Objective:To retrospectively analyze the current status of consultation, clinical characteristics, and treatment status of patients with IgG4-related disease (IgG4-RD) in order to provide assistance and a basis for early and standardized diagnosis and treatment.Methods:IgG4-RD cases admitted to our hospital from June 2015 to October 2023 were collected. The details of patients' basic information, initial symptoms, department visits, laboratory and imaging findings, histopathological examination results, and treatment plans were recorded. A statistical descriptive analysis was performed on the data.Results:A total of 105 patients with IgG4-RD were included, with a median age of 59.0 (18.0, 78.0) years. The main departments visited were clinical immunology and gastroenterology (83.8%, 88/105). The median diagnostic duration was eight months, with a maximum of 300 months, and 33.3% (35/105) of patients needed over one year for diagnosis. 92 cases underwent histopathological examinations and IgG4 staining, with a total positivity rate of 87.0% (80/92). Among these, sixteen cases underwent pathological examination after surgery, with a positivity rate of 100%; the remaining 76 cases out of 92 underwent liver biopsy, with a positivity rate of 76.1%. Out of these, there were 22 cases from the pancreas, 21 from the submaxillary gland, nine from the labial gland, and seven each from the duodenal papilla and liver, with positivity rates of 81.8%, 81.0%, 55.6%, 85.7%, and 85.7%, respectively. Eleven cases (10.5%) with normal serum IgG4 were diagnosed based on multi-organ involvement and pathological results. 94 cases (89.5%) had elevated IgG4, with a predominance of＞2.70 g/L. The median follow-up period for the 87 cases was 14 months. Two cases had poor response, twelve patients relapsed, five cases relapsed without combined drug treatment after surgery, five cases relapsed due to drug withdrawal, and two cases relapsed while tapering off steroids.Conclusions:As a multisystem disease, IgG4-RD still faces the difficulties of time-consuming diagnosis and inappropriate treatment. Therefore, it is necessary to rely on a multidisciplinary collaboration model to improve the awareness level and promote the early and standardized diagnosis and treatment of patients with IgG4-RD.

Objective:To retrospectively analyze the current status of consultation, clinical characteristics, and treatment status of patients with IgG4-related disease (IgG4-RD) in order to provide assistance and a basis for early and standardized diagnosis and treatment.Methods:IgG4-RD cases admitted to our hospital from June 2015 to October 2023 were collected. The details of patients' basic information, initial symptoms, department visits, laboratory and imaging findings, histopathological examination results, and treatment plans were recorded. A statistical descriptive analysis was performed on the data.Results:A total of 105 patients with IgG4-RD were included, with a median age of 59.0 (18.0, 78.0) years. The main departments visited were clinical immunology and gastroenterology (83.8%, 88/105). The median diagnostic duration was eight months, with a maximum of 300 months, and 33.3% (35/105) of patients needed over one year for diagnosis. 92 cases underwent histopathological examinations and IgG4 staining, with a total positivity rate of 87.0% (80/92). Among these, sixteen cases underwent pathological examination after surgery, with a positivity rate of 100%; the remaining 76 cases out of 92 underwent liver biopsy, with a positivity rate of 76.1%. Out of these, there were 22 cases from the pancreas, 21 from the submaxillary gland, nine from the labial gland, and seven each from the duodenal papilla and liver, with positivity rates of 81.8%, 81.0%, 55.6%, 85.7%, and 85.7%, respectively. Eleven cases (10.5%) with normal serum IgG4 were diagnosed based on multi-organ involvement and pathological results. 94 cases (89.5%) had elevated IgG4, with a predominance of＞2.70 g/L. The median follow-up period for the 87 cases was 14 months. Two cases had poor response, twelve patients relapsed, five cases relapsed without combined drug treatment after surgery, five cases relapsed due to drug withdrawal, and two cases relapsed while tapering off steroids.Conclusions:As a multisystem disease, IgG4-RD still faces the difficulties of time-consuming diagnosis and inappropriate treatment. Therefore, it is necessary to rely on a multidisciplinary collaboration model to improve the awareness level and promote the early and standardized diagnosis and treatment of patients with IgG4-RD.

