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With the continuous development of laboratory medicine, the establishment of laboratory clinic has attracted more attention from hospital management departments and laboratory departments. In this paper, we discuss the establishment and function of laboratory clinic from five aspects: the formation of laboratory physician team, the location and equipment, the scope, the regulation and the value and clinical importance, referring to the training project of foreign laboratory physicians and initial experience of domestic hospital laboratory clinics. At present, the establishment of laboratory clinic in most hospitals is still in the active exploratory stage. The standardized rules and regulations of establishment and operation, and the training of multi-disciplinary physicians are the essential requirements and prerequisites for the sustainable development of the laboratory clinics.
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The professional standard for the health industry of People′s Republic of China,"WS/T 807-2022 Performance verification of clinical microbial culture, identification and antimicrobial susceptibility testing systems", was issued on November 2, 2022 and implemented on May 1, 2023. This professional standard (voluntary standard) is the basis for the formulation and implementation of the microbiological testing performance verification scheme, providing guidines for quality control procedures in the laboratories. The purpose of this document is to standardize and homogenize the performance verification protocols in the field of clinical microbiological testing. This article explains and analyzes the background, preparation, main contents, implementation difficulties and significance of the standard, so as to help clinical microbiological laboratory personnel fully understand and implement the relevant provisions of the standard, promoting industry standardization and discipline development.
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Long non-coding RNAs (lncRNAs) are a group of non-coding RNAs with a length of over 200 nucleotides. Recently, studies have shown that lncRNAs can regulate gene expression at the epigenetic, transcriptional, and post-transcriptional levels, affect the proliferation, migration, and infiltration of tumor cells, and participate in the occurrence and development of benign and malignant proliferative skin diseases, such as keloids, hemangioma, squamous cell carcinoma and melanoma. This review summarizes roles of lncRNAs in the pathogenesis of benign and malignant proliferative skin diseases.
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Objective:To compare the differences in radiation dose and image quality between cone-beam CT (CBCT) and multi-slice spiral CT (MSCT) applied to atlantoaxial spine imaging.Methods:Head and neck phantom was scanned at 30 exposure parameter combinations using Pramerica CBCT scanner and 15 parameter combinations using Toshiba 320-row MSCT. The effective dose ( E) of CBCT was calculated based on the Monte Carlo dose estimation software PCXMC, the E value of MSCT was obtained by multiplying the dose length product (DLP) by the related factor. t-test for two independent samples or Wilcoxon rank sum test were used for comparison of radiation dose and subjective and objective image quality between two modalities. The subjective evaluation was a 5-point subjective scale using double-blind method for edge sharpness, contrast, soft tissue level, and artifacts of the images. The signal and noise in the region of interest (ROI) were measured and the contrast signal-to-noise ratio (CNR) was calculated. Results:For radiation dose, the volumetric dose index and E values of 2.9 mGy and 27.61 μSv for CBCT were lower than those of 8.8 mGy and 433.16 μSv for MSCT, and the differences were statistically significant( z=-3.05, -5.25, P<0.05). For objective evaluation of image quality, the noise and CNR were 27.74 HU and 3.69 in CBCT group, 7.84 HU and 27.1 in MSCT group. The difference between them were statistically significant( z=-5.39, -5.42, P<0.05). The overall image quality, contrast and artifact scores of the CBCT group were 3.5, 3.0 and 5 were higher than those of the MSCT group at 2.0, 2.0, and 4.0, respectively ( z=-2.32, -2.46, -3.31, P<0.05). Conclusions:Both atlantoaxial CBCT and MSCT scans provide image quality that meets diagnostic requirements. Compared to MSCT, CBCT atlantoaxial scans can effectively reduce radiation dose according to the principle of optimization of radiation protection.
