Objective To explore the value of the combination of multi-detector row helical CT(MDCT)enhancement and multi-dimensional CT angiography(CTA)in preoperative diagnosis of hypervascular tumors in maxillofacial soft tissues.Methods Eighty-six patients with oral and maxillofacial soft tissue tumors were enrolled and examined with MDCT enhancement combined with multi-dimensional CTA.Κappa test was used to analyze the consistency of the proposed technology with pathological examination as the gold standard for determining benign and malignant tumors.The blood supplies(CT values of plain scan,arterial phase,venous phase,arterial-phase net enhancement and venous-phase net enhancement)of benign and malignant tumors were compared.The diagnostic value of different vascular CT values for tumor properties was evaluated with ROC curves.Results Pathological examination identified 50 benign cases and 36 malignant cases out of 86 patients with oral and maxillofacial soft tissue tumors.Thirty-four cases were diagnosed as malignant tumors when using MDCT enhancement combined with multi-dimensional CTA,and there were 32 confirmed cases,2 misdiagnosed cases and 4 missed cases.The consistency of the proposed technology with pathological examination for diagnosing benign and malignant tumors was 0.878.Benign group had lower CT values of arterial phase,venous phase,arterial-phase net enhancement and venous-phase net enhancement than malignant group(P<0.05).The results of ROC curves revealed that the CT values of arterial phase,venous phase,arterial-phase net enhancement and venous-phase net enhancement were of high differential diagnostic value in tumor properties(AUC=0.778,0.745,0.738 and 0.781,respectively;P<0.05).Conclusion The combination of MDCT enhancement and multi-dimensional CTA provides significant guidance for the diagnosis of hypervascular tumors in maxillofacial soft tissues.

Objective To explore the value of the combination of multi-detector row helical CT(MDCT)enhancement and multi-dimensional CT angiography(CTA)in preoperative diagnosis of hypervascular tumors in maxillofacial soft tissues.Methods Eighty-six patients with oral and maxillofacial soft tissue tumors were enrolled and examined with MDCT enhancement combined with multi-dimensional CTA.Κappa test was used to analyze the consistency of the proposed technology with pathological examination as the gold standard for determining benign and malignant tumors.The blood supplies(CT values of plain scan,arterial phase,venous phase,arterial-phase net enhancement and venous-phase net enhancement)of benign and malignant tumors were compared.The diagnostic value of different vascular CT values for tumor properties was evaluated with ROC curves.Results Pathological examination identified 50 benign cases and 36 malignant cases out of 86 patients with oral and maxillofacial soft tissue tumors.Thirty-four cases were diagnosed as malignant tumors when using MDCT enhancement combined with multi-dimensional CTA,and there were 32 confirmed cases,2 misdiagnosed cases and 4 missed cases.The consistency of the proposed technology with pathological examination for diagnosing benign and malignant tumors was 0.878.Benign group had lower CT values of arterial phase,venous phase,arterial-phase net enhancement and venous-phase net enhancement than malignant group(P<0.05).The results of ROC curves revealed that the CT values of arterial phase,venous phase,arterial-phase net enhancement and venous-phase net enhancement were of high differential diagnostic value in tumor properties(AUC=0.778,0.745,0.738 and 0.781,respectively;P<0.05).Conclusion The combination of MDCT enhancement and multi-dimensional CTA provides significant guidance for the diagnosis of hypervascular tumors in maxillofacial soft tissues.

