ABSTRACT
Objective:To investigate the prognostic value of texture analysis of MRI diffusion weighted imaging (DWI) for neonatal hypoglycemic encephalopathy (HE).Methods:The clinical data and MRI data of 119 patients with neonatal HE admitted to Children′s Hospital of Nanjing Medical University from July 2013 to September 2020 were retrospectively analyzed. The children were followed up to 7—8 months and scored by Bayley scales of infant and toddler development. According to the overall development index, the children were divided into three groups: normal group (≥85, group A, n=42), mild developmental retardation group (70－84, group B, n=46) and developmental retardation group (≤69, group C, n= 31). The whole brain region (except sulcus and cisterna) was delineated as region of interest (ROI) by LIFEx 3.4 software in MRI apparent diffusion coefficient images. A total of 37 parameters were calculated automatically by the software, The clinical data, including gender, gestational age, age at MRI scan, birth weight, mode of delivery, history of asphyxia at birth, maternal preeclampsia or diabetes, minimum blood glucose, duration of hypoglycemia, neonatal behavioral neurological assessment (NBNA), presence or absence of polycythemia); the texture parameters, including histogram, volume, gray level co-occurrence matrix (GLCM), gray level run length matrix (GLRLM), neighborhood gray tone difference matrix (NGTDM), gray level size zone matrix (GLSZM), in the three groups were analyzed; and the diagnostic efficacy of clinical parameters and texture parameters was analyzed. Multivariate Logistic regression was used to analyze statistically significant clinical parameters and texture parameters, and receiver operating characteristic curve (ROC) was used to evaluate the prognostic efficacy of these parameter for neonatal HE. Results:There were no significant differences in gender, gestational age, age at MRI scan, delivery mode and blood glucose minimum among the three groups ( P>0.05). There were significant differences in birth weight [(3 150±130)g, (3 020±220)g, (2 880±140)g, F=-0.31, P=0.015], history of suffocation (10 cases, 18 cases, 20 cases, P=0.001), history of maternal diabetes or preeclampsia (14 cases, 29 cases, 21 cases, P=0.002), blood glucose duration [(5.0±0.2)d, (8.0±0.4)d, (14.0±1.7)d, F=-3.09, P=0.030] and NBNA scores (32.0±3.2, 28.0±2.6, 22.0±1.9, F=-4.21, P=0.010) among three groups. There were significant differences in kurtosis and entropy of histogram (2.57±1.12, 3.66±0.98, 4.23±0.37, F=3.54, P=0.010;5.89±1.09, 7.67±2.12, 8.92±1.62, F=-4.42, P=0.020); energy, contrast and dissimilarity of GLCM (0.48±0.01, 0.36±0.02, 0.23±0.01, F=-3.12, P=0.001;2 419±21, 3 354±31, 4 313±26, F=-4.16, P=0.020;126±14, 153±23, 344±43, F=-3.50, P<0.001); long run emphasis of GLRLM (0.78±0.15, 1.12±0.12, 1.76±0.31, F=-4.13, P=0.006), run length non-uniformity and run percentage (71.7±13.9, 96.6±10.7, 104.1±13.5, F=-0.98, P=0.001;0.91±0.05, 0.84±0.21, 0.72±0.17, F=2.97, P=0.010); coarseness and busyness of NGTDM [0.09±0.01, 0.13±0.03, 0.26±0.07, F=-1.95, P=0.003;0.16(0.04, 4.14), 0.32(0.05, 9.84), 0.45(0.15, 10.14), H=-3.24, P=0.030], short-zone emphasis and short-zone high gray length emphasis of GLSZM (4.74±0.45, 3.44±1.03, 1.88±0.67, F=-3.14, P=0.040; 278 963±239, 164 607±544, 111 653±618, F=-3.84, P=0.001) among three groups. Multivariate Logistic regression showed that duration of hypoglycemia, NBNA score, energy, kurtosis, run percentage and short zone effect were independent risk factors for poor prognosis of neonatal HE ( OR=7.43, 4.09, 1.10, 2.11, 1.36, 1.68, P=0.002, 0.027, 0.001, 0.006, 0.007, 0.010, respectively). ROC curve showed that for combined hypoglycemic duration, NBNA and texture parameters, the area under the curve (AUC) was the highest (AUC=0.94, P<0.001). Conclusion:Texture analysis of the MRI diffusion weighted imaging can predict the prognosis of neonatal hypoglycemic encephalopathy at an early stage, which has better prediction efficiency when combined with clinical features.
