Abstract:Reperfusion therapy has significantly reduced the mortality of patients with acute ST-segment elevation myocardial infarction (STEMI), but the associated heart failure mortality is on a rise. It is important to seek novel cardioprotective therapies to improve clinical outcomes. Cardiac magnetic resonance (CMR) is an important imaging modality for assessing the efficacy of the novel therapies and the prognosis of the patients. T1 mapping and T2 mapping have provided new insights into the pathophysiology underlying myocardial edema, microvascular obstruction, intramyocardial hemorrhage, and the remote myocardial interstitial space after reperfused STEMI. This review sums up the recent advances on the application of the CMR in reperfused STEMI.

Abstract:Clinical evaluation of cardiac function is routine and important. Cardiac magnetic resonance (CMR) cine sequence can obtain dynamic images of the whole cardiac cycle. Based on echocardiographic techniques, CMR has been used to establish a set of scanning sequences and an evaluation index system to evaluate cardiac function, including ejection fraction, ventricular mass index, strain, interventricular septum curvature ratio, tricuspid annular plane systolic excursion and vascular compliance. Understanding the principles, significance and indications of these indicators is helpful to optimize the scanning sequence and make timely and effective diagnosis, which is of great significance for clinical treatment and prognosis evaluation. This review sums up the status and progress of clinical application of CMR in evaluation of cardiac function.

Abstract:Recent advances have droven cardiac magnetic resonance (CMR) from late gadolinium enhancement (LGE) sequence to multi-modality imaging, and CMR has become one of the imaging methods to detect myocardial histological abnormalities. CMR can provide detailed myocardial anatomical and functional information, and can accurately assess myocardial histological abnormalities from qualitative or quantitative, macroscopic or microscopic and even molecular perspectives. Various CMR methods, including LGE sequence, mapping sequence, diffusion-weighted imaging and magnetic resonance spectroscopy, have their own advantages in the diagnosis and treatment and in deep understanding of the mechanisms. And they are of great significance for knowing and treating myocardial diseases. This review summarizes the advantages and clinical application of the myocardial tissue characterization imaging methods in evaluating different kinds of cardiomyopathy.

Abstract:Objective To quantitatively evaluate the left atrial function in healthy Chinese population by cardiac magnetic resonance-feature tracking (CMR-FT). Methods Healthy individuals with normal magnetic resonance examination results were enrolled according to the inclusion criteria. Cardiac long- and short-axis images and cine were obtained using semi-Fourier single-shot technique and balanced steady-state free precession sequence. The left atrial function parameters, including left atrial volume, ejection fraction, strain and strain rate, were measured by 2 independent observers. Two independent sample t test was used to compare the parameters between males and females. One-way analysis of variance was performed to compare the parameters among different age groups. Results A total of 63 volunteers were included in this study. Of 63 volunteers, 34 were males and 29 females; and 19 volunteers were aged ≤ 29 years, 23 were aged 30-44 years and 21 were aged ≥ 45 years. The anteroposterior diameter of left atrium was (26.1±4.5) mm, and the transverse diameter was (54.8±5.9) mm. The total ejection fraction of left atrium was (63.5±6.9)%, total strain was (45.9±11.7)%, and total strain rate was (1.5±0.5) s^-1. The passive ejection fraction of left atrium was (24.6±9.1)%, passive strain was (22.2±8.1)%, and passive strain rate was (-0.8±0.3) s^-1. The active ejection fraction of left atrium was (51.3±8.9)%, active strain was (23.7±9.2)%, and active strain rate was (-1.3±0.5) s^-1. There were significant differences in the body surface area, the left atrial diameters, maximal volume and pre-active contraction volume between the males and the females (all P<0.05), while the differences in the other left atrial function parameters were not significant (all P>0.05). There were significant differences in the left atrial conduit function among the different age groups (all P<0.05), while there were no significant differences in reservior or booster pump function parameters. Correlation analysis showed that there were positive correlations between total ejection fraction and total strain, passive ejection fraction and passive strain, and active ejection fraction and active strain (r=0.77, 0.74 and 0.77; all P<0.01). The correlation coefficients of all left atrial function parameters were all >0.6, and the Bland-Altman analysis showed better consistency between the two observers. Conclusion CMR-FT can be used to obtain parameters related to left atrial function in healthy Chinese population due to its high repeatability.