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Objective:To investigate the value of the extrahepatic bile duct and main pancreatic duct segment patterns on magnetic resonance cholangiopancreatography (MRCP) for differentiating the periampullary carcinoma (PAC).Methods:The clinicopathologic data of 125 patients with PAC who were admitted to Wuxi No.2 People’s Hospital from June 2013 to December 2021 were retrospectively analyzed, including 72 males and 53 females, aged (64.9±8.6) years. According to its anatomy, the extrahepatic bile duct (B) was divided into suprapancreatic and intrapancreatic (including ampullary) segments, and the main pancreatic duct (P) was divided into tail-body and head segments. MRCP patterns: i. the extrahepatic bile duct or main pancreatic duct visible without dilatation, ii. cutoff of the distal extrahepatic bile duct or main pancreatic duct with upstream dilatation, iii. cutoff of the intrapancreatic or head segment with upstream dilatation and remnant intrapancreatic or head segments invisible, iv. cutoff of the intrapancreatic or head segment with upstream dilatation and nondilated remnant intrapancreatic or head segments, were represented as 0, 1, 2, and 3, respectively. Segment patterns of B1/P0+ B1/P1, B0/P2+ B0/P3+ B2/P2+ B2/P3+ B3/P3, B3/P0, and B0/P0+ B2/P0 on MRCP were compared in PAC patients.Results:Of the 125 patients, there were 57 (45.6%) with pancreatic head carcinoma, 36 (28.8%) with ampullary carcinoma, 20 (16.0%) with distal cholangiocarcinoma, and 12 (9.6%) with periampullary duodenal carcinoma. Segment patterns of B0/P2+ B0/P3+ B2/P2+ B2/P3+ B3/P3 were found in 52 patients with pancreatic head carcinoma (91.2%, 52/57), with a significant difference between PAC (χ 2=110.66, P<0.001). Segment patterns of B1/P0+ B1/P1were found in 36 patients with ampullary carcinoma (100.0%, 36/36), fallowed by 11 (91.7%, 11/12) with periampullary duodenal carcinoma, with a significant difference between PAC (χ 2=129.95, P<0.001). Segment pattern of B3/P0 presented in 16 patients with distal cholangiocarcinoma (80.0%, 16/20), with a significant difference between PAC (χ 2=62.45, P<0.001). The segment patterns of B0/P0+ B2/P0 were only seen in 3 of 57(5.3%) patients with pancreatic head carcinoma. Conclusion:On MRCP, cutoff of the head segment with upstream dilatation and remnant head segment invisible or nondilated indicates the pancreatic head carcinoma. Cutoff of the intrapancreatic segment with upstream dilatation, remnant intrapancreatic segment visible, and main pancreatic duct nondilated, indicates the distal cholangiocarcinoma. And cutoff of the distal extrahepatic segment with upstream dilatation and main pancreatic duct dilatation or not, indicates the ampullary or periampullary duodenal carcinoma.
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Pathogen metagenomic next-generation sequencing (mNGS) testing is highly sophisticated. Its requirements for laboratory environment, equipment, and technical capabilities of personnel are very high. How to orderly develop, standardize management, and application of mNGS technology in hospitals is a scientific topic that practitioners must treat with caution. In this article, the establishment mode of the mNGS detection system in clinical laboratories, the analytical and clinical validation of the detection system, the risk management (which from biological factors, detection procedures, and the bioinformatics analysis and information transmission), as well as the requirements for pathogen databases, bioinformatics analysis talents, and diagnostic reports, have been professionally considered and discussed. It is expected to provide scientific advice for the completely implementation of mNGS testing in a clinical laboratory affiliated to a hospital, promoting the standardized application and healthy development of this technology in hospitals.
