Objective To investigate the enhanced CT and MRI imaging features of nasal sinus squamous cell carcinoma(SCC)and lymphoma(NHL),and to analyze the efficacy of different imaging features in differentiating nasal sinus SCC from NHL.Methods The imaging,clinical and pathological data of 67 patients with sinus SCC and NHL who underwent sinus CT and MRI with contrast CT and MRI in our hospital and confirmed by surgical pathology were retrospectively analyzed,and the tumor origin,maximum diameter,CT density,MRI signal intensity,enhancement degree,tumor internal necrosis,adjacent bone destruction,invasion of surrounding tissues,and The imaging features such as cervical lymph node metastasis within the scanning range were analyzed,and the receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the efficacy of different imaging features to distinguish nasal sinus SCC and NHL.Results There were statistically significant differences between the five imaging features of nasal sinus SCC and NHL,including tumor origin,maximum diameter,internal tumor necrosis,surrounding bone destruction and peripheral tissue invasion(P＜0.05),and the AUC of differentiating SCC and NHL were 0.708,0.694,0.785,0.850 and 0.629,respectively.The AUC of SCC and NHL was 0.969,and the sensitivity and specificity were 83.9%and 97.2%,respectively.Conclusion On contrast-enhanced CT and MRI,the imaging signs of tumor origin,maximum diameter,tumor internal necrosis,bone destruction and surrounding tissue invasion are helpful to distinguish nasal sinus SCC from NHL,especially if the tumor originates in the nasal cavity,necrosis is rare,bone destruction is mild,and the possibility of nasal sinus NHL should be given priority.Contrast-enhanced CT and MRI can help differentiate nasal sinus SCC from NHL,and the combination can help improve differential diagnostic performance.

BACKGROUND:Intervertebral disc degeneration is an important cause of low back pain.At present,there are many modeling methods for disc degeneration in China and abroad,but there is not a model for low back pain due to disc degeneration. OBJECTIVE:To compare the effect of mechanical puncture combined with tumor necrosis factor α and complete Freund's adjuvant with a conventional disc mechanical puncture alone. METHODS:A total of 18 male adult Sprague-Dawley rats were randomly divided into 3 groups,with 6 animals in each group.No treatment was given in the blank group.Animal models of intervertebral disc degeneration were made in the L4-5 segments of rats in the control using conventional mechanical puncture.In the experimental group,on the basis of mechanical puncture,tumor necrosis factor α+complete Freund's adjuvant was injected into the L4-5 intervertebral discs using a microinjector to establish a model of disc degeneration induced by mechanical puncture combined with inflammatory factors.Four weeks after surgery,the pain threshold of rats was measured by the hot plate method for assessing the perception of heat injury in rats with intervertebral disc degeneration.MRI examination was performed to observe the disc degeneration in each group.ELISA was used to detect the levels of serum tumor necrosis factor α,interleukin 1β,interleukin 6 and prostaglandin E2.Hematoxylin-eosin and Safranin O-fast green staining were used to observe the morphological changes of the disc. RESULTS AND CONCLUSION:In terms of pain,the behavioral pain threshold of the experimental group was continuously decreased,and the levels of serum inflammatory factors were significantly higher compared with the control group.In terms of morphology,the MRI results showed that the L4-5 nucleus pulposus signal completely disappeared in the experimental group.Histopathological results showed that in the control group,the nucleus pulposus was intact,more notochord cells were visible,and some fiber rings were ruptured,while in the experimental group,there are fewer notochord cells and the structure of the nucleus pulposus and fibrous ring is disturbed,with the boundary disappearing.To conclude,mechanical puncture combined with tumor necrosis factor alpha and complete Freund's adjuvant can successfully establish a discogenic low back pain model in rats.This operation is simple and economical to achieve obvious disc degeneration and low back pain,with greatly shortened molding cycle.This model can be used as a reference for studying discogenic low back pain models.

