Objective:To evaluate the clinical utility of dual-layer detector CT integrated with virtual monoenergetic imaging (VMI) and an orthopedic metal artifact reduction (O-MAR) algorithm in improving the image quality of patients after lumbar pedicle screw fixation surgery, and to analyze its impact on different types of artifacts and image quality of different tissues.Methods:The study was a prospective study, The study enrolled patients who underwent lumbar pedicle screw fixation at West China Hospital of Sichuan University between March and September 2024. All patients underwent lumbar CT scans using a dual-layer detector system, and four image sets were reconstructed. CLumbar routine scans were performed using dual-layer detector CT, and four image sets were reconstructed:onventional images (CI non-O-MAR), conventional images with O-MAR (CI O-MAR), virtual monoenergetic images (VMI non-O-MAR), and VMI with O-MAR (VMI O-MAR). Objective metrics including artifact index (AI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantified, alongside subjective image quality assessment. One-way ANOVA or Friedman test were used to compare the objective evaluation indicators of image quality between VMI non-O-MAR and VMI O-MAR at different energy levels. Paired t-test or Wilcoxon signed-rank test was used for CI non-O-MAR/VMI non-O-MAR versus CI O-MAR/VMI O-MAR comparisons. Results:A total of 30 patients were included, and all underwent internal fixation with titanium alloy pedicle screws. Objective analysis revealed that in both high-and low-density artifact regions, the AI values of the VMI O-MAR group decreased with the increase of energy levels, and were significantly lower than those of the corresponding VMI non-O-MAR group, with a statistically significant difference (all P<0.001). When the energy level≥140 keV, the AI value of the VMI O-MAR group was simultaneously lower than that of the CI non-O-MAR group and the CI O-MAR group, with statistically significant differences (all P<0.05). The SNR and CNR on the vertebral bodies in the VMI non-O-MAR group and the VMI O-MAR group showed a decreasing trend with increasing energy levels, and were always lower than those in the CI group at high energy levels (100-180 keV) (all P<0.05). At high energy levels (100-180 keV), the SNR of VMI O-MAR in the intervertebral disc and intraspinal tissues was higher than that of the VMI non-O-MAR group, with statistically significant differences (all P<0.05). Compared to other groups, subjective analysis indicated that the 140 keV VMI combined with O-MAR group received the highest image quality scores ( P<0.05). Conclusions:The combined application of VMI and O-MAR technology effectively reduces metal artifacts in post-lumbar fixation CT images. The 140 keV VMI with O-MAR reconstruction provides superior image quality and enhances diagnostic confidence.

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

AIM:To investigate the protective effect of Shexiang-Tongxin dropping pills(STDP)against myo-cardial injury induced by coronary microembolization(CME)in rats,with a focus on the cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)signaling pathway.METHODS:Thirty-two Sprague-Dawley rats were randomly allocated into four groups using a random number table:sham group,CME group,STDP group,and RU.521 group,with 8 rats per group.A rat model of CME was established via the injection of embolic microspheres into the left ventricle.The rats in sham group received an equal volume of normal saline via left ventricular injection instead,those in STDP group were given STDP(40 mg/kg)by oral gavage once daily for 14 consecutive days before CME modeling,and those in RU.521 group were intraperitoneally injected with RU.521(5 mg/kg)once daily for 7 consecutive days before CME modeling.Echocardiography was performed to evaluate cardiac function 24 h after modeling.HE staining was used to observe pathological changes in myocardial tissue,and TTC staining was applied to detect myocardial infarction areas.Enzyme-linked immunosorbent assay(ELISA)was used to measure levels of interleukin(IL)-1β and tumor necrosis factor(TNF)-α.A commercial assay kit was employed to detect myocardial injury marker cardiac troponin I(cTnI).Western blot was performed to analyze the expression of cGAS-STING pathway-related proteins in cardiac tissues.RESULTS:Compared with sham group,the rats in CME group exhibited significantly impaired cardiac function and a marked increase in serum cTnI levels(P<0.05).In contrast,compared with CME group,the rats in both STDP group and RU.521 group demonstrated significant improvements in cardiac function and reductions in cTnI levels((P<0.05).Furthermore,HE staining and TTC staining revealed that the rats in CME group had loosely arranged myocardial fibers,swollen cardiomyo-cytes,and an increased myocardial infarction erea compared with sham group(P<0.05).Meanwhile,the expression lev-els of inflammatory factors IL-1β and TNF-α,as well as the relative expression of cGAS,STING and NF-κB p-p65 pro-teins were significantly increased(P<0.05).In comparison,the rats in STDP group and RU.521 group showed a signifi-cant reduction in myocardial infarction area,down-regulated expression of cGAS,STING,and NF-κB p-p65 proteins,and markedly decreased levels of IL-1β and TNF-α compared with CME group(P<0.05).CONCLUSION:STDP pre-treatment ameliorated myocardial injury,cardiac dysfunction and myocardial infarct size induced by CME.The underlying mechenism may involve the suppression of the cGAS-STING signaling pathway,thereby attenuating myocardial inflamma-tion after CME.

