OBJECTIVES:To evaluate the effects of combat sports on cerebellar function in adolescents based on resting-state functional MRI (rs-fMRI).METHODS:Rs-fMRI data were acquired from the combat sports (CS) group (n = 32, aged 14.2 ± 1.1 years) and non-athlete healthy control (HC) group (n = 29, aged 14.8 ± 0.9 years). The amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) within the cerebellum was calculated and then compared between the two groups.RESULTS:None of these participants displayed intracranial lesions on conventional MRI and microhemorrhages on SWI. Compared with the HC group, the CS group showed decreased ALFF and ReHo in the bilateral cerebellum, mainly located in the inferior regions of the cerebellum (Cerebellum_8, Cerebellum_9, Cerebellum_7b, and Cerebellum_Crus2). While increased FC was found within the cerebellar network, mainly located in the superior regions near the midline (bilateral Cerebellum_6, Cerebellum_Crus1_R, and Vermis_6). There is no internetwork FC change between the CEN and other networks.CONCLUSION:This study confirmed extensive effects of combat sports on cerebellar rs-fMRI in adolescents, which could enhance the understanding of cerebellar regulatory mechanism under combat conditions, and provide additional information about cerebellar protective inhibition and compensatory adaptation.ADVANCES IN KNOWLEDGE:Adolescent combat participants are an ideal model to study training-induced brain plasticity and vulnerability. Relative to task-related fMRI, rs-fMRI can bring more information about cerebellar regulation and explain the Central Governor Model more comprehensively.

Background Preoperative assessment of the consistency of pituitary macroadenomas (PMA) might be needed for surgical planning. Purpose To investigate the diagnostic performance of radiomics models based on multiparametric magnetic resonance imaging (mpMRI) for preoperatively evaluating the tumor consistency of PMA. Study Type Retrospective. Population One hundred and fifty‐six PMA patients (soft consistency, N = 104 vs. hard consistency, N = 52), divided into training ( N = 108) and test ( N = 48) cohorts. The tumor consistency was determined on surgical findings. Field Strength/Sequence T1‐weighted imaging (T1WI), contrast‐enhanced T1WI (T1CE), and T2‐weighted imaging (T2WI) using spin‐echo sequences with a 3.0‐T scanner. Assessment An automated three‐dimensional (3D) segmentation was performed to generate the volume of interest (VOI) on T2WI, then T1WI/T1CE were coregistered to T2WI. A total of 388 radiomic features were extracted on each VOI of mpMRI. The top‐discriminative features were identified using the minimum‐redundancy maximum‐relevance method and 0.632+ bootstrapping. The radiomics models based on each sequence and their combinations were established via the random forest (RF) and support vector machine (SVM), and independently evaluated for their ability in distinguishing PMA consistency. Statistical Tests Mann–Whitney U ‐test and Chi‐square test were used for comparison analysis. The area under the receiver operating characteristic curve (AUC), accuracy (ACC), sensitivity (SEN), specificity (SPE), and relative standard deviation (RSD) were calculated to evaluate each model's performance. ACC with P ‐value<0.05 was considered statistically significant. Results Eleven mpMRI‐based features exhibited statistically significant differences between soft and hard PMA in the training cohort. The radiomics model built on combined T1WI/T1CE/T2WI demonstrated the best performance among all the radiomics models with an AUC of 0.90 (95% confidence interval [CI]: 0.87–0.92), ACC of 0.87 (CI: 0.84–0.89), SEN of 0.83 (CI: 0.81–0.85), and SPE of 0.87 (CI: 0.85–0.99) in the test cohort. Data Conclusion Radiomic features based on mpMRI have good performance in the presurgical evaluation of PMA consistency. Level of Evidence 3 Technical Efficacy Stage 2

Purpose To explore the effects of combat sports on functional network connectivity (FNC) in healthy adolescents. Methods Resting-state fMRI data were acquired from the combat sports (CS) group (n = 32) and non-athlete healthy control (HC) group (n = 29). Resting-state networks (RSNs) were obtained based on independent component analysis (ICA), and FNC analysis was performed. Then, the intra-network and inter-network connections were compared between the two groups. Results Compared with the HC group, the CS group demonstrated increased intra-network FC within the sensorimotor network (SMN), visual network (VIN), and cerebellum network (P < 0.01, FDR correction). Besides, decreased inter-network FC was found in the SMN-VIN, SMN-auditory network, SMN-default mode network, attention network (AN)-VIN, and AN-executive control network connections (P < 0.01, FDR correction). Conclusion This study showed a complex relationship between combat sports and FNC in adolescents. The observed FNC patterns in the CS group may reflect training-related brain network optimization, early signs of subclinical brain damage, or preexisting differences. The extensive effects of combat sports on FNC in adolescents could expand our understanding of neuromodulatory mechanisms.

