Advances in the Effects of Antiphospholipid Syndrome on Female Infertility and Outcomes of Assisted Reproductive Technologies / 中山大学学报(医学科学版)

Antiphospholipid syndrome （APS） is an autoimmune disease characterized by the persistent presence of antiphospholipid antibodies， which are associated with thrombosis and pregnancy-related complications. APS may have adverse effects on female reproductive function by affecting ovarian function， endometrialization， and other mechanisms， and may lead to embryo implantation failure and pregnancy loss during in vitro fertilization and embryo transfer （IVF-ET） treatments. The routine screening and management of APS before IVF-ET in infertile populations remains controversial and requires individualized risk assessment and appropriate management measures to improve the success rate of assisted reproductive technologies （ART） and reduce maternal and fetal risks during pregnancy. This review summarizes the effects of APS on female infertility and outcomes of ART， as well as the management of the population affected by APS， providing new insights for clinical diagnosis and treatment.

Applications of Artificial Intelligence in Musculoskeletal System Imaging / 中国医学科学院学报

Artificial intelligence (AI) represents the latest wave of computer revolution and is considered revolutionary technology in many industries including healthcare. AI has been applied in medical imaging mainly due to the improvement of computational learning,big data mining,and innovations of neural network architecture. AI can improve the efficiency and accuracy of imaging diagnosis and reduce medical cost;also,it can be used to predict the disease risk. In this article we summarize and analyze the application of AI in musculoskeletal imaging.

CT spectral curve in differentiating spinal tumor metastasis and infections / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the value of CT spectral curve in differentiating spinal tumor metastasis (STM) from spinal infections (SI).@*METHODS@#In the study, 29 STM and 18 SI patients proved pathologically and clinically were examined by dual energy spectral CT (DESCT). The monochromatic images and CT spectral curves were generated automatically by GSI Viewer software. The attenuation values at different energy levels (40-140 keV, every 10 keV), the attenuation values of the lesions on the conventional polychromatic CT images and the gradients of the curve were calculated and compared between STM and SI.@*RESULTS@#The median age of STM and SI (58 years vs. 64 years) were not significantly different (U=171, P=0.4). The attenuation values of STM at 40-100 keV were 281.79 (143.67, 446.19) HU, 199.68 (100.04, 321.49) HU, 151.54 (81.47, 243.49) HU, (122.64±27.72) HU, (99.90±23.88) HU, (85.82±21.61) HU, and (75.94±20.27) HU, respectively, which were significantly higher than SI: 185.29 (164.19, 277.03) HU, 138.44 (124.98, 238.56) HU, 105.46 (92.94, 169.53) HU, (93.77±15.55) HU, (79.15±12.84) HU, (68.99±11.75) HU, and (62.22±11.71) HU (all P < 0.05). The attenuation values at 110-140 keV and the attenuation value on the conventional CT images were not significantly different between STM and SI. The gradient of CT spectral curve of STM was 2.43±0.58, which was higher than the value of 1.50±0.40 for SI (P < 0.001). Using 1.72 and 248.80 HU as the threshold value for CT spectral curve slope and the attenuation value at 40 keV, could obtain the area under receiver operating characteristic (ROC) curve of 0.905 and 0.892, sensitivity of 88.0% and 80.0%, and specificity of 76.9% and 92.3%.@*CONCLUSION@#CT spectral curve provides valuable semi-quantitative information for the differential diagnosis of STM and SI, which can be used as a supplement to traditional CT imaging.

Value of Diffusion-weighted Imaging in Evaluating the Activity of Sacroiliitis in Ankylosing Spondylitis / 中国医学科学院学报

