Purpose To investigate the effect of two different 1.5T MRI scanners on the apparent diffusion coefficient (ADC) measurement and its reproducibility in diffusion weighted imaging (DWI) of the liver. Materials and Methods Two groups of volunteers (33 people in each group) underwent liver DWI examination twice by using the same DWI sequence with b value of 0 and 800 s/mm2 on different MRI scanners (1.5T Siemens Espree and 1.5T Philips Achieva). On ADC maps, two region of interests were placed on three central slices of the left and right liver lobes, respectively. The ADC measurements of six region of interests on left and right liver lobes were averaged to represent the mean ADC values of the left and right liver lobe, respectively. The reproducibility of the ADC measurements was assessed by Bland-Altman method. Results The ADC values of the left and right liver lobes measured on Siemens MRI scanner were significantly higher than those on Philips MRI scanner (t=2.045-2.713, P<0.05); on both scanners, the ADC values of the left liver lobe were significantly higher than those of the right liver lobe (t=-10.561--7.263, P<0.001). The Bland-Altman results showed that the reproducibility of ADC measurement was similar on both MRI scanners, and both displayed higher reproducibility of right liver lobe than that of left liver lobe (on Siemens MRI scanner: the agreement were 16.65% and 7.55% for the left and right liver lobe, respectively;and on Philips MRI scanner:16.30%and 7.85%, respectively. Conclusion Different MRI scanners may have influence on ADC values, but does not affect its reproducibility. Therefore, when ADC values obtained on different MR scanners are compared in clinical analysis, this influence should be considered.

Objective To investigate the feasibility of magnetic resonance diffusion-weighted intravoxel incoherent motion (DW-IVIM)imaging and its reproducibility in normal liver.Methods Thirty-five young healthy volunteers underwent liver DW-IVIM ex-amination twice on a 1 .5 Tesla Philips MR scanner.Parameter maps of D,D* and f were generated by using a manufacturer-sup-plied software.Six Region-of-interests (ROIs)(3 ROIs in left and right liver lobe,respectively)were drawn on three consecutive middle slices,respectively.The average values of D,D* and f were measured and compared between the left and right liver lobe. The reproducibility of D,D* and f measurement were assessed with Bland-Altman method.Results The values of D,D* and f of left liver lobe [D(×10-3 mm2/s):1.250±0.210,D*(×10-3 mm2/s):101.906±15.063 ,f(%):22.954±5.268]were statistically higher than those of right liver lobe[D(×10-3 mm2/s):1.039±0.124,D*(×10-3 mm2/s):100.127±20.757,f(%),18.317± 3.671](D,f,P<0.001,D*,P<0.232-0.605),however ,their reproducibility of left liver lobe [limit of agreement(LOA):22.55%,51.05%,39.3%,respectively]were lower than those of right liver lobe (LOA:20.3%,39.25%,33.9%).The D values had the best reproducibility in both the left and right liver lobe.Conclusion The liver DW-IVIM is feasible.The values of D,D*and f in left liver lobe were higher that those in right liver lobe but with worse reproducibility of measurement.The D value was most reproducible in both liver lobes.

