pneumonia is an opportunistic infection among immunocompromised people. Studies have found that the increased resistance to sulfa drugs ofmay be associated with the mutation of dihydropteroate synthase () gene and dihydrofolate reductase () genes, but the mechanism is still unclear. The mutation ofandgenes may be the result of sulfa drugs selection or spontaneous genetic polymorphism, and it can be acquired from person-to-person transmission. This article reviews the cause, molecular epidemiology ofandgene mutation, and the relationship betweenandgene mutation and clinical outcomes.

OBJECTIVETo compare the diagnostic value of double-balloon endoscopy (DBE) and multi-detector row computed tomography (MDCT) for small intestinal tumors.

METHODSThe clinical data of 88 patients with small intestinal tumor who underwent DBE and MDCT examinations during January 2010 and December 2016 was retrospectively analyzed. The diagnostic value of DBE and MDCT for small intestinal tumor was compared.

RESULTSThe positive rate of small intestinal tumors by DBE (92.0%, 81/88) was significantly higher than that of MDCT (75.0%, 66/88,<0.01). The positive rates for malignant small intestinal tumors by DBE and MDCT were the same (91.1%), but the rate of histological qualitation was higher in DBE than that in MDCT (94.1% vs 76.5%,=6.331,<0.05); the positive rates for benign tumors or the tumors <3 cm in diameter by DBE were significantly higher than those by MDCT (96.8% vs 48.4%, 88.2% vs 47.1%, respectively,=18.235 and 13.170, both<0.01); also DBE had a higher positive rate for small intestinal tumor presenting gastrointestinal bleeding (97.2% vs 77.8%,=6.222,<0.05).

CONCLUSIONSThe diagnostic value of small intestinal tumor by DBE is significantly higher than that of MDCT. The combination of two methods may improve the diagnostic accuracy for small intestinal tumor.

OBJECTIVETo assess the value of ultrasonography in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thickening type of gallbladder cancer (GBC).

METHODSThe clinical features and sonographic finding of 31 patients with XGC and 36 patients with wall-thickening type of GBC were retrospectively reviewed. The diagnosis of all cases was confirmed by pathological examination, and the ultrasonographic manifestations of the thickening of the gallbladder wall, intramural hypoechoic nodules, gallbladder mucosa line, gallbladder stones, biliary dilatation and gallbladder-liver boundary were compared between two groups.

RESULTSThere were significant differences in the intramural hypoechoic nodules, the continuous gallbladder wall mucosal line and dilatation of bile duct between XGC and GBC groups (all<0.05), while no statistically significant differences in the other sonographic features(all>0.05). In the six positive sonographic features of the XGC patients, the intramural hypoechoic nodules and the continuous mucosa line of the gallbladder wall had highest accuracy in the diagnosis of XGC(64.2% and 65.7%).

CONCLUSIONSIntramural hypoechoic nodule and the continuous mucosal line are characteristic sonographic features of XGC, which can be used for the diagnosis of XGC.

OBJECTIVETo evaluate the application of CT scan in diagnosis of pathological types and origins of metastatic ovarian tumors.

METHODSClinical data, histopathological results and CT images of 43 patients with pathologically-proved metastatic ovarian tumor were retrospectively analyzed. Diagnostic values of CT imaging for pathological type and origin of metastatic ovarian tumors were evaluated.

RESULTSThe pathological types of metastatic ovarian tumor were related to the size of the lesion (<0.01), while not related to the sites of lesion (unilateral or bilateral), the cystic-solid and mixed lesions with or without separation (all>0.05). Metastatic ovarian tumors of colorectal origin were usually unilateral lesions, and showed cystic or cystic-solid masses, while those of gastric origin were usually bilateral lesions, and showed solid or solid-based masses.

CONCLUSIONSCT imaging may be of value in diagnosis of pathological types and origin of metastatic ovarian tumor.

OBJECTIVETo analyze the geographic spatial patterns and risk areas of main digestive system cancers in Yiwu city.

METHODSNewly diagnosed cases of esophageal, gastric and colorectal cancer during 2010-2014 were obtained from Yiwu Center for Disease Control and Prevention (CDC). The household registration population data in 2013 were obtained from public security bureau. Hierarchy clustering and partitioning regionalization method was used to generate geographic units. Global Moran's I was used to evaluate whether cancer incidence was significantly clustered in space, Anselin Local Moran's I was used to identify statistically significant hot spots, cold spots, and spatial outliers, and Spatial Scan Statistics was implemented to analyze the relative risk of cancers in different areas.

