Since 2021,the term"metaverse"has attracted wide attention and become an international hot word,meanwhile,the application of metaverse in the medical field has also attracted great attention.Because of its unique advantages such as the immersive environment,the integration of virtual-real space and the characteristics of super-high simulation,the metaverse have a broad application prospect in the medical field.At present,metaverse medicine has already been applied in the diagnosis and treatment of chronic diseases,psychological intervention,and innovative clinical teaching mode.With the increasing of innovations and applications of the technologies such as vascular interventional surgical robots,extended reality,3-D printing and others,the newly-developed metaverse medicine will be able to play an important role in facilitating interventional surgery and improving doctor training,although the application of metaverse medicine in endovascular interventional therapy is still in its developing stage now.It can be expected that with the gradual maturity of metaverse medicine,the remote-guided interventional surgeries,which can be accomplished with the help of technologies such as 5G,augmented reality(AR)and tactile internet,will become the normal work in medical practice,and,moreover,the simulation surgery training programs,which can be conducted with the help of technologies such as computer-assisted vascular intervention and virtual reality(VR),will also become the common pattern in medical teaching course.(J Intervent Radiol,2024,32:86-89)

Objective To observe the feasibility of 5.0T MR for cardiac imaging.Methods Three patients with heart diseases and 17 healthy volunteers were prospectively enrolled.Cardiac MR(CMR)cine sequence and black blood sequence imaging were performed using 5.0T and 3.0T MR scanner,respectively.The image quality and artifacts degrees were compared between 5.0T and 3.0T CMR images,and the consistency of left ventricular parameters obtained using 5.0T and 3.0T scanners was analyzed.Results No significant difference of image quality nor artifacts degrees was found between 5.0T and 3.0T CMR images(all P＞0.05).The left ventricular end diastolic volume(EDV),end systolic volume(ESV),ejection fraction(EF),stroke volume(SV)and end diastolic mass(EDM)derived from cine images acquired at different fields were in a good agreement(all ICC＞0.75,all P＜0.001).Conclusion 5.0T MR could be used for cardiac imaging,with image quality of cine and black blood sequences comparable to that of 3.0T MR.

Background Heavy metal pollution in cultivated land will affect crop yield and quality, as well as groundwater quality, ecological security, and human health. Objective To analyze the pollution status of heavy metal elements such as chromium (Cr), copper (Cu), zinc (Zn), arsenic (As), cadmium (Cd), and lead (Pb) in cultivated soils of the Donghe River Basin in Chenzhou City, and to evaluate the environmental quality of local cultivated soil. Methods A total of 16 samples of cultivated soil from the Donghe River Basin in Chenzhou City were collected, and the contents of Cr, Cu, Zn, As, Cd, and Pb in the samples were determined by inductively coupled plasma mass spectrometry. The Nemerow comprehensive pollution index method (the evaluation indicators included both Nemerow comprehensive pollution index and single pollution index), the geological accumulation index method, and the potential ecological risk index method were used to evaluate the soil environmental quality. Results The average levels of Cr, Cu, Zn, As, Cd, and Pb in the soil samples in the study area were 58.25, 49.50, 273.88, 137.76, 2.92, and 672.29 mg·kg⁻¹, respectively. The average values of Cu, Zn, As, Cd, and Pb were all exceeded the background values of soil elements in Hunan Province. The single pollution indices of As, Cd, Pb, and Zn in soil were 4.40, 9.74, 5.85, and 1.15 respectively. The contamination of As and Pb reached 93.75% and 81.25% respectively. The geological accumulation indices of soil As, Cd, Pb, and Zn were 2.11, 3.71, 2.97, and 0.58, respectively, which showed heavy Cd pollution, moderate As and Pb pollution, and slight Zn pollution. The potential ecological hazard indices of soil Cr, Cu, Zn, As, Pb, and Cd were 1.63, 9.07, 2.90, 87.75, 113.18, and 695.76. 81.Twenty five percent of Cd samples showed heavy pollution and above, and 62.50% of Pb samples had moderate pollution and above. The Nemerow comprehensive pollution index was 7.72, which belonged to heavy pollution; and the comprehensive potential ecological risk index was 910.29, which belonged to high ecological risk. Conclusion There are certain differences in the results of different evaluation methods. The cultivated soils of the Donghe River Basin in Chenzhou City, is seriously polluted by heavy metals, and Cd, As, and Pb are the main polluting elements.

