Cardiac MRI feature-tracking-derived torsion mechanics in systolic and diastolic dysfunction in systemic light-chain cardiac amyloidosis.

AIM: To describe the myocardial torsion mechanics in cardiac amyloidosis (CA), and evaluate the correlations between left ventricle (LV) torsion mechanics and conventional parameters using cardiac magnetic resonance imaging feature tracking (CMR-FT). MATERIALS AND METHODS: One hundred and thirty-nine patients with light-chain CA (AL-CA) were divided into three groups: group 1 with preserved systolic function (LV ejection fraction [LVEF] ≥50%, n=55), group 2 with mildly reduced systolic function (40% ≤ LVEF <50%, n=51), and group 3 with reduced systolic function (LVEF <40%, n=33), and compared with age- and gender-matched healthy controls (n=26). All patients underwent cine imaging and late gadolinium-enhancement (LGE). Cine images were analysed offline using CMR-FT to estimate torsion parameters. RESULTS: Global torsion, base-mid torsion, and peak diastolic torsion rate (diasTR) were significantly impaired in patients with preserved systolic function (p<0.05 for all), whereas mid-apex torsion and peak systolic torsion rate (sysTR) were preserved (p>0.05 for both) compared with healthy controls. In patients with mildly reduced systolic function, global torsion and base-mid torsion were lower compared to those with preserved systolic function (p<0.05 for both), while mid-apex torsion, sysTR, and diasTR were preserved (p>0.05 for all). In patients with reduced systolic function, only sysTR was significantly worse compared with mildly reduced systolic function (p<0.05). At multivariable analysis, right ventricle (RV) end-systolic volume RVESV index and NYHA class were independently related to global torsion, whereas LVEF was independently related to sysTR. RV ejection fraction (RVEF) was independently related to diasTR. LV global torsion performed well (AUC 0.71; 95% confidence interval [CI]: 0.61, 0.77) in discriminating transmural from non-transmural LGE in AL-CA patients. CONCLUSION: LV torsion mechanics derived by CMR-FT could help to monitor LV systolic and diastolic function in AL-CA patients and function as a new imaging marker for LV dysfunction and LGE transmurality.

Detection of haemodynamic obstruction in hypertrophic cardiomyopathy using the sub-aortic complex: a cardiac MRI and Doppler study.

AIM: To investigate the "sub-aortic complex (SAC)", a new cardiac magnetic resonance imaging (CMRI)-derived parameter, for the evaluation of left ventricular (LV) outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy (HCM), compared with conventional CMRI parameters and Doppler echocardiography. MATERIALS AND METHODS: A total of 157 consecutive patients with HCM were recruited retrospectively. The patients were divided into two groups, 87 with LVOT obstruction and 70 without obstruction. The SAC was defined as a specific anatomical SAC affecting the LVOT, which were measured on the LV three-chamber steady-state free precession (SSFP) cine image at the end-systolic phase. The relations between the existence and severity of obstruction and SAC index (SACi) were evaluated using Pearson's correlation coefficient, receiver operating characteristic (ROC) curves, and logistic regression. RESULTS: The SACs were significantly different between the obstructive and non-obstructive groups. The ROC curves indicated that the SACi was able to discriminate obstructive and non-obstructive patients with the best predictive accuracy (AUC = 0.949, p<0.001). The SACi was an independent predictor of LVOT obstruction and there was a significant negative correlation between resting LVOT pressure gradient and SACi (r=0.72 p<0.001). In the subgroup of patients with or without severe basal septal hypertrophy, the SACi was still able to predict LVOT obstruction with excellent diagnostic accuracy (AUC = 0.944 and 0.948, p<0.001, respectively). CONCLUSION: The SAC is a reliable and straightforward CMRI marker for assessing LVOT obstruction. It is more effective than CMRI two-dimensional flow in diagnosing the severity of obstruction in patients with HCM.

Development and validation of an individualized nomogram for predicting the high-volume (> 5) central lymph node metastasis in papillary thyroid microcarcinoma.

