Objective To investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoff value for the mortality in different age groups in critically ill patients.Methods A retrospective study was conducted.295 patients admitted to the intensive care unit (ICU) of 401st Hospital of PLA from January 2011 to October 2012 were divided into two groups according to age [group with age＜65 years old (n=105) and group with age≥ 65 years old (n =190)].The concentrations of serum NT-proBNP,hematocrit (HCT),procalcitonin (PCT),C-reactive protein (CRP),serum creatinine (SCr),estimated glomerular filtration rate (eGFR),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and probability of survival (PS) were recorded within 24 hours.The primary outcome was ICU mortality.Receiver operator characteristic curve (ROC curve) was used to evaluate the value of NT-proBNP for predicting the mortality.Results ① There were no significant differences in the length of stay in ICU,mechanical ventilation rate,the mortality,the incidence of cardiovascular disease,digestive disease,neurologic disease,and the number of patients having received operation,HCT,PCT and CRP between the two groups (all P＞0.05).The percentage of the male,the APACHE Ⅱ score,the percentage of respiratory disease,and NT-proBNP in group with age ≥ 65 years old were higher than those of the group with age ＜ 65 years old [the percentage of the male:51.6％ vs.33.0％,x2=9.093,P=0.003; APACHE Ⅱ score:22.94 ±8.10 vs.19.44 ±8.51,Z=-3.259,P=0.001; the percentage of respiratory disease:29.47％ vs.17.14％,x2=5.472,P=0.024; NT-proBNP(ng/L):5 859.00(2 050.75,23 802.75) vs.2 882.00 (275.15,6 236.00),Z=-5.514,P=0.000]; PS,the percentage of patients having multiple injuries and other diseases and eGFR in group with age ≥65 years old were lower than those of the group with age ＜65 years old [PS:59.0 (31.5,79.0)％ vs.70.0 (40.0,84.0),Z=-3.431,P=0.001; the percentage of multiple injuries:0.53％ vs.17.14％,x2=30.987,P=0.000; the percentage of other disease:5.79％ vs.13.33％,x2=4.962,P=0.030; eGFR (ml·min-1· 1.73 m-2):81.07 (45.77,131.80) vs.95.54 (33.64,165.55),Z=-2.214,P=0.027].② The area under the ROC curve (AUC) [95％ confidence interval (95％ CI)] of NT-proBNP in patients with age＜65 years old was significantly higher than that of group with age≥65 years old and the entire group [0.825(0.738-0.892) vs.0.664 (0.592-0.731) and 0.725 (0.670-0.775),Z1 =-2.835,P1 =0.005; Z2=-1.995,P2=0.046].③ The sensitivity (76.]0％ vs.64.10％),specificity (82.35％ vs.67.12％),positive predictive value (90.0％ vs.75.8％),and negative predictive value (62.2％ vs.53.8％) with cutoff value of NT-proBNP (2 882 ng/L) in group with age ＜65 years old were significantly higher than those with NT-proBNP cutoff value (6 062 ng/L) in group with age ≥ 65 years old.Conclusion NT-proBNP cutoff value in different age groups for the prediction of mortahty in the critically ill patients maybe more objective and accurate.

Objective To improve the safety of surgery,the application of indocyanine green fluorescein(ICG)angiography in intracranial aneurysm surgery was investigated.Methods Fifty cases of intracranial aneurysms were retrospectively analyzed.All the patients were received ICG angiography before and after intracranial aneurysm clipping.The efficiency of the surgery was evalu-ated with CT angiography(CTA)and(or)digital subtraction angiography(DSA).The postoperative follow-up was conducted using Glasow outcomes score(GOS).Results Of the 50 patients,3 cases of aneurysmal neck remnant,one case of parent arteries steno-sis,one case of nearby branch stenosis and two cases of “false-negative”were observed after ICG angiography.The clips were adjus-ted until the satisfactory blood flew was restored.Postoperative CTA and(or)DSA confirmed the results of intraoperative ICG an-giography.Of the 40 patients underwent follow-up,GOS score was 5 in 30 cases,4 in 7 case,3 in 2 case and 2 in 1 case.Conclusion ICG angiography is a useful way to assess the clipping of aneurysms,blood flew of parent arteries and nearby branches during the aneurysm surgery.It could raise the safety of surgery and further improve the clinical outcomes of intracranial aneurysms.

