Objective To investigate the imaging features and causes of missed diagnosis of colorectal cancer(CRC)in routine abdomi-nopelvic CT examinations.Methods A retrospective analysis was conducted on the clinical and imaging data of 38 patients with CRC which were initially overlooked in routine abdominopelvic CT examinations.The imaging features and causes of missed diagnosis were analyzed.Results Distribution of lesions:ten cases(26.3％)located in the caecum-ascending colon,6 cases(15.8％)located in the transverse colon,1 case(2.6％)located in the descending colon,18 cases(47.4％)located in the sigmoid colon and 3 cases(7.9％)located in the rectum.The mean length of diseased bowel was(2.8±1.3)cm.Pericolic fat stranding was found in 16 cases,locore-gional adenopathy was found in 19 cases,and focal pericolic neovascularity was found in 12 cases.The four reasons for missed diagno-sis included:(1)comprehensive assessment of colorectal conditions was not routinely performed;(2)small lesion size;(3)unfamiliar with the subtle secondary signs of CRC;(4)image-related reasons.Conclusion Radiologists should conduct conventional and com-prehensive assessment of the colorectum in routine abdominopelvic CT examinations.With the accumulation of diagnostic experience,it will be beneficial to reduce the missed diagnosis rate of CRC.

Objective To investigate the imaging features and causes of missed diagnosis of colorectal cancer(CRC)in routine abdomi-nopelvic CT examinations.Methods A retrospective analysis was conducted on the clinical and imaging data of 38 patients with CRC which were initially overlooked in routine abdominopelvic CT examinations.The imaging features and causes of missed diagnosis were analyzed.Results Distribution of lesions:ten cases(26.3％)located in the caecum-ascending colon,6 cases(15.8％)located in the transverse colon,1 case(2.6％)located in the descending colon,18 cases(47.4％)located in the sigmoid colon and 3 cases(7.9％)located in the rectum.The mean length of diseased bowel was(2.8±1.3)cm.Pericolic fat stranding was found in 16 cases,locore-gional adenopathy was found in 19 cases,and focal pericolic neovascularity was found in 12 cases.The four reasons for missed diagno-sis included:(1)comprehensive assessment of colorectal conditions was not routinely performed;(2)small lesion size;(3)unfamiliar with the subtle secondary signs of CRC;(4)image-related reasons.Conclusion Radiologists should conduct conventional and com-prehensive assessment of the colorectum in routine abdominopelvic CT examinations.With the accumulation of diagnostic experience,it will be beneficial to reduce the missed diagnosis rate of CRC.

Objective:To analyze the effect of problem-based learning (PBL) combined with case-based learning (CBL) and clinical pathway (CP) teaching methods in standardized residency training in department of hepatobiliary surgery.Methods:A total of 64 residents who received the standardized residency training in the Department of Hepatobiliary Surgery in Shaanxi Provincial People's Hospital from July 2018 to July 2019 were selected and divided into the observation group and the control group. The control group used PBL + CBL teaching methods, while the observation group adopted PBL + CBL + CP teaching methods. The after-department examination scores and the teaching cognition scores of the two groups were compared. SPSS 15.0 was used for t-test and Chi-square test. Results:The after-department examination scores of the two groups were compared. Compared with the control group, the examination scores of professional theories, case analysis and operation skills in the observation group were significantly higher, and the difference was statistically significant ( t = 6.98, 7.85, 7.01, P < 0.05). In terms of recognition of teaching, the observation group was significantly higher than the control group, and the difference was statistically significant ( t = 9.14, P < 0.05). Conclusion:The PBL + CBL + CP teaching is conducive to the comprehensive and systematic mastery of knowledge and the rapid establishment of scientific clinical thinking. It has a strong scientific and systematic nature and is worthy of promotion.

