To investigate the clinical features and peripheral blood immune cell subsets ofelderly (≥60 years old) onset rheumatoid arthritis (EORA) patients.

Objective To investigate the diagnostic value Tamm-Horsfall protein(THP)and osteopontin(OPN)in serum and 24-hour urine for urolithiasis.Methods A total of 101 patients with urolithiasis who underwent flexible ureteroscopy lithotripsy at the Urology Department of Civil Aviation General Hospital from April 2020 to March 2023 were included as the stone group,and 50 healthy individuals were enrolled as the control group.The samples of serum and 24-hour urine samples were collected from both the groups,and the levels of THP and OPN were measured using enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was performed to evaluate the association between each biomarker and urolithiasis,and receiver operating characteristic(ROC)curves were plotted to assess their diagnostic value.Results The stone group showed significantly lower THP levels(20.13[13.12,26.03]mg/d)and OPN levels(51.24[36.72,101.37]μg/d)in 24-hour urine,and THP levels(182.01[160.91,209.20]ng/mL)and OPN lev-els(18.76[15.72,22.48]ng/mL)in serum compared to the control group(all the P＜0.001).Binary Logistic regression analysis re-vealed that THP(OR=0.736,95％CI:0.606-0.895),OPN(OR=0.975,95％CI:0.958-0.993)and citrate(OR=0.067,95％CI:0.012-0.376)in 24-hour urine,and THP(OR=0.946,95％CI:0.908-0.986)and OPN(OR=0.896,95％CI:0.803-0.999)in ser-um were the protective factors for urolithiasis,while calcium level(OR=2.125,95％CI:1.243-3.633)24-hour urine was a risk factor(all the P＜0.05).ROC curve analysis showed that the areas under the curve(AUCROC)for the individual diagnosis of urolithiasis were 0.846,0.809,0.786,0.823,0.748,and 0.755 for the above six biomarkers,respectively.The AUCROC for the combined diagnosis u-sing THP+OPN in serum,THP+OPN in 24-hour urine and all the six biomarkers were 0.882,0.920 and 0.984,respectively,indica-ting better diagnostic performance.Conclusion The combined detection of the THP and OPN levels in serum and 24-hour urine may have good diagnostic value for urolithiasis and serve as potential diagnostic biomarkers.

Objective:To explore any effect of repeated application of low-frequency transcranial magnetic stimulation (rTMS) on depression and the cognition of depressed elderly persons.Methods:Eighty-six elderly persons with depression were randomly divided into an rTMS group and a control group, each of 43. In addition to anti-depressant treatment, the rTMS group was given 20 minutes of 1Hz rTMS daily applied over the right dorsolateral prefrontal cortex, five times a week for 4 weeks. The control group was given sham treatment on the same schedule. Before the experiment and after 1, 2, 3, 4, 6 and 8 weeks of the treatment, depression in both groups was evaluated using the Hamilton Depression Scale (HAMD-24). At the 4- and 8-week evaluations the Wisconsin Card Sorting Test (WCST) and the Trail Making Test Part A (TMT-A) were also administered.Results:Before the treatment there were no significant differences in the 2 groups′ average HAMD or WCST scores. At each subsequent evaluation both groups′ average HAMD score had decreased significantly. After 3 weeks the average HAMD score of the rTMS group consistently remained significantly lower than the control group′s average. At the 4- and 8-week evaluations both groups′ WCST and TMT-A scores had improved significantly compared with before the treatment, with significantly greater improvement in the rTMS group′s average WCST result, though not in their TPT-A result. There was no signi-ficant difference in the incidence of adverse reactions between the 2 groups.Conclusion:As a supplement to antidepressant treatment, right-side low-frequency rTMS can relieve depressive symptoms and improve the cognitive functioning of depressed elderly persons. It is well tolerated with few adverse reactions.

