Objective To explore the impact of pre-setted generation adaptive statistical iterative reconstruction Veo (ASiR-V) on chest CT radiation dose and image quality.Methods The chest model and 120 patients (divided into 6 groups,each n=20) were scanned by GE Revolution CT under the condition of pre-setted ASiR-V weights for 0,20％,40％,60％,80％ and 100％ respectively.The tube voltage was 120 kV,the tube current was automated mAs (Smart mA10-500) technology,the noise index was 11.The dose-length product of each chest model group and patients group were record,the effective dose (ED) of each group was calculated and compared.The image quality among groups through combining the objective CT and standard deviation (SD) values of different organizations (lung tissue,the soft tissue near by spine,the aorta and vertebral body) in chest model and the image subjective rating of patients were compared,and the subjective score of patients' images was also compared among groups.Results With the increase of pre-setted ASiR-V,the ED of chest model and patients reduced as a logarithmic fitting,there are no obvious changes of the CT value and image noise SD value of different organizations in model.The subjective score of mediastinal and pulmonary window was begin to decline at 40％ weighted ASiR-V.The subjective score of mediastinal and pulmonary window descend obviously at 60％ weighted ASiR-V compare to 40％ (P＜0.05).ED of pre-setted 40％ weighted ASiR-V reduced to 57.21％ compared to that of 0 weighted ASiR-V.Conclusion The pre-setted ASiR-V can reduce the radiation dose,and does not affect the objective image quality at the same time.The pre-setted 40 ％ weighted ASiR-V has the highest clinical application value due to the radiation dose can be obviously reduced with ensuring the image quality,which can meet the demand of diagnosis.

Objective To compare the effectiveness and the influence on life quality of endovenous laser obliteration with those of traditional surgical ligation in treating varicosis of lower extremity.Methods By using numerical random grouping method,40 patients with varicosis of lower extremity were divided into traditional surgical ligation group (high ligation plus stripping,traditional group,n=20) and endovenous laser obliteration group (laser group,n=20).The curative effect and complications were compared between the two groups.According to the brief health survey (SF-36) scale,the influences of the two treatments on the life quality were evaluated.Results During the follow-up period,the differences in the curative effect and complications between two groups were not significant (P＞0.05).The life quality assessed by SF-36 scores in the laser group was better than that in the traditional group,the difference between the two groups was statistically significant (P＜0.05).Conclusion For the treatment of varicosis of lower extremity,endovenous laser obliteration is safe and effective,it carries less influence on the patient's life quality when compared with traditional surgical ligation therapy.

Objective To discuss the efficacy and complications of using AngioJet rheolytic thrombectomy in treating acute lower extremity deep vein thrombosis (DVT).Methods The clinical data of 22 patients with acute lower extremity DVT,who were treated with AngioJet rheolytic thrombectomy during the period from February 2015 to August 2016,were retrospectively analyzed.The improvement of clinical symptoms and the thrombus clearance rate were calculated to evaluate the curative effect.The procedure-related complications were documented.Results The clinical symptoms were relieved immediately after operation in all 22 patients.The thigh circumference difference between the affected side and the healthy side decreased from preoperative (4.5±0.6) cm to postoperative (1.0±0.4) cm,the difference in change was statistically significant (P＜0.05).The mean used dose of urokinase was (0.18±0.03) million unit and the average duration of thrombolysis was (4.2±0.7) hours.Complete removal of DVT (＞90％) was achieved in 19 patients,most removal of DVT (50％-90％) in 2 patients,and partial removal of DVT (＜50％) in one patient.After treatment,6 patients developed transient hemoglobinuria,which was relieved after hydration with fluid infusion on the same day.No serious complications such as pulmonary embolism or hemorrhage occurred.Conclusion For the treatment of acute lower extremity DVT,AngioJet rheolytic thrombectomy is safe and effective with less complications.

