Objective:To investigate the impact of Bayesian penalized likelihood (BPL) PET reconstruction method on the uptake of 18F-fluorodeoxyglucose (FDG) and signal to noise ratio (SNR) of lungs, liver, aorta and bones. Methods:From March 2019 to June 2019, the 18F-FDG PET/CT images of 60 patients with clinical diagnosed tumors (29 males, 31 females, age: 24-89 (60.4±15.2) years) in Yuhuangding Hospital were retrospectively analyzed. PET images were reconstructed with ordered subset expectation maximization (OSEM), time of flight (TOF)+ point spread function (PSF) and BPL (β=350) algorithms. Volumes of interest (VOIs) were delineated on the right upper lung lobe, the right liver, aortic root and lumbar vertebra. The mean standardized uptake value (SUV mean), maximum standardized uptake value (SUV max), peak of lean body standardized uptake value (SUL peak), standard deviation of standardized uptake value (SUV SD) and the SNR were measured. The percentage of SNR change (%ΔSNR) between the BPL method and non-BPL methods were calculated. The correlations between body mass index (BMI) and %ΔSNR were analyzed by Pearson correlation analysis. One-way analysis of variance and the least significant difference (LSD) t test were used to analyze the data. Results:There were no significant differences of SUV mean and SUL peak in lung, aorta, liver and lumbar vertebra among 3 methods ( F values: 0.04-1.95, all P>0.05). The SUV max in lung, aorta, liver and lumbar vertebra of BPL reconstruction (1.14±0.82, 2.13±0.37, 2.95±0.50 and 2.76±0.87) was significantly lower than those of TOF+ PSF (1.56±0.61, 2.99±0.75, 4.32±0.94 and 4.05±1.48) and OSEM (1.51±0.67, 3.00±0.70, 4.45±1.12 and 3.81±1.06) reconstructions ( F values: 20.59-52.24, all P<0.001) and SUV SD (0.13±0.07, 0.20±0.05, 0.26±0.06, 0.38±0.17) was also significantly lower than those of TOF+ PSF (0.24±0.11, 0.43±0.11, 0.58±0.15, 0.67±0.21) and OSEM (0.21±0.09, 0.42±0.10, 0.58±0.14, 0.63±0.20) reconstructions ( F values: 24.46-124.95, all P<0.001), while the SNR (4.67±1.34, 7.74±2.22, 8.17±1.77, 4.45±1.22) was significantly higher than those of TOF+ PSF (2.54±0.72, 3.55±0.82, 3.77±0.91, 2.49±0.69) and OSEM (2.65±0.64, 3.67±0.80, 3.75±0.87, 2.60±0.67) reconstructions ( F values: 83.04-247.73, all P<0.001). However, there were no significant differences between OSEM and TOF+ PSF reconstructed images in SUL peak, SUV mean, SUV SD and SNR (all P>0.05). In BPL group, SNR increased with the increase of BMI, and there were statistically differences of aortic SNR (7.07±2.21 vs 9.67±2.26) and liver SNR (7.75±1.85 vs 9.32±0.70) between BMI<25 kg/m 2 and BMI≥30 kg/m 2 ( F values: 3.46 and 4.19, both P<0.05). Positive correlations were found between %ΔSNR of lung, aorta, liver and lumbar vertebra in OSEM and TOF+ PSF and BMI ( r value: 0.042-0.354, all P<0.05). Conclusion:In background tissues, BPL algorithm has no significant impact on absolute quantification compared with OSEM and TOF + PSF reconstruction methods but it can significantly improve SNR, especially for the patients with large body weight.

