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A case of a 69-year-old female patient, with cough, expectoration, chest tightness and shortness of breath for 10 days accompanied by left pleural effusion, was reported. Initially, a large number of suspected malignant lymphoma cells were found in the patient′s pleural effusion through routine cell morphological examination after admission, which was the direction of clinical diagnosis and treatment in the next step. Then the patient was diagnosed as primary pulmonary diffuse large B-cell lymphoma (DLBCL) through imaging, bone marrow and lung biopsy pathology. Finally, the patient was treated effectively with R-CHOP regimen, but she died of respiratory failure 9 weeks later, because she did not receive regular follow-up and treatment after the sixth chemotherapy cycle. Primary pulmonary DLBCL, an extremely rare extranodal lymphoma' lacks specificity clinical manifestations and is easy to be missed and misdiagnosed. DLBCL with a large number of malignant pleural effusion progresses rapidly and has a poor prognosis. The routine cell morphology examination of pleural effusion is simple and intuitive, which can capture key information in the shortest time, preliminarily provide clinical diagnosis and treatment ideas, and provide accurate basis for disease diagnosis.
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Objective:To investigate the effects and significance of acute and chronic trauma on brain degree centrality (DC) in patients with post-traumatic stress disorder (PTSD) who lost their only child at resting state.Methods:Retrospectively, the study enrolled a total of 51 parents with PTSD, including 35 PTSD parents whose children was lost in emergencies (acute bereaved PTSD group) and 16 PTSD parents whose children was lost of chronic causes such as diseases (chronic bereaved PTSD group). Fifty local adults were also included as healthy controls (HC group). The clinical administered PTSD scale(CAPS) was used to evaluate the severity of the subjects' clinical symptoms.Resting-state functional magnetic resonance imaging(fMRI) data of all subjects were collected and DC values were calculated.SPSS 22.0 software was used for statistical analysis.Covariance analysis was performed among three groups, while post hoc was performed between any two groups.What's more, correlation analyses were utilized between abnormal brain regions and the scores of CAPS.Results:Significant group effects were found in multiple regions, including the right inferior temporal gyrus (MNI: x, y, z=66, -27, -21), right temporal pole (MNI: x, y, z=54, 15, -9), right orbital inferior frontal gyrus (MNI: x, y, z=42, 21, -15), bilateral medial superior frontal gyri (MNI: right x, y, z=6, 63, 12; left x, y, z=-3, 60, 18), left inferior parietal angular gyrus (MNI: x, y, z=-45, -36, 51) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51). Compared with HC group, the DC of two patient groups increased in the right inferior temporal gyrus (MNI: acute x, y, z=63, -27, -21; chronic x, y, z=63, -21, -27); the DC of acute bereaved PTSD group decreased in the right temporal pole (MNI: x, y, z=45, 21, -15) and the right orbital inferior frontal gyrus (MNI: x, y, z=48, 24, -12), while the DC of chronic bereaved PTSD group decreased in the left inferior parietal angular gyrus (MNI: x, y, z=-45, -36, 51) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51). Compared with chronic bereaved PTSD group, the DC of acute bereaved PTSD group increased in the left inferior parietal angular gyrus (MNI: x, y, z=-33, -39, 42) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51), while decreased in the right temporal pole (MNI: x, y, z=51, 12, -9), right orbital inferior frontal gyrus (MNI: x, y, z=42, 21, -15) and bilateral medial superior frontal gyri (MNI: left x, y, z=0, 57, 15; right x, y, z=3, 57, 15). In chronic bereaved PTSD group, the DC of the left postcentral gyrus was negatively correlated with C1 (avoid trauma-related thoughts, feelings) score in CAPS ( r=-0.606, P=0.028). In acute bereaved PTSD group, the DC of the left medial superior frontal gyrus was negatively correlated with D4 (high vigilance) score ( r=-0.416, P=0.020). Conclusion:There exist functional abnormalities of multiple brain regions in acute and chronic bereaved parents with PTSD.The high arousal symptoms of the former may be related with the abnormalities of prefrontal-amygdala neural circuit, while the latter show higher avoidance which may be associated with the dysfunction of somatosensory brain regions such as postcentral gyrus.
