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    25 April 2024, Volume 23 Issue 02 Previous Issue   
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    CONTENTS
    2024, 23 (02):  0-0. 
    Abstract ( 23 )   PDF (9932KB) ( 15 )  
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    Expert forum
    Application norms and research progress of cardiac magnetic resonance imaging in the management of MINOCA patients
    ZHAO Xinxiang, ZHAO Xiaoying
    2024, 23 (02):  101-107.  DOI: 10.16150/j.1671-2870.2024.02.001
    Abstract ( 27 )   HTML ( 5 )   PDF (1255KB) ( 7 )  

    Myocardial infarction without obstructive coronary artery (MINOCA) refers to myocardial infarction (MI) that occurs when the lumen area of coronary artery stenosis is ≤50%, accounting for 1% to 14% of the total MI. The etio-logy of MINOCA is complex and diverse, and accurate diagnosis and identification of the potential causes of MINOCA are crucial for guiding subsequent clinical management. Based on the unique advantages of myocardial tissue imaging, non-invasive cardiac magnetic resonance (CMR) examination has been widely recognized for its value in the management of MINOCA patients. CMR can be used to exclude diseases similar to MI, such as myocarditis and stress-induced cardio-myopathy, and identify the potential causes of MINOCA. It is a necessary diagnostic tool in the diagnostic process, helping to reduce overdiagnosis, misdiagnosis, and missed diagnosis of true MINOCA. Currently, it has been recommended by the American Heart Association (AHA) and the European Society of Cardiology (ESC) as an essential examination method in the MINOCA management process. In addition, compared with patients with coronary artery occlusion, MINOCA patients have a better short-term prognosis, but the risk of poor prognosis increases in long-term follow-up. It is necessary to pay more attention to the prognosis and risk stratification of MINOCA patients and management process. The traditional MI prognosis evaluation system is not entirely applicable to MINOCA patients, and CMR can provide valuable information for the prognosis evaluation of MINOCA patients. Currently, there are no standardized norms or guidelines for the application of CMR in the management of MINOCA patients in China. This article aims to review the application norms and prognostic value of CMR technology in clinical management of MINOCA, providing reference for clinical practice and enhancing understanding and management of this special MI lesion.

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    Advances in interventional magnetic resonance imaging and its clinical applications
    FENG Yuan, HE Zhao, SUN Qingfang, SUN Bomin, YAN Fuhua, YANG Guangzhong
    2024, 23 (02):  108-113.  DOI: 10.16150/j.1671-2870.2024.02.002
    Abstract ( 44 )   HTML ( 4 )   PDF (970KB) ( 27 )  

    Interventional therapy has been widely used in surgeries involving neurology, vasculature, and breasts.Image-guided, robot-assisted interventional therapy significantly enhances surgical precision and safety, emerging as a critical trend in modern interventional surgery. Among various interventional imaging methods, interventional magnetic resonance imaging (i-MRI) stands out due to its excellent soft tissue differentiation, diverse imaging contrasts, ability to yield quantitative data, and no ionizing radiation. However, the challenges facing MRI-guided therapy include the relatively low speed of imaging and the stringent compatibility demands of interventional devices. Advance in the rapid i-MRI techniques and MR-compatible equipment have propelled i-MRI to a pivotal role in clinical applications, encompassing neurological, cardiovascular, prostate, and breast interventions. This review initially provides an overview of the current i-MRI landscape. It then consolidates the application of i-MRI in multiple medical interventions, offering illustrative examples. The article further delves into the obstacles posed by i-MRI, specifically slow imaging speed and the delicate spatiotemporal resolution balance. Ultimately, it envisages the growth potential of i-MRI in multimodal imaging, real-time MRI, and i-MRI-guided interventional robotic surgery.

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    Application and research progress of MRI deep learning image reconstruction technology in clinical diagnosis of musculoskeletal system diseases
    ZHA Yunfei, WU Xiaxia
    2024, 23 (02):  114-118.  DOI: 10.16150/j.1671-2870.2024.02.003
    Abstract ( 17 )   HTML ( 3 )   PDF (933KB) ( 9 )  

    Deep learning based reconstruction (DLR) technology is currently one of the most cutting-edge technological advancements in the field of MRI image reconstruction. Compared to conventional MRI image reconstruction techniques, DLR technology redefines a new boundary between signal-to-noise ratio, spatial resolution, and scanning time on MRI. Its outstanding technical advantage is the effective removal of image noise and artifacts, significantly reducing scanning time, and also has potential advantages in improving the detection rate and accuracy qualitative diagnosis of lesions. With the continuous optimization of algorithms and the improvement of model generalization, DLR has been widely used in MRI examinations for multiple parts, such as the nervous system, musculoskeletal system, and heart. Its applicable scanning sequences and clinical application scenarios are also constantly expanding. DLR technology, while maintaining the original spatial resolution, reduces the number of signal acquisition times and increases the parallel acquisition acceleration factor to shorten the imaging time by more than 50%, achieving rapid imaging of the musculoskeletal system, and obtaining significantly better image quality than traditional reconstructed images. Currently, DLR is widely used in MRI exa-minations of musculoskeletal systems, such as the knee, shoulder, wrist, and spine, and has demonstrated its outstanding performance in shortening imaging time, improving image signal-to-noise ratio and resolution.

