99mTc-3PRGD2 SPECT/CT Imaging for Diagnosing LymphNode Metastasis of Primary Malignant Lung Tumors

Objective@#To evaluate 99mtechnetium-three polyethylene glycol spacers-arginine-glycine-aspartic acid ( 99mTc-3PRGD2) singlephoton emission computed tomography (SPECT)/computed tomography (CT) imaging for diagnosing lymph node metastasis of primary malignant lung neoplasms. @*Materials and Methods@#We prospectively enrolled 26 patients with primary malignant lung tumors who underwent 99mTc-3PRGD2 SPECT/CT and 18F-fluorodeoxyglucose ( 18F-FDG) positron emission tomography (PET)/CT imaging. Both imaging methods were analyzed in qualitative (visual dichotomous and 5-point grades for lymph nodes and lung tumors, respectively) and semiquantitative (maximum tissue-to-background radioactive count) manners for the lymph nodes and lung tumors. The performance of the differentiation of lymph nodes with and without metastasis was determined at the per-lymph node station and perpatient levels using histopathological results as the reference standard. @*Results@#Total 42 stations had metastatic lymph nodes and 136 stations had benign lymph nodes. The differences between metastatic and benign lymph nodes in the visual qualitative and semiquantitative analyses of 99mTc-3PRGD2 SPECT/CT and18F-FDG PET/CT were statistically significant (all P < 0.001). The area under the receiver operating characteristic curve (AUC)in the semi-quantitative analysis of 99mTc-3PRGD2 SPECT/CT was 0.908 (95% confidence interval [CI], 0.851–0.966), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.86 (36/42), 0.88 (120/136), 0.69 (36/52), and 0.95 (120/126), respectively. Among the 26 patients (including two patients each with two lung tumors), 15 had pathologically confirmed lymph node metastasis. The difference between primary lung lesions in patients with and without lymph node metastasis was statistically significant only in the semi-quantitative analysis of 99mTc-3PRGD2 SPECT/CT (P = 0.007), with an AUC of 0.807 (95% CI, 0.641–0.974). @*Conclusion@#99mTc-3PRGD2 SPECT/CT imaging may notably perform in the direct diagnosis of lymph node metastasis of primary malignant lung tumors and indirectly predict the presence of lymph node metastasis through uptake in the primary lesions.

Value of dynamic 18F-FDG PET/CT semi-quantitative parameters in the diagnoses of non-small cell lung cancer subtypes and lymph node metastasis / 中华核医学与分子影像杂志

Objective:To explore the values of dynamic 18F-FDG PET/CT semi-quantitative parameters in the differentiation of histological subtypes of non-small cell lung cancer (NSCLC) and the diagnosis of lymph node metastasis. Methods:Twenty-three patients (10 males, 13 females, age (61.5±8.1) years) with NSCLC in Shengjing Hospital of China Medical University were prospectively enrolled between October 2020 and June 2021. All patients underwent 40 min of dynamic PET/CT scan and static scan at 60 min post-injection of 18F-FDG. SUV max, SUV mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary lesions at different stages of PET/CT imaging were evaluated. SUV max of lymph nodes were also analyzed. The histopathological results were considered as the gold standard. Parameters of primary lesions and lymph nodes at different PET/CT imaging stages in different groups were compared by independent-sample t test or Mann-Whitney U test. The diagnostic efficiencies of those parameters were tested by ROC curve and compared by DeLong test. Results:A total of 24 lesions in 23 patients were pathologically confirmed as NSCLC, of which 11 were squamous cell carcinoma and 13 were adenocarcinoma. The SUV max (13.5±3.4 vs 9.6±5.1), SUV mean (8.1±2.2 vs 5.8±3.2) at the third stage of dynamic PET/CT (33-40 min) between squamous cell carcinoma and adenocarcinoma were both significantly different ( t values: 2.20, 2.10, P values: 0.039, 0.048). SUV max, TLG of static PET/CT between the 2 groups were also different ( t=2.22, P=0.037; z=-2.17, P=0.030). ROC curves of those parameters showed that AUCs were between 0.727 and 0.762. Fourteen patients underwent surgery and lymph node dissection. According to the pathological results, lymph nodes in 15 areas were metastatic, the rest in 70 areas were benign. There were significant differences in SUV max at the second stage of dynamic PET/CT (19-26 min) between metastatic and benign lymph nodes (4.0(2.8, 6.2) vs 2.3(1.8, 2.8); z=-4.31, P<0.001), as well as SUV max at the third stage of dynamic PET/CT and static PET/CT between the 2 groups ( z values: -4.59, -4.10, both P<0.001). ROC curves of those 3 parameters showed that the AUCs were 0.856, 0.879 and 0.838 respectively, with no significant differences ( z values: 0.78, 0.34, 1.27, P values: 0.434, 0.734, 0.205). The sensitivity, specificity, and accuracy of the SUV max of the third dynamic imaging stage were 13/15, 90.0%(63/70) and 89.4%(76/85), respectively. Conclusion:Dynamic 18F-FDG PET/CT semi-quantitative parameters have certain clinical significance in the identification of histological subtypes of NSCLC and the diagnosis of metastatic lymph nodes, especially the third stage dynamic imaging has a better diagnostic performance.

