Distinguishing pseudoprogression (PsP) from true progression (TP) in patients with high-grade gliomas after treatment remains a critical challenge, as their appearances on conventional MRI are often similar. Accurate differentiation between the two is of great clinical significance for guiding and adjusting therapeutic strategies. MRI functional imaging can reveal key tissue characteristics such as water molecule diffusion, microvascular perfusion, and metabolic changes within lesions after treatment, thereby providing valuable objective evidences for differentiating PsP from TP. Especially in recent years, the radiomics analysis method based on large-scale MRI image data has further improved the accuracy in distinguishing PsP from TP. This article reviews the research progress on applications of various MRI techniques and combination of radiomics with other artificial intelligence methods in differentiating PsP from TP in high-grade gliomas, aiming to enhance the clinicians' understanding of differential diagnosis of PsP and TP in high-grade gliomas, and offer ideas and directions for emerging MRI application in this field.

Distinguishing pseudoprogression (PsP) from true progression (TP) in patients with high-grade gliomas after treatment remains a critical challenge, as their appearances on conventional MRI are often similar. Accurate differentiation between the two is of great clinical significance for guiding and adjusting therapeutic strategies. MRI functional imaging can reveal key tissue characteristics such as water molecule diffusion, microvascular perfusion, and metabolic changes within lesions after treatment, thereby providing valuable objective evidences for differentiating PsP from TP. Especially in recent years, the radiomics analysis method based on large-scale MRI image data has further improved the accuracy in distinguishing PsP from TP. This article reviews the research progress on applications of various MRI techniques and combination of radiomics with other artificial intelligence methods in differentiating PsP from TP in high-grade gliomas, aiming to enhance the clinicians' understanding of differential diagnosis of PsP and TP in high-grade gliomas, and offer ideas and directions for emerging MRI application in this field.

Objective:To investigate the effect of behavioral lifestyle on the CT values of urinary tract stones, as well as the relationship between behavioral lifestyle and the therapeutic effect of extracorporeal shock wave lithotripsy (ESWL).Methods:A total of 265 patients with urinary tract stones who underwent ESWL treatment at Affiliated Hospital of Jining Medical University from January 2019 to June 2023 were selected. According to the CT values of the stones, the subjects were divided into high CT value group (CT value > 1 000 HU, n=106) and low CT value group (CT value ≤ 1 000 HU, n=159). A retrospective survey was conducted to assess the patients' behavioral lifestyles, and general data, CT values, number of lithotripsy sessions, lithotripsy time, lithotripsy efficiency, and incidence of complications were compared between the two groups. SPSS 22.0 software was used for statistical analysis. The χ2 test and t-test were used for group comparisons, and Pearson correlation analysis was used to examine the relationship between stone CT values and different behavioral lifestyles. Results:The high CT value group had lower average daily water intake((1 242±347)mL vs (1 784±376)mL), average daily fresh fruit intake((135±43)g vs (196±51)g), and average daily exercise time((18±12)min vs (32±14)min) compared with the low CT value group( t=-11.850, -9.926, -8.434, all P<0.01). In contrast, the high CT value group had higher average daily salt intake((8.3±2.2)g vs (6.5±1.7)g) and average daily animal protein intake ((72±18)g vs (54±16)g) compared with the low CT value group ( t=7.495, 8.531, both P<0.01). The high CT value group required more lithotripsy sessions and longer lithotripsy time than the low CT value group ( t=6.192, 7.507, both P<0.05), while lithotripsy efficiency was lower than the low CT value group ( χ2=33.181, P<0.01). The incidence of complications was higher in the high CT value group compared to the low CT value group ( χ2=3.915, P=0.048), with statistically significant differences. Conclusion:Appropriate water intake, diet, and exercise habits are beneficial in reducing stone CT values, improving the efficacy of ESWL treatment, and decreasing the incidence of complications.

