Objective To explore the feasibility of low dose in MSCT thoracic angiography using Z-axis modulation. Methods The consecutive 60 patients were averagely divided into 3 groups and underwent thoracic angiography with a Toshiba Aquilion 16 scanner. The whole chest acquisition was commenced in automatic exposure control with Z-axis modulation 20-25 seconds after the contrast material was administered at the rate of 3.5-4. 0 ml/s. With the noise index (SD) as the variable, three study groups were classified as A (SD = 12) , B (SD = 15 ), and C (SD = 18 ). The mAs value per slice and the number of slices were recorded. The noises and artifacts of the axial images and the acceptability of CT angiogram were evaluated. The difference among the groups was compared by using ANOVA or nonparametric Kruskal-Wallis test. The threshold of the P value was 0. 05. Results The mean mAs value (46. 4 ± 15.6) mAs in group A was the highest but the SD value (21.6 ±7.7) was the lowest. The mean mAs value ( 37. 0 ± 13.5 ) and the SD value ( 24. 0 t 5.4 ) in group B were the mediate. The mean mAs value ( 20. 7 ±6.3) mAs in group C was the lowe(s)t but the SD value ( 30. 7 ± 6.9) was the highest ( H = 31. 390, P =0. 000). The middle slice images in all patients had the smallest mAs (40. 9,31.3,17. 1 for group A,B,C,respectively; F =9. 578, H =22. 230, F =21. 180,P =0. 000) and SD values( 16. 3, 20. 0,25.4 for group A,B,C, respectively; H = 28. 982, H = 20. 824, H = 24. 396, P = 0. 000). The acceptability of CT angiogram in all patients was excellent. The CT value of descending aorta in group A, B, and C was ( 335 ± 85 ) HU,(334 ±56)HU, and (427 ± 63 )HU, respectively. Conclusion Low dose in MSCT thoracic angiography using Z-axis modulation is feasible. We can use low dose (20 mAs, etc. ) for CT angiography when the contrast is significant.

Objective To examine the correlation of serum neutrophil gelatinase-associated lipocalin (NGAL) with dialysis adequacy,microinflammatory state and iron metabolism,and to assess the value of NGAL in identifying the dialysis adequacy in maintenance hemodialysis (MHD) patients.Methods A total of 150 MHD patients and 50 healthy control people were enrolled in the study.Clinical data were collected and serum NGAL,CRP,transferrin saturation,serum ferritin were measured.MHD patients were divided into adequacy group and non-adequacy group according to spKt/V value.Serum NGAL between two groups was compared and correlation of NGAL with spKt/V,inflammatory factors,and other clinical indexes was examined by Pearson,multivariate regression Logistic model and area under curve (AUC) of ROC.MHD patients were followed up for 3 months.Similar correlation analysis was carried out before and after follow up between two groups.Results Serum NGAL of MHD patients was higher compared to healthy people [(445.45±50.34) μg/L vs (50.02 ±6.45) μg/L].Among 150 MHD patients,95 were classified into adequacy group,while 55 into non-adequacy group according to spKt/V value.Serum NGAL was significantly higher in adequacy group as compared to non-adequacy group [(589.14±56.34) μg/L vs (360.13±46.23) μg/L,P＜0.05].Serum NGAL was positively correlated to spKt/V,CRP,TSAT [r=0.652,0.825,0.785,all P＜0.05],but not to serum ferritin.Serum NGAL was also correlated to spKt/V,CRP,TSAT by multivariate regression Logistic model.AUC showed that NGAL level could reflex the condition of dialysis adequacy.During the follow up,all adequacy patients remained the same adequacy status.Thirty-eight out of 55 non-adequacy patients were qualified for complete adequacy after intervention.The serum NGAL before and after intervention was (368.14±56.21) μg/L and (360.56±46.23) μg/L respectively without significant difference.Conclusions Serum NGAL is obviously higher in MHD patients with dialysis adequacy compared to those without dialysis adequacy.Serum NGAL is positively correlated to spKt/V,CRP,TSAT.NGAL can reflex the condition of dialysis adequate in MHD patients.

