Objective:To compare the differences in the delineation of the gross tumor volume (GTV) and lymph nodes of nasopharyngeal carcinoma (NPC) patients using computerized tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT), and to investigate the optimal standard uptake value (SUV; relative to the MRI-based delineation) for the automatic delineation of GTV using PET. Methods:A total of 53 NPC patients proposing to receive radiotherapy were selected for this study. The CT, MRI, and PET images of each patient were obtained before radiotherapy. Then GTV and positive lymph nodes were delineated on these three types of images. They were individually named GTV MRI, GTV CT, GTV PET2.5 (SUV=2.5), Lymph MRI, Lymph CT, and Lymph PET2.5 and compared. The GTV ∩2.5 (overlapped GTV) was obtained through the alignment of MRI and PET/CT images. Meanwhile, GTV was delineated on PET images using thresholds of SUV=4.0, 4.5, 5.0, and 5.6, obtaining GTV PET4.0, GTV PET4.5, GTV PET5.0, and GTV PET5.6. Then their volume and Dice similarity coefficients (DSCs) were compared. Results:Compared to GTV MRI, GTV CT decreased by 1.73% ( P>0.05) and GTV PET2.5 increased by 21.34% ( t=-3.52, P < 0.05) in the three types of images. The volume of Lymph PET2.5 was 1.61 and 1.87 times the volume of Lymph MRI and Lymph CT, respectively ( t=-4.12, -5.18; P< 0.05). The volume of high-SUV lymph nodes was 4.07 times the volume of lymph nodes with low SUVs or SUV=0 ( t=5.50, P< 0.05) on PET images. The DSC between GTV PET4.0and GTV MRI was 0.78 ± 0.27, which was lower than that between GTV PET2.5 and GTV MRI (0.84 ± 0.18). However, GTV PET4.0 approximated to GTV ∩2.5 ( P>0.05). Conclusions:Compared to CT and 18F-FDG PET/CT, MRI shows more accurate boundaries of GTV and lymph nodes. When 18F-FDG PET/CT was adopted to automatically delineate GTV, the GTV delineated using SUV=4.0 was closer to GTV MRI.

Objective:To assess the feasibility of delayed-enhancement MRI in contouring the lumpectomy cavity (LC) for patients with invisible seroma or a low cavity visualization score (CVS≤2) in the excision cavity after breast-conserving surgery (BCS).Methods:Twenty-six patients with stage T 1-2N 0M 0 who underwent prone radiotherapy after BCS were recruited. The LC delineated on CT simulation images was denoted as LC CT. The LCs delineated on T 2WI, as well as on different delayed phases (2-, 5-and 10-minute) of delayed-enhancement T 1WI were defined as LC T2, LC 2T1, LC 5T1 and LC 10T1, respectively. Subsequently, the volumes and locations of the LCs were compared between CT simulation images and different sequences of MR simulation images using deformable image registration. Results:The volumes of LC T2, LC 2T1, LC 5T1 and LC 10T1 were all larger than that of LC CT. A statistical significance was found between the volume of LC CT and those of LC 2T1 or LC 5T1, respectively (both P<0.05). The conformal index (CI), degree of inclusion (DI), dice similarity coefficient (DSC) and the distance between the center of mass of the targets (COM) of LC CT-LC 10T1 were better than those of LC CT-LC T2, LC CT-LC 2T1 and LC CT-LC 5T1, however, there was no statistical difference among them (all P>0.05). Conclusions:It is feasible to delineate the LC based on prone delayed-enhancement MR simulation images in patients with low CVS after BCS. Meanwhile, the LCs derived from prone delayed-enhancement T 1WI of 10-minute are the most similar with those derived from prone CT simulation scans using titanium clips, regardless of the volumes and locations of LCs.

Objective To investigate the impact of multi-b-value on texture features of DWI in liver cirrhosis.Methods DWI manifestations of liver cirrhosis in 37 patients were analyzed retrospectively,and DWI of 27 healthy volunteers (control group) were enrolled as controls.The b values were set as 0,20,50,100,200,400,800,1 000,1 200 and 1500 s/mm2,respectively.Three ROIs at different levels of every set image were selected,and 37 texture features within these ROIs were extracted.Unstable texture features affected by different b-values were screened with the percent coefficient of variation (％COV),and the fitting degree between the unstable texture features and b values were analyzed with exponential fitting.Results Among 37 texture features,20 (20/37,54.05 ％) were unstable.With the increase of b values,exponential upward trend was found in 10 texture features,exponential downward trend was found in 4 texture features,and the relative trends could not be defined in other 6 unstable texture features.Conclusion The b values of DWI impact the texture features in liver cirrhosis.Correlations exist among some texture features and b values.

