Objective To investigate the effect of exosomal miR-146a-5p expression on gray matter volume in patients with major depressive disorder(MDD).Methods A total of 113 MDD patients(MDD group)and 107 healthy controls(HC)(HC group)were selected.Peripheral blood was collected and exosomes were isolated to quantify miR-146a-5p expression.Brain high-resolution T1 WI images of MDD and HC were obtained via MR,and gray matter volume was computed via SPM12 software.The interaction effect of"Depression×miR-146a-5p expression"on gray matter volume was analyzed using SPM's Flexible factorial design,and the between-group difference was assessed by extracting the mean value,thus to analyze whether MDD-related gray matter volume abnormalities were dependent on miR-146a-5p expression.Results Exosomal miR-146a-5p expression was significantly elevated in MDD group compared to HC group.Voxel-based factorial analysis revealed a relationship between high miR-146a-5p expression in MDD group and reduced gray matter volume in the anterior and posterior cingulate cortices(independent voxel threshold P＜0.001,AlphaSim corrected),and a significantly reduced gray matter volume as compared with HC group was detected in the two regions.Conclusion The exosomal miR-146a-5p is overexpressed in patients with MDD and may be associated with specific cortical atrophy in patients with MDD.

Intracranial seminoma is a rare malignant tumor originating from the germ cells,usually occurring in the pineal gland or pituitary gland.In June 2020,the Department of Endocrinology at the First Affiliated Hospital of Army Military Medical University admitted a 20-year-old male patient with an intracranial germ cell tumor and spinal metastases.The patient presented with headache,dizziness,and visual impairment.Enhanced magnetic resonance imaging(MRI)of the head indicated thickening of the pituitary stalk.After multidisciplinary consultation,the patient underwent endonasal transsphenoidal resection of the tumor,with the pathological diagnosis confirming germ cell tumor.The patient received regular radiotherapy postoperatively.One year later,the tumor recurred and metastasized,leading to a second surgery for tumor resection in the thoracic spinal canal,followed by continued chemotherapy.The patient's clinical symptoms,such as headache and visual disturbances,improved,but he continued to experience panhypopituitarism and required long-term hormone replacement therapy.Early diagnosis of intracranial germ cell tumors is challenging,and they are prone to metastasis and highly sensitive to radiotherapy and chemotherapy.Early diagnosis and multidisciplinary comprehensive treatment can help improve the quality of life and prognosis for patients.

Objective:To investigate the clinical value of abdominal adipose volume in predicting early tumor recurrence after resection of hepatocellular carcinoma (HCC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 132 HCC patients with tumor diameter ≤5 cm who were admitted to The First Affiliated Hospital of Army Medical University from December 2017 to October 2019 were collected. There were 110 males and 22 females, aged (51±4)years. All patients underwent resection of HCC. Preoperative computer tomography scanning was performed and the visceral and subcutaneous fats of patients were quantified using the Mimics Research 21.0 software. Based on time to postoperative tumor recurrence patients were divided to two categories: early recurrence and non-early recurrence. Observation indicators: (1) consistency analy-sis; (2) analysis of factors influencing early tumor recurrence after resection of HCC and construction of prediction model. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribu-tion were represented as M( Q1,Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Consistency analysis was conducted using the intragroup correlation coefficient (ICC) test. Multivariate analysis was performed using the binary Logistic regression model forward method. Independent risk factors influencing early tumor recurrence after resection of HCC were screened. The area under curve (AUC) of receiver operating characteristic (ROC) curve was applied to select the optimal cut-off value to classify high and low risks of recurrence. The Kaplan-Meier method was used to draw survival curve and calculate survival time. The Log-Rank test was used for survival analysis. Results:(1) Consistency analysis. The consistency ICC of abdominal fat parameters of visceral fat volume (VFV), subcutaneous fat volume, visceral fat area, and subcutaneous fat area measured by 2 radiologists were 0.84, 1.00, 0.86, and 0.94, respectively. (2) Analysis of factors influencing early tumor recurr-ence after resection of HCC and construction of prediction model. All 132 patients were followed up after surgery for 662(range, 292-1 111)days. During the follow-up, there were 52 patients with non-early recurrence and 80 patients with early recurrence. Results of multivariate analysis showed that VFV was an independent factor influencing early tumor recurrence after resection of HCC ( odds ratio=4.07, 95% confidence interval as 2.27-7.27, P<0.05). The AUC of ROC curve based on VFV was 0.78 (95% confidence interval as 0.70-0.85), and the sensitivity and specificity were 72.2 % and 77.4 %, respectively. The optimal cut-off value of VFV was 1.255 dm 3, and all 132 patients were divided into the high-risk early postoperative recurrence group of 69 cases with VFV >1.255 dm 3, and the low-risk early postoperative recurrence group of 63 cases with VFV ≤1.255 dm 3. The disease-free survival time of the high-risk early postoperative recurrence group and the low-risk early post-operative recurrence group were 414(193,702)days and 1 047(620,1 219)days, showing a significant difference between them ( χ2=31.17, P<0.05). Conclusions:VFV is an independent factor influen-cing early tumor recurrence of HCC after resection. As a quantitative indicator of abdominal fat, it can predict the prognosis of HCC patients.

