Objective:To evaluate the diagnostic performance of the Vesical Imaging-Reporting and Data System（VI-RADS）based on multiparametric magnetic resonance imaging（mp-MRI）for muscle-invasive bladder cancer（MIBC）.Methods:A systematic search was conducted in PubMed，Web of Science，and Embase databases for studies published between September 2018 and December 2023 that investigated the use of VI-RADS for diagnosing MIBC. Inclusion criteria were studies utilizing mp-MRI-based VI-RADS scoring to determine MIBC. Exclusion criteria were studies with fewer than 10 patients，overlapping study populations，or those failing to assess the diagnostic performance of VI-RADS for MIBC. After quality assessment，RevMan 5.4 and Stata 15.1 were used to calculate pooled sensitivity and specificity，generate forest plots and summary receiver operating characteristic（SROC）curves，and determine the area under the curve（AUC）. Publication bias was assessed using Deeks funnel plot. Heterogeneity was evaluated using the I2 statistic，with meta-regression and subgroup analyses to explore its sources. Results:Twenty-nine studies involving 3 577 patients were included. At a VI-RADS cutoff of 3，the pooled sensitivity and specificity for MIBC diagnosis were 93%（95%CI 0.90-0.95）and 82%（95%CI 0.76-0.88），respectively. At a cutoff of 4，these values were 83%（95%CI 0.78-0.87）and 93%（95%CI 0.90-0.95）. The hierarchical SROC（HSROC）AUCs were 0.95 and 0.94 for cutoffs of 3 and 4，respectively. Subgroup and meta-regression analyses revealed that at a cutoff of 3，patient sample size，study design，MRI field strength，number of radiologists，surgical approach，and DWI/DCE imaging planes contributed to sensitivity heterogeneity（ P < 0.05）. All factors except study design and DWI plane were sources of specificity heterogeneity（ P < 0.05）. At a cutoff of 4，all factors significantly influenced heterogeneity in both sensitivity and specificity（ P < 0.05）. Meta-regression confirmed that both cutoffs（3 and 4）were significant sources of heterogeneity（ P < 0.05）. Conclusions:VI-RADS demonstrates excellent diagnostic performance for MIBC at both cutoffs（3 and 4），with VI-RADS ≥ 3 showing superior sensitivity and VI-RADS ≥ 4 offering higher specificity. The cutoff of 3 provides better overall diagnostic efficacy.

Guided by the theories of yin-yang and collateral disease， this paper identifies the dysregulation of yang qi ascent and descent as the core pathomechanism of hypertension. Based on clinical experience， a treatment approach centered on the method of raising yang and promoting descent was proposed. Clinically， three major syndrome types were identified. Firstly， deficiency of zong qi （ancestral qi） with blood stasis， obstruction of phlegm-turbidity and blood stasis， and hyperactivity of liver yang. Corresponding empirical formulation， Yizong Huoxue Decoction （益宗活血汤） was applied to tonify zong qi， invigorate blood， and raise yang. Secondly， Lizong Huoxue Decoction （理宗活血汤） was used to resolve phlegm， promote yang qi circulation， and regulate qi and blood. Thirdly， Qinggan Tongluo Decoction （清肝通络饮） was used to clear the liver， dredge collaterals， and subdue hyperactive yang. For special types such as non-dipper hypertension， time-specific syndrome differentiation and treatment can be applied based on a thorough understanding of the underlying pathomechanism， aiming to provide new insights into clinical diagnosis and treatment of hypertension.

Chronic heart failure （CHF） is a complex clinical syndrome that the cardiac output is not enough to meet the metabolic needs of the body， or depends on the increase of filling pressure to compensate. Its high morbidity and mortality pose a serious threat to human health， necessitating attention and active intervention. At present， western medicine treatment of CHF is mainly based on diuretics， intravenous vasodilators， intravenous positive inotropic drugs， etc.， which， however， have problems such as long medication cycles， serious side effects， and limited applicable population. Recent studies have shown that traditional Chinese medicine can act in a multi-pathway， multi-component， and multi-target manner， showing unique advantages in the prevention and treatment of CHF. Buyang Huanwutang has the effects of tonifying Qi， activating blood， and dredging collaterals. Clinical and mechanism studies have confirmed that this prescription is effective in treating CHF and its syndromes. The clinical studies can be classified into two categories. Studies of the first category use simple modern medical diagnostic criteria as the inclusion criteria for CHF patients， which can improve the scientificity and objectivity. Studies of the second category uses modern medicine combined with traditional Chinese medicine disease diagnostic criteria for the screening of CHF patients， which helps to improve the accuracy of efficacy evaluation. However， there are problems such as the lack of unified research standards and the insufficiency of mechanism research. In addition， the available studies remain to be classified or summarized. This study systematically sorted out the clinical and mechanism studies of Buyang Huanwutang in the treatment of CHF in recent years to review the research status. In clinical treatment， Buyang Huanwutang can be used alone， or modified， or combined with other prescriptions or Western medicine. The mechanism studies predict that Buyang Huanwutang can ameliorate CHF by regulating the calcium balance， protecting the mitochondrial structure and function， and regulating intestinal flora. This review aims to provide a theoretical basis and practical guidance for the clinical application and optimization and subsequent in-depth study of Buyang Huanwutang in the treatment of CHF.

