Objective:To evaluate the clinical value of peripheral blood monocyte subset analysis in the diagnosis and treatment of chronic myelomonocytic leukemia (CMML) .Method:We retrospectively enrolled 51 patients newly diagnosed with CMML at Guangdong Provincial People's Hospital between June 1, 2020, and December 31, 2024, according to the WHO 2022 diagnostic criteria. Twenty-three patients with other myeloid neoplasms (excluding CMML) and peripheral monocytosis (absolute count ≥0.5×10 9/L and percentage ≥10%) were included as the control group. All patients underwent bone marrow aspiration for examinations including bone marrow smears, biopsies, cytogenetics, and gene mutation analysis to establish a definitive diagnosis. Concurrently, flow cytometry was used to determine the proportions of peripheral blood monocyte subsets: classical (MO1, CD14 +CD16 -) , intermediate (MO2, CD14 +CD16 +) , and non-classical (MO3, CD14 lowCD16 +) . Differences between the groups were compared, and diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves. Result:Among the 51 CMML patients, the proportion of the peripheral blood MO1 subset was significantly higher than that in patients with other myeloid neoplasms ( P=0.027) , whereas there were no significant differences in the MO2 and MO3 subsets (all P>0.05) . Further analysis revealed that 43 (84.31%) of the CMML patients met the WHO diagnostic threshold for the MO1 subset (≥94%) , while the remaining 8 patients did not; 46 patients (90.20%) had MO3 subset proportions below the threshold proposed by Hudson (≤1.13%) , while the remaining 5 patients were above this threshold. In-depth analysis showed that among the 8 patients who did not meet the WHO criteria, 7 were experiencing inflammation. Similarly, all 5 patients who did not meet the Hudson criteria were in an inflammatory state. Subsequent ROC curve analysis of this cohort identified a cut-off value for the MO1 subset of 97.55% [Area Under the Curve (AUC) =0.661, P=0.027], which aligns with the WHO criteria. Conclusion:Peripheral blood monocyte subset analysis, particularly MO1 subset analysis, can effectively assist in CMML diagnosis, but exclusion of inflammatory conditions is required.

Objective:To evaluate the clinical value of peripheral blood monocyte subset analysis in the diagnosis and treatment of chronic myelomonocytic leukemia (CMML) .Method:We retrospectively enrolled 51 patients newly diagnosed with CMML at Guangdong Provincial People's Hospital between June 1, 2020, and December 31, 2024, according to the WHO 2022 diagnostic criteria. Twenty-three patients with other myeloid neoplasms (excluding CMML) and peripheral monocytosis (absolute count ≥0.5×10 9/L and percentage ≥10%) were included as the control group. All patients underwent bone marrow aspiration for examinations including bone marrow smears, biopsies, cytogenetics, and gene mutation analysis to establish a definitive diagnosis. Concurrently, flow cytometry was used to determine the proportions of peripheral blood monocyte subsets: classical (MO1, CD14 +CD16 -) , intermediate (MO2, CD14 +CD16 +) , and non-classical (MO3, CD14 lowCD16 +) . Differences between the groups were compared, and diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves. Result:Among the 51 CMML patients, the proportion of the peripheral blood MO1 subset was significantly higher than that in patients with other myeloid neoplasms ( P=0.027) , whereas there were no significant differences in the MO2 and MO3 subsets (all P>0.05) . Further analysis revealed that 43 (84.31%) of the CMML patients met the WHO diagnostic threshold for the MO1 subset (≥94%) , while the remaining 8 patients did not; 46 patients (90.20%) had MO3 subset proportions below the threshold proposed by Hudson (≤1.13%) , while the remaining 5 patients were above this threshold. In-depth analysis showed that among the 8 patients who did not meet the WHO criteria, 7 were experiencing inflammation. Similarly, all 5 patients who did not meet the Hudson criteria were in an inflammatory state. Subsequent ROC curve analysis of this cohort identified a cut-off value for the MO1 subset of 97.55% [Area Under the Curve (AUC) =0.661, P=0.027], which aligns with the WHO criteria. Conclusion:Peripheral blood monocyte subset analysis, particularly MO1 subset analysis, can effectively assist in CMML diagnosis, but exclusion of inflammatory conditions is required.

