An Exploratory Pilot Study on the Application of Radiofrequency Ablation for Atrial Fibrillation Guided by Computed Tomography-Based 3D Printing Technology.

Radiofrequency ablation (RFA) is the treatment of choice for atrial fibrillation (AF). Additionally, the utilization of 3D printing for cardiac models offers an in-depth insight into cardiac anatomy and cardiovascular diseases. The study aims to evaluate the clinical utility and outcomes of RFA following in vitro visualization of the left atrium (LA) and pulmonary vein (PV) structures via 3D printing (3DP). Between November 2017 and April 2021, patients who underwent RFA at the First Affiliated Hospital of Xinxiang Medical University were consecutively enrolled and randomly allocated into two groups: the 3DP group and the control group, in a 1:1 ratio. Computed tomography angiography (CTA) was employed to capture the morphology and diameter of the LA and PV, which facilitated the construction of a 3D entity model. Additionally, surgical procedures were simulated using the 3D model. Parameters such as the duration of the procedure, complications, and rates of RFA recurrence were meticulously documented. Statistical analysis was performed using the t-test or Mann-Whitney U test to evaluate the differences between the groups, with a P-value of less than 0.05 considered statistically significant. In this study, a total of 122 patients were included, with 53 allocated to the 3DP group and 69 to the control group. The analysis of the morphological measurements of the LA and PV taken from the workstation or direct entity measurement showed no significant difference between the two groups (P > 0.05). However, patients in the 3DP group experienced significantly shorter RFA times (97.03 ± 28.39 compared to 120.51 ± 44.76 min, t = 3.05, P = 0.003), reduced duration of radiation exposure (2.55 [interquartile range 2.01, 3.24] versus 3.20 [2.28, 3.91] min, Z = 3.23, P < 0.001), and shorter modeling times (7.68 ± 1.03 compared to 8.89 ± 1.45 min, t = 5.38, P < 0.001). 3DP technology has the potential to enhance standard RFA practices by reducing the time required for intraoperative interventions and exposure to radiation.

Evaluating the consistency in different methods for measuring left atrium diameters.

BACKGROUND: The morphological information of the pulmonary vein (PV) and left atrium (LA) is of immense clinical importance for effective atrial fibrillation ablation. The aim of this study is to examine the consistency in different LA diameter measurement techniques. METHODS: Retrospective imaging data from 87 patients diagnosed with PV computed tomography angiography were included. The patients consisted of 50 males and 37 females, with an average age of (60.74 ± 8.70) years. Two physicians independently measured the anteroposterior diameter, long diameter, and transverse diameter of the LA using six different methods. Additionally, we recorded the post-processing time of the images. Physician 1 conducted measurements twice with a one-month interval between the measurements to assess intra-rater reliability. Using the intraclass correlation coefficient (ICC), the consistency of each LA diameter measurement by the two physicians was evaluated. We compared the differences in the LA diameter and the time consumed for measurements using different methods. This was done by employing the rank sum test of a randomized block design (Friedman M test) and the q test for pairwise comparisons among multiple relevant samples. RESULTS: (1) The consistency of the measured LA diameter by the two physicians was strong or very strong. (2) There were statistical differences in the anteroposterior diameter, long diameter, and transverse diameter of LA assessed using different methods (χ2 = 222.28, 32.74, 293.83, P < 0.001). (3) Different methods for measuring the diameters of LA required different amounts of time (χ2 = 333.10, P < 0.001). CONCLUSION: The results of left atrium (LA) diameter measurements conducted by different physicians were found to be reliable. However, the LA diameters obtained through various techniques exhibited variations. It was observed that measuring LA long diameters using only the VR (volume rendering) picture was the most clinically applicable method.

Changes in dynamic and static brain fluctuation distinguish minimal hepatic encephalopathy and cirrhosis patients and predict the severity of liver damage.

