Objective To investigate the changes in metabolites detected by magnetic resonance spectroscopy(MRS)in the dorsal thalamus of patients with cervical spondylotic myelopathy(CSM)and to analyze their correlation with spinal cord injury based on diffusion tensor imaging(DTI).Methods A total of 93 patients with CSM(patient group)and 67 healthy volunteers(control group)were selected.DTI parameters of the spinal cord and MRS parameters of the thalamus were compared between the two groups.Correlation analysis were performed among clinical features,conventional imaging features,DTI parameters,and metabolites in CSM patients.Multifacto-rial linear regression equations for thalamic metabolites based on the aforementioned characteristics were established.Results The fractional anisotropy(FA)value was significantly lower in the patient group than in the control group(P=0.005,t=2.874).The N-acetyl aspartate/creatine(NAA/Cr)ratio(P<0.001,Z=-5.922),choline/Cr(Cho/Cr)ratio(P<0.001,Z=-6.857),and myo-inositol/Cr(MI/Cr)ratio(P<0.001,Z=-6.573)were significantly lower in the patient group than in the control group.The NAA/Cr ratio(r=0.444,P<0.001),Cho/Cr ratio(r=0.308,P=0.003),and MI/Cr ratio(r=-0.489,P<0.001)were corre-lated with the FA value in the patient group.There was a correlation between the NAA/Cr ratio and the duration(r=-0.365,P<0.001).Multifactorial linear regression equations for each metabolites in the thalamus:NAA/Cr=0.833+1.520×FA-0.007×duration;Cho/Cr=0.209+0.774×FA;MI/Cr=1.566-1.722×FA+0.008×modified Japanese Orthopaedic Association(mJOA)score;glu-tamate/Cr(Glx/Cr)=0.942+0.009×duration.Conclusion CSM patients exhibit metabolic alterations in the dorsal thalamus,which are linearly correlated with the degree of spinal cord injury.

Objective To access the changes of thalamic metabolites before and 6 months after surgery in patients with cervical spondylotic myelopathy(CSM)using hydrogen proton magnetic resonance spectroscopy(1H-MRS)and to analyze its association with improvement in neurological function.Methods Forty-eight CSM patients(CSM group)who underwent cervical decompression surgery were included,and 33 healthy controls(HC)(HC group)were recruited.All subjects underwent bilateral thalamic 1H-MRS scans before the surgical procedure,and subsequently again 6 months later.Neurological function was assessed pre-operatively and post-operatively(6 months)in all patients with CSM using the modified Japanese Orthopaedic Association(mJOA)score.The changes of mJOA(△mJOA)were employed as an indicator of neurological improvement.The pre-and post-operative thalamic metabolites ratio of N-acetyl aspartate/creatine(NAA/Cr),choline/Cr(Cho/Cr),myo-inositol/Cr(mI/Cr),glutamate and glutamine/Cr(Glx/Cr)were compared in CSM patients and HC.A correlation analysis was conducted to determine the relationship between alterations in pre-and post-operative thalamic metabolites ratio(△NAA/Cr,△Cho/Cr,△mI/Cr,△Glx/Cr)and △mJOA.Results Compared to HC group,patients with CSM group showed significantly lower NAA/Cr(t=-4.988,P＜0.001;t=-3.562,P=0.001),Cho/Cr(t=-5.946,P＜0.001;t=-2.764,P=0.007)and mI/Cr(t=-3.988,P＜0.001;t=-2.079,P=0.041)before and 6 months after surgery.6 months post-operative NAA/Cr(t=-2.805,P=0.007)and mI/Cr(t=-3.285,P=0.003)were increased in CSM groups compared to pre-operative NAA/Cr and mI/Cr.In CSM group,△mI/Cr correlated significantly with △mJOA(r=0.478 2,P=0.000 6).Conclusion There are differences in thalamic metabolites in CSM patients before and after surgery.△mI/Cr is correlated with the improvement of neurological function,which can be used as an imaging parameter to evaluate the neurological function recovery in patients with CSM after surgery.

