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1.
Chinese Journal of Radiology ; (12): 1147-1152, 2021.
Article in Chinese | WPRIM | ID: wpr-910277

ABSTRACT

Objective:To investigate the reproducibility of left ventricular strain assessed by CT feature tracking(CT-FT) and its correlation and agreement with speckle tracking echocardiography (STE).Methods:Thirty outpatients with suspected coronary heart disease who underwent whole cardiac cycle coronary CTA and transthoracic echocardiography within one week were prospectively enrolled in November 2019. Left ventricular volume and strain parameters were measured by CT-FT and STE, including left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), global longitudinal strain(GLS), global radial strain (GRS),and global circumferential strain(GCS). GLS included endocardial global longitudinal strain (EndoGLS) and myocardial global longitudinal strain (MyoGLS), GCS included endocardial global circumferential strain (EndoGCS) and myocardial global circumferential strain (MyoGCS). ICC was used to evaluate intra-and inter-observer differences in strain measured by CT-FT. The differences of measurements between CT-FT and STE were compared by paired-samples t test. Pearson correlation coefficient was used to analyze the correlation between CT-FT and STE measurements. Agreement between measurements of two modalities was assessed by Bland-Altman analysis. Results:There was a good consistency in EDV, ESV, EF, EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT between intra-and inter-observer (ICC was 0.775-0.964, P<0.001). There was no significant difference in EF measured by CT-FT and STE [(60.27±8.70) % and (61.22±5.64) %, P=0.443]. EndoGLS, MyoGLS, GRS and MyoGCS measured by CT-FT were (-20.47±4.01)%, (-18.06±3.75)%, (73.90±20.58) % and (-18.48±3.65)%, respectively, while the strain measured by STE were (-18.97±3.33)%, (-16.49±2.60)%, (18.56±3.06)% and (-20.26±4.45)%, respectively. The differences were statistically significant between CT-FT and STE ( t=-2.367, -2.945, 12.161, 2.459, P<0.05). The EndoGCS measured by CT-FT and STE were (-27.78±6.66)% and (-29.18±7.24)%, respectively, with no statistical significance ( P=0.223).The correlation coefficients of EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT and STE were 0.566, 0.629, 0.509, 0.606 and 0.539, respectively ( P<0.05). The average difference of EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT and STE was -1.5%, -1.6%, 55.3%, 1.4% and 1.8%, respectively, with 95% limits of agreement was -8.3%-5.3%, -7.3%-4.2%, 18.1%-92.5%, -10.7%-13.6% and -6.0%-9.5%, respectively. Conclusions:The left ventricular global strain evaluated by CT-FT was feasible, and the agreement of global strain between CT-FT and STE was good but not interchangeable. CT can be an alternative method for "one-stop" evaluation of cardiac anatomy and function in patients with poor echogenic windows and contraindications for MRI.

2.
Chinese Journal of Radiology ; (12): 955-960, 2021.
Article in Chinese | WPRIM | ID: wpr-910258

ABSTRACT

Objective:To investigate the classification and prevalence of simple congenital coronary artery anomalies (CCAA) in Chinese in a large samples of coronary CT angiography (CCTA), and briefly summarize the CT characteristics of "malignant" anomalies.Methods:The data of patients who had undergone CCTA from July 2009 to January 2017 and were diagnosed as simple CCAA were analyzed retrospectively. CCAA were classified according to the origination, number of orifices and termination, and the prevalence of various CCAA was statistically analyzed. Anomalous origin of coronary artery included the origin of coronary artery from the opposite coronary sinus, the non-coronary sinus, the aorta or around the primary sinus, the pulmonary artery, and left circumflex artery originated from the diagonal branch. Abnormal number of orifices included single coronary artery (SCA), right coronary artery and conus branch arising separately, and left anterior descending branch and circumflex branch arising separately. Abnormal termination was coronary artery fistula (CAF). Anomalous origin of coronary artery from the opposite sinus, anomalous origin of the coronary artery from the pulmonary artery, SCA, and multiple or large CAFs were defined as"malignant"anomalies.Results:Among 165 133 patients, 2 148(1.301%) had coronary anomalies, including 1 302 (0.789%) of origin anomalies, 298 (0.181%) of abnormal number of orifices and 548 (0.332%) of abnormal termination. There were 700 cases (0.424%) with coronary artery rising from the opposite sinus, 179 of which had opening or proximal lumen stenosis due to compression, 7 of which had subendocardial myocardial ischemia or infarction on CCTA without coronary artery disease (CAD). The coronary arteries originated from posterior sinus, the aorta or around the primary sinus were found in 48 cases (0.029%), 531 cases(0.322%), respectively. Coronary artery originating from pulmonary artery was detected in 20 cases (0.012%), all of which were left main trunk originating from pulmonary artery, showed tortuous dilation of coronary arteries. Five cases showed obvious subendocardial myocardial ischemia or infarction without CAD. SCA, right coronary artery and conus branch arising separately, left anterior descending branch and circumflex artery arising separately were detected in 102 (0.062%), 53 (0.032%) and 143 (0.087%) cases respectively. Only 1 of 102 cases with SCA showed myocardial ischemia without CAD. A total of 548 cases (0.332%) were diagnosed as CAF, of which the coronary-pulmonary fistula was most common with a highest prevalence of 0.277% (458 cases). Coronary artery-atrial fistula and coronary artery-ventricular fistula were detected in 22 (0.013%) and 60 (0.036%) cases. There were 6 cases (0.004%) of coronary artery-coronary venous fistula and 2 cases (0.001%) of coronary artery-superior vena cava fistula.Conclusions:The occurrence of CCAA is not uncommon, among which anomalous origin of coronary artery is the most common, and special attention should be paid to "malignant"anomalies.

