Objective To evaluate the value of MR and CT examinations in the diagnosis of nasopharyngeal carcinoma (NPC) and compare 2008 staging system with 1992 staging system and 2002 UICC staging system for NPC. Methods MR and CT images of seventy-six cases with NPC were studied. According to 2008 staging system and taking MR as a standard, differences between these two examinations were evaluated under the new NPC staging system, and three staging system were compared by MR findings. Results MR was inconsistent with CT in eveluating invasion of medial pterygoid muscle(22,24 cases), lateral pterygoid muscle( 15, 11 cases), skull base(35, 32 cases) and intracranial fossa( 11,6 cases), but no statistical diffence existed ( P ＞ 0. 05 ). There were statistical difference ( P ＜ 0. 05 )between MR and CT in determining invasion of parapharyngeal space( 50, 61 cases), retropharyngeal lymph node metastasis(48, 23 cases), stage T1 (18, 11 cases), T2 (15, 22 cases), N0 (18, 24 cases) and N1(33, 27 cases) with differences of 11 cases, 25 cases, 7 cases, 7 cases, 6 cases and 6cases respectively.For invasion of parapharyngeal space, CT showed 11 cases more than MR while 5 cases were comfirmed as compression by local tumor and 6 cases were proved as retropharyngeal lymph node metastasis according to MR. For retropharyngeal lymph node metastasis, MR presented 25 cases more than CT. These two reasons above mainly caused the differences of T-staging and N-staging. For 2008 staging system, when compared with 1992 staging system, there were 9 cases upstaging and 1 case downstaging in T classification, 16 cases upstaging in N classification, and 15 cases upstaging and 1 case downstaging in clinical classification; and when compared with 2002 UICC staging system, there were 7 cases, 10 cases and 12 cases upstaging in T,N, and clinical staging respectively. Conclusions Compared with MR examination which was regarded as standard by 2008 staging system of NPC, there were some differences in demonstrating invasion of parapharyngeal space and retropharyngeal lymph node metastasis by CT. Compared to 1992 staging system and 2002 UICC staging system, 2008 staging system mainly made T and N classification of tumor upstage,resulting in upstaging in clinical classification.

The biologically active constituents in Gynostemma pentaphyllum are dammarane-type glycosides,called gypenosides.They are believed to be the highest contents of this herb,easy to obtain,and mainly active in anti-tumor,controlling the blood glucose,lipid-lowering,cardiovascular protection,etc.The saponins may change into sub-glucoside after hydrolysis,for the intemal acetal glucoside structure is vulnerable to acid,alkali,and enzyme degradation.Through searching the literatures in recent years,this paper summarized the chemical constituents in the hydrolyzed products of gypenosides,for providing references to discover novel and more active lead compounds.

Objective: To explore therapeutic effect of statins on patients with type 2 diabetes mellitus (T2DM) complicated atherosclerotic cardiovascular diseases.Methods: Clinical data of 103 T2DM patients with atherosclerotic cardiovascular diseases, who were treated in our hospital from Oct 2013 to Dec 2015, were retrospectively studied.According to usage of statins or not, patients were divided into routine treatment group (n=50,didn't use statins) and statin group (n=53,received statins based on routine treatment), both groups were treated for one year.Blood lipid levels before and after treatment, and incidence of cardio-and cerebrovascular events during treatment were measured and compared between two groups.Results: Compared with before treatment, after treatment, there were significant reductions in levels of triglyceride (TG), total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C), and significant rise in level of high density lipoprotein cholesterol (HDL-C) in statin group(P<0.01 all).Compared with routine treatment group after treatment, there were significant reductions in levels of TG [(2.13±0.37) mmol/L vs.(1.74±0.41) mmol/L], TC [(5.38±0.45) mmol/L vs.(4.34±0.73) mmol/L] and LDL-C [(3.63±0.72) mmol/L vs.(2.55±0.61) mmol/L], and significant rise in HDL-C level [(0.95±0.31)mmol/L vs.(1.34±0.35)mmol/L] in statin group, P<0.01 all.During one-year treatment, incidence rate of cardio-and cerebrovascular events in statin group was significantly lower than that of routine treatment group (18.18% vs.56.67%), P=0.002.Conclusion: Statins could effectively correct abnormal lipid metabolism and reduce risk of cardio-and cerebrovascular events in patients with type 2 diabetes mellitus complicated atherosclerosis cardiovascular diseases.

