Objective To investigate the value of non-contrast CT(NCCT)-based radiomics for identifying acute unilateral middle cerebral artery occlusion(MCAO)with negative hyperdense artery sign(HAS).Methods All 80 patients with acute unilateral MCAO confirmed by angiography(MR angiography[MRA]or CT angiography[CTA]or DSA)and presenting with negative NCCT presentation for HAS were enrolled from January 2015 to June 2023 in the Emergency Department of Stroke Center of Affiliated Hospital of Yangzhou university.On the NCCT images,the occluded segment of the middle cerebral artery on the affected side of each case and the corresponding segment of the vessel on the normal side were used as the regions of interest,and a total of 108 radiomic features were extracted.The least absolute shrinkage and selection operator(LASSO)was used to screen the key features,construct and calculate the radiomics score,and four imaging histology models,support vector machine(SVM),light gradient boosting machine(LightGBM),GradientBoosting and adaptive boosting(AdaBoost),were built respectively to predict MCAO.Predictive performance was evaluated by the area under the receiver operating characteristic curves,and comparisons between the modeled receiver operating characteristic curves were made using the Delong test.Finally,the value of the application of radiological modeling was assessed by clinical decision curve analysis(DCA).Results The NCCT images based on 160 vessels were finally screened for 6 key features,including skewness,energy,gray level size zone matrix(GLSZM)-gray uneven,GLSZM-low gray area emphasis,GLSZM-size area non-uniform standardization,GLSZM-area entropy.The area under the curve(AUC)of the SVM-test was 0.688(95％CI 0.497-0.878)with an accuracy of 0.688;the AUC of the LightGBM-test was 0.787(95％CI 0.620-0.955)with an accuracy of 0.781;the AUC of the GradientBoosting-test was 0.654(95％CI 0.457-0.852)with an accuracy of 0.688;the AUC of the AdaBoost-test was 0.707(95％CI 0.515-0.899)with an accuracy of 0.750.The Delong test showed a statistically significant difference between LightGBM-test and GradientBoosting-test(P=0.040),and no statistically significant difference in performance between the remaining models(all P＞0.05).DCA showed that the LightGBM-test performed better.Conclusion NCCT-based radiomics has good diagnostic efficacy for identifying acute unilateral MCAO with negative HAS,and this conclusion needs to be further verified by multi-center and large sample studies.

Objective:To evaluate the clinical efficacy of allogeneic hematopoietic stem cell transplantation（allo-HSCT）in children with severe aplastic anemia（SAA）.Methods:Twenty-seven cases with SAA who had been treated with allo-HSCT from January 2020 to December 2022 were retrospectively analyzed and reviewed.Results:（1）A total of 27 SAA patients were enrolled，including 18 males and 9 females，with a median age of 8 (2-15) years.There were 20 cases of SAA-Ⅰ type,7 cases of SAA-Ⅱ type.Based upon donor sources，three cases of matched sibling donors hematopoietic stem cell transplantation,and 24 cases of haploidentical hematopoietic stem cell transplantation were adopted.（2）Hematopoietic reconstruction was achieved in all 27 cases.The median implantation time of neutrophils and platelets was 10（9-20）days and 12（7-26）days respectively.The cumulative incidence of acute graft-versus-host disease（GVHD）was 66.67%（18/27）.The incidence of grade Ⅰ-Ⅱ was 55.56%（15/27）and that of grade Ⅲ-Ⅳ was 11.11%（3/27）.The incidence of chronic GVHD was 7.41%（2/27）.Transplant-associated thrombotic microangiopathy (TA-TMA) occurred in 7.41%（2/27）patients,cytomegalovirus viremia in 62.96%（17/27）patients,epstein-barr virus infection in 33.33%（9/27）patients,and 14.81%（4/27）patients progressed to post-transplant lymphoproliferative disorder (PTLD).（3）The median follow-up time was 12 (2-28) months.The overall survival rate was 96.29%.Twenty-six patients survived,and one patient died due to multiple complications of severe acute GVHD,TA-TMA,cytomegalovirus infection,PTLD and secondary epilepsy.Conclusion:Allo-HSCT is an effective therapy for SAA in children.The effective rate of this research is 96.29%.Acute GVHD is still the key to therapy.The incidence rate of acute GVHD is 66.67% in this study.The blood incompatibility of donor and recipient may affect the incidence of GVHD.The intensity of GVHD prevention should be reduced after HLA-matched sibling donor-hematopoietic stem cell transplantation so as to avoid the complications of virus recurrence and PTLD.