Abstract:Objective To perform cardiac magnetic resonance (CMR) examination with 2-shot compressed sensing (CS) cardiac cine imaging (cine) technique, so as to obtain high-quality images that can quickly and accurately assess cardiac function and are closer to the standard cine sequence. Methods The patients, who underwent CMR examination in Department of Radiology of Peking Union Medical College Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College from Jul. to Sep. 2018, were continuously enrolled. All enrolled patients received the standard cine sequence, single-shot (ss) CS cine sequence and 2-shot CS cine sequence image acquisition. Quantitative analyses of image quality and cardiac function were performed on each cine image acquired from different sequences. Results Twenty-two patients completed the three types of cine sequences. The average acquisition time of standard cine sequence, ss CS cine sequence and 2-shot CS cine sequence was (102.50±18.55), (20.50±3.71) and (30.75±5.57) s, respectively. The median total image quality scores of the standard, ss CS and 2-shot CS cine sequences were 4, 3 and 4, respectively. There was significant difference in the total quality scores between the standard cine sequence and the ss CS cine sequence (Z=-2.828, P=0.005), while there was no significant difference between the standard cine sequence and the 2-shot CS cine sequence (Z=-1.000, P=0.317). In the quantitative study of cardiac function parameters, left ventricular myocardial mass was significantly different between the standard cine sequence and the ss CS cine sequence (100.25[47.30-136.02] g vs 101.25[48.30-135.30] g, Z=-2.484, P=0.013), but there were no significant differences in the other parameters. There were no significant differences in the cardiac function parameters between the standard cine sequence and the 2-shot cine sequence. Spearman correlation analysis showed that there were good correlations in the cardiac function parameters between the standard cine and the ss CS cine, and the standard cine and the 2-shot CS cine (all P<0.01). Conclusion The acquisition time of 2-shot CS cine and ss CS cine sequences is significantly shorter than that of standard cine sequence. However, 2-shot CS cine sequence can obtain images closer to the images obatined by standard cine sequence, which can be used to accurately evaluate the cardiac function.

Abstract:Objective To explore the effect of cardiac magnetic resonance (CMR) imaging parameters on prognosis of the patients with pulmonary hypertension (PH). Methods Ninety PH patients, who were diagnosed by right heart catheterization and received CMR examination in our hospital, were enrolled for this study. The cardiac functional parameters, including end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI) and ejection fraction (EF) of the right ventricle and left ventricle, and tricuspid annular plane systolic excursion (TAPSE), were analyzed. The study end-point was major adverse cardiovascular event (MACE). Two independent sample t test was used to analyze the differences of CMR parameters between MACE group and non-MACE group. Cox proportional hazards regression model was used to determine the independent predictors of end-point events. Kaplan-Meier survival curve was drawn based on the optimal cut-off value of receiver operating characteristic (ROC) curve. Results Compared with the non-MACE group, the right ventricular EF, left ventricular SVI and TAPSE were decreased in the MACE group ([27.00±9.92]% vs[32.68±11.34]%,[29.14±8.73] mL/m² vs[35.41±11.59] mL/m² and[12.51±4.17] mm vs[16.04±7.37] mm), while the right ventricular EDVI and ESVI were increased ([139.72±48.70] mL/m² vs[116.07±44.79] mL/m² and[104.26±42.88] mL/m² vs[79.37±35.67] mL/m²), and the differences were significant (t=-2.065, -2.286, -2.089, 2.076 and 2.668, all P<0.05). Multivariate analysis showed that left ventricular SVI and TAPSE were independent predictors of MACE in the PH patients (hazard ratio[HR]=0.942 and 0.904, P=0.039 and 0.022). The optimal cut-off values of left ventricular SVI and TAPSE determined by ROC curve were 30.27 mL/m² and 15.65 mm, respectively. Kaplan-Meier survival analysis showed that the incidence of MACE was significantly increased when left ventricular SVI ≤ 30.27 mL/m² or TAPSE ≤ 15.65 mm (P=0.001 and 0.019). Conclusion The left and right heart functions of PH patients with MACE are poor. TAPSE and left ventricular SVI are the independent predictors of MACE in the PH patients.

