Objective To observe the value of MRI for differentiating flaps and tumor recurrence after tongue cancer reconstruction.Methods Totally 139 patients after flap reconstruction for tongue cancers were retrospectively enrolled,and MRI manifestations of flaps and recurrence of tongue cancer were comparatively analyzed.Results During follow-up,local flaps mainly presented as equal signals on T1WI,high signals on T2WI within 5 months but then predominately as equal signals.Free flaps consistently showed mixed high signals on both T1WI and T2WI,with striated and sheeted muscle signals.The recurrent lesions consistently showed slightly inhomogeneous equal signals on T1WI and high signals on T2WI.The degree of enhancement of flaps gradually decreased,while the recurrent lesions continued to show severe enhancement.The margins of flaps were predominantly indistinct within 5 months after reconstruction,then became distinct in≥13 while＜74 months with smaller size than before,while recurrent lesions continued to show indistinct borders.The mylohyoid muscles and hyoglossus muscles predominantly swelled within 5 months after construction but then atrophied.Hematoma and cyst cavity in the operation area could be observed 5 months after construction.The recurrence lesions located in the lower and posterior junction part of flaps and the residual tongue tissue,spiculated margins could be found in the ipsilateral or contralateral mylohyoid muscles and hyoglossus muscles,as well as cervical lymph node and distant metastases.Conclusion MRI was helpful to differentiating flaps and recurrence lesions after tongue cancer reconstruction.

Objective:To investigate the predictive value of the quantitative parameters of dual-layer detector spectral CT in arterial and venous phases for the differentiation degree and the E-cadherin protein expression of gastric cancer.Methods:This was a cross-sectional study. The preoperative data from the dual-layer detector spectral CT images among 183 patients with gastric adenocarcinoma confirmed by operation and pathology was retrospectively analyzed from October 2021 to October 2022 in the First Affiliated Hospital of Fujian Medical University. According to the differentiation degree and E-cadherin protein expression of gastric cancer, all patients were divided into the moderately well differentiated group ( n=82) and the poorly differentiated group ( n=101), as well as the E-cadherin-negative group ( n=80) and the E-cadherin-positive group ( n=103). The CT images in arterial and venous phases were used to reconstruct the virtual monoenergetic images (VMI) at 40, 50, 60, 70, 80, 90, and 100 keV, effective atomic number (Z eff) images and iodine concentration (IC) images. The CT values (CT keV) from VMI, Z eff and IC were measured, and the normalized Z eff (NZ eff) and the normalized IC (NIC) were calculated. Independent-sample t test or Mann-Whitney U test were used to compare the differences in quantitative parameters between groups. The logistic regression analysis was used to screen for the independent predictors, after which a combined prediction model was constructed. The receiver operating characteristic curves were used to evaluate the predictive efficiency of the parameters for the differentiation degree and the E-cadherin protein expression of gastric cancer. Results:There were statistically significant differences in CT 40 keV to CT 70 keV, NZ eff and NIC in dual-phase, as well as Z eff and IC in the venous phase between the moderately well differentiated group and the poorly differentiated group ( P<0.05). The combined prediction model was constructed by CT 40 keV ( OR=1.03, 95% CI 1.02-1.05, P<0.001) in arterial phase and CT 40 keV ( OR=1.05, 95% CI 1.03-1.07, P<0.001) and Z eff ( OR=1.32, 95% CI 1.06-1.65, P=0.015) in venous phase, of which the area under the curve (AUC) for the prediction of the moderately-well group and the poor group was 0.932 (95% CI 0.897-0.967), with a sensitivity of 90.1% and a specificity of 85.4%. Between the E-cadherin-negative group and the E-cadherin-positive group, CT 40 keV and NZ eff in arterial phase, as well as CT 40 keV to CT 70 keV, Z eff, NZ eff, IC and NIC in venous phase, had statistically significant differences ( P<0.05). The AUC for the combined prediction model established by CT 40 keV ( OR=1.02, 95% CI 1.01-1.04, P<0.001) and Z eff ( OR=1.33, 95% CI 1.09-1.63, P=0.006) in venous phase was 0.800 (95% CI 0.736-0.864), with a sensitivity of 95.0% and a specificity of 60.2%. Conclusion:The combined prediction model from the quantitative parameters of dual-layer spectral detector CT can be used to predict the differentiation degree and the E-cadherin protein expression of gastric cancer preoperatively.

