Objective:To explore the characteristics, prevention and treatment strategies of lower urinary tract injury in transvaginal reconstructive pelvic surgery (vRPS).Methods:A retrospective analysis was conducted on 24 patients who suffered lower urinary tract injuries occuring in vRPS from January 2005 to June 2021, among which 4 cases were referred to our hospital from other hospitals.Results:(1) In our hospital, 1 952 patients underwent vRPS for anterior and (or) middle pelvic organ prolapse during that study period, with a 1.0% (20/1 952) incidence of lower urinary tract injuries occurring in 20 cases. (2) Ureteral injuries were observed in 14 cases who underwent transvaginal high uterosacral ligament suspension (1.4%, 14/966). The symptoms were relieved after the removal of sutures. (3) Bladder injuries occurred in 6 cases in our hospital, with 4 cases (0.7%, 4/576) in anterior transvaginal mesh surgery (aTVM), one (0.4%, 1/260) in colpocleisis, and one (0.7%, 1/150) in apical suspension for fornix prolapse. An additional 4 cases of bladder injury were referred to our hospital after aTVM. Among the 8 cases of bladder injury during aTVM, 2 cases were intraoperative incidents. Cystoscopy confirmed that the superficial branch or puncture rod of anterior vaginal mesh had penetrated into the bladder. Re-puncturing and placement of the mesh were successfully performed. No abnormalities were observed during a follow-up period of 4-5 years. Postoperative bladder injuries were identified in 6 cases, characterized by mesh erosion into the bladder and formation of calculi. These injuries were confirmed between 6 months to 2 years after vRPS. The exposed mesh and calculi in the bladder were removed through laparotomy or cystoscopy, followed up for 2-12 years. One case experienced slight re-erosion of mesh to the bladder.Conclusions:Lower urinary tract injuries are difficult to avoid in vRPS, particularly in transvaginal high uterosacral ligament suspension and aTVM. However, the incidence is low. Lower urinary tract injuries during vRPS could be easily detected and managed intraoperatively because of the use of cystoscopy. As long-term postoperative complications, erosion of transvaginal mesh to lower urinary tract postoperatively could be treated correctly, seldom with severe sequelae.

Objective:To investigate the clinical value of prospective ECG-gated high-pitch protocol scanning of third generation DSCT in the diagnosis of pediatric congenital heart disease (CHD).Methods:A total of 243 children with confirmed CHD who were expected to undergo surgical treatment were prospectively collected and randomly divided evenly into 3 groups, with first group for prospective ECG-gated high-pitch scanning in third generation DSCT (Flash 3rd), second group for prospective ECG-gated high-pitch scanning in second generation DSCT (Flash 2nd) and third group for prospective sequential scanning in third generation DSCT (Sequence 3rd). The SD value and SNR of aortic root and pulmonary artery of each child were recorded. The 5-point system is adopted with subjective scoring. Based on the result of operation, the diagnosis accuracy in 3 groups was analyzed. Results:The E values in Flash 3rd, Flash 2nd and Sequence 3rd group were 0.24 (0.19, 0.27), 0.11 (0.10, 0.14) and 0.44 (0.39, 0.48) mSv ( H=207.04, P<0.05), respectively. Subjective scores of group Flash 3rd and Sequence 3rd were significantly higher than that of group Flash 2nd [4 (4, 4) vs. 4(3, 4) vs. 3(3, 3), H=124.05, P<0.05] and no difference between these two groups. SD value of aortic root and pulmonary artery of group Flash 3rd and Sequence 3rd were significantly lower than that of group Flash 2nd( H= -40.27-33.38, P<0.05). SNR of aortic root and pulmonary artery of group Flash 3rd was significantly higher than that of group Flash 2nd and Sequence 3rd ( H=-0.90-51.42, P<0.05). Diagnosis accuracy of intracardiac malformation for group Flash 2nd was significantly lower than that of Flash 3rd and Sequence 3rd (77.7%, 90.9%, 88.9%, K=9.36, P<0.05), and there was no significant difference between the latter two groups. There was no difference in diagnosis accuracy of extracardiac malformation among 3 groups (88.6%, 94.8%, 92.2%, K=3.11, P=0.21). Conclusions:The prospective ECG-gated high-pitch scanning in third generation DSCT can take into account radiation dose and image quality, which has important clinical value in the diagnosis of CHD.

