Objective:To investigate the significance of CT imaging features in the diagnosis of first-episode paranoid schizophrenia.Methods:Forty-five patients with first-episode paranoid schizophrenia admitted to Shaoxing 7 th People's Hospital from January 2018 to January 2019 were included in the study group. An additional 40 healthy controls who received health examination were included in the control group. All participants underwent head CT scans and CT values of cerebral lobes were measured. CT imaging features of first-episode paranoid schizophrenia were analyzed. The recurrence rate of paranoid schizophrenia was calculated. The diagnostic effect of CT imaging on paranoid schizophrenia was evaluated. Results:The CT value of the frontal lobe in the study group was significantly lower than that in the control group [(33.1 ± 1.4) HU vs. (36.9 ± 2.1) HU, t = 9.914, P < 0.001]. The proportions of patients having ventricular enlargement, sulcus widening, arachnoid cyst and cisterna magna in the study group were 51.1%, 24.4%, 31.1% and 20.0% respectively, which were significantly higher than 5.5%, 2.5%, 2.5% and 2.5% respectively in the control group ( χ2 = 21.688, 8.411, 11.928, 4.675, all P < 0.05). The recurrence rate of paranoid schizophrenia in the study group was 22.2% (10/45). The CT value of the left and right frontal lobe in patients with recurrent paranoid schizophrenia was (32.1 ± 1.7) HU and (32.5 ± 1.6) HU respectively, which was significantly lower than (35.0 ± 1.9) HU and (34.9 ± 1.7) HU in patients without recurrent paranoid schizophrenia ( t = 4.348 and 3.985, both P < 0.001). Conclusion:Patients with first-episode paranoid schizophrenia have brain structural abnormalities, as manifested by ventricular enlargement, sulcus widening, arachnoid cyst, and cisterna magna. CT imaging features are of great value in the diagnosis of first-episode paranoid schizophrenia. It deserves wide popularization and has a great innovation value.

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.

This study aimed at investigating the effects of Chinese herbal compound Qi Kui granules on urine protein and inflammatory markers in patients with type 2 diabetic nephropathy (DN) based on the treatment of regular western medication.A randomized,parallel controlled method was involved in the present trial,and patients diagnosed with type 2 DN were randomly divided into the Chinese herb group and the control group.Regular treatment of angiotensin Ⅱ receptor blocker (ARB) in western medicine was administered in the two groups with the additional treatment of Qi Kui granules for the Chinese herb group.All the patients revisited the doctor every 4 weeks during the observation period within a 12-week course of the observation.Urinary albumin to creatinine ratio (UACR),urinary albumin excretion rate (UAER) and inflammatory cytokines in the two groups were determined.As a result,seventy-two patients in aggregate were included in the study,while 32 patients of the control group and 31 patients of the Chinese herb group effectively accomplished the observation.After the 12-week treatments,UACR and UAER were significantly decreased in the two groups (P ＜ 0.01),while the efficacy of the Chinese herb group was better than that of the control group (P ＜ 0.05).Compared with the control group,the levels of serum IL-6,tumor necrosis factor α (TNF-α),transforming growth factor f1 (TGF-f1) and urinary monocyte chemoattractant protein (MCP-1) / Cr significantly decreased after the 12-week treatment (P ＜ 0.01).It was concluded that the Chinese herbal compound Qi Kui granules successfully mitigated proteinuria in DN patients.The improvement of glomerular inflammation for renoprotection should be the mechanism behind this.

Objective: To investigate the influencing factors of depressive symptoms among rural elderly patients with chronic diseases in China, so as to provide insights into depression prevention and control among the rural elderly patients with chronic diseases. Methods: The basic demographics, health status, and lifestyle of rural residents at ages of 65 years and older who had at least one chronic disease were retrieved from The Chinese Longitudinal Healthy Longevity Survey (CLHLS) database in 2018, and participants' depressive symptoms were assessed with The Center for Epidemiological Studies Depression-10 (CES-D-10) scale. Factors affecting the depressive symptoms were identified with a multivariable logistic regression model. Results: Totally 5 146 rural elderly patients with chronic diseases were enrolled, including 2 373 men (46.11%) and 2 773 women (53.89%). The prevalence of depressive symptoms was 27.13%. Multivariable logistic regression analysis identified having two and more children (OR=0.614, 95%CI: 0.387-0.975), living alone (OR=1.450, 95%CI: 1.192-1.764), life satisfaction (general, OR=1.933, 95%CI: 1.651-2.264; low, OR=5.366, 95%CI: 3.488-8.254), self-assessed health status (general, OR=2.697, 95%CI: 2.284-3.185; poor, OR=5.338, 95%CI: 4.262-6.685), disability in instrumental activities of daily living (OR=1.592, 95%CI: 1.328-1.908), sleep duration (normal, OR=0.502, 95%CI: 0.429-0.586; too long, OR=0.494, 95%CI: 0.405-0.603), exercise (OR=0.721, 95%CI: 0.607-0.856), watching TV (OR=0.787, 95%CI: 0.664-0.933), and gardening activities (OR=0.781, 95%CI: 0.626-0.975) as factors affecting depressive symptoms among rural elderly patients with chronic diseases. Conclusions The prevalence of depressive symptoms was 27.13% among rural elderly patients with chronic diseases. Number of children, living style, life satisfaction, health status, sleep duration, exercise, watching TV, and gardening activities are associated with the development of depressive symptoms among rural elderly patients with chronic diseases.