PURPOSE: Papillary thyroid microcarcinoma (PTMC) frequently presents a favorable clinical outcome, while aggressive invasiveness can also be found in some of this population. Identifying the risk clinical factors of high-volume (> 5) central lymph node metastasis (CLNM) in PTMC patients could help oncologists make a better-individualized clinical decision. METHODS: We retrospectively reviewed the clinical characteristics of adult patients with PTC in the Surveillance, Epidemiology, and End Results (SEER) database between Jan 2010 and Dec 2015 and in one medical center affiliated to Chongqing Medical University between Jan 2018 and Oct 2020. Univariate and multivariate logistic regression analyses were used to determine the risk factors for high volume of CLNM in PTMC patients. RESULTS: The male gender (OR = 2.02, 95% CI 1.46-2.81), larger tumor size (> 5 mm, OR = 1.64, 95% CI 1.13-2.38), multifocality (OR = 1.87, 95% CI 1.40-2.51), and extrathyroidal invasion (OR = 3.67; 95% CI 2.64-5.10) were independent risk factors in promoting high-volume of CLNM in PTMC patients. By contrast, elderly age (≥ 55 years) at diagnosis (OR = 0.57, 95% CI 0.40-0.81) and PTMC-follicular variate (OR = 0.60, 95% CI 0.42-0.87) were determined as the protective factors. Based on these indicators, a nomogram was further constructed with a good concordance index (C-index) of 0.702, supported by an external validating cohort with a promising C-index of 0.811. CONCLUSION: A nomogram was successfully established and validated with six clinical indicators. This model could help surgeons to make a better-individualized clinical decision on the management of PTMC patients, especially in terms of whether prophylactic central lymph node dissection and postoperative radiotherapy should be warranted.

[Clinicopathological features of low-grade oncocytic renal tumor (CD117-negative, cytokeratin 7-positive): report of seven cases].

Objective: To explore clinicopathological features of low-grade oncocytic tumor (LOT) of the kidney and to analyze its relationship to hybrid oncocytic/chromophobe tumor (HOCT) of the kidney, renal oncocytoma (RO), and chromophobe renal cell carcinoma (chRCC). Methods: Seven LOTs were identified from the pathologic archives of two hospitals, including Xiangya Hospital (5 cases) and the Second Xiangya Hospital (2 cases) of Central South University between 2012 and 2019. Clinical data of the LOTs were collected. The tumor morphology was analyzed and immunohistochemistry was performed. Results: All LOTs occurred in adults, aged from 49 to 72 years (median 56.0 years, mean 60.7 years). The tumor size ranged from 2.5 to 6.0 cm (median 4.3 cm, mean 4.3 cm). There were three male and four female patients. Three cases occurred in the left kidney and four in the right. All the tumors were solitary lesions without the clinicopathologic background of Birt-Hogg-Dubé (BHD) syndrome or oncocytosis. Five patients had available follow-up data (follow-up period 23-95 months, median 69.0 months, mean 64.6 months) and all were alive without disease. Microscopically, all LOTs were well-circumscribed (7/7). Three LOTs were partly encapsulated. The tumors demonstrated a predominant growth pattern comprising prominently compact small nests surrounded by delicately branching thin-walled blood vessels, imparting an organoid architecture (7/7), but variable numbers of glandular or gland-like structures were often seen among the small nests (7/7). There were frequently areas with loose, edematous stroma, and the tumor cells exhibited reticular, trabecular, or single cell arrangements (6/7). Focal hemorrhage was also commonly present in both compact and loose areas (5/7). In addition, focally cystic formation and ossification occurred in the compact area of one case and in the loose area of another case. The tumor cells in LOT showed intermediate cytologic characteristics between RO and chRCC, including abundantly eosinophilic granular cytoplasm, ovoid to round nuclei with mostly smooth contours, discernable small nucleoli (RO features), frequently delicate perinuclear halos, and occasional binucleation (chRCC features). The tumors were typically CK7-positive and CD117-negative (7/7), and variable staining for PAX8 (5/7), P504s (2/7), and vimentin (1/7). They were negative for CK20, CD10 and FOXI1. All tumors retained SDHB immunostaining. Conclusions: LOT is a rare and indolent oncocytic renal tumor with homogeneously intermediate cytologic features between RO and chRCC. There are some clinicopathologic overlaps between LOT and sporadic HOCT. The distinctive morphology and immunophenotype of LOT suggest that it is potentially a distinct tumor entity.

[Uniportal thoracoscopic decortication for stage â ¢ tuberculous empyema of 158 cases].

