PurposeTo investigate clinical significance of echocardiography combined with Flash CT in diagnosis of partial anomalous pulmonary venous connection (PAPVC). Materials and Methods Twenty-eight cases of PAPVC were recruited in the study. All the subjects underwent both preoperative echocardiography and coarse pitch Flash CT scanning. Imaging findings were compared with the results of surgery, including the type of PAPVC, size of atrial septal defect (ASD), and other combined malformations. Results Among 28 patients, 16 cases and 5 suspicious cases (4 cases of PAPVC and 1 case of pulmonary vein embolism) were diagnosed by echocardiography. Six cases were missed, and 1 case was misdiagnosed. CT misdiagnosed 1 case. The accurate diagnosis rate of echocardiography (71.4%, 20/28) was lower than that of Flash CT (96.4%, 27/28) (P<0.05). There were 44 combined malformations in 28 cases, 43 lesions were diagnosed by echocardiography, and 34 lesions were diagnosed by Flash CT. The accurate diagnosis rate of echocardiography (97.7%, 43/44) was higher than that of Flash CT (77.3%, 34/44) (P<0.05). The average DLP was (15.5±3.2) mGy·cm and average effective dose (ED) was (0.354±0.058) mSv.Conclusion Flash CT has a higher diagnosis accuracy of PAPVC but a lower diagnostic accuracy of combined malformations when compared with echocardiography. Moreover, echocardiography can make comprehensive evaluation in valve disease, pulmonary artery pressure and cardiac function. Flash CT combined with echocardiography may improve preoperative diagnosis.

Background and purpose:Adenocarcinoma of the esophagogastric junction (AEG) has a high incidence of early recurrence and metastasis after operation. The prognosis of AEG is poor. However, few studies have investigated the recurrence of AEG. The purpose of this study was to clarify the important clinical pathological factors affecting the early recurrence ofⅠ,Ⅱ type of AEG after operation. Thus more active treatment for patients at high risk of recurrence may improve the prognosis.Methods:This study retrospectively reviewed the clinical data from 145 AEG patients who underwent R0 resection during the period from Dec. 2008 to Dec. 2012. Risk factors associated with the early recurrence were analyzed.Results:The mean time to tumor recurrence was 25.4 months after R0 resection, and the 1-year recurrence rate was 38.6%. Univariate analysis showed that the histological grade (degree of tumor differentiation), number of positive lymph nodes, TNM stage and vascular invasion were signiifcantly related with the early recurrence (P<0.05). Logistic multivariate regression analysis showed that only histological grade and vascular invasion were independently related with early tumor recurrence (P<0.05).Conclusion:Histological grade and vascular invasion are independent risk factors for predicting the early tumor recurrence after R0 resection for AEG.

Objective: To identify the most appropriate meteorological variable for forecasting the health risk of high temperatures. Methods: The surveillance on causes of death, meteorological data and surveillance on air quality among registered residents in Ningbo City, Zhejiang Province during the period between May and October from 2013 to 2019 were collected. The association models of daily minimum temperature, average daily temperature, daily maximum temperature, daily minimum heat index, average daily heat index, daily maximum heat index, average daily apparent temperature and torridity index with deaths and years of life lost (YLL) were created using time series analysis and distributed lag non-linear models, and the model fitting effect was evaluated using the minimum Akaike information criterion (AIC) procedure. The most appropriate meteorological variable for forecasting gender-, age- and mortality-specific health risks of high temperatures was identified. Results: A total of 120 628 deaths were reported during the study period, with daily deaths of 94 cases, and daily YLL rate of 19.74 person-years/105. Except for daily minimum heat index and torridity index, the exposure-response relationships between other six meteorological variables and deaths and overall YLL rate all appeared a “J” shape. The lowest AIC values and the optimal model fitting effects were measured for the association models between average daily temperature and whole populations, females, subjects at ages of 65 years and older, and deaths and YLL rates due to circulatory diseases and respiratory diseases. Conclusion High model fitting effects are observed between average daily temperature and deaths and YLL rates, which are more suitable for forecasting the health risk of high temperature.

