AIM:To investigate the effects of modified Danggui Yinzi decoction combined with diclofenac sodium eye drops on tear film stability and tear protein levels in patients with allergic conjunctivitis.METHODS:Prospective study. Patients with allergic conjunctivitis who attended Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2021 to August 2024 were enrolled as study subjects. They were divided into two groups based on their treatment regimen: a control group(treated with diclofenac sodium eye drops alone)and an observation group(treated with modified Danggui Yinzi decoction combined with diclofenac sodium eye drops). Propensity score matching was used to balance baseline characteristics between the two groups. Log-binomial regression was performed to estimate the risk of adverse reactions. Repeated-measures analysis of variance(ANOVA)was used to assess tear film stability indicators. A difference-in-differences(DID)model was employed to assess the net effect of the combined therapy on changes in tear protein levels.RESULTS:After propensity score matching, a total of 172 patients(344 eyes)were finally enrolled, with 86 patients(172 eyes)in each of the control and observation groups. In the control group, there were 51 males and 35 females, with a mean age of 35.91±10.10 y; in the observation group, there were 49 males and 37 females, with a mean age of 37.87±8.09 y. After treatment, symptom scores decreased in both groups compared with baseline(all P<0.05). At 2 and 4 wk after treatment, symptom scores in the observation group were significantly lower than those in the control group(all P<0.05). The overall response rate was significantly higher in the observation group(89.5%)than in the control group(77.9%)(P<0.05), while the incidence of total adverse reactions was significantly lower in the observation group(7.0%)than in the control group(36.0%)(RR=0.133, P<0.001). Compared with baseline, both groups showed increases in BUT and SⅠt, and a decrease in FL score at 2 and 4 wk after treatment(P<0.017). At 2 and 4 wk after treatment, the BUT and SⅠt levels in the observation group were higher than those in the control group, and the FL score was significantly lower(all P<0.05). The DID model showed that the observation group had greater increases than the control group in lactoferrin(0.411 g/L), total protein(2.792 g/L), secretory immunoglobulin A(14.610 mg/L), and lysozyme(0.419 g/L), respectively(all P<0.05), and these differences remained significant after adjusting for covariates.CONCLUSION:Modified Danggui Yinzi decoction combined with diclofenac sodium eye drops significantly improves tear film stability indicators and tear protein levels in patients with allergic conjunctivitis, and its therapeutic efficacy is superior to that of diclofenac sodium eye drops alone.

Objective:To investigate the feasibility of ultra-low dose (ULD) CT pulmonary angiography (CTPA) combined with deep learning reconstruction (DLR) in the diagnosis of pulmonary embolism (PE).Methods:This cross-sectional study prospectively enrolled 100 patients with suspected PE who underwent CTPA examination in Zhongshan Hospital Fudan University, and Shanghai Geriatric Medical Center from April to July 2024, and were randomly divided into the routine dose (RD) group and ULD group according to block randomization. Effective dose (ED) were calculated. The noise index of RD group and ULD group was set to 10 and 20, respectively. Other scanning parameters and contrast agent injection protocol were the same. The CT images of RD group were reconstructed using hybrid iterative reconstruction (HIR), while ULD images were reconstructed with HIR and DLR (ULD-HIR subgroup and ULD-DLR subgroup). The image quality of the three groups of images was subjectively evaluated (overall image noise, pulmonary artery display) and objectively evaluated [signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) of the images] respectively. Finally, the diagnostic results of PE by the expert committee composed of three chief physicians were taken as the gold standard, and one physician with lower qualifications independently evaluated the diagnostic rate of PE in the three groups of images. Objective image quality parameters across the three groups were compared using ANOVA, with LSD post hoc test was used for multiple comparisons. Subjective scores among the three groups were analyzed using the Kruskal-Wallis H test, with Bonferroni corrected pairwise post hoc test was applied for multiple pairwise comparisons. Results:The ED in the RD group and ULD group were (2.7±0.5) mSv and (0.7±0.2) mSv, respectively, and the differences were statistically significant ( t=26.42, P<0.001). The overall differences in CT values of pulmonary arteries at all levels in the images of the RD group, the ULD-HIR subgroup, and the ULD-DLR subgroup were not statistically significant ( P>0.05).The RD group, ULD-HIR subgroup and ULD-DLR subgroup overall differences in SNR and CNR at all levels pulmonary arteries were statistically significant ( P<0.001), in which except for the differences in CNR and SNR values of the left pulmonary arterial trunk in the RD group and the ULD-HIR subgroup, and SNR values of basal segment pulmonary artery of the lower lobe of the left lung, which were not statistically significant ( P>0.05), the differences of the rest of the indexes in the pairwise comparisons between the groups were statistically significant ( P<0.05). The overall differences in the subjective scores of image pulmonary vascular display and image noise in the RD group, ULD-HIR subgroup and ULD-DLR subgroup were statistically significant ( P<0.001), except that the differences in the subjective scores of image pulmonary vascular display in the ULD-DLR subgroup were not statistically significant when compared with that of the RD group ( P>0.05) and that of the rest of the metrics in the between-groups two-by-two comparisons were all statistically significant ( P<0.05). The difference in diagnostic rates of PE in the pulmonary artery trunk, lobe and segmental levels in the images of the RD group, ULD-HIR subgroup and ULD-DLR subgroup was not statistically significant ( P>0.05). Conclusions:DLR can significantly reduce the radiation dose of CTPA examination. Even at ultra-low radiation dose, its image quality is still better than HIR reconstruction at conventional doses and preserve diagnostic accuracy of PE at the lobe level and segment level.

