Objective To explore the value of time-dependent diffusion MRI(td-dMRI)parameters for differentiating invasive breast cancer(IBC)with ductal carcinoma in situ(DCIS)(IBC-DCIS)from simple IBC.Methods A total of 19 patients with IBC-DCIS(IBC-DCIS group)and 53 patients with simple IBC(IBC group)confirmed by surgery and postoperation pathology were retrospectively enrolled.Breast td-dMRI acquired with oscillating gradient spin-echo(OGSE)and pulsed gradient spin-echo(PGSE)sequences before operation were interpreted,and apparent diffusion coefficient(ADC)and microstructure parameters,including OGSE-ADC value,PGSE-ADC value,cellularity,cell diameter,intracellular volume fraction and extracellular diffusion coefficient were obtained and compared between groups.Receiver operating characteristic(ROC)curves of parameters being significantly different between groups were plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of these parameters for differentiating IBC-DCIS from IBC.Results Significant differences of OGSE-ADC value,PGSE-ADC value,cellularity,cell diameter,intracellular volume fraction and extracellular diffusion coefficient were found between groups(all P＜0.05).The AUC of the above parameters for differentiating IBC-DCIS from IBC was 0.81,0.79,0.78,0.68,0.77 and 0.81,respectively.Conclusion td-dMRI parameters could be used to noninvasively and effectively differentiate IBC-DCIS from simple IBC.

Objective To explore the value of time-dependent diffusion MRI(td-dMRI)parameters for differentiating invasive breast cancer(IBC)with ductal carcinoma in situ(DCIS)(IBC-DCIS)from simple IBC.Methods A total of 19 patients with IBC-DCIS(IBC-DCIS group)and 53 patients with simple IBC(IBC group)confirmed by surgery and postoperation pathology were retrospectively enrolled.Breast td-dMRI acquired with oscillating gradient spin-echo(OGSE)and pulsed gradient spin-echo(PGSE)sequences before operation were interpreted,and apparent diffusion coefficient(ADC)and microstructure parameters,including OGSE-ADC value,PGSE-ADC value,cellularity,cell diameter,intracellular volume fraction and extracellular diffusion coefficient were obtained and compared between groups.Receiver operating characteristic(ROC)curves of parameters being significantly different between groups were plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of these parameters for differentiating IBC-DCIS from IBC.Results Significant differences of OGSE-ADC value,PGSE-ADC value,cellularity,cell diameter,intracellular volume fraction and extracellular diffusion coefficient were found between groups(all P＜0.05).The AUC of the above parameters for differentiating IBC-DCIS from IBC was 0.81,0.79,0.78,0.68,0.77 and 0.81,respectively.Conclusion td-dMRI parameters could be used to noninvasively and effectively differentiate IBC-DCIS from simple IBC.

