Objective To analyze the related factors and the independent risk factors of death in patients with multiple injuries. Methods Data of 651 patients with multiple injuries treated in our hospital from June 2012 to June 2015 were retrospectively analyzed. According to the outcomes, patients were divided into effective group (n=608) and death group (n=43). Data of gender, age, cause of injury, the primary diseases related with the trauma, ISS score, number of trauma, time from injury to the treatment and the body parts of injury were compared between two groups. Logistic regression analysis was used to analyze the risk factors of death in multiple trauma patients. Results The proportion of patients≥60 years old, ISS score≥16 points, the number of trauma≥4, a major brain injury and time of trauma to the treatment ≥3 h were higher in death group than those of effective group (P<0.05). The independent risk factors for emergency death in multiple injuries included patients≥60 years old, major brain injury, ISS score ≥16 points and time of trauma to the treatment ≥ 3 h. The cause of death in patients with craniocerebral trauma (cerebral laceration) accounted for up to 27.91%(n=12), intracranial hematoma accounted for 20.93% (n=9), and traumatic hemothorax accounted for 11.63% (n=5). Conclusion The related factors and independent risk factors should be paid attention to doctors in emergency department, and the emergency plan should be made to reduce the death rate of emergency patients with multiple injuries.

Objective To investigate the value of MR imaging in detecting occult fractures. Methods Sixteen cases with acute trauma were studied using radiography and MR imaging, three cases also underwent CT examinations. Three fractures occurred in the femur condyle, 8 in the proximal tibia and 5 in the thoracolumbar spine. Results All sixteen cases had normal radiographic results. In 11 cases with femur condyle and tibia occult fracture, MR imaging demonstrated linear low signal in the subcortical region in 3 cases and irregular low signal from articular faces to shaft in 8 cases on both T 1WI and T 2WI, and high signal changes around low signal were seen on T 2WI, and the width of low signal was less than 4 mm on both T 1WI and T 2WI. The high signal in T 1 weighted-Fat saturated sequence was more remarkable and wider than that on T 2WI. 3 cases with CT scanning showed no fracture signs. In five cases with thoracolumbar vertebral occlut fractures, MR imaging demonstrated horizontal linear low signal in the center of vertebra on both T 1WI and T 2WI, and high signal changes around low signal were seen on T 2WI. Conclusions MR imaging could early determine the diagnosis of occult fractures. MRI should be the next examination of choice when plain films fail to reveal suspected fractures in the setting of suggestive symptoms and positive physical examination.

Objective To discuss the safety of percutaneous puncture drainage for liver abscess in patients with blood coagulation dysfunction. Methods A total of 85 patients with liver abscess, who were admitted to authors’ hospital during the period from January 2013 to January 2014 to receive ultrasound-guided percutaneous puncture drainage, were included in this study. According to the international normalized ratio of prothrombin time≥1.5 and platelet count≤50 ×109/L, the patients were divided into group A (normal coagulation group,n=67) and group B (coagulation dysfunction group,n=18). The occurrence of postoperative complications was recorded and the results were compared between the two groups. Results In both groups, no statistically significant difference in hemoglobin level existed between preoperative level and postoperative one, and no bleeding complications occurred in all patients after the procedure. Conclusion For patients with liver abscess complicated by blood coagulation dysfunction, percutaneous puncture drainage treatment is safe and reliable.

