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Objective@#To evaluate the performance of baseline clinical characteristics and pretherapeutic histogram parameters derived from T2 mapping of the extraocular muscles (EOMs) in the prediction of treatment response to intravenous glucocorticoid (IVGC) therapy for active and moderate-to-severe thyroid-associated ophthalmopathy (TAO) and to investigate the effect of fat-suppression (FS) in T2 mapping in this prediction. @*Materials and Methods@#A total of 79 patients clinically diagnosed with active, moderate-to-severe TAO (47 female, 32 male;mean age ± standard deviation, 46.1 ± 10 years), including 43 patients with a total of 86 orbits in the responsive group and 36 patients with a total of 72 orbits in the unresponsive group, were enrolled. Baseline clinical characteristics and pretherapeutic histogram parameters derived from T2 mapping with FS (i.e., FS T2 mapping) or without FS (i.e., conventional T2 mapping) of EOMs were compared between the two groups. Independent predictors of treatment response to IVGC were identified using multivariable analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the prediction models. Differences between the models were examined using the DeLong test. @*Results@#Compared to the unresponsive group, the responsive group had a shorter disease duration, lower kurtosis (FSkurtosis), lower standard deviation, larger 75th, 90th, and 95th (FS-95th) T2 relaxation times in FS mapping and lower kurtosis in conventional T2 mapping. Multivariable analysis revealed that disease duration, FS-95th percentile, and FS-kurtosis were independent predictors of treatment response. The combined model, integrating all identified predictors, had an optimized area under the ROC curve of 0.797, 88.4% sensitivity, and 62.5% specificity, which were significantly superior to those of the imaging model (p = 0.013). @*Conclusion@#An integrated combination of disease duration, FS-95th percentile, and FS-kurtosis was a potential predictor of treatment response to IVGC in patients with active and moderate-to-severe TAO. FS T2 mapping was superior to conventional T2 mapping in terms of prediction.
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Objective To explore a method of applying Micro-course in medical imaging teaching reform and to evaluate its effect. Methods The Micro-course platform was constructed by means of network and digital information technology, and micro-courses were made and uploaded. Two large classes of five-year clinical medical students attending medical imaging courses were randomly selected as control group (n=84) and experimental group (n=86). At the end of the course, the academic and practical skills of the two groups of students were compared, and the teaching situation was investigated by scores of electronic questionnaires to evaluate the effect of the method. Results The application of Micro-course platform was successful. The scores for theoretical and practical examination of the experimental group were higher than those of the control group, and the difference was statistically significant (P<0.05). 163 valid questionnaires were retrieved. Compared to the control group, the experimental Micro-course had a higher total score in the 7 positive items, and the difference was statistically significant (P<0.05). Conclusion Micro-course has a positive effect on the teaching reform of medical imaging.
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Objective To investigate the role of CCAAT enhancer binding protein A (C/EBPα) in lung development by analyzing the relationship between dynamic expression of C/EBPα protein and cell differentiation in rat lung tissue.Methods According to the histological stages of rat lung development,lung tissues were collected on 15.5 d (the late pseudoglandular period),17.5 d (the canalicular period),19.5 d (the early saccular period) of embryonic age and at 12 h (the middle saccular period),on 4 d (the late saccular period),7 d (the alveolar period,the alveolar stage),14 d (the alveolar period,the equilibrium stage) of postnatal age.The lung morphologic appearance was observed by using HE staining.Western blot was used to detect the expressions of C/EBPα and surfactant Protein (SP)-A,SP-B,SP-C,SP-D.Phosphatidylcholine (PC) assay kit was utilized to analyze the secretion of PC.Periodic acid-schiff (PAS) staining was used to evaluate the amcunt of glycogen in lung tissue.Results (1) C/EBPαt and SP-A began to express on 15.5 d of embryonic age (0.36 ±0.02,0.01 ±0.01),while SP-B,SP-C and SP-D started to express on 17.5 d of embryonic age (0.33 ±0.06,0.01 ±0.01,0.11 ±0.08).All of them increased with the development of lung,and C/EBPα,SP-A,SP-C reached the highest level at 12 h of postnatal age (3.48 ±0.05,3.24 ± 0.19,1.26 ± 0.21),and SP-D on the postnatal 4 d (1.48 ± 0.10),then gradually decreased,while the expression of SP-B continued to rise.The levels of C/EBPα and SPs maintained stable on postnatal 14 d.The C/EBPα protein level was positively correlated with SPs at embryonic age of 15.5 d,17.5 d,19.5 d and postnatal age 12 h (r =0.999,0.991,0.982,0.951,all P ＜ 0.05).(2) The level of PC was very low at embryonic age of day 15.5 [(60.50 ± 1.30) μg/g].With the development of lung,the secretion of PC increased gradually,but there was no significant correlation between the expression of PC and C/EBPoα(all P ＞ 0.05).(3) The level of glycogen was high in the late pseudoglandular stage (15.5 d) (585.50 ± 2.20),the content of glycogen decreased with the development of lung,especially on the canalicular (embryonic day 17.5) and during early saccular period (embryonic day 19.5),and then it became stable during the alveolar period (postnatal age 7 d).The expression of C/EBPα had negative correlation with the content of glycogen in fetal lung(r =-1.000,P ＜ 0.01).Conclusion C/EBPα plays an important role in rat lung development,as it may promote lung maturation by regulating the synthesis and secretionof SPs and PC.
