secondary to Q fever pneumonia was diagnosed. Anti-Q fever treatment was initiated and the patient's temperature returned to normal. Glucocorticoid was administered after adequate treatment for Q fever. The patient's symptom of dyspnea relieved soon and opacities on CT scan were absorbed remarkably. The final diagnosis was organizing pneumonia secondary to Q fever pneumonia accompanied with left heart failure.

[A case of giant pleural tuberculoma].

We retrospectively analyzed a rare case of giant pleural tuberculoma. The patient was a female, 62 years old, admitted to hospital for intermittent fever and hemoptysis. The CT scan of the chest and abdomen showed a mass in the right thoracic cavity, and the uneven surface of the bilateral fallopian tubes. Routine blood tests showed a decrease in platelets, white blood cells, and hemoglobin. The mass in the chest was finally confirmed as a tuberculoma by biopsy. The patient was diagnosed with tuberculosis more than 9 years ago and had been treated with anti-tuberculosis drugs for more than 9 years, which caused damage to the liver, bone marrow and other organs, and led to the drug-resistant tuberculosis, making diagnosis and treatment more complex.

[The value of nomogram for predicting microvascular invasion based on clinical and Gd-EOB-DTPA-enhanced magnetic resonance imaging features].

Objective: To investigate the risk factors of microvascular invasion (MVI) in China liver cancer staging system stage Ⅰa (CNLC Ⅰa) hepatocellular carcinoma (HCC), and develop a nomogram for predicting MVI based on clinical and radiographic data. Methods: This retrospective study focused on CNLC Ⅰa HCC patients who underwent radical resection at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to December 2020. Patients' clinical characteristics and laboratory test results and pre-surgery gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging results were collected. The clinical and radiographic risk factors for MVI were identified by univariate and multivariate logistic regression analyses and used for the construction of the predictive nomogram. The nomogram model was then internally validated, and its performance was assessed. Results: A total of 104 patients were divided into the MVI-positive group (n=28) and the MVI-negative group (n=76). Multivariate logistic regression analysis at the P<0.1 level identified serum alpha-ferroprotein >7 ng/ml, total bilirubin >21 µmol/L, prothrombin time >12.5 s, non-smooth margin, and incomplete or absent capsule as risk factors of MVI, based on which a nomogram model was built. The model achieved an area under the curve (AUC) value of 0.867 (95% confidence interval, 0.791-0.944) in the internal validation. The sensitivity and specificity of the nomogram model were 0.786 and 0.829, respectively, with the prediction curve nearly overlapping the ideal curve. Based on the Hosmer-Lemeshow test, the predicted and real results were not significantly different (P=0.956). Conclusions: The probability of MVI of CNLC Ⅰa HCC can be objectively predicted by the monogram model that quantifies the clinical and radiographic risk factors. The model can also help clinicians select individualized surgical plans to improve the long-term prognosis of patients.

[Associations between gene polymorphisms of signal transducer and activator of transcription 3 and the susceptibility to hepatitis B virus related liver cirrhosis].

To investigate the associations between gene polymorphisms of signal transducer and activator of transcription 3 (STAT3) and liver cirrhosis (LC) after hepatitis B virus (HBV) infection. A case-control study was conducted in 243 patients with hepatitis B cirrhosis (HBV-LC, case group) and 486 HBV-infected subjects without LC (non-LC, control group) collected from January 2018 to September 2020 at the Changsha Central Hospital Affiliated to Nanhua University. Three single nucleotide polymorphisms (SNPs) of STAT3 gene, including rs4796793C>G, rs2293152C>G, and rs1053004T>C were selected through literature and biological information database, and the genotypes were detected by real-time fluorescent quantitative PCR (RFQ-PCR). The distribution differences of STAT3 SNPs genotypes between the two groups were compared using Chi-square test and haplotype analysis was conducted by Shesis online. The proportion of HBV C genotype in HBV-LC patients was significantly higher than that in the control group (80.91% vs. 70.79%, χ2=7.109, P=0.008), while the logarithm of ALT was significantly lower than that of the control group (1.78±0.43 vs. 1.95±0.54, t=3.801, P=0.000). The genotypes distributions of rs4796793, rs2293152, and rs1053004 were not significantly different between HBV-LC and non-LC in overall analysis and stratified analysis by gender (χ²=2.610, 1.505, 0.586, 2.653, 2.685, 1.583, 0.351, 5.388, 0.339, respectively, P>0.05 for each). Among the subjects infected with HBV genotype C, rs1053004 CC (vs. TT) significantly increased the risk of HBV-LC [odds ratio (OR) = 1.40, 95% confidence interval (CI): 1.03-1.91]. Among the HBV-infected subjects with HBeAg negative, rs4796793 GG genotype (vs. CC) and G allele (vs. C) significantly increased the risks of HBV-LC (OR = 2.17, 95%CI: 1.11-4.23; OR = 1.45, 95%CI: 1.06-1.97, respectively). Haplotypes analysis showed that the frequency of haplotype C-G-T composed of rs4796793, rs2293152, and rs1053004 was significantly lower in HBV-LC than that in the control group (non-LC) (27.3% vs. 35.6%, χ²=9.949, P = 0.001). The correlation between STAT3 and HBV-LC is different in HBV-infected subjects with different infection status. The HBV-infected subjects carrying haplotype rs4796793C-rs2293152G-rs1053004T of STAT3 gene have significantly decreased risk of LC.

