With modified mutual information(MI) measure,Powell search algorithm is utilized to realize mono-modality image registration.The MI's formulae are improved to reduce computation cost,and the replace of Powell's search direction is also rectified to keep the original search direction and eliminate local maxima.With rotation set in advance,local maxima can be avoided.The influence on registration velocity by Powell convergence threshold is also discussed.The results show that the modified MI measure can reach sub-pixel precision with obviously accelerated speed.It has good robustness,high speed and high precision.

Currently,although surgical aortic valve replacement (SAVR) is still the golden standard in treatment of severe aortic stenosis according to the guideline,transcatheter aortic valve implantation (TAVI) is gradually becoming a common treatment for patients who are prohibitive or in high risk for SAVR.Recently,the valve manufacturers,including medical companies in China,are making their utmost to develop valve device,leading remarkable results achieved by TAVI.With the complications being controlled,TAVI displays promising future.It is likely that TAVI is expected to become a substitute for SAVR to treat patients with aortic stenosis or even aortic regurgitation.

Objective To assess the early prognosis of 117 patients after carduopulmonary resuscitation (CPR) in ICU by using the markers of inflammation,Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores.Methods A total of 117 CPR patients admitted between 2010 January to 2012 December were enrolled for study.Within 24 h after admission,inflammatory markers,blood routine items,hepatorenal function,electrolytes of blood were measured.The GCS and APACHE Ⅱ scores were recorded.Arterial blood gas analyses were performed at 0,12,and 24 h after hospitalization,and the 12-h and 24-h lactate clearance rates were calculated.Seven days after treatment,according to the outcomes,the patients were divided into survival group and death group,and the clinical data of two groups were analyzed.Results (1) Of them,73 patients died and 44 survived.Factor analysis showed that age,time elapsed from resuscitation to ICU admission,D-dimer,arterial oxygenation index (FiO2),arterial blood pH,arterial blood lactate concentration upon ICU admission,GCS score and APACHE Ⅱ score were significantly different between the two groups (P ＜ 0.05or P ＜ 0.01); (2) Two classification logistic regression analysis showed that D-Dimer,GCS score and APACHE Ⅱ score significantly correlated with the mortality risk of the patients in the wake of CPR with relative odds ratios of 1.000,2.091,and 0.531,respectively (P ＜ 0.05 or P ＜ 0.01) ; (3) Receiver operating characteristic curve analysis indicated that the area under the curve of GCS (0.821) and APACHE Ⅱ (0.869) had higher predictive value than D-dimer (0.655).The highest accuracy (84.6％) in predicting patient survival was achieved when the GCS score was 6.5.Meanwhile,the highest accuracy (82.1％) in predicting patient death was achieved when the APACHE Ⅱ score was 17.5.Conclusions Both GCS score and APACHE Ⅱ score has obvious correlation with the prognosis of the critically ill patients after CPR and could be used to predict prognosis at early stage.

Objective:To explore the possible mechanism of astragaloside involved in the mouse podocytes injury induced by TGF-β1 in vitro.Methods:Mouse podocytes were cultured in vitro and then all cell were divided into 5 groups:normal control group , TGF-β1 treatment group ,TGF-β1 treatment +astragaloside low dose group ,TGF-β1 treatment +astragaloside middle dose group and TGF-β1 treatment +astragaloside high dose group.The proliferation rate of each group was investigated by MTT assay ,the expression of TRPC6 protein and mRNA were measured by Western blot and RT-PCR respectively after 48 hours.Results:TGF-β1 can significantly inhibit the proliferation of podocytes ( P<0.05) ,fusions of foot processes or even effaced of podocytes were observed .TGF-β1 could also increase the expression of TRPC6.Astragaloside could reduce the inhibition of TGF-β1 to the proliferain of podocytes significantly ,make the cell shape tend to be normal,and reduce the expression of TRPC6 mRNA and protein with dose-effect relation.Conclusion:TRPC6 play an impor-tant role in the TGF-β1 induecd podocytes injury .Astragaloside can alleviate podocytes injury by reduce the expression of TRPC 6.

ObjectiveTo investigate the value of MR diffusion tensor imaging (DTI) of optic nerve in the estimation of optic nerve changes of primary chronic angle-closure glaucoma (PCACG).Methods Twenty-five patients with PCACG including monocular involvement in 4 patients and binocular involvement in 21 patients and involving 46 eyes in which 24 right eyes and 22 1eft eyes,and 20 normal volunteers were enrolled.Conventional MRI and DTI were performed on all subjects using Magnetom Tim 3.0 T MRI.Fractional anisotropy( FA),mean diffusivity ( MD),axial diffusivities ( λ ∥ ) and radial diffusivities ( λ ⊥ )were measured and then compared between patients group and control group and between left eyes and right eyes.Two independent samples t-test and paired t-test were used.ResultsOn conventional MRI,thinner optic nerve with vaginal cavity widened slightly was found in 8 optic nerves of 6 patients.The value of FA,λ∥,λ⊥ and MD of 24 right optic nerves in patient group was(0.27 ± 0.09) × 10-3,(2.30 ±0.26) × 10 - 3,( 1.55 ± 0.35 ) × 10 - 3,and ( 1.80 ± 0.31 ) × 10 - 3 mm2/s respectively and that of 22 left optic nerves was (0.24 ± 0.09) × 10-3,(2.25 ± 0.41) × 10-3,(1.61 ± 0.46) × 10-3,and (1.82 ±0.47) × 10-3mm2/s respectively.The FA of optic nerve in patient group was lower than that of control group (P ＜0.05 ),while the meanλ∥,λ ⊥ and MD values was obviously higher than control group (P ＜ 0.05).There was no significant difference between right and left optic nerves in patient gro up ( P ＞0.05).ConclusionsDTI could detect abnormality and provide information about the pathological process of optic nerve in patients with PCACG.

