Objective : To explore the risk factors of fever after hysterectomy in patients with uterine fibroids，and establish a nomogram prediction model to provide theoretical guidance for clinical diagnosis and treatment． Methods : The data of patients who underwent hysterectomy due to uterine fibroids were collected and randomly divided into training group and validation group at 6 ∶ 4．Univariate and multivariate analyses were performed by χ2 test and Lo- gistic regression model analysis．The nomogram was established based on the results of multivariate analysis，the calibration curve and receiver operating characteristic，curve were used to evaluate the prediction ability and accura- cy of the nomogram．The decision curve reflected the clinical application value of the model. Results : Among 264 patients in the training group，33 patients had fever，and the postoperative disease rate was 12. 5%．The results of univariate and multivariate analysis showed that anemia，preoperative curettage，operation scope and operation time were independent risk factors for fever after hysterectomy in patients with uterine fibroids．The internal and external calibration curves had a good fit with the actual observation results，with an average error of 0. 031 and 0. 025，re- spectively．The area under receiver operating characteristic curve of the internal and external verification of the no- mogramare 0. 788 and 0. 712，respectively，reflecting the good predictive ability of the model．The decision curve showed that the model had good clinical benefit in a certain threshold range． Conclusion Based on multivariate a- nalysis，the independent risk factors of fever after hysterectomy in patients with uterine fibroids，including anemia， preoperative curettage，operation scope and operation time．In addition，we established a nomogram with good pre- dictive ability and accuracy，which is helpful for clinicians to timely manage fever after hysterectomy in patients with uterine fibroids and guide clinical individualized treatment.

Objective To summarize the computed tomographic (CT) manifestations of pulmonary aspergillosis after organ transplantation and compare different signs between pulmonary aspergillosis and bacterial pneumonia.Methods CT images of pulmonary aspergillosis (n =62) and bacterial pneumonia (n =68) in post-transplantation patients were reviewed.The signs were categorized with consolidation,mass,large nodule (≥1crn),small nodule and bud-in-tree pattern.Some detailed useful differentiating signs such as halo sign,air bronchogram sign,reversed halo sign,hypodensity sign and cavitation were also analyzed.Results CT patterns of pulmonary aspergillosis included consolidation,mass,large nodule,small nodule and bud-in-tree pattern.The most common was large nodule (75.8％),followed by consolidation (48.4％)and mass (29.0％).And small nodule (16.1 ％) and bud-in-tree (12.9％) patterns were concurrent.For consolidation pattern,the proportion of bacterial pneumonia (69.1％) was the larger;For mass pattern,the proportion of pulmonary aspergillosis (29.0％) was the larger.For large nodule pattern,there was no difference.The detail sign of large nodule in two groups had no difference In detailed signs of consolidation pattern,air bronchogram sign was more often seen in bacterial pneumonia while cavitation was more frequently found in pulmonary aspergillosis.In detailed signs of mass pattern,pulmonary aspergillosis often has single lesion (66.7％),cavitation (83.3％)and air crescent sign (77.8％) is more common.The proportion of halo sign was 30.7％.Conclusions CT manifestations of pulmonary aspergillosis are diverse after organ transplantation.There is some difference and yet overlap with bacterial pneumonia.

