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25 October 2019, Volume 18 Issue 05 Previous Issue    Next Issue

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Application of cardiac magnetic resonance feature-tracking in assessment of postoperative ventricular strain after repairing of single ventricle with Fontan operation HU Liwei, SUN Aimin, WANG Qian, GUO Chen, OUYANG Rongzhen, YAO Xiaofen, ZHONG Yumin 2019, 18 (05):  509-514.  DOI: 10.16150/j.1671-2870.2019.05.005 Abstract ( 252 )   HTML ( 1 )   PDF (828KB) ( 67 )   Objective: To compare 2D global strain between single left ventricle (SLV) group, single right ventricle (SRV) group after Fontan operation and normal healthy controls using feature tracking (FT) of cardiac magnetic resonance (CMR). Methods: Twenty two patients with single ventricle received Fontan operation with a mean age of (11.18±4.22) years and performing cardiac MRI(CMR) after Fontan operation between July 1, 2015 and January 30, 2017 were retrospectively analyzed. The mean year of MRI follow-up after surgery was (6.41±2.91) years. Of the 22 single ventricle patients, 6 were dominant left ventricle, 16 were 22 dominant right ventricle. Ten age-matched healthy children performing CMR were served as controls for providing reference values of strain. CMR function and ventricle strain comparisons were performed between SLV group, SRV group and control group. Bland-Altman method was used to compare the consistence among the groups. Results: End-diastolic volume index (117.79±56.82) mL versus (73.24±13.77) mL and ejection fraction(EF)(49.61±15.32)% versus (60.95±5.94)% were significantly different between healthy controls and Fontan operation repaired group(P<0.05). The comparison of SLV group and SRV group showed no significant difference in EF(49.00±17.68)% versus (48.0±13.77)% (P>0.05). In the comparison of strain among SLV, SRV and healthy control groups, the global longitudinal strain (-20.24±1.90) for SLV versus (-12.75±3.67) for SRV versus (-9.06±5.93) for controls was signi-ficantly different (P<0.05). The global longitudinal and circumferential strain of Fontan operation repaired groups had good consistence, and were better than radial strain. Conclusions: CMR-FT can be used as a method to evaluate cardiac function of complex congenital heart disease after Fontan operation. Compared with the ejection fraction, the 2D global longitudinal strain can be used as a reference value for evaluating the myocardial contraction function in single ventricle patients. Figures and Tables | References | Related Articles | Metrics

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Clinical application and evaluation of artificial intelligence-assisted semi-automatic segmentation software for detection of liver metastases from gastric cancer: intra-observer and inter-observer differences WANG Lan, ZHANG Huan, GE Yingqian, LU Jing, CUI Zheng, YAN Ling, PAN Zilai 2019, 18 (05):  515-520.  DOI: 10.16150/j.1671-2870.2019.05.006 Abstract ( 378 )   HTML ( 3 )   PDF (789KB) ( 133 )   Objective: To evaluate whether the differences within intra-observer and inter-observer can be reduced by the assisted segmentation based on artificial intelligence algorithm fordetection of liver metastasis from gastric cancer. Methods: Thirty two patients with liver metastasis from gastric cancer were retrospectively analyzed. Two radiologists blindly applied the Liver Lesion Analysis Tool (Siemens Healthineers, not for commercial use) for performing repeated measurement of the longest diameter and three-dimensional volume of liver lesions in CT images in a semi-automatic mode and by the manual mode. The measurements were repeated by one of the two radiologist after two weeks. The Bland-Altman method was used to evaluate the intra-observer and inter-observer differences. The intra-group correlation coefficient(ICC) was used to estimate the difference in variability. Results: In intra-observer analysis, the 95% consistency interval of the manual and semi-automatic longest diameter measurements were -31.70% -34.55% and -28.04% -27.89%, respectively. The 95% consistency interval ininter-observer of manual and semi-automatic longest diameter measurements were -74.26% -38.85% and -59.54% -40.98%, respectively. The 95% consistency interval inintra-observer of the manual and semi-automatic volume measurements were -148.10% -102.70% and -75.92% -63.79%, respectively, and in inter-observer were -127.40% -111.50% and -87.66% -43.77%, respectively. The ICC of the manual longest diameter measurement and the volume measurement variability inintra-observer were 0.914 and 0.950, respectively (P<0.001), and those in semi-automatic mode were 0.967 and 0.970, respectively (P<0.001). The ICC of the longest diameter and the volume measurement variability in inter-observer were 0.884 and 0.939, respectively (P<0.001), and those in semi-automatic were 0.928 and 0.974, respectively (P<0.001). The time required for semi-automatic mode was significantly shorter than that required for manual mode[（25.78±4.23） s vs （4.53±2.82） s, P<0.01]. Conclusions: The semi-automatic segmentation of liver metastasis using artificial intelligence-assisted automatic segmentation software is reproducible and can improve the efficiency of segmentation of liver metastases. The AI-assisted liver analysis tool has the potential to be a quantitative tool for clinical follow-up and treatment evaluation. Figures and Tables | References | Related Articles | Metrics

