Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Parkinson disease(PD)is a common neurodegenerative disease.PD-related pattern(PDRP)based on 18F-FDG PET has been recognized as a brain metabolic pattern that highly correlated with motor symptoms in PD patients,i.e.classical PDRP.Subsequently,derivative PDRP based on other imaging techniques such as MRI can provide supplementary information to brain metabolic patterns of PD patients,having advantages such as low cost and high reproducibility,gradually become an alternative to classical PDRP.The research progresses of PDRP based on PET imaging and MRI for PD were reviewed in this article.

Objective: To evaluate the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) plus oral megestrol acetate (MA) as fertility-preserving treatment in patients with early-stage endometrial cancer (EEC). Methods: In this single-center, phase II study with open-label, randomized and controlled design, young patients (18–45 years) diagnosed with primary EEC were screened, who strongly required fertility-preserving treatment. Patients were randomly assigned (1:1) into MA group (160 mg oral daily) or MA (160 mg oral daily) plus LNG-IUS group. Pathologic evaluation on endometrium retrieved by hysteroscopy was performed every 3 months. The primary endpoint was complete response (CR) rate within 16 weeks of treatment. The secondary endpoints were CR rate within 32 weeks of treatment, adverse events, recurrent and pregnancy rate. Results: Between July 2017 and June 2020, 63 patients were enrolled and randomly assigned. Totally 56 patients (26 in MA group; 28 in MA + LNG-IUS group) were included into primary-endpoint analyses. The median follow-up was 31.6 months (range, 3.1–94.0). No significant difference in 16-week CR rate were found between MA and MA + LNG-IUS groups (19.2% vs. 25.0%, p=0.610; odds ratio=1.40; 95% confidence interval=0.38–5.12), while the 32-week CR rates were also similar (57.1% and 61.5%, p=0.743), accordingly. More women in MA + LNG-IUS group experienced vaginal hemorrhage (46.4% vs. 16.1%; p=0.012) compared with MA group. No intergroup difference was found regarding recurrence or pregnancy rate. Conclusion Compared with MA alone, the addition of LNG-IUS may not improve the early CR rate for EEC, and may produce more adverse events instead.

Objective: This study investigated the characteristics of progestin-insensitive endometrioid endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) patients receiving fertility-sparing treatments and assessed the therapeutic effects of second-line fertility-preserving treatments. Methods: Three hundred and thirty-eight patients with EEC (n=75) or AEH (n=263) receiving fertility-preserving treatment were retrospectively analyzed. ‘Progestin-insensitive’ was defined as meeting one of the following criteria: 1) presented with progressed disease at any time during conservative treatment, 2) remained with stable disease after 7 months of treatment, and/or 3) did not achieve complete response (CR) after 10 months of treatment. Clinical characteristics and treatment results of progestin-insensitive patients receiving second-line treatment and those of progestin-sensitive patients were compared. Results: Eight-two patients (59 AEH and 23 EEC) were defined as progestin-insensitive and 256 as progestin-sensitive. In multivariate analysis, body mass index ≥28.0 kg/m2 (odds ratio [OR]=1.898) and lesion size >2 cm (OR=2.077) were independent predictors of progestin-insensitive status. Compared to AEH patients, progestin-insensitive EEC patients had poorer second-line treatment responses (28-week cumulative CR rate after changing second-line treatment, 56.3% vs. 85.4%, p=0.011). No statistical difference was found in CR rate among different second-line treatments. Conclusion Obesity and larger lesion size were independent risk factors associated with progestin-insensitive status. In progestin-insensitive patients receiving second-line treatment, EEC patients had lower CR rate comparing with AEH patients. Further study with larger sample size is needed to evaluate efficacy of different second-line treatments for progestin insensitive patients.

The clinical features and laboratory tests results of two cases with Fanconi anemia (FA) who were admitted to the Department of Children′s Hematology and Endocrinology, the Provincial Hospital Affiliated to Shandong First Medical University in 2017 were analyzed.Sanger sequencing and multiplex ligation-dependent probe amplification(MLPA) of FA-related genes was carried out.One case was female, 4 years and 3 months old.The other case was a 6-year-old male.The main manifestations were recurrent fever, asthenia and bleeding points in both legs.The girl had milk coffee spots scattered on her legs and waist, and her left thumb nail was absent.The boy had no obvious physical examination abnormality, but his left atrium and left ventricle were large and segmental myocardial damage could be seen by echocardiography.Bone marrow biopsies of both cases showed hypo-proliferation (40%) or extremely low proliferation (10%), and no megakaryocyte was found.There were no significant abnormalities in chromosome aberration, single cell gel electrophoresis, cluster of differentiation(CD) 41, CD 55, and CD 59 and chromosome karyotype.Gene sequencing revealed that the two children had compound heterozygous mutations of Fanc A gene, which came from parents.The heterozygous mutation of c1838delT was found in the exon 21 of the female child and her father, which resulted in amino acid shift mutation pIi613Tfs*27.The heterozygous deletion mutations in exons 1-3 of Fanc A gene were found in the female child and her mother by the MLPA results.The gene sequencing analysis of the male child and his family members showed the heterozygous mutation of c4124_4125del in the exon 41 of the child and his mother, which resulted in amino acid shift mutation p. T1375Sfs*49.The heterozygous deletion mutations were observed in exons 23-40 of the male child and his father, according to the MLPA results.The main basis of diagnosis of FA is to sequence the related genes of suspected children.The c1838delT is a new mutation of Fanc A gene.

