Objective This study mainly focuses on the relationship between the serum glycoprotein non-metastatic melanoma protein B(GPNMB)concentration and the degree of neurological damage and prognosis in patients with acute ischemic stroke(AIS),and screens potential biomarkers to provide a reference for clinical diagnosis and treatment.Methods A total of 105 AIS patients hospitalized in the Department of Neurology of the Hospital 2 of Nantong University from June 2023 to March 2024 were selected as the sample group.In this study,the patients were divided into mild group(n=42)and moderate to severe group(n=63)according to the National Institutes of Health Strobe Scale(NIHSS)score within 24 hours of admission.The Modified Rankin Scale(mRS)was used to evaluate the functional recovery 3 months after discharge.The samples were subdivided into good prognosis group(n=34)and poor prognosis group(n=71).The serum GPNMB protein level was detected by ELISA,and the correlation between serum GPNMB protein level and NIHSS and mRS scores was analyzed.The binary Logistic regression model was used to evaluate the predictive value and prognostic evaluation value of serum GPNMB protein level for AIS neurological function damage.Results The serum GPNMB protein concentration in patients with moderate to severe neurological impairment and poor prognosis was significantly lower than that in patients with mild and good prognosis(P<0.05).The serum GPNMB protein level was significantly negatively correlated with the NIHSS score(r=-0.196,P<0.05)and the mRS score(r=-0.334,P<0.05).Multivariate regression analysis showed that GPNMB was still a key independent risk factor for AIS(P<0.05).The evaluation results obtained based on the receiver operating characteristic curve(ROC)showed that the serum GPNMB protein level had diagnostic value in predicting neurological impairment and poor prognosis(sensitivity reached 55.6%,specificity was 81.8%,and the overall accuracy was 63.81%,P<0.05).Conclusion There is a significant positive correlation between the decrease in serum GPNMB protein concentration and the degree of neurological damage in AIS patients,and it is likely to become an important biological indicator for measuring the severity of the disease and long-term prognosis.

Objective To explore the application value of dual-energy computed tomography(DECT)pulmonary perfusion parameters in the evaluation of pulmonary hypertension(PH).Methods A retrospective selection was performed on 214 patients with suspec-ted PH who underwent DECT pulmonary perfusion examination,and the patients were divided into PH group(n=97)and non-PH group(n=117)according to the pulmonary artery systolic pressure measured by echocardiography.Inter-group comparison,univari-ate and multivariate logistic regression,and the receiver operating characteristic(ROC)curve were used to analyze the two-phase DECT pulmonary perfusion parameters and traditional CT anatomical parameters of the two groups of patients,so as to obtain the best parameters and models for predicting PH.Results There were statistically significant differences in DECT pulmonary perfusion parameters and traditional CT anatomical parameters between the PH group and the non-PH group(P<0.05).In DECT pulmonary perfusion parameters,the ratio of main pulmonary artery enhancement to whole lung enhancement in the pulmonary arterial phase(MPAenh1/WLenh1),the difference between the whole lung enhancement in the pulmonary venous phase and the whole lung enhancement in the pulmonary arterial phase(WLenh2-WLenh1),and in traditional CT anatomical parameters,the main pulmonary artery diam-eter(MPAD)and the ratio of right ventricular diameter to left ventricular diameter(RVD/LVD)were independent predictors of PH.The DECT pulmonary perfusion parameters model had similar diagnostic efficacy to the traditional CT anatomical parameters model for PH,and the combined model of the two parameters had the best diagnostic efficacy,with an area under the curve(AUC)of 0.955 and sensitivity and specificity of 0.866 and 0.940,respectively.Conclusion DECT pulmonary perfusion parameters can be used to evaluate PH,and the combination of traditional CT anatomical parameters and DECT pulmonary perfusion parameters can significantly improve the diagnostic efficacy of PH.

