PurposeSmart neuro attenuation correlation (SNAC) is a new method of calculated attention correction. This paper aims to evaluate the impact of SNAC on the quality and standardized uptake value of brain imaging with PET/CT.Materials and Methods Fifty-eight patients who underwent systematic scan with18F-FDG PET/CT were analyzed retrospectively. CT attenuation correlation (CTAC) and SNAC brain PET images were reconstructed respectively. All images were analyzed by visual assessment and Scenium software and the results of the two methods were compared with regard to image contrast, homogeneity and mean SUV at different cerebral regions. Moreover, the correlation of the mean SUV of the two methods was further analyzed.Results There was no significant visual difference of contrast and uniformity between SNAC and CTAC. The Scenium analysis shows that the contrast of SNAC images were slightly higher than that of CTAC, but the difference were not statistically significant (4.19±1.11vs. 4.08±1.03,t=0.764,P>0.05). The uniformity of SNAC images were slightly lower than that of CTAC (1.00vs. 0.83). The mean SUV at various brain regions measured by SNAC was greater than that by CTAC, but both were significantly correlated (r=0.978,P<0.01), and the linear regression analysis also demonstrated that the results were consistent (R2=0.959). Compared with that measured by CTAC, the average percentage difference of SUV measured by SNAC was 8.45±4.71, but it varied greatly at 10 brain regions (-8.56-27.93). The analysis of variance presented significant differences in the average percentage difference of SUV at different brain regions (F=119.084,P<0.01), while the average percentage difference at the outer slices was greater than that at the central slices. Conclusion No significant difference exists in image quality between SNAC and CTAC. Although the mean SUV at different brain regions measured by SNAC may increase by various degrees, it is significantly associated with the results measured by CTAC. Moreover, SNAC simplifies the process of examination and reduces radiation dose, which is beneficial to patients as a qualitative method.

ObjectiveTo explore the clinical manifestations of infant cytomegalovirus infection in different age. MethodThe clinical data of 237 infants who suffered from cytomegalovirus infection was analyzed retrospectively and divided into three groups: 0-3 months old (77 cases,group A) ,4-6 months old ( 65 cases , group B ) , 7-12 months old ( 95 cases , group C ). ResultsThe incidence of respiratory infection was the highest among all infectious organs in three groups, the numbers of patients who had wheeze in group A was less than that in the other two groups[24.7％(19/77) vs. 61.5％ (40/65), 61.1％( 58/95 )](P ＜ 0.01 ).The incidence of jaundice decreased gradually as the babies grew up[23.4％( 18/77 )→7.7％(5/65 )→1.1％( 1/95 )](P ＜ 0.05). There was no significant difference in diarrhoea and bleeding among three groups (P＞0.05 ). The proportion of alanine aminotransferase], aspartate amino transferase increasing was similar among three groups, but gamma-glutamyl transferase (GGT) was different, the proportion of GGT increasing was 77.9％ (60/77) in group A which was higher than that in the other two groups[10.8％ ( 7/65 ), 2.1％ ( 2/95 )].Granulocytopenia in group B was obviously decreased compared with the other two groups (P ＜ 0.05 ), anemia was easily occurred in group C (P ＜ 0.05 ). ConclusionThe injury of cytomegalovirus infection may be related to month old.

Objective To investigate the characteristics of 18F-FDG PET/CT imaging in Takayasu arteritis (TA) and its clinical value.Methods Five male patients with TA in active phase (age range:65-82 years;mean age:(72.8±6.6) years) from November 2011 to August 2014 were retrospectively analyzed.All patients underwent 18F-FDG PET/CT imaging,and one of them who was in stable phase after one year's treatment underwent follow-up PET/CT imaging.The characteristics of the abnormal 18F-FDG uptake and SUVmax of lesions were analyzed.Another 5 age-and gender-matched patients with slightly elevated tumor markers and normal results of 18F-FDG PET/CT imaging in the same period were selected as the control group.Arteries were divided into 18 segments,including the ascending aorta,the aortic arch,the descending aorta,the abdominal aorta,the brachiocephalic trunk,the left/right common carotid,the left/right subclavian,the left/right brachial,the superior mesenteric,the left/right common iliac,the left/right renal,and the left/right femoral,and their SUVmax were measured respectively.Paired t test was used to analyze the difference of SUVmax between TA group and the control group.Results (1) 18 F-FDG PET/CT imaging displayed diffused increase of radioactivity in the wall of aorta and its major branches in TA group,and CT showed multiple irregular thickening,punctate and banding calcification in arterial walls of those patients.The ascending aorta,the aortic arch,the descending aorta,the abdominal aorta,the brachiocephalic trunk,the left/right subclavian,the left/right common carotid,and the left/right common iliac artery were all involved in 5 patients;the left/right brachial and the left/right femoral artery were involved in 4 patients and the superior mesenteric artery was involved in 2 cases.The SUVmax range was 1.4-7.6,the highest SUVmax was in the left subclavian artery (n=2),the right subclavian artery (n=1) and the abdominal aorta artery (n=2).(2)The SUVmax of TA group and the control group were 3.96±1.35 and 2.13±0.53,respectively(t=10.40,P＜0.001).(3) As to the TA patient in stable phase after treatment,the FDG uptake of the wall of aorta and its major branches decreased obviously compared with that before treatment.The SUVmax of left subclavian artery decreased from 6.8 to 3.2.Conclusions 18F-FDG PET/CT is helpful in diagnosis of TA.It could accurately display the range of involved arteries,reflect the activity of the lesion and evaluate the therapeutic response.

