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25 June 2019, Volume 18 Issue 03 Previous Issue    Next Issue

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Analysis of structural characteristics of gut microbiome in colitis mice based on 16S rRNA high-throughput sequencing WANG Tingting, ZHENG Naisheng, YUAN Xiangliang, SHEN Lisong 2019, 18 (03):  263-270.  DOI: 10.16150/j.1671-2870.2019.03.005 Abstract ( 595 )   HTML ( 7 )   PDF (1499KB) ( 139 )   Objective: To clarify the interrelationship between ulcerative colitis (UC ) and gut microbiome for providing an experimental basis to find a simple and safe treatment for patients with ulcerative colitis. Methods: A model of ulcerative colitis in mice was established by 3% DSS (dextran sulfate sodium), and the body weight and intestinal pathological changes of the model mice were detected. The diversity and differences of gut microbiome in feces of ulcerative colitis mice and normal mice were identified by 16S rRNA high-throughput sequencing technology. The existing gene database was used to estimate the functional gene composition of the intestinal flora and the functional differences between the two groups. Results: The results of comparative analysis showed that the weight of ulcerative colitis mice was significantly reduced, the integrity of intestinal epithelium was destroyed, and the diversity of gut microbiome was significantly reduced. Bifidobacterium in intestinal tract of ulcerative colitis mice decreased to 0.2%, which was significantly lower than that of mice in control group (P<0.05); and the relative abundance of Lactobacillus also decreased to 2.9% (P<0.05), which denoted that ulcerative colitis might be caused by its influence on metabolism of the body. Conclusions: The diversity and distribution of gut microbiome in ulcerative colitis mice have changed significantly. Figures and Tables | References | Related Articles | Metrics

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Clinical value of simultaneous 18F-FDG PET/MR molecular imaging in localizing seizure foci in epilepsy patients ZHANG Miao, HUANG Peng, ZHAN Shikun, MENG Hongping, HUANG Xinyun, LIN Xiaozhu, ZHANG Yifan, CAO Chunyan, SUN Bomin, LI Biao, LIU Wei 2019, 18 (03):  271-277.  DOI: 10.16150/j.1671-2870.2019.03.006 Abstract ( 367 )   HTML ( 2 )   PDF (1326KB) ( 98 )   Objective: To analyze the clinical value of simultaneous 18F-FDG PET/MR imaging(PET/MRI) in precise localization of epileptogenic lesion. Methods: Twenty-five patients with drug-refractory epilepsy were enrolled.All patients underwent simultaneous PET/MR during the interval of epilepsy. The epileptogenic foci were identified by stereo-tactic electroencephalography (SEEG) or surgical pathology in all patients within one month after PET/MRI. The sensitivity and specificity of three imaging modalities including single MRI, single PET and PET/MRI in localizing epileptogenic foci were compared. The standard deviation (SD) values of each brain region were assessed by matching the epileptogenic foci with the normal PET/MR brain metabolic database by MI Neurology software. The differences of SD values and mean standardized uptake value mean (SUVmean) between the lesions and the oppositesite brain regions were compared. Results: The sensitivity and specificity of single MRI in locating epileptogenic focus were 37.5% (9/24) and 100% (4/4), respectively. There were 15 epileptogenic focus which could not be displayed by single MR, among which there were fourteen focus with no structure abnormal. PET/MRI can detected twelve of these fourteen lesions and the sensitivity of PET/MRI in localizing epileptogenic foci was 91.6% (22/24), which was significantly higher than that of single MRI (P< 0.05). The specificity of PET/MRI was 100%. The combination of PET and MRI reduced false-positive diagnosis. At the same time, MRI could provide a very clear anatomical structure and help foraccurate localization. The SD value of epileptogenic foci was -6.16+2.26 and that of opposite healthy side was -0.72+0.89. The SD value of epileptogenic lesion was significantly lower than that of control area (P<0.01). Conclusions: Simultaneous PET/MRI fully combines the advantages of two imaging methods. For the nonstructural abnormal epileptogenic foci, combined MRI with PET (including quantitative PET) can detect the MRI-negative foci, and with the high resolution and clear defining of anatomical structure, MRI combined with PET can accurately evaluate the location and scope of the foci on the same machine, which provides great help to design surgical therapy plan and denotes great application prospect in the individualized and precise medical treatment of epilepsy. Figures and Tables | References | Related Articles | Metrics