Objective:To systematically analyze and integrate the psychological experience of heart failure patients using mobile medical applications (App) for self-management.Methods:Qualitative research on the self-management experience of heart failure patients using mobile medical App was retrieved through computer on PubMed, Web of Science, Embase, Cochrane Library, CINAHL, PsycINFO, Australian Joanna Briggs Evidence-Based Health Care Center Database, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biomedical Literature Database. The search period was from the establishment of the database to December 30, 2022. The quality of literature was evaluated in accordance with the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center (2016) . The results were integrated using the aggregative integration method.Results:A total of 14 articles were included, 32 research results were extracted, and 7 new categories were summarized. Finally, three integrated results were obtained (positive experience of heart failure patients using mobile medical App, risks and challenges of heart failure patients using mobile medical App, and preferences and expectations of heart failure patients towards mobile medical App) .Conclusions:The mobile medical App provides new ideas for self-management of heart failure patients, and its effectiveness is recognized by most heart failure patients, who perceive significant benefits. Future research should enrich the functionality and participation forms of the App based on the personalized needs of patients and their families, explore remote health management intervention models at home, and promote the promotion and application of mobile medical App.

BACKGROUND: The literature recommends that reduced dosage of CPT-11 should be applied in patients with UGT1A1 homozygous mutations, but the impact of UGT1A1 heterozygous mutations on the adverse reactions of CPT-11 is still not fully clear. METHODS: A total of 107 patients with UGT1A1 heterozygous mutation or wild-type, who were treated with CPT-11 from January 2018 to September 2021 in Peking University Third Hospital, were retrospectively enrolled. The adverse reaction spectra of patients with UGT1A1*6 and UGT1A1*28 mutations were analyzed. Adverse reactions were evaluated according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) 5.0. The efficacy was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The genotypes of UGT1A1*6 and UGT1A1*28 were detected by digital fluorescence molecular hybridization. RESULTS: There were 43 patients with UGT1A1*6 heterozygous mutation, 26 patients with UGT1A1*28 heterozygous mutation, 8 patients with UGT1A1*6 and UGT1A1*28 double heterozygous mutations, 61 patients with heterozygous mutation at any gene locus of UGT1A1*6 and UGT1A1*28. Logistic regression analysis showed that the presence or absence of vomiting (P=0.013) and mucositis (P=0.005) was significantly correlated with heterozygous mutation of UGT1A1*28, and the severity of vomiting (P<0.001) and neutropenia (P=0.021) were significantly correlated with heterozygous mutation of UGT1A1*6. In colorectal cancer, UGT1A1*6 was significantly correlated to diarrhea (P=0.005), and the other adverse reactions spectrum was similar to that of the whole patient cohort, and efficacy and prognosis were similar between patients with different genotypes and patients treated with reduced CPT-11 dosage or not. CONCLUSIONS In clinical use, heterozygous mutations of UGT1A1*6 and UGT1A1*28 are related to the risk and severity of vomiting, diarrhea, neutropenia and mucositis in patients with Pan-tumor and colorectal cancer post CPT-11 therpy. In colorectal cancer, UGT1A1*6 is significantly related to diarrhea post CPT-11 use, efficacy and prognosis is not affected by various genotypes or CPT-11 dosage reduction.
Camptothecin/therapeutic use* ; Glucuronosyltransferase/genetics* ; Humans ; Lung Neoplasms/drug therapy* ; Mutation ; Polymorphism, Genetic ; Retrospective Studies

Objective:To evaluate the value of vasoactive-inotropic Score (VIS) at different time points in predicting the 28-day mortality of patients with septic shock, so as to reduce the risk of death and improve the prognosis of patients.Methods:This experiment was a single-center retrospective cohort study. The clinical data of 275 adult patients with septic shock who were treated with vasoactive drugs in the intensive care unit of the Affiliated Hospital of Xuzhou Medical University from February 2016 to February 2020 were collected. According to the 28-day survival condition, all recruited patients were divided into the death group and the survival group, and the maximum vasoactive-inotropic score of all patients at the first 24 h and the second 24 h were calculated, which were expressed as VIS max24 and VIS max48. Multivariate logistic regression analysis was used to find the independent risk factors that influencing the prognosis. The receiver operating characteristic curve was used to analyze the predictive value of VIS. Results:There was no significant difference between the death group and the survival group in the characteristics including age, sex, weight, infection sites, blood culture results, cardiac arrest, hormone use, and 24 h rehydration volume ( P>0.05). APACHE II score, basic lactic acid, and lactic acid after 24 h of treatment were increased significantly in the death group ( P<0.05). VIS max24 could accurately predict the 28-day mortality (AUC=0.953, 95% CI: 0.924-0.982), which were more efficent compared to VIS max48 (AUC=0.919, 95% CI: 0.881-0.957), basic lactic acid (AUC=0.937, 95% CI: 0.900-0.966) and APACHEⅡ score (AUC=0.865, 95% CI: 0.818-0.913). Conclusion:VIS max24 can more accurate predict the 28-day mortality in patients with septic shock.