[Correlation study between changes in intestinal microflora structure and immune indexes in newly treated patients with pulmonary tuberculosis].

To explore the correlation between the changes of the intestinal flora of newly treated pulmonary tuberculosis patients and the immune indicators of the body, and to provide a reference for the prevention and treatment of pulmonary tuberculosis. A single-center and case-control study was adopted. From October 2020 to April 2021, 43 patients with newly diagnosed tuberculosis in the Department of Tuberculosis, Affiliated Changsha Central Hospital,University of South China were selected as the control group. 43 cases of newly treated pulmonary tuberculosis (PTB), 43 healthy control (HC) during the same period, collected fresh feces and whole blood of subjects, and used Illumina Hiseq high-throughput sequencing technology to analyze 16S of all microorganisms in feces The V4 region of rRNA was amplified and sequenced, and the structure of the intestinal flora was analyzed by QIIME software. Use flow cytometry to determine the subject's immune indicators (CD3+, CD4+, CD8+, CD4+CD25+CD127-Treg, CD14+CD16+, CD14+CD16-), and analyze the changes in intestinal flora and immune function in newly treated pulmonary tuberculosis patients Inherent connection. The χ² test, t test, and Wilcox rank sum test were used to analyze the differences in age, gender, α diversity, and relative abundance of the two groups of people. Compared with the HC group, the alpha diversity of the intestinal flora in the PTB group decreased (shannon index: t=3.906, P=0.000 2; simpson index: Z=553, P=0.004 7; chao1 index: t=5.395, P=0.000 0). ß diversity analysis showed that there were significant differences in the structure of the intestinal flora between the two groups (P=0.000). Species difference analysis showed that at the phylum level, the relative abundance of Firmicutes in the PTB group was significantly lower than that in the HC group (Z=486.0, P=0.000 5). At the genus level, there are 15 different bacterial genera between the two groups. In the PTB group, bifidobacterium, enterococcus, lactobacillus, anaerostipes, the relative abundance of the above 5 genera of veillonella is higher than that of the HC group (P<0.05); Butyricimonas, clostridium, and broutella (blautia), coprococcus, dorea, lachnospira, roseburia, faecalibacterium, ruminococcus, the relative abundance of 10 bacterial genera including dialister was lower than that of the HC group (P<0.05). Comparison of immune indexes between groups showed that CD14+CD16+monocytes (%) in the PTB group were higher than those in the HC group (t=2.456, P=0.001 6<0.05), while CD14+CD16-monocytes (%) were lower than HC (t=-4.368, P=0.000<0.05), while the differences in CD3+, CD4+, CD8+, CD4+/CD8+and Treg (CD4+CD25+CD127-) were not statistically significant (P>0.05). Spearman correlation analysis showed that Firmicutes in the PTB group was negatively correlated with CD4+/CD8+, CD14+CD16+(r=-0.218, P=0.048; r=-0.245, P=0.025), and positively correlated with CD14+CD16-Correlation (r=0.250, P=0.022); At the genus level, Faecalis is positively correlated with CD4+/CD8+and CD4+(r=0.250, P=0.023; r=0.258, P=0.019); Rosella and CD3+, CD8+and CD14+CD16-are positively correlated (r=0.27, P=0.024; r=0.219, P=0.046; r=0.027, P=0.039), and negatively correlated with CD14+CD16+(r=-0.280, P= 0.01). Changes in the structure of the intestinal flora of newly treated pulmonary tuberculosis patients may be one of the influencing factors of the immune function of the body. Targeted optimization of the structure of the intestinal flora and improvement of the body's immunity may be used as an effective auxiliary treatment for pulmonary tuberculosis.

