Objective To investigate epidemiological and clinical features of human ehrlichiosis.Methods The epidemiological, clinical, laboratory, therapeutic and prognostic data of 21 clinically diagnosed cases of human ehrlichiosis were retrospectively analyzed. Results The epidemic regions where the ticks' activity was high located at the boundary between Hubei and Henan Provinces. All cases were farmers. The median age was 50 years ranged from 19 to 69 years. The male female ratio evident history of tick bite 1 week before the onset. The common symptoms included fever, diarrhea,cough, nausea and vomiting, abdominal pain and expectoration. The complications included hemorrhage, toxic encephalopathy, acute renal insufficiency, secondary infection and respiratory failure. The common abnormalities of routine lab data were thrombocytopenia, hypoeosinophilia,elevated lactate dehydrogenase, creatine kinase and aminotransferases, leucopenia and proteinuria.Nine cases were tested with peripheral blood smear and intracytoplasmic inclusions in neutrophils were found in one case. Seventeen cases were tested with serological assay and antibodies against Ehrlichia were positive in five cases. After doxycycline, symptomatic and supportive treatments, 14 cases were recovered and seven died. The average age of the deaths was 56 years. Conclusions Human ehrlichiosis is an acute tick-borne zoonosis and multiorgan could be involved. The older cases prone to develop complications and the prognosis is poor.

Purpose To investigate the effect of low contrast dose and low tube voltage combined with adaptive statistical iterative reconstruction (ASIR) on image quality of abdominal CT angiography. Materials and Methods 139 patients with body mass index (BMI) <22 kg/m2 who were supposed to undergo abdominal dynamic contrast-enhanced examination were prospectively enrolled and randomly divided into group A with 78 cases (80 kVp tube voltage +50% ASIR, contrast agent concentration 270 mgI/ml) and group B with 61 cases (120 kVp tube voltage, contrast agent concentration 350 mgI/ml). Subjective score of right renal artery image quality of the two groups were evaluated and the coefficient between them was tested; CT dose index of volume (CTDIvol), CT values of abdominal aorta and its branches, and the right side erector spinae, contrast-to-noise ratio (CNR) of the vessel, the right erector spinae image noise (SD), and the total amount of iodine were also compared between the two groups. Results The inter observer agreement for subjective scores were very good (Kappa value>0.80) in both groups, the subjective score of group A and group B were 4.60±0.51 and 3.81±0.76, respectively, and the difference was statistically significant (Z= - 6.86, P<0.05). CTDIvol of group A and group B were (5.56±4.21) mGy and (7.11±1.54) mGy, respectively, the difference was statistically significant (t= - 9.89, P<0.01); CT values of the arteries in both groups were all greater than 400 HU; CT values and the CNR of the abdominal aortic trunk and branches in group A were higher than those of group B (P<0.05); there was no statistically significant difference of image noise between the two groups (P>0.05). The total amount of iodine dose in group A and group B was 270 mg and 350 mg respectively, with a 22.86% reduce of the total iodine for each patient in A group than in B group. Conclusion For patients with BMI<22 kg/m2, it is feasible to use low dose contrast medium with low tube voltage and ASIR, which may not only improve the image quality of abdominal CTA but also reduce the radiation dose and iodine content.