Objective To detect the volume changes of cerebral gray and white matter in patients with maintaining hemodialysis using voxel-based morphometry(VBM) and to correlate these changes with cognitive function. Methods Forty-two patients with maintaining hemodialysis and 41 age and sex matched normal subjects were recruited in this study. MMSE was obtained to evaluate their neuropsychiatric conditions. Whole brain high-resolution T1WI was performed on 3.0 T MR scanner in both patients and normal controls. The data were analyzed by VBM based on SPM8, using analysis of functional neuroimages (AFNI) software package with the Monte Carlo simulation method(AlphaSim method) for multiple cluster level comparisons correction. Independent sample t test analysis was used to compare the volume of gray and white matter between the patients and normal controls. In addition, Stepwise multiple linear regression analysis was performed to explore the correlation between the voxel value of cerebral volume changes area and dialysis duration and clinical laboratory examination, and Spearman correlation analysis was used for the correlation between the left insula voxel values and neuropsychological test scores. Results Compared with normal controls, patients showed significantly decreased volume in the grey matter of the right putamen, the left putamen, the left insula (numbers of voxel in clusters were 455, 561, 162, t=-9.5681,-5.9516,-5.7185,P<0.001, AlphaSim-corrected). There was negative correlation between decreased grey matter volume of the right putamen[(0.53 ± 0.12)mm3]and the left putamen[(0.48 ± 0.12)mm3] and dialysis duration [19.0(1.5-114.0)months] (r=-0.330,-0.307,P<0.05). MMSE score of patients[29(21-30)score] was significantly lower than normal controls[30(28-30)score] (Z=-30.58,P<0.01). Decreased grey matter volume of the left insula [(0.39 ± 0.12) mm3] was positively correlated with MMSE(r=0.320, P<0.05). Conclusions The patients with maintaining hemodialysis show grey matter atrophy which is associated with neurocognitive dysfunction. Dialysis duration may be an important risk factor for decreased gray matter in patients with maintaining hemodialysis.

Objective To systemically evaluate the accuracy of CT and MR estimating whole liver volume with evidence based medicine methods.Method Published papers about whole liver volume estimation with CT or MR modality were searched in Cochrane library,MEDLINE,EMBASE,CMBdisc(China biology medicine disc) for English and Chinese abstracts.Inclusion criteria were formulated according to validity criteria for diagnostic research published by the Cochrane collaboration.Heterogeneity test of extracted data of Eligible papers was performed first to determine the appropriate statistical model used to pool the result.Finally,sensitivity and publish bias analysis was performed.Result Seventeen articles with 37 studies including 351 patients met the inclusion criteria.There was no heterogeneity between included studies (I2 =0％,Q =5.85,P =1).Fixed effect model was selected for the meta analysis and there was no statistically significant difference between true and radiological estimated whole liver volume (WMD =21.61 mL,95％ confidence interval:-6.33-49.57 mL,z =1.51,P =0.13).Sensitivity analysis revealed the result was robust which was not affected by excluding any of the included studies.Funnel plot and publish bias analysis showed no publish bias (t =-1.55,P=0.13).Conclusion CT and MR volume estimation is accurate for liver volume measurement,which provides important information for preoperative evaluation,postoperative monitoring and follow-up studies of other hepatic pathologies.aximum benefit to patients.

and indexes of the ROI which had significant difference between the groups. Results In the white matter regions, MD, D∥and D⊥in many regions of AD group were increased significantly than the control group, and the differences were statistically significant. MD and D ⊥ showed more abnormalities, including the SCC, PCB, and FWM. Meanwhile, MK, K∥and K⊥in many regions of AD were decreased, and the differences were statistically significant. K ⊥ showed more abnormalities, including the SCC, FWM and TWM. In the gray matter regions, MD, D∥and D⊥of hippocampal of the AD group were all increased than the control group. However, it showed that MK and K⊥of the thalamus in AD group were 0.99 ± 0.10, 1.00 ± 0.11, respectively, and both increased than the control group (the value of MK and K⊥were 0.90±0.06, 0.90±0.07, respectively), and the differences were statistically significant (t values was 3.31, 3.57 respectively, and both P values were<0.01). The indexes of different ROI had correlations with the MMSE scores. There were more regions in kurtosis indexes correlated with the MMSE scores than the diffusion indexes. The strongest correlation among the analyses was MK of the SCC (r=0.73, P<0.05). Conclusions This study based on DKI found the complex alterations aroused by microstructural changes were not only in the white matter but also the gray matter of the AD patients, especially the increased kurtosis of the thalamus, and this suggested that the microstructural complexity of it was increased. Moreover, it also suggested that indexes of DKI had varied sensitivity in detecting different diffusion alterations.

