Objective To investigate and analyze the health care seeking behavior,financial burden and relative factors of patients with rheumatic diseases in Fujian Province.Methods Patients diagnosed with rheumatic diseases were investigated in Fujian Provincial Hospital from December 2013 to February 2014,including demographic data,health care seeking behavior and financial burden.Relevant factors were analyzed by Logistic regression.Results ① In this study,474 patients were enrolled.The ratio of male to female was 1∶2.38.② At the onset of symptoms,51.9％(246 cases) of patients visited a doctor as soon as possible,and 36.1％(171 cases) of them went to hospital within a month after disease onset.③ 74.1％(351 cases) of patients could adhere to medication regimen prescribed by doctors,and the most common reason for stopping medication was symptoms relieved (33.3％,41 cases).④ 63.1％(299 cases) of patients learned about the knowledge of rheumatic diseases from hospitals and doctors.⑤ 34.2％(162 cases) of patients spent 1 000-5 000 yuan every month on treatment.⑥ Insurance type could affect the time of first visit to hospital (P=0.004),while income and cost of therapy might impact patients' compliance (P=0.013,P=0.004).Conclusion Most patients will go to hospital as soon as possible and adhere to treatment.Economic situation is the main factor influencing health care seeking behavior of patients with rheumatic diseases.

ObjectiveTo study the characteristic findings on MRI in children surviving premature delivery with cerebral palsy.MethodsThe clinical data and MR imaging in 16 cases surviving premature delivery with cerebral palsy was retrospectively analyzed, compared with 16 healthy and age-matched controls.Results16 cases were final diagnosed as cerebral palsy with spstic diplegia. MRI features of children surviving premature delivery with cerebral palsy included abnormally high signal intensity in the periventricula white matter on T2WI, marked loss of periventricular deep white matter, ventriculomegaly with or without irregular ventricular outline and atrophy of the corpus callossum. These features were consistent with periventricular leukomalacia(PVL).ConclusionPVL was the characteristic findings on MRI in children surviving premature delivery with cerebral palsy. The characteristic findings of PVL was useful in determining the etiology and type of cerebral palsy in children.

Objective To study the characteristic findings on magnetic resonance imaging (MRI) in children with cerebral palsy (CP) induced by chronic kernicterus.Methods The MR imagings in 13 CP cases induced by chronic kernicterus were retrospectively studied, which were compared with 6 healthy and age-matched controls. 13 cases were finally diagnosed as dyskinetic cerebral palsy (athetoid subtype).Results In 13 cases, all showed symmetric high signals in the the globus pallidus on T2-weighted imaging. There were not apparent abnormality on T1-weighted imaging.Conclusion The bilateral high intensity signals in the globus pallidus on T2-weighted imaging are the characteristic findings on MRI in CP children induced by chronic kernicterus. Paying attention to the globus pallidus on MRI may be useful in determining the type of cerebral palsy.

This paper is to establish a three-dimensional finite element model (3D-FEM) of pelvic floor levator ani muscles in an old healthy women. We acquired the image data of the pelvic bones and pelvic floor muscles from CT and MRI scanning in a non-pregnant old healthy female volunteers. The 3-D reconstruction and mesh optimization of the whole pelvic bones and muscles with application of image processing software Mimics12.0 and Geomagic9.0 were obtained. Then we built the 3D-FEM of the musculoskeletal system of the pelvic bones and levator ani muscles with Ansys11.0 software. We obtained an accurate 3D-FEM of pelvic bones and levator ani muscles in the older healthy woman. The results showed that it was reliable to build 3D-FEM with CT and MRI scanning data and this model could vividly reflect the huge space anatomy of the real pelvic floor levator ani muscles. It avoids the defects to gain the model from the body of anatomical specimens in the past. The image data of model are closer to vivisection, and the model is more conducive to the latter finite element analysis.
Female ; Finite Element Analysis ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Middle Aged ; Muscle, Skeletal ; anatomy & histology ; diagnostic imaging ; Pelvic Floor ; anatomy & histology ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

