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【Objective】 To investigate the possible molecular pathogenesis of a child with hemophilia A accompanied by coagulation factor Ⅺ reduction by testing coagulation-related indicators and genotyping in the child and his family. 【Methods】 Peripheral blood from the patient and his parents for detection of coagulation factors Ⅷ, Ⅸ, Ⅺ, Ⅻ, VWF∶Ag, lupus anticoagulants and F VIII, F XI inhibitors were collected. All exons and flanking sequences of the genes encoding FⅧ and FⅪ were sequenced and bioinformatically analyzed. 【Results】 The child had low FⅧ and FⅪ activity and no parental abnormalities were observed. The sequencing results showed that there was a c. 1834(exon12) C>T heterozygous mutation in the FⅧ gene and a c. 1817 (exon15) G>A heterozygous mutation in the FⅪ gene, which was de novo. Bioinformatics analysis shows that the FⅪ mutation changes the original protein structure and increases the number of carboxyl groups. 【Conclusion】 For patients with prolonged APTT, in addition to excluding factors that interfere with APTT testing, all coagulation factors related to APTT should be tested to clarify the diagnosis.
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Objective:To compare the diagnostic performance in the hepatocellular carcinoma(HCC) with cirrhosis between the 2017 version of liver imaging reporting and data system (LI-RADS v2017) and 2018 version of LI-RADS (LI-RADS v2018) based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI.Methods:Clinical data of 213 patients with 246 hepatic lesions with cirrhosis who underwent Gd-EOB-DTPA enhanced MRI in the Third Affiliated Nantong Hospital of Nantong University from October 2015 to July 2020 were retrospectively collected. The MRI major features and LR categories of lesions were respectively reviewed by two radiologists according to LI-RADS v2017 and LI-RADS v2018, respectively. Taking postoperative histopathological results or follow-up imaging as references, with the LR-5 and LR-4+LR-5 as the diagnosis of HCC, the sensitivity, specificity and accuracy of the LI-RADS v2017 and LI-RADS v2018 were evaluated, respectively. The McNemar test or Fisher exact test was used to compare the diagnostic performance between the two LI-RADS versions.Results:In 246 hepatic lesions, 165 were HCCs, 31 were non-HCC malignancies and 50 were benign lesions. Due to the threshold growth and more simplified definition and changes in the LR-5 classification criteria in LI-RADS v2018, the categories of 38 (15.4%, 38/246) lesions were changed. The threshold growths of 84.6% (33/39) lesions in v2017 were reclassified to subthreshold growth in v2018. Using LI-RADS v2018, 10 lesions were down-categorized compared with LI-RADS v2017, including LR-5 to LR-4 in 7 lesions and LR-4 to LR-3 in 3 lesions, and 28 lesions were up-categorized LR-4 to LR-5, in which 25 were small HCC. With LR-5 as the diagnosis criteria of HCC, the sensitivity and accuracy of LI-RADS v2018 were 66.7% (110/165) and 73.6% (181/246); and the sensitivity and accuracy of LI-RADS v2017 were 55.8% (92/165) and 67.5% (166/246), both with statistical differences (χ2=4.13, P=0.001, χ2=6.20, P<0.001). No significant difference was found in the specificity values of LI-RADS v2018 and v2017 [87.7% (71/81) vs. 91.4% (74/81)], χ2=0.59, P=0.442). Compared with v2017, LI-RADS v2018 increased the sensitivity in the diagnosis of small HCC lesions (10-19 mm) [62.9% (56/89) vs. 40.4% (36/89), χ2=9.00, P<0.001]. With LR-4+LR-5 as the diagnostic criteria of HCC, there was no significant difference in the sensitivity, specificity and accuracy of LI-RADS v2017 and v2018 in the diagnosis of HCC (all P>0.05). Conclusions:Based on Gd-EOB-DTPA enhanced MRI, LI-RADS v2018 has higher sensitivity and similar specificity in the diagnosis of HCC compared to v2017, especially in the diagnosis of small HCC (10-19 mm).
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Objective:To investigate the clinical characteristics and pregnancy outcomes of fetal umbilical artery embolism.Methods:This retrospective case series recruited 18 cases of fetal umbilical artery embolism delivered at Xiamen Maternal and Child Healthcare Hospital from January 2018 to February 2020. Maternal age, complications, umbilical artery condition revealed by prenatal ultrasound, delivery mode, perinatal outcomes, and placental pathological examinations were analyzed using descriptive statistical methods.Results:(1) The total prenatal detection rate of umbilical artery embolism was 0.062% (18/29 130). The average maternal age was (30.1±6.1) years old. Four of the 18 cases aged other 35 and one was younger than 18 years old; 17 cases were singleton pregnancy, and the other one was a dichorionic diamniotic twin pregnancy. The mean gestational age was (35.1±2.6) weeks when an abnormal umbilical artery was first indicated by ultrasound, including 16 with a single umbilical artery shown in the third trimester and two with suspected umbilical artery embolism. The main complications were followed as gestational diabetes mellitus (8/18), fetal growth restriction (4/18), and abnormal umbilical cord insertion (3/18). (2) Cesarean section was performed for 16 cases, resulting in live births, while the other two cases had intrauterine death. Among the 16 neonates, nine were premature infants, and seven were full-term infants, with an average birth weight of (2 434±816) g; four were small for gestational age, and neonatal asphyxia occurred in three cases. Eleven were admitted to the neonatal intensive care unit, including five with brain injury. (3) Placental pathological examinations showed embolism in one of the two umbilical arteries in 17 cases and the umbilical vein in one case. Excessive torsion of the umbilical cord was observed in 11 cases and the umbilical cord's abnormal insertion in three cases. One case refused placental pathological examination.Conclusions:Umbilical artery embolism should be considered when a single umbilical artery is indicated by ultrasound in the third trimester. The time of delivery should be based on the risk of premature birth and unexpected adverse events. A cesarean section is suggested.