3.
Article in Chinese | WPRIM | ID: wpr-910164

ABSTRACT

Objective:To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section.Methods:A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. The risk factors of intraoperative blood loss ≥1 500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results:(1) A total of 848 001 ml of blood was recovered and a total of 418 649 ml of blood was transfused in 1 265 pregnant women who received IOCS transfusions, which was equivalent to 23 258 U red blood cell suspension, greatly saving medical resources. The intraoperative blood loss in <1 500 ml group and ≥1 500 ml group was 800 ml (300-1 453 ml) and 2 335 ml (1 500-20 000 ml), respectively. No amniotic fluid embolism, severe adverse reactions, shock and death occurred in the two groups. (3) Multivariate regression analysis showed that age ≥35 years ( OR=1.5, 95% CI: 1.1-1.9), prenatal hemoglobin level <110 g/L ( OR=1.7, 95% CI: 1.3-2.2), history of uterine surgery ( OR=1.8, 95% CI: 1.3-2.6), placenta previa ( OR=1.9, 95% CI: 1.1-3.1), placenta accreta ( OR=2.6, 95% CI: 1.8-3.9), blood pool in the placenta ( OR=1.6, 95% CI: 1.1-2.3), abnormal posterior placenta muscle wall ( OR=1.8, 95% CI: 1.2-2.6), placenta projecting to the anterior uterine wall ( OR=3.0, 95% CI: 1.3-7.0) were risk factors for blood loss ≥1 500 ml in obstetric transfusion using IOCS technique, with statistical significance (all P<0.05). Conclusion:IOCS is safe and effective in cesarean section, which could save the medical resources and reduces medical expenses, however, it is necessary to strictly master the application indication.

4.
Article in English | WPRIM | ID: wpr-921341

ABSTRACT

Objective@#To evaluate the associations of sarcopenia, handgrip strength and calf circumference with cognitive impairment among Chinese older adults.@*Methods@#Totally 2,525 older adults were recruited from the Healthy Aging and Biomarkers Cohort Study. Cognitive impairment was assessed by the Chinese Mini-Mental State Examination. Handgrip strength was calculated from the means of the right and left hand values. Calf circumference was measured at the site of maximum circumference of the non-dominant leg. The formula developed by Ishii was used to define sarcopenia. Multiple logistic regression was performed to evaluate the associations of sarcopenia, handgrip strength, and calf circumference with cognitive impairment.@*Results@#The prevalence of cognitive impairment was 34.36%. The adjusted odds ratio ( @*Conclusion@#Sarcopenia, identified by low handgrip strength and low calf circumference, was positively associated with cognitive impairment.


Subject(s)
Aged , Aged, 80 and over , China/epidemiology , Cognitive Dysfunction/etiology , Female , Hand Strength , Humans , Leg/anatomy & histology , Logistic Models , Male , Sarcopenia/pathology
5.
Chinese Journal of Digestion ; (12): 654-659, 2021.
Article in Chinese | WPRIM | ID: wpr-912220

ABSTRACT

Objective:To verify the accuracy of the Kyoto classification score of gastritis for the endoscopic prediction of the Helicobacter pylori( H. pylori)infection in Chinese population. Methods:From June 2020 to January 2021, at the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang Chinese Medical University, the clinical data of 489 patients who underwent gastroscopy examination were collected and the gastric mucosal manifestations under white light endoscopy (including atrophy, intestinal metaplasia, widening of gastric fold, nodularity, diffuse redness, white sticky mucus, etc.) were recorded according to the Kyoto classification of gastritis. H. pylori infection of the patients was determined according to 13C-urea breath test, histopathological examination and anti- H. pylori antibody test. The Kyoto classification score of gastritis of each patient was calculated. The sensitivity, specificity and odds ratio( OR)(95% confidence interval(95% CI)) of various endoscopic appearances in prediction of H. pylori infection were analyzed. Chi-square test was used for statistical analysis. Results:Among the 489 patients, 246 patients had H. pylori infection and 243 patients did not have H. pylori infection. There were 242 patients with Kyoto gastritis score ≥ 2, among them 215 cases had H. pylori infection and 27 cases did not have H. pylori infection. The accuracy of Kyoto classification score of gastritis in predition of H. pylori infection was 88.14% (431/489). Among the five indexes of the Kyoto classification score of gastritis, there was no significant difference in the incidence of intestinal metaplasia between patients with H. pylori infection and patients without H. pylori infection ( P>0.05). The incidence rates of atrophy, widening of gastric fold, nodularity and diffuse redness were higher in patients with H. pylori infection than those in patients without H. pylori infection (68.3%, 140/205 vs. 31.7%, 65/205; 95.2%, 99/104 vs.4.8%, 5/104; 89.7%, 35/39, vs.10.3%, 4/39; 85.0%, 227/267 vs.15.0%, 40/267), and the differences were statistically significant ( χ2=45.68, 106.46, 26.37 and 283.48, all P<0.01). The sensitivity, specificity and OR (95% CI) of atrophy, widening of gastric fold, nodularity and diffuse redness in prediction of H. pylori infection were 56.91%, 73.25%, and 3.62 (2.47 to 5.29); 40.24%, 97.94% and 32.06 (12.76 to 80.57); 14.23%, 98.35%, 9.91 (3.47 to 28.35); and 92.28%, 83.54% and 60.63 (34.02 to 108.08), respectively. The sensitivity and specificity of atrophy in prediction of H. pylori infection were low, and the diagnostic efficacy was general. The incidence rates of white sticky mucus and spotty redness of the gastric fundus and body were higher in patients with H. pylori infection than those in patients without H. pylori infection (86.5%, 32/37 vs. 13.5%, 5/37; 86.9%, 146/168, vs. 13.1%, 22/168), and the differences were statistically significant ( χ2=20.96 and 137.12, both P<0.01). The sensitivity, specificity, and OR (95% CI) of the two indicators in prediction of H. pylori infection were 13.01%, 97.94% and 7.12 (2.72 to 18.60), and 59.35%, 90.95%and 14.67(8.84 to 24.34), respectively, and the diagnostic efficacy was ideal. Conclusions:The Kyoto classification score of gastritis used for the endoscopic prediction of H. pylori infection is suitable for Chinese population. However, from the perspective of individual indicator, the diagnostic efficiency of atrophy and intestinal metaplasia is unsatisfactory. At the same time, attention should be paid to whether there is sticky mucus or spotty redness of the gastric fundus and body.