ABSTRACT
Objective@#To know the genetic characteristics of nucleoprotein(N)of wild type measles virus in Xi’an, 2013-2017.@*Methods@#We used the pharyngeal swab specimens of suspected measles cases which were tested positive for measles virus (MV) nucleic acid by Real-time RT-PCR to isolate MV strains with Vero-SLAM cells, extracted RNA of the strains, amplified the N genes of MV strains and the pharyngeal swab specimens which had lower Ct values by One-Step RT-PCR, and analyzed the result after sequencing.@*Results@#Thirty carboxyl terminal sequences of the N genes of MV endemic strains were obtained and identified as genotype H1a. The nucleotide and amino acid homology among the epidemic strains were 97.3%-100% and 96.7%-100%, among the epidemic strains and S191 were 91.3%-92.2% and 87.3%-90.0%, while among the epidemic strains and C47 were 92.2%-92.7% and 88.0%-90.7%. The nucleotide homology among the epidemic strains and wild strains of same period in Anhui, Gansu, Shandong, Henan, Jilin were higher than that in Shanxi, Sichuan, Hunan and Guangdong. The most different amino acid sites among the epidemic strains and the two vaccine strains which had high level of entropy were 422, 457 and 497, secondly 467, thirdly 500. The mutations at the 467 site only existed in 2017. dN/dS=0.199 and no positive selection site was found.@*Conclusions@#The dominant genotype of the epidemic MV strains in Xi’an was H1a in 2013-2017, the genetic diversity of viruses decreased in 2016-2017. We should strengthen the surveillance of etiology of MV to provide evidence for elimination of measles.
ABSTRACT
Objective To investigate the imaging features of necrotizing pneumonia(NP)caused by mycoplasma pneumoniae in children and to review the changes of serum CGreactive protein (CRP)and plasma DGdimer,which may provide an objective and effective help for clinicians.Methods 54 children with mycoplasma pneumoniae pneumonia (MPP)infection in our hospital were studied retrospectively,including 24 cases of NP and 30 cases of nonGNP (the control group).The dynamic changes of chest imaging,serum CRP and plasma DGdimer were compared between two groups.Results Chest imaging in NP group:All cases showed consolidation and necrosis,accompanied by pulmonary cavities,pleural effusion,bronchiectasia,and thickening of the bronchial wall.Decreased enhancement areas could be found in all 24 cases by enhanced CT.The review after treatment showed that the pulmonary consolidation was absorbted or narrowed,accompanied by cavities in lung,atelectasis,and pleura thickening.The imaging of non NP group showed mainly patches and spots shadow in lung, and only a little consolidation.After treatment,the lung lesions were basically absorbed.Only a few cases had fibrotic streaks and pleural thickening.The peak values of serum CRP in group NP and non NP group were respectively 91(33－266)mg/L,37(18－189) mg/L,and the duration of the abnormity were 1 9(1 1－3 8)d and 8(4－1 9)d.The peak values of plasma DGdimer in the 2 groups were respectively 2 3 78(1 9 84－5 908)ng/mL,1 7 6(1 2－41 9)ng/mL,and the duration of the abnormity were 24(13－64)d and 3(0－10)d. There were significant differences between the 2 groups with all parameters above.Conclusion The imaging characteristics of NP caused by MP in children include consolidation,necrosis (decreased enhancement areas in consolidation),pneumothorax ,cavities ,cystic degenerations, atelectasis,bronchial wall thickening,pleural effusion and pleura thickening.The course of NP was long,and the absorption was slow. The peaks value of serum CRP and plasma DGdimer in NP group were significantly higher than those in the non NP group,and the duration was longer than that in non NP group.Therefore,the clinicians should pay more attention to CR,DGdimer and chest imaging,which may help clinicians with the diagnosis and treatment.
