Objective:To investigate multimodality imaging characteristics and clinical features of lymphomatosis cerebri (LC) and reasons for misdiagnosis,with the goal of potentially facilitating an early and accurate diagnosis for this often-missed disease.Methods:Clinical data and cerebral multimodality imaging findings from 11 patients with LC proven basing on pathology in the Affiliated Hospital of Guizhou Medical University from November 30, 2011 to December 28, 2020 were retrospectively extracted, analyzed, and reviewed in combination with the literatures.Results:The common presenting symptoms with subacute onset included cognitive decline (8/11), gait disturbance (9/11), and behavioral disturbance (5/11). Test of cerebrospinal fluid showed that the number of cells and the level of protein increased (8/10), the sugar content (2/10) and chloride (4/10) decreased. The imaging manifestations of 11 patients with LC were diffuse lesions of bilateral cerebral white matter in the both deep and lobar lesion distribution, involving the cerebral cortex and subcortical white matter in eight cases (8/11), basal ganglia in seven cases (7/11), thalamus in five cases (5/11), cerebellum in six cases and brain stem in six cases (6/11). All 11 patients showed equal or slightly low-density shadows on CT plain scan and slightly longer T 1WI and T 2WI signals on magnetic resonance imaging. Six cases (6/11) had no obvious enhancement in the early stage, and five cases and six follow-up cases showed heterogenous spots, patches, nodules or clusters of distinct enhancement. Diffusion-weighted imaging showed non restricted diffusion in nine (9/11) cases initially diagnosed, and restricted diffusion in two cases (2/11) and nine follow-up cases, which were hyperintense on diffusion-weighted imaging and hypointense on apparent diffusion coefficient maps. Five patients (5/5) presented a marked decrease in N-acetyl aspartic acid (NAA)/creatine (Cr) and increase in choline (Cho)/Cr on hydrogen proton magnetic resonance spectrum, including an increase in lipid/Cr in three cases. One case (1/3) showed no abnormal increase in lesion metabolism, and two cases (2/3) showed slightly increased uptake on positron emission tomography/CT. Conclusions:Diffuse bilateral cerebral lesions especially in deep and lobar region, without enhancement or with patchy enhancement, marked decrease in NAA/Cr and increase in Cho/Cr and Lip/Cr are suggestive of LC. Misdiagnosis may be mainly due to insufficient understanding and improper brain biopsy.

Objective To investigate the alteration of M1/M2 polarization of monocyte-macrophages from the peripheral blood of patients with active pulmonary tuberculosis,and the effect of Mycobacterium tuberculosis ESAT6 on the polarization of human THP-1 cells.Methods Whole blood and serum samples were collected from 14 patients with active pulmonary tuberculosis and 10 healthy controls.Peripheral blood mononuclear cells(PBMCs)were isolated from whole blood with heparin sodium using lymphocyte fluid.The mRNA levels of HLA-DR,CD11C,CD68,CD206 and Arg-1 in PBMCs from patients with active pulmonary tuberculosis were detected by real-time quantitative PCR.The secretion of cytokines(IL-2,IL-6,TNF-α,IFN-γ,IL-4,etc.)was detected by flow cytometry.Human THP-1 cells were induced by phorbol ester(PMA)to differentiate into macrophages-like cells,which were divided into M0 group,M1 group,M2 group,and M0+ESAT6 group.After 24 hours of stimulation,the mRNA levels of HLA-DR,CD11C,CD68,CD206 and Arg-1 were detected by real-time PCR.Following stimulation with ESAT6 for 6 h,12 h and 24 h,the levels of cytokines(IL-2,IL-6,TNF-α,IL-4,etc.)in cell culture supernatant from THP-1 cells were detected by flow cytometry.Results Compared with the healthy control group,the mRNA expression levels of M1-polarized phenotypic molecules HLA-DR,CD11C and CD68 in PBMCs of the active pulmonary tuberculosis group were up-regulated(P<0.05).The mRNA expression level of M2-polar-ized phenotype molecule CD206 was decreased(P<0.05),while the expression level of Arg-1 mRNA was not statistically significant(P>0.05).Serum levels of M1-related proinflammatory cytokines IL-2,IL-6,IFN-γ and TNF-α were increased in patients with active pulmonary tuberculosis(all P<0.05),whereas decreased level of anti-inflammatory cytokine IL-4(P<0.05)were found in serum samples from patients with active pulmonary tuber-culosis.THP-1 macrophages were induced to differentiate into different phenotypes in vitro,and the HLA-DR mRNA expression level of cell M1 polarization phenotype molecule was statistically significant among all groups(F=21.83,P=0.000).Pairwise comparison results showed that expressions of HLA-DR mRNA in M1 group and M0+ESAT6 group were significantly upregulated compared with M0 group(P<0.05),there was no significant difference between the other groups(P>0.05).However,there was no significant difference in the expression of CD68 mRNA among all groups(F=2.480,P=0.135).There was no significant difference of mRNA expressions of CD206 and Arg-1 among all groups(F=1.233,P=0.3597;F=6.059,P=0.068).There were no significant differences between the M1-related pro-inflammatory cytokine IL-2 and anti-inflammatory cytokine IL-4 at different time points of cell culture(P>0.05).Compared with the M0 and ESAT6 phenotypes,the levels of pro-inflammatory cytokines IL-6 and TNF-α in the M1 phenotype group were significantly increased at 12 h and 24 h(P<0.05,P<0.05,P<0.001,P<0.001;P<0.05,P<0.05,P<0.01,P<0.01);but there was no significant difference between the other groups(P>0.05).Conclusions The ability of peripheral blood monocyte-macrophages to polarize to M1 is enhanced,while the ability to polarize to M2 is weakened in patients with active pulmonary tuberculosis.Mycobacterium tuberculosis ESAT6 can promote the polarization of macrophages to M1,which affects the activity and progression of tuberculosis.