Objective:To evaluate alterations in dopaminergic neurons, cortical metabolism, and functional connectivity networks in patients with early-onset Parkinson′s disease (EOPD) using multimodal neuroimaging.Methods:In this prospective cross-sectional study, 26 patients with EOPD and 16 healthy controls (HC group) were recruited from the PLA General Hospital between April and November 2023. All participants underwent integrated 11C-β-CFT PET/MR, 18F-FDG PET/CT brain imaging and resting-state functional MRI. Clinical assessments were conducted using the Unified Parkinson′s Disease Rating Scale and Hoehn-Yahr staging. Cognitive status was evaluated using the Mini-Mental State Examination and Montreal Cognitive Assessment. Standardized uptake value ratios for both 11C-β-CFT and 18F-FDG PET images were calculated using cerebellar gray matter as the reference region. Voxel-wise two-sample t-tests were performed to identify regions with significant group differences in tracer uptake. Seed regions showing altered 11C-β-CFT or 18F-FDG uptake were used to compute seed-based functional connectivity (FC) with all other brain voxels, and group differences in FC were assessed. Correlations between imaging metrics and clinical scales were evaluated using Pearson or Spearman analyses as appropriate. Results:Compared with HC group, EOPD group showed significantly reduced 11C-β-CFT uptake in the bilateral putamen, globus pallidus, and left temporal pole ( P<0.05), and decreased 18F-FDG uptake in the right superior frontal gyrus and anterior cingulate cortex ( P<0.05). Relative to HC group, EOPD group exhibited markedly lower FC between the right putamen and the left gyrus rectus as well as the right parahippocampal gyrus; the right superior frontal gyrus and the left gyrus rectus; the anterior cingulate cortex and the olfactory area of the frontal lobe, the left gyrus rectus, and the right superior parietal gyrus; the left temporal pole and the left orbitofrontal cortex as well as the left olfactory area ( P<0.05). Correlation analyses revealed no statistically significant associations between altered FC values and clinical scale scores in the EOPD group. Conclusions:Patients with EOPD demonstrate impaired nigrostriatal dopaminergic function, regional cortical hypometabolism, and aberrant functional connectivity across multiple brain networks.

Objective:To analyze the differentially diagnostic ability of metabolic parameters of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography(18F-FDG PET/CT)in thymic epithelial tumors(TETs)of different histological types.Methods:A total of 72 patients who underwent 18F-FDG PET/CT examination and were confirmed as TETs before treatment at the Department of Nuclear Medicine of the First Medical Center of Chinese PLA General Hospital between January 2013 to May 2022 were analyzed.The patients were divided into thymic tumor with low risk group(9 cases),thymic tumor with high risk group(15 cases)and thymic cancer group(9 cases)according to histological type.The clinical data of patients were recorded,and the patients were staged according to pathological Masaoka-Koga staging of thymic tumor surgery.The maximum standardized uptake value(SUVmax),average standardized uptake value(SUVmean),metabolic tumor volume(MTV),total lesion glycolysis(TLG)and standardized uptake value ratio(SUVR)of the lesions were recorded respectively.The differences of metabolic parameters of various group were compared.The area under curve(AUC)value of receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of 18F-FDG PET/CT in TETs of different histological types.Results:The results of analyzing each metabolic parameter of three groups indicated that the SUVmax,SUVmean and SUVR values of thymic tumor with high risk group and thymic cancer group were significantly higher than them of thymic tumor with low risk group,and the differences were significant(F=10.315,8.336,11.593,P<0.05),respectively.SUVR has the highest diagnostic efficacy in the differential diagnosis for thymic tumor and thymic cancer(AUC:0.864,sensitivity:83.3%,specificity:75.0%),and for thymic tumor with high-risk and thymic cancer(AUC:0.832,sensitivity:56.3%,specificity:100.0%).In addition,SUVR has the highest diagnostic efficacy for thymic tumor with high-risk and thymic tumor with low-risk(AUC:0.748,sensitivity:80.0%,specificity:66.7%).Conclusion:The metabolic parameters of 18F-FDG PET/CT have a certain of differential and diagnostic value in identifying TETs of different histological types.

