Objective:To evaluate the pregnancy outcomes of fetal tethered cord (TC) prenatally diagnosed by MRI.Methods:Clinical data of 38 fetuses diagnosed as having TC by MRI, including 36 singletons and two fetuses who were both one of dichorionic diamniotic twins, were retrospectively collected and analyzed in the Obstetrics and Gynecology Hospital of Fudan University from January 2015 to August 2019. According to whether conus medullaris was located above the bladder or reached the lower edge of the bladder, all cases were divided into high or low groups. Pregnancy outcomes were compared between the two groups using Fisher's exact test and Student's t-test. Results:(1) The gestational age at MRI was (25.5±4.7) weeks. Among the 38 cases, 14 (36.8%) were isolated TC, 24 (63.2%) were complicated by other anomalies. The meningocele was responsible for the most (39.5%, n=15). The results of the ultrasound were consistent with those of MRI in 24 cases (63.2%). While in the other 14 cases (36.8%), the ultrasound only showed vertebral body's abnormal morphology, after which further MRI examination revealed a tethered cord. (2) Twenty-nine women (76.3%) chose to terminate the pregnancy. One patient (2.6%) underwent fetal reduction at 23 gestational weeks (one normal twin was delivered prematurely), and one (2.6%) was lost to follow-up. Seven (18.4%) cases continued the pregnancies to delivery. The postnatal follow-up period was 8.1 months (4.0 to 54.9 months). Two infants without comorbidities showed normal growth and development. Another three cases underwent surgeries after birth, and two cases died in the neonatal period. (3) The average width of the medullary cone was (2.5±0.8) cm. There was no significant difference in the spinal cord width between the high [(2.5±0.8) cm, n=34] and low group [(2.7±1.1) cm, n=4]. Six pregnancies (17.6%) in the high group was continued to delivery, and one of the neonates died of severe hydrocephalus. One patient in the low group (1/4) was delivered, while the baby died of neonatal asphyxia. Conclusions:Fetuses with isolated TC are prone to have a good prognosis. Further study should focus on the relation between the high or low position of the conus medullaris and pregnancy outcomes.

Objective To establish a neural network model based on enhanced CT for distinguishing ISUP grade of clear cell renal cell carcinoma (ccRCC). Methods We collected 131 cases of ccRCC, with 92 cases of low ISUP grade and 39 cases of high ISUP grade. Patients were divided into training set and validation set according to 5:5 stratified sampling. The enhanced CT images of each ccRCC patient were evaluated by the radiologist. Recursive feature elimination (RFE) was used to reduce the dimension of patients' general features and enhanced CT features, which was used for neural network modeling and validation. Results Patients' general features and enhanced CT features were verified by RFE method and then reduced to 14 features. The top 5 features were growth pattern, necrosis, enlargement of lymph nodes, tumor size and capsule. The AUC of the neural network model based on these 5 features in training set was 0.8844 (95%CI: 0.8062-0.9626), sensitivity was 89.47% and specificity was 82.61%; and those in validation set were 0.7924 (95%CI: 0.6567-0.9280), 75.00% and 86.96%, respectively. Conclusion The neural network model of ccRCC ISUP grade based on enhanced CT has relatively high diagnostic efficiency.

