Objective To explore the clinical value of cardiac magnetic resonance imaging (CMRI) in assessment of right ventricular function in patients with pulmonary arterial hypertension (PAH).Methods The PubMed/MEDLINE,Wanfang data,CNKI (from January 2001 to April 2015) were searched.The search terms were pulmonary arterial hypertension,right ventricular function,and cardiac magnetic resonance imaging.An inclusion criterion was the patients suffering from PAH,and the healthy volunteers were served as controls.The study was designed as randomized controlled trial.All the subjects investigated had received CMRI.The end of the trial included right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF).Meta analysis was conducted by RevMan 5.0 software provided by Cochrane Collaboration,and the publication bias was analyzed by the funnel plot analysis.Results Five papers involving 381 patients met the criteria.It was showed by Meta-analysis that compared with healthy control group,RVEDV was increase in PAH group [weighted mean difference (WMD) =33.96,95％ confidence interval (95％CI) =20.80-47.12,P ＜ 0.000 01],RVESV was increased (WMD =41.91,95％ CI =29.63-54.19,P ＜ 0.0O0 01),and RVEF was decrease (WMD =-20.09,95％CI =-22.65 to-17.52,P ＜ 0.000 01).Conclusion CMRI can be used to evaluate the right ventricular function of patients with PAH,and it has important significance in the evaluation of right ventricular function in patients with PAH.

Objective To evaluate the multi-detector CT (MDCT) on pulmonary changes in post-operative adult receptor of liver transplantation complicated with acute respiratory distress syndrome (ARDS).Methods Nineteen adult patients admitted into Tianjin First Center Hospital from January to December 2016 to perform the first time liver transplantation were enrolled in this study. Before operation, the CT showed no significant abnormality in the patients' lungs, after operation MDCT was applied to observe the pulmonary changes of ARDS post-operative complication in the adult receiver of liver transplantation, and the pulmonary changes in different gender of patients were analyzed and compared.Results MDCT showed that after liver transplantation all the 19 patients (100%) had lung pathological changes, of whom 18 cases (94.7%) manifested 2 or more than 2 kinds of pulmonary changes, including consolidation shadows (12 cases, 63.2%), patchy shadows (2 cases, 10.5%), ground glass opacity (6 cases, 31.5%) and pleural effusion (18 cases, 94.7%). In the comparisons between male and female patients with post-operative ARDS after liver transplantation, there were no significant differences in the lung pathological changes shown in MDCT (allP > 0.05) statistically.Conclusion The application of MDCT has great potential value in the evaluation of the disease situation after liver transplantation, that might providehelp to the postoperative treatment.

Objective To summarize the diagnostic efficacy of ADC value for differentiation of benign and malignant lymph nodes on diffusion MRI with Meta-analysis. Methods Published papers on differentiation of benign and malignant lymph nodes with ADC value were searched and reviewed.Quality evaluation was performed for the eligible papers before data extraction.Test for heterogeneity was performed first,then appropriate model was selected to calculate the weighted mean difference,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,pretest and posttest probability.The potential of ADC value for differentiation of benign and malignant lymph nodes was assessed qualitatively and quantitatively.Results Fifteen papers including 735 cases and 1963 lymph nodes were selected.According to Meta-regression analysis,subgroup analysis and robust analysis,two studies with benign lymph nodes in patients with benign lesion and one study using chemical shift saturation technique were excluded because of their impact on the robustness of the pooled results. The weighted mean difference (WMD) between malignant and benign lymph nodes was -0.355 × 10-3mm2/s[95％ confidence interval (CI):-0.423 ×10-3- -0.288 × 10-3 mm2/s].Although the cutoff of ADC value for differentiation in each study was different,the diagnostic efficacy was stable,the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio and area under summarized receiver operator's curve were 0.87 (95％ CI:0.79-0.92),0.87 (95％ CI:0.82-0.90),6.5 (95％ CI:4.7-9.2),0.15 (95％ CI:0.09-0.25 ),43 ( 95％ CI:21-87 ),0.93 ( 95 ％ CI:0.90-0.95 ).The posttest malignancy probability of benign lymph node indicated by ADC was 6％,while that of malignant lymph node was 72％.Conclusion The ADC value can be used to differentiate benign and malignant lymph nodes with good sensitivity and specificity noninvasively.