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The value of change of CT value in differentiating the nature of pulmonary pure ground-glass nodules XIAO Fuguo, PAN Zilai 2019, 18 (05):  521-525.  DOI: 10.16150/j.1671-2870.2019.05.007 Abstract ( 1342 )   HTML ( 1 )   PDF (770KB) ( 104 )   Objective: To explore the value of percentage of CT value increment, CT value and CT value increment for differentiating the pathologic character of pulmonary ground-glass nodules. Methods: Altogether 59 cases and 63 pure ground glass nodules pathologically diagnosed as preinvasive lesion at Ruijin Hospital and Renji Hospital affilia-ted to Shanghai Jiao Tong University School of Medicine from December 2012 to December 2018 were collected. The pathological classification were atypical adenomatous hyperplasia (AAH) (18 cases) and adenocarcinoma in situ(AIS）(45 cases). Their imaging manifestations were pure ground glass nodules. The diameter of AAH and AIS was ≤1.5 cm. The percentage of CT value increment, CT value and CT value increment of pure ground glass nodules and lung CT value were measured. The percentage of CT value increment denotes the percentage of increment of nodules CT value over lung CT value; CT value increment denotes the increment of nodule CT value over lung CT value. Student's t-test, binary regression analysis and receiver operation characteristic curve were used to analyze the value for differentiating AAH and AIS. Results: When cutoff values were taken as percentage of CT value increment of pure ground glass nodule 25%, CT value -615 HU and CT value increment 223 HU, they were helpful for differentiating AAH from AIS（P<0.05）. The sensitivity for diagnosis of AAH were 78%, 76% and 100%, respectively; the specificity were 62%, 77% and 71%, respectively. The area under the ROC curve were 0.83, 0.86 and 0.80, respectively. Conclusions: The percentage of CT value increment, CT value and CT value increment of pure ground- glass nodules are helpful for differentiating AAH and AIS. Figures and Tables | References | Related Articles | Metrics

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Evaluation of TDR NH-AST kit for testing antimicrobial susceptibility of Haemophilus influenza LI Xinxin, XIAO Shuzhen, TAN Xijing, NI Yuxing, HAN Lizhong 2019, 18 (05):  526-531.  DOI: 10.16150/j.1671-2870.2019.05.008 Abstract ( 309 )   HTML ( 2 )   PDF (591KB) ( 77 )   Objective: Haemophilus influenzae is a pathogen that can cause severe infections. Accurate determination of H. influenzae susceptibility is important to ensure treatment efficiency. This study aimed to evaluatethe performance of TDR NH-AST kit for testing the antimicrobial susceptibility of Haemophilus influenzae. Methods: A total of 101 isolates were collected from clinical laboratories. Broth microdilution method was performed following the Clinical and Laboratory Standards Institute guideline M07-A10 as the reference method. The category agreement (CA), essential agreement (EA), major discrepancy (MD) and very major discrepancy (VDM) were used to evaluate the agreement between the TDR NH-AST kit and reference method according to ISO 20776-2. Kappa value was calculated and McNemar test was performed to analyze the consistency between the two methods. Results: A total of 18 antimicrobial drugs were involved. Apart from meropenem, the Kappa values of the other antimicrobial drug susceptibility test were all higher than 0.75, and the P va-lues were all higher than 0.05 except ampicillin. The overall values of CA, EA, MD and VMD were 97.80%, 95.38%, 2.07% and 3.29%, respectively. Although EAs of meropenem, azithromycin and ciprofloxacin were slightly less than 90% (88.12%, 84.16% and 88.12%, respectively), all the other antibacterial drugs were more than 90%, and CAs of all antibacterial drugs were more than 90%. Conclusions: TDR NH-AST has a good consistency, accuracy and reliability in the detection of antimicrobial susceptibility of H. influenzae, and could meet the requirements of routine clinical antimicrobial susceptibility test of H. influenzae. Figures and Tables | References | Related Articles | Metrics

