Objective To observe the abnormal brain activity in patients with migraine without aura(MwoA)with MRI.Methods Fifty MwoA patients(MwoA group)and 46 healthy volunteers(control group)were prospectively enrolled.Functional MRI(fMRI)was performed to observe the dynamic regional homogeneity(dReHo)of brain regions,then brain regions with differences of dReHo value between groups were extracted,and correlations with clinical scales were analyzed.Results Compared with control group,dReHo values of surrounding cortex of bilateral calcarine fissure and right middle occipital gyrus increased,of right middle temporal gyrus,right middle frontal gyrus and left cuneus decreased in MwoA group(GRF correction,voxel level all P＜0.005,cluster level all P＜0.05).The weight analysis showed that brain regions with top 3 absolute weight values were surrounding cortex of right calcarine fissure,left cuneus and right middle occipital gyrus.dReHo value of surrounding cortex of left calcarine fissure in MwoA patients was negative correlated with self-rating depression scale(SDS)(r=-0.28,P=0.04).Conclusion Abnormalities in the upward transmission pathway of visual information existed in MwoA patient,especially in surrounding cortex of right calcarine fissure,left cuneus and right middle occipital gyrus.

Objective:To construct a predict model based on ultrasomics parameters that can identify moderate acute hypoxemic respiratory failure patients at risk of non-invasive respiratory strategies(NIRS) failure and evaluate its value.Methods:This is a prospective observational trial.The patients with moderate acute respiratory failure (100 mmHg≤PaO 2/FiO 2≤200 mmHg) in intensive care unit(ICU) ,emergency and respiratory ward of Changshu Hospital Affiliated to Soochow University from Oct 2020 to Jan 2023 were included, NIRS failure is defined as death or intubation while on therapy.At admission time and 24 h after treatment vital signs,biological and ultrasound parameters were determined.The study subjects were randomly ( random number) divided into a development group (70%) and a validation group (30%).Univariate and multivariate logistic regression was performed.The treatment failure prediction models were constructed according to ultrasonic parameters combined with clinical parameters.The models were also validated by ROC curves, calibration curves, NRI index and decision curve analysis (DCA).The nomograms were drawn. Results:A total of 193 patients were included in the study, 137 were allocated to the development group, and 56 to the validation group, there was no statistically significant difference between the two groups. NIRS failed in 112 (58%) of 193 patients..Univariate analysis revealed that PaO 2/FiO 2, DE at the time of admission and 24 h in the failure group were found to be statistically lower than the success group, RV/LV was higher (all P<0.05). RR, LUS at 24 h in the failure group were higher and ROX index was lower (all P<0.01). In addition, more patients in the failure group received vasopressors ( P= 0.001). Use of vasopressors( OR=4.709, P=0.012), RR( OR=1.254, P=0.035), LUS( OR=1.250, P=0.037), RV/LV( OR=1.057, P=0.008), PaO 2/FiO 2 ( OR=0.950, P=0.001), DE ( OR=0.107, P=0.001) in the development group were independent risk factors for NIRS failure.ROC analysis revealed that model B achieved a larger area under curve (AUC) than model A in the development group, with their AUC values of 0.928 and 0.872 ( P=0.009), AUC of model A and model B in the validation group were 0.867 and 0.932 respectively ( P=0.07).Two prediction models showed a good degree of calibration (all P>0.05). NRI analysis showed significant improvement in the predictive power of model B ( P<0.01). DCA showed that the model B had a good net benefit between the threshold probabilities of 0-80%. Conclusions:Ultrasomics parameters combined with Clinical parameters can effectively predict NIRS failure in moderate acute hypoxemic respiratory failure patients.

