The association of plasma tissue type plasmingogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) with carotid atherosclerosis in patients with type 2 diabetes was explored.The subjects with type 2 diabetes (n =91) and control subjects (n =30) were enrolled for this study.According to carotid artery intima media thickness in Color Doppler Ultrasonography,the subjects with type 2 diabetes were divided into four groups:normal carotid group(group 1,n =25),lining thickening group (group 2,n =30),stable plaques group (group 3,n =23),carotid stenosis group(group 4,n =13).Plasma t-PA and PAI-1 levels were measured by ELISA.Compared with the control group,there was no significant change in the levels of plasma t-PA and PAI-1 in group 1 (P＞0.05),plasma t-PA activity was decreased significantly(P＜0.05) and PAI-1 activity increased obviously (P＜0.05) in group 2,group 3,and group 4.Carotid atherosclerosis degree was negatively correlated with t-PA(r=-0.723,P＜0.01) and positively correlated with PAI-1 (r=0.851,P＜0.01).The results suggested that the abnormal fibrinolysis function may take part in the development of atherosclerosis of carotid arteries in patients with type 2 diabetes.

Objective To investigate the role of transoralsonography guiding fine?needle aspiration biopsy in the diagnosis of retropharyngeal or parapharyngeal masses identified on the CT, MRI or PET?CT images of treated patients with malignant carcinoma. Methods From 2002 to 2013,this study recruited fifty?five patients with a history of cancer, of which 50 were treated with radiation treatment, including 46 nasopharyngeal carcinoma, 3 esophagus squamous cell carcinoma and1 lung apex carcinoma. There were 4 patients with a history of 1 thyroid papillary carcinoma, 1 buccal mucosa squamous cell carcinoma,1 glottis squamous cell carcinoma and 1 sigmoid colon adenocarcinoma treated with surgery. The rest one patient with nasal olfactory neuroblastoma was treated by postoperative radiation. The enlarged retropharyngeal lymph nodes in 44 cases and parapharyngeal masses in 10 cases were identified on CT or MRI imges. The enlarged retropharyngeal lymph node in the rest case was identified on PET?CT. With transoral ultrasound examination, all lesions were with hypo?intensity echo. Cystic areas were noted on occasion. Biopsy was performed in all cases. Results After cytology examination, carcinoma cells were detected in 37 retropharyngeal lymph nodes, with a detection rate of 82% (37/ 45). In the 10 parapharyngeal masses, carcinoma cells were detected in 3 lesions, with a detection rate of 30%. Conclusions Transor alsonography guiding fine?needle aspiration biopsy can be useful in the cytopathology diagnosis of retropharyngeal or parapharyngeal masses identified on the CT, MRI or PET?CT images of treated patients with malignant carcinoma,which facilitates, early diagnosis and treatment for patients.

Objective:To investigate status quo of social support and social function in homeless schizophrenics.Methods:A total of 468 schizophrenics who received treatment in Hangzhou Seventh People's Hospital from January 2018 to December 2019 were included in this study. They were divided into homeless group ( n = 310) and non-homeless group ( n = 158) according to whether they had homeless behaviors. The basic information of admitted patients, level of social support and disease severity were surveyed among admitted patients using self-made questionnaire regarding basic information of admitted patients, Social Support Rating Scale, and Brief Psychiatric Rating Scale. Results:The numbers of schizophrenics in the aspects including male gender, rural household registration, non-local residents, no occupation, unmarried status, low level education, and age at 30-50 years in the homeless group were significantly higher than those in the non-homeless group ( χ2 = 3.58, 20.14, 18.69, 46.29, 33.16, 24.38, 29.75, all P < 0.05). The score for each SSRS domain and total score in the homeless group were significantly lower than those in the non-homeless group [(15.35 ± 5.42) points, (4.34 ± 2.78) points, (6.48 ± 1.89) points, (26.23 ± 7.35) points; (18.99 ± 3.78) points, (6.35 ± 3.23) points, (7.82 ± 2.01) points, (32.59 ± 7.02) points, t = 6.34, 10.52, 12.83, 14.68, all P < 0.001]. The score for each BPRS domain and total score in the homeless group were significantly higher than those in the non-homeless group [(19.35 ± 5.85) points, (22.58 ± 2.73) points, (18.74 ± 2.46) points, (18.48 ± 0.25) points, (16.38 ± 3.12) points, (79.43 ± 3.64) points; (12.92 ± 4.23) points, (16.24 ± 3.66) points, (16.97 ± 3.77) points, (10.58 ± 3.34) points, (6.36 ± 4.23) points, (62.72 ± 2.57) points, t = 9.92, 7.02, 6.33, 10.35, 15.74, 28.46, all P < 0.001]. Conclusion:The poor individual condition and low level of social support in patients with schizophrenia are important factors that cause homelessness.