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Objective:To evaluate the application values of classifications of acute distal occlusion of internal carotid artery and variation of Willis' circle in predicting prognoses of acute ischemic stroke patients after mechanical thrombectomy (MT).Methods:One hundred and fifty-eight patients with acute ischemic stroke, admitted to our hospital from January 2016 to November 2020, were chosen in our study; these patients had conformed imaging diagnosis of acute distal occlusion of internal carotid artery and accepted endovascular MT; the clinical and imaging data of these patients were retrospectively analyzed. The distal occlusion of internal carotid artery was divided into Ia, Ib, L, and T types according to the occlusion positions. Prognoses were evaluated by modified Rankin Scale (mRS) 90 d after treatment. Multivariate Logistic regression was used to determine the independent factors for prognoses.Results:Among these 158 patients, 58 patients achieved good prognosis and 100 had poor prognosis. As compared with patients in the poor prognosis group, patients in the good prognosis group had significantly younger age, significantly lower NIHSS scores at admission, and statistically lower atrial fibrillation ratio ( P<0.05). There were statistical differences in the classifications of acute distal occlusion of internal carotid artery between the two groups ( P<0.05): the proportion of Ia type in patients of good prognosis group was the highest (75.9%), while that of T type was the lowest (3.4%). There was no significant difference in variation of Willis' circle between the two groups ( P>0.05). Multivariate Logistic regression analysis showed that T type of acute distal occlusion of internal carotid artery and atrial fibrillation were independent factors for prognoses of these patients ( OR=0.342, 95%CI: 0.127-0.919, P=0.033; OR=0.066, 95%CI: 0.005-0.803, P=0.033). Conclusion:Patients with T type of acute distal occlusion of internal carotid artery and atrial fibrillation are trend to have poor prognosis.
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Objective:The purpose of this paper is based on the concept of enhanced recovery after surgery, to discuss the timing of taking food and water in knee arthroplasty patients, as well as its feasibility and safety, so as to improve the quality of quality nursing services.Methods:The 226 knee arthroplasty patients in Luoyang Orthopedic-Traumatological Hospital (Henan Provincial Orthopedic Hospital) from September 2020 to November 2021 were selected and divided into a control group and a experimental group using the random number table method, with 113 cases in each group. The control group adopted a conventional postoperative feeding management method; the experimental group adopted the early and timely feeding management method after comprehensive assessment. The data were compared between the two groups, including the incidence and severity of postoperative nausea and vomiting within 6 h and from 6 to 24 h after surgery , the incidence of thirst and hunger at 2 h, 4 h and 6 h postoperatively, and the comfort level.Results:The incidence of postoperative nausea and vomiting was lower in the experimental group [19.5%(22/113), 13.3%(15/113)] than in the control group [32.7%(37/113), 23.9%(27/113)] within 6 h and from 6 to 24 h after surgery, and the severity (21 cases of gradeⅠ, 10 cases of gradeⅡand 6 cases of grade Ⅲ) was also lower than in the control group (17 cases of gradeⅠ, 29 cases of gradeⅡand 18 cases of grade Ⅲ), and the differences were all statistically significant ( χ2 = 5.16,4.21, Z = -2.72, P<0.05). The incidence of thirst were lower in the experimental group [14.2%(16/113), 8.0%(9/113), 2.7%(3/113)] than in the control group [26.5%(30/113), 29.2%(33/113), 40.0%(35/113) at 2 h, 4 h and 6 h postoperatively, and the incidence of hunger at 4 h and 6 h postoperatively [11.5%(13/113), 8.0%(9/113)] were lower than in the control group [32.7%(37/113), 34.5%(39/113)], with statistically significant differences ( χ2 values were 5.35 to 32.39, all P<0.05). The postoperative comfort scale scores of physiological (31.04 ± 1.00) and psychological (33.50 ± 1.45) were higher in the experimental group than in the control group (27.46 ± 1.78) and (31.37 ± 1.29), and the differences were statistically significant ( t values were -102.36 to -66.26, all P<0.05). Conclusions:Early postoperative feeding management at the right time reduces the incidence and severity of postoperative nausea and vomiting inknee arthroplasty patients. In addition, it can also reduce the incidence of thirst and hunger, and improve patients′ postoperative physiological and psychological comfort, which has a facilitating effect on achieving rapid recovery of patients.
