Objective:To explore the predictive value of qualitative and quantitative parameters of dual-layer spectral detector CT plain scan on the invasiveness of pure ground-glass pulmonary nodules (pGGNs).Methods:Clinical and imaging data of 113 patients (119 pGGNs) with pathology-proven lung adenocarcinoma who underwent preoperative dual-layer spectral detector CT plain scan in Tianjin Medical University Cancer Institute and Hospital from November 2019 to December 2020 were retrospectively analyzed. According to invasiveness, pGGNs were divided into non-invasive adenocarcinoma (non-IA) group ( n=66) and IA group ( n=53). The non-IA group included atypical adenomatous hyperplasia ( n=10), adenocarcinoma in situ ( n=26) and minimally invasive adenocarcinoma ( n=30). The qualitative parameters were nodule shape, lung-tumor interface, lobulation, spiculation, pleural retraction, bubblelike lucency, air bronchogram and vascular abnormality. The quantitative parameters included nodule size, effective atomic number (Z eff), CT value on 120 kVp images (CT 120 kVp) and virtual monoenergetic images from 40 keV to 200 keV (CT 40 keV-CT 200 keV), and slope of energy spectrum curve (λHU). The χ 2 test, Mann-Whitney U test and independent sample t test were used to analyze the parameter differences between non-IA group and IA group. Multivariate logistic regression analysis was performed to screen out independent predictors. Receiver operating characteristic (ROC) curve was used to assess the diagnostic efficacy of single predictor and combined independent factors for the invasiveness of pGGN. Results:Significant differences were found in nodule shape, lobulation, air bronchogram, vascular abnormality, nodules size, Z eff, CT 120 kVp and CT 40 keV-CT 200 keV between non-IA and IA groups ( P<0.05). The maltivariate logistic regression analysis showed that nodule size [odds ratio 9.269, 95% confidence interval (CI) 1.640-52.395, P=0.012] CT 200 keV (odds ratio 1.012, 95%CI 1.006-1.019, P<0.001) as well as vascular abnormality sign (odds ratio 4.940, 95%CI 1.358-17.969, P=0.015) were independent predictors of pGGN invasiveness. ROC curve analysis of a single independent predictor and a combination of the three factors showed that the area under the curve (AUC) of the combination of three factors predicting the invasiveness of pGGN was significantly higher than the AUC of vascular abnormality sign ( Z=4.01, P<0.001) and CT 200 keV ( Z=3.25, P=0.001), while there was no significant difference in AUC between the combination of the three factors and nodule size ( Z=1.94, P=0.052). The AUC of the combination of the three independent predictors was 0.909, and the sensitivity and specificity for predicting pGGN invasion were 81.1% and 86.4%, respectively, using a threshold of 0.505. Conclusion:The combination of qualitative and quantitative parameters of dual-layer spectral detector CT plain scan shows a high predictive value for the invasiveness of pGGNs.

Objective To evaluate changes in morphology of the cesarean scar and uterus between one and two years after cesarean section using high-resolution, three dimensional T2-weighted sampling perfection with application optimized contrast using different flip angle evolutions Magnetic Resonance Imaging (3D T2w SPACE MRI). Methods This prospective study was performed to investigate morphological changes in the cesarean scars and uterus from one to two years after cesarean section using high-resolution, 3D T2w SPACE MRI. The healthy volunteers having no childbearing history were recruited as the controls. All data were measured by two experienced radiologists. All data with normal distribution between the one-year and two-year groups were compared using a paired-sample t test or independent t test. Results Finally, 46 women took a pelvic MR examination one year after cesarean section, and a subset of 15 completed the same examination again after two years of cesarean section. Both the uterine length and the anterior wall thickness after two years of cesarean section (5.75 ± 0.46 and 1.45 ± 0.35 cm) were significantly greater than those measured at one year (5.33 ± 0.59 and 1.25 ± 0.27 cm) (t = -2.363 and -2.175, P= 0.033 and 0.048). No significant difference was shown in myometrial thickness two years after cesarean section (1.45 ± 0.35 cm) with respect to the control group (1.58 ± 0.21 cm, P = 0.170). Nine women who underwent MRI twice were considered to have scar diverticula one year after cesarean section, and still had diverticula two years after cesarean section. The thickness, height, and width of the uterine scar showed no significant change from one to two years (all P > 0.05). Conclusions 3D T2w SPACE MRI provides overall morphologic details and shows dynamic changes in the scar and the uterus between one and two years after cesarean section. Scar morphology after cesarean section reached relatively stable one year after cesarean section, and uterine morphology was closer to normal two years after cesarean section.

