Diagnostic and Prognostic Value of 18F-FDG PET/CT in Bone Marrow Infiltration of Newly Diagnosed Diffuse Large B-Cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To explore the diagnostic value of 18F-FDG PET/CT in bone marrow infiltration (BMI) of newly diagnosed diffuse large B-cell lymphoma (DLBCL), compared with the results of bone marrow biopsy (BMB) and investigate whether the BMI diagnosed by 18F-FDG PET/CT and other factors have independent prognostic values.@*METHODS@#Ninety-four newly diagnosed DLBCL patients who underwent PET/CT in Clinical Medical College of Shanghai General Hospital of Nanjing Medical University were included. BMB was performed within 2 weeks before or after PET/CT, and standardized treatment was performed after PET/CT. The manifestations of bone marrow (BM) FDG uptake were recorded. The diagnostic criteria of BMI were BMB positive or focal BM FDG uptake confirmed by imaging follow-up. The relationship between clinical features and BM FDG uptake and the values of PET/CT and BMB in the diagnosis of BMI was analyzed. The progression-free survival (PFS) was analyzed by Kaplan-Meier survival curves, log-rank test was used to compare PFS rate, and Cox regression model was used to analyze the independent risk factors affecting PFS.@*RESULTS@#Among 94 DLBCL patients, 34 patients showed focal BM uptake (fPET), 7 patients showed super BM uptake (sBMU), 11 patients showed diffuse homogenous uptake higher than liver (dPET), and the other 42 patients had normal BM uptake (nPET) (lower than liver). BMB positive was found in all sBMU patients, in 20.6%(7/34) of fPET patients, and in 27.3% (3/11) of dPET patients. All nPET patients had negative BMB results. dPET patients were associated with lower hemoglobin level and leukocyte count compared with nPET group (P < 0.001, P =0.026). Compared with fPET patients, sBMU patients were more likely to have B symptoms and elevated lactate dehydrogenase (LDH). A total of 44 patients were diagnosed BMI, including 17 cases with BMB+. The sensitivity and specificity of BMB in the diagnosis of BMI was 38.6% (17/44) and 100% (50/50), respectively. Using fPET and sBMU as criteria of PET BMI, the diagnostic sensitivity and specificity of PET/CT was 93.2% (41/44) and 100% (50/50), respectively. Kaplan-Meier analysis showed that there was no significant difference in 2-year PFS rate between nPET and dPET patients (P >0.05), while sBMU patients had lower 2-year PFS rate compared with fPET patients (P < 0.001). Multivariate analysis showed that higher Ann Arbor stage (HR=9.010, P =0.04) and sBMU (HR=3.964, P =0.002) were independent risk factors affecting PFS.@*CONCLUSIONS@#Increased BM FDG uptake of DLBCL can be manifested as dPET, fPET and sBMU. fPET and sBMU can replace BMB to diagnose BMI. Although dPET cannot completely exclude the possibility of BMI, it does not affect the prognosis, so it can be diagnosed as PET BMI negative. sBMU is an independent prognostic risk factor.

Prognostic Value of Interim / 中国实验血液学杂志

OBJECTIVE@#To explore the value of interim @*METHODS@#Twenty-one patients with ENKTL who were pathologically diagnosed at Shanghai General Hospital of Nanjing Medical University (Shanghai General Hospital) from January 2015 to December 2018 were retrospectively collected, and @*RESULTS@#After treatment, 11 patients had complete remission (CR), 3 had partial remission (PR), 1 had stable disease (SD), and 6 had disease progression (PD). The CR patients' △SUVmax was significantly higher than non-CR patients ［(66.07±22.33)% vs (36.87±23.28)%, t=2.927, P=0.009］. Calculated from the receiver operating curve (ROC), the optimal cut-off point of ΔSUVmax was 51.45%. The median follow-up time was 32 months. Kaplan-Meier survival analysis showed that KPI, DS and ΔSUVmax had significance in predicting PFS and OS (P<0.05). COX regression analysis showed that DS was an independent risk factor affecting PFS (P<0.05), and KPI and ΔSUVmax were independent risk factors affecting OS (P<0.05).@*CONCLUSION@#Interim

