2019 Vol. 10, No. 1

China Healthcare Big Data
Abstract:
Chronic obstructive pulmonary disease (COPD) is a common lethal disease. In China, it has the third incidence rate and is also the third leading cause of death. Over the past decades, there is a rapid growth in the prevalence of COPD. The three significant causes are the growth of smoking population, severe air pollution, and the aggravating trend of the aging population. Insufficient clinical application of spirometry is a huge obstacle in the diagnosis and treatment of COPD in China. The reasons for the limited use of spirometry in clinical practice, especially in most primary medical institutions, include poor understanding of the significance of pulmonary function tests, lack of equipment, and financial constraints. Main methods for the prevention of COPD include smoking cessation, control of air pollution, and the promotion of pulmonary function testing.
Editorial
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Along with the continuous development of radiological imaging techniques, there are three important aspects of the clinical diagnostic pathway of radiological imaging in the new era, including the multidisciplinary team, establishing and following clinical guidelines, and clinical application of new techniques such as artificial intelligence. Radiologists can play a more important role in patients' diagnosis and treatment and demonstrate their value to their colleagues, healthcare systems, and society through the clinical pathway.
Guidelines and Consensuses
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Coronary computed tomography angiography(CCTA)has become one of the safe and reliable techniques for clinical screening of coronary artery disease. With the development of technology, a large number of upscale CT scanners have been in clinical application in recent years. However, there are still a lot of unreasonable and non-standardized phenomena in scanning indications, scanning methods, and the use of contrast agents. The standardization of CCTA scan and report needs to be improved urgently. The purpose of this consensus is to establish the common guidelines for standardization of indications, scan, and report, so that to promote standardized application nationwide.
Abstract:
Acquired immunodeficiency syndrome (AIDS) is an important public health problem in China. In 2005, the first edition of the guidelines for the diagnosis and treatment of AIDS was formulated by the AIDS Professional Group of Society of Infectious Diseases of Chinese Medical Association, which was updated in 2011 and 2015, respectively. The fourth edition of the guidelines in 2018 is revised on the basis of the third edition and updated according to national clinical practice and the latest research results. The new research progress in opportunistic infections and human immunodeficency virus(HIV) associated cancers, antiretroviral therapy, HIV post-exposure prophylaxis, and prevention of mother to child transmission were updated in these guidelines. In the 2018 edition, pre-exposure prophylaxis is mentioned for the first time. The strategy of whole course management of HIV infection is put forward and how to do the whole course management of HIV infection is detailed in this version. These guidelines will be updated regularly according to the latest clinical evidence.
Original Contributions
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  Objective   The study aimed to explore the risk factors of atherosclerosis in the intracranial anterior circulation (AC) and posterior circulation (PC), and to explore their features of conventional high-resolutionmagnetic resonance imaging (HRMRI) and radiomics approach.   Methods   Consecutive patients with suspected symptomatic intracranial arterial stenosis were enrolled from Beijing Tian Tan Hospital and Chinese People's Liberation Army General Hospital between September 2014 and January 2017. All patients underwent HRMRI. Related risk factors (age, hypertension, diabetes mellitus, hyperlipidemia, smoking, obesity, sex), conventional HRMRI features (plaque distribution, calcification, hemorrhage, remodeling pattern), and radiomic features were compared between the AC and PC groups. All plaques were segmented manually.   Results   A total of 141 patients were enrolled in this study. There were 60 patients in the AC group (including 52 with infarction and 8 with transient ischemic stroke) and 81 patients in the PC group (including 62 with infarction and 19 with transient ischemic stroke); ischemic type showed no statistical significance between the two groups (χ2=2.282, P=0.131). Among the risk factors, hypertension, diabetes mellitus, and hyperlipidemia showed the statistically different between the AC and PC groups (χ2=7.047, 5.979, 11.176, and P=0.008, 0.014, 0.001, respectively). Sixty-three culprit plaques of AC and 105 of PC were identified and the plaque distribution between AC and PC groups showed a significant difference (χ2=34.363, P < 0.001). Among 178 radiomic features, 21.3%(37/174) showed significantly different between AC and PC plaques (t=2.0052-7.7029, P < 0.05). The five selected features with the highest discriminant accuracy were GLCM Cluster Shade, Shape maximum 2D Diameter Colum, Shape maximum 2D Diameter Row, Firstoder Skewness, and Shape Least Axis, and their area under the receiver operating curve were 0.807, 0.760, 0.786, 0.791, and 0.746, respectively.   Conclusions   There are significant differences in risk factors, conventional HRMRI features, and radiomic features between intracranial AC and PC atherosclerosis. More differences can be detected by radiomic features rather than the conventional HRMRI.