Purpose To explore the clinical application value of dual-layer detector spectral CT combined with half volume contrast agent in detecting the liver metastases in portal vein phase.Materials and Methods Ninety-six patients with liver metastases diagnosed by liver enhanced CT in the First Affiliated Hospital of Fujian Medical University from November 2021 to June 2022 were prospectively studied.They were randomly divided into two groups by using the contrast agent administration calculation method based on body surface area.The conventional polyenergetic image(CI)of patients in the conventional contrast agent group(48 cases with 18.6 gI/m2 body surface area iodine contrast agent)was constructed in the portal vein phase,and the 40-70 keV(5 kiloelectron voltage)virtual monoenergetic imaging(VMI)was reconstructed for patients in the semi contrast agent dose group(48 case with 9.3 gI/m2 body surface area iodine contrast agent).The image noise,CT value and contrast noise ratio in the two groups were measured and compared.Besides,the image quality was scored with a 5-point method,and the consistency of subjective scores between two radiologists were evaluated.Results The VMI noise at 40-70 keV was(10.26±1.38)Hu,(9.59±1.35)Hu,(9.15±1.31)Hu,(8.80±1.32)Hu,(8.58±1.31)Hu,(8.40±1.31)Hu and(8.27±1.33)Hu;while the CI noise was(10.86±1.13)Hu.It revealed that the VMI noise at 45-70 keV was lower than the CI noise(t=-3.885,-5.343,-6.449,-7.180,-7.756 and-8.132,P<0.001).There was no significant difference between VMI and CI noises at 40 keV(t=-1.800,P>0.05).With the decrease of energy level,CT value of normal liver parenchyma,and contrast noise ratio values of liver parenchyma and liver metastases gradually increased,at the 40 keV level,the values of which were(148.31±21.34)Hu,8.81±2.83 and 8.18±2.85;at the 45 keV level,the values were(130.10±16.95)Hu,7.66±2.46 and 7.48±2.55;at the 50 keV level,the values were(116.19±13.55)Hu,6.60±2.08 and 55.40±13.77,reaching the highest at 40 keV level,while the CI values were(118.02±7.02)Hu,5.69±1.11 and 5.77±1.41.Therefore,the value of 40 keV and 45 keV VMI was significantly higher than CI(t=3.804,4.883,4.462,all P<0.05;t=2.854,3.465,3.378,all P<0.05),respectively.There was no significant difference between 50 keV VMI and CI(t=-0.612,1.739,2.208,P>0.05).The subjective score in the overall quality of VMI images was higher than that of CI at 40-50 keV(t=9.628,7.508,3.514,P<0.05).The subjective scores of the two physicians were good consistent among image contrast,image noise and overall image quality(Kappa=0.766,0.749 and 0.661,P<0.05),respectively.Conclusion VMI at 40-50 keV can provide better image quality and display ability of liver metastases than CI images at portal vein phase with a 50%reduction in contrast agent dose.

Objective:To analyze the characteristic of prenatal serological screening in fetus with X-linked ichthyosis (XLI), and to explore the relationship between unconjugated estriol (uE 3) levels and XLI. Methods:A total of 56 fetuses with Xp22.31 microdeletion indicated by prenatal diagnosis and 70 fetuses diagnosed with trisomy 21 and 26 fetuses with trisomy 18 in Henan Provincial People's Hospital and Affiliated Hospital of Weifang Medical College from September 2016 to June 2021 were collected. The multiples of median (MoM) values of uE 3, alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG) during the second trimester of pregnancy were retrospectively analyzed. Prenatal diagnosis was made by amniotic fluid karyotype analysis and genome copy number variant analysis, parent genetic verification and pathogenicity analysis were performed, and maternal and infant outcomes were followed up. Results:Of 56 pregnant women with fetal Xp22.31 microdeletion, 43 underwent serological screening during the second trimester of pregnancy, of which 42 were abnormal (39 male fetuses and 3 female fetuses). The median uE 3 MoM value of 39 male fetuses [0.06 (0.00-0.21)] was lower than the normal value and significantly lower than that of fetuses with trisomy 21 [0.71 (0.26-1.27)] and fetuses with trisomy 18 [0.36 (0.15-0.84)], the difference was statistically significant ( Z=99.96, P<0.001). While the MoM values of AFP and hCG were all within the normal range. Among the 56 fetuses carrying Xp22.31 microdeletion, 45 were male fetuses and 11 were female fetuses, and the deletion fragments all involved STS gene. Eighty-nine percent (50/56) were inherited from mother (49 cases) or father (1 case), and 11% (6/56) were de novo mutations. Follow-up showed 48 live births (38 males and 10 females) and 8 chose to terminate pregnancy (7 males and 1 female). Among the 38 male newborns, 37 presented with scaly skin changes from 1 to 3 months of age, and one had no clinical manifestations until 4 months after birth. Ten female newborns had no obvious clinical manifestations. Conclusions:The decrease levels of uE 3 MoM on maternal serological screening is closely related to the higher risk of XLI in male fetuses. For pregnant women with low uE 3 in serological screening or with family history of ichthyosis, in addition to chromosomal karyotype analysis, joint detection of genomic copy number variant analysis should be recommended.

