Volume 102 ·  Issue 27 ·  2022

The appropriate application of medical imaging is a major concern of our nation in recent years. In the year of 2020, we proposed the concept of Evidence-based Medical Imaging Clinical Appropriateness (EB-MICA^®). We preliminary evaluated the value of different kinds of medical imaging in clinical practice. A series of work had be applied in the stage of medical imaging application. It has decreased the cost of patients and medical insurance and improved the medical efficiency, providing key clues for medical policy makers objectively. It is also an important opportunity for the transformation of medical model towards the "value-based model". In the concern of appropriate medical imaging for patients with tinnitus, hearing loss and (or) vertigo, IgG4-related disease in clinical practice, experts in related academic group wrote and published three EB-MICA consensuses as reference. This work keeps promoting rational utilization of medical resource and improving the quality of clinical decision-making.

Tinnitus is a common clinical symptom, and imaging examination is an important basis for disease assessment. Appropriate examination methods should be selected according to clinical diagnosis and treatment needs. According to the evaluation concept of clinical applicability of imaging examination in China, it is necessary for imaging doctors and clinicians to jointly provide reference basis for the reasonable selection of imaging examination methods for patients. This consensus briefly outlines the recommendations for choosing imaging examination methods for four common clinical needs of tinnitus clinics, aiming at improving the diagnosis and treatment efficacy and efficiency of patients and promoting the rational use of medical resources.

Hearing loss and/or vertigo are common clinical symptoms, and imaging examination is an important method for etiology detection and disease assessment. Appropriate examination methods should be selected according to clinical diagnosis and treatment needs. According to the evaluation concept of clinical applicability of imaging examination in China, it is necessary for imaging doctors and clinicians to jointly provide reference basis for the reasonable selection of imaging examination methods for patients. This consensus provides a concise overview of the recommendations for the selection of imaging examination methods for a total of 8 common clinical needs of concern in the diagnosis and treatment of hearing loss and/or vertigo, with the aim of improving the diagnosis and efficiency of patients and promoting the rational use of medical resources.

Multiple cancer societies and professional medical organizations have recommended the inclusion of palliative care in routine oncology treatment, but the optimal model and timing of palliative care are inconclusive. In China, lung cancer is the tumor with the heaviest disease burden. This consensus is facing all disciplines involved in palliative care of lung cancer. According to the current situation of palliative care of lung cancer, combined with domestic and foreign palliative care guidelines, medical evidence-based evidence and clinical practice, suggestions are given for the definition, timing, mode, evaluation and treatment of different symptoms of palliative care of lung cancer, aiming at improving the quality of life of lung cancer patients and caregivers in China and improving the level of palliative care of lung cancer in China.

To investigate the correlation between stress hyperglycemia ratio (SHR) and outcomes in patients with acute ischemic stroke treated with endovascular treatment.

In a multicenter registration study for RESCUE-RE (a registration study for critical care of acute ischemic stroke after recanalization), eligible patients with large vessel occlusion stroke within 24 hours after onset who received endovascular treatment between July 2018 and May 2019 were enrolled. SHR was calculated as the fasting glucose concentration divided by the estimated average glucose concentration and then categorized into four groups according to the quartiles (group Q₁, group Q₂, group Q₃ and group Q₄). The primary outcome was poor neurological outcomeat day 90 fromstroke onset [defined as modified Rankin scale (mRS) of 3-6]. Secondary outcomes included early neurological deterioration (END), death within 3 months after stroke onset, and symptomatic intracranial hemorrhage.Multivariable logistic and Cox regression modelswere used to assess the correlation between quartiles of SHR and prognosis in patients with endovascular treatment.

