OBJECTIVES: With the increasing detection rate of lung nodules, the qualitative problem of lung nodules has become one of the key clinical issues. This study aims to evaluate the value of combining dynamic contrast-enhanced (DCE) MRI based on time-resolved imaging with interleaved stochastic trajectories-volume interpolated breath hold examination (TWIST-VIBE) with T₁ weighted free-breathing star-volumetric interpolated breath hold examination (T₁WI star-VIBE) in identifying benign and malignant lung nodules. METHODS: We retrospectively analyzed 79 adults with undetermined lung nodules before the operation. All nodules of patients included were classified into malignant nodules (n=58) and benign nodules (n=26) based on final diagnosis. The unenhanced T₁WI-VIBE, the contrast-enhanced T₁WI star-VIBE, and the DCE curve based on TWIST-VIBE were performed. The corresponding qualitative [wash-in time, wash-out time, time to peak (TTP), arrival time (AT), positive enhancement integral (PEI)] and quantitative parameters [volume transfer constant (Ktrans), interstitium-to-plasma rate constant (Kep), and fractional extracellular space volume (Ve)] were evaluated. Besides, the diagnostic efficacy (sensitivity and specificity) of enhanced CT and MRI were compared. RESULTS: There were significant differences in unenhanced T₁WI-VIBE hypo-intensity, and type of A, B, C DCE curve type between benign and malignant lung nodules (all P<0.001). Pulmonary malignant nodules had a shorter wash-out time than benign nodules (P=0.001), and the differences of the remaining parameters were not statistically significant (all P>0.05). After T₁WI star-VIBE contrast-enhanced MRI, the image quality was further improved. Compared with enhanced CT scan, the sensitivity (82.76% vs 80.50%) and the specificity (69.23% vs 57.10%) based on MRI were higher than that of CT (both P<0.001). CONCLUSIONS T₁WI star-VIBE and dynamic contrast-enhanced MRI based on TWIST-VIBE were helpful to improve the image resolution and provide more information for clinical differentiation between benign and malignant lung nodules.
Adult ; Humans ; Retrospective Studies ; Magnetic Resonance Imaging ; Plasma ; Tomography, X-Ray Computed ; Lung

Objective To investigate the effect of PTENP1 on the proliferation and apoptosis of colorectal cancer cells and its molecular mechanism. Methods We selected 107 cases of colorectal cancer and corresponding adjacent tissues as the research objects. The expression level of PTENP1 was analyzed by fluorescence quantitative PCR. Colon cancer HT29 cells with PTENP1 overexpression (PTENP1 group) and empty vector cell line (control group) were established by lentivirus. The cell proliferation and apoptosis were analyzed by CCK8 and flow cytometry. The PTENP1 target gene was analyzed by bioinformatics and double luciferase reporter genes. The expression level of target protein was analyzed by Western blot. Results The expression of PTENP1 in colorectal cancer tissues was significantly lower than that in adjacent tissues (P < 0.05). The expression level of PTENP1 in the control group was significantly lower than that in the PTENP1 group (P < 0.05). Compared with the control group, the cell proliferation ability of the PTENP1 group was significantly decreased (P < 0.05), the apoptosis level was significantly increased (P < 0.05). miR-21 was complementary to PTENP1. Compared with the control group, the expression of miR-21 in the PTENP1 group was significantly down-regulated (P < 0.05), and the expression of PTEN protein was significantly up-regulated (P < 0.05). Conclusion PTENP1 and miR-21 competitively bind to regulate the expression of PTEN, and then affect the proliferation and apoptosis of colorectal cancer cells.

