[Value of LSR and ADCs in differential diagnosis of hilar and mediastinal lymph nodes in lung cancer].

Objective: To evaluate the value of minimum ADC(ADC(min))and mean ADC(ADC(mean)), lesion to spinal cord signal intensity ratio (LSR) in diagnosis of metastatic hilar and mediastinal lymph nodes in patients with lung cancer. Methods: A total of 34 patients (89 lymph nodes) pathologically diagnosed as lung cancer were enrolled into this study who were examined in the Second Affiliated Hospital of Nantong University from January 2016 to June 2017. All patients underwent MRI scan 1 week before surgery or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The short-axis diameter, ADC(mean) and ADC(min) of lymph nodes were measured and recorded respectively by two radiologists.The signal intensity of lymph nodes and spinal cord was also measured on DWI images (b=800 s/mm(2)). According to pathological findings, all lymph nodes were divided into metastasis group (58 lymph nodes) and non-metastasis group(31 lymph nodes). An independent sample t-test was used to compare the differences between the two groups of short-axis diameter, LSR, ADC(mean) and ADC(min) between two groups.The diagnostic performance of short-axis diameter, LSR, ADC(mean) and ADC(min) was analyzed by ROC curves. Results: There were significant differences in short-axis diameter, ADC(mean), ADC(min) and LSR values between two groups (all P<0.01). The short-axis diameter and LSR of the metastatic group were higher than that in non-metastasis group, while ADC(mean) and ADC(min) in metastatic group were lower than that in non-metastasis group.The ROC curve analysis showed that ADC(mean), ADC(min) and LSR achieved excellent but comparable diagnostic performance with an AUC of 0.977, 0.972 and 0.941, respectively (P<0.05). While the short-axis diameter of lymph nodes demonstrated poor diagnosis performance with an AUC of 0.798 (P<0.05). The thresholds of short-axis diameter, ADC(mean), ADC(min) and LSR were 9.86 mm, 1.88×10(-3) mm(2)/s, 1.57×10(-3) mm(2)/s and 0.80, respectively.Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for ADC(mean) were 96.6%, 90.3%, 94.9%, 93.3% and 94.4%, respectively, and those for ADC(min) were 98.3%, 90.3%, 95.0%, 96.6% and 94.4%, respectively, those for LSR were 91.4%, 90.3%, 94.6%, 84.8% and 89.9%, respectively, while those for short-axis diameter were 79.3%, 71.0%, 83.6%, 64.7% and 76.4%, respectively.There were significant differences in the area under the ROC curve between short-axis diameter and LSR, short-axis diameter and ADC(mean), short-axis diameter and ADC(min) (P<0.05). But there was no significant difference in the area under ROC curve between LSR and ADC(mean), LSR and ADC(min), ADC(mean) and ADC(min) (P>0.05). Conclusion: LSR, ADC(min) and ADC(mean) are the reliable parameters for the differentiation of metastatic and non-metastatic lymph nodes in lung cancer patients, and have good performance.

[Association between XRCC1 polymorphisms and chromosome damage in workers exposed to benzene in jewelcrafting industry].

OBJECTIVE: To investigate the association between the gene polymorphisms of the DNA damage repair gene X-ray repair cross-complementing gene 1 (XRCC1) and susceptibility to chromosome damage in workers exposed to low-concentration benzene in the jewelcrafting industry. METHODS: A total of 286 workers exposed to benzene in jewelcrafting enterprises were enrolled as study subjects from January 2013 to December 2014. Gas chromatography was used to measure benzene concentration in workplace, cytokinesis-block micronucleus test was used to analyze the level of chromosome damage in peripheral blood, and the Sequenom technique was used to determine the single nucleotide polymorphisms of XRCC1. RESULTS: The time-weighted average concentration of benzene in workplace was <0.6~1.8 mg/m(3), lower than the national occupational exposure limit (6 mg/m(3)). The distribution of allele frequencies met the Hardy-Weinberg equilibrium in genetics (P>0.05). Increase in age (RR=1.38, 95%CI 1.06~3.75) and increase in working years (RR=1.45, 95%CI 1.18~2.58) were risk factors for the increase in micronucleus frequency. Compared with those with the wild-type homozygous genotype, the individuals with XRCC1 rs25487 CT genotype showed a significantly higher risk of increase in micronucleus frequency (RR=1.51, 95% CI 1.28~3.87, P<0.05) , and the individuals with XRCC1 rs1799782 AA genotype also showed a significantly higher risk of increase in micronucleus frequency (RR=1.65, 95% CI 1.30~3.12, P<0.05). There was no clear association between XRCC1 rs25489 polymorphisms and micronucleus frequency (P>0.05). CONCLUSION: Exposure to low-concentration benzene may cause chromosome damage in workers exposed to benzene, and the XRCC1 polymorphisms rs 25487 and rs1799782 may be associated with chromosome damage induced by benzene.