Objective The purpose of this study was to evaluate the written project approval Indexes System of Capital Medical Ddevelopment Research Foundation.We analyzed the approval results of application projects and proposed measures to improve the index system.Methods We evaluated its reliability with Cronbach's alpha coefficient,split-half reliability; validity was evaluated with contract validity and content validity,discrimination was studies according to discretion grouping law,and feasibility was studied with the percentage-of-completion method.Results ① Reliability:Cronbach's alpha coefficient of factor and total scores'and split-half reliability were all over 0.80.②Contract validity:the standard factor loading coefficients of the index system were over 0.70 (range:0.57～0.86),indicating path performed well.All factor loading coefficients were statistical significant (T-values were 30.49～54.25,all were over 1.96).Fit Indexes (RMSEA =0.065、NNFI =0.99、IFI =0.99、CFI =0.99、GFI =0.95、AGFI =0.93、X2 =1028.21、X2/DF =11.82) indicated the system's goodness of fit was good.③ Content validity:Scale-level CVI,S-CVI was 0.97 and Interrater agreement was 0.93,over 0.90,which indicated that indexes system's whole Content validity performed well.Except for the item Academic thought item-level CVI being 0.57 all items' item-level CVI were 1.00.④Discrimination:Discrimination index of every primary index,secondary index and total score ranged from 0.51 to 0.76 (all were over 0.40),meaning that discrimination performed extremely well.Conclusion The indexes system's reliability,contract validity,content validity and discrimination conformed to the actual application projects appraisal results.

ObjectiveTo explore the application of the Structure Equation Model on validity assessment of the evaluation indicator system,we studied Medical Capital Development Fund projects in 2007 to evaluate their construct validity.MethodsPart of the evaluation results (1200 items) were divided into two parts randomly.PART1 was used for Exploratory Factor Analysis (EFA) to explore the Indicator System' structure,and formed model F1.Confirmatory Factor Analysis (CFA) was used to assess the construct validity of model F1.With considerations of Modification Index(MI) and reality,F1 was modified into F3.At last,we take PART2 as the sample to confirm F3.ResultThe results of model F3 fit indices showed a better fit.All the path coefficients,estimated load factors and other parameters were statistically significant.ConclusionStructural Equation Model is professional,reliable and satisfactory for the evaluation of indicator system's contract validity.

Objective To evaluate the safety and effectiveness of intraluminal implantation of 125I seeds strand combined with stent placement in treating malignant biliary obstruction. Methods During the period from June 2009 to June 2013, a total of 68 patients with malignant biliary obstruction were admitted to Shanghai Zhongshan Hospital. Interventional management was carried out in all patients. The clinical data were retrospectively analyzed. Of the 68 patients, intraluminal implantation of 125I seeds strand combined with simultaneous stent placement was performed in 41 (combination therapy group) and only stent placement was employed in 27 (conventional therapy group). The survival time, the improvement of obstructive jaundice, recurrence of jaundice and procedure-related adverse events were recorded, and the results were compared between the two groups. Results Implantation of 125I seeds strand and stent placement were successfully accomplished in all patients. Statistically significant differences in serum bilirubin levels, which were separately determined at 7 days and 14 days after the treatment, existed between the two groups (P<0.05). No obvious marrow depression was observed in the combination therapy group. The median survival time of the conventional therapy group and the combination therapy group was 123 days and 215 days respectively. The difference was statistically significant (P < 0.05). Conclusion For the treatment of malignant biliary obstruction, combination use of intraluminal brachytherapy and stent placement is clinically more safe and effective than conventional pure stent placement therapy.

OBJECTIVETo explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.

METHODS(1) 10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system, MIMICS). The origin and distribution of the angular artery perforator were observed. (2) Between July 2012 and July 2014, twenty-one patients underwent operations for the reconstruction of midface defect. Ten patients had squamous cell carcinoma, nine patients had basal cell carcinoma and two patients had nevus. The flaps' size ranged from 1.5 cm x 3.5 cm to 2.5 cm x 5.0 cm.

RESULTSThe facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth, subsequently strenches to inner canthus continuing as the angular artery. The angular artery anastomoses extensively with the dorsal nasal artery and the infraorbital artery. All the flaps survived. The patients were satisfied with the final aesthetic and functional results.