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Study on in vitro biofilm formation ability of Acinetobacter baumannii HUANGFU Yuchan, DIAO Wenjing, YU Jing, LIU Ying, SHEN Lisong 2019, 18 (05):  532-537.  DOI: 10.16150/j.1671-2870.2019.05.009 Abstract ( 429 )   HTML ( 3 )   PDF (657KB) ( 81 )   Objective: To study the in vitro biofilm formation ability of Acinetobacter baumannii for providing a reference for clinical prevention and treatment of Acinetobacter baumannii infection and control of its biofilm formation. Methods: One hundred and one strains of Acinetobacter baumannii isolated from infected patients at Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from October to December 2017 were collected. The ability of the strains to form biofilm at different temperatures was detected by crystal violet staining; the antimicrobial susceptibility test was performed by Vitek2 Compact and the disc diffusion method. The carrying status of biofilm formation-related genes (bap, abaI, bfmS, csuAB, csuA, csuC, csuD, csuE, cpaA, and ompA) was detected by PCR. Results: The positive rate of Acinetobacter baumannii biofilm formation at 25 ℃ (93.1%) was significantly higher than that at 35 ℃ (60.4%) (P<0.05). There was a correlation between the resistance rate of isolates to Ampicillin/Sulbactam or Aminoglycosides and the biofilm formation ability (P<0.05); and there was no significant correlation between the biofilm formation ability and whether it carried the abovementioned 10 related genes (P>0.05). Conclusions: The biofilm formation ability of Acinetobacter baumannii is related to the culture temperature, and also correlated in some degree with the resistance rate to Ampicillin/sulbactam and Aminoglycosides. However, the biofilm formation ability is not related to the abovementioned 10 related genes (bap, abaI, etc.). Figures and Tables | References | Related Articles | Metrics

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Investigation on common pathogens and related risk factors of urinary tract infection in elderly female diabetic patients in community GU Qin, WANG Tairong, CHEN Liping, WU Shuyao, SHEN Yi 2019, 18 (05):  538-542.  DOI: 10.16150/j.1671-2870.2019.05.010 Abstract ( 369 )   HTML ( 1 )   PDF (575KB) ( 43 )   Objective: To investigate the distribution and drug resistance of pathogens in elderly women with diabetes mellitus complicated with urinary tract infection in Dapuqiao community, Huangpu District, Shanghai, and to study the etio-logical information of patients with different treatment experiences in the region, so as to provide a guidance for clinical treatment. Methods: From June 2016 to June 2018, 214 elderly women with diabetes mellitus and leukocyte positive urine samples were collected for bacterial identification and drug sensitivity test. The patients were divided into community health center group (group A) or general hospital group (group B) according to their previous therapeutic experience whether had been treated in community health center or in general hospital. The basic situation of the two groups and the composition of pathogenic bacteria isolated from clean midstream urine samples were compared and analyzed with the results of drug susceptibility. Results: ① There were 166 patients with pathogenic bacteria, of which 94 were in group A and 72 were in group B. The top five dominant pathogens in group A were Escherichia coli, Proteus, Klebsiella pneumoniae, Enterococcus, Streptococcus agalactiae and Pseudomonas aeruginosa, while the top five pathogens in group B were Escherichia coli, Klebsiella pneumoniae and Enterococcus cloacae, Enterococcus, Proteus and Acinetobacter loffei. No fungus was detected in both groups; ② Drug analysis showed that the drug resistance rate to Escherichia coli exceeded 50%. In group A, the drug resistance was: ampicillin (77.55%), levofloxacin (58.33%) and ciprofloxacin (58.00%); in group B was: cefuroxime (97.73%), ampicillin (97.62%), ceftazidime (88.64%), cefepime (82.93%), ciprofloxacin (82.93%), levo-floxacin (82.22%), compound neomycin (51.16%). ③ The resistance of Escherichia coli to penicillin and its enzyme inhibitors and second generation, third generation, third generation of cephalosporins (including Ceftazidime, Cefepime, Cefuroxime and Cefoxitin) in Group B was significantly higher than that of group A (P<0.01). Both groups were resistant to ampicillin, ciprofloxacin and levofloxacin, but the degree of resistance was 58% in group A and 82% in group B. There was statistically significant difference between the two groups (P<0.05). Conclusions: Escherichia coli is the main pathogen in elderly women with diabetes mellitus complicated with urinary tract infection. However, there are differences in the order of dominant pathogens and drug resistance between patients with different treatment experiences. Figures and Tables | References | Related Articles | Metrics

