Objective To analyze the value of magnetic resonance imaging(MRI)plain scan and contrast-enhanced scan in the staging of cervical cancer.Methods A cohort of 82 cervical cancer patients were enrolled and stratified into 3 pathological stages(Ⅰ,Ⅱ,and Ⅲ-Ⅳ).Concurrently,30 healthy volunteers served as controls.All participants underwent MRI plain scan and dynamic contrast-enhanced MRI(DCE-MRI).Through the comparative analysis of DCE-MRI parameters between healthy controls and cervical cancer patients,and stratified evaluation across stages Ⅰ,Ⅱ,and Ⅲ-,the relationships of DCE-MRI parameters with tumor type,differentiation grade,and lymph node metastasis in cervical cancer patients were explored,and the diagnostic performances of MRI plain scan and DCE-MRI in cervical cancer staging were compared.Results The volume transfer constant(Ktrans),rate constant(Kep),and extracellular extravascular volume fraction(Ve)demonstrated significant elevations in cervical cancer patients compared to healthy controls(P<0.05).Stage Ⅲ-patients exhibited the highest Ktrans,Kep,and Ve,followed by stage Ⅱ patients and stage Ⅰ patients.All inter-stage comparisons reached statistical significance(P<0.05).The Ktrans and Ve in patients with adenocarcinoma were higher than those in patients with squamous cell carcinoma;the poorly differentiated exhibited the highest Ktrans,Kep,and Ve,followed by the moderately differentiated and the high differentiated;and those with lymph node metastasis demonstrated significantly elevated Ktrans and Kep than those without lymph node metastasis(P<0.05).The areas under the curve(AUC)of MRI plain scan,Ktrans,Kep,and Ve for diagnosing stage Ⅲ-cervical cancer were 0.678,0.775,0.731,and 0.695,respectively.The MRI plain scan combined with DCE-MRI demonstrated superior diagnostic performance(AUC=0.859)over individual parameters,with a sensitivity of 90.91％and a specificity of 67.61％.Conclusion The combination of MRI plain scan and DCE-MRI is of high value in cervical cancer staging.

Objective To analyze the value of magnetic resonance imaging(MRI)plain scan and contrast-enhanced scan in the staging of cervical cancer.Methods A cohort of 82 cervical cancer patients were enrolled and stratified into 3 pathological stages(Ⅰ,Ⅱ,and Ⅲ-Ⅳ).Concurrently,30 healthy volunteers served as controls.All participants underwent MRI plain scan and dynamic contrast-enhanced MRI(DCE-MRI).Through the comparative analysis of DCE-MRI parameters between healthy controls and cervical cancer patients,and stratified evaluation across stages Ⅰ,Ⅱ,and Ⅲ-,the relationships of DCE-MRI parameters with tumor type,differentiation grade,and lymph node metastasis in cervical cancer patients were explored,and the diagnostic performances of MRI plain scan and DCE-MRI in cervical cancer staging were compared.Results The volume transfer constant(Ktrans),rate constant(Kep),and extracellular extravascular volume fraction(Ve)demonstrated significant elevations in cervical cancer patients compared to healthy controls(P<0.05).Stage Ⅲ-patients exhibited the highest Ktrans,Kep,and Ve,followed by stage Ⅱ patients and stage Ⅰ patients.All inter-stage comparisons reached statistical significance(P<0.05).The Ktrans and Ve in patients with adenocarcinoma were higher than those in patients with squamous cell carcinoma;the poorly differentiated exhibited the highest Ktrans,Kep,and Ve,followed by the moderately differentiated and the high differentiated;and those with lymph node metastasis demonstrated significantly elevated Ktrans and Kep than those without lymph node metastasis(P<0.05).The areas under the curve(AUC)of MRI plain scan,Ktrans,Kep,and Ve for diagnosing stage Ⅲ-cervical cancer were 0.678,0.775,0.731,and 0.695,respectively.The MRI plain scan combined with DCE-MRI demonstrated superior diagnostic performance(AUC=0.859)over individual parameters,with a sensitivity of 90.91％and a specificity of 67.61％.Conclusion The combination of MRI plain scan and DCE-MRI is of high value in cervical cancer staging.

