Differential diagnosis of benign and malignant breast calcification by quantitative measurement of gray value on contrast-enhanced spectral mammography / 中华放射学杂志

Objective:To investigate the value of gray value (GV) measurement of subtraction images in contrast-enhanced spectral mammography (CESM) in the differential diagnosis of breast benign and malignant calcification.Methods:This was a retrospective study. A total of 95 patients received CESM only with mammographic calcifications without any associated mass or distortions from March 2017 to July 2021 in Peking University Cancer Hospital were enrolled. The patients were all female with an average age of 34-76(48±7) years. The craniocaudal (CC) projection of bilateral breasts was obtained prior to the mediolateral-oblique (MLO) projection. Two radiologists were asked to independently review the images to diagnose the calcification as either benign or malignant based on the presence of enhancement on subtracted imaging. GV of the calcification and background parenchyma including breast parenchyma tissue, the pectoralis major muscle and subcutaneous fatty tissue were measured by another two radiologists. The difference of lesion to background parenchyma GV (D GV) and lesion to background parenchyma gray value ratio (DR GV) were calculated. The consistency of observers was compared using the Kappa statistic. The stability of GV was evaluated with coefficient of variation. Differences of GV, D GV and DR GV between benign and malignant calcification were compared using t test or Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to analyze the efficacy of GV in differentiating benign from malignant calcification. Comparisons between diagnostic efficacies were performed using χ 2 tests. Results:Totally 97 calcification (35 malignant and 62 benign) from 95 patients were enrolled. The consistency and stability of GV values on MLO and CC projections measured by two physicians were high. The GV, D GV and DR GV of malignant calcification were significantly higher than those of the benign lesions ( P<0.05). The area under the ROC curve for the differential diagnosis of benign and malignant calcification by GV in the MLO and CC positions was 0.799 and 0.843, respectively. Threshold of calcified area GV=2015.5 in CC position, its diagnostic accuracy was 76.8%, which was similar to the subjective diagnosis of radiologists (82.1%, 78/95, P>0.05). Conclusion:Quantitative GV on subtracted imaging of CESM can differentiate benign from malignant breast calcification, especially on craniocaudal projection.

Transformation mechanism of carbon tetrachloride and the associated micro-ecology in landfill cover, a typical functional layer zone / 生物工程学报

Landfill is one of the important sources of carbon tetrachloride (CT) pollution, and it is important to understand the degradation mechanism of CT in landfill cover for better control. In this study, a simulated landfill cover system was set up, and the biotransformation mechanism of CT and the associated micro-ecology were investigated. The results showed that three stable functional zones along the depth, i.e., aerobic zone (0-15 cm), anoxic zone (15-45 cm) and anaerobic zone (> 45 cm), were generated because of long-term biological oxidation in landfill cover. There were significant differences in redox condition and microbial community structure in each zone, which provided microbial resources and favorable conditions for CT degradation. The results of biodegradation indicated that dechlorination of CT produced chloroform (CF), dichloromethane (DCM) and Cl- in anaerobic and anoxic zones. The highest concentration of dechlorination products occurred at 30 cm, which were degraded rapidly in aerobic zone. In addition, CT degradation rate was 13.2-103.6 μg/(m2·d), which decreased with the increase of landfill gas flux. The analysis of diversity sequencing revealed that Mesorhizobium, Thiobacillus and Intrasporangium were potential CT-degraders in aerobic, anaerobic and anoxic zone, respectively. Moreover, six species of dechlorination bacteria and eighteen species of methanotrophs were also responsible for anaerobic transformation of CT and aerobic degradation of CF and DCM, respectively. Interestingly, anaerobic dechlorination and aerobic transformation occurred simultaneously in the anoxic zone in landfill cover. Furthermore, analysis of degradation mechanism suggested that generation of stable anaerobic-anoxic-aerobic zone by regulation was very important for the harmless removal of full halogenated hydrocarbon in vadose zone, and the increase of anoxic zone scale enhanced their removal. These results provide theoretical guidance for the removal of chlorinated pollutants in landfills.

The value of MRI enhancement amplitude in qualitative diagnosis of suspicious enhancement after neoadjuvant therapy in breast cancer / 中华放射学杂志

