The incidence and metabolic profiles of adrenal incidentalomas in patients with diabetes / 中华内分泌代谢杂志

Objective:To determine the incidence of adrenal incidentalomas(AIs) in patients with diabetes mellitus and the metabolism profiles.Methods:A total of 615 hospitalized patients with diabetes mellitus in the Department of Endocrinology and Metabolism of Peking University People′s Hospital from March 2020 to May 2021 were retrospectively included in this study. AIs were screened by unenhanced chest computed tomography(CT) retrospectively and subsequently confirmed by multiplanar reconstruction. Participants′ physical indicators, metabolic profiles, and adrenal function parameters were collected. Unpaired t test, Mann-Whitney U test, and Chi-Square test were adopted to compare the metabolism profiles between diabetes mellitus patients with or without AIs. Regression models were used to estimate the correlations between AIs and the metabolism profiles such as blood glucose, blood lipids, blood pressure, and the adrenal function parameters.Results:Twenty-seven out of 615 participants were detected with AIs(4.4%). Patients with AIs had higher body mass index, waist circumference, and hip circumference than patients without AIs [(29.4±5.1)kg/m 2vs(26.8±3.8)kg/m 2,P=0.018; (102.3±11.7)cm vs(95.8±10.3)cm, P=0.002; (107.3±10.1)cm vs(101.4±7.6)cm, P=0.008]. The levels of serum uric acid and urinary albumin/creatinine ratio were also significantly increased in patients with AIs [(409.6±118.1)μmol/L vs(357.4±100.6)μmol/L, P=0.009; 21.25(7.49, 180.24)mg/g vs 8.60(4.71, 34.56)mg/g, P=0.010]. Besides, individuals with AIs were also associated with a higher risk of co-existing hypertension( P=0.045). Conclusion:The incidence of AIs in patients with diabetes is 4.4%. The presence of AIs in patients with diabetes may associated with increased risk of obesity and hypertension.

Exploration and practice of developing top-notch innovative medical personnel based on research-oriented hospital with thick cultivation culture / 中华医学教育探索杂志

In response to the major national strategic needs of "Healthy China" and "Innovation-Driven Development", Sichuan University, as a pilot university of "Excellent Doctor Education and Training Plan-Top Innovative Medical Personnel Training", has been exploring the training strategies since 2012. On the basis of the international theory of "The Third Generation of Medical Education based on Health System", we have innovatively put forward the new era of "Med+" education theory based on research-oriented hospitals (with medical/research/translational facility) and the two-level training paradigm from "cultivating professionalism" to "notch up to top" by planting three cultures. We have also developed a competency training system of "Five Integrated Curricula and Five Teaching & Learning Strategies". We have shifted from "didactic teaching" to "formative learning", edifying excellent doctors with "professionalism culture". We have initiated two kinds of top-notch plans, constructed a "1+2+3" innovation and entrepreneurship education system, explored "transformative learning" to incubate compound top-notch personnel with "innovative culture", opened up a "school-hospital unified" administrative system, built a PDCA closed-loop of quality control supported by mobile technology, and recast the "quality culture" to ensure shifting from "cultivating professionalism" to "notch up to top".

Association between extramural vascular invasion detected by MDCT and clinicopathologic characteristics in patients with colonic cancer / 中华普通外科杂志

Objective To investigate the association between extramural vascular invasion (EMVI) detected by multi-detectors computed tomography (MDCT) with contrast enhanced (ceMDCT) and clinicopathologic characteristics in patients with colon cancer.Methods Between February 2009 and December 2013,patients with histologically proven primary colon cancer and undergoing curative resection were included in this retrospective study.According to American Joint Committee on Cancer TNM staging system,patients of stage Ⅱ and Ⅲ were included in this study.EMVI status detected by MDCT (ctEMVI) was defined according to the EMVI scores.Chi-square test was used to analyze the association between clinicopathologic characteristics and ctEMVI.Results 165 stage Ⅱ and stage Ⅲ patients were included in this study as confirmed by pathology based on AJCC.Positive ctEMVI was demonstrated in 51 patients (34.5％,51/165).There were significant association between positive ctEMVI and age ＜ 65 years (x2 =4.810,P =0.031),ceMDCT defined tumor stage (x2 =17.911,P =0.000),ceMDCT defined metastatic lymph node (x2 =5.436,P =0.022),tumor size≥5 cm (x2 =3.799,P =0.036) and pathological T stage (x2 =13.346,P =0.001).Conclusions EMVI,detected by ceMDCT,is significantly associated with age,tumor size and T staging in colon cancer.

