Objective To investigate the potential of one-stop multi-modality CT in the assessment of collateral circulation and prognosis in acute ischemic stroke(AIS).Methods From February 2022 to May 2024,115 patients diagnosed with AIS at Wuzhou Red Cross Hospital were enrolled in the study.All subjects were examined with one-stop multi-modality CT at admission and received endovascular therapy.According to the collateral circulation score derived from multi-phase CT angiography(mCTA)and the modified Rankin scale score at 90 days,these patients were divided into different groups:good(n=59)vs poor(n=56)collateral circulation groups,and favorable(n=48)vs unfavorable(n=67)outcome groups.Clinical and imaging parameters were compared between these groups.Independent risk factors for collateral circulation and prognosis of AIS patients were identified through multivariate Logistic regression analysis.A prediction model for unfavorable AIS prognosis was developed based on the results of multivariate Logistic analysis,and its predictive value was assessed using receiver operating characteristic(ROC)curve analysis.Results Poor collateral circulation group exhibited higher proportions of insular ribbon and gray-white matter junction blurring as compared with good collateral circulation group(P<0.05),while the ratio of hypoperfusion intensity ratio(HIR)<0.3 was lower in poor collateral circulation group(P<0.05).Relative cerebral blood volume(rCBV)<40%,relative cerebral blood flow(rCBF)<30%,peak time(Tmax)>8 s,and Tmax>10 s volume were all significantly higher in poor collateral circulation group(P<0.05),whereas the Alberta stroke program early CT score(ASPECTS)was lower(P<0.05).Multivariate Logistic regression analysis identified ASPECTS,rCBV<40%,rCBF<30%,and Tmax>10 s as independent risk factors for poor collateral circulation(P<0.05).Unfavorable outcome group had higher rates of hemorrhage following endovascular thrombectomy and mismatch ratio<1.8 than favorable outcome group(P<0.05),with a lower HIR<0.3 ratio(P<0.05).Compared with favorable outcome group,unfavorable outcome group also showed higher admission NIHSS scores,higher percentages of rCBV<40%,rCBF<30%,Tmax>4 s,Tmax>6 s,and Tmax>10 s volumes(P<0.05),but lower mCTA collateral circulation score(P<0.05).Multivariate Logistic regression analysis indicated that admission NIHSS score,mCTA collateral circulation score,rCBV<40%,rCBF<30%,and Tmax>10 s were independent risk factors for unfavorable outcomes(P<0.05).The regression equation was formulated as:Logit(P)=-0.184+(admission NIHSS score×0.134)+(mCTA collateral circulation score×-0.415)+(rCBV<40%×0.107)+(rCBF<30%×0.089)+(Tmax>10 s×0.028).ROC curve analysis demonstrated an area under the curve of 0.775(95 CI:0.689-0.860,P<0.001)for the prediction model in assessing unfavorable AIS prognosis.Conclusion One-stop multi-modality CT has significant application value in assessing collateral circulation and predicting prognosis in AIS patients.