Objective:To analyze the clinical value of 18F-FDG PET/MR for precise localization of epileptogenic foci in patients with refractory epilepsy. Methods:From February 2019 to December 2021, 81 patients (52 males, 29 females; age (30.0±10.9) years) with refractory epilepsy confirmed in Ruijin Hospital Shanghai Jiao Tong University School of Medicine were retrospectively enrolled. All patients underwent preoperative PET/MR exam, and the possible position of the epileptogenic foci were determined by PET/MR imaging and pre-surgical evaluation, then the stereoelectroencephalography (SEEG) electrodes were implanted. Surgery was performed, and outcome was assessed by using a modified Engel classification two years after surgery. χ2 test was used to compare the detection rates of MRI and PET/MR fusion imaging in localizing epileptogenic foci and the detection rates of epileptogenic foci in temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) by PET/MR. Results:MRI correctly localized seizure foci in 38 patients, with the detection rate of 46.91%(38/81), while PET/MR detected seizure foci in 73 patients, with the detection rate of 90.12%(73/81; χ2=35.05, P<0.001). There were 63 TLE and 18 ETLE patients. The detection rate of PET/MR in localizing seizure foci in TLE patients was 95.24%(60/63), which was significantly higher than that in ETLE patients (13/18; χ2=5.94, P=0.015). After 2 years follow-up, the postoperative efficacy rate of TLE patients with Engel grades Ⅰ-Ⅱ was 76.19%(48/63), which was 13/18 of ETLE patients ( χ2=0.12, P=0.731). Conclusion:Hybrid PET/MR imaging can accurately locate epileptogenic foci, especially for MRI negative lesions, which provides precision imaging information for surgical planning and improves surgical success rate.

Objective:To explore the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/MR imaging for liver metastasis. Methods:A retrospective analysis of 75 cases (46 males, 29 females; age (58.9±14.3) years) with suspected liver metastases from January 2020 to October 2020 in Ruijin Hospital were performed. All patients underwent PET/MR and enhanced upper abdominal CT scans. Diagnostic efficacies of enhanced CT, PET, MR and PET/MR for liver metastases (based on lesions and patients respectively) were calculated and compared (McNemar test).Results:A total of 306 liver lesions were detected in 75 patients, of which 179 lesions in 45 patients were confirmed as liver metastases through follow-up or pathology. In lesion-based analysis, the sensitivities of enhanced CT, PET, MR and PET/MR were 74.9%(134/179), 60.3%(108/179), 98.9%(177/179) and 100%(179/179), with specificities of 96.9%(123/127), 100%(127/127), 92.9%(118/127) and 92.1%(117/127), respectively. The diagnostic efficacy of PET/MR was significantly higher than that of enhanced CT and PET ( χ2 values: 51.000 and 81.000, both P<0.001), but there was no statistical difference between PET/MR and MR ( χ2=2.000, P=0.368). In patient-based analysis, the sensitivities of enhanced CT, PET, MR and PET/MR were 82.2%(37/45), 84.4%(38/45), 95.6%(43/45) and 100%(45/45), with specificities of 86.7%(26/30), 100%(30/30), 70.0%(21/30) and 70.0%(21/30), respectively. The diagnostic efficacies of enhanced CT and PET were statistically different from PET/MR ( χ2 values: 13.000 and 16.000, both P<0.05), but there was no statistical difference between MR and PET/MR ( χ2=2.000, P=0.368). Conclusions:Compared with enhanced CT, PET and MR, 18F-FDG PET/MR has a higher detective rate for liver metastases. The overall diagnostic efficacy of 18F-FDG PET/MR is better than enhanced CT and PET alone, but similar to MR.

