Objective To analyze the correlation between quantitative evaluation of high-resolution CT (HRCT) and pulmonary function tests (PFT) in chronic obstructive pulmonary disease (COPD), and evaluate the characteristics of PFT in different CT phenotypes of COPD. Methods 65 patients with COPD underwent CT chest scan and PFT. The dimensions of subsubsegmental apical bronchi of right upper lobes were measured , which included the following parameters:airway wall thickness (T), total airway diameter (D), and pulmonary artery (PA), ratio of airway wall thickness and pulmonary artery (T/PA), thickness diameter ratio (TDR), percentage of wall area (WA%) and percentage of airway luminal area (Ai%). The percentage of total lung area occupied by low attenuation area (LAA%) was measured by lung density software. The relationship between the measurements and PFT parameters were analyzed. Patients were classified into three phenotypes based on the presence of emphysema or bronchial wall thickening evaluated by HRCT. Phenotype A: without or with little emphysema (LAA% < 25%), with or without bronchial wall thickening; Phenotype E: emphysema without bronchial wall thickening (LAA%≥25%, T/PA < 30%); Phenotype M: emphysema with bronchial wall thickening (LAA%≥25%, T/PA≥30%). The characteristics of different CT phenotypes were analyzed. Results LAA% had a good correlation with PFT parameters. PA, T/PA, WA% and Ai% also had correlation with PFT parameters. There was 53 patients of Phenotype A, 12 patients of Phenotype M. PA, T/PA, LAA%and PFT were different in two groups. Conclusions LAA%and airway quantitative measurements in HRCT have certain correlation with PFT parameters. Patients with different CT phenotypes differs in PFT parameters , which can provide reference for clinical diagnosis and treatment.

Objects To evaluate the immune protective effect of dexmedetomidine on breast cancer dur-ing perioperative radical mastectomy via sevoflurane inhalation general anesthesia. To explore reasonable anesthet-ic strategyfor breast cancer radical mastectomy. Methods Patients were divided into two groups. Patients in ex-perimental group receivedgeneral anesthesia with dexmedetomidine and sevoflurane. Control group means general anesthesia with sevoflurane only. In both groups, the level of cortisol, IL-6, IL-8 and of TNF-αin serum were measured at 5 time points , 30 minutes before anesthesia , after cutting skin , after surgery , 24 h after surgery and 72 h after surgery. Results The amount of anesthetic used to induce general anesthesia in the experimen-talgroup were lower than that of the control group.There is no obvious difference of cortisol , IL-6, IL-8 and of TNF-αin serumat the time of 30 min before anesthesia between two groups.Concentrations ofseveral markersin-creasedafter anesthesia, of which experimentalgroup were lower than that of the control group. Conclusions Dexmedetomidine could be immunoprotective for patient with breast cancer during perioperative radical mastecto-my via sevoflurane inhalationgeneralanesthesia. This study recommends usingmultiple anestheticdrugs to anes-thetize patients of breast cancer when performing radical mastectomy.