Objective:To investigate the correlation between amide proton transfer-weighted (APTw) values and Ki-67 labeling index of cervical squamous cell carcinoma.Methods:From October 2017 to December 2018, 24 patients with cervical squamous cell carcinoma [International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ-Ⅲ] were prospectively enrolled in Peking Union Medical College Hospital and underwent pelvic morphological MRI on a 3.0 T MR scanner, including three-dimensional turbo-spin-echo APTw imaging and DWI. The maximum diameters of the lesions, APTw values and ADC values on the slice with the maximum diameter of the lesion were independently measured by two radiologists. The ICC was computed to evaluate the inter-observer consistency. Ki-67 immunohistochemical expression status was assessed by one pathologist. The Pearson correlation analysis was performed between the APTw values, maximum diameters, ADC values and Ki-67 labeling index.Results:The APTw values of cervical squamous cell carcinoma were (2.9±0.5)%. Inter-observer ICC was 0.972 (95%CI 0.937-0.988). The APTw values were positively moderately correlated with Ki-67 labeling index [(61.9±18.7)%, r=0.532, P=0.008]. The maximum diameters of the lesions were (28.7±10.6) mm. The mean ADC values were (0.998±0.217)×10 -3 mm 2/s. No correlations were found between maximum diameters, ADC values and Ki-67 labeling index ( r=0.038, P=0.859; r=0.238, P=0.263). Conclusion:APTw values can partially reveal the proliferation status of cervical squamous cell carcinoma.

Objective:To compare the effects of different intraocular infusion solutions on histology and function of retina.Methods:Human corneal endothelial cells (HCEC), human retinal pigment epithelium (HRPE) cells and rat retinal ganglion cells (RGC) were divided into normal control group, balanced saline solution (BSS) group and compound electrolyte intraocular irrigating solution (CEIIS) group, and the cells were cultured in 10% DMEM/F12 medium, BSS and CEIIS for 12, 24 and 48 hours, respectively, according to grouping.The proliferation absorbance value of cultured cells was measured by cell counting kit-8 (CCK8) method.The expression of apoptosis related proteins in cultured cells was detected by cellular immunofluorescence staining.The cell apoptosis rate and cell cycle were measured by flow cytometry.The mitochondrial damage was detected by lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH) quantitative detection kit.Fifteen New Zealand white rabbits were randomly divided into control group ( n=3), BSS group ( n=6) and CEIIS group ( n=6). The left eyes were taken for vitrectomy and different intraocular perfusion fluids were used during vitrectomy according to grouping.The retinal function of operative eyes was measured by flash electroretinogram (ERG) before operation and 24 hours after operation, and the structural changes of each layer of retina were detected by optical coherence tomography (OCT). The early apoptosis of retinal cells was detected by TUNEL staining.The expressions of cytochrome C and bax protein in retina were detected by immunohistochemical staining.The ultrastructural changes of retina were observed under a transmission electron microscope.The use and care of animals complied with the ARVO statement.This study protocol was approved by an Ethics Committee of Peking University People's Hospital (No.2019PHE059). Results:The three kinds of cultured cells in BSS and CEIIS groups were damaged in various degrees.With the extension of culture time, proliferated cells were decreased and the number of apoptotic cells was increased.Compared with the BSS group, cultured cells in the CEIIS group were dense and in orderly arrangement with uniform morphology and size.The apoptosis rates of HRPE cells and RGC in the BSS group were (37.157±6.918)% and (29.993±12.330)%, respectively, which were significantly higher than (4.163±1.310)% and (6.337±1.903)% in the CEIIS group ( P=0.003, 0.045). There was no significant difference in G0/G1+ S phase ratio of HCEC and HRPE cells among the normal control group, BSS group and CEIIS group (HCEC: F=2.226, P=0.189; HRPE: F=2.634, P=0.151), and the proportion of G2/M division arrest phase of RGC in the BSS group was significantly higher than that in the normal control group and CEIIS group ( P=0.047, 0.024). The proliferation absorbance values of HCEC, HRPE cells and RGC in the CEIIS group were significantly higher than those in the BSS group at each culture time point (all at P<0.05). The fluorescence intensity of cytochrome C, bax, caspase-3 and caspase-9 proteins in the BSS group was stronger than that in the normal control group and CEIIS group, and the fluorescence intensity of bcl-2 was weaker than that in the CEIIS group, and the fluorescence intensity of zonula occluden-1 (ZO-1) was weaker than that in the normal control group and CEIIS group.The release level of LDH in the BSS group was significantly higher than that in the CEIIS group at different time points (all at P<0.001). After 48 hours of culture, the release level of SDH in the BSS group was significantly higher than that in the CEIIS group ( P<0.05). No retinal histological abnormalities was found through OCT examination of rabbit eyes after vitrectomy in the two groups, but transmission electron microscopy showed that there were different degrees of loose arrangement of retinal photoreceptor cells, a large number of photoreceptor outer membrane discs falling off and vacuolar degeneration in the two groups, especially in the BSS group.TUNEL staining showed that the apoptotic cells were mainly located in the inner nuclear layer and RGC layer.The number of apoptotic retinal cells was (135.2±22.8)/high-power field of vision in the BSS group, which was significantly higher than (81.3±17.7)/high-power field of vision in the CEIIS group ( t=4.175, P=0.002). Full field flash ERG showed that the amplitudes of scotopic 3.0 ERG a- and b-wave in the CEIIS group after operation were significantly lower than those before operation, but the differences were not statistically significant (all at P>0.05). The amplitudes of scotopic 3.0 ERG a- and b-wave in the BSS group after operation were significantly lower than those before operation ( P=0.026, 0.010). Conclusions:In vivo and in vitro research results show that compared with BSS, there were few apoptotic cells in retinal tissue after vitrectomy perfused by CEIIS.