Objective To investigate the clinical value of diffusion-weighted imaging (DWI) for evaluating the activity of sacroiliitis in ankylosing spondylitis (AS).Methods Totally 73 AS patients were prospectively enrolled and divided into active group (n=43) and chronic group (n=30) according to Bath ankylosing spondylitis disease activity index (BASDAI) scores and laboratory findings. Conventional magnetic resonance imaging (MRI) and DWI were performed in all subjects. Apparent diffusion coefficient (ADC) values of subchondral lesions in sacroiliac joint were independently measured by two radiologists,and the relative ADC (rADC) values were calculated. ADC and rADC values were compared between active and chronic groups. The efficiencies of ADC and rADC values for differentiating the activity of sacroiliitis were analyzed. In addition,the correlation coefficients of ADC values,rADC values,and BASDAI scores were calculated.Results The ADC and rADC values in the active group were (0.667±0.122)×10 mm /s and (1.715±0.343)×10 mm /s,respectively,which were significantly higher than those of the chronic group [(0.492±0.0651)×10 mm /s and (1.289±0.209)×10 mm /s,respectively)] (P0.81. The correlation coefficients of ADC value and rADC value with BASDAI scores were 0.82 and 0.80,respectively (P<0.0001). The optimal cutoff values of ADC value and rADC value for differentiating AS activity were 0.545×10 mm /s and 1.467×10 mm /s,respectively,The specificity was 81.8% for both indicators,and the sensitivity was 92.0% and 88.0%,respectively.Conclusion DWI is helpful in the quantitative assessment of the activity of sacroiliitis in AS patients.

Radiographic Diagnosis of Spinal Solitary Fibrous Tumor / 中国医学影像学杂志

Purpose To explore the CT and MRI manifestations of spinal solitary fibrous tumor (SFT) to improve the accuracy of imaging diagnosis.Materials and Methods CT and MRI manifestations of eight pathologically confirmed SFT were retrospectively analyzed.CT and MRI scan were performed in 8 cases.The location,shape,size,density/signal,margin,condition of the internal lesion,adjacent bone destruction and reinforcement characteristic were also analyzed.Results Of the 8 patients,4 cases were pathologically confirmed benign and the other 4 cases were malignant.6 cases showed trans-intervertebral foramen dumbbell shaped soft tissue masses,1 case showed lobulated soft tissue mass lying outside the invertebrate canal and 1 case showed long fusiform lying in intradural extramedullary of spinal canal.6 cases had adjacent bone swelling or osteolytic destruction,1 case had compressive bone defect,and 1 cases showed no obvious bone destruction.The tumor showed an equal/mixed density on CT scan.T1WI equal/low signal was seen in MRI scan.Equal/slightly higher T2WI signals were seen in 6 cases and mixed signals in 2 cases.All patients undergoing enhanced scan showed obviously inhomogeneous enhancement.Conclusion Spinal solitary fibrous tumors are lobulated or dumbbell shaped and growth clinging to or surround the dura mater.The feature of MRI signal is evident that T1WI is mostly equal/low signal and T2WI is usually slightly higher/equal signal,often accompanied by bone destruction.

Dynamic Contrast-enhanced MRI in Identification and Diagnosis of Metastasis of Lung Cancer / 中国医学影像学杂志

Purpose To explore the application value of dynamic contrast enhanced MRI (DCE-MRI) in judging and diagnosing metastasis of lung cancer.Material and Methods Sixty-one metastatic spinal tumor patients received DCE-MRI and their images acquired after scanning were post-processed.Signal intensity-time curve,signal intensity amplification in rising period of the curve (Peak SE％),maximum ascending linear slope of the curve (Max Wash-in SE％) and descending slope of the curve (Wash-out SE％) and other semiquantitative parameters were acquired.Double chamber pharmacokinetics was adopted to analyze and obtain Ktrans,rate constant (Kep) and other quantitative parameters.CHAID method was taken to establish tree structure model to confirm optimal sorting parameter and identify optimal division.Results For the DCE-MRI scanning parameters for 61 metastatic spinal tumor patients,differences of Wash-out SE％ and Kep between lung cancer and other tumor spinal metastasis were statistically significant (P＜0.01),while differences of Peak SE％,Max Wash-in SE％ and Ktrans between the two were not statistically significant (P＞0.05).When Wash-out SE％＞-660.6％ and Max Wash-in SE％＞98.0％,original focus of about 94.7％ was possible to come from lung.When taking tree structure model set up in the study for identification,10-fold cross-validation indicated (29.5±5.8)％ error rate.Conclusion Taking DCE-MRI semi-quantitative and quantitative analysis parameters for identification and diagnosis of metastasis of lung cancer is feasible.It can provide reference evidence for source identification of spinal sarcoma and clinical treatment.

