Objective:To explore the application effect of the milestone evaluation system based on ACGME core competencies in the standardized training of residents in the department of rheumatology and immunology.Methods:A modified Milestone Evaluation Scale was developed for the department of rheumatology and immunology. Self evaluation and mentor evaluation were conducted on 150 residents who received standardized training in grades 1-3 before May 2023. The results were collected and statistically analyzed. One-way analysis of variance and t-test were performed using SPSS 27.0. Results:The self-evaluation and mentor evaluation scores of all residents increased with the training years. Self-evaluation scores were significantly higher than mentor evaluation scores ( P<0.05) for the medical knowledge ( t=2.95, P=0.006), diagnosis and treatment ability ( t=2.57, P=0.015), and learning ability ( t=2.67, P=0.015) of grade 2 residents and the learning ability ( t=2.87, P=0.007) of grade 3 residents. There were no significant differences in the baseline score and ability improvement of residents from different institutions ( P>0.05). Conclusions:The milestone evaluation system is an effective tool for training, assessing, and providing feedback to residents in rheumatology and immunology, and provides essential feedback to resident training bases regarding the training effectiveness. The method is worth promoting.

Objective:To perform harmonization based on the ComBat method for PET brain imaging scanned by different types of scanners from the same manufacturer and explored its effect on center effect.Methods:The three-dimensional (3D) Hoffman brain model was scanned by two different PET/CT instruments (Siemens Biograph64 TruePoint and Biograph128 mCT). Fourteen healthy subjects (8 males, 6 females, age: (57.7±9.5) years) underwent 18F-FDG PET/CT on Siemens Biograph64 TruePoint and 12 healthy subjects (9 males, 3 females, age: (55.8±10.5) years) underwent 18F-FDG PET/CT on Siemens Biograph128 mCT (all from Huashan Hospital, Fudan University; from November 2020 to March 2023). The whole brain was divided into 116 brain regions based on the anatomical automatic labeling (AAL) brain template. The ComBat method was applied to harmonized the PET data from brain model and healthy subjects. Mann-Whitney U test was performed on the radioactive counts and SUV ratios (SUVR) before and after homogenization acquired by both PET/CT instruments. Voxel-based statistical parametric mapping (SPM) independent-sample t test was also performed on data of healthy subjects. Results:In 3D Hoffman brain model, radioactivity counts (5 590.33(4 961.67, 6 102.95) vs 6 116.03(5 420.97, 6 660.66); z=-9.35, P<0.001) and SUVR (1.35(1.19, 1.47) vs 1.37(1.21, 1.49); z=-3.63, P<0.001) were significantly different between the two PET/CT scanners before harmonization and not after harmonization (radioactivity counts: 5 845.95(5 192.68, 6 378.63) vs 5 859.17(5 193.84, 6 380.52); SUVR: 1.35(1.20, 1.48) vs 1.36(1.20, 1.49); both z=-0.68, both P=0.498). In the healthy subjects, radioactive counts in 19 brain regions (12 422.78(11 181.60, 13 424.28)-18 166.40(15 882.80, 18 666.27); z values: from -3.24 to -2.06, all P<0.05) and SUVR in 40 brain regions (1.46(1.41, 1.52)-2.28(2.16, 2.36); z values: from -3.65 to -1.70, all P<0.05) were significantly different between the two scanners before harmonization, while after homogenization there were no statistical differences for all 116 brain regions (radioactivity counts: 9 243.55(8 502.38, 9 854.87)-20 419.60(19 931.51, 21 179.43); z values: from -0.72 to 0, all P>0.05; SUVR: 1.04(1.01, 1.09)-2.32(2.24, 2.40); z values: from -0.82 to 0, all P>0.05). SPM showed that significant differences of glucose metabolism in the cerebral cortex, basal ganglia, midbrain and cerebellum were found in healthy subjects between the two PET/CT scanners before homogenization, and brain regions with obvious differences reduced after homogenization. Conclusion:ComBat harmonization method is efficient at removing the center effect among different types of PET/CT scanners from the same manufacturer and may provide a simple and easy-to-implement homogenization for multicenter brain imaging studies.

