Background and purpose:Diffuse large B-cell lymphoma(DLBCL)is subclassified into germinal center B-cell-like(GCB)and non-GCB subtypes,which differ in prognosis and treatment response.However,current distinction still relies on invasive pathological assays.This study developed radiomics and deep-learning models based on multiparametric magnetic resonance imaging(MRI)to non-invasively differentiate the two subtypes preoperatively,thereby reducing dependence on histopathological examination.Methods:This study retrospectively included patients with pathologically confirmed DLBCL diagnosed at Huashan Hospital,Fudan University,and other institutions between March 2013 and December 2024.Using multiparametric MRI data,we developed DLBCL-subtype classification models that combined 4 radiomics-based machine-learning algorithms:support vector machine(SVM),logistic regression(LR),Gaussian process(GP)and Naive Bayes(NB),with 3 deep-learning architectures[densely-connected convolutional networks 121(DenseNet121),residual network 101(ResNet101)and EfficientNet-b5].Additionally,two radiologists with different experience levels independently classified DLBCL on MRI in a blinded fashion.Model and radiologist performance were quantified using the area under the receiver operating characteristic curve(AUC),accuracy(ACC),and F1-score to evaluate their ability to distinguish GCB from non-GCB subtypes.This study was approved by the Ethics Committee of Huashan Hospital of Fudan University(No.KY2024-663),and all patients signed informed consents.Results:A total of 173 patients were enrolled(55 with GCB subtype and 118 with non-GCB subtype).Radiomics and deep learning methods effectively distinguished DLBCL subtypes.Among these,the GP radiomics model(based on T1-CE+T2-FLAIR+ADC sequences)and DenseNet121 deep learning model(based on T1-CE+T2-FLAIR+ADC sequences)demonstrated optimal performance.Both achieved excellent results on the internal validation set(GP:AUC=0.900,ACC=0.896,F1=0.840;DenseNet121:AUC=0.846,ACC=0.854,F1=0.774)and maintained robustness on the external validation set.Furthermore,the classification efficacy of the optimal AI model surpassed that of experienced radiologists(highest physician AUC=0.678).Conclusion:Radiomics and deep-learning models based on multiparametric MRI features can effectively differentiate GCB from non-GCB subtypes of DLBCL.Among them,GP and DenseNet121 exhibit outstanding performance,especially when integrating multi-sequence feature sets for classifying DLBCL subtypes on complex imaging data.

Background and purpose:Diffuse large B-cell lymphoma(DLBCL)is subclassified into germinal center B-cell-like(GCB)and non-GCB subtypes,which differ in prognosis and treatment response.However,current distinction still relies on invasive pathological assays.This study developed radiomics and deep-learning models based on multiparametric magnetic resonance imaging(MRI)to non-invasively differentiate the two subtypes preoperatively,thereby reducing dependence on histopathological examination.Methods:This study retrospectively included patients with pathologically confirmed DLBCL diagnosed at Huashan Hospital,Fudan University,and other institutions between March 2013 and December 2024.Using multiparametric MRI data,we developed DLBCL-subtype classification models that combined 4 radiomics-based machine-learning algorithms:support vector machine(SVM),logistic regression(LR),Gaussian process(GP)and Naive Bayes(NB),with 3 deep-learning architectures[densely-connected convolutional networks 121(DenseNet121),residual network 101(ResNet101)and EfficientNet-b5].Additionally,two radiologists with different experience levels independently classified DLBCL on MRI in a blinded fashion.Model and radiologist performance were quantified using the area under the receiver operating characteristic curve(AUC),accuracy(ACC),and F1-score to evaluate their ability to distinguish GCB from non-GCB subtypes.This study was approved by the Ethics Committee of Huashan Hospital of Fudan University(No.KY2024-663),and all patients signed informed consents.Results:A total of 173 patients were enrolled(55 with GCB subtype and 118 with non-GCB subtype).Radiomics and deep learning methods effectively distinguished DLBCL subtypes.Among these,the GP radiomics model(based on T1-CE+T2-FLAIR+ADC sequences)and DenseNet121 deep learning model(based on T1-CE+T2-FLAIR+ADC sequences)demonstrated optimal performance.Both achieved excellent results on the internal validation set(GP:AUC=0.900,ACC=0.896,F1=0.840;DenseNet121:AUC=0.846,ACC=0.854,F1=0.774)and maintained robustness on the external validation set.Furthermore,the classification efficacy of the optimal AI model surpassed that of experienced radiologists(highest physician AUC=0.678).Conclusion:Radiomics and deep-learning models based on multiparametric MRI features can effectively differentiate GCB from non-GCB subtypes of DLBCL.Among them,GP and DenseNet121 exhibit outstanding performance,especially when integrating multi-sequence feature sets for classifying DLBCL subtypes on complex imaging data.

