Purpose Recently the incidence of bone and joint degeneration is increased,with the increasing of cardiovascular disease complication.This study aims to utilize realtime three-dimensional echocardiography (RT-3DE) in evaluating left ventricular remodeling index (LVRI),to guide treatment and improve the survival rate.Materials and Methods Fifty-seven cases of healthy volunteers (normal control group) and sixty-seven patients with bone and joint degeneration (research group) were respectively divided into two subgroups according to the age.Both groups underwent conventional echocardiography and RT-3DE.The LVRI,left ventricular end diastolic volume index (LVEDVI),left ventricular mass index (LVMI),left ventricular end systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) measured by different methods were analyzed,and the differences and correlations between groups and within each group were compared.Results The age of normal control group and research group was not significantly different (P＞0.05).The LVMI and LVRI in research group were significantly higher than those in the normal control group with same age (P＜0.05).The LVEDVI,LVMI and LVRI measured by two-dimensional echocardiography and M-mode echocardiography were higher than those measured by RT-3DE,and the difference was statistically significant (P＜0.05).Bland-Altman agreement analysis showed good agreement of measured LVRI using 2D echocardiography and RT-3DE.Conclusion Patients with bone and joint degeneration have left ventricular remodeling.RT-3DE can accurately assess LVRI with the advantages of convenience and lack of radiation,which can be widely used in clinic.

Objective To analyze the possibility of using TCR Vβsubfamily as the diagnostic in-dicators for major histocompatibility complex( MHC) deficiency-induced graft-versus-host disease( GVHD) . Methods The BALB/c mice were given 9.5 Gy (950 rad) of irradiation and transplanted with 106 of T-cell depleted (TCD) bone marrow cells from C57BL/6 and DBA/2 mice with MHC Ⅱ deficiency.Two control groups were set up accordingly by injection of TCD bone marrow cells from wild type ( WT) C57BL/6 and DBA/2 mice.Several parameters including the body weight, the GVHD clinical score and the survival time of the recipients were monitored.Flow cytometry analysis and mixed lymphocyte culture test were performed for the evaluation of autoimmune responses.Histological examination was used to analyze the severity of GVHD.Results The MHC deficiency-induced GVHD was successfully induced in the irradiated BALB/c mice receiving MHC mismatched allogeneic hematopoietic cell transplantation ( allo-HCT ) . The MHC matched DBA/2 mice with MHC deficiency could be used as the mice model of subclinical GVHD.Changes of the TCR Vβ6 were consistent with the results of histopathological examination.Conclusion Highly ex-pressed TCR Vβ6 could be used as indicators for the diagnosis of MHC deficiency-induced subclinical GVHD.

Objective:To evaluate the value of Sonazoid contrast enhanced ultrasound (CEUS) in preoperative prediction of proliferating cell nuclear antigen 67 (Ki-67) level of hepatocellular carcinoma (HCC) by establishing predictive model based on radiomics features of Kupffer phase.Methods:From October 2020 to August 2021, patients with histologically confirmed HCC lesion and who underwent Sonazoid CEUS examination 1 week before surgery were prospectively enrolled. The radiomics signatures were extracted from the whole tumor region on gray scale images and Kupffer phase images. Two predictive radiomics models were constructed using radiomic method. The predictive performance of 2 models was compared.Results:A total of 50 patients with histologically confirmed single HCC lesions were prospectively enrolled in this study. Among them, histological results revealed 24 HCC lesions with high level representation of Ki-67 (>20%) and 26 HCC lesions with low level representation of Ki-67 (≤20%). Two radiomics predictive models were established based on gray scale images and Kupffer phase images respectively. While compared with model based on B-mode ultrasound images, model based on Kupffer phase images showed significantly higher area under receiver operating characteristic curve (0.753 vs 0.535, P=0.017), accuracy (0.720 vs 0.580, P=0.023) and sensitivity (0.458 vs 0.250, P=0.043). Calibration plot indicated that Kupffer phase model showed better consistency with the actual Ki-67 level than gray scale model. Conclusions:The radiomics model based on Kupffer phase features of Sonazoid CEUS is a preoperative and noninvasive prediction the presentation level of Ki-67 in HCC lesions.