[Efficacy and safety of paclitaxel liposomes compared to paclitaxel combined with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma: a Meta-analysis].

Objective: To explore the efficacy and safety of paclitaxel liposomes compared to paclitaxel with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma. Methods: SinoMed, CNKI, WanFang MED ONLINE, VIP, PubMed, MEDLINE, Cochrane Library, Embase and ClinicalTrials.gov were searched to collect the papers or clinical studies of paclitaxel liposomes and paclitaxel combined with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma from the inception to January 15th 2021 in Chinese and English. Two independent reviewers screened the literatures, extracted the data and assessed the bias of the included studies. Meta-analysis was performed using RevMan 5.4 and R software. Results: Totally 9 papers involving 666 patients with unresectable cervical carcinoma were included. The results of meta-analysis indicated that compared to paclitaxel combined with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma, paclitaxel liposomes combined with platinum exhibited superiority in near-term efficacy (complete response + partial response) [81.4%(272/334) vs 68.7%(228/332), RR=1.19; 95% CI: 1.09, 1.29, P=0.000 1]; substantially decreased the incidence rates of blood system disorders [myelosuppressio, 50.3%(168/334)vs 65.1%(216/332)], gastrointestinal disorders [34.4%(115/334) vs 55.1%(183/332)], alopecia [42.2%(94/223)vs 63.3%(140/221)], allergic reaction [11.6% (23/198)vs 27.6%(54/196), P≤0.000 1], peripheral neuritis [43.0%(52/121) vs 54.9%(67/122)], or joint and muscle pain [20.3%(16/79) vs 34.6%(28/81), P<0.050 0]. Conclusion: Compared to paclitaxel combined with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma, paclitaxel liposomes is superior in near-term efficacy, and exhibits better safety.

[Analysis of risk factors and construction of predictive nomogram for early recurrence after radiofrequency ablation of hepatocellular carcinoma].

Objective: To assess the optimal cut-off value between early recurrence and late recurrence of patients with hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA), and to construct a nomogram to predict early recurrence. Methods: A total of 119 patients with HCC who recurred after RFA in Cancer Hospital, Chinese Academy of Medical Sciences from January 2012 to December 2017 were identified. The optimal cut-off value to distinguish early and late recurrence was determined based on differences in post recurrence survival (PRS) by minimum P-value approach. The clinical and radiographic risk factors for early recurrence were identified by univariate and multivariate Logistic regression analysis. The predictive nomogram was constructed by these factors and internally validated. Results: The optimal cut-off value to distinguish early recurrence and late recurrence was 12 months after RFA (P=0.005). The patients were divided into early recurrence group (47 cases) and late recurrence group (72 cases). The lower quartile PRS (Q1-PRS) and lower quartile overall survival (Q1-OS) were 11.1 and 19.1 months in the early recurrence group, which were shorter than 31.6 and 81.0 months in the late recurrence group (P=0.005 and P<0.001, respectively). The independent risk factors of early recurrence were alpha fetoprotein (AFP) (OR=8.459, 95%CI: 2.231-32.073), albumin(ALB) (OR=0.251, 95%CI: 0.047-1.339), number of lesions (OR=3.842, 95%CI: 1.424-10.365) and peritumoral enhancement (OR=8.05, 95%CI: 1.23-52.80), which were further incorporated into constructing the predictive nomogram of early recurrence of HCC after RFA. Internal validation results showed the area under the curve, sensitivity, specificity of the receiver operating characteristic (ROC) curve were 0.839, 68.1% and 93.1%, respectively. The calibration curve showed the predicted curve of nomogram was close to the ideal curve. Hosmer-Lemeshow test showed there was no significant difference between the predicted results of nomogram and the actual results (P=0.424). Conclusions: An interval of 12 months after RFA is the optimal cut-off value for defining early recurrence and late recurrence. The nomogram is integrated by clinical and radiographic features, which can potentially predict early recurrence of HCC after RFA and may offer useful guidance for individual treatment or follow up.