Objective:To investigate the value of dynamic contrast-enhanced MRI enhancement amplitude for qualitative diagnosis of suspicious residual enhancing lesions after neoadjuvant therapy (NAT) in breast cancer.Methods:In total, 168 suspicious residual enhancing lesions of 168 patients who received NAT at Peking University Cancer Hospital from January 2015 to June 2016 were retrospectively analyzed and divided into non-residual cancer group ( n=59) and residual cancer group ( n=109) according to pathological findings. Then 168 suspicious residual enhancing lesions were stratified according to molecular subtype and baseline enhancing morphology. According to the breast imaging reporting and data system, the morphology of enhancing lesions, the margin of mass-like enhancing lesions, and the distribution of non-mass-like enhancing lesions on MRI before NAT were recorded. The second phase (1 min 45 s-2 min after contrast injection) was used as the early phase, and the fifth phase (5-6 min after contrast injection) was used as the late phase to measure the signal intensity and time-signal intensity curve (TIC) of suspicious residual enhancing lesions, and the signal enhancement ratio (SER) was calculated. Independent sample t-test, Mann-Whitney U test and χ 2 test were used to compare the difference of SER and clinical features between the non-residual and residual cancer groups. The receiver operator characteristic curve was used to analyze the diagnostic efficacy of SER to determine residual cancer. Results:There are statistically significant differences in invasive ductal carcinoma grade, hormone receptor status, the morphology of enhancing lesion on baseline MRI and TIC type between non-residual and residual cancer groups ( P<0.05). The SER values of the non-residual cancer group in the early [31% (23%, 61%)] and late (72%±43%) enhanced phases were significantly lower than those of the residual cancer group [49% (28%, 71%), 88%±38%, Z=-2.26, t=-2.43, P=0.024, 0.016, respectively]. Among suspicious residual enhancing lesions with hormone receptor negative status and single mass-like morphology, the SER values of the non-residual cancer group in the early (33%±16%) and late [64% (42%, 74%)] enhanced phases were significantly lower than those of the residual cancer group [59%±30%, 84% (77%, 106%), t=-2.86, Z=-3.17, P=0.008, 0.001, respectively]. The area under the curve values of SER in differentiating suspicious residual enhancing lesions were statistically different between early and late enhanced phases (0.606 and 0.637, respectively, Z=2.16, P=0.031). Conclusion:For breast cancer after NAT, it is difficult to determine the suspicious residual enhancing lesions on MRI subjectively, especially the hormone receptor negative lesions with single mass, SER can be used as an auxiliary diagnostic method, and it is necessary for the analysis of late enhancement.

Correlation between human immunodeficiency virus reservoir and poor immune reconstitution of human immunodeficiency virus/acquired immunodeficiency syndrome patients / 中华传染病杂志

Objective:To analyze the correlation between human immunodeficiency virus (HIV)-1 reservoir and poor immune reconstitution of HIV/acquired immunodeficiency syndrome (AIDS) patients, and to investigate the influence of HIV-1 reservoir on the immune reconstitution.Methods:Cross-sectional survey was conducted to measure HIV-1 RNA and T lymphocyte subsets from 219 patients with HIV/AIDS who had been treated with anti-retroviral therapy (ART) for more than two years with HIV RNA lower than the limit of detection. Among them, there are 195 patients from the Sixth People′s Hospital of Zhengzhou, 12 patients from Shangqiu Municipal Hospital and 12 patients from Zhoukou Infectious Diseases Hospital. Peripheral blood mononuclear cells (PBMC) were collected and HIV-1 DNA was detected. The measurement data of normal distribution were analyzed by two independent sample t-test. The measurement data of skewness distribution were analyzed by rank sum test. Spearman′s rank correlation was used for correlation analysis. Receiver operating characteristic curve (ROC) was used to predict the predictive value of occurrence of poor immune reconstitution AIDS patients. Results:There were 121 patients with poor immune reconstitution and 98 patients with healthy immune reconstitution. HIV-1 DNA was (2.50±0.52) copies/1×10 6 PBMC in the group with poor immune reconstitution, which was significantly higher than the healthy immune reconstitution group ((2.11±0.66) copies/1×10 6 PBMC, t=4.78, P<0.001). The CD4 + T lymphocyte counts in the group with poor immune reconstitution was 192(139, 227)/μL, which was lower than that in the healthy immune reconstitution group (573(457, 730)/μL). The difference was statistically significant ( Z=12.68, P<0.001). HIV-1 DNA was reversely correlated with CD4 + T lymphocyte counts and CD4 + /CD8 + T lymphocyte ratio (after adjusting the influence of age and ART time, r=-0.277 and -0.316, respectively, both P<0.001). The area of ROC curve for HIV-1 DNA to predict poor immune reconstitution was 0.679(95% confidence interval ( CI) 0.604 to 0.750). The HIV-1 DNA threshold value was 100 copies/1×10 6 PBMC with the sensitivity of 90.13% and specificity of 42.91%. The area of ROC curve of CD4 + /CD8 + T lymphocyte ratio to predict poor immune reconstitution was 0.905 (95% CI 0.863 to 0.942). The threshold value of CD4 + /CD8 + T lymphocyte ratio was 0.536 with the sensitivity of 77.68% and specificity of 89.84%. Conclusions:There is correlation between HIV-1 DNA and poor immune reconstitution in HIV/AIDS patients. The value of HIV-1 DNA higher than 100 copies/1×10 6 PBMC and CD4 + /CD8 + T lymphocyte ratio lower than 0.536 could be used as predictor of poor immune reconstitution.

