Predictive factors of postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to intensive care unit: a retrospective cohort study.

BACKGROUND: The epidemiology and risk factors for postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to the Intensive Care Unit (ICU) are unknown. METHODS: We performed a retrospective cohort study of patients with free flap reconstruction of head and neck cancer between September 2015 and April 2023 admitted to the ICU of Beijing Tongren Hospital. The univariate and multivariate analyses were used to explore the risk factors for postoperative complications related to free flap reconstruction admitted to ICU, including flap necrosis, bleeding, fistula, and infection. RESULTS: A total of 239 patients were included in this study, and 38 (15.9%) patients had postoperative complications related to free flap reconstruction. The median length of ICU stay was 1 day (interquartile range, 1-2 days). Multivariate analysis found that low BMI (P < 0.001), high postoperative CRP (P = 0.005), low hemoglobin (P = 0.012), and inadequate fluid intake (P < 0.05) were independent risk factors for complications. CONCLUSIONS: Postoperative complications related to free flap reconstruction were common in this ICU population. Careful fluid management and monitoring of CRP and hemoglobin levels may reduce complications.

Review on mechanism and remediation strategies of dissolved oxygen abnormal in surface water.

Dissolved oxygen (DO) is an important index to evaluate the quality of surface water environments. In recent years, anomalies in DO level have emerged as a major contributor to the decline of surface water quality. These anomalies have triggered several ecological and environmental challenges such as biodiversity loss, the degradation of water environmental quality, intensification of eutrophication, and an exacerbation of the greenhouse effect. Understanding the mechanisms underlying DO anomalies and devising targeted remediation strategies holds paramount importance in the scientific pursuit of water pollution control and aquatic ecosystem restoration. We explored and summarized the fluctuations and abnormal mechanism of DO concentration in surface water, focusing on factors like oxygen solubility, reoxygenation rates, and oxygen consumption by water bodies. We compiled a range of approaches for addressing DO anomalies, including pollution source management, artificial oxygenation, and the reconfiguration of aquatic ecosystems. Ultimately, we underscored the emerging significance of monitoring and regulating DO level in surface waters. Future research in this realm should encompass the establishment of distinct quality standards for surface water, the development of a comprehensive real-time spatial monitoring system for DO levels across watersheds, and the formulation of standardized procedures and technical norms.

Synthesis and Biological Activity Evaluation of Novel Chalcone Analogues Containing a Methylxanthine Moiety and Their N-Acyl Pyrazoline Derivatives.

On the basis of the structures of natural methylxanthines and chalcone, a series of novel chalcone analogues containing a methylxanthine moiety, Ia-Ig, and their N-acyl pyrazoline derivatives IIa-IIz and IIaa-IIaf were synthesized and identified through melting points, 1H NMR, 13C NMR, and HRMS. The single crystal of compound IId was obtained, which further illustrated the structural characteristics of the methylxanthine-acylpyrazoline compounds. The biological tests showed that some of them displayed favorable insecticidal activities toward Plutella xylostella L. and were superior to the natural methylxanthine compound caffeine while being comparable with the insecticide triflumuron (e.g., compound Ic: LC50 = 16.8508 mg/L, IIf: LC50 = 1.5721 mg/L, against P. xylostella). Of these compounds, Ic, IIf, and IIu could serve as novel insecticidal leading structures for further study. Some of the compounds showed good fungicidal activities (e.g., compound Ig: EC50 = 14.74 µg/mL, against Rhizoctonia cerealis; IIf: EC50 = 7.06 µg/mL, against Physalospora piricola; IIac: EC50 = 5.37 and 8.19 µg/mL, against Phytophthora capsici and Sclerotinia sclerotiorum, respectively); Ic, Ig, IIa, IIf, IIr, IIs, IIv, IIac, and IIaf could be novel fungicidal leading compounds for further exploration. Furthermore, most of the tested compounds exhibited apparent herbicidal activities against Brassica campestris at a concentration of 100 µg/mL; among others, compound IIa was the best one both toward Brassica campestris and Echinochloa crusgalli and deserves further investigation. The structure-activity relationships of these compounds were also summarized and discussed in detail. The contrast experiment results of compounds C-1 and C-2 showed a positive effect on the biological activity enhancement from the combination of the methylxanthine moiety with the N-dichloroacetyl phenylpyrazoline skeleton. In addition, two 3D-QSAR models with predictive capability were constructed based on the insecticidal and fungicidal activities to afford deep insight into the bioactivity profiles of these compounds. This research provides useful guidance and reference for the discovery and development of novel xanthine natural product-based pesticides.