Objective : To study the effect of lipopolysaccharide ( LPS) -induced immune system activation on syn- aptic structure and DISC1. Methods : 40 rats were divided into 4 groups，which were PBS group，PBS + MK-801 group，LPS group and LPS + MK-801 group．The rats in LPS group and LPS + MK-801 group were administrated with LPS solution (0. 2 mg / kg，i．p．BIW) for 6 times in total， the rats in PBS group and PBS + MK801 group were administrated with PBS．At the third time when the rats were administrated with LPS solution，the rats in PBS + MK-801 group and LPS + MK-801 group were administrated with MK-801 solution (0. 5 mg / kg，i．p．BIW) for a total of 4 times，the rats in PBS group and LPS group were adminis- trated with saline．The head shaking and the open field tests were then evaluated in the rats．Immediately，the rats were sacrificed，and their brain were saved for testing. RT-qPCR , Golgi staining，immunohistochemistry and ELISA kits were used to detect DISC1 gene expression，dendritic spine status，microglia activation and inflammatory cytokine content in cortex，respectively. gene expression in the cortex of rats with schizophrenia． Results : Compared with the PBS group，the expression of DISC1 gene of the rats in the PBS + MK-801 group increased (P ＜0. 01) ，the score of head shaking increased (P ＜0. 01) ，and the distance of the open field increased (P ＜0. 000 1) ; As well as the LPS + MK-801 group，compared with the LPS group，the expression of DISC1 gene increased (P＜0. 000 1) ，the head shaking score and the distance of the open field increased (P＜0. 000 1) . In addition，compared with the PBS + MK-801 group，the expression of DISC1 gene， the shaking head score and the open field distance of the LPS + MK-801 group further improved (P ＜0. 000 1) . Furthermore，compared with PBS group and PBS + MK-801 group，the content of iba1 in the cortex of LPS group and LPS + MK-801 group significantly increased (P ＜0. 05 ) ，the content of inflammatory cytokines significantly increased (P＜0. 05) ，and the length and density of dendritic spines significantly decreased (P＜0. 05) ． Conclusion The activation of the immune system induced by LPS can contribute to the susceptibility of schizophrenia model， and the possible mechanism is that it cooperates with MK-801 to increase the expression of DISC1 gene，which ulti- mately leads to abnormal mental behavior in rats.

Blumea balsamifera belonging to Blumea of Compositae family is a perennial herb or subshrub ，which is the only source of Traditional Chinese medicine Aipian and ethnic medicine essential oil of B. balsamifera . B. balsamifera contains volatile oil，flavonoids，sesquiterpenoids，phenylpropanoids，etc.，and shows antibacterial ，anti-inflammatory，analgesic，treating burns and scalds，neuroprotective and antioxidant effects ，etc. In this paper ，the chemical constituents and pharmacological activities are summarized by reviewing the domestic and foreign research literatures ，and it is expected to provide a reference for the in-depth research and development and utilization of B. balsamifera .

Objective: The study aimed to investigate the diurnal variation in cervical disc hydration and its relationship with cervical degeneration. Materials and Methods: C3–C7 discs of 86 prospectively enrolled participants (37 males, 49 females; mean age ± standard deviation, 23.5 ± 2.5 years) were assessed using T2 mapping in the morning and evening. All discs were stratified by Miyazaki grade or C2–C7 Cobb angle and T2 values (T2). The degree of diurnal T2 variation (T2-DDV), defined as (morning T2 – evening T2)/morning T2 x 100%, was measured for the entire disc, annulus fibrosus (AF), nucleus pulposus (NP), and endplate zones. Results: T2 of the entire disc decreased significantly after the daytime load (p < 0.001), with a T2-DDV of 13.3% for all discs and 16.0%, 12.2%, and 13.0% for healthy (grade I), mild degenerative (grade II), and advanced degenerative (grade III/IV) discs, respectively. T2 of regional NPs and AFs decreased significantly from morning to evening (p ≤ 0.049) except in the healthy anterior inner AF (p = 0.092). Compared with healthy discs, mild degenerative discs displayed lower T2 and T2-DDV in regional NPs (p < 0.001). Advanced degenerative discs showed higher T2-DDV in the anterior inner AF compared with healthy discs (p = 0.050). Significant diurnal T2 changes in the endplate zones were observed only in healthy discs (p = 0.013). Cervical discs in the low Cobb angle group showed higher T2-DDV in the anterior AFs and anterior NP and lower T2-DDV in the posterior AF than those in the high Cobb angle group (p ≤ 0.041). Conclusion This study characterized the diurnal variation in hydration of the cervical discs as assessed using T2 mapping and revealed early chemo-mechanical coupling dysfunction in degenerating discs. Cervical sagittal alignment on MRI can affect the diurnal stress patterns of the cervical discs. T2 mapping is sensitive to disc biomechanical dysfunction and offers translational potential from biomechanical research to clinical application.

