Purpose/Significance The paper analyzes the application of remote consultation in Henan province and the factors affect-ing service efficiency,optimizes service mode,and provides suggestions for the sound development of telemedicine.Method/Process The volume of remote consultation business,patient and doctor data,and consultation process data carried out through the regional tele-medicine integrated service platform in Henan province in 2022 are collected and sorted out.IBM SPSS 23.0 software is used to analyze the distribution of patients and business development of remote consultation,and factors affecting the efficiency of consultation are ana-lyzed through multiple logistic regression.Result/Conclusion The level of the hospital applying for remote consultation and the consulta-tion department affect the duration of the consultation process.The consultation department,expert titles,and referral suggestions are the main factors affecting the response time of consultation.It is suggested to optimize the service process of remote consultation,enhance the enthusiasm of doctors to participate in consultation,reduce the response time of consultation,and improve the efficiency of consultation.

Objective:To investigate the efficacy of functional endoscopic sinus surgery（FESS） in the treatment of olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyps （CRSwNP） , at the same time, it provides an evidence for the prognosis evaluation of olfaction and the clinical application of oERPs to evaluate the plasticity of olfaction cortex. Methods:From October 2021 to October 2022, 45 patients with CRSwNP who underwent FESS nine-step standardized treatment in our department were recruited as the research subjects, divided into 22 patients with eosinophilic CRSwNP（ECRS）and 23 patients with non-eosinophilic CRSwNP（nECRS）. VAS-olfactory dysfunction （VAS-OD） score, SNOT-22 olfactory score, Sniffin' Sticks test and oERPs collection and processing were performed before the operation. All items were evaluated again 3 months after the operation. Results:VAS-OD and SNOT-22 olfactory score were significantly lower in all CRSwNP patients after the operation than those before the operation[F（1, 43） =357.429, P<0.001; F（1, 43） =185.657, P<0.001], the scores of T, D, I and TDI scores in Sniffin' Sticks test were significantly higher than those before the operation[F（1, 43） =126.302, P<0.001; F（1, 43） =311.301, P<0.001; F（1, 43） =131.401, P<0.001; F（1, 43） =295.885, P<0.001]; The decrease of VAS-OD and SNOT-22 olfactory score in the ECRS group was smaller than that in the nECRS group[F（1, 43） =4.825, P=0.033; F（1, 43） =9.916, P=0.003], T, D and TDI scores were significantly lower in nECRS group than those in nECRS group[F（1, 43） =6.719, P=0.013; F（1, 43） =4.890, P=0.032; F（1, 43） =4.469, P=0.040]; There was a positive correlation between preoperative eosinophil-to-lymphocyte ratio（ELR） and SNOT-22 olfactory score and how much it changes（r=0.455, P=0.002; r=-0.414, P=0.005）, a negative correlation between T, TDI score and how much they change respectively（r=-0.431, P=0.003; r=-0.385, P=0.009; r=-0.383, P=0.010; r=-0.316, P=0.035）. The latency of P3 was significantly shorter after operation than that before operation in all CRSwNP patients[F（1, 14） =24.840, P<0.001], however, the amplitude has no significant surgical effect. Conclusion:FESS could significantly improve the olfactory function of CRSwNP patients, while changes in plasticity may occur in the olfactory cortex. In addition, the preoperative peripheral blood eosinophil granulocyte level can predict the postoperative olfactory improvement.
Humans ; Prospective Studies ; Nasal Polyps/surgery* ; Rhinitis/surgery* ; Sinusitis/surgery* ; Olfaction Disorders/etiology* ; Chronic Disease ; Endoscopy/adverse effects*