Objective: To examine the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) decortication in patients presenting with stage Ⅲ tuberculous empyema. Methods: From August 2017 to July 2020, 158 patients of stage Ⅲ tuberculous empyema underwent uniportal VATS decortication with partial rib resection and customized periosteal stripper in Department of Thoracic Surgery, Shanghai Pulmonary Hospital. There were 127 males and 31 females, aged (M(IQR)) 32(28) years (range:14 to 78 years). Follow-up was performed in the outpatient clinic or via social communication applications, at monthly thereafter. If there was no air leak and chest tube drainage was less than 50 ml/day, a chest CT was performed. If the lung was fully re-expanded, chest tubes were removed. All patients received a follow-up chest CT 3 to 6 months following their initial operations which was compared to their preoperative imaging. Results: There was one conversion to open thoracotomy. The operative time was 2.75 (2.50) hours (range: 1.5 to 7.0 hours), and median blood loss was 100 (500) ml (range: 50 to 2 000 ml). There were no perioperative mortalities. There were no major complications except 1 case of redo-VATS for hemostasis due to excessive drainage and 1 case of incision infection, The incidence of prolonged air leaks (>5 days) was 80.3%(126/157). The postoperative hospital stay was 5.00 (2.25) days (range: 2 to 15 days). All patients were discharged with 2 chest tubes, and the median duration drainage was 21.00 (22.50) days (range: 3 to 77 days). Follow-up was completed in all patients over a duration of 20 (14) months (range: 12 to 44 months). At follow-up, 149 patients(94.9%) recovered to grade Ⅰ level, 7 patients to grade Ⅱ level, and 1 patient to grade Ⅲ level. Conclusion: Uniportal VATS decortication involving partial rib resection and a customized periosteal stripper is safe and effective for patients with stage Ⅲ tuberculous empyema.

Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma.

PURPOSE: Patients with papillary thyroid carcinoma (PTC) frequently present a relatively poor prognosis when they coexist with cervical lymph node metastasis (LNM). Moreover, it remains controversial whether prophylactic lymph node dissection (LND) should be performed for patients without clinically lymph node metastasis. Thus, we hereby develop a nomogram for predicting the cervical LNM (including central and lateral LNM) in patients with PTC. METHODS: We retrospectively reviewed the clinical characteristics of adult patients with PTC in the surveillance, epidemiology, and end results (SEER) database between 2010 and 2015 and in our Department of Breast and Thyroid Surgery in the Second Affiliated Hospital of Chongqing Medical University between 2019 and 2020. RESULT: A total of 21,972 patients in the SEER database and 747 patients in our department who met the inclusion criteria were enrolled in this study. Ultimately, six clinical features including age, gender, race, extrathyroidal invasion, multifocality, and tumor size were identified to be associated with cervical LNM in patients with PTC, which were screened to develop a nomogram. This model had satisfied discrimination with a concordance index (C-index) of 0.733, supported by both internal and external validation with a C-index of 0.731 and 0.716, respectively. A decision curve analysis was subsequently made to evaluate the feasibility of this nomogram for predicting cervical LNM. Besides, a positive correlation between nomogram score and the average number of lymph node metastases was observed in all groups. CONCLUSION: This visualized multipopulational-based nomogram model was successfully established. We determined that various clinical characteristics were significantly associated with cervical LNM, which would be better helping clinicians make individualized clinical decisions for PTC patients.

[Improvement of CT spatial resolution brings about enormous changes in the diagnosis and treatment of otological diseases].

CT examination of temporal bone is of great value in the diagnosis and treatment of otological diseases, and improvement in spatial resolution is an inevitable demand to enhance diagnostic efficiency. In the past 40 years, the spatial resolution of temporal bone CT has been continuously improved, making great contribution to improving the diagnosis and treatment level of otological diseases. The newly reported 10 µm otology CT device has greatly improved the ability to visualize fine structures and occult lesions of temporal bone key area and effectively reduced radiation dose, therefore it is expected to bring new changes to diagnosis and treatment of otological diseases.

[Analysis of the performance of a multi-view fusion and active contour constraint based deep learning algorithm for ossicles segmentation on 10 µm otology CT].

Objective: To explore the performance of a deep learning algorithm that combined multi-view fusion with active contour constrained for ossicles segmentation on the 10 µm otology CT images. Methods: The 10 µm otology CT image data from 79 cases (56 cases were from volunteers and 23 cases were from specimens) were retrospectively collected in the Radiology Department of Beijing Friendship Hospital from October 2019 to December 2020. An annotation of malleus, incus, and stapes were conducted. Then the datasets were established and were divided into training set (n=55), validation set (n=8), and test set (n=16). Using the rapid localization of the region of interest combined with the precise segmentation algorithm, the malleus, incus and stapes were segmented and fused from three perspectives of coronal, sagittal and cross-sectional views. Besides, an active contour loss was designed simultaneously for the segmentation of stapes. Dice similarity coefficient (DSC) was used as the objective evaluation metric for the evaluation of the segmentation results. The inter group DSC of the proposed method was compared with that of the basic method and other methods. Results: The average DSC values of the multi-view fusion segmentation algorithm for malleus, incus and stapes reached up to 94.2%±2.7%, 94.6%±2.6% and 76.0%±5.5%, respectively. After adopting the constraint of active contour loss method, the average DSC of stapes was improved (76.4%±5.4% vs 76.0%±5.5%). The visualization results also demonstrated that the segmentation results of the stapes were more complete. Conclusions: Multi-view fusion algorithm based on 10 µm otology CT images can realize accurate segmentation of malleus and incus. Combined with the constraint of active contour loss method, the segmentation accuracy of stapes can be further improved.