Objective:To analyze the diagnostic value of sex hormone combined with carcinoembryonic antigen on lymph node metastasis in breast cancer patients.Methods:52 cases of breast cancer patients who underwent surgical resection were collected and divided into non-metastasis group and metastases group after axillary lymph node ultrasonography. The blood samples was collected from patients and the levels of serum estradiol, testosterone, progesterone and carcinoembryonic antigen were detected; The diagnostic value of the above indexes in patients with lymph node metastasis was analyzed; Logistic risk regression model was used to analyze the independent risk factors for lymph node metastasis after surgical resection.Results:There were significant differences between the non-metastatic group and the metastatic group in the largest tumor diameter and menopause (all P<0.05), but there were no significant differences among other general data (all P>0.05). The serum estradiol level in the non-metastatic group was (153.97±35.55) pg/ml, the progesterone level was (0.33±0.05) ng/ml, and the carcinoembryonic antigen level was (11.44±3.77) ng/ml, while the estradiol level in the metastatic group was (207.19±52.11) pg/ml ( t=4.13, P<0.001), progesterone level (0.38±0.04) ng/ml ( t=4.01, P<0.001), carcinoembryonic antigen level (15.41±3.46) ng/ml ( t=3.94, P<0.001). The above three indicators were significantly increased in patients in the transfer group. The area under the curve of estradiol was 0.83, the area under the curve of progesterone was 0.80, the area under the curve of carcinoembryonic antigen was 0.77, the area under the curve of the combination of the three was 0.85, and the area under the curve of the combination of the three was the largest. Logistic risk regression model showed that estradiol, progesterone, and carcinoembryonic antigen levels were independent risk factors affecting lymph node metastasis in breast cancer patients (all P<0.05) . Conclusion:The sex hormone estradiol, progesterone combined with carcinoembryonic antigen has a high diagnostic value for lymph node metastasis in patients with breast cancer, and can independently predict the occurrence of lymph node metastasis in breast cancer patients.

Objective:To conduct systematic review of symptom-cluster assessment tools in adult leukemia patients based on Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.Methods:Computer searches were conducted on PubMed, Cochrane Library, Web of Science, Wiley Online Library, Embase, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang and VIP databases. The search period was from the establishment of the database to March 2022, and the references included in the study were traced back. Two researchers trained in evidence-based methodology independently selected the title, abstract and full text of the literature according to the inclusion and exclusion criteria, and extracted and evaluated the data based on the COSMIN guidelines.Results:Finally, 10 evaluation tools were included, among which only the methodological quality and measurement attribute quality of M.D. Anderson Symptom Inventory-Chronic Myeloid Leukemia (MDASI-CML) were rated above "good" and "adequate", respectively. Therefore, the recommended strength of the evidence was Class A, and the recommendation strength of the other 9 tools was Class B.Conclusions:MDASI-CML has good methodology, quality of measurement attributes and grading of evidence, which is recommended for use in symptom cluster assessment of adult patients with leukemia. Meanwhile, more targeted assessment tools need to be developed.

Objective:To analyze the influence of magnetic field on the proton beam delivery and dose distribution, and develop a correction method for the Bragg peak (BP) shift under the vertical magnetic field, providing reference for the dose calculation and beam delivery of MRI-guided proton therapy.Methods:Monte Carlo (MC) simulation was used to study the dose distribution of the proton beam in the water phantom under the magnetic field. The BP location was corrected by the method of" angle correction+ energy correction" , and the correction parameters were calculated by the analytical formula based on the simulation data.Results:The magnetic field caused the dose distortion and shift of BP location. The shift degree was increased with the increase of field strength and initial energy. Compared with MC simulation, the result of calculating proton deflection in the air by the analytical method yielded a deviation within 0.2%. Based on the simulation data and calculation formulas, the correction parameters under different conditions could be calculated within 1 s by using the MATLAB programming. The calculation results showed that the air layer with magnetic field, isocenter depth, irradiation direction exerted different influence on the correction parameters. After correction, the BP location was basically consistent with the expected (offset ≤0.2 mm).Conclusions:The BP shift under the vertical magnetic field can be effectively corrected by " the angle correction+ energy correction" method. The correction parameters under different conditions can be quickly and accurately calculated by the calculation formulas based on simulation data.