Objective To explore the association of serum soluble Klotho (sKlotho) with nonfatal cardiovascular disease (CVD) and all-cause/CVD mortality in maintenance hemodialysis (MHD) patients.Methods A total of 132 MHD patients admitted during October 2011 were enrolled.Serum sKlotho was measured by ELISA.Demographic data,including age,gender and comorbid conditions,were obtained from their medical histories,and parameters including calcium,phosphorus and albumin were assessed.The occurrence time of nonfatal CVD and all-cause mortality were recorded during the 60 months follow-up.MHD patients were categorized into four groups according to the quartiles of sKlotho:group Ⅰ (sKlotho ＜ 361.34 ng/L),group Ⅱ (361.34 ng/L≤sKlotho＜ 398.81 ng/L),group Ⅲ (398.81 ng/L≤sKlotho＜445.99 ng/L) and group Ⅳ (sKlotho≥445.99 ng/L).Spearman correlation analysis and binary Logistic regression analysis were used to test the association between sKlotho and nonfatal CVD events.The impacts of sKlotho on all-cause mortality and CVD mortality were assessed by Kaplan-Meier method with log-rank test.Cox regression model was applied to evaluate the effect of sKlotho on MHD patients outcomes.Results All 132 MHD patients had sKlotho ranging from 304.02 ng/L to 550.62 ng/L.And 87 patients suffered from nonfatal CVD,with 192 episodes of nonfatal CVD during the follow-up period.The sKlotho had negative correlations with coronary artery disease (r=-0.286,P=0.001),congestive heart failure (r=--0.190,P=0.029),cerebrovascular accident (r=-0.240,P=0.006) and peripheral arterial occlusion (r=-0.243,P=0.005).The sKlotho were risk factors of coronary artery disease (OR=0.989,P=0.023) and peripheral artery occlusion (OR=0.988,P=0.046).35 patients died in the follow-up period,including 27 death from CVD.The all-cause mortality and CYD mortality rates were significantly different among four groups (P=0.036,P=0.047).Survival rates of all-cause death and CVD death varied among four groups (x2=8.076,P=0.044;X2=7.866,P=0.049).Patients in group Ⅳ had higher survival rates of allcause death and CVD death than those in group Ⅰ and group Ⅱ (all P ＜ 0.05).Multivariate Cox regression analyses revealed diabetes and age were independent risk factors for all-cause mortality and CVD mortality (all P ＜ 0.05),but sKlotho was not associated with the poor prognosis (HR=0.996,P=0.256;HR=0.996,P=0.287).Conclusions Patients with lower sKlotho have worse nonfatal CVD ratio,especially coronary artery disease and peripheral arterial occlusion.Reduced serum sKlotho is associated with all-cause and CVD mortality,but sKlotho is still not a predictive indicator of prognosis of MHD patients.

Objective To determine the relationship between the level of plasma homocysteine and coronary calcification in patients with different blood glucose levels. Methods By measuring plasma homocysteine and coronary calcification in 30 cases of diagnosed diabetes (T2D) ,29 cases of diagnosed impaired glucose tolerance (IGT) in patients and 27 cases with normal, we compared the level of plasma homocysteine and coronary calcification in patients with different blood glucose levels. Results We found significant diffieronces among three groups of the level of plasms homocysteine and coronary calcification (P ＜ 0.01). The plasma homocysteine levels were(19.31 ±3.17) μmol/L, (13.85 ± 1.62) μmol/L, (9.80 ± 1.78) μmol/L in the T2D,IGT and normal groups,respectively. The coronary calcification scores were 207.80 ± 154.10,63.24 ± 10.46,14.47 ± 5.16 in the T2D, IGT and normal groups, respectively. The plasma homocysteine level and coronary calcification score increased with the glycosylated hemoglobin rise in the normal,IGT and T2D groups((4.51 ±0.48)%, (6.13 ±0.31)% and (7.69 ±0.81)%, respectively). Conclusions The plasma homocysteine level is a strong independent predictor of type 2 diabetes and also an important factor of coronary artery event occurrence and develepment.

