Small Bowel Gastrointestinal Stromal Tumors: The Value of CT Enterography in Assessing Pathological Aggressiveness.

OBJECTIVE: This study aimed to characterize the computed tomography (CT) enterography features of the small bowel gastrointestinal stromal tumors (GIST) and to determine the association with pathological aggressiveness. METHODS: Computed tomography enterography images of 30 patients with the histologically confirmed small bowel GIST were retrospectively enrolled. Tumor size, location, border, growth pattern, enhancement pattern, necrosis, calcification, ulceration, internal air, nodal metastasis, liver metastasis, peritoneal metastasis, and draining vein were evaluated. Relationships between imaging features and pathological aggressiveness were analyzed using χ2 test or Fisher exact test. Correlations among CT features were analyzed using Spearman correlation analysis. RESULTS: There were significant differences in tumor size between different risk levels (F = 8.388, P < 0.001). There were statistically significant differences in the 5 imaging manifestations of necrosis, ulcer, tumor boundary, drainage vein, and intratumoral gas (P < 0.05). There was a significant negative correlation between tumor size and enhancement type as well as clear tumor boundary. There was a significant positive correlation between tumor size and necrosis, ulcer, drainage vein, intratumoral gas, liver metastasis, and peritoneal metastasis. CONCLUSIONS: Some CT enterography imaging features might be useful in the determination of the pathological aggressiveness in the patients with small bowel GIST.

[Evaluation on the validity and reliability of the Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale (DSKAB)].

OBJECTIVE: To evaluate the validity and reliability of Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale (DSKAB). METHODS: We selected 460 patients with diabetes in the community, used the scale which was after two rounds of the Delphi method and pilot study. Investigators surveyed the patients by the way of face to face. by draw lots, we selected 25 community diabetes randomly for repeating investigations after one week. The validity analyses included face validity, content validity, construct validity and discriminant validity. The reliability analyses included Cronbach's α coefficient, θ coefficient, Ω coefficient, split-half reliability and test-retest reliability. RESULTS: This study distributed a total of 460 questionnaires, reclaimed 442, qualified 432. The score of the scale was 254.59 ± 28.90, the scores of the knowledge, attitude, behavior sub-scales were 82.44 ± 11.24, 63.53 ± 5.77 and 108.61 ± 17.55, respectively. It had excellent face validity and content validity. The correlation coefficient was from 0.71 to 0.91 among three sub-scales and the scale, P<0.001. The common factor cumulative variance contribution rate of the scale and three sub-scales was from 57.28% to 67.19%, which achieved more than 50% of the approved standard, there was 25 common factors, 91 items of the total 98 items held factor loading ≥0.40 in its relevant common factor, it had good construct validity. The scores of high group and low group in three sub-scales were: knowledge (91.12 ± 3.62) and (69.96 ± 11.20), attitude (68.75 ± 4.51) and (58.79 ± 4.87), behavior (129.38 ± 8.53) and (89.65 ± 11.34),mean scores of three sub-scales were apparently different, which compared between high score group and low score group, the t value were - 19.45, -16.24 and -30.29, respectively, P<0.001, and it had good discriminant validity. The Cronbach's α coefficient of the scale and three sub-scales was from 0.79 to 0.93, the θ coefficient was from 0.86 to 0.95, the Ω coefficient was from 0.90 to 0.98, split-half reliability was from 0.89 to 0.95.Test-retest reliability of the scale was 0.51;the three sub-scales was from 0.46 to 0.52, P<0.05. CONCLUSION: The validity and reliability of the Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale are excellent, which is a suitable instrument to evaluate the self-management for patients with diabetes.

A deep learning-based cascade algorithm for pancreatic tumor segmentation.

Pancreatic tumors are small in size, diverse in shape, and have low contrast and high texture similarity with surrounding tissue. As a result, the segmentation model is easily confused by complex and changeable background information, leading to inaccurate positioning of small targets and false positives and false negatives. Therefore, we design a cascaded pancreatic tumor segmentation algorithm. In the first stage, we use a general multi-scale U-Net to segment the pancreas, and we exploit a multi-scale segmentation network based on non-local localization and focusing modules to segment pancreatic tumors in the second stage. The non-local localization module learns channel and spatial position information, searches for the approximate area where the pancreatic tumor is located from a global perspective, and obtains the initial segmentation results. The focusing module conducts context exploration based on foreground features (or background features), detects and removes false positive (or false negative) interference, and obtains more accurate segmentation results based on the initial segmentation. In addition, we design a new loss function to alleviate the insensitivity to small targets. Experimental results show that the proposed algorithm can more accurately locate pancreatic tumors of different sizes, and the Dice coefficient outperforms the existing state-of-the-art segmentation model. The code will be available at https://github.com/HeyJGJu/Pancreatic-Tumor-SEG.

[Evaluation of the effect of Er:YAG laser combined with guided bone regeneration in the treatment of peri-implantitis with osseous defects].

