Trends in antimicrobial use and hospital infection incidence among inpatients / 上海预防医学

ObjectiveTo understand the use of antibiotics in inpatients and the incidence and trend of hospital infections， to explore the implementation effect of comprehensive management measures， and to provide reference for hospitals to use antibiotics reasonably. MethodsBased on the hospital infection monitoring and management system， a retrospective analysis and comparison were conducted on the use of antibiotics， submission of microbial test samples， and incidence of hospital infections among inpatients in a tertiary hospital from 2012 to 2021. ResultsFrom 2012 to 2021， the use of antibiotics showed a downward trend， from 50.82% in 2012 to 41.29% in 2021. At the same time， the use rate of restricted and special antibiotics had also decreased， and the use rate of restricted and special antibiotics in patients without hospital infection was significantly lower than that in patients with hospital infection， and the microbial testing rate was also on the rise. The annual incidence rate of hospital infection was 0.69%‒1.92%， and the annual case-time prevalence rate was 0.79%‒2.17%. The annual average rate of the above two in 10 years was 1.18% and 1.34%， respectively. The results of the exponential smoothing model also showed that the utilization rate of antibiotics was decreasing and the incidence of nosocomial infection was stable. ConclusionLarge general hospitals took comprehensive management measures to strengthen the management of rational use of antibiotics， which led to a decline in the use rate of antibacterial drugs for inpatients and an increase in the rate of microbial examination. At the same time， the overall incidence of hospital infection was relatively stable， suggesting that the comprehensive management measures of antibacterial drugs in hospitals had achieved certain results. The current measures need to be optimized in the future to continuously improve the management level of rational use of antibacterial drugs.

Prognostic stratification of baseline PET metabolic parameters combined with Bcl-2/c-Myc dual expression in patients with primary gastrointestinal diffuse large B-cell lymphoma / 中华核医学与分子影像杂志

Objective:To explore whether baseline PET metabolic parameters combined with B-cell lymphoma-2 (Bcl-2)/cellular-myelocytomatosis viral oncogene (c-Myc) dual expression (DE) can improve the prognostic stratification of patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL).Methods:From March 2011 to November 2019, 74 patients (33 males, 41 females; age: 20-87 years) pathologically diagnosed with PGI-DLBCL prior to treatment in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School and the First Affiliated Hospital of Nanjing Medical University were retrospectively included. Baseline PET/CT scans were calculated automatically using the boundaries of voxels presenting a SUV max≥2.5, and metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were determined. Expressions of Bcl-2 and c-Myc were detected at protein levels by immunohistochemistry (IHC). A predicting model comprised of MTV and DE was constructed and patients were divided into 3 groups, including low-risk group (low MTV and non-DE), mediate-risk group (high MTV or DE) and high-risk group (high MTV and DE). The distributions of progression-free survival (PFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method, log-rank test and Cox proportional hazards model. Results:Of 74 patients, 20 relapsed or progressed, 13 died, and 29.7%(22/74) patients were DE positive. Multivariate analysis revealed that MTV (hazard ratio ( HR)=9.110, 95% CI: 1.429-18.615, P=0.012) and DE ( HR=9.837, 95% CI: 1.690-57.260, P=0.011) were independent predictors of PFS, while MTV ( HR=12.470, 95% CI: 3.356-46.336, P<0.001) was the only independent predictor of OS. In the predicting model for PFS, low-risk group ( n=42) and mediate-risk group ( n=20) exhibited significant difference ( χ2=7.84, P=0.005), and mediate-risk group and high-risk group ( n=12) also exhibited significant difference ( χ2=18.72, P<0.001). Conclusions:MTV and DE can independently predict PFS of patients with PGI-DLBCL, and MTV can independently predict OS. The predicting model for PFS combining MTV with DE may further improve the ability of clinicians to stratify patients in terms of differential prognoses.

