Objective To analyze the clinical manifestations of patients over 60 years old with acute respiratory infection in Pudong New Area of Shanghai and the risk factors of positive detection of novel coronavirus, and to provide reference for improving prevention and control strategies and measures. Methods General conditions, clinical features, basic complications and respiratory samples of inpatients over 60 years old with acute respiratory infection from eight hospitals in Pudong New Area of Shanghai from January to October 2023 were collected, and SARS-CoV-2 detection was carried out. Chi-square test and binary logistics regression were used for data analysis. Results A total of 604 patients over 60 years old were collected, including 356 (58.945) males with a median age of 77 (IQR:70-85) years. Of the 604 cases, 264 were detected positive for SARS-CoV-2, with a positive detection rate of 43.71%. The results of univariate analysis showed that there were significant differences in the detection rates of SARS-CoV-2 among different age groups (χ²=10.60, P=0.01) and different months (χ²=87.15, P=0.00), and among those with cough (χ²=5.28, P=0.02), sputum (χ²=4.19, P=0.04), sore throat (χ²=3.93, P=0.04), and hypertension (χ²=7.63, P=0.01). In the binary logistics regression analysis, month (P=0.00, OR=2.93, 95% CI=1.49-5.78) and age (P=0.00, OR=2.60, 95% CI=1.55-4.37) were independent risk factors for positive detection of SARS-CoV-2. Conclusion The majority of hospitalized cases of acute respiratory infection over 60 years old are male, and the risk factors for positive detection of novel coronavirus are age 80~89 years old and time between May and June.

Objective:To conduct a multi-center cross-sectional study of elderly patients with cognitive impairment based on real-world data; To analyze the clinical characteristics and core medication law of the disease population.Methods:The medical records of elderly patients diagnosed with cognitive impairment from January 1, 2016 to December 31, 2024 were retrieved from Chinese Evidence-based TCM Database. Excel 2010 software was used to collect general information, TCM syndrome elements and syndrome types, use frequency of Chinese materia medica, property, taste, meridian tropism, efficacy classification and other information, using PivotTable to establish Chinese materia medica matrix. IBM SPSS Modeler 18.0 software was used to display the frequency of co-occurrence among high-frequency Chinese materia medica, and the association rules were analyzed based on the Apriori algorithm. R language 4.4.1 was used for clustering analysis on Chinese materia medica and the cluster pedigree and correlation heat map were drawn.Results:A total of 1 194 elderly patients with cognitive impairment were enrolled, with a mean age of (79.51±7.65) years, and the highest frequency of comorbidities was hypertension (891 cases, 74.62%); AD was the most frequent diagnosis of cognitive impairment (367 times, 30.74%). The proportion of mild cognitive impairment in the low value group of Systemic Immune Inflammation Index (SII) was relatively high, and the high value group of SII was mainly vascular dementia and AD. Wind-phlegm blocking syndrome (106 times, 13.73%) topped the list; phlegm was the most frequent element of pathogenicity (353 times, 45.73%), and meridians and collaterals (194 times, 25.13%). Totally 328 prescriptions were included, involving 308 kinds of Chinese materia medica. The total recorded frequency of Chinese materia medica was 5 665, with tonifying herbs constituting the most frequently used category, accounting for 1 633 times; the medicinal property of drugs for treating elderly patients with cognitive disorders was mostly warm (103 times, 33.44%), the taste was mostly bitter (141 times, 45.78%), and attributed to the liver meridian (145 times, 47.08%); among the two and three association rules, the drug pairs with the highest confidence were Gastrodiae Rhizoma→Uncariae Ramulus cum Uncis (97.22%) and Hyperici Perforati Herba→Acanthopanacis Senticosi Radix et Rhizoma seu Caulis+Alpiniae Oxyphyllae Fructus (97.06%); five medicinal combinations were obtained by high frequency drug clustering analysis.Conclusions:Elderly patients with cognitive impairment are mainly diagnosed with AD. There may be a potential correlation between SII level and the progression of cognitive impairment. The drugs are used to tonify the kidney and replenish essence, detoxify and unblock collaterals, replenish qi and activate blood circulation, and awaken the brain and open the orifices. Shengmai Decoction, Renshen Yangrong Decoction and other TCM classic prescriptions can be used in clinic.