Coronary computed tomography angiography study on the relationship between the Ramus Intermedius and Atherosclerosis in the bifurcation of the left main coronary artery.

OBJECTIVE: This study aimed to explore the relationship between the ramus intermedius (RI) and atherosclerosis in the bifurcation of the left coronary artery (LCA). METHODS: Screening patients who underwent CCTA from January to September 2021, 100 patients with RI (RI group) and 100 patients without RI (no-RI group) were randomly enrolled, Evaluation of RI distribution characteristics and left main coronary artery(LM),Left anterior descending branch(LAD),left circumflex branch(LCX) proximal segment plaque distribution, measurement of LAD-LCX bifurcation angle(∠LAD-LCX),Comparison of the three distribution characteristics with the incidence of plaques in the left main trunk bifurcation area (LM, LAD, LCX) between groups and within the RI group. RESULTS: The difference in the incidence of plaques in the proximal LCX and the LM between the RI group and the no-RI group were not statistically significant (P > 0.05). The incidence of plaques in the proximal LAD in the RI group was significantly higher than that in the non-RI group (77% versus 53%, P < 0.05). However, there was no statistically significant difference between the two groups after PSM. A univariate logistic regression analysis revealed that an RI was a risk factor for plaque formation in the proximal LAD (P < 0.001), and a multivariate logistic regression analysis revealed that an RI was not an independent risk factor for plaque formation in the proximal LAD (P > 0.05). When compared within the RI group, the difference in the incidence of plaques in the proximal segment of LAD, the proximal segment of LCX, and the LM among the different distribution groups of RI was not statistically significant, respectively (P > 0.05). CONCLUSION: RI is not an independent risk factor for atherosclerosis in the left coronary artery bifurcation zone, but it may indirectly increase the risk of atherosclerosis in the proximal segment of the LAD.

Design, synthesis, and fungicidal activities of novel piperazine thiazole derivatives containing oxime ether or oxime ester moieties.

BACKGROUND: To study the effect of changing the piperidine ring of oxathiapiprolin on the fungicidal activity, we designed and synthesized novel piperazine thiazole derivatives containing oxime ether or oxime ester moieties, and studied their fungicidal activities against Phytophthora capsici in vitro. RESULTS: These derivatives showed moderate to good fungicidal activities against Phytophthora capsici, two oxime ether derivatives showed higher fungicidal activity in vitro than dimethomorph (EC50  = 0.1331 µg mL-1 ) and comparable to oxathiapiprolin (EC50  = 0.0042 µg mL-1 ). Oxime ester derivatives showed significantly reduced activities compared with oxime ether derivatives. Most of these derivatives showed broad-spectrum fungicidal activity against the other eight kinds of fungi. Moreover, four derivatives exhibited good antifungal activities in vivo against Phytophthora capsici, Pseudoperonospora cubensis, and Phytophthora infestans. The hyphae morphology study showed that compound 10d might cause mycelial abnormalities of Phytophthora capsici. CONCLUSION: The activity of 10b against Phytophthora infestans was better than that of mandipropamid, and compound 10d exhibited higher fungicidal activities against Pseudoperonospora cubensis and Phytophthora infestans than mandipropamid. These two derivatives emerged as promising candidates for antifungal drugs. © 2023 Society of Chemical Industry.

Facile synthesis, crystal structure, quantum calculation, and biological evaluations of novel selenenyl sulfide compounds as potential agrochemicals.

