Atrial Fibrillation ; Atrial Remodeling ; Diagnostic Imaging ; Heart Atria ; Humans

Objective To evaluate the coronary microvascular dysfunction in patients with hypertrophic cardiomyopathy(HCM) by MR first-pass perfusion and late gadolinium enhancement. Methods From January 2011 to May 2015, 47 cases with HCM (HCM group) from the second affiliated hospital of Nanchang University were retrospectively analyzed. Additionally, 21 healthy volunteers were recruited as the control group. HCM group and control group underwent cardiac MR examinations at rest, including short axial cine, first-pass myocardial perfusion and late gadolinium enhancement scanning. Time to peak(tpeak), maximal upslope of time-intensity curve(Slopemax), peak signal intensity(SIpeak), myocardial thickening, and late myocardial gadolinium enhancement(LGE) were assessed for each myocardial segment. HCM group were divided into LGE segments group and non-LGE segments group. LGE segments group were divided into mild, moderate and severe LGE segments group. The SIpeak, Slopemax and tpeak in multiple groups were compared by one-way ANOVA and Kruskal-Wallis test. Spearman correlation tests were used to determine the relationships between perfusion parameter and LGE. Results The average values of tpeak in non-LGE segments group (527 segments), LGE segments group (225 segments) and control group (336 segments) were (67.0 ± 27.4), (79.4 ± 27.4), (59.7 ± 21.6)s, respectively. The average values of Slopemax in the three groups were 17.2±7.0, 16.4±7.4, 20.4±6.3, respectively. The average values of SIpeak in the three groups were 442.7 ± 143.2, 465.1 ± 138.4, 521.9 ± 146.7, respectively. Compared to the control group, tpeak increased and Slopemax, SIpeak decreased in non-LGE segments group and LGE segments group (P<0.01), while tpeak increased more significantly in LGE segments group. The Slopemax and SIpeak showed no statistically significant differences between non-LGE segments group and LGE segments group (P>0.05). There were significant differences among LGE segments groups, as the tpeak and SIpeak increased with increasing degrees of myocardial LGE (P<0.01). The Slopemax showed no statistically significant difference among them (P>0.05). The degree of LGE were positively correlated with tpeak (r=0.237, P<0.01). Conclusions 3.0 T magnetic resonance myocardial perfusion imaging can show microvascular dysfunction accurately and reliably in non-LGE segments. It may be helpful in the early diagnosis of coronary microvascular dysfunction for HCM.

Objective To study the value of MR diffusion tensor imaging(DTI) in the staging of chronic kidney disease(CKD).Method MR diffusion tensor imaging was used on 26 CKD patients.All patients were diagnosed as CKD according to the criteria of clinical diagnostic.All MR images achieved diagnostic requirements.Diethylenetriamine pentaacetic acid(99mTc-DTPA) renal dynamic imaging was used to determine the unilateral renal function.CKD patients were determined as mildly renal impairment group and moderately to severely renal impairment group based on the glomerular filtration rate(GFR).Twenty healthy volunteers underwent DTI at the same time.The cortical and medullary ADC value and FA value were measured in all subjects who underwent conventional MRI and DTI.The paired Student's t test was used to compare the cortico-medullary difference of the mean ADC and FA values in all subjects.The oneway analysis of variance(ANOVA) was carried out to assess the difference among the medullary and cortical diffusion parameters(ADC,FA) of all the three groups,and LSD was used to assess multiple comparisons.The correlation of GFR and ADC value of the patients,and FA value of the patients were tested by Pearson correlation analysis.Results The cortical and medullary ADC values of 46 subjects were(2.25±0.25) × 10-3 and(2.10±0.20) × 10-3 mm2/s respectively,FA of them were(3.48±0.61) and(4.27±0.75) respectively(t =6.754,10.043 respectively; P＜0.01).The cortical ADC values of volunteers,mild renal impairment group,severely renal impairment group were(2.25±0.22) ×10-3,(2.31±0.19) ×103,(2.18±0.32) ×10-3mm2/s respectively.The medullary ADC value of the three groups were(2.09±0.19) × 10-3,(2.17±0.17) × 10-3,(2.06±0.24) × 10-3mm2/s respectively(F=0.968,0.882 respectively; P＞0.05).The cortical FA values of the three groups were 3.85± 0.47,3.18±0.62,3.20±0.52 respectively.The medullary FA of the three groups were 4.92±0.38,3.93±0.57,3.62 ± 0.53(F=8.725,33.705 respectively; P＜0.01).There was no correlation between cortical ADC,medullary ADC,cortical FA of the patients and GFR [(30.14±15.79) ml· min-1 · 1.73 m-2](r =0.243,0.197,0.196 respectively; P＞0.05).There was a positive correlation between medullary FA of the patients and GFR (r=0.556,P=0.003).Conclusion FA value has certain value in evaluating CKD early diagnosis and renal function.