Objective To explore the value of spiral computed tomography(CT)and three-dimensional reconstruction in diagnosing maxillofacial fractures.Methods A total of 86 patients with suspected maxillofacial fractures were enrolled as the research objects.All patients underwent X-ray examination and multi-slice spiral CT combined with three-dimensional reconstruction.Taking surgical results as the golden standard,the diagnostic consistencies of the two methods were recorded,and the diagnostic efficiency for maxillofacial fractures was compared between two methods.Results The surgical results showed that out of 86 patients with suspected maxillofacial fractures,there were 71 confirmed cases(16 cases of zygoma fractures,20 cases of nasal bone fractures,11 cases of mandible and maxilla fractures,12 cases of sphenethmoid fractures and 12 cases of jawbone fractures)and 15 cases of non-maxillofacial fractures.Taking the results of surgical pathology as the golden standard,X-ray showed that there were 56 cases of maxillofacial fractures,11 cases of non-maxillofacial fractures,15 cases of misdiagnosis and 4 cases of missed diagnosis,and its diagnostic accuracy,positive predictive value,negative predictive value and Kappa value were 77.91％(67/86),93.33％(56/60),42.31％(11/26)and 0.405,respectively,having a low diagnostic consistency.Spiral CT combined with three-dimensional reconstruction showed that there were 68 cases of maxillofacial fractures,9 cases of non-maxillofacial fractures,3 cases of misdiagnosis and 6 cases of missed diagnosis,and its diagnostic accuracy rate,positive predictive value,negative predictive value and Kappa value were 89.53％(77/86),91.89％(68/74),75.00％(9/12)and 0.606,respectively,having a high diagnostic consistency.The difference in diagnostic specificity between X-ray and spiral CT combined with three-dimensional reconstruction was trivial(73.33％vs 60.00％,P＞0.05),but the diagnostic sensitivity and accuracy between X-ray and spiral CT combined with three-dimensional reconstruction differed significantly(78.87％vs 95.77％,77.91％vs 89.53％;P＜0.05).Conclusion Spiral CT combined with three-dimensional reconstruction exhibits higher sensitivity and accuracy in the diagnosis of maxillofacial fractures.

Objective To observe the efficacy of gray-scale ultrasound-based radiomics for differentiating peripheral pulmonary adenocarcinoma and squamous cell carcinoma.Methods Data of 88 patients with single peripheral lung adenocarcinoma and 58 patients with single peripheral lung squamous cell carcinoma proved pathologically with puncture biopsy and clearly visualized with lung ultrasound were retrospectively analyzed.The patients were divided into training set(n=103)and test set(n=43)at the ratio of 7:3.Based on gray-scale ultrasound of training set,radiomics features associated with differential diagnosis of peripheral lung adenocarcinoma and lung squamous cell carcinoma were extracted and screened.Using 4 different classifiers,including support vector machine(SVM),linear discriminant analysis(LDA),logistic regression(LR)and the least absolute shrinkage and selection operator combined with logistic regression(LASSO-LR),4 corresponding radiomics models were obtained,and the relative best models were selected according to their performances under 10-fold cross validation.The receiver operating characteristic curves were drawn,the areas under the curve(AUC)were calculated to evaluate the differentiating efficacy of each model,and DeLong test was used for the comparison.The differentiating accuracy of models were obtained under the best cutoff value with the maximum Youden index.Results The AUC of SVM,LDA,LR and LASSO-LR radiomics models for differentiating peripheral lung adenocarcinoma and lung squamous carcinoma in test set was 0.864,0.867,0.880 and 0.844,respectively,and no significant difference was found among 4 models(all P＞0.05).Under the best cutoff value of each model,the corresponding accuracy of SVM,LDA,LR and LASSO-LR radiomics models for differentiating peripheral lung adenocarcinoma and lung squamous cell carcinoma was 86.05％,83.72％,88.37％and 86.05％,respectively.Conclusion Radiomics models based on gray-scale ultrasound could be used to differentiate peripheral lung adenocarcinoma and lung squamous cell carcinoma.

Objectives:To compare and analyze the MRI characteristics and fatty infiltration(FI)of the lum-bar spine in patients with and without osteoporotic vertebral compression fracture(OVCF)to explore their rela-tionships with fracture.Methods:46 patients with OVCF(70.67±11.99 years old;11 males,35 famales)were retrospectively analyzed,and 46 age-(70.76±5.40)and sex-(11 males,35 famales)matched osteoporotic pa-tients without OVCF were taken as the control group.Paravertebral muscle FI,cross-sectional area(CSA),and vertebral bone quality(VBQ)score were measured on lumbar MRI.Independent samples t-test was used to compare the differences between the OVCF group and the control group,and regression analysis was per-formed to explore the risk factors for the development of OVCF.Results:Patients in the OVCF group had significantly higher VBQ scores(P＜0.05)and significantly higher paravertebral muscle FI(P＜0.05)than those in the control group.There was no significant difference in CSA of paravertebral muscles between the two groups.VBQ score(OR=1.963,P＜0.01)and FI of paravertebral muscles represented by L4(OR=1.203,P＜0.01)were the independent risk factors for OVCF.Conclusions:The MRI parameters of lumbar spine in patients with OVCF had greater VBQ scores and paravertebral muscle FI compared with the osteoporotic patients without OVCF;VBQ scores and paravertebral muscle FI are the independent risk factors for OVCF,and at-tentions should be paid to improve paravertebral muscle functions in the meantime of preventing OVCF.