6.
Chinese Journal of Digestion ; (12): 588-592, 2021.
Article in Chinese | WPRIM | ID: wpr-912213

ABSTRACT

Objective:To analyze the differences in the contraction pattern of esophageal body in patients with different types of non-cardiac chest pain (NCCP).Methods:From January 1, 2019 to December 31, 2020, 46 NCCP patients visited the First Affiliated Hospital of Zhejiang Chinese Medical University were selected. According to the Lyon consensus and Rome Ⅳ dignostic criteria, combined with the results of gastr oscopy and 24 h muitichannel intraluminal impedance combined with pH detection monitoring, 27 patients were finally included. The 27 patients were divided into functional chest pain group (12 cases) and gastroesophageal reflux disease (GERD) group (15 cases). The differences in contraction pattern of esophageal body between the two groups were analyzed according to the results of high-resolution esophageal manometry (the maximal wave amplitude of each contraction segment (S1, S2, S3), average contraction amplitude, contraction transmission time, segment lengths, distal contractile integral (DCI) and the DCI ratio of S2 to S3). Independent sample t test and chi-square test were used for statistical analysis. Results:The segment length and contraction transmission time of S3 in GERD group were shorter than those in functional chest pain group, the DCI of S3 in GERD group was lower than that in functional chest pain group, and the DCI ratio of S2 to S3 was higher than that of functional chest pain group ((5.69±0.55) cm vs. (6.61±0.99) cm, (3.45±0.49) s vs. (4.15±0.90) s, (798.88±354.70) mmHg·s·cm (1 mmHg=0.133 kPa) vs. (1 421.45±802.47) mmHg·s·cm, 0.99±0.44 vs. 0.67±0.17), and the differences were statistically significant ( t=2.682, 2.249, 2.308 and -2.616, all P<0.05). In GERD group, the transmitted segment length of S2 was longer than that of S3 ((7.02±1.40) cm vs. (5.69±0.55) cm), the contraction time of S2 of functional chest pain group was shorter than that of S3 ((3.29±0.80) s vs. (4.15±0.90) s), and the differences were statistically significant ( t=3.413 and -2.269, both P<0.05). Conclusion:High-amplitude contraction of S3 mainly occurs in patients with functional chest pain rather than GERD patients, suggesting that it may have a certain value in differential diagnosis of functional chest pain and GERD.

7.
Article in Chinese | WPRIM | ID: wpr-912180

ABSTRACT

Objective:To investigate the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for the removal of colorectal polyps of 10-15 mm.Methods:A total of 173 polyps of 154 patients with at least one polyp of 10-15 mm were resected under colonoscopy from December 2019 to December 2020. Based on Paris classification, the polyps were divided into Ⅰsp, Ⅰs and Ⅱa. According to random number table, the polyps were randomly divided into CSP group ( n=85) and HSP group ( n=88). The polyp size, location, morphology, histological classification, complete resection rate, incidence of complications, resection time and the number of prophylactic clips were compared between the two groups. Results:There were no significant differences in age, sex, indication of colonoscopy or the success rate of intubation at the end of ileum between the two groups. The polyps of the two groups were comparable in size, position, morphology and histological classification. There were no significant differences in the complete resection rate of polyps, rates of intraoperative bleeding and postoperative bleeding or perforation between the CSP group and the HSP group. The operation time in CSP group was significantly shorter than that in HSP group (63.5 ±23.6 s VS 184.3 ±62.4 s, P<0.05). The number of prophylactic clips used in CSP group was significantly less than that in HSP group (0.8±0.5 VS 1.4±0.7, P<0.05). Conclusion:CSP shows similar complete resection rate and complication incidence, and requires shorter operation time and fewer prophylactic clips, compared with HSP, in the resection of colorectal sessile polyps of 10-15 mm.

