Brilliance型16排螺旋CT的故障分析与维修

针对日常使用中遇到的Brilliance 16排螺旋CT高压系统、机架以及控制器局域网络(CAN)通讯等故障现象进行分析与维修,最终通过更换滤波电容、机架数据采集控制器(DMC)电源以及信号刷等配件得以排除故障。通过对故障准确判断以及合理运用厂家Service模式下的维修工具软件快速解决故障,保障了影像科检查工作的顺利进行,从而提高设备的稳定性。     

乙肝相关性肝癌临床病理学特征与高敏C反应蛋白和溶血磷脂酸表达的相关性

目的探讨乙肝相关性肝癌临床病理学特征与溶血磷脂酸(LPA)和高敏C反应蛋白(hs-CRP)表达的相关性。方法选取2019年1月至2020年1月间河南省驻马店市中心医院收治的198例乙肝相关性肝癌患者作为乙肝组,198例酒精相关性肝癌患者作为酒精组。两组患者都进行血清hs-CRP和LPA表达检测,调查患者的病理学特征并进行相关性分析。结果乙肝组患者血清hs-CRP和LPA含量均高于酒精组,差异均有统计学意义(均P <0.05)。两组患者血清ALP、AFP、ALT、AST和GGT含量比较,差异均无统计学意义(P> 0.05)。乙肝组不同临床分期和组织学分化患者的血清hs-CRP和LPA含量比较,差异均有统计学意义(均P <0.05)。乙肝组患者的临床分期和组织学分化与血清hs-CRP和LPA表达均存在相关性,差异均有统计学意义(均P <0.05)。患者的临床分期和组织学分化均为影响hs-CRP和LPA表达的重要因素,差异均有统计学意义(均P <0.05)。结论相对于酒精相关性肝癌,乙肝相关性肝癌的血清hs-CRP和LPA呈现高表达,与患者的临床病理学特征存在相关性。     

Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography

BackgroundInflammation surrounding the coronary arteries can be non-invasively assessed using pericoronary adipose tissue attenuation (PCAT). While PCAT holds promise for further risk stratification of patients with low coronary artery disease (CAD) prevalence, its value in higher risk populations remains unknown.MethodsCORE320 enrolled patients referred for invasive coronary angiography with known or suspected CAD. Coronary computed tomography angiography (CCTA) images were collected for 381 patients for whom clinical outcomes were assessed 5 years after enrollment. Using semi-automated image analysis software, PCAT was obtained and normalized for the right coronary (RCA), left anterior descending (LAD), and left circumflex arteries (LCx). The association between PCAT and major adverse cardiovascular events (MACE) during follow up was assessed using Cox regression models.ResultsThirty-seven patients were excluded due to technical failure. For the remaining 344 patients, median age was 62 (interquartile range, 55–68) with 59% having ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography. Mean attenuation values for PCAT in RCA, LAD, and LCx were ?74.9, ?74.2, and ?71.2, respectively. Hazard ratios and 95% confidence intervals (CI) for normalized PCAT in the RCA, LAD, and LCx for MACE were 0.96 (CI: 0.75–1.22, p ?= ?0.71), 1.31 (95% CI: 0.96–1.78, p ?= ?0.09), and 0.98 (95% CI: 0.78–1.22, p ?= ?0.84), respectively. For death, stroke, or myocardial infarction only, hazard ratios were 0.68 (0.44–1.07), 0.85 (0.56–1.29), and 0.57 (0.41–0.80), respectively.ConclusionsIn patients referred for invasive coronary angiography with suspected CAD, PCAT did not predict MACE during long term follow up. Further studies are needed to understand the relationship of PCAT with CAD risk.     