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Research on acoustic radiation force impulse imaging in quantitative assessment of testicular stiffness in non-sterility varicocele patients LI Min, LIU Jun, WANG Zhiqian, ZHAN Weiwei 2019, 18 (05):  543-547.  DOI: 10.16150/j.1671-2870.2019.05.011 Abstract ( 248 )   HTML ( 1 )   PDF (614KB) ( 42 )   Objective: To investigate the correlation between the change of testicular tissue stiffness and the semen quality of non-sterility left varicocele(VC) patients by using acoustic radiation force impulse imaging(ARFI). Methods: According to the results of palpation and ultrasonic examination,143 cases of non-sterility left varicocele(VC) patients were divided into subclinical varicocele(SVC) group(42 cases), grade VC1 group (33 cases), grade VC2 group (49 cases),grade VC3 group (19 cases); in addition, 67 cases of normal subjects were served as controls.All subjects underwent semen examination and routine ultrasound examination. The shear wave velocity (SWV) in testis of all subjects were determined by acoustic pulse radiation imaging. The rank-sum test was used to compare the difference of SWV values and sperm quality between VC groups and control group. Pearson correlation analysis was used to analyze the correlation between sperm density, testicular volume, internal diameter of varicose veins and SWV in VC patients. Results: Compared with the control group, SWV value of testis decreased in VC group and VC2, VC3 group(Zvc-CG=-5.015, Zvc2-CG=-7.841, Zvc3-CG=-6.182, P<0.01), sperm density decreased in the VC group and VC2, VC3 groups(Zvc-CG=-6.878,Zvc2-CG=-8.258,Zvc3-XG=-8.695, P<0.01). Compared with the SVC group, SWV value of testis decreased in VC2, VC3 groups (Zvc2-svc=6.674, Zvc3-svc=5.557, P<0.01), sperm density decreased in VC2, VC3 group(Zvc2-svc=6.407, Zvc3-svc=7.432, P<0.01). Compared with VC1 group, SWV value of testis decreased in VC2, VC3 groups (Zvc2-vc1=6.480, Zvc3-vc1=5.529, P<0.01), sperm density in VC2, VC3 groups also decreased (Zvc2-vc1=4.471, Zvc3-vc1=5.953, P<0.01). Pearson correlation analysis showed that there was a positive correlation between SWV value and sperm density and testicular volume in VC group（rleft=0.732,rright=0.664, P<0.01; rleft=0.595,rright=0.417, P<0.01）. And there was a negative correlation between SWV value and internal diameter of spermatic vein（rleft=-0.758, rright=-0.775, P<0.01）. Conclusions: The SWV value of testis can be used as a reference index to evaluate the change of testicular tissue stiffness and testicular spermatogenesis in VC patients. Figures and Tables | References | Related Articles | Metrics

