Objective:To distinguish lung adenocarcinoma (ADC) from squamous cell carcinoma (SCC) using 18F-fluorodeoxyglucose (FDG) PET-based radiomic features. Methods:A retrospective analysis was performed in 182 patients (109 males, 73 females, age (59.0±8.3) years) with non-small cell lung cancer (NSCLC) who underwent 18F-FDG PET/CT scan between January 2018 and December 2019 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. All patients had been diagnosed pathologically with lung ADC or SCC. The patients were divided into a training set ( n=91) and a validation set ( n=91) using simple random sampling method. Radiomic features were extracted from the PET images of segmented tumors using the Python package. The minimum redundancy maximum relevance feature selection algorithm and least absolute shrinkage and selection operator were employed to select informative and non-redundant features, and a radiomics signature score (rad-score) was developed. Differences of rad-score between groups were compared by Mann-Whitney U test. Multivariate logistic regression was applied to select the important factors. A combined model was constructed based on the clinical variable and radiomics signature. The predictive performance of models was analyzed and compared using receiver operating characteristic (ROC) curves and Delong test. Results:Four radiomic features, namely HHL_first order_maximum, LHL_first order_entropy, HHH_ gray level dependence matrix_large dependence high gray level emphasis (GLDM_LDHGLE), HHL_GLDM_LDHGLE (H/L represent the high/low pass filter) were selected to build the rad-score. The rad-score showed a significant ability to discriminate between different histological subtypes in the two sets(training set: -1.30(-1.70, -1.04) vs -0.60 (-1.11, 0.20), z=-4.61, P<0.001); validation set: -1.31(-1.66, -0.96) vs -0.73(-1.02, -0.24), z=-4.76, P<0.001). The area under the curve (AUC) of the rad-score were equal to 0.815 (95% CI: 0.723-0.906) in the training set, and 0.813 (95% CI: 0.726-0.901) in the validation set, respectively, which were larger than those of the clinical variables (smoking had the best prediction performance, training set: 0.721 (95% CI: 0.617-0.810), validation set: 0.726 (95% CI: 0.623-0.814)), however, the difference was not significant ( z values: 1.319, 1.324, both P>0.05). When the clinical variable (smoking) and radiomics signature were combined, the complex model showed a better performance in the classification of histological subtypes, with the AUC increased to 0.862 (95% CI: 0.785-0.940; sensitivity: 88.00%(22/25), specificity: 72.73%(48/66)) in the training set and 0.854 (95% CI: 0.776-0.933; sensitivity: 75.00%(21/28), specificity: 84.13%(53/63)) in the validation set. The AUC values were significantly higher than those of the clinical variable (smoking; training set: z=3.257, P<0.001; validation set: z=3.872, P<0.001). Conclusion:Individualized diagnosis model incorporating with smoking and radiomics signature can help differentiate lung cancer subtypes in a non-invasive, repeatable modality.

Objective　To study clinical value of ultrasoni c diagnosis in the congenital ureterostenosis. Methods　33 cases of ureterostenosis were measured with B-ultrasonographic examination, the resu lt of B-ultrasonographic examination was compared with the diagnosis of X-ray and surgery. Results　The localization rate and accord rate of B -ultrasonographic examination in diagnosis of ureterostenosis(obstruction) were 93.3% and 81.8% respectively. Conclusion　B-ultrasonographic examination in diagnosis of congenital ureterostenosis possesses greater advanta ge and better clinical value.

Objective To evaluate the relationship between varicocele (VC) and the prostativenouplexuby coloDoppleflow imaging(CDFI) and to explore the etiology of varicocele .MethodThe innediameterand the hemorrheologiparameterof spermativein and prostativenouplexuwere observed in 135 patientwith lefvaricocele(lefVgroup) ,51 patientwith bilat-eral V(bilateral Vgroup) and the control group(100 cases) by CDFI .The diameteof the prostativenouplexus(PVD) ,peak velocity of reflux flow (RFV) in the Valsalvtesand the peak velocity of antegrade flow (AFV) aresin 3 groupwere statistical-ly analyzed .ResultPVD and RFV in the bilateral Vgroup were greatethan those in the lefVgroup and the control group (P＜0 .01) .PVD and RFV in the lefVgroup had no statistical differencecompared with the control group (P＞0 .05) .AFV had no statistical difference among 3 group(P>0 .05) .PVD ,RFV and AFV in 30 caseof Vhad no statistical differencebe-tween before and afteoperation (P>0 .05) .Conclusion Bilateral Vmay be accompanied with potential systematic vascular abnormalities.