Objective To explore the value of susceptibility weighted imaging (SWI) in the quantitative analysis of ischemia-reperfusion injury (IRI) of the rabbit kidneys . Methods Thirty New Zealand white rabbits were randomly assigned to IRI group (n=24, operation with clamping) and Sham group (n=6, operation without clamping). Left renal ischemia-reperfusion was performed by occlusion (calmping) of the left renal arterial for 60 minutes, followed by reperfusion. All the rabbits underwent MRI including T2WI and SWI before and 0.5 h, 12 h, 24 h and 48 h after the establishments of models . Three rabbits in IRI group were randomly sacrificed 0.5 h, 12 h, and 24 h after the establishment of model. The rest of the rabbits in IRI group and 6 rabbits in sham group were sacrificed for pathological examination 48 h after the establishment of model All specimen were cut into slices and stained with hematoxylin-eosin (HE). Region of interest ( ROI) was manually created by outlining the inner medulla, inner stripe of outer medulla, outer stripe of outer medulla, and cortex, then relative signal-to-noise ratio of the kidney (rSNR) to muscle in SWI sequence was recorded. and compared with histopathologic features. One-way ANOVA was performed to compare difference of rSNR to muscle in respective location at 5 time-points between Sham group and IRI group, and the differences between groups were tested using repetitive measure analysis of variance, repetitive measure analysis of variance was performed to compare difference of rSNR to muscle in respective location at respective time-points between Sham group and IRI group. Results rSNR value in the inner medulla 0.5 h, 12 h, 24 h and 48 h after the establishments of models were 0.28 ± 0.04, 0.98 ± 0.14, 0.69 ± 0.07, 0.57±0.06, 0.43±0.03, respectively (F=69.82,P<0.01), the inner stripe of outer medulla at the five time-points 0.08 ± 0.03, 0.57 ± 0.05, 0.32 ± 0.07, 0.16 ± 0.02, 0.04 ± 0.01, respectively(F=16.59,P<0.01), the outer stripe of outer medulla were 0.31 ± 0.04, 0.86 ± 0.09, 0.65 ± 0.07, 0.55 ± 0.06 0.43 ± 0.04(F=67.52,P<0.01), respectively,the cortex 0.05±0.01, 0.80±0.04, 0.68±0.07, 0.47±0.07, 0.36±0.08, respectively(F=118.96,P<0.01). The difference of the rSNR was statistically significant in the inner medulla, inner stripe of outer medulla, outer stripe of outer medulla, and cortex at the five different time-points. The differences between two groups were significant (F=206.29, 14.25, 42.8, 39.12, P all<0.05). The pathological findings in Sham group included normalglomerular structure l, clear cavity of tubular, no interstitial hyperemia and edema. The pathological findings in IRI group demonstated, at 0.5 h after IRI, Bowman's capsule cavity expansion, glomerular shrinkage, swelling of renal tubular epithelial cells, vacuoles degeneration, the tube cavity expansion, interstitial edema and congestion ecta became slender, andat 12 h after IR, Bowman's capsule expansion became more obvious, foam degeneration of renal tubular epithelial cells, apoptosis, partial loss of the brush border of the proximal convoluted tubule, formation of protein cast, and a small amount of inflammatory cells appeared in the renal interstitium, swelling of endothelial cells of the vasa recta, congestion of small vessels, and at 24 and 48 h after IRI, more serious injury of renal tubular in the outer stripe of outer medulla , massive necrosis of renal tubular epithelial cells, apoptosis, parts of the renal tubular had the contour lines, and renal tubular outline, increment in inflammatory cells, red cell and protein cast. Conclusion rSNR of SWI in the inner medulla, inner stripe of outer medulla, outer stripe of outer medulla, and cortex of the kidney varies with the degree of IRI over time, and is consistent with corresponding pathological feature, suggesting SWI is useful imaging tool to detect early damage of renal IRI quantitatively.