Objective:To access the relation of aortic arch calcification (AoAC) volume based on parathyroid SPECT/CT imaging with hungry bone syndrome (HBS) in patients with renal secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX).Methods:From June 2015 to May 2024, the imaging and clinical data of 89 renal SHPT patients (52 males, 37 females, age: (51.5±10.3) years) who underwent parathyroid 99Tc m-methoxyisobutylisonitrile (MIBI) SPECT/CT in Affiliated Jiangyin Hospital of Nantong University were retrospectively analyzed. The AoAC volume was measured by Volume software of SPECT/CT system. The patients were divided into HBS group and non-HBS group, and the independent-sample t test, Mann-Whitney U test were used to compare differences of various indicators between the two groups. Logistic regression was used to analyze the influencing factors of HBS. Results:All 89 patients underwent PTX successfully, 50 patients (56.2%) were with HBS and 39 patients (43.8%) were not. The differences of age ((47.9±9.9) vs (56.1±9.0) years, t=-3.98, P<0.001), AoAC volume (0.36(0.02, 1.30) vs 1.57(0.37, 3.77)cm 3, Z=-3.17, P=0.002), preoperative alkaline phosphatase (ALP) (345.75(218.50, 632.50) vs (203.13±114.57)U/L, Z=-4.69, P<0.001), preoperative parathyroid hormone (147.85(109.83, 227.40) vs (135.58±51.14)pmol/L, Z=-2.34, P=0.019) and preoperative serum corrected calcium ((2.38±0.21) vs 2.54(2.39, 2.62)mmol/L, Z=-3.09, P=0.002) between HBS group and non-HBS group were significant. Logistic regression analysis showed that the AoAC volume ((odds ratio, OR)=0.628, 95% CI: 0.427-0.924, P=0.018), preoperative ALP ( OR=1.007, 95% CI: 1.002-1.012, P=0.010) and preoperative serum corrected calcium ( OR=0.041, 95% CI: 0.003-0.545, P=0.016) were independent risk factors for HBS. Conclusion:The AoAC volume measured by preoperative SPECT/CT can be used for an effective criteria of evaluating HBS in patients with renal SHPT after PTX, and AoAC volume may be one of independent risk factors for HBS.

Objective:To investigate the relationship of the number and morphological of parathyroid glands on 99Tc m-methoxyisobutylisonitrile (MIBI) SPECT/CT with hungry bone syndrome (HBS) in patients with renal secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX). Methods:Eighty renal SHPT patients (46 males, 34 females; age (50.3±11.0) years) who underwent PTX between January 2018 and June 2024 were retrospectively analyzed in Affiliated Jiangyin Hospital of Nantong University. The number of parathyroid glands detected on SPECT/CT, diameter of parathyroid gland and its volume were recorded and measured. Patients were divided into HBS group and non-HBS group. Independent-sample t test, Mann-Whitney U test and χ2 test were used to compare differences of various indicators between those 2 groups. Multivariate logistic regression was used to analyze influencing factors of HBS. Results:HBS group included 45 patients and the rest 35 patients belonged to non-HBS group. Age ( t=-3.61, P=0.001), preoperative alkaline phosphatase (ALP) ( Z=-4.65, P<0.001), preoperative parathyroid hormone ( Z=-2.34, P=0.019) and preoperative serum corrected calcium ( t=-2.71, P=0.008) were all significantly different between HBS group and non-HBS group. Patients with the number of parathyroid glands≥4 detected by SPECT/CT were more in HBS group than those in non-HBS group (82.2%(37/45) vs 51.4%(18/35); χ2=8.87, P=0.003), and the total volume of parathyroid glands (2.56(1.93, 4.44) vs 2.00(1.18, 2.94)cm 3;Z=-2.25, P=0.024) and the maximum diameter of parathyroid glands ((17.71±3.78) vs (15.87±3.91) mm; t=2.14, P=0.036) were significantly different between those 2 groups. Logistic regression analysis showed that preoperative ALP (odds ratio ( OR)=1.008, 95% CI: 1.002-1.014, P=0.015), preoperative serum corrected calcium ( OR=0.017, 95% CI: 0.000-0.869, P=0.042) and the number of parathyroid gland≥4 detected by SPECT/CT ( OR=4.156, 95% CI: 1.038-16.642, P=0.044) were independent influencing factors for HBS. The sensitivity of the number of parathyroid glands≥4 detected by SPECT/CT for diagnosing HBS was 82.2%(37/45). Conclusion:The number of parathyroid glands≥4 detected by SPECT/CT is an independent influencing factor for HBS, with high diagnostic sensitivity for HBS, thus having good clinical value.