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    Academic trend at home and abroad
    Advances in study on the diagnosis and treatment of small intestinal diseases in 2023
    ZHANG Shuowen, GU Yubei
    2024, 23 (02):  119-125.  DOI: 10.16150/j.1671-2870.2024.02.004
    Abstract ( 40 )   HTML ( 11 )   PDF (964KB) ( 14 )  

    In 2023, multiple important discoveries and breakthroughs have been made in the field of small intestine diseases, and database-based global epidemiological study on small intestinal cancer was first released. It showed that the global incidence rate of small intestinal cancer in 2020 was 0.6/100 000, which was on an upward trend compared with the average incidence rate from 2010 to 2020 (average annual change percentage in different continents, 2.20% to 21.67%). The burden of small intestinal cancer was geographic disparity, and age-standardized incidence rate (1.4/100 000) was highest in North America. The incidence rate of small intestinal cancer in China was 0.32/100 000 for men and 1.95/100 000 for women. Risk factors for small bowel cancer (β = 0.008 to 0.198; OR = 1.07 to 10.01) included higher human development index and gross domestic product; smoking and drinking habits; lack of exercise, obesity, diabetes, and lipid metabolism disorders; history of inflammatory bowel diseases. Therapeutically, the combined use of sulindac and erlotinib has been effective in reducing the polyp burden in patients with familial adenomatous polyposis. For Crohn’s disease in the small intestine, in terms of software, AI-assisted endoscopic recognition has been proven to reduce misdiagnosis ,improving medical quality. In terms of hardware, the electric spiral enteroscopy is a double-edged sword. Although it has a higher rate of completing entire small intestine examination, it cannot be widely used in clinical practice until its safety is fully guaranteed. In terms of drugs, with the in-depth understanding of the pathogenesis of the disease, targeted therapy for the inflammatory process has gradually become a research hotspot. Clinical data on small-molecule agents such as upadacitinib and filgotinib are continuously accumulating. In terms of surgery, the latest evidence supports that surgery may become a first-line treatment for specific Crohn’s disease. The diagnosis and treatment of small intestine bleeding are also continuously improving. Thalidomide, as a drug used to treat small intestine bleeding caused by capillary malformations, has brought good news to a large number of patients. In addition, the surgical treatment for small intestine obstruction is gradually being updated, and there are now more accurate prediction models for treatment decisions in patients with small intestine obstruction. Looking ahead, with the continuous development and innovation of medical technology, and artificial intelligence, the diagnosis and treatment of small intestinal diseases will become more precise and efficient.

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    Original articles
    The value of magnetic resonance neurography 3 D-STIR-SPACE sequence in displaying neoplasms of the lumbosacral plexus
    LIU Wei, LIN Guangwu, LI Shihong
    2024, 23 (02):  126-130.  DOI: 10.16150/j.1671-2870.2024.02.005
    Abstract ( 15 )   HTML ( 6 )   PDF (3231KB) ( 6 )  

    Objective To investigate the value of the magnetic resonance neurography three-dimensional sampling perfection with application optimized contrasts by using different flip angle evolution (3D-SPACE) in displaying the neoplasms of the lumbosacral plexus. Methods MRI 3D-SPACE images of 16 cases with neoplasm in the lumbosacral plexus collected during January 2018 to December 2023 were retrospectively analyzed. All cases were confirmed by pathology. The maximum diameter of the tumors was measured and the number of lesions was counted. The location of the involved lumbosacral plexus was observed and the number of the involved nerves was counted. The relationship between the tumors and nerves was evaluated. Results Ten cases were of single lesion and 6 cases were of multiple lesions. The average maximum diameter of tumors was (57.1±37.2)mm. Single nerve involved was detected in 5 cases while multiple nerves involved were in 11 cases. The relationship between the tumor and nerve was divided into three types. The tumor grew along the nerve in 5 cases. The nerves were compressed by the tumors in 5 cases, and were invaded and surrounded in 6 cases. Conclusions MRI 3D-SPACE can reveal the location and numbers of the tumor, displaying the relationship between the tumor and nerve clearly and intuitively, which is important for localization and diagnosis of the neoplastm in the lumbosacral plexus.

