Clinical and Biological Characteristics of Severe Malaria in Children under 5 Years Old in Benin.

Background: Malaria is a global public health concern, mainly occurring in sub-Saharan Africa. Children infected with malaria are more likely to develop severe disease, which can be fatal. During COVID-19 in 2020, diagnosing and treating malaria became difficult. We analyzed the clinical characteristics and laboratory indicators of children with severe malaria in Benin to provide important information for designing effective prevention and treatment strategies to manage pediatric cases. Methods: Clinical characteristics of pediatric patients with severe malaria admitted to two hospitals in Benin (Central Hospital of Lokossa and Regional Hospital of Natitingou, located ∼650 kilometers apart) were collected from January to December 2020. Patients were grouped according to age (group A: 4-12 months old, group B: 13-36 months old, and group C: 37-60 months old), and clinical and laboratory indicators were compared. The incidences of severe pediatric malaria in both hospitals in 2020 were calculated. Inclusion, exclusion, and blood transfusion criteria were identified. Results: We analyzed 236 pediatric cases. The main clinical symptoms among all patients were severe anemia, vomiting, prostration, poor appetite, dysphoria, and dyspnea. Over 50% of patients in group A experienced vomiting and severe anemia. Most patients in group B had severe anemia and prostration. Delirium affected significantly more patients in group C than in groups A and B. In group C, the hemoglobin and hematocrit levels were significantly higher (p < 0.05), and the leukocyte count was significantly lower (p < 0.01) than in groups A and B. Parasitemia was significantly higher in group C than in group A (p < 0.01). Twelve deaths occurred. Conclusions: Severe pediatric malaria is seasonal in Benin. The situation in children under 5 years old is poor. The main problems are severe disease conditions and high fatality rates. Effective approaches such as prevention and early and appropriate treatment are necessary to reduce the malaria burden in pediatric patients.

[Imaging and Clinical Characteristics of Primary Pulmonary Mucoepidermoid Carcinoma].

Objective To improve the understanding and diagnostic accuracy of pulmonary mucoepidermoid carcinoma(PMEC) by analyzing the imaging and clinical characteristics.Methods The clinical and CT data of 27 cases of PMEC confirmed by histopathology in the First Medical Center of Chinese PLA General Hospital from January 2016 to December 2020 were retrospectively analyzed,including the location,size,margin,density,enhancement characteristics,accompanying signs,and pathological grade.Results The 27 cases included 6(6/27,22.2%) of large airway type,14(14/27,51.9%) of hilar type,and 7(7/27,26.9%) of peripheral type.The CT manifestations of 20 cases of large airway and hilar PMEC were soft-tissue nodules or mass with clear boundary in the lumen of the trachea and main bronchi,including 6 cases of mild enhancement,4 cases of moderate enhancement,5 cases of marked enhancement,and 5 cases of uneven enhancement.Three of the 20 cases showed calcification.The 7 cases of peripheral PMEC showed soft-tissue nodules or masses in the lungs,including 3 cases of mild enhancement,1 case of moderate enhancement,and 3 cases of marked enhancement. Obstructive pneumonia or atelectasis and bronchiectasis with mucus plug formation occurred in 16(16/27,59.3%) cases,lymph node metastasis in 9(9/27,33.3%) cases,and multiple organ metastasis in 8(8/27,29.6%) cases.Age(t=-3.132,P=0.005),enlarged lymph node (χ2=9.281,P=0.003),and distant metastasis(χ2=7.816,P=0.008) were statistically significant in the low-grade group and high-grade group. Conclusion PMEC have some unique imaging features,and recognizing these signs is conducive to the differential diagnosis and the improvement of the diagnostic accuracy.

Differential Microbial Communities in Paddy Soils Between Guiyang Plateaus and Chengdu Basins Drive the Incidence of Rice Bacterial Diseases.