8.
Article in English | WPRIM | ID: wpr-887723

ABSTRACT

Objective@#Evidence regarding alcohol consumption and cognitive impairment is controversial. Whether cessation of drinking alcohol by non-dependent drinkers alters the risk of cognitive impairment remains unknown. This study prospectively evaluated the potential association between the history of lifetime alcohol cessation and risk of cognitive impairment.@*Methods@#This study included 15,758 participants age 65 years or older, selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that covered 23 provinces in China. Current alcohol use status, duration of alcohol cessation, and alcohol consumption before abstinence were self-reported by participants; cognitive function was evaluated using Mini-mental State Examination (MMSE). Cause-specific hazard models and restricted cubic splines were applied to estimate the effect of alcohol use on cognitive impairment.@*Results@#Among the 15,758 participants, mean (± SD) age was 82.8 years (± 11.9 years), and 7,199 (45.7%) were males. During a mean of 3.9 years of follow-up, 3,404 cases were identified as cognitive impairment. Compared with current drinkers, alcohol cessation of five to nine years [adjusted @*Conclusion@#A longer duration of alcohol cessation was associated with a lower risk of cognitive impairment assessed by MMSE. Alcohol cessation is never late for older adults to prevent cognitive impairment.


Subject(s)
Aged , Aged, 80 and over , Alcohol Abstinence , Alcohol Drinking , China , Cognition , Cognitive Dysfunction/epidemiology , Female , Health Behavior , Humans , Longitudinal Studies , Male , Mental Status and Dementia Tests , Risk
9.
Article in Chinese | WPRIM | ID: wpr-885724

ABSTRACT

Objective:To evaluate the new scoring system for gastric cancer screening and risk assessment of gastric precancerous lesions.Methods:A total of 442 patients who underwent endoscopy due to stomach discomfort at the First Hospital of Jiaxing from March 2018 to September 2019 were enrolled. The patients were divided into three groups based on the new scoring system for gastric cancer screening before endoscopy: low-risk group (0-11 points), median-risk group (12-16 points) and high-risk group (17-23 points). The detection rates of gastric cancer and atrophic gastritis in three groups were analyzed. According to the range or degree of atrophy or intestinal metaplasia, patients were divided into five groups of stage 0 to Ⅳ based on the operative link for gastritis assessment (OLGA) or operative link for gastritis intestinal metaplasia (OLGIM). The correlation between the new gastric cancer screening scoring system and OLGA or OLGIM staging system were evaluated.Results:Among 442 patients, 211 were assigned to low-risk group, 207 median-risk group and 24 high-risk group according to the new scoring system. For OLGA staging system, there were 241 cases of stage-0, 105 of stage-Ⅰ, 58 stage-Ⅱ, 27 stage-Ⅲ and 11 stage-Ⅳ. For OLGIM staging system, there were 224 cases of stage-0, 113 stage-Ⅰ, 61 stage-Ⅱ, 31 stage-Ⅲ and 13 stage-Ⅳ. The pepsinogen (PG) Ⅰ and pepsinogen ratio (PGR) levels had differences among different OLGA stages ( F=2.844, P=0.027; F=5.435, P=0.001), and these two variables at Stage-Ⅲ and Ⅳ were significantly lower than three other OLGA stages (all P<0.001). The PGR level had differences among different OLGIM stages ( F=3.887, P=0.008), which was significantly lower at Stage-Ⅳ than at other OLGIM stages (all P<0.001). Gamma coefficient analysis and Kendall′s tau-b analysis showed significant correlations between OLGA/OLGIM staging system and new gastric cancer screening scoring system ( P<0.001). Conclusion:The new scoring system is reliable for gastric cancer screening, and is closely linked with OLGA/OLGIM staging system in the risk assessment of gastric precancerous lesions.

10.
Article in Chinese | WPRIM | ID: wpr-885147

ABSTRACT

Objective:To compare the value of new gastric cancer screening scoring system and serum pepsinogen (PG) combined with gastrin-17 (G-17) (new ABC method) in screening gastric cancer and precancerous lesions.Methods:A total of 576 patients were enrolled after the examination of endoscopy at Endoscopy Center,Department of Gastroenterology,from December 2017 to December 2019. There were 275 males and 301 females with an age of 40-72 (52±10) years. According to the new ABC method and the new gastric cancer screening scoring system, the population was divided into three groups according to age,gender,serum helicobacter pylori antibody test, PG Ⅰ/PG Ⅱ(PGR) and G-17 before endoscopy. The detection rates of gastric cancer and atrophic gastritis by two different methods were analyzed and the value in screening gastric cancer and precancerous lesions were evaluated. Statistical analysis was accomplished by Chi-square test and Gamma coefficient analysis. Results:A total of 576 patients were enrolled. According to the new ABC method, 382 patients were classified into low-risk group, 170 patients into middle-risk group and 24 patients into high-risk group, respectively. In the new ABC method, 1 case of gastric cancer (0.3%) was detected in low-risk group, 8 cases (4.7%) in middle-risk group and 3 cases (12.5%) in high-risk group. As for atrophic gastritis, 89 cases (23.3%) was detected in low-risk group, 94 cases (55.3%) in middle-risk group and 18 cases (75.0%) in high-risk group. According to the new gastric cancer screening scoring system, 336 patients were classified into low-risk group, 205 patients into middle-risk group and 35 patients into high-risk group, respectively. One case of gastric cancer (0.3%) was detected in low-risk group, 6 cases (2.9%) in middle-risk group and 5 cases (14.3%) in high-risk group. As for atrophic gastritis, 41 cases (12.2%) were detected in low-risk group, 134 cases (65.4%) in middle-risk group and 26 cases (74.3%) in high-risk group. In this two methods, the prevalence of gastric cancer increased according to the disease stage ( χ2 =22.509, P<0.01; χ2=24.156, P<0.01); in terms of atrophic gastritis, the detection rate of the new screening scoring system in the low-risk group was significantly lower than that in the new ABC method ( χ2=14.844, P<0.01), but higher in the middle-risk group ( χ2=3.955, P=0.047). Gamma coefficient test showed that there were strong correlations between gastroscopy pathology and classification grade of both methods ( P<0.01). Conclusions:Both methods are suitable for screening gastric cancer and precancerous lesions, and the new scoring system may be more valuable in screening gastric cancer and precancerous lesions.

