Objective To investigate the value of diffusion kurtosis imaging(DKI)in the differential diagnosis between benign and malignant sinonasal lesions.Methods The clinical and imaging data of 49 patients(20 benign and 29 malignant lesions)with sinonasal lesions confirmed by surgery and pathology were analyzed retrospectively.Conventional MRI and DKI were scanned for all patients.DKI quantitative parameters,including D-value and K-value,were measured by using FireVoxel software.The t-test was used to compare the differences of D-value and K-value between benign and malignant lesions.Diagnostic performances of these parameters and their combination in differentiating benign from malignant sinonasal lesions were assessed by using receiver operating characteristic(ROC)curve.Results Compared with benign group,malignant group showed significantly lower D-value(1.354±0.329 vs 1.924±0.595,P＜0.001)and higher K-value(0.856±0.190 vs 0.630±0.165,P＜0.001).ROC curve analysis showed that the area under the curve(AUC)for D-value in differentiating benign from malignant lesions was 0.820,with a cut-off value of＜1.775,sensitivity of 93.10％,and specificity of 55.00％.The AUC for K-value was 0.831,with a cut-off value of＞0.716,sensitivity of 79.31％,and specificity of 80.00％.The model combining D-value and K-value achieved an AUC of 0.859,sensitivity of 93.10％,and specificity of 70.00％.Conclusion The D-value and K-value obtained based on DKI can provide significant assistance in differentiating benign from malignant sinonasal lesions.

Objective To study influencing factors of hypoproteinemia in maintenance hemodialysis pa-tients.Methods A multicenter study was conducted.We selected 397 maintenance hemodialysis patients hos-pitalized at five hospitals of Wenzhou Kangning Hospital Group from April to June 2024 as study subjects.Pa-tients'general data and laboratory test results were collected.Logistic regression combined with the CHAID decision tree model was used to analyze indicators of hypoproteinemia in patients.Results Among 397 main-tenance hemodialysis patients,92 had hypoproteinemia(hypoproteinemia group),with a prevalence of 23.17%;others were assigned to the normal protein group.Statistically significant differences existed between groups in gender,age,occupation,education level,diabetes,vascular access type,insurance type,weight,Hb,blood calcium,blood phosphorus,blood potassium,blood glucose,parathyroid hormone,creatinine,blood urea,and cholesterol(P<0.05).Logistic regression showed occupation,insurance type,diabetes,Hb,and creatinine were independent influencing factors(P<0.05).The CHAID decision tree model identified age as the root node.Conclusion Occupation,insurance type,diabetes,Hb,age,and creatinine are important influencing fac-tors for hypoproteinemia in maintenance hemodialysis patients.Logistic regression combined with decision tree analysis can play complementary roles.

Objective To explore the time-varying characteristics and correlation degree of autonomous rehabili-tation behavior and related symptoms of middle-aged stroke patients,and to provide a basis for clinical transitional nursing and precise rehabilitation.Methods Ecological momentary assessment was used to select 57 middle-aged stroke patients who underwent rehabilitation treatment in the Rehabilitation Medicine Department of a tertiary com-prehensive hospital in Wuhan from March 15 to August 30,2024,using convenience sampling method.Their au-tonomous rehabilitation behavior and related symptoms(fatigue,pain,emotion,sensation)were continuously monitored for 2 weeks.A hierarchical linear model was used to analyze the correlation between behavior and symptoms.Results The autonomous rehabilitation behavior of middle-aged stroke patients showed a fluctuating increasing trend,and the symptom score showed a slow decreasing trend.The hierarchical linear model showed that compared with female patients,male patients have longer duration of autonomous rehabilitation behavior(P＜0.05).The number and duration of autonomous rehabilitation behaviors in patients without fatigue were higher(P＜0.05).The number of autonomous rehabilitation behaviors in patients without pain was higher than that in patients with pain(P＜0.05).The number of autonomous rehabilitation behavior items among patients who perceived more pleasure in rehabilitation was higher than that among patients with greater difficulty in rehabilitation challenges(P＜0.05).Patients with high rehabilitation confidence have higher numbers and duration of autonomous rehabilitation behaviors compared to pa-tients with low rehabilitation confidence(P＜0.05).Conclusion There are significant individual differences and dy-namic changes in the autonomous rehabilitation behavior and related symptoms of middle-aged stroke patients.Nurs-ing staff should accurately implement personalized rehabilitation services during the transition period,enhance pa-tients'autonomy and self-management ability in home-based rehabilitation,in order to improve the overall rehabilita-tion effect.

