Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection.

BACKGROUND: Gastric cancer is a common malignant tumor of the digestive tract, and endoscopic submucosal dissection (ESD) is the preferred treatment for early-stage gastric cancer. The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD. AIM: To analyze the features of gastric mucosal tumors at different differentiation levels, and to explore the prognostic factors of ESD. METHODS: We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021, according to the latest Japanese guidelines (sixth edition), and divided them into low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and differentiated and undifferentiated early carcinoma. They are followed up by endoscopy, chest and abdominal computed tomography at 3, 6 and 12 months after ESD. We compared clinicopathologic characteristics, ESD efficacy, and complications with different degrees of differentiation, and analyzed the related factors associated with ESD. RESULTS: HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients (P < 0.001) and accounted for more 0-IIc (P < 0.001), atrophic gastritis was common (P < 0.001), and irregular microvascular patterns (IMVPs) and demarcation lines (DLs) were more obvious (P < 0.001). There was more infiltration in the undifferentiated carcinoma tissue (P < 0.001), more abnormal folds and poorer mucosal peristalsis (P < 0.001), and more obvious IMVPs, irregular microsurface patterns and DLs (P < 0.05) than in the LGIN and HGIN tissues. The disease-free survival rates at 2, 5, and 8 years after ESD were 95.0%, 90.1%, and 86.9%, respectively. Undifferentiated lesions (HR 5.066), white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were significantly associated with poor prognosis. CONCLUSION: Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics, which are closely related to the safety and efficacy of ESD.

[The Application Value of True Whole-body PET/CT Scanning Protocol in Patients of Extranodal NK/T Cell Lymphoma].

OBJECTIVE: To assess the staging, restaging, and treatment strategy determination of extranodal NK/T cell lymphoma (ENKT) by PET/CT real body (true whole-body, TWB) imaging, which is superior to PET/CT limitation of the whole body (limited whole-body, LWB, from skull vertex to upper thighs) by adding 'distal lower extremity' images. METHODS: TWB 18F-FDG PET/CT studies performed for staging and follow-up of ENKTL patients between January 2012 and September 2017 were retrospectively reviewed. Patients in staging group received TWB PET/CT evaluation for staging at the first diagnosis. In follow-up group, patients received follow-up evalution with TWB PET/CT and progressive disease (PD) in the LWB range with or without clinical diagnosis or suspicion before follow-up examination, and then divided into four subgroups: staging (+) PD (－), staging (+) PD (+), staging (－) PD (－), staging (－) PD (+). Then the percentage of unexpected ENKTL lesions found at the distal extremity (outside the LWB range) (P1), and the percentage of changes in the staging, restaging/outcome evaluation (P2) in each group were recorded. RESULTS: Among the 225 patients in the staging group, 200 (88.9%) had tumors confined to LWB, while P1 was 11.1% (25 cases) and P2 was 0.4% (1 case). In the follow-up group, the P1 in staging (+) PD (－)( n=85), staging (+) PD (+)( n=4), staging (－) PD (－)( n=43), staging (－) PD (+) goups ( n=15) were 1.2%, 75.0%, 0%, 26.7%, and P2 were 1.2%, 0%, 0%, 13.3%, respectively. In the follow-up group, regardless of whether the TWB PET/CT examination was performed at the initial diagnosis stage, P1 in PD (－) group and PD (+) group was 0.8 vs. 36.8% ( P<0.000 1), and P2 was 0.8% vs. 10.5% ( P<0.000 1). CONCLUSION: It is not recommended that the TWB PET/CT imaging from the top of the head to the bottom of the foot use for the first diagnosis of ENKTL patients. And for follow-up patients with no clinical evidence of tumor progression or with evidence of tumor progression but whose lesions were limited to LWB at the initial diagnosis of TWB PET/CT staging, LWB PET/CT from the top of the head to the middle of the thigh is recommended for routine follow-up. For ENKTL patients, TWB PET/CT was not performed at the initial stage of diagnosis to detect the condition of lower limbs. If the evidence of tumor progression in the LWB range appeared before the follow-up examination, TWB PET/CT was recommended for the follow-up evaluation to evaluate the systemic tumor involvement.

