Purpose To evaluate the diagnostic accuracy of low-iodine contrast subtraction CT pulmonary angiography(CTPA)combined with iodine maps for acute pulmonary embolism(APE),with a focus on detecting subsegmental emboli.Materials and Methods A retrospective analysis included 48 patients with suspected APE who underwent both pulmonary ventilation/perfusion SPECT/CT and low-iodine subtraction CTPA within one week in Beijing Hospital from September 1,2021 to September 1,2024.Using SPECT/CT as the reference standard,the diagnostic performance of subtraction CTPA with iodine maps was assessed.A retrospective review was performed to identify potential causes of false-positive and false-negative results.Results Subtraction CTPA with iodine maps demonstrated high diagnostic accuracy at the segmental and subsegmental pulmonary artery levels,with a sensitivity of 0.917 and specificity of 0.991.At the segmental level,the detection rate was 100%,while at the subsegmental level,it was 66.7%.The method showed consistently high diagnostic performance(83.3%-100%)across different clinical risk stratifications of APE.Retrospective review identified explicable causes for 85.7%(6/7)of false-positive and 33.3%(2/6)of false-negative cases.Conclusion Low-iodine subtraction CTPA combined with iodine maps exhibits robust diagnostic efficacy for APE.Accurate recognition of characteristic perfusion defects on iodine maps may further enhance diagnostic precision.

Microgravity-induced cardiac remodeling presents a substantial challenge that constrains the advancements in the international space industry,which mainly manifests as alterations in the morphology,structure,and function of the heart.This paper analyzed the core pathogenesis and treatment of microgravity-induced cardiac remodeling based on the theory of"yang transforming qi and yin forming shape"in Huangdi Neijing."Yang transforming qi"reflects the changes in cardiac function,whereas"yin forming shape"reflects the changes in cardiac morphology and structure.Based on the basic and clinical research of space cardiac dysfunctions,the core pathogenesis of microgravity-induced cardiac remodeling is the insufficiency of"yang transforming qi",accompanied by yin excess and yang deficiency due to excessive"yin forming shape"in the early stage,which evolves into deficiency of both yin and yang in the late stage.Thus,this paper specifically refined the treatment methods and corresponding formulas,including warming viscera yang to transform qi,draining yin blood to restore yang qi,and consolidating yin and yang to nourish primal energy.These insights provide systematic theoretical support and conceptual inspiration for the traditional Chinese medicine treatment of microgravity-induced cardiac remodeling.

Objective:To investigate the effects of low tube voltage, automatic tube current modulation technology combined with noise index(NI), and forward projected model-based iterative reconstruction solution(FIRST)on radiation dose and image quality in low iodine contrast agent CT pulmonary angiography(CTPA)among elderly patients.Methods:This retrospective study continuously collected imaging and clinical data from elderly patients suspected of having acute pulmonary embolism (APE)who underwent low-iodine contrast CTPA at the emergency department and inpatient department of Beijing Hospital from February 2022 to July 2023.A total of 80 patients were included in the study.Based on the reconstruction algorithm utilized during the CTPA examination, the patients were divided into two groups: the adaptive iterative dose reduction using three-dimensional processing(AIDR 3D)group and the FIRST group, with 40 cases in each group.We measured the average CT value and noise value of the pulmonary artery at various positions in both groups on axial images, calculated the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR), and recorded the average tube current and effective radiation dose for both patient groups.Two observers independently performed subjective scoring on the display of the pulmonary artery in each group using a blind method.Results:There were no statistically significant differences in age, body mass index (BMI), gender, and the extent of pulmonary embolism between the AIDR 3D group and the FIRST group (all P>0.05).In comparison to the AIDR 3D group, the FIRST group exhibited a significantly lower tube current[(220.2±84.5) mA vs.(264.1±81.2) mA, t=0.463, P=0.020], resulting in an effective radiation dose reduction of 15.7%[(1.39±0.49) mSv vs.(1.65±0.41) mSv, t=0.072, P=0.043].No statistically significant differences were observed in the mean CT values, noise values, and SNR values of the main pulmonary artery, left and right pulmonary trunks, and lobar and segmental pulmonary arteries between the AIDR 3D group and the FIRST group (all P>0.05).The CNR of the AIDR 3D group was lower than that of the FIRST group in both the left and right segmental pulmonary arteries( Z=-2.473, -1.973; P=0.013, 0.049), while no significant differences were found in the other pulmonary arteries(all P>0.05).In patients with normal BMI, the FIRST group demonstrated higher CNR values in both the left and right segmental pulmonary arteries compared to the AIDR 3D group( Z=-2.008, -2.662, P=0.046, 0.007), whereas the improvement in CNR was not significant in overweight and obese patients(all P>0.05).The two radiologists provided consistent subjective evaluations in scoring(Kappa=0.744, P<0.001), and there was no statistically significant difference in subjective scores between the AIDR 3D group and the FIRST group ( χ2=0.346, P=0.770). Conclusions:The imaging technique that integrates automatic tube current modulation technology with NI, the FIRST reconstruction algorithm, and a low tube voltage of 100 kVp effectively ensures image quality by providing clear visualization of pulmonary arteries at all levels.Moreover, it reduces radiation dose during low-iodine contrast agent CTPA examinations in elderly patients with APE.

