Assessment of Intracardiac and Extracardiac Deformities in Patients with Various Types of Pulmonary Atresia by Dual-Source Computed Tomography

Background:Pulmonary atresia(PA)is a group of heterogeneous complex congenital heart disease.Only one study modality might not get a correct diagnosis.This study aims to investigate the diagnostic power of dualsource computed tomography(DSCT)for all intracardiac and extracardiac deformities in patients with PA compared with transthoracic echocardiography(TTE).Materials and Methods:This retrospective study enrolled 79 patients and divided them into three groups according to their main diagnosis.All associated malformations and clinical information,including treatments,were recorded and compared among the three groups.The diagnostic power of DSCT and TTE on all associated malformations were compared.The surgical index(McGoon ratio,pulmonary arterials index(PAI),and total neopulmonary arterial index)and radiation dose were calculated on the basis of DSCT.Results:Of the patients,32,30,and 17 were divided into the groups of PA with ventricular septal defect(VSD),PA with VSD and major aortopulmonary collateral arteries,and PA with other major malformations,respectively.Consequently,182,162,and 13 intracardiac,extracardiac,and other major malformations were diagnosed,respectively.Moreover,DSCT showed a better diagnostic performance in extracardiac deformities(154 vs.117,p<0.001),whereas TTE could diagnose intracardiac deformities better(159 vs.139,p=0.001).The McGoon ratio,PAI,and treatment methods were significantly different among the three groups(p=0.014,p=0.008,and p=0.018,respectively).Conclusion:More than one imaging modality should be used to make a correct diagnosis when clinically suspecting PA.DSCT is superior to TTE in diagnosing extracardiac deformities and could be used to roughly calculate surgical indices to optimize treatment strategy.

Non-enhanced Low-tube-voltage High-pitch Dual-source Computed Tomography with Sinogram Affirmed Iterative Reconstruction Algorithm of the Abdomen and Pelvis

Objective To investigate the image quality, radiation dose and diagnostic value of the low-tube-voltage high-pitch dual-source computed tomography(DSCT) with sinogram affirmed iterative reconstruction(SAFIRE) for non-enhanced abdominal and pelvic scans. Methods This institutional review board-approved prospective study included 64 patients who gave written informed consent for additional abdominal and pelvic scan with DSCT in the period from November to December 2012. The patients underwent standard non-enhanced CT scans(protocol 1) [tube voltage of 120 k Vp/pitch of 0.9/filtered back-projection(FBP) reconstruction] followed by high-pitch non-enhanced CT scans(protocol 2)(100 k Vp/3.0/SAFIRE). The total scan time, mean CT number, signal-to-noise ratio(SNR), image quality, lesion detectability and radiation dose were compared between the two protocols. Results The total scan time of protocol 2 was significantly shorter than that of protocol 1(1.4±0.1 seconds vs. 7.6±0.6 seconds, P<0.001). There was no significant difference between protocol 1 and protocol 2 in mean CT number of all organs(liver, 55.4±6.3 HU vs. 56.1±6.8 HU, P=0.214; pancreas, 43.6±5.9 HU vs. 43.7±5.8 HU, P=0.785; spleen, 47.9±3.9 HU vs. 49.4±4.3 HU, P=0.128; kidney, 32.2±2.3 HU vs. 33.1±2.3 HU, P=0.367; abdominal aorta, 44.8±5.6 HU vs. 45.0±5.5 HU, P=0.499; psoas muscle, 50.7±4.1 HU vs. 50.3±4.5 HU, P=0.279). SNR on images of protocol 2 was higher than that of protocol 1(liver, 5.0±1.2 vs. 4.5±1.1, P<0.001; pancreas, 4.0±1.0 vs. 3.6±0.8, P<0.001; spleen, 4.7±1.0 vs. 4.1±0.9, P<0.001; kidney, 3.1±0.6 vs. 2.8±0.6, P<0.001; abdominal aorta, 4.1±1.0 vs. 3.8±1.0, P<0.001; psoas muscle, 4.5±1.1 vs. 4.3±1.2, P=0.012). The overall image noise of protocol 2 was lower than that of protocol1(9.8±3.1 HU vs. 11.1±3.0 HU, P<0.001). Image quality of protocol 2 was good but lower than that of protocol 1(4.1±0.7 vs. 4.6±0.5, P<0.001). Protocol 2 perceived 229 of 234 lesions(97.9%) that were detected in protocol 1 in the abdomen and pelvis. Radiation dose of protocol 2 was lower than that of protocol 1(4.4±0.4 m Sv vs. 7.3±2.4 m Sv, P<0.001) and the mean dose reduction was 41.4%. Conclusion The high-pitch DSCT with SAFIRE can shorten scan time and reduce radiation dose while preserving image quality in non-enhanced abdominal and pelvic scans.

