Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.

Objective:To construct a combined prediction model based on dual-layer detector spectral CT radiomics features and quantitative parameters, and to evaluate its value in preoperative prediction of serosal invasion in gastric cancer.Methods:This case-control study retrospectively analyzed data from 253 gastric cancer patients confirmed by postoperative pathology at the First Affiliated Hospital of Soochow University (Center 1) and Changshu No.2 People′s Hospital (Center 2) from January 2022 to December 2023. Patients from Center 1 ( n=157) were randomly divided into training set ( n=110) and test set ( n=47) in a 7∶3 ratio, while patients from Center 2 ( n=96) served as an external validation set. Based on postoperative pathological serosal invasion status, patients were classified into serosal invasion group ( n=164) and non-serosal invasion group ( n=89), with distributions of 70/40, 30/17, and 64/32 in the training, test, and external validation sets, respectively. Spectral CT quantitative parameters, including arterial and venous phase iodine concentration (IC), normalized iodine concentration (NIC), arterial-venous IC differences, arterial-venous NIC differences (NIC pa), arterial enhancement fraction (AEF), and effective atomic number (Z eff), were measured. Radiomics features were extracted from venous-phase 40 keV monochromatic images. The least absolute shrinkage and selection operator (LASSO) algorithm was used for feature selection. The logistic regression classifier (LR-LASSO) was applied to construct the radiomics model. Univariate and multivariate logistic regression analyses identified independent risk factors for serosal invasion, including the radiomics signature (RadScore) and quantitative parameters. A clinical model was built using significant quantitative parameters, and a combined model integrated RadScore. An artificial model was based on cT4 staging assessed by two radiologists using venous-phase CT. The diagnostic performance of each model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results:A total of six radiomics features were selected to establish the radiomics model. RadScore ( OR=7.598, 95% CI 2.259-25.562, P=0.001) and NIC pa ( OR=4.598, 95% CI 1.404-15.050, P=0.012) served as independent risk factors. The NIC pa served as the clinical model. The AUCs (95% CI) of the combined model in the training, test, and external validation sets were 0.984 (0.969-1.000), 0.855 (0.728-0.982), and 0.773 (0.665-0.882), respectively. The AUCs of the artificial model were 0.741, 0.670, 0.644; of the clinical model were 0.709, 0.633, 0.626. The AUCs of the radiomics model were 0.963, 0.824, 0.741, respectively. Calibration curves showed good agreement between predicted probability and observed probability. The DCA confirmed higher clinical net benefits for the combined model. Conclusion:The combined model integrating dual-layer detector spectral CT radiomics features and quantitative parameters exhibits high efficacy for preoperative prediction of gastric cancer serosal invasion.

Objective:To construct a combined prediction model based on dual-layer detector spectral CT radiomics features and quantitative parameters, and to evaluate its value in preoperative prediction of serosal invasion in gastric cancer.Methods:This case-control study retrospectively analyzed data from 253 gastric cancer patients confirmed by postoperative pathology at the First Affiliated Hospital of Soochow University (Center 1) and Changshu No.2 People′s Hospital (Center 2) from January 2022 to December 2023. Patients from Center 1 ( n=157) were randomly divided into training set ( n=110) and test set ( n=47) in a 7∶3 ratio, while patients from Center 2 ( n=96) served as an external validation set. Based on postoperative pathological serosal invasion status, patients were classified into serosal invasion group ( n=164) and non-serosal invasion group ( n=89), with distributions of 70/40, 30/17, and 64/32 in the training, test, and external validation sets, respectively. Spectral CT quantitative parameters, including arterial and venous phase iodine concentration (IC), normalized iodine concentration (NIC), arterial-venous IC differences, arterial-venous NIC differences (NIC pa), arterial enhancement fraction (AEF), and effective atomic number (Z eff), were measured. Radiomics features were extracted from venous-phase 40 keV monochromatic images. The least absolute shrinkage and selection operator (LASSO) algorithm was used for feature selection. The logistic regression classifier (LR-LASSO) was applied to construct the radiomics model. Univariate and multivariate logistic regression analyses identified independent risk factors for serosal invasion, including the radiomics signature (RadScore) and quantitative parameters. A clinical model was built using significant quantitative parameters, and a combined model integrated RadScore. An artificial model was based on cT4 staging assessed by two radiologists using venous-phase CT. The diagnostic performance of each model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results:A total of six radiomics features were selected to establish the radiomics model. RadScore ( OR=7.598, 95% CI 2.259-25.562, P=0.001) and NIC pa ( OR=4.598, 95% CI 1.404-15.050, P=0.012) served as independent risk factors. The NIC pa served as the clinical model. The AUCs (95% CI) of the combined model in the training, test, and external validation sets were 0.984 (0.969-1.000), 0.855 (0.728-0.982), and 0.773 (0.665-0.882), respectively. The AUCs of the artificial model were 0.741, 0.670, 0.644; of the clinical model were 0.709, 0.633, 0.626. The AUCs of the radiomics model were 0.963, 0.824, 0.741, respectively. Calibration curves showed good agreement between predicted probability and observed probability. The DCA confirmed higher clinical net benefits for the combined model. Conclusion:The combined model integrating dual-layer detector spectral CT radiomics features and quantitative parameters exhibits high efficacy for preoperative prediction of gastric cancer serosal invasion.