OBJECTIVES:To evaluate the subtype imaging features of basal ganglia germ cell tumors (GCTs).METHODS:Clinical and imaging data of 33 basal ganglia GCTs were retrospectively analyzed, including 17 germinomas and 16 mixed germ cell tumors (MGCTs).RESULTS:The cyst/mass ratio of germinomas (0.53 ± 0.32) was higher than that of MGCTs (0.28 ± 0.19, p = 0.030). CT density of the solid part of germinomas (41.47 ± 5.22 Hu) was significantly higher than that of MGCTs (33.64 ± 3.75 Hu, p < 0.001), while apparent diffusion coefficients (ADC, ×10-3 mm2/s) value of the solid part was significantly lower in geminomas (0.86 ± 0.27 ×10-3 mm2/s) than in MGCTs (1.42 ± 0.39 ×10-3 mm2/s, p < 0.001). MGCTs were more common with intratumoral hemorrhage (68.75% vs 11.76%, p = 0.01), T1 hyperintense foci (68.75% vs 5.88%, p < 0.001) and calcification (64.29% vs 20.00%, p = 0.025) than germinomas. There was no significant difference in internal capsule involvement between the two subtypes (p = 0.303), but Wallerian degeneration was more common in germinomas than in MGCTs (70.59% vs 25.00%, p = 0.015).CONCLUSION:The subtypes of GCT have different imaging features. Tumoral cystic-solidity, heterogeneity, ADC value, CT density, and Wallerian degeneration are helpful to differentiate germinomas and MGCTs in basal ganglia.ADVANCES IN KNOWLEDGE:The subtypes of GCT have different histological characteristics, leading to various imaging findings. The imaging features of GCT subtypes in basal ganglia may aid clinical diagnosis and treatment.

BackgroundThe ABC/2 method is usually applied to evaluate intracerebral hemorrhage (ICH) volume on computed tomography (CT), although it might be inaccurate and not applicable in estimating extradural or subdural hemorrhage (EDH, SDH) volume due to their irregular hematoma shapes. This study aimed to evaluate deep framework optimized for the segmentation and quantification of ICH, EDH, and SDH.MethodsThe training datasets were 3,000 images retrospectively collected from a collaborating hospital (Hospital A) and segmented by the Dense U-Net framework. Three experienced radiologists determined the ground truth by marking the pixels as hemorrhage area. We utilized the Dice and intra-class correlation coefficients (ICC) to test the reliability of the ground truth. Moreover, the testing datasets consisted of 211 images (internal test) from Hospital A, and 86 ICH images (external test) from another hospital (Hospital B). In this study, we chose scatter plots, ICC, and Pearson correlation coefficients (PCC) with ground truth to evaluate the performance of the deep framework. Furthermore, to validate the effectiveness of the deep framework, we did a comparative analysis of the hemorrhage volume estimation between the deep model and the ABC/2 method.ResultsThe high Dice (0.89–0.95) and ICC (0.985–0.997) showed the consistency of the manual segmentations among the radiologists and the reliability of the ground truth. For the internal test, the Dice coefficients of ICH, EDH, and SDH were 0.90 ± 0.06, 0.88 ± 0.12, and 0.82 ± 0.16, respectively. For the external test, the segmentation Dice was 0.86 ± 0.09. Comparatively, the ICC and PCC of ICH volume estimations were 0.99 performed by Dense U-Net that overmatched the ABC/2 method.ConclusionThis study revealed the excellent performance of hematoma segmentation and volume evaluation based on Dense U-Net, which indicated our deep framework might contribute to efficiently developing treatment strategies for intracranial hemorrhage in clinics.

