SIRT1 is transcriptionally repressed by YY1 and suppresses ferroptosis in rheumatoid arthritis

Abstract Background Sirtuin 1 (SIRT1) is reported downregulated in rheumatoid arthritis (RA), and the protective effects of SIRT1 on tissue damage and organ failure may be related to cellular ferroptosis. However, the exact mechanism by which SIRT1 regulates RA remains unclear. Methods Quantitative real-time PCR (qPCR) and western blot assays were performed to explore the expressions of SIRT1 and Yin Yang 1 (YY1). CCK-8 assay was used for cytoactive detection. The interaction between SIRT1 and YY1 was validated by dual-luciferase reporter gene assay and chromatin immunoprecipitation (ChIP). DCFH-DA assay and iron assay were applied to detect the reactive oxygen species (ROS) and iron ion levels. Results In the serum of RA patients, SIRT1 was downregulated, but YY1 was upregulated. In LPS-induced synoviocytes, SIRT1 could increase cell viability and decrease ROS and iron levels. Mechanistically, YY1 downregulated the expression of SIRT1 by inhibiting its transcription. YY1 overexpression partly revised the effects of SIRT1 on ferroptosis in synoviocytes. Conclusion SIRT1 is transcriptionally repressed by YY1 and inhibits the ferroptosis of synoviocytes induced by LPS, so as to relieve the pathological process of RA. Therefore, SIRT1 might be a new diagnosis and therapeutic target of RA. Highlights Combining SIRT1 with synoviocytes ferroptosis in rheumatoid arthritis for the first time. The transcription factor YY1 combined to the SIRT1 promoter in synovial cells and inhibited its expression and functional roles. The inhibition of SIRT1 with YY1 decreased the ferroptosis in synoviocytes.

Analysis of Chinese Medical Syndrome Features of Ischemic Stroke Based on Similarity of Symptoms Subgroup / 中国结合医学杂志

OBJECTIVE@#To derive the Chinese medicine (CM) syndrome classification and subgroup syndrome characteristics of ischemic stroke patients.@*METHODS@#By extracting the CM clinical electronic medical records (EMRs) of 7,170 hospitalized patients with ischemic stroke from 2016 to 2018 at Weifang Hospital of Traditional Chinese Medicine, Shandong Province, China, a patient similarity network (PSN) was constructed based on the symptomatic phenotype of the patients. Thereafter the efficient community detection method BGLL was used to identify subgroups of patients. Finally, subgroups with a large number of cases were selected to analyze the specific manifestations of clinical symptoms and CM syndromes in each subgroup.@*RESULTS@#Seven main subgroups of patients with specific symptom characteristics were identified, including M3, M2, M1, M5, M0, M29 and M4. M3 and M0 subgroups had prominent posterior circulatory symptoms, while M3 was associated with autonomic disorders, and M4 manifested as anxiety; M2 and M4 had motor and motor coordination disorders; M1 had sensory disorders; M5 had more obvious lung infections; M29 had a disorder of consciousness. The specificity of CM syndromes of each subgroup was as follows. M3, M2, M1, M0, M29 and M4 all had the same syndrome as wind phlegm pattern; M3 and M0 both showed hyperactivity of Gan (Liver) yang pattern; M2 and M29 had similar syndromes, which corresponded to intertwined phlegm and blood stasis pattern and phlegm-stasis obstructing meridians pattern, respectively. The manifestations of CM syndromes often appeared in a combination of 2 or more syndrome elements. The most common combination of these 7 subgroups was wind-phlegm. The 7 subgroups of CM syndrome elements were specifically manifested as pathogenic wind, pathogenic phlegm, and deficiency pathogens.@*CONCLUSIONS@#There were 7 main symptom similarity-based subgroups in ischemic stroke patients, and their specific characteristics were obvious. The main syndromes were wind phlegm pattern and hyperactivity of Gan yang pattern.

Analysis laboratory results of three cases of COVID-19 complicated with falciparum malaria / 中国热带医学

