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Objective:To explore the application of metagenomics next generation sequencing(mNGS)in the immunosuppressed children with severe pneumonia and to understand the distribution of pathogens in order to provide reference for early prevention and treatment.Methods:We performed a retrospective analysis of the immunosuppressed children with severe pneumonia who had mNGS reports admitted to PICU according with the enrollment condition from July 2019 to July 2020.The records included general clinical data, traditional detection method report and mNGS results.We evaluated the consistency of the mNGS with the clinical microbiology reports and clinical judgment.Results:Twenty-three patients were enrolled, 15 were male and 8 were female, aging from 28 days to 10 years old, with an average age of(3.67±3.20)years old.Seven cases were cured, 2 were improved, and 14 died.A total of 23 samples were obtained, including 21 blood specimens and 2 bronchoal-veolar lavage fluid specimens.Among the 23 cases, 5 were single infected and 15 were mixed infected.Fungi were detected in 15 cases(65.22%), including 12 cases of Pneumocystis jirovecii, 2 cases of Aspergillus fumigatus and 2 cases of Candida albicans.Virus were detected in 14 cases(60.87%), including cytomegalovirus(CMV) in 10 cases(8 cases with pneumocystis infection), Herpes virus in 3 cases and fine ring virus in 2 cases(1 case with herpes virus infection). Bacteria were detected in 10 cases, including 3 cases of Acinetobacter, 1 case of Klebsiella pneumoniae, 1 case of Stenotrophomonas maltophilia, 1 case of Pinocytogenes, 4 cases of Staphylococcus and 1 case of Bacillus licheniformis.There were Mycoplasma in 3 cases with mixed infection.The positive rate and coincidence rate of mNGS were significantly higher than that of the traditional test group( P<0.05). A total of 19 cases were treated with hormone or immunosuppressive agents, and 17 cases were treated for 1 to 6 months when severe pneumonia occurred. Conclusion:Most immunosuppressed children with severe pneumonia are mixed infection.The common pathogens are Pneumocystis jirovecii and CMV.The use of mNGS can significantly improve the pathogen detection rate, effectively guiding the treatment.
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Objective:To better understand the clinical characteristics of children with pneumocystis pneumonia(PCP).Methods:Seven cases of non-human immunodeficiency virus infected children with PCP admitted to pediatric intensive care unit(PICU) at Xi′an Children′s Hospital from January 1, 2019 to December 31, 2019 were enrolled.Clinical findings, laboratory examination results, diagnosis, treatment, and outcome data were retrospectively reviewed.Results:There were seven children enrolled in this study including six boys and one girl.The average age was(6.09±3.80)years.Six patients received a long-term steroid or immunosuppressive therapy, and the average duration of medication was(80±30)days.One patient was eventually diagnosed with immunodeficiency disease despite no history of steroid and immunosuppressive therapy.Fever, cough and progressive dyspnea were the main manifestations.The pulmonary signs were not obvious, however, the chest radiographs showed serious ground glass changes.Laboratory examination showed that white blood cell counts were normal, lymphocyte counts were decreased to varying degrees, while C-reactive protein, calcitonin and lipopolysaccharide increased slightly or normal.Lactate dehydrogenase significantly increased and PaO 2/FiO 2 decreased, respectively.All children combined with different degrees of heart, liver and digestive tract damage.Pneumocystis jirovecii infection was diagnosed by metagenomics next-generation sequencing(mNGS), of which one case was detected by bronchoalveolar lavage fluid, and the remaining six cases were detected by peripheral blood.After entering PICU, mechanical ventilation, intravenous injection of human immunoglobulin, and continuous renal replacement therapy were performed.None of the children used TMP-SMZ for prophylaxis outside the hospital.Among them, one case was diagnosed with PCP before entering PICU and was given TMP-SMZ for 20 days, while the remaining six patients started to receive TMP-SMZ after entering PICU.Finally, one patient was cured, three died and another three cases died after giving up treatment.The average hospitalization days were(11.28±8.78)days, and the average hospitalization costs were (78, 000±24, 000) RMB. Conclusion:Children with non-human immunodeficiency virus infected PCP usually have underlying diseases or immunodeficiency diseases.Due to non-specific manifestations, rapid progression and high mortality, clinicians should pay more attention to it.It is necessary to dynamically observe the respiratory symptoms, perform mNGS as soon as possible, and give TMP-SMZ treatment in time.TMP-SMZ prophylaxis can be given to patients who are highly suspected of PCP but unable to perform pathogenic examinations.