Objective To investigate the potential of one-stop multi-modality CT in the assessment of collateral circulation and prognosis in acute ischemic stroke(AIS).Methods From February 2022 to May 2024,115 patients diagnosed with AIS at Wuzhou Red Cross Hospital were enrolled in the study.All subjects were examined with one-stop multi-modality CT at admission and received endovascular therapy.According to the collateral circulation score derived from multi-phase CT angiography(mCTA)and the modified Rankin scale score at 90 days,these patients were divided into different groups:good(n=59)vs poor(n=56)collateral circulation groups,and favorable(n=48)vs unfavorable(n=67)outcome groups.Clinical and imaging parameters were compared between these groups.Independent risk factors for collateral circulation and prognosis of AIS patients were identified through multivariate Logistic regression analysis.A prediction model for unfavorable AIS prognosis was developed based on the results of multivariate Logistic analysis,and its predictive value was assessed using receiver operating characteristic(ROC)curve analysis.Results Poor collateral circulation group exhibited higher proportions of insular ribbon and gray-white matter junction blurring as compared with good collateral circulation group(P<0.05),while the ratio of hypoperfusion intensity ratio(HIR)<0.3 was lower in poor collateral circulation group(P<0.05).Relative cerebral blood volume(rCBV)<40%,relative cerebral blood flow(rCBF)<30%,peak time(Tmax)>8 s,and Tmax>10 s volume were all significantly higher in poor collateral circulation group(P<0.05),whereas the Alberta stroke program early CT score(ASPECTS)was lower(P<0.05).Multivariate Logistic regression analysis identified ASPECTS,rCBV<40%,rCBF<30%,and Tmax>10 s as independent risk factors for poor collateral circulation(P<0.05).Unfavorable outcome group had higher rates of hemorrhage following endovascular thrombectomy and mismatch ratio<1.8 than favorable outcome group(P<0.05),with a lower HIR<0.3 ratio(P<0.05).Compared with favorable outcome group,unfavorable outcome group also showed higher admission NIHSS scores,higher percentages of rCBV<40%,rCBF<30%,Tmax>4 s,Tmax>6 s,and Tmax>10 s volumes(P<0.05),but lower mCTA collateral circulation score(P<0.05).Multivariate Logistic regression analysis indicated that admission NIHSS score,mCTA collateral circulation score,rCBV<40%,rCBF<30%,and Tmax>10 s were independent risk factors for unfavorable outcomes(P<0.05).The regression equation was formulated as:Logit(P)=-0.184+(admission NIHSS score×0.134)+(mCTA collateral circulation score×-0.415)+(rCBV<40%×0.107)+(rCBF<30%×0.089)+(Tmax>10 s×0.028).ROC curve analysis demonstrated an area under the curve of 0.775(95 CI:0.689-0.860,P<0.001)for the prediction model in assessing unfavorable AIS prognosis.Conclusion One-stop multi-modality CT has significant application value in assessing collateral circulation and predicting prognosis in AIS patients.

Objective:To explore the effects of age,period and cohort on the incidence of endometriosis(EMT)and disability adjusted life year(DALY)in China from 1990 to 2019.Methods:Using the Global Burden of Disease(GBD)2019 database,the incidence of EMT and DALY in China from 1990 to 2019 were analyzed.The time variation trend of standardized incidence and standardized DALY rate was analyzed with Joinpoint 4.8.0.1 software,and the average annual percentage change was calculated.The age-period-cohort model was construc-ted to analyze the effect of age,period and birth cohort on the incidence of endometriosis and DALY trend change.Results:In 2019,the incidence of EMT in China was 72.61/100,000,and the DALY rate was 47.38/100,000.The incidence rate and DALY rate were 39.71％and 24.97％lower than those in 1990.From 1990 to 2019,the standardized incidence rate and standardized DALY rate of EMT in China showed a downward trend,with an an-nual decrease of 1.02％and 1.00％respectively,with statistical significance(P＜0.05).The results of age effect showed that the overall incidence of EMT in China showed was decreasing,and the DALY rate was increasing from 15 to 29 years old,and then decreased after 30 years old.The results of period effect showed that the relative ratio(RR)of EMT incidence risk and DALY risk in China showed a decreasing trend.Taking the period from 2000 to 2004 as the reference group,the incidence risk(RR 1.78,95％CI 1.64-1.95)and DALY risk(RR 1.05,95％CI 0.90-1.23)were the highest in 1990-1994.The results of cohort effect showed that the later people were born,the lower the risk of EMT was.Conclusions:From 1990 to 2019,the standardized incidence rate and standardized DALY rate of EMT in China showed a downward trend.The epidemiological patterns and trends of EMT in differ-ent ages,periods and birth cohorts may provide new insights for public health,and provide an important basis for formulating public health strategies to further reduce the burden of EMT.

