Objective:To explore the predictive value of combined evaluation of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and lactate dehydrogenase(LDH)on the therapeutic effect and prognosis of ICIs(immune checkpoint inhibitors)in metastatic gastric cancer(MGC)patients.Methods:This study conducted a retrospective analysis of pre-and post-treatment peripheral hematological indicators of 88 MGC patients treated at Nanping First Hospital affiliated to Fujian Medical University.The recent treatment efficacy of the two patient groups was evaluated based on the solid tumor response evaluation criteria.χ2 tests were conducted to analyze and compare differences in disease control rate(DCR)and objective response rate(ORR),as well as differences in PD-L1 expression and clinical characteristics between the two groups.Survival analysis was performed using the Kaplan-Meier method for univariate analysis.Intergroup differences were detected by the Log-Rank test.Univariate analysis was conducted using the Cox proportional hazards regression model.Results:After immunotherapy,NLR3,NLR4,PLR2,PLR3,PLR4,LDH2 and LDH3 decreased significantly compared with those before treatment(all P<0.05).There were significant statistical differences in NLR1 and LDH1 before treatment between the complete-remission(CR)+partial-remission(PR)group and the progress-disease(PD)group(all P<0.05).Patients with higher levels of NLR2,NLR3,NLR4,PLR4,LDH1,LDH3,LDH4,ΔNLR1,ΔNLR2,ΔNLR3 and ΔPLR1 had shorter OS(all P<0.05),and patients with higher levels of NLR2,NLR3,NLR4,PLR1,LDH1,ΔNLR1,ΔNLR2,ΔNLR3,Δ PLR1 and Δ PLR2 had shorter PFS compared with patients in low-level group(all P<0.05).The percentage of PD-L1 negative patients among NLR3-H patients was the highest,and the number of NLR3-H patients in the NLR3-L group was larger than that in the negative group,the combined positive score(CPS)=1-5 group and the CPS≥5 group(all P<0.05).The proportion of women in the NLR3-H and PLR3-H groups was higher(all P<0.05).Conclusion:The evaluation of NLR,PLR,and LDH has certain value in predicting the efficacy and prognosis of immunotherapy for MGC.

Objective:To explore the clinical application value of artificial intelligence（AI）-assisted training in enhancing the accuracy of nuchal translucency（NT）identification，standardization of measurement，and diagnostic efficacy for abnormalities among ultrasound residents.Methods:A retrospective collection of 300 standard fetal NT ultrasound images was conducted at the Center for Medical Ultrasound，Suzhou Hospital Affiliated of Nanjing Medical University from January 2018 to June 2024. The AI model performed NT measurements and diagnoses once. Four sonographers of different seniority levels（including two resident physicians）independently conducted NT measurements and diagnoses twice. Prior to the experiment，the middle-age and resident sonographers had uniformly completed traditional theory training. Following the first independent measurements，the two resident sonographers received additional AI-assisted training，after which all 4 sonographers performed the second independent measurements. A fetal medicine expert evaluated blindly all the results and compared the differences in NT recognition accuracy，measurement standard rate and diagnosis accuracy between the middle-age sonographer（traditional training only）and two resident sonographers（traditional + AI-assisted training）.Results:For the middle-aged sonographer who only received traditional lecture-based training，the accuracy of NT recognition，standardization rate of measurement，or diagnostic accuracy were not significantly improved befroe and after the training，and the diffrence was not statistically significant（ χ2=0.189，1.887，0.326；all P>0.05）. In contrast，the second-year resident（Resident 2）and first-year resident（Resident 1），who received both traditional lecture-based training and AI training，demonstrated some improvements in the accuracy of NT measurement site recognition，though the differences were not statistically significant（ χ2=1.301，2.418；all P>0.05）. However，both residents did significant improvements in the standardization rate of NT measurement（ χ2=25.768，17.035；all P<0.05）. In terms of diagnostic accuracy，Resident 1 did significant improvement（ χ2=10.180， P<0.05），while Resident 2 also did some improvement，though the difference was not statistically significant（ χ2=2.573， P>0.05）. Conclusions:The AI-assisted training system enhances the ability of ultrasound resident sonographers to recognize，measure，and diagnose NT，providing a novel and efficient training model for standardized residency training in ultrasound specialties.