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Objective@#To analyze the genetic characteristics of a five generations pedigree with homozygous familial hypercholesterolemia (HoFH).@*Methods@#Prospective study. Twenty family members included a proband diagnosed as familial hyperlipidemia at the cardiology Department of Xi′an Children′s Hospital in October 2018 were research object. Clinical data were collected. Genome DNAs were extracted. Whole exons sequencing was performed on the proband using target capture next generation sequencing. Candidate gene mutation sites identified by bioinformatics were verified by Sanger sequencing in the family members. The genotype-phenotype correlation of the pedigree was analyzed between heterozygous mutation carriers and non-carriers.@*Results@#The proband was a 7-years and 10-month-old boy. He was born with a roundgreen bean size yellow skin protuberance in the skin of the coccyx. Since the age of 3-4 years old, xanthoma-like lesions with a diameter of 0.5-1.5 cm gradually appeared in the skin of bilateral elbow joints, knee joints and Achilles tendon. The height, weight and intellectual development of the child were the same as those of normal children at the same age. No similar xanthoma-like lesion was found in the other family members. The proband′s total cholesterol (TC) reached 18.16-21.24 mmol/L, and his low density lipoproteincholesterol (LDL-C) was 14.08-15.51 mmol/L. Carotid ultrasonography showed diffuse sclerotic plaques in bilateral carotid and vertebral arteries, and color Doppler echocardiography revealed aortic valve thickening and calcification. Gene testing identified that the proband carried a homozygous mutation C. 418G>A (p. E140K) in LDLR gene inherited from his parents who had a consanguineous marriage and carried a heterozygous mutation of LDLR-E140K, respectively.The TC, LDL-C and apolipoproteinB (ApoB) of LDLR-E140K gene heterozygous carriers ((8.40±0.13), (6.79±0.01) and (1.95±0.05) mmol/L, respectively) were significantly higher than those of non-carriers ((4.59±0.28), (3.35±0.39) and (0.86±0.10) mmol/L, t=7.269, 4.595, 6.311, respectively, P<0.05).@*Conclusions@#LDLR-E140K gene homozygous mutation is first reported to be associated with most severe phenotype HoFH. The genotype-phenotype analysis of the pedigree shows that the clinical phenotype of the proband with homozygous mutation is the most serious, and all the heterozygous mutation carriers present with hypercholesterolemia phenotype. The investigation confirms that LDLR-E140K is the pathogenic variation of familial hyperlipidemia.
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Objective@#To summarize the clinical characteristics of a patient with cerebellar ataxia, areflexia, pes cavus, optic atrophy and sensorineural hearing loss (CAPOS) syndrome, followed by relative literature review.@*Methods@#The medical history, physical examination and results of relative auxiliary examinations were collected from a CAPOS syndrome patient, who was definitely diagnosed by gene detection.@*Results@#The patient was a 20-year-old male, complaining of poor coordination for 19 years, impaired vision for 15 years and hearing loss for 13 years. When he was eleven months old, weakness of four limbs happened after diarrhea but recovered spontaneously a few days later. Then his poor coordination was discovered. His vision has decreased progressively since the age of five and he began to suffer from bilateral hearing loss after fever at the age of seven. Anti-infectious and immunoregulatory treatment was ineffective at that time. Physical examination showed that bilateral visual acuity decreased. Transient horizontal gaze-evoked nystagmus and bilateral hearing loss were detected. Obvious shaking was observed with closed eyes and toes together. Finger-to-nose, finger tracking, heel-knee-tibia and alternate motion tests were slightly inaccurate. Deep tendon reflexes disappeared and no pes cavus was observed. Pure tone audiometry revealed bilateral sensorineural hearing loss. Cranial magnetic resonance imaging indicated bilateral optic atrophy. ATP1A3 gene detection in the patient showed c. 2452G>A (p. Glu818Lys) heterozygous mutation while his parents were detected no such mutation in the same locus.@*Conclusions@#As for young patients who suffer from acute cerebellar ataxia after fever, disappeared tendon reflexes, atrophy of optic nerves or sensorineural hearing loss, they should be alerted to CAPOS syndrome when immunomodulating or anti-inflammatory therapy has been proved to be useless. Positive family history and ATP1A3 gene mutation would be beneficial to definite diagnosis.