Abstract:Objective To investigate the incidence and cardiac magnetic resonance imaging features of coronary atherosclerotic artery disease (CAD) in the patients with hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM). Methods A retrospective study was conducted on the clinical and imaging data of the patients who had HCM or DCM diagnosed by cardiac magnetic resonance examination and received coronary examination (coronary angiography or computed tomography) from Sep. 2015 to Sep. 2018. According to the severity of coronary stenosis, the patients with HCM or DCM were divided into normal coronary group, coronary atherosclerosis group (lumen stenosis ≤ 50%) and CAD group (lumen stenosis>50%). The incidence of coronary diseases and the clinical and magnetic resonance imaging features were compared among the three groups. Results A total of 681 patients with primary cardiomyopathy were examined by cardiac magnetic resonance. Two hundred and nineteen of them underwent coronary angiography or computed tomography, including 126 cases with HCM, 78 cases with DCM and 15 cases of other types with cardiomyopathy. The incidence of coronary atherosclerosis and CAD in the HCM patients was 31.7% (40/126) and 21.4% (27/126), respectively, which was not significantly different from that in the DCM patients (30.8%[24/78] and 17.9%[14/78], respectively; both P>0.05). In the patients with HCM and DCM, the mean ages of the CAD group and coronary atherosclerosis group were (62.6±9.8) and (60.1±7.2) years, and (59.3±9.5) and (58.5±8.8) years, respectively, which were higher than those of the normal coronary group ([49.5±11.0] and[49.3±12.9] years, respectively), and the differences were significant (all P<0.05). Both HCM and DCM patients with cardiovascular risk factors (diabetes, smoking, hypertension, hyperlipidemia or obesity) had high incidence of CAD (70.4%[19/27] and 71.4%[10/14], respectively). The left ventricular stroke volume of the CAD group in the HCM patients was significantly lower than those of the normal coronary and coronary atherosclerosis groups ([50.4±21.1] mL vs[64.6±22.9] mL and[64.1±27.1] mL, both P<0.05). There were no significant differences in the left ventricular end-diastolic diameter, detection rate of intramyocardial fibrosis or other left ventricular function parameters among the three groups both in the HCM and DCM patients (all P>0.05). Conclusion Both HCM and DCM patients can be complicated with CAD. Cardiac magnetic resonance imaging can be used to diagnose cardiomyopathy, especially in the differential diagnosis of CAD with myocardial infarction.

Abstract:Objective To explore the value of 3.0 T cardiac magnetic resonance (CMR) intravoxel incoherent motion (IVIM) for evaluating microvascular dysfunction in hypertrophic cardiomyopathy (HCM) patients. Methods Twenty-six HCM patients and 12 healthy controls, who received CMR examination in the First Hospital of Lanzhou University from Apr. 2016 to Oct. 2017, were enrolled. All volunteers underwent short-axis cardiac cine and IVIM scans, and HCM patients underwent late gadolinium enhancement (LGE) scan. The fraction of fast apparent diffusion coefficient (f), fast apparent diffusion coefficient (ADC_fast) and slow apparent diffusion coefficient (ADC_slow) were measured using MITK-Diffusion post-processing software. End-diastolic thickness (EDTH) was measured on short-axis cine image. HCM patients were grouped according to the severity of the left ventricular hypertrophy and whether having LGE or not. The differences of f value, ADC_fast and ADC_slow were compared between HCM patients and healthy controls, non-hypertrophic segments and hypertrophic segments of HCM patients, LGE segments and non-LGE segments of HCM patients, and different hypertrophic subgroups in hypertrophic segment group. Spearman correlation analysis was performed to explore the correlation between IVIM parameters (f value, ADC_fast and ADC_slow) and EDTH in each segment. Results The ADC_slow and ADC_fast of the HCM patients were lower than those of the healthy controls (ADC_slow:0.003[0.002, 0.005] mm²/s vs 0.004[0.002, 0.007] mm²/s, ADC_fast:0.046[0.025, 0.074] mm²/s vs 0.069[0.052, 0.086] mm²/s), and the differences were significant (Z=-2.434 and -7.268, both P<0.05). There was no significant difference in the f value between the HCM patients and healthy controls (P>0.05). The ADC_fast values of the non-hypertrophic segment group and the hypertrophic segment group in the HCM patients were 0.051 (0.029, 0.077) mm²/s and 0.027 (0.019, 0.052) mm²/s, respectively, which were both significantly lower than that of the healthy controls (Z=-5.505 and -8.144, both P<0.01). The f value and ADC_fast of the hypertrophic segment were significantly lower than those of the non-hypertrophic segment (0.444[0.080, 0.834] vs 0.735[0.302, 0.877] and 0.027[0.019, 0.052] mm²/s vs 0.051[0.029, 0.077] mm²/s, Z=-3.527 and -4.722, both P<0.01). There was significant difference in ADC_fast between the mild, moderate, severe and extremely severe hypertrophic segment subgroups (0.035[0.021, 0.061] mm²/s, 0.023[0.015, 0.038] mm²/s, 0.018[0.013, 0.025] mm²/s and 0.012[0.005, 0.055] mm²/s, respectively; H=9.769, P=0.021); however, pairwise comparison showed no significant differences (all P>0.05). The f value and ADC_fast of the segmental myocardia with LGE were significantly lower than those without LGE (Z=-2.704 and -2.143, P=0.007 and 0.032). Spearman correlation analysis showed that EDTH was significantly negatively correlated with f value and ADC_fast (r=-0.195 and -0.282, both P<0.01). Conclusion CMR IVIM technology can non-invasively and quantitatively reflect cardiac microvascular dysfunction in HCM patients. The severity of microvascular dysfunction is related to the severity of myocardial hypertrophy. Microvascular dysfunction is also present in non-hypertrophic and non-LGE myocardia.

