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25 June 2022, Volume 21 Issue 03 Previous Issue    Next Issue

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Analysis of risk factors for delayed healing of peptic ulcer in patients with upper gastrointestinal bleeding DING Yanfei, XIN Xiaorong, ZHOU Yufen, XIE Ling, GU Leilei, WU Yunlin, CHEN Ping 2022, 21 (03):  312-316.  DOI: 10.16150/j.1671-2870.2022.03.004 Abstract ( 212 )   HTML ( 6 )   PDF (519KB) ( 92 )   Objective: To investigate the risk factors for delayed healing of peptic ulcer in patients with upper gastrointestinal bleeding (UGIB), so as to provide evidences for clinical treatment. Methods: A total of consecutive 138 hospitalized patients with UGIB due to peptic ulcer from January 2012 to December 2021 were enrolled. The healing rate of peptic ulcer was determined under reexamination of gastroscopy after 1 week of treatment. The related indice were analyze with univariate analysis to determine possible influencing factors for peptic ulcer, including gender, age, body mass index (BMI), diabetes, history of taking steroid anti-inflammatory drugs (NSAIDS), smoking, drinking, Helicobacter pylori (Hp) infection, hemoglobin, serum albumin, ulcer location or Logistic regression analysis was performed to determine the independent risk factors. Results: Univariate analysis showed that age, levels of serum albumin, Forrest classification, the location and size of ulcers were associated with delayed healing of ulcers in patients with upper gastrointestinal bleeding (P<0.05). Multivariate Logistic regression analysis showed that Forrest classification, location and size of ulcers were independent risk factors for delayed healing of ulcers in patients with upper gastrointestinal bleeding(P<0.05). Conclusions: Forrest classification, location and size of ulcers in patients with upper gastrointestinal bleeding may delay the healing of peptic ulcer in patients with upper gastrointestinal bleeding and countermeasures should be taken to deal with the above risk factors. Figures and Tables | References | Related Articles | Metrics

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Study on correlation of cardiac magnetic resonance strain rate parameters of left ventricular diastolic function with risk of sudden death in hypertrophic cardiomyopathy LIU Peng, YAN Fuhua, QIN Le, XIAO Ruijie 2022, 21 (03):  317-325.  DOI: 10.16150/j.1671-2870.2022.03.005 Abstract ( 246 )   HTML ( 7 )   PDF (1529KB) ( 171 )   Objective: To investigate the relationship between cardiac magnetic resonance(CMR) myocardial strain rate (SR) parameters of left ventricular diastolic function and the risk of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). Methods: A total of 160 HCM patients and 50 healthy control subjects who underwent CMR were enrolled. Radial strain rate (RSR), circumferential strain rate (CSR) and longitudinal strain rate(LSR) of left ventricle (LV) by CMR were measured. Risk stratification of SCD by 2014 European Society of Cardiology(ESC) and the 2020 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were performed in patients respectively. Differences in diastolic function between high-risk and low-risk groups under the same guideline were compared with t test and one-way ANOVA was used to compare diastolic function between subgroups based on two guidelines. Linear regression analysis was performed to analyze the association of commonly risk factors in guidelines and diastolic function. Results: The absolute value of diastolic SR of LV in HCM was significantly decreased when compared with those of control subjects (RSR: -1.27 ± 0.60 vs -2.40 ± 0.59, CSR: 0.71 ± 0.24 vs 1.22 ± 0.25, LSR: 0.52 ± 0.24 vs 0.89 ± 0.20, all P<0.05). There were significant differences in diastolic RSR and CSR among HCM different phenotypes (all P<0.05). Patients with high SCD risk (n=27) according to the 2014 ESC guidelines had significantly lower diastolic RSR(P<0.05) than those with low SCD risk,while had no difference in CSR and LSR. Patients with high SCD risk (n=92) according to the 2020 ACC/AHA guidelines had significantly lower diastolic SR(RSR, CSR and LSR) (all P<0.05) than those with low SCD risk. The diastolic SR in patients with low SCD risk by 2014 ESC but high SCD risk by ACC/AHA were similar with patients at high risk based on both guidelines, and were significantly lower than that of patients at low risk in both guidelines. Among the four major risk factors, the absolute value of diastolic myocardial SR were significantly decreased in the group which had higher maximum left ventricular wall thickness (≥30 mm) and late gadolinium enhancement/left ventricle mass (≥15%), and LV diastolic function was severely impaired. Maximum left ventricular wall thickness and late gadolinium enhancement/left ventricle mass both had significant association with diastolic myocardial SR (correlation coefficient r were 0.48/0.35 in RSR, -0.42/-0.31 in CSR, -0.37/-0.16 in LSR, all P<0.05). Conclusions: SR of LV myocardial by CMR is significantly reduced in patients at high risk of SCD, and is correlated with some risk factors, which may serve as a new biomarker to assist the stratification of SCD risk. Figures and Tables | References | Related Articles | Metrics