Objective To investigate the feasibility of magnetic resonance diffusion tensor imaging (DTI) as a noninvasive way for assessment of kidney transplant function in the early posttransplantation period.Method Fifty-one kidney transplant recipients less than 1 month after kidney transplantation and 26 age-matched healthy volunteers were included and examined using a fatsaturated echo-planar DTI sequence in oblique-coronal orientation at 3.0 Tesla magnetic resonance (MR) imager (diffusion directions=6,b =0,300 s/mm2).According to the estimated glomerular filtration rate (eGFR) recorded and calculated on the examined day,all subjects were divided into four groups:group 1,healthy volunteers (n =26) ; group 2,eGFR≥60 mL/min/1.73 m2 (n =24) ; group 3,30≤eGFR＜60 mL/min/1.73 m2 (n =19) ; group 4,eGFR＜30 mL/min/1.73 m2 (n =8).Mean apparent diffusion coefficient (ADC) and mean fractional anisotropy (FA) were determined separately for the cortex and the medulla.The paired Students t test was used to compare ADC and FA between cortex and medulla within each group.ADC and FA between groups were compared by using the one-way analysis of variance test.Relationship between ADC and FA with eGFR of the transplants was assessed by using Pearson correlation analysis.Result Mean cortical FA was significantly higher in group 1 than in other three groups (P＜0.01 for all),while differences among groups of allograft recipients were not significant (P＞0.05 for all).There was a gradually decreasing trend of medullary FA and ADC,and cortical ADC from group 2 to group 4,and the differences among groups were all pronounced (P＜0.05 for all).In renal allografts,there was a significant positive correlation between eGFR and medullary FA,medullary ADC as well as cortical ADC (r =0.812,0.756,0.757,respectively,P＜0.01).The cortical-medullary discrimination of FA-map and ADC-map in group 3 and group 4 apparently decreased.Meanwhile,DTI revealed that the radial diffusion tracts in the medulla of group 3 and group 4 obviously broke off and reduced,especially in group 4.Conclusion DTI is a promising way to evaluate kidney transplant function early after transplantion,and can quantitatively and visually distinguish transplants with different functions.

Hyaluronic acid (HA) as anticancer drug carrier has become the new hot point in the field of tumor-targeted drugs delivery system in recent years. Tumor therapeutic agents could be transmitted into cells because of hyaluronic acid innate ability to recognize specific cellular receptors that overexpressed on tumor cells surface. This review introduces the basic properties and physiology foundation of hyaluronic acid. Recent research developments based on different forms of HA tumor-targeted drugs delivery systems are reviewed in particular.

Objective To investigate the difference of amplitude of low-frequency fluctuation (ALFF) and fraction of amplitude of low-frequency fluctuation(fALFF) between Alzheimer's disease (AD)patients and normal aging (NA) controls by voxel-based analysis.Methods Thirty-one AD patients and 44 NA controls were enrolled in the study.Blood oxygen level dependent functional (BOLD) EPI data were obtained during resting-state by using 32-channel head coil.Data were realigned,normalized and then smoothed with 8 mm FWHM kernel.Resting-state fMRI toolkit(version 1.6) was used to generate ALFF and fALFF images.Independent two sample t-test was performed with SPM5 to compare ALFF and fALFF of AD and NA controls.Pearson correlation analysis was performed to examine the relationship between MMSE score and ALFF,fALFF parameters.The significance level was set to be uncorrected O.001 on the voxel level and 0.05 on the cluster level.Results AD patients showed increased ALFF in left temporal lobe (0.492 ±0.119) and right cingulated cortex (0.434 ± 0.093) of AD patients,which were 0.443 ± 0.068 and 0.380 ±0.081 in NA controls (t =2.658,2.227,P ＜ 0.05).Decreased fALFF was found in bilateral posterior cingulate cortices (1.167 ± 0.203) and increased fALFF was found in bilateral temporal lobes (left 1.226 ±0.127,right 1.146 ±0.214) with left side dominance,which were 1.453 ±0.269,1.134 ±0.088,1.014 ± O.132 in NA controls (t =5.001,3.695,3.285,P ＜ 0.05).Bilateral temporal ALFF and fALFF correlated with MMSE positively (r =0.768—0.909,P ＜ 0.05) with left dominance.Conclusion AD patients showed increased resting-state functional MRI changes correlated with MMSE score in the temporal lobes with left dominance,which indicated left temporal lobe may be the best location for the observation of disease progression in AD patients.