Objective:To investigate the reproducibility of whole-heart and volume-targeted balanced steady-state free precession (bSSFP) non-contrast MR coronary angiography (CMRA) for displaying coronary trunks.Methods:From February and September 2021, the whole-heart and volume-targeted CMRA examinations of 58 volunteers were prospectively and consecutively acquired in The First Affiliated Hospital of Fujian Medical University. Each volunteer underwent CMRA twice within a week. The subjective score, vessel-to-myocardium ratio (VMR), vessel-to-fat ratio (VFR), signal-noise ratio (SNR), and coronary corresponding coordinate was analyzed and extracted. Inter-observer, intra-observer and inter-scan consistency were evaluated by intraclass correlation coefficient (ICC), Bland-Altman analysis, Hausdorff Distance (HD), and Dice Similarity Coefficient (DSC).Results:The inter-observer and intra-observer consistencies of subjective scores, VMR, and VFR of the whole-heart and volume-targeted coronary artery images were excellent (ICC>0.76, P<0.001). The inter-scan VFR consistencies of RCA, LM, and LCX of whole-heart coronary scans were moderate (ICC=0.235, 0.264, 0.380, all P<0.05), while the consistencies of the remaining variables were good, (all ICCs>0.49, P<0.001). Bland-Altman method showed that most VMR, VFR, and SNR of two CMRA imaging were within the 95% limits of agreement. Whole-heart CMRA inter-and intra-observer mean HD was 1.79 (1.35, 3.25), 1.68 (1.09, 4.10), mean DSC was 0.96±0.04, 0.97±0.03. Volume-targeted CMRA inter-and intra-observer mean HD were 1.74 (1.63, 3.11), 1.74 (1.63, 1.98), and the mean DSC was 0.91±0.10, 0.95±0.05. The subjective score of raw images of the total artery trunk of volume-targeted CMRA [3.86 (3.68,4.00) vs. 3.80 (3.58,3.96) ], VMR [1.45 (1.27,1.58) vs. 1.22 (1.13,1.41) ], and VFR [7.36 (6.44,8.60) vs. 5.97 (4.97,6.64) ] were better than those of whole-heart CMRA (all P<0.05). The overall subjective score of whole-heart CMRA coronary trunk curved projection reformation was better than volume-targeted CMRA [3.75 (3.57, 3.88) vs. 3.63 (3.44, 3.71)] ( P<0.001). Conclusions:Whole-heart and volume-targeted bSSFP non-contrast CMRA represent good reproducibility and image quality in the main coronary artery of healthy volunteers. Both of the two methods have their advantages and complement each other.

Objective To analyze the reasons of invalid detections occurred in using three kinds of nucleic acid detection systems in our laboratory since 2016.Methods Analyze the numbers and types of invalid detections,for Roche Cobas S201 system from January to December 2016,Procleix Tigris system from January to September 2016,and Procleix Panther system from September 2016 to March 2017,respectively.Results The invalidation rates of Cobas s201,Tigris,and Panther systems were 0.90％ (402/44 838),4.01％ (2 960/73 835),and 1.34％ (1 093/81 741),respectively,and there were statistically significant differences between the three detection systems (P＜0.05).Except for the differences between Roche Cobas s201 and Panther 1404,there were statistically significant differences between instruments (P＜0.05).Failure of instruments,invalid detection of reagent calibrators,fault operation and sample quality are the causes of invalid detection.Conelusion The main reason of invalidation is instrument failure and reagent calibrator failmre.Invalid detections of nucleic acid screening is related on different detection systems.

Objective This research is aimed to investigate the efficacy and toxicity of icotinib for lung adenocarcinoma pa-tients with poor performance status and unknown EGFR gene status .Methods A total of 27 lung adenocarcinom patients with poor Eastern Cooperative Oncology Group-Performance status(ECOG-PS) and unknown EGFR gene status referred to Chongqing Canc-er Institute from August 2012 to August 2014 were analyzed .Icotinib (125 mg) was orally administered three times per day .Asess the efficacy and adverse reaction ,calculate survival rates .Results Among the 27 patients ,the objective response rate(ORR) and disease control rates(DCR) were 29 .6% and 81 .5% ,respectively .The median progression free survival time was 6 .0 months .A to-tal of 70 .4% of patients had an significant improvment in ECOG-PS scores ,following icotinib treatment (Z= - 2 .157 ,P= 0 .031) . Fatigue ,anorexia and diarrhea were the most frequent adverse reaction ,which defined as grade 1 to 2 rashes .Conclusion Lung ade-nocarcinoma patients with poor performance status and unknown EGFR gene status may benefit from icotinib therapy ,and patients were tolerated well .