Objective:To compare the dosimetric parameters and plan complexity between newly-delicated HyperArc (HA) and conventional volumetric-modulated arc therapy (VMAT) in the treatment of brain metastases.Methods:For 26 patients with brain metastases, HA, conventional coplanar (Cop) and non-coplanar (Non-cop) VMAT plans with a prescription dose of 9 Gy 3fx or 6 Gy 5fx were generated. The dosimetric parameters for planning target volume (PTV), RTOG conformity index (RTOG CI), Paddick CI, homogeneity index (HI), gradient index (GI), maximum dose (D max) of brainstem and dose-volume parameters of brain-PTV(V 2Gy-V 26Gy) were statisticaly compared among these three approaches. In addition, the monitor unit (MU) and the plan complexity parameters (including MCSv and AlPO) were statistically compared. Results:To prevent missed targets during treatment, all plans were established with RTOG CI of greater than 1.1. For Paddick CI, HA provided significantly higher conformity (0.89±0.019) than Non-cop (0.87±0.036, P=0.001) and Cop (0.88±0.017, P=0.003) VMAT. For GI, the fastest dose fall-off was noted in HA (3.35±0.64), followed by conventional Non-cop VMAT of (3.70±0.80), and conventional Cop VMAT of (4.90±1.85)(all P<0.05). For the brainstem sparing, HA plan performed better than Non-cop plan[(604.14±531.61) cGy vs.(682.75±558.22) cGy, P<0.05)]. For normal brain tissue sparing, HA approach showed significant reduction than conventional Cop and Non-cop VMAT (both P<0.05). For MU, HA approach (2 872.60 ± 566.93) was significantly lower than those of Non-cop VMAT (3 771.28 ± 1 022.38, P<0.05) and Cop VMAT (4 494.08 ± 1 323.09, P<0.05). In terms of plan complexity, the MCSv of Cop plan was the lowest, indicating that the complexity was the highest ( P<0.05). The AlPO of HA was significantly higher than that of Non-cop VMAT ( P<0.05), suggesting that the complexity of HA plan was lower ( P<0.05). Conclusion:For the treatment of brain metastases, HA provides better conformity, more rapid dose fall-off, better sparing of brainstem and normal brain tissues and less plan complexity compared with conventional VMAT.

Objective:To help clinicians simplify the post-processing operations of structures by developing rapid processing software for target area and organs at risk structures based on ESAPI.Methods:SmartStructure script software was developed based on ESAPI, verified and evaluated in clinical work. 10 cases of rectal cancer receiving neoadjuvant radiotherapy, 10 breast cancer treated with postoperative radiotherapy, 10 cervical cancer receiving postoperative radiotherapy, 10 nasopharyngeal carcinoma receiving radical radiotherapy and 10 lung stereotactic body radiotherapy (SBRT) were selected, and different types of tumors had different post-processing operations of structures. In each case, three methods were used for post-processing of structures. In the control group (manual group), normal manual processing was employed. In the experimental group 1(SmaStru-N group), scripts without templates were utilized. In the experimental group 2(SmaStru-P group). scripts combined with templates were adopted. The processing time of the three methods was compared. Clinicians scored the scripting software from multiple aspects and compared the feeling scores of scripting software and manual operation.Results:All three methods can be normally applied in clinical settings. The error rate in the manual group was 7.0%, 3.0% in the SmaStru-N group 0% in the SmaStru-P group, respectively. Compared with the manual method, SmaStru-N shortened the processing time of target area and organs at risk by 60.9% and 93.3% for SmaStru-P. In addition, SmartStructure was superior to manual method in terms of using feeling scores. Clinicians gave lower score for the" applicability" and" simplicity" , and higher score on the" accuracy" and" efficiency" .Conclusions:Compared with conventional manual structure processing method, SmartStructure software can rapidly and accurately process all structures of the target area and organs at risk, and its advantages become more obvious with the increasing number of structures that need to be processed. SmartStructure software can meet clinical requirements, reduce the error rate, elevate processing speed, improve the working efficiency of clinicians, providing basis for the development of adaptive radiotherapy.