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Objective To explore the relationship of serum ubiquitin carboxy terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) with brain injury in preterm infants. Methods A total of 130 premature infants with gestational age <34 weeks from August 2014 to October 2016 were recruited. Blood samples were collected at 6 h and 72 h after birth. The levels of serum UCH-L1 and GFAP were detected by ELISA method. According to the results of cranial ultrasound and MRI examination, the premature infants were divided into white matter damage (WMD) group, periventricular intraventricular hemorrhage (PVH-IVH) group, and no brain injury group. The levels of serum UCH-L1 and GFAP in preterm infants between the three groups, mild to severe brain injury were compared. Results At 6 h and 72 h after birth, the levels of serum UCH-L1 and GFAP among no brain injury group, PVH-IVH group and WMD group were significantly different (all P <0.001). The level of serum UCH-L1 and GFAP were the highest in the WMD group and the lowest in no brain injury group at both 6 h and 72 h after birth. The levels of serum UCH-L1 at 72 h after birth were significantly lower than those at 6 h after birth in PVH-IVH group and WMD group, while the levels of serum GFAP at 72 h after birth were significantly higher than those at 6 h after birth in both of the two groups (all P<0.05). The levels of serum UCH-L1 and GFAP in severe PVH-IVH group and severe WMD group were significantly higher than those in the mild group at 6 h and 72 h after birth (all P<0.05). Conclusions The levels of serum UCH-L1 and GFAP in preterm infants can be used as sensitive markers for early evaluation of brain injury, which can help determine the severity of brain injury in preterm infants.
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Objective To investigate the relationship between the preterm infants after premature rupture of the membranes(PROM)brain injury and some cellular factors in the umbilical cord blood and amniotic fluid,and ana-lyze the biological markers with great predictive value,and provide a theoretical basis for early monitoring of brain injury in premature infants. Methods One hundred and thirty - nine singleton infants with PROM,their gestation less than 34 weeks,were evaluated. The umbilical cord blood and amniotic fluid of cytokines,including interleukin - 1β(IL - 1β),IL - 4,IL - 6,IL - 8,IL - 10,IL - 17A,tumor necrosis factor alpha(TNF - α),granulocyte colony - stimu-lating factor(G - CSF),monocyte chemotactic protein - 1(MCP - 1),S100B protein and soluble intercellular adhe-sion molecule - 1(sICAM - 1)levels were measured with Luminex liquid chip. All the premature infants underwent brain imaging for the diagnosis of brain damage. All cases were divided into brain injury group and non - brain injury group based on brain imaging examination. Results The concentration of IL - 10 in cord blood was significantly lower in the brain injury group than that in the non - brain injury group,and the difference was statistically significant(P ﹤0. 05). The levels of IL - 1β,IL - 6,IL - 8,TNF - α,G - CSF,MCP - 1,S100B and sICAM - 1 in the brain injury group were significantly higher than those of non - brain injury group,and the differences were statistically significant (all P ﹤ 0. 05). The levels of IL - 1β,IL - 6,IL - 8,TNF - α,G - CSF,MCP - 1 and sICAM - 1 in the amniotic fluid were significantly higher than those of non - brain injury group,and the differences were statistically significant(all P ﹤ 0. 05),but amniotic fluid S100B protein level was similar between 2 groups,which had no statistical significance (P ﹥ 0. 05). To predict the value of brain damage in premature infants,the highest sensitivity in cord blood was S100B protein,the highest specificity was IL - 6. The highest sensitivity in amniotic fluid was IL - 1β,and the highest specificity was IL - 8. The levels of IL - 4 and IL - 17A in the umbilical cord blood and amniotic fluid,IL - 10 in amniotic fluid were very low,and had no predictive value for brain damage. Conclusions Many biological markers in umbilical cord blood and amniotic fluid provide information about the risk of brain injury in premature infants. The highest sensitivity in cord blood was S100B protein,the highest specificity was IL - 6. The highest sensitivity in amniotic fluid was IL - 1β,the highest specificity was IL - 8. Changes in inflammation - related biomarkers suggest that brain damage in the preterm infants might be associated with intrauterine inflammation.