Southwest China has the most complex rice-growing regions in China. With great differences in topography, consisting mainly of basins and plateaus, ecological factors differ greatly between regions. In this study, bulk paddy soils collected from long-term rice fields in Chengdu (basins) and Guiyang (plateaus) were used to study the correlation between microbial diversity and the incidence of rice bacterial diseases. Results showed that the microbial community composition in paddy soils and the microbial functional categories differed significantly between basins and plateaus. They shared >70% of the dominant genera (abundance >1%), but the abundance of the dominant genera differed significantly. Functional analysis found that bulk paddy soils from Chengdu were significantly enriched in virulence factor-related genes; soils from Guiyang were enriched in biosynthesis of secondary metabolites, especially antibiotics. Correspondingly, Chengdu was significantly enriched in leaf bacterial pathogens Acidovorax, Xanthomonas, and Pseudomonas. Greenhouse experiments and correlation analysis showed that soil chemical properties had a greater effect on microbial community composition and positively correlated with the higher incidence of rice bacterial foot rot in Guiyang, whereas temperature had a greater effect on soil microbial functions and positively correlated with the higher severity index of leaf bacterial diseases in Chengdu. Our results provide a new perspective on how differences in microbial communities in paddy soils can influence the incidence of rice bacterial diseases in areas with different topographies.

RNA N6 -methyladenosine modification suppresses replication of rice black streaked dwarf virus and is associated with virus persistence in its insect vector.

N6 methylation of adenosine (m6 A) was recently discovered to play a role in regulating the life cycle of various viruses by modifying viral and host RNAs. However, different studies on m6 A effects on the same or different viruses have revealed contradictory roles for m6 A in the viral life cycle. In this study, we sought to define the role of m6 A on infection by rice black streaked dwarf virus (RBSDV), a double-stranded RNA virus, of its vector small brown planthopper (SBPH). Infection by RBSDV decreased the level of m6 A in midgut cells of SBPHs. We then cloned two genes (LsMETTL3 and LsMETTL14) that encode m6 A RNA methyltransferase in SBPHs. After interference with expression of the two genes, the titre of RBSDV in the midgut cells of SBPHs increased significantly, suggesting that m6 A levels were negatively correlated with virus replication. More importantly, our results revealed that m6 A modification might be the epigenetic mechanism that regulates RBSDV replication in its insect vector and maintains a certain virus threshold required for persistent transmission.

Test-retest multisite reproducibility of neurovascular 4D flow MRI.

BACKGROUND: 4D flow MRI shows great potential in neurovascular disorders such as stenosis, atherosclerotic disease, aneurysms, and vascular malformations. Its widespread application in the neurovascular system requires evidence of good test-retest multicenter reproducibility. PURPOSE: To assess the multicenter reproducibility, test-retest reliability and interobserver dependence of 4D flow MRI in measurements of cerebral blood flow/velocity in main intracranial vessels. STUDY TYPE: Prospective study. SUBJECTS: Ten healthy subjects underwent 4D flow scans at three different centers. All subjects were scanned twice at 2 different days at each center. FIELD STRENGTH/SEQUENCE: 3.0 T; 4D flow sequence. ASSESSMENT: Multicenter reproducibility, test-retest reliability and interobserver agreement for measurements of the blood flow and peak velocity from five regions of interest were assessed (bilateral internal carotid arteries, bilateral medial cerebral arteries, and sagittal sinus). STATISTICAL TEST: A Shapiro-Wilks test was conducted to assess normality of measurements in each scan. Coefficient of variances (CVs) was computed to evaluate intra- and intersite variances of all measurements. The multicenter reproducibility was assessed by two-way mixed intraclass correlation coefficient (ICC). A Bland-Altman plot and Pearson correlation were used to evaluate test-retest reliability. ICC was calculated to assess interobserver agreements. RESULTS: All P-values for Shapiro-Wilks tests were greater than 0.05, which indicated the normality of all measurements. Both intra- and intersite CVs were lower than 12%. There was good test-retest reliability for both blood flow and peak velocity of all ROIs (r = 0.75-0.94). In addition, high multicenter reproducibility was detected (ICC = 0.77-0.96, all P < 0.001). The results of these measurements also showed great interobserver agreement (all ICC > 0.9 and all P < 0.001). DATA CONCLUSION: High multicenter reproducibility and test-retest reliability was shown for 4D flow in the measurements of blood flow and peak velocity of intracranial vessels. In addition, these measurements showed great interobserver agreement. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1543-1552.

