Objective To explore the abnormalities in the posterior cingulated cortex structure by voxel based morphometry(VBM)and changes of functional connectivity by resting-state functional magnetic resonance imaging(fMRI)in long-term heroin addictions.Methods High-resolution volumetric T1-weighted images and resting state fMRI examination were performed on 13 long-term heroin addicts and 14 matched healthy volunteers.The T1-weighted images were processed using optimized voxel-based morphometry to investigate abnormalities in the gray matter,at the sarne time,the posterior cingulated cortex was setted as the region-of-interest(ROI)seed,with which a whole-brain voxel temporal correlation in low frequency fMRI fluctuations was calculated,to find changes of the posterior cingulated cortex functional connectivity.Results Compared with the control group,gray matter concentration significantly decreased in the posterior cingnlated cortex,at the same time,the functional connectivity between the left posterior cingulated cortex and the right temporal lobe was increased,but the functional connectivity between the left posterior eingulated cortex and the left thalamus,the left parietal lobe,the left cerebrum were all decreased in heroin addicts.At the same time,the functional connectivity between the fight posterior cingulated cortex and the left thalamus,the left parietal lobe,the left frontal lobe were decreased in heroin addicts(t testing,P<0.01).Conclusion The structure and the functional connectivity in posterior cingulated cortex in long-term heroin addicts are changed,which may affect the dysfunction of the addictive brain and the function of reward mechanism.

Objective To evaluate the application values of diffusion tensor tractography (DTT) combined with neuronavigation in microsurgery of insular gliomas. Methods The clinical data of 27 patients with insular gliomas, admitted to our hospital from March 2013 to October 2017, were analyzed retrospectively. All DTT images were transferred to the neuronavigation system, and the three-dimensional location of tumors and pyramidal tracts were re-constructed. Surgical approaches were designed and excision scopes were defined before the surgery. Techniques on how to distinguish and protect the key blood vessels and pyramidal tracts were discussed. The treatment efficacies were analyzed. Results Total lesion resection was achieved in 22 patients (81.5％), subtotal resection in 4 (14.8％ ), and partial resection in one (3.7％ ). Postoperative pathology indicated 7 were oligodendrogliomas, and 20 were astrocytomas, including WHO grade I in one, grade II in 18, and grade III in one. One patient had transient aphasia (recovery after two weeks), 2 experienced worsened hemiplegia on opposite side of their bodies (normal after one month), and the left 24 patients remained intact function after operation. Conclusions The combination of DTT and neuronavigation is safe and effective in surgical treatment for insular gliomas, which can protect the brain function at greatest degree and maximize lesion resection, and improve the postoperative quality of life.

ObjectiveTo investigate the population distribution of non-alcoholic fatty liver disease before and after renaming and the association between the types of metabolic risk factors （MRF） for metabolic dysfunction-associated steatotic liver disease （MASLD） and advanced liver fibrosis. MethodsThis study was conducted among 515 patients who were admitted to The Affiliated Hospital of Xuzhou Medical University and Wuxi Fifth People’s Hospital from January 2019 to January 2022 and had hepatocyte steatosis ≥5% by liver biopsy. Among these patients， 2 patients did not meet the diagnostic criteria for nonalcoholic fatty liver disease （NAFLD） and metabolic associated fatty liver disease （MAFLD）， respectively， and were classified as steatotic liver disease （SLD） with other specific causes， and the other 513 patients were divided into MASLD group with 275 patients， comorbid group with 216 patients （MASLD comorbid with other liver diseases）， and cryptogenic SLD group with 22 patients. The above groups were compared in terms of clinical features， laboratory markers， and advanced liver fibrosis. The MASLD patients with different types of MRF were compared in terms of clinical features， laboratory markers， and advanced liver fibrosis， and the risk factors for advanced liver fibrosis in patients with MASLD were analyzed. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups and further comparison between two groups； the chi-square test was used for comparison of categorical data between multiple groups， and Bonferroni correction was used for further comparison between two groups. The logistic regression analysis was used to identify the risk factors for liver fibrosis. ResultsAmong the 515 patients with SLD， 297 patients （57.7%） met the diagnostic criteria for NAFLD， among whom 22 were classified as cryptogenic SLD and 275 met the diagnostic criteria for MASLD， and 467 （90.7%） were diagnosed with MAFLD. There were significant differences between the three groups in sex， body mass index （BMI）， gamma-glutamyl transpeptidase， triglyceride， cholesterol， low-density lipoprotein cholesterol， high-density lipoprotein cholesterol， fasting plasma glucose， NAFLD fibrosis score （NFS）， fibrosis-4 （FIB-4）， and F3-4 （all P<0.05）. Compared with the MASLD group and the cryptogenic SLD group， the comorbid group had the highest proportion of patients with advanced liver fibrosis （P<0.001）. With the increase in the type of MRF， the patients tended to have an older age， a significantly higher proportion of female patients， a higher possibility of hypertension and diabetes， and higher levels of metabolic parameters including BMI， blood lipids， and blood glucose （all P<0.05）. With the increase in the types of MRF in MASLD patients， they tended to have significantly higher noninvasive fibrosis scores （NFS and FIB-4） and a significantly higher proportion of patients with advanced liver fibrosis （P<0.05）. The multivariate logistic regression analysis showed that age ≥50 years （odds ratio ［OR］=2.622， 95% confidence interval ［CI］： 1.091‍ ‍—‍ ‍6.300， P=0.031） and the increase in the type of MRF （OR=1.876， 95%CI： 1.194‍ ‍—‍ ‍2.947， P=0.006） were independent risk factors for MASLD with severe liver fibrosis. ConclusionThe new definition of MASLD is based on the positive identification of MRF， and the reclassified population of MASLD is smaller than that of MAFLD， with little difference from that of NAFLD. In addition， age ≥50 years and the increase in the type of MRF are independent risk factors for MASLD with advanced liver fibrosis.