Objective:To develop and validate the accuracy of an independent dose calculation toolkit for the horizontal beamline of Shanghai Advanced Proton Therapy (SAPT) facility based on an open-source dose calculation engine.Methods:Machine data, such as absolute integral depth doses (IDDs) and lateral profiles in air were measured and lateral profiles in water were derived by Monte-Carlo simulations. The dose computation models for SAPT horizontal beamline pencil beams in water were achieved by combining machine data and dose calculation engine. The verification of the dose reconstruction toolkit included absolute dose verification and relative dose verification. The absolute dose verification is performed to mainly compare the reconstructed value and the measured value at different depths along the center axis of the beam direction of a cube plan. The relative dose verification is conducted to mainly compare the lateral profile or two-dimensional dose distribution between the measured value and the reconstructed value. Meanwhile, the precision of double-gaussian and single-gaussian lateral beam models was compared.Results:The deviations of the absolute dose between the calculated and measured values were basically within 2%. The deviations of 20%-80% penumbra between the measured and the calculated values were within 1 mm, and deviations of the full width at half height were within 2 mm. For 3 cube plans and 2 clinical cases, the two-dimensional gamma pass rates (3 mm/3%) between the measured and calculated dose distributions at the corresponding depths were greater than 95%. The double-gaussian lateral beam model was more accurate in the high dose gradient region and deeper depth.Conclusion:The precision of independent dose calculation toolkit is acceptable for clinical requirements, which can be employed to investigate other dose-related issues.

Objective:To investigate the effect and mechanism of paeoniflorin on the permeability of cardiac microvascular endothelial cells (CMECs) in sepsis.Methods:Primary rat CMECs were isolated and cultured in vitro, and the cells in the logarithmic growth phase were used for experiments. Tetramethylazozolium colorimetry (MTT) was used to screen the safe and effective concentrations of paeoniflorin at 10, 20, and 40 μmol/L. The cells were divided into blank control group, lipopolysaccharide (LPS) group and low, medium and high concentration paeoniflorin pretreatment group. The cells in the blank control group were cultured in complete medium; the cells in the LPS group were challenged with LPS (1 mg/L) in complete medium; and the cells in the paeoniflorin pretreatment groups were pretreated with 10, 20, and 40 μmol/L paeoniflorin at 4 hours before LPS stimulation. The cells in each group were further cultured for 24 hours after LPS stimulation. The horseradish peroxidase (HRP) method was used to detect the permeability of rat CMECs. The enzyme-linked immunosorbent assay (ELISA) was used to detect the CXC chemokine ligand (CXCL1, CXCL2) levels in the cell supernatant. The real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-qPCR) was used to detect the mRNA expressions of CXCL1 and CXCL2 in the cells. Western Blot was used to detect phosphorylated Src (p-Src), vascular endothelial-cadherin (VE-cadherin) and phosphorylated mitogen activated protein kinase (p-MAPK). Results:Compared with the blank control group, the permeability of rat CMECs in the LPS group was significantly increased. The cell permeability was improved to some extent after paeoniflorin pretreatment at different concentrations, and the improvement was most obvious in the 40 μmol/L paeoniflorin group, with statistically significant difference as compared with the LPS group ( A value: 1.61±0.07 vs. 2.13±0.06, P < 0.01). ELISA results showed that there were moderate amounts of CXCL1 and CXCL2 in the cell supernatant of rat CMECs in the blank control group. However, the secretion of CXCL1 and CXCL2 in the cell supernatant was increased significantly under the induction of LPS. After pretreatment with paeoniflorin at different concentrations, the secretion of CXCL1 and CXCL2 in the cell supernatant was significantly reduced. The most obvious inhibitory effect on CXCL1 was 40 μmol/L paeoniflorin, and the most obvious inhibition on CXCL2 was 20 μmol/L paeoniflorin, the differences were statistically significant as compared with the LPS group [CXCL1 (ng/L): 337.51±68.04 vs. 829.86±65.06, CXCL2 (ng/L): 4.48±0.11 vs. 9.41±0.70, both P < 0.01]. RT-qPCR results showed that the mRNA expressions of CXCL1 and CXCL2 in the rat CMECs were consistent with the ELISA results. LPS could increase mRNA expressions of CXCL1 and CXCL2 in the rat CMECs, and pretreatment with different concentrations of paeoniflorin could significantly reduce the mRNA expressions of CXCL1 and CXCL2. The 40 μmol/L paeoniflorin had the best inhibitory effect on CXCL1 mRNA expression, and the 20 μmol/L paeoniflorin had the best inhibitory effect on CXCL2 mRNA expression, the differences were statistically significant as compared with the LPS group [CXCL1 mRNA (2 -ΔΔCt): 0.543±0.004 vs. 0.812±0.089, CXCL2 mRNA (2 -ΔΔCt): 10.52±0.71 vs. 17.68±1.09, both P < 0.01]. Western Blot results showed that moderate amounts of p-Src, VE-cadherin and p-MAPK proteins were expressed in the rat CMECs in the blank control group. After LPS stimulation, the expressions of p-Src and p-MAPK proteins were increased significantly, while the expression of VE-cadherin protein was decreased significantly. After pretreatment with different concentrations of paeoniflorin, the expressions of p-Src and p-MAPK proteins in the cells were decreased to varying degrees, while the expression of VE-cadherin protein was increased, and 40 μmol/L paeoniflorin had the most obvious effect, the differences were statistically significant as compared with the LPS group [p-Src protein (p-Src/GAPDH): 1.02±0.09 vs. 1.29±0.05, p-MAPK proteins (p-MAPK/GAPDH): 0.24±0.02 vs. 0.62±0.02, VE-cadherin protein (VE-cadherin/GAPDH): 0.64±0.03 vs. 0.31±0.02, all P < 0.01]. Conclusion:Paeoniflorin can regulate the Src/VE-cadherin pathway in CMECs, inhibit the expression and secretion of inflammation-related proteins and chemokines, and improve the cell permeability of CMECs induced by LPS.

