Sagittal septum duplication of bladder and duplication of posterior urethra combined with congenital megacolon: a case report and literature review.

BACKGROUND: Duplication of the bladder with duplication of the posterior urethra is a relatively rare congenital malformation. Cases of sagittal septum duplication of the bladder with duplication of the posterior urethra have rarely been reported. Furthermore, the combination thereof with congenital megacolon is rare. CASE PRESENTATION: A 21-year-old male was admitted to our hospital because of frequent urination for two months. He presented to another hospital first with frequent urination and underwent computed tomography (CT) and testicular biopsy. Anti-inflammatory therapy was administered by the doctor to the patient. For further diagnosis and treatment, the patient went to the outpatient department in our hospital on June 6, 2022. After admission, the patient underwent ultrasound, CT, MRI, cystoscopy, and other related examinations and tests. The examination results suggested that the patient had duplication of the bladder with duplication of the posterior urethra. In addition, the patient's mother reported that he had suffered from long-term constipation with abdominal distension before the age of 5 years. At the time, he was admitted to the local hospital and was diagnosed with congenital megacolon based on the relevant examinations. After the patient was diagnosed with duplication of bladder and urethra, the doctor recommended surgical treatment to the patient. However, he considered that he only had frequent urination symptoms, and chose conservative treatment rather than to undergo surgical treatment. Thus, the doctor prescribed anti-inflammatory treatment. Four months later, the patient reported that frequent urination symptoms persisted, and was also considering fertility-related problems. The outpatient follow-up will be continued. CONCLUSIONS: In this article, we summarize the imaging findings of duplication of the bladder with duplication of the posterior urethra and propose the advantages and disadvantages of each type of imaging examination. We also review the relevant literature on cases of bladders with duplication of the posterior urethra. The related differential diagnosis is summarized, and the significance of guiding clinical treatment and diagnosis is discussed.

Evaluating the Significance of Titanium Clip Marking Under Endoscopy in Upper Gastrointestinal Bleeding Patients with Failed Endoscopic Hemostasis.

Objective: This study investigated the role of titanium clip marking during endoscopy in managing patients with upper gastrointestinal bleeding (UGIB) for whom endoscopic hemostasis has proven ineffective. Methods: A total of 63 UGIB patients admitted to the Affiliated Hospital of Zunyi Medical University between January 2018 and November 2020 were selected as the study cohort. Patients were randomly assigned to one of two groups: the control group (n=23) and the combined group (n=40). The control group underwent transcatheter arterial embolization (TAE), while the combined group received endoscopic metallic titanium clip-assisted TAE. This study compared the rates of successful embolization, clinical success, recurrence, operation time, radiation exposure time, radiation dosage, levels of hs-CRP, Cor, NE, TNF-α, IL-6, and ADH before and after treatment, as well as postoperative complications between the two groups. Results: The combined group of patients exhibited significantly higher rates of successful embolization and clinical success compared to the control group (P < .05). Additionally, the recurrence rate and levels of hs-CRP, Cor, NE, TNF-α, IL-6, and ADH were significantly lower in the combined group compared to the control group (P < .05). Furthermore, patients in the combined group had shorter operation times, reduced radiation exposure times, and lower radiation dosages compared to the control group (P < .05). There was no statistically significant difference in the occurrence of postoperative complications between the two groups (P > .05). Conclusions: Using titanium clip marking during endoscopy provides valuable guidance in managing patients with upper gastrointestinal bleeding who have not responded to endoscopic hemostasis. This finding is especially relevant in digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE) treatments. It enhances the clinical efficacy and safety of the procedure.

Correlation study between flash dual source CT perfusion imaging and regional lymph node metastasis of non-small cell lung cancer.