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Objective:To explore the value of radiographic assessment of lung edema (RALE) score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted. Patients with ARDS admitted to the department of intensive care unit (ICU) of Affiliated Nantong Third Hospital of Nantong University from January 2016 to November 2020 were enrolled. Clinical data of those patients were collected, and two senior radiologists who did not know the outcome of the patients independently scored each chest radiograph, the mean value of which was taken as the RALE score. The patients were divided into death group and survival group according to the 28-day prognosis. The differences of the basic data, PaO 2/FiO 2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and RALE score between groups were analyzed. ARDS patients were classified according to the Berlin standard and RALE scores were compared between groups. Then, the correlations between RALE score and PaO 2/FiO 2, SOFA score, APACHEⅡ score were analyzed. The prognostic capacity of RALE score for 28-day prognosis of ARDS patients were analyzed by Kaplan-Meier survival curve. Results:Of the 98 ARDS patients, 62 were included in the final analysis, 39 patients survived and 23 patients died. The 28-day mortality was 37.1%. Compared with the survival group, patients in the death group were older (years old: 72.83±12.21 vs. 64.44±14.68), had lower PaO 2/FiO 2 [mmHg (1 mmHg = 0.133 kPa): 122.66±48.32 vs. 150.26±50.40], and higher SOFA score and greater difference of RALE score between the third day and the first day after admission (D3-D1 RALE score) (SOFA score: 11.26±3.91 vs. 9.04±3.72, D3-D1 RALE score: 1.35±6.42 vs. -2.74±7.35), with statistically significant differences (all P < 0.05). However, there were no significant differences in gender, cause of ARDS, APACHEⅡ score, and RALE scores on the first and the third day of admission (D1 RALE, D3 RALE) between the two groups. Among the 62 patients, there were 11 mild cases (17.7%), 36 moderate cases (58.1%), and 15 severe cases (24.2%). The D1 RALE score of patients with mild and moderate ARDS were lower than those of patients with severe ARDS (19.09±3.65, 22.58±6.79 vs. 27.07±5.23, both P < 0.05). Correlation analysis showed that D1 RALE score was negatively correlated with PaO 2/FiO 2 ( r = -0.385, P = 0.002), and positively correlated with SOFA score and APACHEⅡ score ( r1 = 0.433, r2 = 0.442, both P < 0.001). Kaplan-Meier survival curve analysis showed that the 28-day survival rate of ARDS patients in D3-D1 RALE score ≥ -1 group was significantly higher than that in D3-D1 RALE score < -1 group (73.08% vs. 55.56%; log-rank test: χ 2 = 3.979, P = 0.046). Conclusions:The RALE score is a simple and reliable non-invasive evaluation index, which can be used to evaluate the severity of ARDS patients. The difference of RALE score in early stage is helpful to identify ARDS patients with poor prognosis.