Objective:To investigate the risk factors and their warning value for the occurrence of sepsis in patients with severe multiple trauma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 92 patients with severe multiple trauma admitted to Yuyao People′s Hospital from July 2019 to October 2021. There were 71 males and 21 females, with the age range of 36-55 years [(45.5±13.6)years]. The injury severity score (ISS) was 20-29 points [(25.3±6.4)points]. The patients were divided into sepsis group ( n=32) and non-sepsis group ( n=60) according to whether sepsis occurred during hospitalization. Data were recorded for the two groups, including gender, age, basic diseases, cause of injury, number of injury sites, ISS, post-injury complications, and levels of aryl hydrocarbon receptor (AHR), C-reactive protein (CRP) and procalcitonin (PCT) at 1, 3 and 5 days after injury. The above data were analyzed to identify their correlation with the occurrence of sepsis in patients with severe multiple trauma by univariate analysis. The independent risk factors for sepsis in patients with severe multiple trauma were determined by multivariate Logistic regression analysis. The warning value of the single or combined risk factors for the occurrence of sepsis in patients with severe multiple trauma was evaluated by the receiver operating characteristic (ROC) curve and area under the curve (AUC). Results:By univariate analysis, it was demonstrated that the occurrence of sepsis was correlated with ISS, level of AHR at day 1 after injury, level of CRP at day 3 after injury and level of PCT at day 3 after injury ( P<0.05 or 0.01), but not with age, sex, basic diseases, level of AHR at 3, 5 days after injury, level of PCT at 1, 5 days after injury and level of CRP at 1, 5 days after injury (all P>0.05). By multivariate Logistic regression analysis, higher ISS ( OR=1.12, 95% CI 1.01, 1.24, P<0.05), level of AHR at day 1 after injury ( OR=1.30, 95% CI 1.10, 1.52, P<0.01) and level of PCT at day 3 after injury ( OR=1.81, 95% CI 1.08, 3.03, P<0.05) were found to be strongly correlated with the occurrence of sepsis. ROC curve analysis showed that higher ISS (AUC=0.69, 95% CI 0.57, 0.76) and level of AHR at day 1 after injury (AUC=0.79, 95% CI 0.68, 0.90) had warning value for the occurrence of sepsis, and the warning efficiency of combined panel was much better (AUC=0.86, 95% CI 0.77, 0.95). Conclusions:Higher ISS, level of AHR at day 1 after injury and level of PCT at day 3 after injury are independent risk factors for the occurrence of sepsis in patients with severe multiple trauma. ISS, AHR and combination of both exhibit good warning value for the occurrence of sepsis in patients with severe multiple trauma.

Cardiovascular disease is the leading cause of death worldwide, accounting for 48.0% of all deaths in Europe and 34.3% in the United States. Studies have shown that arterial stiffness takes precedence over vascular structural changes and is therefore considered to be an independent predictor of many cardiovascular diseases. At the same time, the characteristics of Korotkoff signal is related to vascular compliance. The purpose of this study is to explore the feasibility of detecting vascular stiffness based on the characteristics of Korotkoff signal. First, the Korotkoff signals of normal and stiff vessels were collected and preprocessed. Then the scattering features of Korotkoff signal were extracted by wavelet scattering network. Next, the long short-term memory (LSTM) network was established as a classification model to classify the normal and stiff vessels according to the scattering features. Finally, the performance of the classification model was evaluated by some parameters, such as accuracy, sensitivity, and specificity. In this study, 97 cases of Korotkoff signal were collected, including 47 cases from normal vessels and 50 cases from stiff vessels, which were divided into training set and test set according to the ratio of 8 : 2. The accuracy, sensitivity and specificity of the final classification model was 86.4%, 92.3% and 77.8%, respectively. At present, non-invasive screening method for vascular stiffness is very limited. The results of this study show that the characteristics of Korotkoff signal are affected by vascular compliance, and it is feasible to use the characteristics of Korotkoff signal to detect vascular stiffness. This study might be providing a new idea for non-invasive detection of vascular stiffness.
Humans ; Vascular Stiffness ; Neural Networks, Computer ; Cardiovascular Diseases/diagnosis* ; Sensitivity and Specificity