Abstract:
  Objective   This study aimed to investigate the short-term weight loss after laparoscopic sleeve gastrectomy and its correlation with visceral adipose tissue distribution in patients with moderate to severe obesity.   Methods   The clinical information of moderately to severely simple obesity patients who underwent laparoscopic sleeve gastrectomy in Peking Union Medical College Hospital from November 2015 to August 2017 was retrospectively analyzed, including age, gender, height, body weight, and abdominal CT images within one week before the operation. The visceral adipose tissue area, total adipose tissue area, and visceral adipose tissue ratio weredetermined by a Siemens post-processing workstation. The body weight of the patients was followed up at 1, 3, and 6 months after surgery; the percentage of total weight loss (%TWL) and the percentage of excess weight loss (%EWL) were calculated.   Results   A total of 20 patients who met the inclusive and exclusive criteria were enrolled in this study, 2 men and 18 women, with an average age of (28.2±6.6) years old. Their preoperative weight was (118.5±20.9)kg, body mass index (BMI) was (41.3±7.8)kg/m2. At the umbilical plane level, the visceral adipose tissue, the subcutaneous adipose tissue, the total adipose tissue, and the visceral adipose tissue ratio were (196.1±49.3)cm2, (738.2±152.7)cm2, (934.3±169.7)cm2, and (21.1±4.6)%. At 1, 3, and 6 months after laparoscopic sleeve gastrectomy, the body weights were (105.4±19.7)kg, (96.0±19.8)kg, and (88.3±17.5)kg; BMIs were (37.1±7.4)kg/m2, (33.8±7.6)kg/m2, and (31.1±6.6)kg/m2; %EWLs were (29.3±9.7)%, (50.0±14.8)%, and (65.3±18.1)%, respectively; all these criteria showed a continuously downward trend. The proportions of successful weight loss (%EWL >50%) at 1, 3, and 6 months after surgery were 0, 55%, and 70%, respectively.%EWL was negatively correlated with the preoperative weight (R=-0.604, P=0.005), BMI (R=-0.621, P=0.005), total adipose tissue (R=-0.686, P=0.001), and positively corrected with the ratio of visceral adipose tissue (R=0.504, P=0.024).   Conclusions   Short-term weight loss after laproscopic sleeve gastrectomy is obvious. Low preoperative body weight, low BMI, and high visceral adipose tissue may be the predictors for effective weight loss after laparoscopic sleeve gastrectomy.
Specialist Forum
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Primary cardiomyopathies were previously defined as primary myocardial disorders of unknown causes, in which the secondary effect of ischemia, hypertension, diabetes, and hyperthyroidism, etc. was excluded. The clinical diagnostic pathway was limited to describing the structural and functional abnormalities, such as dilatation, hypertrophy, restrictive cardiomyopathies, and systolic or diastolic heart failure. With the progression of diagnostic techniques, especially of high-resolution imaging and molecular precision medicine, the previous definition and pathway cannot satisfy clinical demands. Accordingly, large medical centers with sufficient equipment should adopt a new clinical diagnostic pathway including high-resolution imaging and genetic analysis in the new era, which would supply more precise information of cardiac images and particular genetic abnormalities. This new pathway will greatly help the radiomics analysis, gene therapy, the development of targeted drugs, and genetic counseling for patients with cardiomyopathies.
