Clinical characteristics and risk factors of diabetic foot ulcers with PAD

OBJECTIVE

This study aimed to analyze the clinical characteristics of patients with diabetic foot ulcers combined with peripheral arterial disease (PAD) and the risk factors.

PATIENTS AND METHODS

A retrospective study was conducted on 120 patients with diabetic foot ulcers in the Second Affiliated Hospital of Dalian Medical University from October 2018 to February 2021. The patients were divided into uncombined with the PAD group (42 cases) and combined with the PAD group (78 cases). The baseline information and clinical indicators were measured from two groups. Univariate and binary logistic regression was used to analyze the risk factors of PAD in patients with diabetic foot ulcers.

RESULTS

The proportion of patients with age ≥ 60 years, Wagner grade 4-5 and smoking history in the combined group was higher than that in the uncombined group (p < 0.05). The diastolic blood pressure (DBP) of the combined group was lower than that of the uncombined group, while the C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and glycated hemoglobin (HbA1c) levels of the combined group were higher than those of the uncombined group (p < 0.05). Binary logistic regression analysis showed that age ≥ 60 years, high Wagner grade, smoking, elevated CRP, NLR and HbA1c levels were risk factors for patients with diabetic foot ulcer combined with PAD (OR > 1, p < 0.05). An elevated DBP level was the protective factor for PAD in patients with diabetic foot ulcer (OR < 1, p < 0.05).

CONCLUSIONS

Patients with diabetic foot ulcer combined with PAD have the clinical characteristics of poor blood pressure control, long course of disease, and low ABI value. Age ≥ 60 years, high Wagner grade, smoking history, elevated CRP, NLR and HbA1c levels are the risk factors of PAD in patients with diabetic foot ulcer. Increased DBP is protective for PAD in patients with diabetic foot ulcer.

[Advances in the diagnosis and treatment strategy of polymyxin resistant Klebsiella pneumoniae]

In recent years, the detection rate of multidrug-resistant and pandrug-resistant Klebsiella pneumoniae has increased year on year, so polymyxin has received increasing attention as an antibiotic that is still sensitive to most of the multidrug-resistant strains. However, widespread use of polymyxin is likely to lead to the emergence of polymyxin-resistant Klebsiella pneumoniae. At the same time, the polymyxin hetero-resistance has made clinical prevention and treatment difficult. In addition to relying on the combination of polymyxins with other antibiotics, the search for new antibacterial drugs has also become a research hotspot. Research into early detection methods for polymyxin resistance can also help to optimize and improve the diagnosis and treatment strategies. This article reviewed the epidemic status, mechanism, detection methods and prevention measures of polymyxin-resistant Klebsiella pneumoniae.

[Abnormalities of white matter differentiate the Parkinson variant of multiple system atrophy from Parkinson's disease]

Objective: To identify objective markers between the Parkinson variant of multiple system atrophy (MSA-P) and Parkinson's disease (PD). Methods: Retrospective analysis was performed on 10 patients with MSA-P, 15 patients with PD, and 15 healthy control group during the period from August 2016 to February 2019 in Baoshan Branch of Shanghai First People's Hospital.We combined the novel tract based spatial statistics (TBSS) and region of interest (ROI) analyses for the first time to investigate three groups with diffusion tensor imaging. By TBSS, we performed pairwise comparisons of mean diffusivity and fractional anisotropy (FA) maps. The clusters with significant differences between MSA-P and PD were used as ROIs for further analyses. Results: FA values in the left anterior thalamic radiation(ATR) (ROI values were 0.371(0.287-0.535), 0.472(0.390-0.594), 0.473(0.388-0.555); P values were 0.008, 0.008) and left superior longitudinal fasciculus (SLF)(ROI values were 0.397(0.291-0.469), 0.456(0.338-0.560), 0.473(0.427-0.530); P values were 0.013,<0.001) were significantly decreased in MSA-P compared with PD or controls, and significantly correlated with clinical data((r =-0.807, P =0.005),(r =-0.455, P =0.022)). Conclusion: Our findings indicate the abnormalities of left ATR and left SLF as specific biomarkers for differential diagnosis.