Objective:To evaluate the efficacy and prognostic factors of radiotherapy combined with immunotherapy as the first-line treatment for patients with locally advanced or metastatic esophageal squamous cell carcinoma (LA/M ESCC).Methods:A single-center, retrospective analysis was conducted for the recent efficacy, survival, prognostic factors, post-treatment failure modes, and treatment-related adverse reactions of 57 LA/M ESCC patients eligible for enrollment.Results:The entire group of patients had 1-, 2-, and 3-year overall survival (OS) of 86.0%, 57.5%, and 53.9%, respectively and 1-, 2-, and 3-year progression-free survival (PFS) of 61.4%, 31.0%, and 31.0%, respectively. The median OS was not reached, and the median PFS was 15.0 (95% CI: 10.77-19.23) months. These patients had an overall response rate (ORR) of 80.7% (46/57) and a disease control rate (DCR) of 94.7% (54/57). As indicated by the result of the multivariate analysis, the independent prognostic factors affecting the OS of the patients included their age, clinical stage, number of immunotherapy cycles, and recent efficacy ( HR = 0.25, 2.58, 0.35, 4.05, P < 0.05), and the independent factors influencing the PFS of the patients included their clinical stage and recent efficacy ( HR = 2.27, 1.97, P < 0.05). There were no statistically significant differences in the effects of irradiation ranges and the combination modes of immunologic drugs and chemoradiotherapy on both OS and PFS of the patients ( P > 0.05). A total of 32 patients suffered post-treatment failure. After the second treatment, they had 1- and 2-year OS of 55.7% and 25.3%, respectively, with median OS of 14.0 (95% CI: 5.17-22.83) months. A total of 26 cases experienced treatment-associated adverse reactions of grades 2 or higher during and after treatment. Conclusions:The combination of radiotherapy and immunotherapy is effective and safe as the first-line treatment for LA/M ESCC patients. The post-treatment failure modes still include local recurrence and distant metastasis. Therefore, such combination merits further investigation.

Background Air quality health index (AQHI) has been widely used to quantify the health effects of multiple pollutants observed in population-based epidemiological studies, and can better reflect the widespread linear non-threshold between air pollution and health effects. Objective To explore an AQHI for pediatric respiratory diseases (AQHI_r) in Shanghai and evaluate its feasibility. Methods The daily numbers of hospital outpatient visits for pediatric respiratory diseases from 2015 to 2019 were obtained from five general hospitals in Xuhui, Baoshan, Hongkou, Jinshan, and Chongming Districts of Shanghai. Monitoring data on air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, and O₃), air quality index (AQI), and meteorological variables (temperature, relative humidity, air pressure, and wind speed) were collected from five air quality monitoring sites nearest to selected hospitals. Time-series analysis using generalized additive model (GAM) was conducted to estimate the associations between respiratory-related pediatric outpatient visits and the concentrations of air pollutants. The sum of excess risk (ER) of hospital outpatient visits was used to construct AQHI_r. To assess the predictive power of AQHI_r, the associations of AQHI_r and AQI with the number of pediatric respiratory outpatient visits in three hospitals in Xuhui, Hongkou, and Chongming districts were compared. Results Air pollutants had various effects on respiratory diseases outpatient visits. PM_2.5, NO₂, and O₃ had most significant impacts on lag0 day and the associated ERs of hospital outpatient visits for each 10 μg·m⁻³ increase in pollutant concentration were 1.27% (95%CI: 0.88%-1.66%), 0.75% (95%CI: 0.40%-1.11%), and 0.36% (95%CI: 0.10%-0.62%), respectively. PM₁₀ and SO₂ had most significant impacts on lag3 day and the associated ERs of hospital outpatient visits for each 10 μg·m⁻³ increase in pollutant concentration were 0.81% (95%CI: 0.51%-1.12%) and 5.64% (95%CI: 3.37%-7.96%), respectively. There were significant effects of combinations of two pollutants among PM_2.5, PM₁₀, NO₂, SO₂, and O₃ except for PM₁₀+NO₂, SO₂+PM_2.5, and SO₂+NO₂ (P<0.05). According to the results of single-pollutant and two-pollutant models, PM_2.5, NO₂, SO₂, and O₃ were selected to construct AQHI_r. The comparison showed that for every interquartile range increase in AQHI_r, the ER for pediatric outpatient visits was higher than that for the value corresponding to AQI. Conclusion Air pollutants in Shanghai have an impact on the number of pediatric respiratory outpatient visits. The AQHI_r based on and outpatient visits for pediatric respiratory diseases can be a sensitive index to predict the effects of air pollution on children's respiratory health.

Background Non-occupational carbon monoxide (CO) poisoning is a public health problem that seriously affect people’s health and lives. Objective To describe the prevalence of non-occupational CO poisoning during 2007—2018 in Shanghai, analyze its epidemiological characteristics and potential influencing factors, and explore effective prevention and control measures. Methods Daily reported non-occupational CO poisoning cases and meteorological factors from 2007 to 2018 were collected in Shanghai, epidemiological characteristics were analyzed by descriptive epidemiology methods, and a distributed lag nonlinear model was used to assess the association between temperature and non-occupational CO poisoning. Results A total of 2264 non-occupational CO poisoning events and 3866 cases from 2007 to 2018 were reported in Shanghai, including 59 death cases. More than half of the poisoning cases were female (56.3%), and young adults accounted for more cases than any other age group (54.8%). The poisoning events mainly occurred in winter (from December to next February); however, cases reported in summer increased in recent years. The peak period of the events was from 20:00 to 24:00. Households (85.2%) and restaurants (8.0%) were the common places of non-occupational CO poisoning events, and the main cause was improper use of gas water heater (36.9%). A nonlinear curve was found between daily average temperature of current day and the occurrence of non-occupational CO poisoning. Temperature was negatively associated with the risk of non-occupational CO poisoning when the temperature was lower than 9.6 ℃, while a positive association was found during 9.7-26.0 ℃. Conclusion Winter is a high season for non-occupational CO poisoning in Shanghai, rising cases reported in summer is also worthy of attention. Supervision should be strengthened to ban sales of unqualified gas water heaters, and health education on CO poisoning prevention and control should be conducted through multiple channels, in order to reduce the incidence of CO poisoning.

