Objective To assess the feasibility of using an automatic tube current modulation (ATCM)method to obtmn consistent image quality with reduced radiation dose for young children undergoing chest scans with a set of 64-slice spiral CT.Methods Fifry young children underwent chest scans on a GE 64-slice VCT with automatic tube current modulation.The noise index(NI)for this study group was set to 8 or 9 based on the proposed reference for pediatric chest imaging in our hospital.We compared image quality and radiation dose for the study group with the age-matched control group of 50 young children acquired with standard protocol of fixed-mAs(120 and 150 mAs for under 1 and above 1 year old,respectively).The volume CT dose index(CTDIvol)values were recorded for beth groups.Two experienced pediatric radiologists assessed image quality on a 5-point scale with 5 being the best.Scores greater than or equal to 3 were considered clinically acceptable.The degree of interobserver concordance was determined by Kappa statistics.Results The average objective image noise and CTDIvol for control group was(4.78±0.58)and(6.68±0.62)mGy,respectively.For the study group the mean value of objective mAs wag(41.6±11.6)(20-79 mAs)with mean CTDIvol of(2.34 4±0.71)mGy,and the use of ATCM produced mean noise of(7.84±0.66).The average CTDIvol with the use of NI of 8-9 was about 65% lower than that with the fixed mAs setting.The mean image quality score for the study group and control group was(3.46±0.40)and(4.65±0.46)respectively.All studies had acceptable image quality,and there was good inter-observer agreement in diagnostic acceptability(Kappa=0.474 and 0.536).Conclusion The automatic tube current modulation method could be used to obtain consistent image qualityfor young children undergoing 64-slice MSCT chest scans.With proper noise level setting(NI=8 or 9),one may obtmn clinically acceptable images with much reduced radiation dose.

Objective To evaluate 99Tcm-MIBI imaging in patients with hyperparathyroidism and its correlation with serum intact PTH level. Methods Seventy patients with suspicious hyperparathyroidism underwent 99Tcm-MIBI imaging and serum intact PTH measurement. Abnormal increased uptake lesion appeared at early phase and even more clearly at delayed phase was considered as the positive by 99Tcm-MIBI imaging. A cut-off value of PTH ＞ 88 ng/L was taken as the criteria for hyperparathyroidism diagnosis. The diagnostic efficacy of 99Tcm-MIBI imaging combined with serum PTH measurement was assessed according to post-surgical histopathology or clinical follow-up. For those operated patients, Pearson correlation coefficient between serum PTH and the gland volume was calculated. Results Hyperparathyroidism was confirmed in 38 patients by histopathology (n = 36) or follow-up (n = 2). The overall diagnostic accuracy of 99Tcm-MIBI imaging was 90.0% (63/70), in which the accuracy was 80.0% (12/15) for patients with normal serum PTH and 92.7% (51/55) for those with elevated serum PTH. False positive 99Tcm-MIBI imaging were found in 3 patients with normal serum PTH. The diagnostic accuracy of abnormally high serum PTH combined with 99Tcm-MIBI imaging was 94.3% (66/70). There was a positive correlation between serum PTH level and the volume of pathologic parathyroid glands (r = 0.782, P ＜ 0.001 ). Conclusions Serum PTH measurement may help to improve the diagnostic accuracy of 99Tcm-MIBI imaging in patients with hyperparathyroidism.

