Multiple system atrophy (MSA) is a rare neurodegenerative disease with complex clinical manifestations, presenting substantial challenges in clinical diagnosis and treatment. Its symptoms and the eight extraordinary meridians are potentially correlated; therefore, this article explores the association between MSA symptom clusters and the eight extraordinary meridians based on their circulation and physiological functions, as well as their treatment strategies. The progression from deficiency to damage in the eight extraordinary meridians aligns with the core pathogenesis of MSA, which is characterized by "the continuous accumulation of impacts from the vital qi deficiency leading to eventual damage". Liver and kidney deficiency and the emptiness of the eight extraordinary meridians are required for the onset of MSA; the stagnation of qi deficiency and the gradual damage to the eight extraordinary meridians are the key stages in the prolonged progression of MSA. The disease often begins with the involvement of the yin and yang qiao mai, governor vessel, thoroughfare vessel, and conception vessel before progressing to multiple meridian involvements, ultimately affecting all eight extraordinary meridians simultaneously. The treatment approach emphasizes that "the direct method may be used for joining battle, but indirect method will be needed in order to secure victory" and focuses on "eliminate pathogenic factors and reinforce healthy qi". Distinguishing the extraordinary meridians and focusing on the primary symptoms are pivotal to improving efficacy. Clinical treatment is aimed at the target, and tailored treatment based on careful clinical observation ensures precision in targeting the disease using the eight extraordinary meridians as the framework and core symptoms as the specific focus. Additionally, combining acupuncture, daoyin therapy, and other method may help prolong survival. This article classifies clinical manifestations based on the theory of the eight extraordinary meridians and explores treatment.

Objective To explore the impact of the duration of protracted abstinence(PA)treatment on the level of impulsivity among heroin addicts and to analyze the mediating effect of impulsive cognition between abstinence duration and impulsive behavior.Methods Thirty-six heroin addicts undergoing PA treatment(PA group)and forty matched healthy controls(HC)(HC group)were recruited.Demographic information was collected via questionnaires,and impulsive cognition assessments were conducted.Participants completed the GO/NOGO task to collect data on impulsive behavior.Intergroup differences were compared using the independent sample t-test,and multiple linear regression analysis and mediating effect analysis were performed on the PA group.Results The PA group exhibited significantly higher scores on motor impulsivity,non-planning impulsivity,and total impulsivity compared to the HC group.Additionally,the PA group demonstrated significantly increased NOGO error rate during the GO/NOGO task compared to the HC group(P＜0.001).Multiple linear regression analysis revealed that abstinence duration had a significant negative impact on total impulsivity and non-planning impulsivity(P＜0.001).Mediating effect analysis found a partial mediation effect of total impulsivity between abstinence duration and NOGO error rate(P＜0.001).Conclusion The PA treatment has a significant impact on the level of impulsivity among heroin addicts.Impulsive cognition play a partial mediating role between abstinence duration and impulsive behavior.These results provide an important theoretical and practical basis for optimizing PA treatment programs.

Purpose To evaluate the application value of CE-Boost technology in head and neck CT angiography(CTA)with low tube voltage,low contrast agent dosage and low injection rate.Materials and Methods A prospective study was conducted on patients who underwent head and neck CTA at Ji'nan People's Hospital Affiliated to Shandong First Medical University from September to December 2023.Using block randomization,patients were divided into group A(n=30)and group B(n=30).Group A underwent conventional scanning with 120 kV tube voltage,50 ml iodinated contrast agent and 5.0 ml/s injection rate;while group B underwent scanning with 100 kV tube voltage,30 ml iodinated contrast agent and 3.0 ml/s injection rate.CE-Boost images(group B2)were generated by performing flexible subtraction between the enhanced images of group B(group B1)and non-contrast images.CT values,noise,signal-to-noise ratio and contrast-to-noise ratio of major vessels were measured and calculated.Subjective image quality was assessed using a 5-point scale.Vascular CT values,noise,signal-to-noise ratio,contrast-to-noise ratio,subjective scores and radiation dose were compared among the three groups.Results No significant differences in noise were observed among group A,B1 and B2(all P>0.05).The aortic arch CT values,signal-to-noise ratio and contrast-to-noise ratio in group B2 were significantly higher than those in group B1 and A(all P<0.05),while group B1 exhibited significantly lower values than group A(all P<0.05).For other vessels,group B2 demonstrated significantly higher CT values,signal-to-noise ratio and contrast-to-noise ratio than group B1(all P<0.05),but no significant differences were found compared with group A(all P>0.05).Subjective scores were significantly higher in group A[5(5,5)point]and group B2[5(5,5)point]than in group B1[4(3,4)point](Z=-4.790,-4.564,both P<0.001),with no significant difference between groups A and B2(Z=-1.076,P=0.163).Group B reduced iodine intake and injection rate by 40%compared with group A(iodine intake:11.1 g vs.18.5 g;injection rate:3.0 ml/s vs.5.0 ml/s)and achieved a 30%reduction in effective radiation dose[(1.02±0.95)mSv vs.(1.44±1.66)mSv,t=12.217,P<0.001].Conclusion For patients with body mass index<28 kg/m2,CE-Boost combined with 100 kV tube voltage,30 ml iodinated contrast agent and 3.0 ml/s injection rate in head and neck CTA significantly reduces radiation dose,iodine load and injection rate while maintaining image quality.

