OBJECTIVE: To investigate the relationship between peripheral blood circular RNA Bardet-Biedl syndrome 9 (circBBS9) and circRNA catenin beta 1 (circCTNNB1) and weaning failure of mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: A prospective, observational cohort study was conducted. The patients with AECOPD who received invasive mechanical ventilation and passed the spontaneous breathing test (SBT) admitted to the First Affiliated Hospital of Hebei North University from January 2022 to February 2024 were selected as the study subjects. According to the outcome of weaning, the patients were divided into failed weaning group and successful weaning group. At admission and before SBT, the expression levels of circBBS9 and circCTNNB1 in peripheral blood were detected by fluorescence quantitative polymerase chain reaction (PCR). General information, acute physiology and chronic health evaluation II (APACHEII) score within 24 hours of admission, vital signs before SBT and the most recent laboratory indicators before SBT of the patients were collected. The differences in circBBS9 and circCTNNB1 expression levels and clinical data between the two groups were compared. Multivariate Logistic regression was used to analyze the influencing factors of the weaning failure. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of each index on weaning failure. RESULTS: Ultimately, 132 patients with AECOPD who underwent invasive mechanical ventilation and passed the SBT were enrolled in the study. Among them, 82 patients were successfully weaned from mechanical ventilation, while 50 patients failed to be weaned, resulting in a weaning failure rate of 37.88%. There was no statistically significant difference in the expression levels of circBBS9 and circCTNNB1 in the peripheral blood at admission of patients between the two groups. The expression level of circBBS9 in the peripheral blood before SBT of patients in the failed weaning group was significantly higher than that in the successful weaning group (2^-ΔΔCt: 131.64±30.24 vs. 100.00±21.32), and the expression level of circCTNNB1 was significantly lower than that in the successful weaning group (2^-ΔΔCt: 79.90±16.82 vs. 100.00±26.43), and the differences were statistically significant (both P < 0.05). The APACHEII score within 24 hours of admission and the levels of RSBI, SCr, and PCT before SBT in the failed weaning group were significantly higher than those in the successful weaning group [APACHEII score: 22.54±4.62 vs. 16.56±4.58, RSBI: 81.90±16.56 vs. 63.25±17.00, SCr (μmol/L): 100.20±17.27 vs. 89.93±26.29, PCT (μg/L): 1.08±0.18 vs. 0.87±0.22], and the Alb level before SBT was significantly lower than that in the successful weaning group (g/L: 29.71±2.73 vs. 33.93±2.89), and the differences were statistically significant (all P < 0.05). There was no statistically significant difference in other clinical data between the two groups. Multivariate Logistic regression analysis showed that circBBS9 [odds ratio (OR) = 1.291, 95% confidence interval (95%CI) was 1.049-1.588] and APACHEII score (OR = 2.897, 95%CI was 1.004-8.353), RSBI (OR = 1.413, 95%CI was 1.057-1.890) were independent risk factors for weaning failure (all P < 0.05), and circCTNNB1 (OR = 0.812, 95%CI was 0.688-0.959) and Alb (OR = 0.149, 95%CI was 0.036-0.614) were protective factors (both P < 0.05). ROC curve analysis showed that circBBS9, circCTNNB1, APACHEII score, RSBI, and Alb all had certain value for predicting weaning failure. The area under the ROC curve (AUC) and 95%CI were 0.820 (0.750-0.890), 0.755 (0.674-0.835), 0.827 (0.757-0.897), 0.795 (0.715-0.876), and 0.854 (0.791-0.919), respectively. Using the multivariate Logistic regression equation as the combined indicator, the AUC for predicting weaning failure reached 0.997 (95%CI was 0.993-1.000), which was significantly higher than that of the single indicators including circBBS9, circCTNNB1, APACHEII score, RSBI, and Alb (the Z value was 5.582, 6.093, 5.771, 5.932, and 5.182, respectively, all P < 0.05). CONCLUSIONS High expression of circBBS9 and low expression of circCTNNB1 in the peripheral blood of AECOPD patients receiving invasive mechanical ventilation before SBT are associated with weaning failure. circBBS9, circCTNNB1 combined with APACHEII score, RSBI and Alb are helpful for predicting the failure of weaning in these patients.
Humans ; Pulmonary Disease, Chronic Obstructive/blood* ; Prospective Studies ; Ventilator Weaning ; RNA, Circular/blood* ; Respiration, Artificial ; Male ; Female ; Aged