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Objective:Based on UPLC-Q-TOF/MS, to screen a panel of plasma metabolite biomarkers for TB diagnosis and evaluate its diagnostic efficacy.Methods:102 active TB patients [49 males, 53 females, age 40.0(24.0, 48.5) years] from Shanghai Pulmonary Hospital and Shanghai East Hospital from January 2017 to January 2018, 100 TB-IGRA positive patients [55 males, 45 females, age 44.0(37.0, 52.0) years] and 96 healthy controls [55 males, 41 females, age 43.0(32.2, 52.8) years] from Shanghai East Hospital were randomly enrolled. UPLC-Q-TOF/MS technology was used to detect small molecule metabolites in plasma. Combined with multivariate statistical methods VIP and univariate statistic analysis Student's t-test, the main differential metabolites in the plasma of patients with active tuberculosis were filtered. The ROC curve was analyzed for the differential metabolites, and the AUC value, specificity, and sensitivity for diagnosis were used to screen metabolic biomarkers with diagnostic potential. Results:All the samples examined resulted in 10 266 variables, and 1 153 substances were identified by qualitative retrieval through the human metabolome database. After pairwise comparison of samples from the three groups, differential metabolites that simultaneously satisfied VIP > 1 and P<0.05 were plotted into a Venn diagram, and the resulting intersection set contained 38 major differential metabolites. The ROC curve analysis of 38 major metabolites showed that the area under the curve of lactic acid, dopamine, 9-pentadecenoic acid, and 12,13-dihydroxy octadecadienoic acid in the diagnosis of active tuberculosis were 0.92, 0.98, 0.94, and 0.94, respectively, the specificity was both more than 90% and the sensitivity was both more than 80%. The specificity and sensitivity of four metabolites in the combined diagnosis of active tuberculosis were both 94%. Conclusion:Lactic acid, dopamine, 9-pentadecenoic acid, and 12, 13-dihydroxy octadecadienoic acid can be used as potential metabolic biomarkers for tuberculosis diagnosis.
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Objective:To investigate the association between pelvic bone dose-volume parameters and acute bone marrow suppression in cervical cancer treated with concurrent cisplatin and intensity-modulated radiation therapy, in order to provide the limited prescription for making radiotherapeutic plan.Methods:The clinical data of 40 cervical cancer patients receiving cisplatin with concurrent intensity-modulated radiation therapy in the Affiliated Hospital of Ningde Normal College from November 2017 to January 2020 were analyzed. The correlations of the irradiated volume of pelvic bone receiving doses of 5, 10, 15, 20, 25, 30, 35, 40, 45, 50 Gy as a percentage of the total volume of pelvic bone (V 5 Gy,V 10 Gy, V 15 Gy,V 20 Gy,V 25 Gy, V 30 Gy, V 35 Gy, V 40 Gy, V 45 Gy, V 50 Gy), the maximum dose (D max), the minimum dose (D min), and the mean dose (D mean) with the occurrence of ≥grade 3 acute bone marrow suppression were analyzed. The logistic multiple regression analysis was used to study the influencing factors of ≥grade 3 acute bone marrow suppression, and the receiver operating characteristic (ROC) curve was used to determine the diagnostic efficacy of influencing factors for ≥grade 3 acute bone marrow suppression. Results:The incidence rate of ≥grade 3 acute bone marrow suppression was 47.5% (19/40). Between patients with ≥grade 3 and <grade 3 acute bone marrow suppression, the differences in pelvic bone V 5 Gy [(96.0±2.9)% vs. (93.4±3.5)%], V 10 Gy [(90.6±5.0)% vs. (87.5±4.0)%], V 15 Gy [(86.2±5.8)% vs. (83.0±4.2)%], V 20 Gy [(78.8±6.1)% vs. (74.6±4.5)%], V 50 Gy [(15.8±7.1)% vs. (10.2±7.1)%], D max [(6 376±524) cGy vs. (5 813±668) cGy] and D mean [(3 441±255) cGy vs. (3 239±240) cGy] were statistically significant (all P < 0.05). The logistic multiple regression analysis showed that pelvic bone V 5 Gy was an risk factor for the occurrence of ≥ grade 3 acute bone marrow suppression [ OR = 3.108, 95% CI 1.101-8.768, P = 0.032], and the ROC curve showed that the optimal critical value of pelvic bone V 5 Gy was 96.9%, and the area under the curve was 0.709. Conclusions:During cisplatin with concurrent intensity-modulated radiation therapy for cervical cancer, pelvic bone V 5 Gy is a risk factor for the occurrence of ≥ grade 3 acute bone marrow suppression. Setting pelvic bone V 5 Gy below 96.9% when making the radiotherapy plan can effectively reduce the occurrence of ≥ grade 3 acute bone marrow suppression.