Preoperative Evaluation of the Grade and Stability of Osteochondritis Dissecans of the Knee by Magnetic Resonance Imaging / 中国医学科学院学报

Objective To assess the diagnostic performance of magnetic resonance imaging (MRI) in the grading of osteochondritis dissecans (OCD) of the knee.Methods Totally 47 patients with OCD of the knee confirmed by arthroscopy were retrospectively enrolled in this study.The OCD lesions were classified into four stages according to classification system of the International Cartilage Repair Society.Two radiologists analyzed all MRI findings independently,and the results were compared with those of arthroscopy.Sensitivity,specificity,and accuracy were calculated.Kappa value were calculated to quantify inter-observer agreement of the diagnostic OCD grade between two doctors by MRI.Specificity,sensitivity,and accuracy of MRI criteria indicating instability for detection of OCD instability were calculated.Results Of these 47 patients with 48 OCD lesions,stages Ⅰ,Ⅱ,Ⅲ,and Ⅲ lesions were detected in 4,8,16,and 20 patients,respectively.The specificity,sensitivity,and accuracy for the diagnosis of OCD stability were 75.0% (83.3%),88.9% (86.1%),and 85.4% (85.4%) for observer l (2),and the agreement of OCD grade between these two readers was substantial with a Kappa value of 0.82.The specificity,sensitivity,and accuracy of MRI criteria for the detection of OCD instability including high T2 signal intensity at the interface between the OCD and the underlying bone,multiple cysts or a single cyst of>5 mm in diameter surrounding OCD lesions,high T2 signal intensity cartilage fracture line traversing the articular cartilage,and osteochondral defect were 83.3%,80.6%,and 81.3%;75.0%,72.2%,and 72.9%;66.7%,69.4%,and 68.8%;100%,86.1%,and 89.6%,respectively. Conclusions Osteochondral defect is the most specific MRI sign for diagnosing instable OCD of the knee,whereas osteochondral fracture line has the lowest accuracy.MRI is a useful method to evaluate the grade and stability of OCD of the knee.

Imaging Diagnosis of Pigmented Villonodular Synovitis of Spine / 中国医学影像学杂志

PurposeTo explore CT and MRI findings of pigmented villonodular synovitis (PVNS) of spine, and to improve the preoperative diagnosis.Materials and MethodsCT and MRI findings of 7 cases of PVNS of spine confirmed by surgery and pathology were retrospectively analyzed. Seven cases underwent CT scan and 5 of them underwent MRI scan. The location of the lesions, tumor size, shape, density (signal), bone destruction and enhanced features were analyzed.ResultsExcept one case with small lesion, the remaining 6 cases showed lobulated soft tissue masses centering at the facet joint area, with lytic, expansive bone destruction. On CT images (n=7), 3 cases showed the masses density similar to that of the surrounding muscles, and 4 cases showed the tumor density slightly lower than that of the surrounding muscles. On MRI images (n=5), 1 small lesion demonstrated low signal at the peripheral, 1 lesion was isointensity without obvious low-density in it, 3 cases showed characteristic multiple visible low signal nodules in the lesions.ConclusionThe possibility diagnosis of the PVNS should be considered when spinal lesions are characterized by osteolytic bone destruction centering at facet joints and soft tissue masses with distinctive MR signals.

Effect of glutathione on the levels of serum superoxide dismutase, malondialdehyde and sensory nerve conduction velocity in diabetic perineuropathy / 中国医师进修杂志

Objective To observe the change of oxidalive stress indexes in the patients with diabetic perineuropathy (DPN), and investigate the protection role of glutathione (GSH) on neuroprotective effect. Methods The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) and sensory nerve conduction velocity (SCV) were detected in 54 cases with DPN (DPN group) and 30 cases of health examination (control group). Fifty-four cases with DPN were divided into GSH group (given basic treatment and GSH 1.8 g/d) and CON group(given basic treatment and B vitamin) with 27 cases each by random-digits table. After treatment of 2 weeks, the levels of SOD, MDA and SCV were compared. Results The levels of MDA in DPN group were significantly higher than those in control group, while the activity of SOD was significantly lower than that in control group [(7.23 ±2.31) μmol/L vs. (4.87 ± 1.17) μmol/L, (59.72 ± 13.58) kU/L vs. (76.19 ± 7.55 ) kU/L](P＜ 0.01). After treatment, the level of MDA was decreased and the activity of SOD was increased in GSH group and CON group (P ＜0.05),but there was no significant difference between the two groups(P＞ 0.05). After treatment, the level of SCV was significantly increased in GSH group,while there was no significant difference in CON group (P ＞0.05). Conclusions Oxidative stress exists in DPN patients. The antioxidant treatment with GSH can improve impaired nerve and has a better effect of nerve protection than classical nerve nutrition therapy.