Surveillance analysis on influenza-like illness from 2017 to 2018 in the plateau of Qinghai Province / 中华疾病控制杂志

Objective To analyze the surveillance results of influenza-like illness ( ILI) and investigate the prevalent trend of influenza from 14th week 2017 to 13th week 2018 (April 3, 2017-April 1, 2018) in Qinghai Province so as to provide the scientific basis for the development of prevention and control measures. Methods The epidemiological and pathogenic characteristics of influenza-like cases in qinghai province from 14th week 2017 to 13th week 2018 were collected and analyzed. Results ILI mainly occurred in winter and spring from 14th week 2017 to 13th week 2018,26 086 ILI cases reported in total，accounting for 2.95% (26 086/884 529) of total number of outpatients and emergency cases; including 18 655 cases under 5 years old，accounting for 71.51%; 1 991 cases were detected with positive by real -time RT PCR with the positive rate of 17.48% (1 991/11 391), In the early stage, H3 and H1 were the predominate strains and the middle period was mixed with H3, H1 and B, and the latter was dominated by type B. Positive rates of influenza virus testing had no statistical differences in different gender ( 2=5.33, P=0.021)，while with statistical differences in different age and time ( 2=108.59, P<0.001; 2= 1 629.13, P<0.001). Number of ILI cases and the percentage in the outpatients was significantly related with influenza virus positive rates (Pearson correlation coefficient was 0.896 and 0.699, respectively, P<0.001). Conclusions Influenza-like cases at sentinel hospital of Qinghai Province can accurately reflect actual activity level. The peak of positive detection of influenza samples in Qinghai province from 14 weeks 2017 to 13 weeks 2018 season was from mid-December to mid-January. The dominant strain of influenza viruses alternated, and the majority of the affected population is mainly in children under 5 years old. In the future, we should strengthen monitoring works in epidemic season, from October to March of next year and focus on the children under 5 years old and the fever clinic. The collection of samples of influenza-like cases in the 0-year-old group should be strengthened, and collective organizations should focus on influenza prevention and control.

The epidemiological characteristics and the source of infection of reemerge human rabies from 2012 to 2017 in Qinghai / 中华疾病控制杂志

Objective To understand the epidemic situation and the source of infection of the reemerge human rabies in Qinghai. Methods We collected the data on human rabies and the data on the cases of multi- victims bitten by the identical dog, and also the laboratory data of the nucleoprotein ( N) gene of rabies virus from the samples which were detected by reverse transcription-polymerase chain reaction (RT-PCR) and direct immunofluorescence assay (DFA) from 2012 to 2017, to describe the epidemiological characteristics of human rabies and the prevalence of rabies virus in host animals, and to explore the source of infection of reemerge human rabies. Results A total of 7 human cases were reported in 2012-2017 in Qinghai province, among which 1 was bitted by wolf, 2 were bitted by stray dogs, 3 were bitted by domestic dogs which injured by stray dogs or wolfs. A total of 892 canine brain tissue samples were collected, from which 46 positive samples were detected with the positive rate of 5.16% (95% CI：3.70%-6.61%). The positive samples were collected from the nomadic region, which were consistent had the location of the human rabies. The samples collected from the cases of multi-victims bitten by the identical dog/animal had the positive rate of 73.08%, and 4 out of 7 human rabies were exposed to the cases of multi-victims bitten by the identical dog/animal. Genetic sequencing of the rabies virus detected from canine brain tissue samples were belong to China IV lineage, which was closely related to the Arctic clade. Conclusions The reemerging rabies happened in nomadic region of Qinghai province could be a consequence of spillover from wildlife especially from wolfs. The better surveillance system covering the human, livestock and wildlife should be set up to mitigate the rabies virus spread from the wildlife.