Disclosure 1) The scientific guarantor of this publication is Jun Ma, Vice President of Department of Beijing Tiantan Hospital, Capital Medical University. 2) The authors of this manuscript declare relationships with the following companies:. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. 4) No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. if the study is on human subjects: Written informed consent was from all (patients) OBJECTIVES— A precise assessment of angioarchitectural characteristics using non-invasive imaging is helpful for serial follow-up and weighting risk of natural history in uruptured brain arteriovenous malformation (bAVM). This study aimed to test the hypothesis that susceptibility weighted image (SWI) would provide an accurate evaluation of angioarchitectural features of unruptured bAVM. METHODS— A total of 81 consecutive patients with unruptured bAVM were examined. Image quality of SWI for the assessment of bAVM angioarchitectural features were determined by a five-point scale. The accuracy of SWI for detection of angioarchitectural features was evaluated using DSA as a standard reference. And further compared among unruptured bAVMs with or without silent intralesional microhemorrhage on SWI to examine the potential confounding effect of microhemorrhage on image analysis. RESULTS— All lesions were identified on SWI. Image quality of SWI was judged to be at least adequate for diagnosis (range, 3–5) in all patients by both readers. Using DSA as reference standard, the area under receiver operating curve (AUC) of detection of deep or posterior fossa location, exclusively deep venous drainage, venous ectasia, venous varices and the presence of associated aneurysm on SWI was 1, 0.93, 0.94, 0.95, and 0.83, respectively. Silent intralesional microhemorrhage were detected in 39 patients (48.15%) on SWI and no significant difference (P > 0.05) was found in angioarchitectural features between cases with and without silent microhemorrhage. CONCLUSIONS— SWI might be a non-invasive alternative technique for angiogram in the angioarchitectural assessment of unruptured bAVM. microhemorrhage was evaluated on SWI in our study. Higher flow velocities coupled with an abnormal blood-brain barrier may contribute to extravasation of red blood cells into the surrounding brain and explain the hemosiderin occasionally seen around bAVM 31 . As a confounding factor, silent intralesional microhemorrhage did not impair the diagnostic accuracy for each angioarchitectural risk factor evaluated on SWI. Recently, some studies have found that silent intralesional microhemorrahge could be considered in risk evaluation 6, 7 . Our unpublished work shows SWI is sensitive in detecting intralesional microhemorrahge and suggests good correspondence correlating with histological examination. Hence, SWI may have the potential of integrated evaluation of bAVM, both in angioarchitectural characteristics and in detection of microhemorrahge, which is what we are going to explore next.

随着中国经济、文化、医学和国际交流的不断发展,英语型医学人才和医学教师的培养受到广泛的重视,英语也一直是国内众多高校尤其是医学高校必修的课程之一,但是传统的授课模式受到诸多因素的影响,导致授课效果相对较差,学生英语水平出现明显个体差异等现象.随着信息时代的不断进步,网络设备和网络技术蓬勃发展,网络教育成为一种新兴的教育模式.开发适用于网络教育的高质量的课程成为网络教育中一个非常重要而迫切的课题.医学英语有着专业词汇较多、外文影音教学资料稀缺等的特点.Blackboard网络教学平台作为全球应用范围最广的教育软件之一,被众多国内高校选用.

Leukoaraiosis (LA) is associated with cognitive impairment in the older people which can be demonstrated in functional connectivity (FC) based on resting-state functional magnetic resonance imaging (rs-fMRI). This study is to explore the FC changes in LA patients with different cognitive status by three network models. Fifty-three patients with LA were divided into three groups: the normal cognition (LA-NC; n = 14, six males), mild cognitive impairment (LA-MCI; n = 27, 13 males), and vascular dementia (LA-VD; n = 12, six males), according to the Mini Mental State Exam (MMSE) and Clinical Dementia Rating (CDR). The three groups and 30 matched healthy controls (HCs; 11 males) underwent rs-fMRI. The data of rs-fMRI were analyzed by independent components analysis (ICA) and region of interest (ROI) analysis by the REST toolbox. Then the FC was respectively analyzed by the default-mode network (DMN), salience networks (SNs) and the central executive network (CEN) with their results compared among the different groups. For inter-brain network analysis, there were negative FC between the SN and DMN in LA groups, and the FC decreased when compared with HC group. While there were enhanced inter-brain network FC between the SN and CEN as well as within the SN. The FC in patients with LA can be detected by different network models of rs-fMRI. The multi-model analysis is helpful for the further understanding of the cognitive changes in those patients.