Objective This study mainly focuses on the relationship between the serum glycoprotein non-metastatic melanoma protein B(GPNMB)concentration and the degree of neurological damage and prognosis in patients with acute ischemic stroke(AIS),and screens potential biomarkers to provide a reference for clinical diagnosis and treatment.Methods A total of 105 AIS patients hospitalized in the Department of Neurology of the Hospital 2 of Nantong University from June 2023 to March 2024 were selected as the sample group.In this study,the patients were divided into mild group(n=42)and moderate to severe group(n=63)according to the National Institutes of Health Strobe Scale(NIHSS)score within 24 hours of admission.The Modified Rankin Scale(mRS)was used to evaluate the functional recovery 3 months after discharge.The samples were subdivided into good prognosis group(n=34)and poor prognosis group(n=71).The serum GPNMB protein level was detected by ELISA,and the correlation between serum GPNMB protein level and NIHSS and mRS scores was analyzed.The binary Logistic regression model was used to evaluate the predictive value and prognostic evaluation value of serum GPNMB protein level for AIS neurological function damage.Results The serum GPNMB protein concentration in patients with moderate to severe neurological impairment and poor prognosis was significantly lower than that in patients with mild and good prognosis(P<0.05).The serum GPNMB protein level was significantly negatively correlated with the NIHSS score(r=-0.196,P<0.05)and the mRS score(r=-0.334,P<0.05).Multivariate regression analysis showed that GPNMB was still a key independent risk factor for AIS(P<0.05).The evaluation results obtained based on the receiver operating characteristic curve(ROC)showed that the serum GPNMB protein level had diagnostic value in predicting neurological impairment and poor prognosis(sensitivity reached 55.6%,specificity was 81.8%,and the overall accuracy was 63.81%,P<0.05).Conclusion There is a significant positive correlation between the decrease in serum GPNMB protein concentration and the degree of neurological damage in AIS patients,and it is likely to become an important biological indicator for measuring the severity of the disease and long-term prognosis.

Objective:To systematically analyze the definition, development, conceptual application, characteristic attributes, extension, and similar concepts of family avoidance of communication about cancer through the conceptual analysis method, so as to clarify the conceptual connotation of family avoidance of communication about cancer.Methods:Literature on family avoidance of communication about cancer was searched in WanFang Data, VIP, China National Knowledge Infrastructure, China Biomedical Database, CINAHL, Embase, PubMed, PsycINFO and so on. The search period was from database establishment to December 31, 2023. Walker and Avant's conceptual analysis method was used for analysis.Results:Through a compilation and analysis of relevant literature, the conceptual characteristics of family avoidance of communication about cancer were summarized, including bidirectional influence (both the cancer patient and family members tend to conceal their self-emotions and influence each other), information concealment (lack of communicative behaviors on both sides) and the desire to protection (aiming to hopefully protect each other) .Conclusions:The conceptual attributes of family avoidance of communication about cancer compiled can provide a basis for the proper understanding of related concepts within the subject area and provide conceptual support for the practice and research of family avoidance of communication about cancer.

Objective To explore the application value of dual-energy computed tomography(DECT)pulmonary perfusion parameters in the evaluation of pulmonary hypertension(PH).Methods A retrospective selection was performed on 214 patients with suspec-ted PH who underwent DECT pulmonary perfusion examination,and the patients were divided into PH group(n=97)and non-PH group(n=117)according to the pulmonary artery systolic pressure measured by echocardiography.Inter-group comparison,univari-ate and multivariate logistic regression,and the receiver operating characteristic(ROC)curve were used to analyze the two-phase DECT pulmonary perfusion parameters and traditional CT anatomical parameters of the two groups of patients,so as to obtain the best parameters and models for predicting PH.Results There were statistically significant differences in DECT pulmonary perfusion parameters and traditional CT anatomical parameters between the PH group and the non-PH group(P<0.05).In DECT pulmonary perfusion parameters,the ratio of main pulmonary artery enhancement to whole lung enhancement in the pulmonary arterial phase(MPAenh1/WLenh1),the difference between the whole lung enhancement in the pulmonary venous phase and the whole lung enhancement in the pulmonary arterial phase(WLenh2-WLenh1),and in traditional CT anatomical parameters,the main pulmonary artery diam-eter(MPAD)and the ratio of right ventricular diameter to left ventricular diameter(RVD/LVD)were independent predictors of PH.The DECT pulmonary perfusion parameters model had similar diagnostic efficacy to the traditional CT anatomical parameters model for PH,and the combined model of the two parameters had the best diagnostic efficacy,with an area under the curve(AUC)of 0.955 and sensitivity and specificity of 0.866 and 0.940,respectively.Conclusion DECT pulmonary perfusion parameters can be used to evaluate PH,and the combination of traditional CT anatomical parameters and DECT pulmonary perfusion parameters can significantly improve the diagnostic efficacy of PH.