Abstract:Objective To assess the myocardial microcirculation of patients with hypertension using intravoxel incoherent motion (IVIM) diffusion-weighted imaging, and to analyze the differences compared with normal volunteers. Methods Thirty normal volunteers and 18 hypertensive patients, who underwent cardiac magnetic resonance cine and IVIM scans in our hospital from May 2015 to Sep. 2018, were enrolled. The IVIM scan was performed on middle view of left ventricular short-axis with 8 b values (20, 50, 80, 100, 120, 200, 300 and 500 s/mm²). The structural and functional parameters were measured on left ventricular short-axis, and the IVIM parameters (fast apparent diffusion coefficient[ADC_fast], slow apparent diffusion coefficient, fraction of ADC_fast) were measured using biexponential model. The differences of all parameters were analyzed between the normal volunteers and hypertensive patients. Results The left ventricular ejection fraction, cardiac output and myocardial mass of the hypertensive patients were higher than those of the normal volunteers ([68.39±7.51]% vs[63.20±5.22]%,[6.84±2.03] L vs[5.41±1.08] L, and[122.54±33.63] g vs[85.97±25.42] g), and the differences were significant (t=-2.75, -2.64 and -4.15; all P<0.05). There were no significant differences in the left ventricular end-diastolic volume, end-systolic volume, stroke volume or cardiac index between the hypertensive patients and normal volunteers (all P>0.05). The ADC_fast of the hypertensive patients was significantly lower than that of the normal volunteers (0.12[0.03-0.17] mm²/s vs 0.14 [0.10-0.21] mm²/s, Z=-2.83, P<0.01). Conclusion The application of IVIM can contribute to evaluating myocardial microcirculation of the hypertensive patients.

Abstract:Objective To quantitatively assess the myocardial triglyceride (TG) content in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD) using ¹H-magnetic resonance spectroscopy (¹H-MRS), and to explore the correlation of TG content with cardiac function parameters and serum biochemical indexes. Methods Fifty-two T2DM patients diagnosed from Jan. 2017 to Aug. 2018 were enrolled. Serum biochemical parameters were measured, and left ventricular function and myocardial relative TG content were evaluated by ¹H-MRS. Dixon technique was used to perform abdominal magnetic resonance imaging to evaluate the percentage of liver lipid content. Pearson correlation analysis was used to investigate the correlation between myocardial relative TG content and cardiac function parameters and serum biochemical indicators. Results The abdominal Dixon technique showed that the percentage of liver lipid content of the T2DM patients with NAFLD was higher than that of the patients without NAFLD ([14.99±5.21]% vs[3.51±1.75]%), and the difference was significant (t=-7.209, P<0.01). ¹H-MRS showed that the myocardial relative TG content was higher in the T2DM patients with NAFLD than that in the patients without NAFLD ([1.87±0.55]% vs[1.19±0.48]%), and the difference was significant (t=-4.105, P<0.01). The myocardial relative TG content of the T2DM patients was significantly positively correlated to the percentage of liver lipid content, interventricular septal thickness (IVS), fasting blood-glucose and left ventricular mass to end-diastolic volume ratio (LVMVR; r=0.582, 0.293, 0.318, and 0.282; P=0.001, 0.035, 0.021, and 0.042). Conclusion ¹H-MRS is a non-invasive quantitative evaluation method for the abnormal metabolism of myocardial TG in the T2DM patients with NAFLD. The myocardial relative TG content of the T2DM patients with NAFLD is related to the percentage of liver lipid content, IVS, fasting blood glucose and LVMVR.