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    Feasibility of reducing scan time based on deep learning reconstruction in magnetic resonance imaging: a phantom study
    LÜ Xiaoyu, FENG Weiming, ZHOU Huiyun, LI Jiqiang, DONG Haipeng, HUANG Juan
    2024, 23 (02):  131-138.  DOI: 10.16150/j.1671-2870.2024.02.006
    Abstract ( 16 )   HTML ( 5 )   PDF (3989KB) ( 7 )  

    Objective To explore the feasibility of deep learning reconstruction (DLR) in shortening the scanning time through water phantom experiments. Methods The control variable method based on phantom, was adopted to depict the curves of scanning time varying with the number of excitation (NEX) ,matrix,and resolution. The signal-to-noise ratio (SNR) and subjective image quality of different DLR with high, medium and low noise reduction levels (DLR_H, DLR_M, DLR_L) and traditional reconstruction (ConR) were analyzed, including the four-point assessment of sharpness and detail clarity, and distortion degree, and the curves of changes were depicted and the fitting curves were calculated. Results The positive correlation between NEX and resolution with MRI scanning time and SNR was consistent in ConR and DLR reconstructions with different noise reduction levels. Specifically, under the same NEX and resolution conditions, the SNR of ConR, DLR_L, DLR_M, and DLR_H increased sequentially. When the matrix was fixed at 512×512 while images with subjective evaluation score of 3 or 4 were taken as satisfactory ones, the images reconstructed by DLR can obtain satisfactory sharpness, distortion degree and detail display, and when NEX were 3, 4, 5 and 7 and 11, image details were displayed best while scanning time was significantly reduced. Meanwhile, the distortion of images achieved satisfactory results with NEX of 2, 4, 5, and 6. Also, satisfactory detail display was obtained when NEX was 3, 5, 7 and 11. All the above combinations of NEX and resolution saved scanning time from 31 to 244 seconds. Similarly, as the resolution increased, the image scores of the sharpness and detail display gradually increased and. distortion degree decreased. When NEX was fixed at 6, the images reconstructed by DLR_H, DLR_M, DLR_L and ConR obtained satisfactory sharpness ;When the matrix was 320×320, 384×384, 448×448 and 640×640,, the scanning time was 141 seconds, 141 seconds, 187 seconds and 232 seconds, respectively. DLR_H and DLR_M achieved a smaller distortion degree at the 512×512 matrix, while DLR_L and ConR required a higher imaging matrix and longer scanning time to obtain similar image quality. For detail clarity, DLR_H achieved satisfactory detail display when the matrix was 512×512, and the scanning time was less than that of DLR_M, DLR_L and ConR. Conclusions DLR, especially DLR_H, while reducing NEX and resolution to shorten the MRI scanning time, may not only maintain a satisfactory SNR and image detail clarity, but also achieve higher image clarity and lower distortion degree.

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    The application of deep learning image reconstruction in dual-energy CT virtual non-contrast CT urography
    QIAN Jiale, FAN Jing, ZHU Hong, WANG Luotong, KONG Deyan
    2024, 23 (02):  139-145.  DOI: 10.16150/j.1671-2870.2024.02.007
    Abstract ( 17 )   HTML ( 2 )   PDF (2653KB) ( 8 )  

    Objective To investigate the effect of dual-energy CT (DECT) virtual non-contrast (VNC) images reconstructed by deep learning image reconstruction (DLIR) on the image quality and measurements of renal calculus in CT urography (CTU). Methods The clinical and imaging data of 90 patients who underwent abdominal and pelvic non-contrast CT examination followed by a nephrographic-phase DE CTU during September 2022 to April 2023 were retrospectively analyzed. The non-contrast CT images were reconstructed with ASIR-V with 70% weight (TNC-AR70). Four groups of VNC images were reconstructed based on medium level and high level DLIR for venous phase and delay phase, namely venous phase-VNC-DLIR medium (VP-VNC-DM), venous phase-VNC-DLIR high (VP-VNC-DH), delay phase-VNC-DLIR medium (DP-VNC-DM), and delay phase-VNC-DLIR high (DP-VNC-DH). The radiation doses of TNC and VNC in venous phase and delay phase were recorded. The mean CT value, image noise (SD), signal-to-noise ratio (SNR) and contrast-to-noise (CNR) were recorded and compared among the five groups. Two radiologists independently assessed the overall image qua-lity and lesion visibility with 5-point Likert scale. Additionally, according to results of TNC, Bland-Altman was used to analyze the measurement differences between VNC and TNC in mean CT value and mean size of renal calculus. Results In the objective assessments, the image quality of the VNC-DH group was better than that of TNC-AR70, and there was no statistically significant difference in CT value among the five groups of images (P>0.05). DP-VNC-DH showed the lowest SD and the highest SNR and CNR values. In the subjective assessments, DP-VNC-DH achieved the best subject scores on image qua-lity, and VP-VNC-DH achieved the best subject scores on lesion visibility. Furthermore, Bland-Altman analysis showed that there was a strong overall agreement between VNC and TNC for renal calculus characterization (all P>0.005). Conclusions VNC generated by DLIR may provide high-quality image compared with the non-contrast images reconstructed with ASIR-V 70% in CTU.The combination of the VNC images generated by DLIR-H from venous phase and delay phase could replace TNC scanning,reducing the radiation dose of CTU scans.

