Objective To investigate the best weighting of adaptive statistical iterative reconstruction (ASIR) algorithm and optimized low-dose scanning parameters in thoracic aorta CT angiography(CTA).Methods Totally 120 patients with the body mass index (BMI) of 19-24 were randomly divided into 6 groups.All patients underwent thoracic aorta CTA with a GE Discovery CT 750 HD scanner (ranging from 290-330 mm).The default parameters (100 kV,240 mAs) were applied in Group 1.Reconstructions were performed with different weightings of ASIR (10％-100％ with 10％),and the signal to noise ratio (S/N) and contrast to noise ratio (C/N) of images were calculated.The images of series were evaluated by 2 independent radiologists with 5-point-scale and lastly the best weighting were revealed.Then the mAs in Group 2-6 were defined as 210,180,150,120 and 90 with the kilovoltage 100.The CTDIvoland DLP in every scan series were recorded and the effective dose (E) was calculated.The S/N and C/N were calculated and the image quality was assessed by two radiologists.Results The best weighing of ASIR was 60％ at the 100 kV,240 mAs.Under 60％ of ASIR and 100 kV,the scores of image quality from 240 mAs to 90 mAs were(4.78 ±0.30)-(3.15 ±0.23).The CTDIvol and DLP were 12.64-4.41 mGy and 331.81-128.27 mGy,and the E was 4.98-1.92 mSv.The image qualities among Group 1-5 were nor significantly different (F =5.365,P ＞ 0.05),but the CTDIvol and DLP of Group 5 were reduced by 37.0％ and 36.9％,respectively compared with Group 1.Conclusions In thoracic aorta CT Angiography,the best weighting of ASIR is 60％,and 120 mAs is the best mAs with 100 kV in patients with BMI 19-24.

is able to provide pathologic data and achieve the efficacy equivalent to surgery.

Objective To evaluate the diagnostic yield and accuracy of double balloon enteroscopy and capsule endoscopy in patients with obscure small bowel hemorrhage. Methods Twenty four patients with obscure small bowel hemorrhage were performed double balloon enteroscopy and wireless capsule endoscopy separately. The route of enteroscopy could be underwent either via mouth or via anus. Negative result of initial route was required afterwards for another via mouth or via anus examination. Capsule endoscope produced by GIVEN Imaging Company was used. The results of both methods were analyzed independently and final diagnosis of each case was compared thereafter. Results Totally 21 of 24 (87.5%) patients had positive findings with enterosocpy, while 11 of 24 (45.8%) patients had positive findings with capsule endoscopy. The etiological diagnosis of enteroscopy in all cases was confirmed by surgical exploration and pathological examination with the accuracy of 87.5% , however, the accuracy of capsule endoscopy was only 25% (6 cases). On assessment of procedure tolerance, double balloon enteroscopy under anaesthesia and capsule endoscopy were well tolerated than via mouth or anus route enteroscopy without anaesthesia. There was no severe procedure related complications. Conclusions The entire small intestine could be examined by double balloon enteroscopy with combination of mouth and anus route. Double balloon enteroscopy was superior to capsule endoscopy in etiological diagnosis of obscure small bowel bleeding. Capsule endoscopy had clinical diagnostic value in detection of multiple and long segment small bowel lesions. Double balloon enteroscopy could be served as the first option in diagnosis of obscure small bowel bleeding.

Objective Survivin is overexpressed in gastric cancer. However it not expressed in normal gastric mucosa. The expression of survivin is tightly related to the prognosis of gastric cancer.By gene reconstruction we generated pcDNA3 survivin mutant(Cys84Ala) plasmid, and observed its effect on the gastric carcinoma cell lines. Methods The survivin mRNA and protein expression levels were determined by reverse transcription polymerase chain reaction(RT PCR) analysis,Western blot and immunohistochemical staining respectively . Flowcytometry and acridine orange staning were employed to detect apoptosis. Results Overexpression of survivin mRNA and protein were detected in the gastric cancer cell lines. Inhibition of survivin by survivin mutant cDNA induced apoptosis,activated caspase 3 activity,cleaved PARP and promoted cytochrome C releasing in gastric cancer cells,and effectively sensitized gastric cancer cells to chemotherapeutic agents. Conclusion Inhibition of survivin may induce apoptosis in gastic cancer and sensitize gastric cancer cells to chemotherapeutic agents.Survivin targeted therapeutic protocol may potentially benefit gastric cancer therapy.

