Objective:To evaluate the value of spectral CT quantitative parameters in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC).Methods:A total of 100 HCC patients who underwent surgical resection and were pathologically diagnosed in the Affiliated Cancer Hospital of Xiangya Medical College of Central South University from January 2020 to January 2023 were retrospectively enrolled. According to pathological grading, the patients were divided into the microvascular invasion group (invasion group, n=60) and the non-vascular invasion group (non-invasion group, n=40). Serological indicators and spectral CT quantitative parameters were compared between the two groups. Receiver operating characteristic (ROC) curve was used to analyze the value of spectral CT quantitative parameters in predicting MVI of HCC. Results:The serum alpha-fetoprotein (AFP) level in the invasion group was higher than that in the non-invasion group, with a statistically significant difference ( P<0.05). There were no statistically significant differences in serum carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA-199) levels between the two groups (all P>0.05). In the invasion group, arterial phase iodine concentration, arterial phase normalized iodine concentration, venous phase iodine uptake reduction rate, arterial phase effective atomic number, and energy spectrum curve slope were all higher than those in the non-invasion group, with statistically significant differences (all P<0.05); there were no statistically significant differences in venous phase iodine concentration, venous phase normalized iodine concentration, and venous phase effective atomic number between the two groups (all P>0.05). The rates of peritumoral enhancement in the arterial phase and irregular tumor margin in the invasion group were higher than those in the non-invasion group, with statistically significant differences (all P<0.05); there was no statistically significant difference in tumor capsule between the two groups ( P>0.05). ROC curve analysis showed that the areas under the curve (AUC) of arterial phase iodine concentration, arterial phase normalized iodine concentration, venous phase iodine uptake reduction rate, arterial phase effective atomic number, and energy spectrum curve slope for predicting MVI in HCC were 0.812, 0.885, 0.726, 0.823, and 0.788, respectively. Conclusions:Spectral CT quantitative parameters are helpful to improve the preoperative diagnostic efficiency of MVI in HCC and can effectively predict MVI in HCC. Especially, arterial phase normalized iodine concentration has high application value in judging whether there is MVI in HCC.

Objective:To evaluate the value of spectral CT quantitative parameters in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC).Methods:A total of 100 HCC patients who underwent surgical resection and were pathologically diagnosed in the Affiliated Cancer Hospital of Xiangya Medical College of Central South University from January 2020 to January 2023 were retrospectively enrolled. According to pathological grading, the patients were divided into the microvascular invasion group (invasion group, n=60) and the non-vascular invasion group (non-invasion group, n=40). Serological indicators and spectral CT quantitative parameters were compared between the two groups. Receiver operating characteristic (ROC) curve was used to analyze the value of spectral CT quantitative parameters in predicting MVI of HCC. Results:The serum alpha-fetoprotein (AFP) level in the invasion group was higher than that in the non-invasion group, with a statistically significant difference ( P<0.05). There were no statistically significant differences in serum carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA-199) levels between the two groups (all P>0.05). In the invasion group, arterial phase iodine concentration, arterial phase normalized iodine concentration, venous phase iodine uptake reduction rate, arterial phase effective atomic number, and energy spectrum curve slope were all higher than those in the non-invasion group, with statistically significant differences (all P<0.05); there were no statistically significant differences in venous phase iodine concentration, venous phase normalized iodine concentration, and venous phase effective atomic number between the two groups (all P>0.05). The rates of peritumoral enhancement in the arterial phase and irregular tumor margin in the invasion group were higher than those in the non-invasion group, with statistically significant differences (all P<0.05); there was no statistically significant difference in tumor capsule between the two groups ( P>0.05). ROC curve analysis showed that the areas under the curve (AUC) of arterial phase iodine concentration, arterial phase normalized iodine concentration, venous phase iodine uptake reduction rate, arterial phase effective atomic number, and energy spectrum curve slope for predicting MVI in HCC were 0.812, 0.885, 0.726, 0.823, and 0.788, respectively. Conclusions:Spectral CT quantitative parameters are helpful to improve the preoperative diagnostic efficiency of MVI in HCC and can effectively predict MVI in HCC. Especially, arterial phase normalized iodine concentration has high application value in judging whether there is MVI in HCC.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Objective To explore the MRI findings of testicular sex cord-stromal tumor(TSCST).Methods The MRI and clini-copathological data of 12 patients with TSCST proved by pathology were analyzed retrospectively.Results All 12 cases occurred in unilateral testicle,of which 10 cases were nodular,1 case was irregular nodular,and 1 case showed round shape.All 12 cases had clear boundaries.On T1 WI,5 cases showed homogeneous hypo-intensity,4 cases showed iso-intensity,2 cases showed inhomogeneous iso-inten-sity and hypo-intensity,and 1 case showed inhomogeneous hype-intensity.On T2 WI,7 cases were homogeneous hypo-intensity and 5 cases were inhomogeneous hypo-intensity.Diffusion weighted imaging(DWI)was performed in all 12 cases,and the apparent diffusion coefficient(ADC)was obtained.On DWI,10 cases showed homogeneous hypo-intensity,2 cases showed inhomogeneous hypo-intensity.All 12 cases showed hypo-intensity on ADC,with an average ADC value of approximately(0.89±0.09)× 10-3mm2/s.Among the MRI contrast-enhanced scans,5 cases showed progressive and obvious enhancement,1 case showed intratumoral septal enhancement,and 1 case showed obvious enhancement.Conclusion The typical MRI findings of TSCST are hypo-intensity on T2 WI,DWI,ADC,and the lesions show progressive and obvious enhancement,which are helpful for accurate preoperative diagnosis.