Objective: To investigate the current status and real performance of the detection of RUNX1-RUNX1T1 fusion transcript levels and WT1 transcript levels in China through interlaboratory comparison. Methods: Peking University People’s Hospital (PKUPH) prepared the samples for comparison. That is, the fresh RUNX1-RUNX1T1 positive (+) bone morrow nucleated cells were serially diluted with RUNX1-RUNX1T1 negative (-) nucleated cells from different patients. Totally 23 sets with 14 different samples per set were prepared. TRIzol reagent was added in each tube and thoroughly mixed with cells for homogenization. Each laboratory simultaneously tested RUNX1-RUNX1T1 and WT1 transcript levels of one set of samples by real-time quantitative PCR method. All transcript levels were reported as the percentage of RUNX1-RUNX1T1 or WT1 transcript copies/ABL copies. Spearman correlation coefficient between the reported transcript levels of each participated laboratory and those of PKUPH was calculated. Results: ①RUNX1-RUNX1T1 comparison: 9 samples were (+) and 5 were (-) , the false negative and positive rates of the 20 participated laboratories were 0 (0/180) and 5% (5/100) , respectively. The reported transcript levels of all 9 positive samples were different among laboratories. The median reported transcript levels of 9 positive samples were from 0.060% to 176.7%, which covered 3.5-log. The ratios of each sample’s highest to the lowest reported transcript levels were from 5.5 to 12.3 (one result which obviously deviated from other laboratories’ results was not included) , 85% (17/20) of the laboratories had correlation coefficient ≥0.98. ②WT1 comparison: The median reported transcript levels of all 14 samples were from 0.17% to 67.6%, which covered 2.6-log. The ratios of each sample’s highest to the lowest reported transcript levels were from 5.3-13.7, 62% (13/21) of the laboratories had correlation coefficient ≥0.98. ③ The relative relationship of the reported RUNX1-RUNX1T1 transcript levels between the participants and PKUPH was not always consistent with that of WT1 transcript levels. Both RUNX1-RUNX1T1 and WT1 transcript levels from 2 and 7 laboratories were individually lower than and higher than those of PKUPH, whereas for the rest 11 laboratories, one transcript level was higher than and the other was lower than that of PKUPH. Conclusion The reported RUNX1-RUNX1T1 and WT1 transcript levels were different among laboratories for the same sample. Most of the participated laboratories reported highly consistent result with that of PKUPH. The relationship between laboratories of the different transcript levels may not be the same.

OBJECTIVES: Although patients with grade I and II endometrioid endometrial adenocarcinoma (EEA) are considered with good prognosis, among them 15%–25% died in 5 years. It is still unknown whether integrating estrogen receptor (ER) and progesterone receptor (PR) into clinical risk stratification can help select high-risk patients with grade I–II EEA. This study was to investigate the prognostic value of ER and PR double negativity (ER/PR loss) in grade I–II EEA, and the association between ER/PR loss and The Cancer Genome Atlas (TCGA) classification. METHODS: ER and PR were assessed by immunohistochemistry on hysterectomy specimens of 903 patients with grade I–II EEA. ER and PR negativity were determined when < 1% tumor nuclei were stained. Gene expression data were obtained from the TCGA research network. RESULTS: Compared with ER or PR positive patients (n=868), patients with ER/PR loss (n=35) had deeper myometrial infiltration (p=0.012), severer FIGO stage (p=0.004), and higher rate of pelvic lymph node metastasis (p=0.020). In univariate analysis, ER/PR loss correlated with a shorter progression-free survival (PFS; hazard ratio [HR]=5.25; 95% confidence interval [CI]=2.21–12.52) and overall survival (OS; HR=7.59; 95% CI=2.55–22.60). In multivariate analysis, ER/PR loss independently predicted poor PFS (HR=3.77; 95% CI=1.60–10.14) and OS (HR=5.56; 95% CI=1.37–22.55) for all patients, and poor PFS for patients in stage IA (n=695; HR=5.54; 95% CI=1.28–23.89) and stage II–IV (n=129; HR=5.77; 95% CI=1.57–21.27). No association was found between ER/PR loss and TCGA classification. CONCLUSION: Integrating ER/PR evaluation into clinical risk stratification may improve prognosis for grade I–II EEA patients.
Adenocarcinoma* ; Carcinoma, Endometrioid ; Classification ; Disease-Free Survival ; Endometrial Neoplasms ; Estrogens* ; Female ; Gene Expression ; Genome ; Humans ; Hysterectomy ; Immunohistochemistry ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Progesterone* ; Prognosis ; Receptors, Progesterone*