Objective To evaluate the diagnostic value of dual-layer spectral CT(DLCT)virtual non-contrast(VNC)imaging combined with iodine maps in differentiating early post-endovascular therapy(EVT)intracranial hemorrhage from contrast extravasation.Methods Retrospective analysis of 97 patients who underwent DLCT immediately after EVT was conducted.Taking 24-hour follow-up CT/MRI as the gold standard,patients were divided into hemorrhage and non-hemorrhage groups,and their clinical data were compared.VNC CT values and iodine concentration(IC)were measured.Spearman's rank correlation was used to analyze the relationship between VNC CT and IC values,and ROC curve analysis using R software to evaluate the diagnostic performance of VNC,iodine maps,and their combination.Results Among 97 patients,51(52.6%)showed no intracranial hyperdense lesions,while 46(47.4%)with abnormal densities were analyzed.Using 24-hour postoperative CT/MRI as reference stan-dard,among the 46 patients ultimately included in the analysis,38 cases(82.6%)were non-hemorrhagic and 8 cases(17.4%)hemorrhagic.No significant differences existed in age,sex,or treatment methods(all P>0.05).VNC CT values and IC showed significantly negative correlation(r=-0.537,P<0.01).ROC analysis revealed AUCs of 0.917(95%CI:0.786～0.999)for VNC,0.878(95%CI:0.719～0.999)for IC,and 0.919(95%CI:0.812～0.999)for the combination of the two(P<0.05 for combined vs.individual methods).Optimal thresholds were 53.6 HU for VNC and 0.605 mg/ml for IC.Based on the final analysis of 46 enrolled patients,the sensitivity of VNC,iodine map,and their combination in differentiating early cerebral hemorrhage from contrast extravasation was 88.9%,94.3%,and 91.4%,respectively;the specificity 94.3%,77.8%,and 88.9%,respectively;and the accuracy 90.9%,90.9%,and 93.2%,respectively.Conclusion The DLCT VNC-iodine map combination significantly im-proves differentiation between post-EVT hemorrhage and contrast extravasation,and it is recommended for routine clinical application.

To summarize the perioperative nursing of a patient with type A aortic dissection in late pregnancy.Key points of nursing include:①timely activation of the aortic dissection emergency plan based on the intelligent platform to improve the efficiency of surgical preparation;forming an aortic coarctation team and rationalising surgical scheduling;②targeted blood pressure management to avoid the rupture of dissecting aneurysm;rapid establishment of extracorporeal circulation to improve the quality of surgical coordination;target temperature management throughout the whole process;close monitoring of the patient's condition to prevent amniotic fluid embolism;real-time haemorrhage monitoring and enhanced blood product management;③adoption of the traffic light rehabilitation automatic assessment and decision-making system for early rehabilitation training after surgery;multidisciplinary joint health education to enhance self-efficacy.Through multidisciplinary integration and precise nursing care,the patient's surgery was successfully completed and discharged 18 days later.With monthly outpatient review,the patient recovered well.