Analysis of drug resistance in patients with acquired immunodeficiency syndrome who failed antiviral therapy / 中华传染病杂志

Objective:To investigate the drug resistance of patients with acquired immunodeficiency syndrome (AIDS) who failed antiviral therapy.Methods:A total of 156 AIDS patients with antiviral therapy failure at the Sixth People′s Hospital of Zhengzhou from October 2017 to December 2018 were selected. The human immunodeficiency virus (HIV)-1 ViroSeq? genotyping method was used for the detection of HIV resistance, and Stanford University HIV drug resistance database (http: ∥hivdb.stanford.edu/) was used for testing results comparison.Results:Among the 156 AIDS patients with antiviral therapy failure, 122(78.21%) developed drug resistance. One hundred and six (67.95%) cases were multi-resistant to nucleoside reverse transcriptase inhibitor (NRTI), among which, 104 (66.67%) were resistant to lamivudine, emtricitabine and abacavir. One hundred and eighteen (75.64%) were resistant to non-nucleoside reverse transcriptase inhibitor (NNRTI), and 118 (75.64%) were multi-resistant to efavirenz and nevirapine. And seven (4.49%) were resistant to protease inhibitor (PI). There were 16 resistant sites for NRTI, with 87 (71.31%) most frequent M184V/I mutations. There were 13 resistant sites for NNRTI, with 49 (40.16%) K103N/R mutations. There were 11 resistant sites for PI, with 49 (40.16%) A71V/T mutations. The antiviral drugs lamivudine and emtricitabine were moderately and highly resistant in 102 (83.61%) cases, efavirenz and nevirapine were moderately and highly resistant in 117 (95.90%) cases. Once drug resistance developed, these drugs were likely to be moderate or high resistance. There were 29 (23.77%), 48 (39.34%), and five (4.10%) cases were resistant to zidovudine, tenofovir and lopinavir/ritonavir, respectively. The resistance barrier of these drugs was relatively high.Conclusion:The incidence of drug resistance in patients with AIDS treatment failure is high, and multi-drug resistance is serious with various sites of drug resistance.

Epidemiological, Clinical Characteristics and Outcome of Medical Staff Infected with COVID-19 in Wuhan, China: A Retrospective Case Series Analysis

BackgroundsSince December 2019, a novel coronavirus epidemic has emerged in Wuhan city, China and then rapidly spread to other areas. As of 20 Feb 2020, a total of 2,055 medical staff confirmed with coronavirus disease 2019 (COVID-19) caused by SARS-Cov-2 in China had been reported. We sought to explore the epidemiological, clinical characteristics and prognosis of novel coronavirus-infected medical staff. MethodsIn this retrospective study, 64 confirmed cases of novel coronavirus-infected medical staff admitted to Union Hospital, Wuhan between 16 Jan, 2020 to 15 Feb, 2020 were included. Two groups concerned were extracted from the subjects based on duration of symptoms: group 1 ([≤]10 days) and group 2 (>10 days). Epidemiological and clinical data were analyzed and compared across groups. The Kaplan-Meier plot was used to inspect the change in hospital discharge rate. The Cox regression model was utilized to identify factors associated with hospital discharge. FindingsThe median age of medical staff included was 35 years old. 64% were female and 67% were nurses. None had an exposure to Huanan seafood wholesale market or wildlife. A small proportion of the cohort had contact with specimens (5%) as well as patients in fever clinics (8%) and isolation wards (5%). Fever (67%) was the most common symptom, followed by cough (47%) and fatigue (34%). The median time interval between symptoms onset and admission was 8.5 days. On admission, 80% of medical staff showed abnormal IL-6 levels and 34% had lymphocytopenia. Chest CT mainly manifested as bilateral (61%), septal/subpleural (80%) and ground-glass (52%) opacities. During the study period, no patients was transferred to intensive care unit or died, and 34 (53%) had been discharged. Higher body mass index (BMI) ([≥] 24 kg/m2) (HR 0.14; 95% CI 0.03-0.73), fever (HR 0.24; 95% CI 0.09-0.60) and higher levels of IL-6 on admission (HR 0.31; 95% CI 0.11-0.87) were unfavorable factors for discharge. InterpretationIn this study, medical staff infected with COVID-19 have relatively milder symptoms and favorable clinical course, which may be partly due to their medical expertise, younger age and less underlying diseases. Smaller BMI, absence of fever symptoms and normal IL-6 levels on admission are favorable for discharge for medical staff. Further studies should be devoted to identifying the exact patterns of SARS-CoV-2 infection among medical staff.