Abstract:
Pancreatic ductal carcinoma(PDAC)is a highly malignant tumor of the digestive tract. The common problems in its diagnosis and treatment include:(1)screening and early detection; (2)accurate diagnosis and staging; (3)differential diagnosis; (4)follow-up and treatment evaluation, in which imaging plays an important role. This article summarized the role and value of various imaging examinations in the diagnosis and treatment of PDAC, explained the advantages and limitations of various imaging examinations, provided evidence-based PDAC imaging examination process, and focused on the key points of PDAC imaging diagnosis and differential diagnosis, so as to better guide clinical decision-making and improve the prognosis of patients with PDAC.
Reviews
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In response to the reform of the healthcare system, necessary evolution of the mode of radiologists' work has shifted from writing large amounts of reports to becoming the core-component of the multidisciplinary team (MDT). Radiologists play an important role in the quality and safety of medical care, education, advocacy, research, and economics. MDT provides a critical opportunity for radiologists to demonstrate their value to their clinical colleagues, patients, administration, and society.
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Pancreatic cancer is the most common pancreatic tumor, with a 5-year survival rate of less than 5%. Therefore, early detection, effective evaluation and appropriate treatment are critical to the disease. Since diffusion weighted imaging (DWI) was first reported in 1984, it has become more and more important in clinical research and applications. As part of the sequence of magnetic resonance imaging, DWI provides important information for the diagnosis and differential diagnosis of pancreatic cancer, as well as for the evaluation of therapeutic effects. This article reviews the technology of DWI and its application in the diagnosis of pancreatic cancer.
Clinical Research and Evidence Based Medicine
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Clinical data are abundant, but there are some problems that limit clinicians' use of these data for clinical research, such as incomplete baseline data, confounding bias due to nonrandom grouping, and higher loss of follow-up. The inherent defects of retrospective design can be overcome by limitations, matching, stratification, multivariate analysis, propensity score, and other methods. This article elaborated how to do a high-quality cohort study from the perspectives of design, analysis and paper writing.
Clinical Biobank
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The signing of the informed consent is the core of the ethical construction of biobank. Based on the characteristics of current biobank construction, this paper proposed the standardized design, or the example template, of biobank's informed consent. The consent is comprised of two main contents, namely "the informed consent" and "the independent consent". This paper delineated in detail both of these two parts, i.e., "fully informing the donors " and "complete informing the biobank". This paper presented a list and related requirements, hopefully, to provide a reference for practitioners of the biobank.
Bacteria & Resistance
History of Medicine
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Paul C. Hodges, M.D. of the University of Washington, USA, was invited in 1919 to serve as the director of the Department of Radiology of Peking Union Medical College. During his eight years in China, he had made important contributions to improving radiological diagnostics and developing radiation therapy. He equipped and improved X-ray machines, established a standard X-ray inspection system, successfully designed a simple portable X-ray machine system that could be applied to domestic power supply conditions, and widely installed these machines in northern, central, southern China. In addition, he set up an X-ray school and held summer training courses. He trained many Chinese radiology experts including C. K. Hsieh, Dushan Rong, Jing Wu, Guozhen Li, Shaoxun Wang, etc. Considering his tremendous contribution in providing solid talents and technical support for the early development of China's radiology, he can be regarded as the founder of China's radiology.
Yu-pei Zhao
2019, 10(1): 1-1.
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Jing Guo
2019, 10(1): 67-67.
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Huiting Liu
2019, 10(1): 95-96. doi: 10.3969/j.issn.1674-9081.2019.01.016
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Bacteria & Resistance
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Antimicrobial resistance has become a severe challenge worldwide. In China, due to misunderstanding the function of antimicrobials, antimicrobial drugs are abused by the public. The resistance rate of Acinetobacter baumannii to carbapenems has risen to 71.4%. Facing such a severe problem, it is urgent to strengthen the control of antimicrobials. With the awareness and action of the government, this situation has partially improved. Rational use of antimicrobials is becoming more and more accepted by the public. The resistance rate of Enterobacteriaceae bacteria to carbapenems becomes stable, mostly < 10%, and the rate of methicillin-resistant Staphylococcus aureus has greatly reduced from 69% to 38.4%. But it is still necessary to strengthen the management of antimicrobials and take effective measures to prevent resistance and to achieve the grand goal of a healthy China.