Objective:To explore the value of coronary CT angiography (CCTA) in the diagnosis of vulnerable plaques using intravascular ultrasound (IVUS) as the gold standard.Methods:A retrospective analysis was conducted on the clinical and imaging data of coronary artery disease patients who underwent both IVUS and CCTA examinations at Fuwai Central China Cardiovascular Hospital from December 2017 to March 2022. Based on the IVUS results, the coronary plaques were divided into vulnerable and non-vulnerable plaque groups. Finally, 43 patients with a total of 88 coronary artery plaques were included, of which 26 were vulnerable plaques. Plaque analysis were performed on the CCTA images, including qualitative parameters such as low-density plaques (LAP), "napkin-ring" sign (NRS), spotty calcification (SC) and positive remodeling (PR), and the quantitative parameters such as minimum lumen area (MLA), total plaque volume (TPV), lesion length, volume and proportion of calcified plaque and fibrous plaque. The differences of CCTA parameters between the two groups were compared using t-test, chi-square test, and rank sum test. The association between CCTA parameters and the risk of vulnerable plaque was evaluated by logistic regression. Different CCTA parameters were used to establish qualitative, quantitative, and hybrid models, and the diagnostic efficacy of different models for vulnerable plaque was evaluated using the receiver operating characteristic (ROC) curve. Results:There were significant differences in NRS ( χ2=14.22, P<0.001), MLA ( Z=3.25, P=0.001), lesion length ( Z=-3.28, P=0.001), TPV ( Z=-2.04, P=0.041), calcified plaque volume ( Z=-2.52, P=0.012) and fibrous plaque volume ( Z=-2.10, P=0.035) between vulnerable and non-vulnerable plaque groups. The logistic regression analysis showed that NRS ( OR=9.66, 95% CI 2.36-39.54), MLA ( OR=0.76, 95% CI 0.59-0.99) and lesion length ( OR=1.03, 95% CI 1.00-1.07) were independent risk factors for vulnerable plaques. The diagnostic efficacy of the hybrid model based on CCTA parameters was superior to the qualitative model [hybrid model: area under the ROC curve (AUC)=0.82, 95% CI 0.72-0.89; qualitative model: AUC=0.68, 95% CI 0.57-0.78; Z=2.57, P=0.010]. Conclusions:CCTA parameters NRS, MLA, and lesion length are independent risk factors for coronary vulnerable plaques. The diagnostic efficacy of the hybrid model based on CCTA parameters is superior to the qualitative model for vulnerable plaques.

Objective:To investigate the optimal delay time in the quantitative assessment of myocardial fibrosis based on dual-energy CT extracellular volume fraction (DECT-ECV), using MRI as a reference.Methods:Thirty patients with confirmed or suspected of cardiomyopathy were prospectively enrolled in this study. All the patients underwent both cardiac DECT and MRI examination within one week. According to the imaging features of late gadolinium enhancement (LGE) on MRI, myocardial segments were classified into 3 types: ischemic LGE segments, non-ischemic LGE segments and negative LGE segments. According to the DECT delay time, the whole and segmental myocardium were divided into 3 groups: delay of 3 min (Group A), delay of 5 min (Group B) and delay of 7 min (Group C). Correlation and agreement between CT-ECV and MRI-ECV were performed on a basis of overall myocardium and segmental myocardium. Pearson or Spearman test was used for correlation analysis and Bland-Altman test was used for consistency analysis.Results:Thirty patients with 480 segments were finally included in our study. In the analysis based on overall myocardium, MRI-ECV was 33.12%±4.29%, and CT-ECV were 35.81%±4.48%, 36.02%±4.56%, and 36.58%±4.69% in Group A, B, and C, respectively. The agreement between DECT-ECV and MRI-ECV results was good, with the correlation coefficients of 0.878 (group A), 0.955 (Group B) and 0.947 (Group C) (all P<0.001). In the analysis based on segmental myocardium, as for the ischemic LGE myocardial segments, MRI-ECV was 34.60%(31.70%,39.40%), and CT-ECV were 37.50 (34.20, 41.90), 38.20%(36.20%, 40.60%)and 39.40%(35.50%,42.40%)in Group A, B, and C, respectively. The agreement between DECT-ECV and MRI-ECV results was good, with the correlation coefficients of 0.559, 0.695 and 0.682 (all P<0.001) for groups A, B and C, and as for non-ischemic LGE myocardial segments, MRI-ECV was 35.10% (32.68%, 38.70%), and CT-ECV were 38.15% (35.13%, 41.75%), 39.25% (35.78%, 42.20%) and 39.60% (35.88%,42.90%) in Group A, B, and C. The correlation coefficients of CMR-ECV and DECT-ECV of groups A, B and C were 0.531, 0.772 and 0.744 (all P<0.001), showing good agreement; as for negative LGE myocardial segments, MRI-ECV and CT-ECV of Group A, Group B, Group C were 28.50%(27.00%, 30.10%), 31.10%(28.70%, 34.60%), 31.30%(28.40%, 33.80%), 31.30%(29.20%, 34.80%). The correlation coefficients between MRI-ECV and DECT-ECV of group A, B and C were 0.273, 0.508 and 0.425 (all P<0.001), which also showed good agreement. Conclusions:DECT-ECV can be used for quantitative evaluation of myocardial histological features. DECT-ECV with a 5 min and 7 min delay shows good correlation and agreement with MRI-ECV. In order to make this technology more well-known and improve its application capability, our recommendation for clinical practice is a 5 min delay after contrast administration in clinical practice.