ObjectiveTo investigate the clinical features of the abnormal chromosome karyotypes in twin pregnancies complicated with fetal malformations. Methods Totally 181 twin pregnancies (362 fetuses) in which one or two fetuses had abnormalities diagnosed by ultrasound were referred to the First Affiliated Hospital of Sun Yat-Sen University from January, 2000 to September, 2010. They were divided into different groups according to ( 1 ) maternal age: the cases with maternal age ≥35 were divided into advanced pregnancy group ( 105 fetuses) , and those with maternal age ＜35 were divided into young pregnancy group (203 fetuses) ; ( 2 ) conceived method : those conceived by assisted reproductive technology were divided into assisted reproductive group (81 fetuses), and the natural conception pregnancies were divided into natural conception group (227 fetuses) ; ( 3 ) chorionicity: the monochorionic twin (MCT) pregnancies were divided into MCT group( 123 fetuses), and the dichorionic twin (DCT) pregnancies were divided into DCT group( 185 fetuses); (4) structural abnormalities: 205 fetuses with structural abnormalities were divided into the abnormal fetal group, and 103 fetuses without structural abnormalities were divided into the normal fetal group. All fetuses were examined by the ultrasound and chromosomes were examined in 308 fetuses. Results( 1 ) The karyotype of fetuses: among 181 twin pregnancies, 23 cases had chromosomal abnormalities in 1 or 2 fetuses ( 12. 7％ ,23/181 ), and chromosomes were exarmined in both fetuses in 20 of 23 cases. Twenty-six of 308 fetuses were found with abnormal chromosomes ( 8.4％, 26/308 ) , and the aneuploid was the most common type of abnormal karyotypes ( 53.8％ , 14/26 ). Twenty-one of 205 fetuses with malformations were found with abnormal karyotypes (10. 2％, 21/205 ). (2) Seven of 123 fetuses in MCT group were with abnormal karyotypes (5.7％, 7/123), and 19 of 185 fetuses in DCT group were with abnormal karyotypes ( 10. 3％, 19/185 ). There was no statistical difference of abnormal chromosome incidence between the two groups. There were 14 fetuses with aneuploid in DCT group ( 7.6％, 14/185 ) ;but there was no fetus with aneuploid in MCT group. There was statistical difference between these two groups. In two cases of DCT group, only one fetus with malformation received chromosome examination because another fetus was dead, and the karyotypes were trisomy 21 and trisomy 18 respectively. Both fetuses of the rest 17 cases received chromosome examination, and the chromosomes of both fetuses in each pregnancy were different. Fifteen of 19 fetuses with abnormal chromosomes in DCT group were complicated with structural abnormalities, and 7 fetuses of 4 twin pregnancies in MCT group were with chromosomal abnormalities. (3) The comparison of the abnormal karyotype incidence between the advanced pregnancy group and young pregnancy group: the abnormal karyotype incidence of the advanced pregnancy group was 7. 6％ (8/105), and that was 8.9％ (18/203) in young pregnancy group. There was no statistical difference between the two groups ( P ＞ 0. 05 ). Six of 105 fetuses in advanced pregnancy group were aneuploids (5. 7％, 6/105), and 8 of 203 fetuses in young pregnancy group were aneuploids (3.9％, 8/203). The aneuploid incidence in advanced pregnancy group was significantly higher than that in young pregnancy group ( P ＜ 0. 05 ). (4) The comparison of the abnormal karyotype incidence between the assisted reproductive group and the natural conception group: 11 of 81 fetuses were with the abnormal karyotypes in assisted reproductive group ( 13. 6％, 11/81 ), and 15 of 227 fetuses were with the abnormal karyotypes in assisted reproductive group (6. 6％, 15/227). There was statistical difference between the two groups ( P ＜0. 05). There were 7 fetuses with the aneuploid in assisted reproductive group ( 8. 6％, 7/81 ) and 7 fetuses with the aneuploid in natural conception group ( 3. 1％, 7/227 ), which showed no statistical difference ( P ＞0. 05 ).(5) The comparison of the abnormal karyotype incidence between the abnormal fetal group and normal fetal group: 21 of 205 fetuses in abnormal fetal group were with abnormal karyotypes (10. 2％, 21/205), and 5 of 103 fetuses in normal fetal group were with abnormal karyotypes ( 4. 9％, 5/103 ) . There was no statistical difference (P ＞ 0. 05 ). 13 fetuses in abnormal fetal group were with the aneuploid (6. 3％, 1 3/205), and only one fetus in normal fetal group was aneuploid (1.0％, 1/103 ). There was statistical difference between the two groups ( P ＜ 0. 05 ). ConclusionsAneuploid is the most common abnormal karyotype in twin pregnancy complicated with fetal abnormalities, especially trisomy 21. Aneuploid mainly occurs in only one fetus of DCT, and chromosomal discordance is usually found in DCT. While in MCT, the twin fetuses with the same abnormal karyotype may have different pbenotypes. The results suggest that it is necessary to analyze both karyotypes of twins even if only one fetus is complicated with structural abnormalities.

