Purpose To analyze the 18F-FDG PET/CT features of small intestinal malignant neoplasm, and to discuss the diagnosis value. Materials and Methods Forty-seven patients who were highly suspected with small intestinal tumors underwent 18F-FDG PET/CT whole body scan were retrospectively analyzed, the results of PET/CT examinations and the findings of biopsy and surgical pathology were compared. The maximum of intestinal wall thickness (IWTmax) and maximum of standardized uptake value (SUVmax) were calculated to analyze the relationship of them under different pathological conditions. Results Six out of the 47 small intestinal tumors were benign, the other 41 were malignant tumors among which 19 were malignant lymphoma and 17 were adenocarcinoma. The sensitivity, specificity, accuracy rate, positive predictive value and negative predictive value of 18F-FDG PET/CT in the diagnosis of small intestinal malignant neoplasm were 92.7%, 83.3%, 91.5%, 97.4% and 62.5%, respectively. Compared with those of benign tumors, the SUVmax and IWTmax of malignant intestinal tumors were significantly higher (t=5.596 and 2.376, P<0.05). The SUVmax in small bowel adenocarcinoma was significantly lower than that in malignant lymphoma (t=2.419, P<0.05);the IWTmax. between the two kinds of tumors showed no difference (t=0.369, P>0.05). The SUVmax and IWTmax of small intestinal malignant lymphoma had no correlation (r=0.293, P>0.05), whilst there was significant correlation between the IWTmax and SUVmax in small intestinal adenocarcinoma (r=0.542, P<0.05). Conclusion The SUVmax and IWTmax of malignant intestinal tumors are higher than those of benign intestinal tumors; 18F-FDG PET/CT imaging is rather reliable in differentiating small intestinal malignant tumors from benign ones. Intestinal malignant lymphoma shows a higher uptake of 18F-FDG than intestinal adencarcinoma, but the intestinal wall thickness of the two kinds shows no difference.

Although the interventional radiology, a rapidly expanding medical specialty, has already been widely popularized and generally accepted for many years, it is still facing lots of challenges and turf wars, such as the brain drain, understaffed and the gap between the old and the young. This article attempts to analyze the reasons through investigating the current teaching situation of interventional radiology in medical coUeges and finding out the undergraduates' attitude to interventional radiology, in order to explore possible paths for solving the imbalance between supply and demand of qualified personnel.

Although the interventional radiology, a rapidly expanding medical specialty, has already been widely popularized and generally accepted for many years, it is still facing lots of challenges and turf wars, such as the brain drain, understaffed and the gap between the old and the young.This article attempts to analyze the reasons through investigating the current teaching situation of interventional radiology in medical colleges and finding out the undergraduates' attitude to interventional radiology, in order to explore possible paths for solving the imbalance between supply and demand of qualified personnel.

Objective:To reveal the behavior characteristics of health delivery system(HDS) and the dynamical mechanism by which HDS promoting population health,so as to provide theoretical and methodological evidences for the decision-making of national macro health system.Methods: The macro model of HDS was constructed by using the theory of complex system and the method of system dynamics.Results: The principle of "high coverage and reasonable quality" was put forward as developmental strategy of national health service.The improvement of population health was taken as the system objective of HDS;meanwhile,HDS was community-centered and city-country integrative.The macro model of HDS was constructed based on the above objectives.Conclusion: Modeling based on system dynamics is effective to reveal the complexity of health delivery system.The HDS complex system model constructed in this article can be used to analyze and interpret the behavior characteristics of HDS and the dynamic mechanism by which HDS promoting population health.

