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Unlike healthy, non-transformed cells, the proteostasis network of cancer cells is taxed to produce proteins involved in tumor development. Cancer cells have a higher dependency on molecular chaperones to maintain proteostasis. The chaperonin T-complex protein ring complex (TRiC) contains eight paralogous subunits (CCT1-8), and assists the folding of as many as 10% of cytosolic proteome. TRiC is essential for the progression of some cancers, but the roles of TRiC subunits in osteosarcoma remain to be explored. Here, we show that CCT4/TRiC is significantly correlated in human osteosarcoma, and plays a critical role in osteosarcoma cell survival. We identify a compound anticarin-β that can specifically bind to and inhibit CCT4. Anticarin-β shows higher selectivity in cancer cells than in normal cells. Mechanistically, anticarin-β potently impedes CCT4-mediated STAT3 maturation. Anticarin-β displays remarkable antitumor efficacy in orthotopic and patient-derived xenograft models of osteosarcoma. Collectively, our data uncover a key role of CCT4 in osteosarcoma, and propose a promising treatment strategy for osteosarcoma by disrupting CCT4 and proteostasis.
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Family therapy has been introduced to China for more than 30 years.The research of domestic family therapy mainly focuses on two aspects: the promotion of methods and theories, and the study on the application of Chinese culture.This research reviewed the present research status for family therapy in application effectiveness and acculturation in China, pointed out the deficiencies of the current national family therapy in depth, methods and technologies, object of research and research methods, and offered several advices. At the same time, it offered advices on the acculturation of family therapy in China's clinic and proposed that the implementation of family therapy under the background of Chinese culture should enhance the "understanding" on China’s family history and culture, and firmly carry out the clinical research on individual case.
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Objective:To investigate the clinicopathological characteristics and treatment strategies of undifferentiated carcinoma with osteoclast-like giant cells of pancreas (UCOGCP).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients with UCOGCP who were admitted to Peking University First Hospital from January 2004 to January 2019 were collected. There were 1 male and 4 females, aged from 33 to 71 years, with a median age of 56 years. Patients underwent preoperative laboratory test, imaging and histopatho-logical examinations. Patients with pancreatic head tumors underwent pancreaticoduodenectomy, and those with tumors in the body or tail of pancreas underwent distal pancreatectomy combined with splenectomy. All patients underwent standard lymph node dissection. Postoperative adjuvant therapy was individually decided by a multidisciplinary team. Observation indicators: (1) preopera-tive examination and treatment; (2) postoperative histopathological situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence of patients up to January 2020. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers. Results:(1) Preoperative examination and treatment: of the 5 UCOGCP patients, CA19-9 was elevated as 65.43 U/mL in only 1 patient preoperatively, while the CA19-9 was normal in other 4 patients. Four patients showed a solid cystic mass on preoperative contrast-enhanced computed tomography (CT) scan, and 1 patient showed a delayed peripheral enhancement of the solid tumor with central necrosis. The magnetic resonance imaging (MRI) scan showed hypointense signals on T1, T2 and weighted diffusion sequences in all 5 patients. Three of the 5 patients were resectable according to imaging data, 1 patient had locally advanced tumor, infiltrating the transverse colon, stomach, and partial small intestine, with the portal vein thrombus, and 1 patient had pancreatic head tumor with a liver metastatic lesion of 0.4 cm diameter which was detected on position emission tomography CT and was diagnosed as UCOGCP by endoscopic ultrasound-guided fine-needle aspiration biopsy. All patients underwent radical