Objective:To establish O-(2-[ 18F]fluoroethyl)- L-tyrosine( 18F-FET) PET radiomics features-based model and investigate its predictive efficacy for isocitrate dehydrogenase type 1 (IDH1) genotyping in untreated gliomas. Methods:From November 2017 to February 2019, 58 pathologically confirmed glioma patients (36 males, 22 females; age (41.8±15.1) years) with preoperative 18F-FET PET/CT imaging in Huashan Hospital, Fudan University were retrospectively enrolled. PyRadiomics software package was used to extract 105 radiomics features. Least absolute shrinkage and selection operator (LASSO) algorithm with 5-fold cross-validation was used to build the logistic regression model. And radiomic scores (RS) of each lesion were calculated according to their weighted coefficients. The area under the receiver operating characteristic (ROC) curve was used for evaluating the predictive efficacy for IDH1 prediction. The predictive efficacies of radiomics model and traditional semi-quantitative parameters including tumor-to-background ratio (TBR; maximum TBR (TBR max), mean TBR (TBR mean), peak TBR (TBR peak)), metabolic tumor volume (MTV) and total lesion tracer uptake (TLU), were compared by Delong test. Results:Seven radiomics features including maximum 2-dimensional (2D) diameter slice, first order_maximum, first order_range, gray level co-occurrence matrix (GLCM)_joint energy, GLCM_inverse variance, gray level dependence matrix (GLDM)_dependence entropy and GLDM_large dependence low gray level emphasis were selected for the LASSO regression model building and RS calculation. ROC analysis results showed that the predictive accuracy of RS for IDH1 genotyping (mutation, n=20; wild-type, n=38) was 81.0%(47/58), with sensitivity of 65.0%(13/20), specificity of 89.5%(34/38), and area under curve (AUC) of 0.842, respectively. The traditional 18F-FET semi-quantitative parameter TLU ranked the second regarding the diagnostic performance, with accuracy of 60.3%(35/58), sensitivity of 85.0%(17/20), specificity of 47.4%(18/38), and AUC of 0.661( z=3.426, P<0.01). Conclusion:Radiomics analysis based on 18F-FET PET images can improve the predictive efficacy for IDH1 genotyping in untreated adult glioma patients.