Objective To analyze the value of dynamic enhanced multi-slice spiral computed tomography (MSCT) combined with two-dimensional (2D) curved reconstruction technique in the differentiation of benign and malignant intraductal papillary mucinous neoplasm (IPMN) of pancreas,and compare with magnetic resonance cholangiopancreatography(MRCP).Methods MSCT and MRCP data of a total of 50 patients with IPMNs confirmed by pathology after surgery was retrospectively reviewed.The benign and malignant IPMNs were differentiated based on the presence of mural nodules,main pancreatic duct (MPD) ≥ 10 mm,septum thickness ≥2 mm,calcification,surrounding vascular infiltration,enlarged peripancreatic lymph nodules,distant metastatic lesions and maximal branch duct type IPMN lesions ≥30 mm shown in the images.The sensitivity,specificity and accuracy were calculated and the receiver-operating-characteristics (ROC) analysis were drawn.Area under the curve (AUC) was calculated.Results Mural nodules in MSCT had a sensitivity,specificity,and accuracy of 77.1％ (27/35),80.0％ (12/15) and 78.0％ (39/50) for diagnosing malignant IPMN,respectively;which in MRCP were 77.1％ (27/35),86.7％ (13/15),and 80.0％ (40/50) in comparison.When MPD diameter ≥10 mm was used for diagnose malignancy,MSCT and MRCP had the sensitivity,specificity,and accuracy of 96.3％ (26/27),81.8％ (9/11),92.1％ (35/38),and 96.3％ (26/27),90.9％ (10/11),94.7％ (36/38),respectively.For thick septum ≥2 mm,MSCT and MRCP had the sensitivity,specificity,and accuracy of 4.8.6％ (17/35),93.3％ (14/15),62.0％(31/50),and 51.4％ (18/35),93.3％ (14/15),64.0％ (32/50),respectively.Out of 50 cases,calcifications were detected on MSCT in 6 patients,and 5 of them were pathologically diagnosed as malignant IPMN.MRCP failed to identify calcifications in any of these lesions.For MSCT,the AUC of MPD diameter ≥ 10 mm,mural nodules and thick septum ≥ 2 mm were 0.973 (P =0.000),0.825 (P =0.002) and 0.704(P =0.051),respectively.For MRCP,the AUC of the three factors above were 0.976(P =0.000),0.825(P =0.002),0.722 (P =0.034),respectively.For the predicting of IPMN malignancy,MSCT had an overall sensitivity,specificity,and accuracy of 94.3％ (33/35),73.3％ (11/15) and 88.0％ (44/50),respectively;in comparison,MRCP had values of 94.3％ (33/35),80.0％ (12/15) and 90.0％ (45/50),respectively.Conclusions Presence of mural nodules,MPD ≥10 mm and thick septum ≥2 mm on MSCT combined with 2D curved reconstruction or MRCP have a high value for predicting the malignancy of IPMN.The values of MSCT and MRCP were basically consistent in the differentiation of benign and malignant IPMN.MSCT can be used as the preferred examination for diagnosing IPMN in the primary hospitals without MR equipment.

Objective To explore the influence of visual working memory contents on visual func-tion and fluid intelligence.Methods 42 subjects were randomly divided into three groups:controll group in-cluding 17 people who had no training,working memory based on Gabor vision group including 13 people and standard working memory group including 12 people who received the N-back working memory training for 15 days,and lasted half an hour in every day.The contrast sensitivity was recorded and measured using OPTEC6500,and the fluid intelligence was measured with the Raven's advanced progressive matrices before and after training.Results In the Gabor working memory group,there were salient gains in contrast sensitivi-ty(respectively(1.48±0.26)log,(1.87±0.13)log,P＜0.05)and in fluid intelligence(respectively(11.15± 1.28),(13.46±1.76),P＜0.05)between pre-and post-test. In the standard working memory group,the con-trast sensitivity improvement was not significant(respectively(1.72±0.30)log,(1.75±0.31)log,P＞0.05),the fluid intelligence increased significantly(respectively(11.25±1.91),(13.00±1.86),P＜0.05); while the controlling group had no significant difference in contrast sensitivity (respectively(1.61±0.26)log,(1.67± 0.25)log,P＞0.05)and in fluid intelligence(respectively(11.41±1.87),(11.58±1.94),P＞0.05) between pre-and post-test.Conclusion Working memory training based on Gabor vision can enhance the subjective perception of visual stimuli and improve the behavioral effect of visual contrast sensitivity, but the visual working memory contents do not affect the migration effect of working memory training on fluid intelligence.

