Objective:To evaluate the value of 18F-FDG PET metabolic parameters in predicting histopathological grade of soft tissue sarcoma (STS). Methods:From December 2012 to December 2021, 51 patients (26 males, 25 females, age range: 32-84 years) who underwent 18F-FDG PET/CT imaging before treatment and confirmed STS pathologically in the First Affiliated Hospital of Dalian Medical University were retrospectively collected. 18F-FDG PET metabolic parameters SUV max, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and intertumoral FDG uptake heterogeneity (IFH) were measured. Kruskal-Wallis rank sum test was used to analyze the differences in metabolic parameters among different groups and Spearman rank correlation analysis was used to analyze the correlation of each metabolic parameter and histological grade. Logistic regression was used to screen and construct the prediction model for high-grade STS. ROC curve was plotted and Delong test was used to analyze the differences among AUCs. Results:The metabolic parameters SUV max, MTV, TLG and IFH were significantly different among French Federation of Cancer Centers Sarcoma Group (FNCLCC)Ⅰ( n=8), Ⅱ( n=10) and Ⅲ ( n=33) grade groups ( H values: 16.24, 10.52, 19.29 and 16.99, all P<0.05), and each metabolic parameter was positively correlated with histological grade ( rs values: 0.58, 0.45, 0.52, and 0.62, all P<0.05). Multivariate logistic regression analysis showed that SUV max(odds ratio ( OR)=1.27, 95% CI: 1.06-1.51, P=0.009) and IFH ( OR=6.83, 95% CI: 1.44-32.27, P=0.015) were independent risk indicators for high-grade STS. The prediction model constructed by combining SUV max and IFH had better diagnostic efficacy for differentiating high-grade STS with the AUC of 0.93, and the sensitivity of 93.9%(31/33) and the specificity of 16/18, respectively. The AUC of prediction model was significant different from SUV max, MTV, TLG and IFH (AUCs: 0.81, 0.78, 0.86 and 0.85; z values: 2.69, 2.53, 1.94 and 1.97, all P<0.05). Conclusions:The metabolic parameters SUV max, MTV, TLG and IFH are valuable predictors for histological grade of STS. The combination of SUV max and IFH may be a more meaningful method than using each of the above metabolic parameters alone.

Purpose: The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is extremely poor, and systemic therapy is currently the mainstream treatment. This study aimed to assess the efficacy and safety of lenvatinib combined with anti–programmed cell death-1 antibodies and transcatheter arterial chemoembolization (triple therapy) in patients with HCC and PVTT. Materials and Methods: This retrospective multicenter study included patients with HCC and PVTT who received triple therapy, were aged between 18 and 75 years, classified as Child-Pugh class A or B, and had at least one measurable lesion. The overall survival (OS), progression-free survival (PFS), objective response rates, and disease control rates were analyzed to assess efficacy. Treatment-related adverse events were analyzed to assess safety profiles. Results: During a median follow-up of 11.23 months (range, 3.07 to 34.37 months), the median OS was greater than 24 months, and median PFS was 12.53 months. The 2-year OS rate was 54.9%. The objective response rate and disease control rate were 69.8% (74/106) and 84.0% (89/106), respectively; 20.8% (22/106) of the patients experienced grade 3/4 treatment-related adverse events and no treatment-related deaths occurred. The conversion rate to liver resection was 31.1% (33/106), with manageable postoperative complications. The median OS was not reached in the surgery group, but was 19.08 months in the non-surgery group. The median PFS in the surgery and non-surgery groups were 20.50 and 9.00 months, respectively. Conclusion Triple therapy showed promising survival benefits and high response rates in patients with HCC and PVTT, with manageable adverse effects.