CT and histopathologic characteristics of lung adenocarcinoma with pure ground-glass nodules 10 mm or less in diameter.

OBJECTIVE: To evaluate CT and histopathologic features of lung adenocarcinoma with pure ground-glass nodule (pGGN) ≤10 mm in diameter. METHODS: CT appearances of 148 patients (150 lesions) who underwent curative resection of lung adenocarcinoma with pGGN ≤10 mm (25 atypical adenomatous hyperplasias, 42 adenocarcinoma in situs, 38 minimally invasive adenocarcinomas, and 45 invasive pulmonary adenocarcinomas) were analyzed for lesion size, density, bubble-like sign, air bronchogram, vessel changes, margin, and tumour-lung interface. CT characteristics were compared among different histopathologic subtypes. Univariate and multivariate analysis were used to assess the relationship between CT characteristics of pGGN and lesion invasiveness, respectively. RESULTS: There were statistically significant differences among histopathologic subtypes in lesion size, vessel changes, and tumour-lung interface (P<0.05). Univariate analysis revealed significant differences of vessel changes, margin and tumour-lung interface between preinvasive and invasive lesions (P<0.05). Logistic regression analysis showed that the vessel changes, unsmooth margin and clear tumour-lung interface were significant predictive factors for lesion invasiveness, with odds ratios (95% CI) of 2.57 (1.17-5.62), 1.83 (1.25-2.68) and 4.25 (1.78-10.14), respectively. CONCLUSION: Invasive lesions are found in 55.3% of subcentimeter pGGNs in our cohort. Vessel changes, unsmooth margin, and clear lung-tumour interface may indicate the invasiveness of lung adenocarcinoma with subcentimeter pGGN. KEY POINTS: • Invasive lesions were found in 55.3% of lung adenocarcinomas with subcentimeter pGGNs • Lesion size, vessel changes, and tumour-lung interface showed different among histopathologic subtypes • Vessel changes, unsmooth margin and clear tumour-lung interface were predictors for lesion invasiveness.

Value of Baseline Clinical and CT Characteristics for Predicting the Progression of Persistent Pure Ground-glass Nodule 10 mm or Less in Diameter.

Objective To explore the risk factors of the progression of persistent pure ground-glass nodule (pGGN) and make the risk stratification for pGGN 10 mm or less in diameter. Methods From June 2008 to April 2015,100 patients (108 lesions) with persistent pGGN≤10 mm in diameter were included in this study. Patients were followed up at least 1 year using thin-section computed tomography (CT). Patients' baseline clinical data and CT characteristics of pGGN were compared between progression group (size increased or/and solid component appeared) and non-progression group. Cox regression analysis was used to assess the relationship between clinical data,CT characteristics of pGGN,and lesion progression. The risk indices of lesion progression were calculated according to the results of Cox regression analysis and the relative factors of lung adenocarcinoma in previous studies. Logistic regression analysis was used to assess the relationship between risk indices and lesion progression. The optimal cutoff value was decided on receiver operating characteristic curve of risk indices and verified for predicting lesion progression. Results Fifteen of 108 lesions showed progression. The mean follow-up duration was (1016.36±486.00) days. There were statistically significant differences of lesion size,air bronchogram,and vessel changes between progression group and non-progression group (P=0.040,P=0.003,P=0.030,respectively).Lesion density (CT value≥-542.5 HU) and air bronchogram were the risk factors of lesion progression (P=0.003,P=0.021,respectively). The optimal cutoff value of total risk indices on predicting lesion progression was 4.25,with the sensitivity of 46.7%,specificity of 89.2%,and consistency of 83.3%. Conclusions CT value ≥-542.5 HU of pGGN and air bronchogram within lesion may predict lesion progression in persistent pGGN 10 mm or less in diameter. A risk index of less than 4.25 often suggests small probability of disease progression and thus a longer follow-up interval is recommended.