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Targeted therapy and immunotherapy are important methods for the treatment of metastatic melanoma, but monitoring the patient′s disease progress and treatment response during the treatment is the key to accurate treatment and personalized treatment.Circulating tumor DNA (ctDNA) as a non-invasive " liquid biopsy" method, due to its high sensitivity and specificity for gene mutations, and the advantages of being qualitative, quantitative and traceable, which has shown great application value in monitoring metastatic melanoma progression, evaluating efficacy, and predicting prognosis during targeted therapy and immuno-therapy.
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At present, the situation of COVID-19 epidemic prevention and control in China is gradually improving, but the situation of overseas import prevention and control remains difficult. The COVID-19 epidemic may exist for long due to the undetermined source of infection, the difficulty in completely cutting off the transmission route, and a large number of susceptible people. Therefore, prevention and control will be a long-term and arduous task, making it necessary to adhere to the principle of combining emergency response with regular prevention and control, coordinating the epidemic prevention and social-economic development in a balanced way. In retrospect, the epidemic has exposed the ambiguous positioning and unsatisfying hardware construction of hospital laboratory departments, and delayed intervention of laboratory experts in the public health treatment system of China. This paper reflects on the hospital laboratory departments′ problems during the anti-epidemic activities, and put forward suggestions to improve the future development of clinical laboratories in the national public health system.
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The construction of mobile Cabin hospitals is a pioneering effort for the prevention and controlling of the patients with mild symptoms during the outbreak epidemic of Novel Coronavirus Pneumonia. It is a prerequisite and important guarantee for the hospital to manage the hospital infection and prevent the spreading of the epidemic. Our team is located in Dongxihu mobile Cabin hospital, which is one of the first three Cabin hospitals in Wuhan. This article takes the operation process of this hospital as a clue, and discusses aspects of personal protection, environmental sanitation management, item management, occupational exposure disposal, and discharged patient management. It also analyzed common and critical problems in operation. With a view to provide reference for other Cabin hospitals or temporary treatment agencies.
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Objective:To compare CT with MRI on the accuracy in TNM staging of pancreatic ductal adenocarcinoma (PDAC) based on the 8th American Joint Committee on Cancer System and Pathological Staging.Methods:From October 2013 to October 2019, 105 patients who had pathologically confirmed PDAC treated at the Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University were retrospectively studied. Of 52 patients who met the inclusion criteria, there were 32 males and 20 females, with age ranging from 45 to 84 years (mean 66.1 years). Based on the 8th American Joint Committee on Cancer System and Pathological Staging, CT was compared with MRI in their accuracies in categorizing TNM and staging of PDAC.Results:Forty-three of 52 patients who underwent curative resection had a mean tumor size of (3.4±1.2) cm, compared with tumor sizes of (3.3±1.2) cm and (3.3±1.4) cm on CT and MRI, respectively. No significant differences were observed between gross pathological examination and CT ( P>0.05) or MRI ( P>0.05). The accuracy of T, N, and M categories on CT versus (vs) MRI was 97.7% (42/43) vs 97.7% (42/43), 79.1% (34/43) vs 76.7% (33/43), and 100% (9/9) vs 88.9% (8/9), respectively. No significant differences were observed between the two modalities ( P>0.05). The overall accuracy of PDAC staging on CT vs MRI was 82.7% (43/52) vs 76.9% (40/52), respectively. There was also no significant difference between the two modalities ( P>0.05). Conclusion:Both CT and MRI had similar accuracies in categorizing TNM and staging of PDAC. However, the accuracies of T and M stages were higher than that of the N stage for these two imaging modalities.
