OBJECTIVE: To assess the efficacy and safety of different therapeutic regimens for Acinetobacter baumannii infection. METHODS: PUBMED (1995 to 2011), Cochrane Central Register of Controlled Trails (Issue 7, 2011), CNKI (1979 to 2011), and VIP (1989 to 2011) were searched for randomized controlled trial, quasi-randomized controlled trial, prospective and retrospective cohort study. A meta-analysis was performed with Cochrane Collaboration's RevMan 5.0 software. RESULTS: Eight literatures involving 544 patients with Acinetobacter baumannii infection were identified. Five studies used ampicillin/sulbactam. The analysis showed that there was statistically significant difference in the success rate between ampicillin/sulbactam and other drugs with OR of 1.69 and 95% CI of 1.03 to 2.75 and in mortality with OR of 0.51 and 95% CI of 0.29 to 0.89.As for improvement, bacteriologic success, treatment failure and adverse events, there was no statistically significant difference. There was one study involving cefoperazone/sulbactam and four studies on colistin. As far as bacteriologic success, clinical success and adverse events were concerned, there was no statistically significant difference. However, patients receiving colistin treatment had higher mortality with OR of 1.76 and 95% CI of 1.09 to 2.86. CONCLUSION: Ampicillin/sulbactam has better effect against Acinetobacter baumannii. It can improve the symptoms and clinical signs and dose not have significant adverse effect.

Background: The risk of opportunistic infection in ulcerative colitis (UC) is significantly higher than that in healthy subjects, and has adverse impact on clinical outcome. Aims: To analyze the prevalence of opportunistic intestinal infection in UC patients and explore the risk factors of UC complicated with opportunistic infection. Methods: Clinical data of patients with UC hospitalized in Peking University Third Hospital from January 2012 to December 2020 were collected retrospectively. Information on demography, clinical characteristics, laboratory, endoscopic and pathological findings, as well as the medication histories were recorded; the factors associated with opportunistic intestinal infection were analyzed using univariate and multivariate analyses. Results: A total of 275 UC patients were included, with an opportunistic intestinal infection rate of 26.2%; among which, rates of cytomegalovirus (CMV), Epstein ‑ Barr virus (EBV), fungi, Clostridium difficile, amoeba, and multiple infection were 13.5%, 14.5%, 5.1%, 1.5%, 1.1%, and 9.1%, respectively. Multivariate Logistic analysis demonstrated that severe disease activity (OR=6.517, 95% CI: 1.487‑28.552, P=0.013) and albumin <30 g/L (OR=3.895, 95% CI: 1.590 ‑ 9.544, P=0.003) were independent risk factors for CMV infection. The independent risk factors for EBV infection included severe disease activity (OR=11.260, 95% CI: 2.249‑56.382, P=0.003), albumin <30 g/L (OR=2.548, 95% CI: 1.096‑5.927, P=0.030) and C‑reactive protein (CRP) elevation (OR=1.046, 95% CI: 1.007‑1.086, P=0.019). While for intestinal fungal infection, the risk in patients with chronic relapsing type UC was lower (OR=0.278, 95% CI: 0.087‑0.886, P=0.030). Intestinal multiple infection was mainly composed of viral infection, and the independent risk factors were similar to those of CMV and EBV infection. Conclusions: Most of the opportunistic intestinal infection in UC patients is viral infection. Disease activity, inflammatory response and reduced albumin are risk factors for intestinal viral infection in UC patients, while the risk of fungal infection is only related to clinical subtyping.

The incidence of inflammatory bowel disease (IBD) is increasing year by year, yet lacking specific treatment, which seriously affects patients' health and quality of life. The pathogenesis of IBD has not been fully clarified, the psycho-neuro-endocrine-immune regulation through gut-brain axis may play an important role in the pathogenesis of IBD. Studies have shown that IBD patient has an increased risk of depression. More than 20% of IBD patients have depression, the incidence is about 2-4 times that of general population. Antidepressant therapy has good efficacy in some IBD patients. The possible mechanism includes affecting the gut-brain axis, inhibiting inflammation, improving mood, etc. However, there are few relevant studies, and the value of antidepressant therapy in the treatment of IBD needs to be further confirmed by large-sample randomized controlled studies. This article reviewed the application of antidepressant therapy in IBD.