随着教育信息化进程的不断推进,国际间学术交流的日益频繁,医学英语的重要性日益凸显,英语型医学人才的培养被广泛重视.医学英语一直是国内中高等医学院校必修的课程之一,但目前,我国医学生的英语能力出现严重的个体化差异,大部分医学生的英语水平难以满足日常工作以及社会发展的需要,这与我国医学院校的大学英语教学严重滞后有密切的关系,高等学校医学英语的授课模式以及临床英语教学模式有待进一步提高和改善,随着网络信息和技术的不断发展,网络教学平台的应用对医学英语的教学是一个有力的补充.文章对医学英语的网络教学模式进行简单的探讨.

OBJECTIVES: A precise assessment of angioarchitectural characteristics using noninvasive imaging is helpful for serial follow-up and weighting risk of natural history in unruptured brain arteriovenous malformation (bAVM). This study aimed to test the hypothesis that susceptibility weighted imaging (SWI) would provide an accurate evaluation of angioarchitectural features of unruptured bAVM. METHODS: A total of 81 consecutive patients with unruptured bAVM were examined. Image quality of SWI for the assessment of bAVM angioarchitectural features was determined by a 5-point scale. The accuracy of SWI for detection of angioarchitectural features was evaluated using digital subtraction angiography as a standard reference and further compared among unruptured bAVMs with or without silent intralesional microhemorrhage on SWI to examine the potential confounding effect of microhemorrhage on image analysis. RESULTS: All lesions were identified on SWI. Image quality of SWI was judged to be at least adequate for diagnosis (range, 3-5) in all patients by both readers. Using digital subtraction angiography as a reference standard, the area under the receiver operating curve of detection of deep or posterior fossa location, exclusively deep venous drainage, venous ectasia, venous varices, and the presence of associated aneurysm on SWI was 1, 0.93, 0.94, 0.95, and 0.83, respectively. Silent intralesional microhemorrhage were detected in 39 patients (48.15%) on SWI and no significant difference (P > 0.05) was found in angioarchitectural features between patients with and without silent microhemorrhage. CONCLUSIONS: SWI might he a noninvasive alternative technique for angiography in the angioarchitectural assessment of unruptured bAVM.

ObjectiveThe objective of this study was to investigate the clinical presentation, risks, and collateral pathway development of the congenital absence of the internal carotid artery (ICA).MethodsSixty-four patients (10 new patients and 54 patients from the relevant literature) were studied. Data on demographic, clinical, and radiologic features were collected, followed by an analysis of the risks associated with ICA agenesis.ResultsThere were 31 male and 33 female patients whose ages ranged from 5 months to 75 years, with a mean age of 31.1 years. The range of clinical symptoms recorded included transient ischemic attack (17 patients), subarachnoid hemorrhage (12 patients), developmental delay (13 patients), asymptomatic (8 patients), and other symptoms (15 patients). All 64 patients presented with absence of unilateral or bilateral ICAs, as measured by cervical computed tomography angiography or magnetic resonance angiography. The carotid canal was absent in all patients on computed tomography of the base of the skull, and abnormal development of collateral circulation pathways was observed. Five patients presented with basilar artery dilation on angiography. Aneurysms were observed in the angiography results from 16 patients. Ten patients presented with variations in the ophthalmic artery origin (the ophthalmic artery originated from the ipsilateral middle meningeal artery in six patients and from the ipsilateral middle cerebral artery in four patients).ConclusionsFrom analysis of our 10 cases of ICA agenesis and our review of the relevant literature, we conclude that young patients with ICA agenesis may present with developmental delay, subarachnoid hemorrhage, or other developmental abnormalities, whereas older patients most commonly present with transient neurologic events. Complications of carotid agenesis are related to specific anatomic subtypes and the resulting collateral circulation development.