Objective:To investigate the relationship between monocyte/high-density lipoprotein ratio (MHR) and clinical parameters and the prognosis of patients with chronic kidney disease (CKD).Methods:Clinical data were collected of CKD patients who were diagnosed and followed up regularly in Henan Provincial People's Hospital from January 1, 2017 to June 30, 2020. According to the median baseline MHR of the selected patients, they were divided into two groups: low-level MHR group (MHR≤0.347 8) and high-level MHR group (MHR>0.347 8). The patients were regularly followed up for 3-42 months, the renal adverse prognostic events were defined as serum creatinine doubled, estimated glomerular filtration rate (eGFR) reduced to at least 50% of the original, new entry into end-stage renal disease (ESRD), starting renal replacement therapy, death due to renal or cardiovascular events. The Kaplan-Meier method was used to compare the differences in survival rates between the two groups, and Cox regression analysis method was used to explore the influencing factors of renal adverse prognosis in CKD patients. Stratified analysis was used to find special factors that might affect the relationship between MHR and renal adverse prognosis in CKD patients.Results:A total of 405 patients were included in this study. Their age was (49.77±14.82) years old. Body mass index was (25.18±4.22) kg/m 2. Women accounted for 30.62%(124/405). The proportion of patients with smoking, drinking, hypertension and diabetes was 39.51%(160/405), 35.06%(142/405), 73.33%(297/405) and 38.27%(155/405), respectively. Compared with the low-level MHR group ( n=202), the high-level MHR group ( n=203) had more people in late CKD, males, and hypertension (all P<0.01), and body mass index, white blood cells, monocytes, serum creatinine, serum uric acid, serum urea nitrogen, retinol binding protein, cystatin C, blood phosphorus were higher (all P<0.05), while hemoglobin, high density lipoprotein and eGFR were lower (all P<0.05). Spearman rank correlation results show that MHR level was positively correlated with white blood cells, serum creatinine, serum uric acid, serum urea nitrogen, retinol-binding protein, cystatin C, serum phosphorus (all P<0.01), and negatively correlated with hemoglobin and eGFR (both P<0.01). The median follow-up time was 8(4, 16) months. To the end of the follow-up, 113 patients (27.90%) had renal adverse prognostic events. Kaplan-Meier survival analysis results showed that the renal cumulative survival rate of the high-level MHR group was lower than that of the low-level MHR group ( χ2=8.277, P=0.004). Multivariate Cox regression analysis showed that high MHR level was an independent influencing factor for poor renal prognosis in CKD patients ( HR=1.628, 95% CI 1.050-2.523, P=0.029). Stratified analysis showed that, without hypertension, MHR had a more significant effect on the prognosis of the kidneys ( HR=3.414, 95% CI 1.091-10.686, P for interaction=0.001). Conclusions:The level of MHR is related to the severity and poor renal prognosis of CKD, and the high MHR level is an independent predictor for poor renal prognosis in CKD patients.

Objective:To investigate the CT features of primary hepatic lymphoma in order to improve the accuracy of diagnosis.Methods:The clinical data, CT and pathological findings of 11 patients with primary hepatic lymphoma confirmed by surgery and pathology in Wenzhou Medical University Affiliated Yueqing Hospital, Wenzhou People′s Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical College from September 2008 to September 2018 were retrospectively analyzed.Results:Among the 11 patients, the tumors were located in the right liver in 7 cases, in the left liver in 2 cases, and in the left and right lobe of the liver in 2 cases; there were 27 tumors with the largest diameter of 1.7 to 12.6 cm; the tumors were round in 3 cases, oval in 5 cases and irregular in 3 cases; the tumor boundary was clear in 8 cases and unclear in 3 cases. CT scan showed low density in 6 cases, slightly low density in 3 cases and equal density in 2 cases; the density was uniform in 7 cases and inhomogeneous in 4 cases; CT value was 26 to 47 (38 ± 5) HU; there were 2 cases of splenic metastasis, 1 case of rib metastasis and 1 case of abdominal and retroperitoneal lymph node enlargement. CT enhanced scan showed no obvious enhancement in 1 case; in arterial phase, mild to moderate enhancement was seen in 10 cases, including 8 cases of continuous circular enhancement at the edge of the lesions in portal venous phase and delayed phase, and 2 cases with nodular enhancement; the CT value of arterial phase was 30 to 68 (53.8 ± 11.6) HU, that of portal venous phase was 52 to 69 (64.3 ± 9.3) HU, and that of delayed phase was 43 to 64 (56.4 ± 6.0) HU. Eight cases were completely resected, and 6 cases recurred after operation. Five cases survived for 3 years and 2 cases survived for 5 years; 3 cases were not completely resected, and all of them recurred after operation. One case survived for 3 years and no patient survived for 5 years. Among them,. Pathological diagnosis was diffuse large B-cell lymphoma in 10 cases and T-cell lymphoma in 1 case.Conclusions:CT examination of primary hepatic lymphoma has important value in the localization, qualitative and auxiliary clinical diagnosis of the tumor.