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    Bioinformatics analysis for expression of RAD51AP1 in triple negative breast cancer with brain metastasis
    OU Dan, CAI Gang, CHEN Jiayi
    2024, 23 (02):  146-154.  DOI: 10.16150/j.1671-2870.2024.02.008
    Abstract ( 21 )   HTML ( 2 )   PDF (3587KB) ( 19 )  

    Objective To screen differentially expressed genes (DEG) related to brain metastasis in triple negative breast cancer(TNBC) using bioinformatics analysis, and to explore the potential mechanism affecting the prognosis of TNBC patients. Methods Datasets including GSE76250 (TNBC tissues and normal breast tissues) and GSE125989 (TNBC brain metastases tissue and TNBC primary lesion tissue) were retrieved from Gene Expression Omnibus (GEO) database, and DEG was screened using Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to identify potential related genes contributing to brain metastasis in TNBC. The association between gene expression levels and breast cancer prognosis was verified by clinical tissue samples from The Cancer Genome Atlas (TCGA) database, and gene enrichment analysis was performed using the gene set of KEGG to assess the signaling pathways that involved in genes related to brain metastasis. Results A total of 52 DEGs were screened in GSE125989 and GSE76250 datasets. Protein-protein interaction network (PPI) suggested that RAD51AP1 was an important gene related to brain metastasis in TNBC. Analysis of TCGA data showed that RAD51AP1 was significantly overexpressed in breast cancer tissues vs paracancerous tissues, and for different molecular subtypes of breast cancer,basal-like breast cancer had a higher level of RAD51AP1 than that in paracancerous tissues. Patients with breast cancer were divided into high expression and low expression of RAD51AP1 group according to the median expression level of RAD51AP1 in cancer tissues [log2 (TPM+1)=3.85]. Survival analysis showed that the median survival of patients with high expression was lower than that of patients with low expression [median OS 3 873 days vs 3 945 days, P<0.05, HR=1.40 (1.01-1.94)]. GO, KEGG and gene set enrichment analysis (GSEA) showed that signaling pathways, such as cell cycle, DNA replication and mismatch repair, were significantly enriched in RAD51AP1 highly expressed phenotypes. PPI was constructed based on cell cycle and DNA damage repair signaling pathway related protein information, and proteins that directly interacted with RAD51AP1 were screened.It revealed proliferating cell nuclear antigen (PCNA) was strongly correlated with RAD51AP1. Conclusions RAD51AP1 is highly expressed in TNBC and TNBC brain metastasis tissues, which may serve as a potential biomarker for diagnosis of TNBC and prediction of poor prognosis, and mechanism on RAD51AP1 mediating brain metastasis may be related to PCNA.

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    The correlation between free T3 level and left ventricular diastolic dysfunction in elderly male patients with T2DM
    MIAO Jie, WANG Wei, ZHAO Yajie, ZHANG Fengru, SHEN Linhui
    2024, 23 (02):  155-161.  DOI: 10.16150/j.1671-2870.2024.02.009
    Abstract ( 17 )   HTML ( 2 )   PDF (1308KB) ( 4 )  

