The aging trend is intensifying currently,but there is still a lack of standardized diagnosis and treat-ment schemes for severe infections in elderly people.This paper focuses on the recommendations for immune-related clinical diagnosis and treatment routes as well as the idea of risk stratified diagnosis and treatment for elderly peo-ple,aiming to effectively prevent infectious diseases in elderly people and perform stratified management through systematic and scientific means of immune function monitoring and regulation,so as to enhance the standardized level of diagnosis and treatment as well as clinical treatment effect of infection in elderly people.

The aging trend is intensifying currently,but there is still a lack of standardized diagnosis and treat-ment schemes for severe infections in elderly people.This paper focuses on the recommendations for immune-related clinical diagnosis and treatment routes as well as the idea of risk stratified diagnosis and treatment for elderly peo-ple,aiming to effectively prevent infectious diseases in elderly people and perform stratified management through systematic and scientific means of immune function monitoring and regulation,so as to enhance the standardized level of diagnosis and treatment as well as clinical treatment effect of infection in elderly people.

Objective:To observe the effects of electroacupuncture(EA)on sleep electroencephalogram(EEG)and event-related potential(ERP)in patients with somatoform disorders(SFD). Methods:Seventy-five SFD patients were recruited as an EA group to receive EA at Shenting(GV24)and Baihui(GV20)once daily,30 min each time,with 6 straight days as a treatment course,and 4 courses were conducted at 1-day intervals.Before treatment,patients underwent a survey using a physical symptom checklist on their primary symptoms.Before and after treatment,their sleep EEG was monitored using Quisi,and the ERP mismatch negativity(MMN)and P300 were detected.The Quisi sleep EEG and ERP were also examined among 40 normal volunteers as the normal group data. Results:During the trial,13 cases were removed from the EA group due to incomplete data,and 62 cases were finally included for statistical analyses.Of the 62 SFD patients,the main disturbing symptoms were cognitive impairments,sleep disorders,respiratory symptoms,digestive symptoms,five-sense organ problems,and cardiovascular symptoms in order.Before treatment,the EA group had increased MMN and P300 latencies and decreased amplitudes compared with the normal control group(P<0.01 or P<0.05);according to Quisi,the EA group also had reduced total sleep time(TST),shorter rapid eye movement sleep(REM)latency(RL)and REM time(RT),smaller number of REM period(NRP),extended sleep latency(SL),longer awaking time(AT),lower sleep efficiency(SE),larger percent of non-rapid eye movement sleep(NREM)stage 1(S1)and smaller percent of NREM stage 2(S2),and the percent of slow wave sleep(SWS),i.e.NREM stage 3(S3)plus stage 4(S4),also went down,all presenting significant differences between groups(P<0.01 or P<0.05).After 4 courses of treatment,the MMN and P300 latencies were reduced,and their amplitudes became larger in the EA group compared with the baseline(P<0.05);they had insignificant differences compared with the normal control group(P>0.05).Quisi showed that the TST and RL increased,and the SL and AT decreased in the EA group,and the predominant change in sleep architecture was reduced S1 percent,increased S2,and improved SE,all showing significant intra-group differences(P<0.01 or P<0.05);however,the intra-group difference in the NRP was statistically insignificant(P>0.05).Except the TST,RT,S1 percent,and SWS,there was no statistical significance in comparing the other Quisi parameters(including RL,NRP,SL,AT,SE,and S2 percent)between the two groups(P>0.05). Conclusion:SFD patients have a variety of clinical symptoms,and most of them show abnormal sleep EEG and ERP;EA can correct abnormal sleep EEG parameters and the MMN and P300 of ERP in SFD patients.

A 56-year-old man presented with vague upper abdominal pain for more than 4 months. His abdominal ultrasound and MRI showed thickening of the neck and base of the gallbladder and nodule formation at the base of the gallbladder. 18F-FDG PET/CT revealed intense FDG uptake in the base of the gallbladder and multiple lymph nodes. 68Ga-FAPI-04 PET/CT not only showed intense FAPI uptake in the above mentioned FDG-avid lesions but also showed intense FAPI uptake in the neck lesion of the gallbladder and some other additional lymph nodes. Finally, histopathological examination confirmed poorly differentiated tubular adenocarcinoma of the neck and base of the gallbladder. Our case illustrated that 68Ga-FAPI-04 PET/CT may outperform 18F-FDG PET/CT in the detection of gallbladder cancer primary and metastatic lesions.

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.