Objective:To investigate the value of diffusion kurtosis imaging (DKI) combined with quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting axillary lymph node metastasis in breast cancer.Methods:A total of 150 cases of breast cancer confirmed by pathology in the Affiliated Hospital of Jining Medical University were retrospectively analyzed. 68 cases had axillary lymph node (ALN) metastasis and 82 cases had no ALN metastasis. All breast lesions were examined by DKI and DCE-MRI before operation. We analyzed clinical case data, routine MRI features, DKI, and DCE-MRI parameters between two groups, including diffusion kurtosis (MK), mean diffusion rate (MD), volume transfer constant (K trans), extravascular volume fraction (Ve), and rate constant (Kep); The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of quantitative parameters for ALN metastasis of breast cancer. Results:The proportion of lesions with blurred edges in the metastatic group was higher than that in the non ALN metastatic group ( P=0.032); The proportion of uneven and circular enhancement within the ALN metastasis group was relatively high ( P=0.018). The MD value of the ALN transfer group was lower than that of the group without ALN transfer ( P=0.021); The MK value, K trans value, and Kep value were higher than those in the group without ALN metastasis (all P<0.01). The K trans value of DCE-MRI model was the most effective in diagnosing ALN metastasis of breast cancer, and the area under the ROC curve (AUC) was 0.831; The AUC of DCE-MRI model was 0.833, which was higher than that of DKI model (AUC=0.733), and the difference was statistically significant ( Z=2.208; P=0.027). The AUC of DCE-MRI and DKI models were higher than that of conventional MRI models ( Z=3.184, P=0.002; Z=1.917, P=0.046). The sensitivity and accuracy of combined DKI and DCE-MRI models in the diagnosis of ALN metastasis in breast cancer were higher than those of single model. Conclusions:DKI and DCE-MRI models can be used to predict axillary lymph node metastasis in breast cancer. Among them, the K trans value of DCE-MRI model is the most effective in diagnosing axillary lymph node metastasis in breast cancer.

Objective:To evaluate the performance of Hybribio human papillomavirus (HPV) typing test kit for high risk HPV-DNA typing detection in screening of cervical precancer lesions.Methods:A total of 9 914 women were recruited in Henan, Shanxi, and Guangdong provinces from June to July 2017. All women underwent HPV DNA test. The women who diagnosed as HPV positive and cytological examination ≥ atypical squamous cells of undetermined significance (ASCUS) or HPV negative and cytological examination≥low-grade squamous intraepithelial lesions (LSIL) underwent colposcopy biopsy and pathological examination. Using the pathological diagnosis as the gold standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and 95% confidence interval ( CI) of high-risk HPV and HPV16/18 tests were calculated. Results:The mean age of 9 914 subjects was (45.0±9.3) years old. Among them, 1 302 subjects were detected as high risk HPV positive, including 211 of HPV16 positive and 64 of HPV18 positive. According to the pathological gold standard of cervical intraepithelial neoplasia grade 2 (CIN2) or worse, the sensitivity and specificity of high risk-HPV and HPV 16/18 for triaging ASCUS women were 90.6% (95% CI: 75.8%-96.8%) and 78.0% (95% CI: 74.5%-81.2%) as well as 56.3% (95% CI: 39.3%-71.8%) and 95.7% (95% CI: 93.8%-97.1%), respectively. The sensitivity and specificity of high risk-HPV and HPV 16/18 for cervical precancer lesions screening were 95.1% (95% CI: 88.1%-98.1%) and 87.6% (95% CI: 86.9%-88.2%) as well as 65.9% (95% CI: 55.1%-75.2%) and 97.8% (95% CI: 97.5%-98.1%), respectively. Conclusions:The Hybribio HPV test kit has a relative high sensitivity and specificity for cervical precancer lesions screening and ASCUS triaging. It is reliable for HPV DNA detection and cervical cancer screening.