Objective:To analyze the clinical characteristics and risk factors of systemic lupus erythematosus (SLE) with Libman-Sacks endocarditis (LSE).Methods:Data of SLE patients with LSE ( n=20) who admitted in Peking Union Medical College Hospital from January 2012 to May 2021 were retrospectively collected. SLE patients without LSE ( n=60) were randomly selected as controls according to 1∶3 age and sex matched in the hospitalized patients during the same period. Clinical characteristics, laboratory and imaging examinations were analyzed. Data were expressed as Mean± SD, and t test was used to compare quantitative data in normal distri-bution. Data were expressed as M ( Q1, Q 3), and Wilcoxon signed-rank test or Wilcoxon rank sum test were used to compare quantitative data in non-normal distribution. The count data were compared with Chi-square test or Fisher's exact test. Univariate conditional logistic regression was used for univariable analyses. P values less than 0.05 were considered statistically significant. Results:There were 20 SLE patients with LSE, 18 females with an average age of (32±9) years (13 to 49 years). The disease duration of SLE was 16.04(0, 185.1) months when LSE was discovered, and vegetations were located at the mitral valve in 19 (95.0%) patients. Cerebral infarction (45.0% vs 10.0%, χ2=9.87, P=0.001) and antiphospholipid syndrome (APS) (50.0% vs 5.0%, χ2=22.32, P<0.001) were more common in SLE with LSE. In addition, SLE with LSE had lower platelet counts [(140±67)×10 9/L vs (189±115)×10 9/L, t=-2.29, P=0.026] and higher positive rate of lupus anticoagulant (LA) (80.0% vs 23.6%, χ2=19.65, P<0.001), lower positive rate of anti-SSA antibodies (21.1% vs 60.0%, χ2=6.38, P=0.012). Left atrial enlargement (anteroposterior diameter of left atrium>40 mm) was more common in SLE patients with LSE (35.0% vs 5.4%, χ2=9.37, P=0.002), and anteroposterior diameter of left atrium [(37±7) mm vs (33±4) mm, t=2.15, P=0.043] were larger and left ventricular ejection fraction [(63±10)% vs (68±6)%, t=-2.41, P=0.019] was lower. The risk of SLE with LSE complicated with APS was 19 times compared with SLE without LSE [ OR (95% CI)=19.00 (4.43, 81.38), P<0.001]. Conclusion:SLE patients with LSE have increased risk of APS and cerebrovascular diseases. For patients with positive LA, the possibility of LSE should be alerted.

Objective : To explore the spatial and temporal heterogeneity of pathological phenotype of epidermal growth factor receptor (EGFR) -mutant transformed locally advanced or metastatic small-cell lung cancer( SCLC) or neuroendocrine carcinoma (NEC) ． Methods : This study retrospectively analyzed EGFR-mutant LUAD patients who were treated with EGFR-TKIs and underwent a transformation into SCLC / NEC． Baseline clinicopathological characteristics after initial transformation were summarized．According to the different pathological components of initial SCLC / NEC transformation，it was defined as incomplete transformation and complete transformation．Incom- plete transformation was defined as three categories : intratumoral transformation，intertumoral transformation and ef- fusional transformation. Results : This study collected 49 patients who met the criteria．Among forty-nine patients， incomplete transformation was 34. 7% ( 17 /49) and complete transformation was 65. 3% (32 /49) ．In addition， intratumoral transformation ，intertumoral transformation and effusional transformation were respectively 82. 3% ( 14 /17) ，5. 9% ( 1 /17) and 11. 8% (2 /17) . It was mean that the spatial heterogeneity of pathological phenotype of initially transformed SCLC / NEC was 34. 7%．After initial transformation，among the fifteen patients in dynamic histological and / or cytological biopsies，the temporal heterogeneity of pathological phenotype of initially transformed SCLC / NEC was 46. 7% (7 /15) ．In addition，there was no significant difference in first-line treatment post-trans- formation progression-free survival and post-transformation overall survival between incomplete transformation group and complete transformation group． Conclusion EGFR-mutant transformed locally advanced or metaststic SCLC / NEC has spatial and temporal heterogeneity in pathological phenotype.