Application value of stomach filling ultrasonography and intravenous contrast agents in diagnosis of advanced gastric cancer.

OBJECTIVE: To explore the imaging characteristics and clinical application value of gastric filling ultrasound combined with an intravenous contrast agent (double contrast ultrasonography, DCUS) in the diagnosis of advanced gastric carcinoma. PATIENTS AND METHODS: Totally 48 patients with advanced gastric carcinoma were confirmed by endoscopic biopsy and then administrated with DCUS and enhanced magnetic resonance examination before treatment. Retrospective analysis was conducted based on the characteristics of their ultrasonic images, and the results of diagnosis were compared and analyzed between the DCUS technology and the enhanced magnetic resonance examination. RESULTS: The DCUS technology showed rapid positive development in the arterial phase and rapid negative development in the portal phase at all foci of advanced gastric carcinomas. The initiation time in the arterial phase was (19.35±4.82) s, the peak value was (31.41±4.23) dB, and the expurgation time was (41.71±7.03) s. The accuracy rates of the DCUS diagnosis and the enhanced magnetic resonance diagnosis of advanced gastric cancer were 87.5% and 66.7% respectively, with statistical differences (p<0.05). CONCLUSIONS: DCUS had specific fast-in and fast-out characteristics and high accuracy in diagnosing the advanced gastric cancer and so could be used as an effective means to the diagnosis of the disease in clinic.

Assessment of myocardial segmental function with coronary artery stenosis in multi-vessel coronary disease patients with normal wall motion.

OBJECTIVE: To discover the impact of the various degrees of coronary artery stenosis (CAD) on the left ventricular systolic dysfunction in steady state with quantitative analysis of the regional systolic myocardium in longitudinal, radial and circumferential direction in patients with coronary artery disease by two-dimensional speckle tracking imaging (STI). PATIENTS AND METHODS: Forty-three normal wall motion-multi vessel coronary artery disease (NWM-MVD) patients labeled as the experimental groups and forty-two subjects with little risk of CAD marked as the control group were enrolled in this study. The two-dimensional STI was obtained in the apical long axis and three levels of the short axis of the left ventricle. The left ventricular wall was divided into 18 segments. The affected myocardia were divided into three groups: group B (coronary stenosis degree ≤50%), group C (coronary stenosis degree 50%-99%)and group D (coronary stenosis degree ≥99%). Using the Q-analysis software, the longitudinal, radial and circumferential systolic strain (SL, SR, SC) and strain ratio (SrL, SrR, SrC) of the myocardium were analyzed. RESULTS: The bradycardia in the NWM-MVD group is greater than that in the control group (16/43 vs. 7/42, p <0.05). Compared with the control group, the SL and SR of group B, group C and group D decreased significantly (p <0.05). Compared with group C, the SL of group D also decreased significantly (p <0.05). However, there was no SC difference among the four groups. Meanwhile, compared with group A, the SrL, SrR and SrC of group B, group C and group D decreased significantly (p <0.05). Compared with group A, group B and group C, the SrL and SrC of group D also decreased (p <0.05). Compared with group A and group C, the SrR of group D decreased. The SrL was equal to 1.085 for the cut-off value, and the sum (1.348) of sensitivity (0.673) and specificity (0.675) were the greatest. Bland-Altman analysis showed that there was myocardium conformity of in both the multi-vessel CAD patients and the control subjects. CONCLUSIONS: Myocardial systolic function was impaired in the MVD patients of group B (coronary stenosis degree ≤50%), group C (coronary stenosis degree 50%-99%)and group D (coronary stenosis degree ≥99%), especially the longitudinal and radial systolic function, even though they had normal wall motion. The SrL equaled 1.085 for the cut-off value, and the sums (1.348) of sensitivity (0.673) and specificity (0.675) were the greatest. Bradycardia might be a compensatory mechanism in NWM-MVD patients.