Objective:To investigate the value of BRAF V600E and multigene detection and stratified application for the diagnosis of thyroid nodules.Methods:A total of 1 117 patients with thyroid nodules resection at Nanjing Gulou Hospital from December 2020 to July 2022 were enrolled in the study. Fine needle aspiration (FNA) and core biopsy samplings were performed for cytopathologic examination and genetic testings; the findings were combined with BSRTC classification. The diagnostic performance of BRAF V600E and multigene detection were compared.Results:Among the 1, 117 patients who underwent thyroid nodules resection, 285 were male and 832 were female, with a median age of 46 years (range: 24-76 years). Postoperative histopathologic examination confirmed 1 040 cases of thyroid cancer and 77 cases of benign nodules. The sensitivity (87.0% vs. 80.8%, P<0.01) and diagnostic accuracy (87.9% vs. 82.1%, P<0.01) of multigene detection were significantly higher than those of BRAF V600E detection. The result of multigene detection showed that BRAF V600E mutation was the most common finding, followed by CCDC6-RET (E1-E12) fusion, ETV6-NTRK3 fusion, and KRAS mutation. Multigene detection had a higher sensitivity (81.9% vs. 72.8%, P<0.01) and lower cancer risk in wild-type (47.6% vs. 57.7%, P=0.069) than BRAF V600E detection in BSRTCⅠ-Ⅴ lesions. Compared with BRAF V600E detection, multigene had no significant difference of sensitivity in BSRTC Ⅰ lesions, but significantly higher sensitivity (86.3% vs 74.0%, P<0.01) in BSRTC Ⅲ lesions. Conclusions:Genetic detection can be used as an effective tool for the diagnosis of thyroid nodules. A stratified application of molecular markers in the diagnosis of thyroid nodules is proposed. Combined with FNA, single gene or multigene detection both can effectively assist in the diagnosis of thyroid nodules. Moreover, multigene detection is superior to single gene detection. For BSRTC Ⅲ lesion with wild-type BRAF, multigene detection can be considered with a repeated FNA.

ObjectiveTo explore the law of women reproductive aging based on theory of "seven-year period" in traditional Chinese medicine（TCM） through analyzing the characteristics of basic sex hormone levels and anti-müllerian hormone levels in women of different ages. MethodsThe data of female who visited Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2018 to December 2022 and accepted basic hormone and anti-müllerian hormone determination were collected retrospectively. According to the age of subjects， they were divided into the "1-2 seven" group （under 21 years old）， "3 seven" group （21-27 years old）， "4 seven" group （28-34 years old）， "5 seven" group （35-41 years old）， "6 seven" group （42-48 years old） and "7 seven" and older group （49 years old and above）. The age， average menstrual cycle in the past 3 months， basic hormone levels including follicle stimulating hormone （FSH）， luteinizing hormone （LH）， estradiol （E₂）， testosterone （T） and FSH/LH value， and anti-müllerian hormone （AMH） levels were collected and compared. ResultsA total of 1221 cases were included. The differences in FSH， LH， FSH/LH values， E₂， T， AMH levels and average menstrual cycle among the groups were statistically significant （P＜0.05 or P＜0.01）. AMH peaked in the "3 seven" group. Compared to those in the "3 seven" group， the FSH/LH value in the "4 seven" group increased， while the LH， AMH and T levels decreased， and the menstrual cycle was shortened （P＜0.01）. The FSH/LH， LH， AMH， T and menstrual cycle in the "5 seven" group were consistent with the changing trend of those in the "4 seven" group， while the FSH and E₂ levels in the "5 seven" group were significantly higher （P＜0.05 or P＜0.01）. Compared to those in the "5 seven" group， the FSH， LH and E₂ levels of the "6 seven" group increased， and the AMH and T levels continued to decrease （P＜0.05 or P＜0.01）. Compared to those in the "6 seven" group， the FSH and LH levels of the "7 seven" and older group continued to increase， and the AMH and E₂ levels decreased （P＜0.01）. ConclusionThe law of women reproductive aging in the "seven-year period" theory is basically consistent with the characteristics of basic sex hormone levels and anti-müllerian hormone levels in women of different ages. The reproductive capacity reaches its peak in the "three-seven-year period" and gradually moves towards reproductive aging in the "four-seven-year period".