Abstract:Objective To analyze the mortality and influencing factors of hepatobiliary cancer patients using the death data of hepatobiliary malignant tumors of Yangpu District, Shanghai, from 1974 to 2015. Methods Joinpoint regression was used to analyze the mortality trend of hepatobiliary cancer. Age-period-cohort (APC) model was employed to evaluate the effects of age and cohort factors on the mortality rate of hepatobiliary cancer. Results From 1974 to 2015, a total of 9 866 liver cancer deaths were reported in Yangpu District, with a male to female ratio of 2.7:1; and the crude mortality rate and standardized mortality rate were 23.09/100 000 and 18.87/100 000, respectively. A total of 2 173 biliary tract cancer deaths were reported, with a male to female ratio of 1:1.7; and the crude mortality rate and standardized mortality rate were 5.04/100 000 and 3.82/100 000, respectively. Joinpoint regression analysis showed that the standardized mortality rate of liver cancer decreased from 1974 to 2015, while that of biliary tract cancer increased. In APC model, the overall mortality risk of liver cancer and biliary tract cancer increased with the increase of age. The mortality rates of liver cancer and biliary tract cancer were increased in the population born before 1930. The mortality rates of the male liver cancer and the male and female biliary tract cancer were decreased in the population born between 1930 and 1949. The mortality rate of liver cancer was increased in the females born after 1949. Conclusion From 1974 to 2015, the mortality rate of liver cancer has a decreasing trend in Yangpu District, Shanghai, and the mortality rate of male is higher than that of female. The mortality rate of biliary tract cancer shows an increasing trend, and the mortality rate of female is higher than that of male. The mortality rates of liver cancer and biliary tract cancer associated with aging factors have increased. Exposure factors have a consistent effect on liver cancer and biliary tract cancer, which may be related to socioeconomic factors at that time.

Abstract:Objective To evaluate the safety and efficacy of Tubridge and Pipeline embolization devices in the treatment of complex intracranial aneurysms. Methods The clinical data of 99 patients harboring 101 complex intracranial aneurysms, who underwent embolization device treatment between Aug. 2010 and Dec. 2017 in our department, were retrospectively collected and analyzed. Among them, 91 aneurysms were treated for the first time and 10 were recurrent lesions. The mean maximum diameter of the aneurysms was (19.6±6.6) mm. Ninety-four lesions were located in anterior circulation and 7 in posterior circulation. Sixty-one aneurysms of 61 patients were treated with Tubridge embolization device, and 40 of 38 patients were treated with Pipeline embolization device. Clinical and angiographic follow-up were preformed conventionally. Results A total of 116 embolization devices (74 Tubridge and 42 Pipeline) were delivered and implanted successfully. One patient died of delayed hemorrhage, and 2 patients suffered from ischemic events after operation. Angiographic follow-up data was available in 88 aneurysms. The complete occlusion rates of short-term (0-6 months), mid-term (7-18 months) and long-term (>18 months) were 66.7% (42/63), 73.5% (36/49) and 89.3% (25/28), respectively. The complete occlusion rate of all aneurysms was 72.7% (64/88) at the last imaging follow-up, and there was no significant difference between the Tubridge and Pipeline groups (73.6%[39/53] vs 71.4%[25/35], P>0.05). Conclusion Both Tubridge and Pipeline embolization devices are safe and effective in treatment of complex intracranial aneurysms. However, the complications shall not be ignored after implantation of embolization device.