BACKGROUND: To explore the correlation of flash dual source computed tomography perfusion imaging (CTPI) and regional lymph node metastasis of non-small cell lung cancer (NSCLC), and to evaluate the value of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC. METHODS: 120 consecutive patients with NSCLC confirmed by postoperative histopathology were underwent flash dual source CT perfusion imaging in pre-operation. The CT perfusion parameters of NSCLC, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability (PMB) were obtained by the image post-processing. Then microvessel density (MVD), luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP) of NSCLC were counted by immunohistochemistry. These cases were divided into group A (patients with lymph node metastasis, 58 cases) and group B (patients without lymph node metastasis, 62 cases) according to their pathological results. The CT perfusion parameters and the microvessel parameters were contrastively analysed between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC in pre-operation. RESULTS: Group A presented significantly lower LVA, BF and higher MTT, PMB than Group B (P < 0.05), while BV, LVN, LVP and MVD were no significant difference (P > 0.05). Correlation analysis showed that BF was correlated with LVA and LVP (P < 0.05), while BV, MTT and PMB were not correlated with LVN, LVA and LVP (P > 0.05). All the perfusion parameters were not correlated with MVD. According to the ROC curve analysis, when BF < 85.16 ml/100 ml/min as a cutoff point to predict regional lymph node metastasis of NSCLC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 60.8, 81.7, 71.5, 75.6 and 69.5% respectively. CONCLUSION: Flash dual source CT perfusion imaging can non-invasively indicate the luminal vascular structure of tumor and BF can be used as one of the important indexes in predicting regional lymph node metastasis of NSCLC in pre-operation.

Correlations of CT scan with high-sensitivity C-reactive protein and D-dimer in patients with coronavirus disease 2019.

OBJECTIVES: To study the correlations of CT scan with high-sensitivity C-reactive protein (hs-CRP) and D-dimer in patients with coronavirus disease 2019 (COVID-2019). METHODS: From January to March 2020, COVID-19 patients were divided into two groups according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial version 7), with mild and ordinary cases as Group-1 and critical and severe cases as Group-2. The chest CT scan results, hs-CRP, D-dimmer levels of the two groups from admission to discharge were compared by the χ2 test or Fisher's exact test. The quantitative data were represented as mean ± standard deviation ( x ± s). Intergroup comparisons were performed by the independent samples t test, and the ineligible data were subjected to the nonparametric rank sum test. Binary logistic regression model was used for multivariate correlation analysis, using independent variables that were significant in univariate analysis. The correlations between the above indices were analyzed. RESULTS: In Group-1, there were two cases of normal chest CT scan results, one case of fibrosis, and 25 cases of abnormalities during the first diagnosis, mainly manifested as single or scattered ground-glass shadows. After treatment, the CT scan results became normal. The chest CT scan of Group-2 showed abnormalities, including 21 cases of multiple ground-glass shadows, and six cases of multiple consolidations accompanied by ground-glass shadows, who were critically ill and died. In addition, there were 16 cases of multiple ground glass shadows with partial consolidation, and the CRP and D-dimer levels of Group-2 were significantly higher than those of Group-1. Chest CT scan results were significantly positively correlated with CRP and D-dimer levels (P<0.05). CONCLUSION: The chest CT scan results of COVID-19 patients are characteristic, being correlated with CRP and D-dimer levels. D-dimer and CRP levels significantly increase in most severe and critical patients, which are closely related to their prognosis. The indices may play predictive roles in clinical treatment and prognosis evaluation.

Accurate diagnosis of pulmonary inflammatory myofibroblastic tumor by imaging technology before operation: A case report.

RATIONALE: Pulmonary inflammatory myofibroblastic tumor (IMT) is a rare borderline tumor, which has the potential of malignant including invasion of surrounding tissues, distant metastasis and recurrence. However, the preoperative diagnosis is difficult and it can also be difficult to distinguish from malignancy in small tissue samples. Preoperative accurate diagnosis has important clinical significance for patients to choose treatment measures and improve the quality of rehabilitation. We was examined by computed tomography (CT) plain scan plus enhanced scan, magnetic resonance diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) imaging technology in an adult female, compared with lung cancer and pulmonary cryptococcus infection for diagnosis of pulmonary IMT. PATIENT CONCERNS: A 32-year-old female patient was admitted to the hospital "physical examination revealed nodules in the right upper lung for 1 week". DIAGNOSES: The patient was diagnosed with Pulmonary inflammatory myofibroblastic tumor. INTERVENTIONS: Single-port thoracoscopic lobectomy was performed after multidisciplinary consultation. OUTCOMES: DWI and ADC improves the accuracy of preoperative diagnosis and well guides the formulation of treatment measures. The combined CT, DWI, and ADC magnetic resonance imaging technology has more important significance in the diagnosis and differential diagnosis of IMT and lung malignant tumors. LESSONS: Although accurate preoperative diagnosis of pulmonary IMT is difficult. Chest CT examination combined with DWI and ADC imaging technology has high clinical significance for the diagnosis of IMT.

End-to-end Prediction of EGFR Mutation Status with Denseformer.