@#Abstract: Objective　To analyze the laboratory indexes of patients infected with malaria patients and COVID-19, so as to provide reliable evidence for the diagnosis of mixed infection of both. Methods　The routine clinical laboratory items such as routine blood, biochemistry and lymphocyte subsets were tested in three cases of COVID-19 complicated with falciparum malaria who admitted to Guangzhou Eighth People's Hospital Affiliated to Guangzhou Medical University from July to December 2020 were tested. Laboratory data were stage-wise analyzed in conjunction with changes in the course of disease. Results　Three patients confirmed COVID-19 infection recruited all had malaria infection history. Fever, headache, and other symptoms emerged on the 4rd to 11th day after admission. Malaria parasite was detected by malaria parasite antigen testing and blood smear testing, and all three patients had re-ignition of malaria after being confirmed COVID-19 infection. In the early stage of malaria relapse, lymphocytes decreased, CRP and SAA increased, and gradually returned to normal level after antimalarial treatment. Interestingly, we only found one patient at the initial stage of malaria detection showed PLT decreased, no other unnormal changes in other routine blood results (WBC, ESO) and liver function results (ALT, AST, GGT, TBIL, DBIL, CG) were found from the beginning to end course of the disease. Conclusion　COVID-19 infection may promote the resurgence of malaria, so the relapse of malaria should be monitored especially for the patient with malaria infection history who begin to develop fever and other symptoms a few days after the diagnosis of COVID-19. The inflammatory indicators would be worth able as an auxiliary judgment basis for the effective treatment of the two combined infection.

Expression Level and Significance of Tim-3 in CD4+ T Lymphocytes in Peripheral Blood of Patients with Coronary Heart Disease

Abstract Objective: To investigate the expression level and significance of T cell immunoglobulin and mucin-domain containing molecules-3 (Tim-3) and interleukin-7 (IL-7) in CD4+ T lymphocytes in peripheral blood of patients with coronary heart disease (CHD). Methods: 75 patients with CHD treated at our hospital were selected and classified as mild group (25 cases), moderate group (25 cases) and severe group (25 cases), according to the severity of illness. Twenty-five healthy volunteers who underwent a physical examination at our hospital during the same period were selected as the control group. The expression level of Tim-3 in CD4+ T lymphocytes in peripheral blood of patients in four groups was detected by flow cytometry and quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). The expression level of IL-7 in peripheral blood serum was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analyses of Tim-3 and IL-7, Tim-3 and disease severity and IL-7 and disease severity were performed, respectively. Results: Flow cytometry and qRT-PCR demonstrated that the expression of Tim-3 in CD4+ T lymphocytes in peripheral blood of patients with CHD increased with the aggravation of the disease. ELISA showed that the tendency of IL-7 expression in peripheral blood serum was consistent with the expression of Tim-3, and the expression of Tim-3 had a positive correlation with IL-7. The expression levels of both Tim-3 and IL-7 were positively correlated with the Gensini score. Conclusion: The expression of Tim-3 and IL-7 in peripheral blood of patients with CHD was upregulated and increased with the aggravation of CHD.

Application of extended trochanter osteotomy wire fixation combined with autologous bone graft in revision of total hip arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of using lengthened trochanteric osteotomy wire fixation combined with autologous bone graft in patients undergoing revision total hip arthroplasty.@*METHODS@#From December 2010 to December 2018, 18 patients underwent revision of total hip arthroplasty with extended trochanteric osteotomy wire fixation and autogenous bone graft, including 8 males and 10 females with an average age of (78.89±3.32) years old ranging from 68 to 82 years. The time from the initial replacement to the revision was 9 to 22 (16.33±2.93) years. The patients were followed up regularly after operation. The healing time of osteotomy, the time of full weight-bearing activity, Harris score of hip joint and complications were recorded.@*RESULTS@#All 18 patients were followed up for 16 to 38 months with an average of (25.78±6.65) months. The incision length was 16 to 21 cm with an average of (18.89±1.32) cm; the operation time was 105 to 128 min with an average of (115.44±6.59) min, the bleeding volume was 240 to 285 ml with an average of (267.44±13.77) ml. The healing time of osteotomy was 12 to 18 weeks with an average of (15.61±1.75) weeks. Harris score of hip joint was (47.11±5.04) before operation, (76.39±3.85) during full weight-bearing activities, and (82.22±2.76) at the final follow-up(P<0.05). During the follow-up period, there were no complications such as limb shortening, infection, poor incision healing, prosthesis loosening and sinking, and periprosthetic fracture.@*CONCLUSION@#In revision total hip arthroplasty, the use of extended trochanteric osteotomy wire fixation combined with autologous bone graft can achieve satisfactory clinical results, but the surgeon needs to make a systematic plan for the pre-revision, intraoperative and postoperative recovery.

Effect of double plate technique combined with autogenous iliac bone graft in the treatment of femoral nonunion after intramedullary nailing / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing.@*METHODS@#From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation.@*RESULTS@#All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening).@*CONCLUSION@#It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.