Association between serum N-terminal pro-B-type natriuretic peptide levels and characteristics of coronary atherosclerotic plaque detected by coronary computed tomography angiography.

The aim of the present study was to explore the association between the levels of serum N-terminal pro-B-type natriuretic peptide (NT-pro BNP) and the characteristics of coronary atherosclerotic plaque detected by coronary computed tomography angiography (CCTA), in patients with unstable angina (UA). A total of 202 patients (age range, 47-82 years) were divided into the following three groups: Non-cardiac disease group (57 patients); stable angina pectoris (SAP) group (62 patients); and UA group (83 patients). There were significant differences between the serum NT-pro BNP levels among the three groups (P=0.007). However, in multivariant diagnoses, NT-pro BNP level was not an independent risk factor for UA. The levels of serum NT-pro BNP were observed to be positively correlated with the number of vessels involved (r=0.462; P<0.001), SIS (r=0.475; P<0.001), segment-stenosis score (r=0.453; P<0.001), coronary calcification score (r=0.412; P=0.001), number of obstructive diseases (r=0.346; P<0.001), and the number of segments with non-calcified plaque (r=0.235; P=0.017), mixed plaque (r=0.234; P=0.017) and calcified plaque (r=0.431; P<0.001). The levels of serum NT-pro BNP were significantly higher in patients with UA and left main-left anterior descending (LM-LAD) disease, compared with UA patients without LM-LAD disease (P<0.001). In addition, serum NT-pro BNP was significantly higher in patients with obstructive disease and UA than in those without obstructive disease (P<0.001). The area under the curve of log(NT-pro BNP) was 0.656 (P=0.006; optimal cut-off value, 1.74; sensitivity, 77.6%; specificity, 51.9%). In conclusion, the levels of serum NT-pro BNP are associated with the burden and severity of coronary artery atherosclerotic disease in patients with UA, and may be helpful in risk stratification of patients with UA.

Neonatal hypoglycemic brain injury is a cause of infantile spasms.

Neonatal hypoglycemic brain injury is one of the causes of infantile spasms. In the present study, the clinical history and auxiliary examination results of 18 patients who developed infantile spasms several months after neonatal hypoglycemia were retrospectively analyzed. Among the 666 patients with infantile spasms admitted to two pediatric centers between January 2008 and October 2012, 18 patients developed infantile spasms after being diagnosed with neonatal hypoglycemia, defined as a whole blood glucose concentration of <2.6 mmol/l. These patients developed infantile spasms from between 2 and 10 months (mean, 4.9 months) following the diagnosis of neonatal hypoglycemia. All 18 patients had abnormal electroencephalographic findings with either classical or modified hypsarrhythmia. Upon examination using brain magnetic resonance imaging (MRI), 10 patients (55.6%) exhibited abnormalities. The MRI results principally showed a disproportional involvement of parietal and occipital cortices and sub-cortical white matter lesions. In conclusion, the results of this study indicate that neonatal hypoglycemic brain injury is associated with the subsequent development of infantile spasms.

Correlation of creatine kinase with patency of stents using coronary computed tomography angiography.

OBJECTIVE: To explore the potential correlation between creatine kinase and the long-term patency of coronary drug eluting stents. METHODS: The clinical data of 74 patients who had undergone coronary computed tomography angiography after drug eluting stents implantation were retrospecpectively analyzed. Based on the computed tomography angiography findings,these patients were divided into patency group and non-patency group. The mean follow-up time was (20.5 ± 13.1) months. The serum levels of creatine kinase and creatine kinase isoenzyme were measured to determine the relationship of stent patency with these oxidative-related biomarkers after long-term follow-up. The T test or non-parametric test was adopted to compare the intergroup difference of measurement data,whereas chi-square test was conducted to test the difference of enumeration data. Logistic regression was adopted to analyze the biochemical indexes and clinical information. Only variables with a P value of less than 0.05 in the univariable analyses entered the multivariate Logistic regression model. RESULTS: Patients in the non-patency group had significantly higher serum creatine kinase level compared with patients in patency group [(115.5 ± 51.5)U/L vs.(75.9 ± 29.4)U/L, P=0.012] and significantly higher level of creatine kinase isoenzyme [(3.5 ± 5.3)U/L vs.(1.7 ± 1.3)U/L,P=0.034]. Furthermore,the Logistic analysis showed that serum creatine kinase level (odds ratio=1.573,95% CI=1.022-2.421, P=0.039)was an independent predictor of stent patency. CONCLUSION: Creatine kinase is an independent risk factor associated with stent non-patency.