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Objective To investigate the role of endoplasmic reticulum stress (ERS) pathway involving protein kinase R-like ER kinase (PERK)-activating transcription factor 4 (ATF4)-CCAAT/enhancer binding protein homologous protein (CHOP) in apoptosis in lungs of rats with bronchopulmonary dysplasis (BPD).Methods Forty eight premature SD rats were divided into BPD group and control group according to random number table.Rats in BPD group were continually exposed to O2 with volumetric concentration factor of 850 mL/L,while rats in control group were exposed to air.Lung tissues in each group were obtained in 7,14 and 21 days respectively.The apoptosis in lung cells was evaluated by terminal dexynucleotifyl transferase-mediated dUTP nick end labeling (TUNEL) assay.The mRNA levels of glucose regulated protein 78 (GRP78),PERK,ATF4 and CHOP were detected by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR).The protein levels of GRP78,phosphorylated PERK (pho-PERK),ATF4 and CHOP were detected by using Western blot.Results Compared with control group,the lung cells of the rats in BPD group developed more serious apoptosis.Furthermore,the apoptosis index (AI) in lung cells of the rats increased rapidly with the hyperoxia exposure time.This had been statistically verified by comparison with the control group at different timing(7 d:15.50 ± 0.58 vs 1.25 ± 0.50,14 d:27.75 ± 1.71 vs 3.25 ± 0.96,21 d:50.50 ±3.70 vs 4.00 ± 1.15 ;t =57.00,20.58,25.16,all P ＜0.01).The mRNA levels of GRP78,PERK,ATF4 and CHOP in BPD group increased significantly compared to the control group [GRP78:7 d (33.88 ± 3.73) vs (11.65 ± 1.00),14 d (54.50 ±2.18)vs(12.84 ± 1.41),21 d (95.34 ± 7.61)vs(12.43 ±0.59) ;PERK:7 d (5.23 ±0.92)vs (1.45 ±0.46),14 d (7.60 ± 1.56)vs(2.18 ±0.97),21 d (16.55 ±0.50)vs(2.90 ± 1.18) ;ATF4:7 d (23.04 ± 2.45)vs(12.56 ±2.81),14 d (28.66 ±2.66)vs(15.18 ±2.92),21 d (36.63 ±2.99)vs(15.14 ±2.09) ;CHOP:7 d (2.21 ±0.19)vs(0.81 ±0.02),14 d (4.19 ±0.17)vs(0.90 ±0.08),21 d (6.08 ±0.38)vs(0.88 ±0.10) ;all P ＜ 0.05].The protein levels of GRP78,pho-PERK,ATF4 and CHOP in BPD group increased significantly as well [GRP78:7 d (1.33 ±0.03)vs(0.85 ±0.04),14 d (1.31 ±0.02)vs(0.92 ±0.01),21 d (1.82 ±0.28)vs(0.87 ± 0.01);pho-PERK:7 d (0.68±0.02)vs(0.54±0.01),14 d (1.04±0.01)vs(0.65±0.01),21 d (1.29± 0.02)vs(0.73 ±0.01) ;ATF4:7 d (1.26 ±0.01) vs(0.83 ±0.01),14 d (1.39 ±0.02) vs (0.87 ±0.02),21 d (1.67 ±0.02)vs(0.94 ±0.02) ;CHOP:7 d (1.37 ±0.01)vs(0.47 ±0.06),14 d (1.50 ±0.04)vs(0.74 ±0.05),21 d (1.61 ± 0.03) vs (0.55 ± 0.02) ; all P ＜ 0.05].Positive correlation was demonstrated between the expression levels of CHOP protein and AI,PERK,ATF4 in the BPD group (r =0.87,0,92,0.93 respectively,all P ＜ 0.05).Conclusion PERK-ATF4-CHOP mediated ERS may participate in and contribute to the apoptosis mechanism in lungs of rats with BPD.