Carotid is in a high risk of atherosclerosis due to its special geometric features and complex flow characteristics. Various biomechanical parameters are practical tools for carotid risk assessment. It has beenwidely accepted that oscillatory low shear environment promotes plaque formation. Based on this, more and more biomechanical indexes have been proposed, such as time-average wall shear stress, oscillatory shear index, relative residence time and so on. In this paper, multiple biomechanical parameters were introduced from the perspectives of shear stress and its temporal and spatial variation, turbulence, platelet transport and activation, stress concentration in vascular wall, etc. The development trend of biomechanical parameters related to carotid artery risk assessment was also analyzed, so as to provide the theoretical basis for more comprehensive and rapid carotid risk assessment

Objective:To investigate the construction of containing CT imaging features Nomograms model of postoperative intraluminal thromus (ILT) formation in patients with aortic dissective aneurysm (ADA).Methods:One hundred and twenty patients with Stanford type B ADA treated with overlapping stent endoluminal repair and multilayer spiral CT (MSCT) examination in Affiliated Hospital of Jining Medical College from May 2020 to February 2022 were selected. The patients were divided into the modeling population (84 patients) and the validation population (36 patients) according to a 7∶3 ratio. The factors influencing postoperative ILT formation in ADA patients were analyzed by univariate and Logistic multifactor regression models, and the prediction model of postoperative ILT formation was constructed based on the influencing factors.Results:In the modeled population, the rate of ILT formation within 1 month after luminal repair with overlapping stents was 27.38%(23/84), including 5 cases in the aortic arch and 18 cases in the abdominal aorta. In the modeled population, the results of univariate analysis showed that the sex, age, body mass index(BMI), smoking, drinking, hypertension, hyperlipidemia, rupture diameter, rupture distance from left subclavicular artery, involvement of important branches, uneven thickening of aneurysm wall, low density on plain scan and operation timing between the ILT formation group and non-ILT formation group had no statistically significant ( P>0.05). The diabetes mellitus, irregular inner wall, calcified plaque, postoperative anticoagulant therapy, B-type brain natriuretic peptide (BNP), fibrinogen (Fib), D-dimer (D-D) and C-reactive protein (CRP) between the two groups had statistical differences: 43.48%(10/23) vs. 11.48%(7/61), 86.96%(20/23) vs. 57.38%(35/61), 91.30%(21/23) vs. 62.30%(38/61), 21.74%(5/23) vs. 57.38%(35/61), (523.60 ± 128.74) ng/L vs.(271.83 ± 109.65) ng/L, (3.82 ± 0.96) g/L vs. (2.85 ± 0.83) g/L, (601.37 ± 75.62) μg/L vs. (389.20 ± 68.79)μg/L, (0.63 ± 0.19) mg/L vs. (0.48 ± 0.15) mg/L, P<0.05. The results of Logistic multifactor regression analysis showed that diabetes mellitus, irregular inner wall, calcified plaque, postoperative anticoagulant therapy and BNP, Fib, D-D CRP levels were influential factors for postoperative ILT formation in Stanford type B ADA patients ( P<0.05). The C-index of the model was 0.903 and 0.894 for the modeled and validated populations, respectively, which had good discrimination and was good at predicting ILT formation after operation in Stanford type B ADA patients. The model had good clinical utility in predicting postoperative ILT formation in Stanford B ADA patients. Conclusions:The Nomograms model can help to screen and identify patients with high risk of ILT formation at an early clinical stage.