resection. Of the 3 patients with resectable tumors, 2 patients underwent pancreaticoduo-denectomy and 1 patient underwent distal pancreatectomy combined with splenectomy. One patient with locally advanced tumor in the body and tail of pancreas underwent distal pancreatectomy + transverse colostomy + partial gastrectomy + portal vein thrombectomy, and 1 patient with pancreatic head tumor and liver metastasis underwent pancreatoduodenectomy combined with left lateral hepatectomy. Of the 5 patients, 2 received postoperative adjuvant chemotherapy with single-agent gemcitabine, 1 received albumin-paclitaxel+gemcitabine combination chemotherapy, 1 received S1 as single agent chemotherapy, and 1 did not receive adjuvant chemotherapy. (2) Postoperative histopathological situations: of the 5 patients, 4 cases showed a cystic solid appearance of gross specimens, and 1 case had a solid appearance with central hemorrhagic necrosis. The tumor diameter was 5.2 cm(range, 2.0?14.0 cm). All the 5 patients achieved negative margins. Of the 5 patients, there was 1 case with portal vein invasion, 2 cases with vascular invasion, 3 cases with perineural invasion, and 2 cases with regional lymph node metastasis. One patient may had multiple tumor invasion and metastasis. Four of 5 patients had paraffin specimens available for immuno-histochemical staining. Four patients were positive for both CD68 and vimentin stains, while 3 patients were positive for programmed death ligand-1 (PD-L1), including 2 samples with 5% positive cells and 1 sample with 25% positive cells. Postoperative pathological examination showed a large number of spindle histiocytoid sarcoma cells scattered with osteoclast like giant cells and pleomorphic carcinoma giant cells. The tumor mutation burden in the 4 patients was 3.23 Muts/Mb(range, 2.61?21.77 Muts/Mb). Microsatellite status was stable in 4 patients. The next generation sequencing of 4 patients showed that all patients had KRAS mutation which was the most frequently mutation in pancreatic ductal adenocarcinoma. Of the 4 patients, 1 case had germline pathogenic mutation in TP53, 1case had somatic mutation in TP53, 1 case had somatic mutation in TP53, BLM, CDKN2A, and 1 case had somatic mutation in ARID1A. (3) Follow-up: 5 patients were followed up for 14?173 months, with a median follow-up time of 46 months. During the follow-up, 4 patients achieved disease-free survival and 1 patient had local recurrence at postoperative 11 months.Conclusions:UCOGCP is a rare variant of pancreatic tumor that exhibits a cystic solid mass in imaging examinations. High expression of PD-L1 is common in UCOGCP. The prognosis for UCOGCP is favorable following radical surgery. Patients may benefit from extended radical surgery even if the tumor has locally progression or distant metastasis.
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Currently the treatment strategy of pancreatic cancer has shifted from the mode "surgery first" to multidisciplinary team. More and more evidences have revealed that neoadjuvant therapy will help to increase the R0 resection rate, reduce the recurrence rate, and improve the prognosis of the patients with borderline resectable pancreatic cancer. Furthermore, neoadjuvant therapy is also recommended for resectable pancreatic cancer patients with high risk factors of tumor recurrence. In this article, the current controversy and research progress of neoadjuvant therapy for pancreatic cancer are reviewed and commented in order to deepen the understanding of the hot topic in clinial surgeons.
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Currently the treatment strategy of pancreatic cancer has shifted from the mode "surgery first" to multidisciplinary team.More and more evidences have revealed that neoadjurant therapy will help to increase the R0 resection rate,reduce the recurrence rate,and improve the prognosis of the patients with borderline resectable pancreatic cancer.Furthermore,neoadjuvant therapy is also recommended for resectable pancreatic cancer patients with high risk factors of tumor recurrence.In this article,the current controversy and research progress of neoadjuvant therapy for pancreatic cancer are reviewed and commented in order to deepen the understanding of the hot topic in clinial surgeons.