Radiotherapy (RT) is one of the most common treatments for cancer. However, intracellular glutathione (GSH) plays a key role in protecting cancer from radiation damage. Herein, we have developed a platelet membrane biomimetic nanomedicine (PMD) that induces double GSH consumption to enhance tumor radioimmunotherapy. This biomimetic nanomedicine consists of an external platelet membrane and internal organic mesoporous silica nanoparticles (MON) loaded with 2-deoxy-D-glucose (2-DG). Thanks to the tumor-targeting ability of the platelet membranes, PMD can target and aggregate to the tumor site, which is internalized by tumor cells. Within tumor cells overexpressing GSH, MON reacts with GSH to degrade and release 2-DG. This step initially depletes the intracellular GSH content. The subsequent release of 2-DG inhibits glycolysis and adenosine triphosphate (ATP) production, ultimately leading to secondary GSH consumption. This nanodrug combines dual GSH depletion, starvation therapy, and RT to promote immunogenic cell death and stimulate the systemic immune response. In the bilateral tumor model in vivo, distal tumor growth was also well suppressed. The proportion of mature dendritic cells (DC) and CD8⁺ T cells in the mice was increased. This indicates that PMD can promote anti-tumor radioimmunotherapy and has good prospects for clinical application.

Radiotherapy(RT)is one of the most common treatments for cancer.However,intracellular glutathione(GSH)plays a key role in protecting cancer from radiation damage.Herein,we have developed a platelet membrane biomimetic nanomedicine(PMD)that induces double GSH consumption to enhance tumor radioimmunotherapy.This biomimetic nanomedicine consists of an external platelet membrane and internal organic mesoporous silica nanoparticles(MON)loaded with 2-deoxy-D-glucose(2-DG).Thanks to the tumor-targeting ability of the platelet membranes,PMD can target and aggregate to the tumor site,which is internalized by tumor cells.Within tumor cells overexpressing GSH,MON reacts with GSH to degrade and release 2-DG.This step initially depletes the intracellular GSH content.The subsequent release of 2-DG inhibits glycolysis and adenosine triphosphate(ATP)production,ultimately leading to secondary GSH consumption.This nanodrug combines dual GSH depletion,starvation therapy,and RT to promote immunogenic cell death and stimulate the systemic immune response.In the bilateral tumor model in vivo,distal tumor growth was also well suppressed.The proportion of mature dendritic cells(DC)and CD8+T cells in the mice was increased.This indicates that PMD can promote anti-tumor radioimmunotherapy and has good prospects for clinical application.

Objective:To investigate the emergency surgical effect of ruptured intracranial dural arteriovenous fistula (DAVF).Methods:Patients with ruptured intracranial DAVF underwent microsurgery in the Department of Neurosurgery, Nanping First Hospital Affiliated to Fujian Medical University from May 2013 to July 2022 were retrospectively included. The clinical, imaging and follow-up data were collected, and the clinical characteristics, selection of surgical methods and treatment effects of patients were summarized.Results:A total of 8 patients with DAVF were enrolled. Their age ranged from 11 to 60 years (average, 48 years). There were 7 males and 1 female. All 8 patients suffered from intracranial hemorrhage, manifested as headache and vomiting in 2 cases, simple conscious disturbance in 2 cases, conscious disturbance with cerebral hernia in 3 cases, and conscious disturbance with limb paralysis in 1 case. The fistula was located in the anterior fossa in 4 cases (including 2 cases with aneurysms), the middle fossa in 2 cases (including 1 case with moyamoya disease), the transverse sinus in 1 case, and the anterior 1/3 area of the sagittal sinus in 1 case. Cognard classification: 7 patients were type Ⅲ and 1 was type Ⅳ. After admission, all patients underwent emergency craniotomy and microsurgery to remove hematoma. Among them, 4 patients underwent decompressive craniectomy at the same time, 1 patient with moyamoya disease underwent dural turnover and temporalis muscle application at the same time, and 2 patients with aneurysms at the same location were clipped at the same time. Postoperative re-examination of head CT showed that the hematoma was cleared satisfactorily and the midline was no shift in all 8 patients. CT angiography (CTA) showed that the fistula disappeared within 2 weeks. Seven patients were followed up within 1-12 months after operation. CTA or digital subtraction angiography showed no recurrence of DAVF. Two patients with aneurysms did not have residual or recurrent aneurysms. All patients had no new neurological symptoms, and the Glasgow Outcome Scale score in 2 patients increased by 1 compared with that at discharge.Conclusion:Emergency microsurgery is an effective method for the treatment of ruptured intracranial DAVF, especially for patients with special parts or complicated hematoma, cerebral hernia, and other vascular diseases.