Objective To investigate the antimicrobial resistance in the clinical strains isolated from Tongji Hospital to the antimicrobial agents commonly used in 2012.Methods Antimicrobial susceptibility was tested by Kirby-Bauer method.The minimum inhibitory concentration (MIC) of penicillin and ceftriaxone for Streptococcus pneumoniae and vancomycin for Staphylococcus spp.were determined by E-test.All data were analyzed by WHONET 5.6 software.Results A total of 8 191 strains were isolated in 2012,including gram-positive bacteria (2 815,34.4%)and gram-negative bacteria (5 376,65.6%). The top five pathogenic bacteria isolated from outpatients were Escheria coli,Pseudomonas aeruginosa,coagulase-negative Staphylococcus (CNS),Klebsiella spp.and Staphylococcus aureus.For the isolates from non-ICU inpatients,the top five were E.coli,S.aureus,Acinetobacter spp.,Klebsiella spp.and P.aeruginosa.For those isolated from ICU patients,the top five were Acinetobacter spp.,S.aureus,P.aeruginosa,Enterococcus spp.and E.coli.The prevalence of MRSA and MRCNS was 58.1% and 64.3%,respectively.Seventeen strains of vancomycin resistant Enterococcus were identified, including 13 strains of E.faecium with VanA and 4 strains of E.gallinarum with VanA and VanC.The percentage of antimicrobial resistance in E.faecium was significantly higher than that in E.faecalis (P<0.05).A total of 94 strains of carbapenem-resistant Enterobacteriaceae were detected.The prevalence of penicillin-non-susceptible S.pneumoniae in children was much higher than that in adults. The prevalence of carbapenem-resistant P.aerugonosa and Acinetobacter spp. was 28.1% and 56.2% respectively.Beta-lactamase was produced in 41.8% of the H.influenzae and 98.6% of the M. catarrhalis isolates. Conclusions The prevalence of multidrug resistant strains has been increasing, especially vancomycin-resistant Enterococcus and carbapenem-resistant Enterobacteriaceae.

This paper introduces an Excel VBA-based method developed for electronic marrow testing reports.
Bone Marrow Examination ; methods ; Electronics ; Office Automation ; Software

Objective:Summarize and analyze the clinical features of immune checkpoint inhibitor (ICI)-related colitis.Methods:From January 2019 to September 2020, the clinical data of 8 patients with ICI-related colitis from Peking Union Medical College Hospital were retrospectively collected and including the onset of ICI-related colitis, clinical symptoms, endoscopic and pathological findings, treatment, comorbidities and resuming of ICI. Independent sample t test was used for statistical analysis. Results:Eight patients were all male, and the median age (range) was 66 years old (55 to 74 years old), 7 cases were diagnosed with stage Ⅳ lung cancer and 1 case was diagnosed with stage Ⅲc pyelo-carcinoma. Among 8 patients, 4 cases of ICI-related colitis occurred during combination of anti-programmed death-1 (PD-1) treatment and chemotherapy, 2 cases occurred during anti-PD-1 monotherapy after combination of anti-PD-1 treatment and chemotherapy, and 2 cases occurred after anti-PD-1 monotherapy. The median time (range) was 44 d (27 to 128 d) from initial anti-PD-1 treatment to the onset of ICI-related colitis and the median time (range) was 8 d (6 to 35 d) from last anti-PD-1 treatment to onset of ICI-related colitis. The ICI efficacy of 4 patients had partial response, 2 patients had stable disease, 1 patient had disease progression, and 1 patient′s condition was not assessed. All 8 patients had moderate to severe extensive colitis. The main clinical manifestation was diarrhea (5/8), 3 patients accompanied by abdominal pain. The endoscopic findings were diffuse mucosal erosion, accompanied by ulcer in 2 patients. The main pathologic findings were cryptitis or crypt abscess, accompanied by apoptosis in 2 patients. Eight patients were all treated with glucocorticoids, among them 2 patients were further treated with biologics, due to the insufficient efficacy of glucocorticoid treatment, 4 patients had opportunistic infections. The initial prednisone dose for patients with opportunistic infections and patients without opportunistic infections was (85.00±52.60) and (60.00±23.09) mg, respectively. The prednisone treatment course was (8.75±4.03) and (7.50±3.11) weeks, respectively, and the differences were not statistically significant (both P>0.05). The colitis relapsed in all 3 patients after resuming of ICI. Conclusions:ICI-related colitis had corresponding ICI treatment history and clinical, endoscopic, and histopathological features. Glucocorticoid is the main treatment, and it is prone to relapse after resuming of ICI.

OBJECTIVETo evaluate the effectiveness and safety of fluoroscopy-guided percutaneous intratumor injection of pingyangmycin lipiodol emulsion (PLE) in the management of recurrent sacrococcygeal chordomas.

METHODSSeven patients with recurrent sacrococcygeal chordomas presenting with severe local pain with visual analogue score (VAS)≥8 received treatment sessions of fluoroscopy-guided percutaneous intratumor injection of PLE. The patients were followed up every 3 months after the last session to assess their clinical responses and observe the changes in the tumor size measured by computed tomography. The changes in the VAS, tumor necrosis and pain relief as well as the adverse events were recorded.