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Objectives: To explore related factors of sociodemographic characteristics and family dynamics of different self-esteem groups of junior middle school students. Methods: A total of 1059 junior middle school students were recruited. The Self-designed sociodemographic characteristic questionnaire, the Self-Esteem Scale and the Selfrating scale of systemic family dynamic were applied. According to SES scores, the high self-esteem group, the middle group and the low group were constructed. The differences of sociodemographic characteristics and systemic family dynamics were compared between these groups by χ2-test and ANCOVA. Ordinal logistic regression was conducted to determine the relation between self-esteem and sociodemographic characteristics and family dynamic factors. Results:The higher self-esteem group had the better of parental education attainment, family life quality, parent relationship, and the more subjects born in Shanghai (Ps ＜ 0. 05). After controlling the above sociodemographic characteristics, family atmosphere scores and individuality scores in the high self-esteem group were the lowest and these in the low group were highest (Ps ＜ 0. 05). Not being born in Shanghai (OR = 1. 57, 95％ CI: 1. 15-2. 14) was a risk factor for low self-esteem, while the lower scores of family atmosphere (OR = 0. 48, 95％ CI: 0. 36-0. 65) and the lower scores of individuality (OR = 0. 66, 95％ CI: 0. 52-0. 83) were protective factors for low self-esteem. Conclusion:It suggests that there are significant different sociodemographic characteristics and family dynamic factors among different self-esteem junior middle school students. Self-esteem may be related to whether being born natively, family atmosphere, and individuality in junior middle school students.
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Circulating tumor cells (CTC) disseminate from primary tumors by undergoing epithelial mesenchymal transition that allow their entry into the circulation to drive metastatic formation in pancreatic cancer patients.Technological advances in detection and characterization of CTC are conducive to the early diagnosis, differential diagnosis, monitoring disease progression and predicating the probability of canceration or the chemotherapeutic efficacy. Nowadays, detection methods of CTC can be based on immunomagnetic beads technique, cell filtration or microfluidic chips technology, but there are great differences in the sample throughput, CTC recovery rate, purity, and CTC viability among them.Owing to the dilemma in detection methods, the intrinsic relevance between the biological characteristics of CTC and clinical manifestations is still not exactly elucidated. By the improved methodology, next generation sequencing technology and exploring the technique for culturing CTC in vitro and establishing xenotransplanted tumor model in nude mice, more and more biological information will be revealed, and finally, individualized treatment is achieved.
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Objective To investigate the effect of cognitive behavior therapy (CBT) on the conversion of individuals with ultra-high-risk (UHR) of schizophrenia,and to find out the related influence factors.Methods Patients were randomly divided into study group (50 cases) and control group (49 cases) by the digital random table method.The study group received cognitive behavioral therapy,and the control group only got follow-up questionnaire.Structured Interview for Prodromal Syndromes (SIPS) was used to evaluate psychosis risk symptoms of each UHR individuals at baseline,3 months,6 months,12 months and 18 months respectively and the effects of CBT on conversion and related influencing factors were analyzed.Results There was no significant difference in the conversion rate (P＞ 0.05) between study group and control group after 3 months,but the conversion rate of study group was significantly lower than the control group after 6 months(6.00％ vs 20.41％,P＜0.05),12 months(10.00％ vs 24.49％,P＜0.05)and 18 months(10.00％ vs 28.57％,P＜0.05).CBT could effectively improve conditions for individuals with positive symptom (study group:5.30±3.62,5.04±3.89,4.38±4.13,5.26±3.65,5.94±4.19,control group:5.59±3.62,6.33±5.29,6.98 ±4.96,7.02±5.02,8.39±6.42,F=4.326,P=0.000) of UHR,but the improvement was not significant for negative individuals (F=1.555,P=0.215).CBT could be effective for disorganized symptom (F=6.901,P =0.010) and general symptom (F=7.752,P=0.006) as well.The poor family relationship was the risk factor of conversion to the schizophrenia (OR=3.411,95％CI=1.016-11.453,P=0.047).Conclusion CBT can effectively reduce the conversion rate of UHR individuals.CBT has a good remission effect on the positive symptoms,disintegrating symptoms and general symptoms of UHR.Family relationship affects prognosis of UHR individuals.
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The disrupted caregiver infant relationships are not unpopular (infant abuse and non-traumatic caregiver-infant relationship).Animal and human studies have demonstrated this disruptive relationship exerts the fundamental and enduring impacts on stress system, limbic system and relevant cortex.Individual carrying such biological susceptibility might develop psychopathology under stresses at later life.The assessment needs to get involved the measures with more objectivity,real time and moment-to-moment components.The study on caregiverinfant relationship also should focus on the historical and cultural aspects of China.