Objective To investigate the value of three dimensional time-of-flight (3D-TO)F) and three dimensional fast imaging employing steady state acquisition (3D-FIESTA)sequences in evaluation on spatial relationship among trigeminal nerve,facial nerve and peripheral vessels before microvascular decompression(MVD)with 3.0 T MR.Methods Data of MRI of 36 patients with trigeminal neuralgia (TN) and 31 with hemifacial spasm (HFS) before MVD were analyzed retrospectively.The intra-observer agreement for the spatial relationship among trigeminal nerve,facial nerve and adjacent blood vessels were observed.The differences of occurrence rates of neurovascular compression (NVC) of symptomatic side and asymptomatic side in TN and HFS patients were compared.Taking surgical results as the gold standards,the diagnostic efficacy for neurovascular relationships of symptomatic side with 3D-TOF and 3D-FIESTA sequences were calculated.Results The consistency between two observers in assessing relationship of trigeminal nerve,facial nerve and adjacent blood vessels of symptomatic and asymptomatic was good (all Kappa≥0.75,all P＜0.001).In both of TN and HFS patients,the occurrence rates of NVC of symptomatic side were significantly higher than those of asymptomatic side (x2=26.13,20.81,both P＜ 0.001).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of 3D-TOF and 3D-FIESTA sequences in displaying relationship of trigeminal nerve and vascular was 97.22％ (35/36),97.06％ (33/34),100％ (2/2),100％ (33/33)and 66.67％ (2/3),respectively,of relationship between facial nerve and vascular was 93.55％ (29/31),96.55％ (28/29),50.00％ (1/2),96.55％ (28/29) and 50.00％ (1/2),respectively.Conclusion 3D-TOF and 3D-FIESTA sequences can clearly display the spatial relationship of nerve and adjacent vessels,therefore providing imaging evidences for MVD.

Objective To investigate the efficacy and safety of low dose tirofiban combined with reteplase in the thrombolytic treatment of young and middle-aged patients with acute myocardial infarction (AMI).Methods A total of 120 AMI patients were selected and randomly divided into group A and group B,60 cases in each group.The patients in the group A were given reteplase combined with low dose of tirofiban [0.05 μg/(kg·min)],and the patients in the group B were given reteplase combined with routine dose of tirofiban [0.1 μg/(kg·min)].The vascular recanalization rate,the platelet aggregation rate,the levels of coagulation and fibrinolysis related indicators,the main clinical events and bleeding complications were compared between two groups.Results The vascular recanalization rate of group A was 76.67%,which was similar to 81.67% of group B (P>0.05).After treatment,the platelet aggregation rate were significantly lower than that before treatment in both groups (P<0.05).After treatment,the levels of Fg and D-D were significantly lower than those before treatment in both groups,and the levels of PLT and t-PA were significantly higher than those before treatment (P<0.05).After one month of treatment,there was no significant difference in incidence rate of clinical events between two groups (P>0.05).The incidence rate of bleeding complications in group A was significantly lower than the group B (P<0.05).Conclusion The thrombolytic effect of low dose tirofiban on treatment of AMI is similar to that of the conventional dose,but it can reduce the risk of bleeding and improve medication safety.