Objective To evaluate the left ventricular systolic dyssynchrony in patients with left ventricular apical ballooning syndrome (LVABS) quantitatively by real-time three-dimensional echocardiography(RT-3DE) and its correlation with left ventricular ejection fraction(LVEF).Methods 7patients with LVABS were enrolled in this study.The images of left ventricle in full volume mode were obtained by RT-3DE in the different time (just after admission,4 weeks and 8 weeks).Post-processing software of 4D LV Volume Tom-Tec was used for calculation of EF and 16-segmental time-volume curves was obtained.The time to the point with minimal systolic volume(Tmsv) of each segment was calculated and by which the following indexes of systolic dyssynchrony were derived:Tmsv16-SD/Dif,Tmsv-basalSD/Dif,Tmsv-mid-SD/Dif and Tmsv-apical-SD/Dif.The correlation between systolic dyssynchrony index (SDI) and LVEF was analysed.Results ① The Tmsv16-SD/Dif,Tmsv-basal-SD/Dif,Tmsv-mid-SD/Dif and Tmsv apical-SD/Dif of left ventricle in the patients of 4 weeks and 8 weeks were smaller than those of the patients just after admission.There were significant differences among them(all P ＜0.05).②The more SDI increased,the more LVEF decreased,and vice versa.SDI was negatively associated with LVEF in the different time of admission (just after admission:r =-0.758; 4 weeks:r =-0.831 ; 8 weeks:r =-0.889;all P ＜0.05).Conclusions Left ventricular systolic dyssynchrony of severe degree is observed in patients with LVABS just after admission.But the condition of dyssynchrony has been improved gradually after 4 weeks and 8 weeks.SDI is negatively correlated with LVEF.

Objective To explore the clinical characteristics and surgical treatment of gastric cancer in elderly patients.Methods The clinical data of 431 patients older than 70 years with gastric cancer from 1984 to 1998 were analyzed retrospectively.Results The main clinical manifestations were upper abdominal pain,distension or upset,loss of appetite and weight.The patients with clinicalⅢ,Ⅳ stage accounted for 64.2 percent.Pathological findings showed no specificity.Radical gastrectomy was performed in 215 cases(49.9%),and palliative resection was done in 122 ones(28.3%).The operative mortality and postoperative complication rate were 5.1%and 25.5%in the patients respectively.The 5-year survival rate was 29.5%in the patients with surgery,53.2%with radical gastrectomy and 10.7%with palliative resection.There were significant differences in 5-year survival rate between the radical and palliative groups.Conclusions The majority of elderly patients are clinical Ⅲ,Ⅳ stages and their operative complication rate is high.The key to increase the survival rate and life quality of elderly patients with gastric cancer is early diagnoses,strong perioperative management and suitable radical surgery.

Objective To assess the left ventricular systolic function (LVSF) in patients with implanted dual-chamber(DDD) mode cardiac pacemakers using Two-dimensional Echocardiography (2DE),Real-time Tri-plane Echocardiography (RT-3PE)and Full-volume Three Dimensional Echocardiography (FV-3DE).Methods A total of 30 patients with DDD mode cardiac pacemaker were ex-amined by 2DE, RT-3PE and FV-3DE separately.Left ventricle end diastolic volume (LVEDV), left ventricle end systolic volume (LVESV), and ejection fraction (EF) were measured and compared within the three methods above .Results The measurement of EF with patients of post-operation was higher than the patients of pre-operation.The measurements of EF with 2DE were higher than RT-3PE.The measurements of LVEDV , LVESV and SV with 2DE and RT-3PE were lower than FV-3DE, and EF was higher .There were statistically significant differences in above measurements ( P <0.05 ) .But there were no statistically significant differences in measurements of LVEDV and LVESV between 2DE and RT-3DE ( P >0.05).Conclusions Implanting DDD mode cardiac pace-maker can evaluate LVSF of patients obviously .FV-3DE can evaluate LVSF in patients with DDD mode cardiac pacemaker accurately . The LVEDV, LVESV and SV are underestimated by 2DE and RT-3PE, and EF is overestimated by 2DE and RT-3PE.