Accurate genotyping of the epidermal growth factor receptor (EGFR) is critical for the treatment planning of lung adenocarcinoma. Currently, clinical identification of EGFR genotyping highly relies on biopsy and sequence testing which is invasive and complicated. Recent advancements in the integration of computed tomography (CT) imagery with deep learning techniques have yielded a non-invasive and straightforward way for identifying EGFR profiles. However, there are still many limitations for further exploration: 1) most of these methods still require physicians to annotate tumor boundaries, which are time-consuming and prone to subjective errors; 2) most of the existing methods are simply borrowed from computer vision field which does not sufficiently exploit the multi-level features for final prediction. To solve these problems, we propose a Denseformer framework to identify EGFR mutation status in a real end-to-end fashion directly from 3D lung CT images. Specifically, we take the 3D whole-lung CT images as the input of the neural network model without manually labeling the lung nodules. This is inspired by the medical report that the mutational status of EGFR is associated not only with the local tumor nodules but also with the microenvironment surrounded by the whole lung. Besides, we design a novel Denseformer network to fully explore the distinctive information across the different level features. The Denseformer is a novel network architecture that combines the advantages of both convolutional neural network (CNN) and Transformer. Denseformer directly learns from the 3D whole-lung CT images, which preserves the spatial location information in the CT images. To further improve the model performance, we designed a combined Transformer module. This module employs the Transformer Encoder to globally integrate the information of different levels and layers and use them as the basis for the final prediction. The proposed model has been tested on a lung adenocarcinoma dataset collected at the Affiliated Hospital of Zunyi Medical University. Extensive experiments demonstrated the proposed method can effectively extract meaningful features from 3D CT images to make accurate predictions. Compared with other state-of-the-art methods, Denseformer achieves the best performance among current methods using deep learning to predict EGFR mutation status based on a single modality of CT images.

A Comparative Study of Chest Computed Tomography Findings: 1030 Cases of Drug-Sensitive Tuberculosis versus 516 Cases of Drug-Resistant Tuberculosis.

PURPOSE: To investigate the CT features of drug-resistant pulmonary tuberculosis (DR-PTB) and the diagnostic value of CT in DR-PTB diagnosis to provide imaging evidence for the timely detection of drug-resistant Mycobacterium tuberculosis. MATERIALS AND METHODS: A total of 1546 cases of pulmonary tuberculosis (PTB) with complete clinical data, chest CT images and defined drug sensitivity testing results were consecutively enrolled; 516 cases of DR-PTB were included in the drug-resistant group, and 1030 cases of drug-sensitive pulmonary tuberculosis (DS-PTB) were included in the drug-sensitivity group. Comparative analyses of clinical symptoms and imaging findings were conducted. Univariate and logistic regression analyses were performed, a regression equation model was developed, and the receiver operating characteristic (ROC) curve was constructed. RESULTS: In the univariate analysis, some features, including whole-lung involvement, multiple cavities, thick-walled cavities, collapsed lung, disseminated lesions along the bronchi, bronchiectasis, emphysema, atelectasis, calcification, proliferative lesions, encapsulated effusion, etc., were observed more frequently in the DR-PTB group than in the DS-PTB group, and the differences were statistically significant (p<0.05). Exudative lesions and pneumoconiosis were observed more frequently in the drug-sensitivity group than in the drug-resistant group (p<0.05). Logistic regression analysis indicated that whole-lung involvement, multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, bronchiectasis, and emphysema were independent risk factors for DR-PTB, and exudative diseases were protective factors. The total prediction accuracy of the regression model was 80.6%, and the area under the ROC curve (AUC) was 82.6%. CONCLUSION: Chest CT manifestations of DR-PTB had certain characteristics that significantly indicated the possibility of drug resistance in tuberculosis patients, specifically when multifarious imaging findings, including multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, whole-lung involvement, etc., coexisted simultaneously. These results may provide imaging evidence for timely drug resistance detection in suspected drug-resistant cases and contribute to the early diagnosis of DR-PTB.

Positive reverse transcription-polymerase chain reaction assay results in patients recovered from COVID-19: Report of two cases.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread around the globe. On February 28, 2020, the World Health Organization adjusted the risk of spread and impact of COVID-19 to "very high" at the global level. Studies have mainly focused on the etiology, epidemiology, and treatment of COVID-19 to limit further spread and the negative impact of the disease, while less attention has been devoted to the follow-up and reexamination of patients who recovered from COVID-19 or were released from quarantine. CASE SUMMARY: This study reports two cases where patients who had negative reverse transcription-polymerase chain reaction (RT-PCR) test results and met the criteria for discharge subsequently had positive RT-PCR test results. The clinical manifestations and computed tomography (CT) findings of these patients were examined. The conversion of RT-PCR test results in these two patients may be related to false-negative and false-positive outcomes of the test. CT images helped track improvement of pulmonary lesions. CONCLUSION: The timing of discharge of COVID-19 patients should be determined by comprehensive analysis of CT images and RT-PCR test results.