Objective:To systematically analyze the definition, development, conceptual application, characteristic attributes, extension, and similar concepts of family avoidance of communication about cancer through the conceptual analysis method, so as to clarify the conceptual connotation of family avoidance of communication about cancer.Methods:Literature on family avoidance of communication about cancer was searched in WanFang Data, VIP, China National Knowledge Infrastructure, China Biomedical Database, CINAHL, Embase, PubMed, PsycINFO and so on. The search period was from database establishment to December 31, 2023. Walker and Avant's conceptual analysis method was used for analysis.Results:Through a compilation and analysis of relevant literature, the conceptual characteristics of family avoidance of communication about cancer were summarized, including bidirectional influence (both the cancer patient and family members tend to conceal their self-emotions and influence each other), information concealment (lack of communicative behaviors on both sides) and the desire to protection (aiming to hopefully protect each other) .Conclusions:The conceptual attributes of family avoidance of communication about cancer compiled can provide a basis for the proper understanding of related concepts within the subject area and provide conceptual support for the practice and research of family avoidance of communication about cancer.

Objective To explore the value of fractional order calculus(FROC)model diffusion weighted imaging(DWI)for evaluating pathological classification and differentiation degree of cervical cancer(CCA).Methods Totally 74 CCA patients were enrolled and divided into squamous cell carcinoma(SCC)group(n=54)and adenocarcinoma(ACA)group(n=20)based on pathological classification,also low differentiation group(n=33)and medium-high differentiation group(n=41)based on differentiation degree.Conventional MR examination and DWI with 12 b-values were performed,FROC model parameters(D,β,and p value)and the apparent diffusion coefficient(ADC)of mono-exponential model were obtained via software analysis.The parameters were compared between groups,and receiver operating characteristic curve of those being significantly different between groups were drawn,the area under the curves(AUC)were calculated to evaluate the diagnostic efficacy.Results Significant differences of ADC,D,and β values were found between SCC group and ACA group(all P＜0.05),and D value had the highest AUC(0.726)for distinguishing pathological classification CCA.Meanwhile,significant differences of D,β,p values and ADC were observed between low differentiation group and medium-high differentiation group(all P＜0.05),D value also had the highest AUC(0.865).AUC of the combined model constructed based on significant variables β and p values in logistic regression was 0.926,higher than that of each parameter alone(all P＜0.05).Conclusion FROC model DWI could be used to evaluate pathological classification and differentiation degree of CCA.

Objective:To explore the value of coronary artery plaque progression parameters based on coronary CT angiography (CCTA) in predicting the occurrence of major adverse cardiovascular events (MACE) in patients with non-obstructive coronary artery disease.Methods:The study included clinical, imaging, and prognosis (MACE) parameters of non-obstructive coronary artery disease patients who underwent CCTA at the First Affiliated Hospital of Nanjing Medical University from September 2010 to December 2022. Patients were grouped based on the occurrence of MACE, and differences in clinical data, plaque baseline, and progression parameters between the two groups were compared. Univariate and multivariate Cox regression analyses were employed to identify factors that could effectively predict the occurrence of MACE in patients. Models were constructed using plaque baseline parameters, plaque progression parameters, and a combination of both. The concordance index-time curve, net reclassification improvement and integrated discrimination improvement were used to evaluate the risk stratification ability of the models.Results:A total of 258 patients were included, of whom 62 cases experienced MACE during the follow-up period. In comparison to the MACE(-) group, patients in the MACE(+) group exhibited longer lesion length, greater degree of stenosis, larger plaque total volume, calcified plaque volume, non-calcified plaque volume, fibrous plaque volume, total plaque burden, lipid-rich plaque burden, higher peri-coronary adipose tissue attenuation index (FAI), and annual change of diameter stenosis(ΔDS/y). There were also more cases of coronary artery disease reporting and data system upgrades and non-obstructive progression to obstructive status ( P<0.05). Multivariate Cox analysis revealed that FAI, ΔDS/y, and non-obstructive progression to obstructive status were independent predictors of MACE occurrence. Concordance index-time curve results indicated that the combined model had a better predictive efficacy for MACE in patients with non-obstructive coronary artery disease compared to models based on plaque baseline parameters and plaque progression parameters. Conclusion:The plaque progression parameters and FAI based on CCTA have the potential to predict the high-risk population for MACE in patients with non-obstructive coronary artery disease, demonstrating good risk stratification value.