Objective To explore the impact of the duration of protracted abstinence(PA)treatment on the level of impulsivity among heroin addicts and to analyze the mediating effect of impulsive cognition between abstinence duration and impulsive behavior.Methods Thirty-six heroin addicts undergoing PA treatment(PA group)and forty matched healthy controls(HC)(HC group)were recruited.Demographic information was collected via questionnaires,and impulsive cognition assessments were conducted.Participants completed the GO/NOGO task to collect data on impulsive behavior.Intergroup differences were compared using the independent sample t-test,and multiple linear regression analysis and mediating effect analysis were performed on the PA group.Results The PA group exhibited significantly higher scores on motor impulsivity,non-planning impulsivity,and total impulsivity compared to the HC group.Additionally,the PA group demonstrated significantly increased NOGO error rate during the GO/NOGO task compared to the HC group(P＜0.001).Multiple linear regression analysis revealed that abstinence duration had a significant negative impact on total impulsivity and non-planning impulsivity(P＜0.001).Mediating effect analysis found a partial mediation effect of total impulsivity between abstinence duration and NOGO error rate(P＜0.001).Conclusion The PA treatment has a significant impact on the level of impulsivity among heroin addicts.Impulsive cognition play a partial mediating role between abstinence duration and impulsive behavior.These results provide an important theoretical and practical basis for optimizing PA treatment programs.

Purpose To evaluate the application value of CE-Boost technology in head and neck CT angiography(CTA)with low tube voltage,low contrast agent dosage and low injection rate.Materials and Methods A prospective study was conducted on patients who underwent head and neck CTA at Ji'nan People's Hospital Affiliated to Shandong First Medical University from September to December 2023.Using block randomization,patients were divided into group A(n=30)and group B(n=30).Group A underwent conventional scanning with 120 kV tube voltage,50 ml iodinated contrast agent and 5.0 ml/s injection rate;while group B underwent scanning with 100 kV tube voltage,30 ml iodinated contrast agent and 3.0 ml/s injection rate.CE-Boost images(group B2)were generated by performing flexible subtraction between the enhanced images of group B(group B1)and non-contrast images.CT values,noise,signal-to-noise ratio and contrast-to-noise ratio of major vessels were measured and calculated.Subjective image quality was assessed using a 5-point scale.Vascular CT values,noise,signal-to-noise ratio,contrast-to-noise ratio,subjective scores and radiation dose were compared among the three groups.Results No significant differences in noise were observed among group A,B1 and B2(all P>0.05).The aortic arch CT values,signal-to-noise ratio and contrast-to-noise ratio in group B2 were significantly higher than those in group B1 and A(all P<0.05),while group B1 exhibited significantly lower values than group A(all P<0.05).For other vessels,group B2 demonstrated significantly higher CT values,signal-to-noise ratio and contrast-to-noise ratio than group B1(all P<0.05),but no significant differences were found compared with group A(all P>0.05).Subjective scores were significantly higher in group A[5(5,5)point]and group B2[5(5,5)point]than in group B1[4(3,4)point](Z=-4.790,-4.564,both P<0.001),with no significant difference between groups A and B2(Z=-1.076,P=0.163).Group B reduced iodine intake and injection rate by 40%compared with group A(iodine intake:11.1 g vs.18.5 g;injection rate:3.0 ml/s vs.5.0 ml/s)and achieved a 30%reduction in effective radiation dose[(1.02±0.95)mSv vs.(1.44±1.66)mSv,t=12.217,P<0.001].Conclusion For patients with body mass index<28 kg/m2,CE-Boost combined with 100 kV tube voltage,30 ml iodinated contrast agent and 3.0 ml/s injection rate in head and neck CTA significantly reduces radiation dose,iodine load and injection rate while maintaining image quality.