[Analysis of the anatomical features of vestibular nerve canal based on 10 µm otology CT].

Objective: To analysis the anatomical features of normal vestibular nerve canal based on 10 µm otology CT. Methods: Sixty-seven patients (103 ears) underwent 10 µm otology CT examinations in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from September 2020 to March 2021 were retrospectively recruited. There were 24 males and 43 females, aged from 18 to 70 (40±17) years. According to the morphology of the inferior vestibular nerve canal, it can be divided into four types as follows: uniform straight type, curved type, ampullary type and direct connection. The anatomical variables of the superior vestibular nerve canal (external orifice, isthmus and internal orifice widths, canal length, angle with labyrinthine segment of the facial nerve) and inferior vestibular nerve canal (widths of the externaland internal orifice, canal length, angles with long axis of the vestibule and the modiolus) between the different sides, genders and canal morphologies were analyzed and compared, respectively. Results: 100% superior vestibular nerve canals and 75.7% (78/103) inferior vestibular nerve canals are clearly depicted by otology CT. The left-side ear presented with larger internal orifice diameter of the superior vestibular neve canal [(1.46±0.47) mm vs (1.31±0.41) mm], and a smaller angle between the inferior vestibular neve canal and the modiolus [(41.6±16.9)° vs (51.6±21.0)°] than the right-side ear (all P<0.05, respectively), respectively. Compared to females, males demonstrated larger internal orifice of the superior vestibular nerve canal [(1.55±0.37) mm vs (1.28±0.36) mm, P<0.05]. The uniform straight type of the inferior vestibular nerve canal was the most common type (62.1%, 64/103), followed by the direct connection (19.4%, 20/103), and the ampullary type was the least common type (4.9%, 5/103). There were significant differences in external diameter and angles with the long axis of the vestibule and the modiolus between the four morphologies of the superior vestibular nerve canal (all P<0.05, respectively). Conclusion: Ten µm otology CT is capable of depicting normal vestibular nerve canal clearly. Quantitative measurement of the normal vestibular nerve canal can provide references for the imaging diagnosis and preoperative evaluation of lesions in this area.

[Analysis of spatial location of the malleus in patients with chronic otitis media based on 10 µm otology CT].

Objective: To assess the changes of the spatial location of the malleus in patients with chronic otitis media (COM) using 10 µm otology CT. Methods: Forty-five patients with COM (COM group, 45 ears) and 55 patients without external and middle ear disease (control group, 89 ears), who underwent 10 µm otology CT examination in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from October 2020 to March 2021, were retrospectively collected during the same period. In the COM group, there are 20 males and 25 females, aged from 20 to 78 (40±14) years. In the control group, 29 were males and 26 were females, with age of 19 to 57 (32±11) years. The shortest distance between the malleus head and the upper wall, the distance between the outer edge of the malleus neck and the scutum, the distance between the outer edge of the malleus neck and the pars flaccida of the tympanic membrane, the shortest distance between the malleus head and the anterior wall, the shortest distance between the anterior process and the anterolateral wall, the shortest distance between the tip of the malleus handle and the promontory, and the shortest distance between the malleus head and the tympanic segment of the facial nerve were measured and compared between the two groups. Results: Compared with the control group, the head-upper wall distance (M (Q1, Q3)) (0.81 (0.48, 1.21) mm vs 0.57 (0.33, 0.90) mm) and the neck-scutum distance (1.79 (1.54, 2.13) mm vs 1.65 (1.48, 1.83) mm) were larger in the COM group (all P<0.05), and the neck-tympanic membrane distance (1.32 (1.15, 1.49) mm vs 1.45 (1.31, 1.59) mm) and the handle-promontory distance (1.56 (1.33, 2.09) mm vs 2.10 (1.74, 2.43) mm) were reduced in the COM group (all P<0.05, respectively). The neck-tympanic membrane distance on the left was larger than those on the right in the COM group (1.39 (1.19, 1.51) mm vs 1.21 (0.87, 1.31) mm, P<0.05). Conclusion: There are changes in the relative position of the malleus in patients with COM, which are helpful for further understanding the imaging manifestations in patients with COM.

[Application of 10 µm otology CT on evaluation of isolated malleus fixation in patients with conductive hearing loss].