Objective:To explore the application of laparoscopic training in the standardized residency training of pediatric general surgery.Methods:A total of 36 rotating residents who received the standardized residency training in the department of pediatric general surgery of Shenzhen Children's Hospital from January 2017 to December 2019 were selected for laparoscopic training. The training content includes the study and training of laparoscopic theory knowledge, laparoscopic surgery video, skills operation of simulated operating system. Assessment was conducted before and after the training, and statistical analysis was performed to compare the difference of scores before and after the training. The self-evaluation of resident's learning efficiency and the satisfaction with teachers were investigated by questionnaires. SPSS 20.0 was used for paired t-test. Results:After receiving the standardized residency training of pediatric general surgery, the theoretical knowledge and cognition of the application on pediatric general laparoscopic surgery were significantly improved among the 36 residents. The time that the skills spent in vitro simulation box during the simulated operation training was significantly reduced after training, with a statistically significant difference ( P < 0.05). According to the questionnaire survey, resident's satisfaction with self-evaluation of learning efficiency was 97.22% (35/36), their satisfaction with teachers was 94.44% (34/36), and their satisfaction with teaching curriculum was 100.00% (36/36). Conclusion:Laparoscopic training can effectively improve the clinical practice ability of pediatric general surgery residents, which is worthy of promotion.

Objective:To investigate the prognosis value of baseline contrast-enhanced CT in predicting progression-free survival (PFS) and overall survival (OS) for clinically diagnosed as metastatic far-advanced gastric cancer patients.Methods:Between January 2019 and May 2020, 85 pathologically confirmed gastric adenocarcinoma patients with peritoneal or hepatic metastasis at Shanghai Ruijin Hospital with complete preoperative clinical, image and follow-up data were enrolled in this retrospective study. Clinical factors included performance status (PS) score, tumor location, and tumor serological indicators. Imaging factors included the longest diameter and maximum cross-sectional area of the tumor, CT value, enhancement uniformity, CT extramural venous invasion (ctEMVI), the largest short diameter of the metastatic lymph nodes, confluent lymph nodes, lymph nodes necrosis, fused bulk lymph nodes, the maximum cross-sectional area and CT value of the liver metastases, peritoneal metastasis score, longest diameter of nodules with peritoneal metastasis. Kaplan-Meier survival curve and log-rank test were used to analyze the prognostic differences between groups. Univariate and multivariate Cox proportional hazards regression models were used to identify independent risk factors for PFS and OS.Results:There were significant differences in the maximum cross-sectional area of the tumor, non-contrast CT value, delayed-phase CT value, and delayed-phase CT ratio value between the high- and low-risk groups in PFS ( P<0.05). There were significant differences between the high- and low-risk groups with the maximum cross-sectional area of the tumor in PFS and OS ( P<0.05). In the univariate analysis, the maximum cross-sectional area of tumor, plain-scan CT value, delayed-phase CT value, delayed-phase CT ratio value and the largest short diameter of metastatic lymph nodes were risk factors for PFS ( P<0.05). PS score, CA724, maximum cross-sectional area of the tumor, maximum cross-sectional area of liver metastases, and peritoneal metastasis score were shown as risk factors for OS ( P<0.05). In the multivariate analysis, the maximum cross-sectional area of the tumor and non-contrast CT value were independent risk factors for PFS (HR=0.41, 2.50, P<0.05, 0.006). PS score, CA724 and peritoneal metastasis score were independent risk factors for OS (HR=46.78, 6.26, 92.92, P=0.026, 0.009, 0.007). Conclusions:Tumor size, CT attenuations, and peritoneal metastasis score on baseline CT can be used as independent risk factors for survival in patients with far-advanced gastric cancer with peritoneal or hepatic metastasis. Baseline CT is potentially useful in prediction of the survival status for patients with metastatic far-advanced gastric cancer.