Objective To explore the value of carotid pulse wave combined with urinary transferrin(TRF)and β2-microglobulin(β2-MG)in the evaluation of renal injury in patients with hyperten-sive nephropathy.Methods A total of 30 patients with hypertensive nephropathy,30 patients with simple hypertension and 90 patients with non-hypertensive nephropathy who were admitted to our hospital between May 2021 and April 2024,and 30 healthy individuals(control group)who taking physical examination during same period were enrolled and assigned into corresponding groups,respectively.According to the severity of renal injury,the 120 patients from the hyperten-sive nephropathy group and non-hypertensive nephropathy group were divided into normal group(28 cases),mildly injured group(36 cases),moderately injured group(31 cases)and severely in-jured group(25 cases).The carotid pulse wave indicators[pulse wave velocity at beginning of the systole(PWV-BS),pulse wave velocity at ending of the systole(PWV-ES)],and urinary TRF and β2-MG levels were detected and compared in above groups.ROC curves were plotted to ana-lyze the diagnostic values of these indicators in hypertensive nephropathy.The relationship be-tween the above indicators and the severity of renal injury was analyzed with sequential multivari-ate logistics regression analysis.Results There were significant differences in PWV-BS,PWV-ES,and urinary TRF and β2-MG levels among the hypertensive nephropathy group,non-hyperten-sive nephropathy group,hypertension group and control group(P＜0.01).ROC curve analysis showed that the AUC value of the four indictors combined together in the diagnosis of hyperten-sive nephropathy was 0.907,which was statistically greater than that of single indicator alone(0.774,0.743,0.728,0.749,P＜0.01).Obvious differences were also observed in PWV-BS,PWV-ES,and urinary TRF and β2-MG levels among the severely,moderately and mildly injured groups and normal group(P＜0.01).Sequential multivariate logistics regression analysis indicated that PWV-BS(OR=1.824,95％CI:1.272-2.616,P=0.001),PWV-ES(OR=1.910,95％CI:1.268-2.877,P=0.002),and urinary TRF(OR=2.442,95％CI:1.485-4.018,P=0.001)and β2-MG levels(OR=2.807,95％CI:1.580-4.984,P=0.001)were influencing factors of renal injury severity in the renal injured patients.Conclusion Carotid pulse wave combined with urinary TRF and β2-MG can be applied in auxiliary diagnosis of hypertensive nephropathy,and they are correla-ted with the severity of renal injury.

Objective To explore the value of carotid pulse wave combined with urinary transferrin(TRF)and β2-microglobulin(β2-MG)in the evaluation of renal injury in patients with hyperten-sive nephropathy.Methods A total of 30 patients with hypertensive nephropathy,30 patients with simple hypertension and 90 patients with non-hypertensive nephropathy who were admitted to our hospital between May 2021 and April 2024,and 30 healthy individuals(control group)who taking physical examination during same period were enrolled and assigned into corresponding groups,respectively.According to the severity of renal injury,the 120 patients from the hyperten-sive nephropathy group and non-hypertensive nephropathy group were divided into normal group(28 cases),mildly injured group(36 cases),moderately injured group(31 cases)and severely in-jured group(25 cases).The carotid pulse wave indicators[pulse wave velocity at beginning of the systole(PWV-BS),pulse wave velocity at ending of the systole(PWV-ES)],and urinary TRF and β2-MG levels were detected and compared in above groups.ROC curves were plotted to ana-lyze the diagnostic values of these indicators in hypertensive nephropathy.The relationship be-tween the above indicators and the severity of renal injury was analyzed with sequential multivari-ate logistics regression analysis.Results There were significant differences in PWV-BS,PWV-ES,and urinary TRF and β2-MG levels among the hypertensive nephropathy group,non-hyperten-sive nephropathy group,hypertension group and control group(P＜0.01).ROC curve analysis showed that the AUC value of the four indictors combined together in the diagnosis of hyperten-sive nephropathy was 0.907,which was statistically greater than that of single indicator alone(0.774,0.743,0.728,0.749,P＜0.01).Obvious differences were also observed in PWV-BS,PWV-ES,and urinary TRF and β2-MG levels among the severely,moderately and mildly injured groups and normal group(P＜0.01).Sequential multivariate logistics regression analysis indicated that PWV-BS(OR=1.824,95％CI:1.272-2.616,P=0.001),PWV-ES(OR=1.910,95％CI:1.268-2.877,P=0.002),and urinary TRF(OR=2.442,95％CI:1.485-4.018,P=0.001)and β2-MG levels(OR=2.807,95％CI:1.580-4.984,P=0.001)were influencing factors of renal injury severity in the renal injured patients.Conclusion Carotid pulse wave combined with urinary TRF and β2-MG can be applied in auxiliary diagnosis of hypertensive nephropathy,and they are correla-ted with the severity of renal injury.