Objective To investigate the MRI manifestations of alveolar soft part sarcoma(ASPS)and to improve the diagnostic accuracy of ASPS.Methods The clinical and MRI data of 9 patients with ASPS confirmed by surgical pathology were analyzed ret-rospectively,and the MRI features were summarized and analyzed.Results Four cases were located in the thigh,three cases in the pelvis,one case in the calf,and one case under the chin.Seven cases were spindle shaped,one case was irregular,and one case was quasi-circular.All nine cases had clear boundaries.Seven cases of ASPS had lung metastases,and two of these also had brain metasta-ses.On T1WI,three cases showed isointense signals,and six cases showed slightly hyperintense signals.On T2WI,seven cases showed mixed hyperintense signals and two cases showed homogeneous hyperintense signals.On diffusion weighted imaging(DWI),six cases showed mixed hyperintense signals,one case showed homogeneous hyperintense signals,and one case showed isointense sig-nal;the average apparent diffusion coefficient(ADC)value was(1.14±0.10)×10-3 mm2/s.Six cases showed inhomogeneous obvious enhancement,and one case showed homogeneous enhancement;three cases showed relatively obvious enhancement in small strip-like fat suppression(FS)-T2WI hyperintense areas of ASPS.All nine cases of ASPS showed"flow void vessels sign",with seven cases showed"flow void vessels"both intratumor and peritumor,while the other two cases showed"flow void vessels"only peritumor.Six cases of ASPS showed cystic changes and necrosis.Three cases showed"pseudocapsule".Two cases showed T2WI hypointense septa-tion.Conclusion Hyperintense signals on T1WI,"flow void vessels sign"on T2WI,and inhomogeneous obvious enhancement in ASPS are helpful for diagnosis,with final confirmation relying on pathology.

Objective To investigate the clinical efficacy of Xiaoluo Granules combined with an-tituberculosis drugs in the treatment of patients with cervical lymph node tuberculosis.Methods A retrospective analysis was conducted on the clinical data of 118 patients with cervical lymph node tu-berculosis who were treated in our hospital from January 2021 to January 2023.The patients were di-vided into control group(57 patients receiving conventional antituberculosis drug treatment)and ob-servation group(61 patients receiving Xiaoluo Granules combined with antituberculosis drug treat-ment)based on their treatment methods.The efficacy,traditional Chinese medicine(TCM)symptom scores,peripheral blood T-cell subsets,and type 1/type 2 helper T cell(Th1/Th2)-related cytokine levels,including tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10),and interferon-γ(IFN-γ),were compared between the two groups.Results After 6 months of treat-ment,the total effective rate in the observation group was higher than that in the control group(P＜0.05).After 6 months of treatment,the scores for pain,low fever,fatigue,anorexia,and night sweats decreased in both groups,and the scores for these symptoms in the observation group were lower than those in the control group(P＜0.05).After 6 months of treatment,CD3+,CD4+,and CD4+/CD8+increased,while CD8+decreased in both groups.Additionally,CD3+,CD4+,and CD4+/CD8+were higher,while CD8+was lower in the observation group than those in the control group(P＜0.05).After 6 months of treatment,TNF-α,IL-6,and IFN-γ levels decreased,while IL-10 levels increased in both groups.Furthermore,TNF-α,IL-6,and IFN-γ levels were lower in the observa-tion group than in the control group,while IL-10 levels were higher(P＜0.05).Conclusion Xia-oluo Granules combined with antituberculosis drugs can significantly improve the efficacy in the treatment of cervical lymph node tuberculosis and enhance immune function by upregulating CD3+,CD4+,CD4+/CD8+,and IL-10 levels and downregulating CD8+,TNF-α,IL-6,and IFN-γ levels.