Ovarian sclerosing stromal tumor(OSST)is a benign tumor originating from the ovarian sex cord-stroma,accounting for only 2%-6%of ovarian stromal tumors.It predominantly occurs in young women,and cases of OSST concurrently presenting with Meigs syndrome are extremely rare.This study reports a case of OSST,summarizes its clinical manifestations,and reviews relevant literature.The patient,a 22-year-old female,was admitted due to abdominal distension for 2 months,worsening over the past week.The physical examination results revealed abdominal distension,shifting dullness,mild tenderness,and no muscle tension or rebound tenderness.A mass measuring approximately 16.0 cm×14.0 cm×8.0 cm was palpated in the pelvic and abdominal cavity,with a firm texture,moderate mobility,and no tenderness.The gynecological ultrasound results showed a mixed cystic-solid echo of about 15.3 cm×14.0 cm×8.4 cm above the left side of the uterus,with clear boundaries,and fluid-filled dark areas in the pelvic and abdominal cavity,with a maximum anteroposterior diameter of about 11.9 cm.The-CT results revealed a cystic-solid mixed-density mass in the lower abdomen and right adnexal area,suggestive of a neoplastic lesion,with increased glucose metabolism in the solid portion,leaning toward malignancy.Carbohydrate antigen 125(CA125)was>800 U·mL-1,and pelvic puncture cytology indicated no cancer cells.The findings suggested a benign or borderline ovarian tumor,requiring differentiation from ovarian malignant tumors.Based on intraoperative observations and rapid pathological results,a left ovarian tumor enucleation was performed.Postoperative pathology confirmed ovarian sclerosing stromal tumor.Follow-up over 2 years showed no abnormalities.As a benign ovarian tumor,the clinical manifestations of OSST often mimic those of malignant tumors,leading to frequent misdiagnosis.Early diagnostic accuracy should be improved to develop the optimal treatment plan for patients.

Objective:To understand the epidemiological characteristics of injury deaths in local residents in Nanjing from 2009 to 2023, and provide evidence for the development of injury prevention and control strategies.Methods:The injury mortality data in Nanjing from 2009 to 2023 were analyzed based on the death cause surveillance system. In the recorded 33 542 injury death cases, 19 906 (59.35%) were men, and 13 636 (40.65%) were women. The crude mortality rate, age-standardized mortality rate, age-specific mortality rate, cause-eliminated life expectancy (CELE), potential gains in life expectancy (PGLEs) and life loss rate, were calculated. Joinpoint 5.0 software was used to estimate the average annual percentage change (AAPC) and its 95% CI to assess temporal trends of injury deaths. Results:In Nanjing, the crude injury mortality rate showed an upward trend (AAPC=2.11%), while the age-standardized mortality rate exhibited a downward trend (AAPC=-1.27%) from 2009 to 2023. The ranking of injury deaths in all causes of death declined from the 4 th in 2009 to the 6 th in 2023. The crude and age-standardized injury mortality rates in men were consistently higher than those in women. The primary cause of injury deaths was fall (31.42%). Drowning was the primary cause of injury deaths in age group 0-14 years (35.94%), while traffic accident was the primary cause in age group 15-64 years. For residents aged ≥65 years, fall was the primary cause of injury deaths. From 2009 to 2023, the CELE (AAPC=0.61%, 95% CI: 0.34%-0.89%, P<0.05) and the PGLEs (AAPC=1.73%, 95% CI: 0.21%-3.29%, P<0.05) showed increasing trends. The PGLEs and life loss rate due to injury were consistently higher in men than in women, but the AAPC of PGLEs and life loss rate was higher in women. Conclusions:From 2009 to 2023, the age-standardized injury mortality rate decreased, but the life loss due to injury deaths showed an upward trend in Nanjing, indicating that injury still has non-negligible negative impact on life expectancy.