11.
Chinese Journal of Radiology ; (12): 409-414, 2021.
Article in Chinese | WPRIM | ID: wpr-884434

ABSTRACT

Objective:To evaluate the feasibility of making individualized scanning and contrast injection protocol based on body mass index (BMI) and body weight during dynamic myocardial computed perfusion (CTP) imaging in order to get high-quality images while drastically reducing radiation dose.Methods:A total of 128 patients with coronary heart disease diagnosed by coronary CTA (CCTA) performed CTP from June, 2019 to March, 2020 were prospectively enrolled. Patients were divided into six groups: group 1, BMI<24 kg/m 2, ≤60 kg, 70 kV; group 2,BMI<24 kg/m 2, 61≤kg≤70, 70 kV; group 3, BMI 24-28 kg/m 2, 61≤kg≤70, 80 kV; group 4, BMI 24-28 kg/m 2, 71≤kg≤80, 80 kV; group 5, BMI 24-28 kg/m 2,>80 kg, 80 kV;group 6, BMI>28 kg/m 2,>80 kg, 100 kV. 200 mA was fixed for all patients. Contrast agent with iodine containing 370 mg/ml was used in all patients. The iodine delivery rates (IDR) for each group was 0.8, 1.0, 1.2, 1.4, 1.6, 2.0 g/s, respectively. The attenuation and noise of left ventricle (LV) and septal myocardial were measured to calculate signal to noise ratio (SNR) and contrast to noise ratio (CNR) of the images in each group. The Shapiro-Wilk test was conducted to assess the normality of quantitative data. Quantitative variables were compared using one-way ANOVA if normally distributed. Results:The LV attenuation of the six groups were (506±85), (513±77), (510±81), (456±74), (477±111), (462±43) HU, respectively. There was no significant difference among them ( F=2.249, P=0.054). SNR values of LV were 23±8, 20±5, 21±5, 19±4, 19±7, 19±4, and CNR values were 19±7, 17±4, 17±4, 16±4, 15±6, 15±4, respectively. There were no significant differences among them ( F=1.674, 1.736, all P>0.05). Under a single CTP scan, the radiation dose of 70, 80 and 100 kV groups were 1.6, 2.3 and 4.3 mSv, respectively. The does of the 70 kV group and 80 kV group were significantly lower than that of the 100 kV group, and the dose of the 70 kV group was also significantly lower than that of the 80 kV group (all P<0.001). Conclusions:The application of individualized scanning and contrast agent injection protocol based on IDR is feasible in myocardial CTP with successful image quality, and the radiation dose decreases significantly.

12.
Chinese Journal of Radiology ; (12): 40-47, 2021.
Article in Chinese | WPRIM | ID: wpr-884415

ABSTRACT

Objective:To probe the diagnostic performance of the combined evaluation of stenosis and plaque characteristics based on coronary computed tomography angiography (CCTA) in identification of myocardial ischemic lesions, using the invasive coronary angiography (ICA)-based fractional flow reserve (FFR) as the gold standard.Methods:From November 2018 to March 2020, the patients with suspected or known coronary artery disease and scheduled for ICA at 5 clinical trials centers were enrolled in this study. All the patients underwent CCTA, ICA and FFR in turn in one week. The luminal stenosis and plaque characteristics were measured and assessed including plaque burden, volume ratios of calcification and non-calcification, lesion length and CT vulnerable features. All culprit vessels were divided into FFR≤0.8 and FFR>0.8 groups, and the parameters of plaque characteristics were compared. The correlation of ischemic lesions with CCTA stenosis and plaque characteristics was analyzed by the logistic regression analysis. The ROC curve was used to evaluate the sensitivity and specificity of CCTA stenosis rate and plaque characteristics, meanwhile the area under curve (AUC) of each parameter was compared by Delong test.Results:Three hundred and sixty-six culprit vessels in 317 patients were analyzed in this study (169 vessels in ischemia group and 197 in nonischemia group). The plaque burden [34.3% (30.3%, 38.8%) vs. 32.4% (28.5%, 37.9%); Z=-2.622, P=0.009], proportion of CT vulnerable features [26.9% (45/169) vs.11.7% (23/197); χ 2=15.311, P<0.001] and lesion length [22.1 (14.4, 35.0) mm vs. 17.6 (11.0, 26.0) mm; Z=-4.388, P<0.001] in FFR≤0.8 group were higher than those in FFR>0.8 group. The results of logistic regression analysis revealed that CCTA stenosis, lesion length, and CT vulnerable features were significant predictors for myocardial ischemia (OR values: 3.794, 2.461, 1.027; P<0.001, P=0.002, P=0.002). The diagnostic performance of CCTA ≥50% stenosis alone in identification of ischemic lesions was low (AUC=0.625). When it combined high-risk plaque characteristics and lesion length, the AUC was improved to 0.714 with a statistical significance. Conclusions:CCTA stenosis, lesion length, and CT vulnerable features are major predictors in identification of myocardial ischemic lesions, and the combination will significantly improve the diagnostic performance of CCTA ≥50% stenosis.