Assessment of the left ventricular systolic function in multi-vessel coronary artery disease with normal wall motion by two-dimensional speckle tracking echocardiography.

OBJECTIVE: To evaluate the clinical value of two-dimensional speckle tracking echocardiography for analyzing the left ventricular systolic function in patients with multi-vessel coronary artery disease with normal wall motion (NWM-MVD). PATIENTS AND METHODS: Forty-five NWM-MVD patients and thirty-six subjects with low risk of coronary artery disease (control group) were enrolled in this study. Echocardiogram images of the short axis of the left ventricle and apical long axis were obtained. The Q-analysis software was used to analyze the peak systolic strain of the left ventricular segments and the global longitudinal strain (GLS). We calculated the left ventricular global circumferential strain (GCS) and the radial strain (GRS), as well as the longitudinal, radial and circumferential strain of the basal (Bas-GLS, Bas-GCS, Bas-GRS), middle (Mid-GLS, Mid-GCS, Mid-GRS) and apical segments (Ap-GLS, Ap-GCS, Ap-GRS). RESULTS: (1) The coronary occlusion or subtotal occlusion were visible in 85.71% of the NWM-MVD patients. (2) The heart rate of the NWM-MVD patients was lower than that of the control group [(61.78 ± 6.76) beats/min vs. (66.13 ± 6.24) beats/min, p < 0.05]. The conventional ultrasonic measurement indices are similar between the NWM-MVD group and the control group (p > 0.05). (3) Compared with the control group, the GLS, Bas-GLS, Mid-GLS, Bas-GCS, Mid-GCS, GRS and Bas-GRS were lower in the NWM-MVD group (p < 0.05). CONCLUSIONS: The longitudinal, circumferential and radial systolic functions of the NWM-MVD patients were impaired at different degrees.

[Pathologic changes in the brain in burned children with septicemia and epileptiform convulsion--report of 5 autopsies].

Pathologic changes of brain in five burned children with septicemia and epileptiform convulsion are reported in this article. The important findings are cerebral vasculitis, focal malacia, focal hemorrhage and cerebral edema. Author considers that these lesions result from the effect of bacterial toxin, particular pyocyaneus toxin and are the direct causes for epileptiform convulsion and death.

Ultrasonographic diagnosis of achalasia.

A perspective ultrasonographic study on 10 cases of achalasia showed characteristic ultrasonographic features: dilation and persistent water retention of the gastroesophageal vestibule, symmetrical parietal thickening, and delayed or intermittent opening of the cardiac orifice after drinking. We suggest that ultrasonography should play an important role in clinical management of achalasia. If the ultrasonographic features of achalasia were known, the misdiagnosis of achalasia for cardiac carcinoma could be avoided. When an infiltrating cardiac carcinoma found to be smoothly narrowing and difficult to distinguish from achalasia radiologically, an ultrasonogram may be helpful to make a correct diagnosis.

[Ceruminal gland tumor--report of 7 cases and review of literature].

Seven patients with ceruminal gland tumors originating from the external auditory canal are reported. The review of literature of this tumor showed that ceruminal gland tumors are commonly considered to arise from ceruminal gland but also from heterotopia salivary gland in the external auditory canal as believed by others. The term "ceruminal adenoma or adenocarcinoma" is still used by many authors. Histologically, this tumor is divided into four subtypes: adenoma, pleomorphic adenoma, adenocarcinoma and adenoid cystic carcinoma. Different treatments should be given for this tumor according to their different benign or malignant degrees.