Objective:To establish reference ranges of central nervous system-related fetal intracranial markers during the first trimester in a local population of Suzhou.Methods:Ultrasound images of fetuses with normal birth outcomes in singleton pregnancies who underwent nuchal translucency(NT) screening during the first trimester (11-13 + 6 gestational weeks) from January 2021 to July 2022 at the Affiliated Suzhou Hospital of Nanjing Medical University were retrospectively selected. The images including 3 planes: the midsagittal plane of the fetal head, also known as the plane for NT measurement, the trans-ventricular plane of the fetal head, and the axial plane of the fetal head at the posterior fossa level. The brainstem (BS) thickness, brainstem to occipital bone distance (BSOB), the ratio of BS to BSOB (BS/BSOB), intracranial translucency (IT) thickness, cisterna magna (CM) width, and the midbrain (MB) to falx (F) ratio MB/F were measured in the mid-sagittal plane of the fetal head. Choroid plexus length (CPL) to occipital frontal diameter (OFD) ratio CPL/OFD, and choroid plexus area (CPA) to head area (HA) ratio CPA/HA were measured in the trans-ventricular plane of the fetal head. Anteroposterior diameter of the fourth ventricle (4V) and CM were measured in the axial plane of the fetal head at the posterior fossa level.Statistical analysis was performed to obtain the corresponding normal reference range.Intra-class correlation coefficient (ICC) was used to analyze intra-observer and inter-observer consistency. Pearson correlation analysis and linear correlation analysis were used to study the correlations between crown-lump length (CRL) and intracranial markers, and the regression equation was derived. Results:A total of 2 331 fetuses were enrolled, providing 1 023 images of the midsagittal plane, 817 images of the trans-ventricular plane, and 567 images of the axial plane of the fetal head at the posterior fossa level. The intra-observer and inter-observer ICCs of intracranial markers BS, BSOB, BS/BSOB, IT thickness, CM width, MB/F in the mid-sagittal plane, the intracranial markers CPL/OFD, CPA/HA on the trans-ventricular plane, and the intracranial markers 4V and CM width in the axial plane at the posterior fossa level were all >0.75. Fetal intracranial markers were linearly correlated with CRL. The midsagittal plane: BS, BSOB, BS/BSOB, IT thickness, CM width, MB/F were linearly correlated with CRL ( r=0.508, 0.626, -0.234, 0.105, 0.508, -0.493; all P<0.05); the trans-ventricular plane: CPL/OFD, CPA/HA were linearly correlated with CRL( r=-0.324, -0.268; all P<0.001); the axial plane of the fetal head at the posterior fossa level: 4V, CM width were linearly correlated with CRL ( r=0.246, 0.467; all P<0.001). Conclusions:Quantitative analysis of fetal intracranial markers in the first trimester is feasible. This study constructed a normal reference range of multiple intracranial markers related to central nervous system in the first trimester with a local population of Suzhou. And the construction of this normal range can provide an objective basis for the detection of fetal central nervous system malformations in the first trimester.

Objective:To investigate alterations in the glymphatic system of spinocerebellar ataxia type 3 (SCA3) patients based on quantitative MRI, and its association with genetic information and motor dysfunction.Methods:The study was a cross-sectional study. This prospective study recruited 39 confirmed SCA3 patients (SCA3 group) and 40 matched healthy controls (HC group) who were seen at the Southwest Hospital of Army Medical University from May 2017 to June 2023. All subjects underwent cranial MRI scanning. Clinical assessments were conducted on all participants using the scale for the assessment and rating of ataxia (SARA) and the international cooperative ataxia rating scale (ICARS). The automatic segmentation and volume measurement of the choroid plexus based on Freesurfer 6.0; the perivascular interstitial space (PVS) was automatically segmented based on the deep-learning model VB-Net, and the volume of the PVS in each brain region was quantified after manual correction. Independent samples t-test and Mann-Whitney U-test were used to analyze the changes in the class lymphatic system in the SCA3 group and the HC group. Pearson partial correlation analysis was used to explore the relationship between CAG repeats, the glymphatic system, and motor dysfunction. Results:The standardized choroid plexus volume in the SCA3 group was (1.24±0.36)×10 3 mm 3, and that in the HC group was (0.96±0.34)×10 3 mm 3, with a statistically significant difference ( t=4.01, P<0.001). PVS volumes in the frontal lobe, temporal lobe, parietal lobe, basal ganglia, cerebellum, thalamus, and brainstem regions in the SCA3 group were significantly higher than those of HC group ( P<0.05). Partial correlation analysis revealed that CAG repeats in SCA3 group were positively correlated with SARA, ICARS, and basal ganglia PVS volumes ( r=0.65, 0.58, 0.29; P=0.001, 0.001, 0.042). Cerebellar and temporal lobe PVS volumes were positively correlated with SARA ( r=0.59, 0.47; P=0.001, 0.003), and positively correlated with ICARS scores ( r=0.61, 0.40; P=0.001, 0.011). Choroid plexus volume was positively correlated with cerebellar and basal ganglia PVS volumes ( r=0.41, 0.31; P=0.009, 0.043). Conclusions:The glymphatic system of SCA3 patients have significant alteration and have association with CAG repeats and motor dysfunction.

