Objective:To explore the relationship between the abnormal adipose tissue around the primary tumor of colon cancer and the prognosis.Methods:From January 2015 to December 2017, 448 patients with colon cancer in Peking University Cancer Hospital were retrospectively and consecutively collected. The scores were assigned to the severity, horizontal and vertical ranges of peritumoral adipose tissue (PAT) abnormalities, and the cumulative scores were calculated to establish the PAT grades from 1 to 3. We defined a score of 0 or 1 as PAT grade 1, a score of 2 as PAT grade 2, a score of 3 as PAT grade 3. The patients were followed up, and the overall survival (OS) and metastasis-free survival (MFS) were recorded. The Kaplan-Meier curve, log-rank test and Cox regression analysis were used to evaluate its impact on prognosis, and the hazard ratio (HR) and 95% confidence interval (CI) were calculated.Results:Among the 448 patients, patients with PAT grade 1, 2, and 3 accounted for 70.1% (314/448), 18.1% (81/448), and 11.8% (53/448), respectively. The Kaplan-Meier survival curve showed that patients with PAT grade 1 had the best OS, patients with grade 3 had the worst OS, and patients with grade 2 were in between, and the difference was statistically significant (χ 2=27.38, P<0.001). There were statistically significant differences between the grades in pairs ( P<0.05). There was no significant difference in MFS between different PAT grades (χ 2=2.85, P=0.240). The results of Cox regression analysis showed that PAT grade was an independent factor affecting the OS. Compared with PAT grade 1, the risk of death in patients with PAT grade 2 and 3 was significantly increased (HR 2.563, 95%CI 1.181-5.561; HR 2.269, 95%CI 1.005-5.121; P=0.034). PAT grade was not an independent factor of MFS ( P=0.253). Conclusion:The PAT grade established based on the degree and scope of abnormal PAT in colon cancer is an independent factor for poor prognosis of colon cancer.

Objective:To analyze the role of baseline mesorectal fascia (MRF) status and the correlation between MRF changes and prognosis after neoadjuvant therapy in patients with locally advanced rectal cancer.Methods:Totally 321 patients with locally advanced rectal cancer were retrospectively analyzed from January 2014 to December 2016 in Peking University Cancer Hospital. All patients underwent surgery after neoadjuvant radiotherapy and chemotherapy, and were followed up regularly after surgery. The MRF status, extramural vascular invasion (EMVI) status, tumor location, tumor stage and lymph node status were evaluated on baseline MRI. For patients with positive baseline MRF, preoperative MRF status was also evaluated. Chi-square test or independent t test were used to compare the characteristics between MRF positive and negative patients. Kaplan-Meier curve, log-rank test and multivariate Cox regression were used to analyze the correlation between imaging features and prognosis. Results:In all of the 321 subjects, 193 (60.1%) had positive baseline MRF, 54 (28.0%) of the 193 patiens had negative MRF after neoadjuvant therapy, and 139 (72.0%) of them still had positive MRF preoperatively. The postoperative pathological T and N stages were significantly higher in patients with positive baseline MRF than those with negative MRF, and the proportion of patients achieving complete pathological response was significantly lower than those with negative MRF (all P<0.05). The postoperative pathological T and N stages of patients with MRF negative conversion were significantly lower than those without MRF negative conversion. In patients with negative baseline MRF and patients with negative MRF conversion after neoadjuvant therapy, the proportion of positive MRI EMVI was significantly lower (all P<0.05). Univariate survival analysis showed that overall survival and metastasis free survival were poorer in patients with positive MRF at baseline, with a hazard ratio of 3.33 and 1.69, respectively. There was no significant correlation between negative MRF conversion after neoadjuvant therapy and overall survival, metastasis free survival and recurrence free survival. Multivariate Cox analysis showed that baseline MRF and EMVI status were independent factors for overall survival and metastasis free survival, with a risk ratio of 2.15 and 3.35 for overall survival, 1.13 and 2.74 for metastasis free survival, respectively. Conclusions:Baseline MRF status is one of the independent prognostic predictors in locally advanced rectal cancer patients with neoadjuvant therapy. However, the role of the change in MRF status after neoadjuvant therapy is uncertain for predicting prognosis.