    Object To explore the relationship between free triiodothyronine (FT3) level and left ventricular diastolic dysfunction(LVDD) in elderly male patients with type 2 diabetes mellitus. Methods A total of 208 elderly male (≥60 years) hospitalized patients with T2DM in Ruijin Hospital Shanghai Jiao Tong University School of Medicine were enrolled from January 2020 to November 2021. According to the Echocardiographic Assessment of Heart Disease for Systolic and Diastolic Function 2020, patients were divided into LVDD group (112 cases) and normal left ventricular fuction (control group, 96 cases). Baseline data, echocardiographic indicators, thyroid hormone indicators and thyroid hormone levels between 2 groups were compared. Meanwhile, all the patients were also divided into 4 groups according to the quartile level of FT3: F1 group (2.43 pmol/L<FT3≤3.30 pmol/L, n=52); F2 group (3.31 pmol/L<FT3≤3.78 pmol/L, n=52); F3 group(3.78 pmol/L<FT3≤4.65 pmol/L, n=52) and F4 group (4.66 pmol/L<FT3≤6.01 pmol/L, n=52). Baseline data and echocardiographic indicators were compared between the four groups. Pearson correlation was used to analyze the correlation between FT3 and echocardiographic indicators. Multivariate logistic regression analysis was used to explore the relationship between FT3 level and LVDD. Receiver operating characteristic (ROC) curve was used to evaluate the efficacy of FT3 and multivariate logistic regression model for diagnosing LVDD. Results Compared with the control group, the level of FT3 were significantly lower in LVDD group [(3.51±0.24)pmol/L vs (4.72±0.33) pmol/L, P<0.01]. Echocardiographic indicators showed that the percentage of LVDD, ratio of peak flow velocity E peak in early diastole in mitral orifice and peak flow velocity E peak in early diastole in mitral annulus (E/e’) were significantly different (P<0.01) in the four groups by the quartile level of FT3. Pearson correlation analysis showed that FT3 was negatively correlated with E/e’ (P<0.001) and left atrial volume index (P<0.001). Multivariate logistic regression analysis showed that as the quartile level of FT3 decreased, the risk of LVDD gradually increased (F3: OR=2.29; F2: OR=3.36; F1: OR=4.95; all P<0.05). Age, glycosylated hemoglobin (HbA1c), duration of diabetes mellitus and FT3 were entered into the logistic regression analysis model. ROC results showed the AUC of FT3 and multivariate logistic regression model for diagnosing LVDD were 0.742 and 0.858,respectively.When cutoff of FT3 was taken as <3.37 pmol/L,the sensitivity and specificity for diagnosing LVDD were 66.2% and 75.0%,respectively. Conclusions The risk of LVDD increases as FT3 level decreases in elderly male patients with T2DM, and FT3 may serve as a biomarker for early diagnosing LVDD.

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    The clinicopathologic significance of AR, SKP2, SOX10, PD-L1 and TILs expression in triple-negative breast cancer
    LIU Juan, YIN Lijuan, FAN Desheng
    2024, 23 (02):  162-172.  DOI: 10.16150/j.1671-2870.2024.02.010
    Abstract ( 17 )   HTML ( 3 )   PDF (5788KB) ( 10 )  

    Objective To explore the expression of androgen receptor (AR), S-phase kinase associated protein 2 (SKP2), Sry-related HMG box-containing factor 10 (SOX10), programmed death-ligand 1 (PD-L1) and tumor infiltrating lymphocytes (TILs) in triple-negative breast cancer (TNBC) and their relationships with clinical prognosis. Methods The proportion of TILs in 109 TNBCs was assessed on Hematoxylin-eosin stained sections ,and Leica Bond-Max automatic immunohistochemistry apparatus was used to detect the expressions of AR,SKP2,SOX10 and PD-L1 in TNBC tissue. The relationship between the above indicators and clinicopathological charactersitics was analyzed. Univariate survival analysis was performed by Kaplan-Meier, and survival by Log rank test. Multivariate survival analysis was performed by cox regression model. Results A total of 95 patients were followed-up with a median follow-up time of 48 months. For 95patients,the median disease-free survival (DFS) time was 42 months, and median overall survival (OS) time were 48 months. In TNBC, the expression of AR was associated with negative lymph node metastasis, maximum tumor diameter <2 cm. High expression of TILs was associated with low grade TNBC. The expression of SKP2 was associated with positive nerve/vasculature invasion and high grade TNBC. The expression of SOX10 was associated with high grade TNBC and positive lymph node metastasis. The expression of PD-L1 was associated with positive lymph node metastasis, positive nerve/vascular invasion, and high grade TNBC (all the P<0.05 as above). Survival analysis demonstrated that the positive expression of SKP2 or AR SOX10 was correlated with worse DFS (P=0.007、P<0.001) and OS (P=0.013、P<0.001), and patients with high expression of TILs showed better DFS (P=0.016) and OS (P=0.004). TNBC patients with AR+/SKP2- or AR+/SOX10- had better DFS (P=0.004、P<0.001) and OS (P=0.007、P<0.001), while those with SOX10+/low TILs or PD-L1+/low TILs had worse DFS (P=0.000、P=0.008) and OS (P=0.001、P=0.002), and AR-/low TILs had worse OS (P=0.014). Multivariate survival analysis showed positive expression SKP2 (HR=4.143, 95%CI 1.578-10.875), or SOX10 (HR=7.578, 95%CI 2.067-27.782) were independent prognostic factors for worse DFS, postive expression SKP2 (HR=3.758, 95%CI 1.400-10.084), or SOX10 (HR=5.131, 95%CI 1.316-20.000), were independent prognostic factors for worse OS (all the P<0.05 as above) and higher TILs(HR=0.375,95%CI 0.154-0.917) was independent prognostic factors for better OS(all the P<0.05 as above). Conclusions High expression of AR and TILs in TNBC indicate better prognosis, while SKP2, SOX10 and PD-L1 expression demonstrate more aggressive clinicopathological features in TNBC. The expression of SKP2, SOX10 and TILs in TNBC are associated with prognosis, suggesting that these indicators may serve as new prognostic factors and potential therapeutic targets in TNBC.