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The value of myocardial deformation analysis based on deformable registration algorithm in the diagnosis and prediction of prognosis of hypertrophic cardiomyopathy ZHU Lan, GU Shengjia, CHEN Chihua, CAO Qiqi, ZHOU Xiaoyue, YAN Fuhua, MIN Jihua 2019, 18 (03):  278-285.  DOI: 10.16150/j.1671-2870.2019.03.007 Abstract ( 372 )   HTML ( 1 )   PDF (927KB) ( 67 )   Objective: To explore the value of myocardial strain analysis based on deformable registration algorithm (DRA) in the diagnosis of hypertrophic cardiomyopathy (HCM) and its relationship with prognostic risk factors. Methods: Twenty- three patients who were diagnosed as HCM in our hospital with (50.70±14.80) years old were collected retrospectively.In addition, 23 volunteers who matched the age and sex were also recruited. All volunteers underwent a cardiac MRI (CMR) scan consistent with the patients with HCM. According to the presence or absence of late gadolinium enhancement (LGE), the HCM group was divided into non-enhanced [LGE(-)] subgroup andenhanced [LGE(+)] subgroup.Images of patients with HCM and volunteers were analyzed using the DRA-based myocardial deformation post-processing software named TrufiStrain. The measurement parameters includedglobal peak radial strain (GPRS), global peak circumferential strain (GPCS), global peak longitudinal strain (GPLS), and peak radial, circumferential and longitudinal strain(PRS, PCS, and PLS) of different parts of the left ventricle (the apex, the middle of left ventricle, and the base). Student-t test or Mann-Whitney, Pearson correlation analysis, ROC curve were used to statistically analyze the diagnostic efficacy of myocardial deformation parameters in HCM and its relationship with left ventricular wall thickness and LGE. Results: Other than apical PCS, all GPRS, GPCS, GPLS, basal and medial PRS, PCS, PLS, and apical PRS, PLS in patients with HCM were significantly lower than those in healthy volunteers (P<0.05). The global, apical, basal and medial radial, circumferential and longitudinal strain and strain rate of the patients with HCM were significantly smaller than those of the control group (P<0.05). The basal and medial PRS, PCS, PLS of both the control group and the LGE(-) subgroup were significantly higher than those in LGE (+) subgroup (P<0.05). The ratio of radialstrain rate during early and late diastole (REL）, circumferentialstrain rate during early and late diastole (CEL) and longitudinal strain rate during early and late diastole (LEL) of patients in LGE (+) subgroup were smaller than those in LGE(-) subgroup and the control group (P<0.05). GPRS, GPCS, GPLS, REL, CEL and LEL were all significantly correlated with the maximum thickness of left ventricular myocardium (P<0.05). ROC curve analysis showed that areas under the curve of GPRS, GPCS, GPLS, REL, CEL and LEL for the diagnosis of HCM were 0.686, 0.905, 0.921, 0.972, 0.974 and 0.917, respectively. The areas under the curve of GPRS, GPCS, GPLS, REL, CEL and LEL for predicting LGE in patients with HCM were greater than 0.871. Conclusions: DRA-based myocardial deformation analysis is of great value in diagnosing HCM and predicting LGE in HCM patients and is closely correlated to myocardial thickness. Figures and Tables | References | Related Articles | Metrics

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Radiological findings on pituitary MRI in central precocious puberty ZHU Xiaolei, CHEN Lu, LU Wenli, LIU Yan, YAN Fuhua, WANG Wei, DONG Zhiya 2019, 18 (03):  286-290.  DOI: 10.16150/j.1671-2870.2019.03.008 Abstract ( 636 )   HTML ( 2 )   PDF (698KB) ( 106 )   Objective: To investigatethe features of pituitary MRI in different age groups of girls with central precocious puberty (CPP), and to compare the clinical and biochemical parameters and the proportion of abnormal pituitary MRI imaging to provide a clinical basis for exploring the necessity of pituitary MRI in CPP girls. Methods: A total of 474 cases of CPP girls diagnosed in our department from 2013 to 2016 were collected. The average age was (7.90±1.58) years old. Patients were divided into two groups according to age: less than or equal to 6 years old group and greater than 6 years old group. All patients had a complete pituitary MRI plain scan, or plain scan + enhanced MRI. Two radiologists observed the imaging of all these children, and recorded positive and negative findings; and the two groups were compared. Results: Of the 474 CPP girls, 52 (10.9%) had abnormal pituitary MRI findings. There were 2 cases of pituitary MRI abnormalities in the group of children less than or equal to 6 years old, and the 2 cases were diagnosed as hamartoma. There were 50 cases of pituitary MRI abnormalities in the group older than 6 years old. The imaging diagnosis was 1 case of germ cell tumor, 1 case of clear septum cyst, 2 cases of pineal cyst, 19 cases of Rathke cyst, and 27 cases of microadenoma. Among the 11 children who were less than or equal to 6 years old, 2 were positive, and 50 of the 463 children older than 6 years were positive. The chi-square test was not statistically significant (χ2=0.514 4, P>0.05). Conclusions: In children with CPP, there is a certain proportion of abnormal pituitary MRI findings in children before 6 years and after 6 years of age. It is recommended that pituitary MRI should be performed in all the children with CPP. Figures and Tables | References | Related Articles | Metrics