Objective To investigate the value of DWI before treatment on predicting sensitivity of concurrent chemoradiation in nasopharyngeal carcinoma.Methods Seventy patients with nasopharyngeal carcinoma proved by nasopharyngoscope and biopsy pathology conducted DWI before concurrent chemoradiation and reexamined on receiving dose of 50 Gy.The mean, maximum and minimum ADC value of tumor were measured on DWI and maximum area of tumor before and during treatment ( on dose of 50 Gy) was delineated to calculate the tumor regression rate ( RS0-50 ).The patients were classified into three groups according to the RS0-50 as sensitive, moderate, and resistant therapeutic effect.Patients were classified into different groups according to the pathologic type and clinical stage respectively .Spearman correlation analysis was used between RS 0-50 and ADC values of all tumors , different pathologic types and clinical stages , respectively.ROC was used to evaluate the cutoff and value of ADC which had highest correlation to RS0-50 on predicting therapeutic effect.Results DWI of 3 patients were excluded due to obvious swallow artifact which influenced the measurement , and finally 67 patients were included in this study, with pathological type of nonkeratinized differentiated undifferentiated carcinoma in 49 cases, nonkeratinized undifferentiated carcinoma in 18 cases, clinical T1 stage in 7 cases, T2 in 14 cases, T3 in 17 cases and T4 in 29 cases.During treatment , there were 13 cases with sensitive therapeutic effect , 42 cases with moderate therapeutic effect and 12 cases with resistant therapeutic effect.RS0-50 [ ( 65.6 ± 3.1) %] showed mildly and moderately negative correlation to mean ADC [(1.06 ±0.19) ×10 -3 mm2/s] and maximum ADC [(1.29 ±0.33) ×10 -3 mm2/s] respectively ( r =-0.276, P =0.024 and r =-0.434, P=0.001, respectively).ROC showed when setting threshold at maximum ADC value of lower than 1.06 ×10 -3 mm2/s for predicting sensitive therapeutic effect , the specificity , sensitivity , and accuracy was 69.2%(9/13), 88.9%(48/54) and 85.1% (57/67), respectively, and when setting threshold at maximum ADC value of higher than and equal to 1.30 ×10 -3 mm2/s for predicting resistant therapeutic effect, the specificity, sensitivity, and accuracy was 75.0% (9/12), 65.5% (36/55) and 67.2%(45/67), respectively.Conclusion Pretreatment maximum ADC value were able to predict the tumor regression rate and sensitivity of concurrent chemoradiation in nasopharyngeal carcinoma .

Objective To study the DCE-MRI findings of laryngeal and hypopharyngeal carcinoma.Methods 26 new patients di-agnosed laryngeal and hypopharyngeal cancer by pathology were collected and took DCE-MRI before therapy.The TIC type,ADC value,peak time (Tpeak),peak signal enhancement percentage (SERmax),positive enhancement integral(PEI),maximum slope of increase(MSI)and maximum slope of decrease(MSD)were obtained respectively.These semi-quantitative parameters of primary cancer,normal pharyngeal tissue and the same layer neck muscles were compared and P <0.05 was considered statistical signifi-cance.Results The TIC types for primary tumor including type Ⅰ(5),type Ⅱ(6),type Ⅲ(1 5),a significant difference of Tpeak、MSI、MSD were observed(P < 0.05 )no difference in ADC values (P > 0.05 )was found.Different b values (b = 300 s/mm2 , 500 s/mm2 )for ADC values were significantly different.There was statistical significance in semi-parameters among the primary cancer,normal pharyngeal wall tissue and the same layer neck muscles.Setting MSI value 58.32 threshold to distinguish abnormal and normal tissues,sensitivity and specificity both were 84.6%.Conclusion DCE-MRI can reflect morphology and signal differences among neck muscles,normal and abnormal laryngeal and hypopharyngeal tissues,providing help for diagnosis of primary carcino-ma.