Objective To observe the value of augmented reality(AR)navigation system for assisting CT-guided puncture of pulmonary nodules in dog models.Methods Five healthy dogs were selected,and 4 target lung rings were implanted in each dog to build pulmonary nodule models.Deferring to crossover design,CT-guided punctures were performed with or without AR navigation 2 and 4 weeks after successful modeling,respectively,while punctures with AR navigation were regarded as AR group and the others as conventional group,respectively.The time duration of puncturing,the times of CT scanning,of needle adjustment,and the deviation distance between needle pinpoint to the center of pulmonary nodule shown on three-dimensional reconstruction were compared between groups.Results The duration time of puncture in AR group and conventional group was(13.62±5.11)min and(20.16±4.76)min,respectively.In AR group,the times of CT scanning,of needle adjustment,and the deviation distance was 2.40±0.50,2.75±0.44 and(2.94±1.92)mm,respectively,while in conventional group was 3.10±0.64,3.70±0.57 and(4.90±3.38)mm,respectively.The introduction of AR navigation was helpful to shortening the duration of puncture,reducing times of CT scanning and needle adjustment,also decreasing positioning error of needle pinpoint(all P＜0.05).In contrast,the variance of puncture sequences and dogs had no obvious effect on the results(both P＞0.05).Conclusion AR navigation system could improve accuracy and efficiency in CT-guided puncture of pulmonary nodules in dog models.

Objective To explore the image quality improvement of portal vein computed tomography venography(CTV)using CE-Boost technique with low dose and low contrast media usage.Methods A total of 50 patients with suspected portal vein disorders who underwent abdominal non-contrast and biphasic contrast-enhanced CT scans using the Canon 320-row CT machine were retrospectively selected.Images of portal venous phase(PVP)were postprocessed with CE-Boost technique.The CT values of each area,standard deviation(SD)values of the paraspinal muscles,volume CT dose index(CTDIvol),and dose length product(DLP)before and after CE-Boost were measured and recorded.The signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR),effective dose(ED)of each blood vessel before and after CE-Boost were calculated.Subjective image quality was analyzed by two senior radiologists using a five-point scale in a double-blinded method.Statistical analysis was performed using paired t-test and Wilcoxon test.Results The CT values of each area with CE-Boost images were significantly higher than those without CE-Boost images(P＜0.001).SNR and CNR of each blood vessel with CE-Boost images were significantly higher than those without CE-Boost images(P＜0.001).The subjective scores of both images were above 3 points,which met the requirements of clinical diagnosis with good consistency(Kappa=0.772,0.697).The median subjective scores of images with CE-Boost were 5(5,5),which were significantly higher than those without CE-Boost images 5(5,4),(P=0.002).CTDIvol,DLP and ED were(1.85±1.12)mGy,(94.66±44.68)mGy·cm and(1.42±0.67)mSv,respectively.Conclusion CE-Boost technique can significantly improve the image quality of portal vein CTV with low dose and low contrast media usage.

Objective To investigate a novel stroke recurrence risk prediction model,which utilized radiomics machine learning methods and specifically combined carotid computed tomography angiography(CT A)with the Essen stroke risk score(ESRS).Methods A total of 136 patients who underwent carotid CT A were analyzed retrospectively.The features of carotid plaque were extrac-ted by machine learning to construct a radiomics feature model,as well as combined with ESRS.Based on clinical outcomes at one-year follow-up,the stroke recurrence risk prediction model was constructed using the logistic regression(LR)machine learning model.To construct an effective and robust model,the dataset was divided into a training set and a validation set in a ratio of 7∶3.The performance of this model was evaluated using area under the curve(AUC)of receiver operating characteristic(ROC)curve,sensi-tivity and specificity.Results The model had strong predictive value.In the training set,AUC,sensitivity and specificity of this model were 0.903,0.796 and 0.761,respectively.In the validation set,AUC,sensitivity and specificity of this model were 0.869,0.667 and 0.850,respectively.Conclusion The stroke recurrence risk prediction model constructed based on radiomics analysis of carotid plaque characteristics in carotid CTA,in combination with the ESRS,can provide reliable predictions for stroke prognosis.