Objective:To evaluate the application value of small IT knife pre-cut in assistance to duodenal papillary cannulation compared with conventional guidewire cannulation.Methods:A retrospective analysis was performed on the data of 90 patients with choledocholithiasis including 52 patients with small IT knife pre-cut assisted intubation (small IT knife group) and 38 patients with conventional guidewire intubation (conventional group) in endoscopic retrograde cholangiopancreatography (ERCP) from May 2016 to July 2019 in the digestive endoscopy center of Nanjing Drum Tower Hospital. The basic data, curative effect and complications of the two groups were collected and compared.Results:There was statistically significant difference in gender composition between the small IT knife group and the conventional group ( χ2=5.679, P=0.017), but no significant difference in other baseline data between the two groups (all P>0.05). The median intubation time of the small IT knife group was significantly shorter than that of the conventional group (141.5 s VS 270.0 s, Z=1 268.0, P=0.022). There were no significant differences in the success rate of intubation [98.1% (51/52) VS 94.7% (36/38), χ2=0.760, P=0.571], the incidence of intraoperative bleeding [15.4% (8/52) VS 7.9% (3/38), χ2=1.148, P=0.345], postoperative pancreatitis [5.8% (3/52) VS 7.9% (3/38), χ2=0.159, P=0.694], and postoperative cholangitis [1.9% (1/52) VS 5.3% (2/38), χ2=0.760, P=0.571] between the two groups. No perforation occurred in the two groups. After stratifying according to the operator′s proficiency, the median intubation time was significantly different between the small IT knife expert group and the conventional expert group (116.0 s VS 258.0 s, Z=276.0, P=0.038), while there was no significant difference in the intubation time among other groups (all P>0.05). Conclusion:The small IT knife is safe and effective to pre-cut and assist intubation in ERCP, and it may shorten the intubation time.

OBJECTIVES: To understand medical students' mental health, professional pride, and intention to work in the front-line during coronavirus disease 2019 (COVID-19) pandemic, and provide a reference for psychological intervention. METHODS: We used the depression-anxiety-stress scale and self-designed questionnaire on professional pride, intention to work in the front-line and the extent of family support. Medical students from 4 medical schools in Fujian and Hunan were investigated. Their mental health status, professional pride and first-line work willingness with different characteristics were compared, and the influential factors for professional pride and first-line work willingness were analyzed. RESULTS: A total of 266 valid questionnaires were collected. During the pandemic, there were significant differences in the proportion of depressed students among different college and universities, majors and stages (<0.05), and the professional pride was significantly different (<0.001). Medical students with different mental health status showed significant differences in professional pride (<0.01). Marriage, pressure and extent of family support were the influential factors for their professional pride (<0.05). The latter two were also influential factors for their intention to work in the front-line (<0.05). CONCLUSIONS During the pandemic, students from college and nursing have relatively better mental health and higher professional pride. The professional pride is low in medical students who married, with abnormal stress or low family support. The intention to work in front-line is decreased in students with abnormal stress or low family support.
Betacoronavirus ; China ; Coronavirus Infections ; psychology ; Family ; Humans ; Intention ; Mental Health ; Pandemics ; Pneumonia, Viral ; psychology ; Professionalism ; Social Support ; Stress, Psychological ; Students, Medical ; psychology ; Surveys and Questionnaires

Objective To detect the dynamic expression of insulin-like growth factor 2 (IGF2) in lateral geniculate body (LGB) during the critical period of visual development. Methods Three groups of Kunming mice of different ages were selected for testing, which were 3 weeks old, 5 weeks old and 7 weeks old, twelve in each group. The forepaw-reaching reflex test was used to detect whether the visual function of the mice was normal in each group. Immunohistochemical technique was used to detect the expression of IGF2 protein and its receptor in the lateral geniculate body of normal mice at week 3, 5 and 7 postnatal, and to analyze the expression of the protein of IGF2 and its receptor in each part of the lateral geniculate body. Results The expression of IGF2 protein in the dorsal lateral geniculate nucleus decreased significantly at week 5 postnatal and increased significantly at week 7 postnatal, and increased gradually over time at week 5 and week 7 postnatal in the ventral geniculate nucleus. The expression of IGF2 receptor protein in the dorsal lateral geniculate nucleus and ventral nucleus increased significantly at week 5 postnatal, and at week 7 postnatal, the expression of IGF2 receptor decreased to week 3 level in lateral geniculate body of mice. Conclusion The expression of IGF2 and its receptor in lateral geniculate body of mice during critical period of visual development changed dynamically, and the expression patterns of IGF2 and its receptor in different parts of LGB were not completely consistent. The expression of IGF2 and its receptors may be related to the plasticity of visual development in mice.

