Objective To investigate the prediction of diffusion kurtosis imaging(DKI)and intra voxel incoherent motion(IVIM)imaging global histogram parameters for the efficacy of neoadjuvant chemotherapy(NAC)in patients diagnosed with breast invasive ductal carcinoma.Methods A total of 69 patients with breast invasive ductal carcinoma confirmed by penetration pathology were retrospectively selected.Prior to undergoing NAC,all patients underwent sequential scans including MR conventional(T1WI,T2WI),dynamic contrast enhancement(DCE),DKI,and IVIM.After surgery,the patients were divided into significant group(40 patients)and non-significant group(29 patients)based on the efficacy of NAC,which was evaluated using the Miller-Payne(MP)grading method criteria.The differences in global histogram parameters of DKI[mean diffusivity(MD),mean kurtosis(MK)]and IVIM(D value,f value,D*value)between the significant group and the non-significant group were compared by the two-independent sample t-test and Mann-Whitney U test.In addition,the receiver operating characteristic(ROC)curve was plotted,and Spearman rank correlation analysis was used to evaluate the diagnostic efficacy and correlation of DKI and IVIM global histogram parameters in predicting NAC efficacy.The DeLong test was used to compare whether there was statistical significance in area under the curve(AUC)differences among histogram parameters.Results The DKI MD value(90th percentile,mean,median,maximum,range,root mean square),IVIM D value(mean,range,root mean square,median)and D*value(entropy,90th percentile)of patients with breast invasive ductal carcinoma in the significant group with efficacy of NAC were higher than those in the non-significant group,while the DKI MK value(mean and median)were lower than those in the non-significant group,and all the differences mentioned above were statistically significant(P＜0.05).The AUC,sensitivity and specificity of DKI combined with IVIM global histogram parameters were the highest,which were 0.816,72.41％and 90.00％,respectively.MD value,D value and D*value were negatively correlated with the efficacy of NAC in breast invasive ductal carcinoma.MK value was positively correlated with NAC efficacy significance.Conclusion DKI combined with IVIM global histogram parameters can effectively predict the efficacy of NAC in patients with breast invasive ductal carcinoma and provide effective value for clinical NAC preoperative efficacy evaluation.