Objective:To evaluate the efficacy of Jiedu-Huaban Decoction combined with montelukast sodium chewable tablets in the treatment of children with henoch schonlein purpura (HSP). Methods:A total of 80 children with HSP and blood heat syndrome who met the inclusion criteria, from January 2017 to December 2019, were randomly divided into two groups by random number table method, 40 in each group. The control group took montelukast sodium chewable tablets at night, and the study group took Jiedu-Huaban Decoction on the basis of the control group. Both groups were treated for 2 weeks. The disappearance time of gastrointestinal disease, skin purpura, kidney disease, joint swelling and pain were observed. The improvement score of skin purpura was evaluated before and after treatment. The serum levels of IL-6, IL-4, interferon-γ (IFN-γ) and TNF-α were detected by ELISA, and the levels of IgG, IgA and IgM. The T lymphocyte subsets (CD4 + and CD8 +) were measured by nephelometry, and the CD4 +/CD8 +values were calculated. The clinical efficacy was evaluated. Results:The total effective rate was 87.5% (35/40) in the study group and 67.5% (27/40) in the control group, with significant difference between the two groups ( χ2 =4.588, P=0.032). The disappearance time of gastrointestinal disease, skin purpura, kidney disease and joint swelling and pain in the study group were significantly earlier than those in the control group ( t=7.802, 12.167, 7.309, 9.365, all Ps<0.001). After treatment, the serum levels of IL-6, IL-4, IFN-γ and TNF-α in the study group were significantly lower than those in the control group ( t=9.319, 6.738, 8.221, 6.553, all Ps<0.001). The improvement score of skin purpura at 1 week after treatment (2.75 ± 0.69 vs. 3.92 ± 0.83, t=6.856) and 2 weeks after treatment (0.41 ± 0.15 vs. 1.55 ± 0.37, t=18.095) in the study group were significantly lower than those in the control group ( P<0.01). After treatment, the level of IgG, CD4 +, CD4 +/CD8 + in the study group were significantly higher than those in the control group ( t=5.160, 4.558, 3.442, all Ps<0.01), the level of IgA, IgM, CD8 + in the study group were significantly lower than those in the control group ( t=2.614, 6.712, 5.468, all Ps< 0.05). During the treatment, the incidence of adverse reactions in the control group was 17.5% (7/40), and that of the study group was 15.0% (6/40), wherer there was no statistical difference between the two groups ( χ2=0.092, P=0.762). Conclusion:Jiedu-Huaban Decoction combined with montelukast sodium chewable tablets can improve the clinical symptoms of children with HSP and blood heat syndrome, reduce the body inflammatory reaction, improve immunity, with good safety.

[Abstract] Objective: To explore the mechanism of TRIM21 regulating the proliferation of ovarian cancer cells and the resistance of PARP inhibitors by activating Wnt/β-catenin signaling pathway. Methods: Eight pairs of ovarian cancer tissues and cervical epithelial tissues that surgically removed at Yan'an People's Hospital from January 2018 to January 2019 were collected for this study. And the tissues were classified into resistant group and non-resistant group (4 case/group) according to whether the patients were resistant to PARP inhibitor (nilapanib). Ovarian cancer cell lines CAOV3, SKOV3, OVCAR3, ES-2, HO8910, A2780 and OV2008 were also collected for this study. qPCR and Western blotting (WB) were used to detect the expression levels of TRIM21 and β-catenin in the above mentioned tissues and cell lines. Cell lines with TRIM21 overexpression and knockdown were constructed. CCK-8 method was used to detect the proliferation activity of ovarian cancer cells in each group, TOP/FOP dual luciferase assay was used to detect the effect of TRIM21 on Wnt signaling pathway activation, qPCR and WB were used to detect the effect of TRIM21 on mRNA and protein levels of β-catenin, which was further verified by Wnt pathway inhibitor XAV-939. Results: The expression level of TRIM21 in ovarian cancer tissues was significantly higher than that in cervical epithelial tissues (P<0.01), and its expression was more higher in the drug-resistant tissues (P<0.01). TRIM21 expression was the highest in ES-2 cells but comparatively low in CAOV3 and A270 cells (all P<0.01). After TRIM21 knockdown, the expression of TRIM21 in ES-2 cells was significantly decreased, and the cell proliferation was significantly reduced (all P<0.01). After overexpressing TRIM21, the proliferative capacity of ovarian cancer CAOV3 cells was significantly increased (P<0.01), and the antitumor effect of nilaparib was inhibited; TRIM21 overexpression could regulate Wnt/β -catenin pathway activation, while β -catenin knockdown or Wnt/β -catenin inhibitor XAV-939 could significantly reverse the effect of TRIM21 in ovarian cancer. Conclusion: TRIM21 can enhance the proliferation of ovarian cancer cells via regulating Wnt/β-catenin pathway, it plays a certain role in the process of drug resistance of PARP inhibitor nilapani.