Analysis of relation between 18F-FDG PET/CT and clinical manifestations for patients with bone metastases from prostate cancer / 医疗卫生装备

Objective To analyze the relationship between 18F-FDG PET/CT manifestations,tumor differentiation and PSA for the patients with bone metastases from prostate cancer.Methods Retrospective analysis was executed on the distribution,number and density of bone metastases tumor and FDG uptake as well as the relationship between serum PSA,FDG uptake of bone metastases focus,type of bone metastases and the involved range.Results Of the 25 cases,there were 8 ones of poorly differentiated carcinoma and 17 ones of moderately differentiated carcinoma.All the patients had serum PSA higher than 10 μg/ml,of whom there were 19 ones had the PSA not lower than 20 μg/ml.Eight patients with bone metastases restrained in the pelvis and lower lumbar vertebra,and the remained 17 ones had multiple or diffuse bone metastases.Fisher's exact test showed that non-osteoblastic metastases were more common in low-and medium-differentiation patients (P=0.022),the typing of bone metastases had no relationship with the enhancement of PSA,and there were no statistical differences between the involved ranges of the patients.Conclusion Bone metastases from prostate cancer often occurs in the patient with obviously enhanced PSA and poorly differentiation.18F-FDG PET/CT behaves well in the early diagnosis of bone metastases from prostate cancer.18F-FDG PET/CT manifestations differ with the differentiation of carcinoma,poorly differentiated carcinoma shows non-osteoblastic metastases and high FDG uptake,and moderately differentiated carcinoma appears as osteoblastic metastases and low FDG uptake.There is no confirmed correlation between PET/CT manifestation and total serum PSA for the patients with bone metastases from prostate cancer.

(18)F-FDG PET/CT for extranodular natural killer/T-cell lymphoma nasal type: imaging findings and clinical value / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the value of (18)F-FDG PET/CT in the diagnosis and treatment evaluation in patients with pretreatment or recurrent extranodular natural killer/T-cell lymphoma nasal type (ENTCL).</p><p><b>METHODS</b>(18)F-FDG PET/CT images and clinical records of 35 cases (67 scans) of pathologically confirmed ENTCL treated in our hospital within the last 9 years were analyzed. The imaging characteristics of the upper aerodigestive tract (UAT) and the non-aerodigestive tract (NUAT) lesions were analyzed. Lesion distribution, clinical stages, SUVmax and patient survival data were compared between pretreatment and recurrent cases.</p><p><b>RESULTS</b>s All the ENTCL lesions were hypermetabolic. The UAT lesions involved mainly the nasal cavity and pharynx, while the NUAT lesions may involve the lymph nodes and all the organs. UAT lesions were more common in pretreatment cases while NUAT lesions tended to increase in recurrent cases. The SUVmax of pretreatment and recurrent lesions were 10.4∓4.4 and 9.6∓5.2, and showed no significant difference among patients with different lesion distribution patterns, clinical stages, or treatment history. The tumor remission rate evaluated by PET/CT were higher in cases with an initial diagnosis than in those with recurrence [(89.5% (17/19) vs 33.3% (5/15), P<0.005)]. Cox regression analysis revealed no significant differences in the survival rates among patients with different treatment history, clinical stages, lesion distribution patterns, or SUVmax levels (P>0.05).</p><p><b>CONCLUSION</b>(18)F-FDG PET/CT can sensitively detect the pretreatment or recurrent lesions in ENTCL patients and helps in accurate tumor staging and curative effect evaluation.</p>