基于人工智能的骨龄辅助评价系统对四川地区完全性生长激素缺乏症患儿骨龄研究

目的探讨采用基于"人工智能(AI)的骨龄辅助评价系统(上海初云医疗科技有限公司与四川大学华西第二医院合作开发)"(以下简称为AI系统)对完全性生长激素缺乏症(CGHD)患儿诊断及骨龄评价准确性。 方法选择2014年7月至2019年11月，于四川大学华西第二医院确诊的66例来自四川地区CGHD患儿为研究对象，纳入研究组。选择同期于病例收集医院儿童保健科进行骨龄测定的67例来自四川地区身高达标儿童作为对照，纳入对照组。对每例受试儿进行左手腕关节正位X射线摄片骨龄测定，由2位医师采用《TW₂骨龄评分法中国未成年人南方标准》(以下简称为TW₂CHN)》与《TW₃骨龄评分法标准》(以下简称为TW₃)，盲法评价受试儿TW₂CHN-桡、尺、掌指骨(RUS)与TW₂CHN-腕骨(carpal)、TW₂CHN-20、TW₃-RUS及TW₃-carpal骨龄(以下简称为5种传统骨龄)，以及以同性别、年龄身高达标儿童5种传统骨龄为标准，计算受试儿5种传统骨龄百分位数。同时，采用AI系统分别对每例受试儿采取TW₂CHN与TW₃法，评价其AI-TW₂CHN-RUS、AI-TW₂CHN-carpal、AI-TW₂CHN-20、AI-TW₃-RUS及AI-TW₃-carpal骨龄(以下简称为5种AI骨龄)及其相应百分位数。以上述5种传统骨龄＋5种AI骨龄(以下简称为10种骨龄)相应的P₅₀、P₂₅、P₁₀、P₃值(统称为P_n值)作为诊断CGHD患儿临界值，分别计算其诊断CGHD患儿的敏感度、特异度、约登(Youden)指数、准确率、阳性似然比、阴性似然比、阳性预测值、阴性预测值。采用Kappa值评价2组受试儿5种传统骨龄百分位数与对应的5种AI骨龄百分位数评价结果的一致性，以及2位医师对2组受试儿TW₂CHN-RUS骨龄百分位数评价结果一致性。绘制上述10种骨龄百分位数诊断CGHD患儿的受试者工作特征(ROC)曲线，并计算曲线下面积(AUC)。采用配对t检验，对2组受试儿TW₂CHN骨龄与TW₃骨龄进行比较。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。2组受试儿年龄、性别构成比等一般临床资料比较，差异均无统计学意义(P>0.05)。 结果①采用10种骨龄的P_n值分别作为诊断CGHD临界值，对133例受试儿CGHD诊断结果显示，除了TW₃-RUS骨龄中，以骨龄≤P₁₀作为诊断CGHD患儿临界值时的诊断准确率最高(85.0%)，TW₂CHN-RUS、TW₂CHN-carpal、TW₂CHN-20、TW₃-carpal、AI-TW₂CHN-RUS、AI-TW₂CHN-carpal、AI-TW₂CHN-20、AI-TW₃-carpal、AI-TW₃-RUS骨龄中，均为以骨龄≤P₂₅作为临界值时，对CGHD的诊断准确率最高，分别为81.9%、75.2%、88.0%、78.2%、75.2%、73.6%、81.2%、72.9%、78.9%。②一致性检验结果显示，2组受试儿TW₂CHN-RUS与AI-TW₂CHN-RUS、TW₂CHN-carpal与AI-TW₂CHN-carpal、TW₂CHN-20与AI-TW₂CHN-20、TW₃-RUS与AI-TW₃-RUS、TW₃-carpal与AI-TW₃-carpal骨龄百分位数评价结果均为中等一致性，Kappa值分别为0.445、0.578、0.570、0.446、0.430(均为P<0.001)。③对2位医师对2组受试儿TW₂CHN-RUS骨龄百分位数评价结果进行一致性检验显示，其Kappa值为0.790(P<0.001)，一致性较高。④绘制10种骨龄百分位数评价结果诊断CGHD的ROC曲线分析结果显示，TW₂CHN-RUS、TW₂CHN-carpal、TW₂CHN-20、TW₃-carpal、TW₃-RUS、AI-TW₂CHN-RUS、AI-TW₂CHN-carpal、AI-TW₂CHN-20、AI-TW₃-carpal、AI-TW₃-RUS骨龄百分位数诊断CGHD患儿的AUC分别为0.932、0.859、0.915、0.895、0.844、0.823、0.805、0.866、0.860、0.764(均为P<0.001)。⑤133例受试儿的TW₃-RUS、TW₃-carpal、AI-TW₃-RUS、AI-TW₃-carpal骨龄，均分别显著低于TW₂CHN-RUS、TW₂CHN-carpal、AI-TW₂CHN-RUS、AI-TW₂CHN-carpal骨龄，并且差异均有统计学意义(t＝21.746、25.287、16.498、9.290，P<0.001)。 结论TW₂CHN法、TW₃法对CGHD患儿骨龄评价及诊断均有临床价值，TW₂CHN-RUS骨龄对于CGDH患儿诊断效能高。四川地区儿童TW₃骨龄较TW₂CHN骨龄低，TW₃法可能不完全适用于四川地区儿童骨龄评价。AI系统对于四川地区CGHD患儿骨龄评价结果与传统骨龄评价结果具有中等一致性，可为临床医师评价受试儿骨龄提供帮助。     