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    The value of autoantibody and D-dimer detection in evaluating the prognosis of patients with chronic hepatitis B and hepatitis B cirrhosis
    LIU Yue, WU Hanlin, TONG Wuqing, XU Jing
    2024, 23 (02):  173-179.  DOI: 10.16150/j.1671-2870.2024.02.011
    Abstract ( 21 )   HTML ( 6 )   PDF (1083KB) ( 5 )  

    Objective To detect autoantibodies and D-dimer in patients with chronic hepatitis B (CHB) or with hepatitis B cirrhosis (cirrhosis), and explore the value of detection in evaluating disease progression and prognosis of the patients. Methods A total of 147 consecutive cases meeting the enrollment criteria were collected in out hospital during January 2020 to January 2023, including 82 cases of CHB(CHB group) and 65 cases of cirrhosis(Cirrhosis group). Sixty healthy subjects were selected as the control, and autoantibody detection and D-dimer level were analyzed. In Cirrhosis group,patients died or suffered from digestive bleeding or hepatic encephalopathy were classified into poor prognosis group, and the other into good prognosis group. The autoantibody positivity and D-dimer level were included in binary logistic regression analysis to idetntify the risk factors for poor prognosis in patients with cirrhosis. Results The positive rate of autoantibody in CHB Group (25.61%)and Cirrhosis group (27.69%)were higher than that in control group(8.33%) (P<0.05).The positive rates of antinuclear antibody in CHB and Cirhosis group were 14.63% and 4.62% (P<0.05), and there was no significant difference in positive rates of other antibodies between CHB and Cirrhosis group. The D-dimer levels in CHB and Cirrhosis groups were 0.28 (0.19,0.51) mg/L and 1.19 (0.53,2.49) mg/L(P<0.05), and D-dimer level in Cirrhosis group was higher than that in control group[0.27(0.20,0.32)] (P<0.05). The positive rates of autoantibody in the poor and good prognosis groups of cirrhosis were 47.06% and 20.83%(P<0.05), and D-dimer levels were 1.78 (0.90,6.28) mg/L and 1.06 (0.32,2.07) mg/L(P<0.05). Regression analysis showed that the positive autoantibody [OR=7.447(2.016-27.507), P=0.003] and D-dimer level increase [OR=1.336(1.028-1.736), P=0.030] were risk factors for poor prognosis in patients with cirrhosis. The receiver operating characteristic curve showed that the sensitivity and specificity of positive autoantibody for predicting poor prognosis of cirrhosis were 53.6% and 83.0%, respectively. When the optimal cut-off value of D-dimer was ≥ 0.84 mg/L, the prediction sensitivity for poor prognosis in cirrhosis patients was 88.9%, and specificity was 44.7%. When combination of D-dimer level and autoantibody positivity was performed, the sensitivity and the specificity for predicting poor prognosis was 72.2%, 85.1%, respectively. Conclusions Autoantibody positive rate and D-dimer level are higher in patients with CHB or cirrhosis compared to the healthy subjects. The positive rate of autoantibody is not related to the disease course, while the increase of D-dimer is related to the disease course. The positive rate of antinuclear antibody decreased with the progression of the disease. Combined detection of autoantibody and D-dimer may be used to predict the prognosis of patients with cirrhosis.

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    Case reports
    A report on monitoring of coagulation indicators and treatment of microthrombus formation in AML (M4 type) after hematopoietic stem cell transplantation: a case report
    SHEN Lianjun, WU Wei, JI Wei, WANG Hong, SUN Xing, SHI Qingqing, SUN Mei, GU Jian, NI Jun
    2024, 23 (02):  180-183.  DOI: 10.16150/j.1671-2870.2024.02.012
    Abstract ( 19 )   HTML ( 2 )   PDF (1134KB) ( 7 )  

