Objective:To explore the value of fetal lung volume and mediastinal shift angle (MSA) based on fetal MRI in predicting the prognosis of congenital diaphragmatic hernia (CDH).Methods:Fetuses with left CDH that did fetal MRI in Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine from September 2016 to January 2022 were retrospectively collected. There were 65 patients, and their gestational age was 29 (26, 35) weeks when they were diagnosed with left CDH by MRI. Observed fetal lung volume and MSA were measured based on fetal MRI, and observed/expected lung volume (o/eFLV) based on gestational age was calculated. The clinical data were collected from birth to discharge, and patients were divided into survival group and death group in case of prognosis at discharge, with 54 cases in the survival group and 11 cases in the death group. The student′s t test was used to compare the difference of o/eFLV and MSA between the survival group and the death group, and the receiver operating characteristic (ROC) curve was used to evaluate the value of o/eFLV and MSA in predicting the prognosis of left CDH. Results:The o/eFLV of the survival group was 51.5%±18.3%, higher than that of the death group (27.8%±4.4%), and the difference was significant ( t=8.29, P<0.001). The MSA of the survival group was 33.1°±1.2°, lower than that of the death group (41.8°±2.7°), and the difference was significant ( t=-11.15, P<0.001). The area under the ROC curve (AUC) of o/eFLV to predict the fetal survival or death was 0.939 (95%CI 0.851-0.983), the cutoff value was 33.8%, the sensitivity was 100%, the specificity was 88.9%. The AUC of MSA was 0.998 (95%CI 0.941-1.000), the cutoff value was 37.2°, the sensitivity was 100%, the specificity was 98.2%. Conclusions:The o/eFLV and MSA that were measured based on fetal MRI can effectively predict the fetus′s prognosis with left CDH.

Objective:To explore the value of MRI signs in assessing the presence or absence of hernia sacs in fetuses with congenital diaphragm hernia.Methods:MRI images of 57 patients with congenital diaphragm hernia confirmed by postpartum surgery were analyzed from November 2016 to December 2020 in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, with a gestational age of 20－40 (28±5) weeks. In postpartum surgery, 18 cases were found with hernia sacs (hernia sac group) and 39 cases without hernia sacs (hernia-free group). Seven MRI signs were analyzed, including hernia peripheral enveloping sensation, smooth lung-hernia interface, crescent-shaped lung compression, residual lung tissue on the affected side, heart displacement, effusion above the lung-hernia interface and effusion below the lung-hernia interface. The differences in MRI signs between the hernia sac and hernia-free groups were compared using the χ 2 test or Fisher′s exact probability method. The diagnostic efficacy of each sign was calculated. The MRI signs with statistical differences between the two groups were included in the predictive integration model, and 1 point was scored for each sign, the imaging score of each fetus was calculated, and the efficacy of imaging points in diagnosing the presence or absence of hernia sacs was assessed by the subject manipulation receiver operating characteristics (ROC) curve. Results:There were statistically significant differences in 5 MRI signs between the hernia sac and the hernia-free groups, namely hernia peripheral enveloping sensation (χ2=25.74, P<0.001), smooth lung-hernia interface (χ2=48.20, P<0.001), crescent-shaped lung compression (χ2=57.00, P<0.001), residual lung tissue on the affected side (χ2=12.14, P<0.001) and effusion above the lung-hernia interface (χ2=4.31, P=0.022). Among them, the sign of crescent-shaped lung compression had the highest diagnostic efficacy, and the sensitivity, specificity and accuracy all were 100%. Five statistically significant MRI signs were included in the predictive integration model, and the area under the ROC curve was 0.999, the sensitivity was 100%, the specificity was 94.9%, and the optimal threshold was 2 points. Conclusion:Fetal MRI signs and predictive integration model can effectively identify the presence or absence of hernia sacs in fetuses with congenital diaphragm hernia, which has certain clinical significance.

Based on the characteristics of medical imaging specialty, this paper introduces in detail several features of standardized residency training in the Department of Radiology in our hospital, from the aspects of teaching purpose, preliminary preparation and specific implementation, namely, the morning reading and analysis of difficult cases, the analysis of postoperative cases and missed diagnosis cases, and the teaching reading. At the same time, it also deeply analyzes the advantages, existing problems and solutions of this teaching practice. In order to provide reference for improving the teaching quality of the standardized residency training in the Department of Radiology.