Feasibility and Diagnostic Accuracy for Assessment of Coronary Artery Stenosis of Prospectively Electrocardiogram-gated High-pitch Spiral Acquisition Mode Dual-source CT Coronary Angiography in Patients with Relatively Higher Heart Rates: in Comparison wit

Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.

Intravenous Contrast Material Administration at High-pitch Dual-source CT Coronary Angiography: Bolus-tracking Technique with Shortened Time of Respiratory Instruction Versus Test Bolus Technique

Objective To investigate the feasibility of acquiring the similar homogeneous enhancement using bolus-tracking techniques with shortened respiratory time in prospectively electrocardiogram-gated high-pitch spiral acquisition mode (Flash mode) coronary computed tomography angiography (CCTA) compared with test bolus technique. Methods One hundred and eighty-four consecutive patients with mean heart rate ≤65 beats per minute undergoing CCTA were prospectively included in this study. The patients were randomly divided into two groups. Patients in the group A (n=92) instructed to shorten respiratory time received CCTA using bolus-tracking technique with high-pitch spiral acquisition mode (Flash mode), while those in the group B (n=92) underwent CCTA with test bolus technique. The attenuation in the ascending aorta, image noise, contrast-to-noise ratio and radiation doses of the two groups were assessed. Results There were no significant differences in the mean attenuation values in the ascending aorta (483.18±59.07 HU vs. 498.7±83.51 HU, P=0.183), image noise (21.4±4.5 HU vs. 20.9±4.3 HU, P=0.414), contrast-to-noise ratio (12.1±4.2 vs. 13.8±5.1, P=0.31) between the groups A and B. There were no significant differences in the radiation dose of dynamic monitoring scans (0.056±0.026 mSv vs. 0.062±0.018 mSv, P=0.068) and radiation dose of angiography (0.94±0.07 mSv vs. 0.96±0.15 mSv,P=0.926) between the two groups, while 15 mL less contrast material volume was administered in the group A than the group B. Conclusion Bolus-tracking technique with shortened time of respiratory in Flash mode of dual-source CT yields the similar homogeneous enhancement with less contrast material in comparison to the test bolus technique.

Truncus arteriosus:Diagnosis with dual-source computed tomography angiography and low radiation dose

Truncus arteriosus is an uncommon congenital cardiac abnormality which is characterized by a single arterial trunk origin from the heart that supplies both the systemic,pulmonary and coronary circulation.We present a preterm newborn female patient with type 2 truncusarteriosus,left superior vena cava and aberrant subclavian artery diagnosed with low dose dual-source cardiac computed tomography(CT).We discuss that low dose dual-source cardiac CT has more advantages than other imaging methods and it is an important modality for assessment of patients with conotruncal anomalies such as truncusarteriosus.

COVID-19:A pluralistic and integrated approach for efficient management of the pandemic

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which triggered the ongoing pandemic,was first discovered in China in late 2019.SARSCoV-2 is a respiratory virus responsible for coronavirus disease 2019(COVID-19)that often manifests as a pneumonic syndrome.In the context of the pandemic,there are mixed views on the data provided by epidemiologists and the information collected by hospital clinicians about their patients.In addition,the literature reports a large proportion of patients free of pneumonia vs a small percentage of patients with severe pneumonia among confirmed COVID-19 cases.This raises the issue of the complexity of the work required to control or contain the pandemic.We believe that an integrative and pluralistic approach will help to put the analyses into perspective and reinforce collaboration and creativity in the fight against this major scourge.This paper proposes a comprehensive and integrative approach to COVID-19 research,prevention,control,and treatment to better address the pandemic.Thus,this literature review applies a pluralistic approach to fight the pandemic.

