The value of ouantitative parameters of magnetic resonance imaging in predicting the efficacy of chimeric antigen receptor T-cell therapy for children and adolescents with mature aggressive B-cell non-Hodgkin lymphoma / 中华实用儿科临床杂志

Objective:To investigate the value of quantitative parameters of magnetic resonance imaging (MRI) in predicting the efficacy of chimeric antigen receptor T-cell (CAR-T) therapy for children and adolescents with mature aggressive B-cell non-Hodgkin lymphoma (NHL).Methods:It was a retrospective multicenter study.Clinical data of 44 children and adolescents diagnosed with mature aggressive B-cell NHL between January 2016 and January 2023 in Henan Cancer Hospital, Beijing Gaobo Boren Hospital, and the First Affiliated Hospital of Xinxiang Medical University were retrospectively analyzed.Patients were divided into complete response (CR) group and non-CR group based on the international criteria for the diagnosis of pediatric NHL.Quantitative parameters of MRI, including T2 signal intensity, the minimal apparent diffusion coefficient (ADCmin), maximal ADC (ADCmax), and the mean ADC (ADCmean) were measured before and within 2 weeks after CAR-T infusion.The correlation between the above parameters and the achievement of CR was analyzed.The intraclass correlation coefficient (ICC) was used to assess the inter-observer agreement among observers in measuring quantitative parameters of MRI.Differences between groups were analyzed using the independent sample t-test.Factors influencing CR were identified through the binary Logistic regression analysis, and a prediction model was established.Model performance was evaluated by plotting receiver operating characteristic (ROC) curves. Results:Significant differences were observed between the CR group and non-CR group in T2 signal intensity before CAR-T infusion (267±152 vs.364±160, P=0.048), and ADCmin (0.94±0.38 vs.0.53±0.28, P<0.05), ADCmax (1.73±0.69 vs.0.84±0.43, P<0.05), ADCmean (1.28±0.48 vs.0.67±0.33, P<0.05), and T2 signal intensity within 2 weeks after CAR-T infusion (198±139 vs.345±168, P=0.004). A univariate prediction model was created by introducing the above quantitative parameters.The area under the curve (AUC), specificity, sensitivity, and accuracy of T2 signal intensity before CAR-T infusion in predicting the efficacy on children and adolescents with mature aggressive B-cell NHL were 0.800, 84.0%, 57.9%, and 72.7%, respectively.The AUC, specificity, sensitivity, and accuracy of ADCmax within 2 weeks of CAR-T infusion were 0.958, 88.0%, 78.9%, and 84.1%, respectively.The AUC, specificity, sensitivity, and accuracy of T2 signal intensity within 2 weeks of CAR-T infusion were 0.869, 84.0%, 68.4%, and 77.3%, respectively. Conclusions:Quantitative parameters of MRI, including ADC values and T2 signal intensity, are of great significance in the early prediction of CAR-T therapy efficacy on children and adolescents with mature aggressive B-cell NHL.Among these parameters, ADCmax presents the strongest predictive performance and serves as a valuable indicator for predicting a complete response with CAR-T treatment.

CT texture analysis for predicting pseudoprogression in metastatic clear cell renal cell carcinoma during PD-1 inhibitor therapy / 中华内科杂志

