RESUMEN
Objective:To explore the clinical value of quantitative parameters on spectral CT in predicting the invasiveness of lung adenocarcinoma manifesting as ground-glass nodules (GGN).Methods:The clinical and imaging data of 129 patients with pathologically confirmed lung adenocarcinoma who were surgically resected in the First Affiliated Hospital of Zhengzhou University from March to October 2022 were retrospectively analyzed, including 45 males and 84 females, aged from 33 to 81. According to the pathological results, they were divided into the minimally invasive adenocarcinoma (MIA) group ( n=64) and the invasive adenocarcinoma (IAC) group ( n=65). All patients underwent enhanced spectral CT within two weeks before surgery. The iodine density map, Z-Effective (Z eff) map, and electron density (ED) map were reconstructed on the post-processing workstation, and the spectral parameters, including normalized iodine concentration (NIC), arterial enhancement fraction (AEF), Z eff, and ED were measured and calculated. Conventional CT features were analyzed, including maximum diameter, CT value, nodule types, margin, lobulation sign, spiculation sign, bubble sign, pleural retraction sign, abnormal vascular sign, and air bronchial sign. The clinical features, conventional CT characteristics and spectral CT parameters of two groups were compared using the independent sample t test, the Mann-Whitney U test, and the χ 2 test. Multivariate logistic regression analysis was used to evaluate the independent risk factors of lung adenocarcinoma invasiveness, and the model was constructed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of parameters and models in predicting the invasiveness of lung adenocarcinoma. Results:There were significant differences between the MIA group and IAC group in maximum diameter, CT value, nodule type, margin, spiculation sign, pleural retraction sign, air bronchial sign, venous phase NIC, AEF, venous phase Z eff, arterial phase ED, venous phase ED ( P<0.05). Multivariate logistic regression analysis showed that the maximum diameter (OR=1.183, 95%CI 1.062-1.318), CT value (OR=1.004, 95%CI 1.001-1.007), venous phase NIC (OR=1.185, 95%CI 1.083-1.298), AEF(OR=0.975, 95%CI 0.957-0.994), venous phase Z eff (OR=0.031, 95%CI 0.005-0.196) were independent influence factors for the invasiveness of lung adenocarcinoma. The conventional CT model was established with the maximum diameter and CT value, and the spectral CT model was established with venous phase NIC, AEF, and venous phase Z eff. The combined model was established with all the parameters above. Areas under the ROC curve of the conventional CT model, the spectral CT model, and the combined model for predicting the invasiveness of lung adenocarcinoma were 0.828, 0.854, and 0.902, respectively. Conclusion:The quantitative parameters of double-layer detector spectral CT can be used as an indicator to predict the invasiveness of lung adenocarcinoma manifesting as GGN, and AEF has the highest diagnostic efficacy. Spectral CT combined with conventional CT features can further improve the diagnostic efficiency.
RESUMEN
Objective To explore and understand limitations and needs of support for conducting clinical research among clinicians in China.Methods The in-service clinician in our hospital were enrolled in as survey participants,survey questionnaires were designed and filled up by target audience in the questionnaire star platform.Results Main problems identified as restrictions for conducting clinical studies including lack of data platform,have ideas but not protocols,lack of research funding and project management.On the other hand,identified needs for support including research-related technical support,project management facilitation,training,external communication and exchange,as well as quality risk management.Conclusions Hospital should establish Clinical Research Unit to help clinicians to improve research quality by training,providing technical support and administrative service of clinical research.
RESUMEN
Objective: To explore the value of spectral CT plain multi-parameter imaging in judging pathological subtypes of lung adenocarcinoma with pure ground glass nodule (pGGN). Methods: Forty-five patients with pathological confirmed lung adenocarcinoma manifested as pGGN on spectral plain CT scan images were included and divided into group A (non IAC group, including 9 patients of situ adenocarcinoma [AIS] and 12 of microinvasive adenocarcinoma [MIA] ) and group B (invasive adenocarcinoma group, including 24 IAC patients). Monochromatic images at 70 keV with 40% adaptive statistical iterative reconstruction V (ASIR-V) were reconstructed and qualitative analyzed, including the lobulated sign, burr sign, vacuole sign, air bronchial sign as well as pleural indentation sign and abnormal vascular sign. Quantitative parameters, including CT values on monochromatic images raining from 40 keV to 140 keV, water concentration (WC), effective atomic number (Eff-Z) and spectral curve slope of k1-k3 (represent the slope of 40-70 keV, 71-100 keV, 101-140 keV respectively) were obtained and compared between 2 groups. Results: The occurrence rate of abnormal vascular sign in group B was higher than that in group A (P0.05). The k1 in group B was lower than that in group A (P0.05). The WC of group B was higher than that of group A (P0.05). Conclusion: Spectral CT plain multi-parameter imaging can provide a variety of quantitative parameters based on the morphological features of pGGN and more diagnostic information than routine CT, which is helpful to judging pathological subtypes of lung adenocarcinoma manifested as pGGN.