[Comparison of interventional and surgical treatment of paravalvular leak after cardiac valve replacement].

Objective: To assess the immediate and mid-term outcomes and hospital costs of patients who underwent trans-catheter closure (TC) or surgical closure (SC) of perivalvular leakage (PVL). Methods: Patients who underwent treatment of TC and SC of PVL in our center between January 2016 and December 2019 were enrolled. Baseline characteristics, procedure success, in-hospital and mid-term outcomes and hospital costs were compared. Results: A total of 141 patients were enrolled (TC, n=65 and SC, n=76). The patients in TC group were elder ((56.8±12.8) years vs (50.1±12.8) years, t=-3.124, P=0.002). Technical success was significant higher in the SC group (83.1% vs 98.7%, χ²=10.960, P<0.001). And the residual PVLs were less in SC group (33.3% vs 13.3%, χ²=-2.525, P=0.012). One patient in SC group had procedure-related death. Procedure room time ((93±38) min vs (395±132) min, t=19.065, P<0.001), intensive care unit time (0 h vs 28 (21, 74)h, Z=-10.738, P<0.001), length of stay from hospitalization to discharge (7 (4, 10) days vs 21 (15, 25) days, Z=-8.075, P<0.001) and costs (¥46 073 (36 837, 52 448) vs ¥130 798 (104 048, 186 188), Z=-10.059, P<0.001) were significantly less in TC group. After risk adjustment, there was no significant difference in 30 days survival between TC group and SC group. At a median follow-up of 21 months, there was a trend towards reduced all-cause death following TC versus SC (OR = 0.054, 95%CI: 0.07 to 0.445, P= 0.007). Conclusions: SC for PVL is associated with higher technical rates and less residual shunt compared with TC approach. But, the shorter length of stay and lower resources use with TC group significantly reduce hospital costs. In addition, TC achieve a better mid-term results in survival.

[Value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging and diffusion-weighted MR imaging in predicting microvascular invasion in hepatocellular carcinoma and the prognostic significance].

Objective: To investigate the combined value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in predicting pathological microvascular invasion (pMVI) preoperatively, and to determine the relationship between prediction results and prognosis in hepatocellular carcinoma (HCC) patients. Methods: A total of 181 newly diagnosed HCC patients were enrolled in this study. Imaging characteristics and the apparent diffusion coefficient (ADC) value of DWI were analyzed. The differences of imaging characteristics and ADC values between different pMVI groups were analyzed.Multivariate logistic regression and receiver operating characteristic (ROC) curve were used to analyze the value for pMVI prediction by using significant parameters. The patients were grouped based on MRI predicted MVI (mrMVI), and the relationship between mrMVI and recurrence free survival time (RFS) was analyzed. Results: Fifty-one patients were pMVI positive and 130 patients were pMVI negative. The ADC value in pMVI positive group were (1.10±0.17)×10(-3) mm(2)/s, significantly lower than (1.27±0.22)×10(-3) mm(2)/s of pEMVI negative group (P<0.001). The incidence rates of incomplete enhancing "capsule" , non-smooth tumor margin, arterial peritumoral enhancement, mosaic architecture and peritumoral hypointensity on hepatobiliary phase (HBP) in pMVI positive group were significantly higher than those of negative group (all P<0.05). Multivariate logistic regression analysis showed that tumor margin, arterial peritumoral enhancement, peritumoral hypointensity on HBP and ADC value were independently associated with pMVI. ROC analysis showed that the area under curve, sensitivity and specificity of pMVI predicted by combined parameters were 0.830, 76.5% and 81.5%, respectively. The median RFS of mrMVI positive group was 23.6 months, significantly lower than 38.2 months of mrEMVI negative group (P=0.004). Conclusion: Tumor margin, arterial peritumoral enhancement, peritumoral hypointensity on HBP and ADC value are independent predictors of pMVI in HCC, and mrMVI is related with RFS.

Extracorporeal shock wave therapy (ESWT) may be helpful in the osseointegration of dental implants: A hypothesis.