Objective:To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI).Methods:The clinical and imaging data of 90 patients who underwent coronary CT angiography (CCTA) with dual-layer spectral detector CT and invasive coronary angiography (ICA) within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed. A total of 189 coronary arteries were included in the study cohort. The patients were divided into PCI ( n=44) and non-PCI groups ( n=46) according to whether they received PCI after evaluation with ICA. The diameter stenosis rate of the coronary arteries, myocardial iodine concentration (IC) and effective atomic number (Z eff) values were obtained from CCTA conventional and spectral images. The IC values and Z eff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion. The diagnostic performance of these parameters, as well as their combined model, was evaluated and compared using receiver operating characteristic (ROC) curve and area under the curve (AUC) in the pre-PCI assessment of patients with CHD. Results:Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups (all P>0.05). There were statistically significant differences in IC values [(0.42±0.28) and (2.26±0.48) mg/ml] and Z eff values (7.39±0.33 and 8.50±0.25) between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients (all P<0.001). The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Z eff values were 0.865 and 0.853, respectively, which were significantly higher than assessment based only on lumen diameter stenosis rate (AUC=0.726, P<0.001). Conclusions:The IC and Z eff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD. The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD, which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.

Objective:To explore the regulation of eight weeks aerobic exercise on brain spontaneous activity in individuals with subthreshold depression.Methods:Through subject recruitment, a total of 44 subjects with subthreshold depression (subthreshold depression group, StD) who scored≥5 according to Patient Health Questionnare-9 (PHQ-9) but did not meet the diagnostic criteria for clinical depression, and 34 healthy subjects (health control group, HC) were included. Two groups of participants were given 8-week moderate-intensity aerobic exercise intervention, and resting state functional magnetic resonance imaging (rs-fMRI) data were collected before and after the intervention to analyze the fractional amplitude of low frequency fluctuations (fALFF) in the two groups. Horizontal two-sample t-tests with years of education as a covariate and longitudinal paired-samples t-tests were performed for fALFF in both groups at baseline and after 8-week moderate-intensity aerobic exercise intervention. The relationship between the fALFF values in significant difference brain regions and psycho-psychological scales were examined by Spearman correlation. Results:After 8 weeks of moderate intensity aerobic exercise, the scores of PHQ-9 and Self-Rating Anxiety Scale (SAS) in StD were significantly lower than baseline ( t=7.08,5.99, both P<0.001). There was no significant difference in fALFF value between StD and HC at baseline. After aerobic exercise intervention, compared with the HC, the fALFF value of the left parahippocampal gyrus in the StD was significantly decreased, and the fALFF value of the left superior frontal gyrus and left precentral gyrus was significantly increased. After aerobic exercise intervention, compared with the baseline, the StD had significantly higher fALFF values in the left inferior parietal lobe (supramarginal gyrus and angular gyrus), right supramarginal gyrus and left anterior cingulate gyrus. In addition, compared with the baseline, the fALFF value of the right precentral gyrus in the HC was significantly decreased. After aerobic exercise intervention, the fALFF value of the left inferior parietal lobe was negatively correlated with the SAS scores ( r= -0.31, P=0.038), the fALFF value of the left anterior cingulate gyrus and the PHQ-9 item 2 (low mood) scores was negatively correlated ( r= -0.41, P=0.006), and the fALFF values of the left inferior parietal lobe, right supramarginal gyrus and the PHQ-9 item 6 (low self-evaluation) scores were negative correlated ( r=-0.39, P=0.010; r=-0.30, P=0.048). Conclusion:Eight weeks of moderate-intensity aerobic exercise can regulate the spontaneous activity pattern of local brain regions in individuals with subthreshold depression, and fALFF analysis can provide objective evidence for the antidepressant effect of aerobic exercise.