Objective:To investigate the value of ADC map-based radiomics model for identifying the ischemic penumbra (IP) in acute ischemic stroke (AIS).Methods:From January 2014 to October 2019, data of 241 patients with AIS involving the anterior cerebral circulation within 24 h after stroke onset in the First People′s Hospital of Nantong City was analyzed retrospectively. All patients received routine T 1WI, T 2WI, DWI and dynamic susceptibility contrast-perfusion weighted imaging (DSC-PWI). Considering the PWI-DWI mismatch model as the gold standard for determining IP, patients were divided into the PWI-DWI mismatch (84 cases) and PWI-DWI non-mismatch (157 cases) groups. The ROI of the low signal area and the surrounding area was drawn by two doctors at the maximum level of the lesions on the ADC maps. Then the images were imported into AK analysis software to extract the features. Firstly, the inter-class correlation coefficient was used to screen out the features with high consistency, then the maximum relevance and minimum redundancy (mRMR) and least absolute shrinkage and selection operator (Lasso) regression analysis were used to screen the features. The selected features were used to construct their own radiomics model. ROC curve was used to evaluate the performance of the models, and Delong test was used to compare the area under the curve (AUC) of the two models. Results:After screening, 12 features (LongRunLowGreyLevelEmphasis_angle135_offset7, LongRunLowGreyLevelEmphasis_AllDirection_offset7, GLCMEntropy_AllDirection_offset4_SD, GLCMEnergy_angle45_offset1, ColGE_W11B25_16, ColGE_W11B25_24, HaraEntropy, SurfaceVolumeRatio, Sphericity, Quantile0.025, uniformity and Percentile75) were used to construct the radiomics model based on the low signal area of the ADC map. The area under the ROC curve in the training set was 0.900, and the sensitivity, specificity and accuracy were 84.5%, 81.4% and 83.4%, respectively. The area under the ROC curve in the validation set was 0.870, and the sensitivity, specificity and accuracy were 80.9%, 84.0% and 81.9%, respectively. Eleven features(RunLengthNonuniformity_AllDirection_offset1_SD, ShortRunLowGreyLevelEmphasis_angle45_offset1, HighGreyLevelRunEmphasis_AllDirection_offset1_SD, ShortRunLowGreyLevelEmphasis_AllDirection_offset7, HaralickCorrelation_AllDirection_offset4_SD, ClusterShade_angle45_offset7, InverseDifferenceMoment_AllDirection_offset7_SD, ColGE_W3B20_0, sumAverage, SurfaceVolumeRatio and VolumeMM) were used to construct the radiomics model based on the surrounding area of ADC map. The area under ROC curve in training set was 0.820, the sensitivity, specificity and accuracy were 80.5%, 80.2% and 80.4%, respectively; the area under ROC curve in validation set was 0.800, the sensitivity, specificity and accuracy were 78.7%, 80.0% and 79.2%, respectively. The AUC of the radiomics model based on the low signal area of the ADC map was larger than that based on the surrounding area of the ADC map (training set: Z=3.017, P=0.003; validation set: Z=0.604, P=0.002). Conclusion:The radiomics model based on ADC map has a good diagnostic efficacyin identifying the IP.

Aim To investigate the behavioral changes of the pain related neuromodulation and neurotransmission in peripheral and central nervous systems in rats with trigeminal neuralgia (TN)and provide a disease relevant animal model for mecha-nism study of TN.Methods The male SD rats were randomly divided into sham operation group and TN surgical group.The latter group was further divided into model group and gabapentin group (100 mg · kg-1 ). TN was induced by intravenous erythrosine B injection and laser irradiation.The pain behavior of rats was evaluated using mechanical pain threshold measured with Von Frey hairs.Fluorescence quantitative PCR technique was deployed to study the change of Tac1 mRNA expressions in trigeminal ganglia.Utilizing microdialysis technique followed by high performance liquid chromatography fluorescence detection (HPLC-FLD),the extracellular striatum fluid was collected and glutamate(Glu)concentration was determined.Results In the model group,the average mechanical pain threshold in facial ar-ea innervated by the trigeminal nerve remained below 4g after 7 days post surgery.The mechanical threshold of the model group (1.63 ±1.27)g was significantly lower (P<0.01)than the control group (24.17 ±4.49)g on day10 post surgery.In gen-eral,the mechanical withdraw threshold was decreased from the preoperative value of 26g to the postoperative value of (1.60 ± 1.74)g (P<0.01),and maintained stable at (0.71 ±1.24) g during the whole dynamic monitoring period from day7 to day60.The successful rate of this model was 63%.After sur-gery,Tac1 mRNA expression in trigeminal ganglia and extracel-lular Glu levels in striatum were significantly up-regulated (P<0.05 ) in the model group. Animals receiving Gabapentin showed significant improvement in pain symptoms,as well as re-ductions of Tac1 mRNA expression in trigeminal ganglia and ex-tracellular Glu concentration in striatum (P<0.05 ).Conclu-sions The above described photochemically induced TN rat model can partially mimic the clinical TN symptoms and its pathophysiology.Considering its overall high stability,it is very likely that this model could be used in preclinical mechanism study or drug screening of TN.