AIM: To analyze the effect of pan-retinal photocoagulation(PRP)surgery on retinal arteriovenous circulation time and hemodynamics in patients with diabetic retinopathy(DR), and provide reference for clinical treatment.

METHODS: Eighty patients with DR who underwent PRP treatment in our hospital during May 2013 to February 2018 were selected for 80 eyes. The fundus fluorescein angiography system was used to record laminar flow time and total filling time(V1 and V2), retinal artery branch trunk development time and total filling time(A1 and A2), respectively, before and after treatment. Retinal arteriovenous passage time(V2-A1), retinal artery transit time(A2-A1), retinal vein transit time(V2-V1)and retinal capillary passage time(V1-A2)were recorded; we used automatic biochemical analyzer to detect red blood cells aggregation index, hematocrit, plasma viscosity, whole blood viscosity, high shear and low shear viscosity of whole blood; color Doppler ultrasound was used to record ophthalmic artery resistance index(the RI), peak systolic velocity(PSV)and diastolic the end of the flow velocity(EDV).

RESULTS: At 3mo after treatment, the V1-A2 time of this group was significantly longer than that before treatment. The red blood cell aggregation index, hematocrit, plasma viscosity, high blood viscosity and low blood viscosity were significantly lower than before treatment. RI was significantly lower than before treatment. EDV and PSV were significantly higher than before treatment, and the difference was statistically significant(P<0.05).

CONCLUSION: PRP surgery has a certain effect on the retinal arteriovenous circulation time and hemodynamics in patients with DR, and has a significant effect on the transit time of retinal capillaries.

Objective To investigate the influence of duodenal diverticula on cannulation time and complication in patients undergoing ERCP.Methods Data of 3 265 patients undergoing ERCP in Drum Tower Hospital affiliated to Nanjing Medical University between January 1,2008 and December 31,2014 were enrolled.The patients' information and endoscopic pictures/videos were collected.The duodenal diverticula,cannulation time,postoperative complications were analyzed.Results There were 2 599 (79.6％) cases of non-diverticula,445(13.6％) cases of one-diverticula,122(3.7％) patients with two or more diverticula,and 99 (3.0％) intradiverticular papilla.Patients with duodenal diverticula accounted for 20.4％ (666/3 265) of all patients who received ERCP procedure.The mean cannulation time was 6.62 minutes in all cases,6.30 minutes in non-diverticula group,7.63 minutes in one-diverticula group,8.07 minutes in two-or-more group,8.58 minutes in intradiverticular papilla group,respectively.There were significant differences in cannulation time and complication rate between the groups.Conclusion Duodenal diverticula may be one of the factors that affect the cannulation time.It may enhance the cannulation complications and prolong the cannulation time,especially in those with intradiverticular papilla.

Objective To analyze the clinical features,treatment methods,and prognostic factors for early primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma.Methods A retrospective analysis was performed on the clinical data,treatment outcomes,and survival of 32 patients with early pulmonary MALT lymphoma from March 2001 to September 2013.The median age of those patients was 56 years.Twenty-three patients had stage ⅠE disease and nine had stage Ⅱ E disease.According to the marginal zone B-cell lymphoma prognostic index (MZLPI),twenty-three patients were scored as 0 and nine as 1.Nine patients received radiotherapy,eight patients underwent surgery alone,three patients underwent surgery plus chemotherapy,and twelve patients received chemotherapy alone.The Kaplan-Meier method was adapted for calculating the OS,PFS and the log-rank test was used for survival difference analysis and univariate prognostic analysis.Results The 5-year sample size was 22.The 5-year overall survival (OS) and progression-free survival (PFS) rates were 84.5％ and 73.2％,respectively.Radiotherapy yielded an overall response rate of 100％,including a complete response rate of 66.7％ and a partial response rate of 33.3％.The univariate analysis showed that non-radiotherapy treatment was a prognostic factor for poor PFS.The patients treated with radiotherapy had significantly higher 5-year PFS rates than those treated without radiotherapy (100％ vs.63.0％,P=0.029),while there was no significant difference in 5-year OS rate between these two groups (100％ vs.78.8％,P=0.129).Age older than 60 years,an ECOG score of 2,and an MZLPI score of 1 were prognostic factors for poor PFS (P=0.041,0.018,and 0.044) and OS (P=0.001,0.001,and 0.003).Conclusions The prognostic factors for early pulmonary MALT lymphoma include age,ECOG score,and MZLPI score.Low-dose involved-field radiotherapy (24-30 Gy) can improve local control and survival.