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Objective:To investigate the effect of coping style on the gray matter volume in patients with post-traumatic stress disorder (PTSD) who lost their only child, and the mediating role of gray matter volume in evaluating the influence of coping style in clinical symptoms of these parents.Methods:A total of 57 parents with PTSD (PTSD group) and 162 parents without PTSD (non-PTSD group) who lost their only child from September 2016 to March 2017 were enrolled from Jiangsu Province, China. Brain MRI data at resting state were collected. Voxel-based multiple regression analysis was performed to confirm the brain areas in which coping style main effect, diagnosis main effect and their interaction had significant influences in gray matter volumes. Correlations among gray matter volume of brain areas related to coping style, coping style scale scores, and clinician-administered PTSD scale (CAPS) scores were analyzed. Structural equation modeling was used to analyze the mediating role of gray matter volume in the influence of coping style in clinical symptoms of parents lost their only child.Results:(1) The coping style main effect did not significantly influence the gray matter volume in all subjects, and the diagnosis main effect had significant influence in gray matter volume in the right lingual gyrus; their interaction had significant influence in gray matter volume in the right peritalar fissure cortex and lingual gyrus. The positive coping style in the PTSD group had significant influence in the gray matter volumes of the right peritalar fissure cortex and lingual gyrus. (2) In the PTSD group, the scores of positive coping style were positively correlated with the gray matter volumes of the right talus fissure and the lingual gyrus ( P<0.05); the scores of positive coping style, and the gray matter volumes of the right talus fissure and the lingual gyrus were negatively correlated with scores of CAPS-C 5 and CAPS-C ( P<0.05). (3) In the PTSD group, positive coping style can positively predict the gray matter volumes of the right talus fissure and the lingual gyrus; the gray matter volumes of the right talus fissure and the lingual gyrus can negatively predict the avoidance-related symptoms. Conclusion:Positive coping style has influence in the gray matter volumes of the right talar fissure and lingual gyrus of PTSD patients lost their only child; and less positive coping style may affect the brain areas related to visual information processing, thus aggravating avoidance-related symptoms of PTSD patients.
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Objective To evaluate the values of the quantitative parameters obtained from 18F-fluorodeoxyglucose (FDG) PET/CT imaging and MRI in prediction of lymph node metastasis (LNM) in patients with rectal cancer.Methods From May 2013 to October 2015,80 patients with rectal cancer (63 males,17 females,age range:37-85 years) that underwent preoperative MRI-diffusion weighted imaging (DWI) and 18 F-FDG PET/CT were enrolled.All patients had pathological results.Auto-segmentation methods of various thresholds were selected to determine the FDG metabolic parameters and whole volume region of interest (ROI) method was performed to measure apparent diffusion coefficient (ADC) in lymph node.Maximum standardized uptake value (SUVmax) =2.5,20％ SUVmax,30％ SUVmax,40％ SUVmax and 50％ SUVmax were selected as the cut-off values (COV),and named as COV1,COV2,COV3,COV4 and COV5,respectively.ROI was drawn automatically and the corresponding mean standardized uptake value (SUVmean) 1-SUVmean5,metabolic tumor volume (MTV) 1-MTV5 and total lesion glycolysis (TLG) 1-TLG5 were calculated.x2 test and logistic regression analysis were used to analyze the associations between the LNM and pathological factors,as well as 18F-FDG metabolic parameters and ADC.Results LNM was found in 55％ (44/80) of the patients.The metabolic parameters of primary tumor in patients with LNM were significantly higher than those in patients without LNM (u values:152.0-555.0,all P＜0.05);the ADC was significantly lower in LNM positive cases than that in LNM negative cases:0.96 (0.93,1.02) × 10-3 mm2/s vs 1.07(1.01,1.11) ×10-3 mm2/s,u=249.0,P＜0.05.Univariate analysis showed that T stage,SUVmax,SUVmean 1-SUVmean 5,MTV1-MTV5,TLG1-TLG5,ADC value were associated with pathologic lymph node involvement (x2 values:7.730-48.198,all P＜0.05).Multivariate analysis indicated that MTV1 (odds ratio (OR)=0.110,95％ CI:0.014-0.840),MTV2 (OR=0.075,95％ CI:0.007-0.852) and ADC (OR=0.034,95％ CI:0.003-0.381) of tumor were significant risk factors associated with LNM (all P＜0.05).The optimal COV of MTV1,MTV2 and ADC were 20.26 cm3,18.47 cm3 and 1.00× 10-3 mm2/s.Conclusion MTV1,MTV2 measured by 18F-FDG PET/CT and ADC measured by MRI-DWI of the primary tumor are risk factors of LNM from rectal cancer,and they may be useful to predict LNM in patients with rectal cancer.