Objective We performed a diffusion tensor imaging (DTI) study to explore the value of mode of anisotropy (MO) and other DTI-derived indices in assessing white matter fiber damage with mild to moderate Alzheimer disease (AD) patients. Methods This study was a prospective study. From February 2015 to February 2018, 33 patients with mild to moderate AD according to criteria were prospectively recruited as AD group at the First Affiliated Hospital of Wenzhou Medical University. Twenty healthy age-, sex-matched volunteers were recruited as normoal conctrast (NC) group. All subjects were performed by conventional brain MRI and DTI scans. The MO, anisotropic fraction (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AxD) of white matter fibers were obtained from DTI images after TBSS post-processing. The statistical analyses of DTI indices between AD group and NC group were carried out in Functional MRI Software Library software. Results As compared with NC group, we found 1 cluster with significant decrease FA and increase RD in AD group, the affected fibers involving bilateral anterior thalamic radiation, corticospinal tract, cingulate gyrus, hippocampus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, uncinated fasciculus, superior longitudinal fasciculus (P<0.05). The MD value increase(P<0.1) was found to coincide with the decrease of FA and the increase of RD, while no significant increase or decrease in P<0.05. Three clusters of MO increases (P<0.05) accompanying with increases of AxD were found in left anterior limb of internal capsule, bilateral posterior limb of internal capsule, posterior forceps, left centrum semiovale and parietal lobe. Two clusters of MO decreases (P<0.05) accompanying with decreases of FA and increases of RD were found in fornix, forceps, external capsule, centrum semiovale and left frontal lobe. Conclusions The combination of MO with DTI routine tensor indices (FA, RD, MD, AxD) can further reveal the microstructural damage of white matter fibers in AD, especially to crossing-fibers. The abnormalities of MO combined with FA, RD and MD reveal the degeneration of both bundles of crossing-fibers,and the abnormalities of MO combined with AxD reveal that the white matter damage was mainly caused by axon damage of one bundle of cross fibers.

Attention deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder that has been linked to the dopaminergic system. This study aimed to investigate the effects of regulation of the dopamine D4 receptor (DRD4) on functional brain activity during the resting state in ADHD children using the methods of regional homogeneity (ReHo) and functional connectivity (FC). Resting-state functional magnetic resonance imaging data were analyzed in 49 children with ADHD. All participants were classified as either carriers of the DRD4 4-repeat/4-repeat (4R/4R) allele (n = 30) or the DRD4 2-repeat (2R) allele (n = 19). The results showed that participants with the DRD4 2R allele had decreased ReHo bilaterally in the posterior lobes of the cerebellum, while ReHo was increased in the left angular gyrus. Compared with participants carrying the DRD4 4R/4R allele, those with the DRD4 2R allele showed decreased FC to the left angular gyrus in the left striatum, right inferior frontal gyrus, and bilateral lobes of the cerebellum. The increased FC regions included the left superior frontal gyrus, medial frontal gyrus, and rectus gyrus. These data suggest that the DRD4 polymorphisms are associated with localized brain activity and specific functional connections, including abnormality in the frontal-striatal-cerebellar loop. Our study not only enhances the understanding of the correlation between the cerebellar lobes and ADHD, but also provides an imaging basis for explaining the neural mechanisms underlying ADHD in children.
Attention Deficit Disorder with Hyperactivity ; diagnostic imaging ; genetics ; pathology ; Brain ; diagnostic imaging ; Cerebellum ; diagnostic imaging ; Child ; Corpus Striatum ; diagnostic imaging ; Female ; Frontal Lobe ; diagnostic imaging ; Genotype ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Minisatellite Repeats ; genetics ; Neural Pathways ; diagnostic imaging ; Oxygen ; blood ; Receptors, Dopamine D4 ; genetics ; metabolism ; Rest