Objective To evaluate MRI characteristics of solid papillary carcinomas (SPCs) in situ of the breast.Methods A retrospective study included 5 patients with pathologically confirmed SPC in situ was performed.MRI data before operation including conventional MRI,dynamic contrast enhanced MRI (DCE-MRI) and DWI were analyzed.Results All the lesions showed iso/hypointensity on T1 FSPGR sequence,iso/hyperintensity on FSE T2WI sequence and STIR sequence.Mass enhancements were observed for all lesions with oval or irregular shapes on DCE-MRI.The margin of lesions were circumscribed,and internal enhancements were homogeneous or heterogeneous.Time intensity curve appeared a rapid increase in initial contrast phases and platform or outflow types in delayed phases.All the lesions on DWI showed slightly hyperintensity with the ADC value range from 1.34 × 10-3 mm2/s to 1.96)× 10-3 mm2/s.Conclusion MRI manifestations of SPC are characteristics,which may provide valuable information to distinguish SPC in situ from other invasive breast carcinomas.

With constant development and application of new generation information technology such as big data, cloud computing and Internet of Things, traditional management style and thought patterns of TCM are being changed. It is particularly important to introduce information security into budget management of TCM projects. This article discussed security factors in TCM budget monitoring platform, organized key contents of information security construction, built information security model for monitoring platform, and analyzed security strategies for the construction of TCM budget monitoring platform, with a purpose to guarantee effective implementation of budget information management measures of TCM projects.

Objective To explore the patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction ( AEG ) . Methods Clinicopathological data of 393 AEG patients who underwent radical resection and lymphadenectomy in the thoracic or abdominal cavity were collected. We analyzed the metastatic patterns of 5 119 excised lymph nodes with an average of 13 nodes per patient according to Siewert classification, and the associations between lymphatic metastasis and clinicopathological factors, such as tumor invasion, differentiation, maximum diameter, or pathological type were analyzed. Results The lymph node metastasis rate and ratio ( LNR) were 70. 0% ( 275/393) and 29.1% (1 492/5 119), respectively. All the Siewert subtypes of AEG mainly metastasize downwards to the abdominal lymph nodes, while also spread upwards to the mediastinal lymph nodes. Among them, the lymph node metastasis rate was highest in Siewert type Ⅰ and lowest in Siewert type Ⅲ AEG. The lymph node metastasis rate and ratio in T1, T2, T3, T4 AEGs were 0%, 29. 4%, 75. 0%, 74. 6% and 0%, 10. 1%, 14.2%, 32.0%,respectively (χ2=35.305,P<0.001 andχ2=134.034,P<0.001) . The lymph node metastasis rate and ratio of the poorly differentiated adenocarcinoma were 36.0% and 79.3%, respectively, significantly higher than 22.1% and 61.7% of the well?differentiated adenocarcinoma (χ2=14.468, P<0.001 and χ2=120.009, P<0.001). The lymph node metastasis rate and ratio of patients with a tumor in maximum diameter≥4 cm were 73.1% and 30.9%, significantly higher than 46.8% and 14.6%, respectively, in the patients with a tumor in maximum diameter of<4 cm (χ2=13.636, P<0.001 andχ2=64.767, P<0.001) . The group of vascular tumor thrombus showed significantly higher lymph node metastasis rate and ratio than those in the group with no vascular tumor thrombus ( 84. 6% versus 67. 1%, χ2=7. 946, P=0. 005; and 45. 0% versus 26.0%, χ2 = 112. 723, P<0. 001 ) . The lymph node metastasis ratio of mucinous and signet ring cell adenocarcinoma was 34.9%, significantly higher than 28.5% of the adenocarcinoma (χ2=8.710, P<0.001) The depth of tumor invasion and degree of tumor differentiation were independent factors affecting lymph node metastasis (P=0.001 and P<0.001). Conclusions The lymph node metastasis rate and ratio of AEG are high and influenced by many clinicopathological factors. The patterns of lymph node metastasis are different among different Siewert subtype AEGs.The depth of tumor invasion and differentiation degree are independent factors affecting lymphatic metastasis.