In recent decades, with the rapid development of dental implant technology, dental implants have been widely used in clinical practice. Various complications, including a lack of osseointegration, may occur after dental implantation. However, the occurrence of osteointegration failure after dental implantation is often complicated and unpredictable, and existing treatment methods cannot reverse osteointegration failure to achieve the optimum condition. A noninvasive, easy-to-operate, low-cost, fast-acting mechanotherapy is expected to solve this problem. Extracorporeal shock wave therapy (ESWT) is widely used to treat delayed healing, bone nonunion fractures, femoral head necrosis and other orthopedic diseases and plays a significant role in promoting bone regeneration. Studies have shown that ESWT can promote bone formation and osseointegration of titanium devices in vivo. In previous experiments, ESWT was found to regulate the activity of inflammatory cells, osteoblasts and mesenchymal stem cells. Studies have also mentioned the role of ESWT in promoting angiogenesis and bactericidal activity. Therefore, our hypothesis is that extracorporeal shock wave therapy can facilitate the realization of osteointegration by regulating the immune response, inducing regeneration of the jaw and alveolar bone, and promoting angiogenesis and bactericidal efficacy.

[The mid-term and long-term results of endovascular treatment of C/D aorto-iliac artery occlusive disease].

Objective: To evaluate the safety and efficacy of the endovascular treatment for Trans-Atlantic Society Consensus (TASC) C/D aorto-iliac artery occlusive disease in mid-term and long-term follow-up. Methods: A total of 172 patients diagnosed with TASC C/D aorto-iliac lesions who received endovascular treatment from Chinese PLA General Hospital from January 2008 to January 2018 were retrospectively analyzed. The cohort was separated into covered stent group (61 cases), bare stent group (88 cases) and composite stent group (23 cases). Primary endpoint was primary patency, and secondary endpoints were freedom from target lesion revascularization (TLR) rate, major amputation rate and all cause death rate. Results: There were no significant difference of peri-operational all cause death rate and complication rate among all the groups(all P>0.05). Kaplan-Meier was used to analyze the primary patency at 5 year, which were 82.1%, 78.3% and 71.9% in covered stent group, bare stent group and composite stent group (χ(2)=3.47, P>0.05) , and primary patency at 10 year were 68.7%, 52.6% and 58.1%, respectively (χ(2)=18.91, P<0.05) . Freedom from TLR at 5 year were 88.5%, 82.6% and 78.1% in covered stent group, bare stent group and composite stent group (χ(2)=2.93, P>0.05) , and freedom from TLR at 10 year were 74.1%, 70.6% and 65.9%, respectively (χ(2)=6.16, P>0.05) . Diabetes, smoking, TASC D lesions and bare stent were identified as predictors of restenosis by logistic regression analysis. Conclusions: These results suggest that endovacular treatment is safe and effective to complex TASC C/D aorto-iliac artery occlusive disease in mid-term and long-term follow-up. The application of covered stent might further improve the long-term patency.

[Study on the relationship between serum vitamin D and the risk of type 2 diabetes in Harbin residents].

Objective: To analyze the relationship between serum vitamin D level and the risk of type 2 diabetes in Harbin residents. Methods: On April 2010, 24 communities in 7 districts of Harbin were selected as research sites using multi-stage stratified cluster random sampling method. A total of 9 734 residents aged 20-74 years was investigated using general questionnaire survey, dietary survey and biochemical indicators test and followed up from January 2015 to July 2016. A total of 4 721 subjects with serum vitamin D were included in the study. According to the quartile of baseline serum vitamin D, the subjects were divided into four groups, from Q1 to Q4 group. The multivariate logistic regression model was used to analyze the relationship between serum vitamin D and the risk of type 2 diabetes. A mediation analysis model was used to analyze the mediating role of insulin resistance in this risk relationship. Results: At the time of follow-up, 432 patients with type 2 diabetes were screened. The median (P(25), P(75)) age of the diabetic group and the non-diabetic group were 54 (49, 61) and 51 (43, 57) years, respectively, and males accounted for 40.5% (175 cases) and 35.5% (1 513 cases), respectively. The median (P(25), P(75)) serum vitamin D was 16.0 (13.5, 18.5) and 17.4 (14.3, 20.5) ng/ml, respectively. After relevant confounders and insulin resistance index (HOMA-IR) were adjusted, compared to the serum vitamin D level Q(1) group, the risk of diabetes was reduced by 40% in the Q(3) group with RR (95%CI) about 0.60 (0.44-0.82), while the risk of diabetes was reduced by 59% in Q(4) group with RR (95%CI) about 0.41 (0.29-0.57). Through mediation analysis, the Gutt index mediating effect representing peripheral insulin resistance was 53.8%, and the mediating effect of HOMA-IR representing hepatic insulin resistance was 6.6%. Conclusion: The risk of type 2 diabetes is low in Harbin residents with higher serum vitamin D level. Insulin resistance has a mediating effect on the relationship of vitamin D and the risk of type 2 diabetes.