Metabolism of non-steroidal anti-inflammatory drugs (NSAIDs) by Streptomyces griseolus CYP105A1 and its variants

In the field of drug development, technology for producing human metabolites at a low cost is required. In this study, we explored the possibility of using prokaryotic water-soluble cytochrome P450 (CYP) to produce human metabolites. Streptomyces griseolus CYP105A1 metabolizes various non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, mefenamic acid, flufenamic acid, tolfenamic acid, meclofenamic acid, and ibuprofen. CYP105A1 showed 4′-hydroxylation activity towards diclofenac, mefenamic acid, flufenamic acid, tolfenamic acid, and meclofenamic acid. It should be noted that this reaction specificity was similar to that of human CYP2C9. In the case of mefenamic acid, another metabolite, 3′-hydroxymethyl mefenamic acid, was detected as a major metabolite. Substitution of Arg at position 73 with Ala in CYP105A1 dramatically reduced the hydroxylation activity toward diclofenac, flufenamic acid, and ibuprofen, indicating that Arg73 is essential for the hydroxylation of these substrates. In contrast, substitution of Arg84 with Ala remarkably increased the hydroxylation activity towards diclofenac, mefenamic acid, and flufenamic acid. Recombinant Rhodococcus erythrocyte cells expressing the CYP105A1 variant R84A/M239A showed complete conversion of diclofenac into 4′-hydroxydiclofenac. These results suggest the usefulness of recombinant R. erythropolis cells expressing actinomycete CYP, such as CYP105A1, for the production of human drug metabolites.     

改良眶隔法和传统睑板法切开重睑术的术后重睑形态、瘢痕发生率、角膜暴露率比较研究

目的 比较改良眶隔法和传统睑板法切开重睑术中的应用效果及对术后重睑形态、瘢痕发生率、角膜暴露率的影响。方法 选取2020年3月-2021年3月首都医疗爱育华医院收治的80例单睑患者，采用随机数字表法将其分对照组和观察组，各40例。对照组接受传统睑板法切开重睑术，观察组接受改良眶隔法切开重睑术，比较两组术后重睑形态、瘢痕发生率、角膜暴露率、并发症发生率。结果 观察组总有效率高于对照组，差异有统计学意义（P＜0.05）；观察组GAIS评分高于对照组，VAS评分低于对照组，差异有统计学意义（P＜0.05）；观察组右侧角膜暴露率增加值、左侧角膜暴露率增加值高于对照组，差异有统计学意义（P＜0.05）；观察组并发症发生率为5.00%，低于对照组的22.50%，差异有统计学意义（P＜0.05）。结论 相比于传统睑板法切开重睑术，改良眶隔法切开重睑术不会过度增加术后角膜暴露率，术后瘢痕发生率更低，重睑形态更理想，患者接受度更高。     

Optical coherence tomography angiography in the evaluation of vascular patterns of ocular surface squamous neoplasia during topical medical treatment