Objective To explore the application value of simultaneous multi-slice(SMS)technique in diffusion tensor imaging(DTI)for evaluating brain glioma.Methods Thirty-four brain glioma patients were prospectively enrolled,and brain conventional DTI and SMS-DTI were acquired.The subjective scores of image quality,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were compared between SMS-DTI and conventional DTI,so were the numbers of whole brain fiber bundles,tumor relative fractional anisotropy(rFA)and relative mean diffusivity(rMD)obtained based on SMS-DTI and conventional DTI.Results Among 34 patients,there were 23 cases of high-grade glioma and 11 cases of low-grade glioma.No significant difference of subjective scores of image quality,tumor edge clarity nor magnetic susceptibility artifacts was found between SMS-DTI and conventional DTI(all P＞0.05).SNR and CNR on SMS-DTI were both lower than those on conventional DTI(both P＜0.05).No significant difference of the numbers of whole brain fiber bundles,rFA nor rMD of gliomas with different pathological grades was detected based on SMS-DTI compared with those on conventional DTI(all P＞0.05).Conclusion SMS applicated in DTI for evaluating brain gliomas was able to shorten acquisition time under the condition of ensuring image quality and quantitative analysis accuracy.

Objective:To explore the application value of multiple indexes of high-frequency ultrasound in the diagnosis of shoulder stiffness, and to provide data support and theoretical basis for the diagnosis and treatment of shoulder stiffness.Methods:Clinical data of 261 patients with unilateral shoulder pain with limited mobility admitted to the Orthopedic Trauma, Hebei Medical University Third Hospital from January to December 2023 were retrospectively analyzed. With the results of shoulder arthroscopy as the gold standard, the patients were divided into 127 patients with shoulder stiffness (observation group) and 134 patients with non-shoulder stiffness and shoulder pain (control group). The fluid accumulation of long head of the biceps tendon (LHBT), echo of rotator interval (RI) and blood flow signal, thickness of coracohumeral ligament (CHL), thickness of subacromial-subdeltoid bursa (SASD), fluid accumulation and blood flow signal, fluid accumulation of posterior glenohumeral joint capsule (PJ), the inferior capsule thickness (ICT) and the thickness of inferior glenohumeral ligament (IGHL) were observed and measured in the two groups in addition, the CHL difference, ICT difference and IGHL difference between the affected side and the contralateral side were calculated, and the difference between the two groups of ultrasound indicators was compared and the multivariate logistic stepwise regression analysis was performed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of each indicator for shoulder stiffness.Results:RI hypoecho with increased blood flow signal, SASD thickening, SASD effusion, SASD blood flow signal detection rate, IGHL thickness, IGHL difference and ICT difference in observation group were significantly higher than those in the control group (all P<0.05). Multivariate logistic stepwise regression analysis showed that SASD thickening, SASD effusion and IGHL difference were independent predictors of shoulder stiffness (all P<0.05). The area under the curve of SASD thickening, SASD effusion and IGHL difference in the diagnosis of shoulder stiffness were 0.550, 0.540 and 0.636, respectively. The diagnostic sensitivity was 89.8%, 10.2% and 60.6%, and the specificity was 20.1%, 97.8% and 67.2%, respectively. The area under the curve was 0.676, the diagnostic sensitivity was 59.8%, and the specificity was 75.4%. Conclusions:High-frequency ultrasound is an effective imaging method to assist clinical diagnosis of shoulder stiffness. SASD thickening, SASD effusion and IGHL difference may be independent predictors of shoulder stiffness. The combined application of these three indicators has higher clinical application value and provides favorable ultrasound indicators for clinical differential diagnosis of shoulder stiffness.