Objective To improve the clinic,CT and pathologic knowledge of pleomorphic hyanilizing angiectatic tumor of soft parts(PHAT).Methods Clinical,CT and pathologic characters of PHAT in one case at the right nuchal region were detailedly analysed with literature review.Results The clinical symptoms of PHAT were slight and unspecified.The lesion appeared as a orbicular-ovate tumour with sublobe and clear edge,the density of tumor was uneven on plain scan and uneven enhanced after injected contrast agent,and a part of the tumour was enhanced close to the CT value of blood vessel.The characters of pathology were the presence of clusters of dilated thin-walled vessels,with prominent hyalinization of vessel wall,perivascular and intercellular hyalinization,and pantomorphia neoplastic cell distributed between these dilated vessels.Conclusion PHAT is a low potential malignant soft tissue tumor,it has some specific CT and pathologic characters.

Objective To assess the value of blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI)in diagnosis and prediction of early acute renal transplant rejection.Methods BOLD-MRI was performed in a cohort of 103 patients undergoing cadaver renal transplantation between Dec 2005 and March 2007.Among them,82 recipients had nomlal renal function,21 had biopsy-proved acute rejection.R2* (1/s)measurements were obtained in the medulla and cortex of grafted kidneys. Results R2* values of the medulla were significantly lower in the acute rejection group[R2*=(14.02±2.68)/s]than that in the normally functioning transplants group [R2*=(16.66+2.82)/s],the difference between these two groups was significant (P＜0.01);ROC curve analyses suggested that medullary MR2* values could accurately identify acute rejection in the early post-transplantation period.In the normal functioning transplant group,those with lower medullary R2* values (MR2*＜14.9/s,n=23) had higher acute rejection rates than those with higher medullary R2* values (MR2*＞14.9/s,n=59) in the first 6 months following transplantation,but the difference between these two groups was not significant (17.39% vs 8.47%,P=0.259). Conclusions Mean R2* values in the medullary regions of grafted kidneys with BOLD-MPd may be a non-invasive diadynamic criteria with good sensitivity and specificity,and may be a valuable predictor of early acute renal transplant rejection.

Objective To evaluate the value of semi-quantitative parameters of dynamic contrast-enhanced MRI (DCE-MRI)in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma.Methods Forty-four patients with pathologically confirmed laryngeal and hypopharyngeal squamous cell carcinoma were collected.Time signal intensity curves (TIC)and related semi-quantitative parameters were obtained before (point 1 ),during (point 2)and after (point 3 )treatment. Tumor remission were assessed at the end of treatment and the statistical analyses were performed using SPSS.Results Twenty two patients had a complete remission as CR group and 22 had a partial remission as PR group.The parameters of time to peak (TTP), maximum signal enhancement ratio (SERmax ),positive enhancement integral (PEI),SER70 and SER84 at point 1 were higher than those at point 2,and there were significant differences between two groups (P <0.05).The values of SERmax ,SER42 ,SER56 ,SER70 and SER84 before treatment were higher in CR group than those in PR group,exhibiting significant differences between two groups (P <0.05).ROC curve analysis showed the threshold for SER56 was set to ≥129.4％ to predict complete remission,and the sensitivity and specificity were 60％ and 86.4％,respectively.Comparison of remission rates among different types of TIC showed complete remission rates in typeⅠTIC and type Ⅲ TIC were 87.5％ and 39.3％,respectively,exhibiting a significant difference between two groups (P =0.041). Conclusion TIC types and semi-quantitative parameters of DCE-MRI can predict therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma,SER56 is the most important predictive semi-quantitative parameter,and prognosis is much better in typeⅠTIC than type Ⅲ TIC before treatment.

