Objective:To analyze the costs and effectiveness of five common screening modes and genetic screening for thalassemia in China in order to find the optimal way and provide evidence for the implementation of thalassemia prevention and control projects in Hunan Province.Methods:From June 2020 to April 2021, 12 971 couples from 14 cities and autonomous prefectures in Hunan Province were selected as the study population. The diagnosis of thalassemia was based on the results of genetic testing. Results of routine blood test and hemoglobin electrophoresis were collected and analyzed. The efficacy of five screening modes, at the cut-off value of <80 fl or 82 fl for the mean corpuscular volume (MCV), was analyzed by positive predictive value, negative predictive value, Jorden index and cost-effectiveness ratio. Sensitivity analysis was used to assess the feasibility of genetic screening at different costs after fixing the costs of routine blood and hemoglobin electrophoresis. The five thalassemia screening models are as follows: Mode 1: The woman had a blood routine test first. If the result was positive, the spouse required a blood routine test. If both results were positive, a thalassemia gene test should be offered to the couple. Mode 2: Both husband and wife were screened by blood routine and hemoglobin electrophoresis. If one or both of them were positive, both would be tested for thalassemia gene. Mode 3: The couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing. Mode 4: The woman was screened by blood routine and hemoglobin electrophoresis. If any one of them was positive, the woman would be tested for thalassemia gene. If the gene test result was positive, the spouse should receive thalassemia gene. Mode 5: Both spouses conducted a blood routine test. If either was positive, both would conduct hemoglobin electrophoresis test. If both were positive, both spouses should receive thalassemia gene testing. Gene testing mode: The woman would be tested for thalassemia, and her spouse would have thalassemia test too if her result was positive.Results:When using MCV<80 fl as the cut-off for diagnosing thalassemia, the Youden indices of the five prenatal screening modes in Hunan Province were 0.551, 0.639, 0.898, 0.555 and 0.356, while when using MCV<82 fl as the cut-off, the Youden indices were 0.549, 0.629, 0.851, 0.548 and 0.356. When the MCV cut-off value was <80 fl, the missed diagnosis rates of the five screening modes were 44.44%, 0.00, 0.00, 18.52% and 62.96%, and the cost-effectiveness ratios were 21 709, 250 939, 76 870, 138 463 and 92 860 yuan (RMB)/couple, respectively. When the price of genetic testing was lower than 55 yuan (RMB), the cost-effectiveness ratio of genetic screening was lower than that of Mode 3.Conclusions:MCV<80 fl can be considered as the positive criteria in blood routine screening for thalassemia in Hunan Province, and the cost-effectiveness ratio of Mode 3 (the couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing) is the best. Genetic screening has certain advantages with the decreasing price.

Fifteen patients with Crohn′s disease (CD) in remission diagnosed at Shanghai Jing′an District Central Hospital from February 2018 to June 2019, and 26 matched healthy subjects were recruited. All participants underwent resting-state functional magnetic resonance imaging (fMRI) scans of hippocampus. The amplitude of low-frequency fluctuations (ALFF) was calculated to determine differences in the brain. Left hippocampus was selected as seeds for functional connectivity (FC) analysis, and the results were compared between two groups. The relationship between disease duration and ALFF/FC values in abnormal regions were analyzed with Pearson correlation. Compared with the controls, the ALFF of the left hippocampus (voxel size 32) of CD patients decreased [family-wise error correstion(FWE correction), cluster level P<0.05], and the ALFF of the left medial superior frontal gyrus (voxel size 126), left supplementary motor area (voxel size 126) and left anterior cingulate gyrus increased (voxel size 37) (FWE corrected, cluster level P<0.05). Using the left hippocampus as the seed point for the whole brain functional connectivity analysis, CD patients showed increased FC strength with the left superior temporal gyrus, left medial superior frontal gyrus, left inferior frontal gyrus (opercular part), and right supplementary motor area(FEW corrected, cluster level P<0.05). Correlation analysis did not show a significantly differences between ALFF/FC value of altered brain areas and the disease duration. It suggests that there are changes in spontaneous activities and functional connectivity in the left hippocampus in patients with CD.