Objectives To evaluate the value of computed tomography (CT) features of non-thyroidal masses of the neck (NTMN).MethodsThe clinical data of 264 patients with NTMN proved by histology from 2005 to 2010 in our hospital were collected retrospectively.Among them,benign lesions were found in 159 patients (60.2％ ),malignant ones in 105 patients (39.8％ ),and in lymphadenopathy in 111 patients (42.0％ ),non-lymphadenopathy in 153 patients (58.0％).The CT features including lowdensity areas,low-density areas of enhancement ratio,the edge of lesion,lesion morphology and the clinical baselines including the sex,single or multiple lesions,lymphadenopathy or non lymphadenopathy were compared for appreciating the sensitivity and specificity of the diagnosis.Categorical variables were tested with the x2 or Fisher exact tests.Results Independently using each of those four radiological signs ( CT value of low density area,the enhancement ratio of low density area,border and morphology of lesion)and three clinical indexes (sex,single or multiple,lymphadenopathy or non lymphadenopathy) to diagnose the malignant tumors,the sensitivity and specificity were 77.1％ ( 81/105 ),81.9％ ( 86/105 ),71.4％(75/105),56.2％ ( 59/105 ),64.8％ ( 68/105 ),75.2％ ( 79/105 ),82.9％ ( 87/105 ) and 50.9％(81/159),44.7％ ( 71/159 ),73.0％ ( 116/159 ),67.3％ ( 107/159 ),51.6％ ( 82/159 ),73.0％(116/159),84.9％ (135/159) respectively.When four or more signs were showed,the sensitivity and specificity were 86.7％ (91/105) and 74.8％ (119/159) respectively.The special CT features were included mottled high density sign in schwannoma ( P =0.000,25/41 )and regular calcification in hemangioma(P =0.000,7/18 ).Carotid body tumor was often occurred at carotid artery (P =0.000,23/24),and the most of mass of paravertebral was neurogenic tumor(P =0.001,9/50).ConclusionsThe diagnosis of NTMN can be improved by combining CT features and clinical baseline.

Objective To analyze and summarize the CT features of medullary thyroid carcinoma (MTC).Methods 30 patients with MTC proved by surgery and pathology were scanned by CT.And the CT manifestations were analyzed retrospectively.Results In a total of 30 patients,a single lesion in 25 (83.3%)patients and multiple ones in 5 (16.7%)were found with irregular shape in 27 (90.0%),unclear border in 26 (86.7%),heterogenous enhancement with irregular internal hypodensity in 27 (90.0%),cal-cifications in 4 (13.3%)and invasion of trachea in 4 (13.3%).As for the 29 patients underwent the neck surgery ,26 (89.7%) were pathologically confirmed with lymph nodes metastasis.CT showed the metastatic lymph nodes with well-defined border in 1 2 (46.2%)and ill-defined one in 14 (53.8%),calcifications in 5 (19.2%)and heterogenous enhancement with irregular internal hy-podensity in all (100.0%).Conclusion CT features of MTC and metastatic lymph nodes appeared as heterogenous enhancement with irregular internal low attenuation area,which can improve the accuracy of preoperative diagnosis.