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Objective To summarize the clinical characteristics of a patient with cerebellar ataxia,areflexia,pes cavus,optic atrophy and sensorineural hearing loss (CAPOS) syndrome,followed by relative literature review.Methods The medical history,physical examination and results of relative auxiliary examinations were collected from a CAPOS syndrome patient,who was definitely diagnosed by gene detection.Results The patient was a 20-year-old male,complaining of poor coordination for 19 years,impaired vision for 15 years and hearing loss for 13 years.When he was eleven months old,weakness of four limbs happened after diarrhea but recovered spontaneously a few days later.Then his poor coordination was discovered.His vision has decreased progressively since the age of five and he began to suffer from bilateral hearing loss after fever at the age of seven.Anti-infectious and immunoregulatory treatment was ineffective at that time.Physical examination showed that bilateral visual acuity decreased.Transient horizontal gaze-evoked nystagmus and bilateral hearing loss were detected.Obvious shaking was observed with closed eyes and toes together.Finger-to-nose,finger tracking,heel-knee-tibia and alternate motion tests were slightly inaccurate.Deep tendon reflexes disappeared and no pes cavus was observed.Pure tone audiometry revealed bilateral sensorineural hearing loss.Cranial magnetic resonance imaging indicated bilateral optic atrophy.ATP1A3 gene detection in the patient showed c.2452G＞A (p.Glu818Lys) heterozygous mutation while his parents were detected no such mutation in the same locus.Conclusions As for young patients who suffer from acute cerebellar ataxia after fever,disappeared tendon reflexes,atrophy of optic nerves or sensorineural hearing loss,they should be alerted to CAPOS syndrome when immunomodulating or anti-inflammatory therapy has been proved to be useless.Positive family history and ATP1A3 gene mutation would be beneficial to definite diagnosis.
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Objective@#To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland.@*Methods@#In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy.@*Results@#By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children′s hospitals and 7 were general hospitals. Thirty-seven ECMO equipment was available. A total of 518 patients treated with ECMO, within whom 323 (62.4%) successfully weaned from ECMO and 262 (50.6%) survived to discharge. Among 375 pediatric patients, 233 (62.1%) were successfully weaned from ECMO and 186 (49.6%) survived to discharge. Among 143 newborn patients, 90 (62.9%) successfully weaned from ECMO, 76 (53.1%) survived to discharge. ECMO was applied in veno-arterial (VA) mode to 501 (96.7%) patients, veno-venous (VV) mode to 14 (2.7%) patients, and VV-VA conversion mode to 3 (0.6%) patients. Sixty-nine patients required extracorporeal cardiopulmonary resuscitation (ECPR), including 20 newborn patients (29.0%) and 38 pediatric patients (71.0%), who were all with cardiovascular disease. Neonatal respiratory distress syndrome (26/61), persistent pulmonary hypertension of the newborn (PPHN) (12/61), and meconium aspiration syndrome (MAS) (11/61) are the most common pulmonary diseases in newborn patients; among whom, infants with PPHN had highest survival rate (10/12), followed by MAS (9/11). Among newborn patients with cardiovascular diseases, those who admitted were after surgery for congenital cardiac disease were the most common (54/82), while those with septic shock had the highest survival rate (2/3). In pediatric pulmonary diseases, acute respiratory distress syndrome was the most common (42/93), while plastic bronchitis was with the highest survival rate (4/4), followed by viral pneumonia (13/16). Among pediatric cardiovascular diseases, congenital cardiac defect was the most common (124/282), while fulminant myocarditis had the highest survival rate (54/77).@*Conclusion@#The application of ECMO as a rescue therapy for children with severe cardiopulmonary failure has dramatically developed in China mainland.