Objective    To analyze the risk factors of the death associated with infective endocarditis, and to evaluate the timing of surgical treatment of infective endocarditis. Methods    We retrospectively analyzed the clinical data of 62 patients with infective endocarditis in our hospital between August 2015 and August 2017. There were 43 males and 19 females at age of 19–75 (46.1±16.6) years. The clinical data were divided into a death group and a survival group, a paravalvular leakage group and a no periannular leakage group, an emergency operation group and a non-emergency operation group.The risk factors of infective endocarditis and the choice of operation time were analyzed. Results    Three of the 62 patients (4.8%) died after surgery. Postoperative perivalvular leakage (regurgitation over 2 mm) in 8 patients, accounting for 12.9% of the total. Univariate analysis showed that albumin content, creatinine level, total cardiopulmonary bypass time and ascending aorta occlusion time were significantly associated with early postoperative mortality (P<0.05). The results of logistic analysis showed that age, preoperative albumin level, creatinine level, total cardiopulmonary bypass time, and ascending aorta occlusion time were significantly associated with early postoperative perivascular leakage (P<0.05), and long ascending aorta occlusion time is an independent risk factor for early death (P<0.05). There was no statistical difference in early death and the perivalve leakage between the emergency operation and the non emergency operation. Conclusion    Patients with infective endocarditis should accept early surgical treatment. The choice of surgical approach should be selected according to the actual situation of patients. And we should pay more attention to albumin and creatinine levels in preoperative patients. In the operation, to shorten extracorporeal circulation  time and aortic clamping time can improve the prognosis of patients.

Objective? To explore the application effect of comprehensive nursing based on psychological intervention in enhanced CT examination of patients with liver cancer. Methods? By convenience sampling, a total of 100 patients with primary liver cancer who underwent enhanced CT examination in Imaging Department of Baoji Central Hospital from July 2016 to April 2018 were selected and randomly divided into control group and observation group, 50 cases in each group. The control group was given routine nursing care, while the observation group was given comprehensive nursing based on psychological intervention on the basis of routine nursing care. Self-rating Anxiety Scale(SAS) was used to evaluate the degree of nervousness and anxiety in the two groups, and the nursing satisfaction of the two groups was recorded. Results? After intervention, the SAS score of the observation group was (33.92±6.67), lower than that of the control group (47.04±8.32), the difference was statistically significant (P＜0.05); the nursing satisfaction of the intervention group was 88%, higher than 68% of the control group, the difference was statistically significant (P＜ 0.05). Conclusions? Comprehensive nursing based on psychological intervention can effectively improve the patients' nervousness and anxiety undergoing enhanced CT scan,and improve the nursing satisfaction.

Objective To investigate muscle MRI characteristics of lower limbs in Chinese patients with dysferlinopathy. Methods Detailed clinical information of 42 patients with dysferlinopathy confirmed by Western blot or DYSF genetic test were studied retrospectively, including age, course, serum creatinine kinase (CK) and modified Gardner?Medwin and Walto score, and T1WI, STIR image. Each muscle was scored according to its fatty degeneration evaluated on T1WI (fat replacement score). The patients were divided into 3 groups:Miyoshi myopathy (MM), limb girdle muscle dystrophy 2B (LGMD 2B) and preclinical stage (asymptomatic hyperCKemia or exercise intolerance). The data including the scores of each muscle between MM and LGMD 2B were compared by ANOVA analysis and Chi square test. The relationship of fatty replacement score with course and GM?W score was analyzed by Spearman rank correlation analysis. Results Thirty nine patients underwent thigh MR scanning and 36 patients underwent leg MR scanning. At the thigh level, there is no specificity that the fatty replacement was found in both the anterior and posterior parts while the rectus femoris, sartorius and gracilis were rarely involved. At the leg level, the most severely involved muscle was the soleus, followed by gastrocnemius. It formed a sandwich?like pattern that the anterior part (anterior and posterior tibial muscle and peroneus longus muscle) and the posterior part (medial and lateral gastrocnemius) were less involved than the middle part (soleus). Of 42 patients, 14 cases were MM, and 24 were LGMD 2B. The fat replacement score of each muscle between two groups showed no significant differences (F=0.066 to 3.907,P all>0.05) except for the adductor muscle (F=5.239, P=0.028), semimembranosus (F=6.703, P=0.014) and semitendinosus (F=7.689, P=0.009). Of 4 pre?symptomatic cases, 3 showed edema of posterior part of leg on STIR, especially soleus. In all patients, the fat replacement score correlated positively with course (rs=0.732, P=0.000) and GM-W score (rs=0.485, P=0.001). Conclusions The MRI of Chinese patient with dysferlinopathy was characterized by the milder involvement of rectus femoris, sartorius and gracilis muscle in the thigh and a sandwich?like pattern in the leg, which is helpful for differential diagnosis of inflammatory Myopathy versus other types of muscular dystrophy.