Objective To evaluated intra-articular injection of TNF-α inhibitors into the sacroiliac joint as an effective and viable alternative. Methods Sixteen patients with documented ankylosing spondylitis (AS), without steroids or disease modifying anti-rheumatic drugs (DMARDs) were performed CT-guided intra-articular injections of etanercept (TNF-α antagonist) at week 0, 4 and 8 (25 mg per dose). Similarly, 20 patients with AS in the control group received systemic etanercept therapy at a dose of 50 mg per week for 8 weeks. All patients were followed up clinically and evaluated periodically. Pathological features of sacroiliitis were observed with light microscopy and immunohistochemistry. Expression of cytokines in joint biopsy samples was estimated by RT-PCR. Image changes of sacroiliitis were observed by SPECT/CT and MRI. Ttest, t'tesr and χ2 Fisher's test were selected. Results All the 16 patients who received intra-articular etanercept, the mean value of radiological nuclide decrease of the SIJ ROI (region of interest) in the SPECT improved significantly after 8 weeks treatment [(1.38±0.16 vs 1.45±0.14) P<0.05] . Bone marrow edema and fat deposition in MRI were relieved significantly after 8 weeks (P<0.05). In 8 patients the expression of TNF-α and TGF-β mRNA in joint tissue decreased significantly after 8 weeks [(0.89±0.06, 0.84±0.05) vs (l.08± 0.19, 1.13±0.33) (P<0.05)]. The occurrence of gynonitis, enthesitis, chondritis, subehondral bony plate destruction, bone marrow inflammation and inflammatory cell index also decreased significantly (P<0.05). Participants given intra-articular injection showed significant clinical improvement after 8 weeks and 12 weeks treatment(P<0.01 ) in BASDAI score [(32±13) mm]. Conclusion This study has shown that intra-articular injection of etanercept in SIJ can improve joint function and quality of life. It has a satisfactory safety profile and is cost effective. This mode of treatment is most beneficial in local arthropathy of recent onset and in those patients who do not tolerate systemic etanercept therapy.

Background: The emergence of the severe acute respiratory syndrome coronavirus 2 omicron variant has been triggering the new wave of coronavirus disease 2019 (COVID-19) globally. However, the risk factors and outcomes for radiological abnormalities in the early convalescent stage (1 month after diagnosis) of omicron infected patients are still unknown. Methods: Patients were retrospectively enrolled if they were admitted to the hospital due to COVID-19. The chest computed tomography (CT) images and clinical data obtained at baseline (at the time of the first CT image that showed abnormalities after diagnosis) and 1 month after diagnosis were longitudinally analyzed. Uni-/multi-variable logistic regression tests were performed to explore independent risk factors for radiological abnormalities at baseline and residual pulmonary abnormalities after 1 month. Results: We assessed 316 COVID-19 patients, including 47% with radiological abnormalities at baseline and 23% with residual pulmonary abnormalities at 1-month follow-up. In a multivariate regression analysis, age ≥ 50 years, body mass index ≥ 23.87, days after vaccination ≥ 81 days, lymphocyte count ≤ 1.21 × 10 -9 /L, interleukin-6 (IL-6) ≥ 10.05 pg/mL and IgG ≤ 14.140 S/CO were independent risk factors for CT abnormalities at baseline. The age ≥ 47 years, presence of interlobular septal thickening and IL-6 ≥ 5.85 pg/mL were the independent risk factors for residual pulmonary abnormalities at 1-month follow-up. For residual abnormalities group, the patients with less consolidations and more parenchymal bands at baseline could progress on CT score after 1 month. There were no significant changes in the number of involved lung lobes and total CT score during the early convalescent stage. Conclusion The higher IL-6 level was a common independent risk factor for CT abnormalities at baseline and residual pulmonary abnormalities at 1-month follow-up. There were no obvious radiographic changes during the early convalescent stage in patients with residual pulmonary abnormalities.

Objective To summarize the computed tomographic (CT) manifestations of pulmonary aspergillosis after organ transplantation and compare different signs between pulmonary aspergillosis and bacterial pneumonia.Methods CT images of pulmonary aspergillosis (n =62) and bacterial pneumonia (n =68) in post-transplantation patients were reviewed.The signs were categorized with consolidation,mass,large nodule (≥1crn),small nodule and bud-in-tree pattern.Some detailed useful differentiating signs such as halo sign,air bronchogram sign,reversed halo sign,hypodensity sign and cavitation were also analyzed.Results CT patterns of pulmonary aspergillosis included consolidation,mass,large nodule,small nodule and bud-in-tree pattern.The most common was large nodule (75.8％),followed by consolidation (48.4％)and mass (29.0％).And small nodule (16.1 ％) and bud-in-tree (12.9％) patterns were concurrent.For consolidation pattern,the proportion of bacterial pneumonia (69.1％) was the larger;For mass pattern,the proportion of pulmonary aspergillosis (29.0％) was the larger.For large nodule pattern,there was no difference.The detail sign of large nodule in two groups had no difference In detailed signs of consolidation pattern,air bronchogram sign was more often seen in bacterial pneumonia while cavitation was more frequently found in pulmonary aspergillosis.In detailed signs of mass pattern,pulmonary aspergillosis often has single lesion (66.7％),cavitation (83.3％)and air crescent sign (77.8％) is more common.The proportion of halo sign was 30.7％.Conclusions CT manifestations of pulmonary aspergillosis are diverse after organ transplantation.There is some difference and yet overlap with bacterial pneumonia.