Objective:To investigate the association between serum uric acid trajectories and the risk of renal function decline and diabetic kidney disease(DKD) incidence in elderly patients with type 2 diabetes mellitus.Methods:This retrospective cohort study included 5 037 elderly patients with type 2 diabetes mellitus aged 60 years and above who underwent at least three health examinations between 2019 and 2023, with 2019 as the baseline. Latent growth mixture modeling(LGMM) was employed to identify distinct serum uric acid trajectories. Renal function changes and DKD incidence were followed from 2020 to 2023. Binary logistic regression models were used to assess the association between serum uric acid trajectories and the risks of renal function decline and DKD.Results:Two distinct serum uric acid trajectory groups were identified based on model selection criteria: A stable group( n=4 485, 89.04%) and an inverted U-shaped group( n=552, 10.96%). After adjusting for potential confounders, compared with the stable trajectory group, the inverted U-shaped group showed a significantly increased risk of estimated glomerular filtration rate(eGFR) <60 mL·min -1·(1.73 m 2) -1, ≥25% decline in eGFR, doubling of serum creatinine, and DKD events, with OR(95% CI) of 1.99(1.28-3.09), 2.27(1.65-3.13), 1.52(1.09-3.02), and 1.52(1.27-1.82), respectively(all P<0.05). In addition, multivariate analysis indicated that elevated baseline serum uric acid levels were also associated with an increased risk of adverse renal outcomes and DKD incidence; However, the magnitude of the associations was lower than that observed for serum uric acid trajectory groups. Conclusions:An inverted U-shaped serum uric acid trajectory is significantly associated with an increased risk of renal function progression and DKD in elderly patients with type 2 diabetes mellitus. These findings highlight the importance of long-term dynamic monitoring of serum uric acid levels to facilitate early identification and intervention for high-risk individuals.

Objective To observe the effect of a Jianpi Huayu Jiedu formula on the NLRP3-mediated pyroptosis pathway in gastric precancerous lesion(GPL)associated with Helicobacter pylori(Hp)infection.Methods A GPL mouse model was prepared using Hp suspension gavage combined with Atp4a gene-deficient mice.The Jianpi Huayu Jiedu formula was administered as an intervention.Gastric mucosal tissue pathological damage was observed using hematoxylin and eosin(HE)staining.The presence of intestinal metaplasia(IM)was assessed using Alcian Blue-Periodic Acid Schiff(AB-PAS)staining.Ultrastructural changes in cell organelles were observed using transmission electron microscopy.Enzyme-linked immunosorbent assay(ELISA)was used to measure levels of gastrin-17(G-17),pepsinogen I(PGI),and proinflammatory cytokines IL-1β and IL-18.The expression of molecules related to the pyroptosis pathway was detected using Western blot and real-time quantitative PCR(RT-qPCR).Results Compared to the control group,Hp-related GPL mice exhibited gastric mucosal atrophy accompanied by IM and dysplasia.Damage to mitochondria and endoplasmic reticulum in parietal cells was observed.Levels of G-17,PGI,and proinflammatory cytokines IL-1β and IL-18 were elevated.The expression of molecules related to the pyroptosis pathway was increased.The Jianpi Huayu Jiedu formula significantly reduced gastric mucosal tissue pathological damage in GPL mice,decreased G-17 and PGI levels,mitigated inflammatory responses,and downregulated the expression of molecules related to the pyroptosis pathway.Conclusion The Jianpi Huayu Jiedu formula may exert its effects by inhibiting the NLRP3-mediated pyroptosis signaling pathway,thereby alleviating or even reversing the pathological damage of gastric mucosa in Hp-related GPL.

Objective To observe the effect of a Jianpi Huayu Jiedu formula on the NLRP3-mediated pyroptosis pathway in gastric precancerous lesion(GPL)associated with Helicobacter pylori(Hp)infection.Methods A GPL mouse model was prepared using Hp suspension gavage combined with Atp4a gene-deficient mice.The Jianpi Huayu Jiedu formula was administered as an intervention.Gastric mucosal tissue pathological damage was observed using hematoxylin and eosin(HE)staining.The presence of intestinal metaplasia(IM)was assessed using Alcian Blue-Periodic Acid Schiff(AB-PAS)staining.Ultrastructural changes in cell organelles were observed using transmission electron microscopy.Enzyme-linked immunosorbent assay(ELISA)was used to measure levels of gastrin-17(G-17),pepsinogen I(PGI),and proinflammatory cytokines IL-1β and IL-18.The expression of molecules related to the pyroptosis pathway was detected using Western blot and real-time quantitative PCR(RT-qPCR).Results Compared to the control group,Hp-related GPL mice exhibited gastric mucosal atrophy accompanied by IM and dysplasia.Damage to mitochondria and endoplasmic reticulum in parietal cells was observed.Levels of G-17,PGI,and proinflammatory cytokines IL-1β and IL-18 were elevated.The expression of molecules related to the pyroptosis pathway was increased.The Jianpi Huayu Jiedu formula significantly reduced gastric mucosal tissue pathological damage in GPL mice,decreased G-17 and PGI levels,mitigated inflammatory responses,and downregulated the expression of molecules related to the pyroptosis pathway.Conclusion The Jianpi Huayu Jiedu formula may exert its effects by inhibiting the NLRP3-mediated pyroptosis signaling pathway,thereby alleviating or even reversing the pathological damage of gastric mucosa in Hp-related GPL.