Objective To investigate the image quality and radiation dosage of the prospective ECG-triggered 256 multi-slice computer tomography (MSCT) angiography in accessing coronary artery (CA) on children.Methods Coronary arteries of ninety-three children were evaluated using prospective ECG-triggered 256-MSCT with the same system setting.Seventy-four patients had the heart rate records and a four-point scoring system was applied to study the capability of MSCT in detecting CA.The signal,noise and contrast-to-noise ratio (CNR) were analyzed to investigate the association of image quality with age (n =74).Then volumetric CT dose index (CTDIvol),dose-length product (DLP) and effective dose (E) were utilized to study the association of radiation dosage with age (n =93).Results On 74 patients with heart records,the detection rate for original,proximal,middle,distal and all 11 segments of CA was 100％,97％,92％,78％ and 91％,respectively.No influence of age was found on their detection (all P＞0.05).E of group A,B,C and D were 1.8,1.3,0.8 and 0.7 mSv,respectively.A strong negative correlation was found between E and age (r =-0.803,P ＜ 0.01).Higher DLP was found on elder patients,though no correlation was found between ages vs.DLP(r =0.124,P ＞ 0.05).No correlation was found between noise vs.age (r =0.041,P ＞ 0.05).Significantly larger signals,CNR and E(t =3.386,2.073,3.825,P ＜ 0.05) were found on younger patients (age ＜ 3 years).Conclusions Prospective ECG-triggered 256-MSCT has considerable performance for the evaluation of coronary arteries on children.However,children under the age of 3 are not recommended for this examinary,but for examination on children ≥ 8-year old,the tube current could be further needed.

Objective To explore the association between serum FGF23 and Klotho protein,and bone mineral density in maintenance hemodialysis (MHD) patients.Methods A total of 125 MHD patients admitted in the Hospital between January 2015 and November 2015 was enrolled.Their bone mineral densities of femur neck and lumbar spine were studied by dual-energy X-ray absorptiometry.These patients were divided into three groups as normal,osteopenic and osteoporotic,according to World Health Organization criteria based on bone mineral density T scores.Levels of serum FGF23,Klotho protein and 1,25(OH)2VitD3 were measured by ELISA.The parameters including calcium,phosphorus,and parathyroid hormone were assessed.Results The incidences of osteopenia and osteoporosis at the femur neck and lumbar spine in MHD patients were 82.40％ and 56.00％ respectively.No significant difference was found in the levels of serum FGF23 among normal,osteopenic and osteoporotic groups on the basis of femur neck and lumbar spine bone mineral density (P ＞ 0.05).No correlation was found between FGF23 and bone mineral density.There however were significant differences in the levels of serum Klotho protein among three groups on the basis of femoral neck bone mineral density (P ＜ 0.05).And the levels of Klotho protein in the osteoporotic group [(387.172±54.137) ng/L] were significantly decreased than those in normal group [(429.883±41.776)ng/L] and osteopenic group [(410.598±61.056) ng/L] (P ＜ 0.05).There were also significant differences in the levels of serum Klotho protein among three groups in terms of lumbar spine bone mineral density (P ＜ 0.05),while the levels of Klotho protein in the osteopenic group [(387.263 ± 53.255) ng/L] were significantly decreased than those in normal group [(417.108±56.179) ng/L] (P＜ 0.05).A positive correlation was found between Klotho protein and bone mineral densities of femur neck and lumbar spine.Multiple linear regression analysis showed that one of the main factors influencing the degree of bone mineral density in MHD patients was Klotho protein.Conclusions CKD-MBD with low BMD is common and widespread in hemodialysis patients.FGF23 has no direct effect on bone mineral density in MHD patients;while Klotho protein is correlated with the severity of bone mineral density.High-level Klotho protein may reduce the severity of CKD-MBD with low BMD in MHD patients.

Objective:To compare the nutritional status between alcoholic cirrhosis and viral cirrhosis,and to provide reference information for the nutritional support strategy.Methods:95 alcoholic cirrhosis and 260 viral cirrhosis patients were involved in the study.The patients were reviewed with NRS 2002 and SGA within 48 hours after admission.The general information and liver function parameters including gender,age,BMI,Child-Pugh score,ALB,PA and Hb were recorded.Results:The NRS 2002 nutritional risk rate of alcoholic cirrhosis and viral cirrhosis patients was 76.80％ and 65.00％,respectively.The SGA malnutrition rate of alcoholic cirrhosis and viral cirrhosis patients was 67.40％ and 61.90％,respectively.There was statistically significant difference between the two groups in gender,Child-Pugh A rate,ALB,PA,Hb and NRS 2002,while there was no significant difference in age,Child-Pugh B rate,Child-Pugh C rate,BMI and SGA.Conclusion:Nutritional dysfunction exists in both of the two types of liver cirrhosis.The nutritional risk rate and the anemia rate in alcoholic cirrhosis patients are significantly worse than those in viral cirrhosis patients.