Objective To observe the recent effect and safety of minimally invasive transurethral double pole plasma-prostatectomy (PKEP) for the treatment of the benign prostatic hyperplasia (BPH). Methods One hundred and twenty-six patients with BPH were selected by parallel group design, and divided into two groups by piecewise equilibrium stochastic method. Sixty-three patients in the control group were treated with transurethral prostate electrotomy (TURP). The study group of 63 patients was treated with PKEP. Weight, operation time, intraoperative bleeding and complications of the patients were recorded. Three months after surgery, the maximum urine flow rate (Qmax), residual urine volume (PVP), international prostate symptom score(IPSS)and quality of life score(QOL)was used to evaluate the improvement of symptoms. Results The average operation time, postoperative hospital stay, time placing a urinary catheter in study group was shorter than that in the control group(50.2 ± 8.5)min vs (62.4 ± 10.3)min,(5.0 ± 0.7)d vs.(6.4 ± 1.2)d,(38.4 ± 2.7)h vs.(80.5 ± 6.9)h,intraoperative blood loss was less than that in the control group, (62.4 ± 13.7)ml vs.(91.6 ± 23.5)ml,and removing tissue volume was better than that in the control group (53.4 ± 5.9) g vs. (39.6 ± 7.2) g. Differences were statistically significant (P < 0.05). After surgery, the PVP significantly reduced, Qmaxincreased significantly, the IPSS and QOL scores significantly reduced, and the differences were statistically significant(P<0.05). However, there was no significant difference between PVP, Qmax, IPSS and QOL in the two groups(P>0.05).The incidence of postoperative complications in the study was 30.16%(19/63), significantly lower than that of the control group(46.03%,29/63), and the difference was statistically significant(P<0.05). Conclusions PKEP is better than TURP in the treatment of large volume BPH of old age, and PKEP is safer than TURP.

Objective: To explore the occurrence of cognitive impairment in Chinese heart failure (HF) patients and it's impact on prognosis. Methods: In this prospective observational study, a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014. All patients were administrated with the interview-format Montreal Cognitive Assessment (MoCA), according to which they were divided into MoCA<26 (with cognitive impairment) group and MoCA≥26 (without cognitive impairment) group. Baseline data were collected and a 1-year follow up was carried out. Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes. Results: Cognitive impairment was evidenced in 628 patients (63.4%) and they were more likely to be older, female, and with higher proportion of New York Heart Association(NYHA) class Ⅲ-Ⅳ, chronic obstructive pulmonary disease (COPD), ischemic heart disease, while body mass index (BMI), education level, and medical insurance rate were lower (all P<0.05) as compared to patients in MoCA≥26 group. The rate of percutaneous intervention, device implantation, cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group (all P<0.05). During the 1-year follow up, patients in the MoCA<26 group had higher all-cause mortality (10.2%(64/628) vs. 2.2%(8/362), P<0.01), cardiovascular mortality (5.9%(37/628) vs. 0.8%(3/362), P<0.01) and major adverse cardiac and cerebrovascular events (MACCE) (9.6%(60/628) vs. 2.5%(8/362), P<0.01) than patients in the MoCA≥26 group. In univariate regression, MoCA<26 was associated with increased all-cause mortality (HR(95%CI):4.739(2.272-9.885), P<0.01), cardiovascular mortality (HR(95%CI):7.258(2.237-23.548), P=0.001) and MACCE (OR(95%CI):4.143(2.031-8.453), P<0.01). After adjustment by multivariate regression, MoCA<26 was indicated as an independent risk factor for all-cause mortality (HR(95%CI): 6.387(2.533-16.104), P<0.01), cardiovascular mortality (HR(95%CI): 10.848(2.586-45.506), P=0.001) and MACCE (OR(95%CI): 4.081(1.299-12.816), P=0.016), while not for re-hospitalization for HF (OR(95%CI):1.010(0.700-1.457), P=0.957). Conclusions Cognitive impairment is common in HF patients,and it is an independent prognostic factor for 1-year outcomes. Routine cognitive function assessment and active intervention are thus recommended for HF patients.