New insights into leaf and fine-root trait relationships: implications of resource acquisition among 23 xerophytic woody species.

Functional traits of leaves and fine root vary broadly among different species, but little is known about how these interspecific variations are coordinated between the two organs. This study aims to determine the interspecific relationships between corresponding leaf and fine-root traits to better understand plant strategies of resource acquisition. SLA (Specific leaf area), SRL (specific root length), mass-based N (nitrogen) and P (phosphorus) concentrations of leaves and fine roots, root system, and plant sizes were measured in 23 woody species grown together in a common garden setting. SLA and SRL exhibited a strong negative relationship. There were no significant relationships between corresponding leaf and fine-root nutrient concentrations. The interspecific variations in plant height and biomass were tightly correlated with root system size characteristics, including root depth and total root length. These results demonstrate a coordinated plant size-dependent variation between shoots and roots, but for efficiency, plant resource acquisition appears to be uncoupled between the leaves and fine roots. The different patterns of leaf and fine-root traits suggest different strategies for resource acquisition between the two organs. This provides insights into the linkage between above- and belowground subsystems in carbon and nutrient economy.

[Development of a predicting model to estimate the probability of malignancy of solitary pulmonary nodules].

OBJECTIVE: To evaluate the role of (18)F-FDG PET/CT in characterizating solitary pulmonary nodule (SPN) and bone lesions. METHODS: 105 patients with a SPN smaller than 30 mm in axial diameter were recruited for this study. PET/CT images were obtained 60 min after intravenous injection of (18)F-FDG. Logistic regression analysis was performed to identify clinical predictors of SPN malignancy including age, sex, smoking history, malignant history, family history, symptoms, size, location, CT appearances, (18)F-FDG uptake, and to develop a clinical prediction model to estimate the probability of malignancy in the patients with SPN. The model fit was evaluated and the area under curve (AUC) of receiver operating characteristic (ROC) was used to evaluate the power of the model. RESULTS: The logistic regression analysis indicated that male, a positive smoking history, older age, larger nodule diameter, nodule with specula and nodule with high (18)F-FDG uptake were more likely to have malignant SPN. The clinical prediction model is described by the following equation: Logit(P) = -8.722 + 2.448 (gender) + 2.023(smoking) + 0. 851(age) + 1.057 (diameter) + 2.432 (spiculation) + 1.502 (FDG uptake). The AUC of the model was 0.892 (95% confidence interval 0.817 - 0.941). The prediction model had high accuracy in predicting malignant SPN, with 90.2%, 84.1 % and 87.6% sensitivity, specificity and accuracy respectively when the cut off value was set at 0.67. CONCLUSION: The prediction model is valid in predicting the probability of malignant SPN.

Recognition of fibrous dysplasia of bone mimicking skeletal metastasis on 18F-FDG PET/CT imaging.

PURPOSE: Fibrous dysplasia of bone (FDB) reveals intense 18F-FDG uptake mimicking metastases on 18F-FDG PET/CT. We reviewed sites of FDB revealed by 18F-FDG PET/CT imaging to allow identification of this abnormality. MATERIALS AND METHODS: Eleven patients (7 male, 4 female, aged 16-78 years) were evaluated after 55 MBq (0.15 mCi)/kg 18F-FDG utilizing a 16-slice multiple detector CT (MDCT) whole-body PET scanner, with LOR algorithm 3D reconstruction. One- and 2-h imaging was performed in 9 patients. Standard uptake value (SUV) for each lesion, on early and delayed imaging, was calculated. Lesions were confirmed in 6 patients by biopsy. The PET images correlated with MDCT to establish the imaging characteristics. RESULTS: Solitary lesions were found in 4 patients, two lesions in 1 patient, and in 6 patients there were multiple bone lesions. The SUV(early) ranged from 1.23 to 9.64 with an average of 3.76 ± 2.40. The SUV(delayed) ranged from 1.76 to 11.42 with an average of 4.51 ± 3.07. The SUV(delayed) decreased or increased slightly (-31% to 5%) in 6 of our patients, and increased significantly (11% to 39%) in 3. There was a negative correlation between SUVs and age, as well as the number of affected bones. CONCLUSIONS: In our study, FDB had wide skeletal distribution with variability of 18F-FDG uptake and CT appearance. SUV in the delayed stage was seen to either decrease or increase on dual-time 18F-FDG PET scanning. It is very important to recognize the characteristics of this skeletal dysplasia to allow differentiation from skeletal metastasis.