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Application of ultrasound-based radiomics technology in the evaluation of fetal lung maturity DU Yanran, JIAO Jing, REN Yunyun, ZHOU Jianqiao 2022, 21 (03):  326-330.  DOI: 10.16150/j.1671-2870.2022.03.006 Abstract ( 321 )   HTML ( 7 )   PDF (693KB) ( 139 )   Objective: To establish a model with ultrasound-based radiomics technology for evaluating fetal lung maturity and verify its efficacy in predicting risk of newborn respiratory disease. Methods: A total of 295 singleton pregnancies were enrolled, and fetal lung ultrasound images (four-chamber view) of each fetal were obtained within 72 hours before delivery. The 295 images were divided into 2 groups according to gestational age (GA) of the day fetal lung ultrasound images collected on examination day: Group 1(GA <36 weeks) and Group 2(GA 36-37 weeks). Images of Group 1 （66） and Group 2 （229） were further grouped into training set（40, 26） and validation set（95, 134）,respectively. High throughput radiomics features were extracted from each fetal lung ultrasound image by fetal lung texture analysis based on ultrasound-based radiomics technology. Based on outcomes of fetus, diagnostic models by Group 1 or 2 for predicting risk of newborn respiratory disease were established combined with pregnancy complications using training set of Group 1 or Group 2, respectively, and the predictive efficacy were verified in correspondingly validation set. Results: The diagnostic performance of models by Group1 and 2 were as follows: sensitivity were 83.3%(Group 1) and 75.0%, respectively; specificity were 84.6% and 78.3%,respectively; accuracy were 80.8% and 77.2%, respectively. Conclusions: The fetal lung maturity evaluation model based on ultrasonic-based radiomics technology is a new method for noninvasive evaluation of fetal lung maturity, Which have certain efficacy in predicting newborn respiratory disease. Figures and Tables | References | Related Articles | Metrics

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Study on use of right ventricular fractional area change assessed by echocardiogram for evaluating cardiac synchrony in heart failure patients with reduced left ventricular ejection fraction GUI Yanping, CHEN Yefen, SHI Zhongwei, XU Yan 2022, 21 (03):  331-335.  DOI: 10.16150/j.1671-2870.2022.03.007 Abstract ( 252 )   HTML ( 6 )   PDF (489KB) ( 160 )   Objective: To investigate the status of synchronization of cardiac mechanical contraction by means of echocardiogram in heart failure patients with reduced ejection fraction (HFrEF), and analyze use of right ventricular fractional area change (RVFAC) for screening cardiac mechanical dyssynchrony in the population. Methods: A total of 54 hospitalized patients with HFrEF were enrolled, with a mean left ventricular ejection fraction(LVEF) of 33.2%±10.1%. The patients received echocardiogram, echocardiographic and tissue Doppler imaging and 2D speckle tracking imaging. and were divided into three groups according to RVFAC level: Group 1, 19 patients with RVFAC<18%; Group 2, 19 patients with RVFAC 18%-34%; Group 3,16 patients with RVFAC≥34%. The occurrence and degree of of cardiac electrical and mechanical dyssynchrony (atrioventricular dyssynchrony, interventricular dyssynchrony and intraventricular dyssynchorny) were compared between the 3 groups. Results: There was no significant difference in the proportion of complete left bundle branch block among the 3 groups. However, compared with that in Group 3, mean QRS duration was significantly prolonged in group 1[(146.7±37.5) ms vs. (105.7±31.0) ms, P=0.003]. Compared with group 2 and 3, group 1 had higher the prevalence rate of electrical dyssynchrony (QRS>120 ms)（72%, 58%, 28%, P=0.012）, and higher the abnormal rate and more severe degree of both atrioventricular dyssynchrony index[LV-FT/RR, (37.1±10.2) ms vs. (45.6±8.4) ms vs. (48.5±5.6) ms, P<0.01] and interventricular dyssynchrony index [interventricular mechanical delay, IVMD, (49.9±29.9) ms vs. (26.4±27.0) ms vs. (6.9±35.4) ms, P<0.01]. For intraventricular dyssynchorny, asynchrony index showed no significant difference between 3 groups. Furthermore, compared with group 3 which had normal right ventricular function, Group 1 had a higher detection rate of septal flash (SF) sign (47% vs 37% in group 3, P=0.02). Conclusions: In those with HFrEF, patients with severe abnormal right ventricular systolic function have higher risk of cardiac mechanical dyssynchrony, and dyssynchrony is often more severe. RVFAC by echocardiogram may help to select those who will be benefit from cardiac resynchronization therapy in heart failure patients with HFrEF. Figures and Tables | References | Related Articles | Metrics

