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.

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 explore the value of multi-sequence MRI radiomics for predicting clinical stage of cervical squamous cell carcinoma(CSCC).Methods Totally 190 patients with single CSCC confirmed by pathology were retrospectively collected.Among them,67 cases with International Federation of Gynecology and Obstetrics(FIGO)stage ⅠB—ⅡA were classified into early stage group,while 123 cases with FIGO ⅡB—ⅢC were enrolled in middle-late stage group.The patients were divided into training set(n=114,including 40 cases in early stage subgroup and 74 cases in middle-late stage subgroup)and test set(n=76,including 27 cases in early stage subgroup and 49 cases in middle-late stage subgroup)at the ratio of 6∶4.Single factor and logistic analyses were used to screen clinical relevant factors,and a clinical model was constructed.The best radiomics features of lesions were extracted and selected based on pre-treatment pelvic MR T2WI,diffusion-weighted imaging(DWI),dynamic contrast enhancement(DCE)-T1WI and all the three,respectively,and the radiomics models were constructed,including T2WI,DWI,DCE-TWI and combined sequences models,then a clinical-radiomics model was established based on clinical model and combined sequences model.The predictive efficacy of each model was evaluated by receiver operating characteristic curves,and the area under the curves(AUC)were calculated.The integrated discrimination improvement(IDI)index was also calculated to compare the diagnostic efficacy of each model in training set,and decision curve analysis(DCA)was used to evaluate their clinical value.Results Squamous cell carcinoma associated antigen in middle-late stage subgroup was higher than that in early stage subgroup in both training and test sets(both P＜0.05),which was used to establish the clinical model.The AUC of clinical,T2WI,DWI,DCE-TWI,combined sequences and clinical-radiomics models for predicting clinical stage of CSCC was 0.66,0.71,0.78,0.81,0.88 and 0.89 in training set,respectively,which was 0.62,0.64,0.72,0.73,0.77 and 0.76 in test set,respectively.In training set,the predictive efficacy of clinical-radiomics model was higher than that of combined sequences model(IDI=0.19,P＜0.05),both higher than that of the rest models(IDI=0.19-0.47,all P＜0.05).When the thresholds were 0.02-1.00 and 0.05-1.00,combined sequences and clinical-radiomics models had higher clinical net benefits in training set.Conclusion Multi-sequence MRI radiomics could effectively predict clinical stage of CSCC,and combining clinical data could improve its diagnostic efficacy.

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.

Objective:To explore the clinical characteristics and genetic characteristics of gene mutation of pyruvate dehydrogenase E1α deficiency.Methods:The clinical and genetic characteristics of a rare girl infant with pyruvate dehydrogenase E1 α deficiency confirmed by Hebei General Hospital were retrospectively analyzed, and the literature was reviewed combined with the research progress of the disease.Results:The rare case of baby girl, early onset, psychomotor development is severely backward, persistent hyperlactic acid and hyperpyruvemia, metabolic acidosis, the head MRI shows septum pellucidum is small, interventricular septum is absent; fornix is unclear, splenium of corpus callosum is small and extruded forward like a canopy.The top of the third ventricle is elevated to the dorsal side, the left paracele enlarge to the right, the left interventricular foramen is obviously enlarged.Intermittent periods EEG: a large number of medium and high amplitude spike slow waves, slow waves, and a small amount of multiple spike slow waves are scattered or continuously distributed in the left posterior head (O1, T5). A large amount of low amplitude slow wave can be seen in the bilateral hemisphere.The second-generation gene sequencing found a heterozygous missense mutation of C>T (p.A169v) in the position of chrx-19371287 in the PDHA1 gene of the child, but not in the parent PDHA1 gene.And the diagnosis of pyruvate dehydrogenase E1 α deficiency was identifie.Conclusion:PDHAl mutation-induced pyruvate dehydrogenase E1 α deficiency lacks specificity at an early stage, and female patients are more rare due to random inactivation of the X chromosome.It is necessary to be vigilant against metabolic acidosis in children with unexplained psychomotor retardation, persistent hyperlactemia and difficult to correct.It can be diagnosed by gene analysis.