Objective To investigate the correlation between intra-and peri-tumoral radiomics features and the response to con-current chemoradiotherapy(CCRT)in cervical squamous cell carcinoma,and to explore the difference of predictive performance between 2D and 3D radiomics models.Methods The imaging data of 132 patients were analyzed retrospectively and randomly divided into training set(n=92)and validation set(n=40).Radiomics features were extracted based on the dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),the correlation analysis and least absolute shrinkage and selection operator(LASSO)algorithm were used for dimensionality reduction and screening,then the radiomics score was calculated and the logistic model was constructed.The receiver operating characteristic(ROC)curve,internal validation of Bootstrap and Brier score were used to evaluate the discrimina-tion and calibration of the model,and the improvement in predictive performance of 3D model compared with 2D model was evaluated by the integrated discrimination improvement(IDI).Results In the training set,the ROC curve showed that the area under the curve(AUC)of the models(2D-intratumoral,3D-intratumoral,3D-peritumoral,3D-combined)ranged from 0.774 to 0.893.The internal validation of Bootstrap showed the AUC were 0.772,0.860,0.847 and 0.888,respectively,while in the validation set,the AUC were 0.757,0.849,0.824 and 0.887,respectively.The Brier scores indicated that the models were well calibrated.In the training set and the validation set,the IDI values were 0.155 and 0.179,respectively,and the differences were statistically significant(P<0.05).Conclusion The radiomics analysis based on the tumor volume can fully explore the tumor heterogeneity.The intra-and peri-tumoral radiomics combined model shows the best predictive performance,which is important to assist clinicians in developing individualized therapies.

Objective To investigate the value of enhanced CT radiomics combined with CT features model(combined model)for differentiating squamous cell carcinoma(SNSCC)and sinonasal lymphoma(SL).Methods Totally 68 patients with SNSCC and 63 patients with SL were retrospectively collected and divided into training set(n=92,including 48 SNSCC and 44 SL)and verification set(n=39,including 20 SNSCC and 19 SL)at the ratio of 7:3.Univariate analysis and logistic regression were used to analyze clinical data and CT manifestations in training set,and the independent predictive factors for differentiating SNSCC and SL were screened and used to construct a CT features model.Based on enhanced venous phase CT of training set,the best radiomics features of lesions were extracted and screened.The radiomics model was then established,and the radiomics label was calculated.The combined model was finally constructed based on CT model and radiomics labels,and its nomogram was drawn.Receiver operating characteristic(ROC)curve were drawn,and the areas under the curve(AUC)were calculated to evaluate the efficacy of each model for differentiating SNSCC and SL.Calibration and decision curve analysis were used to evaluate the calibration efficacy and clinical benefit of the obtained combined model.Results The primary location of the lesion and bone invasion showed on CT were both independent predictive factors for SNSCC and SL(both P＜0.05),and CT model was constructed.Based on enhanced venous phase CT,3 best radiomics features were selected to establish the radiomics model.The AUC of CT,radiomics and combined model in training set was 0.895,0.730 and 0.925,respectively,and significant differences of AUC were found among 3 models(Z=-3.964 to-1.833,all P＜0.05).The AUC of CT,radiomics and combined model in verification set was 0.845,0.684 and 0.868,respectively,of combined model was greater than of radiomics model(Z=-2.568,P=0.010).The combined model had good calibration.Taken 15％-62％ and 85％-92％ as the thresholds in training set and 88％ to 95％ in validation set,the clinical net benefit of combined model was high.Conclusion The obtained enhanced CT radiomics combined with CT features model could be used to effectively differentiate SNSCC and SL.

Objective To observe the value of extracellular volume(ECV)and relative electron density(RED)based on dual-layer detector spectral CT(DLCT)for identifying colon cancer invasion into serous membrane.Methods Sixty-two patients with pathologically confirmed colon cancer with blurred pericolonic fat gap on CT images were retrospectively collected,including 18 cases of T4a stage tumors with serous membrane invasion and 44 cases of T2-T3 stage without serous membrane invasion.The arterial,venous and delayed phase DLCT images under 40 keV showing the largest diameter of colon cancers were analyzed.The iodine concentration(IC)and RED of the pericolonic fat around tumor-bearing and tumor-free intestines,as well as of the abdominal aorta or the common or external iliac artery were measured,while normalized IC(NIC)and difference of RED(REDdiff)of pericolonic fat around tumor-bearing and tumor-free intestines in each phase and ECV in delayed phase were calculated.The above parameters were compared between tumors with different stages,and for those with significant differences,the receiver operating characteristic curves were drawn,and the areas under the curve(AUC)were calculated to evaluate and compare the efficacies for identifying invasion of serous membrane in T4a stage colon cancer.Results Compared with T2-T3 stage colon cancers,T4a stage colon cancers were found more often occurred in patients aged ＜50 with higher proportion of lymph node metastases(both P＜0.05),also higher values of NIC and REDdiff on images in different phases,as well as ECV in delayed phase images(all P＜0.05).The AUC of arterial,venous and delayed phase NIC for differentiating T2-T3 and T4a stage colon cancers ranged from 0.868 to 0.902,while of REDdiff ranged from 0.848 to 0.903,all without significant difference(all P＞0.05).The AUC of delayed phase ECV was 0.948,not significant different with that of delayed phase NIC and REDdiff,arterial phase NIC nor venous phase REDdiff(all P＞0.05).Conclusion Based on DLCT,ECV and RED could be used to identifying serous membrane invasion of colon cancer when blurred pericolonic fat gaps were noticed.