Objective To evaluate the imaging characteristics of 18 F-FDG PET/CT in patients with Castleman's disease (CD).Methods Twelve patients (male 7,female 5,mean age:(51.2±19.3)years) with pathologically confirmed CD and 18F-FDG PET/CT were retrospectively enrolled.A lesion with SUVmax greater than that of normal liver tissue was defined as positive.Lesion size (short diameter) was measured.Correlation between size and SUVmax was analyzed by Pearson correlation analysis.SUVmax of different clinical and pathological types was compared using Mann-Whitney rank sum test.Results Among 12patients,7 patients had localized CD (LCD) involving a single group of lymph nodes and 5 patients had multicentric CD (MCD) involving more than one group of lymph nodes with some having lung and spleen infiltration.A total of 129 positive lesions were found (7 of LCD,122 of MCD) and the average SUVmax was 4.20±1.84 (range:2.50 to 10.70).There was no significant correlation between SUVmax and lesion size (r =0.189,P＞0.05).There was no significant difference in SUVmax between LCD and MCD (4.23±1.77 vs 4.19±1.86; Z=-0.108,P＞0.05) ; but there was significant difference in SUVmax between the patients with and without clinical manifestations (4.56±2.06 vs 3.41±0.87; Z=-2.443,P＜0.05).No significant difference was found between SUVmax of hyaline vascular CD and plasma cell CD (3.63±0.89 vs 4.26±1.91; Z=-0.519,P＞0.05).Conclusions CD shows primarily lymph node involvement with increased 18F-FDG uptake.However,the degree of FDG uptake does not correlate with clinical presentation or pathological types.

Objective To investigate the potential factors which have impact on the working space for surgeons in gasless laparoscopic cholecystectomy and to probe into the specifications of gasless surgeries.Methods Clinical data of 49 cases of gasless laparoscopic cholecystectomy between March 2007 and July 2010 were summarized.The impacts of body mass index,bowel preparation and means of anesthesia on operation time and conversion to laparotomy were analyzed.Results For patients with body mass index ≤25and ＞ 25,operation times were (43.0 ± 5.4) min,and (52.8 ± 7.4 ) min,respectively,and rates of conversion to laparotomy were 0/34 and 4/15,respectively.Both indices in the first group were higher.For patients with and without bowel preparation,operation times were (44.5 ± 5.4) min and (46.1 ± 8.0)min,respectively,and rates of conversion to laparotomy were 2/26 and 2/23,respectively.For patients with epidural anesthesia and lumbar/epidural anesthesia,operation times were (46.5 ± 7.9) min and (44.1 ±6.8) min,respectively,and rates of conversion to laparotomy were 2/24 and 2/25,respectively.Conclusions The operation time of gasless laparoscopic cholecystectomy could be affected by many factors,such as body mass index.Gasless operations can be improved by evaluating the conditions of patients correctly and by selecting suitable operation methods,anesthesia means and bowel preparation.

Objective To investigate the relationship between metabolic parameters of 18F-FDG PET-CT and cilinicopathological features of patients with lung squamous cell carcinoma. Methods The study comprised 118 patients with lung squamous cell carcinoma. All patients undergone 18F-FDG PET-CT before surgery. Maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) were measured, and total lesion glycolysis (TLG) was calculated. Relationship between metabolic parameters and clinicopathological factors was analyzed. Results SUVmax, MTV and TLG of 118 primary lesions were 11.93 (3.12-41.46), 27.71 cm3 (0.54-347.10 cm3) and 153.13 (1.65-2219.37), respectively. SUVmax was related to tumor differentiation degree and pleural invasion (χ2= 15.358, P= 0.000; Z= -2.875, P= 0.004); MTV was related to tumor differentiation degree, pleural invasion, vascular invasion and lymphatic metastasis (χ2= 13.341, P= 0.001; Z= -2.855, P= 0.004; Z= -2.683, P= 0.008; Z= -3.951, P= 0.000), TLG was also related to these clinicopathological factors (χ2= 15.609, P= 0.001;Z= -3.901, P= 0.002;Z= -2.311, P=0.021;Z= -3.721, P= 0.000). T stage and TNM stage had positive correlation with all metabolic parameters (r= 0.326, 0.794, 0.732;r= 0.358, 0.718, 0.668; all P< 0.05). And for N stage, SUVmax was no correlative (r=0.125, P=0.107), but MTV and TLG were positively correlative (r=0.399, 0.371, both P< 0.05). According the MTV or TLG and tumor size, patiens were divided into three groups: low-risk group, moderate-risk group and high-risk group. Significant differences were found among the three groups not even in MTV model, but also in TLG model (χ2= 20.800, P= 0.000; χ2= 20.069, P= 0.000). Conclusions Metabolic parameters of lung squamous cell carcinoma primary lesion have good correlation with clinicopathological factors, and can reflect partial characteristics of the tumor pathology in a certain extent. Furthermore, the probability of lymphatic metastasis could be predicted by MTV or TLG combined with tumor size.