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Objective This study is to explore the association between self-differentiation and men-tal health among medical students. Methods Differentiation of self inventory-revised (DSI-R) and univer-sity personality inventory (UPI) were used to measure the self-differentiation and mental health of 526 med-ical students from Grade One to Grade Five at a comprehensive university in Shanghai. Result The mean score of DSI-R was (171.25±19.65). 32.2％ of participants had different levels of mental health prob-lems. Female students got higher score of DSI-R than male students (P=0.007). Statistically significant dif-ferences of medical students' self-differentiation were found among years of school attended (P=0.039). Sta-tistically significant differences of self-differentiation were also found between the first class and the third class of UPI (P<0.001) as well as the second class and the third class of UPI (P=0.004). Ordinal regression analysis indicated that self-differentiation was a risk factor for medical students' mental health (OR=1.036, P=0.000). Conclusion The average score of medical students' self-differentiation was higher than college students of other specialties. But their mental health condition was worse. Medical students with higher self-differentia-tion had worse mental health situation.
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Human epidermal growth factor receptor 2 (HER2) proteins are overexpressed in a high proportion of gastric cancer (GC) cases and affect the maintenance of cancer stem cell (CSC) subpopulations, which are used as targets for the clinical treatment of patients with HER2-positive GC. Despite improvements in survival, numerous HER2-positive patients fail treatment with trastuzumab, highlighting the need for more effective therapies. In this study, we generated a novel type of genetically modified human T cells, expressing a chimeric antigen receptor (CAR), and targeting the GC cell antigen HER2, which harbors the CD137 and CD3ζ moieties. Our findings show that the expanded CAR-T cells, expressing an increased central memory phenotype, were activated by the specific recognition of HER2 antigens in an MHC-independent manner, and effectively killed patient-derived HER2-positive GC cells. In HER2-positive xenograft tumors, CAR-T cells exhibited considerably enhanced tumor inhibition ability, long-term survival, and homing to targets, compared with those of non-transduced T cells. The sphere-forming ability and in vivo tumorigenicity of patient-derived gastric cancer stem-like cells, expressing HER2 and the CD44 protein, were also inhibited. Our results support the future development and clinical application of this adoptive immunotherapy in patients with HER2-positive advanced GC.
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Animals , Humans , Mice , Mice, Inbred BALB C , Mice, Nude , Neoplasms, Experimental , Allergy and Immunology , Pathology , Therapeutics , Receptor, ErbB-2 , Allergy and Immunology , Receptors, Antigen, T-Cell , Allergy and Immunology , Stomach Neoplasms , Allergy and Immunology , Pathology , Therapeutics , Tumor Cells, CulturedABSTRACT
Objective To explore the decision-making process of medical students who turned the major from the medicine to other majors,and the related factors that hindered them continuing to study the medicine.Methods According to the design of interpretative phenomenon logical analysis,semi-structured in-depth interviews were used to collect the data.Participants were six undergraduate students who had moved from medical major to another major.Interviews were recorded on audio-tape with the students' permission and then transcribed verbatim.The transcribed interviews were analyzed according to six steps of interpretative phenomenological analysis.Results Even if the participants had left the medical major,they still expressed a strong sense of professional identity for the doctor.However,they also admitted that the professional process of medicine students was very hard and tired,and couldn't get the equal return for their payment.They thus were lack of confidence for the future.Some of the participants talked about the fact that they had been curious about the future of medical students.Internet and seniors were the main avenues for obtaining job-related information,but they were often plagued by the negative information.Education about career adaptation should be carried out as soon as possible,to strengthen the professional identity of medical students,and enhance their ability to defend against negative information,which could help to deal with the status of high turnover rate for medical students.Conclusion Based on the students' perspective,exploring the decision-making process of turning major for medical students will contribute to the educators taking effective strategies to improve the students' career identity,stabilize their professional thought,and reduce the loss of the medical students.