Objective:To understand the epidemiological characteristics of injury deaths in local residents in Nanjing from 2009 to 2023, and provide evidence for the development of injury prevention and control strategies.Methods:The injury mortality data in Nanjing from 2009 to 2023 were analyzed based on the death cause surveillance system. In the recorded 33 542 injury death cases, 19 906 (59.35%) were men, and 13 636 (40.65%) were women. The crude mortality rate, age-standardized mortality rate, age-specific mortality rate, cause-eliminated life expectancy (CELE), potential gains in life expectancy (PGLEs) and life loss rate, were calculated. Joinpoint 5.0 software was used to estimate the average annual percentage change (AAPC) and its 95% CI to assess temporal trends of injury deaths. Results:In Nanjing, the crude injury mortality rate showed an upward trend (AAPC=2.11%), while the age-standardized mortality rate exhibited a downward trend (AAPC=-1.27%) from 2009 to 2023. The ranking of injury deaths in all causes of death declined from the 4 th in 2009 to the 6 th in 2023. The crude and age-standardized injury mortality rates in men were consistently higher than those in women. The primary cause of injury deaths was fall (31.42%). Drowning was the primary cause of injury deaths in age group 0-14 years (35.94%), while traffic accident was the primary cause in age group 15-64 years. For residents aged ≥65 years, fall was the primary cause of injury deaths. From 2009 to 2023, the CELE (AAPC=0.61%, 95% CI: 0.34%-0.89%, P<0.05) and the PGLEs (AAPC=1.73%, 95% CI: 0.21%-3.29%, P<0.05) showed increasing trends. The PGLEs and life loss rate due to injury were consistently higher in men than in women, but the AAPC of PGLEs and life loss rate was higher in women. Conclusions:From 2009 to 2023, the age-standardized injury mortality rate decreased, but the life loss due to injury deaths showed an upward trend in Nanjing, indicating that injury still has non-negligible negative impact on life expectancy.

AIM:To investigate the protective effect of Shexiang-Tongxin dropping pills(STDP)against myo-cardial injury induced by coronary microembolization(CME)in rats,with a focus on the cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)signaling pathway.METHODS:Thirty-two Sprague-Dawley rats were randomly allocated into four groups using a random number table:sham group,CME group,STDP group,and RU.521 group,with 8 rats per group.A rat model of CME was established via the injection of embolic microspheres into the left ventricle.The rats in sham group received an equal volume of normal saline via left ventricular injection instead,those in STDP group were given STDP(40 mg/kg)by oral gavage once daily for 14 consecutive days before CME modeling,and those in RU.521 group were intraperitoneally injected with RU.521(5 mg/kg)once daily for 7 consecutive days before CME modeling.Echocardiography was performed to evaluate cardiac function 24 h after modeling.HE staining was used to observe pathological changes in myocardial tissue,and TTC staining was applied to detect myocardial infarction areas.Enzyme-linked immunosorbent assay(ELISA)was used to measure levels of interleukin(IL)-1β and tumor necrosis factor(TNF)-α.A commercial assay kit was employed to detect myocardial injury marker cardiac troponin I(cTnI).Western blot was performed to analyze the expression of cGAS-STING pathway-related proteins in cardiac tissues.RESULTS:Compared with sham group,the rats in CME group exhibited significantly impaired cardiac function and a marked increase in serum cTnI levels(P<0.05).In contrast,compared with CME group,the rats in both STDP group and RU.521 group demonstrated significant improvements in cardiac function and reductions in cTnI levels((P<0.05).Furthermore,HE staining and TTC staining revealed that the rats in CME group had loosely arranged myocardial fibers,swollen cardiomyo-cytes,and an increased myocardial infarction erea compared with sham group(P<0.05).Meanwhile,the expression lev-els of inflammatory factors IL-1β and TNF-α,as well as the relative expression of cGAS,STING and NF-κB p-p65 pro-teins were significantly increased(P<0.05).In comparison,the rats in STDP group and RU.521 group showed a signifi-cant reduction in myocardial infarction area,down-regulated expression of cGAS,STING,and NF-κB p-p65 proteins,and markedly decreased levels of IL-1β and TNF-α compared with CME group(P<0.05).CONCLUSION:STDP pre-treatment ameliorated myocardial injury,cardiac dysfunction and myocardial infarct size induced by CME.The underlying mechenism may involve the suppression of the cGAS-STING signaling pathway,thereby attenuating myocardial inflamma-tion after CME.