ObjectiveTo investigate the chemical constituents from Aidi Injection.Methods The chemical constituents were isolated by chromatography on Sephadex LH-20 gel columns and reverse phase semi-preparative HPLC repeatedly.Their structures were identified by spectroscopic analysis (NMR and MS).ResultsTwenty-two compounds were isolated and identified to be 3-O-3',4'-diacetyl-β-D-xylopyranosyl-6-O-β-D-glucopyranosylcycloastragenol (1),astragaloside IV (2),astragaloside Ⅱ (3),astragaloside I (4),isoastragaloside I (5),acetylastragaloside I (6),ginsenosid Re (7),ginsenoside Rf (8),ginsenoside Rg1 (9),ginsenoside Rb3 (10),notoginsenoside R4 (11),ginsenoside Rb1 (12),ginsenoside Rc (13),ginsenoside Rb2 (14),ginsenoside Rd (15),lucyoside H (16),3-O-ββ-D-glucopyranosyl(l→4)-β-D-glucopyranosyl(l→3)-α-L-rhamnopyranosyl (1→2)-α-Larabinopyranosyl oleanolic acid 28-O-α-L-rhamnopyranosyl(l→4)-β-D-glucopyranosyl(1→6)-β-D-glucopyranoside (17),3-O-β-D-glucopyranosyl(1→3)-α-L-rhamnopyranosyl [β-D-glucopyranosyl-(l→4)]-(l→2)-αt-L-arabinopyranosyl oleanolic acid 28-O-α-L-arabinopyranosyl(1→4)-β-D-glucopyranosyl(1→6)-β-D-glucopyranoside (18),syringin (19),elentheroside E (20),4-(1,2,3-trihydroxypropyl)-2,6-dimethoxyphenyl-I-O-β-D-glucopyranoside (21),and coniferin (22).ConclusionCompounds 1-6 are originated from Astragalus membranceus,compounds 7-18 are originated from Panax ginseng,and compounds 19-22 are originated from Acanthopanax senticosus by LC-MS analysis.Compound 1 is a new compound.

OBJECTIVETo develop a RP-HPLC-ELSD method for the simultaneous determination of five glycosides in Aidi injection.

METHODThe separation was carried out at 35 degrees C on a Kromasil C18 column (4.6 mm x 250 mm, 5 microm) eluted with acetonitrile and water as the mobile phases in gradient mode. The flow rate was 1.0 mL x min(-1). The SHIMADZU ELSD-LT II detector was used. The detector temperature was at 40 degrees C and the pressure of carrier gas N2 was 0.35 MPa.

RESULTThe linear response (the natural logarithm of peak areas with corresponding mass) ranges were 21.2-212 mg x L(-1) for syringin, 30.8-308 mg x L(-1) for ginsenoside Rg1, 24.8-248 mg x L(-1) for ginsenoside Re, 25.6-256 mg x L(-1) for ginsenoside Rb1, 31.2-312 mg x L(-1), for astragaloside IV, respectively. The average recoveries (n = 9) of five glycosides were greater than 97.6%, and RSD were less than 1.1%.

CONCLUSIONThe results demonstrated that this method had adequate accuracy and selectivity to measure the concentrations of five glycosides in Aidi injection.

Chromatography, High Pressure Liquid ; methods ; Drugs, Chinese Herbal ; analysis ; Ginsenosides ; analysis ; Glucosides ; analysis ; Glycosides ; analysis ; Injections ; Phenylpropionates ; analysis ; Saponins ; analysis ; Triterpenes ; analysis

Objective:To investigate the functional connectivity of default mode network (DMN) and limbic system, the expression level of inflammatory cytokine and their correlation in bipolar disorder type Ⅱ(BDⅡ) patients with depressive episodes.Methods:Thirty-three BD Ⅱ patients with depressive episodes and forty-six healthy controls were recruited to complete the resting-state functional magnetic resonance imaging (rs-fMRI). After image preprocessing, the DMN and limbic system were extracted from the image data by independent component analysis (ICA), so as to compare the differences of functional connectivity of resting brain network between the patients and the controls.Serum levels of inflammatory cytokines interleukin-6 (IL-6), interleukin-8(IL-8), interleukin-10(IL-10), tumor necrosis factor-α (TNF-α), and C-C motif chemokine ligand 4 (CCL4) in patients and healthy controls were detected.The correlation between functional connectivity of different brain regions and inflammatory cytokines was analyzed.SPSS 17.0 software was used for data statistical analysis.The two samples were compared using t-test or Mann-Whitney U-test, and Spearman was used for correlation testing. Results:In BDⅡ patients, the functional connectivity of the right medial prefrontal cortex(cluster-size=7 voxel, cluster-level PGRF<0.05, MNI: x=6, y=54, z=9, t=-3.765) and the left superior frontal gyrus(cluster-size=10 voxel, cluster-level PGRF<0.05, MNI: x=-21, y=54, z=15, t=-4.139) in DMN decreased, while the left cerebellum Ⅳ and Ⅴ lobules of limbic system (cluster-size=21 voxel, cluster-level PGRF<0.05, MNI: x=-15, y=-24, z=-30, t=4.468) and cerebellar tonsil of left cerebellum posterior lobe(cluster-size=8 voxel, cluster-level PGRF<0.05, MNI: x=-15, y=-51, z=-45, t=4.138) in the limbic system increased.Compared with the healthy controls, the serum levels of IL-10(7.39 (6.33, 9.32) pg/mL vs 6.54 (5.84, 7.39) pg/mL, Z=-2.937, P=0.003)and CCL4 (39.31 (25.77, 68.70) pg/mL vs 31.30 (20.32, 40.89) pg/mL, Z=-2.209, P=0.027) were higher in BDⅡ patients.The functional connectivity of the left cerebellum Ⅳ and Ⅴ lobules was positively correlated with the serum levels of IL-10 ( r=0.432, P=0.031) and that of the cerebellar tonsil of left cerebellum posterior lobe was positively correlated with the serum levels of IL-10 ( r=0.429, P=0.032) and CCL4 ( r=0.402, P=0.046). Conclusion:The functional connectivity of DMN and limbic system in BDⅡ patients with depressive episode is abnormal in resting-state fMRI.The expression level of inflammatory cytokines in patients' serum increases, and has correlation with the functional connection of limbic system.