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Objective To evaluate the image quality and the diagnostic value of low radiation,low dose and isotonic low concentration iodine contrast pulmonary computed tomography angiography (CTPA) protocol in pulmonary embolism.Methods Eighty patients with clinic ally suspected pulmonary embolism and BMI＜28 kg/m2 underwent pulmonary CTA on a 64-MDCT scanner (GE Discovery CT750 HD).Eighty patients were divided into two groups (group A:n=40,80 kV,Auto mA,20 ml 270 mg I/ml,60％FBP+40％ ASIR; group B:n=40,120 kV,Auto mA,40 ml 370 mg I/ml,100％FBP).Image quality was assessed,using a five-point scoring scale.Intraarterial density was measured in the common pulmonary artery trunk,the main right and left pulmonary arteries,lobar arteries,and then the average CT value was calculated.Image quality score,Average CT value,noise,SNR,CNR,CTDIvol and DLP were compared between the two groups using t-test.The occurrence rate of the superior vena cava iodine contrast agent sclerosis artifacts and the positive rate of pulmonary embolism were compared between the two groups,using Chi-square test.Results PE was found in 33 patients (14 in group A,19 in group B),and there was no difference of the positive rate of PE between two groups (35.0％ vs 47.5％,x2=1.289,P＞0.05).Overall 4-6 pulmonary artery branches were clearly displayed in all the cases.The image quality scores for two groups were 3.9±0.6 and 4.0 ± 0.7,respectively.There was no statistical difference between two groups (t=0.632,P＞0.05).The superior vena cava iodine contrast agent sclerosis artifacts were reduced in group A (28 cases vs.36 cases,x 2=10.362,P＜0.01).The average CT value and noise in group A [(426.8 ± 84.8),(14.9 ± 1.5)HU,respectively] was higher than those in group B [(359.4±75.3),(7.4± 1.4)HU,respectively],which was statistically significant(t=3.758,22.848,respectively; P＜0.01).However,the SNR (28.8 ±6.3)and CNR (24.5±6.1) in group A were lower than those in group B(SNR 50.4± 14.7,CNR 42.9± 13.8).There was statistically significant difference between two groups (t=8.522,7.669,respectively; P＜0.01 both).The CTDIvol[(3.3±0.3)mGy]and DLP[(101.4± 11.9)mGy· cm] in group A were significantly lower than those in group B [CTDI vol (9.6±0.6)mGy,DLP (328.5 ± 37.3)mGy· cm].The difference between two groups was statistically significant(t=56.393,36.675,respectively,P＜0.01 both).Conclusions The low radiation,low dose and isotonic low concentration iodine contrast CTPA protocol shows pulmonary artery branches of 4-6 levels,reduces radiation exposure and contrast media volume compared with the conventional pulmonary CTA,and achieves the same positive rate of PE in comparison of the conventional CTPA.It can meet the clinical needs.
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Objective To analyze the best methods for diagnostic scanning and image processing of multi-slice spiral CT (MSCT) in the detection of renal malformations (RM). Methods From June 2008 to Februany 2012, one hundred and four patients with kidney malformation received 64-slice MSCT assay were enrolled in our Hospital. Related materials of the patients were used for retrospective analysis. Diagnostic accuracy of urinary malformation were calculated on the image of axial and MPR, Curve, MIP, VR by MSCT unenhangced scanning, enhangced cortical phase scanning, enhangced parenchymal phase scanning and enhangced excretory phase scanning. Results One hundred and four patients with kidney abnormalities received the MSCT unhangced scan axial and MPR, Curve film, enhangced cortical phase scanning, enhangced parenchymal phase scanning, enhangced excretory phase scanning and MPR, MIP, VR film, respectively. The diagnostic accuracy were as follws: renal dysplasia (72.73%, 81.82%, 81.82%, 72.73%), renal hypoplasia (83.33%, 91.67%, 95.83%, 100%), solitary kidney (100%, 100%, 100%, 100%), ectopic kidney (76.92%, 100%, 100%, 100%), horseshoe kidney (100%, 100%, 100%, 100%),misplaced renal lobe (0%,100%). Conclusion The MSCT with image post-processing techniques in the diagnosis of RM has its unique advantages, MSCT can be preferred as a method for renal malformation examination.