Objective: This study aimed at determining the characteristics of the glucose homeostasis and its relationship with iron overload of the patients with β-thalassemia major (β-TM). Method: From Sun Yat-sen Memorial Hospital between January 2014 and December 2015, a total of 57 transfusion-dependent β-TM patients with 5-18 years old were enrolled in this study and fasting blood glucose(FBG) and insulin level, serum ferritin (SF), serum iron, transferrin, total iron binding capacity, unsaturated iron binding capacity were determined.Insulin resistance index (IRI), insulin sensitivity index and β-cell function index (BFI) were also estimated. Besides, in 36 patients cardiac T2* and liver T2* were estimated. Result: (1) Four patients(7%) with β-TM were diagnosed diabetes mellitus, and 14(24%) had impaired fasting glucose. (2) The incidence of abnormal glucose metabolism was significantly different according to levels of SF and degrees of the cardiac iron overload(χ²=9.737, P<0.05; χ²=17.027, P<0.05). It rose while the level of SF increased and the degree of cardiac iron overload aggravated. (3) The incidence of abnormal glucose level was not significantly different in cases with different degree of liver iron overload.The severe group of liver iron overload had significantly higher levels of INS, HOMA-βFI, HOMA-ISI, HOMA-βFI than the non-severe group (Z=-2.434, -2.515, F=8.658, all P<0.05), while no differences were found in the level of FBG, HOMA-βFI between two groups. (4) The result of logistic regression analysis indicated that the cardiac T2* was a significant predictor for the incidence of abnormal glucose metabolism in TM patients (P=0.035, OR=1.182%, 95%CI=1.048 to 1.332). Conclusion The high prevalence of abnormal glucose metabolism in β-TM patients was mainly closely related with the internal iron overload, especially in organs.The cardiac T2* was an independent risk factor for the incidence of abnormal glucose metabolism in TM patients.

Purpose The clinical manifestation of primary lymphoma of bone (PBL) is lack of specificity,and it is easy to be misdiagnosed.This study is to investigate the characteristics of ~F-fluorodeoxyglucose (~F-FDG) positron emission tomography/computed tomography (PET/CT) of PBL and to improve the understanding of its imaging findings.Materials and Methods Fourteen patients with PLB (9 males and 5 females) proved by pathology in the Affiliated Hospital of Southwest Medical University from January 2011 to October 2015 were enrolled.18F-FDG PET/CT findings of all the patients were retrospectively analyzed.The CT image,PET image and fusion image were analyzed by 3 physicians of medical imaging.The SUVmax value of the lesion was measured through region of interesting.Results Ten patients with unifocal lesion involved 4 cases of femoral bone,2 cases of pelvis,2 cases of vertebrae,1 case of ulna and 1 case of tibia.The other 4 patients had multifocal lesions.The lesions showed different level of increased radioactivity on the PET imaging with SUVmax of 9.85±4.29.On syn-CT images,6 cases of unifocal PLB showed cribriform or fuzzy boundary insect erosion osteolytic bone destruction,5 of which were accompanied by cortical bone destruction.The other 4 cases of unifocal PLB showed mixed bone destruction.Among the 10 cases of uniffocal PLB,7 of them showed soft tissue masses with unclear boundary and no obvious necrosis or cystic change,1 of them showed pathological fracture and periosteum reaction.The 4 cases of multifocal PBL patients showed multiple osteolytic bone destruction,2 of them had localized soft tissue masses.Conclusion 18F-FDG PET/CT manifestations of PBL have certain characteristics,which is helpful for early diagnosis.It may provide important information for clinical treatment and prognosis evaluation.

Objective To evaluate the value of 99Tcm-EHIDA SPECT combined with planar hepatobiliary scintigraphy (combined scintigraphy) in the differentiation of infant biliary atresia (BA) from neonatal hepatitis (NH).Methods This is a retrospective study on 32 infants with cholestasis (18 males,14 females;age:28-83 d) from June 2013 to June 2014.All infants underwent sequential 99Tcm-EHIDA hepatobiliary planar scintigraphy and combined scintigraphy,and the diagnostic efficacy of the 2 methods for differentiating infant BA from NH was analyzed by x2 test.Results In sequential planar scintigraphy,the diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 76.2％ (16/21),6/11,68.8％ (22/32),76.2％ (16/21) and 6/11,respectively.In combined scintigraphy,the diagnostic parameters were 95.2％ (20/21),8/11,87.5％ (28/32),87.0％ (20/23) and 8/9,respectively.Combined scintigraphy correctly identified 4 BA cases that were misdiagnosed as NH by planar scintigraphy.The sensitivity of combined scintigraphy was significantly higher than that of planar scintigraphy (x2 =4.285,P＜0.05),while no significant difference was found in the other diagnostic parameters (x2 =0.061-0.405,all P＞0.05).Conclusions Combined scintigraphy has incremental value for the differentiation of infant BA from NH.