Objective:We aimed to analyze the clinicopathological characteristics of differentiated thyroid carcinoma (DTC) in women. Methods:The clinical data of 1,034 female patients with thyroid nodules between January 2003 and December 2012 were retrospectively analyzed. These patients were from Yunnan Province, China. A database was established in Excel. Univariate and multivariate conditional logistic regression analyses were conducted by using SPSS 17.0. Results:Female patients with DTC were younger than those with thyroid nodule disease or benign thyroid disease (BTD). The results of univariate conditional logistic regression analysis showed that the preoperative mean level of serum thyrotropin was higher in patients with DTC than in patients with BTD (P=0.034). The positive ratios of thyroid peroxidase antibody, thyroglobulin antibody (TGAb), and thyrotrophin receptor antibody (TRAb) were higher in patients with DTC than in patients with BTD (P<0.001). The positive ratio of the coexistence of DTC with Hashimoto's thyroiditis (HT;13.3%) or with lymphocytic thyroiditis (LT;4.2%) was higher in patients with DTC than in patients with BTD and HT/LT (P<0.001). The ratio of the patients whose age of menarche was≤13 years, with≤2 of births, or were in pre-menopausal condition in the DTC group was higher than that in the BTD group. The results of multivariate conditional logistic regression analysis showed that age<45 years, nodal size<1 cm, and thyroglobulin increase were protective factors of DTC with odds ratios (ORs) of 0.06, 0.377, and 0.431, respectively. An abnormal increase in TGAb and TRAb was an independent risk factor of female patients with DTC with ORs of 4.949 and 23.001, respectively. Conclusion:Female patients aged 35 years to 44 years and with thyroid nodules were included in a high-risk group of DTC. Serous thyroid-stimulating hormone 1evel and coexistence with HT were positively correlated with the risk of DTC in females. Early menarche, late menopause, and low number of births were associated with the incidence of DTC in females. Age<45 years, nodal diameter<1 cm, and increase in thyroglobulin were protective factors of DTC in female. An abnormal increase in TGAb and TRAb was an independent risk factor of female DTC.

Aim To develop a new method for easy endotrache-al intubation and instillation in mice. Methods Relying on the endoscope of cold light and gel loading tips, a new method was set up for intubated operations. Under high magnification, oper-ations of endotracheal intubation and instillation were completed in mice. Twenty male CB17-SCID mice ( between 24 and 28 g) were repeatedly intubated and instilled with 80 μL suspensions of air polluted fine particulate matters in a week. Results The twenty mice were sacrificed after 24h of the last instillation. The dispersions of the air polluted fine particulate matters were found at the bottoms of tracheas and in both the left and right lungs in all mice. Conclusion Using the endoscope of cold light and gel loading tips, a new method for tracheal instillation is set up in mice, which is rapid, simple and has good repeatability. It could be widely applied for the endotracheal intubation and in-stillation in mice.

Body exposure to fine particulate matter air pollution (PM2.5) can cause a variety of health damage. PM2.5 can act directly on the respiratory system and through the blood barrier, which is closely related to the body's various diseases. This paper elaborated possible mechanism of PM2.5 on the respiratory system as well as varying degrees of damage,pointed out the mechanism of toxicity, and a more in-depth toxicity mechanism from epidemiological studies. Meanwhile, this paper provides a scientific basis about PM2.5 and other cutting-edge issues.

OBJECTIVETo evaluate the efficacy of allograft fibula in anterior cervical fusion for cervical spondylosis patients treated by Smith-Robinson operation supplemented with anterior instrumentation.

METHODSThe clinical outcome of 38 patients with cervical spondylosis treated by Smith-Robinson operation using allograft fibula supplemented with anterior titanium plate were retrospectively studied. The patients were followed up on average was (9.5 +/- 3.4) months. The average preoperative and postoperative JOA scores were assessed and myelopathy severity was graded using the Nurick myelopathy grading system. Lateral views in neutral position, in flexion, and in extension of preoperative cervical roentgenograms were analyzed in comparison with last follow-up films to identify the changes in the height of intervertebral space and the quality of fusion.

RESULTSStatistical analysis of all patients revealed mean JOA scores of 12.54 +/- 1.62 and 16.07 +/- 1.13 before surgery and at final examination (P < 0.05), respectively. And the mean Nurick grades were 2.46 +/- 0.43 and 0.72 +/- 0.37 before and after surgery (P < 0.05), respectively. Radiographic follow-up revealed that the height intervertebral space and the lordosis of the cervical spine had been restored and no allograft was found displaced or collapsed and also revealed that all grafts obtained union by 5 months after surgery.

CONCLUSIONSFibular allograft can replace autologous iliac crest graft in the treatment of cervical spondylosis patients. This method is safe and efficacious and can avoid bone graft-site morbidity.