A total of 592 patients were enrolled in the study, with a mean age of (63±12) years, and 68.07% were male.The median National Institute of Health stroke scale(NIHSS) score on admission was15(11, 20), and the median SHR was 1.23 (1.07, 1.47), with SHR<1.07 in group Q₁, 1.07≤SHR<1.23 in group Q₂, 1.23≤SHR<1.47 in group Q₃ and SHR≥1.47 in group Q₄, respectively. The rate of complete recanalization was lower in group Q₄ than that of group Q₁ (70.27% vs 83.67%, P=0.026). After fully adjusted for potential covariates, the risk of poor neurological outcome at day 90 from stroke onset in group Q₄ was 2.38 folds that of group Q₁(adjusted OR= 2.38, 95%CI: 1.57-3.57,P=0.003). The risk of death within 3 months of patients in group Q₄ was 1.80 times that of the patients in group Q₁, but the difference was not statistically significant(adjusted HR=1.80, 95%CI: 0.90-3.62, P=0.098).

Higher SHR was correlated with poor neurological outcome at 3 months in large artery occlusion related acute ischemic stroke patients receiving endovascular therapy.

To investigate the imaging features of patients with developmental stenosis of atlas (small atlas) complicated with degenerative cervical myelopathy and to explore the diagnostic criteria of small atlas.

The clinical data of patients with degenerative cervical myelopathy treated by posterior cervical laminoplasty and resection of posterior arch of atlas from 2006 to 2020 in the Department of Orthopedics, Peking University Third Hospital were retrospectively analyzed. Sixteen cases had spinal cord compression at C₁ level after the exclusion of ossification of cervical posterior longitudinal ligament (OPLL) and other pathology. These cases were suspected small atlas (small atlas group). Forty-six cases without posterior arch resection in the same period were selected as control group. The middle sagittal diameter of atlas and the vertical distance from posterior tubercle of atlas to occipitoaxial line under CT in both groups were compared. The sagittal diameter of the spinal canal at the atlas level under MRI, the Japanese Orthopaedic Association (JOA) score for functional state of cervical spine before operation and at last follow-up were also measured.

There were 9 males and 7 females in the small atlas group, aged (63±12) years. There were 21 males and 25 females in the control group, aged (57±10) years. The patients in both group were followed-up for at least one year. The sagittal diameter of atlas in the small atlas group was (26.4±3.1) mm, which was significantly smaller than that in the control group [(29.6±2.2) mm, P=0.010]. The vertical distance from the posterior tubercle of atlas to the occipitoaxial line in the small atlas group was larger than that in the control group[(6.79±1.17) mm vs (5.57±1.29) mm, P=0.001]. The diameter of atlas canal in the small atlas group was (8.25±1.44) mm which was significantly smaller than that in the control group [(13.00±1.66) mm, P<0.001]. The JOA score of the small atlas group before operation and at the last follow-up were both slightly lower than that in the control group (both P<0.05), but there was no significant difference in the recovery rate of JOA score between the two groups (61.9% vs 66.0%, P=0.066). Among the 16 cases in the small atlas group, 5 cases of occipital-axial connection were located at the posterior 1/3 of the posterior arch of atlas, and 11 cases of occipital-axial connection were completely located at the posterior arch of atlas.

The effective sagittal diameter of atlas is smaller in small atlas group which can lead to more severe cervical myelopathy. The presence of a small atlas should be highly suspected when the sagittal diameter of atlas canal is less than 26 mm under CT. The existence of the small atlas should be alert when the occipitalaxial line is located at the dorsal 1/3 or behind of the posterior arch of atlas.

To investigate the association of single nucleotide polymorphisms (SNP) of glutamate receptor metabotropic 5 (GRM5) gene with schizophrenia susceptibility(SZ) in a Chinese Han population.

Twenty-two SNPs located in GRM5 gene in 528 paranoid SZ patients and 528 control subjects recruited from northern Henanwere analyzed. The clinical features of 267 first-episode SZ patients were assessed with the Positive and Negative Syndrome Scale (PANSS).