Effects of auricular thumbtack needle on lactation function and TDP-43/Btn1A1/XDH pathway in primiparous women with cesarean section / 中国针灸

OBJECTIVE@#To observe the effects of auricular thumbtack needle on breast feeding and lactation function in primiparous women with cesarean section, and to explore its mechanism of action from the perspective of lactation-related gene expression.@*METHODS@#One hundred cases of primiparous women with cesarean section were randomly divided into an observation group (50 cases, 3 cases dropped off) and a control group (50 cases, 2 cases were eliminated). The patients in the control group were treated with routine obstetric care. Based on the treatment of the control group, the patients in the observation group were treated with auricular thumbtack needle at Neifenmi (CO18), Xiong (AH10), Xiongzhui (AH11), Shenmen (TF4), and Jiaogan (AH6a), etc., with one side of auricular point selected, only once for a total of 3 d. The lactation initiation time, lactation adequacy rate at postpartum 72 h, exclusive breastfeeding rate at postpartum 42 d, and breastfeeding score after treatment were compared between the two groups. Real-time quantitative PCR and Western blot method were used to detect the mRNA and protein expression levels of TDP-43, Btn1A1 and XDH.@*RESULTS@#After treatment, the lactation initiation time in the observation group was earlier than that in the control group (P<0.01), and breastfeeding score in the observation group was higher than that in the control group (P<0.01). The lactation adequacy rate at postpartum 72 h was 63.8% (30/47) in the observation group, which was higher than 41.7% (20/48) in the control group (P<0.05). The exclusive breastfeeding rate at postpartum 42 d was 72.3% (34/47) in the observation group, which was higher than 47.9% (23/48) in the control group (P<0.05). The mRNA and protein expression levels of TDP-43 and Btn1A1 in breast milk in the observation group were higher than those in the control group (P<0.01), while there was no statistically significant difference in mRNA and protein expression of XDH in breast milk between the two groups (P>0.05).@*CONCLUSION@#The auricular thumbtack needle in addition to routine care could promote lactation initiation, improve lactation adequacy rate and exclusive breastfeeding rate in primiparous women with cesarean section, and the action mechanism may be related to up-regulation of TDP-43 and Btn1A1 expression.

Association of hs-CRP with frailty and its components among the elderly over 65 years old in 9 longevity areas of China / 中华预防医学杂志

Objective: To investigate the association of the levels of high sensitivity C-reactive protein (hs-CRP) with frailty and its components among the elderly over 65 years old in 9 longevity areas of China. Methods: Cross-sectional data from the Health Ageing and Biomarkers Cohort Study (HABCS, 2017-2018) were used and the elderly over 65 years old were included in this study. Through questionnaire interview and physical examination, the information including demographic characteristics, behavior, diet, daily activity, cognitive function, and health status was collected. The association between hs-CRP and frailty and its components in the participants was analyzed by multivariate logistic regression model and restrictive cubic spline. Results: A total of 2 453 participants were finally included, the age was (84.8±19.8) years old. The median hs-CRP level was 1.13 mg/L and the prevalence of frailty was 24.4%. Compared with the low-level group (hs-CRP<1.0 mg/L), the OR (95%CI) value of the high-level group (hs-CRP>3.0 mg/L) was 1.79 (1.35-2.36) mg/L. As for the components, the hs-CRP level was also positively associated with ADL disability, IADL disability, functional limitation and multimorbidity. After adjusting for confounding factors, compared with the low-level group, the OR (95%CI) values of the high-level group for the four components were 1.68 (1.25-2.27), 1.88 (1.42-2.50), 1.68 (1.31-2.14) and 1.39 (1.12-1.72), respectively. Conclusion: There is a positive association between the levels of hs-CRP and the risk of frailty among the elderly over 65 years old in 9 longevity areas of China. The higher hs-CRP level may increase the risk of frailty by elevating the risk of four physical functional disabilities, namely ADL disability, IADL disability, functional limitation and multimorbidity.