Objective:To construct the intelligent medical cloud management platform of diabetes education clinic in ClassⅢ general hospital and observe the clinical effects.Methods:A total of 260 young and middle-aged patients with type 2 diabetes mellitus (T2DM) who were admitted to Department of Endocrinology in the First Affiliated Hospital of Henan University from June to December 2019 were selected by convenience sampling method. They were divided into the control group and the experimental group by the random number table method, with 130 cases in each group. Patients in the control group were given routine diabetes outpatient follow-up, while the experimental group was given group education, case management, behavioral intervention, condition supervision and online follow-up intervention based on the intelligent medical cloud management platform of the diabetes education clinic. The blood glucose control status and the self-management ability of the two groups before and after 3 months of intervention were compared.Results:After intervention for 3 months, fasting plasma glucose (FPG) , 2h plasma glucose of 75g oral glucose tolerance test (OGTT 2h PG) and hemoglobin A1c (HbA1c) of patients in two groups were reduced than those before intervention, and FPG, OGTT 2h PG and HbA1c levels in the experimental group were lower than those in the control group. The differences were statistically significant ( P<0.05) . The mean blood glucose (MBG) and mean amplitude of plasma glucose excursions (MAGE) in the experimental group were lower than those in the control group, and the difference was statistically significant ( P<0.05) . After 3 months of intervention, blood glucose was monitored 6 833 times in the control group and 7 279 times in the experimental group. The incidence of hypoglycemia in the experimental group was lower than that in the control group [0.77% (56/7 279) vs. 2.82% (193/6 833) , χ 2=85.885, P<0.05]. After 3 months of intervention, the scores of diet, exercise, blood glucose monitoring, prevention of complications and medical compliance in the two groups were all higher than those before intervention, and the scores of diet, exercise, blood glucose monitoring and medical compliance in the experimental group were higher than those in the control group. The differences were statistically significant ( P<0.01) . Conclusions:The construction and application of intelligent medical cloud management platform of diabetes education clinic can better improve blood glucose control and improve self-management ability of patients.

Objective To evaluate the efficacy of lamivudine and adefovir in the treatment of patients with decompensated hepatitis B cirrhosis . Methods 90 cases of patients with hepatitis B cirrhosis of the liver decompensation period from August 2013 to June 2015 in our hospital were researched.According to the random number table method divided into observation group and control group , each of 45 cases, the total course of treatment was one year.The observation group was treated with lamivudine combined with adefovir dipivoxil , control group was treated with lamivudine.The clinical effect, the indexes of liver function, the changes of HBV-DNA and Child-pugh score were compared between the two groups after treatment.Results After treatment, the total effective rate of the observation group ( 93.33%) was obviously higher than that of control group (48.89%), the difference was statistically significant (P<0.05), the observation group alanine amino acid, total bilirubin, aspartate aminotransferase were (71.23 ±21.32)U/L, (28.32 ±4.65)Umol/lL, (4.65 ±9.25)U/L, they were significantly lower than control group (111.54 ±16.25)U/L, (46.53 ±4.89 ) Umol/L, ( 4.89 ±12.11 ) U/L, the observation group albumin ( 39.82 ±2.62 ) g/L was significantly higher than control group (35.55 ±2.22)g/L, the difference was statistically significant (P<0.05), after treatment, the observation group hepatitis b HBV DNA levels, Dhild pugh score (2.78 ±0.45)log10 copies/mL, (6.12 ±1.23) were significantly lower than the control group (3.89 ±0.65)log10 copies/mL, (7.89 ± 1.21)scores, the difference was statistically significant (P <0.05).Conclusion The combination of lamivudine and adefovir dipivoxil significantly decompensated hepatitis B cirrhosis has a curative effect, it could effectively improve the patient's liver function, Dhild-pugh score, HBV-DNA level.

