In recent years, the clinical experts consensuses or guidelines of ankylosing spondylitis (AS)/spondyloarthritis (SpA) have been constantly updated, but to better understand and practice, patient self-participation management is one of the key points to improve the level of diagnosis and treatment. Through questionnaire survey of these patients, we screened out the most concerned issues, and established the AS/SpA patient practice guideline working group with multidisciplinary physicians and patients. Fifteen opinions, as the AS/SpA patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process.

In recent years, osteoporosis (OP) has become one of the main diseases affecting the health of middle-aged and elderly people in China, and the prevalence of OP has increased significantly. The clinical diagnosis and treatment guidelines for this disease are also constantly updated. The overall principles speciallyemphasise that doctors and patients need to work together to negotiate the details of the diagnosis and treatment guidelines, in order to improve the OP clinical diagnosis and treatment rate. Therefore, patients′ knowledge of the disease, understanding of clinical guidelines, and cooperation with doctors to implement diagnosis and treatment plans are very important. In this study, from the most concerned issues of the patients, we established the OP patient practice guideline working group. 14 recommendations, as the OP patient practice guidelines, are proposed in accordance with the relevant principles of the "World Health Organization guidelines development manual" and the international normative process.

Objective To investigate the level and relationships of posttraumatic growth (PTG) and psychological distress among patients with prostate cancer. Method Totally 116 patients with prostate cancer involved in the investigation by a self-designed demographic questionnaire, posttraumatic growth inventory (PTGI) and distress thermometer (DT). Results The total score of PTGI was (53.12 ± 13.51), at a low level, and the score of DT was (4.32 ± 2.59), at a medium level. The score of DT was negatively correlated to the scores of PTG and its dimensions (all P<0.05). Conclusions Patients with prostate cancer show a low level of PTG and a medium level of psychological distress and they are negatively related . Therefore , nurses should take measures to reduce the patients psychological distress and then improve their PTG level.

OBJECTIVETo analyze the magnetic resonance imaging (MRI) features of endometrial carcinoma and their value in endometrial carcinoma staging according to the International Federation of Gynecology and Obstetrics (FIGO 2009) staging criteria.

METHODSFifty-four patients with pathologically confirmed endometrial carcinoma and complete clinical data underwent preoperative MRI examination. According to FIGO 2009 staging criteria of endometrial carcinoma, the MRI features of the tumor lesions were evaluated for assessment of myometrial invasion and cervical involvement and preoperative staging.

RESULTSThe 54 cases included 27 stage Ia cases, 9 stage Ib cases, 10 stage II cases, 5 stage III cases, and 3 stage IV cases. The total lesion display rate by MRI was 94% (51/54). With an isointensity or hypo-intensity on T1WI, the tumor lesions showed a moderate hyper-intensity on T2WI. In enhanced MRI scanning, the lesions showed a moderate heterogeneous enhancement, which had a lower intensity than the marked enhancement of the myometrium. Combination of T2WI and T1WI in fat suppression sequence enhanced scan had a diagnostic accuracy of 91% (49/54) for myometrial invasion, and the sensitivity, specificity and accuracy of MRI for detecting cervical involvement were 77%, 89%, and 83%, respectively. The accuracy of preoperative MRI-based staging of endometrial carcinoma was 89% (48/54), showing no significant difference from the results of postoperative FIGO 2009 staging and pathological examination (P>0.05).

CONCLUSIONMRI has a high accuracy in the diagnosis, evaluation of myometrial and cervical invasion depth, and preoperative staging of endometrial carcinoma, and serves as an important modality in assisting clinical decisions on the optimal therapeutic protocols and in prognostic estimation.