ObjectiveTo establish an early predictive model using serological markers based on LASSO regression for predicting the possibility of HBsAg clearance in HBeAg-negative chronic hepatitis B （CHB） patients treated with pegylated interferon α-2b （PEG-IFNα-2b）， and to investigate the diagnostic value of the model. MethodsA total of 136 HBeAg-negative CHB patients who received PEG-IFNα-2b treatment in the Affiliated Hospital of Xuzhou Medical University from April 2020 to October 2021 were enrolled， among whom 47 received PEG-IFNα-2b for the first time （previously untreated） and 89 received PEG-IFNα-2b after 48 weeks of treatment with nucleos（t）ide analogues （treatment-experienced）. The patients were randomly assigned to a training set with 95 patients and a validation set with 41 patients at a ratio of 7∶3， and related data were collected for both groups， including virological markers， routine blood test results， and liver function at baseline and week 12 of treatment. According to HBsAg status at week 48 of treatment， the patients were divided into seroconversion group with 38 patients and non-seroconversion group with 98 patients. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical variables between two groups. The LASSO regression analysis and univariate and multivariate logistic regression analyses were used to establish a nomogram model； the receiver operating characteristic （ROC） curve was used to assess its predictive ability， and the area under the ROC curve （AUC） was used for comparison of predictive value. ResultsIn the training set， 95 HBeAg-negative CHB patients were treated with PEG-IFNα-2b for 48 weeks， among whom there were 27 patients in the seroconversion group and 68 in the non-seroconversion group. The univariate Logistic regression analysis， with P<0.2 as the criterion for screening， showed that 9 indicators were included in the LASSO regression analysis， i.e.， sex， baseline HBV DNA level， the reduction in HBV DNA in 0 — 12 weeks， baseline HBsAg level， the reduction in HBsAg in 0 — 12 weeks， baseline aspartate aminotransferase （AST） level， the reduction in AST in 0 — 12 weeks， baseline alanine aminotransferase （ALT） level， and the reduction in ALT in 0 — 12 weeks. The LASSO regression analysis showed that sex， baseline HBsAg level， the reduction in HBsAg in 0 — 12 weeks， and the reduction in ALT in 0 — 12 weeks were non-zero variables and were included in the multivariate Logistic regression analysis. The multivariate Logistic regression analysis obtained 4 independent predictive factors， i.e.， sex （odds ratio ［OR］=5.38， 95% confidence interval ［CI］： 1.11 — 34.21， P=0.049）， baseline HBsAg level （OR=0.12， 95%CI： 0.04 — 0.26， P<0.001）， the reduction in HBsAg in 0 — 12 weeks （OR=5.54， 95%CI： 1.97 — 19.18， P=0.003）， and the reduction in ALT in 0 — 12 weeks （OR=0.99， 95%CI： 0.97 — 1.00， P=0.039）. A nomogram model was established based on the results of the multivariate Logistic regression analysis， and the ROC curve was used to assess the predictive value of this nomogram model. This nomogram model had an AUC of 0.934 （95%CI： 0.886 — 0.981） in the training set and an AUC of 0.921 （95%CI： 0.838 — 1.000） in the validation set. In addition， the results of calibration curve and decision curve analyses showed that the model had good consistency and accuracy. ConclusionBased on general information and serological markers， the LASSO regression analysis is used to establish a nomogram model using sex， baseline HBsAg level， the reduction in HBsAg in 0 — 12 weeks， and the reduction in ALT in 0 — 12 weeks， and this model can be used to predict the probability of achieving HBsAg clearance in HBeAg-negative CHB patients treated with PEG-IFNα-2b， which provides important reference and theoretical support for the clinical treatment of patients.