RESULTSA total of 22 sessions of fluoroscopy-guided percutaneous intratumoral PLE injection was performed in these cases (3 or 4 sessions in each case). The total average pingyangmycin dose delivered was 48.0 mg and the average lipiodol dose was 40.0 ml in each case. Five patients showed low fever and vomiting 48 after the injection. During the follow-up (median time of 21.7 months, range 10-26 months), all the patients showed obviously reduced tumor size and VAS, and partial remission was achieved in 6 patients and stable disease (SD) in 1 patient. None of the patients had complications during the follow-up.

CONCLUSIONFluoroscopy-guided percutaneous intratumoral injection of PLE can be effective and safe and may serve as a alternative for treatment of recurrent sacrococcygeal chordomas.

Adult ; Aged ; Bleomycin ; administration & dosage ; analogs & derivatives ; therapeutic use ; Chordoma ; drug therapy ; Emulsions ; administration & dosage ; therapeutic use ; Ethiodized Oil ; administration & dosage ; therapeutic use ; Female ; Humans ; Injections, Intralesional ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; drug therapy ; Sacrococcygeal Region ; pathology

Objective To investigate the antimicrobial resistant mechanisms of carbapenemrcsistant Entcrobactcriaceae (CRE),construct monitoring system of acquired carbapenemase.Methods Totally 5604 clinical isolates of Enterobacteriaceae in Tongji Hospital were collected from January 2007 to June 2010,including 100 isolates of which zone diameters of meropenem were not larger than 21 mm.Antibiotic susceptibility was performed to select CRE.Then,carbapanemase gene and genetie structure screenings were perforomed by polymerase chain reaction (PCR).Pulsed-field gel electrophoresis (PFGE) and Southern blot were used to analyze the plasmids of CRE.Multilocus sequence typing (MLST) was used to determine the genotypes and homology of these isolates.In addition,out membrane proteins were examined by sodium dodecyl sulfate polyacrylamide gel electrophoresis ( SDS-PAGE ).Results Eleven isolates of CRE were collected and confirmed,most of them were Klebsiella.spp.( 7/11 ).Susceptibility of antimicrobial agents indicated that all these strains resistant to most antimicrobials.The minimal inhibitory concentration (MIC) range of meropenem were 8 - 64 mg/L,imipenem were 4 - 64 mg/L,ertapenem were 4 - 64 mg/L.However,susceptibilities of aminoglycosides and fluoroquinoloncs were significantly different.PCR results showed that six isolates were blaIMP-4 positive and three isolates were blakPC.2 positive,including one isolate of K.pneumoniae (ST476) carrying both blaIMP-4 and blaKPC-2 genes.Genetic structure of carbapenemase genes were analyzed,suggesting that blaKPC-2 located in an integrated structure of a Tn3-based transposon and partial Tn4401 segment.PFGE showed that most CRE contained three or more plasmids.Two isolates of K.pneumoniae were assigned to the same sequence type,ST476,by MLST.SDS-PAGE indicated that only one isolate (Kox656) lacked two out membrane proteins ( OmpK35 and OmpK36 ).Conclusions The most common carbapenemase-resistant Enterobacteriaceae was K.pneumoniae in our hospital.Producing IMP-4 was the most common reason that bacteria resistant to carbapencms.The concomitant presence of these genes poses therapeutic as well as infection control problems.Attention should be payed to the characteristies of bacterial resistance and clinical epidemiology of drug-resistant infections in hospital,and thus to provide clinical reference.

OBJECTIVETo explore the treatment of casualties who suffered from multiple injuries in earthquake and had been treated by damage control (DC) immediately,and the definite postponed surgery time by way of APACHE II score.

METHODSFrom May to June 2008, 21 casualties who had undergone DC accepted further treatment of medicine and surgery, and recovered physical potentiality in the intensive care unit (ICU). APACHE II score was adopted to evaluate the casualties' physical potentiality. Then, internal fixation of intra-articular fractures and centrum fractures, alternation from external fixation to internal fixation, reconstruction of soft tissue was applied by stages according to the plan.

RESULTSAll the patients were effectively cured after definite postponed surgery. There was less complication, low deformity ratio and no death happened.