Objective To study whether electroacupuncture(EA)attenuates traumatic brain injury(TBI)by down-regulating glutamate carboxypeptidase Ⅱ(GCPII)gene expression in rats.Methods Rats were divided into Sham group(n=10),TBI group(n=11),TBI+EA group(n=11),TBI+EA+GCPII-NC group(n=11)and TBI+EA+GCPII-OE group(n=11).Sham group rats underwent sham surgery,while other groups rats underwent TBI modeling using an electronic brain injury instrument.The rats in Sham group and TBI group were fed normally,and the rats in other groups were treated with electroacupuncture for 14 days.On the basis of electroacupuncture treatment,rats in TBI+EA+GCPII-NC group and TBI+EA+GCPII-OE group were injected with GCPII-NC and GCPII-OE,respectively.After treatment,the cognitive function of rats was evaluated by neurological function score and Morris water labyrinth task.HE and TUNEL staining were performed on brain tissue.The water content,glutamate(Glu)content,calcium(Ca2+)concentration,superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px)and malondialdehyde(MDA)in brain tissue of rats in each group were measured.The mRNA or protein expression of GCPII,Bax,Bcl2 and cleaved caspase-3 in brain tissue were detected by qRT-PCR or Western blot.Results Compared with Sham group,the expression of mRNA and protein of GCPII in TBI group increased,the neurological function score and escape latency increased,the number of crossing the platform decreased,the water content increased,the cortex showed obvious damage,the content of Glu increased,the concentration of calcium increased,the levels of SOD,CAT and GSH-Px decreased,the level of MDA increased,the positive rate of TUNEL increased,the expression of Bax and cleaved caspase-3 protein increased,and the expression of Bcl2 protein decreased significantly(P<0.05).Compared with TBI group,the expression level of mRNA and protein of GCPII in TBI+EA group decreased,the neurological function score and escape latency decreased,the number of crossing platform increased,the water content decreased,the morphology of cortex improved obviously,the content of Glu decreased,the concentration of calcium decreased,the level of SOD,CAT and GSH-Px increased,the level of MDA decreased,the positive rate of TUNEL decreased,the expression level of Bax and cleaved caspase-3 protein decreased,and the expression level of Bcl2 protein increased significantly(P<0.05).Compared with TBI+EA group and TBI+EA+GCPII-NC group,the expression level of mRNA and protein of GCPII in TBI+EA+GCPII-OE group increased,neurological function score and escape latency increased,the number of crossing platform decreased,water content increased,cortical injury aggravated,Glu content increased,calcium concentration increased,SOD,CAT and GSH-Px levels decreased,MDA level increased,TUNEL positive rate increased,Bax and cleaved caspase-3 protein expression increased,and the expression of Bcl2 protein decreased significantly(P<0.05).Conclusion By down-regulating the expression of GCPII gene,electroacupuncture reduced the content of glutamate in the brain tissue of TBI rats,thereby inhibiting calcium overload,oxidative stress and neuronal apoptosis in the brain tissue,and thereby improving cognitive function and alleviating brain injury.