OBJECTIVETo establish the method of promoting human peripheral blood mononuclear cell proliferation by polysaccharide of snakegourd root and identify the effects of polysaccharide of snakegourd root on lymphocyte proliferation, T lymphocyte subsets and the different levels of TNF-alpha and IL-6.

METHODThe polysaccharide of snakegourd root preparations were purified with dialysis and ethanol precipitation. The healthy human PBMC were used as the target cells for screening potency of the drugs. MTT colorimetry was established to examine the levels of lymphocyte proliferation on human PBMC by polysaccharide of snakegourd root in vitro. The percents of lymphocyte subsets (CD3+, CD4+, CD8+ T lymphocyte) and the different levels of TNF-a and IL-6 in PBMC were analysed by FCM and ELISA, respectively.

RESULT1.0-50.0 mmol x L(-1) of polysaccharides of snakegourd root showed the significant effects of promoting proliferation of human PBMC (P < 0.05). The percents of CD3+, CD4+, CD8+ T lymphocytes in PBMC treated with 5.0 and 10.0 mmol x L(-1) of polysaccharides of snakegourd root were significantly higher than those of the control group (P < 0.05). The levels of TNF-alpha and IL-6 were significantly higher than those of the control group after 1.0, 5.0, 10.0 mmol x L(-1) of polysaccharides of snakegourd root stimulation on the human PBMC at 8 hours (P < 0.05).

CONCLUSIONThe significant effects on promoting lymphocyte proliferation and activation of the polysaccharide of snakegourd root are confirmed in this study. The percents of lymphocyte subsets are increased in different degrees by the polysaccharide of snakegourd root. The high levels of TNF-alpha and IL-6 are secreted after the polysaccharides of snakegourd root stimulation on the human PBMC, which lays a foundation for further elucidating the immunocompetence effects and mechanism of the polysaccharide of snakegourd root.

Objective:To analyze the clinical efficacy of treatment of cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures.Methods:A retrospective study was conducted to analyze the data of 13 patients who had been treated at Department of Orthopaedics, The First Affiliated Hospital of Soochow University for cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures from July 2013 to July 2022. There were 4 males and 9 females, with an average age of (76.5±8.6) years and a T value of bone mineral density of -3.3±0.6. By the CT and MRI features of cement dislodgement, their conditions fell in 4 types: cement loosening in situ (4 cases), anterior cement moving (6 cases), anterior cement moving with posterior bone mass moving (2 cases), and posterior cement moving (1 case). They were treated by percutaneous vertebroplasty (3 cases), pedicle screw fixation combined with bone graft fusion and decompression (7 cases), and conservative therapy (3 cases). The curative effects for surgical patients were evaluated by comparing their visual analogue scale (VAS), Oswestry dysfunction index (ODI) and cobb angle of kyphosis at preoperation, 1 week and 1 month postoperation, and the last follow-up, and Frankel grading for nerve injury as well. The curative effects for patients undergoing conservative treatment were evaluated by observing their symptoms.Results:This cohort was followed up for 7 (5, 12) months after treatment. The VAS scores [5.0 (4.0, 5.0) points, 3.0 (2.0, 3.0) points, and 3.0 (2.0, 3.0) points] in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value [8.5 (8.0, 9.0) points] ( P<0.05); the VAS scores at 1 month postoperation and the last follow-up were also significantly improved compared with that at 1 week postoperation ( P < 0.05), but there was no significant difference between the last follow-up and 1 month postoperation ( P > 0.05). The ODIs (50.6%±4.2%, 37.8%±4.5%, and 29.3%±5.6%) in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value (93.2%±3.6%), showing significant differences in pairwise comparisons ( P<0.05). The cobb angles [10.0 (9.0, 11.0)°, 9.0 (9.0, 11.0)°, and 10.0 (9.0, 12.0)°] in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value [12.5 (11.0, 14.0)°] ( P<0.05) , but there was no statistically significant difference between the time points after operation ( P>0.05). The Frankel grading was significantly improved in the 6 patients with nerve injury after operation. Of the 3 patients undergoing conservative treatment, the symptoms were cured in one, showed no change during follow-up in one, and aggravated in one. Conclusion:Surgical treatment can significantly relieve pain, improve spinal dysfunction and repair nerve injury in patients with bone cement dislodgement after vertebral augmentation.