Nomogram based on CT texture analysis and morphological characteristics for differentiating Borrmann Ⅳ type gastric cancer from gastric diffuse large B-cell lymphoma / 中华放射学杂志

Objective:To explore the value in differentiating Borrmann Ⅳ type gastric cancer (BT4-GC) from gastric diffuse large B-cell lymphoma (DLBCL) using a nomogram based on CT texture analysis (CTTA) and morphological characteristics.Methods:From June 2011 to December 2020, a total of 60 patients with BT4-GC and 24 patients with DLBCL were retrospectively collected in Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University. Morphological characteristics were evaluated, including major location, long axis range, circumferential range, mucosal line status, and perigastric enlarged lymph nodes. CTTA parameters were calculated using venous CT images with a manual region of interest. The morphological characteristics and CTTA parameters between BT4-GC and DLBCL were compared by χ 2 test, Fisher exact test or Mann-Whitney U test. The multivariate binary logistic regression analysis was used to filter factors into the diagnostic model and construct a nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of CTTA parameters and the diagnostic model in differentiating BT4-GC from DLBCL. Results:For morphological characteristics, mucosal line status showed a significant difference between BT4-GC and DLBCL (χ 2=12.99, P<0.001). For CTTA parameters, 16 parameters showed significant differences between BT4-GC and DLBCL (all P<0.05). The area under the ROC curve (AUC) of 16 CTTA parameters in differentiating BT4-GC from DLBCL was 0.662-0.833. Percentile 90 showed the highest AUC of 0.833 (95%CI 0.736-0.906). The mucosal line status (OR 4.82, 95%CI 1.21-19.25, P=0.026) and percentile 90 (OR 1.09, 95%CI 1.04-1.15, P=0.001) were brought into the diagnostic model and constructed a nomogram. The AUC of the model in differentiating BT4-GC from DLBCL was 0.898 (95%CI 0.813-0.953), sensitivity was 0.833, and specificity was 0.817. Conclusions:The nomogram based on CTTA percentile 90 and morphological characteristics mucosal line status can effectively distinguish BT4-GC from DLBCL and shows high diagnostic efficacy.

Prognostic value of pretreatment 18F-FDG PET/CT in patients with metastatic melanoma treated with anti-PD1 immunotherapy / 中华核医学与分子影像杂志

Objective:To assess the prognostic value of pretreatment 18F-FDG PET/CT metabolic parameters in patients with metastatic malignant melanoma treated with anti-programmed cell death-1 (PD1) immunotherapy. Methods:A retrospective analysis of 29 patients (15 males, 14 females, age (59.1±13.0) years) with pathologically diagnosed metastatic malignant melanoma in Nanjing Drum Tower Hospital between June 2017 and October 2020 was conducted. Anti-PD1 immunotherapy were performed in all patients after 18F-FDG PET/CT imaging. 18F-FDG PET/CT parameters including SUV max, bone marrow-to-liver SUV max ratio (BLR), spleen-to-liver SUV max ratio (SLR) were obtained. Total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) of primary lesions were measured automatically using the thresholds of 40%SUV max. The median value of each PET parameter was regarded as the threshold value and was used to divide patients into 2 groups (≥ and < the median value, respectively). Kaplan-Meier survival curve and Cox proportional risk model were used to analyze the overall survival (OS) differences between groups. Results:The median follow-up time was 15.0 months and 13 patients died. The median OS was 26.0(95% CI: 20.4-31.6) months. The median SUV max, TMTV, TLG, BLR and SLR were 6.2, 8.2 cm 3, 38.6 g, 0.82 and 0.84 respectively. Kaplan-Meier method and log-rank test showed that differences of OS between SUV max≥6.2 and <6.2 groups, TLG≥38.6 g and <38.6 g groups, BLR≥0.82 and <0.82 groups, SLR≥0.84 and <0.84 groups were not significant ( χ2 values: 0.01-0.35, P values: 0.061-0.929), while patients with TMTV≥8.2 cm 3 suffered from poorer OS compared with those with TMTV<8.2 cm 3 ( χ2=5.90, P=0.015). Cox multivariate analysis showed that TMTV (hazard risk ( HR)=6.347, 95% CI: 1.039-38.789) was a significant predictor of OS ( P=0.045). Conclusion:18F-FDG PET/CT parameter TMTV is the independent predictive factor of OS in metastatic melanoma treated with anti-PD1 immunotherapy.

Prognostic value of metabolic parameters measured by 18F-FDG PET/CT in patients with primary advanced cutaneous malignant melanoma / 中华核医学与分子影像杂志

