Objective To investigate the feasibility of developing a grading diagnostic model for schistosomiasis-induced liver fibrosis based on B-mode ultrasonographic images and clinical laboratory indicators. Methods Ultrasound images and clinical laboratory testing data were captured from schistosomiasis patients admitted to the Second People’s Hospital of Duchang County, Jiangxi Province from 2018 to 2022. Patients with grade I schistosomiasis-induced liver fibrosis were enrolled in Group 1, and patients with grade II and III schistosomiasis-induced liver fibrosis were enrolled in Group 2. The machine learning binary classification tasks were created based on patients’radiomics and clinical laboratory data from 2018 to 2021 as the training set, and patients’radiomics and clinical laboratory data in 2022 as the validation set. The features of ultrasonographic images were labeled with the ITK-SNAP software, and the features of ultrasonographic images were extracted using the Python 3.7 package and PyRadiomics toolkit. The difference in the features of ultrasonographic images was compared between groups with t test or Mann-Whitney U test, and the key imaging features were selected with the least absolute shrinkage and selection operator (LASSO) regression algorithm. Four machine learning models were created using the Scikit-learn repository, including the support vector machine (SVM), random forest (RF), linear regression (LR) and extreme gradient boosting (XGBoost). The optimal machine learning model was screened with the receiver operating characteristic curve (ROC), and features with the greatest contributions to the differentiation features of ultrasound images in machine learning models with the SHapley Additive exPlanations (SHAP) method. Results The ultrasonographic imaging data and clinical laboratory testing data from 491 schistosomiasis patients from 2019 to 2022 were included in the study, and a total of 851 radiomics features and 54 clinical laboratory indicators were captured. Following statistical tests (t = −5.98 to 4.80, U = 6 550 to 20 994, all P values < 0.05) and screening of key features with LASSO regression, 44 features or indicators were included for the subsequent modeling. The areas under ROC curve (AUCs) were 0.763 and 0.611 for the training and validation sets of the SVM model based on clinical laboratory indicators, 0.951 and 0.892 for the training and validation sets of the SVM model based on radiomics, and 0.960 and 0.913 for the training and validation sets of the multimodal SVM model. The 10 greatest contributing features or indicators in machine learning models included 2 clinical laboratory indicators and 8 radiomics features. Conclusions The multimodal machine learning models created based on ultrasound-based radiomics and clinical laboratory indicators are feasible for intelligent identification of schistosomiasis-induced liver fibrosis, and are effective to improve the classification effect of one-class data models.

To summarize the experience of Professor WANG Qingguo in diagnosing and treating wind-cold-dampness arthralgia based on the principle that "the nutrient-defense qi does not merge with wind-cold-dampness qi， so it did not result to arthralgia". By analyzing the relationship between nutrient-defense qi and wind-cold-dampness arthralgia， it is believed that the occurrence of wind-cold-dampness arthralgia is closely related to the movement of nutrient qi and defense qi， and the key to the treatment of this disease is to regulate nutrient qi and defense qi and remove the combination of nutrient-defense qi and wind-cold-dampness qi. The core pathogenesis of wind-cold-dampness arthralgia in the early stage is the initial combination of nutrient-defense qi and wind-cold-dampness qi， and the treatment should harmonize nutrient-defense qi and eliminate the pathogen and release pathogenesis， with Chaihu Guizhi Decoction （柴胡桂枝汤） as the main prescription； the core pathogenesis of the middle stage is nutrient-defense qi and wind-cold-dampness qi cemented together， and the treatment should harmonize and tonify nutrient qi and defense qi and separate the pathogen to alleviate disease， with self-prescribed Chuanteng Tongbi Decoction （穿藤通痹汤） as the main prescription； the core pathogenesis of the late stage is deficiency and stagnation of nutrient-defense qi， wind-cold-dampness qi still exist， and the treatment should tonify and free nutrient qi and defense qi to eliminate pathogen and arthralgia， with self-prescribed Chuanqing Haijia Decoction （穿青海甲汤） plus Duhuo Jisheng Decoction （独活寄生汤） as the main prescription.