Objective:To investigate the distribution and influencing factors of the ocular biological parameters related to refractive development in school-age children.Methods:A cross-sectional study was performed.A total of 1 091 children aged 6-12 years old from July, 2017 to August, 2018, resident in downtown of Zhenjiang were enrolled in this study.The corneal radius of curvature (CR) and axial length/corneal radius of curvature ratio (AL/CR) were calculated after AL and corneal curvature (K) were measured by IOL Master.After pupillary dilatation with 0.5% tropicamide, cycloplegic retinoscopy was performed to identify refractive status.According to the spherical equivalent refraction (SER), all right eyes were classified into myopia, hyperopia and emmetropia.The comparison of the above parameters between different genders, as well as among different age groups and different refractive status groups were determined while the relative factors of the biological parameters and refractive status were analyzed by multivariate regression analysis.The study protocol was approved by the Ethics Committee of Affiliated People's Hospital of Jiangsu University (No.K-20190153-W).Results:There were statistical differences in AL, SER and AL/CR value among different age groups ( F=32.34, P<0.01; F=33.69, P<0.01; F=2.19, P=0.04), which showed that refractive status shifted to myopia as well as AL and AL/CR value were increased with age.Compared with the girls, the boys had significantly longer AL, greater CR, greater AL/CR value, and smaller K ( t=7.58, P<0.01; t=-7.48, P<0.01; t=-8.08, P<0.01; t=-2.14, P=0.03). There were statistical differences in AL and AL/CR value among different refractive status groups ( F=192.68, P<0.01; F=143.15, P<0.01). The myopia group had longer AL and greater AL/CR value than the other two groups.Children whose parents were not myopic and children who had outdoor activities more than 14 hours per week and did homework less than 20 hours per week and children who slept more than 9 hours per day had shorter AL, smaller AL/CR value, and were more inclined to hyperopia or emmetropia.The results of multivariate regression analysis suggested that children aged from 6-12 years old with older age, female, increased height, parental myopia, and more time in homework or less time in outdoor activities per week may be more likely to have myopia, and longer AL or bigger AL/CR value was correlated with older age, male, greater body mass index (BMI), increased height, myopia conditions of parents, more time of doing homework, and less time in outdoor activities. Conclusions:The SER shifts to myopia with age in 6 to 12-year-old school-age children in the downtown of Zhenjiang.And there are significant differences in AL, CR and AL/CR value between boys and girls.Female, older age, increased height, more time in homework, less time in outdoor activities, and parental myopia are associated with more negative SER.

Objective:To analyze the optimal preoperative timing of indocyanine green administration to do the fluorescence imaging during laparoscopic cholecystectomy.Methods:A total of 102 patients with laparoscopic cholecystectomy from January 2019 to November 2019 were retrospectively analyzed in this study, including 42 male patients and 60 female patients with an average age of 49(15-87) years old. The preoperative timing of indocyanine green (2.5 mg/ml, 1 ml) administration was set at 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 h before surgery, 12, 7, 8, 6, 6, 7, 8, 10, 8, 8, 8, 7, 7 patients, respectively. The intraoperative fluorescence imaging and signal contrast were compared.Results:Comparing with 0.5h group, the liver fluorescence intensities in 5, 6, 7, 8, 9, 10, 11 and12 h groups were significantly decreased (all P<0.05). There were no differences in the fluorescence intensities of the gallbladder, gallbladder duct, common bile duct and common liver duct between those groups with different injection timepoints (all P>0.05), and signal contrast was significantly lower in 0.5 h group than patients in 6, 7, 8, 9, 10, 11 and 12 h groups (all P<0.05). When preoperative timing of indocyanine green administration was 7 h, the fluorescence signal contrast reached the highest values of 0.29. Conclusions:The optimal preoperative timing of indocyanine green intravenous administration for laparoscopic cholecystectomy under fluorescence navigation was 7 h at dose 2.5 mg.