Objective To explore the application value of optimal energy imaging technique of monoenergetic dual-energy computed tomography (DECT) in feeding arteries examination of rectal cancer.Methods The clinical data of 33 patients with rectal cancer who were admitted to the First Affiliated Hospital of Dalian Medical University from July 2012 to July 2014 were analyzed retrospectively.The polychromatic and monochromatic images of feeding arteries of tumors were reconstructed and evaluated using a subjective image quality score of 5-point scale by 2 observers.The consistency and scores of evaluation were analyzed by the κ test and MannWhitney U test.The CT value of feeding arteries of tumors and hip muscle,image noise and contrast to noise ratio (CNR) were measured and calculated by 2 observers,and were compared by the independent sample t test.The consistency of data between the 2 observers were measured by the intra-class correlation coefficients (ICC).Results Inferior mesenteric arteries were contributor of blood supply of tumors in all the 33 patients,including 4 cases with right inferior rectal artery as contributor of blood supply of tumors,2 cases with bilateral inferior rectal artery.Among patients with abnormal blood vessels,there were 8 patients with left colic artery and sigmoid artery having common trunk,4 patients with left colic artery originated from Inferior mesenteric artery,1 patient with absence of left colic artery.The 0-,1-,2-,3-,4-score polychromatic image quality of feeding arteries of tumors were detected in 0,13,13,5,2 patients and 0,11,14,6,2 patients by 2 observers,respectively.The 0-,1-,2-,3-,4-score monochromatic image quality of feeding arteries of tumors were detected in 0,0,7,7,19 patients and 0,0,6,9,18 patients by 2 observers,respectively.Good interobserver agreement was found for the evaluation of subjective scores (κ =0.864,0.897).The subjective scores of image quality of feeding arteries in the polychromatic images and in the monochromatic images were 1.9 ± 0.9 and 3.4 ± 0.8,with significant difference (Z =-5.21,P ＜ 0.05).The latter was superior to the former.The ICC values of the CT values of feeding arteries of tumor,hip muscle,image noise and CNR were 0.953,0.907,0.839,0.964 and 0.966,0.933,0.952,0.962 from the 2 observers,with a good consistency.The CT values of feeding arteries of tumor,gluteal muscles,image noise and CNR in the polychromatic images and in the monochromatic images were (234 ± 52)HU and (412±83)HU,(57±9)HU and (71 ±15)HU,(21 ±3)HU and (31 ±6)HU,9 ±3 and 11 ±4,respectively,with significant differences (t =-18.65,-4.44,-14.14,-6.55,P ＜ 0.05).The levels of monochromatic images of 33 patients were 51-61 keV,with a median of 55 keV.Conclusion The optimal energy imaging technique of monoenergetic DECT can improve the angiographic quality of feeding arteries in patients with rectal cancer.

PurposeTo investigate the effects of the low concentration contrast medium combined with optimal single source spectral imaging on displaying feeding arteries of gastrointestinal tract malignant tumors.Materials and Methods Seventy-one patients of body mass index (BMI) >25 kg/m2 with gastrointestinal tract malignant tumors were prospectively studied. All the cases were randomly divided into two groups: high concentration group (33 cases with high concentration contrast medium of 350 mgI/ml in routine scan) and low concentration group (38 cases with low concentration contrast medium of 270 mgI/ml in optimal single source spectral imaging). The optimal single source images were generated automatically. The subjective image scores, CT value of the tumor feeding arteries, image noise, contrast-to-noise ratio (CNR) and CT dose index of volume (CTDIvol) of optimal single source spectral images in two groups were compared. Results The optimal single source of low concentration group were 51-60 keV. The subjective image score of low concentration group was higher than high concentration group (Z=-4.280,P<0.01). The consistency between the two investigators was good (Kappa=0.824 and 0.843,P<0.05). The consistency between the two investigators in evaluating CT value of the tumor feeding arteries, CT value at the right erector spinal muscle, image noise and CNR data was good (ICChigh concentration group=0.998, 0.968, 0.959 and 0.990; ICClow concentration group=0.988, 0.981, 0.969 and 0.937). The CT values of the tumor feeding arteries and CNR of the low concentration group were higher than that of the high concentration group, but the image noise was lower than that of high concentration group (t=-14.937, 4.263 and-17.264,P<0.01). There was no statistical difference of CTDIvol between the two groups (t=1.278,P>0.05).Conclusion The low concentration contrast medium with optimal single source spectral imaging in patients with large BMI may improve CTA image quality of feeding arteries of gastrointestinal tract malignant tumors without increasing radiation dose.