EGb761 protects motoneurons against avulsion-induced oxidative stress in rats.

BACKGROUND: Root avulsion of the brachial plexus causes an oxidative stress reaction in the spinal cord and induces dramatic spinal motoneuron death, while EGb761 is a natural free radical cleaning agent. This study was designed to investigate the protective effects of intraperitoneally injected EGb761 against neural damage following brachial root avulsion. METHODS: The effect of EGb761 on avulsion-induced motoneuron injury was studied in 26 total groups of (n) rats, treated as follows. Animals in singular number groups received EGb761(50 mg/kg.d) and those in complex number groups received normal saline solution (i.p.), serving as controls. Groups 1-8 were used for the determination of nitric oxide (NO) levels in the serum and injured spinal cord at the 5 d, 2 w, 4 w, and 6 w time points. Groups 9-16 were used for determination of constitutive nitric oxide synthase (cNOS) and inducible nitric oxide synthase (iNOS) levels in injured spinal cord at the 5 d, 2 w, 4 w, and 6 w time points. Groups 17-26 were used for determination of the number of neuronal nitric oxide synthase (nNOS)-positive and surviving motoneurons in injured C7 ventral horn at the 5 d, 2 w, 4 w, 6 w and 8 w time points. RESULTS: Compared to control groups, the EGb761 treatment group not only had significant decreased levels of NO in serum at 2 w and 6 w after avulsion, but also had reduced levels of NO specifically in the spinal cord at 2 w, 4 w and 6 w. The cNOS activity in the spinal cord was also significant decreased at 2 w and 4 w, while the iNOS activity in injured C6-T1 spinal segments was reduced at 2 w, 4 w and 6 w. All together, the percentages of NADPH-d positive motoneurons in an injured C7 segment were down-regulated and the number of surviving motoneurons in injured C7 ventral horn was increased at 2 w, 4 w, 6 w and 8 w in treated versus untreated animals. CONCLUSIONS: Intraperitoneal administration of EGb761 after root avulsion of the brachial plexus exerted protective effects by decreasing the level of NO in spinal cord and serum and the activity of cNOS and iNOS, easing the delayed motoneurons death. EGb761 should be considered in the treatment of brachial plexus nerve injuries.

[Effects of environmental stress on seedlings root growth and nodulation of leguminous shrubs in the dry valley of Minjiang River].

A field investigation was made to understand the seedlings root nodulation, biomass accumulation, root length, and fine root percentage of Sophora davidii, Indigofera lenticellata and Campylotropis polyantha along an altitudinal gradient on two contrasting sloped hills (north Zongqu and south Jingzhoushan) in the dry valley of Minjiang River. In the meantime, a greenhouse experiment was conducted to study the adaptation responses of 2 month-old S. davidii and C. polyantha seedlings root nodulation to different soil moisture regimes (80%, 60%, 40%, and 20% WHC). For the three test shrub species, fewer nodules were observed at lower altitude (1600-1950 m) areas, the nodule number per plant of S. davidii, I. lenticellata, and C. polyantha being 0.1 +/- 0.1, 0.9 +/- 0.5, and 5.7 +/- 1.9, and the non-nodulation plant accounting for 65.1%, 12.3% and 17.6%, respectively. The nodule number of the three species increased with increasing altitude, and correlated positively with root length and fine root percentage. However, there were no significant differences in the plant growth and biomass at different altitudes. When the soil moisture content was lower than 60% WHC, the nodule number and the fresh and dry mass of both S. davidii and C. polyantha decreased markedly, and at 20% WHC, no nodule and only 9.8 +/- 3.6 nodules were observed for S. davidii and C. polyantha, respectively, indicating that in this dry valley, the root nodulation capability of endemic leguminous shrubs was very low. Comparing with S. davidii, C. polyantha had higher root nodulation capability and drought-resistance. Prior to introducing these shrub species in forestation practices, to keep the soil moisture content higher than 40% WHC was recommended for relatively efficient biological nitrogen fixation.