Objective:This study evaluates the relationship between carcino-embryonic antigen (CEA) and carbohydrate antigen 153 (CA153) continuous and remarkable reduction after chemotherapy and no-imaging progression in patients with advanced breast can-cer. Methods: Medical records of 93 patients who received chemotherapy in the Oncology Department of the General Hospital of Shenyang Military Command were included in the retrospective analysis. A total of 188 CEA and CA153 serum data were collected from response evaluations that included 105 CEA cases and 139 CA153 cases. Predictive validity of serum CEA and CA153 was as-sessed for diagnosing no-imaging progression. Results:CEA was continuously reduced by 10%, with sensitivity of 54.1%and specificity of 95%. CA153 was continuously reduced by 40%, with sensitivity of 19.1%and specificity of 96.6%. Conclusion:Serum CEA and CA153 could be considered as response evaluation tools when they are continuously reduced by at least 10%and 40%, respectively.

BACKGROUND:Recently, studies on three-dimensional reconstruction and biomechanics became more and more. Three-dimensional models of organs were established by modeling software based on image data using computer. Mechanical analysis was conducted using finite element analysis software. After literature retrieval, we found that the principle of three-dimensional reconstruction of human organs is not clear, and the process description is relatively simple. Some is not accorded with the fact. Above studies cannot guide related research. OBJECTIVE:To explore the principle, process, results and further application of three-dimensional reconstruction models of organs, and to provide evidence for future studies. METHODS:We retrieved China National Knowledge Infrastructure for representative literatures about three-dimensional reconstruction of human organs using the computer, and analyzed the principle, process, results and further application of three-dimensional reconstruction models of organs. RESULTS AND CONCLUSION:In combination with established three-dimensional bone models, we explained the principle, process, and application of three-dimensional reconstruction in detail, and laid the theoretical foundation for subsequent biomechanical research. With continuous development of tissue engineering technology, scholars have begun to study the pathogenesis of bone injury from various angles and different aspects so as to better prevent and treat this disease. The related research is stil in its primary stage, and stil needs further investigations. 

Objective To study the relationship between rs290487,rs7903146 of transcription factor 7-Like 2 (TCF7L2) gene and post-transplantation diabetes mellitus in Han Zhejiang population.Method We genotyped two single nucleotide polymorphisms (SNPs) across the TCF7L2 gene in 90 unrelated post-transplantation type 2 diabetes mellitus (PTDM) patients,112 unrelated non-PTDM patients,and a set of post-transplantation diabetes mellitus patients (n =68).Genotyping was performed using direct sequencing SNP Genotyping Assays.The association of SNPs with post-transplantation diabetes mellitus was analyzed.Result In this study,there was statistically significant difference in the T-allele of TCF7L2.rs7903146 between PTDM group (5.1％) and non-PTDM group (1.3％) (P＜0.05).For rs7903146,the frequencies of genotype C/C,C/T (70.0％) and T/T (35.8％) was statistically significant in PTDM group (P＜0.05).For rs290487,the frequencies of genotype C/C,C/T and T/T was 14.7％,38.2％ and 47.1％ respectively in PTDM group,P＞ 0.05.The incidence of PTDM was significantly higher in patients with the CT genotype (odds ratio 18.54 [95％ CI 1.21-282.26],P =0.03).Conclusion With the current sample size,we found that the CT genotype of rs7903146 was significantly associated with post-transplantation diabetes mellitus.