Investigation of psychological state and its influencing factors in children with epilepsy / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the psychological state of children with epilepsy and analyze its influencing factors.</p><p><b>METHODS</b>The Mental Health Scale for Child and Adolescent was used to survey 113 children with epilepsy and 114 normal children to evaluate and compare their psychological state. Questionnaires were used to investigate the general status of all subjects and the disease condition and treatment of children with epilepsy. The possible influencing factors for the psychological state of children with epilepsy were analyzed.</p><p><b>RESULTS</b>The mental health status of children with epilepsy was poorer than that of normal children in cognition, thinking, emotion, will-behavior, and personality traits (P<0.05). Multivariate logistic regression analysis showed that family education, family relations, seizure frequency, seizure duration, EEG epileptiform discharges in the last six months, and number of types of antiepileptic drugs were correlated with the psychological state of children with epilepsy.</p><p><b>CONCLUSIONS</b>There is a wider range of psychological health problems in children with epilepsy than in normal children. Poor family living environment, poor seizure control, and use of many antiepileptic drugs are the risk factors affecting the psychological state of children with epilepsy. Improving family living environment, controlling seizures, and monotherapy help to improve the psychological state of children with epilepsy.</p>

Recent advance in the mechanism study of polymeric inhibitors of P-glycoprotein / 药学学报

P-glycoprotein (P-gp) is an ATP-dependent multidrug efflux pump that acts as a major obstacle for oral drug delivery and cancer therapy. Recent reports have provided evidence that excipients often used in pharmaceutical formulations, such as Pluronic and TPGS, also have inhibitory effects on P-glycoprotein. Because inhibition of efflux transporters by polymeric inhibitors may dramatically increase the bioavailability of P-gp substrates with negligible side effects, identification of the mechanism and their structure activity relationship is therefore of significant importance for pharmaceutical development. Other than competitive inhibition for traditional inhibitors, polymeric inhibitors may modify P-gp function through alterations on membrane fluidity, inhibition of P-gp ATPase, depletion of intracellular ATP and down-regulating of P-gp expression. In the present review, the inhibition mechanism of potential polymeric inhibitors and their structure activity relationship will be discussed along with a brief introduction to the established methodologies.

Evaluation of the primary lesion detection in colorectal carcinoma with (18)F-FDG PET-CT / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the clinical value of detecting primary lesions of colorectal carcinoma with (18)F-FDG PET-CT.</p><p><b>METHODS</b>Clinical data of 23 cases of colorectal carcinoma collected from April 2007 to June 2008, including PET-CT, endoscopy, operation and pathology, were analyzed retrospectively.</p><p><b>RESULTS</b>Of the 23 colorectal cancer patients, including 15 males and 8 females, 11 received abdominal CT contrast examination, 7 abdominal CT general examination and 5 chest CT examination. The lesions located in caecum in 5 cases, ascending colon 4 cases, transverse colon 2 cases, descending colon 2 cases, sigmoid colon 4 cases, rectum 6 cases. CT images showed local mass, incrassation and nodes in colon. PET images revealed intensely hypermetabolic lesions. The maximum of standard uptake value (SUVmax) was 11.7+/-9.5, and the delay SUVmax was 14.8+/-11.0. The bigger was the mass, the higher was the SUV. The highest SUV was 44.8. Metastatic lesions were found in 15 cases. More cases and more metastatic lesions were found by (18)F-FDG PET-CT.</p><p><b>CONCLUSION</b>The primary and metastatic lesions of colorectal carcinoma can be detected sensitively and exactly by (18)F-FDG PET-CT, which is helpful in tumor staging and making the treatment plan.</p>