Objective To predict the response of induction chemotherapy in advanced nasopharyngeal carcinoma (NPC)by using pretreat-ment apparent diffusion coefficient (ADC)values.Methods 35 patients with advanced NPC underwent DWI examination prior to 2-week in-duction chemotherapy.The patients were divided into CR (complete response)group,PR (partial response)one and SD (stable disease)one according to the tumor response of treatment.The effective responders included CR and PR groups.The patients were divided into children-adolescents(below 20 years)group and adults one according to the age,into non-keratinizing undifferentiated carcinoma group and non-kera-tinizing differentiated carcinoma one according to the pathological type,and also into T2,T3 and T4 groups according to the T-staging (UICC2010).Statistical analysis was used to compare the pretreatment ADC values between different groups.Results The average pre-treatment ADC values of CR,PR,responders and SD groups were (0.70±0.06)×10 -3 mm2/s,(0.72±0.04)×10 -3 mm2/s,(0.71± 0.04)×10 -3 mm2/s and (0.85±0.02)×10 -3 mm2/s respectively.The average pretreatment ADC value of the SD group was signif-icantly higher than that of PR group and responders,and the differences were significant (P <0.05).The average pretreatment ADC value of children-adolescents and adults groups were (0.73±0.07)×10 -3 mm2/s and (0.75 ±0.07)× 10 -3 mm2/s,which showed no significant differences.The average pretreatment ADC value of non-keratinizing undifferentiated carcinoma and non-keratinizing dif-ferentiated carcinoma groups were (0.76 ±0.08)×10 -3 mm2/s and (0.74±0.06)×10 -3 mm2/s,which showed no significant differ-ences.The average pretreatment ADC values of T2,T3 and T4 groups were (0.78±0.05)×10 -3 mm2/s,(0.77 ±0.07)×10 -3 mm2/s and (0.75±0.08)×10 -3 mm2/s.Although there were no significant differences between T2,T3 and T4 groups,a trend towards lower ADC was observed with increasing tumor T-staging.Conclusion Pretreatment ADC value is a valuable quantitative parameter,and it can be used for predicting induction chemotherapy response in advanced naso-pharyngeal carcinoma.

Objective To evaluate the discrepancy of parameters generated on dual-energy spectral CT (DECT)imaging in the different pathological grade of laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC),and to provide helpful information of the prognosis and the guide of clinical treatment.Methods 61 patients with pathologically confirmed LHSCC who underwent contrastenhanced DECT before therapy were retrospectively analyzed.The enhanced monochromatic data were analyzed with workstation.Iodine concentration of lesion (IC),water concentration of lesion (WC)and slope of spectral HU curve (s-SHC)were acquired.According to cell differentiation,all patients were divided into well,moderately and poorly differentiated groups.The difference of IC,WC,s-SHC,constituent ratio of T stage were compared among different groups.Results The IC and s-SHC had significant difference among well,moderately and poorly differentiated groups(F =3.56,3.96 respectively,P <0.05).The two-two paired comparisons demonstrated that there were significant difference of IC between poorly and well differentiated group(P <0.05).The others two-two paired comparisons demonstrated no significant difference (P>0.05).There were no significant difference of WC among three groups respectively (H =0.84,P >0.05).χ2 test showed that there was no significant difference for the constituent ratio of T stage among three groups (P >0.05).Conclusion IC and s-SHC can help to judge the pathological grade of LHSCC,and they may be useful to evaluate the prognosis of LHSCC.

Objective To summarize the CT features of anaplastic thyroid carcinoma (ATC).Methods CT manifestations of 12 patients with ATC confirmed by surgery or biopsy were analyzed retrospectively.Results 1 1 (91.7%)patients had single lesion. The lesions appeared as low attenuation mass with cord-like,flocculent or patchy high attenuation areas.The lesions had mild to moderate enhancement in 1 1 cases (91.7%).Coarse calcifications were detected in 8 cases (66.7%),4 of them were incomplete rim or eggshell.11 cases (91.7%)showed invasion into adjacent structures,including trachea (6 cases,50%),esophagus (4 cases,33.3%),strap muscles (7 cases,58.3%),larynx (2 cases,1 6.7%),blood vessels (6 cases,50%).5 cases (41.7%)had tumor thrombus in the internal jugular vein.10 cases (83.3%)had lymph nodes metastasis.The enhancements of lymph nodes were divided into 3 types:mild homogeneous enhancement (4 cases,40%),mild enhancement with internal low-attenuation areas (7 cases,70%)and ring-like enhancement without internal enhancement (7 cases,70%).Conclusion CT features of ATC include low-density mass with cords,flocculent and patchy high-density areas,coarse calcification and mild to moderate enhancement,invasion to adjacent structure and lymph node metastasis with necrosis are common.