Objective:To explore the correlation of apparent diffusion coefficient (ADC) of magnetic resonance diffusion weighted imaging (DWI) examination before radiotherapy in patients with advanced cervical squamous cell carcinoma with clinicopathological characteristics and radiotherapy efficacy.Methods:The clinical data of 80 patients with advanced cervical cancer who were admitted to the Second Hospital of Nanjing from September 2019 to March 2022 were retrospectively analyzed. All patients underwent magnetic resonance imaging (MRI) DWI examination. The differences in ADC values among cervical squamous cell carcinoma patients with different clinicopathological characteristics were analyzed. The patients were divided into the effective group (complete remission+partial remission) and the ineffective group (stable disease+progressive disease) based on the radiotherapy effect, and the differences in ADC values between the two groups were compared. The logistic regression model was used to analyze the factors affecting the radiotherapy efficacy of patients with advanced cervical squamous cell carcinoma.Results:Among 80 patients with advanced cervical squamous cell carcinoma, 21 achieved complete remission, 31 achieved partial remission, 25 achieved stable disease, and 3 achieved progressive disease after radiotherapy; there were 52 cases in the effective group and 28 cases in the ineffective group. The ADC value of the effective group before radiotherapy was higher than that of the ineffective group [(0.99±0.14)×10 -3mm 2/s vs. (0.76±0.20)×10 -3mm 2/s], and the difference was statistically significant ( t = 6.01, P < 0.001); after radiotherapy, the ADC value of the effective group was also higher than that of the ineffective group [(1.43±0.25)×10 -3mm 2/s vs. (1.11±0.23)×10 -3mm 2/s), and the difference was statistically significant ( t = 5.61, P < 0.001); the ADC values of both the effective and ineffective groups increased after radiotherapy compared to before radiotherapy (both P < 0.05). The ADC values of patients with different International Federation of Obstetrics and Gynecology (FIGO) stage, degree of pathological differentiation, depth of lesion infiltration, Ki-67 expression, lymph node metastasis, and distant metastasis were statistically significant (all P < 0.05). The results of multivariate logistic regression analysis showed that ≥FIGO stage Ⅲ, low differentiation, lymph node metastasis, lymphatic vessel infiltration, distant metastasis, and low ADC value before radiotherapy were independent risk factors for efficacy of radiotherapy in patients with advanced cervical squamous cell carcinoma (all P < 0.05). Conclusions:The ADC value before radiotherapy is a factor that affects the radiotherapy effect of patients with advanced cervical squamous cell carcinoma. The lower the ADC value before radiotherapy is, the worse the radiotherapy effect of patients will be.

Objective:By comparing standard gonadotropin-releasing hormone antagonist regimen and gonadotropin-releasing hormone agonist-antagonist protocol (AAP regimen) in Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) group 3 and group 4 patients with low prognosis, to study if AAP regimen could improve the clinical outcomes in low prognosis patients.Methods:A case-control study was performed, the clinical data of 646 cycles of prospective poor ovarian response (POR) patients (POSEIDON group 3 and 4) who received in vitro fertilization and embryo transfer (IVF-ET) in Peking University Third Hospital Department of Obstetrics and Gynecology, Reproductive Medical Center from January 2016 to May 2018 were retrospectively analyzed. The total number of AAP cycle was 323, and control group was selected from the database with 1∶1 matching of contemporaneous prospective POR patients (POSEIDON group 3 and group 4) with similar age and approaching date of oocyte retrieval. Patients' general information, ovarian stimulation indexes and clinical outcomes were compared. Results:AAP group had fewer antral follicle count (AFC) [3.00(2.00,4.00) vs. 4.00(2.00,5.00), P<0.001] and similar anti-Müllerian hormone (AMH) level [0.51(0.25,0.83) μg/L vs. 0.53(0.31,0.81) μg/L, P>0.05] compared with control group. AAP group had shorter duration of gonadotropin (Gn) used [10.00(8.00,11.00) d vs. 10.00(9.00,11.00) d, P=0.020] and lower dosage of Gn used [2 675.00(2 100.00,3 300.00) U vs. 3 075.00(2 550.00,3 750.00) U, P<0.001] than control group. AAP group had similar number of oocytes obtained [3.00(2.00,5.00) vs. 4.00(2.00,6.00), P>0.05] compared with control group. Under the same proportion of fertilization schemes (routine or intracytoplasmic sperm injection methods), AAP group had higher fertilization rate [74.15% (955/1288) vs. 69.13% (918/1328), P=0.004] and good-quality embryo rate [62.57% (585/935) vs. 56.94% (509/894), P=0.014], and ultimately had higher embryo implantation rate [22.31% (87/390) vs. 15.84% (64/404), P=0.020], cumulative clinical pregnancy rate [32.50% (78/240) vs. 22.86% (56/245), P=0.018] and cumulative live birth rate [25.83% (62/240) vs. 17.96% (44/245), P=0.036]. Conclusion:For POSEIDON patients with low prognosis and POR, controlled ovarian hyperstimulation with AAP regimen had better clinical outcomes compared with conventional antagonist regimen.