Objective To analyze the correlation between NOD like receptor pyrin domain containing 3(NLRP3)inflammasome and pro-inflammatory factors interleukin(1L)-1 β and tumor necrosis factor(TNF)-α in the pathogenesis of acute gouty arthritis.Methods From June 2023 to July 2024,76 patients in Wenzhou Hospital of Traditional Chinese Medicine with acute gouty arthritis were selected as case group,and 53 healthy individuals as control group.The mRNA expression levels of NLRP3 inflammasome,apoptosis-associated speck-like protein(ASC),Caspase-1,IL-1β,IL-18,TNF-α were monitored using real-time fluorescence quantitative real-time fluorescence quantitative(PCR),and concentrations of these proteins were determined using enzyme-linked immunosorbent assay(ELISA).Results Age,gender,and other data were similar between both groups(P＞0.05).levels of uric acid,C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)in case group were higher than those in control group(P＜0.001).Expression of NLRP3,ASC,and Caspase-1 were also higher(P＜0.001).Serum levels of IL-1β,IL-18,and TNF-α were higher in case group(P＜0.05).NLRP3 inflammasome activity correlated positively with IL-1β and TNF-α.Multivariate Logistic regression showed uric acid,CRP,ESR,NLRP3,ASC,Caspase-1,IL-1 β,IL-18,and TNF-α were important factors for acute gouty arthritis attacks(P＜0.05).Conclusion By inhibiting activation of NLRP3 inflammasome or release of downstream inflammatory factors,inflammatory response of gouty arthritis can be effectively reduced,thereby alleviating symptoms and preventing joint damage.

Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.

Objective To investigate the relationship between the level of secretory curl related protein(SFRP)and the therapeutic effect of sodium hyaluronate in patients with knee osteoarthritis(KOA).Methods A total of 89 patients with KO A from May 2021 to June 2023 in Wenzhou Traditional Chinese Medicine Hospital were selected as observation group.All patients were treated with sodium hyaluronate.According to the treatment effect,they were divided into obvious/improved group and poor effect group.67 healthy examinees were selected as control group during the same period..The levels of SFRP1,SFRP2 and SFRP5 in each group were determined by enzyme linked immunosorbent assay,and the therapeutic effect of sodium hyaluronate in patients with KOA was analyzed by multivariate Logistic regression.Receiver operating characteristic(ROC)curve was drawn to analyze the evaluation efficiency of SFRP level in the treatment effect of patients with KOA.Results SFRP1,SFRP2 and SFRP5 in observation group were lower than those in control group(P＜0.05);89 patients were treated with sodium hyaluronate,and 67 patients showed good treatment outcomes(75.28％),and SFRP1,SFRP2 and SFRP5 in obvious/improved group were higher than those in poor effect group(P＜0.05).Multivariate results showed that SFRP1,SFRP2,SFRP5 and the Western Ontario and MeMaster Universities osteoarthritis index were the influential factors for the treatment effect of patients with KOA(P＜0.05).ROC curve results showed that the sensitivity and specificity of SFRP1,SFRP2 combined with SFRP5 in the treatment of KOA patients was higher than that of a single index(P＜0.05).Conclusion The levels of SFRP1,SFRP2 and SFRP5 are low in patients with KOA,and their expression levels are closely related to the therapeutic effect of sodium hyaluronate.The combined determination of different indicators can improve the sensitivity and specificity of prognosis.

Objective To analyze the correlation between NOD like receptor pyrin domain containing 3(NLRP3)inflammasome and pro-inflammatory factors interleukin(1L)-1 β and tumor necrosis factor(TNF)-α in the pathogenesis of acute gouty arthritis.Methods From June 2023 to July 2024,76 patients in Wenzhou Hospital of Traditional Chinese Medicine with acute gouty arthritis were selected as case group,and 53 healthy individuals as control group.The mRNA expression levels of NLRP3 inflammasome,apoptosis-associated speck-like protein(ASC),Caspase-1,IL-1β,IL-18,TNF-α were monitored using real-time fluorescence quantitative real-time fluorescence quantitative(PCR),and concentrations of these proteins were determined using enzyme-linked immunosorbent assay(ELISA).Results Age,gender,and other data were similar between both groups(P＞0.05).levels of uric acid,C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)in case group were higher than those in control group(P＜0.001).Expression of NLRP3,ASC,and Caspase-1 were also higher(P＜0.001).Serum levels of IL-1β,IL-18,and TNF-α were higher in case group(P＜0.05).NLRP3 inflammasome activity correlated positively with IL-1β and TNF-α.Multivariate Logistic regression showed uric acid,CRP,ESR,NLRP3,ASC,Caspase-1,IL-1 β,IL-18,and TNF-α were important factors for acute gouty arthritis attacks(P＜0.05).Conclusion By inhibiting activation of NLRP3 inflammasome or release of downstream inflammatory factors,inflammatory response of gouty arthritis can be effectively reduced,thereby alleviating symptoms and preventing joint damage.

The American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) convened a writing group to develop a consensus report on the management of anti-rheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty in June 2022. In particular, the consensus provides significant updates on target synthetic disease modifying anti-rheumatic drugs and perioperative medication management in patients with systemic lupus erythematosus, as well as the addition of newly approved antirheumatic medications for administration. This article will interpret the consensus and provide a reference for the perioperative management of antirheumatic medications for hip and knee arthroplasty in patients with rheumatic diseases in China.