Objective To investigate the effectiveness and safety in patients with largeartery occlusive acute cerebral infarction who received multi-interventional modes mainly with mechanical thrombectomy and its related factors affecting prognosis. Methods The clinical data of 56 patients with large artery occlusive acute cerebral infarction were analyzed retrospectively. The clinical characteristics (gender,age,and underlying diseases),timing of treatment (time from ictus to puncture,time from puncture to recanalization), multi-interventional mode therapies (intra-arterial thrombolysis,thrombectomy,balloon dilation,and stenting, etc. ),and distribution of offending vessels were observed. The modified Thrombolysis in Cerebral Ischemia Scale (mTICI)grade was used to evaluate revascularization. The National Institute of Health Stroke Scale (NIHSS)score was used to observe the neurological function at 24 h before and after procedures. The modified Rankin scale (mRS)was used to evaluate the prognosis at 3 months after procedure. The safety of the treatment was evaluated with operative complications (mainly symptomatic intracranial hemorrhage)and mortality. The patients were divided into either a good prognosis group (n = 34;mRS≤2)or a poor prognosis group (n =22;mRS≥3)according to the prognosis at 3 months after procedure. They were analyzed with univariate analysis. The factors influencing the prognosis were further analyzed with multivariate logistic regression analysis. Results (1)The recanalization rate in 56 patients was 78. 6%(n = 44),in which basilar artery was the highest,reaching 93. 8% (15 / 16),middle cerebral artery was 87. 0% (20 / 23). The NIHSS score at 24 hours was 10 ± 7,it was lower than 16 ± 6 on admission. There was significant difference (t =6. 401,P <0. 01). At 3 months,34 patients (60. 7%)had good prognosis,4 (7. 1%)died,and 8 (14. 3%) had symptomatic intracranial hemorrhage. (2)Multiple factor analysis showed that the high level of recanalization was a protective factor for good prognosis (OR,0. 465,95% CI 0. 267 -0. 809,P =0. 007). Diabetes was an independent risk factor for poor prognosis (OR,5. 535,95% CI 1. 101 -27. 835, P = 0. 038). Conclusion Acute large artery occlusive cerebral infarction treated with the intra-arterial multi-interventional modes may quickly and effectively restore intracranial blood flow. It has the characteris-tics of high recanalization rate and good prognosis,and the higher the level of recanalization,the better the prognosis. Diabetes is an independent risk factor for poor prognosis.

Objective To assess the predictive value of Berden classification in ANCA associated glomerulonephritis.Methods Patients with confirmed ANCA associated glomerulonephritis were included,by retrieving the medical database in Peking Union Medical College Hospital from January 2000 to May 2015.Their detailed information during hospitalization and follow-up was recorded.The patients were divided into four categories based on Berden classification.The differences in clinical characters,renal function and response for treatment were compared.Results Among the 88 patients with ANCA-associated glomerulonephritis,19 (21.6％),21 (23.9％),32 (36.4％)and 16 (18.2％) patients were classified as focal,mixed,crescentic and sclerotic category.22 patients developed ESRD,and 19 patients died during follow up (1 patient developed ESRD before died).The mean estimated glomerular filtration rate (eGFR) at baseline was 68.04,25.45,30.04,15.16 ml·min-1·(1.73 m2)-1 (P ＜ 0.05) in focal,crescentic,mixed and sclerotic category,respectively.During follow-up period,focal category always had the best renal function,while sclerotic category had the worst renal function.Crescentic category and mixed category were similar and in the middle.Remission rate at 6m was 62.5％,73.7％,57.5％,30.8％(P ＞ 0.05).And crescentic category had the greatest improvement in eGFR at 6m.Conclusions Focal category had relatively preserved renal function and favorable renal outcome,while the sclerotic category had the worst renal outcome.Crescentic and mixed category had an intermediate outcome.We support the use of the Berden classification in predicting the renal prognosis of patients with ANCA associated glomerulonephritis.