Objective To assess the quantitative impact of the application of high-throughput sequencing worldwide on clinical virology.Methods The following records from 2000 to 2018 were collected from National Center for Biotechnology Information:The number of complete genome of virus records per year;the number of virus discovery articles per year;the number of virus quasi-species articles per year;the number of viral infection gene signature articles per year.The method of interrupted time series was applied to analyze the trends of those records.Results Since the sequencing centers worldwide began to transit from the Sanger sequencing to the high-throughput sequencing technology in 2008,the annual value of records mentioned above increased by 3.755,2.760,6.195 and 3.885 times respectively.The long-term trends of change of each record are as follows:the number of complete genome of virus records increased by 1639.991 per year (P＜0.001);the number of virus discovery articles increased by 83.091 per year (P＜0.001);the number of virus quasi-species articles increased by 2.509 per year (P＜ 0.001);the number of viral infection gene signature articles increased by 30.836 per year (P＜ 0.001).Conclusions In 2008,the sequencing centers worldwide began to apply high-throughput sequencing technology which led to continuous decrease of the cost for sequencing.It result ed in not only increasingly enriched applications in clinical virology but also a long-term positive impact on the advance of clinical virology.

Objective To evaluate the clinical and pathological features of patients with prostate cancer who were diagnosed by single positive core biopsy and treated by radical prostatectomy (RP).Methods Between July 2012 and June 2016,164 patients with prostate cancer diagnosed by single positive core biopsy underwent RP.The mean age was 66.3 years old (ranged 41-82 years old),and the mean PSA level was 12.3 ng/ml (ranged 0.6-59.5 ng/ml).The biopsy Gleason score showed 6 scores in 113 cases,3 + 4 =7 scores in 21 cases,4 + 3 =7 scores in 18 cases,≥8 scores in 12 cases.Clinical stage was cT1 in 71 cases,cT2 in 92 cases,and cT3 in 1 case.The patients were divided into subgroups according to age,preoperative PSA level,biopsy Gleason score and clinical stage,and the pathological results were compared among these subgroups.Results Of the 164 patients,67 cases had Gleason score ≤ 6,52 cases Gleason score 3 + 4 =7,24 case Gleason score 4 + 3 =7,and 11 cases Gleason score ≥ 8.Ten patients had pT0 disease according to the RP specimen,3 had extraprostatic extensions,5 had seminal vesicle invasions,and 24 had positive surgical margins.Compared to the biopsy,the Gleason score of RP specimens was higher in 53 cases,concordant in 77 cases,and lower in 24 cases.There was no significant difference in the postoperative pathological features between the age group ＜ 70 years and the group ≥ 70 years.Compared with PSA ＜ 10 ng/ml,the likelihood of postoperative Gleason score ＞ 7 was significantly increased in PSA ≥10 ng/ml group [41.4％ (36/87) vs.66.2％ (51/77),P＜0.05].When the biopsy Gleason score was divided into four groups (6,3 + 4 =7,4 + 3 =7,≥ 8),there were significant differences in postoperative pathological stages among the four groups (P ＜ 0.05),and the patients with biopsy Gleason score 6 were more likely to have no residual cancer (stage T0) when compared with other Gleason scores [8.8％ (10/113) vs.0,P =0.09].The probability of no residual cancer in clinical T1 stage patients was significantly higher than that in T2 stage [11.3％ (8/71) vs.2.8％ (2/92),P =0.02],while the probability of Gleason score upgrading was significantly lower [23.9％ (17/71) vs.39.1％ (36/92),P ＜ 0.05].Conclusions Most single core prostate cancer have clinically significant disease.The treatment plan must be evaluated individually for patients with single core prostate cancer.