Objective To confirm the correlation between pre or post processing semen parameters and clinical pregnancy rate in infertile couples with male factors undergoing intrauterine insemination (IUI) .Methods The pregnancy rate based on ovulation in‐ducing agent in infertile couples with male factors infertility per the 2010 world health organization criteria treated with IUI was e‐valuated .One hundred and twenty eight cycles were divided into pregnant group (16 cycles) and non‐pregnant group(112 cycles) . The pre or post processing semen parameters were retrospectively evaluated .Results The overall pregnancy rate was 12 .5% .All parameters in this study has no statistically significant difference between the two groups (P>0 .05) .Logistic multivariate analysis showed that there was no significant correlation between semen parameters and clinical pregnancy rate (P> 0 .05) .Conclusion There are no significant correlations between semen parameters and clinical pregnancy rate when the normal forms of patients with male infertility was 4% or higher .No semen parameters could predict results of clinical pregnancy .

Objective To assess the effect of iDose4 in image quality and radiation dosage in CT angiography of craniocervical arteries.Methods Imaging data of 50 patients with 256-slice spiral CT angiography of craniocervical arteries were randomly divided into two groups:(A) 120 kV,250 mAs (25 patients),(B) iDose4 100 kV,180 mAs (25 patients).Dose length product (DLP) of the two groups were compared.Objective image noise was compared by two blinded readers,t test and nonparametric tests were used for statistical analysis.Results The overall image quality score of group A (3 points =1 patient,4 points =6 patients and 5 points =18 patients) and group B (4 points =5 patients and 5 points =20 patients) were shown.The image noise of group A (1 point =1 patient,2 points =5 patients and3 points =19 patients) and group B (2 points =4 patients,3 points =21 patients) were also evaluated.There was no statistical difference in revealing rate of image quality scores and objective noise between the two groups (Z =-0.334,-0.218,P ＞ 0.05).The estimated effective radiation dose was reduced by 56％ in group B than in group A.DLP was significantly lower in group B [(642.4 ±36.6) mGy · cm]than in group A [(1462.1 ± 64.3) mGy · cm].Conclusion Low dose contrast medium of CT angiography can display craniocervical arteries and the intracranial arteries very well with high image quality.

Objective To study the multi-detector spiral CT (MDCT) features of pancreatic tuberculosis to improve the awareness and correct diagnosis. Methods Imaging features of MDCT were retrospectively reviewed on 9 cases with pancreatic tuberculosis that were diagnosed from 2003 to 2009, among them two patients underwent MDCT angiography, the features were compared with those of operative and pathological findings. Results One case of pancreatic cancer, 2 cases of cystadenocarcinoma and 1 case of pseudocyst, 2 cases of pancreatic cancer with retroperitoneal lymph node metastasis, 2 cases of lymphoma were diagnosed by MDCT, and all the lesions were diagnosed as pancreatic tuberculosis pathologically, and the misdiagnosis rate was 100%. Pancreatic tuberculosis often presented as pancreatic head mass, sometimes pancreatic body and tail were involved. MDCT showed isopycnic or low density solid-cyst mass, occasionally calcification was present, with slightly or moderate ring-like enhancement after contrast injection. There was no enlargement of the pancreatic duct. The retroperitoneal and adjacent lymph nodes were always enlarged with ring-like enhancement. Sometimes there was evidence of tuberculosis of other abdominal organs. Conclusions Ring-like enhanced lesions with ring-like enhanced lymph nodes without enlargement of pancreatic duct are characteristic MDCT features of pancreatic tuberculosis.

Objective To improve the recognition of pituitary hyperplasia secondary to primary hypothyroidism by analyzing clinical and imaging data. Methods The clinical features, hormone data,imaging findings, and treatment were reviewed in 32 patients with pituitary hyperplasia secondary to primary hypothyroidism in Huashan Hospital from 1999 to 2008. Results Thirty-two patients, most juvenile,presented clinical and imaging features suggestive of functional primary pituitary adenoma. The dose of levothyroxine was increased to maintain the thyrotropin concentration at normal values. Following adequate thyroxine replacement, pituitary hyperplasia regressed on average within 6 months. Conclusions Pituitary hyperplasia secondary to primary hypothyroidism seems to be quite prevalent in children and adolescents.Complete regression will be achieved with thyroxine replacement therapy.

Background and purpose: Primary intracranial epithelioid haemangioendothelioma (EH) was rare. This study was to discuss the clinical pathological features, radiographic findings, treatment and prognosis of primary intracranial EH combined with literature review. Methods: We reviewed a case of EH reported from our hospital, and comprehensively analyzed the related literature. Results: Based on our report and review of the literature, EH is rare and with borderline or uncertain behavior. The original tumors demonstrated specific image features. The tumor usually appeared as a small nest or cords composed of eosinophilic epithlioid or spindled cells.Immunohistochemical assay were positive for endothelial markers CD31, CD34 and FⅧ. EH may be treated with complete surgical resection whenever possible and is sensitive to radiation. The EH has a favorable prognosis. Conclusion: EH has variable malignant potential, and should be differentiated from meningioma. Total resection and close follow-up is recommended. Additional radiotherapy is advised for residual tumors.