Objective To explore the value of intensity ratio(IR)of lesion to non-tumor liver parenchyma on contrast-enhanced ultrasound(CEUS)Kupffer phase for differentiating hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(IHC)/metastatic liver carcinoma.Methods Totally 54 patients with HCC(HCC group),30 with IHC and 51 with liver metastatic carcinoma(non-HCC group)diagnosed by pathology were retrospectively enrolled.Quantitative parameters derived from CEUS time-intensity curves,including peak intensity(PI),time to peak(TTP),wash-in area under the curve(WiAUC),wash-out area under the curve(WoAUC),wash-in and wash-out area under the curve(WiWoAUC)of lesion in vascular phase and IR of lesion to non-tumor liver parenchyma in Kupffer phase were compared between groups,and a combined diagnostic model was established based on parameters being significantly different between groups using binary logistic regression analysis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curves(AUC)were calculated to evaluate the efficacy of each CEUS parameter alone and the combined model for differentiating HCC and IHC/liver metastatic carcinoma.Results In HCC group,PI,WoAUC and WiWoAUC were all higher(all P＜0.001),while IR was significantly lower than those in non-HCC group(P＜0.001).The AUC of PI,WoAUC,WiWoAUC and IR for differentiating HCC and IHC/metastatic liver carcinoma was 0.673,0.741,0.738 and 0.736,respectively,all lower than that of combined model(0.862,all P＜0.05).Conclusion IR of lesion to non-tumor liver parenchyma on CEUS Kupffer phase could be used to differentiate HCC and IHC/metastatic liver carcinoma.Combining with quantitative parameters on CEUS vascular phase could improve differentiating efficiency.

Objective:To investigate the predictive value of enhanced computed tomography (CT) combined with magnetic resonance imaging (MRI) examination on prognosis of clear cell renal cell carcinoma (ccRCC) and its correlation with clinical features. Methods:The postoperative follow-up data of enhanced CT and MRI of 80 patients with suspected (ccRCC) who admitted to Bozhou People's Hospital from March 2019 to May 2023 were selected,and they were divided into disease progression group (24 cases) and disease progression-free group (56 cases) according to the condition of disease progression. The disease progression of them were diagnosed through relevant examinations (collection of disease history,physical examination,enhanced CT,MRI,laboratory examination,pathological examination and so on). According to the information of clinical imaging,the age,gender,tumor diameter,with or without tumor thrombus,the location of tumor and surgical method were used to conduct single factor logistic regression analysis,so as to confirm independent predictors. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of enhanced CT combined with MRI to the prognosis of ccRCC. The Pearson linear correlation was adopted to analyze the correlation between the results of enhanced CT combined with MRI and prognosis. Results:Based on the results of the follow-up study,CT value of cortex phase,CT value of medullary phase and apparent dispersion coefficient (ADC) in the disease progression group were significantly smaller than those in the disease progression-free group,and the differences of them between two groups were statistically significant (t=10.610,4.697,2.901,P<0.05),respectively. The diffusion coefficient (K value) of disease progression group was significantly larger than that of disease progression-free group,and there was significant difference between the two groups (t=6.375,P<0.05),while there was no significant in diffusion rate (D) between the two groups (P>0.05). The area under curve (AUC) values of ROC curve of single enhanced CT examination,single MRI examination and the combined examination of them were larger than 0.5 in predicting the prognosis of ccRCC,which indicated that both the two examinations had a certain value in predicting the prognosis of ccRCC,and the AUC value of combined examination was the highest (0.940),which indicated the value of combined examination was the highest in predicting the prognosis of ccRCC. There were not significant differences in gender,surgical method,tumor thrombus and tumor location between the two groups (P>0.05). The age and tumor diameter of the disease progression group were significantly larger than those of the disease progression-free group (t=4.292,3.219,P<0.05),respectively. The results of the logistic regression analysis showed that the age and tumor diameter were respectively independent influencing factor on the prognosis of ccRCC (HR=2.167,0.689,P<0.05). The results of Pearson correlation analysis indicated that there was negative correlation between enhanced CT examination and prognosis (r=-0.65,P<0.05),and there was positive correlation between MRI examination and prognosis (r=0.72,P<0.05). In addition,there was a negative correlation in the results between enhanced CT examination and MRI examination (r=-0.58,P<0.05). Conclusion:The prediction of enhanced CT combined with MRI examination is higher than that of each single examination of them for the prognosis of ccRCC,and there is a certain correlation between that and clinical features,but it is still necessary to conduct comprehensive judgement after combines other influence factors in clinical practice.