Objective:To evaluate the value of enhanced magnetic resonance imaging (MRI) on the assessment of synovial hyperplasia and International Prophylaxis Study Group (IPSG) score of hemophilic arthropathy (HA).Methods:This was a retrospective case series study. Briefly, 54 joints of 46 male patients with hemophilia type A and diagnosed with HA in Henan Provincial People′s Hospital from August 2016 to September 2017 were selected. Plain and enhanced MRI were performed at the same time. The IPSG score of synovial hyperplasia and the total joint before and after enhancement were calculated, and the enhancement rate of the synovium and muscles at the same level were also calculated. The differences in synovial hyperplasia and joint total IPSG scores before and after enhancement were compared by paired rank sum test. The correlation between enhancement joint total IPSG score, synovial IPSG score, synovial enhancement rate, total joint bleeding number, course of disease, and Hemophilia Joint Health Score (HJHS) score were analyzed by Spearman′s correlation analysis.Results:Enhanced MRI could more clearly show synovial hyperplasia and ensure better accuracy of joint total IPSG score ( Z=-2.24, P=0.025). The enhancement extent of synovial hyperplasia was higher than that of the same level muscle. There was no correlation between synovial enhancement rate and total number of joint bleeding, course of disease, and HJHS score. After enhancement, the joint total IPSG score was highly positively correlated with the total number of joint bleeding and the disease course ( r=0.96, 0.84, P<0.001) and moderately positively correlated with the HJHS score ( r=0.58, P<0.001). The enhanced synovial IPSG score showed a low positive correlation with the total number of joint bleeding and the disease course ( r=0.37, 0.36, P=0.006, 0.008), but no correlation with HJHS score. Conclusion:Enhanced MRI can provide accurate imaging of synovial hyperplasia of HA and make joint IPSG score more accurate.

Myocarditis has diverse clinical manifestations,which might develop into acute heart failure,cardiogenic shock and chronic dilated cardiomyopathy.Early diagnosis of myocarditis is crucial for improving prognosis.Cardiac MRI(CMRI)can display myocardial necrosis,fibrosis and edema,having become the best imaging method for evaluating myocarditis.The progresses in multi-parameter CMRI researches of acute myocarditis were reviewed in this article.

Objective To observe the value of cardiac MR(CMR)compressed sensing(CS)sequence and conventional movie(CM)sequence for evaluating biventricular function in patients with congenital heart disease(CHD).Methods A total of 71 patients with CHD,including 31 cases with regular heart rhythm(regular heart rhythm group)and 40 cases with arrhythmia(arrhythmia group)were prospectively collected and scanned with CM and CS sequences.The scanning time of 2 sequences were recorded,and subjective scores of imaging quality of 2 kinds of images were compared.The differences,consistency and correlation between quantitative parameters of biventricular function measured on 2 kinds of images were analyzed.Results The acquisition time of CS was(18.87±1.75)s,of CM was(147.56±5.23)s,which was shortened by 87.21％than CS.The quality of both 2 kinds of images met the diagnostic requirements.The subjective scores of CS images were lower than that of CM in regular heart rhythm group(4[3,5]vs.4[4,5],Z=-2.070,P=0.038),while of CS images were higher than that of CM images in arrhythmia group(4[4,4]vs.3[4,4],Z=-2.673,P=0.008).No significant difference of the left ventricular function parameters was detected obtained based on 2 kinds of images in all 71 cases,nor in regular heart rhythm group as well as in arrhythmia group(all P＞0.05).Meanwhile,the right ventricular(RV)end-diastolic volume index(EDVI)obtained based on CM and CS images were not significantly different(all P＞0.05),but significant differences of ejection fraction(EF),end-systolic volume index(ESVI)and stroke volume index(SVI)were found in all 71 cases,in regular heart rhythm group and in arrhythmia group(all P＜0.05).CMR parameters of biventricular function measured on CM and CS images were all consistent and positively correlated(all P＜0.05).Conclusion CS sequence could be used to accurately assess biventricular function of CHD patients,significantly improve imaging quality and shorten scanning time.