Can narrowing of the mandibular canal on pre-operative panoramic radiography predict close anatomical contact of the mandibular canal with the mandibular third molar? A meta-analysis.

PURPOSE: Inferior alveolar nerve injury is a common complication following mandibular third molar extraction. Accurate pre-operative assessment of the anatomical relationship between the mandibular third molar and the mandibular canal could help to avoid this injury. We performed a eta-analysis to investigate whether panoramic radiography could be used to assess the relationship between these two structures. METHODS: PubMed, EMBASE, SpringerLink, Cochrane Library, and Web of Science databases were searched independently by two researchers from January 2008 to May 2018. RESULTS: Seven articles were identified. Statistical analyses were performed using Revman 5.3 and Meta-disc 1.4 software tools. The pooled sensitivity and specificity were 0.19 (95%CI:0.16-0.22) and 0.90 (95%CI:0.88-0.92), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 2.34 (95%CI:1.42-3.87) and 0.86 (95%CI:0.78-0.96), respectively. The area under the curve was 0.86 (95%CI:0.78-0.96). CONCLUSIONS: According to the sign of narrowing of the mandibular canal, panoramic radiology used to assess the relationship between the mandibular third molar and the mandibular canal yielded high specificity, but low sensitivity. The absence of narrowing of the mandibular canal indicated that there was no close contact between these two structures. However, the presence of narrowing of the mandibular canal could not be used to accurately evaluate the relationship between these two structures, although it might indicate a high probability of close anatomical contact between these two structures. Further tests should be performed for providing adequate pre-operative risk assessment while planning for the surgery to reduce the risk of inferior alveolar nerve injury, as well as to enable an open discussion with the patient to decrease the risk of medical disputes.

Therapeutic principles and strategies of Mirrizi syndrome / 中华消化外科杂志

Mirrizi syndrome is a rare benign disease of biliary tract. With the continuous emergence of new concepts and technologies in the field of disease diagnosis and treatment, the standardization of diagnosis and treatment for biliary diseases is also updated. Mirrizi syndrome is difficult to be diagnosed pre-operatively, and intraoperative unclear Calot′s triangle and tissue adhesion caused by gallbladder inflammation and gallbladder fistula formation increase the risk of biliary tract injury, which lead certain challenges for its surgical treatment. Therefore, strict preoperative evaluation and selection of corresponding surgical procedure for different classification of Mirrizi syndrome are of great significance for reducing postoperative complications. In addition, the development of laparoscopic technology reduces the surgical trauma and enhances recovery, but puts forward higher requirements for the experience and operation of surgeons. It is important that reasonably select laparoscopic surgery indications, correctly hold indications of bilioenetric anastomosis, and prevent iatrogenic injury of bile duct on the premise of clearing stones, which is the basic strategy for surgical treatment of Mirrizi syndrome. Based on relevant literatures and clinical practice, the author investigate the therapeutic principles and strategies of Mirrizi syndrome.

Heat-killed Salmonella typhimurium mitigated radiation-induced lung injury.

Radiation-induced lung injury (RILI) is a serious complication in thoracic tumour radiotherapy. It often occurs in clinical chest radiotherapy and acute whole-body irradiation (WBI) caused by nuclear accidents or nuclear weapon attack. Some radioprotective agents have been reported to exert protective effects when given prior to radiation exposure, however, there is no treatment strategy available for preventing RILI. In this study, we demonstrated that heat-killed Salmonella typhimurium (HKST), a co-agonist of Toll-like receptors 2 (TLR2), Toll-like receptors 4 (TLR4) and Toll-like receptors 5 (TLR5), mitigated radiation-induced lung injury through the transforming growth factor-ß (TGF-ß) signalling pathway. We found that HKST alleviated lung hyperaemia and pathological damage after irradiation, indicated that HKST inhibits the early inflammatory reaction of radiation-induced lung injury. Then, for the first time, we observed HKST reduced collagen deposit induced by irradiation in the later phase (7-14 week) of RILI, and we found that HKST inhibited radiation-induced cell apoptosis in lung tissues. We found that HKST reduced the level of TGF-ß and regulated its downstream signalling pathway. Finally, it was found that HKST inhibited radiation-induced epithelial-mesenchymal transition (EMT) in lung tissues. In conclusion, our data showed that HKST effectively mitigated RILI through regulating TGF-ß, provide novel treatment strategy for RILI in whole-body irradiation and radiotherapy.

miR-455 Functions as a Tumor Suppressor Through Targeting GATA6 in Colorectal Cancer.