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Value of quantitative assay of urinary LH and FSH in differentiating classic from transitional premature thelarche MA Xiaoyu, LU Wenli, NI Jihong, WANG Junqi, CHEN Ye, Qin Xueyan, DONG Zhiya, WANG Wei 2019, 18 (03):  291-295.  DOI: 10.16150/j.1671-2870.2019.03.009 Abstract ( 270 )   HTML ( 3 )   PDF (668KB) ( 106 )   Objective: To investigate the value of quantitative assay of urinary FSH and LH in differentiating classic from transitional premature thelarche. Methods: A total of 112 girls with breast development before 8 years of age and undergone both LHRH stimulation and urinary LH and urinary UFSH assay were enrolled. Of them 53 girls with CPP (central precocious puberty) started treatment immediately, whereas the other 49 girls were observed 6 months for pubertal advancement, gonadal hormone, height acceleration, and bone age maturation, and were categorized into two groups: the classic premature thelarche group and the transitional premature thelarche group. Results: In both groups, the serum LH level was positively correlated with morning urinary LH level. The morning urinary LH/FSH of girls at first visit in classic premature thelarche and transitional premature thelarche were 0.50±0.35 and 1.16±1.08, respectively, the difference was statistically significant (P<0.05). Urinary LH/FSH could differentiate girls with classic premature thelarche from transitional premature thelarche. Receiver operating characteristics analysis showed an LH/FSH cutoff value of 0.512, sensitivity of 80% and specificity of 56%. Conclusions: Urinary LH/FSH assay is a noninvasive, reliable method that can assist the differentiation between classic from transitional premature thelarche. Figures and Tables | References | Related Articles | Metrics

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Report of a case of activated phosphoinositide 3-kinase δ syndrome with onset of repeated bloody stool and review of literature YANG Yuanyan, XIAO Yuan, CHEN Xiaoyan, SU Wen, XU Chundi, ZHANG Qingqing 2019, 18 (03):  296-300.  DOI: 10.16150/j.1671-2870.2019.03.010 Abstract ( 356 )   HTML ( 2 )   PDF (1036KB) ( 86 )   Objective: To investigate the clinical features, endoscopic appearance and genetic characteristic of a child with activated phosphoinositide 3-kinase δ syndrome (APDS) with onset of recurrent bloody stools. Methods: A 19-month-old girl who was diagnosed with APDS because of PIK3CD mutation was admitted into Ruijin Hospital in December 2018. The clinical manifestations, biochemical tests, immunological function, treatment, and follow-up of the patient were analyzed.And Chinese database and PUBMED database were searched for literature review. Results: The child had chronic diarrhea and suffered intestinal infection for 4 times. Serum immunoglobulin levels were decreased: IgG 1.16 g/L,IgA 0.11 g/L, IgM 2.81 g/L. The T cell subset detection found increased CD8+ and decreased CD4+: CD3+ 61.30%, CD3+CD4+ 26.30%, CD3+CD8+ 33.80%, CD56+CD16+ 27.80%, CD19+10.40%. Colonoscopy found lymphonodular hyperplasia. A mutation of c.3061G>A(p.E1021K) in PIK3CD gene was found by whole-exome sequencing. Related literature searched showed that APDS patients had repeated respiratory infections, CM virus and/or EB virus infection, lymphoid tissue hyperplasia as the main manifestations. Conclusions: This is the first report of a case of APDS with onset of recurrent bloody stool in our country. For low aged children who has repeated bloody stools, especially those with lymphonodular hyperplasia found under colonoscopy, should have abnormal immunological findings tested and differentiated from primary immunodeficiency diseases.APDS could be diagnosed by relevant genetic test. Figures and Tables | References | Related Articles | Metrics

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Value of MRI combined with DWI in differential diagnosis of benign papillary lesions with malignant papillary lesions of breast LI Xinyue, TAN Lin, CHAI Weimin 2019, 18 (03):  301-306.  DOI: 10.16150/j.1671-2870.2019.03.011 Abstract ( 451 )   HTML ( 4 )   PDF (780KB) ( 124 )   Objective: To assess the value of magnetic resonance imaging (MRI) in the differential diagnosis of benign papillary lesions with malignant papillary lesions of the breast. Methods: A retrospective analysis of breast MRI findings of 146 papillary lesions of the breast with pathologically confirmed diagnosis (106 benign lesions and 40 malignant lesions）was performed. The MRI findings were categorized according to MRI BI-RADS 2013 edition. Time-signal intensity curve(TIC） and apparent diffusion coefficient (ADC) map were obtained from the1.5 T Siemenseaera workstation. ROIs were drawn on ADC map of the slice with the largest tumor area using b=800 s/mm2, avoiding necrotic or cystic parts. The early enhancement rate was measured within 1.5 min after injection. Results: In the mass cases, malignant lesions tended to appear more commonly in irregular shape than benign lesions （100.0% vs 62.2%）（P<0.05）. The margin of the benign lesions was circumscribed in 54.1%（40/74）, and the margin of the malignant lesions was spiculated in 56.3%（9/16）; 59.5% of the benign lesions were less than 1cm（44/74）, while 100.0% of the malignant lesions were between 1-5 cm（16/16）（P<0.05）. Benign lesions were presented as homogeneous-enhancement in 47.3% (35/74), and malignant lesions were presented as heterogeneous-enhancement in 75.0%（12/16）（P<0.001）. The papillary lesions of the breast tended to be locatedat periphery（benign 70.3% vs malignant 68.8%）. In the non-mass lesions, all the papillary lesions tended to appear in segmental distribution （benign 56.3% vs malignant 62.5%）. Diffuse distribution was more common in malignant papillary lesions（25.0% vs 6.3%）（P<0.05）, and focal distribution was more common in benign papillary lesions（37.5% vs 12.5%）（P>0.05）. Both benign and malignant lesions tended to present plateau and wash-out curves （71.7% vs 95.0%）. Malignant lesions were more commonly to be cystic (solid portion<25%) than benign lesions (10.0 % vs 0.9%). All the papillary lesions tended to be duct-dilated（62.3% vs75.0%）. The mean ADC value was lower in malignant lesions (0.95×10-3 mm2/s vs 1.13×10-3 mm2/s). Conclusions: The shape, margin, size, enhancement pattern of masslesions, distribution of non-mass lesions and ADC had diagnostic value for the differentiation of benign papillary lesions with malignant papillary lesions of the breast. Figures and Tables | References | Related Articles | Metrics