Correlations between pathologic subtypes/immunohistochemical implication and CT characteristics of lung adenocarcinoma ≤ 1 cm with ground-glass opacity.

OBJECTIVE: To discuss the correlation of pathologic subtypes and immunohistochemical implication with CT features of lung adenocarcinoma 1 cm or less in diameter with focal ground-glass opacity (fGGO). METHODS: CT appearances of 59 patients who underwent curative resection of lung adenocarcinoma ≤ 1 cm with fGGO were analyzed in terms of lesion location, size, density, shape (round, oval, polygonal, irregular), margin (smooth, lobular, spiculated, lobular and spiculated), bubble-like sign, air bronchogram, pleural tag, and tumor-lung interface. Histopathologic subtypes were classified according to International Association for the Study of Lung Cancer/ American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma. Common molecular markers in immunohistochemical study included human epidermal growth factor receptor (HER)-1,HER-2,Ki-67, vascular endothelial growth factor (VEGF) and DNA topoisomerase 2Α.Patients' age and lesions' size and density were compared with pathologic subtypes using analysis of variance or nonparametric Wilcoxon tests. Patients' gender, lesion location, shape and margin, bubble-like sign, air bronchogram, pleural tag, and tumor-lung interface were compared with histopathologic subtypes and immunohistochemical implication using ψ² test or Fisher's exact test. RESULTS: The patients' gender, age, lesion location, shape, air bronchogram, pleural tag, and tumor-lung interface were not significantly different among different histopathologic subtypes (P=0.194, 0.126, 0.609, 0.678, 0.091, 0.374, and 0.339, respectively), whereas the lesion size,density,bubble-like sign, and margin showed significant differences (P=0.028, 0.002, 0.003, 0.046, respectively). The expression of Ki-67 significantly differed among nodules with different shapes(P=0.015). Statistically significant difference also existed between tumor-lung interface and HER-1 expression (P=0.019) and between bubble sign and HER-2 expression (P=0.049). CONCLUSIONS: Of lung adenocarcinoma ≤ 1 cm with fGGO,bubble-like sign occurs more frequently in invasive pulmonary adenocarcinoma and less frequently in atypical adenomatous hyperplasia. In addition, preinvasive lesions (atypical adenomatous hyperplasia and adenocarcinoma in situ) more frequently demonstrates smooth margin,while invasive lesions (minimally invasive adenocarcinoma and invasive pulmonary adenocarcinoma) more frequently demonstrates lobular and spiculated margin. Some CT features are associated with immunohistochemical implication of lung adenocarcinoma ≤ 1 cm with fGGO.

Predictive value of apolipoprotein for coronary atherosclerosis in asymptomatic non-diabetic population.

OBJECTIVE: To explore the potential correlation between apolipoprotein (Apo) levels and coronary atherosclerosis and investigate its predictive value for coronary artery lesions in asymptomatic population without diabetes. METHODS: We performed a retrospective analysis of data collected from 401 asymptomatic patients who took health check-ups. They were divided into atherosclerosis group (n=224)and control group (n=177) based on the outcome of CT angiography and blood biochemical findings. The risk factors, lipid profiles, and Apo levels were compared between these two groups. The best biochemical indicators for predicting the coronary atherosclerosis were explored. RESULTS: The levels of ApoB, ApoC2,ApoC3,and ApoE and ApoB/ApoA1 ratio were significantly higher in the atherosclerosis group than in the control group (all P<0.01), whereas the ApoA1,ApoA2, and lipoprotein a levels showed no such significant difference (all P>0.05). Logistic regression analysis revealed that age, male, hypertension,ApoC3(OR=1.572,95%CI 1.200-2.061) and ApoB/ApoA1 ratio (OR=1.767,95% CI 1.335-2.338) were independently correlated with coronary atherosclerosis (all P<0.01). In the prediction of the presence of plaque, ApoB had the largest area under curves, and the optimal cutoff point was 1.005 g/L. CONCLUSIONS: ApoC3 is closely associated with subclinical coronary atherosclerosis,while the decrease of ApoA1 level is not obvious during this period. Compared with other lipid indicators, ApoB is the strongest predictor for coronary atherosclerosis in asymptomatic non-diabetic population.