Surgical technique of lung transplantation exerts significant impact on clinical prognosis of the recipients.Choosing an appropriate surgical incision determines the exposure of intraoperative visual field,which is the first step of surgical success and directly affects subsequent surgical procedures.Lung transplantation incision is usually considered as primary closure.Nevertheless,for patients with high-risk factors such as oversized lung allografts and primary graft failure after lung transplantation,primary closure cannot be achieved.Hence,delayed chest closure is an effective strategy.The selection of incisions and the adoption of delayed chest closure of lung transplantation exert profound impact upon perioperative prognosis,long-term quality of life and surgical complications of the recipients.Therefore,the development and research status of Clamshell incision,anterolateral incision,posterolateral incision and median sternal incision in lung transplantation were reviewed,highlighting the effect of incision patterns on clinical prognosis of lung transplantation and providing reference for the selection of incisions in clinical lung transplantation.

Tumour metastasis is the primary cause of mortality in patients with tumours.Platelets are fragments of anucleated cells shed from the cytoplasm of mature megakaryocytes of the bone marrow，and involved in coagulation and the maintenance of vascular wall integrity.Recent studies have demonstrated that platelets participate in the host immune response by secreting granules containing a range of immunomodulatory and antimicrobial molecules，which are critical for tumour metastasis.In tumours，contact between platelets and tumour cells promotes platelet activation and aggregation.Activated platelets release a large number of reactive biomolecules that assist tumour cells in immune escape，migration，stationary adhesion and extravasation.Meanwhile，platelets accelerate tumour cell metastasis by inducing tumour epithelial mesenchymal transition，neoangiogenesis，metastatic ecological niche formation and other mechanisms.This article presents a review of the current state of research on the role of platelets in tumour metastasis，and offers insights into potential therapeutic avenues to enhance the survival of tumour patients.

As the final resolution for end-stage lung disease, lung transplantation can not only significantly prolong the survival, but also remarkably improve the quality of life of recipients. In recent decades, with the advancement of surgical techniques, immunosuppressants and post-transplantation management, the quantity of lung transplantation has been surged around the globe. However, the shortage of donor lung has severely restricted the development of lung transplantation. It is necessary to develop innovative approaches to expand the donor pool. The number of donors and effective preservation and functional maintenance of potential donor lungs play a key role in expanding the donor pool. The quality of donor lung is a critical precondition to ensure the long-term survival of lung transplant recipients. Preservation and functional maintenance of donor lung are of significance for guaranteeing the quality of lung allograft. In this article, research progresses on the management and maintenance of donor lung before procurement, the procurement of donor lung and the preservation and functional maintenance of lung allograft were reviewed, aiming to provide reference for the development of lung transplantation in clinical practice.

Neuroblastoma is the most common extracranial solid tumor for infants and young children.About 50% of patients have extensive metastasis before diagnosis, and the neuroblastoma can metastasize to bone marrow, bone, lymph node, orbit, liver and skin.Bone marrow is the most common site of neuroblastoma metastasis and recurrence.Once neuroblastoma metastasize or relapse, their survival rate will reduce significantly.The mechanism of neuroblastoma bone marrow metastasis has not been elucidated.The drug resistance of tumor cells, the interaction of bone marrow microenvironment, and the regulation of cell signaling pathways may play important roles in regulating tumor cell bone marrow metastasis.This review summarizes the research progress of bone marrow metastasis in neuroblastoma, which helps us to better understand the mechanism of interaction between neuroblastoma and the bone marrow microenvironment, and to provide new ideas for the diagnosis and treatment of patients.

Objective:To analyze the expression of E-cadherin in the epithelial-mesenchymal transition (EMT) induced by transforming growth factor-β1 (TGF-β1) in neuroblastoma.Methods:TGF-β1(1 μg/L, 5 μg/L, 10 μg/L), was applied to SK-N-SH cells in vitro compared with the blank control group.EMT-related genes mRNA and protein expression were detected by carrying out real-time PCR assays and Western blot.A scratch test and migration assay were performed to verify the alteration of SK-N-SH cell migration capacity.Data collected from 18 cases of neuroblastoma patients were selected from the Department of Hematology Oncology, Shanghai Children′s Hospital from January 2008 to December 2012.The expression of E-cadherin in the tumor tissue of the neuroblastoma patients after operation was detected by immunohistochemistry.The clinical features and survival prognosis of these patients were analyzed. Results:Compared with the control group, after SK-N-SH cells were treated with TGF-β1(1 μg/L, 5 μg/L, 10 μg/L), real-time PCR assays and Western blot revealed that the mRNA(0.603±0.081, 0.606±0.008, 0.716±0.166 vs.1.000) and protein expression levels(0.855±0.026, 0.600±0.017, 0.495±0.011 vs.1.000) of E-cadherin were significantly decreased ( F=8.144, P=0.040; F=74.810, P<0.001), while the mRNA(2.132±0.167, 3.494±0.017, 4.184±0.021 vs.1.000) and protein expression levels (1.175±0.053, 1.189±0.058, 1.225±0.106 vs.1.000)of α - smooth muscle actin were significantly increased ( F=547.300, P<0.001; F=68.810, P=0.007), suggesting that EMT changes occur in cells.Scratch test and Transwell migration assay revealed that the number of migrating cells increased obvious with the treatment of TGF-β1 (5 μg/L) ( t=16.070, P=0.040). The 10-year overall survival(OS) rates of neuroblastoma patients with E-cadherin strong positive expression, positive expression, weak positive expression and negative expression in the pathology were (77.78±13.86)%, (75.00±21.66)%, (25.00±21.65)% and 0, respectively ( F=8.160, P=0.040). Conclusions:TGF-β1 can induce the EMT in SK-N-SH cells and increase cell migration.The decrease expression of E-cadherin in neuroblastoma patients is closely associated with clinical progress and recurrence or metastasis of the disease.