Background: Nasal?type extranodal natural killer/T?cell lymphoma (ENKTCL) originates primarily in the nasal cavity or extra?nasal sites within the upper aerodigestive tract. However, it is unclear whether the primary site can serve as an independent prognostic factor or whether the varying clinical outcomes observed with different primary sites can be attributed merely to their propensities of regional lymph node involvement. The aim of this study was to investigate the prognostic implications of the primary site and regional lymph node involvement in patients with early?stage nasal?type ENKTCL. Methods: To develop a nomogram, we reviewed the clinical data of 215 consecutively diagnosed patients with early?stage nasal?type ENKTCL who were treated in Sun Yat?sen University Cancer Center with chemotherapy and radiotherapy between 2000 and 2011. The predictive accuracy and discriminative ability of the nomogram were determined using a concordance index (C?index) and calibration curve. Results: The 5?year overall survival (OS) and progression?free survival (PFS) rates of patients with nasal ENKTCL were higher than those of patients with extra?nasal ENKTCL (OS: 68.2% vs. 46.0%, P = 0.030; PFS: 53.4% vs. 26.6%, P = 0.010).The 5?year OS and PFS rates of patients with Ann Arbor stage IE ENKTCL were higher than those of patients with Ann Arbor stage IIE ENKTCL (OS: 66.3% vs. 59.2%, P = 0.003; PFS: 51.4% vs. 40.3%, P = 0.009). Multivariate analysisshowed that age >60 years, ECOG performance status score nasal primary site, and regional lymph node involvement were significantly associated with lower 5?year OS rate;≥2, elevated lactate dehydrogenase (LDH) level, extra?age >60 years, elevated LDH level, extra?nasal primary site, and regional lymph node involvement were significantly associated with lower 5?year PFS rate. The nomogram included the primary site and regional lymph node involve?ment based on multivariate analysis. The calibration curve showed good agreement between the predicted and actual 5?year OS and PFS rates, and the C?indexes of the nomogram for the OS and PFS rates were 0.697 and 0.634, respectively. Conclusions: The primary site and regional lymph node involvement are independent prognostic factors for early?stage ENKTCL treated with chemotherapy followed by definitive radiotherapy.

Objective To investigate the feasibility of the scheme of target volume delineation with extended involved?field intensity?modulated radiotherapy (IMRT) for patients with early?stage nasal NK/ T?cell lymphoma (NC?NKTL). Methods Twenty?one patients with stage IE?IIE NC?NKTL were treated with short?course chemotherapy combined with radiotherapy from 2011 to 2013. The majority of patients received the GELOX regimen. All patients received extended involved?field IMRT with a dose of 54?? 6 Gy in 26 fractions for gross tumor volume, 50?? 7 Gy in 26 fractions for high?risk clinical target volume (CTV), and 45?? 5 Gy in 26 fractions for low?risk CTV. The dose distribution, short?term treatment outcomes, and adverse reactions were analyzed. Results The 2?year sample size was 12. The 2?year follow?up rate was 100%. The 2?year local control rate ( LRC) was 100%. The 2?year overall and progression?free survival rates were 90?? 5% and 90?? 5%, respectively. The median coverage rates of planning target volumes with 90% of the prescribed doses of 54?? 6 Gy, 50?? 7 Gy, and 45?? 5 Gy were 99?? 8%, 99?? 6%, and 99?? 7%, respectively. No grade 3 or 4 adverse reactions were observed in patients. Conclusions The scheme of target volume delineation and dose configuration in our study not only achieves excellent target volume coverage, but also reduces adverse reactions in patients, which achieves a 2?year LRC ideal for patients with early?stage NC?NKTL.