Objective Compare the efficacy of superselective arterial embolization with observation in the treatment of HFP caused by trauma.Methods From Jan,2013 to Dec,2017,6 traumatic HFP patients were involved into the study,the age range from 18 to 44 years old,with an average age of 26.2 years.The fistula was measured by doppler ultrasonography before the treatment with its longest diameter,and which ranges from 0.8 to 1.4 cm,the average diameter is 1.14 cm.All patients are divided into two groups according to their treatment.Operation group:4 patients underwent the pudendal artery superselective gelatin sponge vascular embolization.Control group:2 cases were treated with local cold compressing under watchful waiting.In control group,patients are treated by local cold compress with ice bag for 3 weeks:15 mins × 10 times every day.The erectile hardness of the patients was observed and the fistula was evaluated by doppler ultrasonography 3 weeks later,and all the patients were reexamined by doppler ultrasonography 1 year later.The erectile hardness was divided into four grades according to the patient~ subjective feelings:grade Ⅰ,the penis was enlarged but not rigid;grade Ⅱ,the penis had hardness,but not enough to insert into the vagina;grade Ⅲ,the penis could be inserted into the vagina,but not to achieve complete erection;grade Ⅳ,the penis fully erect and firm.The erectile function was evaluated with the International Index of Erectile Function-5(IIEF-5) after 1-year's follow-up.Results 4 patients in the operation group were operated successfully without obvious complications after operation.Median follow-up time of all the patients was 21 months (5-50).In group operation,4 cases of surgical patients did not have the recurrence of priapism.There was no obvious abnormality in the color doppler ultrasound of penis.The score of IIEF-5 was 25,24,24 and 23,respectively.Postoperative erectile function made a complete recovery.In group observation,2 patients under watchful waiting still have grade Ⅱ-Ⅲ sustained priapism,IIEF-5 score is 21 and 19 respectively,the penis color doppler ultrasound scan still showed the change of arteriovenous fistula.Conclusion Superselective arterial embolization is effective in the treatment of HFP,and the recovery of sexual function is better after operation compared with watchful waiting.

Objective To investigate the application value of intravoxel incoherent motion (IVIM) MRI for evaluating the sensitivity of chemoradiotherapy on nasopharyngeal carcinoma (NPC). Methods Sixty eight consecutive patients newly diagnosed with NPC in the stage of T3 (30 patients) or T4 (38 patients) were retrospectively enrolled. They were divided into effective group (45 patients) and poor?effective group (23 patients) clinically after a standard chemoradiotherapy according to the RECIST criteria. IVIM with 13 b?values (range,0 to 800 s/mm2) and general MRI were performed at 3.0 T MR scanner before and after chemoradiotherapy. Two radiologists major in MRI diagnose analyzed all images independently and placed regions of interest (ROIs). Intraclass correlation coefficient (ICC) was used to evaluate intra?observer and inter?observer agreement. And Mann?Whitney test was used to assess the differences between the two groups. Results The reproducibility between intra?observer and inter?observer was relatively good. Statistically,D [(0.69±0.06)×10?3 mm2/s vs. (0.52±0.10)×10?3 mm2/s; U=51.5,P<0.01)] and D* [(161.33 ± 11.50)×10-3 mm2/s vs. (126.96 ± 10.27)×10-3 mm2/s; U=18.0, P<0.01] were significantly higher in effective group than those in poor?effective group, whereas the difference of f (16.68 ± 1.94% vs. 16.40±1.11%, U=434.5, P=0.282) and ADC (1.23±0.11)×10?3 mm2/s vs. (1.25±0.10)×10?3 mm2/s,U=427.0,P=0.240) could not reach statistical significance between the 2 groups (P>0.05). Conclusions IVIM may be potentially useful in assessing the chemoradiotherapy on NPC. The higher D value combined with higher D*value might indicate the chemoradiotherapy on NPC is more sensitive,and the higher D*value might reflect increased blood vessel generation and parenchymal perfusion in NPC.

Objective To investigate the CT and MRI manifestations of intra-abdominal aggressive fibromatosis and correlation with pathology.Methods The CT and MRI manifestations of 26 cases with intra-abdominal aggressive fibromatosis confirmed by pathological examination were analyzed retrospectively.Results 26 cases showed single solid mass,13 cases showed well-circumscribed and round-like,9 cases wrapped around the common bile duct,intestine or ureter,4 cases were lobulated which had unclear margin with surrounding tissues in pelvic.All the lesions displayed isodensity or slightly low density non-enhanced CT appearance,heterogenous high intensity FS T2WI,some larger tumors showed mixed signal.CT/MRI enhanced scan showed gradual enhancement in 26 cases.Conclusion Intra-abdominal aggressive fibromatosis have some certain imaging features,MRI can offer the histo logical features of tumors and have some correlation with pathology.