Objective To investigate the diagnostic value of dual energy CT for small central cervical metastatic lymph nodes in patients with papillary thyroid cancer.Methods The data of 43 patients with thyroid papillary carcinoma confirmed by pathology were retrospectively analyzed.All of the patients underwent dual energy CT scan before operation.The short diameter,iodine concentration and normalized iodine concentration (NIC) of enhanced arterial and venous phases and the slope of the energy spectrum curve were analyzed between metastatic central cervical lymph nodes and non-metastatic lymph nodes.ROC curve was used to analyze the diagnosis efficacy of iodine concentration and NIC for metastatic lymph nodes of thyroid carcinoma.Results Totally there were 119 lymph nodes in 43 patients included 55 thyroid papillary carcinoma metastasis lymph nodes (metastasis group) and 64 non-metastatic lymph nodes (non-metastasis group).There was significant differences of the mean short diameter of the lymph nodes between the two groupos (t=-2.20,P=0.03).In arterial phase,the average iodine concentration of metastasis group and non-metastasis group were (2.93±1.62)mg/ml and (2.17±1.09)mg/ml;the NIC were 0.33±0.21 and 0.19 ± 0.12;and the slope of the energy spectrum curve were 0.79±0.43 and 0.63±0.37 respectively.In venous phase,the average iodine concentration of metastasis group and non-metastasis group were (2.68± 1.54) mg/ml and (2.17 ± 1.01) mg/ml;the NIC were 0.51 ± 0.18 and 0.43 ± 0.15;the slope of the energy spectrum curve were 0.54 ± 0.42 and 0.62 ± 0.39 respectively.The iodine concentration and NIC in both phases and the slope of spectrum curve in arterial phase had statistical differences between the metastasis and non-metastasis groups (all P＜0.05).ROC curve showed that the area under the curve (AUC) of iodine concentration and NIC in the diagnosis of metastatic lymph nodes were 0.62 and 0.73 in arterial phase,respectively.And the AUC of iodine concentration and NIC were 0.61 and 0.63 in venous phase,respectively.Conclusion There are differences of iodine concentration,NIC in arterial and venous phases and curve slope in arterial phase of dual-energy between malignant and benign central cervical lymph nodes in thyroid papillary carcinoma.Dual energy CT technology is helpful in identifying of metastatic from non-metastatic small central cervical lymph nodes.

OBJECTIVETo compare the characteristics of esophageal gastric varices in portal hypertension patients with and without spontaneous shunts.

METHODSClinical data of 118 patients with esophageal gastric varices undergoing portal vein computed tomographic angiography (CTA) and gastroscopy between January 2012 and August 2015 was retrospectively reviewed.

RESULTSPortal vein CTA results showed that spleno-renal or gastro-renal shunts were detected in 24 out of 118 cases. The average portal vein diameters (PVD) of patients with and without spontaneous shunt were (12.48±2.79) mm and (13.58±3.46) mm, respectively (P>0.05). The average area of gastric veins in patients with spontaneous shunt was significantly larger than that of patients without shunt [294.00 (0.00~2400.00) mm2 vs. 26.00 (0.00~1620.00) mm2, respectively, (P<0.001]. Compared with patients without spontaneous shunt, the location of esophageal varices was lower and the degree was less serious in patients with spontaneous shunt (P<0.05). No matter with history of uppergastrointestinal bleeding, the average area of gastric veins in patients with spontaneous shunt was significantly larger than that of patients without shunt (P<0.05). For patients having no history of splenectomy, the average portal vein diameter (PVD) in those with spontaneous shunt was significantly smaller than that in those without shunt (P<0.05).

CONCLUSIONThe portal vein diameter of patients without splenectomy and with spontaneous shunts is shorter and their esophageal varices are less serious; the gastric veins are large and wriggly in patients with spontaneous shunts.

Angiography ; Esophageal and Gastric Varices ; physiopathology ; Gastroscopy ; Humans ; Hypertension, Portal ; physiopathology ; Portal Vein ; pathology ; Retrospective Studies ; Spleen ; Tomography, X-Ray Computed