Objective To observe the value of deep learning image reconstruction(DLIR)algorithm in brain CT perfusion(CTP)using a protocol of 70 kVp and 40 ml contrast agent dose.Methods Totally 105 patients with suspected acute ischemic stroke(AIS)were prospectively enrolled and randomly divided into 3 groups,who underwent standard dose CTP scanning with 80 kVp and 150 mA combined with reconstruction as adaptive statistic iterative reconstruction V(ASIR-V)at 50％level(CN group,n=35),low dose(LD)scanning with 70 kVp and 100 mA combined with DLIR reconstruction at the highest level(DLIR-H)(LD group,n=35),or ultra-low dose(ULD)scanning with 70 kVp and 70 mA combined with DLIR-H reconstruction(ULD group,n=35).Radiation doses were compared among 3 groups.CT values and standard deviations(SDCT)of ROI of gray matter and white matter in the frontal,parietal and temporal lobes were measured.Signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)between gray and white matter were calculated and compared among groups.Then pseudo-color images of cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT)and time to maximum of the tissue residual function(Tmax)were generated.The imaging quality of CTP pseudo-color images was evaluated,and the compatibility of the subjective scores within every kind of CTP pseudo-color images were assessed using Kappa test.Quantitative perfusion parameters were measured and compared among groups.Results Compared with CN group,both LD and ULD groups demonstrated significantly reduced volume CT dose index(CTDIvol),dose-length product(DLP)and effective dose(ED)(all adjusted P＜0.05).In ULD group,SDCT of white matter in frontal,parietal and temporal lobes were higher than those in CN group,and SDCT of white matter in parietal lobe was also higher than that in LD group(all adjusted P＜0.05).No significant difference of SDCT of gray matter was observed among groups(all P＞0.05).SNR of white matter in parietal and temporal lobes in both LD and ULD groups were lower than those in CN group(all P＜0.05),while no significant difference of SNR of white matter in frontal lobe,nor of gray matter in frontal,parietal and temporal lobes was found among groups(all P＞0.05).CNR of gray and white matter in the frontal,parietal and temporal lobes were not significantly different among groups(all P＞0.05).High consistency of inter-observer subjective scores of CBV maps,CBF maps and Tmax maps(Kappa of 0.623,0.644 and 0.638,respectively)were noticed,which of MTT maps had moderate consistency(Kappa=0.560).No significant difference of intra-obsever subjective scores of CTP pseudo-color images was found among groups(all P＞0.05).CBV,CBF,MTT and Tmax values of gray and white matter in frontal,parietal and temporal lobes were not significantly different among groups(all P＞0.05).Conclusion DLIR algorithm applicated in low radiation dose and reduced contrast agent dosage might ensure imaging quality.

Objective To observe the value of deep learning image reconstruction(DLIR)algorithm in brain CT perfusion(CTP)using a protocol of 70 kVp and 40 ml contrast agent dose.Methods Totally 105 patients with suspected acute ischemic stroke(AIS)were prospectively enrolled and randomly divided into 3 groups,who underwent standard dose CTP scanning with 80 kVp and 150 mA combined with reconstruction as adaptive statistic iterative reconstruction V(ASIR-V)at 50％level(CN group,n=35),low dose(LD)scanning with 70 kVp and 100 mA combined with DLIR reconstruction at the highest level(DLIR-H)(LD group,n=35),or ultra-low dose(ULD)scanning with 70 kVp and 70 mA combined with DLIR-H reconstruction(ULD group,n=35).Radiation doses were compared among 3 groups.CT values and standard deviations(SDCT)of ROI of gray matter and white matter in the frontal,parietal and temporal lobes were measured.Signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)between gray and white matter were calculated and compared among groups.Then pseudo-color images of cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT)and time to maximum of the tissue residual function(Tmax)were generated.The imaging quality of CTP pseudo-color images was evaluated,and the compatibility of the subjective scores within every kind of CTP pseudo-color images were assessed using Kappa test.Quantitative perfusion parameters were measured and compared among groups.Results Compared with CN group,both LD and ULD groups demonstrated significantly reduced volume CT dose index(CTDIvol),dose-length product(DLP)and effective dose(ED)(all adjusted P＜0.05).In ULD group,SDCT of white matter in frontal,parietal and temporal lobes were higher than those in CN group,and SDCT of white matter in parietal lobe was also higher than that in LD group(all adjusted P＜0.05).No significant difference of SDCT of gray matter was observed among groups(all P＞0.05).SNR of white matter in parietal and temporal lobes in both LD and ULD groups were lower than those in CN group(all P＜0.05),while no significant difference of SNR of white matter in frontal lobe,nor of gray matter in frontal,parietal and temporal lobes was found among groups(all P＞0.05).CNR of gray and white matter in the frontal,parietal and temporal lobes were not significantly different among groups(all P＞0.05).High consistency of inter-observer subjective scores of CBV maps,CBF maps and Tmax maps(Kappa of 0.623,0.644 and 0.638,respectively)were noticed,which of MTT maps had moderate consistency(Kappa=0.560).No significant difference of intra-obsever subjective scores of CTP pseudo-color images was found among groups(all P＞0.05).CBV,CBF,MTT and Tmax values of gray and white matter in frontal,parietal and temporal lobes were not significantly different among groups(all P＞0.05).Conclusion DLIR algorithm applicated in low radiation dose and reduced contrast agent dosage might ensure imaging quality.