Objective: To explore the application value of 3.0 T MultiVane XD (MVXD) technique in female patients with uterine adenomyosis and fibroids. Methods: Patients diagnosed with uterine fibroids with ultrasound and suspected of adenomyosis were involved prospectively from March to May 2018, 3.0 T pelvic MRI examinations were performed during peri-ovulatory period. Axialconventional turbo spin echo (TSE) T₂WI, axial MVXD T₂WI, sagittal conventional TSE T₂WI and MVXD sagittal T₂WI were acquired. Two observers rated those 4 series in the aspects of sharpness of uterine border, motion artifacts, identification capability of lesions, confidence of diagnosis and overall image quality. Cohen Kappa analysis was used to evaluate the consistency of scores between 2 observers. Scores of TSE T₂WI and MVXD T₂WI qualities were compared using Wilcoxon matched-pairs signed-ranks test. Results: Twenty patients were enrolled. Axial conventional TSE T₂WI, axial MVXD T₂WI were aquired on all of them. Sagittal conventional TSE T₂WI, sagittal MVXD T₂WI were aquired on 19 among them. Nine patients had only obvious adenomyosis, 6 had only uterinefibroids, and 5 had adenomyosis and uterine fibroids. Compared to conventional TSE technique, scores of two observers in the sharpness of uterine border, motion artifacts, and overall image quality is higher by MVXD with significant difference (P<0.05). The Kappa values for image quality scores of two observers ranged from 0.615 to 0.971, the agreement was good or very good. Conclusion Applying MVXD T₂WI technique to patients with uterine fibroids and adenomyosiscould improve image quality, without sacrificing the ability to recognize and diagnose lesions, compared to conventional TSE T₂WI technique.

Objective　To investigate the difference and significance in the expression of miR-134 in peripheral blood of patients with epilepsy.Methods　Trizol was used to extract serum RNAs of patients with epilepsy,NCode TM VILO TM micrornas cDNA short Kit and Express Sybr those TM micrornas qRTPCR Kits was used to reverse transcriptions and real-time fluorescent quantitative PCR to detect the expression of miR-134.All cases were grouped according to the course of disease,seizure frequency,onset time limit,brain electrical activity and special epilepsy syndrome.Results　Compared with control group,the expression of miR-134 in peripheral blood of epilepsy group is significantly increased,it is obviously higher in long course group and acute group.The expression of miR-134 in different seizure frequency group and special epilepsy syndrome group has no difference.Conclusion　The expression of miR-134 in peripheral blood of patients with epilepsy was significantly increased while it was affected by the length of disease and the duration of seizure.In addition,the expression of miR-134 in peripheral blood of patients with epilepsy was positively correlated with the degree of discharge and severity of damage,indicating that miR-134 could be a biomarker for epilepsy.