【Objective】 To study the effect of intravenous immunoglobulin(IVIG) on the detection of blood transfusion compatibility in patients. 【Methods】 56 patients, submitted to our Hospital from March 1, 2017 to December 31, 2020, were enrolled as the research objects. They had negative unexpected antibody screening, major crossmatch incompatibility with the same blood type donors, and had a history of IVIG infusion. ABO and RhD blood groups typing, unexpected antibodies screening, crossmatch, direct antiglobulin test, indirect antiglobulin test, and acid elution test were all conducted by microcolumn gel method. 【Results】 After IVIG infusion, the initially major crossmatch incompatibility with the same blood type donors turned into compatiblity with O-type donors. Among them, 2 patients had transient discrepancy in ABO forward and reverse blood typing due to the IVIG infusion. IgG anti-A were detected in the red blood cell elution of 37 A-type patients; IgG anti-B in 2 B-type patients; 3 cases of IgG anti-A+ anti-B and 14 cases of solo IgG anti-A in 17 AB-type patients. 3 batches of IVIG preparations were detected randomly, IgG anti-A titer was 32-64, and IgG anti-B titer was 8-16. 【Conclusion】 The discrepancy in ABO forward and reverse blood typing and major crossmatch incompatibility with the same blood type donors may occur after non-O type patients received IVIG, which contains IgG types of anti-A and anti-B. In this situation, it is recommended to prepare major crossmatched O-type washed red blood cells to ensure the safety and effectiveness of clinical blood transfusion.

【Objective】 To explore the influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation, so as to provide reference for perioperative blood management (PBM) of lung transplantation patients. 【Methods】 The clinical data of 173 lung transplant patients completed in China-Japan Friendship Hospital from March 2017 to June 2019 were retrospectively analyzed. The patients were divided into two groups according to perioperative red blood cell transfusion volume: large blood transfusion group (transfusion red blood cell volume ≥6 U, n=66) and non-large blood transfusion group (red blood cell transfusion volume <6 U, n=107). The basic information, preoperative laboratory test results, and surgical status of the two groups were statistically analyzed.The clinical data of the two groups were analyzed by univariate analysis. The factors of P<0.15 were included in the binary logistic regression analysis, and the independent influencing factors of perioperative massive blood transfusion in patients with lung transplantation were found. 【Results】 Univariate analysis of clinical data of the two groups of patients (large blood transfusion group vs. non-large blood transfusion group) showed that the differences of smoking history ratio [44(66.7%) vs 87(81.3%)], BMI(20.8±4.5 vs 22.5±4.0)(P<0.05), preoperative Hb [124(111, 138.8) vs 138(126, 149)], preoperative Hct [37.9(34.8, 42.5) vs 41.3(37.9, 44.6)], surgery duration(327.9±107.7 vs 238.4±77.0), intraoperative blood loss(1 108.6±1342.0 vs 341.8±270.8) and single lung transplantation [28(42.4%) vs 84(78.5%)] (P<0.01) were statistically significant. Logistic regression analysis showed that intraoperative blood loss (OR=1.001, P<0.05), surgery duration (OR=1.006, P<0.05), preoperative Hb (OR=0.973, P<0.01), lung transplantation type(single or double lung transplantation)( OR=0.247, P<0.05) and extracorporeal membrane oxygenation (ECMO) (OR=0.187, P<0.01) were independent factors influencing red blood cell transfusion during lung transplantation. 【Conclusion】 Intraoperative blood loss and surgery duration are risk factors for massive blood transfusion during the perioperative period. And the use of ECMO, preoperative Hb, single lung transplantation (compared to double lung transplantation) are protective factors for perioperative massive blood transfusion.