Objective To explore clinical value of cardiac MRI feature tracking (CMR-FT) in evaluation of left ventricular global and regional myocardial strain in hypertrophic cardiomyopathy (HCM).Methods Totally 60 patients with HCM (HCM group) and 10 healthy volunteers (control group) were enrolled and underwent cardiac MR.MR Sequences included fast imaging employing steady state acquisition (FIESTA) and late gadalinum enhancement (LGE) at ventricular short-axis,two-chamber and four-chamber planes.The patients in HCM group were divided into LGE negative subgroup and LGE positive subgroup.CMR-FT processing software was used to measure myocardial global radial peak strain (GPSR),global circumferential peak strain (GPSC) and global longitudinal peak strain (GPSL).The radial,circumferential and longitudinal peak strain (PSR,PSC and PSL) at the apex,middle and basal parts of left ventricular were also measured as well.Resuits GPSR,GPSC,GPSL in LGE positive subgroup,LGE negative subgroup and control group had significant differences (all P＜0.05),and showed upward trends.Except PSL at the apex had no significent difference among three groups,PSR,PSC and PSL at the apex,middle and basal parts had significant differences (all P＜0.05),and also showed upward trends.There were positive correlations between the LVEF,SV and GPSR,GPSC,GPSL (all P＜0.05).The area under ROC curve of GPSR,GPSC and GPSL in diagnosis of HCM were 0.79,0.82,0.77 (all P＜0.05),and the area under ROC curve of GPSC was the largest.Conclusion The CMR-FT technology can find myocardial strain dysfunction in HCM sensitively,and the longitudinal strain is damaged earlier or worse than circumferential and radial strains.

Objective:To provide reference for further research by comprehensively analyzing the present research status, hotspots and developing trends of chronic childhood diseases in China and abroad nearly five years.Methods:The bibliometric analysis and content analysis were used to analyze the literature related to children and adolescent with chronic diseases nearly five years included in CNKI, Wanfang Data, CQVIP Data, CBM, PubMed, Web of Science and Embase integrated by CiteSpace and self-made program.Results:A total of 40 653 articles were included (20 909 in Chinese and 19 744 in English). The high-frequency-word and visual atlas showed that the research hotspots in the field of chronic childhood diseases included: treatment, risk factors, family care and quality of life.Conclusions:The domestic research in the field is developing steadily, and the transitional medical care mode and online medical care are gradually showing a trend. For the transition period and intervention of children with chronic diseases, multi-dimensional research is still needed.

Objective:To analyze the serum and urinary amino acid (AA) profiles of urolithiasis patients to explore the potential biomarkers for clinical screening and early diagnosis.Methods:Case-control study. Serum and urine samples were collected from 74 urolithiasis patients (aged 20-82 years, 41 men, 33 female) in the department of urology of the First Affiliated Hospital of Fujian Medical University and 35 healthy controls (HC, aged 22-80 years old, 20 men, 15 female) from the health examination center from February 2015 to October 2017. Serum and urinary AA levels of patients and HC were analyzed using Gas Chromatography-Mass Spectrometry (GC-MS) based metabolomic strategy. The multivariate statistical analysis methods of principal component analysis (PCA) and orthogonal partial least squares discrimination analysis (OPLS-DA) were employed for modeling. The variable importance projection (VIP) value of OPLS-DA model>1 and P<0.05 of t test were selected to screen the differential amino acid metabolites. The diagnostic capabilities of potential markers were evaluated by receiver operating characteristic (ROC) curve and binary logistic regression analysis. Results:Five AA metabolites including serine, glutamate, aspartic acid, isoleucine and glycine were found, which had statistically significant differences between the patient group and the control group ( P<0.05) and were associated with seven metabolic pathways. Serum serine, glutamate, aspartic acid, isoleucine and urine glycine and aspartic acid were combined into an integrated marker panel whose AUC value was 0.890, the sensitivity was 78.0%, and the specificity was 96.4%. Conclusion:Five amino acids in serum and urine could be used as an integrated biomarker panel for the clinical screening and early diagnosis of urolithiasis, which could provide some experimental basis for molecular urolithiasis research.

