Objective:To evaluate the value of a combined model based on primary lesion 18F-fluorodeoxyglucose ( 18F-FDG) PET/CT radiomics for predicting lymph node metastasis in non-small cell lung cancer (NSCLC) . Methods:A retrospective analysis was conducted on the clinical data of 203 NSCLC patients who underwent pre-treatment PET/CT imaging at Nanjing Drum Tower Hospital from June 2013 to July 2023. Patients were randomly assigned to the training set ( n=142) and the validation set ( n=61) at a ratio of 7∶3. A predictive model was developed in the training set, and its predictive performance and clinical application value were assessed in both the training and validation sets. Traditional PET/CT parameters and PET/CT radiomics features of the primary lesion were obtained by 3D-slicer software. Least absolute shrinkage and selection operator (LASSO), random forest, and extreme gradient boosting were performed to extract features. Support vector machine was used to construct a radiomics score (Radscore). Univariate and multivariate logistic regression analysis was used to predict the influencing factors of lymph node metastasis in NSCLC patients and to establish models. Predictive performance of the models was evaluated by receiver operator characteristic (ROC) curves and clinical application value was assessed by calibration curves and decision curve analysis (DCA) . Results:Among 203 NSCLC patients, 116 had lymph node metastasis, with 64 cases in the training set and 52 cases in the validation set. Three complementary classical machine learning methods were used for feature screening, and finally 10 radiomics features were obtained. The optimal threshold for Radscore-PET was 0.43 and the optimal threshold for Radscore-CT was 0.39. Univariate analysis showed that, sex ( OR=0.48, 95% CI: 0.24-0.95, P=0.036), tumor marker levels ( OR=3.81, 95% CI: 1.84-7.91, P<0.001), long diameter of tumor ( OR=2.56, 95% CI: 1.27-5.16, P=0.009), short diameter of tumor ( OR=3.73, 95% CI: 1.75-7.92, P=0.001), vacuolar sign ( OR=0.32, 95% CI: 0.12-0.86, P=0.024), ring-like metabolism ( OR=3.67, 95% CI: 1.33-10.13, P=0.012), maximum standardized uptake value (SUV max) ( OR=6.57, 95% CI: 3.03-14.25, P<0.001), metabolic tumor volume (MTV) ( OR=2.91, 95% CI: 1.43-5.92, P=0.003), total lesion glycolysis (TLG) ( OR=4.23, 95% CI: 2.08-8.59, P<0.001), Radscore-PET ( OR=21.93, 95% CI: 9.04-53.20, P<0.001) and Radscore-CT ( OR=13.72, 95% CI: 6.12-30.76, P<0.001) were all influencing factors for predicting lymph node metastasis in NSCLC patients. Multivariate analysis showed that, tumor marker levels ( OR=2.55, 95% CI: 1.11-5.90, P=0.028), vacuolar sign ( OR=0.26, 95% CI: 0.08-0.83, P=0.023), SUV max ( OR=5.94, 95% CI: 1.99-17.75, P=0.001), Radscore-PET ( OR=25.51, 95% CI: 5.92-110.22, P<0.001), and Radscore-CT ( OR=8.68, 95% CI: 2.73-27.61, P<0.001) were independent influencing factors for predicting lymph node metastasis in patients with NSCLC. Based on the above independent influencing factors, models were constructed: the traditional model (tumor marker levels, vacuolar sign, SUV max), the PET model (SUV max, Radscore-PET), the CT model (vacuolar sign, Radscore-CT), and the combined model (tumor marker levels, vacuolar sign, SUV max, Radscore-PET, Radscore-CT). ROC curve analysis showed that, the area under curve (AUC) of the traditional, PET, CT, and combined models in the training set were 0.75 (95% CI: 0.67-0.82), 0.90 (95% CI: 0.84-0.95), 0.85 (95% CI: 0.78-0.90), and 0.94 (95% CI: 0.88-0.97), respectively. The predictive value of the combined model was higher than that of the traditional model ( Z=5.01, P<0.001), the PET model ( Z=1.99, P=0.047), and the CT model ( Z=3.25, P=0.001). In the validation set, the AUCs for the traditional model, PET model, CT model, and combined model were 0.65 (95% CI: 0.52-0.77), 0.86 (95% CI: 0.74-0.93), 0.85 (95% CI: 0.73-0.93), and 0.90 (95% CI: 0.80-0.96), respectively. The predictive value of the combined model was superior to that of the traditional model ( Z=3.23, P=0.001). The sensitivity and specificity of the combined model in the training set were 84.37% and 91.03%, while in the validation set, the sensitivity and specificity were 82.61% and 94.74%, respectively. Calibration curves showed a good agreement between the predicted and actual probabilities in both the training and validation sets. DCA showed that the combined models had good discriminative ability in both the training and validation sets. Conclusions:Tumor marker levels, vacuolar sign, SUV max, Radscore-PET, and Radscore-CT are all independent influencing factors for predicting lymph node metastasis in patients with NSCLC. The combined model based on these factors demonstrates excellent predictive performance and clinical application value for predicting lymph node metastasis in NSCLC.