Research on Knowledge Pluralistic Integration of English Teaching Methodology in Higher Vocational Colleges

For colleges and universities,especially higher vocational colleges,personnel training should focus on the cultivation of inter-disciplinary talents,so as to meet the needs of society and the labor market.This requires pluralistic knowledge integration in the process of teaching.This paper starts from the necessity of knowledge pluralistic integration of English teaching methodology,learns the necessity of the integration and studies the specific pathways and methods of the integration,hoping to provide reference for peers.

Exploration the Method of Low Dose Coronary Artery Imaging with Dual-Source CT

Objective: On the premise that the image quality meets the requirements of clinical diagnosis, we explored the methods to reduce the radiation dose of coronary artery imaging with Dual-Source CT (DSCT). Methods: We randomly selected 200 patients with coronary heat disease (BIM 0.05). The average image noise in group A is (41.76 ± 7.98) HU, in group B the average image noise is (43.97 ± 3.88) HU, the dif- ference between the two groups was not statistically significant (P>0.05). The average CTDIvol of group A and B were (20.63 ± 2.24) mGy, (38.11 ± 10.69) mGy, respectively, then P <0.01. The average DLP of group A and B are (235.75 ± 28.64) mGycm and (492.59 ± 125.49) mGycm respectively, then P <0.01, the dif- ference of radiation dose had statistical significance (P<0.05). Conclusions: For coronary artery imaging with DSCT the heart electric pulse (AUTO) regulation technology can meet the diagnostic requirements and effectively reduce the radiation dose.

A Pluralistic Mind Approach to the Complementarity Between Schema and Language

The traditional view is that understanding knowledge is based on language.Is language a sufficient condition for cognitive knowledge?Pluralistic mind holds that understanding knowledge can be obtained independently through schemata.Schema-based cognition is not the only component of cognitive structure.The important language and quasi language thinking play a great role in cognition.Expounding the relationship between schema-based cognition and language and quasi language like thinking can explain the cognitive complementarity between schema and language.It shows that with the increase of language and quasi language thinking,the form of thinking is continuously enhanced and transformed through schema-based cognition.Language and quasi language thinking are cognitive abilities different from schema cognition.They are relatively new additions to cognitive tools.Language and quasi language like thinking are of little use to animals which do not have enough schema forming ability.

Application of Dual-Source CT TurboFlash Coarse Pitch Scanning in Coronary Artery Imaging

Objective: To compare and analyze the image quality and radiation dose of three scanning modes of dual-source CT coronary artery retrospectively, and to discuss the application value of TurboFlash coarse pitch scanning mode. Methods: The imaging data of 100 patients who underwent CT coronary angiography (CCTA) using Siemens force CT retrospective gated triggering spiral scan (RES-SPIRAL), adaptive prospective gated triggering sequence scan (SEQ) and prospective coarse pitch scan (TurboFlash) retrospectively was collected. The image quality was evaluated by objective and subjective methods. The effective radiation dose of patients was compared and analyzed, and the indications of the three scanning modes were analyzed. The application value of dual-source CT TurboFlash coarse pitch scanning in coronary artery imaging was evaluated. Results: The results showed that the left main coronary artery, the right coronary artery and their tertiary branches could be clearly displayed in the three groups of images: the left anterior descending branch, the left circumflex branch, and their three-level branches. There was no statistical difference in subjective image quality among the three groups of pictures (P > 0.05). There was no statistical difference in objective evaluation indexes, such as CT value, SNR, CNR and Noise among the three groups (P > 0.05). The patient radiation dose results showed that the effective radiation dose ED of RES-SPIRA scan was (9.22 ± 1.33) mSv. The dose of SEQ was (2.88 ± 2.47) mSv, and the dose of TurboFlash was (0.51 ± 0.16) mSv. There was significant difference in comparison of the three groups (P 0.05). RES-spiral scanning had the highest radiation dose and TurboFlash coarse pitch scanning (TurboFlash) had the lowest radiation dose. Conclusion: TurboFlash coarse pitch scanning is low in dosage, fast in speed and wide in adaptability. It is especially suitable for the elderly, children, coma and other patients who cannot cooperate with breath-holding examination, as well as for the screening and examination of coronary artery diseases in asymptomatic population. Undoubtedly, it is a worthy method of heart coronary artery examination.