Purpose To explore the influence of duration of scan acquisition on perfusion parameters in whole renal perfusion with Revolution CT.Materials and Methods Fortytwo patients without pathologic changes in bilateral kidneys were divided into group A (with short perfusion time) and group B (with long perfusion time) according to the duration time of the perfusion scan.The Revolution CT axial scan mode was used for perfusion scan,and the width of detector was 16 cm.The perfusion CT series were performed in 50 seconds,each comprising 25 volumes with identical parameters (80 kVp,200 mA) in group A.The perfusion CT series were performed in 594 seconds,each comprising 23 volumes with identical parameters (120 kVp,55 mA) in group B.The source datasets were post-processed with CT Perfusion 4D software,and the perfusion parameter maps were obtained when right renal abdominal aorta was taken as entry artery.Perfusion parameters of bilateral kidneys were compared within and between group A and group B,respectively.CT dosage index of volume (CTDIvol) and dose length product (DLP) were recorded.The effective dose (ED) was calculated and compared.Results There were no statistical difference in all parameters between bilateral kidneys within each group (P＞0.05).However,blood volume,time to peak,and permeability surface in the cortex and medulla of bilateral kidneys all showed differences between the above two groups (P＜0.05).The mean transit time in the medulla between the two groups was different (P＜0.05),but neither the blood flow in the medulla and cortex nor the mean transit time of the cortex had difference between the two groups (P＞0.05).The effective radiation doses were (23.10± 4.39)mSv in group A and (23.19±0.00) mSv in group B,respectively (without statistic difference:P＞0.05).Conclusion CT perfusion parameters with different duration time show differences in whole renal perfusion;therefore,scanning time needs to be set according to the clinical application.

Objective To assess the value of spectral CT imaging in distinguishing mass type colorectal adenocarcinoma from colorectal adenoma. Methods Forty patients underwent preoperative abdominal dual energy spectral CT scan were analyzed restrospectively, including 17 with colorectal adenomas and 23 with mass type colorectal adenocarcinomas proven by endoscopic and surgical pathology. All patients underwent plain and three-phase enhanced CT scanning. The conventional polychromatic CT value and its pre- and postcontrast CT values, monochromatic CT value of 40 to 100 keV, the slope of spectral curve and iodine(water) concentration were measured, and the maximum diameter of the lesion was recorded. The maximum diameters of the lesions and imaging parameter differences between the adenomas and adenocarcinomas in plain and three-phase enhanced scan were analyzed with independent sample t tests. The data of the parameters with significant differences were further analyzed by ROC curves. Results The maximum diameters of the adenomas and mass type adenocarcinomas were (1.97 ± 0.54), (2.32±0.53) cm respectively, and there was no statistically significant difference (t=-2.011, P=0.051). There was no statistically differences of the conventional polychromatic CT value and its pre-and postcontrast CT values between the two groups in 4 phases (P>0.05). However, in the arterial phase, the CT values of adenomas were significantly lower than those of adenocarcinomas at low (40, 50 keV) energy (P<0.05). The values did not differ significantly between these two groups at other phases (P>0.05). The slope of spectral curve and the iodine(water) concentration both showed significant differences in the arterial phase between the two groups (P<0.05), while they were not significantly different at other phases (P>0.05).The largest area under the ROC curve of the iodine(water) concentration in the arterial phase was 0.757 in differentiating adenomas and mass type adenocarcinomas, with sensitivity of 73.9%and specificity of 82.4%at the cut-off of 21.02 mg/cm3. Conclusion Spectral CT imaging is valuable in differentiating colorectal adenoma from mass type colorectal adenocarcinoma with the parameters of the arterial phase.

OBJECTIVETo assess the possibility of using spirometrically controlled computed tomography (CT) to test pulmonary ventilation function.

METHODSSpiral CT scans under the control of a spirometer were performed on 30 healthy adults. Spiral CT scan was performed at 50% vital capacity (VC) with an 8 mm slice thickness. Mean attenuation values and pixel index (PI) of lung regions were evaluated with semiautomatic evaluation software.

RESULTSThere were significant differences in PI values between four pixel intervals.

CONCLUSIONSSpirometrically controlled spiral CT with semiautomatic evaluation software is an accurate and reproducible method of measuring lung density and PI, which has the possibility of indicating pulmonary ventilation function.