Objective:To evaluate the effectiveness of enhanced CT texture feature analysis in predicting pseudoprogression in patients with metastatic clear cell renal cell carcinoma (mccRCC) undergoing programmed cell death protein 1 (PD-1) inhibitor therapy.Methods:A cross-sectional study. Data from 32 patients with mccRCC were retrospectively collected who received monotherapy with PD-1 inhibitors after standard treatment failure at Henan Cancer Hospital, from June 2015 to January 2021. Clinical information and enhanced CT images were analyzed to assess target lesion response. The lesions were divided into pseudoprogression and non-pseudoprogression groups. Manual segmentation of target lesions was performed using ITK-Snap software on baseline enhanced CT, and texture analysis was conducted using A.K. software to extract feature parameters. Differences in texture features between the pseudoprogression and non-pseudoprogression groups were analyzed using univariate and multivariate logistic regression. A predictive model for pseudoprogression was constructed, and its performance was evaluated using ROC curve analysis.Results:A total of 32 patients with 89 lesions were included in the study. Statistical analysis revealed significant differences in seven texture features between the pseudoprogression and non-pseudoprogression groups. These features included“original_ngtdm_Strength”(0.49 vs. -0.61, P=0.006), “wavelet-HLH_glszm_ZonePercentage”(0.67 vs. -0.22, P=0.024),“wavelet-LHL_ngtdm_Strength”(1.20 vs. -0.51, P=0.002), “wavelet-HLL_gldm_LargeDependenceEmphasis”(-0.84 vs. 0.19, P=0.002), “wavelet-HLH_glcm_Id” (-0.30 vs. 0.43, P=0.037),“wavelet- HLH_glrlm_RunPercentage”(0.45 vs. -0.01, P=0.032),“wavelet-LHH_firstorder_Skewness”(0.25 vs. -0.27, P=0.011). Based on these features, a pseudoprogression prediction model was developed with a P-value of 0.000 2 and an odds ratio of 0.045 (95% CI 0.009-0.227). The model exhibited a high predictive performance with an AUC of 0.907 (95% CI 0.817-0.997) according to ROC curve analysis. Conclusions:Enhanced CT texture feature analysis shows promise in predicting lesion pseudoprogression in patients with metastatic ccRCC undergoing PD-1 inhibitor therapy. The developed predictive model based on texture features demonstrates good performance and may assist in evaluating treatment response in these patients.

The diagnostic significance of thin layer reconstruction with spiral CT on the pulmonary hamartoma / 实用放射学杂志

Objective To investigate the diagnostic significance of thin layer reconstruction with spiral CT on the pulmonary hamartoma. Methods Accepted both routine CT examination and thin layer construction,2 1 pulmonary hamartoma cases confirmed by pathology were analyzed retrospectively.The margin and inner features of the lesions were observed and recorded.Significant analysis was performed by using SPSS17.0 Pearson chi-square test and Fisher exact test,with P<0.05 as the significant difference criterion.Results Comparison of the display rates by routine CT and thin layer reconstruction:①the same display rate of lobulation were 57.1%(12/21);②the same display rate of calcification were 42.9% (9/21);③the display rates of fat density were 14.3%(3/21)by routine CT and 42.9% (9/21)by thin layer reconstruction.The difference was statistically significant (χ2=4.200,P<0.05);④the display rates of blood vessel throughing were 14.3%(3/21)by routine CT and 47.6% (10/21)by thin layer reconstruction.The difference was statistically significant (χ2=5.459,P<0.05).Conclusion Displaying the inner features of pulmonary hamartoma better than routine CT,the thin layer reconstruction can improve the diagnostic accuracy significantly.

Comparision between echo planar imaging-diffusion weighted imaging and readout-segmented echo-planar diffusion imaging in the diagnosis of nasopharyngeal carcinoma / 中华放射学杂志

Objective To comparatively analyze the application of conventional echo planar imaging-diffusion weighted imaging (EPI-DWI) and readout-segmented echo-planar diffusion imaging (RESOLVE) in the diagnosis of nasopharyngeal carcinoma.Methods A total of 35 patients with nasopharyngeal carcinoma confirmed by pathology were included in this study.All patients underwent conventional EPI-DWI and RESLOVE (b=800 s/mm2) with a 3.0 T MRI scanner.ADC values of the tumors and normal nasopharyngeal tissues were calculated.Scoring (Five-point score) for imaging quality of conventional EPI-DWI and RESLOVE was independently performed by two radiologists with 5 years experiences and the agreement evaluation was performed using Kappa analysis.The numbers of cases with effectively ADC values,the ADC values of the same tissue in different sequences and the ADC values of the tumor and the normal muscle tissue in the same sequence were compared.The data was statistically analyzed by x2 test,paired sample t test and independent sample t test.Results The agreement between two radiologists was excellent.The Kappa value of the conventional EPI-DWI was 0.91 1(P＜0.01).The Kappa value of the RESOLVE was 0.827(P＜0.01).Four points or more accounted for 97.1％ (34/35) in the RESOLVE group,while only 2.9％ (7/35) images scored four points and most of them were less than four points in the conventional EPI-DWI group.The effectively ADC values can be measured in the conventional EPI-DWI,accounting for 54.3％ (19/35) cases.The ADC values could be measured in all cases of group (100.0％,35/35).The scores of imaging quality of RESOLVE were higher than those of conventional EPI-DWI,which were significantly different (x5=19.091,P＜0.001).The ADC values of the normal nasopharyngeal tissue were (1.65 ±0.13) × 10-3,(1.96±0.14) × 10-3 mm2/s and the ADC values of the tumor were (0.87±0.09) × 10-3,(0.83±0.10)× 10-3 mm2/s in the conventional EPI-DWI and the RESOLVE,respectively.The ADC values were significantly different between the tumors and the normal nasopharyngeal tissues (t=-23.284,-31.509,P＜0.05).The ADC values of the tumors were apparently lower than the normal nasopharyngeal tissues.There were no significant difference of the ADC values between the conventional EPI-DWI and the RESOLVE measuring the same tissue (t=-0.957,-0.921,P＞0.05).Conclusion Compared with conventional EPI-DWI,RESLOVE can provide a higher quality image and may be helpful to accurate diagnosis.