Objective:To separate and purify the polysaccharides from Polygonatum filipes,characterize their primary structure and investigate the immunomodulatory effects on RAW264.7 macrophages.Methods:Crude polysaccharides from Polygonatum filipes were extracted by ultrasound assisted method,then Polygonatum filipes polysaccharides(CSPFPs)were obtained after elimination of the proteins with combined papain-Sevag method.The total sugar content was determined by phenol-sulfuric acid method.Structures of CSPFPs were analyzed by fourier transform infrared spectroscopy(FT-IR),high performance gel permeation chromatography(HPGPC)and high performance liquid chromatography(HPLC).Effects of CSPFPs on cell viability,pinocytic activity,TNF-α secretion,MAPK and NF-κB signaling pathways of RAW264.7 cells were explored by MTT,Neutral red,ELISA and Western blot,respectively.Results:Extraction rate of CSPFPs by ultrasound-assisted method was 41.61%,which contained total sugar content of 94.00%.CSPFPs with Mw of 3 125 Da was composed of arabinose(1.85%),galactose(6.14%),glucose(56.41%)and mannose(35.60%).The in vitro experiments showed that CSPFPs were non-cytotoxic and enhanced the pinocytic activity,TNF-α secretion and phosphorylation levels of p38,ERK,JNK,p65,IκB and IKK,indicating the activation of MAPK and NF-κB signaling pathways under the concentra-tion of 2.5～200 μg/ml.Conclusion:The ultrasound-assisted method can efficiently isolate CSPFPs with immunomodulatory activity,which provides basic data for the development and application of CSPFPs as an immunostimulant.

Objective To explore the effects of commonly used rapid imaging techniques on the image quality of cerebral three-dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA)and to select the optimal imaging technique for clinical use.Methods Thirty subjects were prospectively recruited,and five sets of 3D-TOF-MRA images were acquired as follows:non-acceleration(reference group),intra-layer parallel imaging(PI)(1D group),inter-layer PI(2D group),compressed sensing(CS)group,and artificial intelligence-assisted compressive sensing(ACS)group.The metrics including clarity,pseudo-stenosis,signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR),and edge sharpness of the intracranial proximal,middle,and distal blood vessels were quantitatively or qualitatively assessed.Results There were no significant differences in the clarity of intracranial proximal and middle blood vessels between the groups(P＞0.05).The clarity of distal blood vessels in the ACS group was superior to that in the other groups,and the CS and 2D groups were superior to the 1D group.Compared to the reference group,no stenosis was observed in any segment of the blood vessels in the ACS group,while the incidence of stenosis in the distal blood vessels of the 1D,2D,and CS groups was 36.67％,13.33％,and 6.67％,respectively.The SNR of the proximal and middle blood vessels in the ACS group did not differ from the reference group,and the SNR of the proximal,middle,and distal segments was higher than that in the 1D and CS groups,and higher than the 2D group for the proximal and distal segments.The CNR of the proximal,middle,and distal segments in the ACS group did not differ from the reference group,and was higher than that of the 1D and CS groups,and higher than the 2D group for the proximal and distal segments.The edge sharpness of the ACS group was significantly higher than that of the other groups.Conclusion ACS technology can accelerate the imaging speed and improve the image quality of cerebral 3D-TOF-MRA.It is recommended for use.

Functional constipation（FC）refers to constipation that is not caused by organic diseases of the intestines or systemic conditions，nor by medication-related factors. It is typically characterized by a prolonged course and a tendency for symptoms to recur. When constipation symptoms persist despite standardized treatment and significantly impact daily life，it may be termed refractory FC. In recent years，some novel treatment approaches for refractory FC have begun to be applied in children. These include new medications such as prucalopride，lubiprostone，and linaclotide，as well as fecal microbiota transplantation（FMT），neuromodulation，biofeedback therapy，and antegrade continence enema（ACE）. This article reviews the current advances in the treatment of refractory FC in children，aiming to provide insights and directions for the application of new therapeutic methods in clinical practice in the future.