[Comparative analysis of the prognosis of patients with locally advanced cervical cancer undergoing laparoscopic or abdominal surgery]

Objective: To compare the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy or abdominal radical hysterectomy. Methods: From January 1, 2009 to December 31, 2018, patients with stage Ⅰb2-Ⅱa2 who underwent laparoscopic or abdominal radical hysterectomy (laparoscopic group and abdominal group) in Peking University People's Hospital were collected. The clinicopathological data were retrospectively analyzed. There were 237 cases in this study, including 115 cases in laparoscopic group and 122 cases in abdominal group. The clinicopathological characteristics, surgery-related complications, recurrence and death were analyzed between the two groups. The related factors of recurrence and death were also analyzed.During laparoscopic surgery, the pressure of the carbon dioxide pneumoperitoneum were controlled, to try avoid the tumor tissue in the vagina from being exposed to the abdominal cavity when taking out the uterine specimen through the vagina, and fully flushed the abdominal cavity with sterile water after the specimen was taken out. Results: (1) Clinicopathological characteristics: there was no significant differences between the two groups among age, pathological type, pathological grade, clinical stage, depth of interstitial infiltration, lymph node metastasis,parametrial infiltration, vaginal stump infiltration, lymph-vascular space invasion (LVSI), neoadjuvant chemotherapy, and postoperative adjuvant treatments (all P>0.05). (2) Surgery-related complications: the incidence of surgery-related complications in the laparoscopic group and the abdominal group were 32.2% (37/115) and 25.4% (31/122), respectively. There was no statistically significant difference between the two groups (P>0.05). (3) Recurrence and death: during the follow-up period, the recurrence rates of the laparoscopic group and the abdominal group were respectively 15.7% (18/115) and 12.3% (15/122). There was no statistically significant difference between the two groups (P=0.456). The 5-year overall survival rates of the laparoscopic group and the open group were 86.8% and 87.8%, and the 5-year tumor-free survival rates were 81.7% and 84.6%, respectively. There were no statistically significant differences between the two groups (P=0.405, P=0.429). (4) Analysis of related factors of recurrence and death: univariate analysis showed that neoadjuvant chemotherapy, lymph node metastasis, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative recurrence of cervical cancer patients (all P<0.05); neoadjuvant chemotherapy, lymph node metastasis, parametrial infiltration, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative death in patients with cervical cancer (all P<0.05). Multivariate analysis showed that neoadjuvant chemotherapy and lymph node metastasis were independent risk factors for postoperative recurrence and death of cervical cancer patients (P<0.05). Conclusion: There is no significant difference in the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy with non-touch operative technique and abdominal radical hysterectomy.

[Investigation on the health status of workers exposed to benzene in one province]

Objective: To explore the health status of occupational benzene exposure workers, and to provide a scientific basis for the development of reasonable health monitoring and effective protective measures. Methods: In March 2019, the occupational health surveillance data were collected including blood pressure, electrocardiogram, blood routine, urine routine, liver function, etc of 7810 benzene contact workers in 150 enterprises in Jiangxi Province in 2017, to analyze and assess their health status. Results: Among the 7810 benzene workers, there were 5451 males and 2359 females; the average age was (40.5±9.9) years; and the median benzene working age was 3.5 years. The detection rate of hypertension was 17.0% (734/4317) , the abnormal rate of urine routine was 15.7% (1227/7810) , the abnormal rate of liver function was 8.6% (356/4147) , and the abnormal rate of electrocardiogram was 12.3%(963/7810). The detection rates of low count number of leukocytes, platelets, neutrophils and occupational contraindications were 4.6%(360/7810) , 1.4%(108/7810) , 4.2%(330/7810) and 1.4%(110/7810) , respectively. The detection rates of low count number of leukocytes, platelets and neutrophils in female were all higher than those in male (P<0.05). The detection rates of low count number of platelets, neutropenia and occupational contraindications increased with age and working age (P<0.05 ). There were significant differences in the detection rates of low count number of leukocytes, platelets, neutrophils and occupational contraindications among benzene workers in different economic types (P<0.05) , and the highest among foreign companies, followed by private enterprise. There were statistically significant differences in the detection rates of low count number of platelets, neutrophils and occupational contraindications in benzene workers of different enterprise sizes (P<0.05) , and the highest was found in micro enterprises, followed by small enterprises. Conclusion: In 2017, the occupational health status of workers exposed to benzene in Jiangxi province is not optimistic. It is necessary to strengthen the occupational health supervision of small and micro-sized enterprises, foreign enterprises and private enterprises, take the initiative to improve health surveillance, and effectively protect the physical and mental health of workers.