Objective To evaluate the diagnostic value of dual-layer spectral CT(DLCT)virtual non-contrast(VNC)imaging combined with iodine maps in differentiating early post-endovascular therapy(EVT)intracranial hemorrhage from contrast extravasation.Methods Retrospective analysis of 97 patients who underwent DLCT immediately after EVT was conducted.Taking 24-hour follow-up CT/MRI as the gold standard,patients were divided into hemorrhage and non-hemorrhage groups,and their clinical data were compared.VNC CT values and iodine concentration(IC)were measured.Spearman's rank correlation was used to analyze the relationship between VNC CT and IC values,and ROC curve analysis using R software to evaluate the diagnostic performance of VNC,iodine maps,and their combination.Results Among 97 patients,51(52.6%)showed no intracranial hyperdense lesions,while 46(47.4%)with abnormal densities were analyzed.Using 24-hour postoperative CT/MRI as reference stan-dard,among the 46 patients ultimately included in the analysis,38 cases(82.6%)were non-hemorrhagic and 8 cases(17.4%)hemorrhagic.No significant differences existed in age,sex,or treatment methods(all P>0.05).VNC CT values and IC showed significantly negative correlation(r=-0.537,P<0.01).ROC analysis revealed AUCs of 0.917(95%CI:0.786～0.999)for VNC,0.878(95%CI:0.719～0.999)for IC,and 0.919(95%CI:0.812～0.999)for the combination of the two(P<0.05 for combined vs.individual methods).Optimal thresholds were 53.6 HU for VNC and 0.605 mg/ml for IC.Based on the final analysis of 46 enrolled patients,the sensitivity of VNC,iodine map,and their combination in differentiating early cerebral hemorrhage from contrast extravasation was 88.9%,94.3%,and 91.4%,respectively;the specificity 94.3%,77.8%,and 88.9%,respectively;and the accuracy 90.9%,90.9%,and 93.2%,respectively.Conclusion The DLCT VNC-iodine map combination significantly im-proves differentiation between post-EVT hemorrhage and contrast extravasation,and it is recommended for routine clinical application.

To summarize the perioperative nursing of a patient with type A aortic dissection in late pregnancy.Key points of nursing include:①timely activation of the aortic dissection emergency plan based on the intelligent platform to improve the efficiency of surgical preparation;forming an aortic coarctation team and rationalising surgical scheduling;②targeted blood pressure management to avoid the rupture of dissecting aneurysm;rapid establishment of extracorporeal circulation to improve the quality of surgical coordination;target temperature management throughout the whole process;close monitoring of the patient's condition to prevent amniotic fluid embolism;real-time haemorrhage monitoring and enhanced blood product management;③adoption of the traffic light rehabilitation automatic assessment and decision-making system for early rehabilitation training after surgery;multidisciplinary joint health education to enhance self-efficacy.Through multidisciplinary integration and precise nursing care,the patient's surgery was successfully completed and discharged 18 days later.With monthly outpatient review,the patient recovered well.

Objective To study the differences and the features of thinking styles among undergrad-uates in Beijing University of Chinese Medicine. Methods The thinking styles of a total of 120 under-graduates of grade 3 and 4 were investigated with Sternberg Thinking Style Scale (Chinese version) by ran-dom cluster sampling. All statistical analyses were performed with SPSS software (version 20.0) by means of t-test, analysis of variance and rank sum test. Results The score of oligarchic style in traditional Chinese medicine, traditional Chinese medicine and management students was (4.09±0.67), (3.64±0.50) and (3.72± 0.56) respectively, and the difference was statistically significant (P<0.01). The score of legislative style was (5.14±0.63) in boys and (4.90±0.62) in girls, and the difference was statistically significant (P<0.05). The score of judicial style was (4.46 ±0.56) and (4.23 ±0.62) respectively, and the difference was statistically significant (P<0.05). The score of monarchic style was (4.22±0.52) and (3.79±0.57) respectively, and the difference was statistically significant (P<0.001). The score of global style was (4.36 ±0.48) and (4.00 ± 0.63) respectively, and the difference was statistically significant (P<0.01). The score of internal style was (4.48 ±0.74) and (4.18 ±0.76) respectively, and the difference was statistically significant (P<0.05). The score of liberal style was (4.79 ±0.71) and (4.49 ±0.68) respectively, and the difference was statistically significant (P<0.05). The score of judicial style in undergraduates with and without parents engaged in health industry was (3.97±0.64) and (4.35±0.59) respectively, and the difference was statistically significant (P<0.05). The score of anarchic style was (4.39 ±0.32) and (4.06 ±0.50) respectively, and the difference was statistically significant (P<0.05). Conclusion Correlated with undergraduate majors, gender and parents' background, Medical students differ in legislative style, judicial style, monarchic style, oligarchic style, anarchic style, global style, internal style and liberal style, which correlates with gender, major and parents' background.