Objective:To assess the preoperative 11C-methionine ( 11C-MET) PET imaging in glioma grading efficacy and its predictive value for isocitrate dehydrogenase enzyme 1 (IDH1) gene mutation status. Methods:A total of 118 glioma cases (70 males, 48 females; median age 45 years, age range: 10-71 years; Ⅱ grade 65 cases, Ⅲ grade 34 cases, Ⅳ grade 19 cases) received 11C-MET PET imaging in PET Center of Huashan Hospital from February 2012 to November 2017 were retrospectively analyzed. Lesion-based semi-quantitative analysis was conducted on the 11C-MET imaging. Maximum standardized uptake value (SUV max), peak standardized uptake value (SUV peak), tumor-to-background ratio (TBR; SUV max in lesion/mean standardized uptake value (SUV mean) in normal contralateral cortex) were calculated. Independent-sample t test and one-way analysis of variance were applied to assess the differentiating efficacy of 11C-MET PET imaging for different glioma groups. Based on IDH1 immunohistochemical staining results, predictive efficacy of 11C-MET PET diagnostic parameters on IDH1 mutation status in glioma patients was further analyzed with receiver operating characteristic (ROC) curve analysis. Results:Low-grade glioma (LGG; grade Ⅱ) group showed significant differences from high-grade glioma (HGG; grade Ⅲ-Ⅳ) group in SUV max(2.458±1.100 vs 3.828±1.540; t=5.624, P<0.01), SUV peak (2.160±0.991 vs 3.261±1.319; t=5.175, P<0.01) and TBR (2.283±0.942 vs 3.434±1.395; t=5.328, P<0.01). SUV max (2.458±1.100, 3.591±1.611 and 4.251±1.343; F=17.67, P<0.01), SUV peak(2.160±0.991, 3.040±1.335 and 3.656±1.225; F=15.48, P<0.01) and TBR (2.283±0.942, 3.010±1.242 and 4.192±1.358; F=22.73, P<0.01) were different in grade Ⅱ, Ⅲ and Ⅳ glioma subgroups. SUV max, SUV peak and TBR all showed significant differences between grade Ⅱ and grade Ⅲ gliomas, grade Ⅱ and grade Ⅳ gliomas, and there were also statistical differences between grade Ⅲ and grade Ⅳ glioma with TBR (all P<0.01). SUV max indicated the best single-parameter prediction performance (area under curve (AUC) =0.808, z=7.193, P<0.01), while the SUV max + SUV peak showed the best performance (AUC=0.852, z=9.115, P<0.01). In the subgroup of grade Ⅱ ( n=55), TBR of patients with IDH1 gene mutation ( n=41) was lower than that of patients with IDH1 wild-types ( n=14; 2.152±0.759 vs 2.793±1.208; t=2.326, P=0.02), while TBR of those with oligodendrogenic components ( n=26) was higher than that of patients with IDH1 gene mutation only ( n=18; 2.383±0.825 vs 1.854±0.478; t=2.447, P=0.02). Conclusions:Preoperative semi-quantitative parameters (SUV max, SUV peak, TBR) of 11C-MET brain PET imaging have satisfactory grading discrimination performance for glioma patients. SUV max is the best predictor for IDH1 mutation as a single parameter, while SUV max + SUV peak showed the most optimized predictive ability. The oligodendrogenic components in glioma can increase the uptake of 11C-MET, which may affect the effectiveness of 11C-MET in determining glioma grade to some extent.

Objective To establish a rat xenograft model of human uterine leiomyoma using immunosuppressive a-gent and provide a useful tool for the study on uterine leiomyoma. Methods Intragastric administration with immunosup-pressive agent mycophenolate mofetil(MMF)(40 mg/kg)was given to rats for two weeks before the surgery until the end of the experiment. 20 SPF female Wistar rats were randomly divided into 4 groups after abdominal transplantation of human leiomyoma tissues:group A received femoston containing 0.4 mg/kg estradiol and 2 mg/kg dydrogesterone, group B re-ceived estadiol 0.4 mg/kg,group C received dydrogesterone 2 mg/kg,and group D served as the control group, received distilled water 1 mL/200 g. All rat received the corresponding drugs once per day for 2 days. Samples were taken at 4 weeks after the surgery to observe the pathology of the tumor tissues. Results The modeling success rates were 90% in the group A,40 % in the group B,and 0% in the groups C and D. Conclusions Rat xenograft model of human leiomyoma can be successfully established using an immunosuppressive agent femostone with a high modeling success rate and low cost. It can be used as a new animal model for the study of transplanted leiomyoma.