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Lamb-Shaffer syndrome presenting as short stature with delays in motor and language acquisition: a case report and literature review ZHANG Juanjuan, HE Qinyu, YANG Yuanyan, DONG Zhiya, XIAO Yuan, CHEN Lifen, ZHANG Caiping 2022, 21 (03):  336-342.  DOI: 10.16150/j.1671-2870.2022.03.008 Abstract ( 599 )   HTML ( 10 )   PDF (1062KB) ( 216 )   Objective: To analyze a case of Lamb-Shaffer syndrome(LAMSHF) with short stature and delayed language and motor development as the main manifestation,and summerize data of the disease in data bank for improving the understanding of this disease. Methods: A male child aged 9 year and 3 months with severe short stature and delayed language and motor development admitted to our hospital was analyzed. Their clinical data were collected, and the genomic DNA was extracted from whole blood of the children and their parents for whole exome sequencing and DNA Sanger sequencing verification. Meanwhile, relevant literature was reviewed to analyze the pathogenesis, clinical characteri-stics, diagnosis and therapy and prognosis of LAMSHF. Results: The height of the boy was 108.7 cm [-4.82 standard deviation (SD)], weight was 17.1 kg (<-2.1 SD), body mass index was 14.5 kg/m2 (-1.1 SD), and gross motor and language development 1-year delay. Laboratory test showed the insulin-like growth factor was 74 ng/mL (-2.14 SD), growth hormone challenge test suggested growth hormone and the remaining tests were all normal. Whole exome sequencing revealed that Seq[GRCh37]del(12)(p12.1s; p11.1) involved multiple known pathogenic genes including SOX5, with a copy number deletion of at least 10.4 Mb, and which were not detected before, so the copy number variant was a novel mutation. The mutation was assessed by ACMG guidelines as probable pathogenic (PS2+PM1). Therefore Lamb-Shaffer syndrome was diagnosed. Literature reviewing indicated that 11 LAMSHF-related studies included 1 domestic study and 10 foreign studies, with a total of 75 patients. The diagnosis of LAMSHF depended on genetic testing, and there is no clear genotype-phenotype correlation. The improvement of the patient's intellectual disability depended on rehabilitation treatment. Due to the high risk of epilepsy, ocular signs, and hypotonia in this disease, and the tendency to have tumors, growth hormone should be avoided for treatment of short stature. Patients with this disease currently had a poor prognosis. Conclusions: The boy with LAMSHF carried 12p12.1 deletion, which is the largest deletion and is never reported, presenting severe short stature. Short stature children with abnormal intelligence need to be screened for gene mutation and copy number variation of SOX5, and growth hormone therapy should be avoided due to potential risk of tumorigenesis. Figures and Tables | References | Related Articles | Metrics

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Efficacy of ultrasonic examination in predicting cervical lymph node metastasis in elderly patients with papillary thyroid carcinoma and analysis of related ultrasound signs XU Chenying, LI Yanran, NI Xiaofeng, XU Shangyan, LIN Qing 2022, 21 (03):  343-348.  DOI: 10.16150/j.1671-2870.2022.03.009 Abstract ( 211 )   HTML ( 2 )   PDF (742KB) ( 125 )   Objective: To explore the efficacy of ultrasonic examination for diagnosing cervical lymph node metastasis in elderly patients with papillary thyroidc arcinoma(PTC), and to analyze the related ultrasonographic characteristics. Methods: A total of 232 patients ≥60 years with PTC admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between January 2021 and October 2021, were included in the retrospective analysis. According to postoperative pathology, the efficacy of ultrasound in predicting cervical lymph node metastasis were calculated. Multivariate logistic regression model was used to analyze the risk factor for cervical lymph node metastasis and risk factors were used to construct multi-factor model of risk for predicting cervical lymph node metastasis. Receiver operator characteristic (ROC) curves was used to evaluate the value of the model for predicting lymph node metastasis in elderly participants with PTC. Results: Rate of cervical lymph node metastasis was 30.6% (71 cases). The sensitivity, specificity, positive predictive va-lue and negative predictive value of ultrasound for cervical lymph node metastasis were 40.8%(29/232), 93.2% (150/232), 72.5% (29/40) and 78.1% (150/192). Univariate analysrs showed that the cervical lymph node metastasis rate was higher in patients with nodule size ≥10 mm, microcalcification, abundant color Doppler flow imaging (CDFI) blood flow, or the distance between the nodule and capsule <1 mm by preoperative ultrasound scanning (P<0.05). Multivariate logistic regression analysis demonstrated that preoperative ultrasonographic nodule size ≥10 mm (odds ratio[OR]=4.093, 95%CI: 1.933-8.666, P<0.001) and the distance between the nodule and capsule<1 mm (OR=2.177, 95%CI: 1.101-4.302, P=0.025) were independent risk factors for lymph node metastasis in elderly participants with PTC. The area under the curve(AUC) of combined these two independent risk factors for diagnosing cervical lymph node metastasis was 0.709. The AUC value was larger than either a risk factor. (AUC for the distance between the nodule and capsule<1 mm, was 0.602, and AUC for preoperative ultrasonographic nodule size ≥10 mm was 0.668). Conclusions: Proportion of cervical lymph node metastasis in the elderly patients with PTC. Large nodule size (≥10 mm) and close distance between the nodule and capsule (<1 mm) are independent risk factors for cervical lymph node metastasis for elderly patients with PTC. Figures and Tables | References | Related Articles | Metrics