A great number of studies have demonstrated functional abnormalities in children with attention-deficit/hyperactivity disorder (ADHD), although conflicting results have also been reported. And few studies analyzed homotopic functional connectivity between hemispheres. In this study, resting-state functional magnetic resonance imaging (MRI) data were recorded from 45 medication-naïve ADHD children and 26 healthy controls. The regional homogeneity (ReHo), degree centrality (DC) and voxel-mirrored homotopic connectivity (VMHC) values were compared between the two groups to depict the intrinsic brain activities. We found that ADHD children exhibited significantly lower ReHo and DC values in the right middle frontal gyrus and the two values correlated with each other; moreover, lower VMHC values were found in the bilateral occipital lobes of ADHD children, which was negatively related with anxiety scores of Conners' Parent Rating Scale (CPRS-R) and positively related with completed categories of Wisconsin Card Sorting Test (WCST). Our results might suggest that less spontaneous neuronal activities of the right middle frontal gyrus and the bilateral occipital lobes in ADHD children.

Objective To investigate the radiation dose to phantoms of thick dense breasts (compression thickness ＞ 65 mm) and the influence of Molybdenum-Rhodium (Mo-Rh) and Wolfram Rhodium (W-Rh)) target-filter combination on image quality in full field digital mammography (FFDM).Methods An aluminium plate was placed on polymethyl methacrylate (PMMA) plates to simulate dense breasts.Two of 68 mm in-depth phantoms were used to simulate photography condition of thick dense breasts with 0.1 and 0.2 mm aluminium plates respectively.The two phantoms were exposed automatically,half-automatically and manually.The parameters were recorded for each exposure including the target-filter(T-F),tube voltage (kV),tube current (mAs),average glandular dose (AGD),entrance surface dose (ESD) and the image quality figure inverse (IQFInv).Pearson correlation and regression was used to analyze the influence of AGD on IQFInv.Paired sample t-test was used to analyze the influence of different target-filters on IQFInv and AGD.Results AGD had a positive correlation with IQFInv (r =0.806-0.953,P ＜ 0.05).For the phantom of 0.1 mm aluminium,when the tube current was fixed at 100 mAs or the tube voltage was fixed at 28 kVp,AGD and IQFInv had statistically significant difference for two target-filters(t =3.162-8.028,P ＜0.05).For the phantom with 0.2 mm aluminium,when the tube current was fixed at 100 mAs under different tube voltage,AGD and IQFInv had statistically significant difference for two target-filters(t =4.768-8.028,P ＜ 0.05);when tube voltage was fixed at 28 kVp under different tube current,AGD had statistically significant difference for two target-filters(t =7.730,P ＜ 0.05),while there was no statistical difference in IQFInv(P ＞ 0.05).In addition,when tube current was 100 mAs,IQFInv had statistically significant difference for two phantoms in W-Rh(t =2.345,P ＜ 0.05).Conclusions W-Rh target-filter combination can achieve lower radiation dose under the guarantee of the image quality compared with Mo-Rh target-filter combination.At the same tube current,W-Rh target-filter combination can provide a better image quality under a relatively high tube voltage.