Purpose To analyze the PET image of normal human brain by using Scenium software, so as to ifnd out the change of cerebral glucose metabolism with different age and gender. Materials and Methods Brain PET imaging data of 493 healthy males and 273 healthy females were collected in the study. The subjects were divided into 6 groups according to age:21-30 years group,31-40 years group, 41-50 years group, 51-60 years group, 61-70 years group and 71-82 years group. Each group was further subdivided according to gender. The brain areas were automatically outlined by Scenium and the mean standard uptake value (SUV) of each brain area was calculated and compared among groups. Results Most cerebral glucose metabolism of males at different age was significantly different (F=2.580-5.316, P<0.05), except temporal lobe in right side and cerebellum showed no difference (F=1.611-1.935, P>0.05); whilst difference in cerebral glucose metabolism of females at different age was not signiifcant (F=0.721-1.706, P>0.05). In male groups, cerebral glucose metabolism got peak at 31-40 years, and decreased signiifcantly at 51-60 years mainly involving areas like cinglulate gyrus, calcarine and surrounding cortex;and the groups after 61 years showed no signiifcant decrease. In female groups, cerebral glucose metabolism got peak at 31-40 years and showed no significant decrease along with age. Conclusion Cerebral glucose metabolism decreases unevenly after 40 years old. It drops significantly in males at 51-60 years whilst that in females is not obvious.

Objective:To investigate the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters for occult lymph node metastasis (OLM) in non-small cell lung cancer (NSCLC). Methods:A total of 183 patients (72 males, 111 females; age (61.5±8.4) years) who underwent 18F-FDG PET/CT and preoperatively diagnosed with clinical N0 stage (cN0) in Third Affiliated Hospital of Soochow University from January 2013 to December 2018 were retrospectively enrolled. All patients underwent anatomical pulmonary resection with systematic lymph node dissections within 3 weeks after 18F-FDG PET/CT examinations. According to the presence or absence of lymph node metastasis, patients were divided into OLM positive (OLM+ ) group and OLM negative (OLM-) group. Parameters of primary lesions, such as the maximum diameter (D max), tumor sites, morphological features, maximum standardized uptake value (SUV max), mean standardized uptake value (SUV mean), metabolic total volume (MTV), total lesion glycolysis (TLG), tumor SUV max to liver SUV mean (TLR max), tumor TLG to liver SUV mean (TLR TLG) were analyzed. Mann-Whitney U test and χ2 test were used to compare the parameters between groups. Multivariable logistic regression was used to analyze the independent risk factors for OLM. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of different parameters. Results:Among 183 patients, 25 (13.7%, 25/183) of them were diagnosed as OLM. In OLM+ group, 46 lymph nodes were pathologically positive for metastasis, including 15 N1 disease and 31 N2 disease. D max (2.9(2.3, 3.7) vs 2.3(1.7, 2.8) cm), lobulation ((76.0%(19/25) vs 37.3%(59/158)), SUV max (11.1(7.9, 17.7) vs 4.7(2.3, 9.2)), TLG (41.5(10.2, 91.1) vs 15.6(6.5, 23.8) ml), TLR max (4.7(3.5, 7.6) vs 2.1(0.9, 4.0)) and TLR TLG (18.1(5.0, 44.3) vs 6.1(3.0, 11.4) ml) of the primary lesions in OLM+ group were significantly higher than those in OLM-group ( z values: from -4.709 to -3.247, χ2=13.190, all P<0.05). Multivariable logistic regression analysis showed that TLR max (odds ratio ( OR)=15.145, 95% CI: 3.381-67.830, P<0.001) and D max ( OR=3.220, 95% CI: 1.192-8.701, P=0.021) were independent risk factors for OLM. TLR max yielded the highest area under curve (AUC; AUC=0.794) with the threshold of 3.12, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for predicting OLM were 92.0%(23/25), 63.3%(100/158), 67.2%(123/183), 28.4%(23/81) and 98.0%(100/102), respectively. Conclusions:TLR max of tumor is the independent risk factor for OLM in NSCLC patients. TLR max can sensitively predict OLM preoperatively in patients with NSCLC.