Objective: To evaluate the application of 10 µm otology CT on evaluation of isolated malleus fixation (IMF) in patients with conductive hearing loss. Methods: A total of 19 patients (25 sides) with idiopathic hearing loss, including 8 males and 11 females, aged between 4 to 50 years, who underwent 10 µm otology CT examination in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from October 2020 to July 2021, were retrospectively collected. For those patients with idiopathic hearing loss, there were 5 cases (6 sides), including 2 males and 3 females, with an average age of 18-70 [65(20,68)] years, with bony connection between malleus and tympanum wall. Eighteen sex-and age-matched cases with normal hearing group, including 6 males and 12 females, with an average age of 20-68 (39±14) years, as the ratio of 1∶3, were included as the controls. The distances of the tegmen tympani between malleus head and horizontal semicircular canal, as well the distances between malleus head and horizontal semicircular canal were retrospectively measured and further compared between the two groups. Results: The incidence of IMF in patients with idiopathic conductive hearing loss without other etiologies was 24.0% (6/25). The specificity of 10 µm otology CT in diagnosing IMF was 100%. The distances of tegmen tympani between horizontal semicircular canal and malleus head in IMF patients were significantly smaller compared with the controls [-0.65(-1.21, -0.35) mm vs 1.34(0.04, 1.68) mm;0.92(0.51, 1.49) mm vs 2.82(1.76, 3.53) mm](both P<0.05, respectively). There was no significant difference in distances between malleus head and horizontal semicircular canal [-1.30 (-1.90, -0.46)mm vs -0.42 (-1.15, 0.05),P=0.057]. Conclusions: IMF is not uncommon in conductive hearing loss without other causes, which can be clearly shown by 10 µm otology CT. Its occurrence is related to the local downward shift of tegmen tympani above the malleus, without upwards displacement of the malleus.

[Experimental comparison of temporal bone imaging protocol optimization between 10 µm otology CT and multi-slice CT].

Objective: To evaluate different protocol optimization strategies for temporal bone between10 µm otology CT and multi-slice CT (MSCT). Methods: Ten adult skull specimens (20-sides temporal bones) were prospectively enrolled. From October to November 2020, the temporal bones were scanned under four different imaging conditions using 10 µm otology CT (90 kV, 120 mAs; 90 kV, 140 mAs; 100 kV, 120 mAs; 100 kV, 140 mAs) and MSCT (120 kV, 220 mAs; 120 kV, 310 mAs; 140 kV, 160 mAs; 140 kV, 220 mAs), respectively. The image quality was subjectively scored using 5-grade scores, and the contrast noise ratio (CNR) of the image was measured. The absorbed dose of tissues and organs under different imaging conditions was measured by thermoluminescence dosimeter, and the effective dose was calculated. The figure of merit (FOM) is defined as the ratio of the square of the mean CNR to the effective dose. χ2 test was used to compare the difference of subjective scores of different scanning parameter groups, and paired t test was used to analyze and compare the difference of image CNR of different scanning parameter groups. The image quality, radiation dose and FOM of the combination of recommended parameters of the two devices were analyzed and compared. Results: For 10 µm otology CT, under 100 kV condition, the CNR of 140 mAs group was better than that of 120 mAs group (11.27±1.85 vs 10.26±1.38, P<0.001). There was no significant difference in subjective scores between the two groups [5.00 (4.00, 5.00) vs 5.00 (4.25, 5.00), P=0.264]. For MSCT, under 120 kV condition, the subjective scores and CNR of 310 mAs group were better than those of 220 mAs at 120 kV [4.00(3.00, 4.00) vs 3.00(3.00, 3.00),P=0.002;5.24±0.62 vs 4.60±0.62,P<0.001]. According to the principle of image quality-radiation dose optimization, the combination of 100 kV with 120 mAs and 120 kV with 310 mAs are recommended for 10 µm otology CT and MSCT, respectively. The subjective scores and CNR of 10 µm otology CT images were better than those of MSCT (5.00 (4.25, 5.00) vs 4.00 (3.00, 4.00), 10.26±1.38 vs 5.48±0.22, P<0.001). The effective dose was 1/3 of that of MSCT (82.99 µSv vs 252.56 µSv), and the FOM was 11.16 times of that of MSCT (1 268.44 mSv-1 vs 113.71 mSv-1). Conclusion: The temporal bone image quality of newly developed 10 µm otology CT is significantly better than that of MSCT, and its effective dose is lower than that of MSCT, which has more accurate and safer application potential.

[Study on the relationship between the morphology of the isthmus of the vestibular aqueduct and Meniere's disease based on 10 µm otology CT].