Objective:By comparing standard gonadotropin-releasing hormone antagonist regimen and gonadotropin-releasing hormone agonist-antagonist protocol (AAP regimen) in Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) group 3 and group 4 patients with low prognosis, to study if AAP regimen could improve the clinical outcomes in low prognosis patients.Methods:A case-control study was performed, the clinical data of 646 cycles of prospective poor ovarian response (POR) patients (POSEIDON group 3 and 4) who received in vitro fertilization and embryo transfer (IVF-ET) in Peking University Third Hospital Department of Obstetrics and Gynecology, Reproductive Medical Center from January 2016 to May 2018 were retrospectively analyzed. The total number of AAP cycle was 323, and control group was selected from the database with 1∶1 matching of contemporaneous prospective POR patients (POSEIDON group 3 and group 4) with similar age and approaching date of oocyte retrieval. Patients' general information, ovarian stimulation indexes and clinical outcomes were compared. Results:AAP group had fewer antral follicle count (AFC) [3.00(2.00,4.00) vs. 4.00(2.00,5.00), P<0.001] and similar anti-Müllerian hormone (AMH) level [0.51(0.25,0.83) μg/L vs. 0.53(0.31,0.81) μg/L, P>0.05] compared with control group. AAP group had shorter duration of gonadotropin (Gn) used [10.00(8.00,11.00) d vs. 10.00(9.00,11.00) d, P=0.020] and lower dosage of Gn used [2 675.00(2 100.00,3 300.00) U vs. 3 075.00(2 550.00,3 750.00) U, P<0.001] than control group. AAP group had similar number of oocytes obtained [3.00(2.00,5.00) vs. 4.00(2.00,6.00), P>0.05] compared with control group. Under the same proportion of fertilization schemes (routine or intracytoplasmic sperm injection methods), AAP group had higher fertilization rate [74.15% (955/1288) vs. 69.13% (918/1328), P=0.004] and good-quality embryo rate [62.57% (585/935) vs. 56.94% (509/894), P=0.014], and ultimately had higher embryo implantation rate [22.31% (87/390) vs. 15.84% (64/404), P=0.020], cumulative clinical pregnancy rate [32.50% (78/240) vs. 22.86% (56/245), P=0.018] and cumulative live birth rate [25.83% (62/240) vs. 17.96% (44/245), P=0.036]. Conclusion:For POSEIDON patients with low prognosis and POR, controlled ovarian hyperstimulation with AAP regimen had better clinical outcomes compared with conventional antagonist regimen.

The pathological subtypes of breast cancer can be further divided into different molecular subtypes based on their immunohistochemical staining, such as estrogen receptor (ER) , progesterone receptor (PR) , human epidermal growth factor receptor2 (HER2) and Ki67 expression, including luminal subtype, HER2 overexpression subtype and triple negative subtype. The luminal subtype is defined as ER and/or PR positive. In molecular mechanism, the expression activity of ER can regulate the expression of PR, so the expression of ER and PR is usually consistent. However, in the process of detection, some breast cancers with inconsistent ER/PR expression often appear, especially those with ER (-) /PR (+) . There is still controversy about whether such cases are true. Patients with this type of breast cancer should be subjected to ER and PR immunohistochemical staining again, and then reclassified according to HER2 status. The expression of ER/PR is closely related to the efficacy of endocrine therapy for breast cancer, so its test results will directly affect the treatment options of clinician. This article will review and discuss the research progress of the causes and mechanisms of ER (-) /PR (+) breast cancer.