Objective:To investigate the prenatal MRI diagnosis of fetal intracranial hemorrhage (ICH) and the pregnancy outcomes.Methods:This retrospective study included 49 cases of fetal ICH diagnosed by MRI in Obstetrics and Gynecology Hospital of Fudan University from July 2011 to November 2019. Two experts with more than five years of experience in obstetric radiology determined the location, number, area, stage and grade of the hemorrhage based on the MRI findings. Maternal age, gestational age at MRI, and the site, number, stage and grade of hemorrhage as well as other intracranial and extracranial abnormalities of the fetuses were compared between women with fetal germinal matrix-intraventricular hemorrhage (GM-IVH; GM-IVH group, n=39) and those without (non-GM-IVH group, n=10). MRI and ultrasound examination results of 37 cases who had MRI within three days after the ultrasound examination were compared. Postnatal and follow-up outcomes were summarized. Statistical analysis was performed using the independent sample t-test, Mann-Whitney U test and Chi-square test. Results:There was no significant difference in the maternal age, gestational age at MRI, or the site, number or stage of hemorrhage between the GM-IVH group and non-GM-IVH group (all P>0.05). The incidence of ventriculomegaly was higher in the GM-IVH group than that in the non-GM-IVH group [87% (34/39) vs 0/10, t=24.522, P<0.001]. There were 51% (19/37) of the lesions that were missed by ultrasound found by MRI, including GM-IVH in 17 cases, right cerebellar hemisphere hemorrhage in one case and corpus callosum hemorrhage in one case. Among the 49 cases, seven were lost to follow-up, 29 terminated the pregnancy (six in non-GM-IVH group and 23 in GM-IVH group), two experienced intrauterine fetal death in late pregnancy and 11 gave live birth. Ten live births had GM-IVH, among them a relatively good prognosis was noted in fetuses with grade Ⅰ (two cases), grade Ⅱ (four cases), and grade Ⅲ (three cases) GM-IVH, while one case with grade Ⅳ GM-IVH had mental retardation at eight years old; one non-GM-IVH infant had hearing loss at birth and a cochlear was implanted with no other anomalies reported during a three-year follow-up. Conclusions:MRI can provide a more direct view of the location and grade of fetal ICH and is more accurate than prenatal ultrasound in diagnosing fetal ICH, which is a beneficial supplement to ultrasound. The prognosis of cases with grade Ⅳ GM-IVH is not good.

Objective To analyze the clinical characteristics of community-acquired influenza virus pneumonia in hospitalized children and improve the clinicians' understanding level of this disease.Methods Data of 70 cases with community-acquired influenza virus pneumonia admitted to the Respiratory Department and Infectious Disease,Beijing Children's Hospital,Capital Medical University,from November 2009 to April 2018 were collected and the clinical characteristics were analyzed.Results Of the 70 cases,61 cases(89.7％) were discharged after improvement.The median age was 3.5 years old,and 50 cases(71.4％) were 0 to 5 years old.There were 29 cases with severe influenza pneumonia,41 cases with mild influenza pneumonia,3 cases died,and 19 cases (27.1％) had underlying diseases.Sixty-four cases (91.4％) were hospitalized in winter and spring.The first symptoms were mainly fever in 64 cases (91.4％) and cough in 65 cases (92.9％),and temperatures were mostly from 39.1 ℃ to 41.0 ℃.Lung auscultation was dominated by moist rales (30 cases,58.8％) and wheezing (8 cases,15.7％).There were many complications of influenza virus pneumonia,including 19 cases with myocardial injury,11 cases with liver function injury,4 cases with toxic encephalopathy,3 cases with electrolyte disturbance,2 cases with multiple organ failure,2 cases with hemophagocytic syndrome,and 1 case with septic shock.Chest radiographic results reveal bilateral inflammation in 40 children (57.1％),prodominatly in lower lobe lesions (39 cases).The common changes were patchy shadow,interstitial parenchymal lesion,ground glass shadow,and pleural effusion.Forty-seven children (67.1％) were infected by influenza A,and 23 children(32.9％) were co-infected.The percentage of severe cases with underlying diseases (68.4％) was significantly higher than that in children without chronic diseases (31.4％),the difference was statistically significant (x2 =7.830,P =0.005).The increase rate of C reaction protein (CRP) in severe cases (54.3％) was significantly higher than that in mild cases (28.6％),the difference was statistically significant (x2 =4.769,P =0.029).Conclusions Community-acquired influenza virus pneumonia in children mainly occurs in winter and spring.It is more common seen in children under 5 years of age.The main clinical manifestations of community-acquired influenza virus pneumonia are high fever and cough,extrapulmonary complications are more common.Most children have moist rales and showed bilateral inflammation and lower lobe lesions in chest radiography.Children with underlying diseases are more likely to develop severe influenza virus pneumonia.Elevated CRP is associated with severe influenza virus pneumonia.Most patients have a good prognosis,but there are still cases of death.