Objective: To compare the characteristics of MRI signals in different therapeutic effect of desmoid-type fibromatosis (DF). Methods: One hundred and twenty-four DF patients with pathologically proven postoperative recurrent lesions from Peking University Cancer Hospital from 2008 to 2015 were enrolled in the study. All patients had baseline MRI scans, followed by once MRI scan at least every six months, and the follow-up period was three years. All patients had MRI images at the end of the third year. The therapeutic effect was evaluated by response evaluation criteria in solid tumors (RECIST) criteria, and the patients were divided into three groups: progressive disease (PD), stable disease (SD) and partial response (PR). Differences in features in the PD, SD, and PR groups were compared using one-way analysis of variance, Kruskal-Wallis, or Chi-square test. Multiple comparisons were performed using Bonferroni to correct P values. The spearman correlation coefficient was used to test the correlation between signal score and tumor maximum diameter. Results: Among the 124 patients, 17 experienced PD, 37 exhibited SD and 70 exhibited PR. There were no significant differences in age, gender distribution and the location of lesion among three groups (P>0.05). The difference of treatment strategies was statistically significant (P<0.05). The difference of tumor maximum diameter of baseline and the last follow-up MRI scan was also statistically significant between three groups (P<0.05). There was no significant differences in T₂ scores and enhancement scores of baseline MRI scan among the PD, SD, and PR groups (P>0.05). At the last follow-up MRI scan, the T₂ signal scores, the changes of T₂ signal, the scores of enhancement and the changes of enhancement of the PD, SD, and PR groups were significantly different among three groups (P<0.05). At the last follow-up MRI scan, the tumor maximum diameter was positively correlated with the score of T₂ signal (r=0.434, P<0.01), and the tumor maximum diameter was positively correlated with the score of enhancement (r=0.743, P<0.01). Conclusion MRI has great value in evaluating the therapeutic effect of DF.

The severe fever with thrombocytopenia syndrome virus (SFTSV),a new RNA virus,was discovered in recent years,which can lead to fever,thrombocytopenia and multiple organ dysfunction.Picks is the main media A case of a SFTSV-related encephalitis diagnosed by second-generation gene sequencing was reported here.The patient had fever,disturbance of consciousness,convulsions,with thrombocytopenia and enzymatic indicators increased significantly.After active anti-virus and supportive treatment,the prognosis was good.It is our aim to suggest that,in the epidemic season,when you meet thesimilar patients like this,you should consider the possibility of SFTSV-related encephalitis.Virus nucleic acid detection and second-generation gene sequencing technology are helpful for timely diagnosis and treatment and reducing mortality of the disease.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

Objective To explore airway remodeling and air trapping in asthmatic patients with low dose CT scanning and quantitative analysis. Methods 52 stable asthmatic patients in which 29 were severe and 23 were slight,and 20 healthy control cases were underwent low dose dual phase CT scanning. The LA/BSA, WA/BSA, TA/BSA, WA%and Pi10WA were analyzed as airway remolding indexes. The MLD of expiratory, VI-850 (%) of expiratory, MLD E/I, VI-850E-I (%) and VI-850/-950E-I (%) were analyzed as air-trapping indexes. One-Way ANOVA or H Kruskal-Wallis was used to analyze the above indicators. Results Airway remodeling indexes and LA/BSA were (9.6 ± 2.6), (11.0 ± 3.4) and (12.6 ± 3.0)mm2/m2 in severe asthmatics group, non-severe asthmatics group and healthy control group respectively, and there was significant difference between the three groups (F=5.60, P=0.006). WA%of each group was (65.1 ± 2.5)%, (63.3 ± 4.4)%and (62.0 ± 3.0)%, and there was significant difference between the three groups (F=5.53,P=0.006). The Pi10WA was (18.4±2.6), (17.7±3.1) and (16.4±1.4) mm2 respectively with significant difference between the three groups (F=3.59 ,P=0.033). Air-trapping indexes, MLD of expiratory of each group was-(771 ± 59),-(724 ± 43) and-(676 ± 60) HU respectively with significant difference (F=5.60, P=0.006). VI-850(%) of expiratory of each group was 30.79(30.45)%, 13.53(12.09)%and 2.85(6.87)%respectively with significant difference (H=17.20,P<0.001). Conclusions Low dose of CT scan and quantitative analysis can provide an objective and quantitative information for patients with airway disease of asthma, and both WA% and Pi10WA were objective indexes. The severe asthmatic patients were associated with obvious airway remodeling and air trapping compared with non-severe asthmatic patients.

Objective To evaluate the application value with low-dose CT scan and quantitative analysis in airway disease of chronic obstructive pulmonary disease(COPD).Methods All subjects(34 control cases,88 cases of stable COPD patients)underwent low-dose CT chest scans,and 88 COPD patients underwent pulmonary function tests.Measuring the airway dimensions of 3th generation in apical bronchus of the right upper lobe,the posterior basal bronchus of the right lower lobe and left lower lobe.Results COPD patients with moderate to extremely severe airflow limitation demonstrated higher WA% and Pi10 in comparison with normal volunteers(all P<0.05),meanwhile patients with extremely severe airflow limitation demonstrated higher WA % and Pi10 in comparison with patients with mild airflow limitation(both P <0.05).COPD patients with severe airflow limitation demonstrated higher T/BSA and WA/BSA in comparison with normal volunteers and patients with moderate airflow limitation (all P<0.05).The WA % and Pi10 of COPD patients group were negatively correlated with ventilation indices and small airway indices(all P <0.01).Pi10 were positively correlated with lung volume indices (all P < 0.05 ).Conclusion Low-dose CT scan and quantitative analysis can provide an objective and quantitative method to evaluate the information about airway disease of COPD,inwich both WA % and Pi10 are objective indices.With the increase of air flow limitation,the bronchial wall thickness gradually increased.