Objective To investigate the protective effect and mechanism of adenosine-lidocaine-magnesium sulfate(ALM)resuscita-tion solution against acute lung injury in sepsis were investigated through in vitro and in vivo experiments.Methods ALM resuscitation solution effects on septic lung injury were assessed in SD rats and rat pulmonary micro vascular endothelial cells(PMVEC)in vitro,and the effector mechanism was explored by using network pharmacology combined with molecular biology methods,detecting alterations in nuclear factor kappaB(NF-κB)signaling pathway and inflammatory cytokine key protein expressions.Results Based on in vivo experi-ments,ALM resuscitation solution treatment significantly improved lung histopathological injury in cecal ligation and puncture(CLP)model rats,reduced the lung injury score and lung dry-to-wet ratio(P＜0.01),and significantly suppressed pro-inflammatory cytokine expressions such as that of IL-1β,IL-6,and TNF-α(P＜0.01).Moreover,in vitro experiments confirmed that ALM resuscitation solution significantly reduced p-p65 and p-IκBα protein expressions in LPS-induced PMVEC(P＜0.05),while down-regulating IL-1β,IL-6,and TNF-α protein levels(P＜0.01).Conclusion ALM resuscitation solution exerts a protective effect against acute lung injury in sepsis by inhibiting NF-κB signaling pathway activation and reducing pro-inflammatory cytokine release.

Purpose To develop and validate a nomogram based on 18F-FDG PET/CT for predicting spread through air space(STAS)in stage IA lung adenocarcinoma(LUAD),providing imaging support for surgical decision-making.Materials and Methods This retrospective study analyzed 155 patients with pathologically confirmed stage IA LUAD from the Fifth People's Hospital of Chongqing,Affiliated Hospital of Zunyi Medical University and Cavalier Hospital(December 2019 to December 2023).Patients were stratified into STAS-positive and STAS-negative groups based on postoperative histopathological evaluation.Univariate and multivariate binary Logistic regression analyses identified risk factors for STAS from clinical characteristics,PET/CT semantic features,and metabolic parameters.A nomogram predicting preoperative STAS status was developed and internally validated using bootstrap resampling.Model performance was assessed in training and internal validation sets using receiver operating characteristic analysis,calibration curves and decision curve analysis.Results Among 155 stage IA LUAD patients,20(12.9%)were STAS-positive.Multivariate analysis identified tumor mean diameter(OR=0.618,P=0.024),solid component proportion(OR=2.678,P=0.033),and maximum standardized uptake value(OR=3.437,P=0.028)as independent STAS predictors.The nomogram demonstrated excellent discrimination,with areas under the curve of 0.912(95%CI 0.855-0.942)and 0.843(95%CI 0.805-0.923)in training and validation sets,respectively.Hosmer-Lemeshow goodness-of-fit test indicated satisfactory calibration(χ2=5.591,P=0.693).Decision curve analysis showed substantial net clinical benefit across threshold probabilities of 5%-91%.Conclusion The nomogram incorporating tumor diameter,solid component proportion,and maximum standardized uptake value from 18F-FDG PET/CT effectively predicts STAS status in stage IA LUAD,demonstrating high preoperative predictive performance.