Objective: To assess left atrial(LA)function by evaluating changes of LA wall movement and volume detected by real-time three-dimensional speckle tracking imaging(RT3D-STI)in elderly patients with ischemic mitral regurgitation(IMR). Methods: Eighty-six elderly patients with coronary heart disease(CHD)were enrolled in this study.According to whether or not to have IMR, the patients were divided into the pure CHD group(n=32)and the CHD-induced ischemic mitral regurgitation(IMR)group(n=54, including 20 cases of mild IMR, 18 cases of moderate IMR and 16 cases of severe IMR). Thirty-two healthy elderly volunteers were considered as control group.RT3D-STI was used to evaluate the global atrial longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS)and LA maximal, minimal and pre-systolic volumes(LAVmax, LAVmin, and LAVp). LA ejection fraction(LAEF), LA passive ejection fraction(LApEF)and LA active ejection fraction(LAaEF)were calculated.The relationship of LA volume changes and myocardial strain with LA function was analyzed. Results: The left ventricular ejection fraction(LVEF)and LAEF were reduced in CHD group and IMR group as compared with the control group, and were lower in IMR group than in CHD group(P<0.05). Compared with the control group, the LAVmin was increased, and the LAaEF was decreased in the IMR group(P<0.05). Compared with the control group, the GLS, GCS, GRS were declined in the CHD and IMR groups, and were lower in IMR group than in control group(P<0.05). Along with the increased severity of regurgitation, GLS, GCS, and GRS were decreased in varying degrees.The standard deviations of time to peak longitudinal strains(TLS-SD), of time to peak circumferential strains(TCS-SD), and of time to peak radial strain(TRS-SD)rose in the IMR group as compared with the control group(P<0.05). The myocardial motion indicators(GLS, GCS, GRS)had a quite strong correlation with LAEF in the CHD and IMR groups(CHD group: r=-0.745, -0.718 and 0.627, P=0.006, 0.007 and 0.009; IMR group: r=-0.785, -0.781, 0.643, P=0.006, 0.007 and 0.008). The receiver operating characteristic(ROC)curves analysis showed that the sensitivity and specificity of TLS-SD, TCS-SD and TRS-SD were 89.7% and 81.8%, 78.6% and 84.8%, 85.7% and 72.1%, respectively in the evaluation of LA function changes. Conclusions RT3D-STI can precisely and objectively assess the LA function changes by measuring the volume changes and tracing the myocardial motion in elderly IMR patients.

OBJECTIVETo evaluate the association between chemical exposure, DNA methylation status and gene-environment interactions in the development of childhood acute leukemia (AL).

METHODSFrom January 1st 2009 to December 31st 2010, an exploratory case-control study was conducted on childhood AL among children who were less than 15 years of age in Shanghai, China. A total of 131 patients with newly diagnosed AL were recruited from 3 Shanghai children hospitals. The controls selected from the same hospital were healthy children who attended the physical check-up held by the department of Children's Healthcare, or who visited the clinic of developmental pediatrics or orthopedics (excluding blood diseases and malignant tumors). 140 controls matched with cases in gender and age were included in this study. Chemical exposure were investigated by questionnaires, methylation specific polymerase chain reaction (MSP) was adopted to analyze the methylation or deletion status of 8 genes, and gene-environment interactions were analyzed by relative excess risk of interaction (RERI), attributable proportion of interaction (API) and synergy index (S).