Objective To investigate the effect of gefitinib, an inhibitor of epidermal growth factor receptor ( EGFR ) , on the proliferation and osteogenic differentiation of endosteum-derived stem cells ( EDSCs ) in rats. Methods Femoral fracture models were established in healthy male 4-week old SD rats. They were randomly divided into 2 groups. The experimental group was subjected to intragastric lavage with gefitinib, an EGFR signaling inhibitor ( 100 mg/kg·d ) while the control group to intragastric lavage with an isodose of methyl cellulose. Bilateral femurs and tibias were harvested one week after lavage for separation of EDSCs and bone marrow mesenchymal stem cells ( BMSCs ) respectively using density gradient centrifuga-tion. After proliferative cloning in vitro, expression of the cell surface antigens ( CD29, CD34, CD44 and CD45) of the third passage cells was detected by flow cytometry (FCM). Proliferation of the cells was detected by BrdU, cell cycle was measured by FCM, and expression of the genes related to cell cycle inhibitory factors (p15, p16, p21 and p27) was determined by PCR. ALP staining was performed 14 days after osteogenesis induction. After 21 days of chondrogenic induction, von Kossa staining was conducted. qRT-PCR of the mRNA obtained was used to detect expression of osteogenic differentiation of related genes ( osteocalcin, bsp, runx2 and osterix ). Results CD29 and CD44 were positively expressed while CD34 and CD45 negatively expressed in EDSCs and BMSCs. After the EGFR signaling pathway was blocked by gefitinib, BrdU detection found that gefitinib inhibited BMSCs ( 11.15%) much more than EDSCs ( 0.25%). Cell cycle detection showed that the volume of EDSCs was increased in phases G0/G1 and S but decreased significantly in phase G2-M. ALP staining showed that the increase of EDSCs ALP+ cells (53.31% ) was significantly higher than that of BMSCs (25.04% ) . The increased expression percentages of the genes related to cell cycle inhibitors in EDSCs (103.9%, 58.0%, 117.3% and 105.1%, respectively) were significantly higher than those in BMSCs (39.3%, 38.4%, 24.5% and 83.4%, respectively) ( P ＜0.05). The increased expression percentages of the genes related to osteogenic differentiation in EDSCs (247.0%, 289.9%, 66.1% and 233.2%, respectively) were significantly higher than those in BMSCs (106.5%, 186.4%, 41.7% and 190.8%, respectively). All the above differences were statistically significant ( P ＜0.05) . Conclusions Gefitinib, an EGFR inhibitor, can inhibit proliferation of EDSCs and BMSCs but promote their osteogenic differentiation. It inhibits proliferation of BMSCs more significantly as it promotes osteogenic differentiation of EDSCs.

Objective: To examine the effects of perioperative intravenous administration of flurbiprofen axetil (FA) on pain associated with transrectal ultrasound-guided prostate biopsy.Methods: This was a randomized,controlled study.Eighty-one patients who underwent 12 core prostate biopsy were included in the study.The patients were randomly assigned to one of three groups (n=27 in each) by type of procedure during prostate biopsy.Group intrarectal local anesthesia (IRLA) received intrarectal 5% (0.05 g/L) lidocaine gel 60 mg, 5 minutes before the procedure alone;Group FA received intravenous flurbiprofen axetil (1 mg/kg) 1 hour before the procedure;Group IRLA+FA received intrarectal 5% lidocaine gel 60 mg, 5 minutes before the procedure and intravenous flurbiprofen axetil (1 mg/kg) 1 hour before the procedure.The patients were asked to score the pain by using visual analogue scale (VAS) in 4 situations,including when the probe was inserted (VASⅠ),during anesthesia (VASⅡ),during biopsy (VASⅢ) and 20 minutes after biopsy (VASⅣ).The findings were evaluated with analysis of variance,and the Tukey post hoc test was followed with an overall 2-tailed significance level at α =0.05.P1, P value between Group IRLA and Group FA;P2, P value between Group FA and Group IRLA +FA,P3, P value between Group IRLA and Group IRLA +FA.The bonferroni method was used to adjust the test level, α=0.017,a P value of less than 0.017 was accepted as the threshold for statistical significance.Results: No major complications,including sepsis and severe rectal bleeding,were noted in any patient.There were no differences in general condition of the patients before procedure among the 3 groups.There were statistically significant differences in VAS scores among the 3 groups in VASⅡ (5.7±2.2, 3.0±1.5,3.3±1.9,respectively,P=0.012) and VASⅢ (6.7±2.3,3.0±2.1,2.9±1.6,respectively,P=0.001).There were no differences in the pain scores among the 3 groups during probe insertion (VASⅠ, 3.2±1.0,4.1±2.1,4.2±1.7, respectively,P=5.752) and 20 minutes after biopsy (VASⅣ, 1.4±2.1,1.0±0.9,1.1±0.7,respectively,P=3.772).Between-column differences among the 3 groups were VASⅡ (P1=0.007,P2=5.655,P3=0.001,respectively) and VASⅢ(P1=0.008,P2=7.517,P3=0.001,respectively),the differences between Group IRLA and Group FA,Group IRLA and Group IRLA +FA in VASⅡ and VASⅢ were statistically significant.Conclusion:The intravenous flurbiprofen axetil was found to be more effective than intrarectal lidocaine gel alone.