Abstract:Objective To measure the renal volume of polycystic kidney disease rats using low field magnetic resonance imaging (MRI), and to explore its application value in the basic research of polycystic kidney disease. Methods Fifteen Han:SPRD rats with polycystic kidney disease of different ages were subjected to anesthesia, and the kidney volume was measured using low field MRI. The kidney profile was delineated by engineers and clinicians. The imaging method was T1-weighted imaging. The cross section of the kidney was imaged, and the kidney volume was calculated using image processing software. Pearson correlation analysis was used to analyze the correlation between the kidney volume measured by MRI and anatomical volume after dissection, kidney mass, the ratio of kidney mass to body mass, renal function indexes and cyst index. Results The kidney of Han:SPRD rats was clearly observed with low field MRI. The kidney volumes of 15 rats measured by MRI were 1.51, 1.77, 3.54, 6.45, 9.34, 9.38, 3.72, 9.51, 4.95, 5.31, 6.47, 7.01, 5.39, 5.08, and 7.31 cm³, respectively. The anatomical volumes after dissection were 1.50, 1.70, 2.90, 5.00, 7.00, 7.02, 2.50, 7.10, 4.70, 4.90, 6.50, 6.70, 4.20, 4.90, and 7.00 cm³, respectively. The renal volume measured by MRI was highly correlated with the anatomical volume after dissection, kidney mass and the ratio of kidney mass to body mass (goodness of fit[R²] was 0.903 1, 0.912 8 and 0.777 9, respectively), and was also positively correlated with serum creatinine, urea nitrogen and cyst index (correlation coefficients were 0.86, 0.85 and 0.61, respectively). Conclusion Low field MRI can be used to measure kidney volume of polycystic kidney disease rat models in vivo, providing a reference for the basic research of polycystic kidney disease.

Abstract:Objective To explore the effect of osteopontin (OPN) on pancreatic stellate cell (PSC) and its mechanisms. Methods We transfected PSC with OPN lentiviral overexpression vector (OPN-O/E) and constructed empty vector control cells (control group). After PSCs were treated with OPN-O/E or OPN-O/E in combination with Akt inhibitor LY294002 (10 μmol/L and 50 μmol/L), the proliferation ability and chemotactic activity were detected by CCK-8 and Transwell assays, respectively. The expression levels of α-smooth muscle actin (α-SMA) and related proteins of PI3K/Akt signal pathway were determined by Western blotting. Results Compared with the control group, proliferation ability and chemotactic activity of PCS were significantly increased in the OPN-O/E group, and the expression levels of phosphorylated-PI3K (p-PI3K), phosphorylated-Akt (p-Akt) and α-SMA were also significantly increased (P<0.05 or P<0.01). There were no significant differences in the expression levels of PI3K or Akt between the OPN-O/E and control groups (both P>0.05). Compared with the OPN-O/E group, the expression levels of α-SMA and p-Akt were significantly inhibited in the PCS treated with 10 μmol/L or 50 μmol/L LY294002 (all P<0.01); however, there was no significant difference in the Akt expression. Conclusion OPN can activate PSC through the PI3K/Akt signaling pathway, and the proliferation ability and chemotactic activity of activated PSC are also increased.

Abstract:Aquaporin 1 (AQP1) is an aquaporin distributed in the peripheral nervous system. It has been found in neurons and glial cells of peripheral nerve structures, including trigeminal ganglion, dorsal root ganglion and enteric nervous system. AQP1 may be involved in the regulation of water balance of ganglia and nerve fiber bundles in the peripheral nervous system under physiological and pathological conditions, and plays a key role in maintaining the intracellular and extracellular water balance of peripheral nervous system under pathological condition. Knowing the structure and function of AQP1 can contribute to the understanding of the pathophysiology of the nervous system, providing new ways and methods for clinical treatment. This review summarizes the recent researches on AQP1.

Abstract:Endoscopic retrograde cholangiopancreatography (ERCP) is an important technique for the diagnosis and treatment of biliary and pancreatic disorders. ERCP in the patients with surgically altered anatomy (SAA) is more technically demanding with high risks of procedural failure and complications, and it is challenging for the endoscopists. Recently, the development of endoscopic devices and the improvement of operator skills have led to SAA-ERCP progresses. The success rate of ERCP and the incidence of complications are similar to those of the patients with normal anatomy. This paper reviews the recent advances on SAA-ERCP, including the effectiveness and safety, and endoscopy and assisted techniques, and summarizes the clinical features of SAA-ERCP.