Objective:To investigate the role and underlying mechanisms of inhibiting high mobility group box-1 (HMGB1) in the expression of matrix metalloproteinase-9 (MMP-9) in spinal cord astrocytes (AS) in rats after spinal cord injury (SCI).Methods:After an SCI model was established in Sprague-Dawley (SD) rats using a modified Allen's Weight-Dropping method and ethyl pyruvate (EP) or glycyrrhizin (GL) was used to inhibit the effect of HMGB1, the rats were divided into a sham group, an SCI group, an SCI+EP (50 mg/kg) group, and an SCI+GL (100 mg/kg) group. The expression levels of glial fibrillary acid protein (GFAP) and MMP-9 in spinal cord AS were observed. After the spinal cord AS in SD rats was cultured and incubated by the oxygen-glucose deprivation/reoxygenation (OGD/R) procedure, the expression of MMP-9 protein was detected at 6 h/R 6 h, 12 h, 24 h, and 48 h after OGD. The time point with the highest expression was chosen in the subsequent experiments as an OGD/R group. HMGB1 was inhibited by HMGB1 shRNA or EP to observe the effect of HMGB1 on the expression of MMP-9 protein in AS treated with OGD/R. Then, toll-like receptor 4 (TLR4) inhibitor, TIR-domain-containing adaptor inducing interferon- β (TRIF) inhibitor, and nuclear factor-kappa B (NF- κB) inhibitor were used to investigate the effects of TLR4/TRIF/NF- κB signaling pathway during the regulation of HMGB1 on MMP-9 in vitro. Results:Western blot showed that the expression of MMP-9 protein in the spinal cord was significantly increased in rats at 1 d after SCI, and the expression of MMP-9 protein in the SCI+EP group and the SCI+GL group was significantly lower than that in the SCI group ( P<0.001). Immunofluorescence showed that GFAP and MMP-9 proteins were co-localized in the spinal cord after SCI, and the expression of GFAP and MMP-9 proteins in the SCI+EP and SCI+GL groups was significantly lower than that in the SCI group ( P<0.05). Since the expression of MMP-9 protein in the spinal cord AS cultured in vitro was significantly higher in the OGD 6h/R 12h group than that in the normal group and the OGD 6h/R 6h, 24, and 48 h groups, the OGD 6h/R 12h was taken as the OGD/R group. The MMP-9 protein expression in AS in the OGD/R+HMGB1 shRNA group and the OGD/R+EP group was significantly lower than that in the OGD/R group ( P<0.001). In the cultured AS, moreover, inhibiting TLR4, TRIF, and NF- κB reduced MMP-9 protein expression after OGD 6 h/R 12 h when compared with that in the OGD/R group ( P<0.001). Conclusions:HMGB1 inhibition may result in a reduction in MMP-9 expression both in the spinal cord AS in SCI rats and in AS after OGD/R treatment in vitro. HMGB1 may regulate MMP-9 protein expression in AS after OGD/R treatment via the TLR4/TRIF/NF- κB signal pathway.

Objective:To improve the ability of identification and differential diagnosis of severe systemic lupus erythematosus (SLE).Methods:A severe SLE patient with lupus myocarditis, neuropsychiatric lupus, thrombotic microangiopathy (TMA) and other multiple system involvement was reported and discussed.Results:A young female patient developed albuminuria 5 months ago, edema of both lower limbs 3 months ago, change of consciousness 1 month ago and two convulsions attack 2 days ago. She experienced life threatening manifestations such as neuropsychiatric lupus, myocardial involvement of lupus, and TMA. During the course, her condition was generally improved after glucocorticoid pulse therapy and plasma exchange.Conclusion:Various complicated clinical manifestations related to SLE need to be recognized earlier and intervened as soon as possible.

Objective To investigate the prevalence of allergic and infectious diseases in children， and to assess the influence of indoor and outdoor environmental factors on these two common diseases in children. Methods A questionnaire was used to investigate the prevalence of allergic and infectious diseases in 140 children of 7 years old in Laizhou Bay， Shandong Province. Logistic regression was used to analyze the associations between indoor and outdoor environmental factors and children’s allergic and infectious diseases， respectively. Results The prevalence of previous eczema and other allergic diseases for the past year in children was 37.9% and 15.0%， respectively， and the prevalence of infectious diseases for the past year was 35.7%. As for allergic diseases， eye irritation due to outdoor air （ OR =2.977； 95% CI ： 1.407‒6.296） and nose irritation due to outdoor air （ OR =5.147； 95% CI ： 1.272‒20.827） were the risk factors for previous eczema in children. Indoor musty taste increased the risks of urticaria （ OR =4.306； 95% CI ： 1.062‒17.454） and previous eczema （ OR =3.853； 95% CI ： 1.080‒13.743）. The use of cockroach killers indoors increased the risk of rhinitis （ OR =6.102； 95% CI ：1.297‒28.697）. As for infectious diseases， having outdoor pollution sources increased the risk of gastrointestinal infection （ OR =4.937； 95% CI ： 1.050‒23.216）， and the use of mosquito coils and clothing mothproofing agents increased the risks of respiratory （ OR =6.333； 95% CI ： 1.397‒28.714） and gastrointestinal infections （ OR =3.218； 95% CI ： 1.074‒9.644）， respectively. However， we did not find associations between indoor passive smoking and allergic or infectious diseases. Conclusion Except outdoor passive smoking， all the other indoor and outdoor environmental factors increase the risks of children’s allergies and infectious diseases.