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Dedifferentiated solid variant papillary thyroid carcinoma with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue: a case report with pathological characteristics and literature analysis YANG Zhifang, FANG Guoping, ZHAN Weiwei, JI Ri 2019, 18 (05):  548-554.  DOI: 10.16150/j.1671-2870.2019.05.012 Abstract ( 469 )   HTML ( 1 )   PDF (1358KB) ( 93 )   Objective: To report the clinical manifestation, ultrasonographic imaging (US) feature and pathological feature of a rare case of dedifferentiated solid variant papillary thyroid carcinoma (SVPTC) with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) and to discuss its pathological characteristics. Method: The clinical data, imaging feature and pathologic feature of this rare case were analyzed, and the characteristics of SVPTC, dedifferentiation and MALT were discussed separately. Result: The thyroid tissue was grossly grayish-white in color, and the microscopic examination showed that the tumor cells were arranged in a solid, nested shape, and the mitotic figures were easy to see; no typi-cal nuclear features of papillary carcinoma were seen; the interstitial was composed of small lymphocytes with different forms. Some Russell bodies could be seen. IHC showed CK19(+), Ki67 (80%+), TG(-), TTF-1(+), Bcl-6(+),CK5/6（-）,CD117（-）;peripheral lymphocytes: CD20(+), CD79α(+), CD3 (+), CD5(+), CD43(+), Bcl-2(+). Molecular pathology showed that no mutations were detected in BRAF but mutations in TERT promoter were detected.B lymphoma clone gene rearrangement was positive. The final pathological diagnosis was dedifferentiated SVPTC with MALT. Conclusions: Dedifferentiated SVPTC with MALT is extremely rare and has poor prognosis. Each feature deserves careful documentation and discussion. Figures and Tables | References | Related Articles | Metrics

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Analysis of lymph node density related clinical and gray-scale sonographic characteristics of papillary thyroid carcinoma YU Xiaoqing, ZHAN Weiwei, ZHOU Wei, WU Yu, WANG Yi, LI Weiwei, TAO Lingling, FAN Jinfang 2019, 18 (05):  555-559.  DOI: 10.16150/j.1671-2870.2019.05.013 Abstract ( 444 )   HTML ( 2 )   PDF (694KB) ( 78 )   Objective: To investigate the correlation of clinical and gray-scale sonographic features with cervical lymph node density (LND in papillary thyroid carcinoma(PTC). Methods: A total of 148 patients with PTC were divided into 2 groups: LND≤0.19 and LND>0.19. Clinical data of patients(age, gender and Hashimoto thyroiditis) were collected. Number of PTC nodules as well as the size, margin, internal architecture, internal echoes, calcification and contacting with thyroid capsule were evaluated by gray-scale sonography. Single factor analysis and logistic regression analysis were used to evaluate the correlation between the clinical data and LND. Results: Single factor analysis showed that age,number of nodule, size, calcification and contacting with thyroid capsule were correlated with LND. Logistic regression analysis showed that LND was correlated with the nodule size, calcification and contacting with thyroid capsule. Conclusions: Gray-scale sonographic features may indicate the LND level in PTC, which may be helpful for formulating treatment plan to reduce the risk of recurrence and improving survival. Figures and Tables | References | Related Articles | Metrics