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Large cabin hospitals prove a vital role in " admitting all" of the COVID-19 patients with mild symptoms in the overall measures against the epidemic.For such hospitals, nosocomial infection management to prevent epidemic spreading is a prerequisite and guarantee. The authors studied the operation processes of Dongxihu cabin hospital in Wuhan, and probed into such aspects as personal protection, environmental sanitation management, item management, occupational exposure disposal, and discharged patient management. The paper also analyzed common and critical problems in operation, for references to other cabin hospitals or makeshift treatment facilities.
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Objective:To investigate the clinical application value of computed tomography (CT) and magnetic resonance imaging (MRI) examination in preoperative evaluation of adjacent organ invasion for periampullary carcinomas (PACs).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 81 patients with PACs who were admitted to the Affiliated Wuxi No.2 People′s Hospital of Nanjing Medical University from September 2013 to June 2019 were collected. There were 52 males and 29 females, aged from 41 to 80 years, with an average age of 62 years. Observation indicators: (1) surgical and pathological outcomes; (2) evaluation of adjacent organ invasion on CT and MRI examination for PACs; (3) comparison of diagnostic accuracy between CT and MRI examination in assessing adjacent organ invasion for PACs; (4) auxiliary and feature images of adjacent organ invasion for PACs; (5) comparison between CT and MRI examination in assessing adjacent organ invasion for PACs. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers or percentages. Comparison between groups was analyzed using the Mann-Whitney U test.The receiver operating characteristic curve and area under curve were used to evaluate diagnostic accuracy between CT and MRI examination in assessing adjacent organ invasion for PACs. Consistency was compared using the κ test. Results:(1) Surgical and pathological outcomes: of the 81 patients, 76 underwent pancreatoduodenectomy, 5 underwent palliative gastrojejunostomy or biliary drainage combined with biopsy, including the pancreas, duodenum, or lymph nodes. Of the 81 patients, 35 had pancreatic head carcinoma including 26 with duodenal invasion and 9 without duodenal invasion; 23 had ampullary carcinoma including 17 with duodenal invasion, 4 with both duodenal invasion and pancreatic invasion, and 2 without duodenal invasion or pancreatic invasion; 17 had distal bile duct carcinoma (including papillary type in 4 patients and periductal infiltrative type in 13 patients), of which 8 had duodenal invasion, 1 had duodenal invasion and pancreatic invasion (pathological classification of the 9 patients was periductal infiltrative type), 8 had neither duodenal invasion nor pancreatic invasion; 6 had duodenal carcinoma including 4 with pancreatic invasion and 2 without pancreatic invasion. (2) Evaluation of adjacent organ invasion on CT and MRI examination for PACs: of the 35 patients with pancreatic head carcinoma, duodenal invasion was identified in 25 patients and no duodenal invasion in 10 patients on both CT and MRI examination. Of the 23 patients with ampullary carcinoma, duodenal invasion, pancreatic invasion, both duodenal invasion and pancreatic invasion, and neither duodenal invasion nor pancreatic invasion were identified in 17, 1, 4, and 1 patients on CT examination, respectively; the above indicators were identified in 15, 2, 4, and 2 patients on MRI examination. Of the 17 patients with distal bile duct carcinoma, pancreatic invasion, both duodenal invasion and pancreatic invasion, and neither duodenal invasion nor pancreatic invasion were identified in 8, 1, and 8 patients on CT examination, respectively; the above indicators were identified in 9, 1, and 7 patients on MRI examination. Of the 6 patients with duodenal carcinoma, pancreatic invasion and no pancreatic invasion were identified in 3 and 3 patients on both CT and MRI examination.