Effect of intranasal acupuncture on the pathology of nasal mucosa in rabbits with allergic rhinitis and related regulatory mechanism of transient receptor potential vanillic acid receptor 1-substance P axis / 解剖学报

Objective To investigate the pathological changes of nasal mucosa by intranasal acupuncture, and to explore the possible signal transduction mechanism through the distribution and expression of transient receptor potential vanillic acid receptor 1 (TRPV1)-substance P (SP) axis in nasal mucosa of experimental allergic rhinitis. Methods An animal model of allergic rhinitis was constructed by ovalbumin and aluminium hydroxide gel treatment. Twenty five New Zealand rabbits were randomly divided into normal group, model group, sham acupuncture group, acupuncture Wai Ying Xiang group and intranasal acupuncture group, with 5 rabbits in each group. To observe the effect of intranasal acupuncture on animal behavior, nasal mucosa pathology, eosinophils (EOS) count and IgE content in arterial blood. In addition, HE staining was used to determine the distribution of EOS in nasal mucosa and immunohistochemistry was used to observe the distribution and expression of TRPV1 and SP in nasal mucosa membrane. Results Compared with the model group, the behavioral score of the sham acupuncture group did not decrease significantly, while the behavioral score of the Wai Ying Xiang acupuncture group and the intranasal acupuncture group showed a downward trend, and the decrease degree of the intranasal acupuncture group was more significant. Compared with the normal group, the eosinophil count in the model group increased slightly (P0.05). HE staining found that eosinophilic distribution increased significantly in the model group and the sham acupuncture group compared with the normal group, and the difference was statistically significant (P<0.05). Compared with the model group, the distribution of eosinophil reduced in the nasal acupuncture group and the Wai Ying Xiang group. The difference was statistically significant (P<0.05 ). Immunohistochemical found that TRPV1 and SP expressed significantly in the nasal mucosa of the model group and the sham acupuncture group compared with the normal group, the difference was statistically significant (P<0.05). Compared with the model group, TRPV1 and SP expression decreased significantly in the intranasal acupuncture group and the external yingxiang group, the difference was statistically significant (P<0.05). Conclusion Intranasal acupuncture can alleviate the nasal symptoms of allergic rhinitis model by reducing the Chemotaxis of eosinophils in nasal mucosa and the content of IgE in serum.

Expert Consensus on Otorhinolaryngology Head and Neck Diseases Responding Specifically to Traditional Chinese Medicine / 中国实验方剂学杂志

Traditional Chinese medicine （TCM） and western medicine have their respective advantages and limitations in the diagnosis and treatment of common otorhinolaryngology head and neck diseases. Although the integrated TCM and western medicine exhibits definite curative effects， there is no consensus on the otorhinolaryngology head and neck diseases responding specifically to TCM or integrated TCM and western medicine， as well as the diagnosis and treatment schemes. The China Association of Chinese Medicine （CACM） thus organized the otorhinolaryngology head and neck specialists of both TCM and western medicine to discuss the etiology， pathogenesis， and clinical diagnosis and treatment methods of common otorhinolaryngology head and neck diseases with the results of multiple clinical trials taken into account. The acute pharyngitis， chronic pharyngolaryngitis， paraesthesia pharyngis， hysterical aphasia， allergic rhinitis， subjective tinnitus， and otogenic vertigo were confirmed to respond specifically to TCM or integrated TCM and western medicine. Then a mutually agreed diagnosis and treatment scheme and recommendation with integrated TCM and western medicine was formulated as a reference for clinical practice， thus benefiting more patients.

Research progress on ion channels and receptors in nodose ganglion neurons involved in blood pressure regulation / 药学学报

Hypertension is the most common cardiovascular disease. In recent years, reduced baroreceptor activity has been suggested as a main cause of hypertension. The cell body of the primary afferent nerve of the baroreceptor is located in the nodose ganglion (NG). The ion channels and receptors in the NG can affect baroreceptor sensitivity and neuronal excitability, thus regulating blood pressure. This review focuses on recent research progress on ion channels, receptors and other proteins in NG neurons that are involved in modulating the sensitivity of the baroreceptor reflex to regulate blood pressure.

Double plating through different approaches for periprosthetic femoral fracture following total knee arthroplasty / 中国骨伤