Microgravity-induced cardiac remodeling presents a substantial challenge that constrains the advancements in the international space industry,which mainly manifests as alterations in the morphology,structure,and function of the heart.This paper analyzed the core pathogenesis and treatment of microgravity-induced cardiac remodeling based on the theory of"yang transforming qi and yin forming shape"in Huangdi Neijing."Yang transforming qi"reflects the changes in cardiac function,whereas"yin forming shape"reflects the changes in cardiac morphology and structure.Based on the basic and clinical research of space cardiac dysfunctions,the core pathogenesis of microgravity-induced cardiac remodeling is the insufficiency of"yang transforming qi",accompanied by yin excess and yang deficiency due to excessive"yin forming shape"in the early stage,which evolves into deficiency of both yin and yang in the late stage.Thus,this paper specifically refined the treatment methods and corresponding formulas,including warming viscera yang to transform qi,draining yin blood to restore yang qi,and consolidating yin and yang to nourish primal energy.These insights provide systematic theoretical support and conceptual inspiration for the traditional Chinese medicine treatment of microgravity-induced cardiac remodeling.

Purpose To evaluate the diagnostic accuracy of low-iodine contrast subtraction CT pulmonary angiography(CTPA)combined with iodine maps for acute pulmonary embolism(APE),with a focus on detecting subsegmental emboli.Materials and Methods A retrospective analysis included 48 patients with suspected APE who underwent both pulmonary ventilation/perfusion SPECT/CT and low-iodine subtraction CTPA within one week in Beijing Hospital from September 1,2021 to September 1,2024.Using SPECT/CT as the reference standard,the diagnostic performance of subtraction CTPA with iodine maps was assessed.A retrospective review was performed to identify potential causes of false-positive and false-negative results.Results Subtraction CTPA with iodine maps demonstrated high diagnostic accuracy at the segmental and subsegmental pulmonary artery levels,with a sensitivity of 0.917 and specificity of 0.991.At the segmental level,the detection rate was 100%,while at the subsegmental level,it was 66.7%.The method showed consistently high diagnostic performance(83.3%-100%)across different clinical risk stratifications of APE.Retrospective review identified explicable causes for 85.7%(6/7)of false-positive and 33.3%(2/6)of false-negative cases.Conclusion Low-iodine subtraction CTPA combined with iodine maps exhibits robust diagnostic efficacy for APE.Accurate recognition of characteristic perfusion defects on iodine maps may further enhance diagnostic precision.