Objective To investigate the value of the nomogram model based on the apparent diffusion coefficient(ADC)value of the cervical spinal cord in predicting neurological recovery after cervical spondylotic myelopathy(CSM).Methods One hundred CSM patients undergoing decompression surgery were prospectively enrolled.All patients underwent conventional cervical spine MRI and sagittal position non-shared incentive diffusion weighted imaging(ZOOM-DWI)examination before surgery.The improvement rate of neurological function was calculated according to the modified Japanese Orthopaedic Association(mJOA)score before and 6 months after surgery and divided into the good improvement group(60 patients)and the poor improvement group(40 patients)according to the improvement rate.Independent risk factors for postoperative outcomes were determined by univariate and multivariate logistic regression.Then the prediction model based on the clinical-imaging feature(model 1)and clinical-imaging feature-ADC value(model 2)were established,the receiver operating characteristic(ROC)curve was drawn,and the DeLong test was performed to compare the discrimination efficiency of the two models.A nomogram,calibration curve,and clinical decision curve were drawn for model 2.Results Age,body mass index(BMI),diabetes mellitus,T2 hyperintense,cross-sectional area,and ADC values at the disc level of different segments were independent risk factors affecting the outcome of CSM.The area under the curve(AUC)of the ROC curve constructed by model 2(AUC=0.933)was higher than that of model 1(AUC=0.864).The DeLong test showed that the difference between the two models was statistically significant(P＜0.05).The nomogram,calibration curve,and decision curve analysis(DCA)of model 2 showed that it had good differentiation,accuracy,and clinical value.Conclusion The nomogram model based on ADC value can effectively predict the outcome of postoperative neurological recovery in CSM patients.

Objective To investigate the relationship between quantitative parameters of the histogram of global fat fraction(FF)in the infrapatellar fat pad(IPFP)and the severity of knee osteoarthritis(KOA).Methods A total of 120 patients were prospectively selected and divided into the non-KOA group(KL grade 0-1),the mild KOA group(KL grade 2),and the severe KOA group(KL grade 3-4)based on the Kellgren-Lawrence(KL)classification criteria of knee X-rays.The FF maps of the IPFP were obtained based on the mDIXON-Quant technique.The region of interest(ROI)was delineated using 3D Slicer software,and global histogram analysis was performed to obtain quantitative parameters,including mean,median,10th percentile(10th),90th percentile(90th),skewness,kurtosis,and entropy.Pearson or Spearman correlation analysis was used to evaluate the correlation between each quanti-tative parameter and the severity of KOA.The diagnostic efficacy was analyzed using the receiver operating characteristic(ROC)curves.Results As the progression of KL classification,the mean,median,percentiles,and kurtosis of the global FF histogram quantitative parameters in the IPFP decreased,while skewness and entropy increased,with statistically significant among the three groups(P＜0.001).The mean,median,10th,90th,and kurtosis showed negative correlations with the KL classification(r=-0.563,-0.448,-0.614,-0.294,-0.450),while skewness and entropy showed positive correlations with the KL classification(r=0.385,0.637),all of which were statistically significant(P＜0.05).The area under the curve(AUC)for diagnosing KOA were 0.799,0.725,0.828,0.636,0.741,0.688,and 0.830,respectively.The sensitivity of the 10th and entropy were 74.4％and 77.9％,respectively,and the specificity were 85.3％and 88.2％,respectively.Conclusion The quantitative parameters of the histogram of global FF in the IPFP are correlated with the severity of KOA and can reflect the pathophysiological changes in the IPFP.They can serve as objective indicators for diagnosing KOA and assessing its severity.

Objective To investigate the changes in metabolites detected by magnetic resonance spectroscopy(MRS)in the dorsal thalamus of patients with cervical spondylotic myelopathy(CSM)and to analyze their correlation with spinal cord injury based on diffusion tensor imaging(DTI).Methods A total of 93 patients with CSM(patient group)and 67 healthy volunteers(control group)were selected.DTI parameters of the spinal cord and MRS parameters of the thalamus were compared between the two groups.Correlation analysis were performed among clinical features,conventional imaging features,DTI parameters,and metabolites in CSM patients.Multifacto-rial linear regression equations for thalamic metabolites based on the aforementioned characteristics were established.Results The fractional anisotropy(FA)value was significantly lower in the patient group than in the control group(P=0.005,t=2.874).The N-acetyl aspartate/creatine(NAA/Cr)ratio(P<0.001,Z=-5.922),choline/Cr(Cho/Cr)ratio(P<0.001,Z=-6.857),and myo-inositol/Cr(MI/Cr)ratio(P<0.001,Z=-6.573)were significantly lower in the patient group than in the control group.The NAA/Cr ratio(r=0.444,P<0.001),Cho/Cr ratio(r=0.308,P=0.003),and MI/Cr ratio(r=-0.489,P<0.001)were corre-lated with the FA value in the patient group.There was a correlation between the NAA/Cr ratio and the duration(r=-0.365,P<0.001).Multifactorial linear regression equations for each metabolites in the thalamus:NAA/Cr=0.833+1.520×FA-0.007×duration;Cho/Cr=0.209+0.774×FA;MI/Cr=1.566-1.722×FA+0.008×modified Japanese Orthopaedic Association(mJOA)score;glu-tamate/Cr(Glx/Cr)=0.942+0.009×duration.Conclusion CSM patients exhibit metabolic alterations in the dorsal thalamus,which are linearly correlated with the degree of spinal cord injury.