[Association between dyslipidemia and carotid plaque incidence in a research group: a prospective cohort study].

Objective: To assess the association and intensity of baseline dyslipidemia with the incidence of carotid plaque in a researchers group in China. Methods: A total of 716 researchers were enrolled in this prospective cohort study. Dyslipidemia was assessed in 2010. Follow-up study on carotid plaque was conducted in 2017. Results: Over 8 years' follow-up, 289 carotid plaque patients were identified among 716 individuals who did not have carotid plaque at baseline survey, with cumulative incidence of 40.36%. After adjustment of age, gender, BMI, waist circumference, FPG, SBP, DBP, ALT and uric acid, compared with non-dyslipidemia group, HR of carotid plaque for such populations with ≥3 types of dyslipidemia was 1.681 (95%CI: 1.090--2.593). Conclusions: Dyslipidemia might be associated with higher risk of carotid plaque, and population with ≥3 types of dyslipidemia had higher risk for carotid plaque. Prevention of dyslipidemia or reduction of types of dyslipidemia might be one of the effective precautions for prevention of carotid plaque.

[A preliminary study on the relationship between idiopathic arrhythmia and cardiac magnetic resonance imaging defined cardiac features in patients with straight back syndrome].

Objective: To retrospectively analyze the potential correlation between cardiac magnetic resonance (CMR) imaging and clinical features and idiopathic arrhythmia in patients with straight back syndrome (SBS). Methods: Patients receiving CMR imaging examination from April 2015 to March 2016 at our department (n=1 432) were screened, 76 patients met the diagnosis criteria of flat chest (anteroposterior diameter/transthoracic diameter (APD/TTD) ratio<0.37 at the T8 vertebra). After excluding 33 patients with structural heart disease, 43 SBS patients were divided into two groups: SBS without obvious morphological change in the heart (group A, n=19) and SBS with morphological change of the heart (group B, n=24). CMR images were analyzed, focusing the heart morphological changes induced by SBS. The clinical data were collected to comprehensively analyze the medical history, electrocardiogram and electrophysiological examination in order to observe the relationship between SBS induced heart morphological change and the arrhythmia type and origin. Results: There were 21 male patients in this cohort, mean age was (28.5±11.5) years (13-58 years). APD/TTD ratio was similar between the two groups (0.30±0.03 vs. 0.29±0.04, P>0.05). LVEF tended to be lower in group B than in group A ((47.48±12.77)%vs. (59.31±9.04)%, P>0.05) . In group B, there were 15 patients with left ventricular enlargement, 2 with left ventricular wall thickening, 5 with uncoordinated ventricular wall motion, 5 with tricuspid regurgitation, 3 with mitral regurgitation, 2 with myocardial fibrosis, 5 with increased trabecular and 16 with decreased left ventricular function. Direct compression sign of right ventricle (disappeared precordial fat tissue space, secondary right atria enlargement and tricuspid regurgitation) and left atria (with or without secondary left ventricular enlargement and mitral regurgitation) were evidenced in patients of group B. CMR revealed that the arrhythmia origin corresponded the compression site of the heart in 8 cases (42.1%) in group A and 13 cases (54.2%) in group B, not corresponded to the compression site in 6 patients (31.6%) in group A and in 7 patients (29.2%) in group B, not attributable in 5 patients (26.3%) in group A and 4 patients (16.7%) in group B. The percent of arrhythmia origin corresponded the compression site of the heart tended to be higher in group B as compared to group A (P>0.05). Conclusion: SBS can induce changes of cardiac morphology and cardiac function. SBS induced cardiac compression is linked with the development of arrhythmias and might be one of the reasons of arrhythmias in these patients.

The common variants implicated in microstructural abnormality of first episode and drug-naïve patients with schizophrenia.