With the evolution of endoscopic technology,the early screening for colorectal cancer has been widely promoted,and increasing numbers of patients with T1 stage colorectal cancer have undergone tumor endoscopic resection.Whether additional segmental resection and regional lymph node dissection are required after the endoscopic resection of T1 stage colorectal cancer should be based on histopath-ological results to determine the risk of lymph node metastasis.Some studies have shown that after additional surgery based on the risk factors in the current national and international guidelines,lymph node metastasis affects only approximately 10%of patients with T1 colorectal cancer,resulting in a large number of additional surgical excisions lacking clinical benefit.Therefore,a more accurate risk assess-ment system for lymph node metastasis is needed to solve this problem.This article reviews the current status of the risk factor assessment system for lymph node metastasis in T1 stage colorectal cancer and provides an overview of its future prospects.

Objective:To evaluate the effect of small-dose esketamine on the learning and memory ability of chronic sleep-deprived rats and the role of hippocampal amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPARs).Methods:Forty healthy male Sprague-Dawley rats, aged 4 months, weighing 200-280 g, were divided into 4 groups ( n=10 each) using a random number table method: normal control group (N group), chronic sleep deprivation group (SD group), chronic sleep deprivation+ esketamine group (SDK group) and chronic sleep deprivation + esketamine + AMPAR antagonist CNQX group (SDKI group). The sleep deprivation model was prepared by the modified multi-platform water environment method. For 3 consecutive days after developing the model, ketamine 10 mg/kg was intraperitoneally injected in SDK group, and SDKI group received intraperitoneal injection of CNQX 1 mg/kg followed by ketamine 10 mg/kg. Morris water maze test was used to detect spatial learning and memory ability after the end of sleep deprivation or after administration. After the water maze test, rats were sacrificed, and the hippocampal tissue was obtained to detect the expression of hippocampal Homer1a mRNA (by quantitative polymerase chain reaction), Homer1a, metabotropic glutamate receptor 5 (mGluR5) and AMPAR (by Western blot). The density of dendritic spines in hippocampal CA1 region was determined by Golgi staining. Results:Compared with N group, the escape latency was significantly prolonged, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were decreased, the expression of Homer1a protein and mRNA and mGluR5 was up-regulated, the expression of AMPAR was down-regulated, and the density of dendritic spines in hippocampal CA1 region was decreased in SD group ( P<0.05). Compared with SD group, the escape latency was significantly shortened, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were increased, the expression of AMPAR was up-regulated, and the density of dendritic spines in hippocampal CA1 region was increased in SDK group ( P<0.05). Compared with SDK group, the escape latency was significantly prolonged, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were decreased, the expression of AMPAR was down-regulated, and the density of dendritic spines in hippocampal CA1 region was decreased in SDKI group ( P<0.05). There was no significant difference in the expression of Homer1a protein and mRNA and mGluR5 among SD group, SDK group and SDKI group ( P>0.05). Conclusions:Small-dose esketamine can improve the learning and memory ability of chronic sleep-deprived rats, and the mechanism may be related to up-regulation of the expression of hippocampal AMPARs.