Objective:To explore the application of pyrophosphorolysis-activated polymerization(PAP)to monitor plasma cfDNA in ad-vanced non-small cell lung cancer(NSCLC).Methods:A total of 85 patients diagnosed with advanced NSCLC between March 2016 and June 2017 were enrolled in the present study. EGFR mutations in cfDNA extracted from the plasma were detected using PAP and ARMS-PCR technology.The concordance analysis of EGFR mutations involved plasma vs.tumor tissue and PAP vs.ARMS-PCR.Further-more,38 EGFR-positive patients were selected to monitor EGFR mutations with PAP.Results:No statistical differences in EGFR muta-tions were observed between plasma and tumor tissue(P=0.092),as well as PAP and ARMS-PCR(P=0.210).The detection rate of EGFR mutations in cfDNA was higher in the progressor than in the non-progressor(62.5% vs.21.3%,P<0.001).Conclusions:PAP can be used for detecting and monitoring EGFR mutations in cfDNA to predict disease progression.

Objective:To investigate the value of pericoronary adipose tissue histogram parameters based on coronary CT angiography (CTA) images for the differentiation of acute coronary syndrome and stable coronary artery disease.Methods:The clinical data and CTA images of 93 patients with coronary CTA examination in Suzhou Kowloon Hospital from 2013 to 2018 were analyzed retrospectively. There were 39 patients with acute coronary syndrome (acute coronary syndrome group) and 54 patients with stable coronary artery disease (stable coronary artery disease group). A region of interest (ROI) was drawn around the stenosis of the coronary arteries, with CT attenuation ranging from-190 to -30 HU to exclude non-adipose tissue. The CT attenuation of ROI excluding non-adipose were measured and histogram analysis was performed. The obtained parameters included the mean value, median value and the 5th, 10th, 45th, 55th, 70th and 95th percentiles. The differences in histogram parameters between the two groups were compared, and then the value of each parameter in differentiating acute coronary syndrome and stable coronary artery disease was evaluated based on receiver operating characteristic (ROC) analysis. The stepwise regression of multivariate logistic regression analysis was used to identify the useful features and establish the final prediction model. The ROC curve of the final model was calculated and its value was analyzed.Results:The mean, median and the 5th, 10th, 45th, 55th,70th and 95th percentile differences between the acute coronary syndrome group and the stable coronary artery disease group were statistically significant (all P<0.05). The ROC curve for the median and the 95th percentile had the same area under curve (AUC) of 0.73. The sensitivity, specificity and AUC of the diagnostic model established by multiple logistic regression were 82.1%, 89.1% and 0.90 respectively. Conclusion:CT attenuation histogram of pericoronary adipose tissue is of high value in differentiating acute coronary syndrome from stable coronary artery disease.

CAR-T细胞治疗血液肿瘤已经取得了不错的疗效，已有两款新药（Kymrial和Yescata）上市。然而，在临床上CAR-T 细胞疗法也面临诸如细胞因子释放综合征（CRS）、脱靶现象、载体安全性问题、实体瘤治疗效果不佳、肿瘤复发率高等问题，这使 研究者们不得不重点关注其毒副作用的危害，并对此展开相关对策的研究。随着对CAR-T细胞认识的不断深入以及对治疗方案 的不断优化，已经有部分毒副作用处于可控范围内。本文将对近年来CAR-T细胞治疗在临床应用中产生的问题进行分析，并介 绍相应的对策，旨在为临床医生更好地管理CAR-T细胞治疗过程和肿瘤研究者进一步优化CAR结构提供参考依据。

Pathological insulin resistance (IR) is closely related to gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in women with GDM. Increasing studies have investigated the efficacy of IR indices, such as quantitative insulin sensitivity index, homeostasis model assessment of insulin resistance, triglyceride-glucose index and sex hormone-binding globulin, in predicting GDM and related complications in recent years. This article reviews the research progress in the above topics.