Objective To evaluate the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) in the treatment of bile duct calculi. Methods Clinical data of 236 patients with bile duct calculi in Shaanxi Provincial People's Hospital between September 2012 and March 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 98 males and 138 females, aged from 15-95 with a median of 58 years old. Laparoscopic surgery was performed via four-port approach. The anterior wall of common bile duct was cut in a length of 0.5 to 1.5 cm below the junction of cystic duct and common bile duct. Calculi were removed with a choledochoscope under laparoscope. After the calculi were removed completely, incision of the common bile duct was primarily sutured with 4-0 absorbable thread or a T tube was placed for drainage. Results LCBDE was performed successfully on 233 patients, with a rate of conversion to open laparotomy 1.3%(3/236), including 1 case was converted to laparotomic radical cholecystectomy for gallbladder carcinoma, 2 cases receiving laparotomic hepaticojejunostomy for hilar bile duct stricture. 225 cases underwent common bile duct exploration, 8 cases underwent cystic duct exploration. 161 cases underwent primary suture of common bile duct, and 72 cases received placement of T tube. The calculi incarcerated in the lower end of common bile duct or deep located at intrahepatic bile duct in 16 cases were removed completely after lithotripsy under a choledochoscope. The median length of operation was 95(60-225) min, the intraoperative blood loss was 60(20-250) ml, and the postoperative length of stay was 6.5(4.0-15.0) d. No perioperative death was observed, and the incidence of postoperative complications was 6.9%(16/233), including 9 cases of bile leakage, 3 cases of residual calculi, 3 cases of mild pancreatitis and 1 case of peritoneal effusion. The patients were followed up for 10-40 months, and no recurrent calculi or biliary stricture occurred. Conclusions LCBDE is a safe and effective minimally invasive surgical treatment for patients with bile duct calculi, which is characterized by less trauma, rapid recovery and less complications.

Objective: To evaluate the diagnostic value of saline infusion test (SIT) in patients with primary aldosteronism (PHA). Methods: A total of 116 patients with PHA or essential hypertension (EH) treated in our hospital from 1994-06 to 2013-05 were retrospectively studied. The patients were divided into 2 groups: PHA group,n=72 and EH group, the patients with excluded PHA,n=44. post-SIT plasma levels of aldosterone and post-SIT ratio of aldosterone/renin activity were evaluated by ROC curve in order to analyze the diagnostic capability and the best diagnostic cut-off point. Results: The area under curve (AUC) by ROC for post-SIT aldosterone level was 0.759, the sensitivity and speciifcity were 74.6% and 63.6% respectively; AUC for post-SIT ratio of aldosterone/renin activity was 0.899, the sensitivity and speciifcity were 83.6% and 88.6% with the best diagnostic cut-off point at 111 [ng/dl:ng/(ml?h)]. Conclusion: Post-SIT plasma level of aldosterone and post-SIT ratio of aldosterone/renin activity had the diagnostic value of PHA; post-SIT ratio of aldosterone/renin activity had the higher diagnostic value of PHA.

Objective: To evaluate the clinical value of Captopril test for diagnosing primary aldosteronism (PA) and to calculate the best cut-off point for PA diagnosis. Methods: We retrospectively analyzed 96 PA patients with conifrmed diagnosis by clinical situation, laboratory test and auxiliary examination in our hospital from 1994-06 to 2012-05, and meanwhile, studied 45 highly suspicious PA patients with final exclusion by confirmed diagnosis of primary hypertension (PH). All patients received the in-hospital Captopril test, the area under the curve of receiver operating characteristic (AUCROC) was applied to evaluate plasma aldosterone level and the ratio of aldosterone/renin after Captopril test and to obtain the best cut-off point with the corresponding sensitivity and speciifcity for PA diagnosis. Results: At 1h and 2h after Captopril test, AUCROC for plasma levels of aldosterone were 0.831 and 0.818, the ratios of aldosterone/rennin were 0.909 and 0.922 respectively. At 1h after Captopril test, the cut-off point of aldosterone level was 544.95 pmol/L and the diagnostic sensitivity was 70%, speciifcity was 90.7%; at 2h after Captopril test, the cut-off point of aldosterone level was 466.8 pmol/L and the diagnostic sensitivity was 69.8%, speciifcity was 70.5%. At 1h after Captopril test, the ratio of aldosterone/rennin was 34.6 [ng/dl: μg/(ml·h)] with the sensitivity at 78.3% and speciifcity at 88.4%. At 2h after Captopril test, the maximum AUCROC for the ratio of aldosterone/rennin was obtained, when cut-off point of aldosterone level was 42.2[ng/dl: μg/(ml·h)] , the diagnostic sensitivity was 76.7%, speciifcity was 95.3%. Conclusion: At 1h and 2h after Captopril test, plasma aldosterone level and the ratio of aldosterone/rennin had been valuable for PA diagnosis, the maximum diagnostic value could be obtained at 2h after Captopril test.