Objective:To develop a model for predicting malignant probability of asymmetries signs of BI-RADS category 4 or 5 in mammography, and to evaluate its predictive performance.Methods:The clinical and imaging data of 187 patients with asymmetrical signs of BI-RADS 4 or 5 who underwent mammography in Xinhua Hospital Affiliated of Shanghai Jiao Tong University School of Medicine from January 2014 to September 2017 were analyzed retrospectively. According to the examination time, 187 patients were divided into training set (109 cases) and verification set (78 cases). The clinical and mammographic features of the patients were analyzed. The predictors were screened by univariate and multivariate logistic regression analysis. Then a predictive model was constructed based on the results with a nomogram drawn. Performances of predictive models were evaluated with area under the curve (AUC) of ROC,calibration curve,and decision curve analysis (DCA).Results:A total of 187 asymmetries signs including 72 malignant and 115 benign was collected. Six predictive factors were harvested to construct the predictive model, which included menstrual status, the number of visible standard view of asymmetries signs, whether asymmetries signs locating at the peripheral layer of tissue, whether asymmetries signs associating with suspicious calcification, skin thickening, or nipple retraction. The predictive model had good performance in both training set and verification set, with the AUC values of 0.85 and 0.84, respectively. The DCA curve showed that the nomogram had good clinical application values.Conclusion:The predictive model can predict malignancy probability of BI-RADS category 4 or 5 asymmetries, which can be used as a referable method for radiologist to evaluate mammographic asymmetries signs.

Objective:To explore the diagnostic value of breast MRI in breast imaging reporting and data system (BI-RADS) 4 mammography-detected ultrasound-negative (MG+/US-) pure calcification lesions.Methods:The data of 51 patients (52 calcification lesions) who were diagnosed with BI-RADS 4 pure calcification by mammography, had no significant abnormality on ultrasonography, and finally obtained pathological results at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 2013 to December 2019 were retrospectively analyzed. Of the 52 calcification lesions, 40 were benign and 12 were malignant. The mammographic findings (breast composition, calcification morphology, and distribution) and MR findings (enhancement pattern), of benign and malignant lesions were analyzed and compared with the histopathological results. The diagnostic performance of MRI was calculated.Results:There was a significant difference between benign and malignant calcification lesions in calcification morphology on mammography and enhancement pattern on MRI ( P<0.05). On breast MRI, malignant calcifications lesions showed mass or non-mass enhancement (12/12), while benign calcified lesions mostly showed no enhancement or punctate enhancement (27/40). The sensitivity, specificity, positive predictive value, and negative predictive value of breast MRI in the diagnosis of BI-RADS 4 MG+/US- pure calcification lesions were 66.7% (8/12), 75.0% (30/40), 44.4% (8/18) and 88.2% (30/34), respectively; The sensitivity, specificity, positive predictive value and negative predictive value for BI-RADS 4A calcifications were 66.7% (2/3), 74.2% (23/31), 20.0% (2/10) and 95.8% (23/24), respectively. The sensitivity, specificity, positive predictive value and negative predictive value for BI-RADS 4B calcifications were 66.7% (4/6), 85.7%(6/7),80.0% (4/5) and 75.0% (6/8), respectively. Conclusions:MRI has a high differential diagnostic value for mammographic BI-RADS 4 pure calcifications with ultrasound-negative, especially for BI-RADS 4A calcifications. Follow-up instead of biopsy is recommended for lesions with no enhancement or punctate enhancement on MRI.

This paper introduces the informatization construction of the world's first non-military Type 3 international emergency medical team (EMT Type3), which was established by West China Hospital of Sichuan University. Based on the requirements of World Health Organization (WHO) for EMT, the team built a complete information-based emergency rescue platform from the network layout, the design of software and hardware facilities and other aspects, combined with their own circumstance, which has improved the communication ability effectively, and has passed the expert certification of the WHO smoothly.

Objective:To investigate the risk factors of multi-drug resistant organism（MDRO）infection in orthopedic trauma patients.Methods:A retrospective case series study was made on clinical data of 95 orthopedic patients with in-hospital wound infection admitted to West China Hospital of Sichuan University from January 2020 to December 2020，including 71 males and 24 females at age of 14-70 years［（42.6 ± 13.8）years］. MDRO infection occurred in 38 patients（DRO group），while not in 57 patients（non-MDRO group）. Etiological characteristics of wound infections were observed. Univariate analysis was used to compare variables between the two groups，including baseline data（gender，age，length of hospital stay，chronic comorbidity）and injury as well as hospitalization information（transfer from another hospital，emergency admission，time from injury to first treatment，open injury，combination with fracture，wound contamination，depth of wound，ICU stay，number of operations，cumulative operation time，type of incision，length of hospital stay before diagnosis of infection，type of antibiotics used，usage of hormones/immunosuppressive agents，level of hemoglobin/serum albumin/blood glucose on admission）. Binary Logistic regression was used to analyze independent risk factors for MDRO infection.Results:A total of 119 pathogenic bacteria were detected on the wound，including 21 gram-positive cocci（18%），91 gram-negative bacilli（76%）and 7 others（6%）. Top five strains were Acinetobacter baumannii，Enterobacter cloacae，Escherichia coli，Staphylococcus aureus and Pseudomonas aeruginosa. Univariate analysis showed the two groups had significant differences in terms of length of hospital stay，wound contamination，ICU stay，length of hospital stay before diagnosis of infection，type of antibiotics used and levels of hemoglobin and serum albumin on admission（ P < 0.05），but not in gender，age，hypertension，diabetes，transfer from another hospital and emergency admission（ P > 0.05）. Multivariate Logistic regression analysis showed MDRD infection was obviously correlated with the long hospital stay（ OR = 1.033， 95%CI 1.005-1.061， P < 0.05），time from injury to first treatment over 6 hours（ OR = 4.282， 95%CI 1.174-15.616， P < 0.05），types of antibiotics used ≥ 3（ OR = 7.486， 95%CI 2.451-22.863， P < 0.05）and low level of hemoglobin on admission（ OR = 0.973， 95%CI 0.962-0.985， P < 0.05）. Conclusions:For orthopedic trauma patients，MDRO infection is independently associated with long hospital stay，time from injury to first treatment，type of antibiotics use and level of hemoglobin on admission，suggesting that decreased length of hospitalization，shortened time of first wound treatment，individualized and rational usage of antibiotics and timely correction of anemia are important measures to prevent MDRO infection.