Objective:To investigate HIV-1 genotypes and drug resistance among newly diagnosed young students in Nanjing in order to provide reference for the prevention and control of AIDS in this group.Methods:This study enrolled 200 newly diagnosed young students with HIV-1 infection in Nanjing from September 2015 to July 2019. Demographic information and blood samples were collected. Through RNA extraction and PCR amplification, 191 pol fragments were successfully obtained and subjected to genotyping and drug resistance analysis. Results:CRF01_AE (41.4%) and CRF07_BC (30.9%) were the predominant genotypes, followed by unique recombinant forms (URFs) (15.7%), CRF55_01B (5.2%), CRF68_01B (3.1%), CRF67_01B (2.6%), and subtype B (1.0 %). The incidence of drug-resistant mutations was 16.8%, and the rate of transmitted drug resistance (TDR) was 4.2%. The rates of TDR in CRF01_AE, CRF07_BC, CRF55_01B, URFs and other genotypes were 2.5%, 1.7%, 10.0%, 10.0% and 7.7%, respectively ( P>0.05). Conclusions:The rapid emergence of recombinant HIV-1 strains in the young students should be taken seriously. The prevalence of TDR was close to the alert level, thus needing to be monitored continuously.

Objective:To investigate the effects of probiotics on intestinal flora, intestinal function, and T lymphocyte level in patients with cervical cancer after radiotherapy.Methods:A total of 92 patients with cervical cancer who underwent pelvic radiotherapy in The Second Affiliated Hospital of Zhengzhou University from September 2020 to February 2022 were included in this study. They were randomly divided into control and experimental groups ( n = 46/group). The patients in the experimental group took probiotics during radiotherapy, while the patients in the control group did not take probiotics during radiotherapy. The amount of intestinal flora, D-lactic acid, diamine oxidase, and T lymphocyte subset levels pre- and post-radiotherapy were compared between the two groups. Urinary lactulose (L) and mannitol (M) concentrations were determined in each group. Urinary excretion ratios of L to M were calculated. Results:After 10, 15, and 20 times of radiotherapy and after all radiotherapies, the amount of Escherichia coli and Enterococcus in the experimental group was significantly lower than that in the control group ( F = 128.60, 224.99, all P < 0.05). The amount of Bifidobacteria and Lactobacilli in the experimental group was significantly higher than that in the control group ( F = 2 065.46, 948.23, both P < 0.05). After 10, 15, and 20 times of radiotherapy and after all radiotherapies, plasma D-lactic acid level in the experimental group was (9.34 ± 1.63) μg/L, (9.15 ± 1.36) μg/L, (8.68 ± 1.06) μg/L, and (8.05 ± 0.82) μg/L, respectively. After 10, 15, and 20 times of radiotherapy and after all radiotherapies, plasma diamine oxidase level in the experimental group was (86.34 ± 20.25) μg/L, (84.28 ± 17.45) μg/L, (80.40 ± 13.35) μg/L, and (76.85 ± 10.87) μg/L, respectively, and urinary excretion ratio of L to M in the experimental group was (1.84 ± 0.16), (1.55 ± 0.12), (1.26 ± 0.09), (0.98 ± 0.06), respectively, all of which were significantly lower than those in the control group ( F = 121.60, 31.73, 417.84, all P < 0.05). After 10, 15, and 20 times of radiotherapy and after all radiotherapies, CD4 + level in the experimental group was (39.80 ± 4.90)%, (40.92 ± 5.30)%, (42.52 ± 6.14)%, (43.83 ± 6.55)%, respectively, CD4 +/CD8 + was (1.52 ± 0.25), (1.63 ± 0.22), (1.71 ± 0.39), (1.83 ± 0.22), respectively, all of which were significantly higher than those in the control group ( F = 58.69, 31.07, all P < 0.05). Conclusion:Probiotics can improve the status of intestinal flora and intestinal barrier function in patients with cervical cancer after radiotherapy, and simultaneously improve the cellular immune function of patients.