Background: Inactivated vaccines are limited in preventing foot-and-mouth disease (FMD) due to safety problems. Recombinant virus-like particles (VLPs) are an excellent candidate for a novel vaccine for preventing FMD, given that VLPs have similar immunogenicity as natural viruses and are replication- and infection-incompetent. Objectives: The 3C protease and P1 polyprotein of type O FMD virus (FDMV) was expressed in yeast Hansenula polymorpha to generate self-resembling VLPs, and the potential of recombinant VLPs as an FMD vaccine was evaluated. Methods: BALB/c mice were immunized with recombinant purified VLPs using CpG oligodeoxynucleotide and aluminum hydroxide gel as an adjuvant. Cytokines and lymphocytes from serum and spleen were analyzed by enzyme-linked immunosorbent assay, enzyme-linked immunospot assay, and flow cytometry. Results: The VLPs of FMD were purified successfully from yeast protein with a diameter of approximately 25 nm. The immunization of mice showed that animals produced high levels of FMDV antibodies and a higher level of antibodies for a longer time. In addition, higher levels of interferon-γ and CD4 + T cells were observed in mice immunized with VLPs. Conclusions The expression of VLPs of FMD in H. polymorpha provides a novel strategy for the generation of the FMDV vaccine.

Objective To explore the imaging features of brucellar spondylitis (BS).Methods The imaging data of 49 cases who were diagnosed as brucellar spondylitis by a positive standard tube agglutination titer test (&ge;1:100) and (or) the isolation of brucella species from blood or other tissue at our institution between September 2012 and October 2016 were retrospectively reviewed.X-ray,CT scan and MRI examination was performed in 49,28 and 42 cases,respectively,of which 19 cases underwent both CT scan and MRI examination.The imaging manifestations of the spine were analyzed.The x2 test or Fisher's exact test were applied to compare the imaging manifestations of the patients who underwent both CT scan and MRI examination.Results Of the 49 patients,34 patients (69.4％) had involvement of the lumbar vertebra.Forty-five patients (91.8％) had contiguous involvement at adjacent 2 vertebral bodies.There were 10 cases (20.4％) with bony spur or bone bridge,3 cases (6.1％) with spondylolisthesis and 3 cases (6.1％)with slightly kyphosis deformity.There were 8 cases (28.6％) showing bone destruction of more than half of the vertebral body and 6 cases (21.4％) with sequestra on CT.There were 14 cases (33.3％) with psoas abscesses,of which 2 (4.8％) had migrating abscess.Epidural abscesses with dural sac compression were found in 17 cases (40.5％) and 3 cases (7.1％) showed nerve roots compression.There were statistically significant differences in the detection of vertebral bone destruction,bone marrow edema,hyperosteogeny,intervertebral disc changes,abscess formation and sequestrum between CT and MRI (P＜0.05).Conclusion BS has characteristic imaging features.The presence of bone destruction,sequestrum,and migrating abscess should warrant the possibility of BS.

Objective To observe c-Fos expression in visual cortex of infant rhesus monkeys with myopia induced by hyperopic defocus and preliminarily investigate the possibility of visual cortex participating in myopia. Methods Eight SPF grade healthy infant rhesus monkeys aged 20 to 30 days were randomly divided into hyperopic defocused group and control group,4 monkeys for each group. The monkeys in hyperopic defocused group wore -3 D spectacle lenses. The monkeys in control group wore 0 D lenses. The monkeys' refractive error,corneal topography, vitreous chamber depth were measured at the start of lens wear and at 2,4,6,8,12 weeks post-treatment. At 12 weeks post-treatment,the visual cortex tissues were removed for c-Fos protein measurement by immunohistochemistry and Western blot assays. The results were analyzed semiquantitatively to compare the differences of c-Fos expression between hyperopic defocused group and control group. The use and care of the animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission. This study protocol was approved by Ethic Committee of Zhongshan Ophthalmic Center ( No. 2013-014). Results After 12 weeks'lens wear,the vitreous chamber elongation amplitude of hyperopic defocused group monkeys was more obvious than that of the control group ([0.93±0.24]mm vs. [0.72±0.09]mm;t=2.292,P=0.047). The decrease of hyperopic degrees of hyperopic defocused group monkeys was more obvious than that of the control group ([-3.23± 1.36]D vs. [-1.55±0.52]D;t=-3.273,P=0.006). The eyes of hyperopic defocused group monkeys appeared a remarkable myopic shift after treatment. The number of c-Fos immunoreactive neurons was less in the hyperopic defocused group than that in the control group,with a statistically significant difference between them ([1 843±191]/mm2vs. [2 296±503]/mm2;t=2.381,P=0.041). Western blot assay showed that the optical density of c-Fos protein in the hyperopic defocused group was significantly less than that in the control group (0.50±0.17 vs. 0.99± 0.22;t=-4.982,P<0.01). Conclusions Hyperopic defocus,as an abnormal visual stimulus,can induce the onset of myopia in infant rhesus monkeys and inhibit c-Fos expression in visual cortex. Visual cortex may participate in myopia induced by hyperopic defocus.