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Objective:To investigate the characteristics of perceived stress and coping style and their relationship withsymptoms in college students with psychosis-risk syndrome (PRS).Methods:A two-stage screening process was conducted in 3160 college students.Participants were screened with 16-Item Version of the Prodromal Questionnaire (PQ-16).The students with scores of PQ-16 ≥9 were further interviewed with Structured Interview for Prodromal Syndromes (SIPS).Twenty-two individuals who met the criteria of PRS on SIPS were enrolled as the PRS group.The control group (n =22) were randomly selected from the participants with scores of PQ-16 ＜9 who were matched with age,gender and education level.Two groups were assessed with Chinese Perceived Stress Scale (CPSS),Trait Coping Style Questionnaire (TCSQ) and Self-rating depression scale (SDS) to measure subjective stress,coping style and depressive symptoms.Results:PRS group reported higher CPSS total scores [(34 ± 8)vs.(22 ± 8)] and negative coping styles scores [(35 ± 5)vs.(28 ± 7)],and lowerTCSQ positive coping styles scores [(31 ±6)vs.(37 ±4)] than the controls (Ps ＜0.05).The CPSS scores in PRS group were positively correlated with the scores of negative coping style (r =0.57,P ＜0.01),and the SDS scores were positively correlated with CPSS total scores and scores of negative coping style (r--0.86,0.66,Ps ＜ 0.01).There was no significant relation of psychosis-risk symptoms to scores of CPSS and TCSQ (P ＞0.05).Conclusion:It suggests that college students with PRS have a higher perceived stress and tend to use more negative coping style,which may be positively correlated with depression.
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Psychotherapy is a kind of medical treatments based on interpersonal interaction that is highly context-dependent.While psychotherapy is an important treatment in clinical work and its effectness has been confirmed with wide practical application,its adverse effects has received little attention.This article will review the literaturesand discuss the possible side effects and relatedfactors of psychotherapy.
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Objective This study is to explore the correlation between communication skills attitude and general self-efficacy among medical interns. Methods Medical intern students of three medical colleges in Shanghai were participated in this study, and questionnaire survey was conducted by cluster sampling of class. SPSS 19.0 was used to process descriptive analysis, t-test, F-test, correlation analysis and hierarchical regression analysis for data analysis. Result 600 questionnaires were handed out and 575 valid samples were collected. The effective rate was 95.83％. The mean score of positive and negative attitude dimension in CSAS were (51.880 ±7.003) and (31.550 ±5.839). The mean score of GSES was (26.230 ±4.820). A positive correlation was found between positive attitude of communication skills and general self-efficacy (r=0.165, P<0.01). Hierarchical regression analysis indicated that school, cognition about importance of com-munication skills and general self-efficacy significantly predicted positive attitude of communication skill.These three variables could explain 21.8％ of total variance and general self-efficacy can explained 2.1％after control other variables. Conclusion Communication skills attitudes of medical interns is positive on the whole. Enhancing their general self-efficacy is beneficial to improving their positive attitude towards communication skills.
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Background Limbal stem cells (LSCs) deficiency leads to many ocular surface diseases,such as pterygium and so on.ATP-binding cassette transporter B5 (ABCB5) is a recently discovered marker of LSCs.Understanding the expression changes of ABCB5 in pterygium tissue has an important clinical significance for pterygium.Objective This study was to investigate the expression changes of ABCB5 in pterygium tissue.Methods Thirty-seven pterygium tissue specimens were collected from primary pterygium patients who received pterygium surgery,and 22 normal conjunctival tissue specimens were obtained from the strabismus patients and retinal detachment patients during surgery in 474 Hospital of Chinese PLA from January 2015 to November 2015.Immunochemistry was employed to detect the cxpression and location of ABCB5 in the specimens,and the protein and mRNA expressions of ABCB5 were detected by Western blot and real-time fluorescence quantitative PCR,respectively.The results were compared between normal conjunctival tissues and pterygium tissue.Results ABCB5 protein was expressed in the cytoplasm and nuclei of stratified squamous epithelium of 22 normal counjunctival tissue specimens,especially in the basal layer cells,and showed obvious polarity in normal conjunctiva.In pterygium group,ABCB5 protein was positively expressed in 91.89％ specimens (34/37) and the expression was absent in 8.11％ specimens (3/37).The relative expression levels of ABCB5 protein were 0.90±0.31 and 0.59±0.41,and those of ABCB5 mRNA were 1.01±0.26 and 0.65±0.32 in the normal conjunctival tissues and pterygium tissue,respectively,showing significant differences between them (protein:t =-0.266,P =0.011;mRNA:t =-4.560,P =0.000).Conclusions Down-regulation of ABCB5 in pterygium indicates the decreasing and losing of LSCs,which may play an important role in the development of pterygium.ABCB5 may be a useful indicator for the prediction of development and recurrence of pterygium and has an important implication for treating evaluation,and it may also be a target for the management of pterygium.