Objective To explore the differences in the hippocampal delineation among different radiologists and to evaluate the impact of the delineating guideline training upon improving the accuracy of target area.Methods In this prospective study,20 patients scheduled to receive whole brain radiation therapy were selected.Before and after the delineating guideline training,three physicians from Department of Radiation Oncology delineated the hippocampal targets three times for each patient.One physician from Department of Imaging Diagnosis delivered the delineating guideline training and delineated the hippocampus of 20 patients as the standard target area.The delineating targets before and after the training were statistically compared among different physicians.Results The conformity indexes with the standard target of three physicians before and after the training were 0.66±0.04 and 0.77±0.02,0.62±0.04 and 0.76± 0.02,0.49±0.05 and 0.74±0.04,respectively.The conformity indexes were all statistically increased after the training (all P＜ 0.05).The inter-observer variability significantly differed among different physicians before and after training (all P＜0.05).The coefficient of variance of hippocampal volume before and after training were 0.16±0.06 and 0.08±0.04 with statistical significance (all P＜0.05).Compared with all targets before training,the consistency of each physician was significantly improved after training (all P＜0.05).Conclusion Hippocampal delineation guideline training can improve the accuracy of delineation.

Objective:To investigate the epidemiology, evolution and transmission characteristics of HIV-1 CRF07_BC in Nanjing between 2015 and 2019 to provide scientific basis for precise prevention and control of HIV-1 transmission.Methods:Pol gene sequences of 319 patients with HIV-1 CRF07_BC infection in Nanjing were amplified and sequenced and a maximum likelihood phylogenetic tree was then constructed. Markov Chain Monte Carlo sampling method was used to generate Maximum Clade Credibility Tree. Bayesian Skyline Plot was used to reconstruct the changing trend of the effective population size. Pairwise gene distance method was used to construct molecular network to investigate the transmission features. Results:Among the 319 patients, 303 (95.0%) were male; 264 (82.8%) had multiple sexual partners; only 14 (4.4%) had been using condoms. Most of the infections were occurred in men who have sex with men (MSM), accounting for 77.4%. The maximum likelihood phylogenetic analysis of HIV-1 CRF07_BC revealed two clusters: Cluster1 and Cluster2. Cluster1 mainly contained the strains isolated from MSM and Cluster2 mainly consisted of the strains isolated from heterosexual patients. The most recent common ancestor was 2002.47(1999.91, 2005.43) year for Cluster1 and 1996.38(1992.55, 1999.76) year for Cluster2. The evolutionary rates (95% highest posterior density, 95%HPD) of Cluster1 and Cluster2 were 1.73×10 -3 (1.36×10 -3-2.16×10 -3) substitutions·site -1·year -1 and 2.09×10 -3 (1.50×10 -3 -2.79×10 -3 ) substitutions·site -1·year -1, respectively. The effective population sizes of Cluster1 and Cluster2 tended to be stable after 2002 and 2003, respectively. In addition, Cluster1 and Cluster2 formed eleven and eight unique branches, respectively, suggesting the possibility of divergent epidemics of this genotype. A total of 35 propagation clusters were formed in the molecular propagation network, including 92 Nanjing sequences with an average degree of 4.3. Males, MSM and people with multiple sexual partners were more likely to be connected to the network. Students and young patients were more likely to be connected to the network. Conclusions:HIV-1 CRF07_BC infection was characterized by low age, multiple sexual partners, unprotected behaviors and transmission among MSM in Nanjing from 2015 to 2019. It was recommended to pay more attention to students and young people, to formulate more effective prevention and control measures for high-risk sexual behaviors, and to carry out continuous molecular monitoring of CRF07_BC strain, so as to provide scientific basis for the prevention and control of HIV CRF07_BC.