Repeated transcranial magnetic stimulation (rTMS) is one of the commonly used brain stimulation techniques. In order to investigate the effects of rTMS on the excitability of different types of neurons, this study is conducted to investigate the effects of rTMS on the cognitive function of mice and the excitability of hippocampal glutaminergic neurons and gamma-aminobutyric neurons from the perspective of electrophysiology. In this study, mice were randomly divided into glutaminergic control group, glutaminergic magnetic stimulation group, gamma-aminobutyric acid energy control group, and gamma-aminobutyric acid magnetic stimulation group. The four groups of mice were injected with adeno-associated virus to label two types of neurons and were implanted optical fiber. The stimulation groups received 14 days of stimulation and the control groups received 14 days of pseudo-stimulation. The fluorescence intensity of calcium ions in mice was recorded by optical fiber system. Behavioral experiments were conducted to explore the changes of cognitive function in mice. The patch-clamp system was used to detect the changes of neuronal action potential characteristics. The results showed that rTMS significantly improved the cognitive function of mice, increased the amplitude of calcium fluorescence of glutamergic neurons and gamma-aminobutyric neurons in the hippocampus, and enhanced the action potential related indexes of glutamergic neurons and gamma-aminobutyric neurons. The results suggest that rTMS can improve the cognitive ability of mice by enhancing the excitability of hippocampal glutaminergic neurons and gamma-aminobutyric neurons.
Animals ; Mice ; Hippocampus/cytology* ; Transcranial Magnetic Stimulation ; Neurons/physiology* ; Male ; Cognition/physiology* ; gamma-Aminobutyric Acid/metabolism* ; Action Potentials/physiology*

ObjectiveRepetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, offers a non-pharmacological therapeutic option for the management of Alzheimer’s disease (AD). Studies have demonstrated that ferroptosis plays a pivotal role in the pathological onset and progression of AD, and the inhibition of neuronal ferroptosis can significantly ameliorate cognitive impairments associated with AD. The imbalance of calcium ion (Ca²⁺) homeostasis is intimately associated with the pathology of AD and serves as a catalyst for the induction of ferroptosis through various pathways. This study is designed to investigate whether rTMS can ameliorate AD by inhibiting neuronal ferroptosis or maintaining calcium homeostasis, ultimately establishing a theoretical and experimental framework for the utilization of rTMS in AD treatment. MethodsAPP/PS1 AD mice were subjected to both 0.5 Hz low-frequency and 20 Hz high-frequency rTMS treatments, and the efficacy of these treatments was evaluated using novel object recognition and Morris water maze tests. ELISA was employed to quantify the levels of glutathione (GSH), malondialdehyde (MDA), superoxide dismutase (SOD), Fe²⁺ within the hippocampi of mice from each group. HT-22 cells were induced to undergo ferroptosis via Erastin treatment, and subsequent to high- and low-frequency magnetic stimulation, cell viability was assessed using CCK-8 assay, while intracellular calcium ion concentration fluctuations were monitored using Fluo-4 AM. ResultsThe findings revealed that, when compared to normal mice, AD mice displayed a notable decline in cognitive function, accompanied by a substantial increase in ferroptosis levels and intracellular calcium ion concentrations. Both high-frequency and low-frequency applications of rTMS were found to significantly ameliorate cognitive impairments in AD mice, while also effectively mitigating the abnormal augmentation of neuronal ferroptosis and intracellular calcium ion levels. ConclusionThe present study underscores that both high-frequency and low-frequency rTMS exhibit efficacy in alleviating cognitive dysfunction in AD mice, potentially through the modulation of ferroptosis and intracellular calcium ion homeostasis.