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Objective To identify the expression of CD68-tumor-associated macrophages (TAMs) and proliferative marker Ki-67 in retroperitoneal malignant fibrous histiocytoma (MFH) and their clinical significance. Methods Clinical data about 35 patients with retroperitoneal MFH managed with surgery from February 2002 to December 2015 were retrospectively analyzed and all patients were followed up. There were 24 male and 11 female patients, and they were 18-71 years old, with mean age (53.0 ± 10.8) years old. Patients were divided into CD68 positive group (21 patients) and CD68 negative group (14 patients), while they were also divided into Ki-67 low expression (< 20%) group and Ki-67 high expression ( ≥ 20%) group, according to the immunohistochemical staining results. The overall survival time and all clinical data between two groups were compared. Kaplan-Meier estimations, Cox regression analysis, Fisher exact probabilities and Spearman correlations were performed. Results Of the 35 patients, 18 patients received radical resection, and 17 patients received palliative operation. The overall 1-, 3-, 5-year survival rates were 65.7%, 22.9%and 8.6%and the median survival was 17 (1-86) months. Factors associated with postoperative survival were FNCLCC grade (x2=7.002, P=0.008), modusoperandi of the tumor resection(x2=7.134, P=0.008), and CD68(x2=4.634, P=0.031) and Ki-67 overexpression (≥20%) (x2=8.898, P=0.003 ) . The difference between gender, age, tumor size, blood loss, removal of the joint organs and adjuvant therapy got no statistical significances (P > 0.05). Multivariate analysis showed that survival was associated with modusoperandi of the tumor resection and Ki-67 overexpression (P=0.003, 0.002, respectively). Conclusions Retroperitoneal malignant fibrous histiocytoma is a rare malignancy that display poor prognosis and high mortality. Complete resection remains the mainstream for retroperitoneal malignant fibrous histiocytoma. The patients' life span in CD68 positive or Ki-67 high expression is shorter. CD68 and Ki-67 plays a critical role in retroperitoneal malignant fibrous histiocytoma carcinogenesis and their high expression may be used as a potential survival predictor in patients with retroperitoneal MFH.
