Objective:To establish a combined model of tumor heterogeneity metabolic parameters using 18F-FDG PET/CT and explore its value in differentiating benign from malignant pulmonary lesions. Methods:A total of 251 patients (157 males, 94 females; age 15-88 years) who were diagnosed with malignant lung lesions by 18F-FDG PET/CT and with definitive pathological results at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from February 2017 to February 2024 were retrospectively enrolled. Analysis was conducted on clinical data, traditional parameters (SUV max, metabolic tumor volume (MTV), total lesion glycolysis (TLG)) of primary lesions on 18F-FDG PET/CT, and intra-tumoral metabolic heterogeneity index (HI; such as cumulative SUV volume histogram AUC (AUC-CSH), linear regression slope, CV). AUC-CSH and CV were calculated using SUV thresholds of 2.5 and 40%SUV max. Logistic univariate and multivariate regression analyses were used to extract independent predictors in clinical features and PET/CT parameters for the differential diagnosis of pulmonary lesions. A multi-parameter combined model was established through logistic regression and validated for diagnostic efficacy using ROC curve analysis. Results:Among 251 patients, 101 were benign and 150 were malignant. In univariate analysis, gender, age, tumor markers, spiculation sign, lobulation sign, vessel convergence sign, air bronchogram, long diameter, short diameter, SUV max, AUC-CSH 2.5, AUC-CSH 40%, CV2.5, and CV40% were predictive factors for the diagnosis of benign and malignant tumors (odds ratio ( OR): 0.57-17.39, all P<0.05). In multivariate analysis, gender, age, tumor markers, lobulation sign, vessel convergence sign, SUV max, AUC-CSH 40%, and CV40% were independent predictors for the diagnosis of benign and malignant tumors ( OR: 2.30-13.18, all P<0.05). The AUC, sensitivity, specificity, and accuracy of the multi-parameter combined model established with the above independent predictors were 0.89, 77.33%(116/150), 84.16%(85/101), 80.08%(201/251), respectively. Conclusion:18F-FDG PET/CT multi-parameter combined model has high value in the differentiation of benign and malignant pulmonary lesions.

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.

Objective:To evaluate the prognostic value of 18F-fluorodeoxyglucose ( 18F-FDG) PET/CT metabolic parameters in small cell lung cancer (SCLC) . Methods:A retrospective analysis was conducted on the clinical and imaging data of 156 SCLC patients, who underwent 18F-FDG PET/CT imaging and were diagnosed by histopathological examination at Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School from September 2013 to February 2024. The metabolic tumor volume (MTV), total lesion glycolysis (TLG), linear regression slope, area under the curve of cumulative standard uptake value (SUV) volume histogram (AUC-CSH), and coefficient of variation (CV) were calculated using LIFEx software with different SUV thresholds. Univariate and multivariate analyses were performed using Cox proportional hazards model. Patient stratification was based on the critical values determined by receiver operator characteristic (ROC) curve analysis. The survival curve was plotted using the Kaplan-Meier method and log-rank test was performed. Results:Univariate analysis showed that MTV 40% ( HR=2.91, 95% CI: 1.55-5.47, P=0.001), MTV 60% ( HR=2.31, 95% CI: 1.29-4.17, P=0.005), TLG 40% ( HR=2.07, 95% CI: 1.19-3.60, P=0.010), linear regression slope ( HR=0.45, 95% CI: 0.26-0.79, P=0.005), and CV 40% ( HR=0.27, 95% CI: 0.08-0.84, P=0.024) were factors affecting progression-free survival (PFS) in SCLC patients. MTV 40% ( HR=1.98, 95% CI: 1.22-3.22, P=0.005), MTV 60% ( HR=1.80, 95% CI: 1.12-2.88, P=0.015), MTV 80% ( HR=1.71, 95% CI: 1.08-2.74, P=0.024), TLG 40% ( HR=3.68, 95% CI: 1.59-8.49, P=0.002), linear regression slope ( HR=0.49, 95% CI: 0.30-0.80, P=0.004), and AUC-CSH 80% ( HR=0.44, 95% CI: 0.23-0.84, P=0.013) were found to be factors affecting overall survival (OS) in SCLC patients. Multivariate analysis revealed that MTV 40% ( HR=4.76, 95% CI: 1.11-20.50, P=0.036) was an independent factor influencing PFS, and TLG 40% ( HR=3.19, 95% CI: 1.02-9.92, P=0.046) was an independent factor influencing OS in SCLC patients. ROC curve analysis identified the optimal cutoff value for MTV 40% in predicting PFS as 5.5cm 3 and the optimal cutoff value for TLG 40% in predicting OS as 41.5 g in SCLC patients. Survival analysis showed that patients with MTV 40%≤5.5 cm 3 ( n=33) had a median PFS that was not reached, while patients with MTV 40%>5.5 cm 3 ( n=123) had a median PFS of 10.3 months, with a statistically significant difference ( χ2=12.09, P=0.001). For patients with TLG 40%≤41.5 g ( n=35), the median OS was not reached, whereas for TLG 40%>41.5 g ( n=121), the median OS was 31.6 months, with a statistically significant difference ( χ2=10.55, P=0.001) . Conclusions:The 18F-FDG PET/CT metabolic parameter MTV 40% is an independent factor influencing PFS, while TLG 40% is an independent factor influencing OS in SCLC patients. The above two parameters may serve as indicators for assessing the prognosis of SCLC patients.