Objective:To investigate the association between nonalcoholic fatty liver disease(NAFLD)and mild cognitive impairment(MCI)in the elderly.Methods:Three hundred ninety-two study subjects aged 60 years and above visiting the geriatric department of Peking University People's Hospital for chronic disease management between July 2016 and January 2018 were enrolled, and population-based clinical data of the study subjects were collected.Participants' cognitive function was assessed, and the correlation between NAFLD and MCI was analyzed.Results:The detection rate of MCI in the NAFLD group(n=191)was significantly higher than that in the non-NAFLD group(n=201)[38(19.9%) vs.21(10.4%) χ2=6.837, P=0.009]. Multivariate analysis revealed that NAFLD was closely correlated with and was an independent risk factor for MCI( OR=2.625, 95% CI: 1.250-5.512, P=0.011)after adjusting confounding variables such as age, sex, education level, components of metabolic syndrome, medication, and conditions affecting biochemical and metabolic processes.In addition, the female sex( OR=2.775, 95% CI: 1.363-5.651, P=0.005), unstable carotid plaques( OR=2.736, 95% CI: 1.131-6.620, P=0.026), serum albumin( OR=0.908, 95% CI: 0.840-0.982, P=0.015), fasting serum glucose( OR=1.268, 95% CI: 1.076-1.493, P=0.004), and the serum AST/ALT ratio( OR=2.984, 95% CI: 1.370-6.500, P=0.006)were also independently associated with MCI, of which, the female sex, unstable carotid plaques, increased levels of fasting serum glucose and the AST/ALT ratio were independent risk factors for MCI. Conclusions:NAFLD is associated with and is an independent risk factor for MCI in the elderly.Assessment of cognitive function in elderly patients with NAFLD should be emphasized.

ABSTRACT: Meningiomas are the most common primary intracranial neoplasm with diverse pathological types and complicated clinical manifestations. The fifth edition of the WHO Classification of Tumors of the Central Nervous System (WHO CNS5), published in 2021, introduces major changes that advance the role of molecular diagnostics in meningiomas. To follow the revision of WHO CNS5, this expert consensus statement was formed jointly by the Group of Neuro-Oncology, Society of Neurosurgery, Chinese Medical Association together with neuropathologists and evidence-based experts. The consensus provides reference points to integrate key biomarkers into stratification and clinical decision making for meningioma patients. REGISTRATION Practice guideline REgistration for transPAREncy (PREPARE), IPGRP-2022CN234.
Humans ; Meningioma/pathology* ; Consensus ; Neurosurgical Procedures ; Meningeal Neoplasms/pathology*

Objective? To construct the "Internet +" based health management model for physical examination population. Methods? From September 2016 to September 2017, we constructed the primary"Internet +" health management model by literature review. Two rounds of consultation with 25 experts were carried out with the Delphi method to construct the "Internet +" health management model for physical examination population. Results? Among two rounds of consultation, the recovery rate of questionnaire was all 100%. The expert authority coefficient (Cr) was 0.87. The final "Internet +" health management model included 3 first-level indicators, 7 second-level indicators and 26 third-level indicators. Conclusions? The "Internet +"based health management model is reliable which can be intervention for health management model of physical examination population.