Objective: To evaluate the morphology of isthmus of the vestibular aqueduct (VA) and its relationship with the occurrence, course of Meniere's disease (MD) and the degree of hearing loss based on 10 µm otology CT. Methods: A total of 13 patients with MD in Beijing Friendship Hospital, Capital Medical University from October 2020 to July 2021, including 4 males and 9 females, age from 16 to 77 (56±16) years, were prospectively enrolled. All patients underwent 10 µm otology CT examination. The included lesion side was the MD affected group (14 sides), and the non-lesion side was the MD healthy group (12 sides). According to the 1∶2 side, 16 sex-and side matched cases (28 sides) without external and middle ear disease were included in the control group, including 4 males and 12 females, age from 16 to 77 (56±14) years. The horizontal semicircular canal showed on the largest plane was considered as the standard cross-section, and continuous observation was made on this image. According to the display type of isthmus of the VA, it was divided into Ⅰ to Ⅳ grades. Kruskal Wallis test was used to compare the morphological differences of VA isthmus among the affected group, the healthy group and the control group. The degree of hearing impairment was assessed by pure tone audiometry (PTA) results, which were divided into normal/mild/moderate/moderately severe/severe/extremely severe hearing impairment. Spearman correlation analysis was used to compare the correlation between the morphological rating of VA isthmus on the affected side and age, course of disease and the results of pure tone audiometry (PTA). Results: The proportions of VA isthmic morphology GRADE Ⅰ,Ⅱ,Ⅲ,Ⅳ in the MD affected group were 28.6% (4/14), 42.9% (6/14), 21.4% (3/14), 7.1% (1/14), those in the MD healthy group were 0 (0/12), 33.3% (4/12), 33.3% (4/12), 33.3% (4/12), and those in the control group were 0 (0/28), 7.1% (2/28), 64.2% (18/28), 28.6% (8/28). The VA isthmus scores [M (Q1, Q3)] of MD affected group was lower than that of MD healthy group [2 (1, 3) vs 3 (2, 4)] and control group [2 (1, 3) vs 3 (3, 4)] (all P<0.05, respectively). The morphology of the VA isthmus on the affected side of MD was negatively correlated with age (r=-0.81, P=0.002), and there was no correlation with the course of disease and degree of hearing impairment (r=-0.40, r=-0.26; all P>0.05, respectively). Conclusion: The stenosis of the VA isthmus in MD was a possible anatomical factor for the occurrence of MD.

[Analysis of the imaging characteristics of otosclerosis based on 10 µm otology CT].

Objective: To evaluate the imaging features of otosclerosis based on10 µm otology CT. Methods: Data of 27 patients with otosclerosis (51 sides) in Beijing Friendship Hospital, Capital Medical University from October 2020 to July 2021 were retrospectively collected, including 9 males and 18 females age ffrom 22 to 70 (42±12) years. All patients underwent 10 µm otology CT examination and surgical treatment. The types, amounts and involved sites of otosclerosis were analyzed and the sensitivity of 10 µm otology CT in diagnosing otosclerosis were evaluated. Results: Fenestral type accounted for 49.0% (25/51 sides), and diffuse type accounted for 51.0% (26/51 sides),and he retrofenestral type without fenestral lesion was not seen. Single lesions accounted for 45.1% (23/51 sides) and multiple lesions accounted for 54.9% (28/51 sides). The incidence of involvement of the fissula ante fenestram and annular ligaments were both 100%. The incidence of involvement of stapes footplate, vestibule, cochlea, round window, inner auditory canal wall, facial nerve canal, stapes muscle and semicircular canal was 60.8% (31 sides), 33.3% (17/51 sides), 21.6% (11/51 sides), 17.6% (9/51 sides), 13.7% (7/51 sides), 9.8% (5/51 sides), 7.8% (4/51 sides) and 5.9% (3/51 sides), respectively. The sensitivity of 10 µm otology CT in diagnosis of otosclerosis was 100%. Conclusion: 10 µm otology CT can fully display the imaging features of otosclerosis, and has the potential to be an effective routine method for otosclerosis.

[Role of cardiac magnetic resonance imaging in myocarditis patients with biopsy negative: a retrospective case series study].

Objective: To analyze the cardiac magnetic resonance (CMR) imaging feature of clinically diagnosed myocarditis patients with negative endocardial biopsy (EMB) results, and to further demonstrate the diagnostic value of CMR in these patients. Methods: This was a retrospective case series study. Fourteen patients, who were clinically diagnosed as myocarditis according to 2013 European Society of Cardiology (ESC) clinical diagnostic criteria for myocarditis, but with negative EMB results, were enrolled. All patients underwent CMR examinations. The morphological, functional and histological changes of the heart were assessed based on black blood sequence, cine sequence, T2W-STIR sequence and contrast agent late gadolinium enhancement,(LGE). Results: There were 10 males and 4 females in this cohort, the age was (25.6±13.2) years. The interval between symptom onset and CMR was 21 (13, 60) days, and the interval between symptom onset and EMB was 19 (9, 40) days. There were 13 patients with abnormal CMR results including myocardial oedema, fibrosis, decreased ejection fraction, pericardial effusion or increased cardiac chamber dimension. Nine out of 14 patients had CMR morphological and/or functional abnormalities, including 1 case of left atrium enlargement, 1 case of left ventricle enlargement, 3 cases of right ventricle enlargement, 4 cases of increased left ventricular end diastolic volume index. Left ventricular ejection fraction was<50% in three cases, right ventricular ejection fraction was<40% in 5 cases, and pericardial effusion depth>3 mm was detected in 3 cases. Of the 14 patients, 11 had histological changes, of which 6 had T2 ratio≥2. Among the 10 patients (10/14) with positive LGE, the most common patterns were subepicardial LGE of the lateral wall and/or midwall LGE of the septum (n=9); 2 cases showed extensively subendocardial LGE of the left ventricular wall. No LGE involved in the right ventricular wall in the whole cohort. Conclusion: CMR plays a complementary role in the diagnosis of myocarditis in clinically diagnosed myocarditis patients with negative EMB findings.