BACKGROUND:Patients with degenerative cervical spondylosis often suffer from changed varicosity of the cervical spine,unbalanced neck-shoulder muscular strength,and descending power. OBJECTIVE:To probe into the correlation between sagittal curvature parameters and pain threshold for neck-shoulder muscles in degenerative cervical spondylosis. METHODS:Totally 50 patients with degenerative cervical spondylosis received treatment at the 3D Printed Outpatient Center of Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from January 2022 to March 2023 were included in the study.After excluding the 10 patients of cervical lateral projection that failed to meet the measurement conditions,the cervical lateral projections were shot to measure the following iconography parameters:Borden value and C2-7 Cobb angle as well as pain thresholds on the midpoint of the superior trapezius muscle in bilateral bundles and at 1 cm beside the C5-6 interspike.The correlation between sagittal curvature parameters and pain threshold of neck-shoulder muscles in degenerative cervical spondylosis was analyzed. RESULTS AND CONCLUSION:(1)The Borden value of sagittal curvature showed a moderately positive correlation with the bundle pain threshold in the left upper trapezius muscle,the bundle pain threshold in the right upper trapezius muscle,and the pain threshold at the 1 cm of the left side beside the C5-6 interspike(r=0.498,P<0.01;r=0.448,P<0.05;r=0.405,P<0.05)and a weak positive correlation with the pain threshold at the 1 cm of the right side beside the C5-6 interspike(r=0.322,P<0.05).(2)The C2-7 Cobb angle showed a weak positive correlation with the left squared myalgia threshold(r=0.355,P<0.05),and there was no correlation with the pain threshold of the left trapezius muscle and the pain threshold at the 1 cm of both sides beside the C5-6 interspike.(3)There was a correlation between the pain threshold of the neck-shoulder muscles,and a high correlation between the pain threshold of the left and right muscles and the pain threshold within the left and right side muscles,indicating that the neck-shoulder muscles are consistent and may be related to the coordination of the neck-shoulder movements.

BACKGROUND:Short-term wearing of cervical brace combined with shoulder and neck muscle exercise can significantly improve the symptoms of early cervical spondylosis.After stopping wearing cervical brace,patients'symptoms are easy to recur,which may be due to the lack of cervical curvature correction function. OBJECTIVE:To analyze the effect of 3D printed personalized cervical orthopedic brace for adjusting cervical curvature in the treatment of early cervical spondylosis. METHODS:From January 2021 to January 2023,30 patients with early cervical spondylosis in the Shanghai Fifth People's Hospital,Fudan University were studied,including 11 males and 19 females,with a mean age of(31.7±6.6)years old.All patients customized and wore 3D printed personalized cervical orthopedic braces for 3 hours a day for continuous 12 weeks.Borden value of cervical curvature,pain threshold of shoulder and neck muscles,cervical dysfunction index,and visual analog scale score in 30 patients were recorded before and 4 and 8 weeks after treatment. RESULTS AND CONCLUSION:(1)Compared with before treatment,the difference of Borden value of cervical curvature,right trapezius tenderness threshold,and cervical dysfunction index was not significant in 30 patients after 4 weeks of treatment(P>0.05).Visual analog scale score,left trapezius tenderness threshold,left and right C5C6 tenderness threshold were significantly improved(P<0.05).(2)Compared with before treatment,the cervical curvature Borden value,left and right trapezius tenderness threshold,visual analog scale score,left and right C5C6 tenderness threshold,and cervical dysfunction index of 30 patients were significantly improved after 12 weeks of treatment(P<0.05).(3)Compared with 4 weeks after treatment,the Borden value of cervical curvature,right trapezius tenderness threshold,visual analog scale score,left and right C5C6 tenderness threshold and cervical dysfunction index of 30 patients after 12 weeks of treatment were significantly improved(P<0.05).(4)The results show that short-term wearing of 3D printed personalized cervical orthopedic brace can improve the pain of patients with early cervical spondylosis,while long-term application has certain effect on the recovery of cervical curvature.