OBJECTIVE@#To study clinical effects of double plating through different approaches for communicated and obvious osteoporosis periprosthetic femoral fracture following total knee arthroplasty(TKA).@*METHODS@#From July 2010 to June 2017, 21 patients with periprosthetic femoral fracture following TKA were divided into two groups according to operative approach. Fifteen patients in medial and lateral double approaches group, including 5 males and 10 females aged from 63 to 79 years old with an average of (67.2±5.9) years old; 11 patients were type 33-A2 and 4 patients were type 33-A3 according to AO-OTA classification; 12 patients injured by falling down and 3 patients by traffic accident; treated with double plating. Six patients in medial parapatellar approach group, including 3 males and 3 females, aged from 61 to 74 years old with an average of (64.6±6.0) years old; 3 patients were type 33-A2 and 3 patients were type 33-A3 according to AO-OTA classification; 5 patients injured by falling down and 1 patient by traffic accident; treated with double plating. Operative time, blood loss, postoperative drainage, fracture healing time were compared between two groups; HSS score and radiology at 3 and 12 months were compared between two groups.@*RESULTS@#All patients were followed up, and the follow-up time of bilateral approaches group ranged from 12 to 18 months with an average of (14.2±2.6 ) months, while the follow-up time of single approach group ranged from 12 to 16 months with an average of (12.6±2.5) months, and there was no statistical difference between two groups. The operative time and postoperative drainage in bilateral approaches group were (107.2±10.4) min and (213.9±30.4) ml, while in sigle approach group was (95.4±12.8) min and (256.8±34.2) ml, and the differences were significant(0.05). HHS score at 3 and 12 months after operation in bilateral approach were 82.9±5.7 and 84.8±7.1, while in single approach group were 83.6±6.1 and 86.3±6.8; there was no statistical difference in HSS score between two groups(>0.05). According to HSS score at 12 months after operation, 2 cases got excellent results and 13 good in bilateral approaches group; 1 case got excellent result and 4 good and 1 moderate in single approach group; but there was no statistical difference between two groups (χ²=2.625, =0.105). There wase no significant differences in complications between bilateral approaches group(2 cases) and single approach group (1 case)(>0.05).@*CONCLUSIONS@#Double plating technique for communicated and obvious osteoporosis periprosthetic femoral fracture following TKA could obtain good function of knee joint. The medial parapatellar approach has shorter operative time, while the bilateral approaches had less drainage.

Modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with fracture / 中国骨伤

OBJECTIVE@#To study clinical effects of modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with proximal humeral fracture which area of femoral head injury less than 40%.@*METHODS@#From July 2012 to June 2017, 7 patients with posterior shoulder dislocation were treated, including 5 males and 2 females; aged from 37 to 53 years old. Three patients combined with split of humerus head and 4 patients combined with humerus surgical neck fracture. All patients treated with modified Mclaughlin procedure combined with locking plate. Motion of shoulder joint after operation was observed, postoperative UCLA score was used to evaluate clinical effects.@*RESULTS@#Seven patients were followed up from 10 to 33 months. The motion of anteflexion and up-lift ranged from 130° to 170°, the motion of extorsion ranged from 45° to 75°, the motion of abduction ranged fron 105° to 150°, and the internal rotation was between L₃ to buttock. UCLA score ranged from 29 to 34; and 1 patient reached excellent, and 6 patients good.@*CONCLUSIONS@#The modified Mclaughlin procedure combined with locking plate showed satisfying result for posterior shoulder dislocation combined with fractures. However, the internal rotation of shoulder could be compromised.

A preliminary study on prediction efficacy of multimodal MRI-based radiomics in combination with random forest model for preoperative glioma IDH1 gene type expression / 中华放射学杂志