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Objective To identify the expression of CD68-tumor-associated macrophages (TAMs) and proliferative marker Ki-67 in retroperitoneal malignant fibrous histiocytoma (MFH) and their clinical significance. Methods Clinical data about 35 patients with retroperitoneal MFH managed with surgery from February 2002 to December 2015 were retrospectively analyzed and all patients were followed up. There were 24 male and 11 female patients, and they were 18-71 years old, with mean age (53.0 ± 10.8) years old. Patients were divided into CD68 positive group (21 patients) and CD68 negative group (14 patients), while they were also divided into Ki-67 low expression (< 20%) group and Ki-67 high expression ( ≥ 20%) group, according to the immunohistochemical staining results. The overall survival time and all clinical data between two groups were compared. Kaplan-Meier estimations, Cox regression analysis, Fisher exact probabilities and Spearman correlations were performed. Results Of the 35 patients, 18 patients received radical resection, and 17 patients received palliative operation. The overall 1-, 3-, 5-year survival rates were 65.7%, 22.9%and 8.6%and the median survival was 17 (1-86) months. Factors associated with postoperative survival were FNCLCC grade (x2=7.002, P=0.008), modusoperandi of the tumor resection(x2=7.134, P=0.008), and CD68(x2=4.634, P=0.031) and Ki-67 overexpression (≥20%) (x2=8.898, P=0.003 ) . The difference between gender, age, tumor size, blood loss, removal of the joint organs and adjuvant therapy got no statistical significances (P > 0.05). Multivariate analysis showed that survival was associated with modusoperandi of the tumor resection and Ki-67 overexpression (P=0.003, 0.002, respectively). Conclusions Retroperitoneal malignant fibrous histiocytoma is a rare malignancy that display poor prognosis and high mortality. Complete resection remains the mainstream for retroperitoneal malignant fibrous histiocytoma. The patients' life span in CD68 positive or Ki-67 high expression is shorter. CD68 and Ki-67 plays a critical role in retroperitoneal malignant fibrous histiocytoma carcinogenesis and their high expression may be used as a potential survival predictor in patients with retroperitoneal MFH.
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Objective To study the diagnosis,treatment and prognostic factors of pancreatic neuroendocrine neoplasms (pNENs).Methods The clinical,pathological and follow-up data of 44 patients with pNENs treated at the Peking University First Hospital from Jan.2007 to Dec.2016 were retrospectively studied.Survival analysis was performed with the Kaplan-Meier method.Results There were 21 male and 23 female patients.The mean age was (54.8 ± 14.0) years.25 patients had non-functional,while 19 had functional pNENs.Curative resection was performed in 40 patients.Neural invasion and intravascular cancer emboli were found in 7 and 5 patients,respectively.The pathologic data showed that the number of patients with G1,G2,G3 were 23 (52.3 ％),15 (34.1％),6 (13.6％),respectively.The number of patients with stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ were 23 (52.3 ％),16 (36.4％),2 (4.5 ％) and 3 (6.8 ％),respectively.The predictive factors on prognosis included curative resection or not,WHO grade,TNM staging,lymph node metastasis and distant metastasis (P ＜ 0.05).Conclusions Curative surgical resection is the first choice of treatment for pNENs.WHO grade,TNM staging,lymph node metastasis and distant metastasis were significantly related to the prognosis of pNENs.
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OBJECTIVE: To evaluate orthopedic metal artifact reduction algorithm (O-MAR) in CT orthopedic metal artifact reduction at different tube voltages, identify an appropriate low tube voltage for clinical practice, and investigate its clinical application. MATERIALS AND METHODS: The institutional ethical committee approved all the animal procedures. A stainless-steel plate and four screws were implanted into the femurs of three Japanese white rabbits. Preoperative CT was performed at 120 kVp without O-MAR reconstruction, and postoperative CT was performed at 80–140 kVp with O-MAR. Muscular CT attenuation, artifact index (AI) and signal-to-noise ratio (SNR) were compared between preoperative and postoperative images (unpaired t test), between paired O-MAR and non-O-MAR images (paired Student t test) and among different kVp settings (repeated measures ANOVA). Artifacts' severity, muscular homogeneity, visibility of inter-muscular space and definition of bony structures were subjectively evaluated and compared (Wilcoxon rank-sum test). In the clinical study, 20 patients undertook CT scan at low kVp with O-MAR with informed consent. The diagnostic satisfaction of clinical images was subjectively assessed. RESULTS: Animal experiments showed that the use of O-MAR resulted in accurate CT attenuation, lower AI, better SNR, and higher subjective scores (p < 0.010) at all tube voltages. O-MAR images at 100 kVp had almost the same AI and SNR as non-O-MAR images at 140 kVp. All O-MAR images were scored ≥ 3. In addition, 95% of clinical CT images performed at 100 kVp were considered satisfactory. CONCLUSION: O-MAR can effectively reduce orthopedic metal artifacts at different tube voltages, and facilitates low-tube-voltage CT for patients with orthopedic metal implants.