Objective:To investigate the effects of tert-butyl hydroperoxide (TBH) on the expression of second mitochondria-derived activator of caspase (Smac) and X-linked inhibitor of apoptosis (XIAP) in mitochondrial pathway after cerebral ischemia/reperfusion injury in rats.Methods:From March to December in 2019, 45 healthy male Sprague-Dawley rats were randomly divided into sham-operation, model and TBH groups. Rat models of cerebral ischemia/reperfusion injury were established by ligation of the left carotid artery. Rat neurological function was evaluated to exclude the rats that failed in cerebral ischemia/reperfusion injury induction. Ten rats were left in each group. At 0.5 and 12 hours after cerebral ischemia/reperfusion injury, rats in the TBH group were treated by intragastric administration of 12.5 mg/kg TBH and those in the sham-operation and model groups were identically treated by intragastric administration of equal volume of 0.9% sodium chloride injection. After 24 hours of reperfusion, rat neurological function was assessed in each group. Then the rats were killed and the brains were harvested. Apoptosis of nerve cells was detected by terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) assay. The levels of superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in the brain tissue were detected by enzyme-linked immunosorbent assay. XIAP- and Smac-positive cell count and protein expression were determined by immunohistochemical staining and western blot assay, respectively.Results:Rat neurological function score in the TBH group was significantly lower than that in the model group [(1.36 ± 0.49) points vs. (3.73 ± 0.97) points, t = 6.896, P < 0.001]. In the TBH group, a large number of apoptotic nerve cells were found in the ischemic cerebral cortex, but the number of apoptotic nerve cells in the TBH group was significantly smaller than that in the model group. In the model group, SOD level was significantly lower, MDA, TNF-α and IL-1β levels were significantly higher compared with the sham-operation group [SOD: (51.94 ± 3.46) U/mg vs. (70.68 ± 2.67) U/mg, t = 13.560, P < 0.001; MDA: (5.69 ± 0.78) nmol/mg vs. (1.20 ± 0.96) nmol/mg, t = 11.479, P < 0.001; TNF-α: (89.36 ± 9.84) pg/mg vs. (40.53 ± 4.35) pg/mg, t = 14.353, P < 0.001; IL-1β: (41.35 ± 6.79) pg/mg vs. (17.22 ± 2.31) pg/mg, t = 10.639, P < 0.001]. In the TBH group, SOD level was significantly higher, MDA, TNF-α and IL-1β levels were significantly lower compared with the model group [SOD: (51.94 ± 3.46) U/mg vs. (68.84 ± 5.03) U/mg, t = 8.754, P < 0.001; MDA: (5.69 ± 0.78) nmol/mg vs. (2.46 ± 0.48) nmol/mg, t = 11.153, P < 0.001; TNF-α: (89.36 ± 9.84) pg/mg vs. (57.64 ± 6.22) pg/mg, t = 8.617, P < 0.001; IL-1β: (41.35 ± 6.79) pg/mg vs. (23.84 ± 5.48) pg/mg, t = 6.346, P < 0.001]. XIAP- and Smac-positive cell count and protein expression in the model group were significantly greater than those in the sham-operation group [XIAP-positive cell count: (22.63 ± 4.37) vs. (12.39 ± 3.18), t = 5.992, P < 0.001, Smac-positive cell count: (47.58 ± 6.94) vs. (5.64 ± 1.35), t = 18.759, P < 0.001; XIAP protein expression: (0.53 ± 0.08) vs. (0.24 ± 0.05), t = 9.721, P < 0.001; Smac protein expression: (0.92 ± 0.15) > ( 0.36 ± 0.05), t = 11.200, P < 0.001 ]. In the TBH group, XIAP-positive cell count and XIAP protein expression were significantly higher and Smac-positive cell count and Smac protein expression were significantly lower compared with the model group [XIAP-positive cell count: (36.78 ± 5.26) vs. (22.63 ± 4.37), t = 6.543, P < 0.001, Smac-positive cell count: (31.74 ± 4.26) vs. (47.58 ± 6.94), t = 6.151, P < 0.001; XIAP protein expression: (0.79 ± 0.10) vs. (0.53 ± 0.08), t = 6.420, P < 0.001, Smac protein expression: (0.70 ± 0.09) vs. (0.92 ± 0.15), t = 3.977, P < 0.001]. Conclusion:TBH can effectively reduce neuronal apoptosis, oxidative stress and inflammatory reaction after cerebral ischemia/reperfusion injury, which may be related to the regulation of XIAP and Smac signaling pathways.

Objective: To investigate the value of initial CT quantitative analysis of ground-glass opacity (GGO), consolidation, and total lesion volume and its relationship with clinical features for assessing the severity of coronavirus disease 2019 (COVID-19). Materials and Methods: A total of 84 patients with COVID-19 were retrospectively reviewed from January 23, 2020 to February 19, 2020. Patients were divided into two groups: severe group (n = 23) and non-severe group (n = 61). Clinical symptoms, laboratory data, and CT findings on admission were analyzed. CT quantitative parameters, including GGO, consolidation, total lesion score, percentage GGO, and percentage consolidation (both relative to total lesion volume) were calculated. Relationships between the CT findings and laboratory data were estimated. Finally, a discrimination model was established to assess the severity of COVID-19. Results: Patients in the severe group had higher baseline neutrophil percentage, increased high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and lower baseline lymphocyte count and lymphocyte percentage (p < 0.001). The severe group also had higher GGO score (p < 0.001), consolidation score (p < 0.001), total lesion score (p < 0.001), and percentage consolidation (p = 0.002), but had a lower percentage GGO (p = 0.008). These CT quantitative parameters were significantly correlated with laboratory inflammatory marker levels, including neutrophil percentage, lymphocyte count, lymphocyte percentage, hs-CRP level, and procalcitonin level (p < 0.05). The total lesion score demonstrated the best performance when the data cut-off was 8.2%. Furthermore, the area under the curve, sensitivity, and specificity were 93.8% (confidence interval [CI]: 86.8–100%), 91.3% (CI: 69.6–100%), and 91.8% (CI: 23.0–98.4%), respectively. Conclusion CT quantitative parameters showed strong correlations with laboratory inflammatory markers, suggesting that CT quantitative analysis might be an effective and important method for assessing the severity of COVID-19, and may provide additional guidance for planning clinical treatment strategies.