The role of FDG-PET in staging of lymphoma and evaluation of therapeutic efficiency / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the application of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to the staging and detecting residual masses of lymphoma.</p><p><b>METHODS</b>The clinical data of 179 patients with lymphoma were analyzed retrospectively. The results of FDG-PET, computed tomography (CT) and bone marrow biopsy (BMB) were compared for detection of lymph node/extranodal lymphoid tissue and bone marrow infiltration. Therapeutic efficiency was assessed by International Workshop Criteria (IWC) and Revised Integrated International Workshop Criteria (IWC + PET).</p><p><b>RESULTS</b>In the detection of 286 disease focuses in 98 patients before chemotherapy, the sensitivities of FDG-PET and CT were 73% and 70% (P < 0.01) in detecting nodal focus,and 87% and 45% (P < 0.01) in detecting extranodal lymphoma respectively. In detection of 104 lesions in 81 patients after chemotherapy,the sensitivities of FDG-PET and CT were 81% and 55% respectively (P < 0.01), and the specificities were 68% and 33%, respectively (P < 0.01) in detecting residual masses. According to IWC criteria, 33 patients achieved complete response/unconfirmed complete response (CR/CRu) , and 8 (24%) relapsed. Patients with PET-positive residual masses had a relapse rate of 40%, whereas only 21% of those with no such masses relapsed. Based on IWC + PET criteria, 25 patients achieved CR, with a relapse rate of 20%. Both FDG-PET and BMB produced positive results in 133/179 (74%) patients. Twenty-two patients with positive FDG-PET results were not detected by BMB. The sensitivities and specificities of FDG-PET for BM infiltration were 52% and 83%, respectively.</p><p><b>CONCLUSIONS</b>FDG-PET is a high sensitive and specific technique in staging and detecting residual masses of lymphoma.</p>

The role of 18F-FDG SPECT-CT in detecting recurrence and metastases in breast cancer patients with elevated tumor markers / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare retrospectively the role of (18)F-FDG SPECT-CT and conventional imaging in the detection of recurrence and metastases in postoperative breast cancer patients with elevated level of tumor markers, and to evaluate the impact of (18)F-FDG SPECT-CT on the management of breast cancer patients.</p><p><b>METHODS</b>(18)F-FDG SPECT-CT was performed in 35 breast cancer patients with suspected recurrence based on elevated level of serum tumor markers. Chest, abdomen and pelvic CT were performed in all patients and whole-body bone scan was performed in only 21 patients. The final diagnosis of recurrent breast cancer was confirmed by either pathology or observation by imaging during the follow-up for more than 1 year.</p><p><b>RESULTS</b>Among the 35 patients, the final diagnosis of recurrence or metastasis was established in 19 patients. Of the 114 sites of increased FDG uptake, 93 were interpreted as malignant and 21 as benign. On site-based analysis, the sensitivity, specificity, accuracy, positive and negative predictive values were 93.1%, 55.6%, 84.2%, 87.1% and 71.4%, respectively, for (18)F-FDG SPECT-CT, and 80.5%, 60.5%, 75.6%, 80.2% and 65.1%, respectively, for conventional imaging. On the patient-based analysis, the sensitivity, specificity, accuracy, positive and negative predictive values were 84.2%, 62.5%, 74.3%, 72.7% and 76.9%, respectively, for (18)F-FDG SPECT-CT, and 74.1%, 67.6%, 70.6%, 68.3% and 73.9%, respectively, for conventional imaging. The results of (18)F-FDG SPECT-CT led to changes in the subsequent clinical management of 40.0% of these patients.</p><p><b>CONCLUSION</b>In postoperative breast cancer patients with elevated level of tumor markers during the follow-up, (18)F-FDG SPECT-CT is more sensitive for detecting recurrence and metastases than conventional imaging.</p>