A Pluralistic Approach to Human Rights in a Community of Shared Future for Mankind

'A community of shared destiny for all mankind' has its own inherent logic, structure and development path, and a pluralistic concept of human rights is a key factor to achieve its four core goals: equality, cooperation, security and inclusiveness. A pluralistic concept of human rights and the ideal of a community of shared future for all mankind overlap on certain values and interests, as well as power and cultural attributes. It means that a pluralistic approach to human rights is indispensable to the establishment of a community of shared future for all mankind. Meanwhile, this new view of human rights embodies mutual respect and support for the inherent inevitability among different countries, shared responsibility, and pursuit of common development.

Beijing Olympic Games Welcome A Pluralistic World

It was back in 1908 when the Olympic dream began to take hold. This year, in 2008, this centennial dream has come true. Regarding it as a hard-won opportunity, China has all along wished to host the most successful

多元混合式教学在仪器分析实验课程中的实践

仪器分析实验课程是化学相关专业实践性与应用性极强的核心实验课程之一。在“双一流”建设的大背景下,针对目前仪器分析实验教学存在的问题,从教学模式、教学内容和教学方法三方面进行改革,打造了线上线下相结合,常规实验、虚拟仿真实验和自主创新设计实验相结合,翻转课堂和问题导向学习法相结合的多元混合式教学课程体系。教学实践证明,这种新型的教学课程体系有利于激发学生的学习兴趣与主动性,引导学生内化知识,培养分析和解决问题的高阶思维与综合能力,提高教学效率,优化教学效果。

中国社会变迁与人的发展:多元建构观点和相关研究

当代全球化背景下的社会变迁导致了不同价值观和生活方式共存和整合,构成了人的发展的新的环境。在中国的社会变迁过程中,与市场化相匹配的价值观(如竞争性、独立性、自我表现)和传统价值观(如社会关系,服从集体,自我控制)在人的社会和心理适应中具有不同的功能。不同文化的碰撞和整合也可能促进新的行为品质的产生,有利于增强人们应对各种情境的能力。根据多元建构观点,群体水平上的社会互动过程,如同伴团体活动中的社会评价和反应及其对个体行为的调节,在社会变迁和文化整合对人的发展的影响中起着关键作用。群体中的行为规范与评价标准的变化通过社会互动过程不仅会影响个体认知、行为和情绪的展现水平,而且也影响它们的功能性意义。本文首先回顾这一领域里的主要理论框架及其在中国情境中应用的问题,并在此基础上着重讨论社会变迁与人的发展的多元建构观点。接着,在对中国儿童独特的气质特征和基于传统文化的社会化方式考察后,进一步从多元建构角度讨论中国当代社会变迁对人的发展的影响的相关研究,包括专刊论文中报告的研究。最后,本文对这一领域的发展方向提出一些建议。

智能技术支持的“双减”实施路径研究

“双减”政策出台以来,引起社会各方的高度关注。在对政策的理解与落实中,普遍出现“以盲目减量为目标”和“实践中‘明减’变为‘暗升’”的两大误区。针对这一问题,从对“双减”本质的再认识出发,明确“双减”政策在我国教育发展战略中的重要地位,以及聚焦新时代课堂价值观和课堂“减负提质增效”的本质意蕴,揭示“双减”是教育可持续发展、教育新生态和人才培养的途径和保障。同时,落实“双减”应以课堂教学为主阵地,在以发展智能技术支持教育服务为核心的教育新基建“数字底座”的支撑下,合理利用在线教育平台、人工智能、区块链、云计算、大数据等技术,记录教育教学的全过程,结合智能测评及分析等技术辅助课堂教学模式的创新,满足学生差异化需求,形成以智能技术支持的精准的个性化教学、智能化的作业管理和设计、数据驱动的多元化教学评价、以智能平台为依托的“家—校—社”协同育人“大环境”的实施路径,实现“提质增效减负”的目标,以期为“双减”政策的实施提供理论指导与实践路径。