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Crohn′s disease in a child with Wiskott-Aldrich syndrome: a case report and literature review LIU Ping, XIAO Yuan, WANG Xinqiong, LU Tingwei, ZHAO Xuesong, YANG Yuanyan 2022, 21 (03):  349-354.  DOI: 10.16150/j.1671-2870.2022.03.010 Abstract ( 227 )   HTML ( 4 )   PDF (1307KB) ( 112 )   Objective: To investigate the clinical features, endoscopic manifestations, and genetic characteristics of a child with Wiskott-Aldrich syndrome(WAS) and Crohn′s disease, so as to provide reference for clinical diagnosis. Methods: The clinical manifestations, biological indicators, endoscopic characters, therapy, and follow-up of a child with Crohn′s disease combined with WAS were analyzed retrospectively. And literature was searched from PubMed, Wanfang Data, and CNKI. Results: A 6-year-old boy had recurrent abdominal pain, hematochezia for one month, and had perianal abscess for about half a month. He also had thrombocytopenia since infancy. Complete blood cell count showed moderate anemia (Hb 70 g/L) and decreased platelets (77×109/L). The boy had elevated erythrocyte sedimentation rate (71 mm/h) and fecal calprotectin (>1 800 μg/g). Colonoscopy showed multiple ulcers in colon and the pathological examination revealed chronic inflammation in mucosa of the terminal ileum and colon, some of which were accompanied by microabscess and crypt abscesses. The child was diagnosed with Crohn's disease. A splicing mutation (c.777+3_777+6 del GAGT) was identified in the exon 8 of WAS gene by next-generation sequencing. Consequently, the child was definitely diagnosed as WAS combined with Crohn′s disease. There were 9 relevant articles, showing that all 16 patients had childhood-onset inflammatory bowel disease (IBD) (1 day to 14.9 years old), and 10 of them were accompanied by thrombocytopenia. Various treatments, including drugs, surgery, and bone marrow transplantation were required. Seven patients were followed up, and three of them died. Conclusions: For children with IBD, particularly those with very early-onset inflammatory bowel disease, the possibility of monogenic diseases should be taken into account. If a male child with IBD have thrombocytopenia since childhood, the WAS gene should be detected. Figures and Tables | References | Related Articles | Metrics

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Ampullary adenocarcinoma: analysis of the clinicopathological features and prognostic factors LI Lei, YUAN Fei, WANG Chaofu, XU Haimin, WANG Ting 2022, 21 (03):  355-361.  DOI: 10.16150/j.1671-2870.2022.03.011 Abstract ( 379 )   HTML ( 5 )   PDF (1067KB) ( 206 )   Objective: To evaluate the clinicopathologic features and prognosis of ampullary adenocarcinoma (AA). Methods: The proportion of AA in patients who underwent pancreaticoduodenectomy were calculated in Ruijin hospital from January 2017 to December 2019. The clinical data and pathological features were analyzed. According to the new histological classification standard in the fifth edition of the World Health Organization classification of digestive system tumors in 2019, AA was reclassified and the risk factors for poor prognosis were analyzed. Results: It revealed that AA account for 6.95%(101/1454) in patients undergone pancreaticoduodenectomies. The median age of onset was 64 years, and the male to female ratio was 46∶55. The proportion of histological sub-types were 19.80%(20/101) for intestinal-type adenocarcinoma, 43.56% (44/101) for pancreatobiliary-type adenocarcinoma and 36.63% (37/101) for tubular adenocarcinoma. Among these 101 patients, 26 patients were lost to follow-up, and the remaining 75 patients were followed up for 1-45 months, with a median postoperative follow-up period of 18 months. The 1-year survival rate of the patients was 78.58%, and the 2-year survival rate was 67.40%. Log-rank survival analysis showed difference in overall survival between the non-intestinal-type adenocarcinoma group (pancreaticobiliary-type adenocarcinoma and tubular adenocarcinoma) and the intestinal-type adenocarcinoma group (P=0.0415). There was also statistical difference in the overall survival between the CK7 positive group and the CK7 negative group of tumor cells (P=0.0425). Conclusions: AA occurres frequently in the elderly and there is no significant gender difference. Pancreatobiliary-type carcinoma and tubular adenocarcinoma are dominant histological types, and intestinal-type adenocarcinoma accounts for only a small portion. Non intestinal-type adenocarcinoma and CK7 positivity are risk factors for poor prognosis of AA. Figures and Tables | References | Related Articles | Metrics