Down regulation of lncRNA MEG3 promotes colorectal adenocarcinoma cell proliferation and inhibits the apoptosis by up-regulating TGF-β1 and its downstream sphingosine kinase 1

OBJECTIVE

LncRNA MEG3 is involved in the pathogenesis of several types of cancers. While its participation and function network in colorectal (CR) adenocarcinoma, which is one of the most common malignancies, still hasn't been well studied. Therefore, our study aimed to investigate the role of MEG3 in colorectal adenocarcinoma and to explore the possibly related mechanisms.

PATIENTS AND METHODS

Tumor tissues and adjacent healthy tissues were collected from colorectal adenocarcinoma patients. Blood samples were collected from both colorectal adenocarcinoma patients and healthy controls to prepare serum sample. Expression of MEG3 in those tissues was detected by qRT-PCR. MEG3 knockdown and sphingosine kinase 1 (SPHK1) overexpression colorectal adenocarcinoma cell lines were established. Its effects on cell proliferation and apoptosis were investigated by CCK-8 assay and MTT assay, respectively. Effects of MEG3 overexpression on TGF-β1 and SPHK1 were investigated by Western blot.

RESULTS

MEG3 expression level was decreased in tumor tissues than that in adjacent healthy tissues. Serum level of MEG3 was lower in cancer patients than that in healthy controls, and the serum level decreased with the increased stage of primary tumor. Serum TGF-β1 can be used to predict colorectal adenocarcinoma and its prognosis accurately. MEG3 knockdown and SPHK1 overexpression promoted tumor cell proliferation, but inhibited cell apoptosis. MEG3 knockdown also increased the expression level of TGF-β1 and SPHK1. Treatment with TGF-β1 inhibitor reduced the expression level of SPHK1 but showed no significant effects on MEG3. SPHK1 overexpression showed no significant effects on MEG3 and TGF-β1 expression.

CONCLUSIONS

Downregulation of lncRNA MEG3 can promote colorectal adenocarcinoma cell proliferation and inhibit the apoptosis by up-regulating TGF-β1 and its downstream sphingosine kinase 1.

The relative impact of urbanization and precipitation on long-term water level variations in the Yangtze River Delta

The combined and individual hydrological impacts of climate variation and urbanization have been extensively discussed over the past few decades, yet little is known about the relative impact of each. In this paper we took one of the most developed regions worldwide, Yangtze River Delta, as an example to analyse the long-term relative impacts of precipitation and urbanization change on water level alterations, based on precipitation, water level series, and annual impervious area data from 1960 to 2015. Abrupt changes detection in the water level series divided the data into the pre-impact period (1960-1988) and impacted period (1989-2015), and relative impacts of precipitation and urbanization on the water level increase from pre-impacted to impacted period, as well as their spatial and seasonal variations were estimated with the elasticity method. The results indicated that the urbanization change showed no distinct influence on the water level rise in the pre-impact period, while the precipitation played distinct roles only during summer months in the impacted period; the precipitation dominated two thirds of the water level rise in flood season, and in non-flood season the urbanization controlled the two thirds of the water level rise; spatially, the water level variations in old and new urban area were dominated by precipitation and urbanization process respectively; compared with precipitation amount, the water level correlated more strongly to the contribution ratio of precipitation. The results would provide a good reference for flood control and water resource management in the river basin, especially in the economically developed areas.

Genomic full-length sequence of HLA-B*15:178 was identified by full-length group-specific sequencing

Genomic full-length sequence of HLA-B*15:178 was identified by a group-specific sequencing approach from China.

[Using the sequenced sample cluster analysis to study the body mass index distribution characteristics of adults in different age groups and genders]

Objective: To explore the characteristics of distribution on Chinese adult body mass index (BMI) in different age groups and genders and to provide reference related to obesity and related chronic diseases. Methods: Data from the China Health and Nutrition Survey in 2009 were used. Sequential sample cluster method was used to analyze the characteristics of BMI distribution in different age groups and genders by SAS. Results: Our results showed that the adult BMI in China should be divided into 3 groups according to their age, as 20 to 40 years old, 40 to 65 years old, and> 65 years old, in females or in total when grouped by difference of 5 years. For groupings in male, the three groups should be as 20 to 40, 40 to 60 years old and>60 years old. There were differences on distribution between the male and female groups. When grouped by difference of 10 years, all of the clusters for male, female and total groups as 20-40, 40-60 and>60 years old, became similar for the three classes, respectively, with no differences of distribution between gender, suggesting that the 5-years grouping was more accurate than the 10-years one, and BMI showing gender differences. Conclusions: BMI of the Chinese adults should be divided into 3 categories according to the characteristics of their age. Our results showed that BMI was increasing with age in youths and adolescents, remained unchanged in the middle-aged but decreasing in the elderly.