Adult ; Female ; Humans ; Lung ; diagnostic imaging ; physiology ; Male ; Middle Aged ; Respiratory Function Tests ; Spirometry ; Tomography, X-Ray Computed ; Vital Capacity

OBJECTIVE Aim to evaluate the mental level in 4-6 years old children with obstructive sleep apnea hypopnea syndrome(OSAHS). METHODS Children who were diagnosed as OSAHS with a whole night PSG monitor in the sleep center between January 2015 and August 2016, and 30 healthy children were included in the study. Intelligent levels were evaluated at the enrollment day. The following intelligent levels evaluation questionnaires were used: Wechsler Intelligence Scale for children and infants. Intelligent levels were compared between the patient and healthy control groups. RESULTS The 60 children, including 30 children with OSAHS(patient group) and 30 healthy children(control group) were enrolled. Comparison of the patient versus the control groups revealed that total intelligence quotient(FIQ) was 96.59±12.60 vs 102.53±8.44; language capability(VIQ) was 94.00±13.24 vs 101.03±9.41; comprehension test was 5.96±2.5 vs 7.57±2.14; visual analysis was 8.85±2.32 vs 10.3±1.93. All the 4 values in the patient group were significantly lower than those in the control group(all P ＜0.05). The accumulated time of SO2＜90％ correlated with PIQ negatively and significantly. CONCLUSION The intelligent level of children with OSAHS was in the normal range, but lower than that of healthy group. Snoring affects the IQ level of 4-6 years old children, and the influence on PIQ is closely related to the accumulated time of SO2＜90％ in total sleep time.

Resin-containing drugs in Dracaena from four different appearances were analyzed by headspace sampling-gas chromatography-mass spectrometry(HS-GC-MS) metabolomics technique and hierarchical clustering analysis(HCA) chemometrics method. This study was to analyze differential volatile components in resin-containing drugs in Dracaena from different appearance and metabolic pathways. The results of partial least squares discriminant analysis(PLS-DA) and HCA analysis indicated that there was little difference in volatile components between fiber-rich sample and hollow cork cambium sample, however, the volatile components in the two samples compared with whole body resin-containing sample and resin-secreting aggregated sample had a large metabolic difference. Twenty differential metabolites were screened by VIP and P values of PLS-DA. The content of these differential metabolites was significantly higher in whole body resin-containing sample and resin-secreting aggregated sample than in fiber-rich sample and hollow cork cambium sample. Sixteen significant metabolic pathways were obtained through enrichment analysis(P<0.05), mainly involved in terpenoids biosynthesis and phenylpropanoid metabolism. This result provided a reference for further study of resin formation mechanism of resin-containing drugs in Dracaena from different appearances. At the same time, it also provided a reference for establishing a multi-index quality evaluation system.
Cluster Analysis ; Discriminant Analysis ; Dracaena ; Gas Chromatography-Mass Spectrometry ; Resins, Plant

Purpose To explore the feasibility of denoising algorithm-PixelShine algorithm based on deep learning to enhance the quality of abdominal arterial phase CT images rebuilt by 70 kVp combined with adaptive statistical iterative reconstruction-Veo (ASiR-V). Materials and Methods Abdominal arterial phase images of 33 patients [body mass index (BMI) BMI≤20 kg/m2] scanned by GE Revolution CT were retrospectively analyzed (group A) using 70 kVp tube voltage and 50% ASiR-V technique. PixelShine algorithm B2 mode was applied to post-process group A images to obtain PixelShine image (group B). Two observers rated the image quality of the two groups via a 5-point rating system. The consistency of the rating was analyzed. The difference in ratings, noise, virtual signal-to-noise ratio (SNR) of liver and pancreas and contrast noise ratio (CNR) were compared between the two groups of images. Results The image quality rating of group A and B were(3.12±0.33) scores and(3.97±0.53) scores respectively,noise value(14.50±1.42)HU vs(10.05±1.80)HU, liver virtual SNR 4.51±0.53 vs 6.78.±1.27,liver virtual CNR 0.89±0.55 vs 1.42±0.81,pancreatic virtual SNR 9.51±1.69 vs 13.87±3.26, and pancreatic virtual CNR 5.83±1.66 vs 8.48±2.46.The quality rating of images,liver and pancreas virtual SNR,CNR in group B were all higher than those in group A, and the image noise of group B decreased about 31% compared with that of group A, the difference was statistically significant (P<0.05). Conclusion Post-processing with PixelShine algorithm can improve the image quality of 70 kVp abdominal arterial phase, significantly reduce image noise, and increase image SNR and CNR.