Objective:To develop a simple, practical and repeatable ultrasound method to locate the muscle at the trigger point of female myofascial pelvic pain(MPP), which can provide imaging reference for clinical precision treatment.Methods:A total of 113 patients with suspected MPP who came to the Women′s Hospital School of Medicine Zhejiang University from September 1, 2021 to April 20, 2023 were prospectively selected. The gynecologist performed internal examination with index finger on some pelvic floor muscles (puborectalis, pubococcygeus, iliococcygeus, coccygeus) and pelvic wall muscles (piriformis and obturator internus) respectively, searched for the muscles where the pain trigger point was located, and scored the pain by referring to visual analogue scale (VAS) and numerical rating scale (NRS), and then referred the patients to the ultrasound department. The ultrasound doctor used transvaginal ultrasound to display the above muscle groups in real time for observation and appropriate pressure. The muscle where the painful trigger point was located was found through tenderness and the pain score was performed. The two scores were compared for consistency and difference analysis.Results:The trigger point was clear and of good reproducibility. For the location and score of pain trigger points located in bilateral puborectalis, pubococcygeus and coccygeus, there was a strong consistency between the tenderness guided by vaginal ultrasound probe and clinical palpation (the consistency rate was ≥70%), and there was no significant difference in the pain scores of the trigger points located in the puborectalis muscle and coccygeal muscle between the two methods ( P>0.05), and there was statistically significant difference in the pain scores of the trigger points located in the other pelvic floor and pelvic wall muscles (all P<0.05). At the same time, ultrasonic examination made up for the deficiency of clinical palpation in the evaluation of piriformis muscle. Conclusions:The present method for finding the trigger point of MPP guided by the ultrasound probe is a new non-invasive, safe, simple and practical imaging method, which can provide a new imaging reference for the clinical diagnosis of MPP and the formulation of treatment strategies.

Objective:To explore the regulation of eight weeks aerobic exercise on brain spontaneous activity in individuals with subthreshold depression.Methods:Through subject recruitment, a total of 44 subjects with subthreshold depression (subthreshold depression group, StD) who scored≥5 according to Patient Health Questionnare-9 (PHQ-9) but did not meet the diagnostic criteria for clinical depression, and 34 healthy subjects (health control group, HC) were included. Two groups of participants were given 8-week moderate-intensity aerobic exercise intervention, and resting state functional magnetic resonance imaging (rs-fMRI) data were collected before and after the intervention to analyze the fractional amplitude of low frequency fluctuations (fALFF) in the two groups. Horizontal two-sample t-tests with years of education as a covariate and longitudinal paired-samples t-tests were performed for fALFF in both groups at baseline and after 8-week moderate-intensity aerobic exercise intervention. The relationship between the fALFF values in significant difference brain regions and psycho-psychological scales were examined by Spearman correlation. Results:After 8 weeks of moderate intensity aerobic exercise, the scores of PHQ-9 and Self-Rating Anxiety Scale (SAS) in StD were significantly lower than baseline ( t=7.08,5.99, both P<0.001). There was no significant difference in fALFF value between StD and HC at baseline. After aerobic exercise intervention, compared with the HC, the fALFF value of the left parahippocampal gyrus in the StD was significantly decreased, and the fALFF value of the left superior frontal gyrus and left precentral gyrus was significantly increased. After aerobic exercise intervention, compared with the baseline, the StD had significantly higher fALFF values in the left inferior parietal lobe (supramarginal gyrus and angular gyrus), right supramarginal gyrus and left anterior cingulate gyrus. In addition, compared with the baseline, the fALFF value of the right precentral gyrus in the HC was significantly decreased. After aerobic exercise intervention, the fALFF value of the left inferior parietal lobe was negatively correlated with the SAS scores ( r= -0.31, P=0.038), the fALFF value of the left anterior cingulate gyrus and the PHQ-9 item 2 (low mood) scores was negatively correlated ( r= -0.41, P=0.006), and the fALFF values of the left inferior parietal lobe, right supramarginal gyrus and the PHQ-9 item 6 (low self-evaluation) scores were negative correlated ( r=-0.39, P=0.010; r=-0.30, P=0.048). Conclusion:Eight weeks of moderate-intensity aerobic exercise can regulate the spontaneous activity pattern of local brain regions in individuals with subthreshold depression, and fALFF analysis can provide objective evidence for the antidepressant effect of aerobic exercise.