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Objective To explore the value of small surface coil combined with three-dimensional double-echo steady-state with water excitation (3D-DESS-WE) sequence in displaying mandibular nerves and their branches. Methods The maxillofacial regions of 52 volunteers were scanned unilaterally by a small surface coil combined with 3D-DESS-WE sequence. According to the Gray's anatomy atlas,MPR and CPR was done according to the anatomic position of mandibular nerve and the branches,the signal characteristics of the nerves and neighboring structures were analyzed. The displaying rate of the mandibular nerves and their branches were evaluated.The image quality and display of the nerve were subjectively scored. The signal intensity(SI) of the nerve and adjacent lateral pterygoid muscle were measured. The signal intensity ratio(SIR) of mandibular nerve/lateral pterygoid muscle (SIRN/M) was calculated. Results Compared with the muscles, the nerve showed iso-signal intensity. The subjective scores for all small coil 3D-DESS-WE images were 3.02 ± 0.82. The displaying rates of V3 trunk,anterior trunk,buccal nerve, posterior trunk,inferior alveolar nerve and lingual nerve were all 100%. V3 posterior trunk,inferior alveolar nerve and lingual nerve showed the best quality scores,which were all about 3 points,and the SIRN/M were about 1. The auricular temporal nerve and masseter muscle nerve were also basically satisfied. The displaying rate of mylohyoid muscle nerve,medial pterygoid nerve and lateral pterygoid nerve was low. Conclusion Small surface coil combine with 3D-DESS-WE sequence performed high-quality in mandibular nerves and their branches MR imaging using MPR,CPR post-processing technology,which are suitable for clinical application.
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Objective To investigate the clinical value of three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE) sequence in preoperative evaluation of acoustic neuroma.Methods Totally 57 patients with acoustic neuroma confirmed by surgery and pathology were enrolled.All patients underwent preoperative routine head MR and 3D-SPACE sequence.The position,size and shape of the tumors were observed,and the display rate of surrounding cranial nerves was evaluated with 3D-SPACE sequence.The results were compared with those of conventional MRI and operation.Results All 57 patients were found with single tumor.The tumor in 1 patient (1/57,1.75％) limited in the internal auditory canal,and those in another 56 patients (56/57,98.25％) exceed the internal auditory canal crossing growth.The inner auditory canal fundus in 26 patients (26/57,45.61 ％) were completely filled by the tumors,while those in another 31 patients (31/57) were uncompletely filled.3D-SPACE sequence showed 21 patients (21/57,36.84％) with solid type lesions,35 patients (61.40％,35/57) with solid with cystic type lesions and 1 patient (1/57,1.76％) with cystic type lesion.The coincidence rate of lesion types showed with 3D-SPACE sequence and intraoperative findings was 85.96 ％ (49/57).The display rate of trigeminal nerve internal cisternal segment,lower cranial nerves cisternal segment,abducens nerve cisternal segment,facial nerve internal acoustic meatus segment,facial nerve cisternal segment and acoustic nerve cisternal segment was 100％ (57/57),100％(57/57),75.44％ (43/57),50.88％ (29/57),17.53％ (10/57) and 19.30％ (11/57),respectively,all significantly increased compared with those of conventional MRI (all P＜0.05).Conclusion 3D-SPACE sequence can accurately display the relationship between tumor and adjacent cranial nerves,therefore has important clinical value in preoperative evaluation of acoustic neuroma.