Objective:To investigate the prognostic value of metabolic parameters measured by 18F-FDG PET/CT in patients with primary advanced cutaneous malignant melanoma (CMM). Methods:A retrospective analysis was comprised of 42 patients with advanced CMM (15 males and 27 females; median age: 60.0 years) from Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between June 2014 and December 2019. All patients were initially diagnosed by pathology, and underwent 18F-FDG PET/CT imaging. 18F-FDG PET/CT parameters including SUV max, SUV mean, total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) of metastatic lesions were measured. ROC curve analysis was performed to obtain the optimal cut-off values of those metabolic parameters for predicting progression-free survival (PFS) and over-all survival (OS). Patients were divided into different groups based on their metabolic parameters (≥cut-off values or <cut-off values), and Kaplan-Meier survival curve and log-rank test were used to analyze the OS/PFS differences between 2 groups. The independent prognostic risk factors of PFS and OS were screened by univariate analysis and Cox proportional risk model. Results:The median follow-up time of 42 patients with advanced CMM was 26.3 months, with 32 patients suffered from disease progression and 21 patients died, and the median survival was 33.1 months. The optimal cut-off values for PFS/OS were 4.63/4.77 for SUV max, 3.31/3.31 for SUV mean, 8.22 cm 3/22.32 cm 3 for TMTV, and 18.22 g/51.37 g for TLG, respectively. Kaplan-Meier analysis and log-rank test showed that patients with SUV max ≥4.63 or SUV mean ≥3.31 suffered from poorer PFS ( χ2 values: 7.12, 5.42, P values: 0.008, 0.020), meanwhile, patients with SUV max ≥4.77 or TMTV≥22.32 cm 3 or TLG≥51.37 g suffered from poorer OS ( χ2 value: 4.73, 5.60, 6.31, P values: 0.030, 0.018, 0.012). Multivariate analysis demonstrated that SUV max was significant predictor for both PFS (hazard risk ( HR)=3.03(95% CI: 1.23-7.45), P=0.016) and OS ( HR=3.62(95% CI: 1.19-11.00), P=0.023), while TMTV and TLG were significant predictors for OS ( HR: 2.87(95% CI: 1.20-6.87), 3.34(95% CI: 1.39-8.05); P values: 0.018, 0.007). Conclusions:Baseline 18F-FDG PET/CT metabolic parameters have certain value in prediction of prognosis in patients with advanced CMM. SUV max of metastatic lesions is an independent prognostic risk factor for both PFS and OS, and TMTV and TLG are independent prognostic risk factors for OS in patients with advanced CMM.

Prognostic value of pretreatment 18F-FDG PET/CT in patients with primary malignant melanoma / 中华核医学与分子影像杂志

Objective:To assess the prognostic value of pretreatment 18F-FDG PET/CT metabolic parameters in patients with primary melanoma. Methods:A retrospective analysis comprised of 35 patients (21 males, 14 females, age: 35-85 years; from January 2014 to August 2019; Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School) who were newly-diagnosed primary melanoma with preoperative 18F-FDG PET/CT was conducted. 18F-FDG PET/CT metabolic parameters including SUV max, SUV mean, peak of SUV (SUV peak) were obtained. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary focus were measured automatically using the threshold of 40%SUV max. The optimal thresholds of PET parameters were obtained by using ROC curve analysis. The associations between melanoma-specific survival (MSS), progression-free survival (PFS) and PET/CT metabolic parameters were assessed using Kaplan-Meier method and Cox proportional hazards model. Results:The median follow-up was 15.4 months, and 20 patients showed disease progression and 7 died. The cut-off values for SUV max, SUV mean, SUV peak, MTV and TLG were 3.95, 2.45, 2.65, 3.60 cm 3 and 14.85 g, respectively (AUCs: 0.742, 0.790, 0.728, 0.655, 0.693; P values: 0.016, 0.004, 0.022, 0.121, 0.053). Kaplan-Meier method and log-rank test showed that SUV max, SUV mean, SUV peak, MTV and TLG were predictors of PFS ( χ2 values: 4.06-8.35, all P<0.05). Multivariate analysis showed that MTV (hazard ratio ( HR)=3.09, 95% CI: 1.08-8.86, P=0.036) and TLG ( HR=3.36, 95% CI: 1.11-10.14, P=0.031) were significant predictors of PFS but not for MSS ( HR=5.14, P=0.080). Conclusions:SUV max, SUV mean and SUV peak of primary focus may help for predicting PFS of patients with primary melanoma. MTV and TLG of primary focus may be the best to predict PFS of primary melanoma.