Adult ; Aged ; Cervical Vertebrae ; pathology ; Female ; Fibula ; surgery ; Humans ; Male ; Middle Aged ; Spinal Osteophytosis ; surgery ; Transplantation, Homologous

Objective: To investigate the characteristics of magnetic resonance imaging (MRI) of minimal deviation adenocarcinoma (MDA) of cervix, and improve the diagnostic accuracy of MDA. Methods: The imaging data of eight cases of MDA was retrospectively collected, including tumor size, tumor location, tumor components, signal characteristics, enhancement characteristics and invasive extent. Results: The maximum diameter of tumor was (4.36±1.46) cm. Six tumors were mixed solid and cystic and two were predominantly solid. Six were diffusion limited on diffusion-weighted imaging, and two were not diffusion limited. On multi-phase dynamic contrast-enhanced scan, the enhancement curve of solid components of the tumor showed a plateau-like pattern in three cases and a slow-rising pattern in five cases. Tumors were confined to the cervical canal in three cases, infiltrated to cervical stroma > 1/2 depth in seven cases, and ≤ 1/2 depth in one case. There were four cases of uterine invasion, four cases of vaginal fornix invasion, four cases of bilateral ovarian metastasis and one case of lymph node metastasis. Conclusions Patients suffering from large amount of vaginal discharge had cervical lesions on MRI showing polycystic and solid component enhancement should be alert to MDA. Deep-seated cervical biopsy and even conization is conducive to early diagnosis, treatment and improvement of prognosis.

Objective:To describe clinical characteristics, genetic mutation and therapeutic response of a family diagnosed as slow-channel congenital myasthenia syndrome (SCCMS) and analyze the factors of the efficacy of channel blockers therapy.Methods:Clinical data and therapeutic response in three patients from a family of SCCMS from Department of Neurology, Xuanwu Hospital, Capital Medical University in May 2017 were collected. The clinical data, mutations and response to therapy of all literature SCCMS cases in the English database of Pubmed and Chinese database of Wanfang until December 31, 2018 were analyzed statistically.Results:The proband was a 48-year-old female who referred to Xuanwu Hospital for limb weakness for 40 years. The proband′s elder daughter presented with onset of the birth and delayed motor milestones, scoliosis and difficulty in walking. The younger daughter was born healthy with normal motor milestones, while fatigue and weakness gradually appeared. The antibodies of myasthenia gravis were negative. No repetitive compound muscle action potentials (CMAP) were detected in three patients. Repetitive nerve stimulation showed decrements. Gene test revealed heterozygous mutation of CHRNE p.εV279F, a known pathogenic mutation of SCCMS. Seventeen SCCMS cases were reported in literature. A total of 20 patients with SCCMS were described in terms of clinical manifestation, mutation, drug therapy and efficacy in detail. According to the literature description, they were divided into significant benefit group and mild to modest benefit group to channel blocker therapy. The age of onset in 10 patients with significant benefit was 1.50 (0.75, 28.25) years from birth to 43 years, and that in 10 patients with mild to modest benefit was 2.50 (0, 6.25) years from birth to 11 years. There was no significant difference between the two groups. The age at the initial channel blocker therapy in the group with significant benefit was (23.40±13.29) years from 12 to 43 years, whereas that in the group with mild to modest benefit was (34.10±13.43) years from 20 to 62 years, and there was no significant difference between the two groups. The delay time of treatment (age at the beginning of treatment with channel blockers-age of onset) in patients with significant benefit was 13.0 (10.25, 15.00) years, which was 32.50 (19.25, 38.00) years in patients with mild to modest benefit ( Z=-3.374, P=0.000). According to the response of cholinesterase inhibitor, eight patients were in the effective group, 10 patients were in the ineffective group and two patients were without cholinesterase inhibitor. The age of onset in the effective group was 0 (0, 4.75) years, while that in the ineffective group was 6.50 (1.00, 28.25) years ( Z=-2.315, P=0.021).The age of treatment with channel blockers was (27.90±12.99) years in the effective group and (32.00±13.21) years in the ineffective group, and there was no significant difference between the two groups. The delay time of channel blocker treatment in effective group was (30.25±11.07) years, while that in ineffective group was (14.30±9.60) years ( t=-3.274, P=0.005). Conclusions:In SCCMS, the effect of channel blockers was related to the delay time of treatment. Channel blocker was more effective the sooner it was started after the onset of symptoms. The average age of onset of SCCMS patients with positive responses to cholinesterase inhibitor was younger, but the delay time of channel blocker therapy was longer, resulting in poor therapeutic effect.