BACKGROUND: In order to design compounds with fresh molecular skeleton to break through the limitation of available agrochemicals, a series of 36 novel selenenyl sulfide compounds were chemically synthesized, and their biological activities were fully evaluated against tobacco mosaic virus (TMV), 14 plant pathogenic fungi, three insect species and plant acetohydroxyacid synthase (AHAS). RESULTS: All the target compounds were characterized by proton nuclear magnetic resonance (1 H-NMR), carbon-13 (13 C)-NMR, selenium-77 (77 Se)-NMR, and high-resolution mass spectrometry (HRMS). The crystal structure of 10j indicated that the Se-S bond was successfully constructed. Compounds 10d, 10h, 10s, 10u, 10aa, 10ac, 10ae, 10ag, and 10ai exhibited 40%, 43%, 39%, 41%, 47%, 46%, 47%, 42%, and 39% anti-TMV activities at 500 mg L-1 , better than that of ribavirin. The median effective concentration (EC50 ) against Sclerotinia sclerotiorum of 10ac was 6.69 mg L-1 and EC50 values against Physalospora piricola and Pyricularia grisea of 10z were 12.25 mg L-1 and 15.27 mg L-1 , respectively, superior to the corresponding values of chlorothalonil. Compounds 10c and 10v demonstrated 100% larvicidal activity against Culex pipiens pallens at 5 mg L-1 , while 10a displayed 100% insecticidal activity against Mythimna separata at 200 mg L-1 . Compounds 10c, 10j, and 10o showed > 60% inhibitions against plant AHAS at 10 µmol L-1 . From the quantum calculation, highest occupied molecular orbital (HOMO) was considered as a factor that affects the anti-TMV activity. CONCLUSION: The preliminary results suggested that more efforts should be devoted to exploring the selenenyl sulfides for the discovery of new leads of antiviral agent, fungicide, insecticide or AHAS inhibitors as potential agrochemicals for crop protection. © 2023 Society of Chemical Industry.

Study on the correlation between false-positive filling defect in LAA CT and LAA structure in patients with atrial fibrillation based on TEE.

OBJECTIVE: This study aims to explore the actual meaning of "false positive filling defect" in left atrial appendage (LAA) computed tomography (CT) in patients with atrial fibrillation (AF), with transesophageal echocardiography (TEE) as the gold standard. METHODS: Patients with AF undergoing cardiac CT angiography and TEE examinations for proposed radiofrequency catheter ablation between October 2020 and October 2021 were selected as the study subjects. Transesophageal echocardiography was taken as the "gold standard," and spontaneous echocardiographic contrast (SEC) and thrombus events were defined as positive events. The CT manifestations were classified into three groups (true positive, false positive, and true negative) to evaluate the differences in left atrium (LA) anterior-posterior diameter (LAAP), LA anterior wall thickness, and LAA orifice long diameter and short diameter, area, and depth between the three groups. RESULTS: (1) There was no statistical difference in LA anterior wall thickness between the three groups (p > .05); there was a statistical difference in LAAP (only) between the true-positive group and the true-negative group (p < .05). (2) There was a statistical difference in LAA orifice long diameter, short diameter, and area between the true-positive group and the true-negative group as well as between the false-positive group and the true-negative group (p < .05). (3) There was a statistical difference in LAA depth between the true-positive group and the false-positive group as well as between the true-positive group and the true-negative group (p < .05). (4) The area under the receiver operator characteristic curve (AUC) of LAA depth affecting the LAA thrombus and SEC was 0.863 (confidence interval = 0.718-1.000), the sensitivity was 77.8%, and the specificity was 90.6% for predicting the occurrence of LAA thrombus and SEC in patients with nonvalvular AF (NVAF) and an LAA depth of ≥50.84 mm. CONCLUSIONS: There was a difference in LAA diameter between the TEE-based CT false-positive group and the other groups. A "CT false positive" is an objectively existing state, and CT might be able to identify the LAA hemodynamic disorder earlier than TEE. Furthermore, a CT + TEE combined application could more accurately evaluate LAA hemodynamics in patients with AF.