Objective:To analyze the epidemiological and clinical characteristics of respiratory syncytial virus (RSV) infection in children in Jiangsu Province from 2014 to 2023.Methods:The acute respiratory infection cases in children aged 0-14 years were selected from outpatient/emergency or inpatient departments in 2 surveillance sentinel hospitals, respectively, in Nanjing, Suzhou and Taizhou of Jiangsu from 1 July 2014 to 31 December 2023, and RSV nucleic acid test was conducted and the intensity of the RSV infection was accessed by WHO influenza epidemiological threshold method, and case information and clinical data were collected. χ2 test was used to compare the differences between groups, and the Bonferroni method was used for pairwise comparisons between groups. Results:In 4 946 cases of acute respiratory infections, the RSV positive rate was 8.21% (406/4 946), and the age M( Q1, Q3) of the cases was 1 (0, 3) years. The RSV positive rate was 10.92% (258/2 362) during 2014-2019 and 6.06% (118/1 948) during 2019-2023, the difference was significant ( χ2=31.74, P<0.001). RSV infection mainly occurred from October to March during 2014-2019, with the incidence peak in December and moderate or higher intensity. The seasonality of RSV infection was not obvious during 2019-2023, with low intensity. The RSV positive rate was highest in children in age group 0- years (17.85%, 151/846), and the positive rate declined gradually with age ( χ2=184.51, P<0.001). The RSV positive rate was higher in inpatient cases (9.84%, 244/2 480) than in outpatient/emergency cases (6.57%, 162/2 466) ( χ2=17.54, P<0.001). In the 155 RSV infection cases with complete clinical data, the clinical symptoms mainly included cough (99.35%, 154/155), fever (55.48%, 86/155), and shortness of breath (45.16%, 70/155). In the cases aged <6 months, the proportion of those with fever was low, but the proportion of those with shortness of breath, transferred to intensive care units, and receiving oxygen therapy were higher (all P<0.05). Children aged <6 months and those with underlying diseases were more likely to have severe RSV infection (all P<0.05). Conclusions:RSV infection in children in Jiangsu Province showed seasonal prevalence in winter from 2014 to 2019. Since 2020, the seasonal characteristics of the epidemic have changed, the epidemic period has been dispersed and the epidemic intensity has decreased. Infants <1 year old were at high risk for RSV infection, and those <6 months old and with underlying diseases might have severe infection.

Objective:To establish and verify a nomogram model based on MRI liver imaging reporting and data system (LI-RADS) features for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC) following the Milan criteria.Methods:A retrospective analysis was conducted on data from 118 HCC patients (121 lesions) confirmed by pathology from June 2016 to June 2022 at the Third Affiliated Hospital of Soochow University. Forty-seven HCCs were diagnosed as MVI-positive and 74 HCCs as MVI-negative. The data was randomly divided into the training set (83 patients with 84 HCCs, including 31 MVI-positive and 53 MVI-negative HCCs) and the test set (35 patients with 37 HCCs, including 16 MVI-positive and 21 MVI-negative HCCs) using cross-validation method. HCC imaging features were evaluated based on LI-RADS (version 2018). In the training set, the χ 2 test was used to compare the differences in LI-RADS features between the MVI-positive group and the MVI-negative group. The logistic regression analysis was conducted to identify independent risk factors for predicting MVI-positive and to construct the nomogram model. The receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were used to evaluate the performance and clinical benefits of the nomogram model in predicting MVI tumors. Results:There were statistically significant differences between the MVI-positive group and the MVI-negative group in terms of tumor size, tumor margin, mosaic architecture, and corona enhancement ( P<0.05). Multivariate logistic analysis results showed that HCC maximum diameter>3 cm (OR=1.427, 95%CI 1.314-12.227, P=0.009), nonsmooth tumor margin (OR=3.167, 95%CI 1.227-461.232, P=0.041), mosaic architecture (OR=1.769, 95%CI 1.812-61.434, P=0.022), and corona enhancement (OR=4.015, 95%CI 3.327-836.384, P=0.011) were independent risk factors for predicting MVI-positive tumors. Based on the independent predictors, the constructed nomogram model demonstrated an area under the ROC curve of 0.863 (95%CI 0.768-0.947) and 0.887 (95%CI 0.804-0.987) in the training and test sets for predicting MVI tumors, respectively. DCA showed that the curve of the nomogram model was consistently above the treat-all and treat-none strategies across all reasonable threshold probabilities in the training set, indicating that patients could obtain clinical benefits from the model. Conclusions:The preoperative nomogram model based on MRI LI-RADS features can effectively predict MVI in HCC following the Milan criteria, which could benefit the patients.