Objective To investigate the clinical features and magnetic resonance imaging (MRI)findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy.Methods Three patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy received cervical spine MRI on neutral and flexion position. The relationship between MRI findings and their clinical symptoms were analyzed. The outcomes were compared with those of 43 patients who were diagnosed as Hirayama disease with muscular atrophy at the hand and forearm. Results 1) Clinical features:three patients were young men. The disease was characterized by unilateral weakness and atrophy of the proximal upper limbs, such as pectoralis major muscle, deltoid muscle, and biceps brachii muscle. Electromyogram (EMG) showed bilateral upper extremities neurogenic damage. 2) Cervical spine MRI findings:cervical spine kyphosis without spinal cord compression was found on neutral position. On flexion position,anterior shifting of C3-C5 cervical cord and the posterior wall of dural sac were found; C4-C5 cervical cord was compressed by vertebral body or intervertebral disc or dural sac. Engorged posterior internal vertebral venous plexus were observed in epidural space. In the 43 patients who were diagnosed Hirayama disease with muscular atrophy at the hand and forearm, similar MRI findings were found, while cervical cords compression were at C6-C7 level. Conclusion Hirayama disease could present as proximal upper extremity muscular atrophy and weakness, such as pectoralis major muscle, deltoid muscle, and biceps brachii muscle.Neglecting of this will result in diagnostic errors or missed diagnosis. Flexion position MRI is an important base of early diagnosis of Hirayama disease.

Objective To evaluate the protective effects elicited by ClpP fusion protein in animal protection tests. Methods Pneumococcal antigens were purified from recombinant Escherichia coli express-ing CIpP cloned gene. 6- to 8-week-old female BALB/c mice were immunized intraperitoneally with either ClpP or PBS plus alum. Every mouse received three doses of 20 μg antigen or PBS in 100 mg of alum adju-vant at 14 d intervals. Sera were collected from mice and analyzed by ELISA 1 week after the third immuni-zation, Intraperitoneal-challenge experiments with 12 different serotypes of Streptococcus pneumoniae were carried out 2 weeks after the third immunization, and we compared their median survival times and survival rates respectively by Mann Whitney U test and Fisher exact test. Results ELISA analysis demonstrated high titer specific antibody responses to ClpP. The median survival times for mice immunized with ClpP pro-tein antigens in adjuvant were significantly longer than those for mice that received the adjuvants alone. Con-clusion A highly expressed recombinant ClpP protein has been successfully obtained and proved to exert the protection against invasive pneumococcal infection without relation of serotype, suggesting ClpP can be a promising candidate vaccine.

BACKGROUNDSome studies have supposed that glutathione S-transferases (GSTs) may be involved in detoxification of carcinogens, especially from tobacco smoke. Therefore, polymorphism of GSTs has been considered as potential protectors of individual cancer risk. The objective of this study is to investigate the relationship between genetic polymorphism of GSTT1 and inherent susceptibility to lung cancer in Han population in Sichuan, China.

METHODSA case-control study was carried out to compare the distribution frequency of GSTT1 gene polymorphism between lung cancer (n=150) and control healthy individuals (n=152) with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and to analyze the relationship between the GSTT1 gene polymorphism and smoking and the inherent susceptibility of lung cancer.

RESULTS(1) The distribution frequency of GSTT1(-) genotype was 54.7% (82/150) in lung cancer and 38.2% (58/152) in control group respectively (OR=1.681, 95%CI=1.009- 2.803 , P=0.046); (2) GSTT1(-) genotype remarkably increased the risk of squamous cell carcinoma (OR=2.969, 95%CI= 1.511 -5.834, P=0.002) and adenocarcinoma (OR=2.095, 95%CI=1.060-4.140, P= 0.033 ); (3) In smokers, GSTT1(-) genotype significantly increased the risk for lung cancer (OR=4.051, 95%CI=1.959-8.380 , P=0.000); (4) In people with GSTT1(-) genotype, smoking markedly increased the risk for lung cancer (OR=53.885, 95%CI=11.789-246.302, P=0.000); (5) In heavy smokers (≥20 packyears), GSTT1(-) genotype could remarkably increase the risk of lung cancer (OR=4.296, 95%CI=1.649-11.190, P=0.003).

CONCLUSIONS(1) People with GSTT1(-) genotype have significantly increased risk for lung cancer in Han population in Sichuan, China, especially for squamous cell carcinoma. (2) GSTT1(-) genotype interacts synergistically with smoking on lung cancer risk. The more the cigarettes smoke, the higher the risk of lung cancer increases in those people who are smokers with GSTT1(-) genotype.