[Use of noninvasive high-frequency oscillatory ventilation in very low birth weight infants]

Objective: To evaluate the effectiveness and safety of the use of noninvasive high-frequency oscillation ventilation (nHFOV) in very low birth weight infants. Method: A total of 36 cases received nHFOV between January 2016 and October 2016 in Children's Hospital, Zhejiang University School of Medicine, including 24 males and 12 females, with the gestational age of (27.5±2.5) weeks and birth weight of(980±318)g. The data of the ventilator settings, side effects, and changes of the respiratory function before and after nHFOV were collected and analyzed retrospectively. Nonparametric tests or t tests or χ(2) tests were used. Result: Thirty-two (89%) out of the 36 cases successfully avoided intubation or re-intubation after using of nHFOV. nHFOV was used as the rescue treatment after failure of other noninvasive ventilation in 17 cases, and as the prophylactical treatment preventing re-intubation after extubation in the remaining 19 cases. There were significant decreases in the incidences of apnea and desaturation(SpO(2)<0.85), the level of PaCO(2, )and the FiO(2) 24 h after the initiation of the nHFOV as the rescue therapy((1.2±1.1)vs.(6.3±2.1)episodes , (1.1±1.2) vs.(4.3±1.5) episodes, (43±8) vs.(56±10) mmHg, 0.30±0.07 vs. 0.39±0.11, respectively; 1 mmHg=0.133 kPa, t=7.562, 8.913, 4.179, 3.437 respectively, all P<0.01). No significant changes were found in FiO(2) and PaCO(2) levels 24 h after initiation of nHFOV as the prophylactical therapy after extubation (0.42±0.12 vs.0.40±0.10, (49±8)vs.(48±7)mmHg, t=0.872 and 0.501 respectively, both P>0.05), except for the significant decreases in the mean airway pressure ((7.9±2.6)vs.(9.6±1.6)cmH(2)O, 1 cmH(2)0=0.098 kPa, t=2.198, P=0.041). There were 4 cases suffered from nasal septum injury, while no other nHFOV related complications were noted. Conclusion: nHFOV can be applied in preterm infants as a rescue treatment after the failure of other noninvasive ventilation, or prophylactically used in patients who have high risk of re-intubation.

A novel HLA-E allele, HLA-E*01:01:01:07, identified in a Chinese leukemia patient

A novel HLA-E allele, HLA-E*01:01:01:07, was identified in a Chinese leukemia patient.

The novel KIR3DS1*083 allele identified in a southern Chinese Han individual

KIR3DS1*083 allele differs from the closest allele KIR3DS1*01301 by 3 mutations in exon 4.

The novel KIR3DS1*084 allele identified in a southern Chinese Han individual

KIR3DS1*084 allele differs from the closest allele KIR3DS1*01301 at nucleotide 308 C>T in exon 3.

A novel HLA-E allele, HLA-E*01:01:01:06, identified in a Chinese Leukemia patient

A novel HLA-E allele, HLA-E*01:01:01:06, was identified in a Chinese leukemia patient.

The novel KIR3DS1*085 allele identified in a southern Chinese Han individual

KIR3DS1*085 allele differs from the closest allele KIR3DS1*01301 at nucleotide 934 C>T in exon 5.

The novel KIR3DS1*078 allele identified in a southern Chinese Han individual

KIR3DS1*078 allele differs from the closest allele KIR3DS1*01301 at nucleotide 775 G>C in exon 5.

The novel KIR3DS1*082 allele identified in a southern Chinese Han individual

KIR3DS1*082 allele differs from the closest allele KIR3DS1*01301 at nucleotide 1114T>C in exon 8.

The full length genomic sequence of a novel HLA-A*24 allele, HLA-A*24:353, identified in a patient with hepatitis B infection

HLA-A*24:353 differs from HLA-A*24:02:01 by an amino acid exchange glutamine to glutamate at position 316.