A retrospective analysis of the epidemiology, clinical manifestations, and imaging characteristics of familial cluster-onset COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) virus has a high incidence rate and strong infectivity. The diagnosis and evaluation of familial outbreaks requires a collective consideration of epidemiological history, molecular detection methods, chest computed tomography (CT), and clinical symptoms. METHODS: A group of family patients with COVID-19 diagnosed in Guizhou, China, in February 2020, was retrospectively analyzed. As of March 1, all patients in the group have been discharged from hospital. This study tracked all patients in the group. We report the epidemiology, radiological characteristics, treatment, and clinical outcomes of these patients. RESULTS: We collected a group of 8 clustered cases (3 men and 5 women) from a family with confirmed COVID-19 infection. In the first admission diagnosis, according to the degree of clinical symptoms, the 8 patients were defined as mild type (4/8) or moderate type (4/8). They were also divided according to the CT findings into early period (1/8), progressive period (3/8), and negative on CT scan (4/8); for the first 4 patients, the corresponding CT image scores were 1, 4, 5, and 5 respectively. In this group of COVID-19 patients, half of the patients showed occult clinical manifestations and negative CT performance. We defined these patients as COVID-19-infected patients, or asymptomatic carriers. CONCLUSIONS: The family cluster analysis indicated that COVID-19-infected patients (asymptomatic carriers) and symptomatic COVID-19 patients are distinct but coexistent. This may indicate that the infectivity and virulence of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has decreased. In order to block the transmission pathway of this virus before it spreads, we need to identify the presence of asymptomatic carriers as early as possible.

A rare and fatal respiratory disease: bronchial Dieulafoy's disease.

A 66-year-old woman had two severe episodes of massive hemoptysis without any premonitory symptoms, with approximately 400-500 ml blood each time. Bronchoscopic exam revealed a smooth and pulsatile protrusion that was approximately 8-10 mm in diameter found at the beginning of the right middle lobe bronchus in the bronchial lumen. The protrusion arose from the surface with absolutely normal mucosa. Selective bronchial arteriography showed that elongated, tortuous, and dilated branches of the bronchial artery in the region of the middle lobe bronchus. Further bronchial arterial embolization (BAE) is recommended, although the patient currently has no active bleeding. Bronchial Dieulafoy's disease (BDD) is a rare and life-threatening disease. Selective bronchial arteriography is a diagnostic tool to detect and locate abnormal arteries. There is no unified guideline or expert consensus on the treatment of BDD. Selective BAE or surgical resection is usually used as a first-line treatment to control hemoptysis. The reviews of this paper are available via the supplemental material section.

Correlation study between dual source CT perfusion imaging and the microvascular composition of solitary pulmonary nodules.

OBJECTIVE: To explore the correlation between dual source computed tomography perfusion imaging (CTPI) and microvascular parameters, and evaluate the value of CTPI in the differential diagnosis of solitary pulmonary nodule (SPN). METHODS: 65 consecutive patients with SPN who successfully underwent pre-operative CT perfusion imaging with dual source CT and received a final diagnosis by postoperative pathology. The cases were divided into malignant, benign and inflammatory groups according to the pathological results. CT perfusion parameters, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface (PMB) were obtained by performing CTPI of SPNs. The postoperative specimens of SPNs were immunohistochemically stained for CD34 and SMA to detect microvessel density (MVD) and luminal vascular parameters, such as luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP). The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameter in diagnosing malignant SPNs. RESULTS: In these 65 cases, malignant, benign and inflammatory SPNs were respectively 39, 14 and 12 cases. Significant difference was observed in LVN/MVD, LVA and LVP among the three groups (P < 0.05). The correlation between CT perfusion parameters (BF, BV and PMB) and the luminal vascular parameters was stronger than that with MVD (P < 0.05). PMB has the strongest correlation with LVN/MVD. Using BF≥60ml/100ml/min, BV≥6.34ml/100ml and PMB≥13.35ml/100 ml/min for the diagnosis, the area under the curve (AUC) of the ROC curve was 0.760, the sensitivity was 82% and the specificity was 61%. CONCLUSIONS: The main indicators reflecting blood perfusion of SPN are the degree of lumen or maturity of microvessels (LVN, LVA and LVP), not just the number of microvessels (e.g. MVD). CT perfusion imaging can be used as an important method to non-invasively evaluate tumour angiogenesis and help to distinguish malignant SPNs from benign and inflammatory SPNs.

