Objective To analyze and summarize the MRI findings and clinical features of focal periphyseal edema(FOPE)in adolescents.Methods A retrospective analysis was conducted on the MRI and clinical data from 25 patients(29 knee joints)diagnosed with FOPE.All patients had no history of trauma.The MRI imaging features were analyzed by two senior musculoskeletal radiologists,and the diagnostic value and clinical significance of MRI were summarized.Results In 25 patients,34 lesions were found in 29 knee joints,including 20 in the femoral periphyseal plate region and 14 in the tibial periphyseal plate region.30 lesions were located in the central 2/3 area of the periphyseal plate and 4 were located in the peripheral 1/3 area of the periphyseal plate.On MRI,the lesions appeared as patchy areas of low signal on T1WI and high signal on fat suppression proton density weighted imaging(PDWI),extending from the periphyseal plate to the epiphysis and metaphyseal side with ill-defined borders.The longitudinal diameter of the lesions ranged from 0.4-1.7 cm,and the transverse diameter ranged from 0.3-1.7 cm.Apart from the FOPE,no other abnormal positive findings were observed on MRI of the knee joints in all patients.Conclusion FOPE in adolescents exhibits characteristic MRI findings,which may be related to closure of the periphyseal plate and knee joint pain in adolescents.

Objective To investigate the correlation between patellar tendon-lateral femoral condyle friction syndrome(PT-LFCFS)and bony anatomical abnormalities of the patellofemoral joint.Methods Univariate analysis and multivariate binary logistic regression analysis were performed on MRI measurement data of bony anatomical structures related to patellofemoral joint in 65 knee joints from 59 subjects(29 cases in the patient group and 30 cases in the control group).Based on the results,the pathogenic factors of PT-LFCFS were identified.Results Univariate analysis revealed statistically significant differences between the two groups in the Install-Salvati index(t=8.947,P＜0.001),trochlear groove depth(TGD)(t=-3.540,P=0.001),trochlear facet asymmetry(TFA)(t=—5.598,P＜0.001),lateral trochlear inclination(LTI)(t=—4.453,P＜0.001),patellar displacement(PD)(t=4.358,P＜0.001),tibial tubercle to trochlear groove(TT-TG)distance(Z=—4.814,P＜0.001),patellar tilt angle(PTA)(Z=-3.927,P＜0.001).Multivariate binary logistic regression analysis results showed that an increased Install-Salvati index[P=0.004,odds ratio(OR)=7.324]was a risk factor for the occurrence of the PT-LFCFS.Conclusion PT-LFCFS is associated with bony anatomical abnormalities indicating patellar instability,such as patella alta,increased TT-TG distance,and trochlear dysplasia.An increased Install-Salvati index is a bony anatomical structure risk factor for the occurrence of PT-LFCFS.

Objective To investigate the correlation between patellar tendon-lateral femoral condyle friction syndrome(PT-LFCFS)and bony anatomical abnormalities of the patellofemoral joint.Methods Univariate analysis and multivariate binary logistic regression analysis were performed on MRI measurement data of bony anatomical structures related to patellofemoral joint in 65 knee joints from 59 subjects(29 cases in the patient group and 30 cases in the control group).Based on the results,the pathogenic factors of PT-LFCFS were identified.Results Univariate analysis revealed statistically significant differences between the two groups in the Install-Salvati index(t=8.947,P＜0.001),trochlear groove depth(TGD)(t=-3.540,P=0.001),trochlear facet asymmetry(TFA)(t=—5.598,P＜0.001),lateral trochlear inclination(LTI)(t=—4.453,P＜0.001),patellar displacement(PD)(t=4.358,P＜0.001),tibial tubercle to trochlear groove(TT-TG)distance(Z=—4.814,P＜0.001),patellar tilt angle(PTA)(Z=-3.927,P＜0.001).Multivariate binary logistic regression analysis results showed that an increased Install-Salvati index[P=0.004,odds ratio(OR)=7.324]was a risk factor for the occurrence of the PT-LFCFS.Conclusion PT-LFCFS is associated with bony anatomical abnormalities indicating patellar instability,such as patella alta,increased TT-TG distance,and trochlear dysplasia.An increased Install-Salvati index is a bony anatomical structure risk factor for the occurrence of PT-LFCFS.

Objective To analyze and summarize the MRI findings and clinical features of focal periphyseal edema(FOPE)in adolescents.Methods A retrospective analysis was conducted on the MRI and clinical data from 25 patients(29 knee joints)diagnosed with FOPE.All patients had no history of trauma.The MRI imaging features were analyzed by two senior musculoskeletal radiologists,and the diagnostic value and clinical significance of MRI were summarized.Results In 25 patients,34 lesions were found in 29 knee joints,including 20 in the femoral periphyseal plate region and 14 in the tibial periphyseal plate region.30 lesions were located in the central 2/3 area of the periphyseal plate and 4 were located in the peripheral 1/3 area of the periphyseal plate.On MRI,the lesions appeared as patchy areas of low signal on T1WI and high signal on fat suppression proton density weighted imaging(PDWI),extending from the periphyseal plate to the epiphysis and metaphyseal side with ill-defined borders.The longitudinal diameter of the lesions ranged from 0.4-1.7 cm,and the transverse diameter ranged from 0.3-1.7 cm.Apart from the FOPE,no other abnormal positive findings were observed on MRI of the knee joints in all patients.Conclusion FOPE in adolescents exhibits characteristic MRI findings,which may be related to closure of the periphyseal plate and knee joint pain in adolescents.