Objective:To investigate the characteristics of thymus in patients with COVID-19, and to analyze the CT features and dynamic changes of thymus.Methods:Data of 241 patients diagnosed with COVID-19 admitted to Chongqing Three Gorges Central Hospital from Jan. to Mar. 2020 were retrospectively analyzed, and 242 consecutive subjects were selected as the control group from Nov. to Dec. 2019. The thymus classification, size, and average CT values between COVID-19 patients and the control group were compared, as well as those among different clinical types for COVID-19 patients, before and after treatment, were analyzed.Results:① The attenuation of the thymus: 64.7% (156/241) complete fatty replacement thymus, 17.8% (43/241) predominantly fatty thymus, 11.2% (27/241) approximately one-half fatty and one-half soft-tissue-attenuation thymus, and 6.2% (15/241) predominantly soft-tissue thymus in COVID-19 patients were found. 48.3% (117/242) complete fatty replacement thymus, 25.6% (62/242) predominantly fatty thymus, 10.3% (25/242) approximately one-half fatty and one-half soft-tissue-attenuation thymus, and 15.7% (38/242) predominantly soft-tissue thymus were found in the control group. Complete fatty replacement thymus was an independent factor affecting COVID-19 in 40 to 59 years old patients ( OR=3.071, P=0.000) . The rate of complete fatty replacement thymus: severe or critical type > common type > mild type. ② Size: There was no statistical difference of the thymus size between COVID-19 patients and the control group ( P>0.05) , no statistical difference among the mild type, common type and severe or critical type ( P>0.05) , no statistical difference between before and after treatment ( P>0.05) , and there was no correlation with treatment duration ( r=0.047, r=0.071) . ③ Density: There was no statistical difference of the CT value of thymus between COVID-19 patients and the control group ( P>0.05) , no statistical difference among the mild, common and severe type ( P>0.05) . One patient had a 17 HU increase in thymus density after treatment, but there was no statistical difference in 78 patients in thymus CT values between before and after treatment ( P>0.05) , and there was no correlation with treatment duration (r=0.013) . Conclusions:COVID-19 patients have a high rate of complete fatty replacement thymus. And the heavier the clinical classification, the higher the rate of complete fatty replacement thymus. Complete fatty replacement thymus is a risk factor for COVID-19 patients in 40 to 59 years old.