Objective To explore the value of intensity ratio(IR)of lesion to non-tumor liver parenchyma on contrast-enhanced ultrasound(CEUS)Kupffer phase for differentiating hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(IHC)/metastatic liver carcinoma.Methods Totally 54 patients with HCC(HCC group),30 with IHC and 51 with liver metastatic carcinoma(non-HCC group)diagnosed by pathology were retrospectively enrolled.Quantitative parameters derived from CEUS time-intensity curves,including peak intensity(PI),time to peak(TTP),wash-in area under the curve(WiAUC),wash-out area under the curve(WoAUC),wash-in and wash-out area under the curve(WiWoAUC)of lesion in vascular phase and IR of lesion to non-tumor liver parenchyma in Kupffer phase were compared between groups,and a combined diagnostic model was established based on parameters being significantly different between groups using binary logistic regression analysis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curves(AUC)were calculated to evaluate the efficacy of each CEUS parameter alone and the combined model for differentiating HCC and IHC/liver metastatic carcinoma.Results In HCC group,PI,WoAUC and WiWoAUC were all higher(all P＜0.001),while IR was significantly lower than those in non-HCC group(P＜0.001).The AUC of PI,WoAUC,WiWoAUC and IR for differentiating HCC and IHC/metastatic liver carcinoma was 0.673,0.741,0.738 and 0.736,respectively,all lower than that of combined model(0.862,all P＜0.05).Conclusion IR of lesion to non-tumor liver parenchyma on CEUS Kupffer phase could be used to differentiate HCC and IHC/metastatic liver carcinoma.Combining with quantitative parameters on CEUS vascular phase could improve differentiating efficiency.

Objective:To investigate the predictive value of enhanced computed tomography (CT) combined with magnetic resonance imaging (MRI) examination on prognosis of clear cell renal cell carcinoma (ccRCC) and its correlation with clinical features. Methods:The postoperative follow-up data of enhanced CT and MRI of 80 patients with suspected (ccRCC) who admitted to Bozhou People's Hospital from March 2019 to May 2023 were selected,and they were divided into disease progression group (24 cases) and disease progression-free group (56 cases) according to the condition of disease progression. The disease progression of them were diagnosed through relevant examinations (collection of disease history,physical examination,enhanced CT,MRI,laboratory examination,pathological examination and so on). According to the information of clinical imaging,the age,gender,tumor diameter,with or without tumor thrombus,the location of tumor and surgical method were used to conduct single factor logistic regression analysis,so as to confirm independent predictors. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of enhanced CT combined with MRI to the prognosis of ccRCC. The Pearson linear correlation was adopted to analyze the correlation between the results of enhanced CT combined with MRI and prognosis. Results:Based on the results of the follow-up study,CT value of cortex phase,CT value of medullary phase and apparent dispersion coefficient (ADC) in the disease progression group were significantly smaller than those in the disease progression-free group,and the differences of them between two groups were statistically significant (t=10.610,4.697,2.901,P<0.05),respectively. The diffusion coefficient (K value) of disease progression group was significantly larger than that of disease progression-free group,and there was significant difference between the two groups (t=6.375,P<0.05),while there was no significant in diffusion rate (D) between the two groups (P>0.05). The area under curve (AUC) values of ROC curve of single enhanced CT examination,single MRI examination and the combined examination of them were larger than 0.5 in predicting the prognosis of ccRCC,which indicated that both the two examinations had a certain value in predicting the prognosis of ccRCC,and the AUC value of combined examination was the highest (0.940),which indicated the value of combined examination was the highest in predicting the prognosis of ccRCC. There were not significant differences in gender,surgical method,tumor thrombus and tumor location between the two groups (P>0.05). The age and tumor diameter of the disease progression group were significantly larger than those of the disease progression-free group (t=4.292,3.219,P<0.05),respectively. The results of the logistic regression analysis showed that the age and tumor diameter were respectively independent influencing factor on the prognosis of ccRCC (HR=2.167,0.689,P<0.05). The results of Pearson correlation analysis indicated that there was negative correlation between enhanced CT examination and prognosis (r=-0.65,P<0.05),and there was positive correlation between MRI examination and prognosis (r=0.72,P<0.05). In addition,there was a negative correlation in the results between enhanced CT examination and MRI examination (r=-0.58,P<0.05). Conclusion:The prediction of enhanced CT combined with MRI examination is higher than that of each single examination of them for the prognosis of ccRCC,and there is a certain correlation between that and clinical features,but it is still necessary to conduct comprehensive judgement after combines other influence factors in clinical practice.