RESULTSThere were 131 and 140 subjects in case and control group, who were aged (6.9 ± 3.8) and (6.9 ± 3.9) years old (t = 0.01, P = 0.911), respectively. After adjusting age and other potential confounding factors, chemical substances' exposure of children/mother/father were all significantly higher in cases than that in controls (Children: OR = 3.90, 95% CI: 1.69-9.02; Mother: OR = 2.71, 95% CI: 1.12-6.52; Father: OR = 1.91, 95% CI: 1.05-3.47). For the 8 genes analyzed, the methylation status of DAPK and PTEN and P73 in case group were significantly higher than that in control group (cases: 3.1% (4 cases), 16.0% (21 cases), 7.6% (10 cases); controls: 0.7% (1 case), 2.9% (4 cases), 0.7% (1 case); χ²: 7.11, 16.90, 11.38; P value: 0.029, 0.000, 0.003). The methylation status of P16 in case group was significantly lower than that in control group (cases: 3.8% (5 cases); controls: 8.6% (12 cases), χ² = 10.33, P = 0.007). The interactions of children chemical substances' exposure and 3 genes' (PTEN, P16 and P73) methylation status were probably existed after adjusted for confounding factors (PTEN: RERI = -7.01, API = -2.14, S = 0.24; P16: RERI = 4.08, API = 0.53, S = 2.59; P73: RERI = 4.32, API = 0.48, S = 2.19), we also found the potential interaction between maternal chemical substances' exposure and PTEN, P16 gene methylation status (PTEN: RERI = -1.30, API = -0.38, S = 0.65; P16: RERI = 1.70, API = 0.38, S = 1.97).

CONCLUSIONThe study suggested the strong combined effects of chemical substances exposure of children and abnormal methylation status were risk factors of childhood AL, and there existed different interaction between them, which may indicate the important role in the pathogenesis process of childhood AL.

Acute Disease ; Case-Control Studies ; Child ; Child, Preschool ; China ; DNA Methylation ; Environmental Exposure ; Female ; Gene-Environment Interaction ; Humans ; Leukemia ; epidemiology ; Maternal Exposure ; Polymerase Chain Reaction ; Risk Factors

OBJECTIVETo investigate the association between children's and their parents' lifestyles, household environmental exposures and risk of childhood acute leukemia (AL).

METHODSA 1:2 matched case-control study of childhood AL was conducted in Shanghai between April 2011 and January 2014. The study enrolled 66 cases aged < 15, diagnosed with AL and 132 controls matched by age, gender and residence. All of the controls had no hematological diseases or previous history of malignancy. Children who had been adopted and had congenital genetic syndromes such as Down's syndrome or a positive HIV test result were not eligible as either cases or controls. Information was obtained from standardized face-to-face interviews of their parents/guardians with detailed questions on demographic characteristics, lifestyle, and household environment. Conditional logistic regression models were used to analyze effecting factors of childhood AL, odds ratios (OR) and their 95% confidence intervals (CI) were calculated.

RESULTSAmong 198 cases, 66 cases were aged (5.0 ± 3.7) years old, and 132 controls were aged (6.0 ± 3.8) years old (t = 0.48, P = 0.523). The paternal drink frequencies of cases and controls were 57.6% (38/66), and 31.1% (41/132), respectively (χ² = 4.91, P = 0.027). And the frequencies of household insecticides usage in the last year in the two groups were 78.8% (52/66), and 65.2% (86/132) (χ² = 3.87, P = 0.049). Chemical exposure during childhood (OR = 4.76, 95% CI: 1.34-16.89), maternal exposure to chemicals (OR = 4.51, 95% CI: 1.65-12.33), household insecticides use during 0-3 years of child (OR = 2.90, 95% CI: 1.31-6.39), and renovating after their children's birth (OR = 3.12, 95% CI: 1.26-7.74) were associated with an increased risk of childhood AL and these differences between the cases and the controls have statistical significance. Besides, we found that frequent contaction with other children during 0-3 years old (OR = 0.32, 95% CI: 0.15-0.69) and ventilation during sleeping in summer (OR = 0.43, 95% CI: 0.18-0.98) were associated with a decreased risk of childhood AL.

CONCLUSIONOur results support the association between children's and their parents' lifestyles, household environmental exposures and childhood AL.