Abstract: Objective To investigate the expression of serum C-C chemokine 22 (CCL22) and its receptor C-C chemokine receptor 4 (CCR4) in patients with chronic hepatitis B (CHB), and its correlation with liver function indicators and disease progression. Methods A total of 96 patients with CHB who were treated in Neijiang Traditional Chinese Medicine Hospital from October 2021 to November 2022 were recruited as the observation group, and divided into mild group (n=43), moderate group (n=36) and severe group (n=17) , according to the progress of the disease. In addition, 50 healthy people who underwent physical examination in the same hosiptal were selected as the control group. The levels of serum CCL22 mRNA, CCR4 mRNA and liver function indicators [alanine aminotrans-ferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin (ALB)] were measured. Pearson correlation analysis was performed to analyze the correlation between serum CCL22 and CCR4 levels and liver function indicators and disease severity, and logistic regression was applied to evaluate the factors affecting the progress of CHB patients. Results Compared with the control group, the levels of CCL22 mRNA, CCR4 mRNA, ALT, AST and TBIL in the observation group were obviously higher (P<0.05), the level of ALB was obviously lower (P<0.05); the expression levels of serum CCL22 mRNA, CCR4 mRNA, ALT, AST and TBIL in mild, moderate and severe groups increased in turn, while the expression level of ALB decreased in turn, with significant differences between groups (P<0.05); The levels of serum CCL22 mRNA and CCR4 mRNA were positively correlated with liver function indicators ALT, AST, TBIL levels, and negatively correlated with ALB level (P<0.05); Both CCL22 mRNA and CCR4 mRNA were positively correlated with the severity of the disease (r=0.646, 0.516, P<0.001); the expression levels of CCR4 mRNA, ALT, AST, TBIL and ALB were all factors affecting the development of CHB patients (P<0.05). Conclusions The expression of CCL22 and CCR4 in serum is closely related to liver function index and severity of CHB patients, which can provide reference for clinical evaluation and symptomatic treatment.

Clinical data of 43 patients who underwent endoscopic resection for gastrointestinal stromal tumors (GIST) of length ≤1.2 cm at the Digestive Endoscopy Center of the 909th Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients were divided into the endoscopic ligation resection (ELR) group ( n=27) and the endoscopic submucosal excavation (ESE) group ( n=16). The general, perioperative and follow-up data of the two groups were compared. The results showed that there was no significant difference in the general data between the two groups. The operation time was 20.0 (18.0,25.0) min in the ELR group and 27.5 (23.0,37.5) min in the ESE group, showing significant difference ( U=92.5, P=0.001). The en bloc resection rates were 100.0% (27/27) in the ELR group and 81.3% (13/16) in the ESE group, showing significant difference ( P=0.045). The postoperative hospital stays were 3 (2,4) days in the ELR group and 5 (4,6) days in the ESE group, showing significant difference ( U=125.5, P=0.020). There was no significant difference in the intraoperative bleeding rate, intraoperative hemorrhage volume, intraoperative perforation rate, number of hemostatic clips or postoperative complications including hemorrhage, fever and peritonitis between the two groups ( P>0.05). During the follow-up, there was no recurrence or metastasis of GIST in both groups. ELR and ESE can be safe and effective for small GIST ≤1.2 cm in diameter. Compared with the ESE group, the operation time and postoperative hospital stay are shorter with higher en bloc resection rate in the ELR group.

ObjectiveTo understand the cooperative work and mechanism in the corona virus disease 2019 containment action by the support-to-Hebei epidemiological investigation group formed by five provinces， summarize the existing challenges， and discuss the relevant mechanism， so as to provide evidence for future support actions. MethodsA questionnaire survey was used to investigate the members from five provinces of the support-to-Hebei epidemiological investigation team. The content included basic information， work situation， problems in cooperative work， and suggestions in support mechanisms. ResultsA total of 104 questionnaires were issued， of which 101 valid questionnaires were collected with an effective response rate of 97.12%. The proportions of respondents who participated in the epidemic-related data preparation， case investigation， technical training， supervision of key venues， and specimen collection was 93.07%， 85.15%， 81.19%， 65.35%， and 44.55%， respectively. The respondents believed that information sharing channel of local epidemic situation was blocked （95.05%）， coordination mechanism among local departments was insufficient （84.16%）， communication and coordination mechanism among the dispatch institutions， support team， and local departments was unperfect （84.16%）， management of the dispatch institutions to the support team was relatively loose （79.21%）， dispatch institutions failed to make full use of professional advantages of the support team （72.28%）， and majority of the support team members engaged in a single profession （59.41%）. The respondents suggested that local departments should improve the information sharing mechanism （95.05%）， strengthen communication and coordination among the dispatch institutions， support team， and local departments （92.08%）， and dispatch institutions should clarify the tasks and responsibilities of the support team （91.09%）， formulate cross-regional emergency support plans （87.13%） and evaluation plans of support action （72.28%）. ConclusionIn order to ensure the efficiency and accuracy of future support actions， it is necessary to improve the mechanism of emergency coordination， communication and matching， response procedures， team management， and support evaluation.