Differential diagnosis of the mixed epithelial and stromal tumor of kidney and cystic nephroma with multi-detector CT / 中国医学影像技术

Objective To investigate the features of the mixed epithelial and stromal tumor of kidney (MESTK) and cystic nephroma (CN) on multi-detector CT (MDCT), in order to improve the accuracy of preoperative diagnosis and differential diagnosis. Methods Based on blind-retrospective review, CT features of 6 MESTK patients and 6 CN patients were reviewed retrospectively, and compared with pathological results postoperatively. Results All the lesions were single regular multi-cystic masses. Five patients with MESTK were diagnosed as Bosniak Ⅲ and 1 as Bosniak Ⅳ. In contrast, 6 of CN were all diagnosed as Bosniak Ⅱ. Six MESTK lesions were all consisted of irregular mixture of solid and cystic components, and the average thickness of septa was 0.93 cm. Six CN lesions were entirely cystic masses without solid components, and the average thickness of septa was 0.23 cm. After contrast enhancement, the solid components of MESTK and the cystic wall of CN presented mild-to-moderate delayed enhancement. Conclusion Some signs on multi-detector CT can help to differentiate MESTK and CN, especially the presence of solid components of the tumor.

Proton magnetic resonance spectroscopy on the precentral gyrus of patients with amyotrophic lateral sclerosis / 中华神经科杂志

Objective To explore the significance of proton magnetic resonance spectroscopy(1H- MRS)in patients with amyotrophic lateral sclerosis(ALS).Methods Single-voxel1 H-MRS was carried on the preeentral gyri in 110 patients with ALS and 24 patients with lower motor neuron syndrome (LMNS) compared with 89 healthy controls.The upper motor neuron involvement of the patients was assessed by upper motor neuron(UMN)signs and the reflex scale,and the disease severity was evaluated by the AIJS function rating scale(ALS-FRS)and APPEL ALS rate scale(AARS).Results Compared with the healthy controls(1.62±0.18),the NAA/Cr of patients with ALS(1.40±0.25)remarkably decreased (t= -5.007,P=0.000),however,it did not change in patients with LMNS(1.60±0.17)as compared with that of the controls.The NAA/Cr of patients with ALS was also lower than that of patients with LMNS(t= -2.660,P=0.009).Furthermore,the NAA/Cr of patients with definite ALS was lower than those of patients with probable and possible ALS(definite vs probable:t=-2.626,P=0.010;definite vs possible: t=-2.537,P=0.013).On the other hand,patients with pronounced UMN signs had a lower NAA/Cr ratio than those with probable UMN signs(t=-2.827,P=0.006).In patients with asymmetric clinical presentation,the NAA/Cr ratio was significantly lower in the precentral gyrus contralateral to the clinically predominantly affected side(t=-2.652,P=0.011).The NAA/Cr was correlated with the reflex scale scores,ALS-FRS score,and AARS and its sub-items(P＜0.05). Conclusions 1H-MRS is useful in studying ALS.The marker NAA/Cr of precentral gyrus may reflect the UMN degeneration in ALS,which is related to the disease severity and progression.However,it might not be helpful in the early diagnosis and differential diagnosis of the disease.

Characteristics of proton magnetic resonance spectroscopy on precentral gyrus in 92 healthy Chinese adults / 中国康复理论与实践

@#ObjectiveTo explore the characteristics of the metabolite concentrations of the precentral gyrus in healthy Chinese adults using proton magnetic resonance spectroscopy (1H-MRS).Methods 1H-MRS was carried out in 92 healthy Chinese adult volunteers. The metabolite ratios of NAA/Cr, Cho/Cr and NAA/Cho were compared and analysed.ResultsNo significant changes of NAA/Cr, Cho/Cr and NAA/Cho ratios were observed between the left and right precentral gyrus, nor between the male and female. However, the precentral gyrus NAA/Cr and NAA/Cho ratios were decreased gradually with aging and Cho/Cr ratios were increased gradually with aging.ConclusionThe characteristics of the precentral gyrus metabolite concentrations in healthy Chinese adults have been obtained.