Objective:To explore the diagnostic performance of cardiac magnetic resonance imaging (CMR) with T1 mapping and T2 mapping for detection of acute phase of ischemic cardiomyopathy.Methods:Twenty-four patients with acute myocardial infarction (AMI) detected by coronary angiography from May 2020 to April 2021 in Tianjin First Center Hospital were selected. All patients underwent CMR (Philips Ingenia 3.0-T) at (9±4) days after definite diagnosis, which was defined as the first diagnosis. After 3 months and 6 months of chronic myocardial infarction (CMI) phase, one CMR was performed. On the same period with age and sex matching, a total of 26 cases of healthy volunteers and outpatient with non-specific chest pain and CMR examination without abnormality as control group. Plain scan included Cine, T2-weighted (STIR), and native T1/T2 mapping. The enhanced scan included perfusion, late gadolinium enhancement, post-T1 mapping. The changes of myocardial quantitative parameters before and after myocardial infarction were compared. Receiver operator characteristic curves (ROC curve) were developed to evaluate, compare, and distinguish the changes in the AMI group and the CMI group after 6 months.Results:Pre-enhanced T1 value, T2 value and extracellular volume (ECV) of AMI group were significantly higher than those of control group [pre-enhanced T1 value (ms): 1 438.7±173.4 vs. 1 269.2±42.3, pre-enhanced T2 value (ms): 49.8±9.3 vs. 21.7±4.0 , ECV (%): 33.2±10.2 vs. 27.2±2.1, all P < 0.05]. ECV was significantly higher in AMI (%: 33.2±10.2 vs. 27.2±2.1), but stabilized after 3 months (%: 33.2±10.2 vs. 32.4±5.1), and after 6 months later (%: 27.7±4.9 vs. 32.4±5.1), there were no significant difference (all P > 0.05). Pre-enhanced T1 and T2 values were significantly higher in AMI, lower after 3 months, but significantly decreased after 6 months [pre-enhanced T1 values (ms): 1 438.7±173.4 vs. 1 272.1±25.2, pre-enhanced T2 values (ms): 49.8±9.3 vs. 29.0±4.0, all P < 0.05]. The ROC curve showed that the specificity of pre-enhanced T1 and T2 values between AMI and CMI were 100%, and the sensitivity were 72.7%, 100%, respectively, pre-enhanced T1 and T2 value could be better distinguish between AMI and CMI diagnosis method. Conclusion:T1 mapping and T2 mapping with ECV can clearly diagnosis ischemic cardiomyopathy, especially pre-enhanced myocardial T1 and T2 values which is non-invasive diagnosis method of AMI, and can distinguish AMI or CMI, has a great significance to the patient's clinical treatment and follow-up.

Congenital heart disease (CHD) is a type of birth defects due to the abnormal development of heart and blood vessels during embryonic stage. Studies indicate that the etiology of CHD is complicated. Genetic and epigenetic mechanisms including chromosomal abnormalities, gene mutations, nucleic acid modifications, non-coding RNAs may play important roles in CHD. At present, genetic mechanisms such as chromosome abnormality and gene mutation have been widely used in the diagnosis and treatment of clinical diseases. However, the application of genetic and epigenetic modification in diagnosis and treatment of CHD still need further research. This paper reviews the relationship between chromosomal abnormality, gene mutation, copy number variation, epigenetic modification and the occurrence of CHD, which may provide a basis for further exploring the early diagnosis and individualized therapy of CHD.