[Clinical analysis of the character, family history and prognosis of 6 cases with Crouzon syndrome]

Objective:To investigate the clinical characteristics, family history, treatment and prognosis of patients with Crouzon syndrome. Method:We reviewed and analyzed the clinical data of 6 patients with Crouzon syndrome. All patients suffered from snore during sleep, along with mouth opening, in which 5 cases had apnea and could be awaken. In addition, five of six experienced hearing loss, including one case with right ear discharging repeatedly. During the treatment, all patients were operated under general anesthesia. Among six cases, two were performed by tonsillectomy, adenoidectomy, and myringotomy; one was treated by adenoidectomy and myringotomy; two were performed by adenoidectomy; one was treated by external auditory canal cholesteatoma exenteration. Result:Within half a year to seven years' follow-up, 5 patients snore occasionally at night but without sleep apnea, while 1 patient performed by external auditory canal cholesteatoma exenteration has no improvement in sleep snoring. Additionally, the hearing of 5 patients have been greatly improved after operation and the cranial facial deformity of 2 cases have been alleviated than before, while 4 patients have no alleviation in oxycephaly, exophthalmos, mandibular prognathism and malocclusion.Conclusion:Understanding the clinical characteristics of Crouzon syndrome significantly contributes to early diagnosis of this disease. Individual-based treatment should be carried out according to the clinical symptoms and signs of patients. Early intervention benefit to the improvement of prognosis and the life quality of patients.

[CT guidance 125I seed implantation for pelvic recurrent rectal cancer assisted by 3D printing individual non-coplanar template]

Objective: To analyze the difference of dosimetric parameters between pre-plan and post-plan of ¹²⁵I radioactive seed implantation assisted by 3D printing individual non-coplanar template (3D printing template) for locally recurrent rectal cancer (LRRC). Methods: From February 2016 to April 2016, a total of 10 patients with locally recurrent rectal cancer received ¹²⁵I seeds implantation under CT guidance assisted by 3D printing template in Department of Radiation Oncology, Peking University Third Hospital.Each patient underwent CT simulation, three-dimentional treatment planning pre-implantation, 3D printing template design, radioactive seed implantation assisted by 3D printing template and dosimetric verification post implantation. The median activity of seed was 0.63 mCi (0.58 to 0.7 mCi) (2.15- 2.59×10⁷ Bq), and the median number of seeds was 80 (19 to 192). D₉₀, D₁₀₀, V₁₀₀, V₁₅₀, CI, EI, HI, D_5cc, D_2cc of bladder and bowel of pre-plan and post-plan were calculated, respectively.Paired t test was used to evaluate the difference of dosimetric parameters between pre-plan and post-plan. Results: The median D₉₀ of pre-plan and post-plan were 13 761.0 and 12 798.8 cGy, respectively.The median D₁₀₀ of pre-plan and post-plan were 5 293.6 and 5 397.9 cGy, respectively.The median V₁₀₀ of pre-plan and post-plan were 90.0% and 90.0%, respectively.The median V₁₅₀ of pre-plan and post-plan were 63.8% and 62.4%, respectively.The median CI of pre-plan and post-plan were 0.73 and 0.67.The median EI of pre-plan and post-plan were 0.22 and 0.30, respectively. The median HI of pre-plan and post-plan were 0.29 and 0.31.The median bladder D_2cc of pre-plan and post-plan were 3 088.8 and 4 240.4 cGy, respectively.The median bowel D_2cc of pre-plan and post-plan were 7 051.6 and 7 903.9 cGy, respectively. Conclusions: 3D printing template might be helpful for locally recurrent rectal cancer patients who received ¹²⁵I radioactive seed implantation assisted by 3D printing individual template.Seed implantation might have more chances to achieve prescription dose and dose limitation of organs at risk of pre-plan, which is important for precise implantation and quality control.

Increasing the interval between neoadjuvant chemoradiotherapy and surgery in esophageal cancer: a meta-analysis of published studies

The aim of this meta-analysis was to clarify whether a longer interval between the end of neoadjuvant chemoradiotherapy (nCRT) and surgery is associated with better outcomes in esophageal cancer. nCRT followed by surgery is the most common approach for patients with resectable esophageal cancer. Operations are performed within 2-8 weeks after nCRT; however, the optimal interval between nCRT and surgery for esophageal cancer is unknown. We performed a systematic literature search in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Clinical Trials database for studies published between January 2000 and December 2014. Eligible studies were prospective or retrospective studies of esophageal cancer that assessed the effects of intervals longer or shorter than 7-8 weeks between the end of nCRT and surgery. The primary end-points were the overall survival (OS) and pathologic complete response (pCR). Secondary end-points were anastomotic leak, R0 resection, and postoperative mortality rate. A meta-analysis was performed to estimate odds ratios (ORs) using fixed-effect and random-effect models, with Review Manager 5.2. The five studies that met the eligibility requirements included 1,016 patients: 520 in the shorter interval group (≤7-8 weeks) and 496 in the longer interval group (>7-8 weeks). The results of our meta-analysis indicate that a longer interval between nCRT and surgery may be disadvantageous for 2-year OS (OR = 1.40, 95% confidence interval [CI]: 1.09-1.80, P = 0.010) and R0 resection rate (OR = 1.71, 95% CI: 1.14-2.22, P = 0.009). The pCR, anastomotic leak rate, and postoperative morbidity were similar in the two groups. A longer interval (more than the standard 7-8 weeks) from the end of preoperative nCRT to surgery did not increase the rate of pCR in esophageal cancer, and the different intervals had similar effects on anastomotic leak rate and postoperative mortality rates. However, the longer interval between nCRT and surgery may be disadvantageous for long-term OS. These results should be validated prospectively in a randomized trial.