Purpose To investigate the value of non-invasive preoperative prediction of programmed death ligand 1 expression status in extrahepatic cholangiocarcinoma using MRI radiomics combined with clinical features through nomograms.Materials and Methods A retrospective collection was made of 87 cases of extrahepatic cholangiocarcinoma diagnosed through surgical pathology in the Affiliated Hospital of Southwest Medical University from January 2011 to December 2021.These were randomly divided into training and testing sets at a 7∶3 ratio.Using 3D-Slicer software,regions of interest were manually delineated layer-by-layer on MRI images,and radiomic features were extracted.Data normalization,feature dimensionality reduction and selection were then performed.A Gaussian naive Bayes classifier was used to construct the radiomics model,and radiomics scores were obtained.Multivariate Logistic regression was used to screen clinical features,and individual clinical and combined models were constructed.The predictive performances of the three models were evaluated using the area under the receiver operating characteristic curve(AUC),and the goodness of fit and clinical net benefit of the combined model nomogram were assessed through calibration and decision curves.Results Nine radiomic features and three clinical features were finally selected.The clinical features included alanine transaminase(P=0.020),aspartate transaminase(P=0.025)and total bilirubin(P=0.026).The predictive performance of the combined model(training set AUC 0.813,testing set AUC 0.818)was superior to that of the individual clinical model(training set AUC 0.711,testing set AUC 0.705)and the radiomics model(training set AUC 0.769,testing set AUC 0.767).Calibration and decision curves indicated good fit and better clinical net benefit for the combined model nomogram.Conclusion Based on preoperative multi-sequence MRI images and the radiomics score,along with alanine transaminase,aspartate transaminase and total bilirubin as clinical features,the constructed combined model nomogram effectively predicts the programmed death ligand 1 expression status in extrahepatic cholangiocarcinoma.This provides guidance for the precise and personalized immunotherapy for patients.

Purpose To develop and validate a nomogram based on 18F-FDG PET/CT for predicting spread through air space(STAS)in stage IA lung adenocarcinoma(LUAD),providing imaging support for surgical decision-making.Materials and Methods This retrospective study analyzed 155 patients with pathologically confirmed stage IA LUAD from the Fifth People's Hospital of Chongqing,Affiliated Hospital of Zunyi Medical University and Cavalier Hospital(December 2019 to December 2023).Patients were stratified into STAS-positive and STAS-negative groups based on postoperative histopathological evaluation.Univariate and multivariate binary Logistic regression analyses identified risk factors for STAS from clinical characteristics,PET/CT semantic features,and metabolic parameters.A nomogram predicting preoperative STAS status was developed and internally validated using bootstrap resampling.Model performance was assessed in training and internal validation sets using receiver operating characteristic analysis,calibration curves and decision curve analysis.Results Among 155 stage IA LUAD patients,20(12.9%)were STAS-positive.Multivariate analysis identified tumor mean diameter(OR=0.618,P=0.024),solid component proportion(OR=2.678,P=0.033),and maximum standardized uptake value(OR=3.437,P=0.028)as independent STAS predictors.The nomogram demonstrated excellent discrimination,with areas under the curve of 0.912(95%CI 0.855-0.942)and 0.843(95%CI 0.805-0.923)in training and validation sets,respectively.Hosmer-Lemeshow goodness-of-fit test indicated satisfactory calibration(χ2=5.591,P=0.693).Decision curve analysis showed substantial net clinical benefit across threshold probabilities of 5%-91%.Conclusion The nomogram incorporating tumor diameter,solid component proportion,and maximum standardized uptake value from 18F-FDG PET/CT effectively predicts STAS status in stage IA LUAD,demonstrating high preoperative predictive performance.