Objective: To explore the diagnosis value of 18F-FDG PET/CT for renal cell carcinoma (RCC) with venous tumor thrombosis (VTT). Methods: PET/CT data of 27 patients with pathologically confirmed RCC with VTT were analyzed retrospectively. PET/CT grading was compared with clinical grading for classification of VTT. According to pathological findings, the patients were divided into venous wall invasion group and venous wall noninvasion group. SUVmax of primary tumor, of VTT and inferior vena cava diameter were compared between two groups. Results: The average SUVmax of VTT was 6.98±5.50 in 27 cases with 100% (27/27) detection rate for VTT. Correct classification of VTT was performed in 26 cases with PET/CT, the accuracy rate was 96.30% (26/27). The average SUVmax of bland thrombosis (BT) was 1.30±0.28 in 8 cases, and the diagnostic accuracy was 87.50% (7/8). SUVmax of VTT was significantly higher than that of BT (P<0.001). There was no significant difference in SUVmax of primary tumor, SUVmax of VTT nor inferior vena cava diameter between 2 groups (all P>0.05). Conclusion: PET/CT has high detection accuracy for RCC with VTT and BT, also for tumor thrombus classification, but has limited ability to evaluate vein wall tumor invading.

Objective: To explore the value of models based on characteristics of ultrasonography and demography for predicting breast imaging reporting and data system (BI-RADS) classification. Methods: Breast ultrasonic data and demographic data of 5 324 females who underwent health screening were retrospectively analyzed. Multivariate Logistic regression analysis was used to establish model 1 based on breast ultrasonic characteristics, and model 2 based on breast ultrasonic characteristics as well as demographic characteristics. ROC curve was used to analyze the efficacy of the two models for BI-RADS≥4a breast lesions. Results: Ultrasound showed 5 019 (5 019/5 324, 94.27%) BI-RADS≤3 and 305 (305/5 324, 5.73%) BI-RADS ≥4a grade breast lesions. Logistic regression analysis showed that the number of nodules, morphology, echo, blood flow signal, age and body mass index (BMI) were independent predictors of BI-RADS≥4a lesions (all P<0.05). Regression model 1 was constructed based on nodule number, morphology, echo and blood flow signals, with AUC of predicting BI-RADS≥4a grade 0.821 (P<0.05), specificity of 90.58%, sensitivity of 61.25% and accuracy of 88.13%. Regression model 2 was constructed based on nodule number, morphology, echo, blood flow signal, age and BMI, with AUC of predicting BI-RADS≥4a grade 0.874 (P<0.05), the specificity, sensitivity and accuracy was 93.69%, 68.75%, and 91.80%, respectively. Conclusion: Models based on ultrasonic features and demographic characteristics have certain predictive value for BI-RADS classification.

Objective: To explore the application value of MR ultrashort echo time (UTE) sequence and conventional sequence imaging for displaying lumbar intervertebral disc (IVD) cartilage endplate (CEP) injury. Methods: Totally 87 volunteers underwent conventional and UTE lumbar spine MRI. The correlation between UTE sequence of lumbar IVD CEP injury and vertebral Modic changes classification, Pfirrmann disc degeneration grade were analyzed. Results: UTE showed linear hyperintense uncalcified CEP and hypointense calcified CEP between nucleus pulposus and vertebral body. There was a positive correlation between cartilage endplate injury in L1-S1 and vertebral Modic changes classification, Pfirrmann disc degeneration grade (all P<0.001). Conclusion: MR UTE can clearly show the lamination and damage of CEP, and there is certain relationship between cartilage endplate injury and lumbar degeneration.