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Objective To investigate the predictive value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI for microvascular invision (MVI) in hepatocellular carcinoma (HCC). Methods Retrospective analysis of 70 patients confirmed by pathology as HCC who underwent Gd-EOB-DTPA-enhanced MRI within 2 weeks prior to liver partial resection or liver transplantation surgery from January 2015 to May 2018 in Nantong Third People's Hospital. According to the pathological results of the postoperative pathology, MVI was divided into MVI positive group and MVI negative group, and alpha fetoprotein (AFP) was recorded. In Gd-EOB-DTPA-enhanced MRI, qualitative indicators including whether the tumor signal was uniform, peritumoral enhancement, tumor capsule, tumor margin, peritumor hypointensity and presence of fat in the tumor were assessed. Quantitative indicators including tumor diameter and the increase rate of liver-to-muscle ratio(ΔLMR) of post-enhancement arterial phase, portal vein phase, transitional phase and hepatobiliary phase were assessed and recorded. Theχ2 test was used to compare the qualitative parameters of the MVI-negative group and the MVI-positive group, and the Mann-Whitney U test was used to compare the non-normal quantitative parameters. In both inclusion and non-inclusion of peritumor hypointensity cases in the hepatobiliary phase. The multivariate logistic regression analysis was performed to indicate independent variables after univariate analysis. The prediction probability 1 (pre-1) and the prediction probability 2 (pre-2) were obtained, and the two as independent variables. with MVI as the gold standard, using ROC to analyze the diagnostic efficacy of both for HCC MVI, and using Z test to compare the area under the ROC of pre-1 and pre-2. Results There were 27 lesions in 26 cases of MVI-positive group and 50 lesions in 44 cases of MVI-negative group. There was a statistically significant difference between the MVI-negative group and the MVI-positive group in peritumoral enhancement, tumor capsule, tumor margin and peritumor hypointensity in the hepatobiliary phase (P<0.05), and there was no statistically significant difference in gender distribution, tumor signal uniformity and intratumoral fat (P>0.05). There was significant difference in lesion diameter between MVI-negative group and MVI-positive group (P<0.05) while no significant difference in age, AFP value andΔLMR between the two groups (P>0.05). Multivariate logistic regression analysis showed that tumor diameter, non-smooth tumor margin and peritumor hypointensity were independent risks of MVI when peritumor hypointensity was included, the sensitivity and specificity of the combined diagnosis of MVI were 77.8％ and 94.0％;Multivariate logistic regression analysis showed that tumor diameter and non-smooth tumor margin were independent risks of MVI when peritumor hypointensity was not included, the sensitivity and specificity of the combined diagnosis of MVI were 59.3％and 92.0％. The the area under the ROC of pre-1 and pre-2 were 0.900 and 0.816, their difference was statistically significant (P<0.05). Conclusion Gd-EOB-DTPA enhanced MRI can be used to predict HCC MVI preoperatively, especially peritumor hypointensity in hepatobiliary phase is important for the prediction of MVI.
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OBJECTIVE： To study the effects of simvastatin combined with rivaroxaban on pharmacokinetics of rivaroxaban in rats. METHODS： Thirty rats were randomly divided into rivaroxaban group （intragastric administration of normal saline+rivaroxaban 2.6 mg/kg）， simvastatin+rivaroxaban group （intragastric administration of simvastatin 5.3 mg/kg+rivaroxaban 2.6 mg/kg）， with 15 rats in each group. The rats were given normal saline/simvastatin intragastrically for 5 d， once a day， and then given intragastric administration of rivaroxaban+normal saline/simvastain once. The blood samples were collected from orbital cavity of rats before medication and 0.25， 0.5， 0.75， 1， 1.5， 2， 4， 8， 12， 24 h after medication. The plasma concentration of rivaroxaban was determined by LC-MS/MS. Plasma concentration-time curves were drawn， and the pharmacokinetic parameters were fitted by DAS 2.1.1 software. RESULTS： The pharmacokinetic parameters of rivaroxaban group and simvastatin+rivaroxaban group in rats included that AUC0-24 h were （2 599.86±791.82） and （2 777.74±989.25） ng·h/mL； AUC0-∞ were （3 053.28± 1 116.06） ng·h/mL and （3 396.78±1 409.80） ng·h/mL； t1/2 were （8.06±3.52） h and （9.25±4.18） h； tmax were（0.65±0.28） h and （0.60±0.13） h； CLZ were （0.95±0.32） L/（h·kg） and （0.88±0.34） L/（h·kg）； Vd were（10.37±4.43） L/kg and （11.07±4.48） L/kg； cmax were （424.93±145.30） ng/mL and （507.15±132.40） ng/mL. Compared with rivaroxaban group， AUC0-24 h， AUC0-∞， t1/2， Vd and cmax of simvastatin+rivaroxaban group increased by 6.40％， 10.11％， 12.86％， 6.32％， 16.21％； tmax and CLZ decreased by 8.33％ and 7.95％. There was no significant difference （P＞0.05）. CONCLUSIONS： There is no significant change in pharmacokinetic parameters of rivaroxaban in rats after combination of simvastatin （5.3 mg/kg） and rivaroxaban （2.6 mg/kg）.
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Objective To explore the manifestations and diagnostic value of CT and MRI in gynecological acute abdomen.Methods CT and MRI features of 45 patients with gynecological acute abdomen proved by surgery were reviewed,including 17 ectopic pregnancy,10 ovarian cyst rupture,6 pedicle torsion of ovarian tumors,9 tubo-ovarian abscess and pelvic inflammation and 3 uterine perforation.31 cases underwent CT examination,14 cases underwent MRI examination and 39 cases underwent non-enhancement and enhancement scanning.Results In the 17 ectopic pregnancy cases,cystic structure surrounded by a thick wall or heterogeneous mass located in adnexal area was found,with 10 cases showing increased number of peripheral vessels penetrating into tumors.In the 10 cases with rupture of ovarian cyst, thick capsule wall was incomplete and cystic cavities collapsed in 7 lesions.In the 6 cases with pedicle torsion of ovarian tumors,irregular thickening of tumor pedicle were found in 4 cases,ovarian enlargement with surrounding follicles arrayed as fruit platter were found in 2 cases.In the 9 cases with tubo-ovarian abscess and pelvic inflammation,honeycomb-shaped lesions and multilocular changes were found in 6 cases and fallopian tube expanded like sausages in 5 cases.3 cases with uterine perforation exhibited intrauterine gas and fluid.Uterus with overflowed gas was found in 2 cases.One case had the thin and incomplete uterine wall.Conclusion CT and MRI can be used to confirm the causes of gynecological acute abdomen,and to comprehensively display the anatomical structures and pathological changes of pelvic tissues and organs.Therefore,CT and MRI are effective supplement means for the clinical diagnosis of gynecological acute abdomen.