    This article reports a case of acute myelomonocytic leukemia (AML-M4, CBFB gene positive) with lower limb microthrombus formation after haploidentical hematopoietic stem cell transplantation, and summarizes the experience of diagnosis and treatment. The patient received achieved complete remission (CR) after routine chemotherapy, but relapsed 2 years later and underwent a haploidentical hematopoietic stem cell transplantation. During routine treatment after transplantation, the patient’s coagulation related indicators, including D-dimer (D-D), antithrombin Ⅲ (AT-Ⅲ), von Willebrand factor (vWF), fibrinogen degradation products (FDP) and fibrin monomer (FM), were dynamically observed. The patient experienced jaundice and elevated transaminases around 100 days after transplantation, and underwent plasma exchange treatment three times through the right lower limb femoral vein catheterization. After removing the venous catheter for one week, there was left ankle concavea pitting edema of the left ankle. Vascular ultrasound examination indicated the formation of microthrombus in the superficial venous plexus of the gastrocnemius muscle in the left lower limb. D-D, vWF, FDP, FM and other indicators were increased, while AT-Ⅲ levels was decreased. After 2 weeks of oral administration of 5 mg/d berritol for antithrombotic treatment, the above coagulation indicators gradually returned to normal, and the left lower limb intermuscular venous plexus thrombosis and limb swelling disappeared. Therefore, dynamic monitoring of coagulation indicators, such as D-D, AT-Ⅲ, vWF, FDP, and FM may serve as diagnostic indicators for predict transplant related microthrombus and hypercoagulable status, providing an experimental basis for effective anticoagulant treatment in clinical practice.

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    Review articles
    Advance in study on diagnosis of pancreatic cystic tumors on CT/MRI imaging
    GAO Meng, CHAI Weimin, YAN Fuhua
    2024, 23 (02):  184-191.  DOI: 10.16150/j.1671-2870.2024.02.013
    Abstract ( 23 )   HTML ( 3 )   PDF (3021KB) ( 7 )  

    Pancreatic cystic tumors (PCN) refer to cystic tumor lesions originating from the epithelium and/or interstitial tissue of the pancreatic duct. PCN can be roughly divided into mucinous tumors and non-mucinous tumors. The former mainly includes intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN), while the latter mainly includes serous cystic neoplasms (SCN) and solid-pseudopapillary neoplasms (SPN) and cystic neuroendocrine neoplasms (cNET). Different types of PCNs have differentiated biological behaviors, and some types of PCNs have a risk of developing a malignancy. Preoperative identification of PCN malignancy on CT and MRI imaging is of great significance. Malignant indications for MCN are surgical indications, such as a diameter greater than or equal to 4 cm. IPMN accounts for 22% of PCN, and the risk of malignancy in main pancreatic duct type and mixed type IPMN can reach up to 70.9% and 76.5%, while the risk of malignancy in branch pancreatic duct type IPMN is 2.8%-10.7%. High risk signs of malignancy for IPMN include enhanced parenchymal or diameter of parietal nodules ≥ 5 mm, main pancreatic duct dilation (≥ 10 mm), and obstructive jaundice, and surgical treatment is recommended for these patients. SCN is more common in middle-aged and elderly women, with a male to female ratio of 1:3. Serous cystadenocarcinoma is rare, accounting for only 0.1% of pancreatic SCN. The 2015 edition of the Diagnosis and Treatment Guidelines for Pancreatic Cystic Diseases recommends that all SPNs patients should undergo surgical treatment. When the tumor of SPN with incomplete capsule, the mass diameter larger than 6 cm, and the tumor located in the tail of the pancreas, may have a higher ability of invasiveness and distant metastasis. cNET accounts for approximately 7% of PCN. Imaging diagnosis should be combined with medical history and lesion components, etc. The diagnostic point for SPN on image is that MCN is a round, thick walled cystic tumor that almost exclusively occurs in females in the body and tail of the pancreas body, often presenting as an “intracystic cyst”. IPMN is more common in elderly men. The main pancreatic duct type of IPMN presents as diffuse or segmental dilation of the main pancreatic duct, excluding obstructive factors. Branch pancreatic duct type of IPMN usually presents as tubular cystic tumors that communicate with the pancreatic duct, while mixed type of IPMN combines both manifestations. SCN is a lobulated, thin-walled oligocystic or multicystic honeycomb tumor. SPN is a larger round cystic solid tumor that is more common in young women. cNET is a cystic solid tumor with significantly enhanced circular or crescent shaped edges. There is significant controversy in domestic and foreign guidelines regarding the selection of indications for PCN surgery, and pancreatic surgery is difficult with many postoperative complications, posing challenges to the standardized treatment of PCN. Identifying the imaging characteristics of PCN and clarifying imaging diagnosis has clinical significance.