Objective To explore the effects of detecting of γ-glutamyltransferase( γ-GT)and leucine aminopeptidase(LAP)in urine on early diagnosis of kidney injury induced by zoledronic acid. Methods The patients with malignant tumor bone metastasis and received zoledronic acid from February 2012 to July 2014 in the General Hospital of Shenyang Military Command were enrolled into this study. The patient received IV infusion of zoledronic acid 4 mg,once for 25 to 35 days,finished within 30 minutes. The therapy was applied 3 times continuously. The patients' urine and venous blood samples were taken before and after each medication's morning. The levels of γ-GT,LAP in urine and serum creatinine were detected and compared. Results A total of 100 patients comprised 48 males and 52 females with a mean age of (60 ± 11)years(25-82 years)were enrolled into the study. The levels of γ-GT,LAP in urine and serum creatinine before and after receiving zoledronic acid in the first time were(8 ± 5),(7 ± 5)U/ L;(332 ± 110),(375 ± 113)nmol·s-1 ·L-1;(52 ± 12),(54 ± 12)μmol/ L,respectively. The levels of γ-GT, LAP in urine and serum creatinine before and after receiving zoledronic acid the second time were(10 ± 4), (12 ± 5)U/ L;(407 ± 104),(377 ± 126)nmol·s-1 ·L-1;(51 ± 13),(53 ± 13)μmol/ L,respectively. The levels of γ-GT,LAP in urine and serum creatinine before and after receiving zoledronic acid the third time were(16 ± 8),(19 ± 9)U/ L;(549 ± 159),(662 ± 199)nmol·s-1 ·L-1;(52 ± 15),(53 ± 14)μmol/ L,respectively. The differences of levels of γ-GT,LAP in urine before and after 3 times of medication were statistically significant( all P < 0. 05). But the differences of levels of serum creatinine were not statistically significant(all P > 0. 05). The differences of levels of γ-GT,LAP in urine after 3 times of
medication were statistically significant(all P < 0. 05). But the The differences of levels of serum creatinine were not statistically significant(all P > 0. 05). Conclusions The change in levels of γ-GT and LAP in urine was earlier than that of serum creatinine in patient with kidney injury induced by zoledronic acid. γ-GT and LAP in urine can be the early diagnostic marker of kidney injury induced by zoledronic acid.

Objective To explore the effects of detecting of γ-glutamyltransferase( γ-GT)and leucine aminopeptidase(LAP)in urine on early diagnosis of kidney injury induced by zoledronic acid. Methods The patients with malignant tumor bone metastasis and received zoledronic acid from February 2012 to July 2014 in the General Hospital of Shenyang Military Command were enrolled into this study. The patient received IV infusion of zoledronic acid 4 mg,once for 25 to 35 days,finished within 30 minutes. The therapy was applied 3 times continuously. The patients' urine and venous blood samples were taken before and after each medication's morning. The levels of γ-GT,LAP in urine and serum creatinine were detected and compared. Results A total of 100 patients comprised 48 males and 52 females with a mean age of (60 ± 11)years(25-82 years)were enrolled into the study. The levels of γ-GT,LAP in urine and serum creatinine before and after receiving zoledronic acid in the first time were(8 ± 5),(7 ± 5)U/ L;(332 ± 110),(375 ± 113)nmol·s-1 ·L-1;(52 ± 12),(54 ± 12)μmol/ L,respectively. The levels of γ-GT, LAP in urine and serum creatinine before and after receiving zoledronic acid the second time were(10 ± 4), (12 ± 5)U/ L;(407 ± 104),(377 ± 126)nmol·s-1 ·L-1;(51 ± 13),(53 ± 13)μmol/ L,respectively. The levels of γ-GT,LAP in urine and serum creatinine before and after receiving zoledronic acid the third time were(16 ± 8),(19 ± 9)U/ L;(549 ± 159),(662 ± 199)nmol·s-1 ·L-1;(52 ± 15),(53 ± 14)μmol/ L,respectively. The differences of levels of γ-GT,LAP in urine before and after 3 times of medication were statistically significant( all P < 0. 05). But the differences of levels of serum creatinine were not statistically significant(all P > 0. 05). The differences of levels of γ-GT,LAP in urine after 3 times of
medication were statistically significant(all P < 0. 05). But the The differences of levels of serum creatinine were not statistically significant(all P > 0. 05). Conclusions The change in levels of γ-GT and LAP in urine was earlier than that of serum creatinine in patient with kidney injury induced by zoledronic acid. γ-GT and LAP in urine can be the early diagnostic marker of kidney injury induced by zoledronic acid.