The department of radiology, as one of the public platforms for standardized residency training, is very crucial to the training of high level clinicians and essential to improve quality of medical care. According to the present situation and existing problems of standardized residency training for the non-imaging professional residents in the department of radiology in China, combining with our practice, this article primarily explores the improvement of the rules and regulations, the specific arrangement of the rotation, daily and graduation examination forms, and training quality supervision, etc. We hope to improve the training quality of the non-imaging professional residents' rotation in the department of radiology and explore more suitable and effective medical educative strategies.

Objective To evaluate the effects of magnesium sulphate on the analgestic efficacy of nerve block analgesia with ropivacaine. Methods Sixty cases who used femoral nerve block analgesia after unilateral total knee arthroplasty under the general anesthesia were selected,and according to digital table they were randomly divided into two groups( n=30 each):magnesium sulfate plus ropivacaine( group M) and ropivacaine( group C) . The solution (20mL) of 0. 2% ropivacaine and 0. 15% magnesium sulphate were administered to group M,and 20mL solution of 0.2% ropivacaine was given to the group C. The pain score was measured by visual analogue scale(VAS). The supplementary usage and cumulative dosage of morphine were recorded and the analgesia relevant complications were observed. Results The results of this study indicated that 4h,8h,12h and 24h after the operation,the VAS scores had no statistically significant difference ( all P > 0. 05 ) at rest, which in group M was significantly decreased compared with group C at 12h(t=2. 800,P=0. 009) and 24h(t=2. 934,P=0. 012) after treated with continuous passive motion ( CPM) postoperatively. The cumulative dosages of morphine when patients undergo CPM of knee joint in group M were (2.78 ±0.32)mg,(2.05 ±0.16)mg,respectively,which were significantly lower than those in the groupC[(4.10±0.85)mg,(2.44±0.25)mg](t=7.960,2.632,all P<0.05).No obvious analgesia relevant complications occurred in both two groups. Conclusion Magnesium sulphate can enhance the efficacy of postopera-tive femoral nerve block analgesia with ropivacaine, reduce the usage of morphine without increasing the analgesia relevant complications.

Objective To evaluate the role of Toll-like receptor 4 (TLR4) in non-medullary andmedullary cells in lung ischemia-reperfusion (I/R) injury in mice.Methods Ten healthy male TLR4+/+ in non-medullary cells/TLR4+/+ in medullary cells (WT/WT) mice,10 TLR4-/-in non-medullary cells/ TLR4-/-in medullary cells (KO/KO) homozygote mice,10 TLR4+/+ in non-medullary cells/TLR4-/-in medullary cells (WT/KO) mice,and 10 TLR4-/-in non-medullary cells/TLR4+/+ in medullary cells (KO/WT) heterozygote mice,aged 6-8 weeks,weighing 20-25 g,were used in the study.Lung I/R was induced by occlusion of the left hilum for 60 min followed by 240 min of reperfusion in anesthetized mice.Blood samples were obtained from the femoral artery at 240 min of reperfusion for blood gas analysis,and the oxygenation index (PaO2/FiO2) was calculated.The animals were then sacrificed and lung tissues were immediately removed for determination of wet/dry weight ratio,myeloperoxidase activity and contents of tumor necrosis factor-alpha,interleukin-1beta (IL-1β) and IL-6 (by enzyme-linked immunosorbent assay) and for microscopic examination of the pathological changes of lungs which were scored.Results Compared with WT/WT mice,the oxygenation index was significantly increased in sequence,and lung injury scores,wet/dry weight ratio,myeloperoxidase activity and contents of tumor necrosis factor-alpha,IL-1β and IL-6 were decreased in sequence in WT/KO,KO/WT and KO/KO mice (P＜0.05).Conclusion TLR4 in non-medullary cells plays a rnore important role in lung I/R injury than that in medullary cells of mice.