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Sclerosing angiomatoid nodular transformation of spleen: clinicopathological analysis and literature review WANG Jianjun, CHEN Ya, FAN Xiangshan, NIU Fengnan 2019, 18 (05):  560-564.  DOI: 10.16150/j.1671-2870.2019.05.014 Abstract ( 563 )   HTML ( 1 )   PDF (1193KB) ( 69 )   Objective: To explore the clinicopathological characteristics of sclerosing angiomatoid nodular transformation (SANT) of spleen. Methods Eight cases diagnosed with SANT of spleenin our hospital from 2010 to 2019 were enrolled. Routine pathology and immunohistochemical staining were performed. The clinical symptoms, imaging examination and pathological features of SANT of spleen were analyzed respectively. Results Among the 8 cases, there were 4 males and 4 females, aged from 3 to 67 years old. Five cases had no obvious clinic symptoms, two cases showed abdominal pain.One case had a mass in the left upper abdomen. B-ultrasound showed occupying lesions in the spleen. Further examination revealed a round-shaped low-density mass in the spleen by CT scan, and there was no obvious enhancement under contrast-enhanced CT. The maximum diameter of the tumor was 1.5 cm-11.0 cm with relatively clear boundaries. The section of the mass was gray-brownin color and solid, and the gray-white fiber strips near the section center were divided to form a star-shaped scar. HE staining showed there were many angiomatoid-like nodules scattered in the background of fibroproliferative sclerosis. The vascular lumen in the nodules was irregularly dilated, and there werelots of red blood cells in the lumen. The nodules were fibrously separated or arranged in concentric circles. The spindle cells were wrapped around. Immunohistochemistry revealed that the expressions of CD31, CD34 and CD8 in vascular endothelial cells were varied in nodular lesions. The surrounding spindle cells were positive for CD68, and focally positive for SMA. No recurrence or metastasis was found during 2 to 104 months of follow-up. Conclusions SANT is currently considered as a benign proliferative neoplastic lesion. There is no significant difference in ratio between men and women. Most patients have no obvious clinical manifestations, few of them are characterized by abdomen pain. CT scan usually shows a low-density tumor with no obvious enhancement under contrast-enhanced CT. Surgical resection is the primary treatment for SANT. Postoperative pathological and immunohistochemical staining are important methods for the final diagnosis. Figures and Tables | References | Related Articles | Metrics

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Clinical electromyography study of patients with restless legs syndrome in Chinese population LU Yanqing, CHEN Jie, MA Jianfang, WAN Yanping 2019, 18 (05):  565-569.  DOI: 10.16150/j.1671-2870.2019.05.015 Abstract ( 430 )   HTML ( 2 )   PDF (579KB) ( 115 )   Objectives: To evaluate sleep, mood and autonomic function objectively and electrophysiology subjectively in Chinese RLS (Restless legs syndrome, RLS) patients. Methods: A total of 15 RLS patients and 16 non-RLS controls were recruited from out-patient clinics of neurology department. Questionnaires（PSQI、ESS、HAMA、HAMD、COMPASS-31、SCOPA-AUT） were asked and electromyography （SSR、F-wave、H reflex） was conducted. Results: PSQI score was higher in RLS patients than controls. Mood and autonomic score didn't differ between two groups. In addition, F-wave latency, H-reflex latency, H/M amplitude ratio and SSR latency was similar between two groups. H-reflex amplitude and SSR amplitude didn't differ, neither. SSR amplitude (P=0.042) and H-reflex amplitude (P=0.047) was statically significant, but probably false positive. Conclusion: RLS symptom impacts sleep, especially during bedtime over mood and autonomic function. In the meantime, there is still a lack of electromyography biomarker to help diagnose RLS. More studies with bigger sample size are needed in the future. It is possible that small fiber dysfunction is not involved in the pathophysiology of RLS. Figures and Tables | References | Related Articles | Metrics

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The potential value of serum pepsinogen in screening of chronic atrophic gastritis among population with high risk for gastric cancer of Shanghai central urban area ZHOU Lei, WANG Hong, XU Huiming, YE Tao, GAO Jianping, SUN Yijun, XIE Jun 2019, 18 (05):  570-574.  DOI: 10.16150/j.1671-2870.2019.05.016 Abstract ( 234 )   HTML ( 1 )   PDF (697KB) ( 64 )   Objective: To evaluate the value of measurement of serum pepsinogen(PG) for the screening of chronic atrophic gastritis(CAG) in gastric cancer high risk people. Methods: A symptomatic subjects with high risk for gastric cancer lived in Shanghai central urban area were enrolled to measure serum PG, Helicobacter pylori antibody and conduct endoscopy and biopsy. According to histological results, CAG were divided to no atrophy group, antrum predominant group, corpus predominant group and entire stomach gastricatrophy group. Results: Of the 178 cases enrolled, corpus predominant group and entire stomach group exhibited a significantly lower PGR（PGⅠ∶Ⅱ ratio）when compared with the no atrophy group and antrumpredominant group (P<0.05). The cut-off value of PGR ≤5.16 demonstrated a sensitivity of 91.8%, specificity of 61.9% and area under the receiver operating characteristic curve 0.794 in detecting entire stomach gastric atrophy. The cut-off value of PGR ≤6.43 demonstrated a sensitivity of 78.7%, specificity of 65.5% and area under the receiver operating characteristic curve 0.750 in detecting entire stomach gastric atrophy. Conclusions: Serum PGR is a sensitive and specific marker for detecting corpus involved CAG. PGR might be potentially used as a non-invasive biomarker for detecting CAG among population with high risk for gastric cancer. Figures and Tables | References | Related Articles | Metrics