Objective To discuss the application value of liver shear wave velocity(SWV)and its correlation with portal vein pressure in evaluating the efficacy of interventional therapy for Budd-Chiari syndrome(BCS).Methods The clinical data of 40 BCS patients,who were admitted to the Affiliated Hospital of Xuzhou Medical University of China to receive treatment between April 2020 and April 2022,were collected.During interventional procedure,the hepatic venous pressure gradient(HVPG)was determined separately before and after recanalization of the treated vessels,the liver SWV was determined at one day before,2 days,1 month and 3 months after the treatment,and the above indexes were statistically analyzed.Results Successful initial interventional therapy was accomplished in all patients.The preoperative one-day,postoperative 2-day,one-month and 3-month mean liver SWV values were(2.34±0.36)m/s,(1.74±0.36)m/s,(1.62±0.30)m/s,and(1.56±0.28)m/s respectively.The differences in the mean liver SWV between its preoperative value and its postoperative 2-day,one-month and 3-month value were statistically significant(all P＜0.05),and statistically significant difference in the mean liver SWV also existed between postoperative 2-day value and postoperative 3-month value(P＜0.05).The mean HVPG decreased from preoperative(15.19±2.35)mmHg(1 mmHg=0.133 kPa)to postoperative(6.44±1.34)mmHg(P＜0.05).The preoperative one-day liver SWV was positively correlated with preoperative HVPG(r=0.803,P＜0.01).The postoperative 2-day liver SWV also carried a positive correlation with the postoperative HVPG(r=0.844,P＜0.01).The difference value(D-value)between preoperative liver SWV value and postoperative 2-day liver SWV value was(0.59±0.27)m/s,and the D-value between preoperative HVPG value and postoperative HVPG value was(8.75±1.92)mmHg,and a positive correlation existed between the above two D-values(r=0.676,P＜0.01).Conclusion There is a good correlation between liver SWV and HVPG,which can be used to evaluate the postoperative efficacy of BCS patients after receiving interventional therapy.(J Intervent Radiol,2023,32:1178-1183)

Objective To compare the diagnostic value of shear wave elastography (SWE) and acoustic radiation force impulse imaging (ARFI) in benign and malignant thyroid nodules (TNs).Methods A total of 43 patients with 51 thyroid nodules were included.According to the diameter,all nodules were divided into small nodules (diameter ≤1 cm) and large nodules (1 cm＜diameter≤3 cm).All patients underwent both SWE and ARFI examinations at the same time.SWE (Emax,Emean,Emin),virtual touch tissue quantification (VTQ) and virtual touch tissue imaging (VTI) area ratio were obtained.The optimal cut-off values of SWE,VTQ,VTI area ratio were calculated with ROC curve to identify malignant thyroid nodules from benign ones,and the sensitivity,specificity,accuracy of Emax,VTQ and VTI area ratio were calculated respectively.Results The cut-off value of Emax,VTQ,VTI area ratio in differential diagnosis of benign and malignant TNs was 37.74 kPa,2.19 m/s and 1.24,respectively.The sensitivity was 85.30％ (29/34),76.50％ (26/ 34),64.71％ (22/34),the specificity was 100％ (17/17),94.10％ (16/17),88.20％ (15/17),the accuracy was 90.20％ (46/51),90.20％ (46/51),72.55％ (37/51) of E VTQ and VTI area ratio in diagnosis of malignant thyroid nodules,respectively.The sensitivity of Emax and VTQ in the diagnosis of malignant large NTs was 92.31％ (12/13) and 100％ (13/13),respectively,while the sensitivity of VTI area ratio and Emax in the diagnosis of malignant small NTs were both 80.95％ (17/21).Conclusion Either SWE or ARFI has good diagnostic performance in distinguishing malignant thyroid nodules from benign ones.Emax is of equal value in diagnosing thyroid benign and malignant nodules.VTQ has advantage for diagnosing large NTs,while VTI area ratio shows better diagnostic performance for small NTs.