Objective To investigate the distribution and severity of cerebral artery stenosis and the prognosis in elderly patients with acute cerebral infarction using digital subtraction angiography (DSA). Methods The 432 elderly patients with acute cerebral ischemia infarction underwent DSA,and they were divided into two groups: elderly group (n= 320) and non-elderly group (n= 112). The characteristics of distribution and severity of cerebral artery stenosis, the relationship between artery stenosis and relative risk factors, and the prognosis of acute cerebral infarction were analyzed.Results In elderly group, 270 cases (84.3%) had intra- and extra- cranial artery stenosis, of which 98 patients (30.6%) with pure extracranial arterial stenosis, 132 patients (41.3%) with combined extra- and intra-cranial artery stenosis. They were both significantly higher than the corresponding data in non-elderly group [23 cases (20.5%) and 28 cases (25%), P＜0.05 and 0.01]. The prevalences of moderate and severe cerebral artery stenosises were higher in elderly group than in nonelderly group [224 locations (52.1%) vs. 51 locations (40.8%), P＜0. 05]. The number of patients with previous history of cerebrovascular disease was much more and the prognosis was much worse in elderly group than in non-elderly group (both P＜0.05), Conclusions The elderly patients with cerebral infarction have severer cerebral artery stenosis, increased proportion of multivessel disease and poor prognosis. So it is very important to take aggressive treatment as soon as possible, and to make secondary prevention and effective rehabilitation so as to improve their prognosis.

Objective To investigate the correlation of the lesion pattern of internal border zone infarction (IBZI) with atherosclerosis and outcome.Methods Eighty-one patients with IBZI were retrospectively divided into a simple IBZI group and a mixed IBZI group (combined with other infarct patterns) according to diffusion-weighted imaging (DWI).The clinical characteristics were compared between the 2 groups.And then,the mixed IBZI group was further divided into 3 subgroups:IBZI + pial infarct (PI),IBZI + perforating artery infarct (PAI),and IBZI + PI + PAI.They were compared with the simple IBZI group respectively.Results There were no significant differences in the dinical characteristics,such as age,hypertension,and the numbers of patients with stent implantation between the simple IBZI group and the mixed IBZI group.The proportions of severe stenosis and occlusion of internal carotid artery (ICA) and/or middle cerebral artery (MCA) (P =0.009) and MCA lesions (P =0.032) in the mixed IBZI group were significantly higher.Among the patients with MCA lesions,the severe stenosis in the simple IBZI group was significantly more than that in the mixed IBZI group (P =0.042),while the occlusive lesions in the mixed IBZI group were significantly more than those in the simple IBZI group (P =0.022).The short-term (within 7 days) exacerbation (P =0.039) and poor outcome at 90 days (modified Rankin Scale＞ 3) in the mixed IBZI group (P=0.030) were significantly higher than those in the simple IBZI group.The subgroup analysis showed that the proportions of the short-term exacerbation (P =0.001 ) and poor outcome in patients at 90 days (P =0.010) in the IBZI + PI +PAI subgroup were significantly higher than those in the simple IBZI group.Conclusions The IBZI patients combined with other infarct patterns often exist severe cerebrovascular stenosis and occlusion,and their clinical outcome was poorer.For patients with MCA lesions,the mixed IBZI occurred more in patients with MCA occlusion,and the simple IBZI occurred more in patients with severe MCA stenosis.

Objective To compare the displacements of the clips in the cavity measured with orthagonal kilovoltage (KV) X-my plain film in conditions of moderate deep inspiration breathing hold(mDIBH) and free breath (FB), and compare the margins from clinical target volume (CTV) to planning target volume (PTV) based on the displacements. Methods Before radiotherapy, 2 and 5 sets of orthogonal KV plain film were respectively collected in mDIBH and FB group, then the automatic registration of the reconstructed KV plain film and DRR derived from the planning OF images was finished. In conditions of mDIBH and FB, the displacements of the selected clip at the same location in the different directions and of the different selected clips in the same direction were compared. The margins in three dimensional directions were calculated and compared in conditions of mDIBH and FB . Results In FB hold group, the difference of displacement in left-right (LR), cranial-caudal (CC) and anterior-posterior (AP) directions were statistically significant between the clips at the cranial and caudal border of the cavity (9. 7 mm and 10. 6 nun (Z = -2. 12,P =0. 037) ,7. 3 mm and 8. 3 mm (Z = -2. 31 ,P=0. 041) ,15.5 mm and 16. 1 nun (Z = -2. 32,P = 0. 041)), but not statistically significant for the clips at the bottom and lateral P=0.814),15.7 mm and 16.5 mm (Z=-0.26,P=0.856)). The corresponding differences in the different directions were statistically significant (5.0 mm and 7. 8 mm(Z = -2. 31, P =0. 036), 5.0 mm and 9. 3 nun (Z= -2. 21,P=0. 021),7. 8 mm and9.3 mm (Z= -2. 11,P=0.041)). In FB group, the differences of the displacements of the four selected clips were statistically significant in CC and AP directions (7.3 mm and 8.4 mm (Z= -2.45,P=0.021), 15.5 mm and 16.5 mm (Z= -2.41,P= 0.043)), but not in LF direction (10.6 nun and 10.6 mm (Z= -0.24,P=0. 815)). In mDIBH group, the displacements in LF direction were statistically significant (4. 4 mm and 5.4 mm (Z = -2. 31, P = O. 031)), but not in CC and AP directions (8. 6 mm and 8.6 mm (Z =-0. 21, P = 0. 815), 10. 5 mm and 10. 8 mm (Z = -0. 27 ,P =0. 754)). There were statistically significant difference of the margins in LF and AP directions (9.7 mm and 5.0 mm (Z= -2.34,P=0.029),15.5 mm and 9.3 mm (Z= -2. 31,P= 0.021)), but not in CC direction (7.3 mm and 7. 8 mm (Z= -0.29,P =0.770)) between mDIBH and FB conditions. Conclusions The margins extended from CTV to PTV for EBPBI should be determined based on the respiratory status, border location and border direction.