Objective:To analyze the clinical characteristics and risk factors of rheumatic diseases complicated with Pneumomediastinum (PnM).Methods:A retrospective analysis of 94 inpatients with rheumatic diseases associated PnM from Peking Union Medical College Hospital and Shanxi Bethune Hospital between January 1998 and October 2018 was carried out. Patients were divided into idiopathic inflammatory myopathies (IIM) and the non-IIM group. Clinical features, laboratory examinations and treatment were compared between the two groups. Cox proportional hazard model was used to investigate the risk factors for prognosis.Results:A total of 94 patients were included in the study, with an average age of (45±14) years. Forty-five (48%) of them were male. There were 62 patients in the IIM group and the other 32 were in the non-IIM group. Sixty-nine patients had predisposing factors before PnM. Severe cough and assisted mechanical ventilation were the most common causes. Compared with the non-IIM group, the incidence of digital vasculitis (29% vs 6%, χ2=6.540, P=0.008), arthritis (60% vs 28%, χ2=8.409, P=0.004), interstitial lung disease (ILD)(98% vs 78%, χ2=11.129, P=0.002) were higher in the IIM group, treatment with cyclophosphamide was higher in the IIM group ( χ2=4.458, P=0.035). There was non-significant difference in mortality between the two groups during hospitalization (50% vs 59%) and 6 months after PnM (64% vs72%) ( P>0.05). Pulmonary infection was the only risk factor for poor prognosis [ HR=3.131, 95% CI (1.025, 9.561), P=0.045], in which bacteria infection was the most common cause (65/75, 86.7%). Conclusion:PnM is a severe complication of rheumatic diseases. To get a good prognosis, rheumatol-ogists should balance the benefit and risk of infection of immunosuppressive therapy.

Objective:To investigate the value of texture analysis based on T 2WI and apparent diffusion coefficient (ADC) maps in discriminating low grade from high grade prostate cancer (PCa). Methods:Retrospective analysis was performed on patients who were confirmed to be PCa by pathology after surgery and underwent MRI examination in the department of radiology,Tongji Hospital,Tongji Medical College, Huazhong University of Science and Technology before radical surgery, including routine T 1WI, T 2WI and diffusion weighted imaging (DWI) sequences. 3D data analysis module of the MaZda software was used to manually draw region of interest (ROIs) slice by slice on T 2WI and ADC images, and generate volume of interest (VOI) of the entire tumor. MaZda software was also used to extract texture features. The independent sample t test or Mann-Whitney U test were used to identify the texture features with statistically significant differences between low and high grade PCa groups. Lasso regression model was used to select the best combination of texture features for identifying low and high grade PCa, and then the model was built. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of the model in both training cohort and test cohort. Results:The best texture feature combination selected by Lasso regression model were the S (1, 0, 0) correlation of T 2WI and the S (1, 0, 0) correlation, S (1, -1, 0) sum entropy and vertical-run length nonuniformity of ADC maps. The area under the ROC curve (AUC) of the model in training cohort was 0.823, and the sensitivity and specificity were 70.4% and 80.8%, respectively, which were better than the single texture feature. The AUC of the model in test cohort was 0.714, which was worse than training cohort. Conclusion:The texture analysis of T 2WI and ADC maps is valuable for the identification of low and high grade PCa.