Objective To observe the clinical features and evaluate the risk factors affecting prognosis in patients with secondary sepsis of gastrointestinal perforation (GIP). Methods A retrospective cohort study was conducted, and the patients with GIP admitted to the Department of General Surgery of Affiliated Shuyang People's Hospital of Xuzhou Medical University from January 1, 2014 to April 30, 2017 were enrolled, according to the presence or absence of sepsis occurrence, they were divided into GIP with and GIP without sepsis groups. The difference of gender, age, the time between the onset of GIP and the occurrence of sepsis, infection situation, body temperature, heart rate, respiratory frequency, white blood cell count (WBC), systemic inflammatory response syndrome (SIRS) in accord with standard, C-reactive protein (CRP), blood sugar, mean arterial pressure (MAP), lactic acid, number of cases having undergone laparoscopic surgery, sequential organ failure score (SOFA) and quick sequential organ failure score (qSOFA), Glasgow coma score(GCS), length of stay in intensive care unit (ICU), the total length of stay in hospital were compared;the status of survival and prognosis was assessed on day 30 by the Glasgow Outcome Scale (GOS). The indicators with statistical significance in the two groups were brought into the Cox regression model to analyze the independent risk factors affecting the prognosis of the patients. Results Fifty-eight patients with GIP were enrolled in this study. Among them, 22 cases developed secondary sepsis (GIP with sepsis group, there were 50.0% cases with single organ failure and 50.0% cases with multiple-organ failure, cases only in accord with 0-1 SIRS criteria accounting for 81.8%, and the mortality of secondary sepsis being 31.8%). No sepsis occurred in 36 patients (GIP without sepsis group). In GIP with sepsis group, the age, blood glucose, lactic acid, SOFA score, qSOFA, and the length of stay in ICU were significantly higher than those of GIP without sepsis group [age (years): 68.7±15.9 vs. 56.1±17.2, blood glucose (mmol/L): 6.9±2.3 vs. 5.9±1.2, lactic acid (mmol/L): 2.9±1.3 vs. 1.2±0.7, SOFA score: 5.6±3.2 vs. 0.5±0.4, qSOFA score: 1.0±0.9 vs. 0.3±0.1, the length of stay in ICU (days): 1.0 (0-4.0) vs. 0.1 (0-2.0), all P < 0.05], while MAP, GCS, and GOS scores in GIP with sepsis group were significantly lower than those in GIP without sepsis group [MAP (mmHg, 1 mmHg =0.133 kPa): 83.6±18.7 vs. 100.0±14.3, GCS score: 12.8±3.5 vs. 14.5±0.5, GOS score: 3.5±1.9 vs. 4.9±0.2, all P < 0.01]. Cox multivariable regression analysis showed: only low MAP and low GCS score were the independent risk predictors of death outcome for GIP with sepsis, the relative risk (RR) was 0.896 [95% confidence interval (CI) = 0.815-0.984, P = 0.022] and 0.585 (95%CI = 0.395-0.866, P = 0.007) respectively. Conclusion Patients with secondary sepsis following GIP have relatively high morbidity and much more risk factors, but only low MAP and low GCS score are closely associated with its high risk of death.

Objective To explore the microsurgery methods in patients with early intracranial aneurysm rupture. Methods Sixty-seven patients with early intracranial aneurysm rupture received the emergency microsurgery after releasing cerebrospinal fluid from improved Paine point via pterion craniotomy. Thirty-nine patients received surgery within 1 d after intracranial aneurysm rupture, and the other 28 patients were within 1-3 d. Results The therapeutic effect was evaluated by Glasgow outcome score (GOS) at discharge. Among the 45 patients with Hunt-Hess Ⅰ-Ⅲ grade, cure was in 41 cases, improved in 4 cases. Among the 22 patients with Hunt-HessⅣ-Ⅴgrade, cure was in 6 cases, improved in 6 cases, moderate disability in 4 cases, severe disability in 1 case, and death was in 5 cases. Conclusions The microsurgery of clipping aneurysm directly via pterion approach is still by far the most reliable treatment. And releasing cerebrospinal fluid from improved Paine points can effectively reduce the acute brain swelling of early operation, which will make it an effective adjuvant therapy to emergency microsurgery of clipping aneurysm.