Objective To explore the value of integrating CT image features and quantitative dual-energy computed tomography(DECT)parameters in predicting cervical lymph nodes metastasis from laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC).Methods The clinical and imaging data of 99 patients with LHSCC confirmed by pathology were retrospectively analyzed.All patients were divided into metastatic group(41 cases)and non-metastatic group(58 cases).The CT image features,including location,size and depth,were analyzed,respectively.The quantitative DECT parameters in the arterial and venous phases including iodine concentration(IC)and normalized iodine concentration(NIC)were measured.The rank sum test or independent-samples t-test were used to compare the difference of CT image features and quantitative DECT parameters between the two groups.The multivariate logistic regression analysis was used to build the models based on CT image features(image feature model)and combination of CT image features and quantitative DECT parameters(combined model).The receiver operating characteristic(ROC)curve was performed to analyze and compare the difference of predictive efficiency between the two groups.Results There were significant differences in tumor location between the non-metastatic group and the metastatic group(χ2=21.736,P<0.001).Size(33.20 mm vs 24.95 mm,P<0.001),depth(21.10 mm vs 13.15 mm,P<0.001)and NIC in the arterial phase(0.18 vs 0.14,P<0.001)in the metastatic group were significantly higher than those in the non-metastatic group.The area under the curve(AUC),sensitivity,specificity,positive predictive value,negative predictive value,accuracy of the combined model were 0.851,75.6%,82.8%,58.5%,87.9%and 75.8%for predicting cervical lymph nodes metastasis.The AUC,sensitivity,specificity,positive predictive value,negative predictive value,accuracy of the image feature model were 0.792,95.1%,56.9%,53.7%,81.0%and 69.7%,respectively.The prediction performance of the combined model was better than that of the image feature model(Z=-2.028,P=0.043).Conclusion Integrating CT image features and quantitative DECT parameters has important value for predicting cervical lymph nodes metastasis from LHSCC.

Objective To explore the time-varying characteristics and correlation degree of autonomous rehabili-tation behavior and related symptoms of middle-aged stroke patients,and to provide a basis for clinical transitional nursing and precise rehabilitation.Methods Ecological momentary assessment was used to select 57 middle-aged stroke patients who underwent rehabilitation treatment in the Rehabilitation Medicine Department of a tertiary com-prehensive hospital in Wuhan from March 15 to August 30,2024,using convenience sampling method.Their au-tonomous rehabilitation behavior and related symptoms(fatigue,pain,emotion,sensation)were continuously monitored for 2 weeks.A hierarchical linear model was used to analyze the correlation between behavior and symptoms.Results The autonomous rehabilitation behavior of middle-aged stroke patients showed a fluctuating increasing trend,and the symptom score showed a slow decreasing trend.The hierarchical linear model showed that compared with female patients,male patients have longer duration of autonomous rehabilitation behavior(P＜0.05).The number and duration of autonomous rehabilitation behaviors in patients without fatigue were higher(P＜0.05).The number of autonomous rehabilitation behaviors in patients without pain was higher than that in patients with pain(P＜0.05).The number of autonomous rehabilitation behavior items among patients who perceived more pleasure in rehabilitation was higher than that among patients with greater difficulty in rehabilitation challenges(P＜0.05).Patients with high rehabilitation confidence have higher numbers and duration of autonomous rehabilitation behaviors compared to pa-tients with low rehabilitation confidence(P＜0.05).Conclusion There are significant individual differences and dy-namic changes in the autonomous rehabilitation behavior and related symptoms of middle-aged stroke patients.Nurs-ing staff should accurately implement personalized rehabilitation services during the transition period,enhance pa-tients'autonomy and self-management ability in home-based rehabilitation,in order to improve the overall rehabilita-tion effect.

Objective To investigate the value of diffusion kurtosis imaging(DKI)in the differential diagnosis between benign and malignant sinonasal lesions.Methods The clinical and imaging data of 49 patients(20 benign and 29 malignant lesions)with sinonasal lesions confirmed by surgery and pathology were analyzed retrospectively.Conventional MRI and DKI were scanned for all patients.DKI quantitative parameters,including D-value and K-value,were measured by using FireVoxel software.The t-test was used to compare the differences of D-value and K-value between benign and malignant lesions.Diagnostic performances of these parameters and their combination in differentiating benign from malignant sinonasal lesions were assessed by using receiver operating characteristic(ROC)curve.Results Compared with benign group,malignant group showed significantly lower D-value(1.354±0.329 vs 1.924±0.595,P＜0.001)and higher K-value(0.856±0.190 vs 0.630±0.165,P＜0.001).ROC curve analysis showed that the area under the curve(AUC)for D-value in differentiating benign from malignant lesions was 0.820,with a cut-off value of＜1.775,sensitivity of 93.10％,and specificity of 55.00％.The AUC for K-value was 0.831,with a cut-off value of＞0.716,sensitivity of 79.31％,and specificity of 80.00％.The model combining D-value and K-value achieved an AUC of 0.859,sensitivity of 93.10％,and specificity of 70.00％.Conclusion The D-value and K-value obtained based on DKI can provide significant assistance in differentiating benign from malignant sinonasal lesions.