Objective To investigate the application effect of cold snare endoscopic mucosal resection(CS-EMR)in the treatment of 6 to 9 mm colorectal small polyps.Methods A total of 82 patients with small colonic polyps in our hospital from March 2022 to August 2023 were collected and divided into the observation group(45 cases received CS-EMR)and the control group[37 cases received hot snare endoscopic mucosal resection(HS-EMR)]according to different surgical methods.The clinical efficacy,polyp resection status,complete polyp resection rate,perioperative indicators and occurrence of complications were compared between the two groups.Results Follow-up for 1 month after operation,the effective rate of treatment in the observation group was higher than that in the control group(P<0.05).There was no statistically significant difference in the polyp resection status or perioperative indicators between the two groups(P>0.05).There was no statistically significant difference in the complete polyp resection rates of patients with different pathological types or total complete resection rate between the two groups(P>0.05).The incidence of delayed bleeding and endoscopic hemostasis rate in the observation group were lower than those in the control group(P<0.05).Conclusion The complete resection rate of 6～9 mm colorectal polyps through CS-EMR was comparable to that of HS-EMR,and CS-EMR has a better efficacy and lower risk of perioperative bleeding,along with higher safety.

Objective:To explore the relationship between monocyte-lymphocyte ratio(MLR),modified Glasgow prognostic score(mGPS)and the prognosis of patients with advanced gastric cancer after radical gastrectomy.Methods:A retrospective analysis was conducted on the data of 106 patients with advanced gastric cancer who underwent radical gastrectomy in our hospital from April 2018 to April 2021,the patients were followed up for 3 years after the operation.MLR and mGPS scores of patients with different clinical characteristics were compared.The Kaplan-Meier method was used to analyze the survival differences of patients in different MLR and mGPS groups,and the survival curves were plotted.The Cox regression model was used to analyze variables such as clinical characteristics,laboratory indicators,MLR and mGPS scores,and to screen out the independent factors affecting the prognosis of patients.The receiver operating characteristic(ROC)curve was constructed to evaluate the efficacy of MLR,mGPS scores and their combination in predicting poor prognosis efficiency of patients,and the area under the curve(AUC),sensitivity and specificity were calculated.Results:MLR and mGPS scores were correlated with tumor TNM stage,degree of differentiation,tumor diameter,lymph node metastasis and postoperative chemotherapy(P＜0.05).The 3-year survival rates of the MLR ≥0.3 group and mGPS ≥ 1 group were 45.20％and 50.00％respectively,which were much lower than those in the low MLR group and mGPS group(78.40％and 82.40％,P＜0.05).The survival rate in the high-risk group(MLR ≥0.3 and mGPS ≥ 1)was 29.41％,significantly lower than those in the medium and low-risk groups(P＜0.05).Cox multivariate analysis showed that high clinical stage,lymph node metastasis,high degree of differentiation,high MLR and high mGPS scores were independent risk factors affecting the prognosis of patients.ROC curve showed that the AUC of MLR and mGPS scores alone in predicting poor prognosis of patients was 0.756 and 0.842,respectively,the AUC of combination detection the two was 0.909,the predictive efficacy of the combination detection was significantly better than that of the single detection.Conclusion:Elevated MLR and mGPS scores can be used as independent prognostic indicators after advanced gastric cancer,the combination in predicting is helpful to provide a more accurate basis for clinical prognosis assessment.

Objective To investigate the application effect of cold snare endoscopic mucosal resection(CS-EMR)in the treatment of 6 to 9 mm colorectal small polyps.Methods A total of 82 patients with small colonic polyps in our hospital from March 2022 to August 2023 were collected and divided into the observation group(45 cases received CS-EMR)and the control group[37 cases received hot snare endoscopic mucosal resection(HS-EMR)]according to different surgical methods.The clinical efficacy,polyp resection status,complete polyp resection rate,perioperative indicators and occurrence of complications were compared between the two groups.Results Follow-up for 1 month after operation,the effective rate of treatment in the observation group was higher than that in the control group(P<0.05).There was no statistically significant difference in the polyp resection status or perioperative indicators between the two groups(P>0.05).There was no statistically significant difference in the complete polyp resection rates of patients with different pathological types or total complete resection rate between the two groups(P>0.05).The incidence of delayed bleeding and endoscopic hemostasis rate in the observation group were lower than those in the control group(P<0.05).Conclusion The complete resection rate of 6～9 mm colorectal polyps through CS-EMR was comparable to that of HS-EMR,and CS-EMR has a better efficacy and lower risk of perioperative bleeding,along with higher safety.