Objective: To develop a micro-neutralization test for determination of neutralizing antibody against ZIKA virus (ZIKV) in human sera and to verify the acute and convalescent serum samples of 10 ZIKA virus-infected cases diagnosed by nucleic acid detection and/or virus isolation. Methods: ZIKV isolated from ZIKA cases was used to determine micro-neutralization antibody. The virus solution was prepared by infecting BHK21, VERO and VERO-E6 cell lines and viral titer was tested; 100 TCID₅₀ viral solution and 4 times diluted sera which were inactivated at 56 ℃ for 30 min were neutralized, then added the cell suspension and incubated in 5% CO₂ incubator at 37 ℃ for 7 d. The CPE was observed every day. Results: The sensitivity of BHK21, VERO and VERO-E6 was different after infection with ZIKA virus. VERO cell line was the most sensitive and showed typical CPE. VERO cell line was used to establish a micro-neutralization test for determination of neutralizing antibody against ZIKA virus in sera. Conclusions The neutralizing antibody test for zika virus in sera is a special and usefulmethod to diagnose human infection of ZIKV and to conduct population based epidemiological investigation.

Objective To develop a detection method based on the technology of gene chips which can quickly distinguish genes of Enterococcus faecalis, E.faecium and vancomycin resistance.Methods Based on the specific gene ( ddl) sequences of two types of Enterococcus from GenBank, oligonucleotide probes which could detect and distinguish special genes and drug resistance genes ( vanA,vanB) of Enterococcus were designed and compounded.Then,the probes were dotted to modified slide.The target DNA fragments of vancomycin-resistant Enterococcus ( VRE) were labeled with biotin by multiple PCR amplification, and then hybridized with oligonucleotide probes on slide.The results were analyzed by portable imager.The multiple PCR system, hybridization reaction and condition of the chemiluminescence method were optimized before the specificity, sensitivity and reproducibility of the chip were evaluated.Results One universal primer, four specific primers, one universal probe and four specific probes were selected.This gene chip was demonstrated of high specificity and repeatability.The detection sensitivity was 103 CFU/ml.The gene chip detection results of 10 clinical samples were basically consistent with the drug sensitivity test ( 8/10 ) .Conclusion A gene chip technique for the detection of VRE is established successfully.It is possible to distinguish the type of VRE and detect the genetic phenotypes of drug resistance by gene chip technique.

Objective To determine the renal function compromised in patients after ST-segment elevation myocardial infarction (STEMI) with left ventricular aneurysms (LVA) by measurement of serum cystatin C (Cy-C) concentrations and Cy-C-based eGFR.Methods A total of 355 patients admitted from January 2011 to December 2012 could be categorized into group A (STEMI without LVA,n =183) and group B (STEMI with LVA,n =172) confirmed by echocardiography in 24 hour after admission.Of them,273 patients were treated with primary percutaneous coronary intervention (PCI) after admission and included in the analysis.Cy-C-based estimated glomerular filtration rate (eGFR) and creatinine (Cr)-based eGFR were calculated for evaluating cardiac function in tern to assess the magnitude of compromised renal function.The correlation between magnitude of compromised renal function and in-hospital mortality was analyzed.Distributions of categorical variables were compared using the chi-square test.Continuous variables were compared by one-way ANOVA with the Bonferroni test.Results The in-hospital mortality rate of whole patient cohort was 14.0％.Mortality in the group B was 18.6％ and in the group A was 9.8％ (P ＜ 0.01).With multivariable regression analysis,the compromised renal function was found when the Cr-based eGFR was ＜60 mL/ (min · 1.73 m2) or Cy-C-based eGFR was ＜ 60 mL/min/1.73m2 which were independently associated with in-hospital mortality (OR 0.13,95％ CI 0.02-0.7,P =0.02 ; OR 0.01,95％CI 0.003-0.05,P ＜ 0.01).Compared with the acute myocardium infarction (AMI) patients with chronic kidney disease (CKD) stage 2,the Cy-C based eGFR was greater in the AMI patients with LVA group (P ＜ 0.05),and compared with AMI with CKD stages 3 or CKD 3-5,this difference was also significant (P ＜ 0.01).Conclusions Renal dysfunction was an independent predictor of in-hospital mortality in patients with STEMI,especially in patients with LVA.Cy-C and Cy-C based eGFR were more sensitive to judge renal dysfunction in STEMI patients with LVA.