Objective:To summarize the imaging and pathological features of primary central nervous system lymphoma in special sites, and analyze some misdiagnosed cases to provide help for clinical diagnosis.Methods:Thirty-nine patients with primary central nervous system lymphoma diagnosed by pathology from 2000 to 2019 in Wenzhou People′s Hospital and the Second Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. The imaging and pathological features of primary central nervous system lymphoma in special sites were summarized, and the misdiagnosed cases in these special sites were analyzed.Results:Primary central nervous system lymphoma in special sites included one case of primary dural lymphoma, with thickening of dura mater and obvious enhancement; two cases with lesions in lateral ventricle, with homogeneous enhancement, involving ependyma and spreading to medulla oblongata; two cases with lesions in middle cerebellar peduncle, with patchy abnormal signals and no specific masses, mild to moderate enhancement after enhancement, and one misdiagnosed as demyelinating lesions; one case with lesions in the sellar region which obviously enhanced with a typical “dent sign”, misdiagnosed as invasive pituitary tumor. All the pathological findings indicated diffuse large B cell lymphoma.Conclusions:It is difficult to diagnose primary central nervous system lymphoma in special sites, which is easy to cause misdiagnosis. Understanding its imaging characteristics and pathology can help to diagnose the disease.

Objective:To investigate the epidemiological characteristics of influenza-like illnesses (ILI) and the etiological characteristics of influenza viruses in Minhang District of Shanghai from 2010 to 2021.Methods:The surveillance data collected by influenza surveillance sentinel hospitals and the influenza laboratory network from the first week of 2010 to the 52 nd week of 2021 were used for a statistical analysis. Results:A total of 122 903 cases with ILI were reported by the national influenza surveillance sentinel hospitals in Minhang during 2010 to 2021, and the average percentage of ILI cases was 0.94%, showing an increasing trend ( P<0.001). Among them, those aged 0-4, 5-14, 15-24, 25-59 and ≥60 years accounted for 4.35%, 13.30%, 14.30%, 54.32% and 13.73%, respectively. The percentage of ILI showed obvious periodicity. The seasonal incidence of ILI peaked from December to February and from July to September. But the winter peak at the beginning of 2013 was postponed. There was no significant peak in 2021. A total of 11 625 samples were tested from 2010 to 2021, in which the detection rate of influenza viruses was 20.92% (2 432/11 625). The positive rate was 12.83% (1 492/11 625) for influenza A viruses and 8.09% (940/11 625) for influenza B viruses, indicating that the epidemic intensity caused by influenza A viruses was greater than that caused by influenza B viruses. The overall positive rates for influenza A/H3N2 virus, influenza A/H1N1 virus, influenza B/Victoria lineage and influenza B/Yamagata lineage were 9.04% (1 051/11 625), 3.79% (441/11 625), 2.69% (313/11 625) and 2.19% (255/11 625) during 2010 to 2021. The predominant circulating strains altered between influenza A and influenza B viruses in Minhang District of Shanghai during 2010 to 2019. It generally took six months for an epidemic strain to be replaced by a new one. No obvious regularity was observed in 2020 or 2021. The tendency of the incidence of ILI reported from 2010 to 2019 was basically the same as that of the positive rate of influenza viruses, while there were significant differences in 2020 and 2021. Conclusions:Influenza viruses circulated seasonally in Minhang District of Shanghai with alternating prevalent viral subtypes and the infections mostly occurred in the winter and summer seasons. During the epidemic of COVID-19, the intensity of influenza was decreased, but with the normalization of prevention and control measures, the influenza epidemic showed an obvious upward trend. Therefore, it was important to strengthen the prevention and monitoring of influenza and analyze the virus variations in time.