Immune checkpoint inhibitor-induced eosinophilic fasciitis: a case report and literature review / 中华内科杂志

A 58-year-old male patient with angioimmunoblastic T-cell lymphoma developed a rash and skin tightness on the face, limbs, and trunk together with joint stiffness and dysfunction after 6 months of treatment with the programmed cell death protein-1 inhibitor camrelizumab. Laboratory tests revealed progressive eosinophilia over 6 months, with the eosinophil count increasing from 0.07×10 9/L to 3.3×10 9/L. Magnetic resonance imaging showed thickened skin of both forearms, while T 2-weighted imaging showed markedly increased signal intensity within the myofascia. Skin biopsy of the right forearm showed thickened and fibrosed fascia and infiltration of inflammatory cells, including lymphocytes, plasma cells, and eosinophils. The patient was diagnosed with immune checkpoint inhibitor (ICI)-induced eosinophilic fasciitis (EF). After beginning treatment with methylprednisolone (40 mg daily), methotrexate (10 mg/week), and baricitinib (4 mg daily), his symptoms of skin tightness and joint dysfunction significantly improved within 1 month, and his peripheral blood eosinophil count decreased to 0.17×10 9/L. ICI-induced EF is a rare immune-related adverse reaction. To date, only 20 cases have been reported in published foreign literature, and their clinical characteristics are summarized here. The time from ICI treatment to EF was 12 (8,15) months, and the main clinical manifestations included skin involvement ( n=19), joint dysfunction ( n=11), myalgia/muscle weakness ( n=9), and peripheral eosinophilia ( n=16). After treatment, the clinical symptoms of EF improved in 17 patients, and eosinophil counts returned to normal after 3 (1,8) months. EF is a dysfunctional adverse response to ICI therapy. Tumor patients undergoing immunotherapy should be monitored for symptoms of EF. Early treatment is essential for preventing complications.

Correlation analysis of bone mineral density, hemoglobin and serum albumin in healthy population / 中华健康管理学杂志

Objective:To use quantitative computed tomography (QCT) technology to measure the bone mineral density of the spine of the Chinese healthy population, and to explore its correlation with hemoglobin and serum albumin.Methods:The data in this study came from the China Health Quantitative CT Big Data Project (China Biobank). The spine bone density was measured by using QCT Pro Image Analysis System and all cooperating centers used the European spine phantom (NO.145) for quality control. Total of 50 053 healthy persons who met the criteria for entry were selected as the research subjects. The subjects were divided into 7 groups according to age. The general data, spine bone density, serum albumin, hemoglobin of the subjects were collected. The single-factor analysis of variance, Pearson correlation analysis and multi-classification logistic regression model were applied to analyze the correlation between bone density and hemoglobin and serum albumin.Results:The bone mineral density of healthy people decreased with age ( P<0.05), and there were significant differences in hemoglobin, serum albumin and body mass index (BMI) among different age groups (all P<0.05). Linear correlation analysis showed that there were positive correlation between bone mineral density and hemoglobin in healthy males in different age groups ( r=0.086, 0.101, 0.076, 0.090, 0.072, 0.123, 0.100, all P<0.01). There were negative correlation between bone mineral density and hemoglobin in certain age groups in women (40-49 years group: r=-0.027; 70-79 yearsgroup: r=-0.077; both P<0.05). And corelation were found between bone mineral density and serum levels of albumin in certain age groups of healthy subjects (among men, 30-39 years group: r=-0.048; 40-49 years group, r=-0.027; 70-79 years group, r=-0.051; among women, 30-39 years group: r=-0.044; 40-49 years group, r=-0.042; 50-59 years group, r=-0.086; 70-79 years group, r=-0.070; all P<0.05). After adjusting for age and BMI, the multi-category logistic regression analysis showed that the hemoglobin level was protective factor of normal bone density ( OR=1.022, 95% CI:1.017-1.027) and decreased bone density ( OR=1.012, 95% CI:1.007-1.016) in healthy males, and the serum albumin was risk factor for normal bone density ( OR=0.926, 95% CI:0.905-0.948) and decreased bone density ( OR=1.006, 95% CI:0.951-1.011) in healthy women. Conclusion:There is a correlation between bone mineral density and hemoglobin and serum albumin in Chinese healthy population. Hemoglobin is a protective factor for bone mineral density in men, and serum albumin is a risk factor for bone mineral densityin women.