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Study on clinical value of ultrasound elastography combined with ACR-TIRADS in differential diagnosis of benign and malignant thyroid nodules JI Qin, ZHOU Yifan, CHEN Mo, LI Jie, DING Wenbo, QIAN Tao, CHU Xiaoqiu, WANG Jianhua, XU Shuhang, LIU Chao 2019, 18 (03):  307-312.  DOI: 10.16150/j.1671-2870.2019.03.012 Abstract ( 449 )   HTML ( 3 )   PDF (796KB) ( 60 )   Objective: To analysis retrospectively the value of The Thyroid Imaging Report and Data System recommended by American College of Radiology (ACR-TIRADS) 2017 and ultrasound elastographyalone or in combination for the differential diagnosis of benign and malignant thyroid nodules. Methods: From January 2012 to October 2017, 503 patients with 653 thyroid nodules underwent preoperative thyroid ultrasonography and thyroidectomy at the Integrated Chinese Traditional Medicine and Western Medicine Hospital were enrolled. General clinical information, thyroid ultrasound report, ultrasound elastography and results of postoperative pathology were collected. All the nodules were graded by ACR-TIRADS, elastography grading and scoring system. The four differential diagnostic categories were as follows:category 1, either elastography or ACR-TIRADS considered as malignant nodules; category 2, both elastography and ACR-TIRADS considered as malignant nodules; category 3, elastography score and grade of ACR-TIRADS added; category 4, elastography score and ACR-TIRADS score added. The postoperative pathological results were regarded as a gold standard to construct the receiver operating-characteristic curve (ROC), calculate the area under the curve (AUC), and the best cutoff value was defined according to the Yoden index. Results: The AUC of ACR-TIRADS was as high as that of ultrasound elastography (0.853 vs. 0.848, P=0.745). Category 1 had a differential diagnosis value with higher sensitivity (96.94%) and the negative predictive value (84.85%). The category 2 had a specificity of 88.96% and a positive predictive value of (95.53%). The sensitivity of category 3 was higher than that of category 4 (88.78% vs. 85.92%, P<0.001). There was no statistical difference between AUC of category 3 of category 4.(0.913 vs. 0.901, P=0.088). Conclusions: ACR-TIRADS is superior to ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. Both category 3 and category 4 are superior to ACR-TIRADS or ultrasound elastography alone. The category 4 has a higher discriminatory value in the differential diagnosis of benign and malignant thyroid nodules. Figures and Tables | References | Related Articles | Metrics

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Study on circadian blood pressure rhythmandrelated influencing factors in outpatients HUANG Jianfeng, SHENG Changsheng, HUANG Qifang, CHENG Yibang, GUO Qianhui, ZHANG Dongyan, WANG Jiguang, LI Yan 2019, 18 (03):  313-318.  DOI: 10.16150/j.1671-2870.2019.03.013 Abstract ( 484 )   HTML ( 0 )   PDF (573KB) ( 72 )   Objective: Based on an electronic reporting system of ambulatory blood pressure monitoring (ABPM), the circadian blood pressure rhythm and related influencing factors in outpatients were analyzed. Methods: From February 2017 to February 2018, 5 545 outpatients with eligible ABPM data in the Shuoyun electronic reporting system were recruited. Of them there were 2 524 males and 3 021 females, with an average age of (53±14.3) years. The rate of nocturnal systolic blood pressure(SBP) decrease was calculated, according to which the circadian rhythm was categorized into four types:reverse-dipper, non-dipper, dipper and extreme-dipper. Results: The number of dippers was the most (2 323, 41.9%), followed by non-dippers (2 318, 41.8%), and the reverse-dippers (532, 9.6%) and extreme-dippers (372, 6.7%) were much less. The reverse-dippers were the oldest [average age, (60.2±13.3) years], and the dippers were the youngest [(50.9±14.1) years]. The nighttime SBP, ambulatory arterial stiffness index (AASI), the proportion of concomitant diseases (diabetes, stroke, myocardial infarction) and the prevalence of hypertension of the reverse-dippers were higher than the others (P<0.05); the prevalence of hypertension in dippers was lower than the others.The average daytime SBP of the extreme-dippers was higher (P<0.05) than the others, while the nighttime SBP, AASI were lower(P<0.05) than the others. There were no significant differences in body mass index, proportion of taking antihypertensive drugs and hyperlipidemia among the groups (P>0.05). Logistic regression analysis showed that women, aging, diabetes mellitus and hypertension were risk factors for abnormal circadian rhythm, and patients taking antihypertensive drugs and smokers tended to be dippers (P<0.05). Conclusions: In outpatients of the Hypertension Clinic, around half have abnormal circadian blood pressure rhythm. Female, aging, the presence of diabetes and hypertension were risk factors, while patients on antihypertensive medication and smokers were more likely to be dippers. Figures and Tables | References | Related Articles | Metrics