Objective To provide reference for improving the teaching levels by analyzing the characteristics of training visiting radiologists of cerebral stroke in Beijing Tiantan Hospital, Capital Medical University. Methods The information of 142 visiting physicians of Beijing Tiantan Hospital, Capital Medical University during the year 1999 to 2015 (2009 was excluded) were investigated, including age, sex, professional title, medical grades of original institution, and training period, etc. Results The mean age was (34.9±6.2) years old with 67% (95/142) of male visitors, 51% (73/142) of attending doctors, 76% (108/142) from Class III grade hospitals, and the median training period of 6 months. Conclusion Most of the visiting doctors of our department were attending physicians from Class III hospitals. Based on a good education background and previous professional experience, they have potential for professional development. This is helpful for their individualized education.

Background: Children with untreated brain arteriovenous malformations (bAVM) are at risk of encountering life-threatening hemorrhage very early in their lives. The primary aim of invasive treatment is to reduce unfavorable outcome associated with a bAVM rupture. A better understanding of the morbidity of bAVM hemorrhage might be helpful for weighing the risks of untreated bAVM and invasive treatment. Our aim was to assess the clinical outcome after bAVM rupture and identify features to predict severe hemorrhage in children. Methods: We identified all consecutive children admitted to our institution for bAVMs between July 2009 and December 2014. Clinical outcome after hemorrhagic presentation and subsequent hemorrhage was evaluated using the modified Rankin Scale (mRS) for children. The association of demographic characteristics and bAVM morphology with severe hemorrhage (mRS >3 or requiring emergency hematoma evacuation) was studied using univariate and multivariable regression analyses. A nomogram based on multivariable analysis was formulated to predict severe hemorrhage risk for individual patients. Results: A total of 134 patients were identified with a mean treatment-free follow-up period of 2.1 years. bAVM ruptured in 83 (62%) children: 82 had a hemorrhage at presentation and 6 of them experienced a recurrent hemorrhage during follow-up; 1 patient had other diagnostic symptoms but bled during follow-up. Among them, 49% (41/83) had a severe hemorrhage; emergency hematoma evacuation was required in 28% of them (23/83), and 24% (20/83) remained as disabled (mRS ≥3) at last follow-up. Forty-six percent (38/82) of children with hemorrhagic presentation were severely disabled (mRS >3). Forty-three percent (3/7) were severely disabled after subsequent hemorrhage. The annual rate of severe subsequent hemorrhage was 1% in the overall cohort and 3.3% in children with ruptured presentation. All the subsequent severe hemorrhage events occurred in children with severe hemorrhage history (7%, 3/41). Periventricular location, non-temporal lobe location, and long draining vein were predictors for severe hemorrhage in pediatric untreated bAVMs. A nomogram based on bAVM morphology was contracted to predict severe hemorrhage risk for individual patients, which was well calibrated and had a good discriminative ability (adjusted C-statistic, 0.72). Conclusions: Evaluating bAVM morbidity and morphology might be helpful for weighing the risks of untreated bAVM in pediatric patients.

BACKGROUND:Secondary brain injury is the main cause of mortality from traumatic brain injury (TBI). One hallmark of TBI is intracranial hemorrhage, which occurs in 40-50% of severe TBI cases. Early identification of intracranial hematomas in TBI patients allows early surgical evacuation, and can reduce the case-fatality rate of TBI. Since pre-hospital care is the weakest part of Chinese emergency care, there is an urgent need for a capability to detect brain hematomas early. The purpose of this observational study was to evaluate the performance of a near infrared (NIR) based, device to screen for traumatic intracranial hematomas in Chinese population. METHODS:Data was collected using the NIR device at the time of a computed tomography (CT) or magnetic resonance imaging (MRI) scan was performed to evaluate a suspected TBI. 85 patients were included in the per protocol population. Of the 85 patients, 45 were determined by CT scan to have intracranial hemorrhage. The CT and MRI scans were read by an independent neuroradiologist who was blinded to the NIR measurements. RESULTS:The NIR device demonstrated sensitivity of 95.6% (95% confidence intervals [CI] 83.6-99.2%) and specificity of 92.5% (CI 78.5-98%) in detecting intracranial hematomas larger than 3.5ml in volume, and that were less than 2.5cm from the surface of the brain. CONCLUSION:These results confirm in Chinese population the results of previous studies that demonstrated a NIR based device can reliably screen for intracranial hematomas that are likely to be of clinical importance.