Objective:To explore the relationship between monocyte-lymphocyte ratio(MLR),modified Glasgow prognostic score(mGPS)and the prognosis of patients with advanced gastric cancer after radical gastrectomy.Methods:A retrospective analysis was conducted on the data of 106 patients with advanced gastric cancer who underwent radical gastrectomy in our hospital from April 2018 to April 2021,the patients were followed up for 3 years after the operation.MLR and mGPS scores of patients with different clinical characteristics were compared.The Kaplan-Meier method was used to analyze the survival differences of patients in different MLR and mGPS groups,and the survival curves were plotted.The Cox regression model was used to analyze variables such as clinical characteristics,laboratory indicators,MLR and mGPS scores,and to screen out the independent factors affecting the prognosis of patients.The receiver operating characteristic(ROC)curve was constructed to evaluate the efficacy of MLR,mGPS scores and their combination in predicting poor prognosis efficiency of patients,and the area under the curve(AUC),sensitivity and specificity were calculated.Results:MLR and mGPS scores were correlated with tumor TNM stage,degree of differentiation,tumor diameter,lymph node metastasis and postoperative chemotherapy(P＜0.05).The 3-year survival rates of the MLR ≥0.3 group and mGPS ≥ 1 group were 45.20％and 50.00％respectively,which were much lower than those in the low MLR group and mGPS group(78.40％and 82.40％,P＜0.05).The survival rate in the high-risk group(MLR ≥0.3 and mGPS ≥ 1)was 29.41％,significantly lower than those in the medium and low-risk groups(P＜0.05).Cox multivariate analysis showed that high clinical stage,lymph node metastasis,high degree of differentiation,high MLR and high mGPS scores were independent risk factors affecting the prognosis of patients.ROC curve showed that the AUC of MLR and mGPS scores alone in predicting poor prognosis of patients was 0.756 and 0.842,respectively,the AUC of combination detection the two was 0.909,the predictive efficacy of the combination detection was significantly better than that of the single detection.Conclusion:Elevated MLR and mGPS scores can be used as independent prognostic indicators after advanced gastric cancer,the combination in predicting is helpful to provide a more accurate basis for clinical prognosis assessment.

Background: To ascertain the construct validity and reliability of a self-administered web-based assessment of intrinsic capacity (IC). The study design was a cross-sectional analysis using data from a prospective cohort. Methods: We included data from 6,434 respondents (mean age 65.33±5.81 years; 52.4% women) of the Singapore Life Panel population study who participated in the online surveys in March 2022 and May 2022. Incremental nested factor structures of IC were modelled with confirmatory factor analysis (CFA) and their goodness-of-fit were assessed mainly with root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR). With the most parsimonious model as our eventual factor structure, we further evaluated IC and its domains with reliability indices. Results: CFA demonstrated construct validity for the second-order factor structure with acceptable overall model fit: χ2(147)=7,696.276, p<0.001; CLI=0.947; TLI=0.938; RMSEA=0.089; SRMR=0.051. Amongst the domains, vitality had highest factor loading (0.889), whereas locomotion and cognition (0.534 and 0.601, respectively) had lowest loadings with the second-order IC factor. All five IC domains and the general IC factor fulfilled reliability thresholds (construct validity [CR] or hierarchical omega ≥0.7; average variance extracted ≥0.5); psychological and locomotion domains have high CR (>0.9), whereas vitality and sensory domains have lower values of CR. Conclusion Our study provides proof-of-concept evidence regarding the construct validity and reliability of a self-administered web-based assessment of IC index that can potentially be scalable in other population settings.

Objective:To explore the value of baseline PET/CT parameters for predicting prognosis in patients with double-expression lymphoma (DEL).Methods:The clinical and 18F-FDG PET/CT data of 118 patients (66 males, 52 females; age: 28-85 years) with diffuse large B-cell lymphoma (DLBCL) diagnosed in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University and the First Affiliated Hospital of Nanjing Medical University from June 2015 to September 2022 were retrospectively analyzed. The optimal thresholds for SUV max, total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) in predicting overall survival (OS) rate were determined using ROC curve analysis. Univariate and multivariate analyses, along with Kaplan-Meier survival analysis were performed to construct a survival prediction model. The effect of the model was evaluated by the calibration curve for the model, the time-dependent ROC curve analysis and decision curve analysis. Results:As of the last follow-up, 25 patients died, and the OS rate was 78.8%(93/118). The AUC of the ROC curve for TMTV was 0.705, with a corresponding optimal threshold of 230.9 cm 3. In multivariate analysis, Eastern Cooperative Oncology Group performance status (ECOG PS) score (hazard ratio ( HR)=3.886, 95% CI: 1.455-10.375; P=0.007) and TMTV ( HR=4.649, 95% CI: 1.665-12.979; P=0.003) were identified as independent predictors of OS. The combined model of ECOG PS score and TMTV was superior to ECOG PS score model and TMTV model alone in predicting OS. Conclusion:TMTV, a metabolic indicator, and ECOG PS score, a clinical risk factor, are independent predictors of OS in patients with DEL, and their combination can provide more accurate prognostic predictions.