Association of greenness exposure with waist circumference and central obesity in Chinese adults aged 65 years and over / 中华预防医学杂志

Objective: To examine the association of greenness exposure with waist circumference (WC) and central obesity in older adults in China. Methods: Based on the cross-sectional data from the Chinese Longitudinal Healthy Longevity Survey in 2017-2018, 14 056 participants aged 65 years and over were included. Demographic characteristics, lifestyle, WC, and other information were collected through a questionnaire and physical examination. Based on the satellite monitoring data of moderate-resolution imaging spectroradiometer (MODIS) provided by NASA, the annual mean of normalized difference vegetation index (NDVI) within a radius of 1 000 meters was obtained as the measurement value of greenness exposure. Multivariate linear regression model, multivariate logistic regression model, and restricted cubic splines (RCS) model were used to analyze the association and dose-response relationship between greenness exposure and WC and central obesity in older adults in China. Results: A total of 14 056 participants were enrolled with a median age of 84.0 years [IQR: 75.0-94.0 years]. About 45.0% (6 330) of them were male and 48.6% (5 853) were illiterate. There were 10 964 (78.0%) participants from rural. The mean of WC was (84.4±10.8) cm. Central obesity accounted for 60.2% (8 465), and the NDVI range was (-0.06, 0.78). After adjusting for confounding factors, the multivariate linear regression model showed that the change value of WC in the urban group [β (95%CI):-0.49 (-0.93, -0.06)] was smaller than that in the rural [-0.78 (-0.98, -0.58)] for every 0.1 unit increase in NDVI (Pinteraction=0.022). Compared with the Q1 group in NDVI, WC of Q2 and Q3 groups in rural decreased, and the β (95%CI) values were-1.74 (-2.5, -0.98) and-2.78 (-3.55, -2.00), respectively. The multivariate logistic regression model showed that after adjusting for confounding factors, the risk of central obesity decreased for urban and rural older adults with an increase of 0.1 unit in NDVI, and the OR (95%CI) values were 0.87 (0.80, 0.95) and 0.86 (0.82, 0.89), respectively (Pinteraction=0.284). Compared with the Q1 group in NDVI, the risk of central obesity in the Q2 and Q3 groups in rural was lower, and the OR (95%CI) values were 0.68 (0.58, 0.80) and 0.57 (0.49, 0.68), respectively. The results of the multivariate regression model with RCS showed that there was a non-linear association of NDVI with WC (Pnonlinear=0.006) and central obesity (Pnonlinear=0.025). Conclusion: Greenness exposure is negatively associated with WC and central obesity in older adults in China.

CircFhit Modulates GABAergic Synaptic Transmission via Regulating the Parental Gene Fhit Expression in the Spinal Dorsal Horn in a Rat Model of Neuropathic Pain / 神经科学通报·英文版

Effective treatments for neuropathic pain are lacking due to our limited understanding of the mechanisms. The circRNAs are mainly enriched in the central nervous system. However, their function in various physiological and pathological conditions have yet to be determined. Here, we identified circFhit, an exon-intron circRNA expressed in GABAergic neurons, which reduced the inhibitory synaptic transmission in the spinal dorsal horn to mediate spared nerve injury-induced neuropathic pain. Moreover, we found that circFhit decreased the expression of GAD65 and induced hyperexcitation in NK1R+ neurons by promoting the expression of its parental gene Fhit in cis. Mechanistically, circFhit was directly bound to the intronic region of Fhit, and formed a circFhit/HNRNPK complex to promote Pol II phosphorylation and H2B monoubiquitination by recruiting CDK9 and RNF40 to the Fhit intron. In summary, we revealed that the exon-intron circFhit contributes to GABAergic neuron-mediated NK1R+ neuronal hyperexcitation and neuropathic pain via regulating Fhit in cis.

Mechanism of Fangji Fulingtang for Treating Acute Kidney Injury Induced by Ischemia-reperfusion Based on Network Pharmacology and Molecular Docking Verification / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Fangji Fulingtang in the treatment of acute kidney injury （AKI） induced by ischemia-reperfusion based on network pharmacology and experimental verification. MethodActive components of Fangji Fulingtang were retrieved from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP） and previous report and targets of these components were predicted by SwissTargetPrediction. The targets of AKI were searched from GeneCards， Online Mendelian Inheritance in Man （OMIM）， the database of gene-disease associations （DisGeNET）， and Therapeutic Target Database （TTD）. Protein-protein interaction （PPI） network was constructed by STRING. Metascape was used for Gene Ontology （GO） term enrichment and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment of core targets. Cytoscape was employed to construct the "medicinal-active component-target-disease" network and “active component-target-pathway” network. AutoDock was applied for molecular docking. Finally， animal experiment was carried out to validate the mechanism of Fangji Fulingtang in treatment of AKI. ResultA total of 137 active components and 858 targets of Fangji Fulingtang， 1 294 targets of AKI， and 267 targets of Fangji Fulingtang in the treatment of AKI were screened out. Phosphoinositide-3-kinase regulatory subunit 1 （PIK3R1）， phosphatidylinositol-4，5-bisphosphate 3-kinase catalytic subunit alpha （PIK3CA）， proto-oncogene tyrosine protein kinase （SRC）， protein kinase B1 （Akt1）， and mitogen-activated protein kinase 3 （MAPK3） were the key anti-AKI targets of Fangji Fulingtang， which were involved in 1 609 GO terms， particularly cell response to lipids， membrane rafts， and protein kinase activity， and 140 KEGG pathways such as PI3K/Akt signaling pathway， chemokine signaling pathway， and Toll-like receptor signaling pathway. Molecular docking showed that the core active components had strong binding affinity to the key targets. The hematoxylin and eosin （HE） staining results indicated that Fangji Fulingtang can significantly improve the pathological state and the serological results suggested that the levels of serum creatinine （SCr） and blood urea nitrogen （BUN） were significantly reduced. ConclusionThis study clarified the mechanism of Fangji Fulingtang in the treatment of AKI and found that Fangji Fulingtang had the multi-component， multi-target， and multi-pathway characteristics in the treatment of AKI. The result lays a foundation for further study of its specific mechanism.