Objective:To explore the value of proton density fat fraction(PDFF) based on histogram analysis for quantification hepatic steatosis and fibrosis in rabbit model and the interference of hepatic fibrosis to the evaluation of hepatic steatosis with PDFF.Methods:From March to November 2020, 135 New Zealand white rabbits were randomly divided into control group ( n=30) and experimental group ( n=105) using a random number table. The volume ratio of CCl 4 and olive oil was 1∶1 to prepare 50% CCl 4 oil solution, and experimental rabbits were subcutaneously injected with the oil solution. An equal dose of normal saline was subcutaneously injected for control group rabbits. At the end of the 4 th, 8 th, and 12 th week, 35 in the experimental group and 10 rabbits in the control group were randomly selected to conduct the mDixon-Quant scanning, and histogram analysis of PDFF was analyzed including volume, mean, median, standard deviation, 25 th, 50 th, 75 th, 90 th quantile, skewness, kurtosis, entropy and inhomogeneity. After the examination, the rabbits were sacrificed and the liver percentage of steatosis (PSH) and fibrosis (POF) were recorded by semi-quantitative analysis. Spearman correlation analysis was used to correlate PDFF with PSH and POF. Multiple linear regression analysis was used to determine independent PDFF histogram parameters for evaluating PSH and POF. A receiver operator characteristic (ROC) curve was used to assess the diagnostic accuracy of PDFF for discriminating mild from moderate-severe hepatic steatosis and mild from moderate-severe hepatic fibrosis with median of PSH or POF for dichotomy, and DeLong test was used to compare the area under the curve (AUC). With the correction of hepatic fibrosis, correlation coefficient and AUC were compared of PDFF for discrimination mild from moderate-severe hepatic steatosis. Results:The PDFF mean, median, standard deviation, 75 th, 90 th showed correlation with PSH ( r=0.558, 0.522, 0.319, 0.723, 0.646, -0.589, all P<0.05). The entropy and 75 th were independent parameters for evaluating PSH (β=2.347, -5.960, P=0.018, 0.001). The PDFF 75 th was the optimal parameter for discriminating mild from moderate-severe hepatic steatosis with AUC=0.915 ( P=0.001). The PDFF volume, mean, median, standard deviation, 75 th, 90 th, entropy showed correlation with POF ( r=0.355, 0.393, 0.376, 0.298, 0.485, 0.426, -0.681, all P<0.05). The entropy, standard deviation and volume (β=-11.041, 1.356, 0.190, P=0.001, 0.026, 0.016) were independent parameters for evaluation of hepatic fibrosis, and the entropy was the optimal parameter for hepatic fibrosis (AUC=0.771, P=0.001). The correlation between PSH and PDFF 75 th was less pronounced when fibrosis was present ( r=0.512, P=0.001) than when fibrosis was absent ( r=0.751, P=0.002). The PDFF 75 th showed a significant difference in discriminating mild hepatic steatosis from moderate-severe hepatic steatosis after correction of POF (AUC=0.895, 0.950, Z=2.970, P=0.025). Conclusions:PDFF based on histogram analysis provided a noninvasive, accurate estimation of quantification for hepatic steatosis and fibrosis. Hepatic fibrosis reduced the correlation between hepatic steatosis and PDFF and the presence of hepatic fibrosis can confound the quantification of hepatic steatosis with PDFF.