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Objective To investigate the value of neurite orientation dispersion and density imaging (NODDI) in quantitative evaluation of the microstructural changes in basal ganglia and thalamus in Wilson's disease (WD) patients,and to assess the diagnostic efficacy of NODDI.Methods Totally 27 WD patients (WD group) and 26 age-and sex-matched controls (control group) were enrolled.All subjects underwent MR scanning with NODDI.Parameters of NODDI,including intracellular volume fraction (Vic),orientation dispersion index (ODI) and isotropic volume fraction (Viso) of bilateral caudate nucleus,globus pallidus,putamen and thalamus were compared between the 2 groups.Correlation analysis was performed between each parameter of NODDI and clinical Young scores.Random Forest model was used to assess the relative importance of each parameter and to evaluate the diagnostic efficacy.Results The Vic and ODI of bilateral caudate nucleus,globus pallidus and putamen in WD patients were significantly lower than those in normal controls (all P＜0.05),while Viso was significantly higher than that in normal controls (all P＜0.05).The Vic of bilateral thalamus was lower,while Viso was higher in WD patients than those in normal controls (all P＜0.05),and ODI had no significant difference between the 2 groups (P=0.055).In WD patients,Vic and ODI of bilateral caudate nucleus,globus pallidus and putamen were negatively correlated with clinical Young scores.Viso of globus pallidus and putamen were positively correlated with clinical scores.The prediction accuracy of NODDI was 96.23％,and the area under ROC curve was 0.96.Conclusion NODDI can effectively evaluate changes in microstructures and metabolism during copper deposition in WD patients,and it may be useful in detecting changes of brain deep nuclei and assessing the progression of WD.
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Objective To investigate the CT imaging findings and diagnostic methods of extragonadal seminoma.Methods The CT imaging findings and the causes of misdiagnosis in 6 cases of extragonadal seminoma before and after CT-guided biopsy were analyzed retrospectively in this study.Results One case of seminoma was found in the right supraclavicular region,mediastinuml,retroperitoneal cavity and retroperitoneal-retroperitoneal cavity,respectively.Two cases located in the pelvic-abdominal cavity.Lesions were substantially isodensity soft tissue masseswith creeping growth,clear boundary,mild to moderate enhancement and peripheral blood vessels embedded in the tumor.All the cases performed CT-guided biopsy.The diagnoses before and after puncture were inconsistent,so the misdiagnosis rate was 100%. Conclusion Extragonadal seminoma occurs randomly in the different location and imaging features are lack of specificity,therefore, it is difficult to diagnose qualitatively.CT-guided biopsy is the most effective clinical method of the diagnosis of extragonadal seminoma.
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Objective:To know the amount of literacy and scores of behavior problems of the grade 2-5 pupils in the primary school,and explore the correlation between them.Methods:A total of 673 pupils from grade 2 to 5 in primary school of Nanhai distric,Foshan City were enrolled.Their amount of literacy was assessed with the Primary School Literacy Assessment Scale,and their teachers were assessed with the Conners Teacher Rating Scale.Results:The amount of literacy in different grades,genders and parents' education levels were significantly different among the primary school students (P ＜0.05),girls's scores were higher than boys's [(2312 ±719) vs.(2184 ±734),P ＜ 0.05],students whose parents of high education level were higher than those of low education level (P ＜ 0.05).Scores of hyperactivity,inattentive-passive behaviors and conduct problems in different grades and genders were significantly different.Scores of Grade 2 pupils were higher than others,and boys's scores were higher than girls' s (P ＜ 0.05).Three factors of CTRS,including conduct problems (r =-0.31),hyperactivity (r =-0.43) and inattentive-passive behaviors (r =-0.36) and hyperactivity index(r =-0.38) had significantly negative correlation with the amount of literacy (P ＜ 0.001).Regression analysis showed that hyperactivity (β =-22.27,P ＜ 0.01) and conduct problems (β =-17.69,P ＜ 0.01) could significantly explain the amount of literacy (R2 =0.81).Conclusion:It suggests that hyperactivity and conduct problems are moderately associated with the amount of literacy in primary pupils.
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Objective To study the effect of danshao shugan granule combined with metformin in treatment of nonalcoholic fatty liver and its effects on lipid and uric acid metabolism.Methods 80 patients of nonalcoholic fatty liver who received therapy from February 2014 to February 2015 in our hospital were selected as research objects.According to random number table,those patients were divided into the observation group (n=40) cases in each group and the control group (n=40).The control group was treated with metformin, while the observation group was treated with danshao shugan granule combined with metformin.Then blood lipid level, FBG, FINS, IR, SUA level, SOD, MDA level, therapeutic effect of two groups after treatment were compared.Results After treatment, TG,TC in observation group was significantly less than the control group (P<0.05); FBG, FINS, IR, SUA levels in the observation group were significantly lower than the control group ( P<0.05 ); SOD level higher than the control group, MDA level significantly less than the control group (P<0.05); The total effective rate of observation group was statistically higher than that in the control group (P<0.05).Conclusion Danshao shugan granule combined with metformin is well for nonalcoholic fatty liver,which can improve the glucose, lipid, uric acid metabolism and insulin resistance, and can protect the liver function.