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    Advances in mechanism on pigment epithelium derived factor in diabetes retinopathy
    ZHOU Sifeng, ZHU Jieyun, XU Haishu, NI Ying
    2024, 23 (02):  192-201.  DOI: 10.16150/j.1671-2870.2024.02.014
    Abstract ( 21 )   HTML ( 2 )   PDF (2042KB) ( 16 )  

    Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes mellitus.The incidence of DR (1980-2018: 2.2%-12.7%) increases year by year. The incidence of DR in China is 18.45%, and global prevalence is 22.27%. DR becomes the leading cause of blindness in adults around the world. DR seriously affects the quality of life of diabetic patients. The retinal pigment epithelium (RPE) is the outermost layer of the retina and is essential for maintaining visual function. RPE cells secrete pigment epithelium-derived factor (PEDF), a natural glycoprotein with a molecular weight of 50 000. PEDF is a member of the serine protease superfamily. Existing studies have demonstrated that PEDF has a wide variety of biological activities, including angiogenesis inhibition, antioxidant, anti-inflammatory, and neurotrophic activities, which have significant effects on a variety of diseases, including DR. The pathogenesis of DR is complex and is related to oxidative stress, inflammatory response, mitochondrial dysfunction, vascular endothelial growth factor (VEGF), abnormal activation of microglia, and accumulation of advanced glycosylation end-products (AGEs), which involves the Wnt/β-cantenin signaling pathway, mitochondrial uncoupling proteins (UCPs), nuclear factor-κB (NF-κB) pathway, peroxisome proliferator-activated receptor γ (PPARγ), AGEs, etc. PEDF may work through these targets and pathways to prevent the occurrence and development of DR. This paper mainly focus on the function of PEDF, including inhibition of neovascularization, anti-oxidative stress and anti-inflammation, and elaborate on the mechanism of PEDF on inhibiting the occurrence and development of DR through different targets and pathways, providing a theoretical basis for the development of new DR therapeutic drugs.

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    Advances in research on the risk factors and pathogenesis of connective tissue disease-associated interstitial lung disease
    SHAO Xinlin, ZHU Xuemei, CAO Hua
    2024, 23 (02):  202-209.  DOI: 10.16150/j.1671-2870.2024.02.015
    Abstract ( 33 )   HTML ( 2 )   PDF (1728KB) ( 16 )  

    Connective tissue disease-associated interstitial lung disease (CTD-ILD) is a group of lung diseases caused by connective tissue diseases, with an incidence ranging from 10% to 50% and a mortality rate as high as 20%. The clinical manifestations and imaging features are heterogeneous. However, its pathogenesis is not fully understood. Exploring the risk factors and pathogenesis is crucial for the diagnosis, treatment and prognosis management of CTD-ILD. The risk factors for CTD-ILD are diverse. Firstly,genetic factors play an important role in pathogenesis. Mutation rate of telomere-related genes (including TERT, RTEL1, PARN, and SFTPC) in CTD-ILD patients is three times as high as that of general population. The risk of developing CTD-ILD in patients with the mutation in MUC5B promoter is more than twice that of normal people. The mutations in the TOLLIP and HLA-DRB1 are also associated with increased disease susceptibility. In addition, medications used to treat CTD may also increase the risk of developing ILD. Approximately one-third of CTD-ILD patients also suffer from gastroesophageal reflux disease. Chronic smoking and exposure to air pollution may also increase the incidence of CTD-ILD. CTD-ILD patients with infections have a higher risk of severe outcomes (OR 1.34-2.73) and increased mortality risk (OR 1.2-4.3). The pathogenesis of CTD-ILD involves the abnormality of the immune system, which is mainly manifested in the production of autoantibodies (such as systemic sclerosis-related antibodies and myositis-specific antibodies), the dysfunction of immune cells (such as neutrophils, natural killer cells, Th2 and Th17) and the extensive release of cytokines (such as TNF-α, TGF-β, IL-6 and IL-8), which exist in more than 50% of CTD-ILD patients. The risk factors and pathogenesis of CTD-ILD are complex. Risk prediction model based on these factors may help identify high-risk individuals accurately, which can provide new strategies for the prevention and treatment of the disease, improve the long-term prognosis of patients.

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    Medical education
    Pattern of standardized training for laboratory physicians in Ruijin Hospital and related experience
    MENG Jun, ZHOU Siqi, LU Yiyi, LIANG Qiuli, DAI Jing
    2024, 23 (02):  210-213.  DOI: 10.16150/j.1671-2870.2024.02.016
    Abstract ( 21 )   HTML ( 2 )   PDF (962KB) ( 8 )  
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    Exploring about the application of multimodal teaching in clinical nuclear medicine teaching
    YIN Hongyan, GU Taoying, ZHANG Yifan, XIU Yan
    2024, 23 (02):  214-218.  DOI: 10.16150/j.1671-2870.2024.02.017
    Abstract ( 14 )   HTML ( 2 )   PDF (983KB) ( 3 )  
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