Objective:To investigate the correlation of LymphGen genotyping with the clinicopathologic characteristics, efficacy and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective case series study was conducted. The clinicopathological data and follow-up information of 132 DLBCL patients diagnosed and treated in the First Affiliated Hospital of Soochow University from January 2016 to January 2022 were collected. LymphGen genotyping was made based on the results of second-generation sequencing. The distributions of the main subtypes in the whole group and the stratification of all clinicopathological features were analyzed. The short-term efficacy of patients with different gene subtypes was compared. Survival analysis of patients with different gene subtypes was performed by using the Kaplan-Meier method.Results:Among the 132 patients, 69 were males and 63 were females. The median age was 60 years, with the age ranging from 13 to 87 years. Hans typing: germinal center B cell (GCB) type was detected in 49 cases, non-GCB type was detected in 81 cases, and the remaining 2 cases were unknown. Ann Arbor staging: 31 cases with stage Ⅰ-Ⅱ, 89 cases with stage Ⅲ-Ⅳ, and 9 primary central nervous system lymphoma (PCNSL) cases without stage, and the remaining 3 cases with unknown stage. Among the 132 patients, 64 cases (48.5%) were genotyped with LymphGen, including 6 cases (4.5%) of MCD subtype, 18 cases (13.6%) of A53 subtype, 17 cases (12.9%) of BN2 subtype, 3 cases (2.3%) of EZB subtype, 5 cases (3.8%) of ST2 subtype, and 15 cases (11.4%) of composite subtype, and 68 cases (51.5%) of the other subtypes; N1 subtype was not detected. The differences in the proportion of MCD subtype [5.0% (3/60) vs. 4.2% (3/71)], A53 subtype [16.7% (10/60) vs. 11.3% (8/71)], BN2 subtype [6.7% (4/60) vs. 18.3% (13/71)], EZB subtype [5.0% (3/60) vs. 0 (0/71)], ST2 subtype [5.0% (3/60) vs. 2.8% (2/71)], composite subtype [18.3% (11/60) vs. 5.6% (4/71)], other types [43.3% (26/60) vs. 57.7% (41/71)] were statistically significant between the patients with lactate dehydrogenase (LDH) < 245 U/L and those with LDH ≥245 U/L ( P = 0.023). There were no statistically significant differences in genotype distribution among subgroups with different age, gender, B symptoms, Hans typing, primary site, involvement site, Ann Arbor stage, international prognostic index score/international extranodal lymphoma study group score (all P > 0.05). After 4-6 courses treatment in PCNSL patients and 6-8 courses of standard first-line treatment in non-PCNSL patients, 17 patients with BN2 subtype [including 9 cases of complete remission (CR) and 4 cases of partial remission (PR)] and 3 patients with EZB subtype (including 2 cases of CR) had the higher proportion of those achieving good treatment outcomes. However, 15 patients with the composite subtype showed the worst outcomes including 5 cases of CR, 4 cases of PR, 1 case of stable disease, 3 cases of disease progression, and 2 death cases. The CR rates of the composite subtype group, non-composite subtype group, and other groups were 33.3% (5/15), 44.9% (22/49), and 66.2% (45/68), respectively; and the difference among these groups was statistically significant ( P = 0.034). The CR rate of composite type patients with BN2 subtype was higher compared to composite subtype patients without BN2 subtype (5/8 vs. 0/7), and the difference was statistically significant ( P = 0.023); 7 patients with A53 subtype combined with other subtypes except BN2 subtype did not achieve CR; 2 cases had PR, 3 cases had disease progression and 2 cases died. The median follow-up time was 26 months (ranging from 1 to 86 months) until the last follow-up in March 2023. There were no statistically significant differences in overall survival and progression-free survival among patients with different gene subtypes (all P > 0.05). Conclusions:The distribution of gene subtypes in DLBCL patients may be correlated with LDH levels. Patients with different gene subtypes show variations in short-term efficacy. The composite type patients with A53 subtype and without BN2 subtype have poor treatment outcomes, but no differences in overall survival and progression-free survival of patients with different gene subtypes are observed.