The department of radiology, as one of the public platforms for standardized residency training, is very crucial to the training of high level clinicians and essential to improve quality of medical care. According to the present situation and existing problems of standardized residency training for the non-imaging professional residents in the department of radiology in China, combining with our practice, this article primarily explores the improvement of the rules and regulations, the specific arrangement of the rotation, daily and graduation examination forms, and training quality supervision, etc. We hope to improve the training quality of the non-imaging professional residents' rotation in the department of radiology and explore more suitable and effective medical educative strategies.

Objective To investigate the frailty in maintenance hemodialysis (MHD) patients and its influence factors. Methods A total of 127 adults undergoing hemodialysis from January 2015 and January 2016 in our center were recruited. Their clinical data and blood biochemical data were collected. Frailty was assessed using Fried's Frailty Phenotype. Quantification of coronary artery calcification (CACs) was determined by multi-slice spiral computed tomography (MSCT). According to the frailty scores, patients were divided into non-frailty, pro-frailty and frailty group. Their in clinical and biochemical index as well as CACs were compared. The correlations of frailty scores with above index were assessed by Spearman's correlation. Multiple logistic regression analysis was applied to evaluate the effect factors of frailty on MHD patients. Results Among 127 selected patients, 46(36.22%) patients without frailty, 45(35.43%) patients with pro-frailty, and 36(28.35%) patients with frailty. The age, diabetes, haemoglobin, albumin, pre-albumin, C-reactive protein, fibroblast growth factor 23 (FGF23), CACs and left ventricular end-diastolic dimension (LVEDD) of the 3 groups had statistical differences (all P<0.05). The degrees of calcification among 3 groups were also different statistically (F=31.769, P<0.001). In patients with MHD, frailty was positively correlated with age (r=0.545, P<0.001), diabetes (r=0.236, P=0.008), C-reactive protein (r=0.245, P=0.006), FGF23 (r=0.189, P=0.034) and CACs (r=0.396, P<0.001), while negatively correlated with haemoglobin (r=-0.257, P=0.004), albumin (r=-0.380, P<0.001), pre-albumin (r=-0.313, P<0.001). Age (OR=1.076), C-reactive protein (OR=1.176), albumin (OR=0.796) and artery calcification (OR=2.465) were independent influence factors for frailty in MHD patients (all P<0.05). Conclusions The prevalence of frailty is high among MHD patients. Frailty is associated with age, C-reactive protein, albumin and artery calcification in MHD patients.

Objective To investigate the feasibility of Region 4 Stork(R4S)project used for newborn screening by tandem mass spectrometry in China.Methods This retrospective study was performed among 362 822 neonates screened by tandem mass spectrometry from May 2015 to April 2016 in Zhejiang newborn screening center.Infants were grouped by screening result category: 83 true positive cases,360 554 true negative cases and 2 185 false positive cases.Raw data was uploaded into R4S website to perform postanalytical interpretive tools, then results were analyzed with interpretation rules.The comparisons of normal population percentiles were done at five selected percentiles between Zhejiang newborn screening center and R4S project with min-max normalization.Results Compared with cutoff system by using R4S project with interpretation rules,the positive predictive value increased from 3.7%to 8.3%,the specificity increased from 99.40%to 99.75%, and the false positive rate declined from 0.6% to 0.2%. The two cases of true positive hyperprolinemia were reported negative, and one case of β-ketothiolase deficiency was misdiagnosis.Totally 311 638 cases in true negative group were resolved by postanalytical interpretive tools,and the remaining 48 916 cases were excluded with interpretation rules.False positive cases were reduced to 897 cases.Results of percentiles comparison showed that levels of some markers were significantly different between zhejiang newborn screening center and R 4S project.Conclusions R4S project effectively improved the newborn screening performance, whereas leaded to a small number of misdiagnosis and missed diagnosis.Besides,many true negative cases should be excluded with interpretation rules.Optimization should be achieved based on local normal population.(Chin J Lab Med,2018,41:300-304)