Objective:To study the effect of surgical treatment on the psychological status of initial-diagnosed breast cancer patients.Methods:Using a prospective study method, 73 initial-diagnosed breast cancer patients who received surgical treatment in Beijing Bo′ai Hospital from March 2015 to June 2017 were selected. The self-rating anxiety scale (SAS), the self-rating depression scale (SDS) and the symptom checklist-90 (SCL-90) were used to evaluate the psychological health status before and after surgery by face-to-face conversation. The measurement data were described as mean±standard deviation( ± s), and the scores of SAS, SDS and SCL-90 before and after surgery were analyzed by paired t-test. Chi-square test was used to compare count data before and after surgery. Results:After surgical treatment, the anxiety and depression scores were 38.03±8.53 and 42.17±10.93, which were significantly lower than that in the pre-operation (46.47±11.47 and 51.01±14.22), the differences were statistically significant ( P<0.001). The scores of somatization, obsessive-compulsive symptoms, interpersonal sensitivity, anxiety, depression, hostility, phobia, paranoid and psychotic disorder of initial-diagnosed breast cancer patients in SCL-90 were 4.52±4.71, 6.15±5.49, 3.51±3.26, 4.52±4.44, 7.12±6.23, 1.55±2.03, 3.18±3.36, 0.99±1.36 and 2.85±3.59 after surgical treatment, which were significantly lower than that in the pre-operation (6.88±6.36, 10.08±6.77, 5.99±5.57, 10.03±8.00, 12.59±9.78, 4.12±5.25, 4.92±4.46, 2.59±3.60) and (5.84±5.43), the differences were statistically significant ( P=0.002 in somatization, others P<0.001). Conclusion:Surgical treatment can improve the psychological status of initial-diagnosed breast cancer patients, which has important significance for the psychological rehabilitation of patients who were initial-diagnosed breast cancer.

Objective:To evaluate the effect of high-flow nasal cannula (HFNC) therapy on patients with moderate acute respiratory failure.Methods:This was a randomized controlled trial. The patients with moderate acute respiratory failure in the Intensive Care Unit (ICU) of Changshu Hospital Affiliated to Soochow University from March 2019 to September 2020 were included. Patients with severe asthma or acute exacerbation of chronic respiratory failure, hemodynamic instability, disturbance of consciousness, non-invasive ventilation (NIV) contraindication, urgent need for endotracheal intubation, refusal of intubation, age <18 years and pregnancy were excluded. The patients were randomized to HFNC or NIV. Treatment failure was defined as the need for intubation and invasive ventilation. The vital signs, ROX index, blood gas analysis index, ultrasound parameters and endotracheal intubation rate were recorded at 1, 6, 12, 24 and 48 h after treatment. Kaplan-Meier method was used to draw the survival curve, and multivariate logistic regression was used to analyze the risk factors of treatment failure.Results:A total of 91 patients were included in the study, including 46 patients in the HFNC group and 45 patients in the NIV group. PaO 2/FiO 2 of the two groups were significantly increased after treatment compared with baseline ( P<0.05). The respiratory rate was lower in the NIV group than in the HFNC group at 1 and 24 h ( P<0.05). There were no significant differences in other vital signs, arterial blood gas and ultrasound parameters between the two groups (all P>0.05). The intubation rate was 52.2% in the HFNC group and 48.9% in the NIV group. Kaplan-Meier survival analysis showed that there was no significant difference in intubation rate and mortality between the two groups ( P>0.05). Multivariate logistic regression analysis showed that increased end-diastolic right ventricle/left ventricle ratio ( OR=1.044, 95% CI: 1.012~1.077) and high acute physiology and chronic health evaluationⅡ score ( OR=1.082, 95% CI: 1.006~1.163) at 0 h, lung ultrasound score ( OR=1.353, 95% CI: 1.034~1.772) and end-diastolic RV/LV ratio ( OR=1.097, 95% CI: 1.038~1.159) at 1 h were independent risk factors for non-invasive respiratory strategies failure. Increased diaphragm excursion ( OR=0.341, 95% CI: 0.165~0.704) at 0 h, high PaO 2/FiO 2 ( OR=0.929, 95% CI: 0.884~0.977), increased ROX index ( OR=0.524, 95% CI: 0.332~0.826), and increased diaphragm mobility ( OR=0.119, 95% CI: 0.030~0.476) at 1 h were independent protective factor for successful treatment. Conclusions:HFNC and NIV can improve oxygenation in patients with acute hypoxemic respiratory failure. There is no significant difference in intubation rate and mortality between HFNC and NIV. Ultrasound parameters may be helpful for predicting treatment failure.