Combination of 18 F-Fluorodeoxyglucose PET/CT Radiomics and Clinical Features for Predicting Epidermal Growth Factor Receptor Mutations in Lung Adenocarcinoma

Objective@#To identify epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma based on 18 F-fluorodeoxyglucose (FDG) PET/CT radiomics and clinical features and to distinguish EGFR exon 19 deletion (19 del) and exon 21 L858R missense (21 L858R) mutations using FDG PET/CT radiomics. @*Materials and Methods@#We retrospectively analyzed 179 patients with lung adenocarcinoma. They were randomly assigned to training (n = 125) and testing (n = 54) cohorts in a 7:3 ratio. A total of 2632 radiomics features were extracted from the tumor region of interest from the PET (1316) and CT (1316) images. Six PET/CT radiomics features that remained after the feature selection step were used to calculate the radiomics model score (rad-score). Subsequently, a combined clinical and radiomics model was constructed based on sex, smoking history, tumor diameter, and rad-score. The performance of the combined model in identifying EGFR mutations was assessed using a receiver operating characteristic (ROC) curve. Furthermore, in a subsample of 99 patients, a PET/CT radiomics model for distinguishing 19 del and 21 L858R EGFR mutational subtypes was established, and its performance was evaluated. @*Results@#The area under the ROC curve (AUROC) and accuracy of the combined clinical and PET/CT radiomics models were 0.882 and 81.6%, respectively, in the training cohort and 0.837 and 74.1%, respectively, in the testing cohort. The AUROC and accuracy of the radiomics model for distinguishing between 19 del and 21 L858R EGFR mutational subtypes were 0.708 and 66.7%, respectively, in the training cohort and 0.652 and 56.7%, respectively, in the testing cohort. @*Conclusion@#The combined clinical and PET/CT radiomics model could identify the EGFR mutational status in lung adenocarcinoma with moderate accuracy. However, distinguishing between EGFR 19 del and 21 L858R mutational subtypes was more challenging using PET/CT radiomics.

Association between the Neutrophil-to-lymphocyte Ratio and New-onset Subclinical Macrovascular and Microvascular Diseases in the Chinese Population / 生物医学与环境科学（英文）

OBJECTIVE@#The association between neutrophil-to-lymphocyte ratio (NLR) with subclinical macrovascular and microvascular diseases has been less investigated. We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population.@*METHODS@#From a community cohort, we included 6,430 adults aged ≥ 40 years without subclinical macrovascular and microvascular diseases at baseline. We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and albuminuria.@*RESULTS@#During a mean follow-up of 4.3 years, 110 participants developed incident abnormal ABI, 746 participants developed incident elevated baPWV, and 503 participants developed incident albuminuria. Poisson regression analysis indicated that NLR was significantly associated with an increased risk of new-onset abnormal ABI, elevated baPWV, and albuminuria. Compared to overweight/obese participants, we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight. Furthermore, we found an interaction between the NLR and body mass index (BMI) on the risk of new-onset abnormal ABI ( P for interaction: 0.01).@*CONCLUSION@#NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population. Furthermore, in participants with normal weight, the association between NLR and subclinical vascular abnormalities was much stronger.