Objective:To establish a combined model of tumor heterogeneity metabolic parameters using 18F-FDG PET/CT and explore its value in differentiating benign from malignant pulmonary lesions. Methods:A total of 251 patients (157 males, 94 females; age 15-88 years) who were diagnosed with malignant lung lesions by 18F-FDG PET/CT and with definitive pathological results at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from February 2017 to February 2024 were retrospectively enrolled. Analysis was conducted on clinical data, traditional parameters (SUV max, metabolic tumor volume (MTV), total lesion glycolysis (TLG)) of primary lesions on 18F-FDG PET/CT, and intra-tumoral metabolic heterogeneity index (HI; such as cumulative SUV volume histogram AUC (AUC-CSH), linear regression slope, CV). AUC-CSH and CV were calculated using SUV thresholds of 2.5 and 40%SUV max. Logistic univariate and multivariate regression analyses were used to extract independent predictors in clinical features and PET/CT parameters for the differential diagnosis of pulmonary lesions. A multi-parameter combined model was established through logistic regression and validated for diagnostic efficacy using ROC curve analysis. Results:Among 251 patients, 101 were benign and 150 were malignant. In univariate analysis, gender, age, tumor markers, spiculation sign, lobulation sign, vessel convergence sign, air bronchogram, long diameter, short diameter, SUV max, AUC-CSH 2.5, AUC-CSH 40%, CV2.5, and CV40% were predictive factors for the diagnosis of benign and malignant tumors (odds ratio ( OR): 0.57-17.39, all P<0.05). In multivariate analysis, gender, age, tumor markers, lobulation sign, vessel convergence sign, SUV max, AUC-CSH 40%, and CV40% were independent predictors for the diagnosis of benign and malignant tumors ( OR: 2.30-13.18, all P<0.05). The AUC, sensitivity, specificity, and accuracy of the multi-parameter combined model established with the above independent predictors were 0.89, 77.33%(116/150), 84.16%(85/101), 80.08%(201/251), respectively. Conclusion:18F-FDG PET/CT multi-parameter combined model has high value in the differentiation of benign and malignant pulmonary lesions.