Objective To investigate the value of the nomogram model based on the apparent diffusion coefficient(ADC)value of the cervical spinal cord in predicting neurological recovery after cervical spondylotic myelopathy(CSM).Methods One hundred CSM patients undergoing decompression surgery were prospectively enrolled.All patients underwent conventional cervical spine MRI and sagittal position non-shared incentive diffusion weighted imaging(ZOOM-DWI)examination before surgery.The improvement rate of neurological function was calculated according to the modified Japanese Orthopaedic Association(mJOA)score before and 6 months after surgery and divided into the good improvement group(60 patients)and the poor improvement group(40 patients)according to the improvement rate.Independent risk factors for postoperative outcomes were determined by univariate and multivariate logistic regression.Then the prediction model based on the clinical-imaging feature(model 1)and clinical-imaging feature-ADC value(model 2)were established,the receiver operating characteristic(ROC)curve was drawn,and the DeLong test was performed to compare the discrimination efficiency of the two models.A nomogram,calibration curve,and clinical decision curve were drawn for model 2.Results Age,body mass index(BMI),diabetes mellitus,T2 hyperintense,cross-sectional area,and ADC values at the disc level of different segments were independent risk factors affecting the outcome of CSM.The area under the curve(AUC)of the ROC curve constructed by model 2(AUC=0.933)was higher than that of model 1(AUC=0.864).The DeLong test showed that the difference between the two models was statistically significant(P＜0.05).The nomogram,calibration curve,and decision curve analysis(DCA)of model 2 showed that it had good differentiation,accuracy,and clinical value.Conclusion The nomogram model based on ADC value can effectively predict the outcome of postoperative neurological recovery in CSM patients.

Objective To investigate the relationship between quantitative parameters of the histogram of global fat fraction(FF)in the infrapatellar fat pad(IPFP)and the severity of knee osteoarthritis(KOA).Methods A total of 120 patients were prospectively selected and divided into the non-KOA group(KL grade 0-1),the mild KOA group(KL grade 2),and the severe KOA group(KL grade 3-4)based on the Kellgren-Lawrence(KL)classification criteria of knee X-rays.The FF maps of the IPFP were obtained based on the mDIXON-Quant technique.The region of interest(ROI)was delineated using 3D Slicer software,and global histogram analysis was performed to obtain quantitative parameters,including mean,median,10th percentile(10th),90th percentile(90th),skewness,kurtosis,and entropy.Pearson or Spearman correlation analysis was used to evaluate the correlation between each quanti-tative parameter and the severity of KOA.The diagnostic efficacy was analyzed using the receiver operating characteristic(ROC)curves.Results As the progression of KL classification,the mean,median,percentiles,and kurtosis of the global FF histogram quantitative parameters in the IPFP decreased,while skewness and entropy increased,with statistically significant among the three groups(P＜0.001).The mean,median,10th,90th,and kurtosis showed negative correlations with the KL classification(r=-0.563,-0.448,-0.614,-0.294,-0.450),while skewness and entropy showed positive correlations with the KL classification(r=0.385,0.637),all of which were statistically significant(P＜0.05).The area under the curve(AUC)for diagnosing KOA were 0.799,0.725,0.828,0.636,0.741,0.688,and 0.830,respectively.The sensitivity of the 10th and entropy were 74.4％and 77.9％,respectively,and the specificity were 85.3％and 88.2％,respectively.Conclusion The quantitative parameters of the histogram of global FF in the IPFP are correlated with the severity of KOA and can reflect the pathophysiological changes in the IPFP.They can serve as objective indicators for diagnosing KOA and assessing its severity.