Adult ; Aged ; Endometrial Neoplasms ; diagnosis ; pathology ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Middle Aged ; Neoplasm Staging

Objective To explore the value of Gadofluorine M,a novel M RI enhancement agent,in the diagnosis the early radiation brain injury.Methods Seventy-two Wistar rats were randomly divided into 5 equal groups.To establish the radiation injury model,the rat's posterior brain was irradiated with 0(blank controls),25,35,45,55,and 65 Gy,respectively.After irradiation MR plain scanning and Gadofluorine M enhancement scanning (after the T1WI and T2WI scanning Gf at the dosage of 0.1 mmol/kg was injected intravenously and scanning was performed again 12 h later) were performed once a week for 8 weeks.Another 12 rats were randomly divided into 2 equal groups to exposure to 55 and 65Gy,respectively,and MR scanning was performed once a week for 8 weeks since the third week after MR.After T1WI and T2WI scanning Gd-DTPA was injected intravenously,MR was conducted again 30 min later,and Gf was injected intravenously (Gd-DTPAenhancement and Gf enhancement contrast).The MR image and the pixel count were compared.Since the third week 2 rats from the Gf enhancement scanning group and 1 rat from the Gd-DTPA enhancement and Gf enhancement contrast were killed after MR with their brains taken out to undergo pathological examination.Results No abnormal signal changes were found in MRI in 25 and 35 Gy groups within 2 months after irradiation.A high signal in the Gf enhancement T1 WI image was found in 45,55,and 65 Gy groups within the period of 4-6 weeks after radiation.The signal intensity was significantly higher than that of the control,25,and 35 Gy groups(F =2.15,P <0.05).The emerge time of this signal was negatively correlated with the dose of radiation(r =-0.62,P < 0.05).When there was no obvious change was found by Gd-DTPA enhancement,a high signal representing change of injury could be found in Gf enhancement in the same rat.The signal intensity was significantly enhanced in Gf enhancement compared to the Gd-DTPA enhancement (F = 2.74,P <0.01).Histopathology examination of the 65 Gy group showed frosted degeneration in part of the region,however,no obvious necrotic damage was found in other groups.Conclusions The Gf enhancement change appears before histopathological changes,it helps discover early radiation injury in brain.Compared to the regular MRI and Gd-DTPA enhancement,Gadofluorine M enhancement has obvious advantage and is worth further research and application.

ObjectiveTo investigate the postoperative 3D MRI appearances and their evolvement patterns of ACL grafts and bone tunnels at follow-up.Methods There were 26 double bundles ACL reconstructions and 16 single bundle ACL reconstructions,and a total of 56 follow-up 3D MR Imaging.MR images were reconstructed with MPR technique to evaluate grafts,bone tunnels,fixers and associated.complications.Proportions of grafts with hypointensity or hyperintensity and occurrence rates of marrow edema around bone tunnels were calculated respectively among groups of different periods after operation.ResultsThere were 24 grafts of hypointensity and 32 grafts of hyperintensity.Grafts of 2 cases were suspended with cross pins within femoral tunnels,graft of 1 case was suspended with an endobutton within the femoral tunnel,and grafts of other sites were fixed with interference screws.In the three periods as 3 months,6 to 9 months and over 12 months after cruciate ligament reconstruction,proportions of hypointensive grafts were 20/25,0/14 and 4/10 respectively,while proportions of hyperintensive grafts were 5/25,14/14 and 6/10 respectively,occurrence proportions of marrow edema around bone tunnels were 54/54,10/32 and 4/26 respectively.There was 1 tear graft,4 tibial tunnels placed anteriorly with ACL graft impingement on the intercondylar roof,3 femoral tunnels placed anteriorly,and 2 bone tunnels with mismatching interference screws.Conclusion3D MRI can accurately demonstrate the state of ACL grafts,bone tunnels,fixers and associated complications.Intensity of grafts presented a rise and reduce pattern after operation.