Reference value of lumbar spine bone mineral density and regional differences based on quantitative CT examination in healthy adult female in China / 中华健康管理学杂志

Objective:To establish the normal reference value of lumbar bone mineral density (BMD) under quantitative CT (QCT) in Chinese healthy adult females and to explore the regional differences.Methods:Total of 35 431 healthy women who met the inclusion criteria of Chinese health quantitative CT big data program were selected in this study. The BMD of the central plane of L 1 and L 2 vertebrae was measured by Mindways′s QCT system, and the mean value was taken. One-way analysis of variance was used to compare the BMD differences of lumbar vertebrae in women of different ages and regions. The subjects were grouped by an age interval of 10 years, and the level of BMD in different regions of the same age group were compaired. Results:The peak BMD of Chinese healthy adult women appeared in the age group of 20-29 years (Northeast China(183.01±24.58) mg/cm 3, North China (188.93±24.80) mg/cm 3, East China (187.54±27.71) mg/cm 3, South China (186.22±33.72) mg/cm 3, Central China (176.33±24.91) mg/cm 3, Southwest China(182.25±28.00) mg/cm 3), and then it decreased with age. The level of BMD in different regions decreased with the age. Before the age of 70 years, BMD in Central and Southwest China was always at a low level((176.23±24.91) to (90.38±28.12) mg/cm 3, 182.25±28.00 to (88.55±25.68) mg/cm 3), lower than those in Northeast China ((183.01±24.58) to (99.69±27.85) mg/cm 3), North China ((188.93±24.80) to (95.89±26.12) mg/cm 3), East China ((187.54±27.71) to (95.65±27.86) mg/cm 3). After 70 years of age, BMD tended to be the same in different regions ( P>0.05). The BMD values in Central China and Southwest China were similar in the age group of 40-60 years ( P>0.05). The BMD values in the health adult femles in the age group of 60 years in different regions of Chinawere all lower than those of bone mass abnormality (all P<0.05). The detection rate of osteoporosis in females over 50 years was the highest in Southwest China (25.65%) and it was the lowest in North China (17.30%). Conclusions:This study establishes reference values of BMD under QCT in healthy Chinese women, which can be used as a reference basis for identifying women with low BMD who are at risk of osteoporosis. The BMD value is the lowest in Southwest China and the highest in South China.

Normal reference and regional variation of spinal bone mineral density under the quantitative CT in Chinese male population / 中华健康管理学杂志

Objective:To investigate the normal reference values of spinal bone mineral density measured by quantitative computed tomography (QCT) and the differences of bone mineral density (BMD) in different regions of in Chinese adult males.Methods:Men who underwent low-dose CT lung scan for cancer screening in regions of Northeast, North, East, South, Central and Southwest of China from January 2018 to December 2019 were selected. And the lumbar vertebrae BMD values in the male subjects were measured by the QCT system (Mindways Software, Inc.). The mean BMD values and their decline rates were calculated at an age interval of 10 years, and the prevalence of osteoporosis was calculated according to the American College of Radiology spine QCT osteoporosis diagnostic criteria.Results:A total of 50 682 males with a mean age of (50.22±12.79) years (ranged 20 to 98 years) were included in this study. The peak BMD of (173.11±28.56) mg/cm 3 in the healthy Chinese adult male population appeared in the age group of 20 to 29 years and then declined with age. Before the age of 70 years, the BMD was relatively higher in males in South China, and it was lower in Central China and Southwest China, and it was intermediate in Northeast, North and East of China, with statistically significant differences. There was no significant differences in BMD in the males in the two age groups of 70 to 79 years and 80 and older among the regions in China. The overall decline rate of spinal BMD in Chinese males under QCT was about 46.92% over the lifetime, and it declined obviouslyin the 40-49 age group. The overall prevalence of osteoporosis in Chinese male population aged 50 years and above was approximately 11.42%, with the highest prevalence in Southwest China and Central China (14.72% and 13.87%, respectively) and the lowest in North China and South China (8.53% and 7.71%, respectively). Conclusions:A reference of lumbar spine BMD values for healthy males in China based on QCT is established. BMD values were highest in South China and Lowest in Central China.