13.
Article in Chinese | WPRIM | ID: wpr-867914

ABSTRACT

Objective:To characterize tibial plateau fractures using a computed-tomography-based "four-column and nine-segment" classification.Methods:A retrospective analysis was conducted of the 698 adult patients with tibial plateau fracture (704 knees) who had been admitted to Department of Orthopedics, The Affiliated People's Hospital of Jiangsu University from December 2007 to May 2018. They were 377 males and 321 females with an average age of 51.6 years. The left knee was affected in 371 cases (53.2%), the right knee in 321 cases (46.0%) and bilateral knees in 6 cases (0.9%). According to the differentiated morphological characteristics, the tibial plateau and proximal fibula were divided into 4 columns, which were subdivided into 9 segments. Tibial plateau injury index (TPII) was innovatively introduced to represent the extent of injury. Fracture mapping was retrospectively analyzed according to the "four-column and nine-segment" classification based on the CT imaging.Results:The rates of one-column, two-column, three-column and four-column injuries were 30.5% (215/704), 31.5% (222/704), 28.0% (197/704), and 9.9% (70/704), respectively. On average, 2.2 columns ± 1.0 columns and 3.6 segments ± 2.1 segments were affected in each case. The mean TPII was 5.7±3.0. The rates of mild, moderate and severe comminuted fractures were 50.0% (352/704), 37.5% (264/704), and 12.5% (88/704). The columns most frequently affected were the lateral column (572, 81.3%) and the intermedial column (524, 74.4%) while the less frequently involved ones the medial column (219, 31.1%) and the fibular column (218, 31.0%). The sequence of the segments affected was the posterolateral segment (465, 66.1%), the anterolateral segment (453, 64.3%), the posteromedian segment (379, 53.8%) and the tubercle segment (85, 12.1%).Conclusions:The novel "four-column and nine-segment" classification may be a beneficial system for clinical diagnosis, statistical analysis and prognostic judgment of tibial plateau fractures.

14.
Chinese Journal of Digestion ; (12): 87-92, 2020.
Article in Chinese | WPRIM | ID: wpr-871455

ABSTRACT

Objective:To analyze the differences in esophageal motility between patients with gastroesophageal reflux disease (GERD) and functional esophageal disorders by comparing the esophagogastric junction (EGJ) barrier function, esophageal body motor function and results of provocative test.Methods:From December 2016 to December 2018, the 100 patients with typical symptoms of GERD, who visited The First Aftiliated Hospifal of Zhejiang Chinese Medical Universtiy wese selected. According to the Rome Ⅳ standand and the Lyon consensus, and the results of endoscopic examination, 24 h multichannel intratuminal impedante pH (MII-pH) monitoring and esophageal high resolution manometry (HRM), the patients were divided into GERD group ( n=32), hypersensitivity(RH) group ( n=33) and functional heartburn(FH) group ( n=35). According to the results of esophageal HRM, the differences in esophageal dynamics among the groups were analyzed. T test, variance analysis and Chi square test were performed for statistical analysis. Results:The lower esophageal sphincter (LES) resting pressure of GERD group was lower than that of FH group ((19.37±7.92) mmHg vs. (25.35±12.38) mmHg (1 mmHg=0.133 kPa)); the EGJ-contractile integral of GERD group and RH group was lower than that of FH group ((20.84±21.52) mmHg·cm and (20.72±19.35) mmHg·cm vs. (35.93±36.82) mmHg·cm), and the level of distal contractile integral of GERD group was lower than that of FH group and RH group ((802.35±496.86) mmHg·s·cm vs. (1 316.84±853.92) mmHg·s·cm and (1 141.65±607.93) mmHg·s·cm), and the differences were statistically significant ( t=-2.377, -2.069, -2.149, -3.045 and -2.467, all P<0.05). There were no major motility disorders in patients of the three groups. The incidence of ineffective oesophageal motility of GERD group was higher than that of RH group and FH group (62.5%(20/32) vs. 39.4%(13/33) and 25.7%(9/35)), and the differences were statistically significant ( χ2=4.440 and 9.214, both P<0.05). Conclusions:GERD patients have abnormal esophageal motility, which is mainly manifested by reduced LES resting pressure, decreased EGJ barrier function, and abnormal peristalsis of the esophagus. Patients with RH also have decreased EGJ barrier function.