Objective:To compare the diagnostic efficacy of MR elastography (MRE), Gd-EOB-DTPA dynamic contrast-enhanced MRI (DCE-MRI) in early quantitative evaluation of liver fibrosis (LF) staging of experimental rabbits.Methods:From April to December 2019, 200 healthy rabbits were randomly divided into LF group ( n=160) and control group ( n=40). LF group were injected subcutaneously with 50% CCl 4 oil solution, while control group were injected with normal saline solution. The LF group ( n=40) and control group ( n=10) were randomly selected at the end of the 4th, 8th, 12th and 16th weeks respectively to undergo axial MRI scan including MRE and Gd-EOB-DTPA DCE-MRI. The quantitative parameter values were obtained, including liver stiffness (LS), volume transfer constant (K trans), reflux rate constant (K ep), volume fraction of extravascular extracellular space (V e) and volume fraction of plasma (V p). Histopathological LF staging was based on Scheuer staging. One-way ANOVA analysis was used to evaluate the differences of LS, K trans, K ep, V e and V p among different LF stages. The Spearman correlation analysis was used to evaluate the correlations between pathological LF staging and quantitative parameter values. The ROC curve was used to compare the diagnositic performance of all quantitative parameter values. Results:Among the final qualified 150 rabbits, there were 32 in F0, 32 in F1, 35 in F2, 30 in F3, 21 in F4. Significant differences of LS, K trans, K ep, V e and V p were found among different LF stages. There was correlation between LS, K trans, K ep and LF stages ( r=0.832, 0.730, -0.617, all P<0.001), respectively. However, no statistically correlation was found between V e, V p and LF stages ( r=-0.074, P=0.367; r=-0.078, P=0.342). The area under the ROC curve (AUCs) of LS were the greatest (0.920 for F0 vs F1-F4, 0.900 for F0 vs F1-F2, 0.945 for F0 vs F3-F4, 0.926 for F1-F2 vs F3-F4), while the AUCs of K trans were 0.897, 0.863, 0.942, 0.809, respectively. Conclusion:The early quantitative diagnostic efficacy for LF staging by MRE was superior to Gd-EOB-DTPA DCE-MRI in rabbits.

Objective To assess diagnostic performance of multi?parametric MRI including MR elastography (MRE), susceptibility?weighted imaging (SWI) and T1ρ imaging in detecting the early stage of liver fibrosis (LF). Methods Eighty healthy rabbits were randomly divided into LF group (n=60) and control group (n=20). The LF group (n=12) and control group (n=5) were randomly selected at the end of the 4th, 5th, 6th, 15th week after injection of 50% CCl4 oil solution, respectively. All rabbits underwent 3.0 T MRI scans and histopathological Scheuer staging. Differences between groups were examined using one?way analysis of variance with Dunnett's T3 test. Spearman correlation was used to analyze the correlation between liver stiffness (LS), liver?to?muscle SI ratio (SIR), T1ρ value in different LF stages. ROC curve analysis was used to assess the diagnostic performance. Results Fifty?five rabbits were included in our study, which covered F0 (n=14), F1 (n=11), F2 (n=10), F3 (n=9) and F4 (n=11). Significant differences of all characteristic values were found among different LF stages (P<0.05).There were significant differences in LS values between F0 and F2, F3, F4, respectively; F1 and F3, F4, respectively; F2 and F4; F3 and F4 (P<0.05). There were significant differences in SIR between F0 and F2, F3, F4, respectively; F1 and F2, F3, F4, respectively; F2 and F4 (P<0.05). T1ρ value showed significant differences between F0, F1, F2, F3 and F4, respectively (P<0.05). LS, SIR, and T1ρ values were correlated with LF stage (r=0.910, -0.808, 0.512, respectively, P<0.01). The area under curve (AUC) for LS value were greater than those for the other two methods (0.953 for≥F1, 0.949 for≥F2, 0.986 for≥F3, 0.979 for F4). The AUCs of the combination of MRE and SWI for detecting≥F1 was 0.965, for≥F2 was 0.983, for≥F3 was 0.991, and for F4 was 0.950. Combining all three MR methods showed the highest diagnostic performance for staging LF with AUCs of 0.969, 0.985, 0.996 and 1.000.Conclusion MRE is the most prominent MRI method, and combination of MRE and SWI show higher diagnostic performance than the others for staging LF; however, combining all three MR methods exhibits the most excellent diagnostic efficacy.