Objective@#To preliminarily analyze the prediction efficiency of multimodal MRI-based radiomics model for preoperative glioma IDH1 gene expression type.@*Methods@#The MRI data of 108 surgery-proven glioma patients from May 2015 to January 2019 were retrospectively analyzed, and the MRI data included axial T1WI,T2WI,fluid attenuated inversion recovery (FLAIR),DWI imaging and enhanced T1WI sequence.Forty-seven cases were IDH1 mutant type, and 61 cases were IDH1 wild type. All patients were divided into training and validation groups according to the 7∶3 ratio of the random forest model. Seventy-three cases were in training group, and 35 cases were in validation group. Independent predictors of IDH1 mutation were screened by univariate analysis combined with multivariate logistic regression analysis (P<0.05) in order to construct a random forest diagnosis model of general clinical information and conventional MRI morphological features.General clinical information and conventional MRI morphological features included gender, age, umbers of cases of left and right hemispheres, location of tumors, maximum diameter of tumors, peritumoral edema, intratumoral cystic degeneration, enhancement and ADC value of tumors. The ROI was manually outlined by MaZda software in the most obvious level of 5 sequences of tumor mass and the radiomics features were extracted, including the gray-level co-occurrence matrix(GLCM), the run-length matrix(RUN), the absolute gradient(GRA),the auto-regressive model(ARM) and wavelets transform(WAV). The least absolute shrinkage and selection operator (LASSO)regression were used to select image radiomics features with a method of 10 fold cross -validation and to reduce the dimensions. The screened image radiomics labels were combined with the conventional morphological feature independent predictors to construct a multimodal MRI-based random forest model, and the validation data set was used to evaluate the accuracy and diagnostic efficiency of each model. The sensitivity and specificity of conventional MRI morphological feature model and multimodal MRI-based radiomics prediction model were evaluated dynamically by drawing ROC curves, and the prediction efficiency of the two models was quantified by using AUC statistical indicators. The model classification error rate under different outcomes and the classification error rate of out of bag(OOB)were used to evaluate the stability of the multimodal MRI-based random forest model. The contribution rate of each variable to the model was reflected by the characteristic variables importance assessment map.@*Results@#Univariate regression analysis of the conventional MRI morphological characteristics showed that peritumoral edema, cystic degeneration and enhancement were the three independent predictors of IDH1 gene expression (P<0.01). LASSO algorithm and 10-fold cross-validation identified six robust radiomic features including high frequency coefficients of wavelet transform (WavEnHH_s-4) of T2WI, S(4,4) inverse difference of gray uniformity measurement (InvDfMom),S(5,0) Entropy (entropy),WavEnHH_s-4 of T1WI enhancement, S(1,1) InvDfMom,S(1, -1) Entropy Difference (DifEntrp)of Flair.The error rate of classification for different outcomes and classification error rate of random forest OOB data of multimodal MRI radiomics diagnosis model finally stabilized at 10%. The results of Characteristic Variable Importance Assessment Map: Mean Decrease Accuracy and Mean Decrease Gini index were consistent, which showed that besides three conventional MRI morphological predictors peritumoral edema, enhancement and cystic degeneration, the radiomics labels also played a key role in the model. The results of ROC curve showed that the accuracy, specificity, sensitivity and AUC of conventional MRI morphological feature model were 82.7%, 68.4%, 90.9% and 0.835, respectively, and those of multimodal MRI-based radiomics model were 88.5%, 89.5%, 87.8% and 0.956 respectively.@*Conclusion@#Multimodal MRI-based radiomics random forest model can improve the predictive efficiency of preoperative glioma IDH1 gene expression type more quantitatively.

A preliminary study on prediction efficacy of multimodal MRI?based radiomics in combination with random forest model for preoperative glioma IDH1 gene type expression / 中华放射学杂志

Objective To preliminarily analyze the prediction efficiency of multimodal MRI?based radiomics model for preoperative glioma IDH1 gene expression type. Methods The MRI data of 108 surgery?proven glioma patients from May 2015 to January 2019 were retrospectively analyzed, and the MRI data included axial T1WI,T2WI,fluid attenuated inversion recovery (FLAIR),DWI imaging and enhanced T1WI sequence.Forty-seven cases were IDH1 mutant type, and 61 cases were IDH1 wild type. All patients were divided into training and validation groups according to the 7∶3 ratio of the random forest model. Seventy-three cases were in training group, and 35 cases were in validation group. Independent predictors of IDH1 mutation were screened by univariate analysis combined with multivariate logistic regression analysis (P<0.05) in order to construct a random forest diagnosis model of general clinical information and conventional MRI morphological features.General clinical information and conventional MRI morphological features included gender, age, umbers of cases of left and right hemispheres, location of tumors, maximum diameter of tumors, peritumoral edema, intratumoral cystic degeneration, enhancement and ADC value of tumors. The ROI was manually outlined by MaZda software in the most obvious level of 5 sequences of tumor mass and the radiomics features were extracted, including the gray?level co?occurrence matrix(GLCM), the run?length matrix(RUN), the absolute gradient(GRA),the auto?regressive model(ARM) and wavelets transform (WAV). The least absolute shrinkage and selection operator (LASSO)regression were used to select image radiomics features with a method of 10 fold cross?validation and to reduce the dimensions. The screened image radiomics labels were combined with the conventional morphological feature independent predictors to construct a multimodal MRI?based random forest model, and the validation data set was used to evaluate the accuracy and diagnostic efficiency of each model. The sensitivity and specificity of conventional MRI morphological feature model and multimodal MRI?based radiomics prediction model were evaluated dynamically by drawing ROC curves, and the prediction efficiency of the two models was quantified by using AUC statistical indicators. The model classification error rate under different outcomes and the classification error rate of out of bag(OOB)were used to evaluate the stability of the multimodal MRI?based random forest model. The contribution rate of each variable to the model was reflected by the characteristic variables importance assessment map. Results Univariate regression analysis of the conventional MRI morphological characteristics showed that peritumoral edema, cystic degeneration and enhancement were the three independent predictors of IDH1 gene expression (P<0.01). LASSO algorithm and 10?fold cross?validation identified six robust radiomic features including high frequency coefficients of wavelet transform (WavEnHH_s?4) of T2WI, S(4, 4) inverse difference of gray uniformity measurement (InvDfMom), S(5, 0) Entropy (entropy), WavEnHH_s?4 of T1WI enhancement, S(1, 1) InvDfMom, S(1, -1) Entropy Difference (DifEntrp)of Flair.The error rate of classification for different outcomes and classification error rate of random forest OOB data of multimodal MRI radiomics diagnosis model finally stabilized at 10%. The results of Characteristic Variable Importance Assessment Map: Mean Decrease Accuracy and Mean Decrease Gini index were consistent, which showed that besides three conventional MRI morphological predictors peritumoral edema, enhancement and cystic degeneration, the radiomics labels also played a key role in the model. The results of ROC curve showed that the accuracy, specificity,sensitivity and AUC of conventional MRI morphological feature model were 82.7%, 68.4%, 90.9% and 0.835, respectively, and those of multimodal MRI?based radiomics model were 88.5%, 89.5%, 87.8% and 0.956 respectively. Conclusion Multimodal MRI?based radiomics random forest model can improve the predictive efficiency of preoperative glioma IDH1 gene expression type more quantitatively.