Objective To discuss the application of the correlation between spleen shear wave velocity (SWV) and portal vein pressure in evaluating short-term curative effect of interventional therapy for Budd-Chiari syndrome (BCS).Methods The clinical data of a total of 30 BCS patients,who were admitted to authors' hospital during the period from May 2016 to October 2016 to receive treatment,were collected.The hepatic venous pressure gradient (HVPG) was measured before as well as after percutaneous transluminal angioplasty in all patients.Spleen SWV,the velocity and internal diameter as well as the velocity-to-diameter ratio of portal vein were calculated,the results were statistically analyzed.Results Technical success was achieved in all 30 patients.The mean HVPG score was strikingly reduced from preoperative (13.70±4.55)mmHg to postoperative (3.20±1.94) mmHg (P＜0.05).The preoperative and postoperative difference in HVPG had a parallel relationship with the preoperative and 2-day postoperative difference in spleen SWV as well as with the preoperative and 2-day postoperative difference in velocity-to-diameter ratio (r=0.856,P＜0.0001 and r=0.741,P＜0.0001 respectively).Conclusion A significant correlation exists between the spleen SWV and HVPG,therefore,SWV can be used as an effective index to evaluate the short-term curative effect of interventional treatment for BCS.

Objective To investigate the influence of age on perioperative clinical parameters, tumor resection effects and complications of patients with early stage gastric cancer for single lesion treated by ESD.Methods 60 patients with early stage gastric cancer for single lesion treated by ESD were chosen from January 2013 to July 2014 and divided into 2 groups including A group (35 patients) with < 60 years old and B group (25 patients) with ≥ 60 years old; and the operation time, intraoperative blood loss, hospital staying time, tumor curative resection and completed rate, the recurrence rate with follow-up and complications incidence of 2 groups were compared.Results All the patients were successfully performed the operation and no bleeding cases. There was no significant difference in the operation time, intraoperative blood loss, hospital staying time between 2 groups (P < 0.05). There was no significant difference in the tumor curative resection and completed rate between the 2 groups (P < 0.05). There was no significant difference in the recurrence rate with follow-up between 2 groups (P < 0.05). There was no signiifcant difference in the complications incidence between 2 groups (P < 0.05).Conclusion ESD is safe and feasible in the treatment of elderly patients with early stage gastric cancer for single lesion, and it is equivalent to short- and long-term efifcacy in non-elderly patients and not increase the operation time, the trauma degree and complications risk.

Objective To investigate the applicative value of acoustic radiation force impulse imaging (ARFI) in the differential diagnosis of small hypoechoic thyroid nodules.Methods 31 patients were pathologically confirmed as having a total of 44 small hypoechoic thyroid nodules ≤ 1 cm in diameter,followed by analyses of the characteristics of their ARFI images,including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ).Based on VTI images of the nodules,the hardness of small hypoechoic thyroid nodules was respectively scored,and the ratios of VTI images to gray scale image areas were calculated.With pathological diagnosis as the gold standard,VTI scores,area ratios and VTQ values of the ROC curve in diagnosis of thyroid malignant nodules were sketched so as to explore the optimal cut-off points in VTI scores,area ratios and VTQ values in the diagnosis of malignant nodules.Results By the ROC curve test,VTI score of 3 was determined as the cut-off point of areas ratio,with the sensitivity and specificity of diagnosing thyroid cancer being 96.0 ％ and 94.7％,respectively.There were 34 nodules with VTI score greater than 3 (including 9 benign nodules and 25 malignant nodules) and 10 nodules with VTI score of 3 or less (all benign nodules).Malignant thyroid nodules had higher ratio of VTI images to gray scale image area than that of the benign nodules (1.58 ± 0.18 vs 1.30 ± 0.10,P ＜0.05).When 1.47 was set as the cut-off point of areas ratio,the sensitivity and specificity of diagnosing thyroid cancer were 80.0％ and 94.7％,respectively.The VTQ value of 2.76 m/s in diagnosis of thyroid malignant nodules was designated as the cut-off point,with a sensitivity of 88.0 ％,specificity of 94.7 ％.Conclusions The ARFI technique is able to provide information of thyroid nodule hardness,which guarantees its high applicative value in the differential diagnosis of small hypoechoic thyroid nodules.

Objective To investigate the value of virtual touch tissue imaging (VTI) in the differential diagnosis of small solid thyroid nodules.Methods 35 patients with 41 small thyroid nodules were examined by conventional ultrasound and VTI examination.The stiffness of the nodules in VTI images was scored.Area ratios of VTI and gray scale images of nodules were calculated.The pathological diagnosis was used as the gold standard.The ROC curve was drawn to determine the cut off point of area ratio to predict thyroid cancer.Results 41 small thyroid nodules were confirmed by pathological diagnosis,including 23 benign and 18 malignant nodules.Compared with benign nodules,the ratio of VTI hardness score ≥4 was significantly higher in the malignant nodules (88.9％ vs 8.7％,P ＜0.01).Compared with benign nodules,the area ratios of malignant nodules were higher (1.67 ± 0.16 vs 1.23 ± 0.12,P ＜0.01).When 1.46 was set as the cut off point of areas ratio,the sensitivity and specificity of diagnosing thyroid cancer were 88.9％ and 95.7％,respectively.Conclusions VTI can provide information about thyroid nodules hardness.It has high value in the differential diagnosis of small solid thyroid nodules.