Objective: The etiology of schizophrenia is unknown and is associated with abnormal spontaneous brain activity. There are no consistent results regarding the change in spontaneous brain activity of people with schizophrenia. In this study, we determined the specific changes in the amplitude of low-frequency fluctuation/fractional amplitude of low-frequency fluctuation (ALFF/fALFF) and regional homogeneity (ReHo) in patients with drug-naïve first-episode schizophrenia (Dn-FES). Methods: A comprehensive search of databases such as PubMed, Web of Science, and Embase was conducted to find articles on resting-state functional magnetic resonance imaging using ALFF/fALFF and ReHo in schizophrenia patients compared to healthy controls (HCs) and then, anatomical/activation likelihood estimation was performed. Results: Eighteen eligible studies were included in this meta-analysis. Compared to the spontaneous brain activity of HCs, we found changes in spontaneous brain activity in Dn-FES based on these two methods, mainly including the frontal lobe, putamen, lateral globus pallidus, insula, cerebellum, and posterior cingulate cortex. Conclusion We found that widespread abnormalities of spontaneous brain activity occur in the early stages of the onset of schizophrenia and may provide a reference for the early intervention of schizophrenia.

Objective:To investigate the value of pre-therapy 18F-FDG PET/CT radiomic models in differentiating epidermal growth factor receptor (EGFR) exon 19 deletion from exon 21 L858R missense in patients with non-small cell lung cancer (NSCLC). Methods:A total of 172 patients with EGFR mutant NSCLC (54 males, 118 females, age: (56.2±12.5) years) in the Fourth Hospital of Hebei Medical University between January 2015 and November 2019 were retrospectively included. Exon 19 mutation was found in 75 patients and exon 21 mutation was identified in 97 patients. The patients were divided into training set ( n=121) and validation set ( n=51) in a 7∶3 ratio by using random number table. The LIFEx 4.00 package was used to extract texture features of PET/CT images of lesions. The least absolute shrinkage and selection operator (LASSO) algorithm was used for feature screening. Three machine learning models, namely logistic regression (LR), random forest (RF), and support vector machine (SVM) models, were constructed based on the selected optimal feature subsets. The ROC curve analysis was performed to assess the predictive performance of those models. Finally, decision curve analysis (DCA) was used to evaluate the clinical value of the models. Results:Nine radiomics features, including 6 PET features (histogram (HISTO)_Kurtosis, SHAPE_Sphericity, gray level run length matrix (GLRLM)_ low gray-level run emphasis (LGRE), GLRLM_ run length non-uniformity (RLNU), neighborhood grey level different matrix (NGLDM)_Contrast, gray level zone length matrix (GLZLM)_ short-zone low gray-level emphasis (SZLGE)), and 3 CT features (gray level co-occurrence matrix (GLCM)_Correlation, GLRLM_ run percentage (RP), NGLDM_Contrast), were screened by LASSO algorithm. Three machine learning models had similar predictive performance in the training and validation sets: AUCs for the RF model were 0.79, 0.77, and those for the SVM model were 0.76, 0.75, for the LR model were 0.77, 0.75. The DCA showed that the 3 machine learning models had good net benefits and clinical values in predicting EGFR mutation subtypes.Conclusion:18F-FDG PET/CT radiomics provide a non-invasive method for the identification of EGFR exon 19 deletion and exon 21 L858R missense mutations in patients with NSCLC, which may help the clinical decision-making and the formulation of individualized treatment plan.