Diagnostic value of 3.0-tesla high-resolution magnetic resonance imaging for invasion depth of rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of 3.0T high-resolution magnetic resonance imaging(MRI) in definition of tumor invasion depth staging (T staging) before operation.</p><p><b>METHODS</b>Clinical and radiographic data of 49 rectal cancer patients who underwent radical resection within two weeks after 3.0 T high-resolution MRI examination without preoperative neoadjuvant chemotherapy in Peking University People's Hospital between February 2015 and November 2015 were retrospectively collected. Two radiologists reviewed the MRI imagines and evaluated the location and T staging of rectal cancer independently(radiologist A and B). The kappa statistics was used to evaluate the interobserver agreement, and kappa value greater than 0.81 indicated excellent agreement. The accuracy, sensitivity and specificity of high-resolution MRI in definition of rectal cancer T staging were assessed with pathological result as golden standard.</p><p><b>RESULTS</b>According to pathological result of 49 rectal cancer patients, 3 were pT1, 17 were pT2, 22 were pT3, and 7 were pT4a. In 2 cases of mucinous adenocarcinoma, MRI T2WI showed focal or diffuse significantly higher signal close to perirectal fat. And in other 47 patients of non-mucinous adenocarcinoma, MRI T2WI showed equal or higher signal compared with pelvic muscle. Interobserver agreement was excellent in diagnosis of T staging of rectal cancer with 3.0T high-resolution MRI(Kappa=0.87). The accuracy, sensitivity and specificity of both radiologists for T1 staging was 95.9%(47/49), 1/3 and 100%(46/46) respectively, besides, 1 case was both diagnosed correctly and 2 cases were overstaged. For 2 radiologists, the accuracy of T2 staging was 87.8%(43/49) and 91.8%(45/49) respectively, the sensitivity was both 88.2%(15/17), and the specificity was 87.5%(28/32) and 93.5%(30/32) respectively, besides, 15 cases were both diagnosed correctly and 2 cases were overstaged. The accuracy for T3 staging was 89.8%(44/49) and 93.9%(46/49) respectively, the sensitivity was 86.4%(19/22) and 95.5%(21/22) respectively, and the specificity was both 92.6%(25/27). Radiologist A made correct diagnosis for 19 cases, understaged 2 cases and overstaged 1 case. Radiologist B made correct diagnosis for 21 cases and only overstaged 1 case. The accuracy, sensitivity and specificity of both radiologists for T4a staging was 98.0%(48/49), 7/7 and 97.6%(41/42) respectively, besides, 7 cases were both diagnosed correctly. The overall accuracy of T staging was 85.7%(42/49) and 89.8%(44/49) by two radiologists respectively. The accuracy for differentiating T1/T2 from T3/T4 was 91.8%(45/49) and 95.9%(47/49) by two radiologists respectively. Radiologist A overstaged 2 cases and understaged 2 cases, and radiologist B overstaged 2 cases.</p><p><b>CONCLUSION</b>High-resolution MRI can accurately evaluate preoperative T staging of rectal cancer and help select the high-risk rectal cancer patients with over T3 to receive neoadjuvant treatment.</p>

Clinicopathological characteristics of solid pseudopapillary neoplasm of the pancreas, an analysis of 23 cases / 中华普通外科杂志