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Value of NT-proBNP level in predicting prognosis of hospitalized elderly pneumonia patients without heart failure history LUO Xiaoying, ZHU Xuemei, XU Yan, ZHANG Fengru, WU Liqun, QI Wenhang 2019, 18 (03):  319-322.  DOI: 10.16150/j.1671-2870.2019.03.014 Abstract ( 357 )   HTML ( 1 )   PDF (465KB) ( 67 )   Objective: To analyze the value of NT-proBNP level in predicting prognosis of elderly pneumonia patients without heart failure history. Methods: A total of 503 hospitalized elderly pneumonia patients without heart failure history admitted from June 2015 to December 2018 and had NT-proBNP level detected at emergency room were enrolled. According to the interquartile range of serum NT-proBNP, patients were divided into low level group, lower level group, higher level group, and high level group. And according to the occurrence of death in hospital, patients were divided into death group (n=125) and survival group (n=378). The receiver operating characteristic curve (ROC) was used to analyze the predictive value of NT-proBNP on prognosis of elderly pneumonia patients without heart failure history and the optimal cutoff value.And multi-factor Cox regression analysis was used to analyze the influence of NT-proBNP level on prognosis of elderly pneumonia patients without heart failure history. Results: There was a difference in mortality between different groups of NT-proBNP level, and it was the highest in high level group (49.2%) (P<0.05). Compared with survival group, the NT-proBNP, serum creatinine, C reactive protein level were significantly higher and hemoglobin, serum albumin, estimated glomerular filtration rate were significantly lower（P<0.05）in death group; the occurrence of atrial fibrillation was higher and use of RAS blockers before admission was lower (P<0.05). Area under ROC (AUC) of NT-proBNP to predict in-hospital death was 0.714(95%CI: 0.504-0.925, P<0.01). The optimal cut-off value was 1 377.8 pg/mL, with a sensitivity of 75.8% and a specificity of 76.4%. Cox regression analysis indicated that NT-proBNP level（≥1 377.8 pg/mL）, hemoglobin (<131 g/L) and serum albumin(<35 g/L) were independent risk factors for the hospitalized elderly pneumoniapatients without heart failure (P<0.05). Conclusions: Serum NT-proBNP level has a substantial value for predicting the prognosis in elderly pneumonia patients without heart failurehistory. Figures and Tables | References | Related Articles | Metrics

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Epidemiological investigation on cardiometabolic abnormalities in Songnan Community residents with type 2 diabetes LIU Shanshan, Niu Jingya, WANG Tiange, LI Mian, ZHAO Zhiyun, XU Yu, LU Jieli, XU Min, BI Yufang, ZHANG Di 2019, 18 (03):  323-328.  DOI: 10.16150/j.1671-2870.2019.03.015 Abstract ( 366 )   HTML ( 1 )   PDF (621KB) ( 42 )   Objective: To investigate the prevalence of cardiometabolic abnormalities and the association between the risk factors and cardiometabolic abnormalitiesin community residents with type 2 diabetes. Methods: A cross-sectional study was conducted among 1 322 diabetic adults aged 40 years in Songnan district, Shanghai in 2009. Clinical data, anthropometric measurements, and results of biochemical analysis were collected, and participants were categorized into male and female and divided into three groups according to the number of cardiometabolic abnormalities present (including general obesity or abdominal obesity, hypertension, dyslipidemia, albuminuria, elevated CIMTmax): group 1 (0-2 abnormality), group 2 (3 abnormalities), and group 3(4-5 abnormalities), to analyze the association between risk factors such as age, sex, glycated hemoglobin and cardiometabolic abnormalities. Results: Of the 1 322 type 2 diabetic patients, there were 501 men and 731 women, average age was (64.1±9.8) years. Ratios of cardiometabolic abnormalities in male vs. female diabetic patients were 9.8% vs. 17.4% (general obesity); 57.5% vs. 69.6% (abdominal obesity); 72.9% vs. 76.6% (hypertension); 50.1% vs. 55.3% (dyslipidemia); 26.4% vs. 23.9% (albuminuria); 19.1% vs.12.0% (elevated CIMTmax). Multiple logistic regression analysis showed that increasing age, high serum HbA1c and C reactive protein levels, current smoking,and insulin resistance were risk factors of associated cardiometabolic abnormalities(all P<0.05). Conclusions: A high prevalence of cardiometabolic abnormalities existed in community residents with type 2 diabetes in Songnan district, Shanghai.Increasing age, high serum HbA1c and C reactive protein levels, current smoking, and insulin resistance are correlated with the increase of associated cardiometabolic abnormalities. Figures and Tables | References | Related Articles | Metrics