Correlation between MLH1 methylation and distant metastasis of solid pseudopapillary tumor of pancreas / 中华肝胆外科杂志

Objective:To investigate the significance of MLH1 protein expression and MLH1 gene methylation rate between metastatic solid pseudopapillary tumor of pancreas (SPT) and non-metastatic SPT, and to explore the correlation between MLH1 gene methylation and SPT metastasis.Methods:Twelve metastatic SPT patients admitted to Peking University People's Hospital, Rizhao Central Hospital and Chaoyang Central Hospital of Liaoning Province from January 2009 to May 2022 were studied retrospectively, including 3 males and 9 females, with a median age of 47 years old, ranging from 21 to 73 years old. Thirty non-metastatic SPT patients with clear diagnosis, clear medical history and complete follow-up data from pathological database of Peking University People's Hospital from January 2009 to May 2017 were selected as the control group, including 12 males and 18 females, with a median age of 42 years old, ranging from 34 to 69 years old. Clinical data such as gender, age and pathological data were collected. Immunohistochemical expression of MLH1 protein and methylation of MLH1 gene were detected by pathological paraffins.Results:There was no significant difference in general data between the two groups (all P>0.05). Among the 12 metastatic SPT patients, 4 cases metastasized to liver, 2 to spleen, 2 to lung, 2 to lymph nodes, 1 to mediastinum, and 1 to sacrum. Compared with the non-metastatic tissue, the MLH1 protein deletion in metastatic pancreatic lesions (metastatic SPT-P) and metastatic lesions (metastatic SPT-M) were increased [both 33.3%(4/12)], and the difference was statistically significant (both Chi square=5.00, both P=0.041). Compared with 0 (0/30) MLH1 gene methylation rate in non-metastatic SPT tissues, the methylation rate of MLH1 gene in metastatic SPT-M and metastatic SPT-P tissues [both 30% (3/10)] were higher, with statistical significance (both Chi square=0.96, both P=0.032). Conclusion:Compared with non-metastatic SPT, the loss rate of MLH1 protein expression and MLH1 gene methylation are increased in metastatic SPT. MLH1 methylation may occur before metastasis, which can be used as a predictor of SPT metastasis.

Role of interim 18F-FDG PET/CT combined with Bcl-2/MYC protein dual expression status in risk stratification for patients with primary gastrointestinal diffuse large B-cell lymphoma / 中华核医学与分子影像杂志

Objective:To explore the potential value of interim 18F-fluorodeoxyglucose (FDG) PET/CT combined with B-cell lymphoma-2 (Bcl-2)/MYC protein dual expression (DE) status in the prognostic stratification for patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL). Methods:Forty-six patients (21 males, 25 females; age 20-83 years) with newly diagnosed PGI-DLBCL from June 2012 to May 2019 in Nanjing Drum Tower Hospital were enrolled in this retrospective study. Immunohistochemistry for Bcl-2 and MYC protein expression was performed. All patients underwent baseline and interim (after 2-4 cycles of cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (R-CHOP) regimen) 18F-FDG PET/CT scans for assessment. Interim 18F-FDG PET/CT results were determined based on Deauville 5-point scale (DS) and changing rate of maximum standardized uptake value (ΔSUV max%) in 18F-FDG PET/CT images. Kaplan-Meier survival analysis, Cox proportional hazards regression model (single factor, multiple factors analysis) were used to analyze the prognosis (3-year progression free survival (PFS) and overall survival (OS) rates). Results:Patients were followed up for 6-84 months, and 14 showed disease progression and 9 died. The PFS rate and OS rate were 69.6% and 80.4%, respectively. DE, DS as well as ΔSUV max% were significant predictors of PFS (hazard ratio ( HR) values: 3.280, 5.120, 9.167, all P<0.05); lactate dehydrogenase (LDH), MYC protein expression, DS and ΔSUV max% were significant predictors of OS ( HR values: 4.091, 9.618, 7.697, 11.151, all P<0.05). Multivariate analysis revealed that DS and ΔSUV max% were independent predictors of PFS and OS ( HR values: 4.370-9.244, all P<0.05). In the DS negative (-) group, patients with DE positive (+ ) had lower PFS and OS rates than those with DE- (PFS rate: 50.0% vs 88.9%; OS rate: 66.7% vs 96.3%; χ2 values: 6.050, 4.966, both P<0.05). In ΔSUV max%<90% group, patients with DE+ had lower PFS rate than those with DE- (12.5% vs 68.8%; χ2=6.649, P=0.01). Conclusions:Interim PET/CT analysis using DS and ΔSUV max% is able to predict survival in PGI-DLBCL patients. The combination of DS, ΔSUV max% and DE can risk-stratify PGI-DLBCL patient more effectively.