Purpose: Minimal hepatic encephalopathy (MHE) is characterized by mild neuropsychological and neurophysiological alterations that are not detectable by routine clinical examination. Abnormal brain activity (in terms of the amplitude of low-frequency fluctuation (ALFF) has been observed in MHE patients. However, little is known concerning temporal dynamics of intrinsic brain activity. The present study aimed to investigate the abnormal dynamics of brain activity (dynamic ALFF; dALFF) and static measures [static ALFF; (sALFF)] in MHE patients and to strive for a reliable imaging neuromarkers for distinguishing MHE patients from cirrhosis patients. In addition, the present study also investigated whether intrinsic brain activity predicted the severity of liver damage. Methods: Thirty-four cirrhosis patients with MHE, 28 cirrhosis patients without MHE, and 33 age-, sex-, and education-matched healthy controls (HCs) underwent resting-state magnetic resonance imaging (rs-fMRI). dALFF was estimated by combining the ALFF method with the sliding-window method, in which temporal variability was quantized over the whole-scan timepoints and then compared among the three groups. Additionally, dALFF, sALFF and both two features were utilized as classification features in a support vector machine (SVM) to distinguish MHE patients from cirrhosis patients. The severity of liver damage was reflected by the Child-Pugh score. dALFF, sALFF and both two features were used to predict Child-Pugh scores in MHE patients using a general linear model. Results: Compared with HCs, MHE patients showed significantly increased dALFF in the left inferior occipital gyrus, right middle occipital gyrus, and right insula; increased dALFF was also observed in the right posterior lobe of the cerebellum (CPL) and right thalamus. Compared with HCs, noMHE patients exhibited decreased dALFF in the right precuneus. In contrast, compared with noMHE patients, MHE patients showed increased dALFF in the right precuneus, right superior frontal gyrus, and right superior occipital gyrus. Furthermore, the increased dALFF values in the left precuneus were positively associated with poor digit-symbol test (DST) scores (r = 0.356, p = 0.038); however, dALFF in the right inferior temporal gyrus (ITG) was negatively associated with the number connection test-A (NCT-A) scores (r = -0.784, p = 0.000). A significant positive correlation was found between dALFF in the left inferior occipital gyrus (IOG) and high blood ammonia levels (r = 0.424, p = 0.012). Notably, dALFF values yielded a higher classification accuracy than sALFF values in distinguishing MHE patients from cirrhosis patients. Importantly, the dALFF values predicted the Child-Pugh score (r = 0.140, p = 0.030), whereas sALFF values did not in the current dataset. Combining two features had high accuracy in classification in distinguishing MHE patients from cirrhotic patients and yielded prediction in the severity of liver damage. Conclusion: These findings suggest that combining dALFF and sALFF features is a useful neuromarkers for distinguishing MHE patients from cirrhosis patients and highlights the important role of dALFF feature in predicting the severity of liver damage in MHE.

Using integrated problem- and lecture-based learning teaching modes for imaging diagnosis education.

BACKGROUND: There are two parts included in traditional imaging diagnosis teaching: theoretical lessons and experimental lessons. Most of the time, the experimental lesson is a review of the theoretical lesson. The teacher is the centre of the course and students are passive learners. Thus, in this study we included the patient problem of the imaging centre in our imaging diagnosis education. The traditional theoretical lessen was used to discuss prior knowledge, the discussion and analysis of patient problems was arranged under class, and the experimental lesson was used to synthesize and test the newly acquired information. The aim of this study is to determine whether or not integration of problem- and lecture-based learning teaching modes in imaging diagnosis education was associated with a good teaching effect. Forty-six of sixty students (76.7%) like integrated problem- and lecture-based learning teaching mode and 53 of 60 students (88.3%) think that integrated problem- and lecture-based learning teaching mode can make their ability of self-study be improved. METHODS: Sixty students participated in a prospective study with a two-phase cross-over design. All of the students were divided into 2 groups of 30 each. In the first term, the first group participated in an integration of the problem- and lecture-based learning teaching mode, whereas students in the second group underwent the lecture-based learning teaching mode alone. During the second term, the teaching modes were exchanged between the two groups. A close-exam and survey were used to evaluate the teaching effect, and the data were analysed means of analysis of variance with a two-phase cross-over design and a χ2 test with a 2-tailed α of 0.05. RESULTS: There was a statistically significant difference in the test scores between the integration of the problem- and lecture-based learning teaching mode and the lecture-based learning teaching mode alone (P < 0.05). The integration of problem- and lecture-based learning teaching mode was well-appraised. CONCLUSION: Integration of the problem- and lecture-based learning teaching modes in teaching imaging diagnosis education resulted in a good teaching effect.

[Examination of resistance of lung adenocarcinoma cells to cisplatin by technetium-99m methoxyisobutyl isonitrile].

OBJECTIVE: To study whether technetium-99m methoxyisobutyl isonitrile ((99m)Tc-MIBI) can be used to examine the drug resistance of lung adenocarcinoma cells and to explore the efficiency of gensenoside Rh2 in reversing the resistance of adenocarcinoma cells to cisplatin (DDP). METHODS: Human lung adenocarcinoma cells of the line A549 sensitive to DDP and drug-resistant lung adenocarcinoma cells of the line A549DDP were cultured. DDP and gensenoside (Rh2) of different concentrations were added. Mthoxyisobutylisnitrile (MTT) method was used to test the inhibit concentration (IC) of DDP and Rh2 to the cells. The IC(50) of DDP to these 2 kinds of cells and its low-efficiency inhibition concentration (< or = IC(20)) to A549DDP cells, and the IC(5) of Rh2 to A549DDP cells were calculated. < or = IC20 was regarded as the low-efficiency concentration of DDP to A549DDP cells and IC(5) was regarded as the in-toxic concentration of Rh2 to A549DDP cells. A549DDP cells were divided into 4 groups: control group, added with normal saline; DDP group, added with DDP at the low-efficiency concentration; Rh2 group, added with in-toxic Rh2; and DDP + Rh2 group, added with DDP at the low-efficiency concentration and Rh2 at the in-toxic concentration. Cell apoptosis was detected by fluorescence microscopy and flow cytometry. Forty-seven hours after the stimulation by different drugs (99m)Tc-MIBI solution was added and 1 hour later the radioactivity of the cells was detected by gamma-counter. Twenty-four nude mice were divided into 4 equal groups: A549 group, inoculated with A549 cells and normal saline intraperitoneally; control group, inoculated with A549DPP cells and normal saline intraperitoneally; DDP group, inoculated with A549DDP cells and low-efficient DDP intraperitoneally; and Rh2 + DDP group, inoculated with A549DDP cells and low-efficient DDP and in-toxic Rh2intraperitoneally. The growth of tumor and survival of mice were observed. Before the inoculation of tumor cells, 4 mice were randomly selected to undergo single photons emission computed tomography (SPECT). Two months after the inoculation SPECT was performed on all mice. By the end of experiment all the mice were killed and their tumors underwent pathological examination. RESULTS: The IC(50) of DDP was 24 microM to A549 cells and 325 microM to A549DDP cells, with a resistance index of 13.54. When the concentration of Rh2 was < or = 10 microM there was no evident toxicity to A549DDP cells. The inhibition rate of 100 microM DDP to the A549DDP cells was 12%. After the cells were treated by 10 microM Rh2 and 100 microM DDP, the IC(50) of DDP to A549DDP cells was decreased to 94 microM; compared with the cells treated by 100 microM DDP alone, the reverse resistance of the latter was 3.5 times that of the former. Fluorescence microscopy showed that fluorescence was distributed uniformly in the nuclei of A549DD cells in the Rh2 group, DDP group, and the control group, and fluorescence were conglomerated like grain in the nuclei and apoptotic little substance appeared in the Rh2 + DDP group. The apoptotic rates of the control group, Rh2 group, DDP group, and DDP + Rh2 group were 6.1% +/- 1.0%, 5.9% +/- 1.1%, 8.2% +/- 1.0%, and 59.5% +/- 1.2% with a significant difference between the DDP + Rh2 group and control group (P < 0.01). There was no evident apoptotic apex in the control group, Rh2 group and DDP group, whereas there was distinct apoptotic apex in the Rh2 + DDP group. The radioactivity of (99m)Tc-MIBI could be incepted by the 4 groups. The radioactivity of the DDP + Rh2 group was significantly lower than that of the control group (P < 0.05) and there were no significant difference in radioactivity between the other 3 groups and the control group (all P > 0.05). The radioactivity of the A549 cells was significantly higher than that of the A549DDP cells (P < 0.01). Dense (99m)Tc-MIBI image of tumor could be seen in the A549 group mice, control group mice, and DDP group mice, the latter 2 groups with lighter images. No tumor image was seen in the Rh2 + DDP group mice. The R or R' value in the A549 group mice was remarkably higher than those in the control group and DDP group mice (both P < 0.05). CONCLUSION: (99m)Tc-MIBI can be used to examine the resistance of lung adenocarcinoma A549DDP cells. Gensenoside Rh2 of in-toxic concentration can reverse the resistance of lung adenocarcinoma A549DDP cells to cisplatin.