Acute Disease ; Case-Control Studies ; Child ; Child, Preschool ; China ; Environmental Exposure ; Female ; Humans ; Insecticides ; Leukemia ; epidemiology ; Life Style ; Logistic Models ; Maternal Exposure ; Neoplasms ; Odds Ratio ; Parents ; Risk Factors

Purpose To detect left atrial volume change and myocardial strain,and to evaluate left atrial (LA) function in coronary heart disease patients with mitral regurgitation (MR) by real-time three-dimensional speckle tracking imaging (RT3D-STI).Materials and Methods Eighty-eight patients with coronary disease were divided into non mitral regurgitation group (NMR group,n=30) and mitral regurgitation group (MR group,n=58),including mild MR (n=20),moderate MR (n=20) and severe MR (n=18).Thirty healthy participants were also included as control group.Using RT3D-STI,the global atrial longitudinal strain (GLS),global radial strain (GRS),global circumferential strain (GCS),LA maximal,minimal and pre-systolic volume (LAVmax,LAVmin and LAVp),LA passive ejection fraction (LApEF) and LA active ejection fraction (LAaEF) were measured,and the relationship between LA myocardial strain and left ventricular function was analyzed.Results ① The LAEF,LVEF,LApEF in NMR group and MR group decreased compared those with the control group (P＜0.05),and the LApEF in MR group were lower than those in NMR group (P＜0.05);② compared with the control group,the GLS and GCS in NMR group and MR group decreased observably (P＜0.05),and the parameters in MR group was lower than those in NMR group (P＜0.05);along with the severity of mitral regurgitation,GLS,GCS and GRS declined in varying degrees.③ The overall strain ability of left atrial myocardium (GLS,GCS,GRS) had a positive correlation with LAEF (NMR group:r=-0.810,-0.760 and 0.851;MR group:r=-0.680,-0.745 and 0.583;P＜0.05).Conclusion RT3D-STI plays an important role in assessing LA myocardial movement change and evaluating left atrial function of mitral regurgitation patients by nvestigating left atrial volume change,calculating LAEF and tracing myocardial motion,which provides valuable references for clinical diagnosis and treatment.

OBJECTIVETo investigate the endovascular treatments for the ruptured aneurysms located at anterior communicating artery complex (ACoAC).

METHODSThe data of patients with ruptured ACoAC aneurysms treated in Department of Neurosurgery, First Affiliated Hospital to Fourth Military Medical University from May 2013 to December 2014 was retrospectively analyzed. Sixty-six cases were recruited including 50 male and 16 female patients. The patients aged from 31 to 69 years old, averaging (51±8) years. The Hunt-Hess grade at admission were 13 cases with grade Ⅰ, 36 cases with grade Ⅱ, 11 cases with grade Ⅲ, and 6 cases with grade Ⅳ. The most diameter of aneurysms sac: 14 cases less than or equal to 3 mm, 36 cases more than 3 mm but less than or equal to 7 mm, and 16 cases more than 7 mm. The height diameter/neck width ratio: 8 cases with absolute wide neck, 50 cases with relatively wide neck, and 8 cases with narrow neck. There were 28 cases underwent single micro-catheter embolization, 18 cases underwent double micro-catheters embolization, 14 cases underwent stent-assisted embolization and 6 cases underwent balloon-assisted embolization. The patients were followed up for 6 to 12 months and evaluated by modified Rankin score (mRS) and digital subtraction angiography (DSA). The ratio of total embolization, recurrence rate, and time from operation to reexamination of four groups managed by different endovascular treatment were compared by χ(2) test or F test.

RESULTSSixty cases were totally embolized, 3 cases subtotally embolized, 3 cases incompletely embolized. Mild hemiparalysis and aphasia occurred in 2 cases, and 1 case died of infarction induced by subarachnoid haemorrhage. The mRS at six months after operation were 0 in 31 cases, 1 in 22 cases, 2 in 8 cases, 3 in 2 cases, 4 in 2 cases, 6 in 1 case. All the included cases reexamined the DSA at averaging (7.5±1.0) month post-operatively and 4 cases recurred. There were not significant differences of the ratio of total embolization, recurrence rate, time from operation to reexamination among four groups (all P>0.05).