Identification of urinary hsa_circ _0137439 as potential biomarker and tumor regulator of bladder cancer.

Cell-free circular RNAs (circRNAs) stably and abundantly exist in body fluids. In this study we aimed to investigate the potential of urinary cell-free circRNAs as a novel class of noninvasive disease biomarkers for diagnosis of bladder cancer. Differentially expressed circRNAs from 10 normal and 10 bladder cancer urine samples were firstly detected by microarray. Hsa_circ_0137439 was then screened and validated in 30 normal and 116 bladder cancer samples. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of hsa_circ_0137439. The Kaplan-Meier method was used to evaluate the significance of hsa_circ_0137439 in the prognosis of bladder cancer. We found that hsa_circ_0137439 was significantly upregulated in bladder cancer samples. Moreover, increased expression of hsa_circ_0137439 was correlated with higher tumor stage, higher tumor grade, higher lymph node status, and history of muscle-invasive bladder cancer (MIBC). Also, urinary cell-free hsa_circ_0137439 could not only differentiate bladder cancer from normal controls but also distinguish MIBC from non-muscle-invasive bladder cancer (NMIBC). Additionally, hsa_circ_0137439 in urine supernatant could serve as an independent prognostic predicator of recurrence-free survival and overall survival for patients with bladder cancer. Cell assays showed that hsa_circ_0137439 knockdown contributed to the inhibition of cell proliferation and migration via hsa_circ_0137439/miR-142-5p/ MTDH axis. In conclusion, urinary cell-free hsa_circ_0137439 could be a promising biomarker for tumor diagnosis and prognostic assessment of bladder cancer patients.

Efficacy of recombinant N- and C-terminal derivative of EmIMP1 against E. maxima infection in chickens.

1. Immune mapped protein-1 (IMP1) of E. maxima has been identified as a vaccine antigen candidate for E. maxima infection. 2. In the current study, the N- and C-terminal derivative of EmIMP1 were expressed in E. coli and administered to chickens. The antibody response, cell-mediated immune (CMI) response and the protective efficacy of the protein vaccines against E. maxima challenge were evaluated. 3. The results showed that C-terminal derivative of EmIMP1 vaccination could increase weight gain, reduce enteric lesions, and decrease faecal oocysts shedding. Moreover, the C-terminal derivative of EmIMP1 caused reasonable improvement in serum antibodies and the numbers of IFN-γ producing peripheral blood mononuclear cells (PBMC), as compared to the control group. 4. This study demonstrated that the C-terminal derivative of EmIMP1 could be used as a potent immunogenic candidate in the development of subunit vaccines against E. maxima infection.

[The clinical significance of plasma PTX3 in patients with secondary hemophagocytic lymphohistiocytosis].

Objective: To investigate the significance of plasma pentraxin 3 (PTX3) in patients with secondary hemophagocytic lymphohistiocytosis (sHLH). Methods: Plasma PTX3 levels were tested by ELISA in 48 newly diagnosed sHLH patients, 18 healthy volunteers and 9 lymphoma controls in the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2019. Clinical parameters were collected, and the correlations with PTX3 levels were analyzed. Results: PTX3 level in newly diagnosed group was significantly higher than that of healthy control group [16.29(1.17-66.00) vs. 0.76(0.01-7.86) µg/L, P<0.01]. Patients with lymphoma-associated HLH(LHLH) had higher plasma level of PTX3 than Fhose with infection-associated HLH (IHLH) [24.29(3.36-66.00) vs. 9.56(1.17-36.50)µg/L, P<0.05]. Plasma PTX3 levels in 48 sHLH patients were positively correlated with serum ferritin (P<0.05). Receiver operating characteristic (ROC) curve for plasma PTX3 levels of sHLH and healthy controls produced a cutoff value at 3.9 µg/L, with its 86.7% sensitivity and 94.4% specificity. And ROC analysis showed that PTX3 17.5 µg/L was the critical value for diagnosis of LHLH from non-LHLH group, that the sensitivity and specificity were 63.0% and 76.2% respectively. The 1-year overall survival (OS) rate in patients with PTX3≥17.5 µg/L was significantly lower in those with PTX3<17.5 µg/L (18.5% vs. 75.8%, P<0.01). Conclusion: These results indicate the potential of PTX3 as a biomarker for diagnosis and prognosis in patients with sHLH.