Objective To investigate the aging features of pure leukoaraiosis (LA) in nondemented outpatients. Methods The outpatients with age older than 40 years, without taking cholesterol lowering and B vitamin medications and with mini-mental state examination more than 24 scores were selected from July 2008 to December. 2009 in Beijing Tiantan Hospital. LA was defined with MRI. Patients were classified into two groups i. e. LA group consisting of 138 patients with leukoaraiosis but without lacunar lesions and cortical infarcts and a control group consisting of 124 patients without any lesion in brain. Age and other vascular risk factors were also investigated. Results Age of the patients in the LA group was significantly higher than that in the control group (P< 0.001). Multivariable logistic regression analysis showed that age was independently associated with pure LA ( OR 1.080, 95% CI 1.042-1.120), after adjusting sex, vascular risk factors and presence of atherosclerosis in cervical arteries. If age-stratification was further considered, logistic regression analysis showed that OR (95% CI) for LA was 2.693 (95% CI 1.103-6.575) in a 60-69 year group and 13. 527(95%CI 3.319-55.131) in a≥70 year group as compared with a 40-49 year group. Conclusion Age is a determining risk factor for pure LA and patients with age older than 60 years are at high risk of LA.

Objective To observe the effect of catechol-O-methyltransferase inhibitor (COMTI) tolcapone on levodopa-treated patients with Parkinson's disease (PD) and on the motor function fluctuation, and safety taking this drug.Methods50 PD patients treated with levodopa were divided into the trial group and control group with 25 cases in each group. The patients in the trial group were given tolcapone 100 mg three times per day. The cases in the control group were given placebo with the same dose. The hepatic function of the patients was examined every month after administration. The time variety of patients' motor function fluctuation was recorded by the diary. The time of clinical observation was 6 months.ResultsThe UPDRS scores of the trial group in the first and second months after taking tolcapone were not significantly different from that of the control group ( P>0.05), but scores of the third to sixth months were significantly different from that of the control group ( P<0.05～0.01). There was a significant difference between UPDRS scores of the trial group before and after treatment ( P<0.01～0.001). The Honhe-Yahr scores of the trial group in the first and second months after treatment were not significantly different from that before treatment ( P>0.05), but scores of the third to sixth months were significantly different from that before treatment ( P<0.05). The motor function fluctuation of the patients in the trial group improved significantly after treatment ( P<0.05). The numbers of the cases had dry mouth, nausea and astriction were 3 respectively; those had acratia, insomnia and diarrhea were 2 respectively; those had muscular soreness, abdominal distention, hidrosis and fidget were 1 respectively. All adverse effects had a little influence to administration. The hepatic function of all patients had no significant change.ConclusionTolcapone can increase the curative effect of PD patients treated with levodopa and improve the motor function fluctuation, and is safety after taken.

OBJECTIVETo evaluate the value of the clinical use of CT perfusion imaging (CTPI) and CT subtraction angiography (CTSA) for diagnosing acute ischemic cerebrovascular disease (AICVD).

METHODSTwenty-four patients with AICVD onset within 24 hours were examined with regular CT, CTPI, and CTSA. Some cases received CTPI, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) or single photon emission computer tomography (SPECT) during follow-up examinations.

RESULTSOf the 24 cases, 11 had negative results from regular CT scans 3 - 6 hours after onset of stroke in 6 cases, 6 - 12 hours in 3 cases, and 12 - 24 hours in 2 cases. Ten of these cases were then confirmed by CTPI as having ischemic lesions, 2 with middle cerebral artery occlusion (MCAO), and 1 case with transient ischemic attack (TIA) with CTPI negative. Of the 24 cases, 13 had positive results from regular CT, 9 were diagnosed with ischemic lesions larger by using CTPI than regular CT, 1 case had MCAO and 1 had internal carotid artery occlusion (ICAO). There were 4 cases with ischemic lesions observed with regular CT having nearly the same range as that of lacunar infarctions using CTPI. Another 4 cases had more than 2 lesion areas. The peak time (PT), mean transit time (MTT) and relative flow (RF) of 24 cases were markedly different. The sides of ischemic lesions compared to each other and the core of the lesion compared to peripheral zones were also altered significantly (P < 0.01).

CONCLUSIONSCombined CTPI with CTSA can detect acute ischemic lesions at early and hyper-early stages and could distinguish between TIA, lacunar infarction and a larger area of infarction. Using semiquantitative blood perfusion analysis status, CTPI with CTSA could define position, area and range of the ischemic lesion and penumbra. These scans can also analyze the brain blood perfusion status. It is important to early diagnose the occlusion of the entire division of the internal carotid artery or middle cerebral artery and it is meaningful to assess prognosis and assignment of therapy.

Adult ; Aged ; Angiography, Digital Subtraction ; Brain Ischemia ; diagnostic imaging ; Cerebral Angiography ; Cerebrovascular Circulation ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed