Objective: To evaluate the performance of 5T magnetic resonance imaging (MRI) in visualizing dental pulp and periodontal ligament (PDL) tissues in vivo in the young adult population, thereby providing a basis for the application of high-field MRI technology in clinical oral examinations. Methods: The study was approved by the Ethics Committee of the hospital. A total of 15 healthy volunteers (413 permanent teeth altogether) were recruited and underwent full-mouth 5T MRI scans. Among them, six volunteers (168 permanent teeth) also received both 3T MRI and cone-beam computed tomography (CBCT) scans. Two dental specialists independently evaluated the imaging quality of the dental pulp and PDL on the images using a 5-point Likert scale and recorded the number of detectable root canals for each tooth. Inter-rater agreement was assessed using weighted kappa statistics and intraclass correlation coefficient (ICC). Non-parametric tests were employed to compare differences in imaging performance among different tissue structures, tooth positions, and imaging modalities. Results: 5T MRI can achieve in vivo imaging for most dental pulp tissues and partial periodontal membrane structures. There was a high level of agreement between the two raters in their imaging scores for the dental pulp and PDL (dental pulp κ = 0.934, PDL κ = 0.737). The imaging scores for dental pulp were significantly higher than those for PDL (P < 0.001), and the scores for molar dental pulp were lower than those for premolars and anterior teeth. In the multimodal comparison involving six volunteers, the raters showed good consistency in scoring dental pulp and PDL imaging across 5T MRI, 3T MRI, and CBCT, as well as in root canal counts (5T MRI for dental pulp κ = 0.971, 3T MRI for dental pulp κ = 0.933, CBCT for dental pulp κ = 0.964; 5T MRI for PDL κ = 0.625, 3T MRI for PDL κ = 0.667, CBCT for PDL κ = 0.571; ICC for root canal counts all ≥ 0.990). The imaging scores for dental pulp and PDL using 5T MRI were significantly higher than those using 3T MRI (dental pulp: P < 0.001; PDL: P = 0.022), but there was no statistically significant difference in the detection rate of the number of root canals between the two (P > 0.05). Although the imaging scores for dental pulp and PDL as well as the detection rate of the number of root canals with 5T MRI were inferior to those with CBCT (dental pulp: P < 0.001; PDL: P = 0.02; number of root canals: P < 0.05), 5T MRI can truly achieve "direct imaging" of these two soft tissues. Conclusion 5T MRI enables effective in vivo direct imaging of dental pulp and PDL tissues in the young adult population, indicating its potential clinical application value in the diagnosis and treatment of pulp and periodontal diseases.

Pyroptosis is a new type of programmed cell death that can efficiently enhance the immune response by inducing cell lysis and inflammation, thereby facilitating tumor immunotherapy. Recently, an increasing number of studies have revealed close relationships between pyroptosis and nanomedicine, which has been regarded as a new strategy for developing nanomedicine-based immunotherapy for highly effective therapy of various cancers. In this review, the development and associated signaling pathways for pyroptosis, including the correlation between pyroptosis and anti-tumor immunity, were first presented. Then, various nanomedicines that induce pyroptosis for tumor therapy, especially immunotherapy, were systematically discussed. Finally, the current challenges and constructive perspectives in this field were proposed.

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.

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 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.

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.

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.

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.