Objective To compare the success rate, time of tumor formation and number of tumors in three methods of tumor transplantation, in order to seek an ideal animal model for molecular imaging study. Methods Forty-eight BALB/C-nu/nu nude mice were randomly divided into three groups (each n=16). Tumor tissue mass of 2 mm3 was injected into subcutaneous of nude mice in experiment group. Tumor tissue mass of 1 mm3 was applied in control group 1. Tumor cells suspension liquid was injected into subcutaneous of nude mice in control group 2. The tumor formation rate, the time of tumor formation and the number of tumors were observed. MRI scanning were performed 3-6 weeks after implantation. Results The rate of tumor formation of three groups was 93.75%, 75.00% and 43.75%, respectively. The time of tumor formation was (21.7±2.4), (29.8±2.9) and (34.6±3.9) days, respectively. The rate of solitary nodule implanted tumor was 93.33% in experiment group, higher than that in control group 1 (75.00%) and control group 2 (14.29%). The tumors were hypointense on T1WI and hyperintense on T2WI. Conclusion Transplantation 2 mm3 tumor tissue mass is effective to set up the subcutaneous implanted tumor models with a high success rate of tumor formation, a short time of tumor formation and high rate of solitary tumors, being suitable for the study of molecular imaging. The models can undertake conventional T1WI, T2WI and T2-mapping imaging, and the imaging qualities are good.

Objective To investigate the clinical value of three dimensional dynamic contrast enhanced MRA(3D DCE MRA)on esophageal and gastric varices compared with endoscopy.Methods From April 2003 to June 2008,153 patients with portal hypertension who underwent both 3D DCE MRA and endoscopy were reviewed retrospectively.All the patients were divided into bleeding group and non-bleeding group according to the clinical symptoms.The location and degree of the esophagogastric varices on 3D DCE MRA were assessed with postprocessing images,including subtraction,MIP and thin-slab maximum intensity projection(thin-MIP),and were compared with the results of endoscopy.The maximum,minimum and mean diameters of esophagogastric varices inside and outside of the wall were measured on the reformed images.The correlation between the findings of 3D DCE MRA and endoscopy were analyzed with Spearman rank correlation coefficient test The rates of esophagogastric varices outside of the wall in bleeding and non-bleeding group were compared by means of Chi-square test Results In bleeding group,severe esophageal varices were documented in 59 patients,moderate in 6 patients,mild in 5 patients;in non-bleeding group,severe esophageal varices were documented in 32 patients,moderate in 4 patients,mild in 5 patients.Severe,moderate,and mild gastric varices were documented in 28,34 and 16 in bleeding group,while they were 7,12 and 9 in non-bleeding group.Esophageal and gastric varices can be wholly presented on MIP images after subtraction,while the esophagogastric varices inside and outside of the wall can be differentiated on thin-MIP images.The location and degree of esophagogastric varices on 3D DCE MRA were correlated with the findings of the endoscopy.The range of r was from 0.544 to 0.878(P＜0.01).In 91 patients with severe esophageal varices,27 patients presented outside esophageal varices in bleeding group(n=59)and 24 patients presented outside esophageal varices in non-bleeding group(n=32).There was a significant difference in ratio of outside esophageal varices between bleeding group and nonbleeding group(X~2=7.199,P＜0.01).In 35 patients with severe gastric varices,22 patients showed adventitial gastric varices in bleeding group(n=28)and 4 patients showed adventitial gastric varices in non-bleeding group(n=7).The ratio of adventitial gastric varices in bleeding group was not significantly different from that of non-bleeding group(P=0.340).Conclusions 3D DCE MRA can display and differentiate the esophagogastric varices both inside and outside of the wall by three dimensional reconstruction.The results of 3D DCE MRA and endoscopy have good correlation.It is of importance in evaluating the esophageal varices outside of the wall,because they may indicate decreased risk of haemorrhage in patients with severe degree of esophageal varices.