Objective To explore the patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction ( AEG ) . Methods Clinicopathological data of 393 AEG patients who underwent radical resection and lymphadenectomy in the thoracic or abdominal cavity were collected. We analyzed the metastatic patterns of 5 119 excised lymph nodes with an average of 13 nodes per patient according to Siewert classification, and the associations between lymphatic metastasis and clinicopathological factors, such as tumor invasion, differentiation, maximum diameter, or pathological type were analyzed. Results The lymph node metastasis rate and ratio ( LNR) were 70. 0% ( 275/393) and 29.1% (1 492/5 119), respectively. All the Siewert subtypes of AEG mainly metastasize downwards to the abdominal lymph nodes, while also spread upwards to the mediastinal lymph nodes. Among them, the lymph node metastasis rate was highest in Siewert type Ⅰ and lowest in Siewert type Ⅲ AEG. The lymph node metastasis rate and ratio in T1, T2, T3, T4 AEGs were 0%, 29. 4%, 75. 0%, 74. 6% and 0%, 10. 1%, 14.2%, 32.0%,respectively (χ2=35.305,P<0.001 andχ2=134.034,P<0.001) . The lymph node metastasis rate and ratio of the poorly differentiated adenocarcinoma were 36.0% and 79.3%, respectively, significantly higher than 22.1% and 61.7% of the well?differentiated adenocarcinoma (χ2=14.468, P<0.001 and χ2=120.009, P<0.001). The lymph node metastasis rate and ratio of patients with a tumor in maximum diameter≥4 cm were 73.1% and 30.9%, significantly higher than 46.8% and 14.6%, respectively, in the patients with a tumor in maximum diameter of<4 cm (χ2=13.636, P<0.001 andχ2=64.767, P<0.001) . The group of vascular tumor thrombus showed significantly higher lymph node metastasis rate and ratio than those in the group with no vascular tumor thrombus ( 84. 6% versus 67. 1%, χ2=7. 946, P=0. 005; and 45. 0% versus 26.0%, χ2 = 112. 723, P<0. 001 ) . The lymph node metastasis ratio of mucinous and signet ring cell adenocarcinoma was 34.9%, significantly higher than 28.5% of the adenocarcinoma (χ2=8.710, P<0.001) The depth of tumor invasion and degree of tumor differentiation were independent factors affecting lymph node metastasis (P=0.001 and P<0.001). Conclusions The lymph node metastasis rate and ratio of AEG are high and influenced by many clinicopathological factors. The patterns of lymph node metastasis are different among different Siewert subtype AEGs.The depth of tumor invasion and differentiation degree are independent factors affecting lymphatic metastasis.

Objective To analyze the patterns and distribution of lymph node metastasis in patients with adenocarcinoma of the esophagogastric junction ( AEG). Methods The pathological data of 393 patients with AEG from 2006 to 2009 were analyzed. The patterns and distribution of lymph node metastasis were analyzed in patients with different Siewert subtypes, depths of tumor invasion, and maximum diameters of the tumor, and the high?risk lymphatic drainage areas were investigated. Between?group comparison was performed by χ2 test. Results The metastatic rate and ratio of abdominal lymph nodes in AEG were 69?? 2%and 31?? 31%, respectively. The incidence rates of lymph node metastasis in the cardia, lesser curvature, left gastric artery, splenic artery, splenic hilum, mesenteric root, and abdominal aorta were the highest. The metastatic rate and ratio of mediastinal lymph nodes were 16?? 4% and 8?? 3%, respectively. The incidence rates of lymph node metastasis in the lower paraesophageal, esophageal hiatus, and superior diaphragmatic areas were the highest. Compared with Siewert type II and type III AEG, Siewert type I AEG had a significantly higher mediastinal lymph node metastatic rate (P= 0?? 003) and a significantly lower abdominal lymph node metastatic ratio (P= 0?? 002).The metastatic ratios of lymph nodes in multiple abdominal regions were higher in patients with stage T3+T4 AEG and a maximum tumor diameter of ≥6 cm than in the control group, while the metastatic ratios of mediastinal lymph nodes in groups with different maximum tumor diameters were similar. The metastatic ratios of lymph nodes in the greater curvature, hepatoduodenal ligament, and inferior diaphragmatic areas were lower than 10% in all groups. Conclusions In radiotherapy for AEG, the abdominal high?risk lymphatic drainage areas involve the cardia, lesser curvature, left gastric artery, splenic artery, splenic hilum, mesenteric root, and abdominal aorta, while the mediastinal high?risk lymphatic drainage areas involve the lower paraesophageal, esophageal hiatus, and superior diaphragmatic areas. In addition, the personalized target volume design should be based on the patterns of lymph node metastasis with different Siewert subtypes and clinical pathological characteristics.