Comparison of 18F-FDG coincidence SPECT imaging and computed tomography in the initial staging and therapeutic evaluation of lymphomas / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of 18F-fluorodeoxyglucose (18F-FDG) coincidence SPECT imaging versus computed tomography (CT) for malignant lymphoma in the initial staging, early response to therapy, evaluation after completion of therapy and long-term follow-up.</p><p><b>METHODS</b>18F-FDG SPECT scans was performed on 61 patients with pathologically proven malignant lymphoma. The mean age of this series was 55 years ranged from 12 to 85 years. The data of these patients were retrospectively analyzed, and the result of 18F-FDG SPECT scan was compared with the CT imaging result performed within 2 weeks before or after FDG scan. 161 18F-FDG SPECT scans were performed for initial tumor staging (n=61), early response to therapy (n=42), evaluation after completion of therapy (n=26) and long-term follow-up (n=32). Each patient had a follow-up >6 months.</p><p><b>RESULTS</b>(1) Compared with CT scan, 18F-FDG SPECT imaging accurately upstaged the disease for 34.4% (21/61) of these patients at initial staging. It detected the lesions which were undetected by CT including bone marrow infiltration (n=17), foci of lymph node (n=3) and liver involvement (n=1). However, 3 patients were incorrectly staged, either downstaged or upstaged by 18F-FDG SPECT imaging. Of 212 lesions in 61 patients, 18-FDG SPECT imaging detected more lesions than CT (P < 0.01). The correspondence rate of '18-FDG SPECT imaging with marrow histology was 80.3% (49/61). (2) In early evaluation of the response to treatment, the accuracy, positive predictive value and negative predictive value of 18F-FDG SPECT imaging was 85.7%, 92.0% and 76.5% respectively, which is much higher than that of CT (64.3%, 75.0% and 50.0%), therefore, the therapeutic scheme in 21.4% (9/42) of these patients was changed by 18F-FDG SPECT imaging. Of 17 cases with negative 18F-FDG SPECT scan in early evaluation of therapy, clinical remission (13 complete remission and 3 partial remission) were achieved in 16 patients. Of the 25 patients with positive ones, 13 were considered as having progressive disease. (3) In the evaluation at the end of therapy or during follow-up, 58 18F-FDG SPECT imagings were performed in 26 patients. The specificity and positive predictive value were 85.7% and 68.4% versus 59.5% and 43.3%, respectively, by CT scan. Of 14 patients with residual masses detected by CT scan, 8 were diagnosed as complete remission (CR) by 18F-FDG SPECT imaging based on persistently negative FDG scans; The other 6 were interpreted as CR (n=1), partial remission (PR, n=2), non-remission (n=1) and progressive disease (n=2), thus there was only one false-positive FDG scan in these 14 patients.</p><p><b>CONCLUSION</b>18F-FDG imaging is quite effective and superior to CT scan for malignant lymphoma in initial staging, evaluation of early response to therapy and after completion of therapy, and long-term follow-up, especially for evaluating the residual masse.</p>

Therapeutic Evaluation of ~(18)F-FDG Coincidence SPECT Imaging in Malignant Lymphoma / 上海第二医科大学学报

Objective To study the clinical value of ~(18)F-fluorodeoxyglucose(~(18)F-FDG) coincidence SPECT imaging in the therapy of malignant lymphoma. Methods Serial ~(18)F-FDG SPECT imaging were performed on 42 patients with malignant lymphoma before and after treatment.The results were compared with other conventional imaging.Patients were divided into two groups. Twenty-seven new-diagnosed patients(group Ⅰ) and 15 operated patients(group Ⅱ) had ~(18)F-FDG imaging pre-and post-chemotherapy. Results(In group Ⅰ,) 15 cases(achieved) clinical remission,five cases relapsed and one case progressed.In group Ⅱ,tumor residues were detected in four patients,and one patient relapsed. Conclusion Serial ~(18)F-FDG imaging during treatment is very useful for therapeutic evaluation in malignant lymphoma.

Determination of hedychenone in Hedychium yunnanense / 中国中药杂志

<p><b>OBJECTIVE</b>To establish an HPLC method for determination of hedychenone in Hedychium yunnanense.</p><p><b>METHOD</b>C18 Chromatographic column was used, acetonitrile-water (9:1) as mobile phase, at flow rate of 1.0 mL x min(-1): The wavelength for detection was 235 nm.</p><p><b>RESULT</b>The linear range of hedychenone was 5.92-29.6 microg x mL(-1)(r = 0.9999). The average recovery was 99.0%, RSD of precision was less than 2%.</p><p><b>CONCLUSION</b>The method is simple, effective and feasible, and can be used to evaluate the quality of the herb.</p>