Pulse wave analysis plays an important role in the theoretical and clinical studies of both the traditional Chinese medicine and the modern western medicine.In recent years,some researchers raised the opinion of resonance between the harmonics of the pulse wave and the viscera,and applied it to explain the mechanism and the clinical application of the pulse waves,which had a great impact on the related research in the traditional Chinese medicine especially about the pulse diagnosis.To evaluate the feasibility of this opinion,this study summarized the theoretical model and the main arguments of the harmonics-viscera resonance opinion,analyzed the opinion from the aspects of Zang-xiang theory and meridian theory in the traditional Chinese medicine,the anatomy in Western medicine,observations in biology,the resonance phenomenon in physics,and the blood flow study in hemodynamics.Some technical thoughts in the harmonics-viscera resonance opinion that need to be further improved and refined were also identified for further exploration.

This paper reports the clinical data and the diagnosis and treatment of a patient with exogenous insulin autoimmune syndrome(EIAS)induced by long-term use of exogenous insulin(Eucrin 50).For diabetes patients with hyperinsulin-induced hypoglycemia,detection of IAA is helpful for diagnosis EIAS.Due to different test methods affect IAA results,if negative,EIAS cannot be completely excluded.The polyethylene glycol precipitation method can assist in early diagnosis.

Objective To observe the value of intratumoral and peritumoral radiomics based on dynamic contrast-enhanced MRI(DCE-MRI)combined with clinical indexes for predicting Ki-67 expression of prostate cancer(PCa).Methods Totally 294 PCa patients were retrospectively enrolled and randomly divided into training set(n=205)and test(n=89)set at a ratio of 7∶3,who were stratified into low-expression subgroup(Ki-67≤10%)and high-expression subgroup(Ki-67＞10%)based on pathological findings.ROIintratumoral and ROIperitumoral were delineated on DCE-MRI,and radiomics features were extracted from ROIintratumora,l ROIperitumoral and ROIintratumoral+peritumora,l respectively.Radiomic features significantly associated with Ki-67 expression status were selected to construct radiomics models.A multivariate logistic regression analysis was performed to develop a clinical predicting model,then a combined model was established combined with the optimal radiomics model.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)were calculate to evaluate the predictive efficacy of the models and compared between each two models.Decision curve analysis(DCA)was used to assess the clinical net benefit of each model.Results The AUC of modelintratumora,l modelperitumoral and modelintratumoral+peritumoral for predicting Ki-67 expression in training set was 0.905,0.867 and 0.930,and the last one was the best.In clinical model,total prostate-specific antigen(t-PSA)and T stage≥3 were both independent predictors of high Ki-67 expression of PCa(both P＜0.05).The AUC of combined model based on modelintratumoral+peritumoral and clinical model was 0.911 in test set,being not significantly different with that of modelintratumoral+peritumoral(AUC=0.906;Z=0.349,P=0.727)but higher than that of clinical model(AUC=0.684;Z=4.370,P＜0.05).DCA revealed that the combined model provided higher clinical net benefit than clinical model and modelintratumoral+peritumoral across risk thresholds of 0.10-0.70.Conclusion DCE-MRI intratumoral+peritumoral radiomics model could effectively predict Ki-67 expression status of PCa.Combining with clinical indexes could further enhance its clinical net benefit.

This paper reports the clinical data and the diagnosis and treatment of a patient with exogenous insulin autoimmune syndrome(EIAS)induced by long-term use of exogenous insulin(Eucrin 50).For diabetes patients with hyperinsulin-induced hypoglycemia,detection of IAA is helpful for diagnosis EIAS.Due to different test methods affect IAA results,if negative,EIAS cannot be completely excluded.The polyethylene glycol precipitation method can assist in early diagnosis.

Objective To observe the value of intratumoral and peritumoral radiomics based on dynamic contrast-enhanced MRI(DCE-MRI)combined with clinical indexes for predicting Ki-67 expression of prostate cancer(PCa).Methods Totally 294 PCa patients were retrospectively enrolled and randomly divided into training set(n=205)and test(n=89)set at a ratio of 7∶3,who were stratified into low-expression subgroup(Ki-67≤10%)and high-expression subgroup(Ki-67＞10%)based on pathological findings.ROIintratumoral and ROIperitumoral were delineated on DCE-MRI,and radiomics features were extracted from ROIintratumora,l ROIperitumoral and ROIintratumoral+peritumora,l respectively.Radiomic features significantly associated with Ki-67 expression status were selected to construct radiomics models.A multivariate logistic regression analysis was performed to develop a clinical predicting model,then a combined model was established combined with the optimal radiomics model.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)were calculate to evaluate the predictive efficacy of the models and compared between each two models.Decision curve analysis(DCA)was used to assess the clinical net benefit of each model.Results The AUC of modelintratumora,l modelperitumoral and modelintratumoral+peritumoral for predicting Ki-67 expression in training set was 0.905,0.867 and 0.930,and the last one was the best.In clinical model,total prostate-specific antigen(t-PSA)and T stage≥3 were both independent predictors of high Ki-67 expression of PCa(both P＜0.05).The AUC of combined model based on modelintratumoral+peritumoral and clinical model was 0.911 in test set,being not significantly different with that of modelintratumoral+peritumoral(AUC=0.906;Z=0.349,P=0.727)but higher than that of clinical model(AUC=0.684;Z=4.370,P＜0.05).DCA revealed that the combined model provided higher clinical net benefit than clinical model and modelintratumoral+peritumoral across risk thresholds of 0.10-0.70.Conclusion DCE-MRI intratumoral+peritumoral radiomics model could effectively predict Ki-67 expression status of PCa.Combining with clinical indexes could further enhance its clinical net benefit.