Objective To study the clinicopathological characteristics and immunophenotype of solid pseudopapillary neoplasm (SPN) of the pancreas.Methods Retrospective analysis was performed for the clinical materials,pathological features and immunohistochemical phenotype characteristics of the 23 SPN cases.Results Ratio of male to female was 1:10;the average age was 32 years.10(43％) patients had no clinical symptoms,12 (52％) patients had abdominal pain,abdominal distention or diarrhea;1 patient had jaundice.Tumors were in the head of pancreas in 10(43％) cases,and were in the tail or body of pancreas in 13 cases.Grossly,tumors were solid-cystic or solid;the maximum diameter were from 1.3 cm to 17 cm,with the average of 5.9 cm;12 (52％) cases appeared encapsulated.Histopathologically,21 (91％) cases appeared to exhibit a fibrous capsule surrounding the tumors,and the fibrous capsule invasion were observed in all these cases;Pancreas tissues were involved in 8(35％) cases.Tumor cells arranged in sheets,nests and pseudopapillary patterns.Hemorrhage,necrosis and cystic degeneration were often seen.Tumor cells were positive for vimentin,β-catenin,CK,CD10,PR,CD56 and Syn.Tumor were mostly negative for CgA and Ki-67.23 cases were followed up for 2 to 44 months,and all were alive.Conclusion SPN is a low degree malignant tumor often seen in young women with various histological patterns and multiple immunophenotypes.Definite diagnosis of SPN can be made by combining clinicopathological characteristics with a panel of immunohistochemicat marks.SPN grows slowly,often responds to surgical resection and rarely recur.

Advances in imaging and pathological research on extramural vascular invasion of rectal cancer / 中华消化外科杂志

Extramural vascular invasion(EMVI)was defined as the presence of tumor cells within an endotheliumlined vessel beyond the muscularis propria.High-resolution MRI had 100％sensitivity and 89％specificity in identification of large(caliber greater than 3 mm)EMVI with histopathology as reference.EMVI detected by both histopathology and MRI was significantly associated with local recurrence,distance metastasis and tumor-related death in rectal cancer,which was also identified as an independent prognostic factor for 3-year tumor-free survival and overall survival.EMVI could be used as one of the risk factors,which would allow stratification of patients with rectal cancer to receive neoadjuvant chemoradiotherapy(neoCRT).Moreover,EMVI detected by high-resolution MRI was identified as an independent predictor for response to neoCRT.Tumor regression grading scale defined by high-resolution MRI could be used to evaluate EMVI regression after neoCRT.

Detection of Focal Liver Lesions with Diffusion Weighted Imaging:Results of A Multi-center Clinical Trial / 中国医学影像学杂志

PurposeTo investigate the role of diffusion weighted imaging (DWI) in the detection of focal liver lesions (FLL).Materials and Methods T2WI, dynamic contrast enhancement (DCE) and DWI (b=100 s/mm2 and 600 s/mm2 respectively) were performed in 205 patients with 310 FLLs. All images were read by two reviewers to determine the detection of FLLs and score the confidence. The consistency of the results given by the two reviewers was evaluated. The confidence scores between different sequences and the detection rate of different sequences were also compared.Results The consistency of the two reviewers was excellent or good in T2WI, high b value DWI, low b value DWI, and DCE (Kappa=0.71, 0.85, 0.82 and 0.64,P0.05), but higher than T2WI (P<0.01). The combination of DWI and DCE detected more small malignant lesions than DWI or DCE alone (P<0.01).Conclusion DWI can detect more FLLs than T2WI, and can help DCE detect small malignant FLLs. Therefore DWI is suggested to be included in the routine protocol of liver MRI examination.

Tissue culture of medicinal plant and abscisic acid / 中国中药杂志

Abscisic acid (ABA) plays a key role in many physiological processes of plants, and it was also applied to fields of medicinal plant biotechnology. The article presents a review of some recent application of ABA in enhancing the production of secondary metabolites of medicinal plants, improving the in vitro conservation in medicinal plant tissue culture system.

Reform of clinical internship training according to the new Chinese standards in undergraduate medical education / 中华医学教育探索杂志

Clinical internships play an important role in higher medical education. According to the new standards in undergraduate medical education set by the MOE and MOH,we identified 4 main problems in our internships training,including lack of awareness of career planning,interns'absence from duty,lack of hands-on opportunities,psychological problems,etc. According to these problems,we carried out a series of solutions such as strengthening intern orientation,especially in aspects of professionalism and clinical skills training,optimizing the rotation schedule and improving the evaluation methods etc. Experiential evidence and perceptions of interns and their tutors showed that these changes were effective.