Objective To explore the risk factors for postoperative bleeding after endoscopic resection of gastric gastrointestinal stromal tumor(gGIST)and to construct prediction models using 4 different machine learning algorithms for accurately predicting postoperative bleeding.Methods The clinical data of gGIST patients were collected,and the patients were randomly divided into a training cohort(n=502)and a validation cohort(n=130)at an 8:2 ratio.Synthetic minority over-sampling technique-nominal continuous was used for oversampling in the training cohort.Four prediction models were constructed using gradient boost machine(GBM),deep learning,generalized linear model and distributed random forest,separately;and in addition,the least absolute shrinkage and selection operator was used to screen variables and construct a traditional Logistic regression model.Model performance was evaluated by calculating the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,accuracy,positive predictive value and negative predictive value.Interpretability analyses,including feature importance,SHapley additive exPlanation and force plot,were performed on the optimal model,and a practically applicable web application was developed.Results Among 632 patients,78(12.3%)experienced postoperative bleeding.In the validation cohort,GBM model performed best among 5 prediction models,with an AUC value of 0.889 and a 95%CI of 0.829-0.948,superior to the other 4 models.Variable importance analysis identified surgeon experience,operation time,intraoperative hemorrhage,tumor size as the factors affecting postoperative bleeding prediction.The SHapley additive exPlanation plot and force plot showed the distribution characteristics of variables in the binary classification prediction results and the effect of each variable on the prediction results.Conclusion GBM model has high predictive value for postoperative bleeding following endoscopic resection of gGIST,and the construction of the web application facilitates its clinical use.

Objective To construct a classification model for the Los Angeles grading of endoscopic reflux esophagitis based on the SimCLR algorithm's semi-supervised learning framework.Methods The designed learning framework was pre-trained on a large unlabeled dataset through self-supervised learning,and further finely tuned on a small labeled dataset according to the Los Angeles grading criteria.The performance test on the model was conducted on an independent dataset,and the proposed model was compared with the models of supervised learning algorithms and endoscopists in terms of accuracy,Matthews correlation coefficient,and Cohen's kappa value.Finally,Grad-CAM and t-SNE were used for the visualization of the model's interpretation.Results The SimCLR model with ResNet as the backbone network showed superior performance in accuracy(0.840),Matthews correlation coefficient(0.800),and Cohen's kappa value(0.960)than the traditional supervised learning model with ResNet as the backbone(0.680,0.601,and 0.870)as well as junior endoscopists(0.770,0.713,and 0.940),but there was still a slight gap compared with senior endoscopists(0.850,0.813,and 0.960).In addition,the results of t-SNE showed that self-supervised learning in SimCLR was more effective in clustering multi-dimensional samples than traditional supervised transfer learning.Conclusion Compared with traditional supervised learning methods,semi-supervised learning demonstrates outstanding performance even with only a small number of labeled endoscopic images.

Objective:X-linked non-syndromic hearing loss is an extremely rare type of hearing impairment. This study conducted a phenotypic and genetic analysis of a family with X-linked dominant inheritance to explore the causes of hearing loss. Methods:Clinical data were collected from a patient with non-syndromic hearing loss who visited the Otorhinolaryngology Department of the First Affiliated Hospital of Zhengzhou University in June 2023. Phenotypic and genetic analyses were performed on family members, including audiometric tests, whole-exome sequencing, and PCR-Sanger sequencing verification. Audiological assessments comprised pure-tone audiometry, impedance audiometry, auditory brainstem response, and otoacoustic emission tests. Results:The affected individuals in this pedigree have X-linked dominant non-syndromic deafness caused by mutations in the SMPX gene. The proband, along with their mother and maternal grandmother, exhibit varying degrees of sensorineural hearing loss. Whole-exome sequencing revealed a novel pathogenic variant, NM_014332.3: c. 133-2A>C, in the SMPX gene in the proband. Sanger sequencing confirmed that the proband, proband's mother, and grandmother all carried this pathogenic variant. Conclusion:This study reports a novel pathogenic variant in the SMPX gene, providing additional medical evidence for the diagnosis and treatment of X-linked dominant inherited non-syndromic hearing loss. It enriches the mutation spectrum of the SMPX gene.
Humans ; Pedigree ; Mutation ; Phenotype ; Male ; Hearing Loss, Sensorineural/genetics* ; Exome Sequencing ; Female ; Adult ; Hearing Loss/genetics* ; Evoked Potentials, Auditory, Brain Stem ; Muscle Proteins