Purpose To explore the application value of contrast enhancement boost(CE-Boost)technique in image quality of tumors and their feeding arteries in preoperative evaluation of renal cancer patients.Materials and Methods A total of 36 renal cancer patients in People's Hospital Affiliated to Shandong First Medical University from August 2022 to May 2023 with pathologically confirmed were retrospective collected.All patients underwent renal enhanced CT.The cortical phase images were post-processed using the CE-Boost technique to obtain CE-Boost images.The cortical phase images were set as group A and the CE-Boost images were set as group B.The CT value and image noise(SD)of abdominal aorta,renal artery,tumor and its adjacent renal cortex,and SD of the vertical spinal muscle on both sides of the spine of two groups were measured and recorded,and then the signal-to-noise ratio and contrast-to-noise ratio of tumor,abdominal aorta and renal artery were calculated.The image quality of the tumor,tumor feeding artery and renal artery was scored on 4 points by 2 doctors with double-blind method.Results The signal-to-noise ratio,contrast-to-noise ratio and CT value of group B were significantly higher than those of group A(t=-27.385--5.267,all P<0.05).The SD of tumor,abdominal aorta,right and left renal artery were not significantly different between group A and B(t=-1.849-0.993,all P>0.05).The subjective score of tumor in group A and B were no significant difference(Z=-1.490,P=0.136).However,the subjective score of tumor feeding arteries and renal arteries were significantly higher in group B than in group A(Z=-3.512,P=0.000;Z=-2.127,P=0.033).Conclusion The CT CE-Boost technique can improve the image quality of renal enhanced CT and provide visualization of tumor feeding arteries.

Objective To investigate the distribution and antimicrobial resistance profiles of pathogenic bacteria in Children's Hospital of Hebei Province to inform reasonable use of antibiotics.Methods Antimicrobial susceptibility of the bacterial isolates was tested using Kirby-Bauer method,VITEK-2 Compact,BD Phoenix 100 automated systems,and E-test method.The results were interpreted according to the breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2022.Results were analyzed by WHONET 5.6 software.Results A total of 11909 isolates were collected from 2020 to 2022,of which 45.1％ were Gram positive organisms and 54.9％ were Gram negative organisms.The prevalence of MRSA and in S.aureus and MRCNS in coagulase-negative Staphylococcus was 36.8％ and 73.8％,respectively.The resistance rate of Enterococcus faecalis and Enterococcus faecium to ampicillin was 2.6％ and 93.5％,respectively,while the resistance rates of E.faecalis and E.faecium to high concentration gentamicin was 42.2％ and 66.2％,respectively.E.faecium showed significantly higher resistance rates to the antibiotics tested than E.faecalis.The prevalence of PRSP and PSSP was 1.7％ and 95.7％ respectively in the non-meningitis S.pneumoniae isolates.No vancomycin-or linezolid-resistant strains were found in Staphylococcus,Enterococcus,or Streptococcus.The prevalence of ESBLs-producing E.coli and K.pneumoniae was 47.4％ and 32.3％,respectively.The prevalence of carbapenem-resistant E.coli and K.pneumoniae was 2.0％ and 22.4％,respectively.The prevalence of carbapenem-resistant P.aeruginosa (CRPA) and carbapenem-resistant A.baumannii (CRAB) was 9.5％ and 22.1％,respectively.The resistance rate of Haemophilus influenzae to ampicillin was 83.8％.The prevalence of β-lactamase-producing H.influenzae and β-lactamase-non-producing ampicillin-resistant (BLNAR) H.influenzae was 76.1％ and 7.7％,respectively.No meropenem-resistant strains were found in H.influenzae.Majority (98.0％) of Moraxella catarrhalis strains produced β-lactamase.Conclusions Multi-drug resistant bacterial pathogens are still serious in pediatric inpatients.The common clinical isolates showed various levels of resistance to different antimicrobial agents.It is important to continue the surveillance of bacterial resistance in children,take proactive measures to curb the spread of drug-resistant bacteria,and use antibiotics rationally.