Objective To explore the influencing factors for postoperative adjuvant chemotherapy effects in elderly patients with breast cancer. Methods Five hundred and ninety female patients aged 65 years or older with invasive breast cancer were treated in our hospital, and the influencing factors for postoperative adjuvant chemotherapy effects were analyzed by chi-square test and logistic regression. Results Two hundred and thirty-one (39.2%) patients received postoperative adjuvant chemotherapy. The results showed that diabetes, age, patterns of operation and pathological characteristics of tumor had significant influences on postoperative adjuvant chemotherapy effects (χ2=4.49,88. 27,23.49 and 9.40, all P<0.05). Logistic regression analysis showed that age, tumor size, lymph node status(pN) and estrogen receptor (ER) status were related to postoperative adjuvant chemotherapy effects(χ2=68.857,15. 284,43. 540 and 7.009 ,all P<0.01). Forty-four patients (66.7%) with pN(+)/ER(-) received adjuvant chemotherapy. Conclusions Age, tumor size, lymph node status and ER status were independent predictive factors for postoperative adjuvant chemotherapy effects in elderly patients with breast cancer.

Objective: To explore the reliability and validity of the Chinese Pediatric Quality of Life Inventory（PedsQL）in influenza children. Methods: From January 2017 to February 2018,we selected laboratory-diagnosed influenza cases and healthy children according to age and gender ratio by stratified random sampling and systematic sampling method. We employed Chinese version of PedsQL 4.0 to investigate their quality of life,used Cronbach's α to evaluate the reliability,and used Pearson correlation coefficient, t-test,confirmatory factor analysis（CFA）and ROC curve to evaluate the validity. Results: Totally 300 influenza cases and 300 healthy children were surveyed,with 294（98.00%）and 295（98.33%）valid questionnaires recovered. The general Cronbach's α was 0.89,and the Cronbach's α of each dimension ranged from 0.79 to 0.84. The Pearson correlation coefficients between the items and their belonged dimension ranged from 0.537 to 0.755,between the items and other dimension ranged from 0.203 to 0.384. The CFA resulted in RMSEA of 0.06,GFI of 0.88,AGFI of 0.90,CFI of 0.91 and NFI of 0.89. The scores in total and in all the dimensions in influenza cases were significantly different with those in healthy children（P<0.05）. Taking the scores in influenza cases as a golden standard,the area under the ROC curve was 0. 985（P<0.05）,the sensitivity was 0.92,and the specificity was 0.95. When the limit score was 82.18,the Youden index was the largest. Conclusion The Chinese version of PedsQL4.0 has good reliability and validity, which can be applied to quality of life assessment in children.

Objective:To evaluate the safety and immune effect of recombinant hepatitis B vaccine （CpG ODN adjuvant).Methods:On Oct. 26, 2016, we launched volunteer recruitment in Kaihua county, Quzhou city, Zhejiang Province. In the randomized, double-blind, controlled trial, a total of 48 subjects with negative HBV screening tests and normal hepatorenal function among 18 and 60 years old were selected and divided into two groups randomly, 24 cases each. The experimental group was given 250 μg of CpG ODN recombinant （Hansenula polymorpha) Hepatitis B vaccine and the control group was given 10 μg of commercial Hepatitis B vaccine with timed at 0, 1and 6 months. The inoculation reactions were compared the difference between the two groups after observed and recorded in time periods. We also collected serum before and after immunization to compare the two groups of anti-HBs positive rate, geometric mean concentration（GMC).Results:During the study period, the incidence of adverse events was 66.67%（16/24) in the experimental group and 54.17%（13/24) in the control group, with no significant difference（ P=0.556). The severities of adverse events were level 1 or level 2, and no level 3 or above adverse reactions occurred. After full-course immunization, in the FAS data set, the anti-HBs GMC in the experimental group [2 598.56（1 127.90-5 986.90) mIU/ml] was higher than that in the control group[371.97（164.54-840.91) mIU/ml] In the PPS set, the GMC of test group was 7 808.21（3 377.00-18 052.00) mIU/ml, which was higher than that of the control group [843.22（213.80-3 325.90) mIU/ml]. The anti-HBs positive rate of FAS（PPS) was 95.83%（100.00%) in the experimental group and the control group; The anti-HBs strongly positive rate of FAS（PPS) was 79.17%（90.00%) in the experimental group and 33.33%（50.00%) in the control group, with statistically significant differences among the FAS set（ P=0.003) and no statistically significance differences among the PPS set（ P=0.074). Conclusion:CpG Hepatitis B Vaccine is safe and shows better immunogenicity than the control vaccine.