Effect of acupuncture on vascular endothelial function in patients of polycystic ovary syndrome with different glucose tolerance status / 中国针灸

OBJECTIVE@#To observe the effect of acupuncture on vascular endothelial function in patients of polycystic ovary syndrome (PCOS) with impaired glucose tolerance (IGT) and normal glucose tolerance (NGT).@*METHODS@#A total of 140 patients with PCOS were divided into an IGT group (70 cases, 11 dropped off) and a NGT group (70 cases, 9 cases dropped off). The patients in the two groups were treated with full-cycle acupuncture at Zhongwan (CV 12), Guanyuan (CV 4), Qihai (CV 6), Tianshu (ST 25), etc. once every other day, 3 times a week, for 3 months. Before and after treatment, TCM symptom score, insulin resistance index [including fasting plasma glucose (FPG), 2-hour blood glucose (2hPG), fasting serum insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR)] and vascular endothelial related factors [including asymmetric dimethylarginine (ADMD), endothelin-1 (ET-1), malondialdehyde (MDA), nitric oxide (NO)] were compared between the two groups; in addition, the obese subgroup and non-obese subgroup of the two groups were further compared.@*RESULTS@#Compared before treatment, the TCM symptom scores, ADMD, ET-1 and MDA after treatment were decreased (@*CONCLUSION@#Acupuncture could improve vascular endothelial function in PCOS patients, IGT patients have better efficacy than NGT patients, and obese patients have better efficacy than non-obese patients.

Analysis of hepatitis C virus infection status and risk factors among people in Chengdu / 公共卫生与预防医学

Objective To investigate the hepatitis C virus (HCV) infection status and risk factors among people in some areas of Sichuan, so as to provide scientific theoretical basis for disease prevention and control. Methods A multi-stage cluster random sampling method was used to select 79 132 permanent residents from 13 districts of Chengdu for anti-HCV testing and questionnaire survey. The distribution of anti-HCV positive was analyzed, and the risk factors of HCV infection were analyzed by case-control method. Results In this study, the investigation valid rate was 92.00% (72 805 / 79 132), and the overall anti-HCV positive rate was 0.82% (597/72805). The positive rate of anti-HCV in male was significantly higher than that in female (P2trend=31.257, P<0.001). Among different occupation groups, the positive rate of anti-HCV was the highest in farmer group (P<0.05), and was the lowest in student group (P<0.05). The districts with top 5 anti-HCV positive rates were Tianfu New District, Xindu District, Wenjiang District, Pidu District and Qingbaijiang District. The positive rate of anti-HCV in suburbs was significantly higher than that in main urban area (P<0.05). The ratio of HCV history, oral diagnosis and treatment history, invasive examination history, operation history, blood donation history, blood transfusion history, acupuncture history, tattoo history, syringes sharing history, toothbrush sharing, razor sharing and never using condom in the case group was significantly higher than that in the control group (P<0.05). Invasive examination, acupuncture, frequent sharing of toothbrush and razor were the high risk factors of HCV infection (P<0.05). Conclusion In Chengdu, the infection rate of HCV is relatively high among males, 51~ 60 years old, primary school and below, farmers and suburban population, moreover, invasive examination, acupuncture, frequent sharing of toothbrushes and razor are high risk factors for HCV infection. Therefore, health education on HCV infection-related knowledge and targeted intervention measures are of vital importance.

Effect of combined treatment with acupuncture, moxibustion and medication on endometrial receptivity and expression of serum HOXA10 in polycystic ovary syndrome of kidney deficiency and blood stagnation / 中国针灸

OBJECTIVE@#To compare the clinical effect of the combined treatment of acupuncture, moxibustion, Chinese herbal medicine and western medication and simple western medication on polycystic ovary syndrome (PCOS) of kidney deficiency and blood stagnation pattern and explore the effect on endometrial receptivity and the expression of serum homeobox gene A10 (HOXA10).@*METHODS@#A total of 60 patients with PCOS of kidney deficiency and blood stagnation pattern were randomized into a combined treatment group and a western medication group, 30 cases in each one. In the western medication group, on the fifth day of menstruation, clomiphene citrate tablets were taken orally, 50 mg each time, once daily, consecutively for 5 days. On the day when the follicle diameter was ≥ 18 mm, chorionic gonadotrophin for muscular injection, a dose of 10 000 U was given. Before sleep, the aspirin enteric-coated tablets were taken orally, 50 mg (except during menstruation). In the combined treatment group, on the base of the treatment as the western medication group, acupuncture and moxibustion were adopted and the Chinese herbal for tonifying the kidney and activating blood circulation was taken orally. The acupoints were Guanyuan (CV 4), Qihai (CV 6), Zusanli (ST 36), Sanyinjiao (SP 6), Zigong (EX-CA 1), etc. Acupuncture was remained for 30 min each time, once every two days and discontinued during menstruation. Chinese herbal was given from the 3rd day of menstruation till the onset of the next menstruation, one dose each day. After consecutive treatment for 3 menstrual cycles in the two groups, the real-time polymerase chain reaction (RT-PCR) method was adopted to determine the expression of serum HOXA10 before and after treatment in the patients of the two groups. The endometrial thickness at ovulatory phase, uterine arterial flow 7 days after ovulation [including uterine arterial pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV)/end diastolic velocity (EDV), meaning S/D], pregnancy rate and the score of Chinese medicine symptoms before and after treatment were compared in the patients between the two groups.@*RESULTS@#① After treatment, the expression of serum HOXA10 was higher than that before treatment in the patients of the two groups (@*CONCLUSION@#The combined treatment with acupuncture, moxibustion and medication effectively improves endometrial receptivity and uterine arterial flow in the patients with PCOS of kidney deficiency and blood stagnation pattern and increases pregnancy rate. The therapeutic effect is better than the simple western medication and its mechanism is probably related to the regulation of serum HOXA10 expression.