Objective To investigate the learning curve of contrast-enhanced ultrasonography ( CEUS) in sentinel lymph node( SLN ) of breast cancer and provide a theoretical basis for leaners to learn SLN CEUS . Methods The multi-center study of SLN CEUS in breast cancer" was planned by Sichuan Cancer Hospital . According to the uniform inclusion and exclusion criteria , 511 patients with complete clinical data and follow-up results from 9 hospitals in Multi-center were included in this study . According to the inspection time ,the patients were divided into 3 groups named as group A ( 170 patients) ,group B ( 170 patients) and group C ( 171 patients ) ,respectively . The basic clinical data ,ultrasound imaging data , intraoperative and postoperative pathological findings of all patients were recorded . With the accumulation of cases examined ,analysis was performed to find the learning curve of the SLN CEUS examination time , SLN CEUS detection rate ,SLN CEUS surface marking accuracy rate and SLN CEUS diagnosis rate ,the learning curve was analyzed . Results ① There was no statistical significant difference in patients ages , tumors sizes ,tumors locations ,SLNs numbers and LCs numbers among the three groups( all P > 0 .05) . ②As the number of cases examined increases ,the examination time was reduced gradually ,but SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate were increased gradually( F = 151 .75 , 1 .96 ,7 .49 ,5 .50 ; P = 0 .000 ,0 .143 ,0 .001 ,0 .005 ) . Conclusions The skill of the doctor is improved gradually when learning SLN CEUS . With the number of the cases increase ,the operating time of SLN CEUS is shorted ,and the SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate of SLN-CEUS are gradually increased . It has an important clinical significance for beginners to learn the SLN CEUS technology .

Objective: To analyze pre- and post-operation electrocardiograms (ECGs) features of patients underwent orthotopic heart transplantation (OHT), and provide evidences for identifying and analyzing post OHT ECGs. Methods: Nine hundreds and ninty-eight pre- and post- OHT standard 12-leads ECGs from 110 consecutive patients, who underwent OHT in our hospital from May 2008 to May 2014, were analyzed. Results: The mean heart rate(HR)was (86.9±16.4) beats per minute before OHT, and (100.0±0.4) beats per minute after OHT. P wave′s amplitude, duration, amplitude multiplied by duration of donor heart in lead Ⅱ were (0.124±0.069)mV, (111.1±17.2)ms, (14.34±9.51)mV·ms before OHT; (0.054±0.037)mV, (86.9±27.0)ms, (5.02±4.03)mV·ms at 1 month after OHT; (0.073±0.049)mV, (93.9±17.5) ms, (7.00±4.81)mV·ms at 6 years after OHT. ECGs rotation occurred in 83.64%(92/110) patients after OHT, and prevalence of clockwise rotation was 76.36%(84/110). Sinus tachycardia was evidenced in 99.09%(109/110) patients after OHT, and incomplete right bundle branch block was present in 60.91%(67/110) patients after OHT. Pseudo complete atrioventricular block mostly occurred at 2 days after OHT. Prevalence of double sinus rhythm was 27.95%(263/941) post OHT, 40% of them occurred between the 1st and the 2nd month post OHT; the atrial rate of recipient hearts was (104.0±10.2) beats per minucte between the 3rd and the 6th month post OHT, and was (95.3±4.2) beats per minucte between the 4th year and the 5th year. P wave′s amplitude, duration, amplitude multiplied by duration of recipient heart in lead Ⅱ were (0.066±0.055) mV, (52.8±34.7) ms, (4.67±4.95) mV·ms at 1 month after OHT, (0.043±0.040)mV, (44.4±40.5) ms , (3.11±3.61) mV·ms between the 1st year and 2nd year after OHT. The absolute value of P-wave(originating from the donor heart) terminal force in chest leads increased in 48.99%(461/941) patients post OHT, the P-wave terminal force of V₁ , V₂ and V₃ were -0.044(-0.066, -0.028), -0.060(-0.087, -0.038), -0.035(-0.056, 0) mm·s. Notched P wave in chest leads was presented in 10.31%(97/941) patients post OHT. PR segment depression in chest leads occurred in 60.24%(100/166) patients between the 3rd month and the 6th month, the incidence of PR segment depression in V₁ , V₂ and V₃ was 21.04%(198/941), 37.41%(352/941) and 28.69%(270/941), respectively. Conclusions OHT is related to significantly changed ECGs. The mean HR increased significantly after OHT, then decreased gradually after half a year to one year, but it was still higher than preoperative mean HR after five or six years; the P waves of donor heart were usually inconspicuous or small in first month after OHT, and they became bigger after 2 months, and their duration and amplitude then became relatively steady afterwards. ECGs rotation, especially the clockwise rotation, was common post OHT. A variety of arrhythmias originating from the donor heart including sinus tachycardia and incomplete right bundle branch block could be found. Pseudo complete atrioventricular block could also be found in the early phase after OHT. With the extension of time, the incidence of double sinus rhythm reduced gradually. The atrial rate and P wave of recipient heart presented with a tendency to become lower. The absolute value of P-waves(originating from the donor heart) terminal force in chest leads (mainly V₁, V₂ and V₃) increased, notched P waves in chest leads (mainly V₁, V₂) and PR segments depression in chest leads (mainly V₂, V₃ and V₄) also belong to typical post OHT ECGs features.