Objective To explore the efficiency of 6-18 F-fluoro-L-3,4-dihydroxyphenylalanine (18 F-FDOPA) PET/CT imaging in the diagnosis of pheochromocytoma/paraganglioma (PPGLs). Methods Twenty-six patients (15 males, 11 females;age:13-76 years) who were suspected of PPGLs with adrenal or retro-peritoneal mass were enrolled into this prospective study. All patients underwent 18 F-FDOPA PET/CT ima-ging. The clinical data, laboratory data and imaging results were collected. Region of interest ( ROI) was drawn on the liver and lesions, and the mean standardized uptake value ( SUVmean ) of the liver and the max-imum standardized uptake value ( SUVmax ) of lesions were calculated, as well as the ratio of tumor/lesion ratio ( T/L) . Based on the pathological results considered as the gold standard, the diagnostic efficiency of 18 F-FDOPA PET/CT imaging in PPGLs was calculated and compared with that of CT/MR. Besides, receiv-er operating characteristic ( ROC) curve analysis of T/L was used. Results Twenty-five patients were path-ologically confirmed, including 12 patients with PPGLs and 13 patients with non-PPGLs. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 18 F-FDOPA PET/CT ima-ging was 11/12, 12/13, 92.00％(23/25), 11/12 and 12/13, respectively. The area under the ROC curve of T/L was 0.978, with the cut-off value of 1.55. 18 F-FDOPA PET/CT imaging totally detected 29 positive foci, including 12 of pheochromocytoma (PCC) and 17 of paraganglioma (PGL). Among those 18F-FDOPA positive PGL foci, 11 were detected by CT/MR, while 6 with diameter less than 1 cm were missed. Conclu-sion 18 F-FDOPA PET/CT imaging can detect more small PGL lesions than CT/MR, suggesting that it may be a proper imaging modality of PPGLs.

Objective To investigate the MRI manifestations of pilomyxoid astrocytoma (PMA)at unusual sites and differential diagnosis in children.Methods The clinical and MRI data from 6 cases of PMA with atypical locations confirmed by surgery and pathology were analyzed retrospectively.Results 2 cases located at cerebral hemisphere,1 case at tegmentum mesencephali,1 case at medulla and 2 cases at cerebellar hemisphere.There were 4 cases of solid tumor and 2 case belonged to cystic-solid mass.5 cases were round or oval and 1 case was shallow lobulated.In addition,there were 2 cases with hemorrhage and 2 cases with peritumoral edema.T1WI showed hypointensity,isointense or slightly hyperintense while T2WI and fluid attented inversion recovery (FLAIR)exhibited isointensity or hyperintensity.After contrast administration,there were 3 cases of obvious multi-ring enhancement,of which 1 case showed astral enhancement of the mural nodules and the other 3 cases showed mild homogeneous or inhomogeneous enhancement.4 cases showed non-enhanced areas in the solid parts.No signs of leptomeningeal dissemination were found in all 6 cases.Conclusion The PMA at unuaual sites in children is primarily solid or cystic-solid,and the image manifestations of plain scan are varied.After enhancement,the tumors show obviously multi-circular enhancement and mild homogeneous or inhomogeneous enhancement could be observed,no enhancement areas are visible in the solid parts.It is noteworthy to distinguish this astrocytoma from other lesions.

Objective To differentiate between pulmonary mucosa-associated lymphoid tissue lymphoma (MALT) and adenocarcinoma by radiomics, and then evaluate the diagnostic value of this novel approach. Methods We retrospectively analyzed CT images of pulmonary MALT lymphoma (n=16) and invasive pulmonary adenocarcinoma (n=41) and all these cases were confirmed by pathology in the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2012 to June 2017. After we delineated the lesions as region of interest (ROI), sixty-one radiomics features were extracted from each individual's CT images by Radcloud 1.0. All cases in each group were randomly divided into training set (70％cases) and testing set(30％cases), with 7 features (Wilcoxon test) of which showed group differences and were used to train and validate a support vector machine (SVM) classifier. Results Seven of 61 radiomics features showed differences between the two groups, i.e. 10th percentile, mean, median, minimum, total energy, run length non uniformity, gray level non uniformity. Using these 7 features, the resulted SVM successfully differentiated two diseases. The SVM showed high performance with 90％precision, recall 0.89, F1-score 0.87, ROC 0.75. Conclusions Pulmonary MALT and adenocarcinoma differ in radiomics features and machine learning can utilize these features to differentiate between pulmonary MALT and adenocarcinoma. Combination of radiomics and machine learning is promising in the differential diagnosis of these two diseases.