Imaging examination is a crucial part in diagnosis and treatment of central nervous system infection(CNSI),involving complex imaging sequences and parameters.This consensus was jointly written by multiple CNSI imaging experts in China,aimed to standardize imaging examination of CNSI.

Objective To evaluate the diagnostic value of black blood computed tomography(BBCT)in vulnerable plaques at the carotid bifurcation.Methods The imaging data of 73 patients with suspected carotid atherosclerosis were retrospectively analyzed.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of conventional computed tomography angiography(CTA)ima-ges and BBCT images were compared by paired sample t-test.The 5-level scoring method was applied to evaluate the image quality subjectively,and the Friedman test was used to compare the differences in the subjective evaluation of image quality among the groups.Taking high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)as the gold standard,the diagnostic value between BBCT and conventional CTA was compared,and the consistency of BBCT and HRMR-VWI in the evaluation of vulnerable plaques was calculated.Results The standard deviation(SD)value of BBCT images was lower than that of conventional three-phase CTA images,indicating better quality of BBCT images(P＜0.001).The mean CT value and CNRplaque-lumen of non-calcified plaques were higher in BBCT images than those in conventional three-phase CTA images,suggesting that BBCT had a higher contrast with sur-rounding tissues and could better display the fine structure of non-calcified plaques(P＜0.001).BBCT images achieved the highest scores in the subjective evaluation of image quality(P＜0.001).Compared with conventional CTA images,BBCT had higher sensi-tivity(88.2％vs 29.4％)and accuracy(90.9％vs 54.5％)in identifying vulnerable plaques(P＜0.001).The Kappa value between BBCT and HRMR-VWI was 0.813,showed good consistency.Conclusion The image quality of neck BBCT is superior to that of conventional CTA.BBCT has a better effect than conventional CTA in identifying vulnerable plaques at the carotid bifurcation,which is comparable to HRMR-VWI.

Objective To evaluate the diagnostic value of black blood computed tomography(BBCT)in vulnerable plaques at the carotid bifurcation.Methods The imaging data of 73 patients with suspected carotid atherosclerosis were retrospectively analyzed.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of conventional computed tomography angiography(CTA)ima-ges and BBCT images were compared by paired sample t-test.The 5-level scoring method was applied to evaluate the image quality subjectively,and the Friedman test was used to compare the differences in the subjective evaluation of image quality among the groups.Taking high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)as the gold standard,the diagnostic value between BBCT and conventional CTA was compared,and the consistency of BBCT and HRMR-VWI in the evaluation of vulnerable plaques was calculated.Results The standard deviation(SD)value of BBCT images was lower than that of conventional three-phase CTA images,indicating better quality of BBCT images(P＜0.001).The mean CT value and CNRplaque-lumen of non-calcified plaques were higher in BBCT images than those in conventional three-phase CTA images,suggesting that BBCT had a higher contrast with sur-rounding tissues and could better display the fine structure of non-calcified plaques(P＜0.001).BBCT images achieved the highest scores in the subjective evaluation of image quality(P＜0.001).Compared with conventional CTA images,BBCT had higher sensi-tivity(88.2％vs 29.4％)and accuracy(90.9％vs 54.5％)in identifying vulnerable plaques(P＜0.001).The Kappa value between BBCT and HRMR-VWI was 0.813,showed good consistency.Conclusion The image quality of neck BBCT is superior to that of conventional CTA.BBCT has a better effect than conventional CTA in identifying vulnerable plaques at the carotid bifurcation,which is comparable to HRMR-VWI.

Imaging examination is a crucial part in diagnosis and treatment of central nervous system infection(CNSI),involving complex imaging sequences and parameters.This consensus was jointly written by multiple CNSI imaging experts in China,aimed to standardize imaging examination of CNSI.