Objective To investigate whether the presence of infection in a case series with coma would predict sepsis associated encephalopathy(SAE).Methods From Jan 2013 to Oct 2014,we used the criteria of systemic inflammatory response syndrome (SIRS)positive sepsis with encephalopathy and retrospective diagnosed a comatose case series with infection and from a tertiary teaching hospital intensive care unit (ICU).Results Among 6 comatose patients with evidence of infection,3 cases were secondary infection after hemorrhagic stroke,1 case was secondary infection after trauma,and the other 2 cases were primary infection.All patients met the diagnosis of SIRS -positive sepsis with encephalopathy.Among them,the presence of SIRS 3 criteria was in 2 cases,four criteria in 4 cases. All patients with severe brain failure (100%),in addition to 5 cases with acute respiratory failure caused by lung injury,one case with acute liver failure.Brain imaging confirmed that the delayed vasogenic edema was in two cases (33.3%),the cerebral ischemic lesions in four cases(66.7%).The ischemic lesion included 1 patient with minor infarcts and 1 case with mild white matter lesions,and with a good prognosis.The other two ischemic cases included multifocal leukoencephalopathy with central pontine myelinolysis in 1 case and extensive white matter lesions in 1 case,eventually with a poor prognosis.Conclusion SAE is a common critically illness,the use of the new classifi-cation criteria of sepsis is helpful in the diagnosis of sepsis associated encephalopathy.

Objective To assess the value of contrast-enhanced ultrasonography (CEUS ) in diagnosing BI-RADS 4 breast lesion.Methods The CEUS findings of 79 breast lesions of BI-RADS 4 were analyzed,and the CEUS diagnosis was made according to our preliminary study results.Histology results were served as golden reference.Results Of all the 79 breast lesions that were confirmed by histopathology results,36 were malignant and 43 were benign.The differences of morphologic features of area variety, margin,heterogeneous or homogeneous distribution between benign and malignant lesions were significant (P < 0.05 ).The area under ROC curve of correction BI-RADS classification in the diagnosis of breast cancer was 0.938,and it was significantly higher than that of the BI-RADS classification (0.889,Z =2.209, P =0.0272).Conclusions CEUS can improve the diagnostic accuracy of breast lesions preoperatively.

Objective To discuss the relationship between echogenicity and fat content in renal tumor.Methods 52 renal tumors were examined with preoperative ultrasonography,all tumors were 3 cm in diameter or less.The tumor echogenicity was classified as echogenicity increasement type (including hyperechoic and slightly hyperechoic) and echogenicity decreasement type (hypoechoic).The relationship between echogenicity and adipose staining in tumor were analyzed.Results In 18 cases pathologically proved benign renal tumor,14(77.8 ％) of the tumors were hyperechoic and were angiomyolipoma(AMLs),4(22.2％) of the tumors were hypoechoic including 2 poor fat AMLs and 2 rare benign tumors,slightly hyperechoic case was not detected.In 34 cases malignant renal tumors,27(79.4％) of the tumors were slightly hyperechoic including 22 clear cell renal cell carcinomas (RCCAs) and 5 papillary RCCAs,7 (20.6％) of the tumors were hypoechoic including 2 clear cell RCCAs,3 papillary RCCAs and 2 chromophobe RCCAs.Hyperechoic case was not detected.The adipose staining of 41 cases of echogenicity increasement type was all positive,in the 11 cases of echogenicity decreasement type,9 tumors were adipose staining negative,while the other 2 tumors were positive,and there were statistically significant between two groups (P ＜0.05).Conclusions Echogenicity was obviously correlate with fat content in renal tumor.Tumors containing rich fat appear to be increased in echogenicity,tumors without fat content appear to be decreased in echogenicity.