Objective To prospectively evaluate the value of diffusion-weighted imaging with background signal suppression (DWIBS) in the detection and diagnoses of metastatic cervical lymph nodes. Methods Twenty patients with head and neck squamous cell carcinomas underwent conventional MRI and DWIBS. The ADC values were measured and compared between metastatic and benign lymph nodes. The abilities of DWIBS and conventional MRI in the evaluation of metastatic cervical lymph nodes were compared. Results Conventional MRI demonstrated 101 lymph nodes, in which 58 were diagnosed as metastatic nodes. When MRI criteria were used for discrimination between metastatic and benign nodes, the obtained sensitivity, specificity, accuracy, positive and negative predictive value were 78% (47/60), 81%(44/54), 80% (91/114), 82% (47/57) and 77% (44/57), respectively. The mean ADC values of metastatic nodes (n =60) and benign nodes (n =54) were (0.945 ±0.122) × 10-3 mm2/s and (1. 210 ±0. 151 ) × 10-3 mm2/s ( t = - 10. 354 ,P ＜0. 01 ). When an ADC value of 1. 090 × 10 -3 mm2/s was used as the threshold for discrimination between metastatic and benign nodes, the obtained sensitivity, specificity,accuracy, positive and negative predictive value were 88% (53/60), 80% (43/54), 84% (96/114), 83%(53/64) and 86% (43/50), respectively. Conclusion DWIBS is helpful in diagnosing metastatic cervical lymph nodes of head and neck squamous cell carcinoma, and is superior to conventional MRI in their detection.

Objective To compare the Chinese 2008, 1992 and 2002 UICC (International Union Against Cancer) staging System for nasopharyngeal carcinoma and find out the reasons for the changes in the new Chinese 2008 staging system. Methods From Apr. 2007 to Dec. 2008, 285 naive patients with pathologically proved NPC, but without metastasis, received standard enhanced MRI scans of the nasopharynx and neck. Based on MRI imaging data and clinical information, clinical stage was classified according to the Chinese 2008, Chinese 1992 staging system and 2002 6th UICC staging system,respectively. Comparisons were made between Chinese 2008 and 1992 staging system, and between Chinese 2008 and 2002 UICC staging system by χ2 test. Results As a result of deleting some details of the old staging system, Chinese 2008 staging system is easier to grasp. With Chinese 2008 staging system, the number of cases in stage T1 to T4 are 66, 84, 72,63, respectively; those in stage N0 to N3 are 12,48,169,56; the number of cases in clinical stage Ⅰ -Ⅳ are 5,30,141 and 109. With 2002 6th UICC staging system, the number of cases in stage T1 to T4 are 66, 83, 55,81; those in stage N0 to N3 are 26,50,201,8;the number of cases in clinical stage Ⅰ -Ⅳ are 6,40,153 and 86. With Chinese 1992 staging system, the number of cases in stage T1 to T4 are 62,91,71,61; those in stage No to N3 are 26,189,61,9; the number of cases in clinical stage Ⅰ -Ⅳ are 6, 110, 98 and 71. Comparing with the staging results of Chinese 1992 staging system, many cases showed different stage based on Chinese 2008 system including 12 cases (4.21%) inT stage (3 up-staging and 9 down-staging), 217 cases (76.14%) in N stage (216 up-staging, most rise I stage, and 1 down-staging), 123 cases (43. 16% ) in clinical stage ( 121 up-staging and 2 down-staging). Comparing with the staging results of 2002 UICC staging system, 35 cases ( 12. 28% )changes in T stage (8 up-staging and 27 down-staging), 77 cases (27. 02% ) changes in N stage (all upstaging, most rise 1 stage), 74 cases (25. 95% ) changes in clinical stage (54 up-staging and 20 downstaging) based on Chinese 2008. Comparing the constituent ratio of T, N and clinical staging results separately, statistical differences were found between Chinese 2008 and Chinese 1992 staging system in N0,N1, N2, N3, clinical stage Ⅱ , Ⅲ, Ⅳ. Statistical difference was also found in N0, N2, N3, clinical stage Ⅳ between Chinese 2008 and 2002 UICC staging system. χ2 test results show that there is N0 significant difference of T stage constituent ratio among the 3 staging system ( χ2 = 6. 916, P = 0. 329 ), but the difference of N stage and clinical stage constituent ratio are significant( χ2 = 275. 169 and 84. 515, P ＜0. 0125). Conclusion Chinese 2008 Staging System for nasopharyngeal carcinoma is based on MRI, with clear definition to some anatomical location, after deleting some details in the old stage system, it's easier to use. The most obvious change for Chinese 2008 Staging System is the up-staging in N staging,which leads to the changes in clinical stage and constituent ratio of stage result.