Objective To investigate the risk factors for NAFLD patients with mild cognitive impairment ( MCI) in elderly through comparing the clinical features among elderly NAFLD patients with MCI. Methods A total of one hundred and sixteen elderly patients with NAFLD were enrolled in this study and were divided into MCI group (37 cases) and non-MCI group (79 cases). The clinical data including medical history of myocardial infarction,diabetes mellitus,hypertension,medications,blood pressure,BMI,liver function, kidney parameters,glucose metabolism, serum lipid profile, vitamin D, NAFLD fibrosis score, HOMA-IR and carotid plaques were analyzed and compared. Results Compared with non-MCI group,the age,AST/ALT ratio, serum creatinine,NAFLD fibrosis score,serum uric acid of MCI group were significantly higher ((80. 5±7. 4) years vs.(72.5±8.0)years,t＝5.87,P＜0.001; (1.33±0.51) vs. (1.09±0.30),t＝2.599, P＝0.012;(100.86±78.02) μmol/L vs. (78.12±22.12) μmol/L,t＝2.402, P＝0.018; (0.73±1.01) vs. (0.03 ±1. 17),t＝3. 132,P＝0. 002; (382. 95±79. 61) μmol/L vs (349. 99±79. 18) μmol/L,t＝2. 086,P＝0. 039), while serum γ-glutamyl transpeptidase (γ-GT),diastolic blood pressure (DBP),estimated glomerular filtration rate (eGFR) of MCI group were significantly lower than those in the non-MCI group (22. 00(17. 00,26. 00) U/L vs. 28. 00(19. 00,39. 50) U/L,Z＝－3. 038,P＝0. 002;(69. 30±6. 78) mmHg vs. (74. 30±9. 45)mmHg,t＝－3.252, P＝0.002; (62.60±17.78)(ml/min×1.73 m2) vs. (79.41±16.95)(ml/min×1.73 m2),t＝－4. 900,P＜0. 001). Detection rates of carotid unstable plaques and high BMI in MCI group were higher than those in the non-MCI group (83. 78%(31/37) vs. 64. 56%(51/79),χ2＝4. 496, P＝0. 034)(83. 78%(31/37) vs. 60. 76%(48/79),χ2＝6. 149, P＝0. 013) . There were no significantly differences between the two groups in history of myocardial infarction,diabetes mellitus,hypertension,usage rates of antiplatelet drugs and statins. Logistic regression showed that age (regression coefficient＝0. 166,OR＝1. 181,95%CI 1. 078－1. 293,P＜0. 001), high BMI (regression coefficient＝1. 942,OR＝6. 974,95%CI 1. 466－33. 176,P＝0. 015),diastolic blood pressure ( regression coefficient＝ －0. 099, OR＝ 0. 905, 95%CI 0. 828－0. 990, P＝ 0. 029 ), γ-GT (regression coefficient＝－0. 094,OR＝0. 910,95%CI 0. 852－0. 972,P＝0. 005), serum uric acid (regression coefficient＝－0. 009,OR＝1. 009,95%CI 1. 000－1. 017,P＝0. 039) and low density lipoprotein cholesterol ( LDL-C) (regression coefficient＝0. 898,OR＝2. 454,95%CI 1. 029－5. 854,P＝0. 043) were related to elderly NAFLD patients with MCI. Conclusion The high BMI,diastolic blood pressure,serum uric acid,low density lipoprotein are related to MCI in elderly patients with NAFLD. For elderly patients with NAFLD,these indicators may be used to assess the risk of MCI and to locate high-risk groups at an early stage.

Objective To explore the feasibility of one-stop examination with Revolution CT for axial perfusion of normal pancreas.Methods Thirteen patients who received axial perfusion scan by one-stop examination with Revolution CT were analyzed as perfusion group.Two radiologists measured pancreatic CT perfusion (CTP) parameters independently and selected optimal phase for CTA and three phases of enhanced images.The effect dose (ED) was calculated.Eighteen patients who underwent abdominal enhanced CT and CTA with spiral scan were included as control group.Patients in both groups had no pancreatic disorders.The interobserver variation of CTP parameters was estimated.Two independent radiologists separated the superior pancreaticoduodenal artery (SPDA) image into 5 points according to image quality,and the consistency was assessed.The subjective points of SPDA image quality of two groups was compared.CT value,images noise,CNR and SNR of SPDA on CTA images and those of pancreas on three phases enhanced scan images between two groups were compared.Results ICC values of all CTP parameters were higher than 0.75.The ED of perfusion protocol was (24.52±-0.01)mSv.The subjective image scores of SPDA on CTA images in both groups were both 5,the consistency was good (Kappa=0.629,0.769).The CT value,CNR,and SNR of SPDA on CTA images of CTP group were higher than those of control group (all P＜0.05).The CT value,CNR,and SNR of pancreas of CTP group were higher than those of control group in venous phase and balanced phase (all P＜0.05).Conclusion The pancreatic CT one-stop examination can be performed by Revolution CT scanner with maximum detector width with acceptable radiation dose,from which pancreatic CT perfusion data,enhanced images with high quality and better CTA images can be extracted.

Objective To measure the lethal dosage values ( LD50 ) of i.v.asarone injection for mice and to establish a standard for abnormal toxicity test of asarone injection to potentially reduce the occurrence of adverse drug reaction.Methods To obtain the LD50 value, a weighted linear probit regression method ( Bliss method) is employed. The limit of abnormal toxicity test is determined according to Appendix XI C in its 2010 edition of the Chinese pharmacopoeia.Results It is found that the LD50 of intravenously asarone injection in mice ranges from 51.9 to 153.1 mg/kg.The abnormal toxicity test should be added as an additional item in the standard.Conclusions Based on analyses in this study, an appropriate limit of abnormal toxicity test is 15 mg/kg, which is also in line with current medical standard in China.