Objective:To explore the feasibility of chemical exchange saturation transfer (CEST) imaging at 3.0 T MRI in quantifying renal redox metabolism in vitro models and experimental animals.Methods:Redox metabolites in vitro models with physiological concentrations were prepared, including reduced metabolites (glutamate, alanine, glutathione) and oxidized metabolites (2-ketoglutarate, pyruvate, glutathione disulfide, ammonium hydroxide). CEST examinations were performed at 3.0 T MRI. The imaging parameters were as follows: CEST images with different saturation pulse intensity (B 1) (1, 2, 3, 4 μT) and a fixed radio frequency (RF) duration of 2 000 ms; CEST images with different RF durations (1 500 and 2 000 ms) were acquired with a fixed B 1 value of 2 μT to obtain the optimal scanning parameters. CEST examinations with optimized parameters were performed on the left kidneys of seven healthy rabbits, and the differences in magnetic resonance ratio asymmetry (MTR asym) between rabbit renal cortex and outer medulla were measured. A paired t-test was used to compare the differences. Results:The optimal B 1 for CEST examination of redox metabolites was 2 μT, and the optimal RF duration was 2 000 ms. The MTR asym peaks of glutathione disulfide, glutathione, glutamic acid, and alanine were at 3.75, 3.5, 3, and 1.5 ppm, respectively. The MTR asym peaks of pyruvate, 2-ketoglutarate, and ammonium hydroxide were at 1 ppm. The MTR asym peak values of reduced metabolites were higher than those of oxidized metabolites. When the B 1 value was 2 μT and the RF duration was 2 000 ms, the MTR asym signal of the renal cortex was (2.60±1.10) %, (2.86±1.32) %, (3.04±1.06) %, and (2.98±0.91) % at 1, 3, 3.5, and 3.75 ppm, respectively. The MTR asym signal of the outer medulla was (1.00±0.56) %, (2.43±0.94) %, (2.29±0.88) % and (1.98±0.58) %, respectively. The MTR asym signal of the renal cortex was higher than that of the outer medulla, and the differences were statistically significant ( t=3.04, P=0.023; t=2.56, P=0.043; t=3.50, P=0.013; t=3.45, P=0.014). Conclusion:CEST imaging at 3.0 T MRI can be used to quantitatively evaluate redox metabolism of healthy rabbit kidneys in vitro model and normal experimental rabbits.

Objective:To explore the relationship between MRI texture features with the histopathology in early renal ischemia-reperfusion injury (IRI).Methods:Forty-eight healthy New Zealand rabbits were randomly divided into the IRI group ( n=40) and the sham group ( n=8). As for the IRI group, rabbits underwent the left kidney surgery by clamping the left renal artery for 60 mins and then releasing the clamp to establish renal IRI model. The rabbits in the sham group underwent the same operation, but without clamping the left renal artery. MR examination were performed before and at 1 h, 12 h, 24 h, and 48 h after the operations. As for the IR group, eight rabbits were randomly sacrificed at each time point immediately after MR exam. The eight rabbits in the sham group were sacrificed after MR exam at 48 h after the operation. The left kidney was harvested for histopathological examination. The single item score of the histopathological features, the microvessel density (MVD), and the pathological total score were calculated. Differences in the single item score of the histopathological features, MVD, and the pathological total score among IRI group with different time points and sham group were determined using the Kruskal-Wallis test. MRI texture features of the left kidney were extracted. Multiple dimensionality reduction for MRI texture features were performed, and the features associated with the pathological total score were selected. The relationship between MRI texture features with the single item score of the histopathological features and MVD was assessed by Pearson correlation coefficients. Results:There were significant differences in renal tubular brush border destruction, renal tubular epithelial edema, necrosis, cast, interstitial inflammatory cell infiltration, MVD, and the pathological total score in IRI group among the different time points (all P<0.05). T 2WI_S (3, -3) InvDfMom had the highest correlation with renal tubular brush border destruction, renal tubular epithelial edema, necrosis, and cast ( r=0.56, -0.58, 0.62, 0.69, all P<0.01). BOLD_S (4, -4) Correlat had the highest correlation with interstitial inflammatory cell infiltration ( r=0.63, P<0.01). SWI_S (4, 4) DifEntrp had the highest correlation with MVD ( r=0.61, P<0.01). Conclusion:MRI texture analysis can provide valuable information for evaluating early renal IRI.

Benign tumors of the parotid gland are common tumors of the head and neck. Surgical resection is considered the main treatment. For the treatment of benign parotid tumors, different surgical approaches can be applied based on many factors, such as tumor type, size, location, depth of tumor and patient requirements, such as improved periauricular incision and improved facial wrinkle removal incision, to achieve the best therapeutic effect. In parotidectomy, the facial nerve, great auricular nerve and parotid duct should be protected as much as possible to preserve the function of the nerve and gland and reduce postoperative complications. In addition, complications after parotidectomy, such as facial nerve injury, salivary fistula, Frey syndrome, postoperative facial depression, abnormal ear sensation and recurrence, should be actively prevented and treated early after the operation, consequently minimizing the impact on patients' postoperative life and improving patients' satisfaction with the operation.