Objective To explore the relationships of MRI manifestations of pericruciate ligament fat pad(PCFP)with the severity of knee osteoarthritis(KOA).Methods Fifty patients with MRI diagnosed KOA(KOA group)and 30 healthy subjects(control group)were retrospectively included.Signal intensity changes of PCFP,infrapatellar fat pad(IPFP),quadriceps fat pad(QFP)and prefemoral fat pad(PFP)were observed,and the maximum cross-sectional areas were obtained.The severity of KOA was assessed,including knee cartilage injury,anterior cruciate ligament tear,bone marrow lesion(BML),meniscal injuries and Park classification.MRI parameters of fat pad were compared between groups,and correlations of PCFP MRI parameter and other fat pad MRI parameters with the severity of KOA were analyzed.Results Signal change grade of IPFP and PCFP were significant different between groups(both P＜0.05),and the maximum cross-sectional area of IPFP and the thickness of PFP patellofemoral in KOA group were smaller than,while the maximum cross-sectional area of PCFP in KOA group was larger than that in control group(all P＜0.05).The signal change grade of PCFP was positively related to signal change grade of IPFP(rs=0.557)but negatively related to PFP interpatellofemoral thickness(rs=-0.651).The maximum cross-sectional area of PCFP was positively related to the maximum cross-sectional area of IPFP,PFP and QFP,also to the QFP occupancy effect(n=0.314 to 0.368).The signal change grade of PCFP was positively related to the cartilage injuries of knee compartments(medial and lateral patellofemoral joints,the femoral medial and lateral,the tibial medial and lateral)(rs=0.502 to 0.735),and the maximum cross-sectional area of PCFP was related to the lateral femoral cartilage injury(rs=0.305).In addition,the signal change grade of PCFP was positively related to tear of anterior cruciate ligament,BML,medial meniscus tears,lateral meniscus tears,medial meniscus extrusion,exudative synovitis and Park grading(rs=0.425 to 0.789),while the maximum cross-sectional area of PCFP was positively related to BML(rs=0.313).Conclusion MRI signal changes of PCFP could indicate KOA,and the grade of signal changes was correlated with the severity of KOA.

Objective To investigate the clinical and imaging features of patients with reabsorption of lumbar disc herniation.Methods Forty-two patients with reabsorption of lumbar disc herniation were selected.The patients'age,gender,reabsorption time and MRI imaging features were analyzed.The degree of disc herniation was classified using Komori classification and Michigan State University(MSU)grading,and the tissue components were classified using Iwabuchi classification.Results The average age of the 42 patients was(41±5.6)years old,with a male to female ratio of 1.1∶1.The reabsorption time ranged from 3 to 15 months,with an average of(6.58±5.54)months.In the initial MRI examination,all 42 patients showed intervertebral disc herniation beyond the posterior longitudinal ligament.Among the various types,Komori type Ⅲ was most prone to reabsorption,accounting for 66.67％.MSU grade 3 was most prone to reabsorption,accounting for 73.81％.Iwabuchi type Ⅰ was most prone to reabsorption,accounting for 92.86％.Six patients had concomitant Modic degeneration.Conclusion The MRI manifestations of reabsorption in patients with lumbar disc herniation have certain characteristics,which can provide imaging guidance for the selection of surgical or non-surgical treatment.