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The analysis of activities of vitamin K-dependent coagulation factors, protein C and protein S in patients on warfarin therapy FAN Zhenjia, LIU Yu, XU Guanqun, WU Wenman, WANG Xuefeng 2022, 21 (03):  362-366.  DOI: 10.16150/j.1671-2870.2022.03.012 Abstract ( 292 )   HTML ( 7 )   PDF (530KB) ( 86 )   Objective: To investigate the effects of warfarin anticoagulant therapy on vitamin K dependent clotting factors and down-regulation of protein C and protein S activities in anticoagulant system, as well as the effects of changes in above indic on anticoagulant balance. Methods: A total of 57 patients with pulmonary embolism or deep venous thrombosis treated with warfarin anticoagulant therapy in our hospital from January 2018 to March 2020 were enrolled, and activities of coagulation factors FⅡ, FⅦ, FⅨ, FⅩ, PC and PS were detected. International standardized ratio(INR) wasgrouped by quartile and the differences in the activity levels of coagulant and anticoagulant factors, protein C and protein S activities between 4 groups were compared. Results: There were statistically significant differences in the activity levels of each factor between different INR quartile groups (FⅡ, FⅦ, FⅩ: P<0.000 1; PC: P<0.001; FⅨ P<0.05). However, there was no significant difference in PS activity among different INR quartile groups(INR: 1.32-5.85), and INR level was negatively correlated with the activity of FⅡ, FⅦ, FⅨ, FⅩ, PC and PS (r was -0.678 7, -0.692 6, -0.376 7, -0.595 4, -0.466 6, and -0.212 2 respectively). The ratio of coagulation factor activity to anticoagulant protein activity decreased with the increase of INR. Conclusions: Although warfarin also interferes with carboxylation of vitamin K dependent clotting factors and anticoagulant proteins PC and PS, and decreasing their activity, clotting factors are affected more significantly. Figures and Tables | References | Related Articles | Metrics

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Transcriptome study of glucagon like peptide-1 agonist Exendin-4 on mouse embryonic osteoblast precursor MC3T3-E1 in vitro LIU Xin, QI Caihui, WANG Zhenjing, LÜ Na, WANG Shaoting, WANG Shuping 2022, 21 (03):  367-373.  DOI: 10.16150/j.1671-2870.2022.03.013 Abstract ( 210 )   HTML ( 1 )   PDF (1287KB) ( 165 )   Objective: To observe the effects of Exendin-4, a glucagon-like peptide-1(GLP-1) receptor agonist, on proliferation and osteogenic differentiation of Mc3t3-E1(mouse embryonic osteoblast precursor cells) in vitro. Methods: Mc3t3-E1 cells were treated with Exendin-4 at a pre-experimental concentration of 30 nmol/L for 72 h. The cells were collected for sequencing, and the RNA-SEQ data were obtained. The differentially expressed genes greater than 2 times were screened and KEGG PATHWAY enrichment analysis and GO enrichment analysis were performed. Results: Mc3t3-E1 cells were proliferated after Exendin-4 treatment, and a total of 418 differentially expressed genes were screened, including 236 up-regulated genes and 182 down-regulated genes. GO enrichment analysis showed that the up-regulated differentially expressed genes were mainly enriched in the immune system, cellular adhesion and proteolytic pathways. KEGG PATHWAY enrichment analysis showed that The down-regulated differentially expressed genes were mainly enriched in PI3K-Akt signaling pathway, abnormal transcription in cancer, mammalian target of Rapamycin (mTOR) receptor signaling pathway, and hypoxia inducible factor 1 (HYPO xia inducible) Factor-1, HIF-1) signaling pathway. It revealed that up-regulated genes related to osteoporosis included Fosl1, Cxcl13, Clec11a, Phex, Fasl, Camk4, Stab1, Zbp1, Adora2a, Igfbp7, Cxcr2, Hp, MTI; while for Down-regulated genes included Nog, Zeb1, Esr1, Igf2bp2, Plxnb3, Rgs14. Conclusions: Exendin-4 can affect the differentiation of precursor cells into osteoblasts by influencing the expression levels of gene related to cell immunity, cell adhesion and proteolysis related genes, and ultimately affect the formation and development of osteoporosis. Figures and Tables | References | Related Articles | Metrics