Synthesis, Crystal Structures, and Biological Activity Evaluation of Novel Xanthine Derivatives Containing a Pyrethroid Moiety.

On the basis of the structures of natural xanthines and pyrethroid insecticides, a series of novel xanthine derivatives Ia-Is containing pyrethroid motifs were synthesized and identified by means of melting points, 1H NMR, 13C NMR, and HRMS. The single crystals of compounds In and Iq were obtained, which further confirmed the structures and configurations of this type of compounds. The biological tests showed that some of them exhibited favorable insecticidal activities toward Mythimna separata Walker and Plutella xylostella L. and were superior to the natural methylxanthine compound caffeine and comparable with the insecticide tetramethrin (e.g., compound Im: LC50 = 0.6162 mg/L, against P. xylostella). Among others, Im, Ib, Ij, and Ik could serve as new insecticidal leading structures for further study. Moreover, some of the compounds showed favorable fungicidal activities against a broad spectrum of plant pathogenic fungi (e.g., compound Ie: EC50 = 6.0922 µg/mL, against Physalospora piricola; EC50 = 9.0637 µg/mL, against Rhizoctonia cerealis), which in turn would be an exciting new finding in xanthine chemistry; Ie, Ih, and Ii could be novel fungicidal leading compounds for further investigation. The structure-activity relationships of the compounds were also analyzed and discussed in detail. The research results presented in this paper provide a useful reference and guidance for the development of new natural product-based agrochemicals.

The Comparison of the Diagnostic Value of Left Atrial Pulmonary Vein Single-Phase and Dual-Phase Enhanced CT Scanning for Left Atrial Appendage Thrombosis and SEC in Patients with Atrial Fibrillation.

Objective: The accuracy of left atrial pulmonary vein CT enhanced single-phase and dual-phase scanning in the detection of left atrial appendage (LAA) thrombosis and spontaneous echo contrast (SEC) before radio frequency ablation was compared in atrial fibrillation patients, so as to optimize the scanning scheme. Methods: 78 patients with atrial fibrillation who were admitted to Cangzhou Central Hospital from October 2020 to September 2021 and underwent bilateral enhanced CT scan of left atrial pulmonary vein and transesophageal echocardiography (TEE) examination for planned frequency ablation were selected. TEE results were used as the "gold standard" to compare the diagnostic efficacy of the first phase, second phase, and double-phase comprehensive mode of enhanced left atrial pulmonary vein CT in detecting left atrial thrombosis and SEC. Results: The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the first phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 22.2%, 98.6%, 66.6%, and 90.7%, respectively, in the detection of left atrial thrombosis and SEC by the second phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the double-phase comprehensive mode of CT enhanced scan. There was no statistically significant difference in the accuracy of CT diagnosis of left atrial appendage thrombosis and SEC between the three modes of the first phase, the second phase, and the double-phase comprehensive CT (P > 0.05). The mean effective radiation dose of double-phase enhanced scan was 7.49 ± 1.02 mSv. Conclusion: Single-phase enhanced CT scan of left atrial pulmonary vein can meet clinical requirements and significantly reduce the radiation dose compared with double-phase enhanced CT scan. Therefore, it is recommended as an initial screening examination for patients with atrial fibrillation before radiofrequency ablation.

Design, Synthesis, and Fungicidal Activities of Novel Piperidyl Thiazole Derivatives Containing Oxime Ether or Oxime Ester Moieties.