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Objective To investigate the diagnostic value of CT and MRI in struma ovarii (SO).Methods Imaging features of 9 cases with SO confirmed by pathology were analyzed retrospectively.9 patients underwent CT,3 cases underwent both CT and MRI, which were both pre-and post-contrast enhancement.The location,size,shape,margin,density or signal intensity of the lesion,as well as the enhancement patterns of the cystic wall and solid components were observed.Results 7 tumors were located in the right ovary and 2 in the left,with smooth margins and clear boundary.The diameters of the lesions were 5-1 5 cm.The tumors were round in 2 cases,oval round in 2 cases and irregular in 5 cases.9 tumors all appeared cystic-solid type,mainly muti-cystic.The cystic components showed heterogeneous density on CT,mostly low signal intensity on T1WI and high signal intensity on T2WI,few cystic components showed high signal intensity on both T1WI and T2WI.Calcifications were found in 3 cases and fat in 2 cases.The solid components showed slightly high density on plain CT scanning and enhanced markedly either on CT or MRI.6 cases were accompanied with hysteromyomas and 2 cases with ovarian embryoma in the contralateral ovary.Conclusion CT and MRI appearances of SO have a certain characteristic,often manifested as a unilateral adnexal cystic-solid mass and the solid components obviously enhancement,but the boundary is smooth and clear.CT and MRI have different advantages.
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Objective To evaluate the value of T1 mapping in Gd-EOB-DTPA-enhanced MRI for the assessment of liver function with HBV-related cirrhosis according to the model for end-stage liver disease (MELD) score.Methods 158 patients with HBV-related cirrhosis were included in this prospective study,and divided into MELD score ≤10 (n =103) group and MELD score ＞ 10 (n =55) group.All patients un derwent non-enhanced and Gd-EOB-DTPA enhanced MRI of liver,and T1 mapping was performed using Look-Locker sequences with the same scan parameters and geometry position (the level of porta hepatis) preand post-contrast at 5,10,15 and 20 minutes after Gd-EOB-DTPA administration.T1 relaxation times of the liver were measured and reduction rates of T1 relaxation times (△T1) were calculated.Independent samples t test was performed to compare T1 relaxation times and △T1 between MELD score≤ 10 and MELD score ＞ 10 groups.Receiver operating characteristic curve (ROC) analysis were done to differentiate the diagnostic performance of T1 relaxation times and △T1 between MELD score ≤ 10 and MELD score ＞ 10 groups.Pearson correlation analysis was used to analyse the correction between T1 relaxation times,△T1 and MELD scores.Results T1 relaxation times pre-and post-contrast at 5,10,15 and 20 minutes and △T1 post-contrast at 5,10,15 and 20 minutes of MELD score≤10 group were (889.3 ±91.2) ms,(377.5 ± 55.0) ms,(350.8±61.2)ms,(328.0±69.4)ms,(302.7±73.7)ms,(57.4±5.6)％,(60.4± 6.5) ％,(63.0 ± 7.3) ％ and (65.9 ± 7.8) ％,respectively,and those of MELD score ＞ 10 group were (936.6 ±95.4) ms,(460.2 ±68.5) ms,(457.5 ±94.5) ms,(453.4 ± 116.4) ms,(444.6 ± 134.6) ms,(50.8 ± 5.7) ％,(51.3 ± 7.9) ％,(51.8 ± 10.3) ％ and (52.8 ± 12.2) ％,respectively,and T1 relaxation times and △T1 at all time points were significantly different (P ＜ 0.05) between the two groups.The areas under ROC curve of T1 relaxation time pre-and post-contrast at 5,10,15,20 minutes and △T1 post-contrast at 5,10,15,20 minutes for differentiating MELD score ≤ 10 and MELD score ＞ 10 groups were 0.638,0.824,0.832,0.832,0.830 and 0.795,0.814,0.820,0.825,respectively.The correlation coefficients between T1 relaxation time pre-and post-contrast at 5,10,15,20 minutes,△T1 post-contrast at 5,10,15,20 minutes and MELD scores were 0.256,0.499,0.540,0.538,0.548,-0.412,-0.495,-0.507 and-0.527,respectively.Conclusions T1 mapping on Gd-EOB-DTPA-enhanced MRI is helpful for evaluating liver function with HBV-related cirrhosis.T1 relaxation times post-contrast on different time points were equally accurate as △T1.T1 relaxation times post-contrast and △T1 were superior to T1 relaxation times pre-contrast.