Objective:To evaluate the safety and immune effect of recombinant hepatitis B vaccine （CpG ODN adjuvant).Methods:On Oct. 26, 2016, we launched volunteer recruitment in Kaihua county, Quzhou city, Zhejiang Province. In the randomized, double-blind, controlled trial, a total of 48 subjects with negative HBV screening tests and normal hepatorenal function among 18 and 60 years old were selected and divided into two groups randomly, 24 cases each. The experimental group was given 250 μg of CpG ODN recombinant （Hansenula polymorpha) Hepatitis B vaccine and the control group was given 10 μg of commercial Hepatitis B vaccine with timed at 0, 1and 6 months. The inoculation reactions were compared the difference between the two groups after observed and recorded in time periods. We also collected serum before and after immunization to compare the two groups of anti-HBs positive rate, geometric mean concentration（GMC).Results:During the study period, the incidence of adverse events was 66.67%（16/24) in the experimental group and 54.17%（13/24) in the control group, with no significant difference（ P=0.556). The severities of adverse events were level 1 or level 2, and no level 3 or above adverse reactions occurred. After full-course immunization, in the FAS data set, the anti-HBs GMC in the experimental group [2 598.56（1 127.90-5 986.90) mIU/ml] was higher than that in the control group[371.97（164.54-840.91) mIU/ml] In the PPS set, the GMC of test group was 7 808.21（3 377.00-18 052.00) mIU/ml, which was higher than that of the control group [843.22（213.80-3 325.90) mIU/ml]. The anti-HBs positive rate of FAS（PPS) was 95.83%（100.00%) in the experimental group and the control group; The anti-HBs strongly positive rate of FAS（PPS) was 79.17%（90.00%) in the experimental group and 33.33%（50.00%) in the control group, with statistically significant differences among the FAS set（ P=0.003) and no statistically significance differences among the PPS set（ P=0.074). Conclusion:CpG Hepatitis B Vaccine is safe and shows better immunogenicity than the control vaccine.

Objective:To investigate the correlation between the SUV index (SUV max of the lesion/SUV mean of the liver) in 18F-FDG PET/CT imaging and the invasiveness of early lung adenocarcinoma presenting as ground-glass nodule (GGN). Methods:From January 2012 to March 2020, 167 GGN patients (49 males, 118 females; age: (61.5±9.0) years) with early lung adenocarcinoma who underwent PET/CT imaging in Changzhou First People′s Hospital were retrospectively enrolled. The image parameters including the GGN number, location, type, edge, shape, abnormal bronchus sign, vacuole sign, pleural depression, vessel convergence sign, GGN diameter ( DGGN), solid component diameter ( Dsolid), consolidation to tumor ratio (CTR, Dsolid/ DGGN), CT values (CT value of ground-glass opacity (CT GGO), CT value of lung parenchyma (CT LP), ΔCT GGO-LP (CT GGO-CT LP)) and SUV index were analyzed. Single and multivariate logistic regressions were used to analyze the correlation between SUV index and infiltration. The generalized additive model was used for curve fitting, and the piece-wise regression model was used to further explain the nonlinearity. Results:In 189 GGNs, invasive adenocarcinoma accounted for 85.2% (161/189). Single logistic regression showed that the GGN number, type, shape, edge, abnormal bronchus sign, pleural depression, vessel convergence sign, DGGN, Dsolid, CTR, CT GGO, ΔCT GGO-LP and SUV index were related factors of infiltration (odds ratio ( OR) values: 0.396-224.083, P<0.001 or P<0.05). After fully adjusting for confounding factors, SUV index was significantly correlated with increased risk of invasion ( OR=2.162 (95% CI: 1.191-3.923), P=0.011). Curve fitting showed that the SUV index was non-linearly related to the risk of infiltration, and the risk of infiltration increased significantly only when the SUV index was greater than 0.43 ( OR=3.509 (95% CI: 1.429-8.620), P=0.006). The correlation between SUV index and infiltration had no interaction between age, vacuoles, pleural depression and CTR subgroups (all P>0.05). Conclusions:SUV index is an independent factor related to the invasiveness of early lung adenocarcinoma. The higher the SUV index, the greater the risk of invasion; but the two are not simply linearly correlated.