Comparison of 18F-FDG PET/CT and digestive endoscopy findings in gastric mucosa-associated lymphoid tissue lymphoma / 中华核医学与分子影像杂志

Objective:To investigate 18F-fluorodeoxyglucose (FDG) PET/CT imaging manifestations and digestive endoscopy of gastric mucosa-associated lymphoid tissue (MALT) lymphoma and evaluate whether maximum standardized uptake value (SUV max) can reflect the tumor proliferation activity and diagnose the diffuse large B cell transformation. Methods:18F-FDG PET/CT of 36 untreated histologically confirmed gastric MALT lymphoma patients (19 males, 17 females, age (46.4±18.1) years) between December 2012 and January 2019 in Nanjing Drum Tower Hospital were reviewed retrospectively. A positive or negative PET was defined based on visual analysis. 18F-FDG uptake above surrounding tissues in the regions of interest defined by the nuclear physician was considered positive, while negative was definited if the 18F-FDG uptake below surrounding tissues. Types of uptake included focal uptake and diffuse uptake. The characteristic findings of 18F-FDG PET/CT and digestive endoscopy (3 types: chronic gastritis-like type, depressed type and protruding type) in the consecutive patients were evaluated. The region of interest was drawn and the maximum standardized uptake value (SUV max) was measured. One-way analysis of variance and the least siginficant difference t test were used to compare the SUV max of 3 types of lesions and Mann-Whitney U test was used for comparison of SUV max between lesions with/without diffuse large B cell transformation. The correlation between SUV max and Ki-67 was assessed by Spearman rank correlation analysis. Receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal cut-off value for the diagnosis of diffuse large B cell transformation. Results:Positive 18F-FDG PET/CT were found in 15 patients and the diagnostic accuracy was 41.7%(15/36). 18F-FDG uptake results were positive for all protruding tumors (5/5) mainly with focal uptake (4/5), but only 4/16 for chronic gastritis-like type tumors and 6/15 for depressed type tumors. SUV max of protruding type tumors (10.7±6.4) was significantly higher than chronic gastritis-like type tumors (2.1±0.8) and depressed type tumors (2.7±1.4; F=13.010, all P<0.05). SUV max (2.7(1.8, 5.0)) was associated with Ki-67 (10%(15%, 40%); rs=0.345, P=0.039). SUV max of tumors with diffuse large B cell transformation in 36 patients was significantly higher than that with no transformation (9.4(3.1, 14.8) vs 2.3(1.7, 3.9); z=-3.044, P=0.002), and the cut-off value of SUV max was 6.5 (area under the curve: 0.788, P=0.011). Conclusions:18F-FDG PET may be a useful method for evaluating protruding type gastric MALT lymphoma but not appropriate for chronic gastritis-like type or depressed type tumors. SUV max may be a useful biomarker for tumor proliferation activity and can be used for diffuse large B cell transformation diagnosis in gastric MALT lymphoma patients.

Clinical and pathological analysis of clear cell chondrosarcoma / 中华骨科杂志

Objective:To investigate the clinical manifestations, imaging features, histopathological features, diagnostic pitfalls, treatment and prognosis of clear cell chondrosarcoma (CCCS).Methods:23 cases of CCCS admitted and operated from January 2010 to January 2020 were analyzed retrospectively. Among the 23 cases, 21 were males and 2 were females. There were 8 cases (35%) aged 21-40, 10 cases (43%) aged 41-60 and 5 cases (23%) aged 61-80. There were 8 femurs, 7 pelvis, 4 thoracolumbar spine, 3 sacrum and 1 tibia. The specimens were fixed with 10% phosphate-buffered formalin, decalcified with 5% nitric acid, embedded in paraffin and stained with hematoxylin and eosin (HE) and immunohistochemistry (Envision). The preoperative imaging and clinical symptoms, and the postoperative histopathological and immunophenotype under the microscope were collected. And the relevant literature was reviewed to summarize the clinical, imaging and pathomorphological characteristics of CCCS.Results:23 cases of CCCS showed bone destruction in imaging, some cases were well-circumscribed lytic lesions, some cases had sclerotic margin. The serum alkaline phosphatase was increased in 7 patients before operation. The tumor tissue was gray-white and gray-red in general and some cases showed porcelain white cartilage-like areas. Microscopically, the tumor cells are round or polygonal, some of them have clear cytoplasm and boundary, some of them are eosinophilic, some of them have round and centrally located nuclei, and mitotic image is rare. It is often seen that there are nodular distribution of cartilage-like matrix and immature woven bone, multinucleated osteoclast-like giant cell scattered in those components. Immunohistochemical staining: S-100, D2-40, EMA, Vimentin, p16, SATB2 can be positive in varying degrees. The surgical treatment is mainly through en bloc excision. 10 patients had recurrence and no distant metastasis.Conclusion:CCCS is a rare subtype of chondrosarcoma, which has low-grade malignant biological behavior and is easy to be misdiagnosed clinically and pathologically. Pathological diagnosis needs to be careful. Careful observation of microscopic histology is necessary in order to avoid over-diagnosis of osteosarcoma leading to clinical treatment errors. Once the biopsy is confirmed, it needs en bloc excision in order to reduce the recurrence rate. Long-term follow-up is needed after the operation, the overall prognosis was good.