Objective To systematically evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in the investigation of bile duct anatomy of liver transplantation living donors.Methods A search in Cochrane library,MEDLINE,EMBASE,CBMdisc (China Biology Medicine disc) was performed to identify relevant English and Chinese-language abstracts,supplemented by Springer,OVID,Sciencedirect full text database,etc.Criteria for inclusion were based on validity criteria for diagnostic research published by the Cochrane collaboration.With Meta analysis package for Stata10.1,heterogeneity of the included articles was tested,which was used to select proper effect model to calculate pooled weighted sensitivity and specificity,positive likelihood ratio,negative likelihood ratio. Summary receiver operating characteristic (SROC) curve was performed and the area under the curve (AUC) was calculated. Finally,sensitivity analysis was performed.Results Seventeen articles with 34 studies were included.Heterogeneity analysis revealed heterogeneity between studies and the source was MRCP imaging methods spotted by meta-regression analysis. Subgroup analysis according to MRCP imaging methods showed homogeneity within subgroups.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odd ratio of breath-holding thick slice MRCP,3D MRCP,the combination of the prior two methods,contrast enhance MRCP were 0.89,0.78,4.1,0.14,29; 0.92,0.80,4.5,0.10,45;0.95,0.82,5.2,0.06,85; and 1.00,0.76,4.1,0,1228,respectively with fixed effect model analysis.The area under the SROC curve was 0.83,0.92,0.96 and 0.99 respectively.Conclusion The combination of thick slice and 3D MRCP is a practical and effective method with good sensitivity and specificity to investigate bile duct anatomy of living liver transplantation donors,which fully meets the requirements of the preoperative assessment of bile duct structure.

Objective To summarize the diagnostic efficacy of ADC value for differentiation of benign and malignant lymph nodes on diffusion MRI with Meta-analysis. Methods Published papers on differentiation of benign and malignant lymph nodes with ADC value were searched and reviewed.Quality evaluation was performed for the eligible papers before data extraction.Test for heterogeneity was performed first,then appropriate model was selected to calculate the weighted mean difference,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,pretest and posttest probability.The potential of ADC value for differentiation of benign and malignant lymph nodes was assessed qualitatively and quantitatively.Results Fifteen papers including 735 cases and 1963 lymph nodes were selected.According to Meta-regression analysis,subgroup analysis and robust analysis,two studies with benign lymph nodes in patients with benign lesion and one study using chemical shift saturation technique were excluded because of their impact on the robustness of the pooled results. The weighted mean difference (WMD) between malignant and benign lymph nodes was -0.355 × 10-3mm2/s[95％ confidence interval (CI):-0.423 ×10-3- -0.288 × 10-3 mm2/s].Although the cutoff of ADC value for differentiation in each study was different,the diagnostic efficacy was stable,the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio and area under summarized receiver operator's curve were 0.87 (95％ CI:0.79-0.92),0.87 (95％ CI:0.82-0.90),6.5 (95％ CI:4.7-9.2),0.15 (95％ CI:0.09-0.25 ),43 ( 95％ CI:21-87 ),0.93 ( 95 ％ CI:0.90-0.95 ).The posttest malignancy probability of benign lymph node indicated by ADC was 6％,while that of malignant lymph node was 72％.Conclusion The ADC value can be used to differentiate benign and malignant lymph nodes with good sensitivity and specificity noninvasively.