Objective To investigate the value of multi-slice CT (MSCT) in diagnosing early acute appendicitis (AA).Methods From June 2008 to June 2011,abdomen MSCT images of 41 patients with acute simple appendicitis confirmed by surgery and pathology were evaluated retrospectively. Thirty-six patients with clinically confirmed normal appendix served as the control groups with 18 patients in complicated-normal-appendix (CNA) group and 18 patients in noncomplicated-normal-appendix (NCNA)group. The appendix was reconstructed by using multiplanar reformation (MPR) and curved planar reformation (CPR) techniques. The differences between early AA and normal appendix in appendiceal diameter,thickness of the appendiceal wall, maximum depth of the intraluminal appendiceal fluid (MDIAF), abnormal enhancement of the appendiceal wall, appendicolith and the periappendiceal abnormalities were evaluated and compared by using analysis of variance,R test and Chi-square test.Results The mean thickness of the appendiceal wall was (2.88 ±0.62),(2.58 -±0.50) and (2.73 ±0.53) mm in early AA,CNA and NCNA groups respectively,with no statistically significant difference among them ( F =1.73,P=0.19).The nean appendiceal diameter was (11.37 ± 1.94),(7.03 -±0.89),(6.75 ±0.63) mm,and median MDIAF was 4.05 (2.65-8.50),1.68 (0-.40),0 (0-1.90) mm in early AA,CNA and NCNA groups respectively,with statistically significant differences between early AA and the two normal appendix groups ( Z =7.02,7.24 ; P =0.00 ).The abnormal enhancement of appendiceal wall was found in 61.1％ (11/18) of early AA,16.7％ (3/18) of CNA and 11.1％ (2/18) of NCNA groups respectively,with statistically significant differences between early AA and the two normal appendix groups (x2 =12.83,P =0.00). Using a cutoff value of 7.8 mm of the appendiceal diameter and 2.6 mm of MDIAF for the early AA,the sensitivity,specificity and accuracy were 97.6％ (40/41),91.7％ (33/36) and 94.8％ (73/77),and 100.0％ (36/36),88.9％ (32/36) and 94.4％ (68/72),respectively.Conclusions MSCT is particularly useful for the diagnosis of early AA. When appendiceal diameter is greater than 7.8 mm,and MDIAF greater than 2.6mm,early AA can be diagnosed with confidence.

Objective To analyze the status of blood supply at appearance of the first enhanced signal on dynamic contrast-enhanced MRI of hepatic cell cancer(HCC) of differentiated degree.Methods HCC was induced chronically with 1 ml of 2% DEN solution once a day in 80 rats for 14 weeks,and another 10 rats served as normal controls.All rats received dynamic contrast-enhanced MRI examination on week 16,18,20,21,22,23,24,25.The time-intensity curve was drawn and the slope rate of the first enhanced signal(S_(first)) was counted,then specimens were taken and observed of microvessel density(MVD) with light microscope.Results The differentiated degree of HCC was correlated with S_(first) and MVD.The poorer HCC differentiation,the bigger S_(first).Well differentiated HCC had low MVD,while poorly differentiated had higher MVD.Conclusion MVD is the main influence factor for that the S_(first) were significantly different between HCC of differentiated degree.