[Association of myocardial bridge in the left anterior descending coronary with coronary atherosclerosis proximal to the bridge site in diabetic patients].

OBJECTIVE: To investigate whether myocardial bridging (MB) is an independent risk factor for coronary atherosclerosis proximal to the bridge site in the left anterior descending coronary artery (LAD) in diabetic patients. METHODS: From March 2011 to December 2012, 9862 patients with suspected coronary disease underwent coronary computed tomography angiography (CCTA) using a dual-source CT scanner. The baseline clinical characteristics (age, gender, smoking history, presence of hypertension, dyslipidemia, diabetes mellitus, family history of heart attack and body mass index) and the results of CCTA were reviewed. Two radiologists evaluated the MB and coronary atherosclerosis stenosis (CAS) over 50% in the LAD and made a diagnosis by consensus. Significant independent risk factors for CAS were investigated by logistic regression analysis. RESULTS: Of the 2345 patients identified to have diabetes mellitus, 1373 had MB, among whom 827 had coronary atherosclerosis proximal to the bridge site; 972 of the diabetic patients were free of MB, among whom 254 had coronary atherosclerosis at the equivalent site. None of the patients had CAS in the tunneled segment. After adjusted for clinical data, logistic regression analysis showed that MB in the LAD was significantly correlated with coronary atherosclerosis in the proximal LAD in diabetic patient (OR=3.91) and non-diabetic patients (OR=2.69) (P<0.05). CONCLUSION: In diabetic patients, atherosclerosis occurred frequently in the segment proximal to MB in the LAD, and MB in the mid-LAD is an independent risk factor for CAS in the proximal LAD.

[Evaluation of association of myocardial bridge in the left anterior descending coronary with coronary atherosclerosis (stenosis > 50%) in the segment proximal to the site of bridge on coronary cta in hypertension subjects].

OBJECTIVE: To investigate whether myocardial bridging (MB) is an independent risk factor for coronary atherosclerosis (stenosis > 50%) proximal to MB in the left anterior descending coronary artery (LAD) in subjects with hypertension identified by coronary computed tomography angiography (CCTA). METHODS: From March 2011 to December 2012, Patients with suspected coronary disease underwent CCTA using dual-source CT scanner. The baseline clinical characteristics (age, gender, smoking history, presence of hypertension, dyslipidemia, diabetes mellitus, family history of heart attack and body mass index (BMI) ) and the results of CCTA were reviewed. Two radiologists evaluated the MB and more than 50% coronary atherosclerosis stenosis (CAS) in LAD and made a diagnosis by consensus. Significant independent risk factors for more than 50% CAS were investigated by Logistic regression analysis. All tests were two-tailed, the significance threshold was P value less than 0.05. RESULTS: The study included 9 862 patients, including 5 292 cases of patients with hypertension (MB in LAD 2 139 cases, more than 50% CAS proximal to MB 1 240 cases; no MB in 3 153 cases, more than 50% CAS in counterpart segment proximal to MB 898 cases); 4 570 cases of non-hypertensive patients (MB in LAD 1 043 cases, more than 50% CAS proximal to MB 418; no MB 3 527 cases, more than 50% CAS in counterpart segment proximal to MB 803 cases). After adjusted for clinical data, Logistic regression analysis showed that MB in LAD were significantly associated with CAS proximal to MB in LAD in hypertension and no hypertension subjects (OR, 3.17, 2.02, respectively, P < 0.05). CONCLUSION: MB in the LAD is an independent risk factor for more than 50% CAS in the proximal LAD in subjects with or without hypertension, and the OR of MB in subjects with hypertension is higher than that of MB in subjects without hypertension.