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Objective To evaluate the category modifications and prognosis of cirrhotic nodules depending on MRI imaging report and data system of LR-2,LR-3 and LR-4.Methods Clinical data of 109 patients(151 lesions)with cirrhosis who underwent two or more MRI examinations in the Third People's Hospital of Nantong City from September 2012 to February 2017 were retrospectively collected. All the patients were diagnosed as LR-2, LR-3 and LR-4 lesions for the first time without biopsy or operation. Among all the lesions, 40 were LR-2,71 were LR-3 and 32 were LR-4.Routine liver MRI scanning,DWI and multiphase dynamic contrast-enhanced MRI were performed on all patients. The follow-up time and category modifications were recorded for each lesion. The single-factor analysis was used to analyze the follow-up time of LR-2, LR-3 and LR-4 lesions. The incidence of up-regulation of LR-2, LR-3 and LR-4 nodules were analyzed by Kaplan-Meier curve. Log-Rank test was used to compare the results. Results The mean follow-up time of LR-2, LR-3 and LR-4 was (17.4 ± 9.2), (16.3 ± 8.5) and (12.4 ± 9.3) months respectively,the difference were statistically significant(F=3.30,P=0.041).Among 48 index LR-2 lesions, 1 upgraded to LR-5 after 52.3 months of follow-up, 4 upgraded to LR-3, 29 remained stable, and 14 decreased to LR-1. Among 71 index LR-3 lesions, 13 upgraded to LR-5, among which 12 demonstrated threshold growth, 9 developed newly enriched pleural signs, 7 showed capsules and 3 demonstrated hypervascular transformation;6 upgraded to LR-4,34 remained stable and 18 decreased to LR-1.Among 32 index LR-4 lesions, 14 upgraded to LR-5, among which 11 demonstrated threshold growth, 1 developed newly enriched pleural signs,6 showed capsules and 1 demonstrated hypervascular transformation;1 leision developed to LR-5V with portal vein thrombosis, 15 remained stable and 2 decreased to LR-1. The cumulative incidence of LR-4 nodules up-regulated to LR-5 was higher than that of LR-2 and LR-3 nodules (all P<0.01). The cumulative incidence of LR-4 nodules at 3, 6, 12 months to LR-5 were 6.3%, 18.8%, 34.4%, and LR-3 nodules were 0, 4.2%, 5.6%. LR-2 nodules are 0. The cumulative incidence of LR-3 nodules classified as LR≥4 was higher than that of LR-2 nodules(P<0.01).Conclusion LR-2,LR-3,and LR-4 nodules have different prognostic outcomes based on the LI-RADS classification criteria for MRI,and the cumulative incidence of LR-4 progression to LR-5 was higher.
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Objective To investigate the prevalence of iron deficiency(ID)and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country. Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results The median serum ferritin level during pregnancy was 20.60 μg/L(11.78-36.98 μg/L), the hemoglobin level was(118±12)g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L(34.48-94.01 μg/L), 28.60 μg/L(16.40-50.52 μg/L), and 16.70 μg/L(10.20-27.00 μg/L)respectively(P<0.01). The mean hemoglobin levels were(127 ± 10)g/L,(119 ± 11)g/L and(117 ± 11)g/L respectively(P<0.01). The prevalence of ID in urban pregnant women was 48.16%(5 973/12 403), and IDA prevalence was 13.87% (1 720/12 403). The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019), 8.40%(293/3 487)and 17.82%(1 407/7 897), respectively(P<0.01). The prevalence of standardized ID and IDA were significantly different in various regions of China(P<0.01). The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%,the differents in various regions were significant(all P<0.01). Conclusion The current phenomenon of ID and IDA in pregnant women is still very common,and nutrition and health care during pregnancy should be strengthened.
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Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI in assessing liver reserve function in patients with normal liver function and abnormal liver function.Methods Totally 99 hepatitis B cirrhosis patients with abnormal liver function were classified into the following three groups,i.e.Child-Pugh A group (n=48),Child Pugh B group (n=40),Child Pugh C group (n=11),while 21 patients without chronic liver disease were taken as normal liver function group.All patients underwent Gd-EOB-DTPA enhanced MRI.At 3 min,10 min and 20 min after intravenous administration of Gd-EOB-DTPA,the relative enhancement (RE) of whole liver and liver segments (S1-S8) was calculated,and the differences of liver RE were compared among different liver function groups and liver segments.Results At 3 min,10 min and 20 min after intravenous administration of Gd EOB-DTPA,the differences of whole liver RE and segmental liver RE among the Child Pugh A group,Child-Pugh B group,Child Pugh C group and normal liver function group were statistically different (all P＜0.05).At 3 min,10 min and 20 min after injection,RE of normal liver function group and Child Pugh A group was significantly different among different liver segments (S1-S8).At 10 min and 20 min after injection,RE of Child-Pugh B group was significantly different among different liver segments,while at 20 min after injection,RE of Child-Pugh C group was significantly different among different liver segments.Conclusion Gd-EOB-DTPA enhanced MRI can accurately assess whole liver and segmental liver function.