RESUMEN
Objective To summarize the practical experiences of Clinical Research Unit (CRU) platform established by Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine,provide reference for domestic institutions that have prepared or to prepare to establish CRU platform.Methods Oriented by demand,this platform has set up six modules including project management module,methodology support module,data management module,quality risk management module,project transformation module and training and international exchange module.Besides,it also establishes and improves the corresponding module system,quality assurance,technical support and information data platform system.Results With this platform,the enthusiasm of departments to carry out clinical research has been continuously enhanced,the talent pool of clinical research has been expanded;the awareness of clinical research cooperation has been improved and the international cooperation fields have been further extended;the number of clinical research projects and funding have increased rapidly.Conclusions CRU Platform in Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine provides all-dimensional technical support and whole-process informatization management to improve clinical research quality and efficiency.While learning from the advanced international concepts,we still need to explore and improve the platform construction and management mode in line with general research-oriented hospitals in China,further to enhance the academic research internationally.
RESUMEN
This study was aimed to offer a scientific basis for the differentiation and control quality of Castanea mol-lissima Blume shell. The determination was given from the morphological identification, microscopical identification and TLC identification. The results showed that through obtained information such as morphological traits, tissue powder and TLC characteristics, the longitudinal section micrographs of C. mollissima Blume shell and the micro-scopic images of tissue powder had been received. It was concluded that the study provided a reliable reference for the identification of the quality control standards of C. mollissima Blume shell.
RESUMEN
Objective To study the profile of peripheral blood cortisol concentration in patients with hepatitis B virus (HBV)-related acute on chronic liver failure (ACLF) and its association with disease severity and predictive value on prognosis.Methods Forty-five patients with HBV-related ACLF,including 15 patients in early-stage,15 in medium stage and 15 in end-stage; and 15 patients with severe chronic hepatitis B (CHB) were also enrolled.Peripheral blood cortisol concentration was tested by chemiluminesence immunoassay.SPSS version 18.0 was used to compare peripheral blood cortisol concentration among different groups and analyze its correlation with prothrombin activity (PTA),total bilirubin (TBil),albumin (Alb),alanine aminotransferase (ALT),aspartate aminotransferase (AST),HBV DNA,international normalized ratio (INR) and model for end-stage liver disease (MELD) scores.The independent risk factors of prognosis in patients with HBV-related ACLF were determined by performing Logistic regression analysis.Results The concentrations of peripheral blood cortisol in severe CHB group,early stage ACLF group,medium stage ACLF group and end-stage ACLF group were (595.6±114.0),(496.0±87.2),(303.9±81.1),and (183.8±71.8) nmol/L,respectively.A decreasing trend was observed and the differences among groups were statistically significant (F =63.93,P ＜ 0.01).Peripheral blood cortisol concentration were significantly different among subgroups of patients with MELD＜30,followed by 30-40 and ＞40(F 9.01,P＜0.01).Peripheral blood cortisol concentration in patients with ACLF was positively correlated with PTA level (r=0.83,P＜0.01),and inversely correlated with TBil (r =-0.34,P＜0.05),MELDscore (r =-0.60,P＜0.01),AST/ALT (r =-0.35,P＜0.05),and INR (r=-0.59,P＜0.01).Association with Alb,ALT,AST and HBV DNA was not observed.According to multivariate Logistic regression analysis,MELD score,cortisol level,Alb and total cholesterol were independent risk factors of prognosis for patients with ACLF.Serum cortisol concentration in survival group of HBV-related ACLF was higher than that in death group,while the death group exhibited a gradually decreasing trend.Conclusions The peripheral blood cortisol concentration decreases in patients with HBV-related ACLF,which is related to the degree of liver dysfunction,disease severity and prognosis of patients.Moreover,the lower level of cortisol concentration indicates poor short-term prognosis in patients with HBV related ACLF.
RESUMEN
Objective To identify the accurate measurement of glomerular filtration rate (GFR) in chronic glomerulonephritis (CGN)patients. Methods Forty-two patients were enrolled in the study, including 15 females with age from 18 to 73 years old (mean 46 years old) and 27 males with age from 20 to 77 years old (mean 48 years old). The methods used for measuring GFR were classical dual plasma sample clearance method (tGFR), considered to be the gold standard,renal dynamic imaging method (dGFR), 24-hour creatinine clearance method (24hCcr). The difference and correlation amony them were analyzed. When the difference was significant, Pearson correlation and linear regression analysis were further performed. The difference of GFR detected by dGFR between left and right kidney of patients was compared simultaneously. A two-sided P value＜0.05 was considered as statistically significant. Results Either dGFR or 24hCcr was statistically different from tGFR, but had excellent correlation with tGFR, and the coefficient was 0.916 (P=0.000) and 0.957 (P=0.000) respectively. The linear regressions correlation existed and the regression equations were tGFR=0.936 dGFR-4.648 (F=208.941, P=0.000), tGFR =0.887 24hCcr+2.919 (F=376.513, P=0.000) respectively. Difference had not statistically significance between left and right kidney of patients (P=0.591). Conclusions Neither dGFR nor 24hCcr can substitute tGFR, but both can reflect the GFR of the CGN patients safely and effectively. The decrease of GFR is homochronous for left and right kidney of CGN patients. Therefore, the 24hCcr can be chosen to evaluate the GFR in the hospitals without SPECT.