Objective To investigate the value of kinetic features measured by computer-aided diagnosis (CAD)for breast MRI.Methods One hundred and sixty four lesions diagnosed pathologically by operation or biopsy comprised the analysis set.Automated lesion kinetic information from CADStream programs for breast MRI was identified.Three CAD variables were compared for benign and malignant lesions: initial phase peak enhancement (greatest percentage of signal intensity increase on first contrast enhanced sequence),delayed phase enhancement categorized by a single type of kinetics comprising the largest percentage of enhancement (washout,plateau,or persistent),and delayed phase enhancement categorized by single most suspicious type of kinetics (any washout ＞ any plateau ＞ any persistent).Morphological characteristics of breast lesions were described according to breast imaging and reporting data system (BI-RADS).Initial phase peak enhancement mean values between benign and malignant breast lesions were compared by using Wilcoxon rank-sum test,delayed phase enhancement categorized by a single type of kinetics comprising the largest percentage of enhancement or by single most suspicious type of kinetics between benign and malignant breast lesions were compared by using Chi-square test.Results There were 72 benign and 92 malignant breast lesions.A total of 123 (75.0％) mass lesions were identified,and the other 41 (25.0％) lesions showed no mass.Thirty lesions were BI-RADS-MRI 2,68 lesions were BI-RADS-MRI 3,43 lesions were BI-RADS-MRI 4,23 lesions were BI-RADS-MRI 5.Initial phase peak enhancement mean values of benign and malignant lesions were 237％ (69％ to 629％)and 336％ (86％ to 793％),respectively.There was no significant difference between benign and malignant lesions in initial peak enhancement mean value (Z =-1.626,P =0.104).Delayed phase enhancement categorized by single most suspicious type of kinetics (any washout ＞ any plateau ＞ any persistent) for benign and malignant lesions were 15,10,47 and 2,3,87 respectively.There was a significant difference between benign and malignant lesions (x2 =23.562,P =0.000).Initial peak enhancement value ＜ 100％ or ≥100％ were 5 and 67 for benign lesions,3 and 89 for malignant lesions,respectively.There was no significant difference between benign and malignant lesions at 100％ threshold (x2 =1.181,P =0.277).Delayed phase enhancement categorized by a single type of kinetics comprising the largest percentage of enhancement (washout,plateau,or persistent) for benign and malignant lesions were 48,6,18 and 47,15,30 respectively.There was no significant difference between benign and malignant lesions (x2 =4.496,P =0.106).Conclusions Of CAD kinetics analyzed,only delayed enhancement categorized by most suspicious type is helpful for the differentiation between benign and malignant lesions.However,there is significant overlap between initial peak enhancement at 100％ threshold or delayed kinetics categorized by largest percentage enhancement types of benign and malignant lesions,so lesion morphologic features should be considered.

