Objective To observe the value of combined synthetic MRI and multiplexed sensitivity encoding diffusion weighted imaging(MUSE-DWI)for differentiating benign and malignant endometrial lesions.Methods Data of 112 patients with benign or malignant endometrial lesion confirmed by pathology were retrospectively analyzed.According to pathologic diagnosis,the patients were divided into malignant group(n=72)and benign group(n=40).Synthetic MRI and MUSE-DWI quantitative parameters,including T1,T2,proton density(PD)and apparent diffusion coefficient(ADC)of all lesions were acquired.The clinical data as well as ADC,T1,T2 and PD values of lesions were compared between groups,and those being significantly different between groups were included in univariate and multivariate logistic regression.Then the univariate and combined models were established for differentiating benign and malignant endometrial lesions.The receiver operating characteristic curves were drawn,and areas under the curves(AUC)were calculated to evaluated the diagnostic efficacy of the models,which were compared with DeLong test.Results Patients'age in malignant group were higher than that in benign group(P＜0.05).The length of the maximum diameter was larger,ADC,T2 and PD values were lower in malignant lesions than those in benign ones(all P＜0.05),while no significant difference of T1 value was found between groups(P=0.074).The AUC of ADC univariate model was 0.966,and there was no significant difference in AUC(0.970)between the combined ADC+T2+PD model(adjusted P＞0.05),but both higher than AUC of T2 univariate model(0.618),PD univariate model(0.664)and the combined T2+PD model(0.668)(all adjusted P＜0.05).Conclusion ADC univariate model and combined model with other parameters of combined synthetic MRI and MUSE-DWI could be used to effectively differentiate benign and malignant endometrial lesions.

Objective To investigate the relationship between cerebral atrophy and total burden of cerebral small vessel disease in patients with recent small subcortical infarct(RSSI).Methods A total of 194 elderly RSSI patients admitted to Department of Neurology of Changzhou Second People's Hospital Affiliated to Nanjing Medical University from September 2021 to November 2022 were recruited in this study.All patients completed cranial MRI examination and were divid-ed into a non-mild group 1(97 cases)and a moderate to severe group 1(97 cases)based on the to-tal burden of cerebral small vessel diseases(CSVD)imaging.Visual assessment scale was used to assess the severity of brain atrophy in the whole brain and various regions of the brain.According to the global cortical atrophy scale(GCA)score,all patients were divided into a non-mild group 2(88 cases)and a moderate to severe group 2(106 cases).Brain atrophy in various regions,medial temporal lobe atrophy(MTA)score,frontal temporal lobe atrophy(FTA)score,and posterior cortical atrophy(PA)score were evaluated.Their general clinical and imaging data were collected,multivariate logistic regression analysis was employed to analyze the relationship between GCA score and total burden of CSVD imaging in RSSI patients,and Spearman correlation analysis was further adopted to explore the correlation of GCA score and different parts of brain atrophy with total burden of CSVD imaging.Results When compared with the non-mild group 1,the moderate to severe group 1 had significantly larger proportions of having GCA score of 2-3 points,PA score of 2-3 points,MTA score of 2-4 points and FTA score of 2-4 points(P＜0.01).The ra-tio of having 2-4 points in total imaging burden score of CSVD was obviously higher in the mod-erate to severe group 2 than the non-mild group 2(P＜0.01).Multivariate logistic regression anal-ysis showed that age and total burden of CSVD imaging were independent risk factors for brain atrophy in RSSI patients(OR=1.184,95％CI:1.099-1.276,P=0.000;OR=3.537,95％CI:1.664-7.518,P=0.001).Spearman correlation analysis revealed that the total burden score of CSVD imaging was positively correlated with GCA,MTA,FTA and PA scores in RSSI patients(r=0.518,r=0.382,r=0.471,r=0.388,P=0.000).Conclusion The total burden of CSVD is an independent risk factor for GCA in elderly RSSI patients.The more serious the total burden of CSVD is,the higher the grade of GCA is.The total burden of CSVD is related to the whole brain and brain atrophy in other different regions of the brain.