15.
Chinese Journal of Digestion ; (12): 40-44, 2020.
Article in Chinese | WPRIM | ID: wpr-871451

ABSTRACT

Objective:To study the role of corticotropin-releasing hormone (CRH) system in locus ceruleus (LC) in irritable bowel syndrome (IBS) and to explore its molecular mechanism.Methods:The IBS rat was established by maternal separation following with postnatal stress. The tissues sample of LC was obtained by micropunched nuclei. The expression of c- Fos, CRH and its receptors including corticotropin-releasing hormone receptor (CRHR) 1 and CRHR2 of rats’ LC tissues of control group and IBS group was detected by quantitative polymerase chain reaction(PCR). The expression of DNA methyltransferase ( DNTM) 1, DNMT3a and DNMT3b at the mRNA level were also measured. In addition, the expression of histone methyltransferase ASH2-like protein (ASH2L) and SET and MYND domain containing 2 (SMYD2) was determined by Western blotting. T test was used for statistical analysis. Results:The rectal pneumatic pressure of IBS group was lower than that of control group ((69.82±5.47) mmHg vs. (86.86±5.98) mmHg; 1 mmHg=0.133 kPa), however compared with that of control group, the expression of c- Fos at the mRNA level increased (2.11±0.44 vs.1.00±0.19), and the differences were statistically significant ( t=6.215 and 2.321, P<0.01 and 0.05). In addition, compared with that of control group, the expression of CRH at the mRNA level increased (1.99±0.35 vs.1.00±0.13), and the difference was statistically significant ( t= 2.797, P<0.05). Compared with that of control group, the expression of SMYD2 at the protein level up-regulated (1.04±0.21 vs. 0.61±0.12), and the difference was statistically significant ( t=4.451, P<0.01). However, there were no statistically significant differences in the expression of CRHR-1, CRHR2, DNMT1, DNMT3a, DNMT3b at the mRNA level, and the expression of ASH2L between IBS group and control group (0.96±0.13 vs. 1.00±0.26, 1.35±0.63 vs. 1.00±0.43, 1.40±0.61 vs.1.00±0.19, 1.39±0.58 vs. 1.00±0.21, 1.45±0.71vs.1.00±0.39 and 0.80±0.19 vs. 1.05±0.26, respectively; all P>0.05). Conclusions:Maternal separation combined with postnatal stress affect the transcription of Crh gene in LC and cause the activation of the stress regulation network CRH and norepinephrine system, resulting in the increase of the visceral sensitivity of rats. The abnormal transcription of Crh gene may be related with SMYD2-mediated histone H3K36 methylation, but not related with the modification of DNA methylation.

16.
Article in Chinese | WPRIM | ID: wpr-787738

ABSTRACT

To investigate the relationship of sleep duration and sleep quality with anxiety in the elderly aged 60 years and older in China. The elderly aged 60 years and older were selected from the China Short-term Health Effects of Air Pollution Study conducted between July 18, 2017 and February 7, 2018. Multivariate logistic regression models were used to analyze the association of sleep duration and sleep quality with anxiety. A total of 3 897 elderly aged 60 years and older were included in the study. The age of the elderly was (73.4±8.0) years old. Among the elderly surveyed, 6.5 were defined with anxiety, and 18.7 reported poor sleep quality. Multivariate logistic regression models showed shorter sleep duration was the risk factor for anxiety in the elderly that after adjusting for factors such as general demographics, socioeconomic factors, lifestyle, health status, social support and ambient fine particulates exposure. Compared with the elderly with 7 hours of sleep duration daily, the (95) of anxiety for those with sleep duration ≤ 6 hours was 2.09 (1.49-2.93). Compared with those with good sleep quality, the (95) of anxiety for those with poor sleep quality was 5.12 (3.88-6.77). We also found statistically significant correlations of the scores of subscales of Pittsburgh sleep quality index with anxiety, in which the effects of sleep disturbance, subjective sleep quality and daytime dysfunction scores were most obvious, the (95) were 4.63 (3.55-6.04), 2.75 (2.33-3.23) and 2.50 (2.19-2.86), respectively. Subgroup analysis showed that the association of sleep duration and sleep quality with anxiety was more obvious in males and in those aged <80 years. Shorter sleep duration and poor sleep quality are associated with anxiety in the elderly in China.

17.
Article in Chinese | WPRIM | ID: wpr-787713

ABSTRACT

To analyze influencing factors for depressive symptoms in the elderly aged 65 years and older in 8 longevity areas in China. We recruited 2 180 participants aged 65 years and older in 8 longevity areas from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey in 2017. Multivariate logistic regression analysis was performed to evaluate the relationships of socio-demographic characteristics, behavioral lifestyle, chronic disease prevalence, functional status, family and social support with depressive symptoms in the elderly. The detection rate of depression symptoms was 15.0 in the elderly aged 65 years and older in 8 longevity areas of China, and the detection rate of depression symptoms was 11.5 in men and 18.5 in women. Multivariate logistic regression analysis results showed that the detection rate of depressive symptoms was lower in the elderly who had regular physical exercises (=0.44, 95: 0.26-0.74), frequent fish intakes (=0.57, 95: 0.39-0.83), recreational activities (=0.65, 95: 0.44-0.96), social activities (=0.28, 95: 0.11-0.73) and community services (=0.68, 95: 0.50-0.93). The elderly who were lack of sleep (=2.04, 95: 1.49-2.80), had visual impairment (=1.54, 95: 1.08-2.18), had gastrointestinal ulcer (=2.97, 95: 1.53-5.77), had arthritis (=2.63, 95: 1.61-4.32), had higher family expenditure than income (=1.80, 95: 1.17-2.78) and were in poor economic condition (=4.58, 95: 2.48-8.47) had higher detection rate of depressive symptoms. The status of doing physical exercise, fish intake in diet, social activity participation, sleep quality or vision, and the prevalence of gastrointestinal ulcers and arthritis were associated with the detection rate of depressive symptoms in the elderly.