Value of coronary computed tomography angiography in ruling out coronary artery disease before intermediate- and high-risk non-cardiac surgery.

OBJECTIVE: To assess the value of preoperative coronary computed tomographic angiography (CCTA) in the detection of coronary artery disease (CAD) in patients planned to undergo non-cardiac surgery at intermediate or high risk to avoid unnecessary invasive coronary angiography (ICA). METHODS: The study protocol was approved by our institutional review board and informed consent was given. In this prospective study, 157 consecutive patients who underwent CCTA before undergoing non-cardiac surgery at intermediate or high risk was involved. The non-cardiac surgery included high-risk surgery (17 patients) and intermediate-risk surgery (140 patients). Follow-up was performed in 6-11 months to define cardiac events described as acute coronary syndrome (ACS) or death secondary to ASC, arrhythmias, cardiac revascularization, or cardiac failure. χ(2) test was performed to compare the differences in incidence of cardiac events among patients who had undergone or who had not undergone preoperative ICA. RESULTS: CCTA was of diagnostic value in 145 of 157 patients. Thirty-seven of 145 had no CAD, and 88 of 145 had no significant CAD (<50% stenosis), and non-cardiac surgery was performed in them without preoperative ICA. No patients in those patients had postoperative ischemic events at follow-up; 20 had significant CAD (≥50% stenosis) and underwent surgery after preoperative ICA. CCTA was non-diagnostic in 12 patients who were referred for preoperative ICA, and 4 of 12 underwent surgery after PCI or CABG. There were no differences in cardiac events between patients who had undergone preoperative ICA and those who had not (P=0.45). CONCLUSIONS: In patients with planned non-cardiac surgery at medium or high risk of cardiovascular events, preoperative CCTA is an effective diagnostic tool for detecting CAD. Preoperative ICA can be safely avoided in patients with normal findings or with stenosis<50% in CCTA.

[Association of myocardial bridge of the left anterior descending coronary artery with coronary atherosclerotic stenosis in the segment proximal to the site of bridge].

OBJECTIVE: To investigate whether myocardial bridging (MB) is independently associated with coronary atherosclerosis proximal to MB in the left anterior descending coronary artery (LAD) identified by computed tomographic coronary angiography (CCTA). METHODS: From March 2011 to December 2012, patients (n=9 862) with suspected coronary disease underwent CCTA using dual-source CT scanner. The baseline clinical characteristics (age, gender, smoking history, presence of hypertension, dyslipidemia, diabetes mellitus, family history of heart attack, and body mass index) and the results of CCTA were reviewed. Two radiologists evaluated the coronary artery for MB and coronary atherosclerosis stenosis (CAS) in LAD and made a diagnosis by consensus. Significant independent risk factors for CAS were investigated by multivariate logistic regression analysis. RESULTS: A total of 3 182 (32.3%) cases of MB and 3 359 cases of CAS of LAD were identified. No patient with CAS in the tunneled segment was found. The mean length of bridges and the mean thickness of the overlying myocardium was (17.3±5.2) mm and (1.2±0.9) mm, respectively. There were 1658 MB cases in 3 359 cases of LAD stenosis and 1 524 MB cases in 6 503 cases of no LAD stenosis (χ(2)=681.12, P<0.05). Logistic regression analysis showed that MB in the LAD were significantly associated with CAS in the proximal LAD (OR=3.07, 95%CI=2.81-3.37, P<0.001), and after final adjustment for age, gender, body mass index, family history of heart attack, smoking, hypertension, dyslipidemia, diabetes mellitus, and resting heart rate (OR=2.86, 95% CI=2.60-3.16, P < 0.001). CONCLUSION: MB in the LAD is independently associated with CAS in the proximal segment to MB.

MR imaging of the spine at 3.0T with T2-weighted IDEAL fast recovery fast spin-echo technique.