Objective To investigate the effects of human urinary kallidinogenase (HUK) on cerebral perfusion,inflammatory marker level,neurological deficits,and short-term clinical outcomes in patients with acute ischemic stroke who exceeded the time window of thrombolytic therapy.Methods Patients with acute ischemic stroke exceeded the time window of thrombolytic therapy and treated in the Department of Neurology,the Second Affiliated Hospital of Nantong University from June 2016 to March 2018,and performed magnetic resonance perfusion imaging on the 1st and 14th d after admission were enrolled retrospectively.Patients were divided into HUK and control groups according to whether they received HUK treatment or not.All patients underwent magnetic resonance perfusion imaging and serum inflammatory markers measurement on the 1st and 14th d after admission.The National Institute of Health Stroke Scale (NIHSS) scores,cerebral perfusion levels,and serum inflammatory marker levels were compared between the 2 groups.On the 14thd after admission,the outcome was determined according to the modifiel Rankin Scale (mRS) scores.0-2 was defined as good outcome and ＞2 was defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent influencing factors of outcome.Results A total of 62 patients with acute ischemic stroke exceeded the time window of thrombolytic therapy were enrolled,including 37 patients in the HUK group and 25 in the control group.There were no significant differences in the demographic and other baseline data between the HUK group and the control group,except for baseline NIHSS score (P =0.049).The reduction of NIHSS score after treatment in the HUK group was more significant than that in the control group (P ＜0.01).Serum high-sensitivity C-reactive protein level in the HUK group decreased significantly after treatment (P ＜ 0.01),and plasma lipoprotein-associated phospholipase A2 also showed a downward trend.In terms of perfusion imaging parameters,the relative cerebral blood flow was significantly increased after treatment in the HUK group,and the relative mean transit time and relative peak time were significantly decreased.The above increase and decrease were statistically significant compared with the control group (all P＜0.05).On the 14th d after admission,the mRS score showed that 51 patients had a good outcome and 11 had a poor outcome.Multivariate logistic regression analysis showed baseline NIHSS scores (odd ratio [OR] 2.545,95％ confilence interval [CI]1.124-5.541;P=0.024),atrial fibrillation (OR 5.712,95％ CI 1.737-24.685;P=0.039),and cardiogenic embolism (OR 4.485,95％ CI 1.148-18.262;P =0.040) were the independent risk factors for poor outcomes,and whether using HUK was not significantly associated with the outcomes.Conclusion For patients with acute ischemic stroke that exceeds the time window for thrombolysis,HUK improves cerebral perfusion,reduces inflammation,and improves neurological deficits in patients,but does not improve short-term neurological outcomes.

Objective To explore the influence of WeChat platform rehabilitation guidance mode on refracture of osteoporotic fracture patients.Methods Totally 100 osteoporotic fracture patients admitted to the Department of Orthopedics of the hospital from 2018 to 2019 were selected and randomly divided into control group and experimental group with 50 patients in each group.The control group adopted the conventional discharge rehabilitation guidance mode,and the experimental group implemented WeChat platform rehabilitation guidance mode on this basis,including WeChat platform construction and detailed intervention mode.The changes of bone mineral density and the recurrence rate of osteoporotic fracture were compared between the two groups at admission and after 3 years of follow-up.Results There were 7 cases of lost follow-up in the experimental group,and there were 6 cases of lost follow-up in the control group.After 3 years,the bone mineral density of the experimental group was significantly higher than that of the control group,and the recurrence fracture rate was significantly lower than that of the control group(P<0.05).Conclusion The application of WeChat platform rehabilitation guidance mode can effectively improve bone density and reduce the incidence of refracture in osteoporotic fracture patients.