Objective:To explore the value of 5G-based robotic remote ultrasound diagnosis system in musculoskeletal joint injuries.Methods:From March to December 2020, 58 volunteers at a training base who felt musculoskeletal pain or paresthesia were selected and performed both robotic remote ultrasound (remote ultrasound group) and conventional ultrasound (portable ultrasound group). The two types of examinations were compared, the consistency of the two diagnosis results was analyzed by the Kappa test, and the the difference of the diagnosis results was compared by McNemar test.Results:Among the 58 volunteers, 40 cases were positive by both methods and 11 volunteers had 2-3 positive results. There were 59 positive results in the remote ultrasound group and 64 positive results in the portable ultrasound group. The positive rate of the examination sites from high to low was knee joint>foot and ankle joint >hand and wrist joint >shoulder joint>elbow joint, calf and hip. The diagnosis results of the two groups were in good consistency (Kappa=0.782, P<0.001), and there was no statistically significant difference in the diagnosis results between the two groups (χ 2=3.2, P=0.063). Five more diseases with positive results were detected in the portable ultrasound group: 1 meniscus injury, 1 medial collateral ligament injury, 1 soft tissue injury around the metatarsal, 1 biceps tendinitis with effusion and 1 cubital ulnar nerve subluxation. Conclusions:The 5G-based robotic remote ultrasound system has good consistency with conventional ultrasound in the diagnosis of musculoskeletal injures. It can be applied to the ultrasound diagnosis of musculoskeletal joint injuries in remote areas.

Objective To explore the efficacy of debridement combined with antibiotic-loaded artificial bone in the treatment of clavicular osteomyelitis.Methods The data of 45 patients with clavicle osteomyelitis admitted to Luoyang Orthopedic Hospital(Henan Orthopedic Hospital)in Henan Province from January 2012 to June 2022 were retrospectively analyzed.They were divided into treatment group(n = 24)treated with debridement combined with antibiotic-loaded artificial bone,and control group(n = 21)treated with debridement.We compared the operation time,the duration of drainage tube placement,wound healing time,white blood cells(WBC),C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)in the two groups.Preoperative visual analog scores(VAS)and VAS 1 month after operation,and preoperative Constant-Murley score(CMS)and CMS 12 months after operation were observed.Infections,recurrence and complications in the two groups were recorded in the follow-up.Results All the 45 patients completed the surgery successfully and were followed up for 13 to 35 months,with an average of(23.53±5.11)months.The operation time and the duration of drainage tube place-ment of the treatment group were longer than those of the control group(P<0.05),and there was no significant difference in the wound healing time(P>0.05);preoperative and 14-day postoperative WBC,CRP,and ESR,VAS 1 month after operation,and CMS 12 months after operation were all significantly improved in the two groups.The differences were all statistically significant(P<0.05),and the CMS of the treatment group was higher than that of the control group(P<0.05).During the follow-up,there were less cases of infection recurrence in the treatment group when compared with that in the control group(2/24,8.33%vs.5/21,23.81%).There were 2 cases of aseptic exudation in the treatment group.There were 1 case of bone defect in the treatment group and 5 in the control group,all of which had healed after the second-stage iliac implantation,and the rest did not have the complication of aseptic exudation,bone defects and pathologic fracture.Conclusion Debridement and antibiotic-loaded artificial bone can effectively control the infection and preserve the shape and function of the clavicle,with a low recurrence rate of postoperative infection,simple surgical operation,and no serious complications.It is wor-thy of clinical promotion.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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