To explore the influence of the positions of the two nitrogen atoms on the thiazole ring and the isoxazoline ring on the activity, a series of novel piperidyl thiazole derivatives containing oxime ether and oxime ester moieties with two nitrogen atoms on the same or opposite sides have been designed, synthesized, and first evaluated for their fungicidal activities against Phytophthora capsici in vitro. The bioassay results showed that the target compounds possessed moderate to good fungicidal activities against P. capsici, among which oxime ether compound 11b shows the highest fungicidal activity in vitro (EC50 = 0.0104 µg/mL) which is higher than dimethomorph (EC50 = 0.1148 µg/mL) and diacetylenyl amide (EC50 = 0.040 µg/mL). Compared with oxime ether compounds (the two nitrogen atoms are on the opposite sides), the activities of oxime ester compounds were significantly reduced. It is different from the commercial fungicide fluoxapiprolin, and the activities of the compounds with the two nitrogen atoms on the same side were significantly reduced compared to the compounds with the two nitrogen atoms on the opposite sides. Moreover, compounds 11b, 11d, 11e, and 11g showed moderate to good antifungal activities in vivo against Phytophthora capsici, Pseudoperonospora cubensis, and Phytophthora infestans. Scanning electron microscopy of compound 11b on the hyphae morphology showed that compound 11b might cause mycelial abnormalities of P. capsici.

Radiomics Based on CECT in Differentiating Kimura Disease From Lymph Node Metastases in Head and Neck: A Non-Invasive and Reliable Method.

Background: Kimura disease may be easily misdiagnosed as malignant tumors such as lymph node metastases based on imaging and clinical symptoms. The aim of this article is to investigate whether the radiomic features and the model based on the features on venous-phase contrast-enhanced CT (CECT) images can distinguish Kimura disease from lymph node metastases in the head and neck. Methods: A retrospective analysis of 14 patients of head and neck Kimura disease (a total of 38 enlarged lymph nodes) and 39 patients with head and neck lymph node metastases (a total of 39 enlarged lymph nodes), confirmed by biopsy or surgery resection, was conducted. All patients accepted CECT within 10 days before biopsy or surgery resection. Radiomic features based on venous-phase CECT were generated automatically from Artificial-Intelligence Kit (AK) software. All lymph nodes were randomly divided into the training set (n = 54) and testing set (n = 23) in a ratio of 7:3. ANOVA + Mann-Whitney, Spearman correlation, least absolute shrinkage and selection operator, and Gradient Descent were introduced for the reduction of the highly redundant features. Binary logistic regression model was constructed based on the selected features. Receiver operating characteristic was used to evaluate the diagnostic performance of the features and the model. Finally, a nomogram was established for model application. Results: Seven features were screened out at the end. Significant difference was found between the two groups for all the features with area under the curves (AUCs) ranging from 0.759 to 0.915. The AUC of the model's identification performance was 0.970 in the training group and 0.977 in the testing group. The disease discrimination efficiency of the model was better than that of any single feature. Conclusions: The radiomic features and the model based on these features on venous-phase CECT images had very good performance for the discrimination between Kimura disease and lymph node metastases in the head and neck.

Computed tomography-based radiomics model for discriminating the risk stratification of gastrointestinal stromal tumors.

PURPOSE: The pathological risk degree of gastrointestinal stromal tumors (GISTs) has become an issue of great concern. Computed tomography (CT) is beneficial for showing adjacent tissues in detail and determining metastasis or recurrence of GISTs, but its function is still limited. Radiomics has recently shown a great potential in aiding clinical decision-making. The purpose of our study is to develop and validate CT-based radiomics models for GIST risk stratification. METHODS: Three hundred and sixty-six patients clinically suspected of primary GISTs from January 2013 to February 2018 were retrospectively enrolled, among which data from 140 patients were eventually analyzed after exclusion. Data from patient CT images were partitioned based on the National Institutes of Health Consensus Classification, including tumor segmentation, radiomics feature extraction and selection. A radiomics model was then proposed and validated. RESULTS: The radiomics signature demonstrated discriminative performance for advanced and nonadvanced GISTs with an area under the curve (AUC) of 0.935 [95% confidence interval (CI) 0.870-1.000] and an accuracy of 90.2% for validation cohort. The radiomics signature demonstrated favorable performance for the risk stratification of GISTs with an AUC of 0.809 (95% CI 0.777-0.841) and an accuracy of 67.5% for the validation cohort. Radiomics analysis could capture features of the four risk categories of GISTs. Meanwhile, this CT-based radiomics signature showed good diagnostic accuracy to distinguish between nonadvanced and advanced GISTs, as well as the four risk stratifications of GISTs. CONCLUSION: Our findings highlight the potential of a quantitative radiomics analysis as a complementary tool to achieve an accurate diagnosis for GISTs.