Objective:To explore the application of COVID-19-specific IgG antibody in identifying epidemic Omicron BA.5 strain infection.Method:Omicron BF.7/BA.5 naturally infected population, healthy population vaccinated with the COVID-19 vaccine, and Omicron BF.7/BA.5 breakthrough cases were enrolled into this study. The serum WT-S-IgG and BA.5-S-IgG were detected by indirect ELISA, and the serum-specific IgG antibody levels of different populations were compared. The application value of the two antibody titers and the ratio of the two antibodies in identifying Omicron BA.5 epidemic strain infection were explored by the ROC curve, aiming to provide technical support for pathogen diagnosis.Results:The antibody titers of WT-S-IgG and BA.5-S-IgG in the breakthrough cases were higher than those in the naturally infected population and the healthy population ( P<0.05). The area under the curve (AUC) of WT-S-IgG and BA.5-S-IgG in identifying epidemic Omicron BA.5 strain infection was 0.947 and 0.961, respectively. The AUC of BA.5-S-IgG and WT-S-IgG antibody titer ratio was 0.873. When the antibody titer ratio was 0.855, the sensitivity and specificity were 80.00% and 90.00%, respectively. According to the interval since the last infection, the AUC of the ratio of BA.5-S-IgG to WT-S-IgG antibody titer to identify the infection of epidemic strains less than 30 days and more than 30 days was 0.887 and 0.863, respectively, and the sensitivity and specificity were both above 80%. Conclusion:Both BA.5-S-IgG and WT-S-IgG, as well as the combination of these two antibodies, are of high value in the identification of epidemic strains.

Objective:To explore the application of COVID-19-specific IgG antibody in identifying epidemic Omicron BA.5 strain infection.Method:Omicron BF.7/BA.5 naturally infected population, healthy population vaccinated with the COVID-19 vaccine, and Omicron BF.7/BA.5 breakthrough cases were enrolled into this study. The serum WT-S-IgG and BA.5-S-IgG were detected by indirect ELISA, and the serum-specific IgG antibody levels of different populations were compared. The application value of the two antibody titers and the ratio of the two antibodies in identifying Omicron BA.5 epidemic strain infection were explored by the ROC curve, aiming to provide technical support for pathogen diagnosis.Results:The antibody titers of WT-S-IgG and BA.5-S-IgG in the breakthrough cases were higher than those in the naturally infected population and the healthy population ( P<0.05). The area under the curve (AUC) of WT-S-IgG and BA.5-S-IgG in identifying epidemic Omicron BA.5 strain infection was 0.947 and 0.961, respectively. The AUC of BA.5-S-IgG and WT-S-IgG antibody titer ratio was 0.873. When the antibody titer ratio was 0.855, the sensitivity and specificity were 80.00% and 90.00%, respectively. According to the interval since the last infection, the AUC of the ratio of BA.5-S-IgG to WT-S-IgG antibody titer to identify the infection of epidemic strains less than 30 days and more than 30 days was 0.887 and 0.863, respectively, and the sensitivity and specificity were both above 80%. Conclusion:Both BA.5-S-IgG and WT-S-IgG, as well as the combination of these two antibodies, are of high value in the identification of epidemic strains.

Sleep is a complex physiological process of great significance to physical and mental health, and its research scope involves multiple disciplines. At present, the quantitative analysis of sleep mainly relies on the "gold standard" of polysomnography (PSG). However, PSG has great interference to the human body and cannot reflect the hemodynamic status of the brain. Functional near infrared spectroscopy (fNIRS) is used in sleep research, which can not only meet the demand of low interference to human body, but also reflect the hemodynamics of brain. Therefore, this paper has collected and sorted out the related literatures about fNIRS used in sleep research, concluding sleep staging research, clinical sleep monitoring research, fatigue detection research, etc. This paper provides a theoretical reference for scholars who will use fNIRS for fatigue and sleep related research in the future. Moreover, this article concludes the limitation of existing studies and points out the possible development direction of fNIRS for sleep research, in the hope of providing reference for the study of sleep and cerebral hemodynamics.
Brain/diagnostic imaging* ; Hemodynamics ; Humans ; Polysomnography ; Sleep ; Spectroscopy, Near-Infrared