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The application of deep learning algorithm reconstruction in low tube voltage coronary CT angiography FAN Jing, YANG Wenjie, WANG Mengzhen, LU Wei, SHI Xiaomeng, ZHU Hong 2022, 21 (03):  374-379.  DOI: 10.16150/j.1671-2870.2022.03.014 Abstract ( 384 )   HTML ( 4 )   PDF (804KB) ( 171 )   Objective: To compare the quality of low tube voltage coronary CT angiography (CCTA) images reconstructed with deep learning-based image reconstruction (DLIR) and with filter back projection (FBP) and with adaptive statistical iterative reconstruction-veo (ASiR-V). Methods: One hundred patients who underwent CCTA were included. The CCTA tube voltage were set as 70 kVp (n=50, BMI≤26 kg/m2) and 80 kVp (n=50, BMI>26 kg/m2) according to body mass index(BMI). The images were reconstructed with FBP (Group A), ASIR-V 50% (Group B), DLIR at medium (DLIR-M, Group C) and high DLIR(DLIR-H, Group D) levels, respectively. Objective evaluation indice including CT attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio(CNR) were measured or calculated between groups, and Likert 5-point scale was adopted for subjective image quality assessment. Results: There were significant differences in image noise, SNR, CNR among the 4 groups(P<0.05), and Group D had the highest SNR and CNR, and lowest noise. There was no significant difference between Group C and Group D in subjective scores, but Group C and D both had higher subjective scores than those of Group A and B (P<0.05). Conclusions: For low tube voltage CCTA, images reconstructed with DLIR generate higher quality,and DLIR may be suitable to apply in low tube voltage CCTA. Figures and Tables | References | Related Articles | Metrics

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Application value of iMAR algorithm in reducing metal artifacts from abdominal implants ZHOU Huiyun, LÜ Xiaoyu, LI Jiqiang, DONG Haipeng, ZHANG Weihua 2022, 21 (03):  380-384.  DOI: 10.16150/j.1671-2870.2022.03.015 Abstract ( 258 )   HTML ( 4 )   PDF (713KB) ( 185 )   Objective: To explore application value of iterative metal artifact reduction (iMAR) algorithm in reducing the artifacts from abdominal metal implants. Methods: The CT images of 32 patients with abdominal metal implants were reconstructed with both iMAR and filtered back projection (FBP) algorithm, respectively. Subjective image quality was assessed by two independent radiologists. Objective image quality indic including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and artifact index (AI) were calculated by the noise values measured at the most severe level of artifacts near metal implants on images of both iMAR and FBP algorithms. Difference in subjective and objective image quality assessment between iMAR and FBP algorithms was compared. Results: The overall subjective quality score of iMAR images was significantly higher than FBP images (3.656±0.475 vs. 2.156±0.618, P<0.050). Both SNR and CNR of iMAR image were significantly higher than those of FBP images(SNR: 1.890±1.864 vs. 0.720±1.384, P=0.002; CNR: 35.872±13.154 vs. 15.245±12.362, P<0.050, respectively). AI of iMAR images was significantly lower than that of FBP images (32.690±15.694 vs. 152.594±117.203, P<0.050). Conclusions: iMAR can significantly decrease the metal artifacts and improve the image quality in clinical practice. Figures and Tables | References | Related Articles | Metrics

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Study on blood oxygen level-dependent magnetic resonance imaging for the assessment of early renal hypoxia in chronic kidney disease HUANG Juan, ZHU Xiaolei, LI Xiao, CHEN Kemin, YAN Fuhua, XU Xueqin 2022, 21 (03):  385-389.  DOI: 10.16150/j.1671-2870.2022.03.016 Abstract ( 183 )   HTML ( 2 )   PDF (678KB) ( 94 )   Objective: To evaluate value of blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) for early renal hypoxia assessment in chronic kidney disease(CKD). Methods: Fifty-two patients with CKD and 52 age- and sex-matched health volunteers underwent BOLD MRI of the kidneys. Serum creatinine (sCr) levels and estimated GFR (eGFR) were collected. The patients were classified into 5 stages according to the National Kidney Foundation′s Kidney Disease Outcomes Quality Initiative. Difference in R2*s were compared between patients and volunteers and among different stages of CKD. Results: In patients with CKD and volunteers, R2* of renal medulla was higher than that of renal cortex (P<0.05). Compared with those of volunteers, medulla R2*s in patients with CKD were significantly lower [(16.40 ± 2.47)/s vs (18.17± 2.38)/s, P<0.05]. There were no differences in cortical R2*s among CKD stages and volunteers (P>0.05). However, medullar R2*s were lower in patients with CKD1 [(16.55 ± 2.12)/s], CKD4 [(16.48 ± 2.95)/s], or CKD5 [(13.99 ± 2.21)/s] than those in volunteers [(18.17± 2.38)/s] (P<0.05). Conclusions: BOLD MRI is sensitive to renal medullary hypoxia, and which is helpful for diagnosing early stage of CKD. Figures and Tables | References | Related Articles | Metrics