Objective: A predictive model of WHO/ISUP grading of renal clear cell carcinoma was constructed based on CT radiomics. Methods: The clinical data of 104 patients with ccRCC confirmed by operation or biopsy from March 2014 to December 2018 in the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were retrospectively analyzed. There were 70 males and 34 females, and the age was 61.2±11.7 years. The patients were randomly divided into development cohort (73 cases) and validation cohort (31 cases) by stratified sampling according to 7∶3 ratio. According to the WHO/ISUP pathological grading criteria of renal cancer in 2016, Ⅰ and Ⅱ were defined as low-grade group, Ⅲ and Ⅳ were defined as high-grade group. The radiomics features of ccRCC were calculated in cortical phase images of CT enhanced scanning. LASSO regression was used to reduce the radiomics feature dimensionality in the training group, and to establish radiomics risk scores. The binary logistic regression was used to build the prediction model, which was used in the validation group. Bootstrap method was used to validate the model of training and validation group. AUC, sensitivity and specificity were calculated respectively. Hosmer-Lemeshow goodness-of-fit test was used to evaluate model calibration degree. Results: After dimensionality reduction, the radiomics risk score of ccRCC was established. The low and high-level risk scores of the training group were -2.49±1.73 and 1.23±2.17, with significant difference (t=-7.785, P < 0.01). The binary logistic regression multivariate analysis showed that the radiomics risk score was an independent risk factor in identifying low or high-grade ccRCC with odds ratio of (OR=3.576, 95%CI 1.964~6.513). The predictive model was Y=1/[1+ exp(-Z)], Z=1.274×radiomics risk score+ 0.072. The AUC of radiomics risk score in training group was 0.940 (95%CI 0.883-0.998) with 95.5% sensitivity and 88.2% specificity after internal verification by Bootstrap method, and good Hosmer-Lemeshow goodness-of-fit test (χ²=4.463, P>0.05). The low and high-level risk scores of the Validation group were -2.27±2.02 and 0.82±2.08, with significant difference (t=-3.832, P<0.01). The AUC in validation group was 0.859(95%CI 0.723-0.995) with 77.8% sensitivity and 81.8% specificity, and with good Hosmer-Lemeshow goodness-of-fit test (χ²=14.554, P=0.068) as well. Conclusions The prediction model based on CT radiomics has high accuracy in predicting high or low grade of ccRCC.

Objective: To evaluate the clinical value of three-dimensional ultrasound VOCAL technique in evaluating gastric emptying function in children with functional dyspepsia (FD). Methods: Seventy-one children with FD who were treated in Wenzhou Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from January 2018 to June 2018 were enrolled as the study subjects (observation group), and 71 normal children without FD were selected as controls (control group). The gastric emptying, antral pyloric systolic contraction frequency and distal gastric contraction movement in different time groups were analyzed, and GET1/2 and 2h gastric residual situation before and after treatment in the observation group were compared. Results: The GET1/2 of the observation group was (60.2±12.69)min, and the gastric emptying rate of the observation group was (61.9±12.2)min and (72.0±12.3)min at 90min and 120min, which were significantly better than those of the control group, and the differences were statistically significant (t=19.092, 15.092, 14.882, P=0.016, 0.024, 0.033). The frequency of antral pyloric systolic contraction, gastric antrum contraction frequency and gastric antrum contraction amplitude were (1.1±0.7)times/min, (2.9±0.8)times/min, (1.0±0.6)cm, respectively.Compared with the control group, the differences were statistically significant (t=16.092, 21.224, 8.092, all P<0.05). In the observation group of 71 children: GET1/2 before treatment and after treatment were (68.1±11.8)min, (54.2±9.8)min, respectively.The gastric residual at 2h after treatment was (31.2±8.0)%, (22.1±7.0)%, respectively.The GET1/2 and 2h gastric residual rate of the children were significantly lower than before treatment, and the differences were statistically significant (t=18.983, 21.004, all P<0.05). Conclusion Three-dimensional ultrasound VOCAL technology can be used as an evaluation standard for FD in children.