Objective To investigate the MRI manifestations of alveolar soft part sarcoma(ASPS)and to improve the diagnostic accuracy of ASPS.Methods The clinical and MRI data of 9 patients with ASPS confirmed by surgical pathology were analyzed ret-rospectively,and the MRI features were summarized and analyzed.Results Four cases were located in the thigh,three cases in the pelvis,one case in the calf,and one case under the chin.Seven cases were spindle shaped,one case was irregular,and one case was quasi-circular.All nine cases had clear boundaries.Seven cases of ASPS had lung metastases,and two of these also had brain metasta-ses.On T1WI,three cases showed isointense signals,and six cases showed slightly hyperintense signals.On T2WI,seven cases showed mixed hyperintense signals and two cases showed homogeneous hyperintense signals.On diffusion weighted imaging(DWI),six cases showed mixed hyperintense signals,one case showed homogeneous hyperintense signals,and one case showed isointense sig-nal;the average apparent diffusion coefficient(ADC)value was(1.14±0.10)×10-3 mm2/s.Six cases showed inhomogeneous obvious enhancement,and one case showed homogeneous enhancement;three cases showed relatively obvious enhancement in small strip-like fat suppression(FS)-T2WI hyperintense areas of ASPS.All nine cases of ASPS showed"flow void vessels sign",with seven cases showed"flow void vessels"both intratumor and peritumor,while the other two cases showed"flow void vessels"only peritumor.Six cases of ASPS showed cystic changes and necrosis.Three cases showed"pseudocapsule".Two cases showed T2WI hypointense septa-tion.Conclusion Hyperintense signals on T1WI,"flow void vessels sign"on T2WI,and inhomogeneous obvious enhancement in ASPS are helpful for diagnosis,with final confirmation relying on pathology.

Objective To explore the value of integrating CT image features and quantitative dual-energy computed tomography(DECT)parameters in predicting cervical lymph nodes metastasis from laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC).Methods The clinical and imaging data of 99 patients with LHSCC confirmed by pathology were retrospectively analyzed.All patients were divided into metastatic group(41 cases)and non-metastatic group(58 cases).The CT image features,including location,size and depth,were analyzed,respectively.The quantitative DECT parameters in the arterial and venous phases including iodine concentration(IC)and normalized iodine concentration(NIC)were measured.The rank sum test or independent-samples t-test were used to compare the difference of CT image features and quantitative DECT parameters between the two groups.The multivariate logistic regression analysis was used to build the models based on CT image features(image feature model)and combination of CT image features and quantitative DECT parameters(combined model).The receiver operating characteristic(ROC)curve was performed to analyze and compare the difference of predictive efficiency between the two groups.Results There were significant differences in tumor location between the non-metastatic group and the metastatic group(χ2=21.736,P<0.001).Size(33.20 mm vs 24.95 mm,P<0.001),depth(21.10 mm vs 13.15 mm,P<0.001)and NIC in the arterial phase(0.18 vs 0.14,P<0.001)in the metastatic group were significantly higher than those in the non-metastatic group.The area under the curve(AUC),sensitivity,specificity,positive predictive value,negative predictive value,accuracy of the combined model were 0.851,75.6%,82.8%,58.5%,87.9%and 75.8%for predicting cervical lymph nodes metastasis.The AUC,sensitivity,specificity,positive predictive value,negative predictive value,accuracy of the image feature model were 0.792,95.1%,56.9%,53.7%,81.0%and 69.7%,respectively.The prediction performance of the combined model was better than that of the image feature model(Z=-2.028,P=0.043).Conclusion Integrating CT image features and quantitative DECT parameters has important value for predicting cervical lymph nodes metastasis from LHSCC.