Emerging evidence indicates that microRNAs (miRNAs) are often aberrantly expressed in human cancers. Meanwhile, the importance of miRNAs in regulating multiple cellular biological processes has been appreciated. The aim of this study was to investigate the significance of miR-455 and identify its possible mechanism in regulating colorectal cancer (CRC) progression. We found that the expression of miR-455 was sharply reduced in CRC tissues and cell lines. Importantly, the low expression of miR-455 was associated with poor overall survival of CRC patients. Overexpression of miR-455 in CRC cell lines significantly inhibited cell proliferation and migration in vitro. Moreover, GATA-binding protein 6 (GATA6), whose expression can be inversely regulated by miR-455 in CRC cell lines, was validated as a direct target of miR-455. Overall, our results revealed that miR-455 functions as a tumor suppressor, and its downregulation may contribute to CRC progression. Our study may provide a novel therapeutic target for CRC in the future.

Histogram analysis of dynamic contrast enhancement MRI in predicting long-term treatment effect of cervical cancer after chemoradiotherapy / 中华放射学杂志

Objective To investigate the potential value of pre-treatment dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting long-term survival of cervical cancer treated by concurrent chemoradiotherapy. Methods Uterine cervical cancer patients who received chemo-radiation therapy during 2008 to 2014 in a single institute were retrospectively collected and followed up. Pre-treatment DCE-MRI images were retrieved to generate four hemodynamic related parameters including positive enhancement integral (PEI), maximum slop of increase (MSI), maximum slope of decrease (MSD) and signal enhancement ratio (SER). Region of interests were drawn manually on T2WI along the rim of tumors on each slice, and were then registered to DCE-MRI parametric maps. Histogram analysis software was used to calculate the mean, median, maximum, minimum,10th percentile, 90th percentile, kurtosis and skewness values for each DCE-MRI parameters. Median follow-up time was 54.7 months (range 2.1 to 94.6 months). Uni-and multivariable Cox regression analyses were used to evaluate correlation between the above values and the disease free survival (DFS). Kaplan-Meier curve was used to evaluate survival time. Results Of the 75 patients, 16 of them died from cervical cancer, 3 patients had metastasis, and 1 patient continued to progress. Median, mean, 10th and 90th percentile from MSI, and minimum, kurtosis, skewness were the influencing factors of disease-free survival of cervical cancer with concurrent chemoradiotherapy (P<0.1) Pearson relationship analysis and multivariable Cox regression analysis was performed which indicated PEI kurtosis value of cervical cancer was an independent influencing factor for cervical cancer without disease survival (hazard ratio 1.658, P=0.001). Conclusion PEI kurtosis was an independent factor for DFS of locally advanced cervical cancer treated with concurrent chemoradiotherapy.

Whole tumor histogram analysis of early and late phase contrast-enhanced MRI in predicting residuals after neoadjuvant chemotherapy for mass-like breast cancer / 中国医学影像技术

Objective To investigate the diagnostic value of whole tumor histogram analysis of early and late phase contrast-enhanced MRI in predicting residual tumor after neoadjuvant chemotherapy (NAC) for mass-like breast cancer. Methods Totally 52 patients with mass-like breast cancer underwent contrast-enhanced MR scanning after NAC. ROIs were drawn on early phase images to cover the whole enhanced areas. Patients with enhanced signals on site of original tumor were divided into residual group (n=29) and non-residual group (n=9) according to pathological results. Parameters of histogram were compared between the 2 groups, and Logistic regression was used to analyze the impact factors of residual tumors, then diagnostic value of histogram parameters to residual tumors was assessed with ROC curves. Results There were significant differences in volume of enhanced areas, maximal signal intensity on early phase and kurtosis on late phase between residual group and non-residual group (all P<0.05). Logistic regression analysis showed that kurtosis on late phase was an independent factor of residual tumor (P=0.025, OR=4.303, 95%CI [1.205,15.359]). The diagnosis cutoff value of kurtosis on late phase was 2.25, the diagnostic specificity, sensitivity and accuracy rate were 76.19%(16/21), 90.32%(28/31) and 84.62%(44/52), respectively. Conclusion Histogram analysis is a useful method to reflect the internal distribution of signal intensities on early and late enhanced phases. Kurtosis on late phase is an independent factor for diagnosis of residuals after NAC for mass-like breast cancer.