CONCLUSIONThe endovascular treatment maybe an ideal management for ruptured ACoAC aneurysms.

Adult ; Aged ; Aneurysm, Ruptured ; therapy ; Catheters ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Postoperative Period ; Recurrence ; Retrospective Studies ; Stents ; Treatment Outcome

Objective:To quantitatively evaluate the stiffness of pancreatic parenchyma and lesions by virtual touch tissue imaging and quantification (VTIQ) technique, and to investigate the potential usefulness of ultrasound shear wave elastography (SWE) in the prediction of clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreatectomy.Methods:Patients who scheduled to receive pancreatectomy were prospectively enrolled in Zhongshan Hospital, Fudan University from March 2021 to December 2021. VTIQ assessment was applied to patients within one week before the scheduled surgery to make quantitative SWE evaluation of target tissue. The SWV values of body part pancreatic parenchyma and lesions were measured and recorded. The palpation stiffness of pancreas was qualitatively evaluated during the operation by the surgeon.CR-POPF was diagnosed according to 2016 International Study Group of Pancreatic Fistula (ISGPF) standard.Grade B/C pancreatic fistula was defined as CR-POPF positive. Recognized peri-operative risk factors of CR-POPF were analyzed. ROC curve analysis was used to evaluate the diagnostic efficacy of SWV value in predicting CR-POPF.Results:A total of 72 patients were finally enrolled in this study, including 47 (65.3%, 47/72) patients who received pancreaticoduodenectomy (PD) and 25 (34.7%, 25/72) patients who underwent distal pancreatectomy. CR-POPF occurred in 22 (30.6%, 22/72) patients after pancreatectomy. The SWV value of body part pancreatic parenchyma was significant lower in CR-POPF positive group than in CR-POPF negative group ( P<0.001). There was no significant difference in lesion SWV value between CR-POPF positive and negative groups ( P=0.664). Besides, the palpation stiffness was no difference between the two groups ( P=0.689). Taking SWV value of pancreatic parenchyma >1.16 m/s as a cut-off value for predicting CR-POPF, the area under the ROC curve (AUROC) was 0.816 with 0.760 of sensitivity, 0.634 of specificity, 67.5% of positive predictive value and 72.5% of negative predictive value, respectively. Conclusions:The VTIQ method may improve the objectivity and accuracy of CR-POPF prediction via pre-operative, non-invasive and quantitative evaluation of pancreatic stiffness, which has potential value in clinical applications.

Objective: To understand the knowledge of disinfection and its influencing factors among caregivers in childcare centers in Huangpu District, Shanghai, in order to provide a basis for the future development of targeted training programs and the work plan to enhance the professional level of disinfection practitioners in childcare centers. Methods: A total of 423 caregivers from 62 childcare centers (including nursery schools) in Huangpu District were selected for a questionnaire about disinfection knowledge, influencing factors, and training needs in March 2023. Differences in disinfection knowledge among subjects with different characteristics were compared using χ 2 tests, and influencing factors were analyzed using a multi factor binary Logistic regression model. Results: The overall knowledge rate of disinfection among caregivers was 50.12%, and those in public kindergartens, private ones, and nursery schools were 51.35%, 46.18%, and 42.57%, respectively, with statistically significant differences ( χ 2=14.25, P < 0.05 ). The caregivers in the highest level kindergartens ( OR =4.50, 95% CI =1.97-10.29), in first level ones ( OR =4.29, 95% CI = 1.98-9.33), in the institutions had clusters of outbreaks ( OR =1.87, 95% CI =1.14-3.07), in which the number of children to caregivers ratio being less than 10∶1 ( OR =21.81, 95% CI =2.55-186.59), with 6-14 years of working experience ( OR =3.51, 95% CI = 1.59 -7.75) had better knowledge of disinfection( P <0.05). Conclusions Knowledge of disinfection among caregivers of childcare institutions is low in Huangpu District, Shanghai. Training of caregivers disinfection knowledge should be strengthened for caregivers with fewer years of experience, in childcare institutions, to improve caregivers disinfection expertise and skills.