Research in length of naso-gastric tube for infants / 中国实用护理杂志

Objective To accurately measure the length of naso-gastric tube for infants by adopting ap-propriate body surface measurement. Methods We chose 60 infants and adopted two methods to measure the length of tube,one was the new method by which we measured the distance from the middle of hair border of forehead to umbilicus and the other was the traditional method by which we measured the distance to xiphoid process from the same beginning point as the new method.Then we compared the results from the two methods with the actural length of the tube. Results The result of the traditional method was statistically different from the actural length of the tube (P ＜ 0.01 )But the result of the new method was near to the actural length of the tube (P＞ 0.05). Conclusions The result of the new measuring method was near to the actural length of the naso-gastric tube and was suitable to the infants.It reduced the adverse effect caused by the traditional method and improved the effect of diagnosis and treatment greatly.So we advocated to measure the distance from the middle of hair border of forehead to umbilicus as the length of naso-gastric tube.

Assessment of sedative effects by intravenous injection of fentanyl on neonates with mechanical ventilation / 中国实用护理杂志

Objective We aimed to assess the sedative effects by intravenous injection of fentanyl on neonates with mechanical ventilation. Methods We divided 142 neonates with mechanical ventilation into the observation group (92 cases) and the control group (50 cases). The observation group received intravenous injection of fentanyl, while the control group was given no sedative medication. The pain and sedation was assessed before ventilation, 1 and 2 hours after ventilation and later every 4 hours by adoption of NPASS evaluation inventory. Results The scores of pain at different time points 2 hours after medication in the observation group were lower than those in the control group, especially 24 hours after medication. The mean airway pressure and oxygen concentration required by the observation group was lower than those of the control group. But no difference was seen in blood oxygen saturation between the two groups. Conclusions Intravenous injection of fentanyl was proper in the application of sedative treatment for neonates with mechanical ventilation. N-PASS inventory could effectively assess the pain and sedation condition and ensure the safe medication.

Analysis of Clinical Features and CT Findings of Pulmonary Fungal Infection Secondary to Malignant Tumor / 实用放射学杂志

Objective To study the clinical features and CT findings of pulmonary fungal infection(PFI) secondary to malignant tumor.Methods The clinical features and CT findings of PFI secondary to malignant tumor proved clinically and pathologically were analyzed retrospectively.Results In pulmonary fungal infection,pulmonary candidiasis was most common seen,which were found in 34 (68%) of 50 cases.CT findings of PFI usually consist of a mixture of patterns,ground-glass attenuation(n=31,62%)and air-space consolidation (n=29,58%) were most common CT findings. Other CT findings included nodule(n=20,40%), air cresceut sign (n=2,4%), thickening of bronchovascular bundles (n=7,14%), mass (n=1,2%),tree-in-bud appearance(n=5,10%),cavity(n=3,6%).Conclusion CT findings of PFI secondary to malignant tumor were nonspecific,which can’t distinguish from other pneumonia,to pay more attentions on it is necessary.