Objective To explore ultrasonic image for the normal anatomy of the larynx,and provide the basis of ultrasonic diagnosis in laryngeal diseases.Methods Ultrasound anatomy for the larynx was established by way of comparing the structures of four corpses and ultrasonic imaging of the larynx of normal control group.Results Ultrasonic image for the normal anatomy of the larynx was established by comparing the anatomy tomography of corpses and ultrasonic imaging of the larynx of normal control group.Conclusions Ultrasonography could be applied in the examination of the laryngeal diseases as it could show unambiguous ultrasonic imagings of the larynx,and adding an important complementary technique to clinical medicine.

Methods: Preoperatively, all 160 patients with OVCFs underwent pressure-pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and imaging assessments. Pain intensity and pain-related disability were evaluated before and after PVP. Results: Preoperatively, patients with OVCFs had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy participants (p<0.05). Unlike patients with acute fractures, patients with subacute/chronic OVCFs showed higher TS with or without lower CPM in the pain-free area compared with healthy participants (p<0.05). Postoperatively, RBP occurred in 17 of 160 patients (10.6%). All preoperative covariates with significant differences between the RBP and non-RBP groups were subjected to multivariate logistic regression, showing that intravertebral vacuum cleft, posterior fascia edema, numeric rating pain scale scores for low back pain at rest, and TS were independently associated with RBP (p<0.05). Conclusions Augmented central pain processing may occur in patients with OVCFs, even in the subacute stage, and this preexisting CS may be associated with RBP. Preoperative assessment of TS in pain-free areas may provide additional information for identifying patients who may be at risk of RBP development, which may be beneficial for preventing this complication.

OBJECTIVETo identify whether there is significant changes between the cervical neutral F-waves and cervical flexion F-waves in the patients with Hirayama disease.

METHODSThis study was performed on 25 normal subjects and 22 male patients with identified Hirayama disease (age: 15 to 44 years; height: 165 to 183 cm; duration: 6 to 240 months) between May 2010 and March 2014. Both cervical flexion F-wave (cervical flexion 45 °, 30 minutes) and conventional F-waves to median nerve stimulation and to ulnar nerve stimulation were performed in all subjects bilaterally.

RESULTSwere analyzed by t-test or Fisher exact probability.

RESULTSIn the normal subjects, all measurements of the bilateral F-waves didn't have any difference between the cervical flexion position and the cervical neutral position. On the cervical neutral position, the persistence (t = 5.209, P = 0.000), average latencies (t = 4.731, P = 0.022) and minimal latencies (t = 23.843, P = 0.006) of ulnar F-wave on the symptomatic heavier side from the patients with identified Hirayama disease were significantly lower or longer than those from the normal subjects, and the repeat F-waves were found in 3 patients (13.6%). On the symptomatic lighter side, the ulnar F-waves only had lower persistence (t = 22.306, P = 0.001) along with 5 repeat F-waves. Only lower persistence were found in the median F-wave on the both side (higher side t = 23.696, P = 0.000; lighter side t = 23.998, P = 0.000), along with 5 (22.7%) repeat F-waves on the symptomatic heavier side and 6 (27.3%) ones on the symptomatic lighter side. After cervical flexion maintaining 30 minutes, the increased maximal amplitudes (t = -2.552, P = 0.019), average amplitudes (t = -3.322, P = 0.003), duration (t = -3.323, P = 0.00), persistence (t = -2.604, P = 0.017) and frequency of repeat F-waves (9/22, 41%) (P = 0.044) were found on the symptomatic heavier side of ulnar F-wave, and 5 of 10 absent ulnar F-wave on the cervical neutral position were also recover. The median F-wave on the symptomatic heavier side mainly had increased maximal amplitude (t = -3.847, P = 0.001), average amplitudes (t = -2.188, P = 0.040) and persistence (t = -2.421, P = 0.025), and 1 of 6 absent median F-wave on the cervical neutral position were also recover after cervical flexion.