ObjectiveTo investigate the impact of acute respiratory infections in children under 12 years old in Pudong New Area， Shanghai from 2019 to 2023. MethodsAcute respiratory infection samples of children under 12 years old from three sentinel hospitals in Pudong New Area， Shanghai from 2019 to 2023 were collected， and 42 respiratory infection pathogens， including influenza virus， adenovirus， parainfluenza virus， respiratory syncytial virus， human enterovirus/rhinovirus， human pulmonary virus， human bokavirus， coronavirus （229E， HKU1， NL63 and OC43）， and novel coronavirus， were detected with microfluidic chips. The situation of acute respiratory infections among outpatient and inpatient children in this area was analyzed for the before the implementation of non pharmacological intervention measures （2019.12‒2020.1）， during the period of non pharmacological intervention measures （2020.2‒2022.12）， and after non pharmacological intervention measures （2023.1‒2023.6）. ResultsFrom 2019 to 2023， a total of 1 770 samples were collected， and 445 pathogens were detected， with a detection rate of 25.14% （445/1 770）. The main pathogens detected during the study period were influenza virus： 8.70% （154/1 770）， respiratory syncytial virus： 4.41% （78/1 770）， human enterovirus/rhinovirus： 2.66% （47/1 770）， human adenovirus： 2.49% （44/1 770）， and parainfluenza virus： 2.20% （39/1 770）. Before the implementation of non pharmacological intervention measures， outpatients were primarily infected with influenza， parainfluenza virus， and respiratory syncytial virus， with detection rates of 8.09%， 4.49%， and 4.04%， respectively； inpatients were mainly infected with influenza， respiratory syncytial virus， and parainfluenza virus， with detection rates of 4.49%， 3.82%， and 3.15%， respectively. During the period of non pharmacological intervention measures， influenza， rhinovirus and respiratory syncytial virus were the main viruses detected in the samples of outpatient children， with detection rates of 4.04%， 3.60%， and 2.47%， respectively； inpatient samples mainly detected respiratory syncytial virus， rhinovirus， and influenza virus， with detection rates of 3.60%， 2.02%， and 1.80%， respectively. After non pharmacological intervention measures， influenza， rhinovirus and respiratory syncytial virus were the main pathogens detected in the outpatients， with detection rates of 9.89%， 2.92% and 2.02%， respectively； influenza， respiratory syncytial virus， and rhinovirus were the main pathogens detected in inpatient children， with detection rates of 6.29%， 1.57%， and 1.35%， respectively. ConclusionThe prevalence of pathogens related to acute respiratory infections in children is influenced by non pharmacological preventive measures.

Background In recent years, radiation diagnosis and treatment technology has been increasingly applied and popularized in the medical field, and the status of radiation health protection has attracted widespread attention. Objective To understand the knowledge, attitude, and behavior of radiological health protection in radiation workers in Jiading District of Shanghai. Methods Convenience sampling method was used to select 441 radiation workers from 33 medical institutions in Jiading District, Shanghai to conduct a questionnaire survey from May to August 2023. Basic information and radiation protection associated knowledge, attitude, and behavior were collected from the study participants, and the scores of knowledge, attitude, and behavior were calculated. Factors affecting the behavior were evaluated by multiple linear regression. Results A total of 441 subjects were included in this study, with an age range of 22-71 years, 53.06% male and 46.94% female. In terms of knowledge, the correct response rate of the study subjects to the seven questions on the basics of radiation protection ranged from 44.22%-96.60%, with the lowest rate of 44.22% for the question on "radiation stochastic effect diseases". The subjects acquired knowledge about radiation hygiene mainly through vocational training (98.41%), and wanted to acquire knowledge mainly about the basics of nuclear and radiation (76.42%). In terms of attitude, the recognition level (strongly agree/agree) of the study subjects on the six attitude questions ranged from 73.47% to 96.37%, in which only 56.92% of the radiological staff at tertiary hospitals believed that the radiation dose they were exposed to at work would be hazardous to their health, and 73.85% believed that it was necessary to participate in training on knowledge of radiological protection, both lower than those in other levels of hospitals. In terms of behavior, the implementation rate (always/often) of the five behavioral questions by the study participants ranged from 75.28% to 91.84%, and there was a statistically significant difference in the total behavioral scores of the study participants by levels of hospitals (P=0.015). The results of multiple linear regression showed that gender, age, and radiation work permit associated with the behavioral scores of the study subjects. Conclusion In Jiading District, Shanghai, the coginitive rate of radiation workers' basic knowledge of theoretical protection still needs to be improved, and occupational training should be carried out in a targeted manner; the attitude of radiation workers varies by levels of hospitals, and the publicity and education of workers at tertiary hospitals in particular should be strengthened; and the supervision and management of male, senior, and non-certified radiation workers in hospitals of different levels should be enhanced.