PURPOSE: To evaluate the clinical benefits of Er:YAG laser combined with guided bone regeneration (GBR) in the treatment of peri-implantitis-assocaited osseous defects. METHODS: Twenty-six patients (34 implants in total) who underwent implant restoration in Dental Disease Prevention and Treatment Institute, Jiading District, from 2017 to 2019 and were diagnosed with peri-implantitis with osseous defects, and randomly divided into the experimental group and control group. The two groups of patients received open flap surgery, debridement and GBR treatment. The only difference in the experimental group was the use of Er: YAG laser to modulate and remove inflammatory tissue as well as to decontaminate the implant surface, instead of traditional mechanical treatment in the control group. The probing depth (PD), bleeding on probing (BOP), and plaque index (PI), the height of the bone defect around the implant (reduce of marginal bone level, RBL) were recorded and compared. SPSS 20.0 software package was used to analyze the data. RESULTS: The PD, BOP, PI and RBL of the two groups of patients were significantly improved after treatment with different methods. There was no significant difference in the improvement of PD, BOP and PI between the two groups 6, 12 and 24 months after treatment, while the improvement of RBL in the experimental group was significantly better than that of the control group 12 and 24 months after treatment. CONCLUSIONS: In the treatment of GBR with peri-implantitis and osseous defects, Er: YAG laser therapy is more effective than traditional mechanical methods, and is more conducive to the regeneration of new bone.

Value of dynamic ³¹P magnetic resonance spectroscopy technique in in vivo assessment of the skeletal muscle mitochondrial function in type 2 diabetes.

BACKGROUND: Phosphorous magnetic resonance spectroscopy ((31)P-MRS) has been successfully applied to study intracellular membrane compounds and high-energy phosphate metabolism. This study aimed to evaluate the capability of dynamic (31)P-MRS for assessing energy metabolism and mitochondrial function in skeletal muscle from type 2 diabetic patients. METHODS: Dynamic (31)P-MRS was performed on 22 patients with type 2 diabetes and 26 healthy volunteers. Spectra were acquired from quadriceps muscle while subjects were in a state of rest, at exercise and during recovery. The peak areas of inorganic phosphate (Pi), phosphocreatine (PCr), and adenosine triphosphate (ATP) were measured. The concentration of adenosine diphosphate (ADP) and the intracellular pH value were calculated from the biochemistry reaction equilibrium. The time constant and recovery rates of Pi, PCr, and ADP were analyzed using exponential curve fitting. RESULTS: As compared to healthy controls, type 2 diabetes patients had significantly lower skeletal muscle concentrations of Pi, PCr and ß-ATP, and higher levels of ADP and Pi/PCr. During exercise, diabetics experienced a significant Pi peak increase and PCr peak decrease, and once the exercise was completed both Pi and PCr peaks returned to resting levels. Quantitatively, the mean recovery rates of Pi and PCr in diabetes patients were (10.74 ± 1.26) mmol/s and (4.74 ± 2.36) mmol/s, respectively, which was significantly higher than in controls. CONCLUSIONS: Non-invasive quantitative (31)P-MRS is able to detect energy metabolism inefficiency and mitochondrial function impairment in skeletal muscle of type 2 diabetics.

[Assessment research on the inter-proximal mesial papilla height of single implant-supported maxillary central incisor].

OBJECTIVE: This prospective study was to observe the correlation between the mesial papilla's height of single implant-supported maxillary central incisor and the distance from the base of the contact point to the alveolar bone crest. METHODS: 56 patients involved in single implant-supported maxillary central incisor were included in this study. The distances from the base of the contact point to the alveolar bone crest in the digital periapical film of maxillary central incisor were measured using the software Planmeca Dimaxis Version 3.3.2. The time of measurements were as follows: The pre-surgical and post-surgical periods, before and after the crown installation, the follow-up examination of more than 0.5 year. To analyze the factor of influencing distance, and the correlation between the distance and the height of gingival papilla during the whole restored period. Correlation analysis between the distance and the height of gingival papilla during the whole restoration was done by the statistical software SPSS 12.0. RESULTS: The results demonstrated that the ratio of esthetic papilla can achieve 54.5% at the crown installation and 95.5% at the follow-up examination when the distance was between 3 mm and 5 mm. When the distance was between 5 mm and 6 mm, they dropped to 30.0% and 75.0%, respectively. However, when the distance increased to above 7 mm, the papilla could hardly be in an esthetic outcome. There was a significant change of the distance was found during the periods from the post-surgery to pre-restoration, and the scope of the changes was between -0.13 mm and 0.46 mm. A negative correlation was found between the distance and the index of papilla. The correlation coefficient r was -0.715 (P < 0.01). CONCLUSION: It is proposed that the pre-surgery distance of maxillary central incisor from the base of the contact point to the alveolar bone crest can be used as one of the important reference indexes to assess and predict the height conditions of gingival papilla.