Objective:To investigate the effects of low tube voltage, automatic tube current modulation technology combined with noise index(NI), and forward projected model-based iterative reconstruction solution(FIRST)on radiation dose and image quality in low iodine contrast agent CT pulmonary angiography(CTPA)among elderly patients.Methods:This retrospective study continuously collected imaging and clinical data from elderly patients suspected of having acute pulmonary embolism (APE)who underwent low-iodine contrast CTPA at the emergency department and inpatient department of Beijing Hospital from February 2022 to July 2023.A total of 80 patients were included in the study.Based on the reconstruction algorithm utilized during the CTPA examination, the patients were divided into two groups: the adaptive iterative dose reduction using three-dimensional processing(AIDR 3D)group and the FIRST group, with 40 cases in each group.We measured the average CT value and noise value of the pulmonary artery at various positions in both groups on axial images, calculated the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR), and recorded the average tube current and effective radiation dose for both patient groups.Two observers independently performed subjective scoring on the display of the pulmonary artery in each group using a blind method.Results:There were no statistically significant differences in age, body mass index (BMI), gender, and the extent of pulmonary embolism between the AIDR 3D group and the FIRST group (all P>0.05).In comparison to the AIDR 3D group, the FIRST group exhibited a significantly lower tube current[(220.2±84.5) mA vs.(264.1±81.2) mA, t=0.463, P=0.020], resulting in an effective radiation dose reduction of 15.7%[(1.39±0.49) mSv vs.(1.65±0.41) mSv, t=0.072, P=0.043].No statistically significant differences were observed in the mean CT values, noise values, and SNR values of the main pulmonary artery, left and right pulmonary trunks, and lobar and segmental pulmonary arteries between the AIDR 3D group and the FIRST group (all P>0.05).The CNR of the AIDR 3D group was lower than that of the FIRST group in both the left and right segmental pulmonary arteries( Z=-2.473, -1.973; P=0.013, 0.049), while no significant differences were found in the other pulmonary arteries(all P>0.05).In patients with normal BMI, the FIRST group demonstrated higher CNR values in both the left and right segmental pulmonary arteries compared to the AIDR 3D group( Z=-2.008, -2.662, P=0.046, 0.007), whereas the improvement in CNR was not significant in overweight and obese patients(all P>0.05).The two radiologists provided consistent subjective evaluations in scoring(Kappa=0.744, P<0.001), and there was no statistically significant difference in subjective scores between the AIDR 3D group and the FIRST group ( χ2=0.346, P=0.770). Conclusions:The imaging technique that integrates automatic tube current modulation technology with NI, the FIRST reconstruction algorithm, and a low tube voltage of 100 kVp effectively ensures image quality by providing clear visualization of pulmonary arteries at all levels.Moreover, it reduces radiation dose during low-iodine contrast agent CTPA examinations in elderly patients with APE.

Objective:To investigate the impact of neuroendocrine function on postoperative complications and nutritional status in gastric cancer patients.Methods:Clinical data of 102 gastric cancer patients who underwent radical gastrectomy at the Department of General Surgery, First Affiliated Hospital of Soochow University, from Aug 2021 to Jun 2022 were retrospectively analyzed.Results:Among the 102 gastric cancer patients, 18 (17.6%) suffered from postoperative complications. Univariate analysis indicated that age, BMI, preoperative plasma ghrelin concentration, and preoperative hemoglobin levels were associated with early postoperative complications following radical gastrectomy. Multivariate analysis revealed that age, BMI, and preoperative plasma ghrelin concentration ( P<0.05) were independent risk factors for postoperative complications in gastric cancer patients. Differential analysis of ghrelin concentration demonstrated correlations with hemoglobin levels, skeletal muscle index, albumin, and creatinine, and a positive correlation with the skeletal muscle index. Conclusions:Reduced preoperative neuroendocrine hormone ghrelin concentration is an independent risk factor for postoperative complications in gastric cancer patients. Ghrelin concentration is correlated with the skeletal muscle index in these patients.