(3) Comparison of diagnostic accuracy between CT and MRI examination in assessing adjacent organ invasion for PACs: two reviewers had good agreement in assessing adjacent organ invasion on CT examination for pancreatic head carcinoma, ampullary carcinoma, and distal bile duct carcinoma ( κ=0.868, 0.701, 0.881, P<0.05), but they had poor agreement for duodenal carcinoma ( κ=0.333, P>0.05). Meanwhile, two reviewers had good agreement in assessing adjacent organ invasion on MRI examination for pancreatic head carcinoma and ampullary carcinoma( κ=0.860, 0.747, P<0.05), and moderate agreement for distal bile duct carcinoma ( κ=0.643, P<0.05), but they had poor agreement for duodenal carcinoma ( κ=0.333, P>0.05). (4) Auxiliary and feature images of adjacent organ invasion for PACs: for the 25 patients who had pancreatic head carcinoma with duodenal invasion on CT and MRI examination, based on well filling in duodenum, 12 patients showed locally morphological change of lumen and flattened or disappeared duodenal mucosal folds on negative contrast CT cholangiopancreatography; 14 patients showed similar signs on T2 weighted imaging or magnetic resonance cholangiopancreatography. The 17 patients who had distal bile duct carcinoma with pancreatic invasion on CT and MRI examination were periductal infiltrative type. Pancreatic invasion manifested as local thickenness of ductal wall with marked enhancement and narrowed ductal lumen, which was indistinguishable from the pancreas, and the pancreatic parenchyma showed hyperdense or hyperintense signs similar with the lesion, like a "transmural" sign. One patient with both duodenal invasion and pancreatic invasion showed locally thickened and enhanced duodenal wall on both CT and MRI examination. Four patients, who had papillary type distal bile duct carcinoma with neither duodenal invasion nor pancreatic invasion, showed intraductal growing mass which had a discernible boundary to the pancreas and slighter enhancement than infiltrative type on both CT and MRI examination. (5) Comparison between CT and MRI examination in assessing adjacent organ invasion for PACs: CT examination evaluating adjacent organ invasion for pancreatic head carcinoma, ampullary carcinoma, distal bile duct carcinoma, and duodenal carcinoma had a sensibility of 92.3%, 90.5%, 88.9%, 75.0%, a specificity of 88.9%, 50.0%, 87.5%, 100.0%, an accuracy of 0.906, 0.702, 0.882, 0.875, respectively. MRI examination evaluating adjacent organ invasion for pancreatic head carcinoma, ampullary carcinoma, distal bile duct carcinoma, and duodenal carcinoma had a sensibility of 88.5%, 85.7%, 88.9%, 75.0%, a specificity of 77.8%, 50.0%, 75.0%, 100.0%, an accuracy of 0.831, 0.679, 0.819, 0.875. There was no significant difference in sensibility for pancreatic head carcinoma, distal bile duct carcinoma, or duodenal carcinoma between CT and MRI examination( χ2=3.140, 0.141, 0.444, P>0.05), while there was a significant difference in sensibility for ampullary carcinoma ( χ2=13.263, P<0.05). There was no significant difference in specificity for pancreatic head carcinoma, ampullary carcinoma, or distal bile duct carcinoma between CT and MRI examination( χ2=0.321, 2.000, 3.429, P>0.05). There was no significant difference in accuracy for pancreatic head carcinoma, ampullary carcinoma, distal bile duct carcinoma, or duodenal carcinoma between CT and MRI examination( Z=0.967, 0.273, 0.559, 0.000, P>0.05). Conclusion:CT and MRI examination can be used for preoperative evaluation of adjacent organ invasion for periampullary carcinoma, with similar performance in specificity and accuracy, however, CT examination has a higher sensibility for ampullary carcinoma.
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Small cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma with a very high degree of malignancy. Currently, the standard treatment for SCLC is still chemoradiotherapy, and although SCLC is sensitive to chemotherapy in the early stage, recurrence and metastasis often occur due to drug resis-tance. In recent years, immunotherapy has made some progress in the study of SCLC. The immunodetection point programmed death-1 (PD-1) and its ligand (PD-L1) inhibitors, such as nivolumab, atezolizumab and pabolizumab, have shown good antitumor activity in clinical studies of SCLC, and PD-1/PD-L1 inhibitors combined with chemotherapy have shown better efficacy, providing a new strategy for the treatment of SCLC.