Objective:To explore the added value of T 1-weighted stack-of-stars volumetric interpolated body examination (StarVIBE) sequence on PET/MR image quality. Methods:A retrospective analysis was performed on 60 patients (42 males, 18 females; age 11-86 (58±12) years) who underwent 18F-FDG PET/MR examination and with positive PET results in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from April 2020 to April 2021. All patients completed StarVIBE sequence collection, and volumetric interpolated body examination (VIBE) sequence was used as control. StarVIBE and VIBE sequence images were evaluated independently using five-point method by two physicians. The evaluation was carried out from six aspects: lesion display, lesion boundary display, vascular around lesions display, fusion level with PET image, image artifact and overall image quality. Wilcoxon signed rank test was used to compare the image quality of the two sequences, and Kappa test was performed to assess the consistency of the image quality scores between the two physicians. Results:There were 26 cases with cervical lesions, 14 cases with chest lesions, 7 cases with abdomen lesions and 13 cases with pelvic lesions. The scores of lesion display (4.0(3.8, 4.5) vs 3.5(3.0, 4.0)), lesion boundary display (4.0(4.0, 4.0) vs 3.0(3.0, 3.5)), vascular around lesions display (5.0(4.0, 5.0) vs 4.0(3.5, 4.5)), fusion level with PET image (5.0(5.0, 5.0) vs 4.5(4.0, 5.0)), image artifact (4.5(4.0, 5.0) vs 4.5(4.0, 5.0)) and overall image quality (5.0(4.0, 5.0) vs 4.0(4.0, 4.0)) of StarVIBE sequences were better than those of VIBE sequences ( z values: 3.77-6.54, all P<0.001). On the vascular around the lesions display, the scores of StarVIBE were significantly better than those of VIBE sequence in the neck (5.0(4.5, 5.0) vs 3.0(2.7, 3.5); z=4.49, P<0.001) and chest (4.5(4.3, 4.7) vs 4.0(3.6, 4.3); z=3.10, P=0.002). As for image quality, the scores of StarVIBE were also significantly better than those of VIBE in neck (5.0(4.5, 5.0) vs 4.0(3.7, 4.5); z=4.36, P<0.001) and chest (5.0(5.0, 5.0) vs 4.0(4.0, 4.5); z=3.02, P=0.003). In abdominal lesions, the score of StarVIBE was higher than that of VIBE in blood vessels (4.5(3.5, 5.0) vs 4.0(3.5, 4.5); z=2.07, P=0.038), and there was no difference between score of overall image quality (4.0(3.7, 4.5) vs 4.0(3.5, 4.5); z=0.27, P=0.785). The score of overall image quality of pelvic StarVIBE sequence was better than that of VIBE sequence (5.0(4.5, 5.0) vs 4.0(4.0, 4.5); z=2.12, P=0.034). Kappa value of image quality score between two physicians was 0.554, indicating moderate consistency. Conclusion:In whole-body PET/MR imaging, StarVIBE sequence can significantly improve the image quality of cervical, thoracic and pelvic lesions when comparing with VIBE sequence.

Objective:To investigate the effects of severe famine exposure during early life on their later adult obesity/central obesity.Methods:We recruited 4 495 subjects who were born before and during 3 years of unpredictable natural disasters in China and from Guiyang subcenter of the Risk Evaluation of cAncers in Chinese diabeTic Individual: a lONgitudinal (REACTION) Study for data analysis. The subjects were divided into childhood exposure group(born from October 1, 1954 to September 30, 1956, n=947), infant exposure group(born from October 1, 1956 to September 30, 1958, n=939), fetal exposure group(born from October 1, 1959 to September 30, 1961, n=525), and control group(born from October 1, 1952 to September 30, 1954 and from October 1, 1962 to September 30, 1964, n=1 525) according to their birth date. Obesity was defined as body mass index (BMI)≥28 kg/m 2, and central obesity was defined as waist circumference≥90 cm in men and ≥85 cm in women. We used logistic regression models to assess the effect of severe famine exposure on adult obesity/central obesity. Results:After adjusting for confounding factors, we found that men in the fetal exposure group had higher risk of adult obesity than the control group( OR=2.817, 95% CI 1.120-7.088, P=0.028), women in the fetal exposure group( OR=2.383, 95% CI 1.517-3.743, P=0.000), and infant exposure group( OR=1.554, 95% CI 1.039-2.324, P=0.032) had higher risk of adult obesity than the control group. In addition, compared with the control group, the male fetal exposure group had an increased risk of adult central obesity ( OR=2.440, 95% CI 1.253-4.752, P=0.009), which was unfound in females. Conclusion:Severe famine exposure during earlylife, especially in fetus and female infancy, increases the risk of obesity in their adulthood. In addition, males who experienced severe famine in their fetuses period may have higher risks of central obesity when reaching adulthood.