To explore the utility of apparent diffusion coefficient(ADC)histogram analysis for differentiating genetic subtypes of diffuse lower-grade gliomas. A total of 55 patients with WHO grade Ⅱ/Ⅲ diffuse lower-grade gliomas who underwent preoperative routine brain magnetic resonance imaging and diffusion weighted imaging in our center were retrospectively evaluated.Among whom there were 14 patients with isocitrate dehydrogenase(IDH)wild-type gliomas(IDH group),19 patients with IDH-mutant 1p19q intact gliomas(IDH 1p19q group),and 22 patients with IDH-mutant 1p19q co-deleted gliomas(IDH 1p19q group).The whole-lesion ADC values derived from histogram analysis(including ADC,ADC,ADC5%,ADC10%,ADC25%,ADC50%,ADC75%,ADC90%,ADC95%,ADC,mode,range,skewness,kurtosis,standard deviation,inhomogeneity,and entrophy)were measured for each patient.All parameters between the different genetic subtypes were compared by using the Student's test or Mann-Whitney test.Receiver operating curve(ROC)analysis was used to assess the diagnostic performance of ADC histogram in distinguishing the different genetic subtypes. Compared with IDH group,the ADC75%(=0.021),ADC90%(=0.015),ADC95%(=0.014),ADC (=0.035),range(=0.009),standard deviation(=0.001)and inhomogeneity(=0.001)were significantly lower in IDH group;in contrast,the ADC (=0.031)and kurtosis(=0.020)of IDH group were significantly higher than those in IDH group.The ADC(=0.010),ADC5%(=0.016),ADC10%(=0.012),ADC25%(=0.007),ADC50%(=0.005),ADC75%(=0.015),and mode(=0.002)were significantly higher in IDH 1p19q group than in IDH 1p19q group.Inhomogeneity achieved the highest area under ROC(AUC)(0.811)in differentiating IDH gliomas and IDH gliomas,with a cutoff value of 0.229;the sensitivity and specificity were 85.7% and 73.2%.The mode achieved the highest AUC(0.744)in differentiating IDH 1p19q gliomas and IDH 1p19q gliomas,with a cutoff value was 1448.75×10 mm /s;the sensitivity and specificity were 57.9% and 90.9%. ADC histograms analysis may be helpful to differentiate genetic subtypes in lower-grade gliomas.
Brain Neoplasms ; Diffusion Magnetic Resonance Imaging ; Glioma ; Humans ; ROC Curve ; Retrospective Studies

Objective:To study the clinical features and molecular genetic mechanisms of children with lissencephaly (LIS), as well as to analyze the relationship between genotypes and phenotypes of the disease.Methods:From October 2016 to December 2017, the clinical data and follow-ups of 21 LIS children were collected in the Department of Neurology, Shenzhen Children′s Hospital.Whole genome sequencing (WGS) was performed for genetic testing.Results:Among these 21 cases, 18 cases developed epilepsy (86%), and 3 cases were seizure free (14%). The onset age of children with epilepsy was relatively young, and 16 cases occurred within 1 year old (89%). Among these cases, 16 were pachygyria (76%), 3 cases were agyria combined with pachygyria (14%) and 2 cases were agyria (10%). Epileptic syndromes included 12 cases of West syndrome (67%), 2 cases of Ohtahara syndrome (11%), 2 cases of other epileptic encephalopathy (11%), and 2 cases of focal epilepsy (11%). Brain magnetic resonance imaging(MRI) demonstrated that most cases were pachygyria, among which diffuse pachygyria was more common (56%, 9/16 cases). The results of WGS: 13 pathogenic or likely pathogenic single nucleotide variants (SNV) and copy number variants (CNV) were detected.The total detection rate was 62%, of which 2 cases were frameshift, 1 case was nonsense and 1 case was missense variants of PAFAH1B1, 6 cases were chromosome 17p13.3 deletion syndrome, thus lea-ding to the whole gene deletion of PAFAH1B1, and 1 case was missense variant of DCX, frameshift variant of KIF2A, and missense variant of PIK3R2, respectively.Totally, 48% (10/21 cases) of the cases were variants or deletions of PAFAH1B1, which resulted in lissencephaly in the parietal-occipital region of the brain.Novel variants were PAFAH1B1: c.1067G>A, PAFAH1B1: c.897delT and KIF2A: c.2225delG. Conclusions:Most cases of LIS accompanied with epilepsy, in which West syndrome was relatively more common.Brain MRI showed that most cases were diffuse pachygyria.The variants and deletions of PAFAH1B1 was the main genetic cause of LIS.The identification of the novel variants expanded the genotypical spectrum of LIS.