Objective:To compare the image quality, radiation dose, and total iodine content of abdominal computed tomography (CT) enhancement scanning of overweight and obese patients with different scanning protocols, and to explore the optimal keV image serial for abdominal CT.Methods:A total of 90 overweight or obese patients [24 kg/m 2 ≤ body mass index (BMI) < 28 kg/m 2 or BMI ≥ 28 kg/m 2] were divied into groups A, B and C, with 30 patients in each group. Group A used Gemstone spectral imaging (GSI) mode and contrast medium with 320 mg I/ml, group B used low tube voltage mode (100 kVp) and contrast medium with 370 mg I/ml, and group C used conventional tube voltage mode (120 kVp) and contrast medium with 370 mg I/ml. Monochromatic energy images at 50-70 keV (5 keV interval) were reconstructed for the arterial and portal vein phases of group A. Radiation dose and total iodine content were recorded and calculated for the 3 groups. The region of interest was placed on the organ, blood vessel, and erector spinae muscle at same level. The CT values and image noise values were measured, and the contrast-to-noise ratio (CNR) was calculated. All images were scored subjectively in double-blinded by two radiologists. One-way analysis of variance or Kruskal-Wallis H test were used to compare The CT values, CNRs, and subjective scores of each subgroup image in group A, group B and group C, and the radiation doses and total iodine contents in 3 groups were compared. The optimal keV value for group A was selected. Results:At 50-60 keV, the CT values and CNRs of arterial and portal vein phases in group A were higher ( P < 0.05) than or similar to those in groups B and C ( P > 0.05), and the subjective scores were lower than those of groups B and C at 50 and 55 keV ( H = 34.47, 41.27, P < 0.05), whereas there was no statistically significant difference at 60 keV ( P > 0.05). At 65 and 70 keV, only the CT value and CNR of the renal cortex in group A at the 65 keV of arterial phase were higher than those in groups B and C ( F = 102.38, 29.47, P < 0.001). The subjective scores were not significantly between groups B and C ( P > 0.05). There were no statistically significant difference between CT values, CNRs, or subjective scores in group B and group C ( P > 0.05). The effective doses in groups A and B were 24.72% and 25.78% lower than those in group C, respectively. Compared to groups B and C, the total iodine content in group A decreased by 12.50% and 13.34%, respectively. Conclusions:GSI model combined with a low-concentration contrast medium in abdominal CT for overweight and obese patients can meet the image quality requirements while reducing patient total iodine content and radiation dose. The optimal keV value of enhanced abdominal CT for double phases was 60 keV.

With the continuous development of traditional Chinese medicine （TCM）， the requirement for the quality of Chinese medicines has become increasingly higher since they have been widely used in clinical practice. Chinese medicinal materials are the material basis for the inheritance and development of TCM， and their quality directly affects the clinical efficacy. Studying the quality of Chinese medicinal materials is the key to ensure the quality and realize the large-scale application. As one of rare Chinese medicinal materials， Cistanches Herba has the functions of tonifying kidney yang， invigorating blood and essence， moistening intestines to relieve constipation. High-quality Cistanches Herba is characterized by glossy appearance， high density， fleshy and soft texture， and sweet taste. With the reduction of wild resources， the products from cultivated Cistanche deserticola or C. tubulosa become dominant on the market of Cistanches Herba. The cultivation areas are widely distributed， mainly concentrated in Gansu， Inner Mongolia， and Xinjiang. However， the cultivated products have varied quality due to the differences in germplasm， producing region， cultivation method， harvesting， and processing. According to the theories of quality evaluation based on morphological characteristics and excellent appearance indicating high quality， this paper reviewed the literature on the quality evaluation， growth， development， and processing of Cistanches Herba in the last decade to explore the main factors （genetic characteristics， environmental conditions， and harvesting and processing factors） affecting the quality of Cistanches Herba. The review aims to explore the factors for the high quality and provide a reference for the producing region screening， directional cultivation， and production of Cistanches Herba.