Objective:To investigate the value of multimodal MRI radiomics in the preoperative prediction of Fuhrman nuclear grade of clear cell renal cell carcinoma (ccRCC).Methods:A total of 129 patients with ccRCC confirmed by pathology from April 2011 to April 2021 in Third Affiliated Hospital of Soochow University were collected, and the imaging and clinicopathological data were retrospectively analyzed. All patients were divided into training set ( n=90) and validation set ( n=39) at the ratio of 7∶3 using random indicator method. According to the postoperative pathological results, Fuhrman grades Ⅰ and Ⅱ were included in the low grade group (96 cases, 65 cases in the training set and 31 cases in the validation set), and Fuhrman grades Ⅲ and Ⅳ were included in the high grade group (33 cases, 25 cases in the training set and 8 cases in the validation set). Two radiologists manually delineated regions of interest (ROI) on T 1WI, T 2WI, Dixon-water, Dixon-fat, susceptibility weighted imaging (SWI), blood oxygen level dependent (BOLD) images, and 396 texture features were extracted from each ROI. In the training set, intra-class correlation coefficient, Mann-Whitney U test, minimum redundancy maximum relevance and least absolute shrinkage and selection operator method were used to reduce the dimension of features to obtain the best texture features. The logistic regression was used to develop the multimodal radiomics model, and the receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of the model in identifying high and low-grade ccRCC in training set and validation set. Results:Four SWI, one T 2WI and one BOLD texture features were selected for modeling. The areas under the ROC curve (95%CI) of the multimodal radiomics model for identifying high and low grade ccRCC in the training and validation sets were 0.859 (0.770-0.923) and 0.883 (0.740-0.964), with the specificity at 95.4% and 87.1%, the sensitivity at 68.0% and 87.5%, the accuracy at 87.8% and 87.2%, respectively. Conclusion:The multimodal MRI radiomics model based on T 2WI, SWI and BOLD images has high effectiveness in preoperative predicting Fuhrman nuclear grade of ccRCC.

Objective:To explore the evolution of CT characteristics of the "reversed halo sign" of pulmonary tuberculosis, and to further improve the recognition of its CT signs.Methods:Clinical and CT data of 12 patients with pulmonary tuberculosis who were clinically and pathologically confirmed and accompanied with CT manifestation of "reversed halo sign" in First Affiliated Hospital of Henan University of Science and Technology from August 2013 to April 2020 were analyzed retrospectively. Pathological and imaging contrastl analysis was performed on 1 patient undergoing surgical treatment.Results:Among 12 cases with "reversed halo sign", there were 2 cases with single lesion in unilateral lung, 2 cases with multiple lesions in unilateral lung, and 8 cases with multiple lesions in bilateral lungs. Three cases showed only "reversed halo sign", 9 cases showed both halo-like sign and uniform fireworks sign. "Tree-in-bud "sign was found in all 12 patients in the outer ring of the "reversed halo sign". Eight patients received three or more CT examinations, and six of them showed reduction of density and volume of the "reversed halo sign" after standardized anti-tuberculosis treatment. Under the natural course of the disease in two cases, the overall enlargement of the lesion was observed in 1 case, and the overall density of the lesion was reduced and the outer ring wall of the "reversed halo sign" was thinned in 1 case. The pathology of one case after surgical lobectomy showed granulomatous inflammatory nodules of varying sizes containing Langerhans nodule giant cells in the lung parenchyma. The typical caseous necrotic granulomatous nodules were rare here. The "reversed halo sign" showed dense Langerhans nodules in the outer ring, sparse central areas with fibrous hyperplasia and alveolar wall thickening.Conclusions:The outer ring of "reversed halo sign" of pulmonary tuberculosis shows as "tree-in-bud" sign, and its center shows as the fine reticulation pattern. After effective anti-tuberculosis treatment, both the overall density of "reversed halo sign" and the lesion size reduced. Finally, the lesions mostly present as as fine grid shadows for a long time.