Changes of endogenous nociceptin/orphanin FQ (N/OFQ) and C-reactive protein in elderly patients with atrial fibrillation before joint replacement / 天津医药

@#Objective To investigate the serum changes of endogenous nociceptin / orphanin FQ (N / OFQ) and C reactive protein (CRP) before total knee arthroplasty in elderly patients with atrial fibrillation, and to explore its significance. Methods The patients with paroxysmal atrial fibrillation were divided into PAAFⅠ subgroup (≤75 years old, n=32) and PAAFⅡ subgroup (＞75 years old, n=31). At the same time, the patients with persistent atrial fibrillation were divided into PEAFⅠ subgroup (≤75 years old, n=27) and PEAFⅡ subgroup (＞75 years old, n=32). Forty-seven patients with non-AF sinus rhythm were used as control group. The levels of N/OFQ and CRP, left atrial dimension (LAD), ejection fraction of left ventricle (LVEF), fasting triglyceride (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein cholesterol (HDLC) were measured, and the above-mentioned indicators were analyzed. Results The LAD value was higher in PAAF group and PEAF group than that in control group. The LAD value was higher in PEAF group than that in PAAF group, and the LVEF and TG values were lower in PAAF group and PEAF group than those in control group. The values of LVEF, TG, HDL-C and LDL-C were lower in PEAF group than those of PAAF group. The values of HDL-C and LDL-C were higher in PAAF group than those of control group, and the values of HDL-C and LDL-C were lower in PEAF group than those of control group. The levels of N/OFQ and CRP were higher in PAAF group and PEAF group than those in control group, and the levels of N/OFQ and CRP were significantly higher in PEAF group than those in PAAF group (P＜0.05). The level of N/ OFQ was higher in PAAFII subgroup than that in PAAFI subgroup, and the level of N/OFQ was significant higher in PEAF Ⅱ subgroup than that in PEAFⅠ subgroup (P＜0.05). There was no significant difference in CRP level between groups (P > 0.05). Multiple Logistic regression showed that N/OFQ elevation (OR=2.911,95％CI:1.291-6.564) and CRP elevation (OR= 4.636, 95％CI:1.042-20.616) and LAD enlargement (OR=1.369,95％CI:1.000-1.875) were the risk factors of AF. LVEF elevation (OR=0.489,95％CI:0.302-0.792) was the protective factor of AF. The levels of N/OFQ and CRP were positively correlated with LAD and negatively correlated with TG, LDL-C and HDL-C in patients with atrial fibrillation. N/OFQ and CRP levels were positively correlated. The age of AF patients was positively correlated with N/OFQ level, but not with CRP level. LVEF was negatively correlated with N/OFQ level in patients with atrial fibrillation, but no correlation with CRP level. The result of ROC curve analysis showed that the area under the curve of N/OFQ for predicting atrial fibrillation was 0.949 (95％CI：0.917-0.982, P＜0.01), the area under the curve of CRP for predicting atrial fibrillation was 0.855 (95％CI: 0.775- 0.935, P＜0.01), the area under the curve of joint forecasting factor for predicting atrial fibrillation was 0.960 (95％CI: 0.933- 0.987, P＜0.01). Conclusion N/OFQ and CRP are closely related to the occurrence of atrial fibrillation in the elderly, and N/ OFQ is more advantageous in assessing cardiac function before total knee replacement in elderly patients with atrial fibrillation.