Objective: To assess the conventional and functional MRI features of parotid Warthin tumor (adenolymphoma) and to investigate the correlation between MRI and clinicopathological features which can provide evidence for clinical diagnosis and treatment. Methods: Sixty-seven patients with parotid Warthin tumor who were treated in the Department of Stomatology, The Fifth Clinical Medical College of Yangzhou University, Changshu No. 2 People′s Hospital from June 2008 to April 2017 were included in this study. The retrospective study evaluated preoperative conventional and functional MRI features and clinicopathological findings of this group of patients. Among 67 patients (65 males, 2 females) with 92 lesions, there were 16 patients with multiple lesions and others with single lesion. Their age was (62.1±8.8) years, ranging from 42 to 84 years. According to pathological features, parotid Warthin tumor were classified into two types. Type Ⅰ was predominantly solid component which included completely solid or solid tumor with some cystic components. Type Ⅱ was predominantly cystic component which was characterized by big cyst with some solid components, and could be divided into capsule-like and scum-like cystic type, based on whether its interface of solid and cystic component was clear or not. On contrast-enhanced MRI, according to whether the lesion showed enhancement or not, solid or cystic component was defined. Results: Seventy-two lesions were located in the lower pole of the parotid gland, of which sixty-eight lesions were located in posterior inferior quadrant. In addition, sixteen lesions were located in the upper pole and four lesions in the middle. Because MRI features were consistent with pathological findings, parotid Warthin tumor were classified into solid (73) and cystic types (19). On T2WI, solid components showed isointense (92), whereas on T1WI cystic components demonstrated hyperintense (90). On contrast enhanced T1WI, solid types showed marginal vasculature sign (73), mild (69) or moderate (4) enhancement, whereas its cystic component showed no enhancement. On contrast enhanced T1WI, cystic types showed ring-like enhancement of cycle-wall and intra-cystic septal linear enhancement, whereas its solid components demonstrated mild enhancement (19). On diffusion weighted imaging, these masses demonstrated hyperintensity and lower apparent diffusion coefficient value indicating restricted diffusion (59/59). On dynamic contrast-enhanced-MRI, the masses showed "wash-out" pattern (28/29) or plateau pattern (1/29). Conclusions Parotid Warthin tumor mainly occur in the posterior inferior quadrant of parotid gland and mostly in mid-aged or elder men. It has certain characteristics on conventional and function MRI. There is correlation between MRI and clinicopathological findings and it is useful for accurate diagnosis and treatment to understand these features.

Objective: To explore the characteristics of the default memory network (DMN) and working memory network (WMN) at resting state brain functional network of exercise addiction people. Methods: Twenty-nine sports addicts and 26 non-sports addicts matched by sex, age, average education level and sports dependence were screened by the exercise addiction index (EAI). Resting status brain scanning was performed with 3.0T magnetic resonance scanner.Sparse approximation coefficients independent component analysis (SACICA) model was used to analyze the independent components of brain networks. Results: Compared with the DMN template, four features were extracted, including " basic conformity" , " less frontal lobe" , " more frontal lobe" and " less occipitoparietal lobe" . Compared with the parameters of " basic conformity" , the proportion of exercise addiction group (33.3%, 9/27) was higher than that of control group (18.2%, 4/22). In the other three parameters, the proportion of exercise addiction group (37.0%, 10/27; 3.7%, 1/27; 22.2%, 6/27) was lower than those of control group (45.5%, 10/22; 22.7%, 5/22; 27.3%, 6/22). But Chi-square test showed that there was no significant difference between the two groups(all P>0.05). Compared with the WMN template, six features were extracted, including " basic conformity" , " more frontal and parietal lobes" , " more parietal lobes" , " more frontal lobes" , " less frontal lobes" and " less parietal lobes" . The percentages of the first three features in exercise addiction group (22.2%, 6/27; 7.4%, 2/27; 7.4%, 2/27) were less than those in the control group (45.5%, 10/22; 22.7%, 5/22; 9.1%, 2/22), while the percentages of the last three features in the exercise addiction group (7.4%, 2/27; 37.0%, 10/27; 14.8%, 4/27) were higher than those in the control group (4.5%, 1/22; 13.6%, 3/22; 0, 0). Chi-square test showed that there was no significant difference in all features between the two groups was statistically(P>0.05). Conclusion No significant characteristic changes are found in DMN and WMN networks of exercise addiction population.

Objective To assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.Methods The clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region,were analyzed retrospectively.The first part,data of 106 patients with moderate,high-risk NMIBC were collected.A total of 83 patients were male,while the other 23 patients were female.The average age was 66.7 years old.The clinical staging were T1 in 86(81.1％) cases,Ta in 20(18.9％) cases and carcinoma in situ in 6 (5.7％) patients.Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor.The incidence rate of recurrence and progression during more than 6 months' follow-up time were observed.Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method.The second part,treatment compliance of 276 patients with bladder cancer,including moderate/high-risk NMIBC in 263 cases,moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries,were observed.Patients consisted of 211 males and 65 females with average age of 68.3 years.Results With a median follow-up of 12 months,9 (8.5％) patients experienced tumor recurrence and 2 (1.9％) patients were found progression in the first part.The one-year cancer free recurrence rate of the patients was 91.5％.Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR =3.214,95％CI0.804-12.845,P =0.099).In the second port,an incidence rate of adverse effects was 64.1％ (177/276).The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment.A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 ％),9 cases (3.3 ％) with economic reasons and 11 cases (4.0％) with serious complications.Conclusions NMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects.Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.