Objective:To summarize the clinical phenotypes, genotypes, and treatment outcomes of NPRL2-related epilepsy. Methods:This was a case summary.Clinical data of patients with NRPL2 variants admitted to the Department of Pediatrics, Peking University People′s Hospital between October 1, 2013 and October 31, 2023 were retrospectively analyzed.Previous reports of patients with the same disease were reviewed. Results:Six cases of NPRL2-related epilepsy were collected, and 37 cases were reported in the previous literatures.The age of onset ranged from 3 days to 18 years with the median age of 24 months.There were 15 patients with onset in infancy.Among the 41 patients diagnosed with epilepsy, 73.1% (30/41) had focal seizures, 34.1% (14/41) had frontal lobe epilepsy, and 17.1% (7/41) had epileptic spasms.Among the patients with known cranial imaging, 58.6% (17/29) had cortical malformations. NPRL2 variants involved 11 nonsense mutations, 10 splice site mutations, 7 frameshift mutations, 1 large fragment deletion, and 14 missense mutations; among them, 39 mutations were pathogenic or likely pathogenic, while the rest 4 mutations had unclear pathogenicity.Among the 27 patients with known outcomes, 11 (40.7%) had no seizures after administration of 1 or 2 types of drugs, and 16 (59.2%) had drug-resistant epilepsy.Among the 16 patients, 1 had no seizures after treatment with 3 types of anti seizure medications, and 7 had no seizures after surgery.Most patients had varying degrees of delay in intellectual and motor development. Conclusions:Patients with NPRL2 variants usually present with frequent focal seizures and epileptic spasms, and the age of onset varies greatly.About half of the patients have drug-resistant epilepsy, half of whom have cortical malformations.For those with drug-resistant epilepsy and abnormal cranial imaging, surgery may be considered.

Objective:To investigate the pathogen distribution, temporal trends in the rates of antimicrobial resistance, and susceptibility of bloodstream isolates and comparatively explore the epidemiological characteristics of bloodstream infections in hematology departments across 56 healthcare facilities in Guangdong Province from 2020 to 2024.Methods:A multicenter analysis was conducted to evaluate the constituent ratio of different pathogens isolated from clinical isolate data from bloodstream specimens in hematology, respiratory, and intensive care unit (ICU) departments across 56 healthcare facilities in Guangdong Province (2020-2024), and antimicrobial resistance trends in pathogens with high-detection rate over 5 years were assessed. Carbapenem-resistant Gram-negative organisms (CRO) were randomly sampled for carbapenemase gene detection and in vitro antimicrobial susceptibility tests with novel antimicrobial agents.Results:From 2020 to 2024, a total of 8 968, 6 440, and 25 511 bloodstream isolates were identified in the hematology, respiratory, and ICU departments, respectively, across 56 participating facilities in Guangdong Province, with significant differences in the pathogen constituent ratio among departments ( P<0.001). Notably, the hematology department demonstrated a predominance of Escherichia coli (24.1%), Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (11.7%), coagulase-negative Staphylococci (15.2%), and Staphylococcus aureus (5.1%). In the resistance analysis, the rates of meropenem resistance of Escherichia coli and Klebsiella pneumonia increased from 6.7% and 5.8% (2020) to 14.0% and 15.8% (2024), respectively. Conversely, Pseudomonas aeruginosa exhibited a declining trend in the rate of meropenem resistance (6.2% to 1.9%) and imipenem (10.2% to 6.1%) during the same period. Acinetobacter baumannii demonstrated a biphasic resistance pattern to common antimicrobial agents, characterized by an initial decline, followed by a rebound. In this study, the susceptibility rates to conventional antimicrobial agents were significantly higher in Staphylococcus aureus versus coagulase-negative Staphylococci, with no glycopeptide- or linezolid-resistant strains detected. Notably, the prevalence of vancomycin-resistant Enterococcus faecium increased from 0 in 2020 to 23.1% in 2024. CRO carbapenemase phenotypes through active surveillance revealed that 80% Escherichia coli isolates were carrying blaNDM, 90% Klebsiella pneumoniae isolates were carrying blaKPC, 10% Pseudomonas aeruginosa isolates were carrying blaVIM, and 100% Acinetobacter baumannii were carrying blaOXA-23. The results of the antimicrobial susceptibility test in CRO revealed that carbapenem-resistant Escherichia coli (CRECO) demonstrated a 0 resistance rate to tigecycline, polymyxin B, and aztreonam/avibactam, whereas carbapenem-resistant Klebsiella pneumoniae exhibited a 0 resistance rate to aztreonam/avibactam, ceftazidime/avibactam, and imipenem/relebactam. Carbapenem-resistant Pseudomonas aeruginosa exhibited a 95.0% susceptibility rate to amikacin and polymyxin B, with a 45.0% resistance rate to ceftazidime/avibactam. In contrast, carbapenem-resistant Acinetobacter baumannii demonstrated complete susceptibility (100.0%) to sulbactam/durlobactam (MIC90=2 μg/ml), whereas eravacycline showed MIC50 and MIC90 values of 1 and 2 μg/ml, respectively. Conclusion:The pathogen constituent ratio of bloodstream isolates differed significantly among hematology, respiratory, and ICU departments. Notably, although CRO exhibited an escalating prevalence, it sustained high susceptibility to novel antimicrobial agents.