“Cold-dampness entering ying （营）” is the key to the worsening of cold-dampness epidemic， and is more common in the elderly or critically ill cases of cold-dampness epidemic with pathogen exuberance and healthy qi deficiency. This paper reported a case of critically ill COVID-19 combined with multiple organ dysfunction treated by integrative traditional Chinese and western medicine based on “cold-dampness entering ying” theory. The patient did not have high fever after being infected with SARS-Cov-2， but D-dimer continued to increase， and she developed multiple thrombosis throughout the body and multiple organ dysfunctions such as pulmonary embolism， edema， oliguria， and shock. The patient were with enlarged and dusky tongue， with yellow， thick and greasy coating， and sublingual blood stasis， and thready， rapid and rough pulse. All these were characteristic manifestations of “cold-dampness entering ying”， and was differentiated as cold-dampness stasis. For the treatment， symptomatic and supportive western medicine of improving heart function， anti-infection， relieving asthma， stopping cough and reducing phlegm was given as the basic therapy， and additionally， traditional Chinese medicine to open the constraint and the blocked， save from collapse and restore yang， boost qi and relieve collapse， invigorate blood and drain water was used， usually with Modified Poge Zilong Xuanbai Chengqi Decoction （破格子龙宣白承气汤加减）， which was in accordance with the pathogenesis and thus achieving good effect.

We reported a case of a patient dignosed as tuberculosis and severe malnutrition with coronavirus disease 2019 （critical type） treated with a combination of Chinese medicine and Western medicine. Through the retrospective analysis of the diagnosis and treatment process of this patient， on the basis of Chinese medicine's understanding of the etiology and pathogenesis of “old state” and “deficient state”， the critical coronavirus pneumonia combined with pulmonary tuberculosis and severe malnutrition was mostly due to the physical condition and the invasion of epidemic toxin， resulting in dysfunctions of the internal organs such as the lungs， spleens， kidneys and other organs. Based on the understanding of the cause and mechanism of the coronavirus disease， the treatment combined Chinese and Western medical therapies was given. The western medicine was used with the main treatments of oxygen therapy， anti-viral， intestinal nutritional support， and anti-coagulation， while the Chinese medicine was used by tonifying qi， blood， yin， and yang， warming yang and dissipating cold， and clearing heat and dampness， then tonifying qi， nourishing yin and eliminating heat， in which tonifying middle and replenishing qi ran through the whole process. The integrated treatment eventually improved the patient's symptoms and accelerated the negative conversion of nucleic acid of the coronavirus.

Gegen Qinlian Decoction (GQD), a traditional Chinese medicine (TCM) formula, has long been used for the treatment of common metabolic diseases, including type 2 diabetes mellitus. However, the main limitation of its wider application is ingredient complexity of this formula. Thus, it is critically important to identify the major active ingredients of GQD and to illustrate mecha-nisms underlying its action. Here, we compared the effects of GQD and berberine, a hypothetical key active pharmaceutical ingredient of GQD, on a diabetic rat model by comprehensive analyses of gut microbiota, short-chain fatty acids, proinflammatory cytokines, and ileum transcriptomics. Our results show that berberine and GQD had similar effects on lowering blood glucose levels, modulating gut microbiota, inducing ileal gene expression, as well as relieving systemic and local inflammation. As expected, both berberine and GQD treatment significantly altered the overall gut microbiota structure and enriched many butyrate-producing bacteria, including Faecalibacterium and Roseburia, thereby attenuating intestinal inflammation and lowering glucose. Levels of short-chain fatty acids in rat feces were also significantly elevated after treatment with ber-berine or GQD. Moreover, concentration of serum proinflammatory cytokines and expression of immune-related genes, including Nfkb1, Stat1, and Ifnrg1, in pancreatic islets were significantly reduced after treatment. Our study demonstrates that the main effects of GQD can be attributed to berberine via modulating gut microbiota. The strategy employed would facilitate further stan-dardization and widespread application of TCM in many diseases.