Axial pedicle screw fixation technique, as a classic posterior fixation technique, is the first choice and gold standard of posterior axial screw fixation. Since it can pass through the whole vertebrae and play the role of three-column fixation, it has excellent biomechanical properties and is widely used in cervical spine surgery. However, with the deepening of clinical research, some scholars found that the application of axial pedicle screws was limited in patients with pedicle hypoplasia, high-riding vertebral artery and irreducible atlantoaxial dislocation. At the same time, in order to expose bone markers during screw placement, the muscle dissection of pedicle screws is wider compared with that of isthmus screws. Isthmus screw fixation, as a complementary technique for pedicle screw technique, has gradually attracted the attention of scholars in recent years and has been applied in the surgical treatment of various types of cervical spine diseases. The entry point of axial isthmus screw is closer to the midline of the spine and the inferior facet joint than pedicle screw, to avoid extensive muscle dissection during the operation, so that the paravertebral muscles can be protected, which make the surgery more minimally invasive and the invasion of the operation further reduced. At the same time, compared with the lateral mass or pedicle screw of the atlas combined with axial pedicle screw fixation, the lateral mass or pedicle screw of the atlas combined with axial isthmus screw fixation can increase the anteroposterior and vertical distance between the heads of C 1 and C 2 screws due to the change of screw entry points, which can provide a wider operative space for the three dimensional reduction of atlantoaxial dislocation. However, since the axis is a transitional vertebra between the upper and lower cervical spine which has complexity and variability in anatomical structure, many scholars have limited understanding of this new technique. There are no unified standards for screw placement and surgical details, which are mostly based on the personal experience of clinicians. Meanwhile, the biomechanical properties, surgical complications and long-term efficacy of this technique have received little attention and concern, resulting in the limitation of clinical application and promotion for this technique. This review evaluates the relative advantages of axial isthmus screws according to existing literature reports, and analyzes the anatomy, biomechanics, clinical applications and surgical complications of axial isthmus screw fixation technique, aiming to provide a reference for the safety and feasibility of axial isthmus screw placement.

OBJECTIVETo investigate the clinicopathological features and postoperative short-term complications in the elderly gastric cancer patients.

METHODSClinical data of 270 elderly patients with gastric cancer who underwent gastrectomy in Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine between July 2012 and June 2014 were analyzed retrospectively. Among 270 patients, 220 were 70 to 79 years old( old group) and 50 were ≥80 years old(oldest group). The clinicopathological features were compared between the two groups. Perioperative factors were analyzed to determine if they are associated with postoperative complications. Multivariate logistic regression model was performed.

RESULTSBefore operation, most elderly patients (n=161, 59.6%) had 2 or more than 2 comorbidities, including hypertension (n=154, 57.0%), anaemia (n=126, 46.7%), diabetes (n=53, 19.6%), arhythmia (n=52, 19.3%), cardiovascular disease(n=33, 12.2%), and chronic pulmonary disease(n=28, 10.4%). Elderly gastric cancers were more likely to locate at the lower third of the stomach (n=116, 43.0%). The pathological type was mainly the poorly differentiated carcinoma (n=152, 56.3%), and stage III was more common in TNM staging(n=138, 51.1%). As compared to the old group, the oldest group had more preoperative comorbid diseases(P=0.048), more previous surgery(P=0.029), more preoperative transfusion (P=0.019), more combined cholecystectomy (P=0.007) and feeding jejunostomy (P=0.037), but less tumor invasion of nerves(P=0.045). No significant differences in other clinicopathological parameters were found between the two groups (all P>0.05). A total of 121 (44.8%) patients presented postoperative complications, including severe complication in 30 cases(11.1%) and death in 4 cases(1.5%). Forty-seven patients(17.4%) presented operation-associated complications, including infection in 28 cases(10.4%) and leakage in 21 cases(7.8%). One hundred and seven(39.6%) patients presented non-operation-associated complications, including pneumonia in 48 cases(17.8%), hypertension in 23 cases(8.5%), and arhythmia in 17 cases(6.3%). Postoperative morbidities of Clavien-Dindo class II complication and non-operation-associated complication were higher in the oldest group compared with old group(P<0.05), while other postoperative complications were compared between the two groups, only urinary tract infection was significantly different(P<0.05). Univariate analysis showed that postoperative complications were significantly associated with age(χ(2)=7.308, P=0.007), number of comorbid diseases (χ(2)=10.872, P=0.001), cardiovascular disease (χ(2)=9.412, P=0.002), hypertension (χ(2)=4.934, P=0.026) and preoperative transfusion (χ(2)=3.911, P=0.048). Multivariate analysis showed that only the number of comorbid diseases was an independent risk factor for postoperative complications(OR=2.810, 95% CI: 1.710 to 4.616, P=0.000).