Objective To access the changes of thalamic metabolites before and 6 months after surgery in patients with cervical spondylotic myelopathy(CSM)using hydrogen proton magnetic resonance spectroscopy(1H-MRS)and to analyze its association with improvement in neurological function.Methods Forty-eight CSM patients(CSM group)who underwent cervical decompression surgery were included,and 33 healthy controls(HC)(HC group)were recruited.All subjects underwent bilateral thalamic 1H-MRS scans before the surgical procedure,and subsequently again 6 months later.Neurological function was assessed pre-operatively and post-operatively(6 months)in all patients with CSM using the modified Japanese Orthopaedic Association(mJOA)score.The changes of mJOA(△mJOA)were employed as an indicator of neurological improvement.The pre-and post-operative thalamic metabolites ratio of N-acetyl aspartate/creatine(NAA/Cr),choline/Cr(Cho/Cr),myo-inositol/Cr(mI/Cr),glutamate and glutamine/Cr(Glx/Cr)were compared in CSM patients and HC.A correlation analysis was conducted to determine the relationship between alterations in pre-and post-operative thalamic metabolites ratio(△NAA/Cr,△Cho/Cr,△mI/Cr,△Glx/Cr)and △mJOA.Results Compared to HC group,patients with CSM group showed significantly lower NAA/Cr(t=-4.988,P＜0.001;t=-3.562,P=0.001),Cho/Cr(t=-5.946,P＜0.001;t=-2.764,P=0.007)and mI/Cr(t=-3.988,P＜0.001;t=-2.079,P=0.041)before and 6 months after surgery.6 months post-operative NAA/Cr(t=-2.805,P=0.007)and mI/Cr(t=-3.285,P=0.003)were increased in CSM groups compared to pre-operative NAA/Cr and mI/Cr.In CSM group,△mI/Cr correlated significantly with △mJOA(r=0.478 2,P=0.000 6).Conclusion There are differences in thalamic metabolites in CSM patients before and after surgery.△mI/Cr is correlated with the improvement of neurological function,which can be used as an imaging parameter to evaluate the neurological function recovery in patients with CSM after surgery.

Objective To investigate the effect of Shenqi Yizhi Granules on brain structure and function in prodromal Alzheimer disease（pAD） under hypoxic conditions based on MRI. Methods A total of 77 female Han Chinese patients， aged 50‒85 years， who had at least 6 years of education and long-term residence in Qinghai region and met the inclusion criteria for pAD were enrolled as subjects. They were randomly divided into drug group （39 patients receiving Shenqi Yizhi Granules） and control group （38 patients receiving placebo） for 24 weeks of clinical observation. Related data were collected from all subjects， including clinical information， cognitive and neuropsychological assessments， diffusion tensor imaging （DTI） data， and rs-fMRI data. Results Cognitive and neuropsychological assessments showed that after treatment， the drug group had significant increases in MoCA， AVTL， SDMT， and CFT-copy scores and significant reductions in ADAS-cog and GDS scores（P<0.05）， while the control group had a significantly increase in ADAS-cog score （P<0.001）； compared with the control group after treatment， the drug group had significantly higher MoCA and AVTL scores （P<0.05） and a significantly lower ADAS-cog score （P<0.01）. DTI results showed that the drug group had significant increases in axial diffusivity （AD） values of multiple brain regions after treatment （P<0.05）. The results of rs-fMRI showed that after treatment， the drug group had significant increases in the amplitude of low-frequency fluctuation （ALFF） in the right temporal middle gyrus， the triangular part of the inferior frontal gyrus， and the medial cingulate gyrus and paracingulate gyrus and significant reductions in ALFF in the left cerebellar hemisphere Crus1 lobule， superior occipital gyrus， and supramarginal gyrus， and compared with the control group， the drug group had a significant increase in ALFF in the right dorsolateral superior frontal gyrus （P<0.05）. After treatment， the drug group had significant increases in the regional homogeneity （ReHo） values of the left triangular part of the inferior frontal gyrus and the inferior occipital gyrus and a significant reduction in the ReHo value of the left cerebellar hemisphere Crus1 lobule （P<0.05）， and compared with the control group， the drug group had a significant increase in the ReHo value of the left inferior parietal gyrus（P<0.05）. Conclusion Shenqi Yizhi Granules can effectively improve overall cognition and the function of multiple cognitive domains in pAD patients living in plateau regions by modulating the microstructure of white matter and spontaneous neuronal activity in cognitive-related brain regions.

Objective To provide a rapid and efficient tool for the development and optimization of the medical support scheme of unexpected accidents during operational ocean training of the aircraft carrier detachment,so as to enhance the medical decision support capability of the aircraft carrier at sea.Methods The computer simulation software system for medical support of unexpected accidents during operational ocean training of the aircraft carrier detachment was investigated and developed by utilizing system modeling,computer simulation and software engineering,as well as evaluation and optimal evidence study,was made for the medical support scheme.Results Dynamic optimization and evidence evaluation of the medical support scheme were performed by using the software system,thus enhancing meticulous and accurate research capability of medical support schemes and orientation of resource distribution.Conclusion Emergency care and medical support evacuation of casualties by unexpected accidents was a hard and key problem in operational ocean training of the aircraft carrier detachment,Medical support scheme for unexpected accidents during operational ocean training of the aircraft carrier by computer simulation and optimization was a technical breakthrough in the research of medical support at sea.