The SZ group included 264 males and 264 females, aged (27±8) years; the healthy control group had 264 males and 264 females, aged (28±8) years.The differences in the genotypic and allelic frequencies of two SNPs (rs567990 and rs12421343) were statistically significant between the SZ patients and control groups (all P<0.05). The allele frequency of rs504183 was also statistically different between the two groups (P=0.030). When the subjects were stratified by sex, the genotypic and allelic frequencies of rs12421343 in female subjects were statistically different between the SZ patients and control groups. The allele frequencies of SNPs (rs12422021, rs567990, and rs7101540) were also statisticallydifferent between the two groups (all P<0.05). Meanwhile, rs567990 AG+GG carriers had a higher risk for SZ than AA carriers in female subjects(OR=1.946, 95%CI: 1.264-2.995). In addition, the patients with different genotypes (GG, AA+AG) of rs12422021 showed statistically significant differences in PANSS total score(84.8±24.4 vs 75.3±18.6), positive (16.2±4.3 vs 14.4±4.2), excitement (12.4±5.1 vs 10.2±4.1) and cognitive impairment factor scores (15.2±6.8 vs 13.3±3.9) (all P<0.05). The patients with AC and the other two genotypes (AA and CC) of rs504183 showed statistically significant differences in PANSS negative factor score(27.4±9.9 vs 24.7±8.4 and 23.4±8.1, both P<0.05).

The current study provides further evidence that GRM5 is associated with SZ, and suggests a putative sex difference.

To analyze the effects and mechanisms of three commonly used epidural coverings, gelatin sponge, bovine Achilles tendon extract collagen and polyester urethane fiber, in preventing epidural scar adhesions after laminectomy in rats.

Forty-eight adult Wistar rats were excised from L₂ to L₅ lamina to establish laminectomy models, and were divided into four groups with random number table according to different covering materials (12 rats in each group): blank group (group A), gelatin sponge group (absorbable, group B), polyester urethane fiber group (non-absorbable, group C) and bovine Achilles tendon extract collagen group (absorbable, group D). At 4 and 12 weeks postoperatively, the spinal tissues of the operated area were taken for gross observation (Rydell scar adhesion rating criteria) and histological observation (Nussbaum criteria); and the expression of three scar proliferation-related cytokines, basic fibroblast growth factor (bFGF), growth transforming factor β1 (TGF-β1) and vascular endothelial growth factor (VEGF), were measured in the peridural tissues. The differences between the indices in each group were analyzed and compared.

All 48 rats survived, and gross and histological findings at 4 and 12 weeks showed no dural adhesions in the gelatin sponge and bovine Achilles tendon extract collagen groups, adhesions in the polyester urethane fiber group, and heavy adhesions and spinal cord compression in the blank control group. There were significant differences in the Rydell grade and Nussbaum histological score between the absorbable material group and the non-absorbable group (both P<0.05). Western protein blotting at 4 and 12 weeks confirmed that the expression levels of three cytokines, including bFGF, TGF-β1, and VEGF, were lower in the absorbable material group than those in the non-absorbable group (all P<0.01). Immunofluorescence tests at 12 weeks confirmed that the expression of bFGF, TGF-β1 and VEGF were all lower in the gelatin sponge group (9.81±0.81, 12.42±2.35, 8.63±1.76) and the bovine Achilles tendon extract collagen group (12.70±2.02, 8.23±1.03, 10.19±2.67) than those in the polyester urethane fiber group (33.94±2.03, 30.29±2.76, 25.79±1.21) (all P<0.01).

Bovine achilles tendon extract collagen and gelatin sponge can effectively reduce the hyperplasia of scar and dural adhesions after spinal surgery.