One-pot synthesis, structure and structure-activity relationship of novel bioactive diphenyl/diethyl (3-bromo-1-(3-chloropyridin-2-yl)-1H-pyrazol-5-yl)(arylamino)methylphosphonates.

BACKGROUND: N-Pyridylpyrazole derivatives have received continuous attention in agrochemical research during the last decade owing to their remarkable insecticidal or fungicidal potentials. To look for novel heterocyclic agrochemicals for increasing production of agriculture, a series of novel α-aminophosphonate derivatives containing N-pyridylpyrazole moiety were synthesized. RESULTS: The structures of the title compounds were confirmed via melting point, IR, 1 H NMR, 13 C NMR, 31 P NMR, HRMS and elemental analysis. The single crystal structure of diethyl (3-bromo-1-(3-chloropyridin-2-yl)-1H-pyrazol-5-yl)(2,6-dimethylphenylamino)methylphosphonate (compound 12b) was first reported. Moreover, the bioassays displayed that the title compounds exhibited modest or weak insecticidal activities against oriental armyworm at 200 µg mL-1 . The first investigation on the fungicidal potential of chlorantraniliprole showed no significant activities towards the six tested fungi found in this study, however, most of the title compounds displayed apparent in vitro fungicidal activity against some plant fungi, in particular excellent activities towards Physalospora piricola. Compounds 11a and 11b had EC50 values of 18.8 and 17.4 µg mL-1 , respectively, which were comparable with that of fungicide control triadimefon (EC50  = 24.7 µg mL-1 ) against Physalospora piricola. In addition, some compounds exhibited modest in vivo control efficacy at 0.5 mg mL-1 towards Sclerotinia sclerotiorum (11b: 30.1(±1.8)%), Rhizoctonia cerealis (11a: 20.4(±2.1)%; 11b: 30.2(±2.2)%), and Erysiphe graminis (11a: 30.3(±1.8)%; 12d: 40.2(±0.9)%). CONCLUSION: Compounds 11a, 11b and 12d could be promising new lead structures for the development and discovery of novel fungicides towards Physalospora piricola and Erysiphe graminis. The structure-activity relationship (SAR) analysis provided useful guidance and new understanding for the design of novel pyridylpyrazole-containing agrochemicals. © 2019 Society of Chemical Industry.

Chemical synthesis, crystal structure, versatile evaluation of their biological activities and molecular simulations of novel pyrithiobac derivatives.

Since pyrithiobac (PTB) is a successful commercial herbicide with very low toxicity against mammals, it is worth exploring its derivatives for an extensive study. Herein, a total of 35 novel compounds were chemically synthesized and single crystal of 6-6 was obtained to confirm the molecular structure of this family of compounds. The novel PTB derivatives were fully evaluated against various biological platforms. From the bioassay results, the best AHAS inhibitor 6-22 displayed weaker herbicidal activity but stronger anti-Candida activity than PTB did. For plant pathogenic fungi, 6-26 showed excellent activity at 50 mg/L dosage. Preliminary insecticidal activity and antiviral activity were also observed for some title compounds. Strikingly, 6-5 exhibited a promising inhibitory activity against SARS-CoV Mpro with IC50 of 4.471 µM and a low cellular cytotoxicity against mammalian 293 T cells. Based on the results of molecular modeling, HOMO-1 was considered to be a factor that affects AHAS inhibition and a possible binding mode of 6-5 with SARS-CoV Mpro was predicted. This is the first time that PTB derivatives have been studied as biological agents other than herbicides. The present research hence has suggested that more attentions should be paid to compounds belonging to this family to develop novel agrochemicals or medicines.