18.
Article in Chinese | WPRIM | ID: wpr-787712

ABSTRACT

To understand the current status of BMI of the elderly and related factors in longevity areas in China, and provide scientific evidence for the control of BMI level in elderly population. Data used in this study were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey. A total of 2 825 elderly in 8 longevity areas in China were surveyed and measured in 2017. The BMI levels of 2 217 elderly aged 65 years and older were calculated and in follow up. The ordered classification logistic regression model was used to analyze the influencd factors for the BMI in the elderly. The BMI of the elderly in 8 longevity areas in China was (22.36±3.87) kg/m(2), and it was (22.76±3.58) kg/m(2) for males and (21.75±3.98) kg/m(2) for females. The BMI levels were normal in 1 165 elderly persons. The prevalence of underweight, overweight and obesity were 15.8, 24.0 and 7.7, respectively. Multivariate analysis showed that the main factors affecting the BMI of people under 100- years old were age (65-: =2.78, 95: 1.87-4.15; 80-: =1.47, 95: 1.00-2.17), smoking status (=0.46, 95: 0.32-0.66), annual household income (<30 000 Yuan: =1.26, 95: 1.07-1.47; 30 000-70 000 Yuan: =1.52, 95: 1.12-1.86), and frequency of tea intake(=1.36, 95: 1.01-1.71), while the factor in people aged ≥100 years was gender (=3.68, 95: 1.32-10.36). The prevalence of underweight, overweight and obesity were high in the elderly from longevity areas in China. It is necessary to pay attention to the trend of overweight and obesity due to smoking, higher annual household income and regular tea drinking in the elderly men.

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Article in Chinese | WPRIM | ID: wpr-787711

ABSTRACT

To understand the relationship between visual impairment and risk of all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China. The data of the elderly aged 65 years and older in the project in 2012 were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, including physical measurement and survival status, and a follow-up for survival outcomes were conducted in 2014 and 2017 respectively. Cox proportional hazard regression model was used to analyze the influence of visual impairment on mortality. Gender and age specific analysis was conducted. A total of 1 736 elderly adults were included. A total of 943 deaths occurred during the 5-year follow-up period with a 5-year mortality rate of 54.3. The 5-year mortality rate was 76.7 in the group with visual impairment, and 47.6 in the group without visual impairment (<0.001). After adjusting for demographic information, life style and some disease factors, the risk of 5-year mortality in the group with visual impairment group was 1.30 times higher than that in the group without visual impairment (=1.30, 95: 1.09-1.55). In the females, the risk for mortality in the group with visual impairment was 1.48 times higher than that in the group without visual impairment (=1.48, 95:1.20-1.84). However, vision status was not associated with the risk for mortality in males (=1.02, 95: 0.72-1.43). The risk for mortality in the group with visual impairment was 1.39 times higher than that in the group without visual impairment in the elderly aged over 90 years (=1.39, 95: 1.13-1.70). Vision status was not associated with mortality risk in the elderly aged 65-79 years and 80-89 years (=1.37, 95: 0.61-3.07; =0.95, 95: 0.61-1.48). In the elderly people in China, visual impairment is a risk factor for mortality.

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Article in Chinese | WPRIM | ID: wpr-787710

ABSTRACT

To investigate the association between estimated glomerular filtration rate (eGFR) and all-cause mortality in the elderly aged 65 years and older in longevity areas in China. Data used in this study were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, 1 802 elderly adults were collected in the study during 2012-2017/2018. In this study, the elderly were classified into 4 groups, moderate-to-severe group [<45 ml·min(-1)·(1.73 m(2))(-1)], mild-to-moderate group [45- ml·min(-1)·(1.73 m(2))(-1)], mild group [60- ml·min(-1)·(1.73 m(2))(-1)] and normal group [≥90 ml·min(-1)·(1.73 m(2))(-1)] according to their eGFR levels. After 6 years of follow-up, 852 participants died, with a mortality rate of 47.3. Multivariate Cox regression analysis showed that the levels of eGFR were negatively correlated with all-cause mortality risk in the elderly (the of elderly was 0.993 and the 95 was 0.989-0.997 for every unit of eGFR increased, =0.001), while compared with the group with normal eGFR, the (95) of the elderly in the moderate-to-severe group, mild-to-moderate group, and mild group were 1.690 (1.224-2.332, =0.001), 1.312 (0.978-1.758, =0.070), 1.349 (1.047-1.737, =0.020) respectively [trend test <0.001]. The decrease in eGFR was associated with higher mortality risk among the elderly in longevity areas in China.

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