Objective:To explore the technical feasibility of CT feature tracking (CT-FT) technique in evaluating left ventricular myocardial strain and evaluate the change of myocardial strain in patients with coronary heart disease.Methods:Eighty-one patients with coronary heart disease (lesion group) and 33 patients with normal coronary artery (control group) matched with age and sex were collected retrospectively from the Second Affiliated Hospital of Nanchang University from April 2019 to October 2020. The lesion group was first divided into single vessel stenosis group (42 cases) and multi vessel stenosis group (39 cases) according to the number of coronary artery stenosis branches, and the global myocardial strains of the left ventricle between the groups were analyzed. Lesion site included the left anterior descending branch (LAD), right coronary artery (RCA) and left circumflex branch (LCX), respectively. According to the degree of vascular stenosis, the lesion groups were divided into normal group, mild stenosis group, moderate stenosis group and severe stenosis group. The segmental myocardial strains of the branch segment of LAD, RCA or LCX were analyzed between groups. All CCTA examinations were performed with retrospective electrocardiogram gating. CVI 42 cardiac postprocessing software was used to obtain myocardial strain parameters, including global peak longitudinal strain (GPLS), global peak circumferential strain (GPCS), global peak radial strain (GPRS), and the segmental myocardial strains of the branch segment of LAD, RCA or LCX. The segmental myocardial strains included the peak longitudinal strain (PLS), peak circumferential strain (PCS) and peak radial strain (PRS). One way ANOVA or Kruskal Wallis H test were used for multi group analysis. Results:With the increased number of coronary artery stenosis branches, the absolute value of GPLS gradually decreased. The GPLS of the control group, single vessel stenosis group and multi vessel stenosis group were -14.1%±2.7%, -11.5%±2.3% and -8.8%±2.0%, respectively. The difference of GPLS between the 3 groups or any 2 groups was statistically significant (all P<0.001). The absolute values of GPRS and GPRS in multi vessel stenosis group were significantly lower than those in control group and single vessel stenosis group (all P<0.001). There was no significant difference in GPRS or GPRS between single vessel stenosis group and control group ( P=0.083, 0.118). And there were significant differences in the segmental myocardial strains of the branch segment of LAD, RCA or LCX among 3 groups ( P<0.001). In severe stenosis group, the absolute values of PRS, PCS and PLS in LAD, RCA or LCX were significantly lower than those in moderate stenosis group, mild stenosis group and normal group (all P<0.05). In the moderate stenosis group, the absolute value of PLS in each branch segment was lower than that of the mild stenosis and normal group (all P<0.05), and there was no significant difference in any 2 other myocardial strain parameters of each branch (all P>0.05). Conclusions:CT-FT technique was feasible to evaluate left ventricular myocardial function. With the increased number or degree of coronary artery stenosis, the global and segmental myocardial strain parameters of left ventricle gradually decreased, and the longitudinal strain was more sensitive.

Objective:To study the diagnostic value of the artificial intelligence (AI) diagnostic system, ACR TI-RADS classification and AI+ ACR TI-RADS combined diagnostic performance in benign and malignant thyroid nodules and its guiding significance for surgical treatment.Methods:From Nov. 1, 2021, to Feb. 26, 2022, 349 patients with 605 thyroid nodules who received surgical treatment in Department of Thyroid (Hernia) Surgery, Department of General Surgery, the First Medical Center of the PLA General Hospital, were selected. There were 95 males and 254 females, male: female=1:2.67, aged 16-78 years, and the nodule diameter was 0.2-5.6 cm. SPSS 26.0 and R studio software were used for data processing. AI diagnostic system, ACR TI-RADS grading and AI+ ACR TI-RADS combined diagnostic efficacy were statistically analyzed, respectively. ROC curve analysis was performed in parallel.Results:The AUC value of AI+ ACR TI-RADS combined diagnosis was 0.900, greater than 0.857 of AI diagnostic system and 0.788 of ACR TI-RADS, and the difference was statistically significant ( Z= 7.631, both P<0.001) . The sensitivity of the combined diagnosis was 95.32%, the specificity was 84.61%, the accuracy was 92.56%, the positive predictive value was 94.69%, the negative predictive value was 86.27%, the missed diagnosis rate was 4.68%, and the misdiagnosis rate was 15.38%, which were better than the other two diagnostic methods. With an excellent coincidence rate with postoperative pathological results ( Kappa=0.804, P<0.001) . The accuracy of combined diagnosis in identifying the maximum diameter of different tumors was 89.58% for d≤0.5 cm, 96.09% for 0.54.0 cm, better than the other two diagnostic methods. Conclusions:The combined application of AI+ACR TI-RADS has a certain primary screening value in evaluating thyroid nodule properties. The combined diagnosis of the two can more effectively determine the benign and malignant thyroid nodules.