Background::Long non-coding RNAs (lncRNAs) plays an important role in the progression of gastric cancer (GC). Their involvement ranges from genetic regulation to cancer progression. However, the mechanistic roles of RP11-789C1.1 in GC are not fully understood.Methods::We identified the expression of lncRNA RP11-789C1.1 in GC tissues and cell lines by real-time fluorescent quantitative polymerase chain reaction. A series of functional experiments revealed the effect of RP11-789C1.1 on the proliferation of GC cells. In vivo experiments verified the effect of RP11-789C1.1 on the biological behavior of a GC cell line. RNA pull-down unveiled RP11-789C1.1 interacting proteins. Western blot analysis indicated the downstream pathway changes of RP11-789C1.1, and an oxaliplatin dosing experiment disclosed the influence of RP11-789C1.1 on the drug sensitivity of oxaliplatin. Results::Our results demonstrated that RP11-789C1.1 inhibited the proliferation of GC cells and promoted the apoptosis of GC cells. Mechanistically, RP11-789C1.1 inhibited checkpoint kinase 1 (CHK1) phosphorylation by binding ataxiatelangiectasia mutated and Rad3 related (ATR), a serine/threonine-specific protein kinase, promoted GC apoptosis, and mediated oxaliplatin sensitivity.Conclusion::In general, we discovered a tumor suppressor molecule RP11-789C1.1 and confirmed its mechanism of action, providing a theoretical basis for targeted GC therapy.

Objective To investigate the clinical characteristics and risk factors of plastic bronchitis(PB)occurrence in children patients with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods A retrospective analysis was performed on the clinical data of 399 children patients with RMPP treated by fiberoptic bronchoscopy hospitalized in this hospital from January 2017 to December 2019.The pa-tients were divided into the PB group(n=142)and non-PB group(n=257)according to whether or not find-ing PB under fiberoptic bronchoscopy.The differences in clinical characteristics,laboratory detection indicators and imageological manifestations were compared between the two groups.The risk factors of PB occurrence in children RMPP were analyzed.Results Compared with the non-PB group,the incidence rates of hypoxemia and extrapul-monary complications,and the highest body temperature in the PB group were higher,number of fever days and hospitalization days was longer,the proportions of hormone and intravenous injection of immunoglobulin were higher,the levels of NEUT,CRP,IL-6,AST,ALT LDH CK and D-Dimer and incidence rates of pulmo-nary atelectasis and pleural effusion were higher,the levels of PLT and lymphocytes were lower,and the differences were statistically significant(P＜0.05).The receiver operating characteristic(ROC)curve analy-sis results showed that the highest body temperature,NEUT,PCT,IL-6,AST and LDH could serve as the predictive indicators for PB occurrence in RMPP(P＜0.05).The multivariate logistic regression analysis re-sults showed that the highest body temperature＞39.8 ℃,NEUT＞72.9％,IL-6＞26.65 pg/mL,AST＞49.5 U/L and pulmonary atelectasis were the risk factors of PB occurrence in RMPP.Conclusion Should pay at-tention to the risk factors of PB occurrence in children patients with RMPP and take necessary preventive measures to improve their prognosis.

Objective:To summarize the genotype and clinical phenotype of children with WWOX gene related developmental and epileptic encephalopathy (DEE).Methods:Case series studies. The clinical data of 12 children with WWOX gene related DEE who were admitted to the Neurological Department of Children′s Medical Center, Peking University First Hospital from June 2019 to December 2023 were analyzed. The children′s characteristics of gene variation, clinical phenotype, auxiliary examination results, treatment and prognosis were analyzed.Results:Among 12 children with WWOX gene related DEE, there were 7 boys and 5 girls, the age of seizure onset ranged from 10 days to 6 months (median 1.8 months). Multiple seizure types were observed, including focal seizures in 10 cases, epileptic spasms in 9 cases, tonic seizures in 4 cases, myoclonic seizures in 1 case. Among 12 cases, 9 cases had multiple seizure types. All 12 cases showed microcephaly and global developmental delay. Video electroencephalography showed slowed background activity in 6 cases, hyperarrhythmia in 6 cases, multifocal discharges in 6 cases, and focal discharges in 1 case. Epileptic spasms were detected in 8 cases, tonic seizures in 4 cases and myoclonic seizures in 1 case. Brain magnetic resonance imaging showed bilateral frontotemporal subarachnoid space widening in 5 cases, deep sulci in 3 cases, bilateral ventricular enlargement in 2 cases, callosal hypoplasia in 5 cases, and delayed white matter myelination in 3 cases. The phenotypes of 12 cases were consistent with the diagnosis of DEE, and 8 of them were diagnosed with infantile epileptic spasm syndrome. All the WWOX gene variants in 12 cases were complex heterozygous variants, including 20 variants, 11 variants and 1 large intragenic WWOX gene deletion (p.Ala149Thr, p.Arg156Ser, p.R167Tfs*8, p.Leu186Val, c.605+5G>A, p.Trp218*, p.His263Arg, p.Leu275fs*19*1, p.N285Kfs*10, p.Ser304Tyr, p.Met326Arg, loss1 exon2-8) had not been reported previously. The age of last follow-up ranged from 11 months to 5 years and 3 months. During the follow-up, 1 case died at the age of 1 year and 10 months, 2 cases were seizure-free, and 9 cases still had seizures after multiple anti-seizure medications.Conclusions:The seizure onset age of children with WWOX gene related DEE is usually less than 6 months, and some of them in neonate. The common seizure types include focal seizures and epileptic spasms. Children usually have microcephaly and global developmental delay. WWOX gene related DEE usually has drug refractory epilepsy.