CONCLUSIONThe cervical flexion F-waves have significant regular changes compared to the cervical neutral F-waves in patients with Hirayama diseases, especially maximal and average amplitudes of F-waves.

Adolescent ; Adult ; Humans ; Male ; Neck ; Range of Motion, Articular ; Spinal Muscular Atrophies of Childhood ; physiopathology ; Ulnar Nerve ; Young Adult

Objective　To establish Huashan diagnostic criteria and clinical classification system for Hirayama disease.Methods　Retrospective analysis 359 cases of puberty onset,upper extremity muscle atrophy as main clinical manifestations,and complete clinical data from September 2007 to August 2018.There were 348 males and 11 females(31.6:1 male and female)in this group.The average age of onset was 16.7±2.2 years,the average age of visits was 19.2±4.5 years,and the average duration of treatment was 29.3±45.4 months.Descriptive study of the clinical manifestations,radiologic and neurophysiological findings of this group of patients,the Huashan clinical diagnostic criteria of Hirayama disease were established by including 100% of the clinical manifestations,imaging and neurophysiological findings.According to the following parameters,the clinical classification system of Hirayama disease was proposed.The parameters specifically included:the muscle atrophy involves the upper limbs,whether the quadriplegia was active or hyperactive,the Babinski sign positive and other pyramidal tract damage,whether it was accompanied by sensory dysfunction such as upper limb numbness,muscle atrophy location,and the progress of clinical symptoms or electrophysiological examination within 6 months.Thirty patients were randomly selected from the above 359 cases.Four orthopedic surgeons who were not involved in the classification system completed the clinical classification within the specified time.The Kappa value was used for the credibility evaluation.Results　The Huashan diagnostic criteria of Hirayama disease included clinical manifestations,imaging examinations and neurophysiological examinations.The main diagnostic indicators were:1)occult onset puberty,more common in men;2)localized muscle atrophy and weakness in the upper extremities;3)compared with the cervical neutral MRI,the MRI of cervical flexion showed that spinal cord was significantly shift forward and the anterior spinal cord was narrowed or disappeared.4)MRI T2 weighting of the cervical flexion showed cyst-wall separation behind the spinal cord;5)Neurophysiological examination showed that the affected muscles were neurogenic damage.6)The affected parts are limited to the middle and lower neck segment.At the same time,it was necessary to combine imaging and neurophysiological manifestations to distinguish cervical spondylosis with upper limb muscle atrophy and motor neuron disease.According to the clinical characteristics of different patients,Hirayama disease can be divided into type I-III.Type I:72.1%,one-sided upper limb or one upper limb-based hand inner muscle and forearm muscle atrophy.According to whether progress of symptoms or electrophysiological examination was seen in the past 6 months,type I can be divided into:Ia.stable period.Regular follow-up assessment was recommended.If the disease progressed,to wear a cervical collar was suggested;surgery could be done if necessary;Ib.progression period,it was recommended to use a cervical collar,and regularly evaluate,if patients could not wear cervical collar for long,it was recommended to operate.Type II:14.2%,unilateral upper limb or one upper limb-based hand inner muscle and forearm muscle atrophy with pyramidal tract injury.Surgery was recommended.Type II:13.7%,atypical Hirayama disease,including upper limb proximal muscle atrophy,symmetrical double upper limb muscle atrophy,and sensory disturbances associated with upper limb numbness.Wear a cervical collar,and follow-up and assess closely,and choose surgical treatment if necessary.The credibility evaluation showed that the average Kappa value of the classification was 0.732(0.688-0.834),which is a basic credibility.Conclusion　The Huashan diagnostic criteria of Hirayama disease was conducive to the early diagnosis.The clinical classification system of Hirayama disease has good credibility and good clinical intervention guidance value.