Objective To assess the effects of image fusion of CT spectral monochromatic imaging on image quality in small hepatocellular carcinoma (HCC).Methods Thirty patients with 40 pathologically proven small HCCs (≤3 cm) underwent upper abdominal plain CT and dual-phase enhanced spectral CT scan were analyzed retrospectively.Conventional 140 kVp polychromatic images (group A) and monochromatic images with energy levels from 40 to 140 keV were reconstructed by using spectral imaging viewer.Monochromatic images with highest CNR (group B)and 70 keV images with lowest noise (group C) were fused to generate fused images (group D) with image fusion software.Objective evaluation of 40 HCCs [contrast-to-noise ratio (CNR) of lesion,image noise in HU] and subjective rating score of 30 patients (image noise score,overall image quality score,and lesion conspicuity score) among the four groups were compared by using One-way ANOVA and Kruskal-Wallis H test.Results CNR (1.3±0.6,2.1±0.6,1.5±0.6 and 2.4± 1.3 respectively) and image noise [(20±7),(32±9),(18±3) and (24±6) HU respectively] among group A,B,C and D all had statistical differences (F =5.724 and 13.619,both P values ＜ 0.01).CNR in group D was higher as compared with group A and C (both P values ＜ 0.05),but was similar to group B (P ＞ 0.05).Image noise in group D was lower than group B and higher than group C,but showed no difference from group A (all P values ＞ 0.05).Image noise scores [(3.5±0.5),(3.3±0.4),(3.6±0.5)and(3.5±0.4)point,respectively],overall image quality scores [(3.2 ± 0.4),(3.3 ± 0.3),(3.1 ± 0.3) and (3.7 ± 0.4) point respectively] and lesion conspicuity scores [(3.3 ±0.4),(3.9±0.4),(3.2±0.4) and (3.7 ±0.4) point,respectively] among the four groups all had statistical differences (Z =9.581,37.495 and 43.436,all P values ＜ 0.05).Scores of the four groups were all greater than 3 and met the clinical diagnostic level.Group D was higher than group B in image noise score,higher than the other three groups in overall image quality score,higher than group A in lesion conspicuity score (all P values ＜ 0.05).Conclusion Combined use of CT spectral monochromatic imaging and image fusion can improve overall image quality while maintaining or increasing CNR in small HCC.

Objective To analyze the correlations of clinical characteristics,CT and pathology features of peripheral primitive neuroectrodermal tumors (pPNET)in abdomen-pelvis region,and to improve the understanding of the disease.Methods The clinical information,CT and pathological features of 23 confirmed pPNET patients in abdomen-pelvis region were analyzed retrospectively.Results (1)All patients had preoperative clinical and imaging data integrallty.(2)23 cases showed soft tissue masses with fuzzy boundary and the average diameter were 10.72 cm.Among all,9 cases showed with varying degrees of sac necrosis,while 2 cases showed with platelet hemorrhage and 4 cases with speckled calcifications.Most showed slight-to-moderate heterogeneous enhancement and the necrosis and cystic are-as showed more obvious.12 cases showed with different degree of recurrence,invasion or distant metastasis.5 cases combined with tumor emboli and 4 cases with tumor feeding vessels.(3)Immunohistochemical examination showed CD99 expressed in 1 9 patients, CD56 in 11,vimentin(Vim)in 12,synaptophysin(Syn)in 11,neuron specific enolase(NSE)in 4,FLI-1 in 4 and epithelial membrane antigen (EMA)in 4 patients.Conclusion pPNET is common among young patients with a high degree of malignancy.CT features include large mass with invasive growth,commonly combined heterogenous density,necrosis and cystic changes.Persistent enhancement is observed during nephrographic phase.

Objective : To evaluate the excess mortality risk related to heat wave in Ningbo, Zhejiang from 2013 to 2018, so as to provide a basis for formulating coping strategies for heat wave. Methods : The data of daily mortality, meteorological and air quality from May to October in Ningbo from 2013 to 2018 were obtained from Ningbo Center for Disease Control and Prevention, Ningbo Meteorological Bureau and Environmental Monitoring Center of Ningbo, respectively. The generalized linear model ( GLM ) and distributed lag non-linear model ( DLNM ) were used to estimate the associations between heat wave and cause-specific mortality. Results : Among 1 104 days of the study period, 18 heat waves occured and lasted for 132 days, accounting for 11.96%. A total of 102 954 deaths were reported in the same period. The risks of mortality in circulatory system diseases ( RR=1.09, 95%CI: 1.03-1.16 ), respiratory system diseases ( RR=1.14, 95%CI: 1.04-1.25 ), digestive system diseases ( RR=1.38, 95%CI: 1.15-1.65 ), nervous system diseases ( RR=1.32, 95%CI: 1.08-1.61 ), mental disorders ( RR=1.51, 95%CI: 1.12-2.03 ) and accidental injury ( RR=1.18, 95%CI: 1.06-1.32 ) and all causes ( RR=1.10, 95%CI: 1.06-1.14 ) increased at lag 0-1 day of heat wave. The total excess death related to heat wave was 1 218 ( 95%CI: 731-1 705 ) . The excess deaths of circulatory system diseases, respiratory system diseases, accidental injury, digestive system diseases, nervous system diseases, mental disorders, urinary system diseases and endocrine system diseases were 313 ( 95%CI: 104-556 ), 206 ( 95%CI: 59-368 ), 164 ( 95%CI: 55-292 ), 122 ( 95%CI: 48-208 ), 69 ( 95%CI: 17-131 ), 56 ( 95%CI: 13-113 ), 18 ( 95%CI: -15-64 ) and 3 ( 95%CI: -51-72 ). The excess deaths of urinary system and endocrine system diseases was not statistically significant ( P>0.05 ). Conclusion Heat wave can increase the mortality risk on the day and after a day in Ningbo from 2013 to 2018. Circulatory system diseases, respiratory system diseases and accidental injury rank top three in excess deaths.