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The application value of computer-aided ultrasound diagnosis system in differentiating malignant from benign thyroid nodules in diffuse thyroid lesions ZHAO Ran, ZHAN Weiwei, HOU Yiqing 2022, 21 (03):  390-394.  DOI: 10.16150/j.1671-2870.2022.03.017 Abstract ( 197 )   HTML ( 3 )   PDF (599KB) ( 158 )   Objective: To investigate the effect of ultrasound by computer aided diagnosis (CAD) system in diagno-sing nodules in patients with diffuse thyroid lesions. Methods: A total of 342 patients with diffuse thyroid lesions and thyroid nodules who underwent thyroid surgery in our hospital during August 2017 to December 2017 were enrolled. Based on guidelines for adult thyroid nodules and differentiated thyroid cancer, ultrasound with and without CAD were performed on 533 nodules from the patients. The findings of ultrasound were compared with pathological results, and sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve(AUC) were calculated to observe difference in efficacy between ultrasound and ultrasound by CAD system. Results: The sensitivity, specificity of conventional ultrasound for diagnosing malignant and benign nodules in diffuse thyroid lesions was 96.6%, 72.5%, with AUC of 0.846. While the diagnostic sensitivity, specificity of ultrasound and ultrasound by CAD system was 96.6%, 80.9%, with AUC of 0.888. The use of CAD system enabled ultrasound achieve a higher specificity and AUC (P<0.01). Conclusions: For patients with diffuse thyroid lesions, ultrasound aided by CAD has a better specificity in diagnosis of thyroid nodules, which may reduce unnecessary puncture biopsies. Figures and Tables | References | Related Articles | Metrics

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Effect of surgical aortic valvuloplasty for aortic insufficiency using echocardiography one year after surgery in 25 patients WANG Chenchen, FANG Yuehua, SHI Zhongwei, QU Xuezheng 2022, 21 (03):  395-398.  DOI: 10.16150/j.1671-2870.2022.03.018 Abstract ( 229 )   HTML ( 1 )   PDF (488KB) ( 90 )   Objective: To investigate effect of surgical aortic valvuloplasty(AVP) for aortic insufficiency in patients using transthoracic echocardiography (TTE). Methods: A total of 25 patients underwent AVP surgery for aortic insufficiency(AI) were enrolled, and TTE was performed to evaluate effects of AVP. Cardiac chamber size, left ventricular(LV) systolic and diastolic function, AI grade, systolic transvalvular blood flow velocity and pressure gradient were measured one year after surgery, and results were compared to those before operation. Results: Echocardiographic measurements show that AVP, LV overload was reversed, Left ventricular end-diastolic diameter [(54.4±4.6) mm preoperatively vs ( 50.0±4.9) mm postoperatively, P=0.003), left ventricular end-diastolic volume[(145.7±28.8) mL preoperatively vs (120.4±27.8) mL pos-toperatively, P<0.001), left ventricular end-systolic diameter [34.0(31.0, 38.0) mm preoperatively vs 31.0(29.5, 34.0) mm postoperatively, P<0.001], left ventricular end-systolic volume [47.0(37.5, 63.0) mL preoperatively vs 37.0(32.5, 48.5) mL postoperatively, P=0.005], left ventricular stroke volume [(92.6±18.4) mL preoperatively vs (78.4±17.8) mL postoperatively, P<0.001] were significantly decreased, and the degree of aortic valve regurgitation was also significantly relieved (chi-square value is 21.000, P=0.021). However, there were no significant changes in aortic transvalvular flow velocity and pressure gradient [(1.8±0.4) m/s preoperatively vs (1.7±0.4) m/s postoperatively, P=0.086) and [(13.4±5.2) mmHg preoperatively vs (11.6±5.7) mmHg postoperatively, P=0.152). Postoperative regurgitation score ≥3 points were found in 5 cases. Conclusions: One year after AVP, the rate of moderate regurgitation in these patients is 20%. All AI is signifi-cantly alleviated after AVP, with reversed LV overload and accompanied by favorable LV remodelling, which is consistent with clinical manifestations. Figures and Tables | References | Related Articles | Metrics