Objective To evaluate the value of radiomics models and comprehensive models based on multiparametric magnetic resonance imaging(mpMRI)in predicting the expression of human epidermal growth factor receptor 2(HER2)in bladder cancer(BCa).Methods A total of 76 pathologically confirmed BCa patients undergoing pelvic mpMRI during Jan.2022 and Nov.2024 at the Affiliated Zhongda Hospital of Southeast University were retrospectively included.After the volume of interest(VOI)was sketched,7 modal features were obtained,including T2WI,DWI,DCE,T2WI+DWI,T2WI+DCE,DWI+DCE,and T2WI+DWI+DCE,which were analyzed with logistic regression to obtain the predictive values.After that,the best sequences were screened with receiver operating characteristic(ROC)curves,and then combined with support vector machine,logistic regression,K-nearest neighbor,plain Bayes and adaptive enhancement,to construct the radiomics prediction models.Logistic regression analysis was used to screen the predictors of high HER 2 expression and to construct a comprehensive prediction model and a nomogram.Finally,decision curve analysis(DCA)was used to quantify the clinical benefits.Results Among the radiomics models based on the T2WI+DWI+DCE sequence,the AdaBoost model demonstrated the best predictive performance,with area under the ROC curve(AUC)being 0.863(95％CI:0.807-0.920)in the training set and 0.716(95％CI:0.601-0.830)in the validation set.Based on radiomics features and clinical imaging characteristics,logistic regression analysis identified tumor pedicle and risk group as the predictors of high HER2 expression.The comprehensive prediction model based on the two factors achieved the AUC of 0.869(95％CI:0.772-0.965)in the training set and 0.875(95％CI:0.712-0.986)in the validation set.Conclusion The radiomics model based on the T2WI+DWI+DCE sequence has high accuracy in predicting HER2 expression,outperforming single-sequence models.The nomogram based on the comprehensive prediction model has high clinical decision-making efficacy and is useful for non-invasive identification of HER2 expression.

Teicoplanin,currently one of the preferred drugs for treating infections caused by multidrug-resistant Staphylococcus aureus and Enterococcus in clinical practice,has a high plasma protein binding rate.Most of the drug binds to protein after entering the body,only a portion of the drug exists in a free form.Since the free drug can pass through biological membranes and enter the target tissue to exert its therapeutic effect,monitoring the free teicoplanin blood concentration is clinically important and plays a role in guiding individualized drug therapy.This article summarizes and compares the current methods for determining the concentration of free teicoplanin in the blood,and analyzes their advantages and disadvantages.Based on this,it analyzes the possible factors affecting the concentration of free teicoplanin in the blood,providing a reference for the development of new methods for detecting free teicoplanin concentration and providing more accurate individualized medication plans based on free concentration.