The impact of adaptive iterative dose reduction 3D on the improvement of shoulder image quality in head and neck CTA.

OBJECTIVE: The aim of this study was to determine the impact of adaptive iterative dose reduction 3 D (AIDR3D) on the improvement of shoulder image quality in low-radiographic dose head and neck CT angiography (CTA). MATERIALS AND METHODS: Ninety patients who underwent CTA examination were randomly divided into two groups, namely group A (n = 45) and B (n = 45). Patients in group A were scanned under 120 kV and 300 mA, with images reconstructed by filtered back projection (FBP), and patients in group B were scanned under 80 kV and auto mA with images reconstructed by AIDR3D. Image quality was accessed by two experienced radiologists. The noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of common carotid artery (CCA) at C7 level, and radiation dosage were compared between the two groups. RESULTS: The score of CCA in group B was significantly higher than group A (p < 0.05), and there were no significant differences in the scores of carotid sinus and internal carotid artery between the two groups (p > 0.05). The score of intracranial artery in group B was lower than that of group A, however, the image quality in group B can meet the requirement of clinical diagnosis. The noise value of CCA at C7 level in group B was significantly lower than that of group A (p < 0.05). SNR and CNR values of CCA at C7 level in group B were significantly higher than those of group A (p < 0.05). Effective radiation dose in group B was significantly decreased compared with group A (p < 0.05). CONCLUSION: AIDR3D remarkably improved image quality in low-radiographic dose head and neck CTA over FBP, which made the low-dose CTA images meet the requirement of clinical diagnosis.

Acute Kidney Injury in Critically Ill Patients with Sepsis: Clinical Characteristics and Outcomes.

Objective: The objectives of this study were to examine the clinical profile of critically ill patients with septic acute kidney injury (AKI) and to investigate clinical characteristics associated with the outcome of patients. Methods: Data from 582 critically ill patients were collected and retrospectively reviewed. Patients were divided into two groups: without AKI development and with AKI development. Baseline characteristics, laboratory, and other clinical data were compared between these two groups, and correlations between the characteristics and AKI development were examined. Patients with AKI development were further divided into two groups according to the survival outcome, and variables associated with the outcome were determined. Results: AKI was developed in 54.12% (n = 315) of patients, and these patients had blood pressure, SOFA score, APACHE II score, GCS, and various blood chemistry and hematology characteristics significantly different from the patients without AKI. Demographic characteristics (e.g. age and weight) were comparable between the two groups of patients. Among the 315 patients with AKI, 136 of them died during the study period. Multivariate logistic regression analysis revealed that the outcome of patients was associated with lung infection, coagulation system dysfunction, staphylococcus aureus infection, and use of various treatments (epinephrine, norepinephrine, and the use of mechanical ventilation) after AKI development. Conclusion: AKI occurred in approximately half of the critically ill patients admitted to ICU. The site and type of infections, as well as the use of vasopressor agents, were associated with the outcome.

Craniocervical computed tomography angiography with adaptive iterative dose reduction 3D algorithm and automatic tube current modulation in patients with different body mass indexes.

The aim of this study was to investigate the feasibility of head and neck computed tomography angiography (CTA) using the 80-kV tube voltage and the adaptive iterative dose reduction (AIDR) 3D algorithm in patients with different body mass indexes (BMIs).From November 2016 to January 2017, 128 consecutive patients scheduled for head and neck CTA examinations were randomized into the 100-kV group (n = 60) and the 80-kV group (n = 68). Both groups used the automatic tube current modulation technique and the AIDR 3D algorithm. The patients were further grouped as slender (BMI < 22 kg/m), normal weight (22 kg/m≤BMI < 25 kg/m), and overweight (BMI ≥25 kg/m). The image quality and the radiation dose of each subgroup were analyzed.The images of the head and neck vessels and the brain tissue obtained with 100 kV were all of diagnostic quality. Slender and normal weight patients imaged with 80 kV also produced images of diagnostic quality. However, 80 kV in the overweight patients failed to produce images of diagnostic quality. The radiation dose in the patients imaged with 80 kV was significantly decreased in comparison with those imaged with 100 kV. The effective dose was 0.36 ±â€Š0.06 and 0.41 ±â€Š0.05 mSv in the slender and normal weight patients imaged with 80 kV.Head and neck CTA scanning with 80 kV, automatic tube current modulation, and AIDR 3D algorithm can produce high quality images with reduced radiation dose in slender or normal weight patients.