Radiographic features of 18F-FDG PET/CT in the assessment of disease activity in adult-onset Still′s disease / 中华核医学与分子影像杂志

Objective:To investigate the characteristic findings of 18F-fluorodeoxyglucose (FDG) PET/CT in patients with adult-onset Still′s disease (AOSD) and the correlation between the maximum standardized uptake value (SUV max) and clinical disease activity score as well as laboratory data. Methods:Twenty-two patients (6 males, 16 females, age range: 19-73 (41.5±16.3) years) with AOSD according to criteria set by Yamaguchi between May 2015 and June 2018 in Nanjing Drum Tower Hospital were recruited in the retrospective study. The characteristic findings of 18F-FDG PET/CT in the consecutive AOSD patients were evaluated. The correlation between SUV max and clinical disease activity score as well as laboratory data was assessed with Spearman rank correlation analysis. Results:PET/CT results contributed to the diagnosis of AOSD in all the 22 patients (100%). The accumulation of 18F-FDG was showed in lymph nodes of 21 patients(95.5%), and the spleen and bone marrow uptake were observed in all the 22 patients (100%). Besides, 18F-FDG uptake was found in shoulder joint ( n=6, 27.3%), submaxillary glands ( n=9, 40.9%) and parotid glands ( n=7, 31.8%). The SUV max of lymph nodes were significantly correlated with the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) ( r s values: 0.622, 0.538, both P<0.05). The SUV max of spleen was significantly correlated with CRP and ESR levels ( r s values: 0.543, 0.475, both P<0.05). The SUV max of bone marrow was significantly correlated with the level of CRP and neutrophils(%) ( r s values: 0.497, 0.431, both P<0.05). However, there was no correlation between the SUV max and clinical disease activity score ( r s values: 0.008, 0.102, 0.210, all P>0.05). Conclusions:Characteristics findings of 18F-FDG PET/CT imaging can provide useful information for differential diagnosis as well as extent assessment for AOSD, and play an important role in the diagnosis process of AOSD. 18F-FDG PET/CT scan may be a helpful imaging technique for evaluation of disease activity in patients with AOSD but prospective study with large cohort of individuals are needed.

Clinicopathological study of SET subtype of ovarian high-grade serous carcinoma / 中华妇产科杂志

Objective@#To investigate the clinicopathological characteristics and significance of solid, endometrioid and transitional (SET) ovarian high-grade serous carcinoma (HGSC).@*Methods@#A total of 408 cases of ovarian HGSC admitted to Peking University People's Hospital from January 2011 to September 2016 were collected. (1) According to the proportion of tumors with SET form in all tumors, they were divided into three groups: HGSC-classic group (<25%), HGSC-SET Ⅰ (25%-50%) and HGSC-SET Ⅱ (>50%) group. The clinical and pathological characteristics of three groups of ovarian HGSC patients were compared respectively. (2) According to the growth pattern, that was, the proportion of pushing/expanding invasive tumors in the whole pelvic disseminated tumors of pelvic disseminated tumors, the three groups were divided into four subgroups: group A (0-25%), group B (26%-50%), group C (51%-75%) and group D (>75%). Differences in progression-free survival (PFS) among the four subgroups in each group were compared respectively.@*Results@#The median age of 408 cases with ovarian HGSC was 63.3 years (47-78 years), including 152 cases premenopausal and 256 cases postmenopausal. Among 408 cases of ovarian HGSC, 290 cases were in HGSC-classic group, 91 cases in HGSC-SET Ⅰ and 27 cases in HGSC-SET Ⅱ group. (1) There were significant differences in age, proportion of menopausal patients, tumor necrosis (including map necrosis or acne necrosis), response rate to primary chemotherapy, 5-year mortality rate and PFS between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P<0.05). There was no significant difference among the above indexes between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P>0.05). In HGSC-classic group, HGSC-SET Ⅰ and HGSC-SET Ⅱ, the proportion of family members or patients with history of epithelial ovarian cancer or breast cancer increased in turn, and the detection rate of serous tutal intraepithelial carcinoma (STIC) in fallopian tube tissue decreased in turn. There were significant differences between the two groups (P<0.05). (2) In HGSC-classic group, there were 147 cases in group A, 124 cases in group B and 19 cases in group C (0 case in group D), with median PFS of 17.4, 17.7 and 16.5 months respectively (P<0.05); 10, 6, 29 and 46 cases in group A, B, C and D in HGSC-SET Ⅰ, with median PFS of 9.6, 12.7, 30.1 months and 39.0 months respectively, which there were significant difference among group A and C and D (all P<0.05); among group B, C and D group in HGSC-SET Ⅱ, there were respectively 3, 12 and 12 cases (0 case in group A), and the median PFS was 13.5, 34.2 and 47.8 months (P<0.05). PFS was positively correlated with the increase of push/expansive infiltration ratio.@*Conclusions@#The detection rate of STIC in ovarian HGSC patients with SET is higher, the effect of primary chemotherapy is better, and PFS is prolonged. PFS was significantly prolonged in patients with pelvic disseminated tumors of HGSC-SET, the infiltration of which were predominated by pushing or expanding boarder.