Baseline characteristics of the Chinese health quantitative CT big data program in 2018—2019 / 中华健康管理学杂志

Objective:To describe the baseline characteristics of the subjects enrolled in the China Quantitative CT (QCT) big data program in 2018—2019.Methods:Based on baseline data from the Chinese health big data project from January 2018 to December 2019 from the eligible enrolled population, measurements of bone mineral density (BMD) and visceral adipose tissue (VAT) were performed using Mindways′ QCT Pro Model 4 system. The baseline data of age, gender, regional distribution, height, weight, abdominal circumference, blood pressure, blood routine and blood biochemical tests were analyzed. And the single factor analysis of variance (ANOVA) was used to check the age related trend of BMD and VAT in both genders.Results:After screening the inclusion exclusion criteria and outliers of the main indicators, 86 113 people were enrolled in the project. The enrollment rate was 92.47%, including 35 431 (41.1%) women and 50 682 (58.9%) men, and the ratio of men to women was 1.43. The mean age was (50.3±12.7) years in all the subjects, and it was (50.2±12.8) years and (50.4±12.5) years in men and women, respectively, and there was no statistical difference between the two genders ( P>0.05). Total of 43 833 people were enrolled in east China, it was the largest group by region (50.90%), it was followed by central China (16 434 people, 19.08%), and the number of people enrolled in Northeast China was the lowest (2 914 people, 3.38%). The rate of completing of health information indicators related to the main outcome of the study were all above 70%, and there were significant differences between men and women (all P<0.05). The mean BMD was (139.33±46.76) mg/cm 3 in women, (135.90±36.48) mg/cm 3 in men, which showed a decreasing trend with age in both gender (both P<0.001); the mean intra-abdominal fat area was (116.39±56.23) cm 2 in women, (191.67±77.07) cm 2 in men, and there was an increasing trend with age in both men and women (both P<0.001). Conclusions:There are gender differences in BMD and VAT measured by QCT with different age tendency, and there are gender differences in health information index. Regional factors should also be taken into account for regional differences in the inclusion of data.

Quantitative computed tomography-derived abdominal visceral adipose tissue and cardiometabolic risk in a large-scale population / 中华健康管理学杂志

Objective:To investigate the relationship between abdominal visceral adipose tissue (VAT) and cardiometabolic risk (CMR) through quantitative computed tomography (QCT).Methods:The present study included 76226 participants. Abdominal fat areas were measured using the QCT Pro Model 4 system. Cardiometabolic indices were collected, including systolic and diastolic blood pressures, fasting plasma glucose, total cholesterol, triglyceride, and low-density and high-density lipoprotein cholesterols CMR score was the sum of abnormal blood pressure, fasting glucose, triglyceride, and high-density lipoprotein cholesterol. Restricted cubic spline and ordered logistic regression models were applied.Results:The mean age was 50±13 years and the percentage of men was 58.8%. The level of VAT area was higher in men than in women (191.7±77.1 cm 2 vs 116.4±56.2 cm 2, P<0.0001 for all). After adjustment for age, the cardiometabolic indices except high-density lipoprotein cholesterol increased with increasing VAT area. When VAT area was 300 cm 2, age-adjusted odds ratios and 95% confidence intervals of a CMR score ≥ 1 were 14.61 (13.31, 16.04) for men and 5.46 (4.06, 7.36) for women, and the age-adjusted probability of a CMR score ≥ 3 was 31.7% for men and 31.3% for women. Conclusions:QCT-derived VAT is closely related to CMR. The findings suggest that measurement of visceral fat is recommended for the management of abdominal obesity in subjects who agree to undergo lung cancer screening via low-dose CT without additional radiation exposure.