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Small cell lung cancer (SCLC)is an aggressive neuroendocrine carcinoma with a very high degree of malignancy. Currently,the standard treatment for SCLC is still chemoradiotherapy,and although SCLC is sensitive to chemotherapy in the early stage,recurrence and metastasis often occur due to drug resis-tance. In recent years,immunotherapy has made some progress in the study of SCLC. The immunodetection point programmed death-1 (PD-1)and its ligand (PD-L1)inhibitors,such as nivolumab,atezolizumab and pabolizumab,have shown good antitumor activity in clinical studies of SCLC,and PD-1 / PD-L1 inhibitors com-bined with chemotherapy have shown better efficacy,providing a new strategy for the treatment of SCLC.
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Objective To prepare manganese-doped carbon quantum dots ( Mn-CDs) dual-modal nanoprobe for fluorescent-magnetic imaging, and evaluate its characteristics and potential on fluorescence imaging and MRI. Methods Mn-CDs were synthesized at 150 ℃. The form, diameter, component, fluo-rescent capability, T1 relaxation rate, stability and cytotoxicity of Mn-CDs in vivo were verified. The fluores-cence imaging of HO-8910 tumor-bearing mice was performed on small animal imager, and the whole-body enhanced imaging was performed on 3.0 T MRI scanner. One-way analysis of variance was used to analyze the data. Results The Mn-CDs with the diameter of (4.64±0.85) nm showed a well-defined spherical morpholo-gy. The fluorescent spectra of Mn-CDs exhibited that the excitation maximum was at 360 nm and the emission maximum was at 440 nm. The T1 relaxation rate was (3.26±0.04) mmol·L-1·s-1. The Mn-CDs had good stability of fluorescent and magnetic imaging capability at 0, 0.25, 0.5, 0.75, 1.0 and 2 months at room tem-perature with no significant differences of fluorescent and magnetic signals ( F=1. 566 and 0. 987, both P>0. 05) . After injection of 200 μl Mn-CDs ( 15 g/L) , mice were all alive and had no viscera damage. The tumor could be observed obviously on fluorescence imaging at 5 min. Enhanced MRI showed that the tumor was unevenly enhanced and Mn-CDs were mainly cleared away through urinary system. Conclusion Mn-CDs are stable and have good potential on fluorescence imaging and MRI, which provides a promising multimodal im-aging method for tumor detection and monitoring.
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Objective To study the role of MDCT with 3D fusion images in the preoperative evaluation of pancreaticoduodenectomy.Methods 37 patients who underwent pancreaticoduodenectomy from March 2016 to May 2018 in the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University were included in this retrospective study.All patients underwent a dual-phase enhanced MDCT before operation.The volume data of enhanced MDCT were transmitted to a dedicated CT post-processing workstation.The 3D images,including the tumor,pancreas,portal vein system,arterial system,pancreatic and biliary tract,were reformatted respectively before the fusion imaging.Two reviewers analyzed the tumor location and its spatial relations with the pancreaticobiliary system,peripancreatic vessels and vascular variations by means of zooming,rotating,splitting and transparent displaying on fusion images.Then,the assessed items were compared to the surgical and pathological findings.Results The 3D fusion images of 37 patients in this study depicted the tumor,pancreas,peripancreatic vessels and pancreatic and biliary tract clearly.Compared with the intraoperative and pathological findings,the accuracy of both tumor detection and localization with the 3D fusion images was 100％.To compare the intraoperative findings,visualization and variation detection of the celiac,splenic,common hepatic,gastroduodenal,hepatic,and superior mesenteric arteries,and the superior mesenteric and portal veins were all 100％.Visualizations of the anterior superior pancreaticoduodenal artery (ASPDA),posterior superior pancreaticoduodenal artery (PSPDA),inferior pancreaticoduodenal artery (IPA) and dorsal pancreatic artery (DPA) were 85.7％,82.8％,72.2％ and 75.8％,respectively.Conclusion The MDCT 3D fusion imaging technology allowed one stop preoperative assessment of pancreaticoduodenectomy,especially in clearly outlining the tumor location and its spatial relations with the surrounding surgical anatomies before surgery.