Objective: To assess diagnostic performance of multi-parametric MRI including MR elastography (MRE), susceptibility-weighted imaging (SWI) and T₁ρ imaging in detecting the early stage of liver fibrosis (LF). Methods: Eighty healthy rabbits were randomly divided into LF group (n=60) and control group (n=20). The LF group (n=12) and control group (n=5) were randomly selected at the end of the 4^th, 5^th, 6^th, 15^th week after injection of 50% CCl₄ oil solution, respectively. All rabbits underwent 3.0 T MRI scans and histopathological Scheuer staging. Differences between groups were examined using one-way analysis of variance with Dunnett's T3 test. Spearman correlation was used to analyze the correlation between liver stiffness (LS), liver-to-muscle SI ratio (SIR), T₁ρ value in different LF stages. ROC curve analysis was used to assess the diagnostic performance. Results: Fifty-five rabbits were included in our study, which covered F0 (n=14), F1 (n=11), F2 (n=10), F3 (n=9) and F4 (n=11). Significant differences of all characteristic values were found among different LF stages (P<0.05).There were significant differences in LS values between F0 and F2, F3, F4, respectively; F1 and F3, F4, respectively; F2 and F4; F3 and F4 (P<0.05). There were significant differences in SIR between F0 and F2, F3, F4, respectively; F1 and F2, F3, F4, respectively; F2 and F4 (P<0.05). T₁ρ value showed significant differences between F0, F1, F2, F3 and F4, respectively (P<0.05). LS, SIR, and T₁ρ values were correlated with LF stage (r=0.910, -0.808, 0.512, respectively, P<0.01). The area under curve (AUC) for LS value were greater than those for the other two methods (0.953 for≥F1, 0.949 for≥F2, 0.986 for≥F3, 0.979 for F4). The AUCs of the combination of MRE and SWI for detecting≥F1 was 0.965, for≥F2 was 0.983, for≥F3 was 0.991, and for F4 was 0.950. Combining all three MR methods showed the highest diagnostic performance for staging LF with AUCs of 0.969, 0.985, 0.996 and 1.000. Conclusion MRE is the most prominent MRI method, and combination of MRE and SWI show higher diagnostic performance than the others for staging LF; however, combining all three MR methods exhibits the most excellent diagnostic efficacy.

Objective To investigate the value of susceptibility weighted imaging (SWI) with T1ρimaging in staging of hepatic fibrosis(HF) in rabbits. Methods Eighty selected white rabbits from New Zealand were randomly divided into the HF group (n=60) and the control group (n=20). Rabbits in the HF group were injected subcutaneously with 50％CCl4 oil solution to establish HF model,and the normal control rabbits were injected with saline solution subcutaneously.The HF group(n=15) and control group(n=5) were randomly selected at the 4th, 5th, 6th and 10th week after injection, to undergo liver MR scan. The liver signal intensity (SI liver), the muscle signal intensity (SI muscle),liver-to-muscle SI ratios (SIR) and liver T1ρvalues were measured. Scheuer was adopted to stage the rabbits in HF. One-way analysis of variance was used to compare the differences between SIR and T1ρ values in different stages of HF pathological. Spearman correlation was used to analyze the correlation between SIR and T1ρ values in the different stage of HF pathological.The ROC were used to compare the efficacy between SIR and T1ρvalues in the diagnosis of HF pathological stage. Results Among the final qualified 68 rabbits in the study, 17 in F0 phase, 11 in F1 phase, 16 in F2 phase, 11 in F3 phase, and 13 in F4 phase. The SIR were (0.977 ± 0.013), (0.960 ± 0.015), (0.802 ± 0.026), (0.786 ± 0.022), (0.541 ± 0.116); T1ρ values were (22.301 ± 1.849), (24.034 ± 0.867), (25.374 ± 1.309),(25.364±1.945),(30.948±2.925) ms.There were statistically significant in SIR between F0 and F2,F0 and F3, F0 and F4, F1 and F2, F1 and F3, F1 and F4, F2 and F4, F3 and F4 (P<0.01). There were statistically significant in T1ρvalues between F0 and F1,F0 and F2,F0 and F3,F0 and F4,F1 and F2,F1 and F4,F2 and F4, F3 and F4(P<0.05). SIR were negatively correlated with HF staging while T1ρ values were positively. ROC showed that the AUC of the T1ρvalues was slightly larger than SIR in the F4 group(0.992>0.966),and the AUC of the SIR was greater than T1ρvalues in the other groups. Conclusion SWI and T1ρvalues can provide an important objective basis in staging of HF. Both of them have great clinical application prospects but SIR diagnostic efficiency is slightly better than that of T1ρvalues.