PurposeOptical coherence tomography angiography (OCTA) was utilized to examine changes in ocular surface squamous neoplasia (OSSN) vascular patterns over time in individuals treated with topical medical therapy.MethodsTen individuals with OSSN diagnosed by clinical examination and high resolution (HR)-optical coherence tomography (OCT) were recruited. All individuals received topical immuno- or chemotherapy. OCTA images were obtained and analyzed at three points: presentation, mid-treatment and tumor resolution. Tumor metrics including tumor area (TA), tumor volume (TV), tumor depth (TD), and total tumor density (TTD) were calculated. Vessel area density (VAD) was also quantified within the OSSN, the subepithelium under and adjacent to the OSSN and the subepithelium of the uninvolved, contralateral eye. Vascular network changes were also subjectively evaluated.ResultsTA, TV, TD and TTD all significantly decreased with time (p < 0.001). The mean VAD within the OSSN significantly decreased (p < 0.001) between visits (presentation: 26.52 ± 6.8%, mid-treatment: 7.19 ± 5.88%, tumor resolution: 0.11 ± 0.34%). The mean subepithelial VAD under the OSSN also decreased with time (23.22 ± 11.03%, 20.99 ± 5.99% and 19.58 ± 7.08%), and after resolution the sub-tumor VAD (19.58 ± 7.08%) was comparable to the subepithelial VAD in the contralateral eye (15.47 ± 4.37%, p > 0.05). The mean VAD in the subepithelium adjacent to the OSSN increased with treatment, then decreased significantly between mid-treatment and resolution (23.26 ± 4.54, 28.30 ± 7.43% and 21.68 ± 6.10%, p = 0.009). Qualitatively, the tumor subepithelial vascular network was complex and dense but with tumor resolution appeared less tortuous and similar to the uninvolved eye.ConclusionOCTA provided insight into the pathophysiology of tumor angiogenesis, showing decreased vascular density and normalization of vascular networks associated with tumor resolution.     

Prostate cancer incidence in men with prostate-specific antigen below 3 ng/mL: The Finnish Randomized Study of Screening for Prostate Cancer

Prostate-specific antigen (PSA)-based screening for prostate cancer (PCa) can reduce PCa mortality, but also involves overdetection of low-risk disease with potential adverse effects. We evaluated PCa incidence among men with PSA below 3 ng/mL and no PCa diagnosis at the first screening round of the Finnish Randomized Study of Screening for PCa. Follow-up started at the first screening attendance and ended at PCa diagnosis, emigration, death or the common closing date (December 2016), whichever came first. Cox regression analysis was used to estimate hazard ratios and their confidence intervals (CI). Among men with PSA <3 ng/mL, cumulative PCa incidence was 9.1% after 17.6 years median follow-up. Cumulative incidence was 3.6% among men with baseline PSA 0 to 0.99 ng/mL, 11.5% in those with PSA 1.0 to 1.99 ng/mL and 25.7% among men with PSA 2 to 2.99 ng/mL (hazard ratio 9.0, 95% CI: 7.9-10.2 for the latter). The differences by PSA level were most striking for low-risk disease based on Gleason score and EAU risk group. PSA values <1 ng/mL indicate a very low 20-year risk, while at PSA 2 to 2.99 ng/mL risks are materially higher, with 4- to 5-fold risk for aggressive disease. Using risk-stratification and appropriate rescreening intervals will reduce screening intensity and overdetection. Using cumulative incidence of clinically significant PCa (csPCa) as the criterion, rescreening intervals could range from approximately 3 years for men with initial PSA 2 to 2.99 ng/mL, 6 years for men with PSA 1 to 1.99 ng/mL to 10 years for men with PSA <1 ng/mL.     

Trends in cancer incidence by socioeconomic deprivation in Germany in 2007 to 2018: An ecological registry-based study

Age-standardized cancer incidence has decreased over the last years for many cancer sites in developed countries. Whether these trends led to narrowing or widening socioeconomic inequalities in cancer incidence is unknown. Using cancer registry data covering 48 million inhabitants in Germany, the ecological association between age-standardized total and site specific (colorectal, lung, prostate and breast) cancer incidence in 2007 to 2018 and a deprivation index on district level (aggregated to quintiles) was investigated. Incidence in the most and least deprived districts were compared using Poisson models. Average annual percentage changes (AAPCs) and differences in AAPCs between deprivation quintiles were assessed using Joinpoint regression analyses. Age-standardized incidence decreased strongly between 2007 and 2018 for total cancer and all cancer sites (except female lung cancer), irrespective of the level of deprivation. However, differences in the magnitude of trends across deprivation quintiles resulted in increasing inequalities over time for total cancer, colorectal and lung cancer. For total cancer, the incidence rate ratio between the most and least deprived quintile increased from 1.07 (95% confidence interval: 1.01-1.12) to 1.23 (1.12-1.32) in men and from 1.07 (1.01-1.13) to 1.20 (1.14-1.26) in women. Largest inequalities were observed for lung cancer with 82% (men) and 88% (women) higher incidence in the most vs the least deprived regions in 2018. The observed increase in inequalities in cancer incidence is in alignment with trends in inequalities in risk factor prevalence and partly utilization of screening. Intervention programs targeted at socioeconomically deprived and urban regions are highly needed.