Effect evaluation of standardized bowel preparation nursing process on the quality of abdominal CT examination / 中国实用护理杂志

Objective:To evaluate the effect of standardized bowel preparation and nursing procedures in patients with colon disease underwent full abdominal CT examination.Methods:A total of 281 inpatients who were diagnosed as "colon tumors" and underwent full-abdominal CT examinations from January 2016 to December 2017 were selected. From January to December 2016, 153 patients were included in the study, which is the pre-implementation group; from January to December 2017, 128 patients were included in the study, all of whom received standardized bowel preparation and nursing procedures, and were the post-implementation group. Compare and observe the differences in the cleanliness, intestinal filling and CT image quality of patients before and after the intervention measures.Results:After the implementation of standardized nursing procedures, the proportion of patients with good intestinal cleanliness was 71.09% (91/128), which was higher than the pre-implementation of 33.33% (51/153) ( χ2 value was 40.79, P<0.001). The proportion of patients with sub-intestinal preparations also decreased ( P<0.05). The proportion of patients with good intestinal filling in the post-implementation group was 75.00% (96/128), which was higher than 42.48% (65/153) in the pre-implementation group ( χ2 value was 42.63, P<0.001). After the implementation of standardized nursing procedures, the image quality rate of patients with whole abdominal CT was 90.63% (116/128), which was higher than the pre-implementation 32.68% (50/153) ( χ2 value was 98.34, P<0.001). Conclusion:The standardized nursing process can improve the quality of bowel preparation and significantly improve the image quality of abdominal CT examination.

MRS in quantitative assessment of lumbar discs degeneration / 中国医学影像技术

Objective To evaluate the value of MRS in quantitative assessment of degeneration of lumbar discs.Methods Totally 82 patients with lumbago underwent lumbar MR scanning.All the discs were classified with Pfirrmann grades in the sequences of sagittal T2WI.The area under N-acetyl peak,under water peak and the ratio of N-acetyl/Water were measured by MRS.Correlation between MRS values and Pfirrmann grade,age were analyzed.Results In 82 patients,204 lumbar discs were measured by MRS.There were 89,73,39,3 discs in Pfirrmann Ⅱ,Ⅲ,Ⅳ,V respectively.The areas of N-acetyl,water peak and N-acetyl/Water ratio of nucleus region were positively correlated with Pfirrmann grading,respectively (rs =-0.460,-0.204,-0.526,all P＜0.05).There were 62,25,37,51,29 discs in patients aged ＜30,30-39,40-49,50-59,＞59 years respectively.The ares of N-acetyl peak,N-acetyl/Water ratio of nucleus region was negatively correlated with the age (rs=-0.247,-0.385,both P＜0.05).Conclusion MRS can be used for quantitative assessment of lumbar discs degeneration.

Changes in apparent diffusion coefficient and T2 values in the lumbar intervertebral disc under short-time axial load / 中国组织工程研究

BACKGROUND:Disc functional magnetic resonance imaging studies are mostly carried out under lying and a non-load state, and do not reflect the changes in morphology and function of the upright human body under disc load conditions. Therefore, we need to study characteristics of disc functional magnetic resonance imaging in the upright state. OBJECTIVE: To analyze the effect of axial load on apparent diffusion coefficient and T2 of intervertebral discs. METHODS:The study consisted of 17 patients with low back pain aged 34-65 years. Before and after axial load, T2 weighted MR imaging, T1 weighted MR imaging, diffusion tensor imaging, and T2-mapping imaging of the lumbar spine were performed. Load quality was 40%-50% body weight. At 10 minutes after axial load, another diffusion tensor imaging was performed. After 15-minute load, another T2-mapping sequence was scanned. Diffusion tensor imaging scan parameters: single echo-planar imaging, repetition time 2 500 ms, echo time 89 ms, six diffusion directions, b value of 400 s/mm2, sweep time 4:10 minutes. Raw data of diffusion tensor imaging were used to construct apparent diffusion coefficient map and b0 map. Apparent diffusion coefficient value of intervertebral discs was calculated before and after loading. T2 map was automaticaly constructed using T2-mapping sequence to measure apparent diffusion coefficient and T2 values in the whole intervertebral disc of nucleus pulposus, and the changes of them were analyzed under short-time axial load. RESULTS AND CONCLUSION:Pfirrmann grading results in 17 patients with 85 discs were obtained as folows: 0 in Grade I, 26 in Grade II, 19 in Grade III, 30 in Grade IV, and 10 in Grade V. Al 85 disc T2 relaxation time mapping and 84 disc apparent diffusion coefficient mapping were accepted. Under short-time axial load in 84 discs, apparent diffusion coefficient reduced in the whole disc (reduced 38×10-3 mm2/s,Z=2.567,P 0.05). These results suggest that changes in apparent diffusion coefficient and T2 values were different due to different Pfirrmann grades under short-time axial load. To evaluate magnetic resonance imaging function of intervertebral discs, we should choose different evaluation method according to different degeneration degrees.