Objective To investigate the influencing factors of treatment decision dilemma in the pa-tients with intracranial aneurysm.Methods A total of 210 patients with intracranial aneurysms hospitalized in the neurosurgery department of this hospital from January to December 2022 were selected as the research subjects.The questionnaire survey on the patients was conducted by using the general data questionnaire,De-cision Dilemma Scale (DDS),Perceptive Social Support Scale (PSSS) and Hospital Anxiety and Depression Scale (HADS).Results The scores of decisional dilemma,perceived social support,anxiety and depression of the patients with intracranial aneurysm were (38.08±14.05) points,(50.59±3.38) points,(11.12±3.46) points and (9.56±2.11) points respectively.The multiple linear regression analysis showed that the age,fam-ily per capita monthly income,aneurysm diameter,social support and anxiety were the main influencing fac-tors of treatment decision dilemma in the patients with intracranial aneurysm (P<0.05).Conclusion The de-cision-making dilemma in the patients with intracranial aneurysms is in a moderate level.Medical care staff should for-mulate the targeted decision support measures according to the patient' s age,economic status,aneurysm size,patient's social support and anxiety situation to help the patients to improve their decision-making level.

Objective:To mine the risk signals of hypoxia-inducible factor prolyl hydrocylase inhibitor (HIF-PHI)-related adverse events (AEs) and provide reference for the safe use of the drugs in clinic practice.Methods:AE reports of HIF-PHI drugs were collected from the US FDA Adverse Event Reporting System (FAERS) database during January 1, 2004 to September 30, 2023. AEs were classified and standardized according to the system organ class (SOC) and the preferred term (PT) in Medical Dictionary for Regulatory Activities 25.0. The AE risk signals of above mentioned 3 drugs were mined using reporting odds ratio (ROR) method. An AE with reports ≥3 and the lower limit of the 95% confidence interval ( CI) of ROR >1 was defined as a risk signal. Descriptive analysis on the signals was performed. Results:Only AE report data for roxadustat, daprodustat, and vacladustat were collected. A total of 78 AE reports related to roxadustat were collected, involving 12 PTs and 8 SOCs. The top 5 PTs in signal intensity were shunt occlusion, central hypothyroidism, gastrointestinal perforation, colon cancer, and hepatic function abnormal. Except for central hypothyroidism, the other 4 were not recorded in the labels. A total of 459 AE reports related to daprodustat were collected, involving 29 PTs and 13 SOCs. The top 5 PTs in signal intensity were gastrointestinal erosion, retinal haemorrhage, haemorrhoidal haemorrhage, abnormal feces and colon cancer. Retinal haemorrhage, abnormal feces and colon cancer were new adverse events not recorded in the labels. A total of 26 AE reports related to vadadustat were collected, involving 6 PTs and 4 SOCs. The top 5 PTs in signal intensity were drug eruption, face oedema, colon cancer, gastrointestinal haemorrhage, and dehydration, all of which were new adverse event not recorded in the labels.Conclusions:The risk signals of roxadustat, daprodustat and vadadustat are mostly adverse events not recorded in the labels, such as shunt obstruction, gastrointestinal perforation, colon cancer, etc. When using the 3 drugs, clinicians should not only pay attention to the adverse reactions recorded in the labels, but also be alert to the adverse events not recorded in the labels.

Objective:To mine the risk signals of hypoxia-inducible factor prolyl hydrocylase inhibitor (HIF-PHI)-related adverse events (AEs) and provide reference for the safe use of the drugs in clinic practice.Methods:AE reports of HIF-PHI drugs were collected from the US FDA Adverse Event Reporting System (FAERS) database during January 1, 2004 to September 30, 2023. AEs were classified and standardized according to the system organ class (SOC) and the preferred term (PT) in Medical Dictionary for Regulatory Activities 25.0. The AE risk signals of above mentioned 3 drugs were mined using reporting odds ratio (ROR) method. An AE with reports ≥3 and the lower limit of the 95% confidence interval ( CI) of ROR >1 was defined as a risk signal. Descriptive analysis on the signals was performed. Results:Only AE report data for roxadustat, daprodustat, and vacladustat were collected. A total of 78 AE reports related to roxadustat were collected, involving 12 PTs and 8 SOCs. The top 5 PTs in signal intensity were shunt occlusion, central hypothyroidism, gastrointestinal perforation, colon cancer, and hepatic function abnormal. Except for central hypothyroidism, the other 4 were not recorded in the labels. A total of 459 AE reports related to daprodustat were collected, involving 29 PTs and 13 SOCs. The top 5 PTs in signal intensity were gastrointestinal erosion, retinal haemorrhage, haemorrhoidal haemorrhage, abnormal feces and colon cancer. Retinal haemorrhage, abnormal feces and colon cancer were new adverse events not recorded in the labels. A total of 26 AE reports related to vadadustat were collected, involving 6 PTs and 4 SOCs. The top 5 PTs in signal intensity were drug eruption, face oedema, colon cancer, gastrointestinal haemorrhage, and dehydration, all of which were new adverse event not recorded in the labels.Conclusions:The risk signals of roxadustat, daprodustat and vadadustat are mostly adverse events not recorded in the labels, such as shunt obstruction, gastrointestinal perforation, colon cancer, etc. When using the 3 drugs, clinicians should not only pay attention to the adverse reactions recorded in the labels, but also be alert to the adverse events not recorded in the labels.