Objective To study whether electroacupuncture(EA)attenuates traumatic brain injury(TBI)by down-regulating glutamate carboxypeptidase Ⅱ(GCPII)gene expression in rats.Methods Rats were divided into Sham group(n=10),TBI group(n=11),TBI+EA group(n=11),TBI+EA+GCPII-NC group(n=11)and TBI+EA+GCPII-OE group(n=11).Sham group rats underwent sham surgery,while other groups rats underwent TBI modeling using an electronic brain injury instrument.The rats in Sham group and TBI group were fed normally,and the rats in other groups were treated with electroacupuncture for 14 days.On the basis of electroacupuncture treatment,rats in TBI+EA+GCPII-NC group and TBI+EA+GCPII-OE group were injected with GCPII-NC and GCPII-OE,respectively.After treatment,the cognitive function of rats was evaluated by neurological function score and Morris water labyrinth task.HE and TUNEL staining were performed on brain tissue.The water content,glutamate(Glu)content,calcium(Ca2+)concentration,superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px)and malondialdehyde(MDA)in brain tissue of rats in each group were measured.The mRNA or protein expression of GCPII,Bax,Bcl2 and cleaved caspase-3 in brain tissue were detected by qRT-PCR or Western blot.Results Compared with Sham group,the expression of mRNA and protein of GCPII in TBI group increased,the neurological function score and escape latency increased,the number of crossing the platform decreased,the water content increased,the cortex showed obvious damage,the content of Glu increased,the concentration of calcium increased,the levels of SOD,CAT and GSH-Px decreased,the level of MDA increased,the positive rate of TUNEL increased,the expression of Bax and cleaved caspase-3 protein increased,and the expression of Bcl2 protein decreased significantly(P<0.05).Compared with TBI group,the expression level of mRNA and protein of GCPII in TBI+EA group decreased,the neurological function score and escape latency decreased,the number of crossing platform increased,the water content decreased,the morphology of cortex improved obviously,the content of Glu decreased,the concentration of calcium decreased,the level of SOD,CAT and GSH-Px increased,the level of MDA decreased,the positive rate of TUNEL decreased,the expression level of Bax and cleaved caspase-3 protein decreased,and the expression level of Bcl2 protein increased significantly(P<0.05).Compared with TBI+EA group and TBI+EA+GCPII-NC group,the expression level of mRNA and protein of GCPII in TBI+EA+GCPII-OE group increased,neurological function score and escape latency increased,the number of crossing platform decreased,water content increased,cortical injury aggravated,Glu content increased,calcium concentration increased,SOD,CAT and GSH-Px levels decreased,MDA level increased,TUNEL positive rate increased,Bax and cleaved caspase-3 protein expression increased,and the expression of Bcl2 protein decreased significantly(P<0.05).Conclusion By down-regulating the expression of GCPII gene,electroacupuncture reduced the content of glutamate in the brain tissue of TBI rats,thereby inhibiting calcium overload,oxidative stress and neuronal apoptosis in the brain tissue,and thereby improving cognitive function and alleviating brain injury.

Objective:To explore the predictive value of combined evaluation of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and lactate dehydrogenase(LDH)on the therapeutic effect and prognosis of ICIs(immune checkpoint inhibitors)in metastatic gastric cancer(MGC)patients.Methods:This study conducted a retrospective analysis of pre-and post-treatment peripheral hematological indicators of 88 MGC patients treated at Nanping First Hospital affiliated to Fujian Medical University.The recent treatment efficacy of the two patient groups was evaluated based on the solid tumor response evaluation criteria.χ2 tests were conducted to analyze and compare differences in disease control rate(DCR)and objective response rate(ORR),as well as differences in PD-L1 expression and clinical characteristics between the two groups.Survival analysis was performed using the Kaplan-Meier method for univariate analysis.Intergroup differences were detected by the Log-Rank test.Univariate analysis was conducted using the Cox proportional hazards regression model.Results:After immunotherapy,NLR3,NLR4,PLR2,PLR3,PLR4,LDH2 and LDH3 decreased significantly compared with those before treatment(all P<0.05).There were significant statistical differences in NLR1 and LDH1 before treatment between the complete-remission(CR)+partial-remission(PR)group and the progress-disease(PD)group(all P<0.05).Patients with higher levels of NLR2,NLR3,NLR4,PLR4,LDH1,LDH3,LDH4,ΔNLR1,ΔNLR2,ΔNLR3 and ΔPLR1 had shorter OS(all P<0.05),and patients with higher levels of NLR2,NLR3,NLR4,PLR1,LDH1,ΔNLR1,ΔNLR2,ΔNLR3,Δ PLR1 and Δ PLR2 had shorter PFS compared with patients in low-level group(all P<0.05).The percentage of PD-L1 negative patients among NLR3-H patients was the highest,and the number of NLR3-H patients in the NLR3-L group was larger than that in the negative group,the combined positive score(CPS)=1-5 group and the CPS≥5 group(all P<0.05).The proportion of women in the NLR3-H and PLR3-H groups was higher(all P<0.05).Conclusion:The evaluation of NLR,PLR,and LDH has certain value in predicting the efficacy and prognosis of immunotherapy for MGC.