OBJECTIVE: To compare the iterative decomposition of water and fat with echo asymmetry and the least-squares estimation (IDEAL) method with a fat-saturated T2-weighted (T2W) fast recovery fast spin-echo (FRFSE) imaging of the spine. MATERIALS AND METHODS: Images acquired at 3.0 Tesla (T) in 35 patients with different spine lesions using fat-saturated T2W FRFSE imaging were compared with T2W IDEAL FRFSE images. Signal-to-noise ratio (SNR)-efficiencies measurements were made in the vertebral bodies and spinal cord in the mid-sagittal plane or nearest to the mid-sagittal plane. Images were scored with the consensus of two experienced radiologists on a four-point grading scale for fat suppression and overall image quality. Statistical analysis of SNR-efficiency, fat suppression and image quality scores was performed with a paired Student's t test and Wilcoxon's signed rank test. RESULTS: Signal-to-noise ratio-efficiency for both vertebral body and spinal cord was higher with T2W IDEAL FRFSE imaging (p < 0.05) than with T2W FRFSE imaging. T2W IDEAL FRFSE demonstrated superior fat suppression (p < 0.01) and image quality (p < 0.01) compared to fat-saturated T2W FRFSE. CONCLUSION: As compared with fat-saturated T2W FRFSE, IDEAL can provide a higher image quality, higher SNR-efficiency, and consistent, robust and uniform fat suppression. T2W IDEAL FRFSE is a promising technique for MR imaging of the spine at 3.0T.

[Study on the overall anatomical features and clinical value of lumbar nerve root, plexus and branches in CT reconstruction].

OBJECTIVE: To identify the overall anatomical characteristics and the clinical value of the lumbar nerves under CT multiplanar reconstruction. METHODS: Fifty normal subjects and 30 patients with LN diseases (51 sides) were selected, including 10 patients with lumber intervertebral disk hernia, eight patients with spinal stenosis, 5 patients with spondylolisthesis, 1 patient with tethered cord syndrome, 1 patient with lumbar scoliosis, and 5 patients with spinal trauma The 16-slice helical CT (Light Speed, GE Company) was used for scanning the lumbar vertebra with multiplanar reconstruction in Workstation (ADW4.1) with UNIX System in DICOM format. The image was set on the same slice for the overall anatomy and manifestations of the lesions. RESULTS: The same-slice imaging showed the strip-like LN slightly lower than the surrounding muscle in density. Each LN went out of the dural sac at an acute angle. The course of the lumbar plexus and its major branches, including the obturator nerve, femoral nerve and reproductive nerve, and their relations to the adjacent structures were clearly revealed. The percentage of the segments displayed was well associated with the reconstruction angle, with the order being oblique coronal > outward-rotated oblique coronal > oblique sagittal > coronal > sagittal section. The major manifestations of abnormal LN included compression and displacement (50 sides, 98.0%), morphological changes (49 sides, 96.1%), adhesion (41 sides, 80.4%). CONCLUSIONS: The CT multiplanar reconstruction is ideal for the imaging of the overall size, shape, running and tension of the LN root; it is valuable in clinical diagnosis.

[Analysis of liver function index and clinical characters in 122 patients with acute hepatitis E virus coinfection with other hepatitis virus].

OBJECTIVE: To compare the liver function index and clinical characters in 122 patients with acute hepatitis E virus overlapping with other infection. METHODS: The liver function index and clinical characters of 122 patients with acute hepatitis E virus overlapping infection and 40 patients with acute hepatitis E were retrospectively analyzed. RESULTS: No significant differences of ALT, AST, TBIL, DBIL were found between acute hepatitis E groups and overlapping infection hepatitis A or hepatitis B (P > 0.05). However, there were significant differences of Albumin (ALB) and Globulin (GLO) were found between acute hepatitis E groups and overlapping infection hepatitis B (P < 0.01). In acute hepatitis E overlapping infected hepatitis B or hepatitis A patients, more and severe complications were also observed. CONCLUSION: The patients with acute Hepatitis E virus, especially Hepatitis E virus overlapping infection, need to pay more clinical monitor, prevent complication early and lower death rates.