Objective To explore the role of the improved computer aided design of the digital three -dimensional titanium mesh in the repair of skull,to reduce the incidence of postoperative epidural hematoma and epidural fluid.Methods Retrospective analysis of 93 cases of skull repair using the three -dimensional titanium mesh was conducted.49 cases in the conventional group used the conventional three -dimensional titanium mesh. 44 cases in the observation group were given the improved three -dimensional titanium mesh.The clinical effect of the two groups was observed.Results In the conventional group,postoperative epidural hematoma occurred in 4 cases, 1 case of epidural fluid.All patients were fine in the observation group.The improved three -dimensional titanium mesh could reduce the incidence of epidural hematoma and effusion(χ2 =4.745,P =0.029).The conventional group and the observation group both had one case of infection after operation,there was no significant difference between the two groups(χ2 =0.001,P =1.000).Conclusion The improved three -dimensional titanium mesh can effective-ly reduce the incidence of postoperative complications and improve the curative effect of the operation.

Objective To observe the changes in estrous cycle and vaginal smears in ovarectomized NOD/SCID mice.Methods To continuously observe the estrous cycle time by vaginal smears of NOD/SCID mice in consecutive nine days, twice daily.After ovariectomy, the changes of estrous cycle were observed by vaginal smears for 7 days.Results The estrous cycle in NOD/SCID mice was 4-6 days.Regular estrous mice accounted for 80%.There was no significant correlation between vaginal opening and estrous cycle status.After ovariectomy, the vaginal smears showed characteristics of metestrus or diestrus.Conclusions Vaginal smear cytology can be used to determine the estrous cycle and characteris-tics of NOD/SCID female mice.The ovariectomized operation of NOD/SCID female mice is effective.

Objective: To explore the relationship between expression of tumor necrosis factor-α( TNF-α) and electrophysiological heterogeneity in isolated heart tissues and isolated rat ventricular myocytes.The arrhythmogenic mechanisms of TNF-αwere further studied.Methods:Langendorff perfused heart tissues models were used to verify the arrhythmogenic effects of TNF-α.The monophasic action potentials( MAPs) of the endocardium and epicardium from the isolated heart tissues were recorded by elec-trophysiological experiments.The isolated rat ventricular myocytes were obtained by enzymatic dissociation.K+currents(Ito,IK1)were recorded by using whole cell patch clamp technique.Results: Compared to the control group, the difference in MAPD between endocardium and epicardium dramatically increased with TNF-α( P<0.05 ) .TNF-αcould cause MAP duration ( MAPD ) prolongation, and a single dose of TNF-αdifferentially affected the MAPs of endocardium and epicardium of isolated heart tissues.Compared to the control group,the K+currents(Ito,IK1)were dose-dependently decreased with TNF-αin rat ventricular myocytes(P<0.05).However, etanercept had no effects on the MAPD in the absence of TNF-α.Conclusion:TNF-α-induced heterogeneity of MAPD between the endo-cardium and epicardium may provide the substrate for the onset of ventricular arrhythmias during acute myocardial infarction.The effect might be associated with TNF-αcontribute to re-entrant ventricular arrhythmias which resulted from decreased K+currents(Ito,IK1).