Objective:To develop a Core Competency Scale for Ophthalmic Specialist Nurses and test its reliability and validity.Methods:This study was a questionnaire development study. This study transformed the core competency evaluation indicators for ophthalmic specialist nurses constructed through literature review, semi-structured interviews, expert consultations, and other methods to form the initial draft of the Core Competency Scale for Ophthalmic Specialist Nurses. From October 2022 to March 2023, a survey was conducted on 364 ophthalmic specialist nurses in China using purposive and snowball sampling. Item analysis, exploratory factor analysis, and reliability testing were performed on the scale.Results:The final Core Competency Scale for Ophthalmic Specialist Nurses included six dimensions of ophthalmic specialized knowledge, ophthalmic specialized skills, essential nursing practice ability, communication and education ability, scientific research ability, and professional competence, totaling 30 items. Exploratory factor analysis extracted six common factors, with a cumulative variance contribution rate of 73.077%. The total Cronbach's α coefficient of the scale was 0.955, the half reliability coefficient was 0.796, and the retest reliability coefficient was 0.973.Conclusions:The Core Competency Scale for Ophthalmic Specialist Nurses has good reliability and validity, which can be used to evaluate the core competency of ophthalmic specialist nurses.

Objective:To explore the effects of age,period and cohort on the incidence of endometriosis(EMT)and disability adjusted life year(DALY)in China from 1990 to 2019.Methods:Using the Global Burden of Disease(GBD)2019 database,the incidence of EMT and DALY in China from 1990 to 2019 were analyzed.The time variation trend of standardized incidence and standardized DALY rate was analyzed with Joinpoint 4.8.0.1 software,and the average annual percentage change was calculated.The age-period-cohort model was construc-ted to analyze the effect of age,period and birth cohort on the incidence of endometriosis and DALY trend change.Results:In 2019,the incidence of EMT in China was 72.61/100,000,and the DALY rate was 47.38/100,000.The incidence rate and DALY rate were 39.71％and 24.97％lower than those in 1990.From 1990 to 2019,the standardized incidence rate and standardized DALY rate of EMT in China showed a downward trend,with an an-nual decrease of 1.02％and 1.00％respectively,with statistical significance(P＜0.05).The results of age effect showed that the overall incidence of EMT in China showed was decreasing,and the DALY rate was increasing from 15 to 29 years old,and then decreased after 30 years old.The results of period effect showed that the relative ratio(RR)of EMT incidence risk and DALY risk in China showed a decreasing trend.Taking the period from 2000 to 2004 as the reference group,the incidence risk(RR 1.78,95％CI 1.64-1.95)and DALY risk(RR 1.05,95％CI 0.90-1.23)were the highest in 1990-1994.The results of cohort effect showed that the later people were born,the lower the risk of EMT was.Conclusions:From 1990 to 2019,the standardized incidence rate and standardized DALY rate of EMT in China showed a downward trend.The epidemiological patterns and trends of EMT in differ-ent ages,periods and birth cohorts may provide new insights for public health,and provide an important basis for formulating public health strategies to further reduce the burden of EMT.

Bilateral Wilms'tumor (BWT) affects approximately 5% of children with WT. The goal of treatment in BWT is to preserve normal renal function as much as possible, in order to postpone and reduce the risk of end-stage renal disease and other long-term complications. For neoadjuvant chemotherapy, vincristine/dactinomycin/doxorubicin is used in cases with favorable histology. Cases with diffuse anaplasia or other unfavorable histology receive an intensified regimen, including additional agents such as ifosfamide, cy-clophosphamide, carboplatin, and others. Nephron-sparing surgery is performed to preserve long-term renal function. Radiotherapy is given according to local staging, when margins or lymph nodes are positive, or tumor spillage has occurred, or pathological type is ana-plasia. The survival rate of relapsed BWT is low. Some experts suggest that patients with recurrent BWT are most likely to benefit from high-dose therapy including stem-cell transplantation, but this remains controversial.