Both post-mortem and neuroimaging studies have identified abnormal white matter (WM) microstructure in patients with schizophrenia. However, its genetic underpinnings and relevant biological pathways remain unclear. In order to unravel the genes and the pathways associated with abnormal WM microstructure in schizophrenia, we recruited 100 first-episode, drug-naïve patients with schizophrenia and 140 matched healthy controls to conduct genome-wide association analysis of fractional anisotropy (FA) value measured using diffusing tensor imaging (DTI), followed by multivariate association study and pathway enrichment analysis. The results showed that one intergenic SNP (rs11901793), which is 20 kb upstream of CXCR7 gene on chromosome 2, was associated with the total mean FA values with genome-wide significance (p = 4.37 × 10-8), and multivariate association analysis identified a strong association between one region-specific SNP (rs10509852), 400 kb upstream of SORCS1 gene on chromosome 10, and the global trait of abnormal WM microstructure (p = 1.89 × 10-7). Furthermore, one pathway that is involved in cell cycle regulation, REACTOME_CHROMOSOME _MAINTENANCE, was significantly enriched by the genes that were identified in our study (p = 1.54 × 10-17). In summary, our study provides suggestive evidence that abnormal WM microstructure in schizophrenia is associated with genes that are likely involved in diverse biological signals and cell-cycle regulation although further replication in a larger independent sample is needed.

[The quantitative analysis of MR dynamic contrast-enhangced imaging on efficacy and prognosis of transcatheter arterial chemoembolization on hepatocellular carcinoma].

Objective: To investigate the prognostic value of quantitative parameters of dynamic contrast-enhangced MR (DCE-MR) on short-term efficacy of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma(HCC). Methods: 79 patients with HCC underwent non-enhanced MR imaging and DCE on a 3.0T MR scanner before and one month after TACE. The quantitative parameters were measured on the maximal tumor region, including maximal tumor diameter(MTD), ADC, K(trans,) K(ep) and V(e) value before and after TACE. All patients were divided into stable group (36 patients) and progressive group (43 patients) based on follow-up. The quantitative data of the two groups before and after TACE was collected for analysis. Results: Among the 79 lesions in 79 patients, 21 were located in the left lobe of the liver, 53 in the right lobe of the liver and 5 in the junction area of the hepatic lobe. The maximum tumor diameter (MTD) was 2.2-9.9 cm, the median MTD was 5.1 cm. There were significant differences between progressive group and the stable group in MTD, K(trans,) K(ep) values of the tumor before TACE (P<0.05). One month after TACE, the MTD, K(trans,) K(ep,)ΔMTD, ΔK(trans) and ΔK(ep) values of the tumor in progressive group were statistically different with the stable group (P<0.05, respectively). For all the patients, the pre-TACE MTD, AFP, K(trans) and K(ep) values of tumors were statistically different with the post-TACE values (P<0.05). Conclusion: The quantitative parameters (K(trans,) K(ep,)ΔK(trans) and ΔK(ep) values) of the DCE-MR could predict and evaluate the short-term efficacy of TACE on HCC.

[The application of Critical Care Chest Ultrasonic Evaluation-plus Protocol in the etiological diagnosis of dyspnea and/or hemodynamic instability caused by abdominal abnormality].

Objective: To investigate the application of Critical Care Chest Ultrasonic Examination (CCUE)-plus (CCUE-plus) in the etiological diagnosis in patients with dyspnea and/or hemodynamic instability caused by abdominal abnormalities. Methods: Patients who suffered from dyspnea and/or hemodynamic instability in the Department of Critical Care Medicine, Xiangya Hospital, Central South University from September 2013 to September 2016 were recruited in this study. A total of 255 consecutive patients completed CCUE within 2hrs of admission. If the diaphragm could not be seen in the routine phrenic points according to Bedside Lung Ultrasound Evaluation (BLUE) protocol, it would be found along midaxillary line and defined m-point. The 59 patients with altered diaphragmatic position (m-point was more than 2 cm higher than phrenic point) received sequential abdominal ultrasonography. The latter ultrasonographic findings were compared with CT results. Results: There were 42(71.19%) cases with positive findings of abdominal ultrasonography, including 18 cases of seroperitoneum, 16 cases of intestinal obstruction and 8 cases combined. Compared with 56 patients who applied with CT exam, the abdominal ultrasonography revealed a sensitivity of 76.7% and a specificity of 100.0% to diagnose seroperitoneum (AUC(ROC) 0.917); whereas the sensitivity was 75.0% and the specificity was 90.9% (AUC(ROC) 0.778) to diagnose intestinal obstruction. Moreover, there were 44(74.58%) patients with normal left ventricular systolic function; more than three quarters (46/59, 77.97%) patients had pulmonary consolidation. Conclusion: In patients with dyspnea and/or hemodynamic instability caused by abdominal abnormalities and altered diaphragmatic position in BLUE protocol, CCUE-plus protocol has a high positive predictive value of more than 90% in abdominal abnormality. The findings of abdominal ultrasonography may change therapeutic target from cardio-pulmonary optimization to relief of intestinal obstruction or drainage of seroperitoneum.