基于多元治理的少数民族档案资源主体协同整合模式研究

少数民族档案资源整合面临资源异构、数量庞大、保存分散的问题。以多元治理理论为基础,通过构建参与主体协同整合模式,解决主体分散割裂问题。对参与多元治理的主体及其特征进行分析,归纳了政府部门主导模式、文化机构主导模式、社会组织主导模式、社会公众参与模式四种少数民族档案资源主体整合模式,在深入分析和比较四者之间的相似性和差异性后,构建了动态性、场景化的少数民族档案资源多元主体协同整合模式。

伦理先行:生成式人工智能的治理策略

生成式人工智能的迅猛发展为数字经济发展提供新动力,为社会民生创造新福祉,同时也引发了一系列现实挑战。中国现行立法已为生成式人工智能的发展划定了基本的安全保障底线,但该技术的发展方向和产业发展均处在高度不确定性当中,部分安全风险可能是被制造的焦虑,以国家立法形式进行规制为时尚早。生成式人工智能的治理需要伦理先行,坚持激励相容精神,为人工智能新技术新应用创新留下充分空间,以伦理治理的方式推动技术社区、产业群体、社会组织、社会公众、治理机构共同进行探索磨合,凝聚共识,待实践经验充足、立法时机成熟时,再将共识性规范纳入法律框架之中。

“全民一体”:一个述说中华民族的原创概念

民族复兴被确立为国家发展目标,中华民族得到了前所未有的凸显,也进一步突出了中华民族与国家之间的内在联系。为了体现中华民族的国家属性,形成对中华民族的完整述说,笔者在中华民族“多元一体”概念的基础上,提出了中华民族“全民一体”概念,并通过原创的“人口国民化”“国民整体化”等概念来丰富其内涵。因此,就能将从中华民族与现代国家关系角度提出的“全民一体”概念,与从国内民族关系角度提出的“多元一体”概念结合起来,在既揭示中华民族与世界上其他现代民族的共同性,又揭示中华民族特殊性的基础上,对中华民族进行完整、有效的述说。

从生活品到商品:海南黎锦手工艺遗产的嬗变研究

在传统社会中,手工产品的交换或买卖主体为地方人群或地域人群共同体,呈现出遗产持有者的主体间关系;在消费社会中,以商品形态为主导的手工产品的买卖主体为地方人群共同体和外来消费群体,构建了遗产持有者与消费者的客体间关系。手工艺遗产具象化的生活品与商品既造成了对手工艺遗产认知的混乱,又对手工艺遗产存续产生了误读。从主客位角度去考察抽象化的海南黎锦在不同主体诉求下的具象化形态及其内在逻辑关系,认为手工艺品的生活态与商品态均为手工艺遗产以其所依存的社会场域为基础,以遗产持有者与社会群体需求为动力而形成的形态链,手工艺遗产不同形态的多元一体是其在消费社会中的应然态势。

辽宁省体育特色小镇可持续发展机制研究

在理论与实证研究的基础上,借鉴发达地区体育特色小镇相对成熟的管理模式和运行机制,坚持有选择地借鉴适合辽宁省的有益经验和成功路径,为体育特色小镇的可持续发展提供参照.在充分考虑可持续发展指标体系的基础上,形成体育特色小镇发展的多元机制.建立健全与之相关的规划先行机制、特色产业引领机制、标志性赛事培育机制、融资渠道开放机制、发展成果共享机制、安全风险规避机制、区域产业联动机制、社会大众参与机制、生态保护预警机制和舆论支持机制等.最终形成新发展理念下我国体育特色小镇内涵创新、格局开放、成果共享、生态保护与管理协调的实践模式与可持续发展机制.