[Finite element analysis of the influence of anchorage number and location on Bankart repair strength of shoulder joint].

OBJECTIVE: To study the influence of the number and position of anchor nails on the Bankart repair by the finite element analysis. METHODS: The 3D CT data of shoulder joints including normal adult volunteers were imported into Mimics 10.0 and Geomagic 2012 software to reconstruct the related tissues, and then meshed in Hypermesh 13.0 software to give material attributes. The position and number of MPC constraints were adjusted in Abaqus 6.14 to establish finite element model of shoulder joint under 6 working conditions including A model(normal control model), B model (Bankart damage control model), C model (1 anchor), D model (2 anchors), E model (3 anchors), F model (4 anchors). The humerus external rotation and forward load were added to simulate the fear test of the shoulder joint forward instability. RESULTS: (1)Normally, the inferior glenohumeral ligament complex accompanied by the external rotation of the humerus head has a wrinkle and a significant stress concentration around its anterior and posterior bundle terminations.(2)The stress of the anterior bundle and posterior bundle of the inferior glenohumeral ligament were increased by 52.33% and 45.67% respectively after Bankart's injury.(3)In each model of anchor repair, the stress concentration was obvious at the anchor site, and the stress of anterior and posterior bundle ligaments could be reduced; there were no obvious differences between C, D models and B model(P>0.05), and there were significant differences between E, F models and B model(P<0.05). CONCLUSIONS: One or two anchors can reduce the stress of the anterior and posterior bundles of the inferior glenohumeral ligament in the repair of Bankart's injury, but when the angle of rotation is large, the stress concentration in the anchor position increases significantly, leading to the increases of the risk of failure. The application of three or four anchors can enhance the constraints on the inferior glenohumeral ligament and reduce the stress of the anchor itself through the "load sharing" effect between anchors, so as to ensure the stability of the shoulder joint and provide a mechanical environment for the early rehabilitation of patients.

CT and MRI of adrenal gland pathologies.

Besides ultrasound and nuclear medicine techniques, computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used to examine adrenal lesions in both symptomatic and asymptomatic patients. Some adrenal lesions have characteristic radiological features. If an adrenal nodule is discovered incidentally, determining whether the lesion is benign or malignant is of great importance. According to their biological behavior, lesions can be divided into benign (mainly: adenoma, hyperplasia, pheochromocytoma, cyst, hemorrhage, cystic lymphangioma, myelolipoma, hemangioma, ganglioneuroma, teratoma) and malignant (mainly: metastases, adrenal cortical carcinoma, neuroblastoma, lymphoma) conditions. In this paper, we review CT/MRI findings of common adrenal gland lesions.

Epidemiological investigation of 264 sporadic cases of ruptured cerebral aneurysm at a single institution in southwest China.

BACKGROUND: The purpose of this study was to investigate the epidemiology of sporadic ruptured cerebral aneurysm in the Chinese population. METHODS: We retrospectively analyzed the medical records of 264 consecutive Chinese patients admitted to the Affiliated Hospital of Zunyi Medical University of Guizhou Province in Southwest China between December 2012 and March 2015 for spontaneous subarachnoid hemorrhage due to a ruptured cerebral artery aneurysm. RESULTS: The study population comprised 171 females and 93 males with a median age of 50 (range 5-76) years. The female to male ratio was 1.84:1. For both males and females, aneurysm rupture was most common in the 40-49-year age group (34.5%). Most of the ruptured aneurysms were in the size range of 2-5 mm (47.2%), followed by 5-10 mm (43.8%). Ruptured aneurysms occurred most often in the posterior communicating artery (36.6%) or the anterior communicating artery (25.7%). There were more cases of anterior communicating artery aneurysm on the left side (53 [Left side]/16 [Right side]=3.31, P>0.001) and slightly more cases of posterior communicating artery aneurysm on the right side (54 [Right side]/44[Left side]=1.23, P<0.05). CONCLUSION: This study provides valuable information on the epidemiology of ruptured cerebral aneurysm in the Chinese population.