Texture features of pre-operative contrast enhanced MRI early phase images in predicting complete response for breast cancer after neoadjuvant chemotherapy / 中华放射学杂志

Objective To evaluate the ability of texture analysis in early phase of enhanced MRI in predicting pathological complete response(pCR) after neoadjuvant chemotherapy(NAC) for breast cancer. Methods This retrospective study enrolled 64 breast cancers samples from 64 patients that were diagnosed by core-needle biopsy and received NAC before operation in Peking University Cancer Hospital between July and Dec 2015. MRI were conducted after NAC. Regions of interest were drawn to cover the whole enhanced areas on subtraction images of early phase to pre-enhanced phase on MRI, and were sent to an in-house developed texture-analyzing software to achieve parameters including average signal intensity (SIav), mean signal intensity (SIm), signal intensity range(SIr), skewness, kurtosis, energy and entropy. Groups of pCR (no invasive tumor) and non-pCR were separated based on pathology results. Differences of MRI parameters were compared by independent-sample t test (normal distribution) or Mann-Whitney U test (abnormal distribution) and ROC curve were drawn to evaluate the diagnostic abilities. Results Post-operation pathology found 28 pCR and 36 non-pCR. ROIs of 13 samples were not drawn because no residual enhanced areas could be found on subtraction images of post-NAC MRI. For 51 lesions (17 pCR and 34 non-pCR) that still had residual enhancement, tumor volume, SIav, SIr, energy and entropy of pCR group were all significantly lower than that of non-pCR group (P＜0.05). ROC curves were drawn, yielding AUC=0.669 for non-enhancement criterion, and the accuracy, sensitivity and specificity were 70.3%, 39.3% and 94.4%. AUCs for volume, SIav, SIr, Energy and Entropy were 0.870, 0.772, 0.810, 0.883 and 0.881 respectively. Conclusion Texture analysis on early-enhanced phase of breast MRI is able to help to improve the diagnostic ability in predicting complete response on in breast cancer after NAC.

Prospective study on 180 cases of endoscopic selective varies devascularization / 中国内镜杂志

Objective To study the clinical efficacy and safety of endoscopic selective varies devascularization prospectively. Methods 180 cases of cirrhosis with esophagogastric variceal endoscopic treatment were included in the prospective analysis. They were treated with selective source of blood vessel devascularization using modified sandwich method (lauromacrogol-tissue adhesive-saline). The improvement rates, effective rates, significant effective rates, rebleeding rates and rates of complications were observed. Results One month after treatment, the significant effective rate of varices was 67.8% (122/180), effective rate was 30.0% (54/180), inefficient rate was 2.2% (4/180) and improvement rate was 97.8% (176/180). Within two weeks after treatment, the rebleeding rate was 3.3% (6/180). Within three months after treatment, the rebleeding rate was 7.2% (13/180). No serious complications occurred. The incidence of overall complication was 37.8% (68/180). Conclusion Endoscopic selective varies devascularization has good efficacy and safety, and is worth promoting.

Overpression of miR-29b suppresses the proliferation and induces apoptosis of cholangiocarcinoma cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the expression of miR-29b in cholangiocarcinoma and explore its effects on cell proliferation and apoptosis of cholangiocarcinoma cells.</p><p><b>METHODS</b>Real-time PCR was used to detect the expression of miR-29b in cholangiocarcinoma cells line QBC939 and cholangiocarcinoma tissues. The lentiviral vector LV-hsa-miR-29b and blank vector were constructed to infect QBC939 cells. MTT assay and cell clone formation assay were performed to assess the changes in the cell proliferation and clone formation, respectively; flow cytometry was employed to evaluate the effect of miR-29b overexpression on cell cycle and apoptosis.</p><p><b>RESULTS</b>The expression of miR-29b was significantly down-regulated in QBC939 cells and cholangiocarcinoma tissues as compared with H-69 cells and normal tissues ( < 0.01). Compared with the blank vector, the lentiviral vector LV-hsa-miR-29b caused significantly increased expression of miR-29b in QBC939 cells ( < 0.01), which exhibited suppressed cell proliferation and clone formation ( < 0.01 or 0.05), cell cycle arrest at the S phase ( < 0.05), and significantly increased cell apoptosis ( < 0.01).</p><p><b>CONCLUSIONS</b>As a tumor-suppressing miRNA, miR-29b is down-regulated in cholangiocarcinoma, and its overexpression can suppress the proliferation and induce apoptosis of cholangiocarcinoma cells.</p>

Feasibility of ADC reflecting enhancement and differentiation of cervical squamous cell carcinomas in multi-b-value DWI on 3.0T MRI / 中国医学影像技术