Influence of thread shapes of custommade root-analogue implants on stress distribution of peri-implant bone: A three-dimensional finite element analysis / 北京大学学报(医学版)

OBJECTIVE@#To explore the effects from the thread shapes of custom-made root-analogue implant (RAI) on distributions of von Mises stress around the peri-implant bone.@*METHODS@#Five one-stage RAI three-dimensional finite element (FE) models with different thread shapes (V-shaped design, square design, buttress design, reverse buttress design and none thread design) and congruent bone were created through reverse engineering technology. The data of the five models were imported into the FE analysis software to calculate. A force of 100 N was applied parallelly and of 45° to the implant axis respectively. Analysis was performed to evaluate the von Mises stress distributions at the peri-implant regions with the help of the Ansys 16 software.@*RESULTS@#The von Mises stresses distributed mostly at the implant cervical regions and the tip ends of the threads on the cortical bone under oblique loading, while on the cancellous bone, the stresses concentrated mostly on the implant lateral cervical regions, the tip ends of the threads and the apical regions. When under vertical loading, the von Mises stresses distributed mostly at the implant cervical regions on the cortical bone while at the tip ends of the threads and the lateral apical regions on the cancellous bone. The von Mises stresses were better distributed on the thread groups under both kinds of loadings compared with no thread design. But there was no obvious difference among the different thread groups. The concentrations of the von Mises stresses on the cancellous bone in the thread groups were mostly at the tip ends of the threads while less in the apical area. The von Mises stresses were better distributed on the cancellous bone on the other three thread designs than on square design.@*CONCLUSION@#Thread designs are advocated for the reason that adding thread designs to the RAI standard design will have a positive effect on stress distributions at the peri-implant regions and it will reduce the concentrations of von Mises stresses on the cortical bone. From the standpoint of the stress distribution, V-shaped design, buttress design and reverse buttress design are more suitable for RAI than square design. There is no difference of the distributions of the von Mises stresses in the RAI between different thread designs.

Risk factors and PET/CT diagnosis of pelvic lymph node metastasis in early-stage cervical cancer / 中国医学影像技术

Objective To explore risk factors of pelvic lymph node (PLN) metastasis in cervical cancer,and to observe the value of PET/CT in diagnosis of PLN metastasis with qualitative and semi-quantitative evaluation.Methods Clinical data of 206 patients with cervical cancer who underwent PLN dissection were respectively analyzed.The age and BMI of patients,pathological type,depth of invasion and International Federation of Gynecology and Obstetrics (FIGO) stage of tumor,serum SCC level,lymph node status of PET/CT and tumor SUVmax were analyzed with univariate analysis.Multivariate analysis was performed for indicators with statistically significant variables.The accuracy,sensitivity and specificity of PET/CT in diagnosis of PLN metastasis of cervical cancer were calculated.Besides,the ratios of lymph node 'S SUVmax (SUVmaxLN) to SUVmax of primary tumor (SUVmaxL/T),to liver (SUVmaxL/H) and to arota (SUVmaxL/A) were recorded.ROC curves were plotted,whereas the areas under curve (AUC) were calculated to confirm the best diagnostic cutoff value.Results Univariate analysis showed that age,BMI,pathological type,depth of invasion,FIGO stage,serum SCC level,lymph node status of PET/CT and tumor SUVmax were important factors of PLN metastasis (all P＜0.05).Multivariate analysis revealed that serum SCC levels,depth of invasion,lymph node status of PET/CT and tumor SUVmax were independent predictors of PLN metastasis (P＜0.05).The sensitivity,specificity and accuracy of PET/CT in diagnosis of PLN metastasis was 54.90％ (28/51),91.61％ (142/155) and 82.52％ (170/206),respectively.The sensitivity of SUVmaxLN =4.19 was higher than SUVmax =2.5.No significant difference of SUVmaxLN with SUVmaxL/T,with SUVmaxL/H nor with SUVmaxL/A was found.Conclusion Serum SCC levels,depth of invasion,lymph node status of PET/ CT and tumor SUVmax are independent predictors of PLN metastasis.PET/CT has certain value in qualitative and semiquantitative analysis of cervical cancer PLN metastasis.