Objective To study the changes of micro structure of white matter and gray matter in alcohol dependent patients by using diffusion kurtosis imaging(DKI) based on the method of voxel-based analysis.Methods Thirty alcohol dependent individuals and twenty healthy control volunteers,matched in gender, age, handedness and education, were enrolled as the alcohol dependent group and control group from September 2016 to June 2017.Michigan alcoholism screening test(MAST)was done for all subjects.All the subjects underwent DKI data acquisition by MR scanning. The relevant parameters were obtained by DKE software, including fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD), radial diffusivity(RD), mean kurtosis(MK), axial kurtosis(AK), radial kurtosis(RK), FA of kurtosis(FAK). Independent sample t test was performed to evaluate the significant difference of DKI parameters of two groups,meanwhile,the correlation analysis was conducted in DKI parameter values of different brain regions and MAST scores. Results Compared with the healthy control group, the FA value, MK value and RK value were decreased while the RD value was increased in alcohol dependence group, and there was significant difference between the two groups respectively(P<0.001). There was no significant difference between the two groups in the other parameters (AD, MD, AK, FAK). Compared with the healthy control group,the FA values of left lingual gyrus(164 voxels,t=-5.582)and left hippocampus(38 voxels,t=-3.664) increased;the MK value of left cerebellum posterior lobe(71 voxels,t=-4.004)reduced;the RK value of left cerebellum posterior lobe(67 voxels, t=-4.174), left middle cingulum(32 voxels, t=-3.925), left superior parietal gyrus(36 voxels,t=-3.812)reduced;and the RD value of the left inferior parietal gyrus(31 voxels,t=3.731)increased in alcohol dependence group.There was no correlation between MAST score and the value of DKI parameters. Conclusions There are dominant areas of brain injury in patients with alcohol dependence. The DKI parameters can reflect the changes of the whole brain microstructure of alcohol dependent patients and provide imaging basis in the diagnosis of alcohol dependence.

Objective To investigate the clinicopathological characteristics and the expression of related molecular markers of heterotopic pancreas for better understanding and avoiding overtreatment of this disease.Methods From 24th March 2009 to 10th November 2016,92 patients with heterotopic pancreas in upper digestive tract diagnosed after endoscopic submucosal dissection(ESD),were collected. Tissues were sectioned and pathologically classified by Heinrich classification.The expressions of seven different molecular markers including cytokeratin(CK)19,insulin,trypsin,Ki-67,p53,CD133 and CD56 were detected by immunohistochemistry staining. Clinical features, pathological features and immunohistochemical results were retrospectively analyzed.Analysis of variance and Kruskal-Wallis test were used.Results According to Heinrich classification,the percentages of type Ⅰ,Ⅱ,and Ⅲ of heterotopic pancreas were 27.2%(25/92),63.0%(58/92)and 9.8%(9/92),respectively.There was no type Ⅳ patients.The heterotopic pancreas mainly located in stomach with proportion being about 91.3%(84/92)of the total heterotopic pancreas.CK19(the marker of pancreas ducts),insulin(as marker of endocrine function)and trypsin(as the marker of exocrine function)were all expressed in heterotopic pancreas.The positive rate of CD56,a pancreatic neuroendocrine marker,was 66.3%(61/92).The umbilicus like depression was the typical endoscopic appearance of heterotopic pancreas,which only found in 29 patients(31.5%).The average rate of Ki-67,cell proliferation index,was(2.08 ± 1.41)%.The expression of mutant p53 was negative in all 92 cases of heterotopic pancreas.The average staining area of CD133,a marker of pancreatic cancer stem cell,was(2.53 ± 2.43)%.The average follow-up period of 92 patients was(43.6 ± 27.5)months.No relapse and malignant change were found and all patients survived after ESD.Conclusions Heterotopic pancreas has normal pancreatic construction and function.The cell proliferation index is low in heterotopic pancreas and no mutant p53 expression is found.The expression of CD133 is also low.Heterotopic pancreas is a congenital benign disease which requires a long-term follow-up rather than overtreatment.