ABSTRACT
Objective To understand the situation of medical students' social adaptability and analyze its relationship with their family upbringing style.Methods A cross-sectional study was adopted,and the random sampling method was used to selected medical students as targeted population in a medical university in Jilin City.Parenting Style Assessment Scale and Social Adaptation Diagnostic Scale were applied to know the family rearing styles and social adaptability status of medical college students.Results Among the 198 responders,the proportion of good and strong social adaptability among medical college studies accounted for only 8.1％ (16) and 2.0％ (4);The social adaptation ability of the urban students and the only child students was higher than that of the rural and non only child students (P＜0.05);In parental rearing pattems,regardless of sex,whether students were the only child and where their census register was,emotional warmth and understanding were all positively correlated with medical students' social adaptation ability (P＜0.05),while refusal and denial were negatively correlated with medical students' social adaptation ability (P＜0.05);In addition,the punishment,severe over protection and other parenting styles also showed a certain degree of negative correlation with social adaptability(P＜0.05).Conclusion The social adaptability of medical students is poor,and their parenting styles was correlated with their social adaptation ability.Parents should give their children warmth and understanding,rather than rejection,denial,punishment,and overprotection,which will help to improve medical students' social adaptability.
ABSTRACT
Objective To evaluate the imaging features and causes of cerebral cortical laminar necrosis(CLN) in children,to improve understanding this sign.Methods The imaging and clinical data of 33 children diagnosed with CLN were analyzed retrospectively.The imaging features of CT and MRI were summarized and compared according to their etiologies.Results Children cerebral CLN involved multiple lobes of bilateral hemicerebrum, including the cortical region, subcortical region and basal ganglia region, and linear or gyral shape,patchy shape and punctate shape abnormal density or signal were demonstrated.The typical imaging features were high-signal intensity over the lateral cortical surfaces or along the gyri on T1WI and FLAIR.Diffusion weighted imaging(DWI) showed high signal with restricted diffusion on acute-stage, and Gd-DTPA enhancement demonstrated linear or gyrate enhanced appearance on early-stage.The extent of CLN of cerebral infarction was relatively limited.Acute anoxic encephalopathy showed an early imaging change and extensive involvement.While chronic anoxic encephalopathy and inflammatory encephalopathy showed a late imaging change and a longer existence.Conclusion Children cerebral CLN may have various causes and imaging features,and show characteristic chronological signal changes on imaging studies.The different causes result in the different patterns for CLN in distribution and time distribution.
ABSTRACT
Objective To investigate MRI findings and its relationship with clinical grading and prognosis of infant muggy syn-drome (IMS).Methods Twenty five cases of IMS diagnosed newly and nine cases of IMS with follow-up were collected.MRI find-ings were retrospectively analyzed and compared with their clinical data.Results Seven early abnormal signs could be shown on cer-ebral MRI examination.There was no correlation between the clinical grading and three abnormal signs,which were subdural effu-sion,supratentorial cerebral edema and subarachnoid hemorrhage (P >0.05).In contrast,the other four abnormal signs (abnormal signal of subcortex and cortex,diffuse cerebral hemorrhage,basal ganglia and corpus callosum edema or infarction,large area cere-bral infarction)were closely related to the severity of clinical symptom (P <0.05).MRI findings had certain correlation with clinical classification.Conclusion MRI can objectively reflect the serious change of brain damage in IMS,and provide important information for clinical therapy and prognosis.
ABSTRACT
<p><b>OBJECTIVE</b>To understand the age distribution of pertussis patients admitted in the children hospital and to analyze the source of infection as well as its transmission patterns.</p><p><b>METHODS</b>Patients visiting to the Children Hospital and epidemiologically related cases during Feb. 2012 to Aug. 2013 were tested to confirm the diagnosis. Excel 2007 software was used to analyze the age distribution and clinical symptoms of clinic cases, the source of infection or subsequent cases.</p><p><b>RESULTS</b>165 out of 254 clinically suspicious pertussis cases and 38 out of the 54 epidemiologically related cases were confirmed of having pertussis infection. There were 138 (83.6%) cases under 1 year of age in the confirmed clinical cases and 36 (94.7%) cases older than 20 years of age among the confirmed epidemiologically related pertussis cases. All the confirmed epidemiologically related cases were misdiagnosed or missed for diagnosis. As the source of pertussis infection in confirmed clinical cases, parents played an imported role among 25 of the 32 cases. Transmission from infants and/or little children to adults were also observed in this study.</p><p><b>CONCLUSION</b>Infants accounted for the most among the pertussis patients that visiting the clinics. Adults, being misdiagnosed or missed diagnosed, were the main sources of infection to infants. Epidemics of pertussis occurred under family aggregation. Further study was in need to develop the proper strategy for pertussis booster vaccination.</p>