Objective:To investigate the effect and molecular mechanism of high concentration of IL-17A on osteoclast differentiation by inhibiting autophagy of osteoclast precursor cells through PI3K/Akt pathway.Methods:With RANKL (50 ng/ml) inducing osteoclast precursor cells (osteoclast we cells, OCPs), osteoclast differentiation model is set up. In osteoclast differentiation model of high levels of IL-17A (100 ng/ml), RAW264.7 cells were divided into negative control CTR-N group, CTR-R group with RANKL, IL-17A group, IL-17A+LY294002 group. BMMs were divided into negative control CTR-N group with M-CSF, CTR-R group, IL-17A group and IL-17A+LY294002 group with M-CSF and RANKL. IL-17A was applied to OCPs, and tartrate-resistant acid phosphatase (TRAP) staining was used to observe the number of osteoclast differentiation. The number of autolysosomes was observed under transmission electron microscope. RAW264.7 was treated with IL-17A. Western blot was used to detect the relative expression levels of p-Akt/Akt, p-mtor/mTOR, p-PI3K/PI3K, p-ULK1/ULK1, Cleaved-caspase3/caspase3, Beclin1/β-actin. The apoptosis rate of RAW264.7 cells treated with IL-17A was detected by flow cytometry. OCPs were treated with IL-17A and PI3K inhibitor LY294002, and TRAP staining was used to observe the number of osteoclast differentiation.Results:The TRAP staining showed that the positive ratio for RAW264.7 cells CTR-N group, CTR-R group, IL-17A group was 1.33%±0.58%, 100%±3.01%, 51.11%±4.02% with that of IL-17A significantly lower than CTR-R group ( t=16.970, P<0.05). The positive rates of BMMs in the CTR-N group, CTR-R group and IL-17A group were 1.67%±0.58%, 100%±1.01% and 50.33%±2.52%, respectively, with that of IL-17A group significantly lower than CTR-R group ( t=31.770, P<0.05). Transmission electron microscopy showed that the number of autophagosomes in RAW264.7 cells in CTR-R group and IL-17A group were 3.67±1.53 and 0.67±0.58, respectively, with significant difference between the groups ( t=3.182, P<0.05). While in BMMs cells CTR-R group and IL-17 the numbers of autophagosome were 3.00±1.00 and 0.33±0.58 with significant difference ( t=4.000, P<0.05); Western blot results showed 0.69±0.03、0.69±0.13、1.47±0.13、0.78±0.04、0.66±0.10、0.82±0.03 for RAW264.7 cells CTR-R group Akt/Akt, p-mTOR/mTOR, p-PI3K/PI3K, p-ULK1/ULK1, Cleaved caspase3/caspase3, Beclin1/β-Actin and 0.89±0.04、1.14±0.18、1.87±0.04、0.53±0.09、0.93±0.02、0.54±0.03 for RAW264.7 cells IL-17A group p-Akt/Akt, p-mTOR/mTOR, p-PI3K/PI3K, p-ULK1/ULK1, Cleaved caspase3/caspase3, Beclin1/β-Actin with significant difference ( t=6.708; t= 3.497; t=5.424; t=4.542; t=4.638; t=11.220, all P<0.05); Flow cytometry detection showed that in CTR-R group, IL-17A RAW264.7 cells apoptosis rates of group A were 6.92%±0.62%, 12.12%±0.69%, with significant difference between the two groups ( t=9.747, P<0.05); After using LY294002 TRAP staining, it showed a positive result of 9.00%±2.00%, 158.33%±3.51%, 100%±2.65% and 128.99%±4.01% for CTR-N, CTR-R, IL-17A and IL-17A+LY294002 in RAW264.7 cells respectively with significant difference between IL-17A+LY294002 group and the IL-17A in group A ( t=10.470, P<0.05). For BMMs cells CTR-N, CTR-R group, IL-17A in group, IL-17A+LY294002 group, the positive rate was 8.01%±0.99%, 151.67%±4.51%, 100%±3.61%, with significant difference between IL-17A+LY294002 group and IL-17A group ( t=6.535, P<0.05). Conclusion:High concentration of IL-17A inhibits osteoclast differentiation by inhibiting autophagy of osteoclast precursor cells through PI3K/Akt pathway.

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

Heart failure and cardiogenic shock occurred again on the patient who undergone coronary artery bypass grafting, mechanical mitral valve replacement, and tricuspid valve repair surgery for coronary heart disease, mitral regurgitation, and tricuspid valve regurgitation 2 months ago. His heart function could not recover after Intra-Aortic Balloon Pump (IABP) supported for 1 month, and then Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) was applied. During the VA-ECMO assisted procedure, complex coagulation dysfunction was present, bleeding and thrombosis was coexisting. Treatment with anti-infective drugs, adjustment dosage of anticoagulant and anti-infective drugs, and infusion of blood products, coagulation function was improved. Cardiac transplantation was applied after VA-ECMO support for 10 days. Right heart failure, multiple serosal fluid accumulation (in the chest and abdominal cavities), repeated infections in the lungs and blood flow, liver dysfunction, renal dysfunction, coagulation dysfunction, pneumothorax were occurred successively after cardiac transplantation. The patient recovered and discharged from the hospital after active treatment. The recipient's quality of life is good and the transplanted heart function is basically normal.

Heart failure and cardiogenic shock occurred again on the patient who undergone coronary artery bypass grafting, mechanical mitral valve replacement, and tricuspid valve repair surgery for coronary heart disease, mitral regurgitation, and tricuspid valve regurgitation 2 months ago. His heart function could not recover after Intra-Aortic Balloon Pump (IABP) supported for 1 month, and then Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) was applied. During the VA-ECMO assisted procedure, complex coagulation dysfunction was present, bleeding and thrombosis was coexisting. Treatment with anti-infective drugs, adjustment dosage of anticoagulant and anti-infective drugs, and infusion of blood products, coagulation function was improved. Cardiac transplantation was applied after VA-ECMO support for 10 days. Right heart failure, multiple serosal fluid accumulation (in the chest and abdominal cavities), repeated infections in the lungs and blood flow, liver dysfunction, renal dysfunction, coagulation dysfunction, pneumothorax were occurred successively after cardiac transplantation. The patient recovered and discharged from the hospital after active treatment. The recipient's quality of life is good and the transplanted heart function is basically normal.

Objective: To investigate the delay in identification, healthcare-seeking, and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and to identify the influencing factors, so as to provide insights into tuberculosis control among students. Methods: The demographic and diagnosis data of tuberculosis patients in Urumqi City from 2010 to 2019 were captured from the Tuberculosis Information Management System of Chinese Disease Control and Prevention Information System. The delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis was analyzed among students, and the factors affecting the delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis were identified using a multivariable logistic regression model. Results: A total of 996 tuberculosis cases were identified among students in Urumqi City from 2010 to 2019. There were 702 students with delay in identification of tuberculosis (70.48%), 500 students with delay in healthcare-seeking (55.22%) and 534 students with delay in definitive diagnosis (53.61%). Multivariable logistic regression analysis identified active identification (OR=0.116, 95%CI: 0.032-0.420) as a factor affecting delay in identification of tuberculosis, women (OR=1.424, 95%CI: 1.104-1.836), non-local household registration (OR=1.311, 95%CI: 1.016-1.694) and active identification (OR=0.232, 95%CI: 0.064-0.848) as factors affecting delay in healthcare-seeking, and active identification (OR=0.143, 95%CI: 0.032-0.644) as a factor affecting delay in definitive diagnosis of tuberculosis among students. Conclusions There is a high proportion of delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and female and non-locally household-registered students were at a high risk of delay in healthcare-seeking for tuberculosis. Active detection and screening of tuberculosis should be reinforced.