CONCLUSIONSThe flap can be designed flexibly and simply with reliable blood supply. The donor sites could be closed directly without skin graft, it is a simple and fast method for the reconstruction of midface defect.

Anastomosis, Surgical ; methods ; Arteries ; anatomy & histology ; Cadaver ; Carcinoma, Basal Cell ; surgery ; Carcinoma, Squamous Cell ; surgery ; Face ; blood supply ; Facial Neoplasms ; surgery ; Humans ; Nevus ; surgery ; Nose ; blood supply ; Perforator Flap ; blood supply ; transplantation ; Skin Neoplasms ; surgery ; Skin Transplantation ; Software ; Tomography, Spiral Computed

Objective:To investigate the application value of magnetic resonance (MR) diffusion tensor imaging (DTI) automatic fiber quantification (AFQ) in the diagnosis and prediction of Alzheimer's disease (AD).Methods:Clinical and MR data of 21 patients with AD (AD group) and 33 normal controls (NC group) were collected.AFQ software was used to analyze DTI data, track 20 white matter fiber bundles in the brain, and compare the differences of fractional anisotropy (FA) and mean diffusivity (MD) value of each bundle between groups.Each fiber bundle was divided into 100 equal parts along the direction of travel, and the FA or MD value of each part was taken as a characteristic.Screening the characteristics with statistic differences between groups for classification of AD and NC by support vector machine (SVM) with leave one method for cross validation.Classification effectiveness was evaluated using the receiver operating characteristic (ROC) curve.Results:Eleven (left/right anterior thalamic radiation (ATR), left/right corticospinal tract (CST), genu of corpus callosum (CC Genu), right inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF), left/right uncinated fasciculus (UF), and left/right arcuate fasciculus (AF)) of the 20 fiber bundles were successfully tracked in all subjects.Compared with NC group, the FA values of 2 fiber bundles (left/right UF) in AD group were significantly decreased( t=-2.532, -2.391, both P<0.05), and the MD values of 7 fiber bundles (left ATR, left/right CST, right ILF, left/right UF, and left AF) were significantly increased ( t=2.569, 2.411, 2.108, 2.357, 3.773, 3.796, 3.492, all P<0.05). Among the 2 200 characteristics of 11 fiber bundles, 412 classification characteristics with inter-group differences were selected.Among which, 78 FA characteristics were distributed in 7 fiber bundles (left ATR, left/right CST, CC Genu, right ILF, left/right UF), and 334 MD characteristics were distributed in 9 fiber tracts (left/right ATR, left/right CST, CC Genu, right ILF, left/right UF, and left AF). The accuracy of SVM classification was 85.19%, sensitivity was 80.95%, specificity was 87.88%, and area under ROC curve was 0.894 7. Conclusion:AFQ analysis based on DTI has a high application value in the diagnosis and prediction of AD.