[Abstraet] Purpose To explore the application of noise reduction settings among modelbased iterative reconstruction (MBIRn) on decreasing radiation dose in CTA through experimental study.Materials and Methods Spectral CT was used to scan vessel model which could accommodate 8 tubes under static condition under 120 kVp fixed tube voltage at 10 mA,50 mA,150 mA and 600 mA.The tubes were filled with purified water,1,2,5,10,20 and 30 mgI/ml solutions and 30 mgCa/ml solution.Algorithms of FBP (standard),ASIR40 (combined by 40％ ASIR and FBP),MBIRc and MBIRn with optimized spatial resolution setting as MBIRRP20,MBIRstnd (standard setting),and MBIRNR40 (noise reduction setting) were adopted for original scanning data to reconstruct images of 0.625 mm slice thickness for contrastive analysis.Three fixed layers were chosen and regions of interest were placed on central tube and surrounding ester matrix,and CT value and standard variation (SD) were measured to represent noise.Noise reduction setting MBIRNR40 and solution noise of other reconstruction algorithm images were calculated and compared and average value of contrast noise ratio (CNR) was compared.Results Compared to FBP under different tube currents,ASIR40,MBIRc,MBIRRP20,MBIRstnd and MBIRNR40 reduce noise and increase CNR at different levels.Average noise of MBIRNR40 was the lowest (reduced by 78.33％) and CNR the highest (increased by 241.74％),making it superior to other reconstruction algorithm images (P＜0.05).Meanwhile,the lower the radiation dose was,the more obvious its advantage was.Reconstruction image noise of MBIRNR40 at 10 mA was close to that of FBP and ASIR40 at 600 mA.CNR was obvious greater than that of FBP and ASIR40 at other tube voltage.Conclusion Reconstruction algorithms of MBIRc,MBIRn and ASIR can help enhance CTA image quality and reduce radiation dose.Noise reduction setting MBIRNR40 from MBIRn has the lowest noise and greatest CNR.The lower the radiation dose is,the more obvious its advantage is.

Objective To assess image quality of adaptive statistical iterative reconstruction (ASIR),conventional modelbased iterative reconstruction (MBIRc) and a new lung-specific setting (MBIRRP20 and MBIRNR40) from the new version of model-based iterative reconstruction (MBIRn) in submillisievert chest CT comparing with ASIR in standard-dose.Methods Two chest CT examinations were performed with standard-dose and low-dose in 30 patients.Low-dose CT images were reconstructed with ASIR,MBIRc and MBIRn,while standard-dose CT images were reconstructed with ASIR only.Objective image noise and SNR were measured on the same part from the back muscle and subcutaneous fat which located at the level of thoracic entry,trachea carina and hepatic portal.Image quality of lung,mediastinum and upper abdomen structures were evaluated on a 5-point scale.The results were compared with one-way ANOVA and Wilcoxon signed-rank tests.Results The effective dose equivalent for standard-dose CT was (3.01 ± 1.89) mSv,compared with (0.88 ± 0.83) mSv for low dose CT,which decreased by 70.76％.The mean image noise for low-dose MBIRNR40 was significantly lower than that of conventional-dose ASIR,low-dose ASIR and MBIRc (P＜0.05).The mean SNR for low-dose MRIRNR40 was significant ly higher than that of conventional dose ASIR,low-dose ASIR and MBIRc (P＜0.05).The subjective image noise score was significantly lower than that of ASIR and MBIRc,and the score of sharpness of details of the structures score for low dose MBIRn was significantly better than that of the ASIR and MBIRc (P＜0.05).Conclusion MBIRNR40 can significantly reduce image noise and improve SNR compared to ASIR and MBIRc in low-dose,even better than ASIR in standard dose,which reduce radiation dose by about 70％.In low-dose,MBIRPP20 can well display lung structures,and MBIRNR40 can display mediastinal and the upper abdominal structures.