Objective: To investigate the value of 30° flexed knee MRI in evaluating anterior cruciate ligament (ACL) tears. Methods Totally 64 knee trauma patients who underwent arthroscopy were included. Knee MRI in slightly flexed (about 17°) and 30° flexed positions were successively performed in all patients. The delineation of ACL full length, double-bundle structure and torn ACL's disrupted sites combined with ligament remnants were rated separately by 2 radiologists. Taken arthroscopy results as golden standards, the sensitivity, specificity and accuracy were calculated. Results: The diagnosing sensitivity, specificity and accuracy of ACL tears were 97.44% (38/39), 100% (25/25) and 98.44% (63/64) respectively in slightly flexed knee MRI, while they were all 100% in 30° flexed knee MRI. There was good consistency between the two positions (Kappa=0.967). MRI of 30° flexion was superior to slightly flexion in delineation of ACL full length and torn ACL's disrupted sites combined with ligament remnants (both P<0.001), while no statistical difference was found in the delineation of ACL double-bundle structure (P=0.223). Conclusion: Both slightly flexed and 30° flexed knee MRI have high sensitivity, specificity and accuracy in diagnosing ACL tears, whereas 30° flexion MRI is superior to slightly flexion images in delineation of ACL and its tears.

Objective: To observe 18F-FDG PET/CT manifestations of elastofibroma dorsal (EFD). Methods 18F-FDG PET/CT findings of 26 patients with EFD were retrospectively analyzed. The differences of maximum standard uptake (SUVmax) of lesions and the ratio of SUVmax to mean standardized uptake of liver (SUR-BP) were compared between males and females, patients aged <72 years and ≥72 years, lesion volume <39 cm3 and ≥39 cm3, respectively. Results: Among 26 patients, there were 19 patients of bilateral EFD involvement and 7 of unilateral involvement (right lateral).There were total 45 EFD lesions in all 26 patients. All the lesions were found as round or fusiform soft tissue masses,located between inferior corner of scapula and posterior chest wall, bordered by the subscapularis, rhomboid, latissimus dorsi and serratus anterior muscles. The density of lesions were close to or slightly lower than that of the surrounding normal muscle tissue. Radioactive uptake of lesions increased slightly to moderately compared with the surrounding normal muscle tissue. Except for 6 lesions with higher 18F-FDG uptakes, the uptakes of 18F-FDG in the other 39 EFD lesions were lower compared with the hepatic blood pool. There was no significant difference of SUVmax nor SUR-BP among EFD patients with different sex, age norlesion volume (all P>0.05). Conclusion: 18F-FDG PET/CT manifestations of EFD demonstrate some characteristics, and might be helpful to diagnosis of this disease.

Objective To observe 18F-FDG PET/CT manifestations of Langerhans cell histiocytosis (LCH) of the adult spine. Methods 18F-FDG PET/CT imaging features of 9 adult patients with LCH of spine confirmed by pathology were retrospectively analyzed. The lesions number, location, density, margin and the maximum standardized uptake (SUVmax) were observed. Results Among 9 cases (18 lesions of spine), single lesion was found in 6 patients, while multiple lesions were found in 3 patients. Sixteen lesions displayed different degrees of osteolytic bone destruction, with sharp margins and were filled with soft tissue, 7 lesions showed rim osteosclerosis, while 3 lesions invaded canalis vertebralis. Another 2 lesions were found as shape shadow of slightly high density and no density abnormity, respectively. High 18F-FDG uptake was found in all 18 lesions, the mean SUVmax was 9.07±4.99. Conclusion 18F-FDG PET/CT manifestations of LCH of adult spine have some characteristics, which are helpful to the diagnosis of this disease.

The treatment of locally recurrent rectal cancer (LRRC) is multidisciplinary, including surgery, external beam radiotherapy, intraoperative radiotherapy, radioactive seed implantation, hyperthermia therapy, radiofrequency ablation, etc. Nevertheless, the predominant treatments are surgery and radiotherapy. Complete resection (R0 resection) is an independent prognostic factor. With the advent of intensity modulated radiation therapy (IMRT) and stereotactic body radiotherapy (SBRT), the efficacy of re-irradiation for patients who have previously received radiotherapy is confirmed, and the side effects are acceptable. Moreover, with the development of more treatment modalities, the survival rate and local control rate of patients are increasing, and the quality of life is improved. In conclusion, the treatment of LRRC is comprehensive and requires the participation of multidisciplinary physicians. However, proper and effective treatment needs more research evidence. This review summarized the latest progress in the multidisciplinary treatment of LRRC and the unresolved problems.