Objective To evaluate the clinical value of enhanced 3D-SPACE-STIR sequence MR in brachial plexus injury post-ganglionic nerve.Methods Eighteen patients with suspected brachial plexus injury were examined by routine MRI,3D-SPACE-STIR sequence and enhanced scan.The position,morphology,signal intensity of the brachial plexus injury and its relation with the proximal and distal portions of the brachial plexus were evaluated by senior radiologists.The image quality of plain and enhanced 3D-SPACE-STIR was evaluated respectively.Results The CNR of plain scan and enhanced 3D-SPACE-STIR sequence images were 32.31+2.98 and 43.66+2.78 respectively and the difference was statistically significant.Plain and enhanced 3D-SPACE-STIR sequences of supraclavicular nerves display rate were 95.0% and 96.1% respectively without having statistically significant difference.However,the subclavicular segment of the brachial plexus showed the displaying rates of 66.7% and 94.4% and the difference was statistically significant.Moreover, the background suppression effect of enhanced scan was better than that of the plain scan.Conclusion Enhanced 3D-SPACE-STIR sequence can clearly show brachial plexus injury,and its image quality is better than that of the plain scan,which can provide important imaging basis for accurate diagnosis of brachial plexus injury.

Objective To investigate the radiation dose delivered to the patients with dense breasts and the influence of photographic conditions on image quality in full field digital mammography (FFDM).Methods (1) Clinical test:we analyzed the compression thickness of breasts,Target-filter(T-F),voltage current (kV),tube current (mAs),average glandular dose (AGD) and entrance surface dose (ESE) of 100 patients (a total of 370 images,277 images of Molybdenum-Rhodium(Mo-Rh)and 93 images of Wolfram-Rhodium (W-Rh)) who underwent examinations in mode of automatic exposure by FFDM with dense breasts.(2) Phantom experiments:placed the Aluminium plate on different thickness of polymethyl methacrylate (PMMA) plates to simulate the dense breasts.68 mm phantom was used to simulate photographic condition of W-Rh and 58 mm to Mo-Rh.The two groups of dense phantom were exposed automatically and manually.The parameters were recorded for each exposure including the compression thickness of breasts,T-F,kV,mAs,AGD,ESE,the calculation of the ratio between ESE and AGD (ESE/AGD).The image quality figure inverse (IQFInv) was obtained by software.To the clinical test,used multiple factors of variance to analyze the influence of compression thickness and mAs on AGD and ESE,Pearson correlation and regression to analyze the influence of compression thickness on ESE/AGD.To the phantom experiments,used Pearson correlation to analyze the influence of kV and mAs on AGD,ESE and ESE/AGD,single factor of variance to analyze the influence of kV and mAs on IQFInv.Results (1) Clinical test:to Mo-Rh and W-Rh,with the increase of compression thickness,ESE/AGD was increased significantly.Compression thickness had linear relationship with ESE/AGD.Pearson correlation coefficients of W-Rh and Mo-Rh were 0.956 and 0.980,respectively(P＜0.01).The effects of compression thickness and mAs on AGD and ESE were statistically significant (P＜0.05) in the two groups.(2)Phantom experiments:adjusted exposure parameters to the two dense phantoms of W-Rh and Mo-Rh.With the increase of mAs and kV,IQFInv was increased in W-Rh and Mo-Rh.Different mAs and kV were statistically significant (P＜0.05) on IQFInv,mAs and kV had positive correlation with ESE and AGD (P＜0.05),mAs and kV had different correlation with ESE/AGD in the two dense phantoms.Conclusions In mode of automatic exposure by FFDM,choosing W-Rh can achieve relatively high image quality and lower radiation dose.According to the results of phantom experiments,adjusting kV and mAs properly in manual exposure can reduce AGD and ESE effectively and ensure the quality of the image.