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Objective: To investigate the recovery of splenomegaly and hypersplenism after liver transplantation in children and explore the necessity of splenomegaly management before and during liver transplantation. Method: The data of 22 children who were underwent liver transplantation with preoperative splenomegaly and hypersplenism who were not treated with splenomegaly before and during operation and with no recurrence of portal hypertension during postoperative follow-up in Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University from December 2008 to January 2019 were collected. There were 13 male patients and 9 female patients with a median age of 6.5 months. The changes of erythrocyte, platelet, white blood cell and spleen length and thickness were analyzed by paired t-test before and at the 1st, 3rd and 6th months after surgery. Correlation analysis was performed on the change of spleen long diameter and thickness product and blood cell recovery. Results: There were 21 cases of red blood cell decreased before surgery, with a mean value of(3.1±0.5)×10¹²/L, and(3.7±0.7)×10¹²/L, (4.6±0.6)×10¹²/L and (4.3±0.5)×10¹²/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the preoperative and postoperative groups were statistically significant (P<0.05). There were 7 cases of thrombocytopenia before operation, with an average of (70.0±17.0)×10⁹/L, and (191.0±129.0)×10⁹/L, (156.0±79.0)×10⁹/L and (167.0±63.0)×10⁹/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the first, third, and sixth months after surgery were significant compared with that before surgery (P<0.05). Leukocyte count decreased in 5 cases with an average value of (3.30±0.56)×10⁹/L before surgery, (7.5±4.4)×10⁹/L, (7.4±1.4)×10⁹/L, (5.1± 2.5)×10⁹/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the two groups were significant (P<0.05). The average value of preoperative spleen length times thickness was (35.7±12.9) cm² and at the 1st, 3rd, 6th month after surgery it was (26.2±8.1)cm², (25.2±13.4)cm², (27.2±7.4)cm², respectively. The differences between the first, third months after surgery were significant compared with that before surgery (P<0.05). The white blood cell and platelet counts of children before and after surgery were correlated with spleen size negatively (correlation coefficients were -0.902, -0.933, respectively), and the differences were statistically significant (P<0.05). Conclusions In the early stage of liver transplantation, the size of spleen retracts to varying degrees, and hypersplenism can be alleviated continuously. Therefore, it is unnecessary to treat splenomegaly and hypersplenism before and during liver transplantation.

Objective To explore the methods for solving the neck two-point T2-DIXON fat-water separation misalignment. Methods During August 2015 to July 2016, 140 patients with fat-water separation on the nasopharynx and cervical axial T2-DIXON images were prospectively recruited from Sichuan Cancer Hospital. There was no metal implant in the fat-water separation misalignment area. The patients were divided into 7 groups by random number table method with 20 patients in each group for the axial T2-DIXON scan: Group A adopted plan 1( increasing localized shim box on the fat-water separation misalignment area);Group B adopted plan 2(increasing the times of repeated acquisition to 2 of the T2-DIXON sequence);Group C adopted plan 3 (placing the shimming assist device on the inspection area);Group D adopted plan 1+plan 2;Group E adopted plan 1+plan 3;Group F adopted plan 2+plan 3;Group G adopted plan 1+plan 2+plan 3. The images quality of two scans were graded and compared. We compared the signal-to-noise ratio (SNR) of T2-DIXON image on the same muscle tissue between the two scans of each group. The difference of SNR on the two scan images was compared with the paired t test, the difference of SNR among seven groups was conducted with independent sample t test, and the comparison of image quality classification was conducted by rank sum test. Results The image quality of all the seven groups was improved to some different degrees. The cases with image quality reaching level 3 were 12, 15, 15, 16, 17, 18 and 18 in A to G groups, respectively. It was better to use the combination of two or more methods to improve the quality of the image than to use a single method. There were no statistically significant differences in SNR between two scans in A, C and E group (all P>0.05).There were statistically significant differences in SNR between two scans in groups of B, D, F and G(all P<0.05). There were statistically significant differences among the 7 groups, with the best quality in G group (P<0.05). There was no significant difference in the first SNR among the 7 groups (P>0.05);there were significant differences in the second scans among the 7 groups (P<0.05) .Conclusions This study suggests that placing localized shim box, increasing the times of repeated acquisition, and use of shimming assist device in MRI correct the fat-water separation misalignment, help to provide images with high quality. The combination of the above method was better than using the single method. The SNR can be improved when increasing the times of repeated acquisition.