ObjectiveTo explore the effects and the side effects of different pattems of postoperative analgesia. MethodsThe data of postoperative analgesia in 725 patients underwent obstetrics and gynecology operation was analysed retrospectively, patient-controlled intravenous analgesia(PCIA) with 352 cases (PCIA group) or patient-controlled epidural analgesia(PCEA ) with 373 cases(PCEA group ). The analgesic effect, sedation scale and side effects were compared. ResultsThe analgesic effect and sedation scale at 12,24 h after operation in PCEA group was lower than that in PCIA group(P ＜0.05). The incidence of vomiting in PCEA group was lower than that in PCIA group [6.4％(24/373) vs. 9.9％(35/352)], the incidence of itchy skin and infection in PCEA group were higher than those in PCIA group [4.8％(18/373)vs. 2.6％ (9/352), 3.2％( 12/373 ) vs. 0], there was significant difference between two groups (P ＜ 0.05 ). Old people fell less pain than wrinkly and young people (P＜0.05). ConclusionsThe effect of PCEA is better than PCIA. Paresthesia is main in PCEA. Vomiting is more in PCIA. Old people feel less pain than wrinkly and young people. So postoperative analgesia is selected by concrete conditions.

Objective To analyze the clinical manifestations of familial acute necrotizing encephalopathy (ANE)and to improve the recognition of this disease. Methods The clinical data of a 25 - month - old girl with fa-milial and recurrent ANE with evidence of mutation in the RANBP2 gene were collected and analyzed,and the gene examination of their family members was performed. Results A previously healthy girl experienced recurrent ANE epi-sodes at the ages of 8 months,18 months and 25 months,respectively. At each beginning of each episodes the patient presented with lethargy and tremor of limbs following febrile illness of 3 - 4 days,even developed coma and convulsions in the last time. Brain magnetic resonance imaging showed bilateral and high T2 signal changes in thalamus,cerebellum and hippocampus. Abnormal signals also appeared in the brainstem,claustrum,corpus scallosum and cortex(temporal, parietal and cingulate)also appeared abnormal signals. Spinal MRI showed spinal cord involvement. The girl recovered after her first episode;she could speak but could not walk steadily after the second time;after the third episode,al-though she regained consciousness from coma,she could no longer speak or walk. The patient's sister died of encephali-tis at the age of 18 months. Her paternal uncle had suffered from dysnoesia from meningitis at his 17 months of age. The patient and her grandmother,father,uncle and one of her aunts harbored a mutation(c. 1754C ﹥ T)in RANBP2 gene. Conclusions Familial ANE has typical clinical manifestations and characteristic MRI findings. The patient with recur-rent history,especially with positive family history,should have the mutation in RANBP2 gene detected earlier in order to clarify the diagnosis of ANE.

Objective To explore the main influence factors(heart rate,rotation speed,and reconstruction algorithm)on the image quality of coronary artery with 40 mm VCT(64-detector row helical CT)using a pulsating cardiac phantom.Methods An adjustable pulsating cardiac phantom(GE) containing predetermined simulated coronary arteries was scanned using a 40 mm VCT(GE LightSpeed CT) with cardiac pulsating rates of 40,45,50,55,60,65,70,75,80,85,90,95,100,105,110,and 115 beats per minute(bpm).The variable rotation speeds technique of 0.35 s,0.40 s,and 0.45 s were used, respectively.The raw data were reconstructed using both one-sector and multi-sector reconstruction algorithm at optimal window of the R-R interval.The image quality score(IQS)was evaluated by two radiologists according to the same evaluation standard of reformated image.The correlation between heart rate(HR), roation speed,reconstruction algorithm,and IQS were analyzed.The IQS as independent variable and the HR,rotation speed,reconstruction algorithm as dependent variables were analyzed by multiple linear regression analysis.Restllts The heart rate and the reconstruction algorithm had significant influence on IQS.The rotation speed(0.35s,0.40s,and 0.45s)didn't have significant influence on IQS.There was linear regression relationship between heart rate,reconstruction algorithm and IQS(P