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OBJECTIVE:To determine quality indexes of Hejiang Dendrobium nobile at different harvesting time and months,and to provide scientific reference for reasonable harvesting period of Hejiang D.nobile.METHODS:The stem of annual,biennial and triennial D.nobile were collected.The drying rate,the contents of polysaccharides (colorimetry),dendrobine (GC) and total alkaloids (colorimetry),effective component total rate (dendrobine×drying rate) were measured.Biennial D.nobile were collected in autumn and winter (Oct.of the second year-Mar.of the third year,15th day a month) to determine drying rate,the contents of polysaccharides and dendrobine.RESULTS:The drying rate,the contents of polysaccharides and effective component total rate were higher than annual and triennial D.nobile.The content of total alkaloids and dendrobine were in descending order:annual D.nobile (0.52％,0.48％) ＞biennial D.nobile(0.48％,0.44％) ＞triennial D.nobile (0.32％,0.22％).From Oct.of the second year to Mar.of the third year,the drying rate of biennial D.nobile was increasing month by month;the contents of polysaccharides and dendrobine increased firstly and then decreased;the content of polysaccharide was the highest in Feb.(17.32％),and the content of dendrobine reached the highest level in Dec.(0.51％).CONCLUSIONS:The optimal harvesting period is biennial Hejiang D.nobile in Dec.and Jan.(third years before flowering),considering flowering characteristics,drying rate,the contents of polysaccharide and dendrobine.
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Objective To investigate the effectiveness of T1 mapping on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA-enhanced) MRI for the assessment of liver function.Methods One hundred and twenty six patients with clinically suspected focal liver lesions and chronic viral hepatitis B underwent MRI were prospectively enrolled.Patients were divided into four subgroups as follows: chronic viral hepatitis B (n=22), liver cirrhosis with Child-Pugh A (n=52), Child-Pugh B(n=41),Child-Pugh C(n=11).Twenty three healthy volunteers with normal liver function were enrolled as control group.Non-enhanced and Gd-EOB-DTPA enhanced MRI of liver were performed in all subjects.Look-Locker sequences with exactly the same scan parameters and geometry position(the level of porta hepatis) were performed pre and post-contrast separately at 5, 10, 15 and 20 minutes after Gd-EOB-DTPA administration.T1 relaxation times and reduction rates of T1 relaxation times[ΔT1(%)]of the liver parenchyma were measured and calculated.One-way ANOVA was used to compare T1 relaxation times and ΔT1(%) for control group, chronic viral hepatitis B group, liver cirrhosis with Child-Pugh A group, Child-Pugh B group,and Child-Pugh C group.ROC curve analysis was performed to compare the diagnostic performance of T1 relaxation times and ΔT1(%) values in discriminating control group + chronic viral hepatitis B group + liver cirrhosis with Child-Pugh A group from Child-Pugh B + C group. Results T1 relaxation times and ΔT1(%)showed significant difference(P<0.05)among control group and different liver function groups. T1 relaxation times and ΔT1(%) of both liver cirrhosis with Child-Pugh B group and Child-Pugh C group were significantly different(P<0.05)in comparison with those of control group,chronic viral hepatitis B group and liver cirrhosis with Child-Pugh A group at all time points.T1 relaxation times of the control group,chronic viral hepatitis B group,liver cirrhosis with Child-Pugh A group and Child-Pugh B group reduced with the scanning time increase,ΔT1(%)raised with the scanning time increase.T1 relaxation times progressively increased from control group to Child-Pugh C group at every time point.ΔT1(%)showed a constant decrease from control group to Child-Pugh C group at all time points.The areas under ROC curve of T1 relaxation time pre and post-contrast at 5,10,15 and 20 minutes for assessment of liver function were 0.817,0.952,0.950,0.946,and 0.949 respectively.The areas under ROC curve of ΔT1(%)post-contrast at 5, 10, 15 and 20 minutes for evaluation of liver function were 0.873, 0.876, 0.885, and 0.898, respectively. Conclusion Gd-EOB-DTPA-enhanced T1 mapping MRI is useful for the evaluation of liver function, and helpful for distinguishing patients with moderate and severe liver damage from normal and mild liver damage.
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The umbilical cord normally contains one vein and two arteries, which is vital for gas exchange, nutrient supply and excretion of metabolic wastes between mother and fetus, and is protected by the surrounding Wharton jelly. Thrombosis of the umbilical cord could lead to fetal hypoxia, even endanger the fetal life. However, umbilical vessel thrombosis, which is rarely reported at home and abroad, is difficult to be identifed prenatally. We here reported two cases of umbilical vessel thrombosis in Xiamen Maternity and Child Health Care Hospital in order to improve prenatal diagnosis of umbilical vessel thrombosis and to avoid adverse pregnancy outcomes.