CONCLUSIONNon-operation-associated postoperative complications are more likely to occur in the elderly patients due to more comorbid diseases. Perioperative intensive care should be carried out for the elderly gastric cancer patients with comorbid diseases in order to improve surgical safety and efficacy.

Aged ; Aged, 80 and over ; China ; Comorbidity ; Gastrectomy ; adverse effects ; Humans ; Hypertension ; complications ; Logistic Models ; Multivariate Analysis ; Neoplasm Staging ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; complications ; surgery

OBJECTIVE: To evaluate the application of MR diffusion-weighted imaging(DWI) texture features in differentiation of malignant from benign nonpalpable breast lesion for patients with microcalcifications-only in mammography. METHODS: The clinical and MR-DWI data of 61 patients with microcalcifications, who underwent three-dimensional positioning of breast X-ray wire from October 2012 to December 2015 in Zhejiang Cancer Hospital, were retrospectively analyzed, including 38 patients with malignant lesions and 23 patients with benign lesions. Two radiologists independently drew the regions of interest (ROI) on DWI for image segmentation, and 6 histogram features and 16 grayscale symbiosis matrix (GLCM) texture features were extracted on each ROI. The random forest algorithm was applied to select the features and built the classification model. The leave-one-out cross-validation (LOOCV) was used to validate the classifier, and the performance of the classifier was evaluated by ROC curve. RESULTS: Six features were selected, including histogram features of mean, variance, skewness, entropy, as well as contrast (0°) and correlation (45°) in GLCM. The histogram features of mean, variance, skewness and entropy were significantly different between the benign and malignant breast lesions (all <0.05). The AUC of the model was 0.76, and the diagnostic accuracy, sensitivity and specificity were 77.05%, 84.21% and 65.21%, respectively. CONCLUSIONS The texture feature analysis of DWI can improve the diagnostic accuracy of differentiating benign and malignant breast nonpalpable lesions with microcalcifications-only in mammography. Histogram features of mean, variance, skewness, entropy of DWI may be used as important imaging markers.
Breast ; diagnostic imaging ; Breast Neoplasms ; diagnostic imaging ; Calcinosis ; diagnostic imaging ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Mammography ; Retrospective Studies ; Sensitivity and Specificity

Objective To investigate the relationship between the development of terminal rectal ganglion and spinal cord/sacral abnormalities in boys with complex anorectal malformations(ARMs)in order to improve the understanding of rectal ganglion development abnormalities in ARMs patients.Methods A retrospective trial was conducted on the male patients with complex ARMs admitted to our hospital from 2015 to 2021.The terminal rectal specimens were taken from them during anoplasty.According to the findings on development of terminal rectal ganglion after HE staining,the patients were classified into G1 group(ganglion cells observed)and G2 group(no ganglion cells observed).Imaging techniques were used to evaluate whether there were abnormalities in the spinal cord and sacrum,and their correlation with the terminal rectal ganglion development was analyzed.Results A total of 139 patients were enrolled,and their median age at anoplasty was 5.77(4.57,6.97)months.There were no significant differences between the G1(n=80,57.6％)and G2(n=59,42.4％)groups in ARMs pathological type(P=0.706)and age at surgery(P=0.140).Radiological findings showed there were 48 cases(34.5％)of spinal cord anomalies(SCA),25 cases(18.0％)of sacral abnormalities and 18 cases(12.9％)of coccyx abnormalities.No significant differences were observed in the incidences of SCA and sacral abnormalities between the G1 and G2 groups(P＜0.05).Moreover,the differences of fatty filum terminale and syrinx were statistically significant(P＜0.05).In addition,the ratio of sacrum to coccyx between the G1 and G2 groups were 0.72±0.10 vs 0.67±0.12(P＜0.05)of the anteroposterior position and 0.77±0.09 vs 0.72±0.09(P＜0.05)of the lateral position.Multivariate logistic regression analysis showed that sacral abnormalities,fatty filum terminale and syrinx were independent predictors of rectal terminal ganglion absence in male patients with complex ARMs.Conclusion The development of terminal rectal ganglia in male patients with ARMs is closely associated with the abnormalities of spinal cord and sacrum.Sacral abnormalities,fatty filum terminale and syrinx are independent predictors of rectal terminal ganglion absence in male patients with complex ARMs.