RESULTSThe 5-year average incidence of esophageal, gastric and colorectal cancers were 9.99/100 000, 34.01/100 000 and 31.46/100 000, respectively. Males showed significantly higher incidence than females. The incidence was heterogeneous throughout the study area. Spatial Scan analysis revealed that southern Yiwu presented a significantly higher male esophageal cancer (=1.78) and gastric cancer (=1.87) risk. The central area of Yiwu showed a significantly lower female esophageal cancer risk (=0.00) and male stomach cancer risk (=0.63) and the northern Yiwu exhibited a significantly lower female colorectal cancer risk (=0.48).

CONCLUSIONSThe incidence of main digestive tract cancers shows a heterogeneous distribution in Yiwu city.

OBJECTIVETo analyze the clinical features, diagnosis and treatment of gestational trophoblastic diseases in cesarean scar.

METHODSClinical data of three cases of gestational trophoblastic diseases in cesarean scar diagnosed in Women's Hospital, Zhejiang University School of Medicine during December 2011 and December 2016 were collected. And literature search was performed in Wanfang data, VIP, CNKI, PubMed, ISI Web of Knowledge and EMbase database.

RESULTSA total of 20 cases of gestational trophoblastic diseases were included in the analysis. Clinical features were mainly abnormal vaginal bleeding after menopause, artificial abortion or medical abortion, which might be accompanied by abdominal pain. Serum β-human chorionic gonadotropin (β-hCG) levels were increased in 19 patients. The sonographic features were increase of uterine volume, honeycomb-like abnormal intrauterine echo (or described as multiple cystic dark area, multiple anechoic area and multiple liquid dark area) or heterogeneity echo conglomeration, and no clear bound with muscular layer in some cases. There were abundant blood flow signals inside or around the lesions. The ultrasonography indicated that the lesions were located in the anterior side of the uterine isthmus with the involvement of cesarean section scar. In 12 cases with lesions in cesarean scar shown by preliminary diagnosis, 9 underwent uterine artery embolization (UAE) for pretreatment; the blood loss greater than 1500 mL was observed in only one case without UAE; no patient received hysterectomy. In 8 patients whose lesions were not shown in cesarean scar, only one case received UAE pretreatment, and hysterectomy was performed in 3 cases due to blood loss greater than 1500 mL. Two cases were lost in follow-up and no death was reported in remaining 18 cases. The serum β-hCG levels returned to normal or satisfactory level during the follow-up in 17 cases with increased β-hCG levels before treatment and no recurrence was observed.

CONCLUSIONSThe misdiagnosis rate and missed diagnosis rate of gestational trophoblastic diseases in cesarean section scar are high. The identification of cesarean section scar involvement and UAE may reduce the bleeding and avoid hysterectomy.

OBJECTIVETo investigate the expression and prognostic value of memory T lymphocyte in patients with non-small cell lung cancer(NSCLC) following radiotherapy.

METHODSForty-six patients with NSCLC receiving radiotherapy in Ningbo Medical Center Lihuili Hospital from February 2010 to May 2012 were enrolled in the study and 50 healthy subjects served as the control group. The central memory T cell (T) and effector memory T cell (T) in peripheral blood CD4, CD8cells were detected by flow cytometry. Survival of patients was analyzed by Kaplan-Meier curve, and the relationship between clinical features, memory T lymphocyte changes and overall survival was analyzed by multivariate Cox regression model.

RESULTSCD4T, CD4T, CD8Tlevels and CD4/CD8Tof NSCLC patients were significantly lower than those of the control group, while CD4/CD8Twas significantly higher than that of the control group(all<0.05). In NSCLC patients, CD4T, CD4Tand CD8Twere decreased and CD8Tlevels were increased 4 weeks after radiotherapy(all<0.05); CD4T, CD4Tand CD8Tat 12-week after radiotherapy were increased significantly compared with those at 4-week after radiotherapy(all<0.05). Multivariate Cox regression analysis showed that the change of CD4Tafter radiotherapy was correlated with the overall survival (95%:1.135-2.994,<0.01). The survival rate and overall survival time for patients with decreasing CD4Twere 23.1% and 10.7 months (95%:0.29-12.41), while those of patients with stable CD4Twere 52.7% and 27.4 months (95%:0.00-31.26), and those of patients with increasing CD4Twere 66.4% and 37.4 months (95%:0.33-29.21), respectively.

CONCLUSIONSNSCLC patients show a significant immunosuppression at the initial stage after radiotherapy, and then a gradual improvement. Change of memory T lymphocyte after radiotherapy can be used to help predicting the prognosis of the patients.

OBJECTIVETo assess the value ofF-fluorodeoxyglucose (F-FDG) positron emission tomography-CT (PET-CT) in detection of primary tumor and pelvic lymph node metastasis in International Federation of Gynecology and Obstetrics (FIGO) stages ⅠA2-ⅡA cervical cancer.