ObjectiveTo construct traditional Chinese medicine （TCM） diagnostic scale of turbid toxin syndrome in order to provide corresponding reference for the standardization of TCM syndromes and studies. MethodsWe systematically searched the Chinese Medical Dictionary （CMD）， China Knowledge Network （CNKI）， Wanfang Data Knowledge Service Platform （WF） and VIP database for TCM classics and modern literature on turbid toxin syndrome， and initially screened the four diagnosis information of turbid toxin syndrome， established a pool of information entries， and conducted a cross-sectional clinical survey. Discrete trend method， correlation coefficient method， Cronbach's coefficient method， and factor analysis method were applied to objectively screen the entries. The diagnostic scale of turbid toxin syndrome were constructed through three rounds of Delphi method expert survey to determine the scale entries， using hierarchical analysis to get the judgement matrix scores and relative weight of each entry， after passing consistency test and then isometric expansion of the relative weight of the entries to get the weight of each entry and assign the value. ResultsA total of 35 articles were included， 45 entries were obtained after the initial screening. After the clinical investigation， 12 entries were not suitable by the discrete trend method， 23 entries not suitable by correlation coefficient method， 13 entries by the internal consistency screening were removed with the Cronbach's alpha coefficient rising， and 10 entries not suitable by the factor analysis method. Twenty-two entries were retained after objective screening by the combined use of the four statistical methods. The positive coefficients of experts in the three rounds of Delphi method of expert consultation were 96.67%， the coefficients of expert authority were 0.834， 0.856， and 0.867， and the coefficients of co-ordination were 0.126， 0.326， and 0.312， respectively. After consulting with clinical experts， and three rounds of Delphi method survey and hierarchical analysis method weight assignment， the diagnostic scale entries of turbid toxin syndrome were finally established. Primary symptoms： dark red or purple and dusky tongue， yellowish greasy or dry coating （10 points）； sticky and unpleasant stools （8 points）； disharmony of tastes including halitosis， sticky and greasy taste in the mouth， dry mouth and bitter taste in the mouth （6 points）； unfavourable or yellowish or red urination （5 points）； and dark complexion （4 points）. Secondary symptoms： heavy body （3 points）； dizziness （3 points）； profuse， sticky， foul-smelling secretions （2 points）； wiry and slippery， or slippery， or slippery and rapid pulse （2 points）； feeling of hardness in the abdomen （1 point）. ConclusionUsing Delphi method combined with the hierarchical analysis method， combining qualitative and quantitative study， a diagnostic scale of turbid toxin syndrome was initially developed.

Objective:To discuss the efficacy of dredging pulmonary collaterals treatment（Suzi Jiangqi decoction plus Scolopendra and Scorpio）on the level of IL-1β in induced sputum in patients with refractory asthma. Methods:A total of 60 patients with refractory asthma，admitted to the two affiliated hospitals of Shanghai University of Tradition Chinese Medicine，were randomly assigned to control group and treatment group. Both groups were given aerosol inhalation of salmeterol，fluticasone，and tiotropium bromide. Additionally，the control group was given Suzi Jiangqi decoction，while the treatment group was given Suzi Jiangqi decoction plus Scolopendra and Scorpio. Both groups were treated for 12 weeks. Asthma control test（ACT）scores，IL-1β levels in induced sputum，and safety indicators such as complete blood count，and lung，liver，and renal functions were compared between the two groups. Results:After treatment，the ACT score，the forced expiratory volume in the first second（FEV 1.0），and the ratio of FEV 1.0 to the forced vital capacity（FEV 1.0/FVC）all increased，while the IL-1β levels decreased in both two groups. And the treatment group had significantly better improvements in the above-mentioned items than the control group，all with statistically significant differences（ P<0.05 or P<0.01）. Before and after treatment，there was no obvious change in the level of eosinophil in peripheral blood in either group. After treatment，all the safety indicators were within normal ranges in both groups. Conclusion:Suzi Jiangqi decoction plus Scolopendra and Scorpio can effectively control the severity of asthma and improve the lung function in patients with refractory asthma by reducing the level of IL-1β in induced sputum，the mechanism of action may be related to the inhibition of cell pyroptosis.

Objective:To discuss the efficacy of dredging pulmonary collaterals treatment（Suzi Jiangqi decoction plus Scolopendra and Scorpio）on the level of IL-1β in induced sputum in patients with refractory asthma. Methods:A total of 60 patients with refractory asthma，admitted to the two affiliated hospitals of Shanghai University of Tradition Chinese Medicine，were randomly assigned to control group and treatment group. Both groups were given aerosol inhalation of salmeterol，fluticasone，and tiotropium bromide. Additionally，the control group was given Suzi Jiangqi decoction，while the treatment group was given Suzi Jiangqi decoction plus Scolopendra and Scorpio. Both groups were treated for 12 weeks. Asthma control test（ACT）scores，IL-1β levels in induced sputum，and safety indicators such as complete blood count，and lung，liver，and renal functions were compared between the two groups. Results:After treatment，the ACT score，the forced expiratory volume in the first second（FEV 1.0），and the ratio of FEV 1.0 to the forced vital capacity（FEV 1.0/FVC）all increased，while the IL-1β levels decreased in both two groups. And the treatment group had significantly better improvements in the above-mentioned items than the control group，all with statistically significant differences（ P<0.05 or P<0.01）. Before and after treatment，there was no obvious change in the level of eosinophil in peripheral blood in either group. After treatment，all the safety indicators were within normal ranges in both groups. Conclusion:Suzi Jiangqi decoction plus Scolopendra and Scorpio can effectively control the severity of asthma and improve the lung function in patients with refractory asthma by reducing the level of IL-1β in induced sputum，the mechanism of action may be related to the inhibition of cell pyroptosis.

Tocilizumab has been reported to attenuate the "cytokine storm" in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI-7.19%-21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 (P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI-99.17% to-17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome.
Antibodies, Monoclonal, Humanized ; COVID-19/drug therapy* ; Humans ; SARS-CoV-2 ; Treatment Outcome