Objective To explore effects of ephedrine on epinephrine (EPI) and estradiol( E2)concentration in blood, histological structures and activity of superoxide dismutase (SOD) and maleic dialdehyde (MDA) content in the ovary of female mice.Methods Pregnant female mice in the experimental group were treated with ephedrine (2g/L,4g/L, 6g/L), and the mice in the control group were treated with saline by intraperitoneal injection .Using ELISA method to detect concentration changes of EPI and E 2 in plasma, the changes in the enzymatic activity of SOD and MDA content were analyzed by colorimetry .The ovarian weight was measured , histological structures in ovary were observed by microscopy and the number of ovarian follicles were counted .Results EPI concentration in plasma of female mice increased , and the E2 concentration decreased dose-dependently in the experimental group .The activities of SOD were lower , and MDA content significantly increased compared to the control .The ovary weight of experimental groups was lower than the control group.The numbers of primary follicle , secondary follicle and atretic follicle increased and corpus luteum decreased in the experimental groups .There were pyknotic ovarian tissues , including oocyte ateophy , degradation granulose cells , and karyopyknotic granulose lutein cells in the experimental groups .Conclusion Ephedrine has a great effect on the ovarian histological structure and ovarian function of female mice , which may be correlated with the low activities of SOD .

Objective To investigate the predictive value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) calculated from 18F-FDG PET-CT results for postoperative recurrence and prognosis in patients with resectable pancreatic cancer. Methods From may 2009 to December 2015, 30 patients with pancreatic cancer who underwent curative resection after PET-CT examination were enrolled, and the clinic pathological data and 18F-FDG PET-CT data were retrospectively analyzed. The prognostic value of SUVmax, SUVmean, MTV, TLG and other prognosis factors were analyzed. Results In 30 patients with pancreatic cancer, preoperative 18F-FDG PET-CT detected all primary lesion (10 0%). 29 patients were recurrence or metastasis, and 26 patients were died with median of 17.8 months (2.6-39.6 months) follow-up. The median progression-free survival (PFS) time was 6.5 months and the median overall survival (OS) time was 11.6 months. The multivariate analysis revealed the histological differentiation and MTV were the independent influencing factors for PFS (both P<0.05). The lymph node metastasis, MTV and TLG were the independent influencing factors for OS (all P<0.05). Conclusion The MTV and TLG of PET-CT may be predicting the recurrence and survival of patients with pancreatic cancer after curative resection, suggesting that it can be used to guide the individual treatment.

Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG) PET/CT examination to predict the prognosis of patients after colorectal cancer operation.Methods The retrospective cross-sectional study was adopted.The clinicopathological data of 80 patients with colorectal cancer who were admitted to the First Hospital of Nanjing Medical University from March 2007 to October 2015 were collected.Eighty patients received first preoperative 18 F-FDG PET/CT examination and underwent operations under decisions of patients and their families,and then adjuvant chemotherapy were performed according to the patients' condition.Observation indicators included:(1) preoperative imaging examination,(2) situations of treatment and follow-up,(3) analysis of prognostic factors.The patients were followed up by outpatient examination and telephone interview once every 3 months within postoperative 1 year,once every half a year within postoperative 2 years and then once a year up to May 2016.The follow-up included tumor recurrence or progression and survival of patients.Tumor-free survival time was from postoperative day 1 to tumor recurrence or progression and death or end of follow-up.Overall survival time was from postoperative day 1 to death or end of follow-up.Measurement data with skewed distribution were represented as M (Qn) and M (range).The optimal cutoff point of tumor-free survival of maximum standardized uptake value (SUVmax),mean standardized uptake value (SUV),metabolism of volume (MTV) and total lesion of glycolysis (TLG) were investigated using the ROC curve analysis,and calculating area under the curve (AUC).The median was used as a cutoff point if there was smaller AUC.The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis,and COX proportional hazards model for multivariate analysis.Results (1) Results of preoperative imaging examination:results of PET/CT in patients with colorectal cancer showed there were circumscribed thickening of bowel wall,intestinal cavity strictures,fuzzy fat space around the some lesions,enlarged lymph node and 18 F-FDG uptake increased abnormally.The SUV SUV MTV and TLG of 80 patients were 11.83(4.26,35.42),7.06(2.38,20.92),20.47 cm3 (1.29 cm3,161.50 cm3) and 138.58 (14.17,857.89),respectively.ROC curve showed that the AUC of SUV SUV MTV and TLG were 0.453,0.448,0.815 and 0.749 [95％ confidence interval (CI):0.307-0.600,P ＞0.05;0.303-0.594,P ＞ 0.05;0.717-0.913,P ＜ 0.05;0.635-0.863,P ＜ 0.05],respectively.The median SUVmax (11.83) and SUV (7.06) were used as the cutoff points due to smaller AUC of SUVmax and SUV.The cutoff point of MTV was 18.79 cm3 (sensitivity =86.2％ and specificity =68.3％),and the cutoff point of TLG was 142.05 (sensitivity =75.9％ and specificity =70.7％).(2) Situations of treatment and follow-up:among 80 patients,13 underwent the radical resection of colorectal cancer and resection of liver metastasis and 67 underwent radical resection of colorectal cancer.Sixty-two patients received postoperative chemotherapy,including 45 with chemotherapy regimens of capecitabine and 17 with fluorouracil.Eighty patients were followed up for 41.8 months (range,6.5-109.1 months).During the follow-up,29 patients had tumor recurrence or progression,and 19 patients were dead.The median tumor-free survival time,1-,3-and 5-year tumor-free survival rates in 80 patients were 19.5 months (range,2.0-109.1 months),73.7％,36.3％ and 18.8％,respectively.The median overall survival time,1-,3-and 5-year overall survival rates were 31.8 months (range,3.3-109.1 months),76.3％,37.5％ and 20.0％,respectively.(3) Analysis of prognostic factors:results of univariate analysis showed that tumor location,N staging,M staging,clinical staging,postoperative chemotherapy,MTV and TLG were relative factors affecting postoperative tumor-free survival rate (HR =3.469,5.325,5.295,8.605,2.630,7.388,5.155,95％ CI:1.522-7.906,2.256-12.568,2.405-11.657,2.969-24.937,1.063-6.504,2.550-21.403,2.178-12.204,P ＜ 0.05).The tumor location,tumor differentiation,N staging,M staging,clinical staging,MTV and TLG were relative factors affecting postoperative overall survival rate (HR =2.697,2.814,3.083,2.916,4.193,5.450,4.876,95％ CI:1.011-7.197,1.121-7.062,1.166-8.149,1.140-7.454,1.386-12.678,1.581-18.786,1.727-13.766,P ＜ 0.05).In multivariate analysis,stage Ⅲ-Ⅳ of clinical staging and TLG≥ 142.05 were independent risk factors affecting postoperative tumor-free survival rate (HR =9.879,3.569,95％ CI:1.854-22.836,1.127-11.306,P＜0.05).The stage M1,stage Ⅲ-Ⅳ of clinical staging and TLG≥ 142.05 were independent risk factors affecting postoperative overall survival rate (HR =4.522,9.315,10.120,95％ CI:1.223-16.717,1.338-24.864,2.385-12.947,P＜0.05).Conclusion TLG through 18 F-FDG PET/CT examination is an independent prognostic factor affecting postoperative tumor-free survival rate and overall survival rate in patients with colorectal cancer after curative resection,and it has certainly reference value for prognosis.