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Objective To explore the efficacy of saxagliptin in the treatment of failed glycemic control of patients with type 2 diabetes mellitus on the basis of established treatments.Methods 172 cases of failed glycemic control of patients with type 2 diabetes mellitus from June 2013 to December 2014 in department of endocrinology of the first hospital of Ningbo were selected and received health education of 8 weeks, then received saxagliptin on the basis of established treatments for a consecutive treatment of 12 weeks.The HbA1c, fasting blood glucose ( FBG), 2-hours postprandial blood glucose (2hPBG), body mass index (BMI), insulin dosage and adverse event were observed.Results The FBG,HbA1c and 2hPBG after treatment of 12 weeks were significantly lower than those pre-treatment[(7.1 ±2.0)vs.(8.3 ±1.6)mmol/L,(10.2 ±2.3)vs.(15.2 ±2.9)mmol/L,(7.0 ±1.5) vs.(8.0 ±1.7)%], with significant difference (all P <0.05), while there was no significant difference in BMI between pre-and post-treatment [(24.4 ±3.0)vs.(24.9 ±2.7)kg/m2].The insulin dose after treatment of 12 weeks was significantly lower than that pre-treatment[(22.6 ±7.9)vs. (32.3 ±8.2) U/d], with significant difference (P <0.05).There were two patients dropout because of the intolerable digestive tract symptom. Conclusion The adding of saxagliptin could control FBG,2hPBG and HbA1c effectively and decrease insulin dose, without gaining weight in the treatment of failed glycemic control of patients with type 2 diabetes mellitus on the basis of established treatments.
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Objective To evaluate functional activity of the subcortical nuclei in Wilson's disease (WD) using resting state functional MRI (rs-fMRI),and to evaluate damage to the functional conjunction in the extracorticospinal tract in WD patients.Methods Twenty-two patients with WD (between January 2015 and January 2016),including 18 with cerebral type and 4 with hepatic type,and 20 age-matched healthy controls were enrolled.Neurological symptoms were scored using the modified Young Scale.Patients with cerebral type WD were divided into 4 subgroups.All study subjects underwent rs-fMRI of the brain.The values of amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (REHO) in the thalamus,caudate nucleus,putamen and globus pallidus were determined.The relationships between rsfMRI metrics and clinical status were evaluated.Results ALFF values were lower in the caudate nucleus,putamen and right thalamus of WD patients than in controls (t =-3.07,-3.00,-3.12,-2.46,-2.20;P =0.005,0.006,0.004,0.020,0.036),while REHO values were lower in the left caudate nucleus and left thalamus of WD patients (t =-2.38,-2.16;P =0.025,0.040).In the caudate nucleus (P =0.032,0.029,0.023),thalamus (P =0.022,0.041,0.035) ALFF values were lower in group 4 than in other groups.REHO values of the putamen (P =0.040,0.017,0.040) and thalamus (P =0.024,0.029 7,0.041) were higher in group 4 than in other groups.ALFF values in the caudate nucleus (t =-0.29,P=0.037),and thalamus (t =-1.77,P =0.042) were lower,and REHO values in the caudate nncleus (t =-1.46,P =0.040) were lower,in patients of cerebral type than in hepatic type patients.Conclusions The damage to the functional activity of the subcortical nuclei may occur in the WD patients.The functional activity of nuclei may be different between hepatic and cerebral type patients.Damage to the activity of neurons in the putamen and thalamus may correlate with psychiatric symptoms in WD patients.