Objective:To explore the normal ranges of perfusion parameters between cerebral hemisphere, cerebellar hemisphere and brain anatomical subregions (56 pairs) in different gender and age groups with multiple post labeling delay time (Multi-PLD) arterial spin labeling (ASL) imaging.Methods:From November 2020 to December 2020, 42 healthy adult volunteers (Male 25, Female 17) were recruited to perform 7 PLD ASL imaging, including 21 young adults (15 males and 6 females, aged 23—35 years) and 21 seniors (10 males and 11 females, aged 36—74 years). The data was processed offline by Cereflow software to obtain arterial arrival time (ATT) and corrected cerebral blood flow (CBF) and cerebral blood volume (CBV) perfusion parameters. SimpleITK standardization function was used to standardize the calculated perfusion image according to the anatomical automatic labeling (AAL) template. Therefore, CBF, ATT, CBV perfusion values of brain subregions were obtained. Paired samples t test, Wilcoxon rank sum test, independent samples t test and Mann-Whitney U test were used to compare the differences of perfusion parameters in the cerebral hemisphere, the cerebellar hemisphere, brain subregions depending on side, gender and age. Pearson correlation analysis was used to compare the correlations of perfusion parameters with age. Results:CBF in 62.5% (35/56) subregions and CBV in 44.6% (25/56) subregions were higher in right side than those in left side. ATT in most brain anatomical subregions (16/56) were higher in left side. The CBF [(35.30±8.31) vs. (34.34±7.53) ml·100g -1·min -1, P=0.021], CBV [(0.47±0.11) vs. (0.45±0.09) ml/100g, P<0.001], ATT [(1.30±0.10) vs. (1.24±0.11) s, P<0.001] in left cerebellar hemisphere were higher than that of right side. The CBF (28/56) of cerebral hemisphere, cerebellar hemisphere and brain subregions was higher in females than that in males, while ATT in 83.9% (47/56) subregions was lower than that in males (all P<0.05). CBV in female subjects was higher only in 5 brain regions (superior occipital gyrus, middle occipital gyrus, inferior occipital gyrus, superior parietal gyrus and cerebelum_7b) (all P<0.05). In young subjects, CBF in 44.6% (25/56) subregions and CBV in 33.9% (19/56) subregions were higher than those in the senior group (all P<0.05). The ATT in most subregions in young group were lower than those in senior group, but the difference was statistically significant only in rectus gyrus ( P=0.026) and paracentral lobule ( P=0.006). The CBF ( r=-0.430, P=0.005) and CBV ( r=-0.327, P=0.035) of cerebral hemisphere were negatively correlated with age. The CBF (24/25, r range:-0.497 —-0.343, all P<0.05) and CBV (16/19, r range:-0.474 —-0.322, all P<0.05) in most subregions were negatively correlated with age, while ATT was positively correlated (gyrus rectus: r=0.311, P=0.045; paracentral lobule: r=0.392, P=0.010). Conclusions:Multi-PLD ASL imaging could be applied for quantitative analysis of brain perfusion. The perfusion parameters of anatomical subregions are different depending on side, gender, and age.

Objective To investigate the regulation of SIRT1 on ovarian granulosa cell in women with poor ovarian response.Methods A total of 60 women who underwent IVF/ICSI-ET were included in this study,30 women in poor ovarian response(POR)group and 30 women in normal ovarian response(NOR)group.The granulosa cells in follicular fluid were isolated and purified by density gradient centrifugation.The granulosa cells of POR group were treated with SIRT1 agonist resveratrol(RESV)or inhibitor EX527,respectively,and the control group was granulosa cells treated without drugs.mRNA levels of SIRT1 and key enzymes of steroid hormone synthesis(StAR,CYP19,CYP17)in granulosa cells were detected by qPCR.The levels of SIRT1,steroid hormone synthesis key enzymes protein and apoptosis-related protein(Bcl-2,Caspase-3)in granulosa cells were detected by Western blot.The apoptosis rate of granulosa cells was detected by TUNEL method.Determination of estradiol in granulosa cell culture medium by chemiluminescence.Results The mRNA and protein levels of SIRT1 in granulosa cells in POR group were lower than those in NOR group(P = 0.003,P<0.001).RESV up-regulated SIRT1 mRNA and protein levels(P<0.001),up-regulated mRNA and protein levels of steroid hormone synthesis key enzyme(P<0.05).EX527 down-regulated SIRT1 mRNA and protein levels(P = 0.023,0.001),down-regulated mRNA and protein levels of steroid hormone synthesis key enzymes(P<0.05).After RESV treatment,the apoptosis rate of granulosa cells was decreased(P<0.001),the Bcl-2 protein level was increased(P<0.001),and the Caspase-3 protein level was decreased(P<0.001).After EX527 treatment,the apoptosis rate of granulosa cells was increased(P<0.001),the Bcl-2 protein level was decreased(P = 0.003),and the Caspase-3 protein level was increased(P<0.001).Conclusion The SIRT1 level in granulosa cells of POR women was lower than that of NOR women.RESV up-regulated SIRT1 expression in granulosa cells.SIRT1 inhibited granulosa cell apoptosis,increased the level of steroid hormone synthesis key enzyme,and promoted estradiol synthesis in granulosa cell.Therefore,SIRT1 activators such as RESV may be a therapeutic agent to improve ovarian reactivity and increase the number of oocytes obtained in women with POR.