OBJECTIVE To explore the clinical characteristics of Tropheryma whipplei(TW)infection and observe the application of pathogenic metagenomic next-generation sequencing(mNGS)in diagnosis of TW infection.METHODS The clinical data were collected from 1 patient who was diagnosed by mNGS in the Affiliated Hospital of Jining Medical University on Apr.9,2022.The data including the results of laboratory tests and treatment out-comes were summarized,and a literature review was conducted.RESULTS A 50-year-old woman presented to the hospital with chest tightness and chest pain lasting for 3 days,accompanied by dyspnea,palpitations,and expec-toration.The chest plain CT scan and magnetic resonance imaging(MRI)scan suggested a high probability of pul-monary infection.Normal flora were isolated by culture of bronchoalveolar lavage fluid(BALF);TW and human βherpes virus type 7 were detected in BALF by mNGS,with the sequence numbers 327 000 and 9,respectively.The pulmonary symptoms of the patient were improved after joint treatment of the infection with etimicin,levo-floxacin and minocycline.The patient repeatedly sought for medical treatment due to the pain of shoulder joint and limitation of motion.CONCLUSIONS TW is one of major pathogens leading to the infections of systemic multiple systems,and it is necessary to attach great importance to the diagnosis and treatment.The traditional laboratory test method can not achieve ideal diagnosis effect and is more likely to make a missed diagnosis.mNGS is more ac-curate and more efficient than the traditional detection method in diagnosis of TW-induced diseases.Early use of mNGS can make a rapid identification of pathogens and facilitate the reasonable clinical use of antibiotics.It is of great significance for control of the disease progression,improvement of prognosis and prevention of recurrence.

Pulse wave analysis plays an important role in the theoretical and clinical studies of both the traditional Chinese medicine and the modern western medicine.In recent years,some researchers raised the opinion of resonance between the harmonics of the pulse wave and the viscera,and applied it to explain the mechanism and the clinical application of the pulse waves,which had a great impact on the related research in the traditional Chinese medicine especially about the pulse diagnosis.To evaluate the feasibility of this opinion,this study summarized the theoretical model and the main arguments of the harmonics-viscera resonance opinion,analyzed the opinion from the aspects of Zang-xiang theory and meridian theory in the traditional Chinese medicine,the anatomy in Western medicine,observations in biology,the resonance phenomenon in physics,and the blood flow study in hemodynamics.Some technical thoughts in the harmonics-viscera resonance opinion that need to be further improved and refined were also identified for further exploration.

OBJECTIVE To explore the clinical characteristics of Tropheryma whipplei(TW)infection and observe the application of pathogenic metagenomic next-generation sequencing(mNGS)in diagnosis of TW infection.METHODS The clinical data were collected from 1 patient who was diagnosed by mNGS in the Affiliated Hospital of Jining Medical University on Apr.9,2022.The data including the results of laboratory tests and treatment out-comes were summarized,and a literature review was conducted.RESULTS A 50-year-old woman presented to the hospital with chest tightness and chest pain lasting for 3 days,accompanied by dyspnea,palpitations,and expec-toration.The chest plain CT scan and magnetic resonance imaging(MRI)scan suggested a high probability of pul-monary infection.Normal flora were isolated by culture of bronchoalveolar lavage fluid(BALF);TW and human βherpes virus type 7 were detected in BALF by mNGS,with the sequence numbers 327 000 and 9,respectively.The pulmonary symptoms of the patient were improved after joint treatment of the infection with etimicin,levo-floxacin and minocycline.The patient repeatedly sought for medical treatment due to the pain of shoulder joint and limitation of motion.CONCLUSIONS TW is one of major pathogens leading to the infections of systemic multiple systems,and it is necessary to attach great importance to the diagnosis and treatment.The traditional laboratory test method can not achieve ideal diagnosis effect and is more likely to make a missed diagnosis.mNGS is more ac-curate and more efficient than the traditional detection method in diagnosis of TW-induced diseases.Early use of mNGS can make a rapid identification of pathogens and facilitate the reasonable clinical use of antibiotics.It is of great significance for control of the disease progression,improvement of prognosis and prevention of recurrence.

【Objective】 To investigate the efficacy and safety of 450 nm blue laser with 6 o’clock positioning in the treatment of middle lobe hyperplasia of prostate, in order to promote the clinical application of this surgery. 【Methods】 Clinical data of 20 patients with middle lobe hyperplasia of prostate treated with 450 nm blue laser with 6 o’clock positioning during Mar.and Aug.2023 were retrospectively analyzed.The operation time, postoperative bladder irrigation time, catheter indwelling time, hospital stay, and complications were recorded.The maximum urinary flow rate (Qmax), post-void residual volume (PVR), quality of life scale (QoL), international prostate symptom score (IPSS) before surgery and 1 month after surgery were compared. 【Results】 The operation time was (26.80±7.22) min, and bladder irrigation time was (20.50±1.79) h.The catheter was removed on the next day after surgery and all patients were discharged 2 days after operation.Compared to preoperative, one month after surgery, the Qmax [(7.40±1.05) mL/s vs.(19.60±1.76) mL/s] was significantly higher, PVR [(73.50±12.26) mL vs.(9.25±4.94) mL], QoL [(4.55±1.19) vs.(1.95±0.95)], and IPSS [(26.55±1.88) vs.(10.05±1.36)] were significantly lower, the differences being statistically significant (P<0.05).No complications occurred during operation and 1-month follow-up. 【Conclusion】 The 450 nm blue laser with 6 o’clock positioning is a new, safe and effective surgical treatment of middle lobe hyperplasia of prostate, which is worthy of clinical promotion and application.