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Value of new-type serum fibrosis-related biomarkers level in diagnosing IgG4-related disease ZHOU Xinyun, CHEN Hui, SHEN Lisong 2019, 18 (03):  329-333.  DOI: 10.16150/j.1671-2870.2019.03.016 Abstract ( 284 )   HTML ( 0 )   PDF (515KB) ( 51 )   Objective: To explore serological biomarkers which can be used for diagnosing IgG4-related diseases (IgG4-RD) and to analyze its correlation with involvement of IgG4-RD and patients' response to corticosteroid therapy. Methods: Seventy-two patients with untreated IgG4-RD from January 2015 to January 2019 were enrolled. The serum concentrations of growth differentiation factor 15 (GDF-15), CC chemokine ligand 2 (CCL2), hyaluronic acid (HA), amino-terminal propeptide of type Ⅲ procollagen (PⅢNP), and tissue inhibitor of metalloproteinases 1 (TIMP-1) were measured by enzyme-linked immunosorbent assay. The enhanced liver fibrosis (ELF) score was calculated from the TIMP-1, PⅢNP and HA values. The value of these biomarkers in reflecting the degree of tissue fibrosis and extent of organ involvement was assessed. Results: Compared with healthy controls, patients with IgG4-RD had significantly elevated serum concentrati-ons of GDF-15, HA, PⅢNP, and TIMP-1; the average concentrations of CCL2, HA, PⅢNP and TIMP-1 were 1 121 pg/mL, 398 pg/mL, 87.2 ng/mL and 211 ng/mL, respectively. The ELF score of IgG4-RD patients was also significantly elevated (11.2). Among them, serum GDF-15 of 666 pg/mL distinguished most efficiently patients with IgG4-RD from healthy controls (area under ROC 0.92, sensitivity 77.8%, specificity 100%). Conclusions: New-type serological biomarker GDF-15 and CCL2 have substantial clinical value in diagnosis of IgG4-RD but can not reflect the severity of organ involvement and degree of fibrosis, or cannot be served as criteria of outcome of corticosteroid treatment. Figures and Tables | References | Related Articles | Metrics

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Effect of laser-assisted hatching with complete removal of zona pellucida on the outcome of frozen single blastocyst transfer HUANG Ya, XU Li, GE Fengju, WU Yunlong, CHEN Yaning, QI Xiujuan 2019, 18 (03):  334-339.  DOI: 10.16150/j.1671-2870.2019.03.017 Abstract ( 394 )   HTML ( 3 )   PDF (788KB) ( 97 )   Objective: To study the effect of laser-assisted hatching with complete removal of zona pellucida on pregnancy outcomes such as pregnancy rate and embryo implantation rate of frozen single blastocyst transfer. Methods: The cases of 200 cycles of single blastocyst transfer in Shanghai Towako hospital from September 2016 to August 2018 were enrolled and were divided into two groups randomly. Partially thinned zona pellucida was performed in the control group and complete removal of zona pellucida was performed in the study group. The general information of the patients including age, body mass index (BMI), cause of infertility, basic FSH level, etc, good quality embryo rate, cleavage rate, blastocyst formation rate, pregnancy rate, embryo implantation rate, monozygotic twins rate and abortion rate were observed and compared. Results: The age, BMI, cause of infertility in the study group were not significantly different from those of the control group (P>0.05). There were also no significant differences in good quality embryo rate, cleavage rate and blastocyst formation rate (P>0.05) between the two groups, and the pregnancy rate and embryo implantation rate in the study group were significantly higher than those in the control group (P<0.05), and the rates of monozygotic twins and abortion were significantly lower than those of the control group (P<0.05). Conclusions: Complete removal of zona pellucida before frozen blastocyst transfer can be an effective method to improve the success rate of single blastocyst transfer. Figures and Tables | References | Related Articles | Metrics

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Feasibility of dual-energy CT in evaluation of marrow edema of gouty arthritis ZHU Siqi, WU Mengxiong, QIN Le, DONG Haipeng 2019, 18 (03):  340-343.  DOI: 10.16150/j.1671-2870.2019.03.018 Abstract ( 424 )   HTML ( 0 )   PDF (488KB) ( 71 )   Objective: To investigate the feasibility of dual-energy CT in the evaluation of marrow edema of gouty arthritis. Methods: One hundred and sixty-one patients who had undergone plain dual-energy CT and diagnosed as gout between January 2017 and June 2018 were retrospectively analyzed. All examinations were performed on dual-source CT (Somaton Definition Flash, Siemens, Germany) with tube voltage of Sn140 kVp and 80 kVp. Then the images were transferred to Syngo. via (Siemens, Germany) postprocessing workstation for further analysis with 'marrow edema' module to diagnose marrow edema and acquire CT values on (double energy-virtual non-calcium, DE-VNC) images. MRI images of corresponding sites were also analyzed by the sequence of T1WI (T1 weighted imaging), T2WI (T2 weighted imaging) and STIR (short T1 inversion recovery). Results: After being analyzed by Syngo.via postprocessing workstation, it had been demonstrated that CT values between sites with marrow edema, sites adjacent to marrow edema and sites distant to marrow edema had significant differences (P<0.05). Based on the golden standard of MRI images, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of dual-energy CT was 82.2%, 90.7%, 86% and 88.1%, respectively. Twelve missed cases was due to widespread bone destruction. Conclusions: Not only could dual-energy CT detect gouts, it also has good diagnostic accuracy in the evaluation of marrow edema of gouty arthritis. Cases with widespread bone destruction may be missed. Figures and Tables | References | Related Articles | Metrics