The current study analyzed the morphologic features of macular ganglion cell complex (mGCC) thickness in optic pathway-related neuro-ophthalmic diseases by swept-source optical coherence tomography (SS-OCT). mGCC has the location diagnostic value similar to visual field, and the distribution of macular ganglion cells has accurate horizontal, vertical and quadrant characteristics. Specifically, prechiasmatic lesions showed atrophy and thinning of mGCC ring in single eye or mGCC atrophy in the upper and lower half of horizontal demarcation, chiasmatic lesions exhibited atrophy and thinning of mGCC in the half of bilateral nasal side demarcated by mid-vertical line, and retrochiasmatic lesions presented with atrophy of mGCC in the half of mid-vertical line demarcated or 1/4 quadrant. Therefore, the morphological characteristics of mGCC thickness are of value in the location diagnosis of optic path-related neuro-ophthalmic diseases.

This paper reports the diagnosis and treatment of a case of fetal oral mass diagnosed by prenatal ultrasound. The mother found fetal oral mass in the second trimester of pregnancy. Amniotic fluid chromosome karyotype and microarray analysis showed no obvious abnormality. In the third trimester, the tumor grew larger than before. After term, the child was delivered by cesarean section. Because of oral mass affecting feeding, oral mass resection was performed. Postoperative pathological diagnosis was congenital granulosa cell gingivoma. After 4 months of follow-up, the child had good growth and development, and there was no recurrence in the affected area.

N⁶-Methyladenine (m⁶A) Methylation modification is the most common internal transcriptional modification in eukaryotic messenger RNA (mRNA). It is a dynamic and reversible regulatory modification. Regulatory factors include methyltransferase, demethyltransferase and m⁶A recognition protein. In recent years, related studies have found that m⁶A methylation modification plays an important role in the development of tumor. This paper focuses on m⁶A methylation modification and its regulatory factors related concepts, research progress in digestive tract tumors, prognostic evaluation value and therapeutic resistance are reviewed.

Imaging examination is an important part of clinical diagnosis and treatment. The irrational use of imaging examination not only increases the burden of patients seeking medical treatment, delays the opportunity of diagnosis and treatment, but also causes the waste of medical resources and reduces the efficiency of medical system. Establishing a scientific evaluation system for the rationality and necessity of imaging examination has gradually become a hot topic concerned by scholars in many fields such as imaging, medical statistics and medical informatics. This paper summarizes the relevant theories, technologies and methods of imaging applicability evaluation at home and abroad, focuses on the intersection of big data + artificial intelligence technology and imaging applicability evaluation, and looks forward to the development trend of imaging applicability evaluation field, and makes a related review.

Takotsubo cardiomyopathy (TTC) is an important complication of subarachnoid hemorrhage (SAH), which may lead to delayed surgery or endovascular treatment, which in turn affects the prognosis of patients. This prospective follow-up study was conducted to assess the prevalence, severity, influencing factors, and long-term outcome of TTC in patients with non-traumatic SAH. The study included consecutive admissions with a diagnosis of non-traumatic SAH. Initial assessment included brain CT, Hunt-Hess score, mFisher score and WFNS score, 12-lead electrocardiogram, transthoracic echocardiography (TTE), transcranial dual-function ultrasound and collection of laboratory parameters [creatine kinase (CK), creatine kinase isoenzyme (CK-MB), cardiac troponin T, N-terminal B-type natriuretic peptide precursor (NT-proBNP), and urine methoxyepinephrine and isoproterenol]. The diagnosis of TTC is based on the modified Mayo criteria. Patients with TTC are classified into mild and severe categories. Follow-up with TTE, Glasgow Outcome Scale (GOS), Barthel's and Karnofsky scores was performed on days 30 and 180.

Since 1995, the rapid advance in medical treatment modalities for patients with asymptomatic carotid stenosis, with studies showing that medical treatment alone can improve patient outcomes, raises questions about the absolute benefits of surgical intervention to prevent stroke in patients. The best management of patients with asymptomatic severe carotid stenosis is uncertain due to the lack of comparison of recent data on medical and surgical treatment. The aim of the study was to describe the long-term risk of stroke in patients with asymptomatic severe carotid stenosis who have not undergone surgical intervention in a more modern, racially and ethnically diverse community population.