Correlations of 18F-FDG PET/CT standardized uptake value, vascular endothelial growth factor, Aquaporin-1 level and clinicopathological features of cervical cancer / 中国医学影像技术

Objective To explore the correlations among standardized uptake value (SUV) and clinicopathological features of cervical cancers,and to observe the association among SUV and expression level of vascular endothelial growth factor (VEGF) and Aquaporin-1 (AQP-1).Methods PET/CT imaging data were analyzed retrospectively in 56 patients with cervical cancer before surgery.The mean SUV (SUV),maximum SUV (SUVmax) and peak SUV (SUVpeak) were measured,and immunohistochemical method was used to detect the expression of VEGF and AQP-1.The relationships of SUV and expression level of VEGF,AQP-1 and clinicopathological features were analyzed.Results SUV SUVpeak and expression level of VEGF and AQP-1 were significantly different in different FIGO stages (all P＜0.05).SUVpeak and expression level of VEGF in tumors with maximum diameter ≥ 4 cm were higher than those in patients with tumors maximum diameter ＜4 cm (both P ＜0.05).SUVpeak and expression level of VEGF and AQP-1 in tumors with cervical stromal invasion depth ≥1/2 were significantly higher than those with cervical stromal invasion depth ＜ 1/2 (all P＜ 0.05).The expression level of VEGF and AQP-1 in patients with lymph node metastasis were higher than those without lymph node metastasis (both P ＜0.05).SUVpeak was correlated with expression level of VEGF (rs =0.529,P＜0.001) and AQP-1 (rs =0.356,P =0.007).Conclusion Preoperative SUVpeak of cervical cancer measured with PET/CT is correlated with clinicopathological features and can be used to guide individual treatment of patients with cervical cancer.

Value of PET/CT and PET/MR in diagnosing primary cervical cancer and evaluating pelvic lymph node metastasis: Comparative study / 中国医学影像技术

Objective To compare the application value between PET/CT and PET/MR in diagnosing primary cervical cancer and pelvic lymph node metastasis.Methods Forty cases of cervical cancer were prospectively enrolled.PET/CT and PET/MR examinations were performed before treatment.All imaging data were evaluated by two experienced radiologists.The diagnostic consistency and difference of PET/CT and PET/MR were evaluated with Cohen's Kappa and paired Chi-square test.ROC curve was adopted to observe the value in diagnosing pelvic lymph node metastasis of cervical cancer.The lesions' visibility and diagnostic confidence of metastatic lymph nodes on PET/CT and PET/MR images were compared with Wilcoxon signed ranks test.Results Compared with the gold standard,the diagnostic consistency of PET/MR staging was much higher than that of PET/CT (x2 =10.286,P=0.002).The area under ROC curve of PET/CT and PET/MR on lymph node metastasis had no significant difference (Z=0.83,P＞0.05).No significant differences in lesion visibility between PET/CT and PET/MR images were detected in the evaluation of metastatic lymph nodes (P=0.157),while PET/MR revealed higher values regarding diagnostic confidence (P=0.014).Conclusion Both PET/CT and PET/MR provide high diagnostic value in detecting primary cervical cancer,but PET/MR has greater diagnostic superiority in the correct identification of cervical cancer stage and pelvic lymph node metastasis.PET/MR is expected to be a new technique for replacement of PET/CT in evaluation of cervical lesions.

Correlation between standardized uptake value and intravoxel incoherent motion parameters of cervical squamous cell carcinoma with 18F-FDG PET/MR / 中华核医学与分子影像杂志

Objective To assess the correlation between standardized uptake value (SUV) and intravoxel incoherent motion (IVIM) parameters of primary cervical squamous cell carcinoma (CSCC) and pelvic metastatic lymph nodes in the use of hybrid PET/MR.Methods Forty-six CSCC patients in Shengjing Hospital from January 2015 to December 2015 were prospectively enrolled and divided into well-differentiated (G1) group,moderate-differentiated (G2) group and poorly-differentiated (G3) group.PET/MR examination with the multi-b-value diffusion-weighted imaging (DWI) sequence was performed before treatment.Maximum SUV (SUVmax) and mean SUV (SUVmean) were calculated.IVIM parameters,including the slow diffusion coefficient (D),fast diffusion coefficient (D*),perfusion fraction (f) were also measured.Pearson correlation analysis was used to evaluate the correlation between IVIM parameters and SUV(SUVmax,SUVmean).Results The D of G1,G2,G3 lesions and metastatic lymph nodes were (0.827± 0.232) × 10-3,(0.640±0.153) × 10-3,(0.563±0.090) × 10-3 and (0.772±0.246) × 10-3 mm2/s respectively.The f was 0.310±0.068,0.348±0.073,0.287±0.057 and 0.413±0.103 respectively.The D* was (9.241± 2.001) × 10-3,(9.408± 1.927) × 10-3,(9.715± 1.827) × 10-3 and (8.830± 1.632) × 10-3 mm2/s respectively.The SUVmax was 9.988±3.806,12.941±5.990,14.543±7.050 and 9.890±3.906 respectively.The SUVmean was 5.717±2.830,7.094±3.518,8.263±4.124 and 4.952±1.343 respectively.The D of G1 and G2 lesions had negative correlations with SUVmax and SUVmean(G1,r values:-0.816,-0.842;G2,r values:-0.528,-0.559;all P＜0.05);the f of G2 lesions had positive correlations with SUVmax and SUV (r values:0.554,0.550,both P＜0.05).Conclusions The SUVmax and SUV of the well-moderate differentiated CSCC are consistent with D and f,which reflect the cell density and the microvascular perfusion.PET/MRIVIM could provide important complementary information for treatment-monitoring and prognostic assessment of patients with cervical cancer.