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Improved imaging quality and diagnostic performance of low dose CT scan of lumbar intervertebral disc by combined with IMR reconstruction FANG Shu, DU Lianjun, QIN Le, DONG Haipeng, YAN Fuhua, WANG Tao 2019, 18 (03):  344-348.  DOI: 10.16150/j.1671-2870.2019.03.019 Abstract ( 344 )   HTML ( 2 )   PDF (672KB) ( 122 )   Objective: To study the CT imaging quality of low dose scanning lumbar intervertebral disc combined with IMR reconstruction and its consistency with MRI diagnosis. Methods: Forty patients suspected of lumbar intervertebral disc diseases were enrolled in the study. All patients underwent lumbar plain CT and MRI examination. Patients were divided into two groups: low-dose group (100 kV and DoseRight index 15) and conventional dose group（100 kV and Dose Right index of 26）. Images were reconstructed along the direction of the intervertebral space with 1 mm thickness. Images in the low-dose group were reconstructed by filtering back-projection (FBP) and IMR (level 1, soft tissue algorithm), while those in the conventional dose group were reconstructed by FBP algorithm. Parameters of each intervertebral disc were measured, including the CT value of intervertebral disc, yellow ligament, vertebral canal, lumbar major or iliopsoas muscle, and subcutaneous fat noise in the back. SNR (signal to noise ratio) and CNR (contrast to noise ratio) were calculated, respectively. Imaging quality was evaluated by 5-scale points. MRI was defined as the reference standard to evaluate the diag-nostic accuracy. Results: Radiation dose indices in the low dose group were significantly lower than those in the conventional dose group [CTDIvol: （5.49±1.48） mGy vs（1.06±4.42） mGy; DLP: （182.36±51.10） mGy·cm vs （730.05±182.45） mGy·cm; Effective dose: （2.35±0.66） mSv vs （9.42±2.35） mSv, P<0.05]. The SNR and CNR of IMR images of the low-dose IMR group were superior to those of FBP images of low-dose and conventional-dose group(P<0.05). The diagnostic accuracy of low-dose IMR images (95%) was significantly higher than that of FBP images in low-dose group(45%) and was similar to that of FBP images of conventional-dose group (90%). Conclusions: Low-dose CT scan of intervertebral disc combined with IMR reconstruction algorithm can improve imaging quality and diagnostic performance. Figures and Tables | References | Related Articles | Metrics

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Prognostic value of 18F-FDG PET/CT metabolic parameters in NK/T cell lymphoma SHEN Wenbin, GUO Rui, LI Biao 2019, 18 (03):  349-352.  DOI: 10.16150/j.1671-2870.2019.03.020 Abstract ( 564 )   HTML ( 0 )   PDF (462KB) ( 65 )   Objective: To analyze the prognostic value of metabolic parameters of 18F-FDG PET/CT examination [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)] in patients with natural killer (NK)/T-cell lymphoma. Methods: A retrospective analysis of 27 patients with pathologically confirmed NK/T-cell lymphoma who underwent baseline PET/CT before treatment and then receiving the same treatment was performed. The median follow-up was 23 months. Each patient had at least one PET/CT re-assessment during follow-up or at the end of treatment. The PET/CT metabolic parameters SUVmax, MTV and TLG were analyzed statistically. The Kaplan-Meier survival curve was used to assess the progression-free survival (PFS) and overall survival (OS). Results: Of the 27 patients, 5 had disease progression and 3 of them died. Among the PET/CT parameters, MTV and TLG were the predictors of PFS in patients with NK/T-cell lymphoma (MTV: P=0.013, TLG: P=0.029), while SUVmax could not predict PFS (P=0.661). However, none of the 3 metabolic parameters could predict the OS (SUVmax, P=0.293; MTV, P=0.198; TLG, P=0.108). Conclusions: 18F-FDG PET/CT metabolic parameters MTV, TLG may help predicting PFS in patients with NK/T-cell lymphoma, but cannot predict OS; SUVmax is of little value in prognostic prediction of NK/T-cell lymphoma Figures and Tables | References | Related Articles | Metrics