CT observation of retromaxillary posterior ethmoid / 临床耳鼻咽喉头颈外科杂志

To investigate the morphologic characteristics of the retromaxillary posterior ethmoid.A total of 103 outpatients encountered in our hospital during March 2012 and December 2012,who completed paranasal sinus CT examination,were included in this study.Patients had no sinus trauma,surgery or tumor history.Their paranasal sinus CT scans were analyzed from scheduled axial and coronal plane.The incidence and imaging features of the retromaxillary posterior ethmoid were observed.The retromaxillary posterior ethmoid(RMPE)was the posterior ethmoid cell that expanded along the lamina papyracea toward the infraorbital region.RMPE was located behind the posterior wall of the maxillary sinus and under the orbital floor.The occurrence rate of the RMPE was 74.3%.The ethmomaxillary septum is the bony septum the between the maxillary sinus and posterior ethmoid.Anatomical confirmation of RMPE is based mainly on the presence of the ethmomaxillary septum.RMPE is located at the back of ethmomaxillary septum.The sagittal angulation of the ethmomaxillary septum ranged from 22 to 87 degrees,with an average of(50.34±12.10)degrees.The ethmomaxillary septum is important for anatomic recognition of the RMPE.Accurate identification of the RMPE before ESS can help improve the removal of the posterior ethmoid sinus.

Conventional MRI texture analysis of peritumoral edema in the differential diagnosis of glioblastoma and solitary metastatic brain tumor / 中华放射学杂志

Objective To investigate the value of conventional MR texture analysis of peritumoral edema in differentiating between glioblastoma and solitary metastatic brain tumor. Methods Forty patients with brain glioma and forty patients with brain metastases confirmed by pathology or clinic were enrolled . All patients underwent conventional MRI scan and enhanced examination, including axial T1WI, T2WI, fluid attenuated inversion recovery(FLAIR) and enhanced T1WI. The ROI was manually outlined by MaZda software in the most obvious level of 4 sequences of peritumoral edema and the texture features were extracted, including mean, variance, skewness, kurtosis, 1 percentile, 10 percentile, 50 percentile, 90 percentile, 99 percentile. Independent sample t-test (in case of normality and variance homogeneity test) or rank sum test (in case of not satisfying normality and homogeneity of variance) was used to compare the differences of the histogram parameters and to make meaningful parameters based on logistic regression modeling and drawing the receiver operating characteristic curve (ROC curve) to evaluate the differential diagnosis efficacy. Results Through the preliminary feature screening, skew of FLAIR (SkewFLAIR) for glioblastomas was -0.358±0.432, respectively,while for solitary metastatic brain tumor, the statistics was-0.648 ± 0.503. The results showed statistically significant difference(t=7.574,P=0.006). The differencesbetween the kurtosis (KurtFLAIR) were also proven to be statistically significant (Z=4.360 ,P=0.037),with-0.384 (-0.798, 0.049) for glioblastomas and-0.089 (-0.456, 0.613) for solitary metastasis brain tumor. The sensitivity of the corresponding logistic regression differential diagnosis model was 77.5％, specificity was 94.3％, and area under the curve (AUC) was 0.85. Conclusion Conventional MRI texture analysis of peritumoral edema provides reliable and quantified objective basis for the differential diagnosis of glioblastoma and solitary metastasis.

Diagnostic value of CT texture analysis in the quantification of radiological phenotype for pancreatic cystadenoma / 中华胰腺病杂志

Objective To provide objective parameters for differentiating pancreatic cystic tumors via using computed tomography texture analysis (CTTA) to quantify the special imaging features of pancreatic cystadenomas.Methods Enhanced CT images of pancreas from patients who were admitted in Department of Radiology in First Hospital affiliated with Zhejiang University and First People's Hospital of Hangzhou City and pathologically diagnosed as pancreatic serous cystadenomas (n =48) and mucinous cystadenomas (n =34) from January 2009 to December 2016 were retrospectively analyzed.Regions of interest were drawn on the parenchymal phase CT images in 5 slices according to the border of the tumors.Mean grey level intensity (M),variance (V),entropy (E),skewness (Ske) and kurtosis (Kur) were obtained from fine texture (σ =1.0) to coarse texture (σ =2.5).Receiver operating characteristic (ROC) curve for texture parameters with statistically difference was drawn,and the area under curve (AUC),diagnostic sensitivity and specificity were calculated.The diagnostic accuracy of senior and junior doctors was compared with the traditional CT analysis method.Results Reliability coefficient of the two radiologists was 0.809 ～ 0.997 with high consistency.Compared with mucinous cystic tumors,serous cystadenomas had a significantly different V (5.93 ± 9.02 vs 1.29±0.62),E (2.39±0.61 vs2.02±0.39) and Kur(30.18 ±42.55 vs 8.80-±4.34) in Ske0 of 2.5 (P ＜0.05),and there were no statistically significant differences on other parameters.The AUC of differential parameters for diagnosing two kinds of cystic tumors ranged from 0.56 to 0.84.The diagnostic accuracy of the traditional CT analysis method by junior doctor and senior radiologist was 60％ and 71％,respectively.Conclusions CTTA can not only effectively quantify the heterogeneity of pancreatic cystadenomas,but also is effective in the differentiation.