A male patient undergoing extracorporeal ultrasound lithotripsy developed the symptoms of dyspnea, low blood pressure, palpitations, chest tightness, and sweating, and a clinical diagnosis of pulmonary capillary leak and hypovolemic shock was made. Pulse indicator continuous cardiac output (PiCCO) technique was used for resuscitation according to the measurements of extravascular lung water index (EVLWI) and global end-diastolic volume index (GEDI). The patient showed low levels of cardiac output (CO) and GEDI with a peak EVLWI of 32 ml/kg and profuse pink and thin sputum overflow from the trachea. The high ventilator support parameters failed to correct low oxygen saturation. Restricted fluid infusion was used to reduce pulmonary edema. Colloidal solution was given when GEDI was below 500 ml/m(2), and the volume and fluid infusion rate were reduced for a GEDI higher than 500 ml/m(2). Pulmonary edema was gradually reduced after the treatments with improvement of lactic acid level and liver and kidney functions. Vasopressors were withdrawn 6 days later, mechanical ventilation was discontinued 10 days later, and tracheal intubation was removed 25 days later, after which the patient was discharged. In the treatment of the patient, PiCCO monitoring played an important role.
Adult ; Capillary Leak Syndrome ; complications ; therapy ; Fluid Therapy ; Humans ; Lithotripsy ; adverse effects ; Male ; Pulmonary Edema ; complications ; therapy ; Shock ; complications ; therapy

Objective:To evaluate the clinical efficacy and changes between Dynesys and Posterior lumbar interbody fusion (PLIF) in the treatment of two-level lumbar degenerative disease.Methods:43 consecutive patients with lumbar degenerative disease were treated using the Dynesys or PLIF between June 2010 and June 2012. In all patients, 23patients were implanted Dynesys and other patients for PLIF. The follow-up period was at least 60 months. Used the Visual analogue scale (VAS) and Oswestry disability index (ODI) to evaluate the clinical outcomes. And during the follow-up period, collected the data for the intervertebral height and the range of motion (ROM), for the operation section and the upper adjacent vertebral. MRI and Grading Scale from the University of California at Los Angeles (UCLA) were used to define the change of intervertebral disc signal.Results:The ODI index and VAS score both improved significantly at the final follow-up evaluation ( P<0.05), as compared to the basal line values. And in terms of imaging, there were no significant difference in the vertebral height of the operation section and the upper adjacent vertebral. The range of motion (ROM) for the operative section in the group of PLIF was significantly lower than that in Dynesys group ( P<0.05). And when it comes to the upper adjacent vertebral space, it was higher at the same time ( P<0.05). According to the UCLA Grading Scale, there were 3 cases in the Dynesys group and 11 in the PLIF group had radiological adjacent degeneration, the difference was significant between two groups ( P<0.05). And when it comes to the second intension, there were 3 patients in PLIF groups (TLIF 1; PLIF 2) but only 1 in Dynesys groups. Conclusion:Dynesys and PLIF are both effective for lumbar degenerative disease and show good medium and long-term clinical and radiographic results. But when it comes the risks in developing ASD and the ROM of adjacent segments, Dynesys stabilization can be the better choice.

Objective:To determine the characteristics of hospitalized newly diagnosed systemic lupus erythematosus (SLE) patients with high disease activity, and identify the risk factors.Methods:Data from 194 newly diagnosed SLE patients at Shanghai Renji Hospital between May 2013 and December 2018 were collected retrospectively. All patients were followed up for 1 year or until death. Patients' demographic, clinical, and laboratory characteristics on admission and medication history were retrospectively collected as baseline data. Patients were divided into two groups, lupus patients with infection (51 cases) and lupus patients without infection (143 cases). The method of univariate analysis of data depended on the data distribution type. Variables that suggested association in the univariate analysis ( P<0.05) were entered into Cox regression model. Results:Among 194 patients with newly diagnosed SLE, 21 cases (11%) died and 51 cases (26%) were infected during 1-year follow-up. Regarding the infection site, 34 cases (67%) had lung infection, 9 cases (18%) had central nervous system infection and 9 cases (18%) had blood stream infection. Common bacteria were identified in 19 cases (45%), followed by fungal infection in 18 cases (43%) and mycobacterium infection in 7 cases (17%). Among the 51 patients with infection, 38 patients (75%) had infection within the first 3 months after diagnosis, and mortality in this group was significantly higher than that in the uninfected group (39%, 15/38 vs 2%, 3/143 , P<0.01). Comparing baseline parameters between patients with 3-month infection and without, significant differences ( P<0.05) were detected in age (≥40 years), systemic lupus erythematosus disease activity index (SLEDAI) score (>10 points), Systemic Lupus International Collaborating Clinic (SLICC)/American College of Rheumatology(ACR) systemic lupus erythematosus damage index (SDI) (≥1 point), pericardial effusion, nephritis, gastrointestinal vasculitis, diabetes, lymphocyte count <0.8×10 9/L platelet count <100×10 9/L, serum creatinine >104 mmol/L and serum globulin level <20 g/L. Finally, clinically meaningful candidate predictors were included in the Cox regression model and it showed that lymphocyte count <0.8×10 9/L, nephritis and gastrointestinal vasculitis were independently predictive for 3-month infection in new-onset lupus patients. Conclusion:Understanding disease spectrums and risk factors of infection in newly diagnosed SLE patients will help clinicians to manage those patients with infection effectively to achieve favorable prognosis.