BACKGROUND:At present,using membrane materials to separate spinal dura mater and scar tissue or using semiliquid materials to surround the dimension of operation are very common after laminectomy.However,therapeutic eflfects ale not satisfactory.Inhibition to the proliferation of fibroblasts,which are the main components of repairing cells,and regulating collagen metabolism have become a hot spot for preventing and treating pathological scar by a biological method.OBJECTIVE:To compare the therapeutic effects of topical application of different concentrations of mitomycin C (MMC)on preventing pefidural adhesion in rats after laminectomy by a qualitative and quantitative combined method.DESIGN:A completely randomized grouping.controlled animal experiment.SETTING:Department of Orthopaedics,Second People's Hospital of Lianyungang City.MATERIALS:Forty healthy adult male SD rats,weighing 200-220 g,were provided by the Animal Experimental Center,Nanjing Medical University.MMC was produced in Union Fermentation Co.,Ltd(Batch No.425ACI,Import drugs registration No.H20020163,Japan).METHODS:The study was performed at the Animal Laboratory Center,Nanjing Medical University,and the Basic Experimental Center,Medical College,Jiangsu University from June 2004 to October 2006.The 40 SD rats were ralndomly divided into 4 groups with 10 rats in each group:MMC high-,medium-,and low-concentration groups,and a control group.After anesthesia,each rat was removal of L1 vertebral plate.A defect(0.2 cm×0.5 cm)was created to expose duml mater.After hemostasia,cotton Pads soaked either with various concentrations ofMMC(0.1,0.05,0.01 g/L)or saline were covered on the laminectomy defects in the three MMC-treated groups and the control group for 5 minutes respeetively.The protocol was carried out in accordance with ethical guidelines for the use and care of animals.MAIN OUTCOME MEASURES:After the operation,4 rats were randomly selected from all anesthetized rats in each group,separately.The peridural scar tissue in the laminectomy segment was cut for calculating the contents of hydroxyproline.Spine columns in the laminectomy segment including Surrounding muscle tissue were resected for measuring irregular sear transverse area and counting the number 0ffibroblasts.The degree of peridural scar adhesion was evaluated by the light microscope.RESULTS:Forty rats were included in the final analysis.In the control group,peridural scar tissue was dense and closely adhered to dura mater.In the MMC high-concentration group.no noticeable peridural adhesion was found.and contents of hydroxyproline,collagen tissue area and the amount of fibroblasts in the scartissue were significantly reduced compared to control group(all P＜0.05).In the MMC medium-and low-concentration groups,contents of hydroxyproline,collagen tissue area and the amount of fibroblasts had reduced to different extents compared to control group.There was significant difference only in the amount of fibroblasts between the MMC mediumconcentration group and the control group(P＜0.05).Incontinuous adhesion between scar tissue and dura mater was found in the MMC medium-and low-concentration groups.CONCLUSION:Topical application of 0.1 g/L MMC can effectively reduce peridural scar tissue hyperplasia and avoid peridural scartissue adhesion afterlaminectomy.