Objective:To explore the clinical application value of artificial intelligence（AI）-assisted training in enhancing the accuracy of nuchal translucency（NT）identification，standardization of measurement，and diagnostic efficacy for abnormalities among ultrasound residents.Methods:A retrospective collection of 300 standard fetal NT ultrasound images was conducted at the Center for Medical Ultrasound，Suzhou Hospital Affiliated of Nanjing Medical University from January 2018 to June 2024. The AI model performed NT measurements and diagnoses once. Four sonographers of different seniority levels（including two resident physicians）independently conducted NT measurements and diagnoses twice. Prior to the experiment，the middle-age and resident sonographers had uniformly completed traditional theory training. Following the first independent measurements，the two resident sonographers received additional AI-assisted training，after which all 4 sonographers performed the second independent measurements. A fetal medicine expert evaluated blindly all the results and compared the differences in NT recognition accuracy，measurement standard rate and diagnosis accuracy between the middle-age sonographer（traditional training only）and two resident sonographers（traditional + AI-assisted training）.Results:For the middle-aged sonographer who only received traditional lecture-based training，the accuracy of NT recognition，standardization rate of measurement，or diagnostic accuracy were not significantly improved befroe and after the training，and the diffrence was not statistically significant（ χ2=0.189，1.887，0.326；all P>0.05）. In contrast，the second-year resident（Resident 2）and first-year resident（Resident 1），who received both traditional lecture-based training and AI training，demonstrated some improvements in the accuracy of NT measurement site recognition，though the differences were not statistically significant（ χ2=1.301，2.418；all P>0.05）. However，both residents did significant improvements in the standardization rate of NT measurement（ χ2=25.768，17.035；all P<0.05）. In terms of diagnostic accuracy，Resident 1 did significant improvement（ χ2=10.180， P<0.05），while Resident 2 also did some improvement，though the difference was not statistically significant（ χ2=2.573， P>0.05）. Conclusions:The AI-assisted training system enhances the ability of ultrasound resident sonographers to recognize，measure，and diagnose NT，providing a novel and efficient training model for standardized residency training in ultrasound specialties.

The present study was conducted to clarify the therapeutic effect of cornuside on experimental autoimmune encephalomyelitis (EAE) and its influence on T helper 17 (Th17) cell and regulatory T (Treg) cell infiltration into the central nervous system. Rats were randomly placed into four treatment groups: control, EAE, EAE+cornuside, and EAE+prednisolone. The neurological function scores of rats were assessed daily. On the second day after EAE rats began to show neurological deficit symptoms, the four groups were treated with normal saline, normal saline, cornuside (150 mg/kg), and prednisolone (5 mg/kg), respectively. The treatment was discontinued after two weeks, and the spinal cord was obtained for hematoxylin and eosin (H&E) and luxol fast blue staining, as well as retinoic acid receptor-related orphan receptor γ (RORγ) and forkhead box protein P3 (Foxp3) immunohistochemical staining. Blood was collected for Th17 and Treg cell flow cytometry testing, and the serum levels of interleukin (IL)-17A, IL-10, transforming growth factor-β (TGF-β), IL-6, IL-23, and IL-2 were measured via enzyme-linked immunosorbent assay (ELISA). Compared with rats in the EAE group, rats in the EAE+cornuside and EAE+prednisolone groups began to recover from neurological deficits earlier, and had a greater degree of improvement of symptoms. Focal inflammation, demyelination, and RORγ-positive cell infiltration were reduced by cornuside or prednisolone treatment, whereas the Foxp3-positive cell numbers were not significantly different. Meanwhile, the number of Th17 cells and the IL-17A, IL-6, and IL-23 levels were lower in the blood after cornuside or prednisolone treatment, whereas the number of Treg cells or the levels of IL-10, TGF-β, and IL-2 were not markedly different. Cornuside can alleviate symptoms of EAE neurological deficits through its anti-inflammatory and immunosuppressive effects, and Th17 cells may be one of its therapeutic targets.

Objective:To clarify the infection and epidemic characteristics of the human metapneumovirus (HMPV) in Chinese patients with febrile respiratory syndrome (FRS), and to provide important baseline data for clinical diagnosis, treatment, prevention and control of HMPV-induced respiratory tract diseases in China.Methods:FRS cases from January 2009 to June 2021 in 9 provinces in China, including Beijing, Hebei, Jilin, Shandong, Shaanxi, Xinjiang, Anhui, Guangdong, Hunan were retrospectively analyzed for their respiratory samples, clinical and epidemic data.The respiratory samples were detected for HMPV by quantitative real-time PCR.Results:A total of 11 660 cases were tested for HMPV, involving 296 (2.54%) HMPV-positive cases.Among 296 HMPV-positive cases, 218 were single HMPV infection, and 78/296 (26.35%) were co-infected with one or more respiratory viruses.HMPV mainly affected children under 5 years of age (3.10%), and in this population, the proportion of pneumonia in HMPV co-infection cases was significantly higher than that of single HMPV infection.HMPV could be detected all year round, which was more popular in winter and spring, with the peak of HMPV epidemic in March.Conclusions:HMPV is one of the important pathogens causing acute respiratory infection in children, showing a clear seasonal epidemic.HMPV can be infected alone or in combination with other respiratory viruses, which may increase the risk of pneumonia in children.