Efficacy and influence factors of icotinib hydrochloride in treating advanced non-small cell lung cancer.

OBJECTIVE: To evaluate the efficacy and safety of icotinib hydrochloride in the treatment of patients with advanced non-small cell lung cancer (NSCLC) and discuss the influence factors on efficacy. PATIENTS AND METHODS: 120 treatment-experienced patients confirmed by pathology or cytology with stage III B-IV non-small cell lung cancer took icotinib hydrochloride and erlotinib orally until the occurrence of disease progression or serious adverse reactions. Then, the efficacy of icotinib hydrochloride and the related influence factors were analyzed. RESULTS: In icotinib hydrochloride group, the response rate and the disease control rate were 30.00% and 65.00%, and the median progression-free survival time was 179 days (95% CI: 103.21-254.78); in erlotinib group, the response rate and the disease control rate were 25.00% and 56.70%, and the median progression-free survival time was 121 days (95% CI: 95.05-146.94). Moreover, the objective response rate and the disease control rate of second-line therapy were both superior to the third-line and above therapy. The objective response rate of patients with complete response/partial response/stable disease after the first-line therapy was higher than that of patients without response after the first-line therapy (p<0.05), and the significant differences existed in the objective response rate and the disease control rate among mutant group, wild-type group, and unknown group (p<0.05). The response rate and the disease control rate of erythra group were higher than those of non-erythra group (p<0.05). It was showed in the univariate analysis that the progression-free survival was correlated with the smoking status and the epidermal growth factor receptor gene mutations. CONCLUSIONS: The icotinib hydrochloride is effective and safe in treating the treatment-experienced patients with advanced NSCLC, especially for patients with sensitive mutations.

[Research of mHLA-G and the receptor expression with kidney rejection and CMV active infection following kidney transplantation].

Objective: To study the expression of membrane HLA-G (mHLA-G) and the receptor immunoglobulin-like transcript 2(ILT2) on lymphocyte and find their association with rejection and cytomegalovirus (CMV) infection after renal transplantation. Methods: A total of 88 cases of renal transplant recipients for the first time from February 2014 to February 2016 were studied in this work. Recipients can be divided into rejection group (n=12) and stable renal function group (n=41) according to whether rejection occurred. Recipients only infected CMV not developed rejection were included in the CMV positive group (n=24). CMV negative group (n=11) including CMV negative recipients once infected CMV.The expression of mHLA-G and ILT2 on lymphocytes were detected by flow cytometry, and the differences among different groups were analyzed. Results: The data showed that after renal transplantation, T and B lymphocytes mHLA-G expression rate was the lowest in the rejection group (0.42%±0.35%, 0.88%±0.47%), having significant difference with renal function stable group and CMV positive group (all P<0.01). In CMV positive group the expression of mHLA-G on T and B lymphocytes was the highest (1.31%±0.69%, 2.01%±0.91%), having significant difference with rejection group (P<0.001). The expression of mHLA-G on B cell was statistically significantly different between CMV positive group and CMV negative group (P<0.05). There was no significant difference in ILT2 expression on B cell among the four groups (P>0.05). The expression rate of ILT2 on T cells was higher in the CMV positive group (36.91%±14.91%), having significant difference with the other three groups (P<0.01). Conclusions: Low expression of mHLA-G on T and B lymphocytes may predict rejection after renal transplantation. High expression of mHLA-G and ILT2 on lymphocytes is prone to CMV infection after renal transplantation .