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Prevalence of overweight and obesity and analysis of blood pressure related factors among children and adolescents in Xinzhuang community, Shanghai WANG Yajuan, GUO Qianhui, ZHANG Dongyan, CHENG Yibang, CHEN Ling, ZHU Dingliang, LI Yan 2019, 18 (05):  575-580.  DOI: 10.16150/j.1671-2870.2019.05.017 Abstract ( 288 )   HTML ( 2 )   PDF (700KB) ( 66 )   Objective: To investigate the prevalence of overweight and obesity and blood pressure related factors among children and adolescents in Xinzhuang community, Shanghai, for providing reference information for the prevention and treatment of hypertension in children and adolescents. Methods: Students aged 7-17 yearsin primary and secondary schools in Xinzhuang district, Shanghai, were invited to participate in the study. Body height, weight, waist and hip circumference were measured. Omron HBP1100 electronic sphygmomanometer was used to measure brachial blood pressure for three times at sitting position. Questionnaires were used to collect basic information, including disease history, birth history, use of medications, maternal pregnancy and delivery history, parents' smoking habits and history of hypertension and diabetes, and family history, etc. Results: ①Among all the 14 715 students (male 7703, female 7 012), the prevalences of overweight, obesity and high waist circumference were 17.3%, 13.9% and 18.0%, respectively. ② Both the brachial systolic and diastolic blood pressure were positively associated with age, body height, BMI, waist circumference, father or mother hypertension history and mother pregnancy hypertension history (r= 0.03-0.37, P≤0.01). Students whose both parents had hypertension had a higher blood pressure (120/77 mmHg) than those with single parent having hypertension (118/75 mmHg) and those having both normotensive parents (116/74 mmHg, P for trend ≤0.001). ③ Obese students had higher blood pressure (122/76 mmHg) than those overweight (119/75 mmHg) and those with normal weight (115/74 mmHg). Similar trend was observed between students with high(121/76 mmHg), high-normal (118/75 mmHg) and normal (115/74 mmHg) waist circumference. P values were all <0.001 after adjustment for age and other factors. Conclusions: In addition to factors could not be revised such as age and parent's hypertension, blood pressure of children and adolescents is related to obesity indices such as BMI and waist circumference, indicating that obesity control should be the key for the prevention and control of hypertension in children and adolescents. Figures and Tables | References | Related Articles | Metrics

Medical education

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Effect of problem-based learning on teaching of diagnosticsfor medical students in China: ameta-analysis FENG Yimei, CHEN Xiaoli, ZHANG Xi 2019, 18 (05):  595-601.  DOI: 10.16150/j.1671-2870.2019.05.023 Abstract ( 286 )   HTML ( 2 )   PDF (852KB) ( 122 )   Objective: To evaluate the effect of problem-based learning (PBL) on teaching of diagnostics for medical students. Methods: Randomized controlled trials (RCT) of PBL on teaching of diagnostics from January 1990 to May 2018 were collected by literature searching. After evaluating the quality of literatures, RevMan 5.3 and Stata software were used to analyze the data. Results: A total of 25 RCT covering 3 825 medical students were included. Meta-analysis showed that theoretical scores and clinical skill scores of students accepting PBL were higher than those accepting traditional teaching. Moreover, it is superior to traditional teaching mode in improving their learning interest, clinical thinking and comprehensive analytic ability. Conclusions: The PBL not only can improve the students' academic examination score and the clinical skill, yet can also trigger the students' learning interest, increase the clinical thinking ability, and the clinical comprehensive analytic ability. Figures and Tables | References | Related Articles | Metrics