Application value of iterative reconstruction with CTA to intractable headache patients.

Application value of iterative reconstruction with computed tomographic angiography (CTA) in the patients with intractable headache was investigated. One hundred and eighty patients with headache, who were admitted and treated in Cangzhou Central Hospital, were selected to undergo CTA scan. The patients were divided into group A, B and C according to different scanning conditions and data reconstruction techniques. In group A, the scanning parameters were 120 kV and 300 mA, and filtered back projection (FBP) algorithm was used for data reconstruction. In group B, the scan parameters were 100 kV and automatic milliamperes. Further, adaptive iterative dose reduction via three-dimensional processing (AIDR-3D) was used for data reconstruction. In group C, the scan parameters were 80 kV with automatic milliamperes, and AIDR-3D technique was utilized for data reconstruction. The CT value, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective assessment score of image quality and radiation dose of the three groups of images were compared. There were significant differences in CT values, standard deviation (SD) values, SNRs and CNRs of different vessel segments and muscles among the three groups (P<0.05). The image assessment scores at the levels of the atlas and C7 vertebra as well as those of the brain parenchyma in the three groups had notable differences (P<0.05). However, they showed no differences at the level of the C4 vertebra (P>0.05). Further, significant differences were observed in volume computed tomography dose index (CTDIvol), dose-length product (DLP) and effective dose (ED) (P<0.05). In conclusion, for patients with intractable headache, the image quality of the CTA scan using AIDR-3D reconstruction method showed better results over FBP reconstruction method. Further, best results were observed when the scan parameters were 100 kV, automatic milliamperes and the data reconstruction was performed by AIDR-3D.

Performance of Cardiac Magnetic Resonance Imaging for Diagnosis of Myocarditis Compared with Endomyocardial Biopsy: A Meta-Analysis.

BACKGROUND Cardiac magnetic resonance imaging (CMRI) is considered to be useful for the diagnosis of myocarditis, and the Lake Louise Criteria (LLC) has been proved to be of significance as the standard of diagnosis. However, the diagnostic performance of LLC-based CMRI for myocarditis compared with endomyocardial biopsy (EMB) has not been quantitatively evaluated in a meta-analysis. MATERIAL AND METHODS The databases PubMed, Cochrane's Library, and EMBASE were searched to identify studies on LLC and its individual components for the diagnosis of myocarditis. EMB was the control reference. The sensitivity, specificity, and positive and negative diagnostic likelihood ratios were calculated with a random-effects model. The area under the receiver operating characteristic curve (AUC) was estimated to show overall effectiveness. RESULTS We included 9 cohorts (614 patients) of patients with suspected MC. The combined sensitivities, specificities, and AUCs for T1-weighed global relative enhancement were 0.66, 0.73, and 0.71; for T2-weighed edema ratio they were 0.52, 0.73, and 0.72; for the late gadolinium enhancement, they were 0.70, 0.57, and 0.67; and for LLC-based CMRI they were 0.70, 0.56, and 0.70, respectively. Subgroup analysis indicated that the sensitivities, specificities, and diagnostic accuracies of LLC and its individual component-based CMRI seemed to be similar in patients with acute or chronic myocarditis. Results of the Deeks' funnel plot asymmetry test showed no significant publication bias among the studies. CONCLUSIONS CMRI based on LLC or its individual components seems to have moderate accuracy in diagnosis of acute or chronic myocarditis.