The effect of axial loading to the lumbar intervertebral discs MR diffusion characteristics / 中华放射学杂志

Objective To analysis the effect of axial loading to ADC value, FA of lumbar intervetebral discs. Methods Forty five patients with low back pain (age range, 25 to 54 years) were evaluated with MR T2WI, MR T1WI and diffusion tensor imaging (DTI) of the lumbar spine. Following axial loading with 40% to 50% body weight for 10 minutes, a repeat DTI was performed. DTI were obtained by using an echo-planar imaging ( EPI ) sequence, TE 89 ms, TR 2500 ms, b value of 400 s/mm2,6 noncollinear diffusion directions. Scan time was approximately 4 min 10 s. An isotropic ADC map, FA map and bo map were calculated from DTI sequence. The mean ADC value, FA prior to and following axialloading were analyzed with t test and Rank Sum test. Results Forty five patients with 225 discs were evaluated and 223 discs were included in the study except for 2 calcified discs. The Pfirrmann grading results were as following: 100 Grade Ⅱ , 48 Grade Ⅲ, 59 Grade Ⅳ, and 16 Grade Ⅴ. No significant difference existed in the mean ADC value before [ ( 1666 ± 252 ) × 10-3 mm2/s ] and after [ ( 1662 ± 253 ) ×10 -3 mm2/s ] axial loading ( Z = - 1.363, P ＞ 0.05 ), but the mean FA [ ( 301 ± 104 ) × 10 -3, ( 316 ±112) × 10-3 ] value increased ( Z = - 2.794, P ＜ 0.05 ). The paired-samples t test show that the mean ADC value [ ( 1685 ± 190) × 10-3 mm2/s, ( 1624 ± 180) × 10-3mm2/s] of Grade Ⅲ discs decreased after axial loading, t=3.513, P＜0. 05, Grade Ⅲ, Ⅳdiscs mean FA value [(300±87) ×10-3, (326±87) ×10-3 for Grade Ⅲ and (348 ±67) × 10-3, (351 ± 71 ) × 10-3 for Grade Ⅳ ] increased, t = - 2. 210,- 2.006, P ＜ 0.05. No significant difference existed in Grade Ⅱ , Ⅳ and Ⅴ discs ADC value, all the P ＞0.05. No significant difference existed in Grade Ⅱ and Ⅴ discs FA value, both the P ＞ 0.05. Conclusions Short time axial loading mainly affect the mildly degenerated discs, the ADC value decreases and the disc diffusion ability decreases. No obvious change in ADC value or disc diffusion ability existed in the normal and severely degenerated discs.

Comparison analysis of Chinese 2008, 1992 and 2002 UICC staging system for nasopharyngeal carcinoma / 中华放射学杂志