Objective To evaluate the effect of intravenous Gd-DTPA on 3.0T proton MR spectroscopy (MRS) water suppression and shimming. Methods Prospective study of proton MRS was performed with GE Signa Excite HD 3.0T system and eight-channel phased-array coils with PRESS sequence (head, liver and kidney, respectively). Routine auto prescan program was operated to record full width half maximum (FWHM) and water suppression (WS%). Routine scan was performed after injection of Gd-DTPA, then prescan program was reoperated to record FWHM and WS%. The data of FWHM and WS% in head, liver and kidney were compared between before and after injection of Gd-DTPA with the Wilcoxon matched pairs signed test. Results WS% of spectroscopy of head and liver after administration of Gd-DTPA decreased significantly (T_+=12, T_-=66, P=0.02; T_+=0, T_-=45, P=0.007). The effect of shimming of kidney after administration of Gd-DTPA was poor (T_+=0, T_-=435, P<0.001) and WS% of spectroscopy of kidney after administration of Gd-DTPA decreased significantly (T_+=0, T_-=435, P<0.001). Conclusion WS% of spectroscopy in head, liver and kidney can be impacted negatively by Gd-DTPA. Gd-DTPA has great influence on shimming of spectroscopy of kidney, but has little influence on shimming of spectroscopy of head and liver. It is better to acquire MRS data before administration of contrast medium in kidney.

Objective To observe the effect of full width half max (FWHM) on spectra signal-to-noise ratio (SNR), NAA/Cr, Cho/Cr and water suppression at 3.0T MR. Methods GE Signa Excite HD 3.0T MR scanner with 8 channel phrased-array head and neck coil was used. The respective study of liver 1H-MRS was performed using PRESS sequence. A total of 49 spectrums were obtained with parameters of TR 1500 ms, TE 30 ms, NSA 128. FWHM and water suppression were recorded automatically and the subjects were divided into better shimming group (FWHM<10 Hz) and worse shimming group (FWHM≥10 Hz). Independent t test was used to analyze the Cr_SNR, NAA/Cr, Cho/Cr, water suppression and volume of interest (VOI). Results Compared with worse shimming group, better shimming group could provide better Cr_SNR (t=5.976, P<0.001), higher NAA/Cr (t=2.469, P=0.017), lower Cho/Cr (t=-4.460, P<0.001) and smaller VOI (t=3.862, P<0.001). Conclusion When single voxel proton spectroscopy of head is adopted with 3.0T MR, small VOI is easy to achieve effective shimming, and better shimming is helpful to improve SNR, the ratio of main metabolites as well as water suppression.