Objective To observe the value of MRI for differential diagnosis of ovarian granulosa cell tumor(OGCT)and ovarian thecoma-fibroma(OTF).Methods Data of 37 females with OGCT(OGCT group)and 74 with OTF(OTF group)were retrospectively analyzed.MRI parameters were compared between groups.Multiple logistic regression analysis was performed,and the efficacy of each parameter alone and their combination for distinguishing OGCT and OTF were observed.Results Significant differences of cystic-solid classification,degree of cystic changes,the maximum diameter of cyst area of lesions,T2WI signal,enhancement degree and apparent diffusion coefficient(ADC)of the solid part of lesions,presence of honeycomb sign/cheese sign,presence of tumor blood vessels and bleeding were found between groups(all P＜0.05).Degree of cystic changes,ADC and presence of honeycomb sign/cheese sign were impact factors of MRI for distinguishing OGCT and OTF.The area under the curve(AUC)of the above three for distinguishing OGCT and OTF was 0.834,0.868 and 0.744,respectively,and of the combination was 0.934,greater than any alone(all P＜0.05).Conclusion MRI features such as degree of cystic changes,ADC and presence of honeycomb sign/cheese sign were helpful for distinguishing OGCT and OTF.

Objective To investigate the relationship between choroidal thickness and white matter hyperintensity(WMH)in patients with recent subcortical small infarct(RSSI).Methods A total of 83 RSSI patients hospitalized in our hospital from November 2021 to May 2023 were enrolled,and according to paraventricular WMH,they were divided into no to mild lesion group 1(46 cases)and moderate to severe lesion group 1(37 cases),and based on deep WMH,40 of them were assigned into no to mild lesion group 2 and 43 cases into moderate to severe lesion group 2.All patients underwent cranial MRI for paraventricular WMH and deep WMH,and optical coher-ence tomography to measure choroid thickness by semi-automatic segmentation.The relationship between choroidal thickness and WMH at paraventricular and deep parts was analyzed.Results Significant advanced age,higher proportions of smoking and hypertension,and larger volume of deep WMH,while obviously thinner choroid thickness were observed in the moderate to severe lesion group 2 than the no to mild lesion group 2(P＜0.05,P＜0.01).While the moder-ate to severe lesion group 1 had older age,higher smoking and hypertension ratios,and higher volume of paraventricular WMH when compared with the no to mild group 1(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that age(OR=1.170,95％CI:1.064-1.287,P=0.001),hypertension(OR=4.533,95％CI:1.215-16.914,P=0.024),and choroidal thickness(OR=0.953,95％CI:0.931-0.975,P=0.001)were independent risk factors for deep WMH grade.Conclusion Changes in choroidal thickness in RSSI patients are independent influ-encing factors for severity of deep WMH lesions.The more severe the deep WMH lesion is,the thinner the choroidal thickness.

Quantitative susceptibility mapping (QSM) is a noninvasive MR post-processing technique that can quantitatively analyze tissue magnetic susceptibility, which has important value in early diagnosis and assessment of cerebral small vessel disease (CSVD). In recent years, QSM has gradually been applied in clinical neuroimaging both domestically and internationally, becoming a new hotspot. This review focuses on the principle and classification of QSM, application of QSM in the gray matter microstructure, white matter microstructure, venous oxygen saturation assessment, cerebral microhemorrhage and cognitive function assessment of CSVD, so as to provide new perspective for its neuroimaging evaluation.