Objective To compare the Chinese 2008, 1992 and 2002 UICC (International Union Against Cancer) staging System for nasopharyngeal carcinoma and find out the reasons for the changes in the new Chinese 2008 staging system. Methods From Apr. 2007 to Dec. 2008, 285 naive patients with pathologically proved NPC, but without metastasis, received standard enhanced MRI scans of the nasopharynx and neck. Based on MRI imaging data and clinical information, clinical stage was classified according to the Chinese 2008, Chinese 1992 staging system and 2002 6th UICC staging system,respectively. Comparisons were made between Chinese 2008 and 1992 staging system, and between Chinese 2008 and 2002 UICC staging system by χ2 test. Results As a result of deleting some details of the old staging system, Chinese 2008 staging system is easier to grasp. With Chinese 2008 staging system, the number of cases in stage T1 to T4 are 66, 84, 72,63, respectively; those in stage N0 to N3 are 12,48,169,56; the number of cases in clinical stage Ⅰ -Ⅳ are 5,30,141 and 109. With 2002 6th UICC staging system, the number of cases in stage T1 to T4 are 66, 83, 55,81; those in stage N0 to N3 are 26,50,201,8;the number of cases in clinical stage Ⅰ -Ⅳ are 6,40,153 and 86. With Chinese 1992 staging system, the number of cases in stage T1 to T4 are 62,91,71,61; those in stage No to N3 are 26,189,61,9; the number of cases in clinical stage Ⅰ -Ⅳ are 6, 110, 98 and 71. Comparing with the staging results of Chinese 1992 staging system, many cases showed different stage based on Chinese 2008 system including 12 cases (4.21%) inT stage (3 up-staging and 9 down-staging), 217 cases (76.14%) in N stage (216 up-staging, most rise I stage, and 1 down-staging), 123 cases (43. 16% ) in clinical stage ( 121 up-staging and 2 down-staging). Comparing with the staging results of 2002 UICC staging system, 35 cases ( 12. 28% )changes in T stage (8 up-staging and 27 down-staging), 77 cases (27. 02% ) changes in N stage (all upstaging, most rise 1 stage), 74 cases (25. 95% ) changes in clinical stage (54 up-staging and 20 downstaging) based on Chinese 2008. Comparing the constituent ratio of T, N and clinical staging results separately, statistical differences were found between Chinese 2008 and Chinese 1992 staging system in N0,N1, N2, N3, clinical stage Ⅱ , Ⅲ, Ⅳ. Statistical difference was also found in N0, N2, N3, clinical stage Ⅳ between Chinese 2008 and 2002 UICC staging system. χ2 test results show that there is N0 significant difference of T stage constituent ratio among the 3 staging system ( χ2 = 6. 916, P = 0. 329 ), but the difference of N stage and clinical stage constituent ratio are significant( χ2 = 275. 169 and 84. 515, P ＜0. 0125). Conclusion Chinese 2008 Staging System for nasopharyngeal carcinoma is based on MRI, with clear definition to some anatomical location, after deleting some details in the old stage system, it's easier to use. The most obvious change for Chinese 2008 Staging System is the up-staging in N staging,which leads to the changes in clinical stage and constituent ratio of stage result.

Effects of different exercises on the bone metabolism level of middle-aged and old women / 生物医学工程学杂志

We have investigated the effects of different exercises on middle-aged and old women's bone mineral density (BMD), on the metabolic indexes of bone, on the levels of serum elements, and on the correlation between body components and the indexes. On the basis of informed consent, 90 cantonal women pursued three types of exercises (Taijiquan, Swimming and brisk walking) in Chengdu City. BMD indexes of calcaneus were tested by Osteospace quantitative ultrasound instruments; The serum levels of Mg, Ca, P elements and alkaline phosphatase (ALP) were determined by full-automatic biochemical analysis instrument; The serum level of osteocalcin (BGP) was determined by radioimmunoassay. There were no obvious differences of anthropometric indexes between Taijiquan, Swimming, Brisk walking and Control groups. In comparison with control, the serum levels of Mg element increased significantly in the three exercise groups, and the serum levels of Ca and P element increased significantly in Swimming group and Brisk walking group. The serum levels of BGP and ALP were lower than those of control group, but no statistically significant differences were observed. Speed of sound (SOS) and stiffness index (STI) of BMD indexes in Brisk walking group were significantly higher than in Taijiquan group, Swimming group and Control group, and the prevalences of osteopenia and osteoporosis were the lowest in the Brisk walking group, but no obvious decreases of osteopenia and osteoporosis were observed in Taijiquan group and Swimming group. Broadband ultrasound attenuation (BLIA), SOS, STI of BMD indexes were positively correlated to serum levels of Mg, Ca, P, and were negatively correlated to the serum levels of BGP and ALP, and were positively correlated to body weight, BMI, lean body mass and body fat percentage. In conclusion, brisk walking is a fitting type of exercise for middle-aged and old cantonal women; it maintaines normal levels of bone metabolism.