Objective:To discuss the application and effectiveness of the flipped classroom based on Wechat platform in the teaching of neurology.Methods:clinical students of grade 2014 of binjiang college of Zhejiang Chinese Medical University were selected as teaching subject. The students were divided into experimental group which contained a total of 74 students in class one and class three and the control group which contained a total of 38 students in class two. Peripheral neuropathy and neuromuscular-junction disease were selected as teaching contents. The experimental group adopted flipped classroom as the teaching mode and Wechat platform for pre-class preparation, after-school review and interactive communication. The control group was taught by traditional teaching mode. Before and after class, students in the two groups had a small-scale test and were surveyed by questionnaire, respectively. Students in the two groups took the same final exam which included case analysis when the course was over. The scores of the final exam and the results of the case analysis of each group were recorded and analyzed. All data were processed with statistical software SPSS 20.0, and t-test or chi-square test was used. Results:Students in the experimental group had significantly higher test scores in the after-class small-scale test than those in the control group ( P=0.038). Their final exam scores were higher than those in the control group ( P=0.046), and their scores of case analysis in the final exam were higher than those in the control group ( P=0.026). The results of pre-class questionnaire survey showed that the proportion of students who chose "good" in the experimental group was higher than that in the control group on the understanding of the learning content and the preparation ( P<0.05). In the after-class questionnaire survey, the proportion of students who chose "excellent" and "good" in the evaluation of learning interest in the experimental group was higher than those in the control group ( P<0.05), the proportion of students in the experimental chose "good" in evaluating their self-learning ability was higher than that in the control group ( P<0.05), the proportion of "excellent" on clinical thinking ability and teaching satisfaction was higher in the experimental group than that in the control group ( P<0.05), and the overall proportion of students who chose "excellent" and "good" in all items in the experimental group were higher than that in the control group ( P<0.05). In the experimental group, the overall proportion of students who selected "excellent" and "good" in on the evaluation of their learning interest was significantly increased in the after-class questionnaire survey compared with the pre-class questionnaire survey ( P<0.01). Conclusions:The application of flipped classroom based on Wechat platform is feasible and effective in the teaching of neurology. It can make up for the deficiency of traditional teaching methods. It is helpful to improve students' learning interest and self-learning ability, and is also helpful to exercise their clinical thinking ability. Thus this method deserves further popularization.

OBJECTIVE: To investigate the effect of curcumin on dopamine neurons in Parkinson's disease (PD) and its mechanism. METHODS: SH-SY5Y human neuroblastoma cells were treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to establish the PD cell model. The model cells were treated with curcumin and/or autophagy inhibitor 3-MA. After 48 h of drug treatment, the number of surviving dopamine neurons was detected by tyrosine hydroxylase immunofluorescence method. Western blotting was used to detect protein expression of α-Synuclein (α-Syn), transcription factor EB (TFEB) and autophagy-related proteins lysosome-associated membrane protein 2A (LAMP2A) and microtubule-associated protein 1 light chain 3-Ⅱ(LC3-Ⅱ); RT-PCR was used to detect mRNA expression of α-Syn. RESULTS: Compared with MPTP model group, curcumin increased the number of surviving dopamine neurons(<0.01), decreased both protein expression and mRNA expression of α-Syn (all <0.01), and increased protein expression of TFEB, LAMP2A and LC3-Ⅱ (all <0.01). When curcumin and 3-MA were given concurrently, the number of surviving dopamine neurons, protein expression of TFEB, LAMP2A and LC3-Ⅱ increased (<0.05 or <0.01), and both protein expression and mRNA expression of α-Syn decreased (<0.05 or <0.01) compared with MPTP model group; but the number of surviving dopamine neurons and protein expression of LAMP2A and LC3-Ⅱ decreased compared with curcumin group (all <0.05). CONCLUSIONS Curcumin exerts protective effect on dopamine neurons in PD, which may be associated with enhancing autophagy and promoting the clearance of α-Syn.
Animals ; Cell Line ; Curcumin ; pharmacology ; Dopaminergic Neurons ; drug effects ; Humans ; Mice ; Mice, Inbred C57BL ; Parkinson Disease ; alpha-Synuclein ; metabolism