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Objective To evaluate the diagnostic value of the heparin-binding protein (HBP),procalcitonin (PCT),C-reactive protein (CRP),white blood cell (WBC) in respiratory tract bacterial infection.Methods 66 respiratory tract bacterial infection patients,37 respiratory tract non-bacterial infection patients and 39 control group in the Third Xiangya Hospital from October 2015 to March 2017 was selected as objects in this prospective study.The levels of HBP,PCT and CRP in blood of the objects were tested with ELESA,immunofluorescence assay,immunoturbidimetry respectively;WBC counts were taken by Sysmex XE-5000 blood analyzer.The difference among the three groups was analyzed by Student's t test,one-way ANOVA or Wilcoxon test.Receiver operating characteristic curve was utilized to analyze the diagnostic value of HBP,PCT,CRP and WBC in respiratory tract bacterial infection.Results The plasma level of HBP were 36.30 (7.78-89.36) ng/ml,5.57 (4.37-8.23) ng/ml,2.84 (1.53-6.51) ng/ml in respiratory tract bacterial infection group,respiratory tract non-bacterial infection group and control group respectively.The socre of PCT were 0.08 (0.04-0.83) ng/ml,0.09 (0.04-0.30) ng/ml,0.04 (0.03-0.08) ng/ml.The socre of CRP were 56.20 (19.33-76.23) mg/L,34.40 (2.15-83.95) mg/L,(2.20 ± 0.99) mg/L.The socre of WBC count were (10.59 ±4.58) × 109/L,8.40 (5.80-11.88) × 109/L,(6.14± 1.31) × 109/L.There were statistically significant differences in HBP scores between respiratory tract bacterial infection group and respiratory tract non-bacterial infection group or control group (Z =-4.828,P ＜0.001;Z =-5.685,P ＜ 0.001).There were no statistically significant differences in PCT,CRP and WBC scores between respiratory tract bacterial infection group and non-bacterial infection group (F =0.045,P ＞ 0.05;F =0.100,P ＞ 0.05;F =2.417,P ＞ 0.05),but significant differences between respiratory tract bacterial infection group and control group (Z =-2.881,P ＜ 0.05;Z =-6.595,P ＜ 0.001;t =6.499,P ＜ 0.001).The area under curve (AUC) of HBP,PCT,CRP and WBC diagnosing respiratory tract bacterial infection was 0.89,0.69,0.95 and 0.85 respectively.The AUC of HBP differential diagnosising was 0.80.Conclusion HBP can be used as an efficient supplementary indicator for respiratory tract bacterial infection,the differential diagnostic value is superior to PCT,CRP and WBC.
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Objective To evaluate the ability of Gd-EOB-DTPA enhanced MRI in the evaluation of liver reserve function in patients with hepatitis B cirrhosis.Methods Patients with hepatitis B cirrhosis and controls with normal liver function and free of chronic liver disease were collected prospectively.Signal intensity(SI)of each hepatic segments(S1-S8)were measured of all cases before injection and after bolus administration of Gd-EOB-DTPA,and the whole liver signal intensity was assessed as the average signal intensity.The whole liver relative enhancement degree(relative enhancement RE)was calculated.The one way A NOVA was used to compare SI and RE among four groups at different time and the Friedman test was used to compare SI and RE within each group at different time.The Spearman rank correlation analysis was used to do correlation analysis.ROC curve was used to analyze the efficacy of Gd-EOB-DTPA enhanced MRI in the diagnosis of liver dysfunction and was used to compare the diagnostic performance of SI and RE in discriminating normal liver function group-Child A from Child B-C.Results Patients enrolled with normal liver function,Child-Pugh A,B and C was 21, 40,48 and 11.SI and RE between different groups were statistically significant at each time(P<0.05);and was statistically significant at different time within the same group.Correlation analysis of SI and RE with liver function classification at different time points showed:in addition to SI20 s(r= -0.190,P= 0.038),RE20 s(r=0.081,P=0.382),SI and RE at each time point were highly negatively related with liver function classification(P<0.01).SI10 minand RE10 minwere higher significantly negatively related with liver function classification.T he area under the ROC curve was 0.839,0.707,0.779 and 0.547,respectively.Conclusion Gd-EOB-DTPA enhanced MRI can assess liver reserve function in patients with hepatitis B cirrhosis,SI and RE can reflect the degree of liver function reserve in a certain extent.It has some value in predicting the normal or mild injury of liver function with moderate or severe injury of liver function.