Objective In this preliminary survey,we sought to determine the composition of mosquito species inhabiting the Emeifeng Nature Reserve,Fujian Province,China.Methods Mosquito larvae were collected by straw and spoon trapping,and adult mosquitoes were collected by lamp trapping at selected breeding sites in the reserve.The specimens were initially identified based on morphology,with subsequent verification using molecular biology methods.Results A total of 34 mosquito species in 13 genera were collected,among which,there were 4 species of Anopheles(Genus Anopheles Meigen,1818),2 species of Lutzia(Genus Lutzia Theobald,1903),15 species of Culex(Genus Culex Linnaeus,1758),4 species of Stegomyia(Genus Stegomyia Theobald,1901),and single species of Hulecoeteomyia(Genus Hulecoeteomyia Theobald,1904),Luius(Genus Luius Reinert,Harbach et Kitching,2008),Aedes(Genus Aedes Meigen,1818),Downsiomyia(Genus Downsiomyia Vargas,1950),Collessius(Genus Collessius Reinert,Harbach et kitching,2006),Uranotaenia(Genus Uranotaenia Lynch 1891),Armigeres(Genus Armigeres Theobald,1901),Toxorhynchites(Genus Toxorhynchites Theobald,1901),and pestle mosquito(Genus Tripteroides Giles,1904).Conclusions The species composition of mosquitoes sampled in the Emeifeng Nature Reserve will provide a basis for further research on mosquito vectors and contribute to measures for local mosquito control.

Microbial communities such as those residing in the human gut are highly diverse and complex, and many with important implications for health and diseases. The effects and functions of these microbial communities are determined not only by their species compositions and diversities but also by the dynamic intra- and inter-cellular states at the transcriptional level. Powerful and scalable technologies capable of acquiring single-microbe-resolution RNA sequencing information in order to achieve a comprehensive understanding of complex microbial communities together with their hosts are therefore utterly needed. Here we report the development and utilization of a droplet-based smRNA-seq (single-microbe RNA sequencing) method capable of identifying large species varieties in human samples, which we name smRandom-seq2. Together with a triple-module computational pipeline designed for the bacteria and bacteriophage sequencing data by smRandom-seq2 in four human gut samples, we established a single-cell level bacterial transcriptional landscape of human gut microbiome, which included 29,742 single microbes and 329 unique species. Distinct adaptive response states among species in Prevotella and Roseburia genera and intrinsic adaptive strategy heterogeneity in Phascolarctobacterium succinatutens were uncovered. Additionally, we identified hundreds of novel host-phage transcriptional activity associations in the human gut microbiome. Our results indicated that smRandom-seq2 is a high-throughput and high-resolution smRNA-seq technique that is highly adaptable to complex microbial communities in real-world situations and promises new perspectives in the understanding of human microbiomes.
Humans ; Gastrointestinal Microbiome/genetics* ; Bacteriophages/physiology* ; High-Throughput Nucleotide Sequencing ; Sequence Analysis, RNA/methods* ; Bacteria/virology*