[Comparative study on three implantation approaches of the totally implantable venous access ports using dual-guided technique].

Objective: To compare the clinical application effect of totally implantable venous access ports (TIVAP) via the internal jugular vein,the subclavian vein and the brachiocephalic veins under the guidance of ultrasound combined with DSA. Methods: The clinical materials of 346 patients (162 males and 184 females) who implanted TIVAP in intervention Department of Jiangsu Cancer Hospital between August 2018 and January 2019 were retrospectively reviewed and the average age was (57±12) years (17 to 83 years). The patients were divided into three groups according to the different implantation approaches. One hundred and twenty-six patients (67 males and 59 females) were group A who implanted from the internal jugular vein and the average age was (52±11) years,114 patients (52 males and 62 females) were group B who implanted from the subclavian vein and the average age was (58±10) years,106 patients (43 males and 63 females) were group C who implanted from the brachiocephalic vein and the average age was (60±9) years.The first-puncture success rate,operating time,implanting length,intraoperative pain score, one month comfort rating after surgery, unscheduled decannulation rates, early and late complication rates were compared among three groups. Results: All the patients implanted the TIVAP successfully.There were no significant differences about the first-puncture success rate (χ(2)=1.375,P=0.503),operating time (F=0.968, P=0.624), unscheduled decannulation rates (χ(2)=1.570, P=0.456), and the total pipe length among the three groups (F=0.821, P=0.441),while the catheter length inside the blood vessel were the shortest in group C (F= 263.618, P=0.000), and the one month comfort rating after surgery of group C were higher compared with group A and B (F=52.248,P=0.000).Pitch-off syndrome was a unique complication of group B (χ(2)=6.159,P=0.046) and other complications were no significant differences (P>0.05). Conclusion: There are high accuracy and safety among three implantation approaches,and the approach via brachiocephalic vein under the guidance of ultrasound combined with DSA is more comfortable and lower complication rates, which could be priority to choose.

[Effects of parental rearing patterns and their consistency on the emotional and behavioral problems of preschool children].

Objective: To explore the effect of parental rearing patterns and their consistency on the emotional and behavioral problems of preschool children. Methods: From October to November 2017, 27 987 children aged 3 to 6 years old from 109 kindergartens in 11 cities of Hubei, Anhui and Jiangsu Provinces were selected by using the cluster sampling method. A total of 27 200 valid questionnaires which were completed by subjects' parents were collected. The emotional and behavioral problems of preschool children were collected by "strengths and difficulties questionnaire" and the parental rearing patterns were evaluated by the "Parental Behavior Scale". The differences in emotional and behavioral abnormality rates of preschool children with different characteristics were analyzed; with emotional and behavioral problems as dependent variables and parental support/participation and compulsion/hostility as independent variables, the multivariate logistic regression model was used to analyze the effect of parental rearing patterns and their consistency on the emotional and behavioral problems of preschool children. Results: The age of children was (4.35±0.96) years old, and 51.4% of children were 13 975 males. There were 24 634 (90.6%) urban children and 17 916 (65.9%) only children. Both parents with strong support/participation accounted for 14.9%, and those with poor support/participation accounted for 11.9%; both parents with strong compulsion/hostility accounted for 15.2%, and those with low compulsion/hostility accounted for 11.3%. The rates of emotional symptoms, conduct behavior, hyperactive behavior, peer interaction, total difficulty score, and abnormal prosocial behavior of preschool children were 9.5%, 9.5%, 18.2%, 24.5%, 11.2%, and 10.2%, respectively. The multivariate logistic regression model analysis showed that after adjusting for gender, only child, living area, family economic status, mother's age and education level, father's education level, and other factors, compared with fathers/mothers with strong support/participation and low compulsion/hostility and parents with strong support/participation and low compulsion/hostility, preschool children who had fathers/mothers with poor support/participation and strong compulsion/hostility or parents with poor support/participation and strong compulsion/hostility were more likely to have emotional symptoms, conduct behavior, hyperactive behavior, peer interaction, total difficulty score, and abnormal prosocial behavior (P<0.05). Conclusions: Parental rearing patterns and their consistency are related to the emotional and behavioral problems of preschool children.