Objective To investigate the feasibility of ADC values that derived from MR DWI with multiple b values in reflecting the amplitude of enhancement and degree of differentiation in cervical squamous cell carcinomas on 3.0T MR scanner.Methods DWI and multiple phase contrast enhanced MRI images of 31 patients with pathologically diagnosed cervical squamous cell carcinomas were retrospectively analyzed.All ADC values in different b values and the amplitude of signal intensity enhancement were measured in various areas of tumors.Correlations of differences of ADCs in high and low b values with early and late enhancement,and the relationship of ADC and differences of ADCs with pathologically tumor differentiation grades were analyzed.Results ADC value in high and low enhanced areas of cervical cancer was inversely related with different b values.Differences of ADCs between low b value (200 s/mm2) and high b values (800,1 000,1 200,1 400 s/mm2) had weak positive correlation with early enhancement (r=0.315-0.339,all P＜0.05).While b=800 s/mm2 and 1 000 s/mm2,ADCs in highly enhanced areas of tumor were significantly lower in well-differentiated cancer lesions compared with those of poorly differentiated cancer lesions.There was no statistically significant of ADC value in other b values,and also of differences of ADCs in all b values in different differentiation foci (all P＞0.05).No differences were found in ADC values under other b values in various degree of differentiation foci,nor in differences of ADCs in all b values (all P＞0.05).Conclusion Combination of multiple b values of DWI may have the potential to reflect blood supply and tumor differentiation grades in cervical squamous cell carcinomas,while low b value of 200 s/mm2 and high b values of 800 s/mm2 and 1 000 s/mm2 will be the preferable choice on 3.0T MR scanner.

Pixel-based quantitative evaluation of CT values in differentiating cystic-solid ovarian tumors / 实用放射学杂志

Objective To assess the ability of pixel-based quantitative evaluation of CT values in differentiating benign and malignant cystic-solid ovarian tumors.Methods CT images of 41 cystic-solid ovarian lesions from 39 patients were reviewed,with 27 benign and 14 malignant confirmed by post-operation pathology or follow-up.Regions of interest (ROIs) were drawn along edges of tumors on all slices of contrast-enhanced images with ImageJ software.CT values of each pixel were extracted.CT values of 20,25,30,35 and 40 HU were used respectively as the threshold to divide cystic and solid components.Solid proportion,the mean and median CT values of solid component were calculated and compared between benign and malignant groups.Results Mean CT values of solid components were all higher in malignant than in benign ovarian masses under all the threshold values (P<0.05).For median CT values, the same trend existed under the threshold of 20,25,35 and 40 HU (P<0.05).For the solid proportion,difference was found only under the 40 HU threshold, with lower value in malignant group (0.67±0.25) than in benign group (0.47±0.31).ROC curves were drawn to differentiate benign and malignant lesions.The highest AUC was obtained by using the mean CT value of solid components defined by 40 HU threshold (AUC=0.735).Conclusion Pixel-based quantitative evaluation on CT images could help to define cystic and solid components of ovarian masses, with 40 HU to be an optimal threshold.Cystic-to-solid proportion and CT value of solid components derived from whole lesion can help to differentiate benign or malignant lesions.

Diffusion-weighted MRI in residual foci evaluation of uterine cervical cancer after chemoradiation therapy / 实用放射学杂志

Objective To evaluate the usefulness of diffusion-weighted MR combined with routine T2 WI in finding the possible residual foci in uterine cervical cancers after radical chemo-radiation therapy.Methods This was a retrospective study including 25 consecutive cervical cancer patients who received hysterectomy after radical chemo-radiation therapy.All of them underwent MR examinations post-chemoradiation and just before operation.Images of T2 WI alone and those of T2 WI combining DWI were evaluated respectively by 2 senior radiologists,in order to decide whether there were residual tumors.ADC values were also measured.Taking the post-operation pathological results as the gold standard,the accuracies,sensitivities and specificities of T2 WI alone,T2 WI combining DWI,and ADC values were all calculated.Results In those 25 patients,9 were found with foci of residual cancer in operative pathology,while no cancer cells were found in the other 1 6 patients.The accuracy,sensitivity and specificity in finding the positive residual cancer using T2 WI alone were 56.0%,77.8% and 43.8%,comparing with 72.0%,66.7% and 75.0% in T2 WI combining DWI.The accuracy and specificity increased with statistical significance after combining DWI (P =0.01 6 for accuracy,P =0.031 for specificity),while the sensitivity decreased but did not reach statistically significant level (P =0.099).No difference in ADC values was found.Conclusion DWI can be used as a supplementary sequence in finding the existence of residual tumors of cervical cancer after radical chemo-radiation therapy.Routine T2 WI combing DWI increased the specificity and accuracy,but still facing the risk of decreasing sensitivity.