ObjectiveTo study the feasibility of abdominal aortic CT angiography with low dose contrast medium.MethodsThe patients who took the examinations were divided into three groups.In 34 patients of group A,the injection flow rate was 4 ml/s,and the contrast medium volume was 90 ml and 20 ml of saline was applied.The contrast medium dose and injection flow rate of the other 64 patients were determined according to the formula,injection tlow rate = patients' body mass × ratio of contrast medium dose to the body mass / (5 + exposure time).In B and C group with 32 cases each,the ratio of contrast medium dose to body mass were 0.8 to 0.9 and 0.6 to 0.7 ml/kg.The depiction and the measured intraarterial concentration of contrast medium of the abdominal aorta and the renal arteries as well as their branches were compared and evaluated on the source images and MIP images generated among three groups respectively.CT values of the abdominal aorta and its branches in each group were analyzed using singlefactor analysis of variance,while renal artery and its branches were analyzed using x2 test score.Results The abdominal aorta,the celiac trunk,the splenic artery,the superior mesenteric artery,the renal arteries and their branches were all well shown in three groups.The CT value within the abdominal aorta were (363 ±28),(362 ±28) and (334 ± 14) HU for the three groups respectively,the CT values within the celiac were (368 ±28),(367 ±28) and (338 ± 15)HU,the CT value within the renal artery were (365 ±27),(364 ± 29) and (336 ± 15) HU respectively,the CT value within the splenic artery were (373 ±28),(372 ± 28) and (343 ± 15) HU respectively,and the CT value within the superior mesenteric artery were ( 374 ± 28 ),( 372 ± 28 ) and ( 344 ± 16 ) HU respectively.There were significant differences among the three groups ( P = 0.000).There were significant differences between A group and C group,B group and C group ( P ＜ 0.01 ),while no significant difference existed between A group and B group( P ＞0.05 ).The amount of contrast agent for each patient in group A was 90 ml,while the amount of contrast agent in group B and C was (51 ± 9) and (40 ± 9) ml respectively.There were significant differences of the contrast medium volume among the three groups ( F = 537.091,P = 0.000).Results of pairwise comparisons were statistically significant(P =0.000).Image quality of renal artery in group A was rated as excellent,good,and generally for 26,7 and 1 cases,24,7 and 1 for group B,and 22,8 and 2 for group C.There were no significant differences in image quality of the renal arteries among the three groups ( x2 = 0.561,P = 0.755 ).ConclusionThe individualization of injection method in abdominal aortic CT angiography can minimize the amount of contrast agent but to meet the clinical requirements.

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Objective:Tumor-treating fields (TTFields) is a kind of non-invasive anti-mitotic tumor therapy, which has been approved for patients with newly diagnosed and recurrent glioblastoma. This study aims to explore the efficacy and safety of TTFields in high-grade gliomas in clinical practice settings.Methods:The clinical data of 15 patients with recurrent glioma and 9 patients with newly diagnosed high-grade glioma admitted to our center from April 2019 to January 2021 were retrospectively analyzed. All patients accepted TTFields≥1 month. Follow-up was performed for 5.3 months (ranged from 2.3 to 10.7 months); Response Assessment in Neuro-Oncology Working Group (RANO) criteria was used to evaluate the glioma responses. The progression-free survival (PFS) and overall survival (OS) were calculated according to Kaplan-Meier method. Common Terminology Criteria for Adverse Events v5.0 (CTCAE v5.0) and TTFields related skin adverse reaction (dAE) criteria were used to evaluate the adverse events. Quality of life questionnaire-core 30 (QLQ-C30) and QLQ-brain cancer module (QLQ-BN20) questionnaires were used to evaluate the health-related quality of life (HRQoL). Treatment compliance was evaluated by data on the use of NovoTTF-200A devices, and calculated as a percentage of daily TTFields usage.Results:The median duration of TTFields was 4.2 months (ranged from 1.0 to 10.7 months), with a median compliance rate of 91.5% (67.0%-97.0%). TTFields was used alone in 2 patients and used with combination of chemotherapy in 22 patients. From follow-up to April 2021, 14 patients had stable symptoms and 10 had disease progression (8 died). The median PFS and OS of recurrent patients were 5.9 months ( 95%CI: 3.3-8.6 months) and 8.5 months ( 95%CI: 3.2-13.8 months), respectively; and the median PFS and OS of newly diagnosed patients were both 10.7 months (without 95%CI). The common adverse events included grading 1 dAE (58.3%) and grading 2 dAE (12.5%), without grading 3 or 4 dAE, manifested as contact or allergic dermatitis, erosion, folliculitis and ulcers. And 87.5% patients had stable HRQoL. Conclusions:The preliminary results showed that the survival of recurrent high-grade glioma patients treated by TTFields is similar to that reported in foreign literature; and the newly diagnosed patients need further survival follow-up. The patients' treatment compliance and safety are good. The dAE incidence (grading 1-2) is higher than that reported in the literature, and the toxicity was acceptable.

BACKGROUND: Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia. METHODS: In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared. RESULTS: A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model ( P <0.05). CONCLUSIONS The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.
Humans ; Retrospective Studies ; Pneumonia/diagnostic imaging* ; Analysis of Variance ; Tomography, X-Ray Computed ; Lymphoma/diagnostic imaging*