Objective To evaluate MR diffusion-weighted imaging (DWI)and MR perfusion-weighted imaging(PWI) in differentiating benign from malignant soft tissue tumors by comparing the related parameters. Methods Fifty patients with soft tissue tumors verified by pathology( benign 24, malignant 26) underwent DWI and dynamic contrast-enhanced T2 * -weighted PWI. DWI and PWI data of benign and malignant soft tissue tumors were acquired at the workstation and their difference was analyzed with t-test. The diagnostic accordance rate was verified with x2-test. Subjective overall performance of two techniques were evaluated with receiver operating characteristic (ROC) analysis. Results ADC values of benign and malignant tumors were (2. 03±0. 36) × 10-3 mm2/s, ( 1.52±0. 39) × 10-3 mm2/s,respectively. The signal intensity decrease of them during the first-pass perfusion (SIdecrease ) were ( 13.54 ± 3.37 )%, (47. 57 ± 5. 21 ) % ,respectively. The maximum linearity slope rate of TIC ( SSmax ) of them were ( 5.51 ± 2. 54 ) %, (7.94 ± 3. 33) %, respectively. There were significant differences between benign and malignant tumors of ADC value and SIdecrease ( t = 2. 515,2. 938 ;P < 0. 05 ), while there was no significant difference in SSmax (t = 1. 272,P >0. 05). When the threshold of ADC value was 1. 866 × mm2/s, sensitivity and specificity for determining malignant tumors were 84. 6% (22/26)and 83.3% (20/24). When the threshold of SIdecrease was 40. 33% ,sensitivity and specificity for determining malignant tumors were 88. 5% (23/26)and 75.0% (18/24). In type Ⅰa of TIC,the proportion of benign soft tissue tumor was 3/24 and malignant tumor was 20/26. In type Ⅰb , benign tumor was 14/24 and malignant tumor was 3/26. In type Ⅰc, malignant tumor was 3/26. In type Ⅱ ,benign tumor was 7/24. The diagnostic accordance rate of DWI and PWI were 84. 0% (42/50) and 82. 0% (41/50), respectively. There was no significant difference between them ( x2 = 0. 8, P >0. 05). The accuracies of them were 81.7% , 83. 6% respectively by the area under the ROC curve (AUC). The sensitivity of PWI in diagnosing malignant soft tissue tumors was higher. Conclusions ADC value and SIdecrease are Valllable diagnostic parameters in differentiating benign and malignant soft tissue tumors. The threshold of these parameters for diagnosing malignant soft tissue tumors are 1. 866 × 10-3 mm2/s and 40. 33%, respectively. The type of TIC can help to distinguish malignant tumors from benign tumors, while the SSmax can not. The accuracies of DWI and PWI in the diagnosis of malignant soft tissue tumors are moderate. Compared with DWI, PWI should be selected firstly because of its higher sensitivity in diagnosing malignant tumors.

Objective To study the recovery mechanism of dysphagic patients after stroke using functional magnetic resonanee imaging(fMRI). Methods Thirteen patients with dysphagia caused by unilateral cortical or subcortical lesions were recruited into a dysphagia group,and eight age-matched healthy volunteers were recruited as controls.Both grouDs performed experimental volitional swallowing tasks during fMRI studies.All patients of the dys-phagia group received rehabilitation treatment targeting dysphagia.Of the 13 dysphagia patients,7 reached almost complete recovery and were identified as recovered in follow-up fMRI studies.A 3.0 T MR scanner and echo planar imaging(EPI)T_2 WI sequence were employed to obtain the fMRI data.SPM2 software was used for post-processing of the fMRI data and displaying activated brain maps.Lateral index(LI)was calculated as LI:(C-1)/(C+I).Paired t tests were used to compare activated brain volume before and after complete recovery. Results Consistent activation of the bilateral primary sensorimotor cortex,anterior cingulated gyrus and the bilateral insular cortex were observed in the control group. Activation of the pons,medulla,left cerebellum,left prefrontal area,right occipital area and the left insular cortex were observed in the dysphagia group.Activation was observed in the bilateral primary sensorimotor cortex.bilateral prefrontal area,bilateral superior temporal gyrus,left insular cortex,bilateral frontal o-pereulum and anterior cingulated gyrus in the recovered patients.The total activated volume before recovery in the ip-silesional hemisDhere was significantly less compared with the contralesional hemisphere in the dysphagia group.In the recovered patients,both the activated brain volume of the ipsilesional hemisphere and value of LI were significant-ly larger than those at the initial examination.Conclusions Decreased activation in the sensorimotor cortex,the in-sular lobe and the cingulate gyms might be causes.of dysphagia.Compensation by the contralesional hemisphere in the early stages and then the restoration of the ipsilesional hemisphere after recovery may be mechanisms of dysphagia recovery in stroke patients.