ObjectiveTo determine the epidemiological characteristics and risk factors of a norovirus GII.17 outbreak in Minhang District of Shanghai in 2018， and provide evidence for prevention and control measures of norovirus infection. MethodsDescriptive epidemiological analysis was performed. In addition， a retrospective cohort study was conducted to determine the risk factors. ResultsFrom May 30^th to June 1^st of 2018， a total of 132 cases （126 clinical cases and 6 confirmed cases） were documented，with an attack rate of 29.20%（132/452）.All cases were children in a kindergarten， with the average age of 5 years and 43.9% being male. The cases were reported in all the classes， with no clustering by class or floor．The epidemic curve was characterized by a point source exposure， which was estimated to be probably between 7 AM on May 30^thand 0：30 AM on May 31^st. The retrospective cohort study showed that the attack rate significantly differed between the children who had taken and did not take the school lunch （RR=∞） on May 30^th，and those who had taken and did not take seafood noodles （RR=4.11， 95%CI：1.09-15.55） （P<0.05）. Among a total of 73 specimens， six specimens collected in child cases and one specimen in an asymptomatic chef tested positive for GII.17 type of norovirus. In addition， one retained food specimen of seafood noodles was positive for Aeromonas hydrophila. Viral shedding in the asymptomatic chef remained over 30 days. ConclusionThe outbreak was caused by seafood noodles contaminated by norovirus. It warrants enhancement in the regulation of food safety in canteens and regular examination of norovirus infection in catering industry employees.

Background Heavy metals are widely present in the environment, difficult to degrade, and bioaccumulative. Children's physical development are not mature, and exposure to heavy metals which may cause irreversible harm to them. However, the current research conclusions are still inconsistent. Therefore, it is very important to pay attention to the impact of heavy metal pollutants on physical development. Objective To detect the level of heavy metal exposure of school-age children in Laizhou Wan, Shandong Province, and to explore the relationship between heavy metal exposure level and physical development indexes of school-age children. Methods The subjects of this study were 318 children born to pregnant women recruited from Laizhou Wan Birth Cohort in Shandong Province from September 2010 to December 2013. The school-age children at age 7 were followed up from July to September 2019. Their urine samples were collected and the levels of arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) in urine were detected by inductively coupled plasma mass spectrometry (ICP-MS). At the same time, the height, weight, body mass index (BMI), waist circumference, and body fat percentage of the children were evaluate to analyze the relationship between the four heavy metals in children's urine and the indicators related to children's physical development. Results Among the 318 school-age children with an age (\begin{document}$\bar x \pm s $\end{document}) of (7.77±0.67) years, the median (P₂₅, P₇₅) levels of As, Cd, Pb, and Hg in urine were 73.98 (44.81, 124.61), 0.40 (0.27, 0.58), 1.20 (0.71, 1.72), and 2.38 (1.32, 4.80) µg·g⁻¹ (of creatinine), respectively. The children’s urinary Cd level was positively correlated with their weight, BMI, and waist circumference (P<0.05), and corresponding regression coefficients (b) and its 95% confidence intervals (CI) were 0.99 (0.14-1.83), 0.43 (0.06-0.81), and 1.35 (0.27-2.42), respectively; while the other heavy metals were not related to the above physical development indicators (P>0.05). After sex stratification, it was found that boys’ urinary Cd level was positively correlated with their height, weight, BMI, and waist circumference (P <0.05) with associated b (95%CI) of 1.73 (0.53-2.93), 2.03 (0.60-3.47), 0.75 (0.11-1.38), and 2.66 (0.85-4.47), respectively; such associations were not found in girls. After further stratification of boys’ BMI according to normal, overweight, and obesity, it was found that a higher urinary Cd level was correlated with an increased risk of obesity in boys (P<0.05), and the associated b (95%CI) was 2.34 (1.02-5.36). Conclusion The level of urinary Cd exposure of boys in Laizhou Wan, Shandong Province is positively correlated with their height, weight, BMI, and waist circumference, and may be related to obesity in boys.