Objective To investigate the iodine nutritional status of targeted population in the high-risk areas of iodine deficiency disorders in Chongqing, so as to provide scientific evidence for establishing prevention and remedial measures. Methods Six towns were selected in Chengkou and Wuxi Counties to found suspected dementia patients born after first Jan, 1997. Two hundred children aged 8-10 years were investigated in every town. The thyroid volume, intelligence quotient(IQ) and urinary iodine of the children were examined. Forty women (pregnant and nursing women) were investigated in every town. The iodine content of salt from their home was measured. The thyroid volume was examined by palpation and B-uhrasound. IQ was measured by combined Raven Test in China(CRT-RC2). Urinary iodine was determined using the acid digest arsenic-cerium contacting method, and iodined salt was detected using direct titration method. Results Six suspected dementia patients were found in the local town hospital. Five eases were excluded. There was 1 case born in other place. The rates of goiter by palpation and B-ultrasound were 9.58%(92/960) and 8.89%(65/731), respectively. The median of urinary iodine of children and women was 319.15 μg/L and 248.42 μg/L, respectively. The mean of IQ of the children was 103.32. The coverage rate of iodine salt from residents was 98.82%(336/340). Conclusions The iodine nutrition of children was good and there is no newly occurred cretinism in Chengkou and Wuxi Counties. Goiter rate and median of urinary iodine aged 8-10 years and of women, coverage rate of iodine salt from resident has meet the standard set for basical elimination iodine deficiency disorders.

The effect of acupuncture cooperated with low-frequency repetitive transcranial magnetic stimulation (rTMS) on chronic insomnia was explored.Seventy-eight patients with chronic insomnia were randomly allocated into two groups:treatment group and control group.In the treatment group,the patients received acupuncture combined with rTMS treatment,and those in the control group were given acupuncture cooperated with sham rTMS treatment,3 days per week for 4 weeks.Before and after treatment,the primary outcomes including the scores on Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) and the secondary outcomes including total sleep time (TST),sleep onset latency (SOL),wake after sleep onset (WASO),sleep efficiency (SE％) recorded by sleeping diary and actigraphy were observed in both groups.Seventy-five participants finished the study (38 in treatment group and 37 in control group respectively).After treatment,the scores in the two groups were improved significantly,more significantly in the treatment group than in the control group.It can be inferred that acupuncture cooperated with rTMS can effectively improve sleep quality,enhance the quality of life of patients and has less side effects.

Objective To understand the clinical features and prognosis of children with severe viral encephalitis (SVE), evaluate the related factors affecting prognosis. Methods Clinical data of 102 children with SVE in pediatric neurological ward and pediatric intensive care unit in Hunan Children's Hospital between January 2014 and January 2016 were analyzed retrospectively. According to prognosis, children were divided into good prognosis group(n =24, children's Glasgow outcome scale[CGOS]: 4 — 5) and poor prognosis group(n = 78, CGOS: 1 - 3), clinical data of two groups of children were compared, risk factors affecting the prognosis of SVE children were analyzed. Results In good prognosis group, 15 cases were cured and 9 had mild sequelae; in poor prognosis group, 14 cases died, 25 had severe sequelae, and 39 had moderate sequelae. The duration of fever and length of hospital stay in good prognosis group were both shorter than poor prognosis group, difference was statistically significant (both P く0.05). Multivariate unconditioned logistic regression analysis showed that adverse factors for prognosis of SVE were as follows: convulsive status, respiratory failure, longer fever period(＞5 days), severely abnormal electroen-cephalogram(EEG), head magnetic resonance imaging (MRI) lesions involving more than two sites or lesions involving the infratentorial, and stress hyperglycemia, odds ratio(OR) were 13.468, 4.580, 2.378, 10.196, 3.012, and 6.316 respectively. Conclusion SVE is a serious threat to quality of children's life, convulsive status, respiratory failure, longer fever period, severely abnormal EEG, head MRI lesions involving more than two sites or lesions involving the infratentorial, and stress hyperglycemia are risk factors for prognosis of SVE in children.