Objective To investigate the differences of CT features for different subtypes of pulmonary neuroendocrine tumors (PNETs).Methods CT imaging data of 41 patients with PNETs and 5 patients of lung cancer with neuroendocrine differentiation confirmed by pathology were analyzed retrospectively,and the differences in CT features among pathological subtypes were explored. Results Among the pathological subtypes of 41 PNETs,the statistical differences in the CT features including vascular invasion,the metastatic lymphadenopathy in the hilus and mediastinum were found(P<0.05).However,no differences were found in other imaging findings (lesion location,spiculation,bronchial invasion,atelectasis and obstructive pneumonia,and pleural effusion or thickening)among the subtypes (P>0.05).Among those subtypes PNETs and lung cancer with neuroendocrine differentiation,the differences in tumor size,vascular invasion,and metastatic lymphadenopathy in the hilus and mediastinum were also found (P<0.05).However,no differences were found in other imaging findings (P>0.05).In addition,there were differences in tumor size among different enhancement types and different metastastic presences in the lung or outside of the chest (P<0.05).Conclusion CT shows certain differences among the different subtypes of PNETs,which may be helpful for the differential diagnosis but not specific.

Objective To investigate the application value of pH sensitive manganese-loaded caramelized carbonaceous nanospheres (Mn-CNS) in the synchronous MRI and photothermal therapy for breast cancer. Methods Anhydrous glucose was used as carbon source to prepare caramelized carbonaceous nanospheres(CNS).Mn2 +was absorbed and bonded to its surface to obtain the Mn-CNS.The MR signal values of aqueous solutions of Mn-CNS under different pH(pH=7.4,6.0,5.0)with different Mn2+concentrations(0,0.14,0.28,0.57,1.14 and 2.28 mmol/L)were measured to obtain the relaxation rate.The cell counting kit-8(CCK-8)assay was used to determine the effect of Mn-CNS on the viability of 4T1 cells. Pathological examination was used to evaluate the systemic toxicity. Inductively coupled plasma mass spectrometry (ICP-MS) was used to analyze Mn uptake by different cell lines (human breast cancer cells MCF-7, human normal mammary epithelial cells MCF-10A and human macrophages cells). The 4T1 tumor-bearing BALB/c mice were divided randomly into four groups (6 mice per group): (1) normal saline (intratumoral injection)plus near infrared laser(NIR);(2)normal saline(intravenous injection)plus NIR;(3) Mn-CNS(intratumoral injection)plus NIR;(4)Mn-CNS(intravenous injection)plus NIR.After intratumoral injection for 30 min and intravenous injection for 12 h,the tumors were continuously irradiated with 808 nm laser for 10 min,the temperature changes and relative tumor volume were recorded.The MRI was obtained at different time point(pre-injection and post-injection at 15 min,30 min,1 h,4 h,8 h,12 h,24 h,48 h,4 d, respectively)with the dose of Mn-CNS(4 mg Mn/kg)by intravenous injection.The changes of Mn2+content before and after Mn-CNS incubation and the tumor volume differences among each group were compared by t test.Results The values of r1were 0.18 L·mmol-1·s-1(pH 5.0),3.48 L·mmol-1·s-1(pH 6.0)and 5.42 L· mmol- 1·s- 1(pH 7.4), respectively. The cells viability of 4T1 were all above 90 % when the cells were incubated with Mn-CNS at different concentrations (25, 50, 100 and 200 μg/ml). MCF-7 and human macrophages cells were ingested Mn2+.The Mn2+amount before and after uptake were significant difference(P<0.05).The MCF-10A had a slight uptake of Mn2+which was not statistically significant(P>0.05).After 10 minutes of the laser exposure (2 w/cm2), the change of temperature with tumor among different groups were shown as follow:Mn-CNS(intratumoral injection)>Mn-CNS(intravenous injection)>normal saline(intravenous injection)>normal saline (intratumoral injection). After photothermal therapy, the relative tumor volumes of Mn-CNS (intratumoral injection)and normal saline(intratumoral injection)were statistically different(t=-2.724,P<0.05). Meanwhile,the relative tumor volumes also showsd significant difference among Mn-CNS(intravenous injection) and normal saline (inject intravenous injection) groups (t=-5.193,P<0.05). After intravenous injection of Mn-CNS in 4T1 tumor-bearing mice, the signal intensity of T1gradually increased and reached the peak of enhancement at 4 h after which the signal intensity remained stable and decreased slightly at 12 h,then gradually decreased to normal. The T1signal intensity of kidney was consistent with that of the tumor and higher. Meanwhile, the degree of liver tissue enhancement was the lowest. Conclusions Mn-CNS is highly biocompatible and self-degradable,it can targeted MRI and achieve precise photothermal therapy simultaneously, which is of great value in the integrated diagnosis and treatment of breast cancer.