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Objective To explore the value of small surface coil combine with three-dimensional fast imaging with steady state precession and fat-suppression (3D-FISP-FS) sequence in displaying intra-parotid facial nerves segment and parotid ducts.Methods The parotid regions of 18 healthy volunteers who were excluded any parotid diseases were scanned by head&neck coil (36 sides) and 4 cm small surface coil (32 sides) combined with 3D-FISP-FS sequence prospectively. The obtained original images were treated through MIP, MPR and CPR, The MRI signal characteristics of parotid region structure, the subjective score of image quality, the signal intensity ratio (SIR) of facial nerve/parotid tissue (SIR N) and parotid duct/parotid tissue (SIRD) was calculated, and the displaying rates of the facial nerves and parotid ducts were observed. Wilcoxon matched-samples signed rank sum test was used to compare the scores of head&neck coil and small coil 3D-FISP-FS sequence images, paired t test was used to compare SIRN, SIRD of the two groups, Chi-square test was used to compare of the displaying rate of the facial nerves and parotid ducts in two groups. Results Eighteen volunteers were successfully performed MRI scan of parotid gland. On 3D-FISP-FS sequence images, the parotid gland was showed slightly low signal intensity, muscle tissue was showed medium signal intensity, the vessels were showed slightly high or high signal, parotid segment of facial nerve was showed tortuous line-like high signal intensity, and parotid duct was showed curve high signal intensity, lymph nodes were showed kidney shaped, oval or spindle shaped high signal intensity structures. The subjective scores for head and neck coil and coil images were (2.0 ± 0.9) and (1.5 ± 0.7) respectively, and the difference was statistically significant (Z=-2.714, P=0.007), image quality of small coil group was better than that of head and neck coil group. The SIRN of the two groups was 1.7±0.8 and 2.1± 1.2 respectively, and the SIRD was 1.8±0.7 and 2.5±1.7 respectively, which showed a statistically significant difference between the two groups (t value was 2.978, 2.427 respectively, P value was 0.006, 0.031 respectively).All facial nerve trunks could be displayed by head and neck coil and small coil. On head and neck coil images, 25 sides of temporofacial truck, 15 sides of cervicofacial truck, 17 sides of temporofacial branches, 11 sides of cervicofacial branches, 16 sides of the parotid duct could be displayed. On small coil images, 30 sides of temporofacial truck, 28 sides of cervicofacial truck, 26 sides of temporofacial branches, 23 sides of cervicofacial branches, 27 sides of the parotid duct could be displayed, which showed a statistically significant difference (P<0.05). Conclusion Small surface coil performed better in parotid MR imaging with 3D-FISP-FS sequence than that of head and neck coil, which can simultaneous clearly display the trunk and branches of the intra-parotid facial nerves and parotid ducts.
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Objective To explore the imaging characteristics of different sizes of MR small surface coil.Methods A water phantom with NiSO4· 6H2O for Siemens was scanned with 4 cm,7 cm and 11 cm small surface coils in Siemens 3.0 T MR system.T1WI,T2WI,three dimensional reversed fast imaging with steady state precession with diffusion-weighted(3D-PSIF-DWI) and three dimensional fast imaging with steady state precession and fat suppression(3D-FISP-FS) images were obtained.The imaging area,signal intensity (SI),standard deviation (SD) and signal-to-noise ratio (SNR) variations of different depths (from the near to the distant) were measured and compared.Curves according to the SI and SNR data were draw.SI and SNR characteristics of images obtained by L11 separately and used together with spine matrix coil were compared by using signed rank sum test.Results The signal intensity of images scanned by 4 cm,7 cm small surface coil decreased gradually in the depth of 0.2 to 2.2 cm,maintain good signal uniformity in the depth of 2.2 to 4.2 cm,and the signal intensity obtained by 11 cm coil maintain good signal uniformity in the depth of 5.2 cm.The optimum imaging widths of 4 cm,7 cm and 11 cm coil were about 7.0,8.5 and 11.0 cm.As the diameter of the coil increased,the imaging width and depth increased,but the received noise also increased.The SNR gradually reduced from the center to the edge of the coils.The imaging area increased but the local SNR decreased when using L11 coil combine with spine matrix coil,which showed a statistically significant difference (Z=-2.354,P=0.019).Conclusions A suitable size of small surface coil should be chosen according to the location and size of the organ or lesion before clinical MR examination.Other coils should be turned off to improve the SNR.