Objective To evaluate the advantages of MR LAVA multi-phase dynamic contrast enhancement in abdominal MRI.Methods 42 cases which clinically suspected liver lesions and 15 normal volunteers underwent MRI examination,including routine T_1WI and T_2WI scan,T_1W 2D and 3D FSPGR,LAV A multi-phase contrast enhancement.The detecting rates of 2D,3D and LAVA images were analysed and the signal noise ratio(SNR)of the liver and spleen was observed.Results 68 lesions were detected by LAVA sequence,the detecting rate was 100%,the accurate rate of diagnosis was 95.6%(65/68),while the detecting rates of the lesions were 91.2%(62/68)and 89.7%(61/68)with 3D T1W FSPGR and 2D T1W FSPGR,respectively,the accurate rates in diagnosing the lesions were 76.5%(52/68)and 70.6%(48/68)with 3D and 2D sequences,respectively.The SNR of liver,spleen of 15 normal volunteers were:29.68±2.31 in liver,36.21 ±3.67 in spleen at LAVA plain scan,46.21 ±5.32 in liver,58.75±4.68 in spleen at 2D T_1W FSPGR,19.79±2.23 in liver,23.63±2.14 in spleen at 3D T_1W FSPGR,41.75±5.13 in liver,57.96±6.13 in spleen at LAVA contrast enhancement,56.33±5.63 in liver,63.21±5.32 in spleen at 2D contrast enhancement,29.05±4.68 in liver,46.37±5.17 in spleen at 3D contrast enhancement sequence.Conclusion LAVA multi-phase dynamic contrast enhancement is more predominant than T1W 2D and 3D and 3D FSPGR in displaying the lesions and blood vessels of liver.

Objective To characterize the effect of the ~1H-MRS scan parametem, including the type of coil, TE,NSA and VOI, on shimming, water suppression, spectral signal to noise ratio(SNR)and the stability of the baseline of liver in vivo. Methods ~1H-MRS of liver in vivo was performed prospectively on GE Signa Excite HD 3.0 T system in 46 volunteers. Point-resolred spectroscopy(PRESS)sequence with built-in body coil and eight-channel torso phased-array coils was applied. After the localized scan,the first PRESS sequence with a TR of 1500 ms,TE of 30 ms. VOI of 2 cm×2 cm×2 cm and NSA of 64 times was acquired using eight-channel torso phased-array coils.(The first PRESS sequence parametem was deemed as A).Then,the sequence was repeated with alteration of the three parameters including the type of coil,TE and size of VOI.(Changed parameters deem as B).The data were analyzed with the Wilcoxon matched pairs signed test.0 mark:A is similar to B,1 mark:A better than B,-1 mark:A worse than B.Results SNR(-1 mark 0 pair,0 mark 1 pair,1 mark 10 pair,Z=-3.162,P=0.002)was better in data(n=11)with eight-channel torso phased-array coils(A)than that with the built-in body coil(B),but the autoshimming line width with eight-channel torso phased-array coils were inferior to those with built-in body coil (-1 mark 8 pair,0 mark 2 pair,1 mark 1 pair,Z=-2.511,P=0.012).SNR was better in data(n=13)with TE of 30 ms(A)than that at the sequence with TE of 90 ms(B)(-1 mark 2 pair,0 mark 0 pair,1 mark 11 pair,Z=-2.496,P=0.013).whereas baseline stability was,poorer in the former(-1 mark 10 pair,0 mark 2 pair,1 mark 1 pair,Z=-2.333,P=0.020).SNR at the sequence(n=10)with VOI of 2 cm×2 cm×3 cm(B)was better(-1 mark 6 pair,0 mark 4 pair,1 mark 0 pair,Z=-2.449,P=0.014)than that at the sequence(n=29)with VOI of 2 cm ×2 cm × 2 cm(A),but poorer(-1 mark 0 pair,0 mark 5 pair,1 mark 5 pair,Z=-2.041,P=0.041)auto-shimming line width was shown. By comparison the sequences with NSA of 128 times(B)and NSA of 64 times(A),the former could provide better spectrum SNR(-1 mark 21 pair,0 mark 7 pair,1 mark 1 pair,Z=-4.264,P=0.000).Conclusion It is more easy to achieve a homogeneous bo magnetic field using a small size of VOI and builtin body coli.The sequence with VOI of 2 cm ×2 cm ×3 cm.NSA of 128 times is recommended for clinical use. Increase VOI and NSA are helpful to improve SNR. Longer TE is helpful to improve baseline stability.