Objective To explore the fibrotic stroma characteristics of orthotopic liver cancer in rat and the relationship with MR delayed contrast enhancement.Methods 4 Wistar rats with orthotopic liver cancer underwent conventional triphasal and longer-de-layed contrast-enhancement MR scanning.12 HCC specimens obtained from the four Wistar rats were sliced and stained with HE, picric-sirius red,Verhoeff Van-Gieson elastic fiber,Gordon-Sweets reticular fiber and anti-α-SMA immunohistochemical staining.The relationshp between intratumoral fibrotic stroma and MR delayed phases of the 1 2 tumors were analyzed.Results Collagen fiber was expressed mainly in tumor fibrous septum.Elastic fiber distributed in tumor fibrous septum and the artery wall.Reticular fiber dis-tributed in fibrous septum of the regenerative nodules,portal area and tumor psuedocapsule.Integrated optical density (IOD)value of collagen fiber,elastic fiber and reticular fiber analyzed by Image-pro Plus6.0 were 0.102±0.020,0.063±0.018 and 0.109±0.032, respectively.As a result,the amount of collagen and elastic fibers were statistically different (P<0.01),and so were reticular fibers and elastic fibers (P<0.01).And there was a positive correlation between collagen fiber and MR delayed contrast enhancement (P<0.05).Conclusion MR delayed contrast enhancement of hepatic cancer in rat is closely associated with the collagen fiber,thus this fiber in liver cancer can be evaluated noninvasively by MRI.

Objective To evaluate the effect of dexmedetomidine on the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.Methods Forty-two patients of either sex with intracranial aneurysm,aged 57-78 yr,weighing 53-86 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective balloon occlusion test of the internal carotid artery under general anesthesia,were assigned into 2 groups (n =21 each) using a random number table:propofol conbined with remifentanil group (group PR) and dexmedetomidine combined with propofol and remifentanil group (group DPR).In group DPR,dexmedetomidine was intravenously infused over 15 min in a loading dose of 0.5 μg · kg-1 before induction of anesthesia,followed by an infusion of 0.3 μg · kg-1 · h-1 throughout surgery.Propofol and remifentanil were given by target-controlled infusion (TCI) after infusion of the loading dose.The patients were mechanically ventilated after placement of the laryngeal mask airway.Maintenance of anesthesia was as follows:propofol and remifentanil were given by TCI with the target plasma concentrations of 0.5-1.0 μg/ml and 1-3 ng/ml,respectively,in group DPR;propofol and remifentanil were given by TCI with the target plasma concentrations of 3-5 μg/ml and 3-6 ng/ml,respectively,in group PR.Bispectral index (BIS) value was maintained at 40-60.Before wakeup test,propofol infusion was stopped and the target plasma concentration of remifentanil was decreased to 0.5 ng/ml in two groups,and the infusion rate of dexmedetomidine was decreased to 0.1 pg · kg-1 · h-1 in group DPR.The wake-up time was recorded and the wake-up quality was assessed.After admission to the operating room (T0,baseline),at 10 min before wake-up test (T1),immediately after patients were wakened (T2),at 10 min after patients were wakened (T3) and at the end of wake-up test (T4),the mean blood pressure (MAP),heart rate,respiratory rate (RR),SpO2 and BIS values were recorded.The development of intraoperative awareness,emergence time,postoperative agitation,nausea and vomiting,regurgitation and aspiration and severe pain was recorded.Results MAP,heart rate,SpO2 and RR were all within the normal range during wake-up period in two groups.Compared with the baseline at To,MAP was significantly decreased at Ti,3,4 in group PR,and BIS value was decreased at T1-4 in DPR and PR groups (P＜0.05).Compared with group PR,MAP was significantly increased at T1.3,BIS value was decreased at T24,the wake-up time was shortened,Ramsay sedation score and wake-up quality were increased,the emergence time was shortened,and the incidence of agitation was deceased (P＜0.05),and no significant change was found in verbal rating scale scores assessed after extubation in group DPR (P ＞ 0.05).No cardiovascular events,respiratory depression,intraoperative awareness,postoperative nausea and voniting,regurgitation and aspiration or severe pain was found in two groups.Conclusion Dexmedetomidine can raise the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.