OBJECTIVE: To investigate the value of T2 mapping in the assessment of myocardial changes and prognosis in patients with acute ST segment elevation myocardial infarction (STEMI). METHODS: A retrospective study was conducted. A total of 30 patients with acute STEMI admitted to Tianjin First Central Hospital from January 2021 to March 2022 were enrolled as the experimental group. At the same time, 30 age- and sex-matched healthy volunteers and outpatients with non-specific chest pain with no abnormalities in cardiac magnetic resonance (CMR) examination were selected as the control group. CMR was performed within 2 weeks after the diagnosis of STEMI, as the initial reference. A plain CMR review was performed 6 months later (chronic myocardial infarction, CMI). Plain scanning includes film sequence (CINE), T2 weighted short tau inversion recovery (T2-STIR), native-T1 mapping, and T2 mapping. Enhanced scanning includes first-pass perfusion, late gadolinium enhancement (LGE), and post-contrast T1 mapping. Quantitative myocardial parameters were compared between the two groups, before and after STEMI myocardial infarction. The receiver operator characteristic curve (ROC curve) was used to evaluate the diagnostic efficacy of native-T1 before myocardial contrast enhancement and T2 values in differentiating STEMI and CMI after 6 months. RESULTS: There were no statistically significant differences in age, gender, heart rate and body mass index (BMI) between the two groups, which were comparable. The native-T1 value, T2 value and extracellular volume (ECV) were significantly higher than those in the control group [native-T1 value (ms): 1 434.5±165.3 vs. 1 237.0±102.5, T2 value (ms): 48.3±15.6 vs. 21.8±13.1, ECV: (39.6±13.8)% vs. (22.8±5.0)%, all P < 0.05]. In the experimental group, 12 patients were re-examined by plain CMR scan 6 months later. After 6 months, the high signal intensity on T2-STIR was still visible, but the range was smaller than that in the acute phase, and the native-T1 and T2 values were significantly lower than those in the acute phase [native-T1 value (ms): 1 271.0±26.9 vs. 1 434.5±165.3, T2 value (ms): 34.2±11.2 vs. 48.3±15.6, both P < 0.05]. ROC curve analysis showed that the area under the ROC curve (AUC) of native-T1 and T2 values in differentiating acute STEMI from CMI was 0.71 and 0.80, respectively. When native-T1 cut-off value was 1 316.0 ms, the specificity was 100% and the sensitivity was 53.3%; when T2 cut-off value was 46.7 ms, the specificity was 100% and the sensitivity was 73.8%. CONCLUSIONS The T2 mapping is a non-invasive method for the diagnosis of myocardial changes in patients with acute STEMI myocardial infarction, and can be used to to evaluate the clinical prognosis of patients.
Humans ; ST Elevation Myocardial Infarction/diagnosis* ; Contrast Media ; Prognosis ; Retrospective Studies ; Magnetic Resonance Imaging, Cine/methods* ; Gadolinium ; Myocardium/pathology* ; Myocardial Infarction ; Predictive Value of Tests

Objective: To investigate the efficacy and safety of the new investigational drug pegylated interferon α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 µg/week) combined with ribavirin in the treatment of patients with genotype 1/6 chronic hepatitis C (CHC), with standard-dose Peg-IFN-α-2a combined with ribavirin as a positive control. Methods: A multicenter, randomized, open-label, and positive-controlled phase III clinical trial was performed. Eligible patients with genotype 1/6 CHC were screened out and randomly divided into Peg-IFN-α-2b(Y shape, 40kD) group and Peg-IFN-α-2a group at a ratio of 2:1. The patients in both groups were given oral ribavirin for 48 weeks in addition and then followed up for 24 weeks after drug withdrawal. Abbott Real Time HCV Genotype II was used to determine HCV genotype, and Cobas TaqMan quantitative real-time PCR was used to measure HCV RNA level at 0, 4, 12, 24, 48, and 72 weeks. Adverse events were recorded in detail. The primary efficacy endpoint was sustained virological response (SVR), and a non-inferiority test was also performed. Results: A total of 561 patients with genotype 1/6 CHC were enrolled, among whom 529 received treatment; 90.9% of these patients had genotype 1 CHC. The data of the full analysis set showed that SVR rate was 69.80% (95% CI 65.00%-74.60%) in the trial group and 74.16% (95% CI 67.73%-80.59%) in the control group (P = 0.297 0). The data of the per protocol set (PPS) showed that SVR rate was 80.63% (95% CI 76.04%-85.23%) in the trial group and 81.33% (95% CI 75.10%-87.57%) in the control group (P = 0.849 8), and the 95% CI of rate difference conformed to the non-inferiority standard. The analysis of the PPS population showed that of all subjects, 47.9% achieved rapid virologic response, with a positive predictive value of 93.8%. The incidence rate of adverse events was 96.30% in the trial group and 94.94% in the control group, and the incidence rate of serious adverse events was 5.13% in the trail group and 5.06% in the control group. Conclusion In the regimen of Peg-IFN-α combined with ribavirin for the treatment of genotype 1/6 CHC, the new investigational drug Peg-IFN-α-2b(Y shape, 40 kD) has comparable clinical effect and safety to the control drug Peg-IFN-α-2a.