Objective Toexplorethecorrelationbetween MRIcharacteristicsandaxillarylymphnode metastasisofmass-type breastcancer.Methods MRIcharacteristicsandpathologicalresultsofpostoperativeaxillarylymphnode metastasisin187cases withmass-typebreastcancerwereanalyzedretrospectively.Accordingtothenumberoflymphnodemetastases,allofthepatients weredividedintothefourgroups:pN0,pN1,pN2andpN3.Thecorrelationbetween MRIsignsand N pathologicalstagesineach groupwereanalyzed.Results Therewere108casesinpN0group,33casesinpN1group,22casesinpN2groupand24casesinpN3 groupI.nthedifferentgroups,therewere15,5,1and1casewithroundmassrespectively;8,1,1and0casewithlobularmasserespectively;85, 27,20and23caseswithirregularmasserespectively.Theshapeswerenotsignificantlydifferentamongthedifferentgroups(P>0.05)I.nthe differentgroups,therewere7,0,1and0casewithclearmarginrespectively;69,14,7and8caseswithirregularmarginrespectively;32,19,14and16caseswithspiculatedmarginrespectively.Themarginsweresignificantlydifferentamongthedifferentgroups(P<0.05)I.nthe differentgroups,therewere55,16,14and18caseswithheterogenousenhancementrespectively;43,14,5and6caseswithringenhancement respectively;3,1,1and0casewithcentralenhancementrespectively;7,2,2and0casewithseptumenhancement.Theenhancement patternswerenotsignificantlydifferentamongthedifferentgroups (P>0.05).ThenumbersofthemasswithtypeⅠ,ⅡandⅢtime-signalcurvesandtheADCvalueswerenotsignificantlydifferentamongthedifferentgroups(P>0.05).Conclusion MRIfeaturesof mass-typebreastcancershavelimitedvalueindeterminingaxillarylymphnodemetastasis.However,thespiculatedmarginofmassis valuableindeterminingaxillarylymphnodemetastasis.

OBJECTIVE: To develop a deep features-based model to classify benign and malignant breast lesions on full- filed digital mammography. METHODS: The data of full-filed digital mammography in both craniocaudal view and mediolateral oblique view from 106 patients with breast neoplasms were analyzed. Twenty-three handcrafted features (HCF) were extracted from the images of the breast tumors and a suitable feature set of HCF was selected using -test. The deep features (DF) were extracted from the 3 pre-trained deep learning models, namely AlexNet, VGG16 and GoogLeNet. With abundant breast tumor information from the craniocaudal view and mediolateral oblique view, we combined the two extracted features (DF and HCF) as the two-view features. A multi-classifier model was finally constructed based on the combined HCF and DF sets. The classification ability of different deep learning networks was evaluated. RESULTS: Quantitative evaluation results showed that the proposed HCF+DF model outperformed HCF model, and AlexNet produced the best performances among the 3 deep learning models. CONCLUSIONS The proposed model that combines DF and HCF sets of breast tumors can effectively distinguish benign and malignant breast lesions on full-filed digital mammography.
Breast Neoplasms ; classification ; diagnostic imaging ; Deep Learning ; Diagnosis, Computer-Assisted ; methods ; Female ; Humans ; Mammography ; methods

Objective To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) breast X-ray photography image texture characteristics based deep learning classification model on differentiating malignant masses. Methods Retrospectively collected 132 cases with simplex breast lesions (89 benign lesions and 43 malignant lesions) which were confirmed by pathology and DBT during January 2016 to December 2016 in Nanfang Hospital. DBT was performed before biopsy and surgery. Image of cranio-caudal view (CC) and medio-lateral oblique (MLO) were captured. The lesion area was segmented to acquire ROI by ITK-SNAP software. Then the processed images were input into MATLAB R2015b to establish a feature model for extracting texture features. The characteristics with high correlation was analyzed from Fisher score and one sample t test. We built up support vector machine (SVM) classification model based on extracted texture and added neural network model (CNN) for deep learning classification model. We randomly assigned collected cases into training group and validation group. The diagnosis of benign and malignant lesions were served as the reference. The efficiency was evaluated by ROC classification model. Result We extracted 82 texture characteristics from 132 images of leisure (132 images of CC and 132 images of MLO) by establishing deep learning classification model of breast lesions. We randomly chose and combined characteristics from 15 texture characteristics with statistical significance, then differentiated benign and malignant by SVM classification model. After 50 iterations on each combination of characteristics, the average diagnostic efficacy was compared to obtained the one with higher efficacy. Nine of CC and 8 of MLO was selected. The result showed that the sensitivity, specificity, accuracy and area under curve (AUC) of the model to differentiate simplex breast lesions for CC were 0.68, 0.77, 0.74 and 0.74, for MLO were 0.71, 0.71, 0.71 and 0.76. Conclusions MLO has better diagnostic performance for the diagnosis than CC. The deep learning classification model on breast lesions which was built upon DBT image texture characteristics on MLO could differentiate malignant masses effectively.