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Urinary sodium was measured by means of 24-hour urine collection in 186 patients with type 2 diabetes.All patients were categorized into quartiles of urinary sodium.There was a significant positive trend of association of greater carotid intima-media thickness(CIMT) with increasing urinary sodium quartile,even adjusting for age,smoking,and blood pressure (Ptrend＜0.01).Multiple linear regression analysis showed that 24-hour urinary excretion may be associated with CIMT in type 2 diabetes patients (β=0.074,P＜0.01).
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ObjectiveTo investigate the capacity and diagnostic value of various MRI seguences in patients with trigeminal neuralgia.Methods MR images of 60 patients with trigeminal neuralgia were analyzed retrospectively.The sensitivity,specificity and diagnostic value of various MRI sequences were evaluated comparing with clinical data and operation results.All patients were scanned with conventional sequences including SE-T1WI,T2WI,FLAIR of head.Among them,9 cases were injected with contrast agent,49 cases were scanned with 3D-TOF and 3D-TSE sequences on cerebellopontine angle additinally.The sensitivity,specificity and accuracy of the 3D-TOF and 3D-TSE sequences were analyzed by using the x2 test.Results Six cases with tumor,3 cases with radiculitis and meningitis,1 case with multiple sclerosis and 1 case with pons infarction were diagnosed by conventional MR sequences.MRI of 49 cases with 3D-TOF and 3D-TSE showed neurovascular compress proved by operation.The sensitivity,specificity and accuracy of 3D-TOF and 3D-TSE were 95.3％ (41/43)vs.95.6％ (43/45),66.7％ (4/6)vs.50.0％(2/4) and 91.8％ (45/49)vs.91.8％ (45/49),and no significantly difference was found between the two sequences (x2 =0.13,0.19 and 0.17,P ＞0.5).ConclusionsMRI plays an important role in displaying the causes and diagnosis of trigeminal neuralgia.The conventional head MR sequences should be recommended for diagnosis of secondary TN caused by tumor and inflammation et al,and further 3D-TOF and 3D-TSE with high sensitivity and accuracy should be applied in patients with primary TN to display the neurovascular relationship.
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Objective To determine the effect of the modified UW (University of Wisconsin)solution in the treatment of acute renal tubular necrosis in newborn swine. Methods Ten one-week-old newborn swine were used to establish the animal model of acute renal tubular necrosis by clamping their renal arteries,and were divided into two groups: the model group( n = 5 ) and the treatment group ( n = 5 ) in which fructose diphosphate sodium UW solution was used. Sham surgery was performed on other five swine, which were used as the sham group. At 12 h,l d,2 d,3 d and 7 d after the operation,the urine volume,urine protein,blood urea nitrogen(BUN) and creatinine(Cr) were determined. At 12 h ,24 h and 7 d after the operation ,renal pathological examination was conducted. Results The renal pathological examination and the blood biochemistry tests showed that the animal model was successful. BUN and Cr in the model group and the treatment group were significantly higher than those in the sham group at 12 h after operation(P ＜0. 05) ,and they arrived at their peak values at 2 d after operation,showed remarkable decline at 7 d,especially in treatment group,and returned to the level of the sham group. The urine protein in the model group and treatment group were higher than those in the sham group at various times(P ＜0.05 or P ＜0.01) and it peaked at 1 d after operation,then declining gradually,especially in the treatment group. Compared with the sham group,there were a significant decrease in the urine volume at various times in the model group(P ＜0. 05 or P ＜0. 01 ) ,while in the treatment group,the decrease in the urine volume were significant only at 12 h, 1 d and 2 d( P ＜ 0. 05 ) ,and turned insignificant at 3 d and 7 d. The pathological examination showed that the pathological changes in the treatment group were significantly milder than those in the model group. Conclusion The modified UW solution is effective in reducing the acute renal tubular necrosis in newborn swine.
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The purpose of the present study was to investigate teacher-dominant action and focus on learning-oriented group.Medical teachers should pay more attention to three important aspects,such as optimizing teaching pattern,dealing with the relationship carefully among pre-class,inter-class and post-class.It is important to attach importance to pre-class,giving prominence to inter-class and also giving attention to post-class,which can form a harmonious,interactive and collaborate class.In addition,it stimulates deep processing interactions between teachers and students by increasing students learning interests,which is very helpful in improving teaching effects of medical image.