Background and Aims:In recent years,function-preserving proximal gastrectomy with reconstruction has become an important approach for the treatment of early gastric cancer.However,there is no standardized surgical technique,and the short-and long-term outcomes of various new procedures remain unclear.This study was performed to evaluate the safety and short-term efficacy of laparoscopic proximal gastrectomy plus esophagogastrostomy with single-flap technique for early gastric cancer. Methods:The clinical data and follow-up records of 7 patients who underwent laparoscopic proximal gastrectomy with single-flap esophagogastrostomy in the First Affiliated Hospital of Soochow University between December 2021 and December 2022 were retrospectively analyzed.Perioperative safety,postoperative reflux,anastomotic stricture at 6 months,and related nutritional parameters were assessed.The nutrition-related indicators of this group of patients were compared with those of 11 patients who underwent total gastrectomy with Roux-en-Y anastomosis for early gastric cancer during the same period. Results:All 7 patients successfully underwent laparoscopic proximal gastrectomy with single-flap esophagogastrostomy.The average operative time was(212.9±20.6)min,with anastomosis taking(54.7±10.5)min;the mean intraoperative blood loss was(28.6±9.0)mL.No Clavien-Dindo grade Ⅲ or higher complications were observed during hospitalization.None of the patients experienced significant reflux symptoms,although 1 patient developed anastomotic stricture 3 months after operation.There were no statistically significant differences in hemoglobin concentration,albumin level,prealbumin level,total protein concentration,and lymphocyte count between preoperative and 6-month postoperative measurements(all P＞0.05).Compared to patients who underwent total gastrectomy with Roux-en-Y anastomosis,those who had the proximal gastrectomy with single-flap esophagogastrostomy showed a lower percentage decrease in body weight,skeletal muscle area at the third lumbar vertebra(L3),visceral fat area at L3,and hemoglobin concentration at 1 year after operation(all P＜0.05). Conclusion:Laparoscopic proximal gastrectomy with single-flap esophagogastrostomy is a safe and feasible surgical option for early gastric cancer,offering effective anti-reflux outcomes while minimizing the risk of anastomotic stricture.This procedure has a lower impact on postoperative nutritional status compared to total gastrectomy.

Objective:To explore the clinical characteristics and genetic variants in three children with late-onset Multiple acyl-Coenzyme A dehydrogenase deficiency (MADD type Ⅲ).Methods:Clinical data of three children diagnosed with late-onset MADD at the Children′s Hospital Affiliated to Zhengzhou University between March 2020 and March 2022 were retrospectively analyzed. All children were subjected to whole exome sequencing (WES), and candidate variants were verified by Sanger sequencing. All children had received improved metabolic therapy and followed up for 1 ~ 3 years.Results:The children had included 2 males and 1 female, and aged from 2 months to 11 years and 7 months. Child 1 had intermittent vomiting, child 2 had weakness in lower limbs, while child 3 had no symptom except abnormal neonatal screening. Tandem mass spectrometry of the three children showed elevation of multiple acylcarnitines with short, medium and long chains. Children 1 and 2 showed increased glutaric acid and multiple dicarboxylic acids by urine Gas chromatography-mass spectrometry (GC-MS) analysis. All children were found to harbor compound heterozygous variants of the ETFDH gene, including a paternal c. 1211T>C (p.M404T) and a maternal c. 488-22T>G variant in child 1, a paternal c. 1717C>T (p.Q573X) and a maternal c. 250G>A (p.A84T) variant in child 2, and a paternal c. 1285+ 1G>A and maternal c. 629A>G (p.S210N) variant in child 3. As for the treatment, high-dose vitamin B2, levocarnitine and coenzyme Q 10 were given to improve the metabolism, in addition with a low fat, hypoproteinic and high carbohydrate diet. All children showed a stable condition with normal growth and development during the follow-up. Conclusion:The compound heterozygous variants of the ETFDH gene probably underlay the muscle weakness, remittent vomiting, elevated short, medium, and long chain acylcarnitine, as well as elevated glutaric acid and various dicarboxylic acids in the three children with type Ⅲ MADD.

Considering that photodynamic therapy (PDT)-induced oxygen consumption and microvascular damage could exacerbate hypoxia to drive more glycolysis and angiogenesis, a novel approach to potentiate PDT and overcome the resistances of hypoxia is avidly needed. Herein, morpholine-modified PEGylated bilirubin was proposed to co-deliver chlorin e6, a photosensitizer, and diclofenac (Dc). In acidic milieu, the presence of morpholine could enable the nanocarriers to selectively accumulate in tumor cells, while PDT-generated reactive oxidative species (ROS) resulted in the collapse of bilirubin nanoparticles and rapid release of Dc. Combining with Dc showed a higher rate of apoptosis over PDT alone and simultaneously triggered a domino effect, including blocking the activity and expression of lactate dehydrogenase A (LDHA), interfering with lactate secretion, suppressing the activation of various angiogenic factors and thus obviating hypoxia-induced resistance-glycolysis and angiogenesis. In addition, inhibition of hypoxia-inducible factor-1α (HIF-1α) by Dc alleviated hypoxia-induced resistance. This study offered a sequentially responsive platform to achieve sufficient tumor enrichment, on-demand drug release and superior anti-tumor outcomes in vitro and in vivo.