Objective To describe the MSCT manifestations of different pathological grading of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN)and to improve the understanding of CT characteristics of this disease.Methods MSCT images and pathological results of 38 GEP-NEN proved by surgical pathology were analyzed retrospectively in our hospital.All of the tumors were graded as G1 to G3.Measured respectively the CT value of the same location of each tumor in the noncontrast enhanced phase, arterial and venous phase.And divided them into mild,moderate and obvious.Statistically analyzed the number of tumors with different degree of enhancement.Results In arterial and venous phase of G1 group,the number of mild enhancement was respectively 3 and 0 case, the number of moderate enhancement was respectively 6 and 8 cases,and the number of obvious enhancement was respectively 7 and 8 cases.In arterial and venous phase of G2 group,the number of mild enhancement was respectively 2 and 0 case,the number of moderate enhancement was respectively 4 and 6 cases,and the number of obvious enhancement was respectively 4 and 4 cases.In arterial and venous phase of G3 group,the number of mild enhancement was respectively 9 and 4 cases,the number of moderate enhancement was respectively 3 and 8 cases,and the number of obvious enhancement was respectively 0 and 0 case.Kruskal-Wallis rank sum test was performed for the number of tumor enhancement,the result was P<0.05.Conclusion MSCT multi-phase enhancement is valuable in judging the pathological grade of GEP-NEN.Arterial phase usually shows moderate to obvious enhancement in G1 group.The enhancement of tumors with higher grade shows a trend of decrease in arterial phase,while shows mild to moderate enhancement in venous phase.

Immune checkpoints are inhibitory signaling pathways in the immune system that maintain balance with co-stimulatory molecules, maintain tolerance to their own tissues, and avoid autoimmune responses. The development of tumors is accompanied by the upregulation of co-suppressor molecules and related ligands, causing the decline or exhaustion of T cell functions, which makes tumor cells excape immune surveillance. The development of monoclonal antibodies against inhibitory receptors and ligands to regulate T cell activity and improve antitumor immune responses have achieved promising clininal results. Combined treatment of immunomodulatory signaling pathways also showed a certain of synergy. This article summarizes the evaluation of combined tumor immunotherapy strategies and synergies, and outlooks the feasibility of combined immunotherapy and the selection of immunization strategies.

Objective To investigate the diagnostic value of susceptibility-weighted imaging (SWI)in the application of mild traumatic brain injury.Methods The clinical data of 78 patients with mild traumatic brain injury were analyzed retrospectively.All patients received SWI and conventional MRI examination (T1WI, T2WI and FLAIR), and the number of intracerebral hemorrhagic lesions was compared between SWI and conventional MRI.Results The number of intracerebral hemorrhagic lesions of SWI examination was significantly much than that of conventional MRI examination: 39.74% (31/78)vs.21.79%(17/78),and there was statistical difference(χ2=5.898,P=0.015).SWI depicted 156 hemorrhagic lesions,and conventional MRI(T1WI,T2WI and FLAIR)depicted 16,26 and 37 hemorrhagic lesions.SWI depicted a significantly higher number of hemorrhagic lesions than conventional MRI,and there was statistical difference(Z=-4.563,-4.476 and-4.478;P<0.01).The Glasgow coma score on admission in patients with hemorrhagic lesions of SWI examination was significantly lower than that in patients without hemorrhagic lesions of SWI examination:(14.23 ± 0.80)scores vs.(14.84 ± 0.48)scores, and there was statistical difference (Z =- 3.956, P<0.01).The number of intracerebral hemorrhagic lesions in SWI examination was negative correlation with Glasgow coma score on admission(rs=-0.471, P = 0.008).Conclusions SWI has higher sensitivity in detecting intracerebral hemorrhages compared with conventional MRI.It can objectively and accurately evaluate the severity of patients with mild traumatic brain injury.