Role of intracellular Ca2+ in regulating NHE3 expression in Caco-2 cells during rotavirus infection / 中华微生物学和免疫学杂志

Objective To investigate the effects of rotavirus ( RV) on the expression and bioactiv-ity of Na+-H+ exchanger 3 ( NHE3 ) in Caco-2 cells and the possible regulatory mechanism. Methods Caco-2 cells expressing NHE3 were constructed and divided into four groups as follows: control ( CTL ) group, RV group, BAPTA-AM ( a Ca2+ chelator) group and BAPTA-AM+RV group. Na+-H+ exchanger ac-tivity and NHE3 expression on cell surface were determined using BCECF-AM and biotinylation assay, re-spectively. Expression of Cdc42 at protein level was measured by Western blot. Results Compared with the control group, RV infection significantly decreased the activity of NHE3 and its expression on cell surface. BATPA-AM antagonized the inhibitory effects on NHE3. Moreover, the expression of Cdc42 at protein level was increased following RV infection, which was also antagonized by BATPA-AM. Conclusions Intracellu-lar Ca2+-mediated Cdc42-dependent endocytosis pathway might be involved in regulating the expression and bioactivity of NHE3 during RV infection.

Clinicopathological study of SET subtype of ovarian high?grade serous carcinoma / 中华妇产科杂志

Objective To investigate the clinicopathological characteristics and significance of solid, endometrioid and transitional (SET) ovarian high-grade serous carcinoma (HGSC). Methods A total of 408 cases of ovarian HGSC admitted to Peking University People's Hospital from January 2011 to September 2016 were collected. (1) According to the proportion of tumors with SET form in all tumors, they were divided into three groups: HGSC-classic group (<25%), HGSC-SET Ⅰ (25%-50%) and HGSC-SETⅡ (>50%) group. The clinical and pathological characteristics of three groups of ovarian HGSC patients were compared respectively. (2) According to the growth pattern, that was, the proportion of pushing/expanding invasive tumors in the whole pelvic disseminated tumors of pelvic disseminated tumors, the three groups were divided into four subgroups: group A (0-25%), group B (26%-50%), group C (51%-75%) and group D (>75%). Differences in progression-free survival (PFS) among the four subgroups in each group were compared respectively. Results The median age of 408 cases with ovarian HGSC was 63.3 years (47-78 years), including 152 cases premenopausal and 256 cases postmenopausal. Among 408 cases of ovarian HGSC, 290 cases were in HGSC-classic group, 91 cases in HGSC-SETⅠand 27 cases in HGSC-SET Ⅱ group. (1) There were significant differences in age, proportion of menopausal patients, tumor necrosis (including map necrosis or acne necrosis), response rate to primary chemotherapy, 5-year mortality rate and PFS between HGSC-SET Ⅰ and HGSC-SET Ⅱ (P<0.05). There was no significant difference among the above indexes between HGSC-SETⅠand HGSC-SETⅡ(P>0.05). In HGSC-classic group, HGSC-SET Ⅰ and HGSC-SET Ⅱ, the proportion of family members or patients with history of epithelial ovarian cancer or breast cancer increased in turn, and the detection rate of serous tutal intraepithelial carcinoma (STIC) in fallopian tube tissue decreased in turn. There were significant differences between the two groups (P<0.05). (2) In HGSC-classic group, there were 147 cases in group A, 124 cases in group B and 19 cases in group C (0 case in group D), with median PFS of 17.4, 17.7 and 16.5 months respectively (P<0.05); 10, 6, 29 and 46 cases in group A, B, C and D in HGSC-SETⅠ, with median PFS of 9.6, 12.7, 30.1 months and 39.0 months respectively, which there were significant difference among group A and C and D (all P＜0.05); among group B, C and D group in HGSC-SET Ⅱ, there were respectively 3, 12 and 12 cases (0 case in group A), and the median PFS was 13.5, 34.2 and 47.8 months (P＜0.05). PFS was positively correlated with the increase of push/expansive infiltration ratio. Conclusions The detection rate of STIC in ovarian HGSC patients with SET is higher, the effect of primary chemotherapy is better, and PFS is prolonged. PFS was significantly prolonged in patients with pelvic disseminated tumors of HGSC-SET, the infiltration of which were predominated by pushing or expanding boarder.