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<p><b>OBJECTIVE</b>To summarize the general condition, regional distribution, prevalence and clinical characteristics of Shandong province based on hemophilia case registry information.</p><p><b>METHODS</b>A retrospective study was carried out on 1979 hemophilia patients registered at Shandong Hemophilia Registration Center.</p><p><b>RESULTS</b>The 1979 cases have included 1704 hemophilia A and 275 hemophilia B patients. Hemophilia A was characterized as severe in 1021 patients (59.9%), moderate in 483 patients (28.4%), and mild in 200 patients (11.7%); while hemophilia B was characterized as severe in 125 patients (45.4%), moderate in 116 patients (42.2%), and mild in 34 patients (12.4%). The median age was 23 years (ranging from 1 month to 81 years), and most were young patients. Joint deformity occurred in 963 patients, and 948 patients had a family history of hemophilia. All counties of Shandong province had patients except for Changdao county and Fushan district of Yantai city. The prevalence of Heze city and Dongying city (3.39/100 000 and 3.05/100 000, respectively) were relatively higher.</p><p><b>CONCLUSION</b>The above data revealed epidemiological and clinical characteristics of Shandong Province. Patient-centered registry system allowed a more detailed and accurate patient information, and promoted the comprehensive care of hemophilia, which also suggested the necessity for the establishment and improvement of the National Hemophilia Registry System.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Humans , Infant , Middle Aged , China , Epidemiology , Hemophilia A , Epidemiology , Prevalence , RegistriesABSTRACT
ObjectiveTo study the effects of group BStreptococcus (GBS) colonization in late pregnancies on neonatal GBS infection.MethodsA total of 17 019 pregnant women who received antenatal care and delivered in Xiamen Maternal and Child Care Hospital from June 1, 2014 to May 31, 2015 were enrolled in this study. Secretions from the lower third of the vagina in the pregnant women at 35-37 weeks of gestation or having premature baby(regardless of gestational age) were obtained to test GBS by standard bacterial culture, and 1 472 cases underwent GBS DNA test by real-time fluorescent quantitative-polymerase chain reaction (PCR) meanwhile. The pregnant women colonized with GBS (GBS culture and/or PCR DNA test positive) were given intrapartum antibiotic prophylaxis (IAP) during parturition or rupture of fetal membranes. Detection rate of the two methods was compared, and the effects of GBS colonization and IAP on neonatal GBS infection were analyzed to identify the risk factors of neonatal early-onset GBS disease (GBS-EOD). Two independent samplest-test,Chi-square test and Logistic regression analysis were used for statistical analysis. ResultsThe detection rate of GBS culture and PCR DNA test was 14.43% (2 456/17 019) and 14.13%(288/1 472), respectively. The total colonization rate was 14.52%(2 472/17 019). Based on the culture results as golden criteria, the sensitivity, specificity, positive predictive value and negative predictive value of PCR assay were 95.05%, 98.74%, 92.31% and 99.21%, respectively. There were 17 332 deliveries from the 17 019 pregnant women, of which 31 cases had GBS-EOD. The incidence of neonatal GBS-EOD in maternal GBS colonization [1.05%(26/2 472)] was 31 times higher than in pregnant women without GBS colonization [0.34‰(5/14 547)]. Among the 31 infants with GBS-EOD, 24 had pneumonia, five had sepsis, and two had meningitis. The case fatality rate was 6.45%(2/31). Logistic regression analysis found that chorioamnionitis was an independent risk factor of neonatal GBS-EOD (OR=40.425, 95%CI: 7.514-379.782,P=0.000). Compared with the non-IAP group,IAP group had a lower incidence of GBS-EOD among the pregnant women colonized with GBS [0.94%(23/2 443) vs 10.34%(3/29),χ2=24.350,P<0.01].ConclusionsGBS colonization in late pregnant women has adverse effects. Therefore, routine maternal rectovaginal culture of GBS may be necessary and IAP should be applied in those with GBS colonization.
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Objective To investigate the magnetic resonance imaging (MRI)features and pathologic characteristics of the fungal ball (FB)of the nasal sinuses,for the purpose to provide reference for surgical treatment.Methods The MRI data of 27 patients of nasal sinuses who were diagnosed by surgical pathology were retrospectively analyzed.Of 27 patients,there were 14 male and 13 female,aged from 49 to 86,anverage age 57.6,with course of disease from 6 months to 5 years.All patients preoperatively recieved 1.5 T high field strength mri scan and enhanced scan and functional nasal endoscopic surgical radical resection lesions.Results Maxillary sinus disease,which unilateral 92%(25 /27),bilateral 4% (1 /27),sphenoid sinus disease 4%(1 /27),FB was located in the sinus cavity central.FB isointense signal (com-pared with the white matter of the brain),hypointense on T2WI,DWI (b value =1000)was mixed high and low signal,Gd DTPA enhanced no enhancement,with around mucosal thickening isointense signal,high signal intensity on T2WI,ring enhancement.The histopathology slices of 27 cases were found wrapped fungal hyphae,which confirmed for FB.The pathological basis of FB was fungal silk containing manganese (paramagnetic substances),FB calcium phosphate and calcium sulfate and other substances,due to the magnetic susceptibility effect of T2WI was low signal,DWI high and low mixed signal changes.Conclusion MRI can reflect the histopathological characteristics of FB,and it is of great value in diagnosis and differential diagnosis,as well as providing important imaging evidence for patients undergoing surgical treatment.