The teaching model of flipped classroom by means of virtual reality technology / 中华医学教育探索杂志

It is difficult to implement the multidimensional teaching targets through the flipped classroom, which is mainly based on the technique of video. In view of the fact that flipped classroom and virtual reality teaching have the same theoretical basis, and both of them embody the thought of construc-tivism learning theory, the flipped classroom teaching model can be extended with the help of virtual reality technology. Before class, both of "virtual reality" and "watch the teaching video" can be used as a tool for flipping, in class, in the course of "creating the environment", the students should use the virtual reality technology according to the teaching content, and after class as the means to consolidate the practice. Thus, it can fully motivate students' learning motivation, improve their ability of problem solving and help them accumulate experience or wisdom. The most important thing is that teachers can give students some guid-ance and feedback about personality and value.

MR texture analysis in differential diagnosis of glioblastoma and solitary metastatic brain tumor / 中国医学影像技术

Objective To explore the value of MR texture analysis in differential diagnosis of glioblastoma and solitary metastasis.Methods Thirty-five patients with brain glioblastomas and forty patients with brain metastases confirmed by pathology or clinic were enrolled.All patients underwent conventional MR scan and enhanced examination,including T1 FLAIR,T2WI,T2 FLAIR,DWI,and enhanced T1WI.Texture features of the lesions were extracted with MaZda software by manually drawing ROI on the maximum level of tumor delineation in DWI and enhanced T1WI.Results There were statistical differences between glioblastoma and solitary metastasis of enhanced T1WI skewness in the histogram class texture parameters,gray co-occurrence matrix parameters including enhanced T1WI image correlation,mean and DWI correlation.Logistic regression analysis showed the area under ROC curve of the model was 0.834.Conclusion Texture analysis can provide reliable and quantified objective basis for differential diagnosis of glioblastoma and solitary metastatic brain tumor.

Combined application of low kV,low mAs, and iterative model reconstruction (IMR) in carotid CT angiography / 中华放射医学与防护杂志

Objective To evaluate the application value of combination of low kV,low mAs,and iterative model reconstruction (IMR) in carotid CT angiography.Methods Forty patients (BMI 20-25 kg/m2) were enrolled and randomly divided into routine dose group(20) and low dose group(20),The parameters in routine dose group were 120 kV,automatic mAs,and filter back projection(FBP);and that in low dose group were 80 kV,automatic mAs but upper limit 150 mAs,and FBP or IMR.All patients received the injection of 32 ml of iopamidol(370 mg I/100 ml) at a flow rate of 4 ml/s,followed by 50 ml normal saline at the same rate.The CT value and image noise(SD)of the aortic arch,left carotid artery bifurcation,and right carotid artery of rock bone were measured with region of interest(ROI) method,and then signal to noise ratios (SNR) and contrast to noise ratio (CNR)of image were calculated.The image quality was evaluated by two radiologists using a subjective four points scale on multiplanar reformated (MPR),maximum density projected (MIP) and volume rendered (VR) images.Volume CT dose index (CTDIvol),dose length product (DLP),and the effective dose (E) of each patient were recorded.Results CT values of carotid artery[(479.87 ± 70.28),(514.78 ± 82.69),(436.50 ± 89.87) HU] in low dose group were significantly higher than those in routine dose group [(295.63 ± 34.75),(325.09 ± 37.81),(286.93±36.46)HU](t =-6.47,-5.76,-3.66,P＜0.05).The SNR and CNR of IMR reconstructed image in low dose group were significantly higher than those of FBP reconstructed image in routine dose group (t =-7.54,-3.55,-5.31,-7.13,-5.28,-8.35,P＜0.05).The image quality of FBP reconstructed images in routine dose group and IMR reconstructed images in low dose group were all enough for diagnosis.The image quality of FBP reconstructed images in low dose group was significantly poorer than that in routine dose group and IMR reconstructed images in low dose group (Z =-2.87,-3.69,P ＜0.05).The effective dose in low dose group (0.57 ±0.13) mSv was 73％ less than that in routine dose group (2.22 ± 0.36) mSv.Conclusions Using low kV,low mAs,and IMR would help to obtain good carotid CT angiographic images and low radiation dose.