Instruction: Children with brain arteriovenous malformations (bAVM) are at risk of life-threatening hemorrhage in their early lives. Our aim was to analyze various angiographic features of bAVM in conjunction with other morphological risk factors to predict the risk of subsequent hemorrhage during follow-up in children. Methods: We identified all consecutive children admitted to our institution for bAVMs between July 2009 and September 2015. Children with at least 1 month of treatment-free follow-up after diagnosis were included in further analysis. The effects of bAVM features on hemorrhagic presentation were studied. Annual rates of AVM rupture as well as several potential risk factors for subsequent hemorrhage were analyzed using Kaplan-Meier analyses and Cox proportional hazards regression models. Results: We identified 110 patients with a mean follow-up period of 2.1 years (range, 1 month-15.4 years). The average annual risk of hemorrhage from untreated AVMs was 4.3%. Risk factors predicting hemorrhagic presentation in multivariable analysis were no generalized venous ectasia, deep venous drainage, fast arteriovenous shunt, and deep location. No generalized venous ectasia in conjunction with fast arteriovenous shunt was predictive of subsequent hemorrhage (RR, 7.55; 95%CI, 1.96-29.06). The annual rupture risk was 11.1% in bAVMs without generalized venous ectasia but with fast arteriovenous shunt. Conclusions: bAVM angiographic features suggesting unbalanced inflow and outflow might be helpful to identify children at higher risk for hemorrhage. No generalized venous ectasia and fast artriovenous shunt might be associated with an increased risk for hemorrhagic presentation and subsequent hemorrhage in pediatric patients with untreated bAVM.

Objective To explore the clinical factors of the brain rebound speed after drainage in patients with chronic subdural hematomas.Methods The clinical and imaging data of 90 adult patients with chronic subdural hematomas were retrospectively reviewed who were treated at Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from January 2015 to December 2016.Those data analyzed included the patient's age,gender,maximal diameter of the hematoma,maximal anteroposterior diameter of the skull,and maximal distance between the brain and the inner edge of the skull.The correlation between clinical factors and the velocity of brain tissue recovery was analyzed.Results The postoperative brain rebound speed was significantly higher in the younger age group (＜ 40 years) than in the older age group (＞ 80 years) (P =0.008),and it was significantly higher in patients with small hematomas (＜ 100 mm) than in those cases with larger hematomas (140-150 mm) (P ＜ 0.05).In addition,this study suggested a negative correlation between relative brain tissue recovery and the longest diameter of the skull (P =0.027).Gender,the maximal width of initial hematoma,maximal area of initial hematoma were not associated with the postoperative brain rebound speed (all P ＞ 0.05).Conclusion The brain rebound speed in patients with chronic subdural hematomas seemed to be related to age,the longest diameter of initial hematoma and maximal anteroposterior diameter of the skull.

The exploring application of WeChat public platform in the study of students in medical English course by establishment of mobile learning mode compared with the traditional teaching. It increases the students' learning enthusiasm, initiative, and participation. The results shows it made improvement of the learning scores, meanwhile, it increased the interaction between teachers and students both inside and outside of the classroom through the communication. In conclude this method could improve the quality of teaching;improve medical English application ability for the seven-year medical students.

Standardized training of general physician is main way to train the general practitioner in our country, which is largely invisible, the ability of residency is weak on different levels. There have many different characteristics with the standardized training of specialist in the training base and teachers. The electronic medical record system can strengthen the training and supervision to participants in standardized training of general practitioner, can ensure the quantity and quality of managing patients and clinical skills, and ensure the rotation in accordance with the arrangement. Achieving the remote monitoring of community training base through the cloud platforms. By taking a series of safeguard measures, the whole training process was supervised using the electronic medical record, which can improve and ensure the effectiveness of standardized training.

The Medical English teaching for seven-year clinical medical student has its own characteristics. It is important for medical students to enhance the comprehension of clinical practice. And it should be very valuable to retrieve and use English medical literature for future research and academic communication. The purpose of this article is to list some suggestions from our experiences for seven-year medical students teaching.