Objective:To explore the feasibility of mismatch of amide proton transfer weighted (APTw) imaging with diffusion weighted imaging (DWI) in evaluating ischemic penumbra (IP) in patients with wake-up stroke.Methods:A prospective study was performed; 96 patients with wake-up stroke and unilateral middle cerebral artery territory infarction admitted to Emergency Stroke Department, Affiliated Hospital of Jining Medical University from September 2020 to January 2023 were chosen. All patients underwent routine MRI, DWI, APTw imaging and 3D arterial spin labeling (3D-ASL) before treatment and 90 d after treatment. IP presence was defined as changes of abnormal signal on T2-fluid-attenuated inversion recovery (FLAIR) 90 d after treatment greater than 20% of high signal range on DWI before treatment, and it was used as the gold standard to compare the efficacy in evaluating whether the patients had IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw imaging with DWI before treatment. The infarct core (IC) region, mismatch region of APTw imaging with DWI, mismatch region of 3D-ASL with APTw imaging were delineated on the fusion images in patients with IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw with DWI, and the differences of APTw values in different regions were compared.Results:According to the 90-d follow-up results, 50 patients had IP and 46 patients did not have IP. Specificity, accuracy and sensitivity evaluating whether the patients had IP based on mismatch of 3D-ASL with DWI were 86.9%, 93.7% and 100.0%, respectively; specificity, accuracy and sensitivity evaluating whether the patients had IP based on mismatch of APTw imaging with DWI were 100.0%, 95.8% and 92.0%, respectively. The APTw max, APTw min and APTw ave values of the IC region were significantly lower than those of mismatch region of APTw with DWI, and the APTw max-min values of mismatch region of APTw imaging with DWI were significantly higher than those of mismatch region of 3D-ASL with APTw imaging ( P<0.05). Conclusion:APTw imaging can reflect the acidosis status of different brain regions in patients with wake-up stroke; specificity and accuracy evaluating whether the patients have IP based on mismatch of APTw imaging with DWI are higher than those based on mismatch of 3D-ASL with DWI.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

Objective:To explore the value of monocyte subsets and CD64 expression in the diagnosis and prognosis of sepsis.Methods:A prospective case-control study was designed. 30 septic patients and 30 non-septic patients who were admitted to the intensive care unit (ICU) of the PLA Army Characteristic Medical Center from March 2021 to March 2022 were enrolled. After 1, 3, and 5 days of ICU admission, peripheral blood samples were taken from patients. Flow cytometry was used to detect the proportion of monocyte subsets and the expression level of CD64 on the surface, and the difference of expression between patients in two group was analyzed. The risk variables for sepsis were analyzed using single-factor and multi-factor Logistic regression. The diagnostic efficacy of each risk factor for sepsis was determined using the receiver operator characteristic curve (ROC curve).Results:One day after ICU admission, the proportions of monocytes and classic monocytes in white blood cells (WBC) of septic patients were significantly lower than those of non-septic patients [proportion of monocytes to WBC: (4.13±2.03)% vs. (6.53±3.90)%, proportion of classic monocytes to WBC: 1.97 (1.43, 2.83)% vs. 3.37 (1.71, 5.98)%, both P < 0.05]. The proportion of non-classical monocytes in monocytes was significantly higher in septic patients than that in non-septic patients [(11.42±9.19)% vs. (6.57±4.23)%, P < 0.05]. The levels of CD64 expression in monocytes, classic monocytes, intermediate monocytes and non-classic monocytes were significantly higher in sepsis patients than those in non-septic patients [mean fluorescence intensity (MFI): 13.10±6.01 vs. 9.84±2.83 for monocytes, 13.58±5.98 vs. 10.03±2.84 for classic monocytes, 13.48±6.35 vs. 10.22±2.99 for intermediate monocytes, 8.21±5.52 vs. 5.79±2.67 for non-classic monocytes, all P < 0.05]. Multivariate Logistic regression research showed that CD64 in typical monocytes [odds ratio ( OR) = 1.299, 95% confidence interval (95% CI) was 1.027-1.471, P = 0.025] and the proportion of non-typical monocytes in monocytes ( OR = 1.348, 95% CI was 1.034-1.758, P = 0.027) were the independent risk factors for sepsis. ROC curve showed that the area under the ROC curve (AUC) of CD64 expression of classical monocytes, the fraction of non-classical monocytes in monocytes, and procalcitonin (PCT) in the diagnosis of sepsis was 0.871. A correlation analysis revealed a negative relationship between the acute physiology and chronic health status evaluation Ⅱ (APACHE Ⅱ) on the first, third, and fifth days following ICU admission and the expression level of CD64 in patients' classic monocytes ( r values were -0.264, -0.428 and -0.368, respectively, all P < 0.05). Conclusions:Combining the proportion of non-classical monocytes in monocytes, the level of plasma PCT, and the CD64 expression of classic monocytes in peripheral blood has good efficacy in identifying sepsis and assessing its severity.