Objective:To analyze the relationship between molecular cytogenetic abnormalities and clinical characteristics of acute lymphoblastic leukemia (ALL) in childhood .Methods:A total of 403 patients newly diagnosed with ALL in the Department of Hematology, Shanghai Children′s Hospital from January 2009 to December 2018 were enrolled in this study.All the patients had completed the test of bone marrow smear cytology, immunotyping, karyotype analysis, and fluorescence in situ hybridization (FISH).Results:(1)There were 240 males (59.6%) and 163 females (40.4%) aged (5.31±3.46)years.There were 374 patients(92.8%) with B cell acute lymphoblastic leukemia (B-ALL)and 29 patients(7.2%) with T cell acute lymphoblastic leukemia (T-ALL). (2)Cytogenetics: A total of 311 cases (77.2%) showed mitosis in the chromosomal karyotype analysis, of which 126 cases were abnormal (abnormality detection rate was 40.5%), including 15.4% (48/311cases) hyperdiploid.(3)Fusion gene: Positive fusion genes were found in 110 cases (27.3%), including TEL/AML1 gene in 70 cases (17.4%), BCR/ ABL in 13 cases (3.2%), MLL in 19 cases (4.7%). From 2015-2018, 8 cases (4.0%) of PBX1/TCF3 fusion gene, 1 case of EBF1-PDGFRB fusion gene, 6 cases of SIL/TAL1 fusion gene were detected, SIL/TAL1 positive patients which were accounting for 33.3% of T-ALL improved the detection rate of T-ALL molecular abnormalities.Patients with positive BCR/ ABL were older than those with positive TEL/AML1 and positive MLL[(8.01±3.11) years vs.(3.89±1.84) years, (1.56±1.25) years, P<0.001]; patients with positive PBX1/TCF3 [6.58±4.83) years]were older than those with positive TEL/AML1 and positive MLL (all P<0.05); patients with positive MLL were younger than those with positive TEL/AML1 [(1.56±1.25) years vs.(3.89±1.84) years, P=0.001]; the white blood cell (WBC) count of positive MLL patients was higher than that of positive TEL/AML1 and positive BCR/ ABL patients [(76.97±19.87)×10 9/L vs.(16.94±2.28)×10 9/L, P=0.002; (76.97±19.87)×10 9/L vs.(20.53±6.49)×10 9/L, P<0.05]; the WBC count of PBX1/TCF3 positive children was higher than that of positive TEL/AML1 patients [(85.75±30.32)×10 9/L vs.(16.94±2.28)×10 9/L, P=0.002]. The immunotyping of positive MLL patients was dominated by early precursor B-ALL (14/19 cases), while the immunotyping of TEL/AML1 and BCR/ABL positive patients were dominated by common-B-ALL(57/70 cases and 11/15 cases). (4)The detection rates of chromosome karyotype analysis, FISH, and polymerase chain reaction (PCR) were used to detect molecular genetic abnormalities in primary ALL patients, the detection rate was 40.5% (126/403 cases), 69.2% (279/403 cases), and 29.7% (60/202 cases), respectively.The difference was statistically significant ( P<0.001). There was no significant difference in the abnormality detection rate between chromosome karyotype analysis and PCR ( P=0.71). (5)There was no significant difference in the detection rate of molecular cytogenetic abnormalities between different genders and age groups ( P=0.651, 0.721). There was a significant difference between the WBC count ≥50 × 10 9/L group and <50 × 10 9/L group(37/51 cases vs.107/352 cases, P<0.001). The detection rate of B-ALL genetic abnormalities was higher than that of T-ALL genetic abnormalities(275/374 cases vs.14/29 cases, P=0.005). Conclusions:There are a higher proportion of hyperdiploidy chromosomes in children ALL.The distribution of fusion genes is related to age, primary white blood cell count, and immunotyping.The three detection methods complement each other and greatly improve the detection rate of genetic abnormalities.The detection rate of T-ALL genetic abnormality is low, and new detection methods may be needed.