[Relevant factors of nm23 protein expression and dangerous factors of bone metastasis in breast cancer].

OBJECTIVE: To investigate the relevant factors of the expression of nm23 protein and the dangerous factors of bone metastasis in breast cancer. METHODS: Seventy-six breast cancer patients confirmed by histological examination after surgeries were enrolled in this study. nm23 protein expressions in original breast cancer tissues were detected by immunohistochemical procedures. The relevant factors of nm23 protein expression and the dangerous factors of bone metastasis were conducted logistic regression analysis. RESULTS: Among the 58 breast cancer patients who did not have bone metastasis in the observation period, 55 did not have bone metastasis;while the other 18 breast cancer patients having bone metastasis were confirmed in only 14 patients. The correction was 94.83% and 77.78% respectively. The general correction was 90.79%. CONCLUSION: The detection of nm23 protein is helpful to evaluate prognosis and improve the therapy. It is one of the important methods to instruct the breast cancer patients to perform radio-nuclide imaging in the follow-up.

[99mTc-MIBI myocardial perfusion tomography for monitoring the anthracycline cardiotoxicity].

OBJECTIVE: To investigate the value of 99mTc-MIBI myocardial perfusion tomography monitoring the cardiotoxicity induced by anthracycline. METHODS: Twenty-three patients with anthracycline chemotherapy were examined by electrocardiogram (ECG), myocardial enzyme (CK-MB), nuclear angiography for detecting left ventricular ejection fraction (LVEF) and 99mTc-MIBI myocardial perfusion tomography for detecting myocardial relative quantity (MRQ). These examinations were repeated after every chemotherapy. RESULTS: The MRQ after one period of anthracycline chemotherapy was significantly lower than the pretherapy in 23 patients (P < 0.01). The MRQ significantly decreased after one period of chemotherapy in 11 patients treated by pirarubicin, in 6 by epirubicin, and 6 by mitoxantrone (P < 0.05). There was not significant change in the mean value of ECG and CK-MB after one period of chemotherapy (P > 0.05). After multiple-period anthracycline chemotherapy in 10 patients, a decrease was observed in MRQ (P < 0.01). There was not significant difference in MRQ between multiple periods and one period therapy (P > 0.05) and in LVEF in the period before and after multiple-period chemotherapy (P > 0.05). CONCLUSION: 99mTc-MIBI myocardial perfusion tomography can monitor the anthracycline cardiotoxicity and its changes are earlier than LVEF's. 99mTC-MIBI myocardial perfusion tomography may be helpful to the clinical treatment for anthracycline.