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Objective To analyze implementation outcomes and obstacles of “treatment before payment” reform seen by medical institutions' managers,along with an optimal strategy proposed.Methods Quantitative survey and qualitative interviews were called into play,and the data so acquired are subject to evaluation of the radar chart and fishbone diagram analysis to learn the implementation outcomes and obstacles.Results The reform proves workable at hospitals of county and lower levels,achieving win-win for the people,hospitals and government.Obstacles found include poor allocation of designated funds for risk coverage,insufficient circulating funds in advance,poor risk aversion mechanism,and poor preparation for tertiary hospitals.Conclusion It is recommended to promote awareness of the reform,enhance inter-department cooperation,improve hospital information systems,clarify the screening standards of “purposely evasion offenders”,standardize the issuance and use of the NRCMS certificates,and better build the credit system of the society.
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Objective To evaluate the risk factors for intracranial hemorrhage in premature infants. Methods Cochrane Library, PubMed, ScienceDirect, Chinese Academic Literature Main Database, Chinese Science and Technology Periodi-cal Database, Wanfang Periodicals and Dissertation Database were searched for articles published from January 2000 to December 2012 on the risk factors of intracranial hemorrhage in premature infants, with retrospective retrieval and manual retrieval as supplement. RavMan5.2 provided by Cochrane was used for meta-analysis. Fixed-or random-effects models were selected according to the results of heterogeneity test. Results Nine studies were conifrmed to be eligible. Odds ratio (OR) and 95%conifdence interval (CI) of the risk factors were as follows:gestation age≤32 weeks (OR=3.29, 95%CI=2.76-3.91), birth weight≤1 500g (OR=2.68, 95% CI=2.24-3.20), maternal complications (OR=1.59, 95% CI=1.23-2.06), intrauterine distress or birth asphyxia (OR=2.42, 95% CI=2.06-2.84), mechanical ventilation (OR=3.23, 95% CI=2.55-4.09), metabolic acidosis (OR=2.88, 95%CI=2.04-4.05), use of high concentration of oxygen (OR=2.98, 95%CI=1.63-5.44), prenatal use of dexametha-sone (OR=0.69, 95%CI=0.55-0.86), respiratory distress syndrome (OR=1.57, 95%CI=1.04-2.39). Those differences were all statistically signiifcant. There was no difference in caesarean section (OR=0.99, 95%CI=0.84-1.17), multiparity (OR=1.05, 95%CI=0.79-1.40) and gender (OR=1.25, 95%CI=0.97-1.59). Conclusions The risk factors for intracranial hemorrhage in premature infants are gestation age≤32 weeks, birth weight≤1 500 g, maternal complications, intrauterine distress or birth asphyxia, mechanical ventilation, metabolic acidosis, use of high concentration of oxygen, respiratory distress syndrome, but prenatal use of dexamethasone can reduce the incidence of intracranial hemorrhage in premature infants.
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In this study, the time-dependent changes on dynamic computed tomograph (CT) of radiation-induced liver injury in gastric cancer patients was examined. The CT images of 52 gastric cancer patients who had received chemoradiotherapies were reviewed on the PACS system. Dynamic CT scan was performed in all the subjects. Our results showed that 18 patients were found to have radiation-induced liver injury. The CT findings of radiation-induced liver injury in gastric cancer patients tend to show up one month after radiation treatment. The damaged area was of low density on all three phases, and then it was enhanced on portal vein phase or delay phase. The focal radiation reaction of liver without basic disease vanished 9-11 months later after treatment. We are led to conclude that dynamic CT is of help in the diagnosis of CRT-induced liver injury, and it may be the method of choice for following up the whole course of the CRT-induced liver injury, i.e., form hepatic damage to healing. The classification of CT findings we recommend can avoid the influence of technological factors, and thereby serve as a better guide for treatment of CRT-induced liver injury.
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Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.