Objective:To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) in tuberculous meningitis (TBM).Methods:From August 1, 2020 to August 31, 2022, 99 patients with suspected TBM admitted to the Tuberculosis Diagnosis and Treatment Center, Hangzhou Chest Hospital, Zhejiang University School of Medicine were enrolled. The cerebrospinal fluid (CSF) was tested for mNGS, GeneXpert Mycobacterium tuberculosis/rifampin (GeneXpert MTB/RIF) and mycobacterium culture. The sensitivity, specificity, positive predictive value, negative predictive value, agreement rate, Kappa value of the diagnostic efficacy of the three test methods were compared.The receiver-operating characteristic (ROC) curve of the diagnostic efficacy of mNGS was drawn. Chi-square test and rank sum test were used for statistical analysis. Results:Among the 99 suspected patients with TBM, 67 were diagnosed with TBM and 32 were non-TBM. Based on the results of 67 cases clinically diagnosed with TBM, the sensitivity, specificity, positive predictive value, negative predictive value, agreement rate and Kappa value of mNGS for the diagnosis of TBM were 82.1%, 100.0%, 100.0%, 72.7%, 87.9% and 0.748, respectively. The sensitivity of mNGS was higher than that of GeneXpert MTB/RIF (50.7%) and mycobacterium culture (28.4%). The differences were statistically significant ( χ2=12.61 and 32.42, respectively, both P<0.01). The detection time of mNGS was 1.0 (1.0, 2.0) day, which was shorter than 42.0 (42.0, 42.0) days of mycobacterium culture with statistical significance ( Z=10.80, P<0.001). ROC curve analysis showed that mNGS had the best diagnostic efficacy when the number of Mycobacterium tuberculosis sequences in CSF was one. Conclusions:The sensitivity and specificity of mNGS in the diagnosis of TBM are high, and the detection time is shorter, which could be used in the early diagnosis of TBM.

Objective To investigate the role of muhiple diagnostic methods in the head and neck tumor.Methods One hundred and ninety-six patients without definite pathological diagnosis referred from other hospitals were included in this retrospective study.All patients had a biopsy or fine needle aspiration (FNA) of the suspected region after detailed medical history enquiry,physical examination and imaging examination.Results All patients had ultrasound-guided FNA except 4 patients who had direct FNA.One hundred and seventy-one patients (87.2％) were confirmed to have tumor cells by pathological diagnosis,among them,31 patients by biopsy of primary region alone,106 by FNA,and 34 by both.The positive rate of FNA was 71.4％ (140/196) for the whole group,71.1％ (123/173),66.7％ (10/15) and 87.5％ (7/8) for retropharyngeal lymph node subgroup,parapharyngeal space subgroup and oropharynx subgroup.Conclusion The combined use of endoscope,MRI,and ultrasound-guided FNA is useful for the diagnosis of head and neck tumor.

Objective To develop a model for predicting cryptogenic stroke(CS)in patients with right to left shunt(RLS)through the patent foramen ovale(PFO).Methods We consecutively included 66 patients with CS confirmed by cranial magnetic resonance imaging and PFO-related RLS verified by contrast-enhanced transcranial Doppler ultrasonogra-phy and transesophageal echocardiography who were admitted to the Department of Neurology of The First Affiliated Hospi-tal of Soochow University from January 2020 to October 2022.83 patients diagnosed with PFO-RLS without stroke during the same period were included in the non-stroke(NCI)group.We analyzed the clinical data,anatomical parameters of PFO,and PFO-RLS status of patients;explored factors affecting the risk of CS in patients with PFO-RLS through a multi-variable logistic regression analysis;and built a combined prediction model,and evaluated its performance using the area under the receiver operating characteristic curve(AUC)in comparison with those of individual indicators with the use of the Delong test.Results At baseline,the CS group had significantly higher systolic and diastolic blood pressure levels and D-dimer levels as well as significantly greater PFO diameter and length than the control group(all P<0.05).The mul-tivariable logistic regression analysis revealed that hypertension,higher D-dimer levels,larger PFO diameter,and longer PFO length were factors affecting the risk of CS in patients with PFO-RLS,with the odds ratios[95%confidence intervals(CI)]being 4.16(1.31-13.15),1.01(1.00-1.01),2.29(1.14-4.61),and 1.19(1.03-1.36),respectively(all P<0.05).The AUCs(95%CI)of the combined prediction model,hypertension,D-dimer,PFO diameter,and PFO length were 0.79(0.71-0.86),0.64(0.55-0.73),0.62(0.53-0.71),0.67(0.58-0.75),and 0.65(0.56-0.74),respectively.According to the Delong test,the AUC of the combined prediction model differed sig-nificantly from those of individual indices(all P<0.05).At the optimal cut-off value,the sensitivity and specificity of the combined prediction model were 0.73 and 0.76,respectively.Conclusion Hyperten-sion,increased D-dimer levels,larger PFO diameter,and longer PFO length were factors associated with CS in patients with PFO-RLS.The combined prediction model is effec-tive in predicting the risk of CS for patients with PFO-RLS.

[Objective] To study the molecular biological mechanism for a case of ABO blood group B subtype, and perform three-dimensional modeling of the mutant enzyme. [Methods] The ABO phenotype was identified by the tube method and microcolumn gel method; the ABO gene of the proband was detected by sequence-specific primer polymerase chain reaction (PCR-SSP), and the exon 6 and 7 of the ABO gene were sequenced and analyzed. Homologous modeling of Bw.03 glycosyltransferase (GT) was carried out by Modeller and analyzed by PyMOL2.5.0 software. [Results] The weakening B antigen was detected in the proband sample by forward typing, and anti-B antibody was detected by reverse typing. PCR-SSP detection showed B, O gene, and the sequencing results showed c.721 C>T mutation in exon 7 of the B gene, resulting in p. Arg 241 Trp. Compared with the wild type, the structure of Bw.03GT was partially changed, and the intermolecular force analysis showed that the original three hydrogen bonds at 241 position disappeared. [Conclusion] Blood group molecular biology examination is helpful for the accurate identification of ambiguous blood group. Homologous modeling more intuitively shows the key site for the weakening of Bw.03 GT activity. The intermolecular force analysis can explain the root cause of enzyme activity weakening.