Implementation of Constant Dose Rate and Constant Angular Spacing Intensity-modulated Arc Therapy for Cervical Cancer by Using a Conventional Linear Accelerator / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Volumetric-modulated arc therapy (VMAT) can only be implemented on the new generation linacs such as the Varian Trilogy® and Elekta Synergy®. This prevents most existing linacs from delivering VMAT. The purpose of this study was to investigate the feasibility of using a conventional linear accelerator delivering constant dose rate and constant angular spacing intensity-modulated arc therapy (CDR-CAS-IMAT) for treating cervical cancer.</p><p><b>METHODS</b>Twenty patients with cervical cancer previously treated with intensity-modulated radiation therapy (IMRT) using Varian Clinical 23EX were retreated using CDR-CAS-IMAT. The planning target volume (PTV) was set as 50.4 Gy in 28 fractions. Plans were evaluated based on the ability to meet the dose volume histogram. The homogeneity index (HI), target volume conformity index (CI), the dose to organs at risk, radiation delivery time, and monitor units (MUs) were also compared. The paired t-test was used to analyze the two data sets. All statistical analyses were performed using SPSS 19.0 software.</p><p><b>RESULTS</b>Compared to the IMRT group, the CDR-CAS-IMAT group showed better PTV CI (0.85 ± 0.03 vs. 0.81 ± 0.03, P = 0.001), clinical target volume CI (0.46 ± 0.05 vs. 0.43 ± 0.05, P = 0.001), HI (0.09 ± 0.02 vs. 0.11 ± 0.02, P = 0.005) and D95 (5196.33 ± 28.24 cGy vs. 5162.63 ± 31.12 cGy, P = 0.000), and cord D2 (3743.8 ± 118.7 cGy vs. 3806.2 ± 98.7 cGy, P = 0.017) and rectum V40 (41.9 ± 6.1% vs. 44.2 ± 4.8%, P = 0.026). Treatment time (422.7 ± 46.7 s vs. 84.6 ± 7.8 s, P = 0.000) and the total plan Mus (927.4 ± 79.1 vs. 787.5 ± 78.5, P = 0.000) decreased by a factor of 0.8 and 0.15, respectively. The IMRT group plans were superior to the CDR-CAS-IMAT group plans considering decreasing bladder V50 (17.4 ± 4.5% vs. 16.6 ± 4.2%, P = 0.049), bowel V30 (39.6 ± 6.5% vs. 36.6 ± 7.5%, P = 0.008), and low-dose irradiation volume; there were no significant differences in other statistical indexes.</p><p><b>CONCLUSIONS</b>Patients with cervical cancer treated with CDR-CAS-IMAT using Varian Clinical 23EX can get equivalent or superior dose distribution compared to those treated with IMRT. CDR-CAS-IMAT has a less treatment time and MU, which can reduce the uncertainty factor and patient discomfort in treatment.</p>

Correlation of diffusion weighted MR imaging with the prognosis of local advanced gastric carcinoma after neoadjuvant chemotherapy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the correlation of the apparent diffusion coefficient (ADC) on diffusion-weighted MRI (DWI) with the prognosis of locally advanced gastric carcinoma after neoadjuvant chemotherapy (NACT).</p><p><b>METHODS</b>Patients with locally advanced gastric carcinoma undergoing NACT in our hospital from November 2010 to September 2011 were enrolled in this prospective study. MRI examinations were performed before and after NACT. ADCs of the whole lesion (ADCentire) and high signal area on DWI (ADCmin) were calculated, and the cancer thickness on T2-weighted images was measured. All the patients were divided into long-term survival group and poor prognosis group, according to the 3-year survival status. The pre-therapy baseline values and early percentage changes (%delta) of the above parameters were compared between the two groups. Receiver operating characteristics (ROC) curves were employed to compare the performance of the above parameters in the discrimination of different prognosis groups.</p><p><b>RESULTS</b>A total of 24 patients were enrolled in the study. There were 14 patients of long-term survival group and 10 patients of poor prognosis group. No statistical difference in baseline ADCmin and ADCentire was shown between long-term survival group and poor prognosis group [ADCmin: (1.17 ± 0.23)×10⁻³ mm²/s vs. (1.23 ± 0.27) × 10⁻³ mm²/s, P>0.05; ADCentire: (1.43 ± 0.20) × 10⁻³ mm²/s vs. (1.50 ± 0.24) × 10⁻³ mm²/s, P>0.05]. The % ΔADCmin and % ΔADCentire were both higher in long-term survival group than those in poor prognosis group (% ΔADCmin: 21% vs. 5%, P=0.06; % ΔADCentire: 23% vs. 1%, P=0.02). Through ROC curves, the AUCs for pre-therapy cancer thickness, ADCmin and ADCentire were 0.693, 0.543 and 0.600 respectively, and AUCs for % deltathickness, % ΔADCmin and % ΔADCentire were 0.532, 0.729 and 0.779 respectively, in the differentiation of prognosis. Using % ΔADC≥15% to predict long-term survival, the positive predictive value (PPV) for % ΔADCmin was 81.8% and % ΔADCentire was 83.3%. Using % ΔADC ≤ 10% to predict poor prognosis, the PPV for % ΔADCmin was 63.6% and % ΔADCentire was 70.0%.</p><p><b>CONCLUSIONS</b>The change of ADC after NACT of gastric carcinoma is correlated with long-term prognosis. The significantly increased ADC is prone to signify long-term survival. ADCentire is better than ADCmin in the prognosis prediction.</p>