[Differentiation of malignant and benign superficial lymph nodes by dual time point 18F-FDG PET].

OBJECTIVE: To evaluate the value of dual time point 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in differentiating malignant and benign superficial lymph nodes. METHODS: Sixty-eight patients with ninety superficial lymph nodes were examined. Whole body 18F-FDG PET imaging was performed one hour (early) after FDG injection and repeated one hour (delayed) later but only for the interesting areas. The maximum standardized uptake value (SUVmax) was determined for each of the node on both early and delayed images (SUV early and SUV delayed, respectively). Retention index (RI) was then calculated. The cutoff values of SUV early, SUV delayed and RI were determined by receiver operating characteristic (ROC) analyses. The efficacy of each parameter was also analyzed by ROC analyses. RESULTS: The histopathology examinations confirmed 51 malignant nodes and 39 benign nodes. The SUV early (x +/- s) for benign nodes and malignant nodes were 3.26 +/- 1.62 and 8.04 +/- 5.56, respectively (P=0.000). The SUV delayed for benign nodes and malignant nodes were 3.93 +/- 2.11 and 9.82 +/- 6.29, respectively (P=0.000). The RI for benign nodes and malignant nodes were 19.1 +/- 22.5 and 24.8 +/- 18.8, respectively (P=0.191). The cutoff values of SUV early, SUV delayed and RI were 4.3, 4.8 and 18, respectively. The cutoff values of SUV early, SUV delayed and RI produced a sensitivity of 71%, 78% and 63%, a specificity of 87%, 85% and 46%, and an accuracy of 78%, 80% and 57%, respectively. The ROC analyses illustrated that the diagnostic efficacy of SUV early, SUV delayed was higher than RI (P<0.001). However, there was no difference in diagnostic efficacy between SUV early, and SUV delayed (P=0.409). CONCLUSION: Dual-time point 18F-FDG PET does differentiate benign and malignant superficial lymph nodes effectively.

[SPECT/CT fusion imaging for the diagnosis of benign and malignant lesions in bones].

OBJECTIVE: The aim of the study was to evaluate the value of the single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging in the diagnosis of benign and malignant lesions in bones. METHODS: One hundred and forty one bone lesions of 125 cancer patients, for whom the natures of the lesions were not able to be determined by the 99Tc(m)-MDP whole-body bone scan, were examined by the SPECT, CT and SPECT/CT fusion imaging simultaneously. All of the images were blindly interpreted independently by two experienced nuclear medicine physicians. The natures of the lesions were eventually confirmed by MRI, pathology or follow-up diagnosis six months later. RESULTS: The diagnostic sensitivity of SPECT, SPECT+CT and SPECT/CT for the 141 bone lesions was 82.5%, 93.7%, and 98.4% respectively. The specificity was 66.7%, 80.8%, and 93.6% respectively. The accuracy was 73.8%, 86.5%, and 95.7% respectively. The specificity and accuracy of SPECT/CT for diagnosing bone lesions were significantly higher than those of SPECT and SPECT+CT (P<0.05). CONCLUSION: SPECT/CT can effectively differentiate benign and malignant bone lesions.