Objective To evaluate the value of radiomics models and comprehensive models based on multiparametric magnetic resonance imaging(mpMRI)in predicting the expression of human epidermal growth factor receptor 2(HER2)in bladder cancer(BCa).Methods A total of 76 pathologically confirmed BCa patients undergoing pelvic mpMRI during Jan.2022 and Nov.2024 at the Affiliated Zhongda Hospital of Southeast University were retrospectively included.After the volume of interest(VOI)was sketched,7 modal features were obtained,including T2WI,DWI,DCE,T2WI+DWI,T2WI+DCE,DWI+DCE,and T2WI+DWI+DCE,which were analyzed with logistic regression to obtain the predictive values.After that,the best sequences were screened with receiver operating characteristic(ROC)curves,and then combined with support vector machine,logistic regression,K-nearest neighbor,plain Bayes and adaptive enhancement,to construct the radiomics prediction models.Logistic regression analysis was used to screen the predictors of high HER 2 expression and to construct a comprehensive prediction model and a nomogram.Finally,decision curve analysis(DCA)was used to quantify the clinical benefits.Results Among the radiomics models based on the T2WI+DWI+DCE sequence,the AdaBoost model demonstrated the best predictive performance,with area under the ROC curve(AUC)being 0.863(95％CI:0.807-0.920)in the training set and 0.716(95％CI:0.601-0.830)in the validation set.Based on radiomics features and clinical imaging characteristics,logistic regression analysis identified tumor pedicle and risk group as the predictors of high HER2 expression.The comprehensive prediction model based on the two factors achieved the AUC of 0.869(95％CI:0.772-0.965)in the training set and 0.875(95％CI:0.712-0.986)in the validation set.Conclusion The radiomics model based on the T2WI+DWI+DCE sequence has high accuracy in predicting HER2 expression,outperforming single-sequence models.The nomogram based on the comprehensive prediction model has high clinical decision-making efficacy and is useful for non-invasive identification of HER2 expression.

Teicoplanin,currently one of the preferred drugs for treating infections caused by multidrug-resistant Staphylococcus aureus and Enterococcus in clinical practice,has a high plasma protein binding rate.Most of the drug binds to protein after entering the body,only a portion of the drug exists in a free form.Since the free drug can pass through biological membranes and enter the target tissue to exert its therapeutic effect,monitoring the free teicoplanin blood concentration is clinically important and plays a role in guiding individualized drug therapy.This article summarizes and compares the current methods for determining the concentration of free teicoplanin in the blood,and analyzes their advantages and disadvantages.Based on this,it analyzes the possible factors affecting the concentration of free teicoplanin in the blood,providing a reference for the development of new methods for detecting free teicoplanin concentration and providing more accurate individualized medication plans based on free concentration.

Objective:To access the relation of aortic arch calcification (AoAC) volume based on parathyroid SPECT/CT imaging with hungry bone syndrome (HBS) in patients with renal secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX).Methods:From June 2015 to May 2024, the imaging and clinical data of 89 renal SHPT patients (52 males, 37 females, age: (51.5±10.3) years) who underwent parathyroid 99Tc m-methoxyisobutylisonitrile (MIBI) SPECT/CT in Affiliated Jiangyin Hospital of Nantong University were retrospectively analyzed. The AoAC volume was measured by Volume software of SPECT/CT system. The patients were divided into HBS group and non-HBS group, and the independent-sample t test, Mann-Whitney U test were used to compare differences of various indicators between the two groups. Logistic regression was used to analyze the influencing factors of HBS. Results:All 89 patients underwent PTX successfully, 50 patients (56.2%) were with HBS and 39 patients (43.8%) were not. The differences of age ((47.9±9.9) vs (56.1±9.0) years, t=-3.98, P<0.001), AoAC volume (0.36(0.02, 1.30) vs 1.57(0.37, 3.77)cm 3, Z=-3.17, P=0.002), preoperative alkaline phosphatase (ALP) (345.75(218.50, 632.50) vs (203.13±114.57)U/L, Z=-4.69, P<0.001), preoperative parathyroid hormone (147.85(109.83, 227.40) vs (135.58±51.14)pmol/L, Z=-2.34, P=0.019) and preoperative serum corrected calcium ((2.38±0.21) vs 2.54(2.39, 2.62)mmol/L, Z=-3.09, P=0.002) between HBS group and non-HBS group were significant. Logistic regression analysis showed that the AoAC volume ((odds ratio, OR)=0.628, 95% CI: 0.427-0.924, P=0.018), preoperative ALP ( OR=1.007, 95% CI: 1.002-1.012, P=0.010) and preoperative serum corrected calcium ( OR=0.041, 95% CI: 0.003-0.545, P=0.016) were independent risk factors for HBS. Conclusion:The AoAC volume measured by preoperative SPECT/CT can be used for an effective criteria of evaluating HBS in patients with renal SHPT after PTX, and AoAC volume may be one of independent risk factors for HBS.