Objective To explore the role of an artificial intelligence(AI)model based on real-time object detection network in fetal facial ultrasound examination.Methods With the normal fetal facial ultrasound standard plane(FFUSP)at 20-24 weeks of gestation as the research object,a FFUSP recognition model based on real-time object detection network was constructed.The recognition accuracy of the model for FFUSP and the anatomical structures were analyzed,and the clinical value was evaluated by analyzing its performance in identifying FFUSP in 119 cases of fetal ultrasound images.Results The overall precision,recall rate,mAP@.5 and mAP@.5:.95 of the AI model were 97.8%,98.5%,98.1%and 61.0%,respectively.The clinical validation showed that the AI model had a sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 100.0%,98.5%,87.4%,100.0%and 98.7%for facial anatomy recognition,and the results were highly consistent with the classification of fetal ultrasound experts(k=0.925,P<0.001).The recognition accuracy of the model for 3 types of standard planes reached 100%;and the average speed of dynamic video detection was 33.93 frames per second.Conclusion The FFUSP recognition model based on real-time object detection network exhibits excellent performance,and it can be applied to real-time ultrasound diagnosis,teaching and intelligent quality evaluation.

Objective To assess the effect of ultrasonic thyroid artificial intelligence(AI)-assisted diagnostic system(AI-assisted diagnostic system)for diagnosing medullary thyroid carcinoma(MTC)compared with different physicians and taken papillary thyroid carcinoma(PTC)as the controls.Methods Totally 63 MTC,70 PTC and 62 benign thyroid nodules confirmed by pathology were enrolled.AI-assisted diagnostic system was utilized to analyze thyroid nodules and identify the likelihood of malignancy,and the probability value threshold was set at ≥0.40.All thyroid nodules were retrospectively reviewed and categorized by 3 physicians(1 senior physician,1 attending physician and 1 junior physician)according to Chinese thyroid imaging reporting and data system(C-TIRADS).The efficacy of AI-assisted diagnostic system and physicians for diagnosing MTC and PTC were evaluated.Results AI-assisted diagnostic system showed lower sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and area under the curve(AUC)for diagnosing MTC and PTC compared with physicians.Significant differences of AUC were found between senior physician and AI-assisted diagnostic system,as well as between attending physician and AI-assisted diagnostic system for diagnosing MTC and PTC(all P＜0.01),while no significant difference of AUC was between junior physicians and AI-assisted diagnostic system(both P＞0.05).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and AUC for AI-assisted diagnostic system for diagnosing MTC were all lower than those for diagnosing PTC,but the AUC was not significantly different(P＞0.05).Conclusion Ultrasonic thyroid AI-assisted diagnostic system had relatively high value for diagnosing MTC.