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Investigation on mastery status of standardized diagnosis and treatment of Helicobacter pylori(Hp) infection in general practitioners in Pudong New Aera, Shanghai RUAN Yufeng, HU Liping, CHEN Shirong, YIN Jun, SUN Jing 2022, 21 (03):  399-404.  DOI: 10.16150/j.1671-2870.2022.03.019 Abstract ( 188 )   HTML ( 1 )   PDF (630KB) ( 77 )   Objective: To investigate the mastery status of standard diagnosis and treatment of Helicobacter pylori (Hp) infection among general practitioners in Pudong New Area of Shanghai and its influencing factors. Methods: From January to May in 2021, 348 general practitioners from 24 community health service centers in Pudong New Area were selected by using stratified random sampling method. A self-made questionnaire (full score of 30) was used to investigate the general practitioners′ mastery of Hp infection diagnosis, treatment and prevention. According to the scores, they were divided into poor mastery group (0-10 points), moderate mastery group (11-20 points) and good mastery group (21-30 points), and the differences among the groups were compared. Results: A total of 320 valid questionnaires were collected in this survey, and the general practitioners′ mastery of standard diagnosis and treatment of Hp infection was at a high level, with an average score of 21.69. There were 116 people in the moderate mastery group, accounting for 36.25%, with an average score of 17.53 points. There were 204 people in the good mastery group, accounting for 63.75%, with an average score of 24.05 points, and 0 people in the poor mastery group. For diagnosis of current Hp infection, only 50.0% of general practitioners knew that fecal Hp antigen positive was one of diagnostic criteria, while 66.6% of general practi-tioners mistakenly believed that serum Hp antibody positive could be used for diagnosing Hp infection. In terms of indications for eradication treatment of Hp infection, only 41.9% of general practitioners believed that "confirmation of Hp infection" was the indication of eradication treatment. There were significant differences in educational background and working years between the moderate mastery group and the good mastery group. In terms of standardized treatment, fol-lowup and prevention of Hp infection, there were significant differences in other options between the two groups except for the choice of antibiotics (P<0.05). Logistic regression analysis showed that the working years was the influencing factors for the general practitioners′ mastery of the standardized diagnosis and treatment of Hp infection, which was inversely proportional to the mastery. Conclusions: The general practitioners in Pudong New Area do not have enough knowledge about the current infection of Hp and the indications of eradication treatment. It is necessary to strengthen the training on the indications of diagnosis and eradication treatment of Hp infection among all general practitioners, especially senior general practitioners. Figures and Tables | References | Related Articles | Metrics

Case report

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The extra-gastrointestinal stromal tumors located in vagina: A case report and literature review GUO Yebing, ZHENG Jinfeng 2022, 21 (03):  405-407.  DOI: 10.16150/j.1671-2870.2022.03.020 Abstract ( 302 )   HTML ( 9 )   PDF (620KB) ( 88 )   Extra-gastrointestinal stromal tumor(EGIST) is a relatively rare mesenchymal tumor occurring outside the gastrointestinal tract. The immunophenotype, histological morphology, gene mutation sites and mutation frequency of EGIST are similar to GIST. EGIST lacks typical clinical features and is not easily diagnosed. Due to the small number of reported cases, there is no unified risk assessment standard. A case of EGIST originating in vaginal wall is reported in this paper, which diagnosis depended on clinical data and immunohistochemical markers. Literature reviewing suggestes that the incidence of EGIST is low and patients with EGIST have worse prognosis. Figures and Tables | References | Related Articles | Metrics

Review article

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Study on advances in the association between autoantibodies and clinical phenotypes in idiopathic inflammatory myopathy ZHANG Hao, CHI Huihui, SU Yutong, YANG Chengde 2022, 21 (03):  408-414.  DOI: 10.16150/j.1671-2870.2022.03.021 Abstract ( 246 )   HTML ( 2 )   PDF (677KB) ( 163 )   Myositis specific autoantibodies(MSA) are important for the diagnosis and classification of idiopathic inflammatory myopathy (IIM). It reveales that there is a close relationship between various types of MSA and unique clinical manifestations as well as pathological phenotypes. The titers of some autoantibodies are also correlated with the disease activity score and prognosis. Therefore, detection of MSA is helpful to the identification of the disease subtypes, personalized treatment selection and the judgement of prognosis in clinical practice. In future, more in-depth researches on MSA are needed to furtherly explore the pathogenic mechanism of the disease. Figures and Tables | References | Related Articles | Metrics