Objective: To study the repeatability and consistency among different operators while different b-value DWI was used to detect mass and non-mass breast lesions. Methods: Between December 2010 and October 2017, we collected 131 female patients (one hundred and thirty-three lesions) from Zhongda Hospital Southeast University, they were diagnosed as non-cystic lesion of the mammary gland by contrast enhancement MRI (DCE-MRI),were examined with DWI and confirmed by surgical pathology. There were 94 cases of mass lesion (96 lesions) and 37 cases of non-mass lesion (37 lesions). All patients were examined with DWI before surgery,80 patients were examined with b-value of 0, 400, 800 and 1 000 s/mm², there were 51 tumor lesions and 29 non-tumor lesions;53 patients were examined with b-value of 0, 400, 800 and 1 200,1 600 s/mm²,there were 45 tumor lesions and 8 non-tumor lesions. Two radiologists with the same qualifications used double-blind reading to measure ADC values. Paired t test was used to compare the differences in measurement parameters between the two physicians. The repeatability of data between the two physicians was analyzed by intraclass correlation coefficient (ICC) and Cronbach α coefficients. The consistency of data between the two physicians was evaluated by Bland-Altman analysis. Results: In different b values (0,400,800,1 200,1 600 s/mm²), the ADC value of non-mass type breast cancer and mass type breast cancer was no statistically significance between the two operators (P>0.05).The ICC of the ADC values of the non-mass breast lesion under the different b values measured by 2 physicians were 0.72, 0.78, 0.87, 0.76, 0.74, and the repeatability was good or very good; The Cronbach α coefficients are 0.83, 0.88, 0.93, 0.86, 0.85, and the reliability is high. The ICC of the ADC values of the mass breast lesion under the different b values measured by 2 physicians were 0.88,0.95,0.97,0.93,0.91, and the repeatability was very good. the Cronbach α coefficients were 0.94,0.97,0.99,0.96,0.95, and the reliability was high. The results of the Bland-Altman image analysis showed that the ADC values of non-mass and mass lesion detected by different operators in different b values have good consistency. In different b values, there were 97.3% (36/37), 94.6% (35/37), 93.1% (27/29),8/8 and 8/8 points within the 95% consistency limit of non-mass breast lesions; there were 97.9% (94/96), 94.8% (91/96), 92.2% (47/51), 95.6% (43/45), 93.3% (42/45) within the 95% consistency limit of mass breast lesions. Conclusion The ADC values were measured under different b values, and different operators had favarable repeatability and consistency for different lesions of different types of breast cancer.

Objective:To improve the prognosis stratification, especially early mortality(EM), of elderly patients with newly diagnosed multiple myeloma(NDMM).Methods:In this retrospective study, univariate and multivariate Cox regression analysis were conducted to identify the independent prognostic factors associated with overall survival(OS)and the chi-square test and multivariate Logistic analysis were used to identify the prognostic factors associated with EM in 223 elderly patients(age≥65 years)with NDMM from three centers in the country.Results:Increased NT-pro-BNP(≥300 pg/ml), ECOG-PS≥2 and stage Ⅲ R-ISS were identified as three independent adverse prognostic factors of OS.The rates of EM3, EM6, EM12 and EM24 were 12.1%, 20.1%, 32.2% and 60%, respectively.The most common cause for EM6(particularly EM3)was disease-related complications resulting from ineligibility for treatment due to poor physical performance, severe organ dysfunction or treatment discontinuation due to treatment intolerance, while the most common cause for EM12(particularly EM24)was disease progression or relapse mainly as a result of inadequate treatment.R-ISS staging failed to predict EM, while decreased eGFR, ECOG-PS≥2, and increased NT-pro-BNP were able to estimate the risk of EM, with increased NT-pro-BNP as a common independent factor for EM12( P=0.03)and EM24( P=0.015). Conclusions:R-ISS staging, which primarily reflects MM biology, cannot predict EM.However, factors such as NT-pro-BNP, eGFR and ECOG-PS associated with frailty and impairment of organ functions can be used to estimate the risk of EM, among which NT-pro-BNP may be the most important independent factor for EM.Therefore, incorporation of these frailty-related biomarkers into R-ISS staging may be able to more precisely estimate the prognosis and particularly early death of elderly patients with NDMM.

ObjectiveTo decipher the mechanism of modified Sanpiantang in the treatment of nitroglycerin-induced migraine in rats. MethodSeventy-two Wistar rats were randomized into the control， model （nitroglycerin， 10 mg·kg^-1）， positive control （rizatriptan， 0.89 mg·kg^-1）， and high- （12.96 g·kg^-1）， medium- （6.48 g·kg^-1）， and low-dose （3.24 g·kg^-1） modified Sanpiantang groups. The rat model of migraine was established by intraperitoneal injection of 10 mg·kg^-1 nitroglycerin. The behavioral test was carried out to measure the mechanical pain thresholds （MPT） of the periorbital region and hindpaw after successful modeling. The serum levels of nitric oxide （NO）， tumor necrosis factor-α （TNF-α）， interferon-γ （IFN-γ）， and interleukin-1β （IL-1β） in rats were determined by enzyme-linked immunosorbent assay （ELISA）. Immunohistochemistry （IHC） was employed to determine the expression of inducible nitric oxide synthase （iNOS） in the trigeminal nucleus caudalis （TNC）. Western blot was employed to determine the protein levels of iNOS and phospho-p38 mitogen-activated protein kinase （p-p38 MAPK） in the TNC. Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） was performed to measure the mRNA levels of iNOS， p38 MAPK， and IL-1β in the TNC. ResultCompared with the control group， the model group showed decreased MPT （P<0.01）， elevated serum levels of NO， TNF-α， IFN-γ， and IL-1β （P<0.01）， and up-regulated expression levels of p38 MAPK， iNOS， and IL-1β in the TNC （P<0.05， P<0.01）. Compared with the model group， modified Sanpiantang increased the MPT （P<0.05）， and the medium-dose group showed the most significant effect （P<0.01）. In addition， modified Sanpiantang down-regulated the mRNA levels of iNOS， p38 MAPK， and IL-1β and the protein levels of p-p38 MAPK and iNOS in the TNC of migraine rats （P<0.05， P<0.01） and lowered the serum levels of NO， TNF-α， IFN-γ， and IL-1β （P<0.05， P<0.01）. ConclusionModified Sanpiantang may treat migraine by down-regulating the expression of pro-inflammatory factors such as NO， TNF-α， IFN-γ， and IL-1β in the p38 MAPK/iNOS signaling pathway to reduce the neurogenic inflammation.

Stroke is considered a leading cause of mortality and neurological disability, which puts a huge burden on individuals and the community. To date, effective therapy for stroke has been limited by its complex pathological mechanisms. Autophagy refers to an intracellular degrading process with the involvement of lysosomes. Autophagy plays a critical role in maintaining the homeostasis and survival of cells by eliminating damaged or non-essential cellular constituents. Increasing evidence support that autophagy protects neuronal cells from ischemic injury. However, under certain circumstances, autophagy activation induces cell death and aggravates ischemic brain injury. Diverse naturally derived compounds have been found to modulate autophagy and exert neuroprotection against stroke. In the present work, we have reviewed recent advances in naturally derived compounds that regulate autophagy and discussed their potential application in stroke treatment.