CONCLUSIONTimely evaluation of the casualties' physical potentiality, appropriate surgery time and exact surgery can reduce the casualties' complication, deformity rate and death rate.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Earthquakes ; Female ; Fracture Fixation ; Fractures, Bone ; complications ; surgery ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Multiple Trauma ; complications ; surgery ; Treatment Outcome

Objective:To explore the effect of intragastric administration of diphenoxylate on inducing epilepsy in mice, as well as the changes in neurobehavioral and hippocampal neurons in mice.Methods:Forty C57 male mice aged 2-3 weeks were selected and divided into control group and diphenoxylate group using random number table method, with 20 mice in each group. The mice in the diphenoxylate group were given diphenoxylate (200 mg/kg) by gavage once a day for 14 consecutive days, while the control group mice were given an equal volume of 0.9% sodium chloride solution every day. After each gavage, the seizure status of mice within 2 hours was observed and the mice were graded based on the Racine score. Open field test, elevated cross test, and Morris water maze test were used to observe the neurobehavioral activities of mouse.A digital electroencephalogram machine was used to monitor the epileptic seizures of mice induced by diphenoxylate.Nissl staining was used to observe the damage of hippocampal neurons in mice.SPSS 25.0 software was used for statistical analysis of the data, and independent sample t-test was used for pairwise comparison. Results:The Racine grading results showed that the mice in diphenoxylate group exhibited grade 2 and 3 seizures at 1 hour after gavage. The EEG monitoring results showed that compared with before gavage, the frequency and amplitude of brain waves of mice in diphenoxylate group increased.In the open field test, the residence time in the central region of mice in diphenoxylate group was significantly lower than that of the control group ((12.21±3.37)s, (17.05±4.34)s, t=3.29, P<0.01). In the elevated cross test, the residence time in the open arm of mice in diphenoxylate group was significantly lower than that of the control group ((17.36±5.41)s, (26.70±9.06)s, t=3.31, P<0.01). In the Morris water maze test, the residence time in the platform quadrant of diphenoxylate group was significantly lower than that of the control group((22.08±6.76)s, (27.64±4.60)s, t=2.54, P<0.05). The residence time and the number of stays in the platform area of diphenoxylate group were both significantly lower than those of the control group(both P<0.05). Nissl staining showed that the number of hippocampal neurons in the CA3 region of mice treated with diphenoxylate was significantly lower than that in the control group((135.67±4.59), (140.67±2.73), P<0.05). Conclusion:Excessive diphenoxylate can induce seizures in mice, and the mice exhibit increased anxiety-like behavior and decreased spatial learning and memory abilities.

Aim To evaluate the effects of salvianolic acid B ( Sal B ) on bone metabolism and its potential mechanism in high fat diet ( HFD) mice.Methods Thirty C57BL/6J male mice were divided into three groups with 10 mice each, namely normal , HFD and HFD+Sal B.HFD and HFD+Sal B mice were treated with HFD, and HFD+Sal B group mice were also with Sal B (125 mg· kg -1· d-1).After 12 weeks' treat-ment, femurs were harvested .The effects of Sal B on biomechanical strength were evaluated by biomechani-cal tests, and the effects of Sal B on bone microstruc-ture were evaluated by Safranin O/fast green staining and hematoxylin and eosin staining .The expression of nuclear factor-kappa B ( NF-κB)-p65 and NADPH ox-idase 4 ( Nox4 ) and cathepsin K in femurs was deter-mined by immunohistochemical staining . Results Maximum load and elastic load significantly decreased ,and the trabeculae became thinner and irregular in the femurs of HFD mice , while Sal B treatment could re-verse the descending biomechanical strength and the disorganized femurs bone micro-structures in HFD mice.In addition, the expressions of Nox4, NF-κB-p65 and cathepsin Kmarkedly increased in HFD mice , and Sal B possessed the ability to down-regulate the ex-pression of Nox4, NF-κB-p65, and cathepsin K in the femurs triggered by HFD .Conclusions Sal B treat-ment improves bone metabolism via regulating Nox 4/NF-κB/cathepsin K signaling pathway in HFD mice . The findings contribute to the understanding and exten-sion of the applications of Salvia miltiorrhiza and its constituents on osteoporosis .