Objective:To evaluate the effect of buccal acupuncture on analgesia after tonsilloadenoidectomy in pediatric patients.Methods:This was a randomized controlled study. One hundred and twenty-six American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ pediatric patients, aged 3-12 yr, weighing 12-34 kg, with body mass index <30 kg/m 2, undergoing elective tonsilloadenoidectomy with general anesthesia, were divided into 2 groups ( n=63 each) by the random number table method: buccal acupuncture group (group B) and control group (group C). All pediatric patients received the same anesthesia induction and intraoperative anesthesia maintenance. The concentration of sevoflurane was adjusted to keep the fluctuation amplitude of vital sign parameters within 20% of the baseline value. After surgery, the drug was immediately stopped and the children were transferred to the postanesthesia care unit for resuscitation under general anesthesia. In group B, the bilateral neck points, upper neck points, hologram points on the head and Zhongjiao points were selected before removal of the tracheal catheter, and disposable acupuncture needles were inserted directly into the acupoints and remained for 20-30 min. Group C received no buccal acupuncture. The pain Assessment Scale (FLACC) was used to assess the severity of postoperative pain. The postoperative agitation score was evaluated by Aono four-point rating method to evaluate the occurrence of agitation. The effective pressing times of patient-controlled analgesia, rescue analgesia and occurrence of nausea and vomiting within 48 h after operation were recorded. The occurrence of bleeding, infection and broken needle at acupuncture sites was recorded. Results:Compared with group C, the effective pressing times of patient-controlled analgesia and incidence of nausea and vomiting were significantly decreased in group B ( P<0.05). There was no significant difference in the rate of rescue analgesia and incidence of postoperative agitation between the two groups ( P>0.05). No infection or broken needle was found at acupuncture sites after buccal acupuncture, only 2 cases had slight bleeding at the puncture site, and there was no abnormality after pressing in group B. Conclusions:Buccal acupuncture can enhance the analgesic effect after tonsilloadenoidectomy in pediatric patients.

Objective To observe the value of virtual non-contrast(VNC)image combined with 40 keV virtual monoenergetic image(VMI)for reducing radiation dose of CT enterography(CTE)based on dual-layer spectral detector CT(DLCT).Methods Data of 63 patients with inflammatory bowel disease(IBD)who underwent CT true non-contrast(TNC)scanning and dual-phase contrast scanning were retrospectively analyzed.CT values,noise(SD),signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)of lesion/tissue/structure on TNC,conventional arterial and venous phase,VNC of arterial and venous phase(VNCa and VNCv)and 40 keV VMI images were measured,and dose-length product(DLP),volume CT dose index(CTDIvol)and effective dose(ED)were calculated,respectively.Objective evaluation was performed to compare TNC and VNC,also between conventional arterial phase and 40 keV VMI.Subjective score and radiation dose were compared between conventional CT and VNC combined with 40 keV VMI.Results No significant difference of CT values of involved intestinal wall,non-involved intestinal wall nor psoas major muscle was found among TNC,VNCa and VNCv images(all P＞0.05).CT values,SNR and CNR of involved intestinal wall,non-involved intestinal wall and psoas major muscle on 40 keV VMI images were all higher than those on conventional arterial phase CT images(all P＜0.05).The subjective score of conventional CT and VNCv combined with 40 keV VMI images was 4(4,5)and 4(4,5),without significant difference(P＞0.05).Compared with conventional CT scanning,radiation dose of CTE using VNCv combined with 40 keV VMI decreased about 67.53％.Conclusion DLCT VNC combined with 40 keV VMI could reduce radiation dose of CTE.

Objective To explore the optimal virtual monoenergetic image of superior thyroid artery(STA)based on dual-layer spectral detector CT,and to optimize the image quality of STA.Methods A total of 100 patients who underwent dual-phase neck enhanced spectral CT scan were selected retrospectively.The 120 kVp conventional images and the 40-70 keV(interval of 10 keV)virtual monoenergetic images in the arterial phase were analyzed.The CT values,background noise,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of blood vessels and surrounding tissues were analyzed in the five groups of images,and the image quality was scored.Results In monoenergetic image groups,the CT values,SNR and CNR of STA increased with the monoenergetic level decreased,and the highest values were found when the monoenergetic level was 40 keV,which was significantly higher than those in the 120 kVp conventional image group(P＜0.05).The background noise increased with the monoenergetic level decreased,and reached the maximum at 40 keV,but it was still lower than that in the 120 kVp conventional image group,and the difference was statistically significant(P＜0.001).The subjective score of 40 keV image was significantly better than that of 120 kVp conventional image group(P＜0.001).In the evaluation of the origin of the STA in 100 patients,a total of 200 STA were shown,69％of which originated from the external carotid artery.Conclusion The image quality of the STA on the 40 keV monoenergetic image is significantly higher than that on the conventional image,which has obvious advantages in evaluating the anatomy of the STA.