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Clinical value of serum procalcitonin in patients of chronic kidney disease with bacterial infection WANG Yuanyuan, FAN Qiuling 2019, 18 (03):  353-359.  DOI: 10.16150/j.1671-2870.2019.03.021 Abstract ( 257 )   HTML ( 1 )   PDF (788KB) ( 59 )   Objective: Clinical data of chronic kidney disease(CKD) patients (n=354) of different disease stages were collected to analyze the median serum procalcitonin (PCT) level and diagnostic value of serum PCT in CKD patients with bacterial Infection. Methods: A total of 354 CKD patients admitted to the First Affiliated Hospital of China Medical University, including 153 patients with bacterial infection and antibiotics treatment and 201 patients without infection, were enrolled in this study. According to eGFR, patients were divided into stage 1, stage2, stage3, stage4, stage5 with nondialysis andstage5 with hemodialysis (HD) groups. Spearman correlation was used to analyze the relationship between PCT and serum creatinine and eGFR. ROC curve was used to analyze the diagnostic efficacy of serum PCT in different stage CKD patients with bacterial infection. Multivariate logistic regression analysis was used to assess the impact factors of infection. Results: The serum PCT level of CKD patients with infection was significantly higher than that of non-infected. The dynamic change of PCT was in parallel with recovery of clinical infection.PCT was positively correlated with serum creatinine, and negatively correlated with eGFR. Serum PCT cutoff values for differentiating infection and non-infection in overall CKD, stage 3, stage 4, stage 5 with nodialysis and with hemodialysis (HD) groups were 0.40 ng/mL,0.12 ng/mL, 0.23 ng/mL, 0.28 ng/mL and 0.60 ng/mL, respectively. Logistic regression analysis showed, WBC, PCT, CRP and serum albumin were independent risk factors for infection. Conclusions: PCT can be used as a useful clinical indicator of infection in different stages of CKD; the dynamic change of PCT has important diagnostic value in the diagnosis and treatment of CKD patients. Figures and Tables | References | Related Articles | Metrics

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Value of color Doppler ultrasonography in evaluation of stenosis and thrombosis of autogenous arteriovenous fistula FENG Wei, ZHU Haohui 2019, 18 (03):  360-364.  DOI: 10.16150/j.1671-2870.2019.03.022 Abstract ( 442 )   HTML ( 2 )   PDF (852KB) ( 83 )   Objective: To evaluate the value of color Doppler ultrasonography in evaluation of stenosis and thrombosis of autogenous arteriovenous fistula. Methods: Eighty six patients with suspected stenosis or thrombosis of autologous arteriovenous fistula in the dialysis center of our hospital from January 2015 to October 2017 were analyzed retrospectively. According to angiographic examination, patients were categorized into roughly normal group (20 cases), stenosis group (38 cases) and thrombosis group (28 cases). Results of color Doppler ultrasound examination (internal diameter of radial artery and cephalic vein, flow velocity ratio, degree of stenosis, presence or absence of thrombus and blood flow) were compared among the three groups. Results of angiography were used as the gold standard to evaluate the efficacy of color Doppler ultrasound examination for diagnosing fistula stenosis and thrombosis. Results: Compared with the roughly normal group, fistula diameter, cephalic vein diameter and blood flow were decreased in stenosis group and thrombosis group, while flow velocity ratio and degree of stenosis were increased, the differences were statistically significant (P<0.05). The ROC curve showed that the area under the curve of blood flow in diagnosing fistula stenosis was the highest (AUC=0.964), followed by flow velocity ratio (AUC=0.903) and stenosis (AUC=0.823), and internal diameter of fistula (AUC=0.697) was the smallest. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value by blood flow (<482.62 mL/min) for predicting stenosis were significantly higher than other indices (P<0.05). The diagnostic efficacy of color Doppler ultrasonography for diagnosing arteriovenous fistula thrombosis was similar to that of angiography（Kappa=0.931, P<0.001）. Conclusions: For the evaluation of stenosis and thrombosis of autologous arteriovenous fistula, color Doppler ultrasonography has a high application value, blood flow (less than 482.62 mL/min) predicts the presence of arteriovenous fistula stenosis. Figures and Tables | References | Related Articles | Metrics

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The clinical significance of screening irregular blood group antibodies and detecting its specificity in pregnant women SUN Wenjin, WANG Shuping, TANG Weixian, CHEN Huifen 2019, 18 (03):  365-367.  DOI: 10.16150/j.1671-2870.2019.03.023 Abstract ( 466 )   HTML ( 2 )   PDF (367KB) ( 86 )   Objective: To screen irregular blood group antibodies and detecte its specificity in pregnant women for exploring the presence of irregular antibodies and related clinical characteristics. Method: Microcolumn gel card was used to screen irregular blood group antibodies in pregnant women undergoing maternal examination in our hospital from January 2017 to August 2018 and analyzing the antibody specificity of positive screening specimens. Results: Of the 7 381 pregnant women, 32 had irregular blood group antibodies detected,the positive rate was 0.434%. Among them, 10 cases were anti-M, 3 cases were anti-E, 8 cases were anti-Ec, 4 cases were anti-D, 4 cases were anti-Lea, 1 case was anti-Dia, 1 case was anti-Wra,1 case was cold antibody. The pregnant women who had irregular blood group antibodies detected all had more than one pregnancy history. Conclusions: The irregular blood group antibodies detection rate was 0.434% in pregnant women taking maternal examination at our hospital; anti-M was the most frequent. The antibodies of Rh blood group system and MNS blood group system could lead to the occurrence of hemolysis disease in newborn infants. Figures and Tables | References | Related Articles | Metrics