METHODSThe clinical data of 91 patients with FIGO stagesⅠA2-ⅡA cervical cancer were retrospectively analyzed. The sensitivity ofF-FDG PET-CT in detection of cervical cancer was calculated. The long diameter, short diameter and SUVmax were compared between metastatic lymph nodes (MLN) and non-metastatic lymph nodes (NMLN). The optimal cut-off values of different indexes were determined by receiver operating characteristic (ROC) curve and area under curve (AUC), and the sensitivity, specificity and accuracy were calculated.

RESULTS F-FDG PET-CT examinations were positive in 89 patients (89/91, 96.7%). The short diameters of NMLN and MLN were (6.50±2.31)mm and (4.21±1.49)mm(=4.855,<0.05); the SUVmax of NMLN and MLN were 4.56±3.34 and 1.92±1.41(=31.685,<0.05). ROC AUCs of the short diameter and SUVmax in diagnosis of metastatic lymph nodes were 0.802 and 0.861. Taken short diameter ≥ 5.05 mm and SUVmax ≥ 2.05 as cut-off values, the corresponding sensitivity, specificity and accuracy in diagnosis of metastatic lymph nodes were 85.0%, 93.0% and 86.8%, respectively.

CONCLUSIONS F-FDG PET-CT is sensitive to detect primary lesion and pelvic lymph node metastases in FIGO stages ⅠA2-Ⅱ A cervical cancer, and the highest diagnostic accuracy may be obtained by taking short diameter ≥ 5.05 mm and SUVmax ≥ 2.05 as the standard.

OBJECTIVETo assess the diagnostic value of dual energy CT for lymph node metastasis in patients with non-small cell lung cancer (NSCLC).

METHODSForty NSCLC patients, including 15 cases of squamous cell carcinoma and 25 cases of adenocarcinoma, underwent dual energy CT examination in pre-contrast and venous phase contrast scans, then the CT attenuation value of the lung cancer lesions and 85 mediastinal enlarged lymph nodes (the short diameter ≥ 5 mm, 53 metastatic and 32 non-metastatic) were measured at different energy levels (40-190 keV, spacing 10 keV) in venous phase contrast. CT spectral curves of the lung cancer lesions, hilus pulmonis and mediastinal enlarged lymph nodes were produced automatically, through comparing their CT spectral curves slope to judge whether or not the lymph nodes were metastatic. Receiver operating characteristic (ROC) curve was used to evaluate the efficiency of CT spectral curve in diagnosis of lymph node metastasis.

RESULTSThe CT spectral curves slopes of the lung cancer, metastatic lymph nodes and non-metastatic lymph nodes were 1.10±0.11, 1.08±0.07 and 1.54±0.17, respectively. There was no significant difference in curve slope between metastatic lymph nodes and lung cancer (=-1.32,>0.05); while there was significant difference between non-metastatic lymph nodes and lung cancer (=-2.58,<0.05). The CT spectral curve slope ratios of metastatic and non-metastatic lymph nodes to lung cancer were 0.98±0.05 and 1.40±0.12, respectively (=-2.86,<0.05). ROC curve showed that taking CT spectral curve slope ratio of 1.15 as cut-off value for the diagnosis of metastatic lymph nodes, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 81.1%, 87.5%, 91.5%, 73.7% and 83.5%, respectively.

CONCLUSIONSDual energy CT is of value in improving the diagnostic accuracy of lymph node metastasis in NSCLC patients before treatment.

OBJECTIVETo investigate the association of parameters in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using reference region model with prognostic factors and molecular subtypes of breast cancer.

METHODSMRI and pathological data of 50 patients with pathologically confirmed invasive ductal carcinoma of the breast were retrospectively analyzed. Reference region model was applied to analyze pharmacokinetic quantitative parameters including volume transfer constant (RR K), rate constant (K) and the ratio of Kto extracellular space volume (K/V). The associations of the above parameters with prognostic factors and molecular subtypes of breast cancer were analyzed.

RESULTSRR Kand Kwere significantly higher in patients of histological grade 3 compared with those of histological grade 1 & 2 (all<0.05); and the patients with estrogen receptor (ER)-negative and/or progesterone receptor (PR)-negative also had higher RR Kand Kthan those with ER-positive or PR-positive (all<0.05). For immunohistochemistry, RR Kand Kwere significantly higher in triple negative breast cancer compared with luminal type breast cancer (all<0.05).

CONCLUSIONSHigh RR Kand Kare associated with poor prognosis of breast cancer, and which can also be used to distinguish molecular subtypes of breast cancer.