Objective To explore the curative effect of day care unit on the efficacy,safety and satisfaction of elderly patients who underwent a cold snare polypectomy for the treatment colorectal polyps.Methods Clinical data from 454 elderly patients with 824 colorectal polyps(Diameter 4～10 mm)who received a polypectomy from Mar 2020 to Mar 2021 were collected.These patients were classified into three groups.The cold snare polypectomy group and hot snare polypectomy group in day care unit,and the cold snare polypectomy group in general wards.The clinical characteristics,adverse events,recurrence,hospitalization time,and expenses,were compared among three groups.Additionally,the patients'hospitalization satisfaction was investigated and analyzed.Results There were no significant differences in clinical characteristics,histopathology,and rates of postoperative bleeding,perforation,and recurrence among the 3 groups(P＞0.05),but the probability of immediate bleeding was higher in the cold snare polypectomy group.Moreover,coagulation syndrome was unique to the hot snare polypectomy group.The hot snare polypectomy group used the highest amount of endoclips,while the cold snare polypectomy group in the general wards used the least.Furthermore,the hospitalization time and expenses in the day care unit group were significantly lower than in the general wards group.However,the patients'satisfaction survey showed that the day care unit group scored lower than the general wards group(P＜0.05).Conclusions It is safe,cost-effective and effective for elderly patients with colorectal polyps using cold snare polypectomy technique under the day care unit mode,but the lack of communication with the patient's condition in a short period of time rather leads to a decrease in hospital satisfaction.

The abdomen-rubbing qigong exercise was first developed by Fang Kai, a Xin’an medical practitioner. It’s an essential part of Xin’an health preservation works. This health preservation method integrates massage with Daoyin and integrates meridian theory with Zangxiang theory. It’s safe, simple and has no side effects. Practice of this qigong exercise can protect the spleen and stomach, tonify qi and essence, harmonize Ying-Nutrients and Wei-Defense, unblock meridians and circulate qi. This paper aims to summarize and promote this exercise.

AIM: To investigate the downstream genes of the transcriptional factor Pax-8 related to cardiopathy. METHODS: The total RNA derived from the heart of Pax-8 KO~(-/-) and Pax-8 KO~(+/-) mice was extracted. Mouse genome DNA microarray containing 31 802 mouse oligonucleotides probes was used to investigate the differential expression between the Pax-8 KO~(-/-) and the Pax-8 KO~(+/-) mice hearts. The candidate genes were confirmed by RT-PCR and real time RT-PCR assay. RESULTS: Microarray results showed that, compared to the Pax-8 KO~(+/-) mice, 25 genes were down-regulated and 17 were up-regulated in the Pax-8 KO~(-/-) mice, concerning metabolize enzymes, cell signal conducting and nuclear transcript factors and so on. Bcl2-like 14 (Bcl2l14) was proved to be up-regulated by RT-PCR. Real time RT-PCR results revealed that Bcl2l14 in the Pax-8 KO~(-/-) mice was 2.07 and 2.23 fold as much as that in the Pax-8 KO~(+/-) and the Pax-8KO~(+/+) mice (P<0.01). CONCLUSION: The Bcl2l14 gene is one of the downstream genes of Pax-8 and probably plays an important role in the mechanism of ventricular septum defect.