Clinicopathological analysis of 42 patients with sarcomatoid hepatocellular carcinoma / 中华肝胆外科杂志

Objective To study the clinicopathological features of sarcomatoid hepatocellular carcinoma (SHC).Methods The clinical data of 42 patients with SHC who underwent surgical resection in the Peking University People's Hospital (n =33) and the Department of Pathology of the Peking University Health Science Center (n=9) from January 2008 to May 2017 were retrospectively analyzed.Results The average age was 58.3 (aged 32～84) years;the ratio of male to female was 2.2 ∶ 1;the average diameter of the lesions was 8.2 cm;the median AFP value was 45.2 ng/ml.The median survival time was 10.5 months,the average progression-free survival time was 2.9 months,and the 5-year survival rate was 25.0％.On histopathology,the tumor consisted of various degrees of different differentiated carcinomas with aligned sarcomatoid spindle cells.Immunohistochemical results in the sarcomatoid region expressed both mesenchymal markers and epithelial-derived markers.Conclusions SHC tumors were highly aggressive,with high rates of lymph node metastasis and poor prognosis.The diagnosis of SHC mainly depended on histopathology.Immunohistochemistry was very important for its diagnosis and differential diagnosis.Surgical resection was the treatment modality of choice to achieve prolonged survival time.

Prognostic value of △SUV and Deauville 5-point scoring in patients with diffuse large B-cell lymphoma / 中华核医学与分子影像杂志

Objective To investigate the prognostic value of △SUV and Deauville 5-point scoring (5-PS) in patients with DLBCL.Methods Thirty-nine patients (20 males,19 females;median 58 (23-85) years) with pathologically confirmed DLBCL were retrospectively analyzed from January 2009 to April 2015.PET/CT imaging was performed before and after 4 courses of chemotherapy.The optimum cutoff values of △SUVmax and its decline proportion (△SUVmax％) were calculated by ROC curve,and then the Kaplan-Meier analysis and Cox regression analysis were performed in patients with different △SUVmax and △SUVmax％.Patients were also evaluated by the observers using Deauville 5-PS,Kaplan-Meier analysis and Cox regression analysis were performed in patients with scores ≥ 4 and those with scores ＜ 4.x2 test and Spearman correlation analysis were used.Results (1) There were 10 patients (25.64％,10/39) with progressed disease within the 2 year-follow-up.The △SUVmax,△SUVmax％ of progressed group were markedly lower than those of non-progressed group:9.55± 11.90 vs 15.61±7.86,71.66％ (33.90％-78.91％) vs 87.83％(76.51％-92.43％);t=-2.37,z=-3.25,both P＜0.05.(2)The optimum cutoff values of the △SUVmax,△SUVmax％ were 11.2 and 72.88％ respectively.(3) The patients with △SUVmax ＜ 11.2,△SUVmax％ ＜72.88％ or Deauville 5-PS≥4 showed shorter PFS and △SUVmax％ was proved to be an independent prognostic factor(x2 =5.734,14.821,5.851,all P＜0.05).(4) △SUVmax％ and Deauville 5-PS were correlated (rs =-0.633,P＜0.001).Conclusions △SUV and Deauville 5-PS could be used for prognosis prediction in DLBCL patients and △SUVmax％ might be an independent predictive factor.The values of △SUVmax ％ and Deauville present a negative relationship.