Industrialization condition and development strategy of Notopterygii Rhizoma et Radix / 中国中药杂志

Notopterygii Rhizoma et Radix, the underground part of Notopterygium incisum and N. franchetii, is used as a classical traditional Chinese medicine, and as raw materials for 262 Chinese patent drugs production in 694 pharmaceutical factories currently. It plays an important role in the whole Chinese medicine industry with irreplaceable important economic and social values. However, wild resource of was abruptly depleted, and large-scale artificial cultivation has been inapplicable. In this study, Utilization history and the industrialization status of Notopterygii Rhizoma et Radix were summarized. Resource distribution, ecological suitability of Notopterygii Rhizoma et Radix and core technologies for seeds production, seedling breeding, large-scale cultivation has been reported by current studies, and basic conditions are already available for industrialization production of Notopterygii Rhizoma et Radix. However, there still some key technical problems need to be solved in the further research, and some policy dimensions need to be focused on in the coming industrialization cultivation of Notopterygii Rhizoma et Radix.

Relationship of PET/CT characteristic manifestations and pathology in ovarian sex cord-stromal tumor / 中华核医学与分子影像杂志

Objective To investigate the value of PET/CT in the diagnosis of ovary sex cord-stromal tumor (SCST), and the correlation of PET/CT findings with pathological features.Methods PET/CT findings of 40 patients (median age 57 years) with ovary SCST confirmed by pathology from November 2011 to December 2015 in Shengjing Hospital were retrospectively analyzed.ROI was drawn and SUVmax was calculated.The correlation of imaging features with pathological structural features was analyzed.Two-sample t test and one-way analysis of variance were used.Results Pathological results showed 27 patients were ovarian thecoma-fibroma group (20 patients with theca cell tumor, 7 patients with fibroma), 12 patients had granulosa cell tumor and 1 patient had sertoli-leydig cell tumor.Solid mass with or without cystic low-density area was found in 24 patients, 14 cases were cystic-solid tumors, and 2 cases showed cystic mass with irregular and thickened septations.SUVmax between solid and cystic-solid tumors was not significantly different (2.94±1.64 vs 3.77±1.40;t=2.325, P>0.05).There was no significant difference of SUVmax among theca cell tumors, fibromas and granulosa cell tumors(3.00±1.42, 2.32±1.04 and 3.68±1.65, respectively;F=2.036, P>0.05).Slight or moderate 18F-FDG uptake in solid component was demonstrated in 35 patients (SUVmax 2.96±1.25).Other 5 cases with high 18F-FDG uptake (SUVmax 6.31±0.96) were confirmed malignancy or malignant potential by pathological results, including 2 solid theca cell tumors, 2 cystic-solid granulosa cell tumors and 1 solid sertoli-leydig cell tumor.Conclusion There are some features to diagnose ovary SCST on 18F-FDG PET/CT imaging, which have some correlation with pathological features.

The model and version upgrade of community health care reform:A case study of Changning District of Shanghai / 中国卫生政策研究

Any reform needs to be converted into a series of institutional arrangements or micro behavior incen-tive mechanism,not only to ensure basic behavioral strategies of incentive compatibility between actors are motivated, but also to ensure that the behavior mode of grass-roots actors and policy direction are consistent. From the practice of community health reform of Changning District of Shanghai,it has generally gone through four stages:standardization construction and organization establishment,service model and mechanism reform, incentive mechanism design and connotation construction,platform build and performance improvement. Changning medical reform in the continuous deepening of policy trials and solve all kinds of new problems in the new medical reform policy implementation gener-ated by the process of policy and system innovation in the test(such as doctors weakened incentive problems after two lines of revenue and expenditure) and its compatibility with the environment problem. In order to realize the system of health care policy and provide stable behavioral expectations for the stakeholders to improve the welfare of stake-holders thereby continuously reducing the potential resistance to the implementation of the policy of grass-roots actors, and gradually guide the behavior of various actors to guide the direction consistent with the policy objectives