Objective:To evaluate the performance of Hybribio human papillomavirus (HPV) typing test kit for high risk HPV-DNA typing detection in screening of cervical precancer lesions.Methods:A total of 9 914 women were recruited in Henan, Shanxi, and Guangdong provinces from June to July 2017. All women underwent HPV DNA test. The women who diagnosed as HPV positive and cytological examination ≥ atypical squamous cells of undetermined significance (ASCUS) or HPV negative and cytological examination≥low-grade squamous intraepithelial lesions (LSIL) underwent colposcopy biopsy and pathological examination. Using the pathological diagnosis as the gold standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and 95% confidence interval ( CI) of high-risk HPV and HPV16/18 tests were calculated. Results:The mean age of 9 914 subjects was (45.0±9.3) years old. Among them, 1 302 subjects were detected as high risk HPV positive, including 211 of HPV16 positive and 64 of HPV18 positive. According to the pathological gold standard of cervical intraepithelial neoplasia grade 2 (CIN2) or worse, the sensitivity and specificity of high risk-HPV and HPV 16/18 for triaging ASCUS women were 90.6% (95% CI: 75.8%-96.8%) and 78.0% (95% CI: 74.5%-81.2%) as well as 56.3% (95% CI: 39.3%-71.8%) and 95.7% (95% CI: 93.8%-97.1%), respectively. The sensitivity and specificity of high risk-HPV and HPV 16/18 for cervical precancer lesions screening were 95.1% (95% CI: 88.1%-98.1%) and 87.6% (95% CI: 86.9%-88.2%) as well as 65.9% (95% CI: 55.1%-75.2%) and 97.8% (95% CI: 97.5%-98.1%), respectively. Conclusions:The Hybribio HPV test kit has a relative high sensitivity and specificity for cervical precancer lesions screening and ASCUS triaging. It is reliable for HPV DNA detection and cervical cancer screening.

Objective To set up a living mice colonoscopy platform to establish an orthotopic model of colorectal cancer in mice under direct vision,and to observe its biological behavior such as metastasis.Methods Eighteen-week-old male C57/BL mice were anesthetized,and the intestinal lumen of the mice was examined by a self-developed living mice colonoscopy and Olympus URF-P5 ureteroscopy,respectively.The imaging effects of the two methods were compared.Human colon cancer HT-29 cells were injected into the colonic mucosa of BALB/c-nu mice under direct vision.The colonoscopy was performed on the 3rd,7th and 15th day after the injection to observe the tumor formation in the intestinal lumen.The mice were sacrificed when the body weight decreased significantly or cachexia appeared,and then the abdominal cavity was examined including the tumor formation and metastasis.Results The self-developed living mice colonoscopy platform can provide clear vision of enteric cavity,and no mice died in the colonoscopy examination.In vivo subcutaneous injection of HT-29 cells in mice was performed with a perforation rate of 15％,a mortality rate of 33.3％,a tumor formation rate of 62.5％,an abdominal metastasis rate of 60％,a liver metastasis rate of 25％,and an abdominal wall transfer rate of 25％.Conclusion The self-developed mice colonoscopy platform can be used for the study of colorectum in living mice.The imaging effect is no less than that of Olympus URF-P5 ureteroscopy.In addition,an orthotopic colorectal cancer model can be established by this platform combing with submucosal injection technology.

Objective To investigate the clinical application and manifestation of dynamic contrastenhanced MRI (DCE-MRI) in differentiating true progession from pseudoprogression in patients with gliobastomas.Methods Twenty five glioma patients were treated with postoperative concurrent chemoradiotherapy and enrolled in this study.All patients were underwent DCE-MRI using a 1.5T scanner.Fifteen patients were confimmed by secondary pathology or clinical and imaging follow-up of patients with gliomas true progession (TP),10 patients were pseudoprogress (PP).Nonparametric Mann-Whitney test was used to compare perfusion parameters between two groups (TP and PP),were used for receiver operating characteristic (ROC) curve analysis to clear if these parameters can be the indicators to differentiate true progession from pseudoprogression.Results Ktrans (volume transfer constant),Ve (fractional volume of extravascular extracellular) values between TP and PP glioma groups were statistically significant,K and Ve values were significantly higher in the TP group than in the PP group (P ＜ 0.05).The areas under the ROC curve are 0.990 and 0.847,respectively.Kep (efflux rate constant) value,Vp (fractional volume of plasma) value in the identification of glioma TP group and PP group was not statistically significant (P ＞ 0.05).Conclusions DCE-MRI can be used to identify glioma TP and PP,Ktrans value and Ve value have clinical significance.

Objective To evaluate the academic level of Chinese Journal of Internal Medicine by analyzing its citation status by using bibliometrics method.Methods The distribution of articles published in Chinese Journal of Internal Medicine from January,2005 to December,2011 indexed by Chinese Science Citation Database (CSCD) was analyzed.Results A total of 2809 articles were published in Chinese Journal of Internal Medicine between January,2005 and December,2011.Among them,832 (29.62％) articles were cited for totally 1993 times.There were 14 authors whose total citation number in 2005-2011 was ≥ 10 times.Authors of the cited articles came from 25 provinces,autonomous regions and municipalities.The regions from where the articles had the highest citation were Beijing (341 articles),Shanghai (87 articles),Guangdong (64 articles),Jiangsu (45 articles) and Zhejiang (43 articles).The medical institutions with the highest citation were Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences (205 times),Peking University People's Hospital (77 times),and Chinese PLA General Hospital (76 times).Conclusions Quite a few high level academic papers had been published in Chinese Journal of Internal Medicine in recent years.Chinese Journal of Internal Medicine plays a good role in enhancing academic exchange.