Abstract:The United States Army has studied and measured military team performance for over 60 years, and has established a complete theoretical and practical system. However, PLA is still in its infancy in this area. In this review, we introduced the research results on team performance of United States Army from 4 aspects:definition, measurement content, methods of measurement, and requirements for measurement system design. Then we also retrospectively and prospectively reviewed the research and practice of PLA in the team performance measurement.

Abstract:Objective To assess the computed tomography (CT) and magnetic resonance imaging (MRI) features of acinar cell carcinoma of pancreas (ACCP). Methods The clinical data of 5 patients with ACCP confirmed by operation or biopsy were retrospectively analyzed. Among them, 2 patients underwent CT plain scan and enhanced scan, 2 underwent MRI plain scan and enhanced scan, and 1 underwent both CT and MRI plain scan and enhanced scan. The clinical data and imaging features of 5 patients were analyzed. Results The tumor of 1 case occurred in the uncinate process of head of pancreas, and 4 cases in the tail of pancreas. The maximum diameter of the lesion was 44.6-142.3 mm, with an average of 86.14 mm. The density or signal of tumors was not uniform in the 5 patients. Hemorrhage, necrosis and calcification were found in 1 patient, while the other 4 patients only had necrosis. The tumor capsule was intact in 1 case, with tumor located at the head of pancreas, and the capsules were incomplete in the other 4 cases. The enhancement of tumors in the 5 cases was lower than that of normal pancreatic parenchyma and reached the peak value in portal vein phase, and the tumors of all cases had internal necrosis. The patient whose lesion located at the uncinate process of pancreatic head had dilatation of pancreaticobiliary duct. Four tumors located at the tail of pancreas invaded splenic vein, and 2 of them had hepatic metastasis. Conclusion ACCP is characteristic on CT and MRI images, which is helpful for diagnosis and differential diagnosis.

Abstract:Objective To analyze the use of carbapenems in a hospital in 2016, so as to provide evidence for rational use of antibiotics. Methods The medical records of all patients treated with carbapenems in 2016 were collected. The use of antimicrobial agents, types of infections and etiological examinations were investigated. The medication rationality of antibiotics was evaluated, and the inappropriate problems were classified. Results A total of 383 cases were extracted, including 137 (35.78%) females and 246 (64.22%) males, with an average age of (59±12) years and a median age of 61 years. The total inspection rate was 95.30% (365/383). A total of 258 cases (67.36%) received the medicine according to the drug sensitivity results. The drug utilization indexes of imipenem/cilastatin sodium and biapenem were 1.29 and 0.76, respectively. There were 60 cases (15.67%) of irrational use of carbapenems. Conclusion There is still unreasonable clinical use of carbapenems in the hospital in 2016. The rationality evaluation of carbapenems use is conducive to understanding the clinical use and finding the typical problems, so as to provide reference for rational drug intervention.

Abstract:Objective To investigate the relationship between stress and social anxiety of medical students in military universities, and to explore the related mechanisms. Methods Two hundred and eleven military medical university students were tested by interaction anxiousness scale (IAS), stress scale for college students (SSCS) and Connor-Davidson resilience scale (CD-RISC). The Pearson correlation analysis and structural equation model were used to analyze the relationship between the variables. Results A total of 198 valid questionnaires were collected, with the effective rate being 93.8%. There were significant correlations between social anxiety and various dimensions of stress and resilience (all P<0.01). Structural equation model showed that the resilience partially mediated the relationship between stress and social anxiety (χ²/df=2.08, P<0.05; root mean square error of approximation=0.074, comparative fit index=0.98, normed fit index=0.97, incremental fit index=0.98). The total stress score of the male students was greater than that of the female students in military medical universities (24.67±15.01 vs 20.17±13.07, t=2.17, P<0.05). Conclusion Resilience has partial mediating effect on the relationship between stress and social anxiety. Therefore daily management of military medical university students should be emphasized on the cultivation of resilience.