Objective:To provide references for further assessment of fighter pilots′ physical status by comparing and analyzing the difference of cardiopulmonary reserve function between different performance fighter aircraft pilots.Methods:A total of 96 fighter pilots were selected in the annual physical examination of the Air Service Department of Northern Theater Air Force Hospital. They were divided into the high-performance fighter group and the ordinary fighter group according to the aircraft types. Cardiopulmonary exercise testing (CPET) was performed to compare the basic parameters and cardiopulmonary reserve function parameters such as peak equivalent, peak oxygen pulse and peak kilogram oxygen uptake in the CPET monitoring results of the 2 groups.Results:There was no significant difference in general information between the 2 groups (all P>0.05). There was no significant difference between the high-performance fighter pilots and the ordinary fighter pilots in the main exercise cardiopulmonary reserve function parameters such as peak exercise load, peak oxygen pulse and peak kilogram oxygen uptake (all P>0.05). Conclusions:The general performance of the ordinary fighter pilots is the same as that of the high-performance fighter pilots in terms of exercise cardiopulmonary reserve function, and the CPET results can also reflect the status of pilot′s physical training.

Objective:To provide references for further assessment of fighter pilots′ physical status by comparing and analyzing the difference of cardiopulmonary reserve function between different performance fighter aircraft pilots.Methods:A total of 96 fighter pilots were selected in the annual physical examination of the Air Service Department of Northern Theater Air Force Hospital. They were divided into the high-performance fighter group and the ordinary fighter group according to the aircraft types. Cardiopulmonary exercise testing (CPET) was performed to compare the basic parameters and cardiopulmonary reserve function parameters such as peak equivalent, peak oxygen pulse and peak kilogram oxygen uptake in the CPET monitoring results of the 2 groups.Results:There was no significant difference in general information between the 2 groups (all P>0.05). There was no significant difference between the high-performance fighter pilots and the ordinary fighter pilots in the main exercise cardiopulmonary reserve function parameters such as peak exercise load, peak oxygen pulse and peak kilogram oxygen uptake (all P>0.05). Conclusions:The general performance of the ordinary fighter pilots is the same as that of the high-performance fighter pilots in terms of exercise cardiopulmonary reserve function, and the CPET results can also reflect the status of pilot′s physical training.

Objective:To investigate the predictive value of mid-regional proadrenomedullin (MR-proADM) on poor prognosis of low-risk patients with sepsis.Methods:This was a prospective cohort study. Patients with sepsis admitted to the Emergency Intensive Care Unit of China Rehabilitation Research Center from December 2018 to December 2020 were included in this study. The patients were divided into the low-risk group (SOFA≤7) and medium-high-risk group (SOFA>7) according to the sequential organ failure assessment (SOFA) score, and the clinical characteristics of the two groups were compared. Proportional hazards regression model (COX regression model) was used to investigate the risk factors of 28-day mortality in the low-risk and medium-high-risk group. The predictive ability of MR-proADM, C-reactive protein (CRP), lactic acid (Lac), interleukin-6 (IL-6), SOFA score, and acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score for the prognosis in each group was evaluated by receiver operating characteristic (ROC) curve. The outcomes of patients with different concentration of MR-proADM in the low-risk group were compared.Results:Totally 205 patients with sepsis were included, and the 28-day mortality was 41.0% (84/205). There were significant differences in the number of organ dysfunction, acute kidney injury, use of vasoactive drugs, Lac, IL-6, SOFA score and APACHEⅡ score between the two groups ( P<0.05). Cox regression model showed that age, MR-proADM, mechanical ventilation, IL-6 and APACHEⅡ score were the risk factors of 28-day death in the low-risk group, while MR-proADM, Lac, SOFA score and APACHEⅡ score were the risk factors of 28-day mortality in the medium-high-risk group. In each group, MR-proADM had a good predictive ability for the prognosis of patients with sepsis ( P<0.001). Especially in low-risk patients with sepsis, the predictive ability of MR-proADM was better than other indicators. Kaplan-Meier survival curve suggested that the patients with MR-proADM >2.53 nmol/L had worse prognosis than those with MR-proADM ≤2.53 nmol/L, and the difference was statistically significant ( P<0.001). In the low-risk group, the mortality of patients increased from 7.8% to 58.2% if MR-proADM >2.53 nmol/L. Conclusions:MR-proADM is a risk factor for 28-day mortality in patients with sepsis, and MR-proADM can early identify the poor prognosis of low-risk patients with sepsis.