Genomic full-length sequence of two HLA-A alleles, A*24:08 and A*24:10, identified by cloning and sequencing

Genomic full-length sequences of HLA-A*24:08 and A*24:10, were identified by cloning and sequencing.

Genomic full-length sequence of two HLA-A alleles, A*33:01:01 and A*33:03:01, identified by cloning and sequencing

Genomic full-length sequences of HLA-A*33:01:01 and A*33:03:01, were identified by cloning and sequencing.

Effect of cardiopulmonary bypass on leukocyte activation: changes in membrane-bound elastase on neutrophils

Background: Neutrophil elastase is known to be released from the activated leukocytes as a result of cardiopulmonary bypass (CPB). However, its biological effect on organ injury is questionable because it is quickly bound by natural proteinase inhibitors (PIs). Recently, membrane-bound elastase (MBE) was found to be able to resist the PIs’ process and, thus, is biologically more active. This paper studies the effect of CPB on the kinetic change of MBE and its possible link to postoperative inflammation and organ function.

Method: Ten consecutive patients undergoing elective coronary artery bypass grafting (CABG) surgery with CPB were recruited into the study. Blood samples were taken before sternotomy, after aortic declamping, at the end of CPB, three and six hours after CPB and on the first postoperative day. MBE was determined by substrate assay from isolated neutrophils. Inflammation and organ function markers were determined according to routine laboratory methods.

Results: MBE slightly increased after aortic declamping, while it significantly increased and reached its peak at the end of CPB; it returned to its preoperative level on the first postoperative day. In contrast to lung sequestration of neutrophils, there was no transpulmonary gradient of MBE between left and right atria after aortic declamping. Neither MBE nor total MBE activity was positively correlated with postoperative inflammation markers such as blood lactate and C-reactive protein and organ function markers such as creatine phosphokinase and alanine aminotransferase.

Conclusions: CPB induces increased MBE expression on neutrophils with its peak at the end of CPB. Lack of association between neutrophil MBE and clinical markers suggests that multiple systems might be involved in the post-CPB inflammatory reaction and organ dysfunction.

PET/CT imaging in diagnosing lymph node metastasis of esophageal carcinoma and its comparison with pathological findings

OBJECTIVE

To investigate the usefulness of 18F-FDG PET/CT imaging in the diagnosis of lymph node metastasis of esophageal carcinoma and to compare its results with pathological findings.

PATIENTS AND METHODS

This study examined 43 cases of patients (32 males and 11 females, aged 54 ± 13 years old) being diagnosed with lymph node metastasis of esophageal carcinoma in our hospital between 2005 and 2014. All of these patients accepted 18F-FDG PET/CT imaging 10 days before the operation. Before reconstruction, each patient went through the body scan. PET/CT images were subject to comprehensive diagnostic analyses, by three experienced radiologists and/or professional nuclear physicians, on the number of metastatic lymph nodes and the maximum standardized uptake value (SUVmax). A control study was also performed on the pathological findings according to the latest esophageal cancer lymph node partition.

RESULTS

A total of 846 lymph nodes were taken out from the patients, among which 154 were confirmed with metastasis. When the SUVmax cutoff values were set at 2.5 and 5, 201 and 173 metastatic lymph nodes were found by 18F-FDG PET/CT imaging, respectively. Additionally, under such condition, 18F-FDG PET/CT imaging had the esophageal sensitivity of 69.48% vs 87.66%, specificity of 92.71% vs 94.51%, accuracy of 83.33% vs 93.26%, positive predictive value of 53.23% vs 78.03%, and negative predictive value of 92.71% vs 97.18%.

CONCLUSIONS

18F-FDG PET/CT had high accuracy in imaging lymph node metastasis of esophageal cancer. SUVmax cutoff value of 5 had a higher diagnostic accuracy and should be recommended in clinical practice.