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Objective:To investigate the value of radiomics based on three-dimensional high resolution MR vessel wall imaging (3D HRMR-VWI) for identifying culprit plaques in symptomatic patients with middle cerebral atherosclerosis.Methods:The clinical and imaging features of 117 patients (139 middle cerebral artery plaques) with cerebrovascular diseases in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2018 to October 2020 were respectively reviewed. Stratified random sampling was used to divide 139 plaques into training set (97 plaques) and validation set (42 plaque) at the ratio of 7∶3. The plaques were divided into 69 culprit plaques and 70 non-culprit plaques based on plaque MR features and clinical symptoms. The clinical and imaging characteristics of culprit plaques and non-culprit plaques were compared by independent sample t-test, Mann-Whitney U test and χ 2 test, and factors with significant difference between two groups in univariate analysis were further analyzed by multivariate logistic regression to find out the independent predictors of culprit plaques. Radiomics features were extracted, screened and radiomics model was constructed using pre-and post-contrast 3D HRMR-VWI based on the training set. The combined model was constructed by combining the independent predictors and radiomics model. Receiver operating characteristic curve and area under curve (AUC) were used to evaluate the efficacy of each model, and DeLong test was used to compare the efficacy of different models. Results:Significant difference was found in intraplaque hemorrhage, lumen area of stenosis, stenosis diameter, stenosis rate, plaque burden and enhancement rate between culprit and non-culprit plaques (all P<0.05). Multivariate logistic regression analysis confirmed that only intraplaque hemorrhage was the independent predictor for culprit plaques (OR=7.045,95%CI 1.402-35.397, P=0.018). In the validation set, the AUC of the pre-contrast 3D HRMR-VWI model was lower than that of the post-contrast 3D HRMR-VWI model ( Z=-2.01, P=0.044). The AUC of pre+post-contrast 3D HRMR-VWI model was not significantly different from that of post-contrast 3D HRMR-VWI model ( Z=0.79, P=0.427). The AUC showed no significant difference between combined model and pre+post-contrast 3D HRMR-VWI model ( Z=-0.59, P>0.05). The combined model showed the best performance in predicting culprit plaques of middle cerebral artery (AUC=0.939), with the sensitivity, specificity and accuracy of 95.24%, 76.19% and 85.71%. Conclusion:Radiomics based on 3D HRMR-VWI has potential values in identifying culprit plaques in symptomatic patients with middle cerebral atherosclerosis.
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Objective@#To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. @*Materials and Methods@#Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. @*Results@#Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825–0.910) in the training cohort and 0.890 (0.844–0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. @*Conclusion@#The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.
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Objective To investigate the clinical effect of glutamine on parenteral alimentation in patients with severe craniocerebral injury in ICU. Methods 120 patients with severe brain injury in our hospital from November 2013 to November 2014 were selected as the research object.According to the random number table method, the 120 patients were divided into experimental group and control group, 60 cases in each group.The patients in the experimental group received glutamine parenteral nutrition support, while the control group received conventional parenteral nutritional support.The serum total protein, albumin, the complications and malnutrition-inflammation score(MIS) scores of the two groups were compared.Results The serum total protein and serum albumin levels of the experimental group post-treatment were significant higher than those in the control group (P<0.001).The complication rate in the experimental group was 15.0%, significantly lower than the control group of 55.0%(χ2 =21.099,P<0.001).The patients of normal MIS score in the experimental group were obviously superior to the control group ( 70.0% vs.33.3%, χ2 =16.151, P <0.001 ). Conclusion Adding glutamine to parenteral nutrition support therapy in the treatment of patients with severe craniocerebral injury can effectively improve the nutritional status after operation and strengthen nutrition support.
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Objective To obtain information on the application value of percutaneous epididymal sperm aspiration(PESA) and percutaneous testicle sperm aspiration(PTSA) in the differentiating diagnosis of obstructive and nonobstructive azoospermia.Methods Sperm recovery procedures were done in infertile men with obstructive azoospermia(OA)(n=37) and nonobstructive azoospermia(NOA)(n=28) by PESA or PTSA.Cytological smears were analysed.Results Sperm was found in the 32 epididymides and 5 testicles of OA group and in the 7 epididymides and 11 testicles of NOA group.Sperm counts were significantly different in two groups.Conclusion PESA and PTSA are efficient methods in differentiating OA and NOA.
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Objective:To investigate the content change of EGF and NT-4/5 in the the frontal lobe,hippocampus and thalamus of rats after cerebral ischemia-reperfusion,in order to reveal the dynamic protection of EGF and NT-4/5 to cerebellum ischemia-reperfusion injury.Methods:Wistar senile rats were divided into the control group and the experiment groups at random.The control group included 5.The experimental groups were divided into cerebral ischemia 15 min group and ischemia-reperfusion 1 h,6 h,2 d,4 d,9 d groups after 15 min ischemia,5 rats per group.Results:There was all a little expression of EGF and NT-4/5 in the frontal lobe,hippocampus and thalamus of normal senile rats.The frontal lobe was shown evident increase of EGF expression in ischemia-reperfusion 2 d only.The hippocampus was shown continued increase of EGF expression during ischemia-reperfusion 6 h to 4 d and the EGF expression was shown a peak in ischemia-reperfusion 4 d.The increase of EGF expression in thalamus continued during ischemia-reperfusion 2-9 d too.The NT-4/5 expression of the frontal brain was clearly reduced after ischemia-reperfusion and returned to normal in ischemia-reperfusion 9 d.The NT-4/5 expression of hippocampus was shown one-off reduction after ischemia-reperfusion,but the expression quickly returned to normal and shows a little increase.The thalamus had only one-off reduction of NT-4/5 expression.Conclusion:The frontal lobe lacks of fast neuroprotective mechanism of EGF in early stage of ischemia-reperfusion and it has a limited neuroprotective effect of EGF in middle and advanced stage.The hippocampus has a fast and long-lasting neuroprotective mechanism of EGF.The thalamus has a delayed neuroprotective mechanism of EGF.The frontal brain and hippocampus have a delayed neuroprotective mechanism of NT-4/5.The neuroprotective mechanism of NT-4/5 is weaker in thalamus.