Objective To investigate the clinical efficacy and prognostic factors for M4/M5subtypes in chil-dren with acute myeloid leukemia(AML).Methods A retrospective analysis of the clinical data of M4/M5subtypes in Shanghai Children′s Hospital Affiliated to Shanghai Jiaotong University,from January 2009 to December 2014 was carried out.The long-term efficacy,prognosis and relapse factors were analyzed.Results The clinical data of 46 ca-ses were collected,among which 38 cases were treated with more than 2 courses,including 22 male,16 female,19 cases M4and 19 cases M5.The median age was 5 years.5-year overall survival(OS)rate and 5-year event-free survival (EFS)rate were(57.7 ± 9.3)% and(47.2 ± 8.9)%,and 5-year EFS of M4and M5were(52.4 ± 12.7)% and (45.4 ± 11. 9)%. Compared with the international risk stratification:5-year EFS rate of favorable-risk, intermediate-risk and poor-risk were(77.2 ± 12.4)%,(49.5 ± 14.9)% and(25.0 ± 19.8)%(χ2=6.305,P=0.043).Single factor analysis showed that extramedullary infiltration(χ2=4.828,P=0.028),Chromosome karyotype (χ2=10.178,P=0.017),the eighth day assessment(χ2=5.382,P=0.020)and course of treatment(χ2=4.771, P=0.029)were prognostic factors;multivariate analysis showed extramedullary infiltration(HR =5.323,95%CI:1.620-17.490,P=0.006)and less-than-6 courses of treatment(HR=6.186,95%CI:1.726-22.176,P=0.005)were the independent risk factors of affecting survival.Conclusions (1)Strengthening treatment and ade-quate courses of treatment are the critical to improve the overall curative effect in children with M4/M5subtypes.(2) Extramedullary infiltration was the risk factor for survival and recurrence in M4/M5subtypes.(3)It is suggested that the children who have the initial symptoms and molecular biology with poor prognostic factors choose hematopoietic stem cell transplantation as early as possible.

Objective: To investigate the possibility and diagnostic efficiency of ¹⁸F-NaF PET/CT bone scan after oral administration (PO) by comparing with that of intravenous injection (IV). Methods: Fifty patients (19 males, 31 females; average age: (52.8±11.7) years) with cancer who underwent PET/CT scans after oral and intravenous administration of ¹⁸F-NaF respectively with an interval of 2-7 d from June 2015 to September 2016 were prospectively enrolled. Single-phase ¹⁸F-NaF PET/CT was performed 60 min after IV, and dual-phase ¹⁸F-NaF PET/CT was performed 60 and 120 min after PO. All PET/CT images were reviewed, lesions were counted, and maximum standardized uptake value (SUV_max) and target/non-target (T/NT) ratios were calculated and compared. Paired t test was used. Results: Forty-one patients (15 males, 26 females; average age: (53.5±10.4) years) who finished all PET/CT scans were enrolled. The images at 120 min after PO was visually similar to the images at 60 min after IV. Three modalities detected the same cases and lesions (35 positive cases: 25 malignant, 8 benign, 2 cases with indefinite diagnosis; 302 lesions: 172 malignant, 108 benign, 22 ambiguous lesions). The SUV_{max-PO60 min} and SUV_{max-PO120 min} were lower than the SUV_{max-IV60 min} in the same lesion (18.22±12.64, 26.60±19.49 vs 28.07±16.34; t values: -12.36 and -3.59, both P<0.05). A total of 194 lesions were included for T/NT ratio analysis. T/NT_{IV60 min}, T/NT_{PO60 min} and T/NT_{PO120 min} were 2.76±1.30, 2.87±1.50, 2.98±1.42, respectively, and T/NT_{PO120 min} was higher than T/NT_{IV60 min} (t=3.18, P<0.05). Conclusion ¹⁸F-NaF PET/CT images after PO, especially at 120 min post-PO, has similar diagnostic power of lesion-detection and SUV_max-measurement with IV.