Glioblastoma is carcinogenesis of glial cells in central nervous system and has the highest incidence among primary brain tumors. Brain metastasis, such as breast cancer and lung cancer, also leads to high mortality. The available medicines are limited due to blood-brain barrier. Abnormal activation of phosphatidylinositol 3-kinases (PI3K) signaling pathway is prevalent in glioblastoma and metastatic tumors. Here, we characterized a 2-amino-4-methylquinazoline derivative XH30 as a potent PI3K inhibitor with excellent anti-tumor activity against human glioblastoma. XH30 significantly repressed the proliferation of various brain cancer cells and decreased the phosphorylation of key proteins of PI3K signaling pathway, induced cell cycle arrest in G1 phase as well. Additionally, XH30 inhibited the migration of glioma cells and blocked the activation of PI3K pathway by interleukin-17A (IL-17A), which increased the migration of U87MG. Oral administration of XH30 significantly suppressed the tumor growth in both subcutaneous and orthotopic tumor models. XH30 also repressed tumor growth in brain metastasis models of lung cancers. Moreover, XH30 reduced IL-17A and its receptor IL-17RA in vivo. These results indicate that XH30 might be a potential therapeutic drug candidate for glioblastoma migration and brain metastasis.

ObjectiveTo investigate the effects of the inoculation of potassium-solubilizing bacteria on the rhizosphere soil microenvironment of Paris polyphylla var. yunnanensis. MethodThe effects of different potassium-solubilizing bacteria on the physical and chemical properties， microbial community structure， and soil enzyme activity in the rhizosphere soil of P. polyphylla var. yunnanensis were investigated by pot planting at room temperature. The correlation of various indexes was analyzed. ResultThe inoculation with different potassium-solubilizing bacteria could significantly affect the physical and chemical properties of rhizosphere soil of P. polyphylla var. yunnanensis. The mass fractions of available nitrogen， available phosphorus， and available potassium were 24.5-90.5 mg·kg^-1， 2.53-25.9 mg·kg^-1， and 132-312 mg·kg^-1， respectively， and the soil pH was 7.08-7.75， which were in line with the optimal ranges of P. polyphylla var. yunnanensis planting. The inoculation of different potassium-solubilizing bacteria could affect the number of bacteria， actinomycetes， and fungi in rhizosphere soil to varying degrees. The transformation of soil from "fungal type" to "bacterial type" marks the improvement of soil fertility. It also affected the enzyme activity of rhizosphere soil， and the activities of neutral phosphatase， protease， and polyphenol oxidase showed an increasing trend. The correlation analysis showed that the number of bacteria was negatively correlated with the number of fungi （r=-0.856， P<0.01）， positively correlated with the number of actinomycetes， the content of available nitrogen and available potassium， and negatively correlated with soil pH. ConclusionThe inoculation of potassium-solubilizing bacteria can effectively improve the content of available potassium， available nitrogen， available phosphorus， and other nutrients in the rhizosphere soil of P. polyphylla var. yunnanensis， improve soil fertility， alleviate the continuous cropping obstacles of P. polyphylla var. yunnanensis， and lay a theoretical foundation for the green and sustainable development of P. polyphylla var. yunnanensis.

Objective:To develop a prediction model of acute gastrointestinal injury (AGI) grading combined with qSOFA score for the diagnosis of sepsis, and evaluate its value.Methods:This was a prospective observational study. The patients with infection or suspected infection in the General Ward of Changshu Hospital Affiliated to Soochow University from September 2018 to September 2019 were included. Patients younger than 18 years, pregnant, abandoned treatment and died within 3 days after admission were excluded. Clinical characteristics, laboratory test results and AGI grading from 48 h before the infection to 24 h after the onset of infection were recorded. The patients were divided into the sepsis and non-sepsis groups according to whether they were diagnosed with sepsis. The patients were allocated randomly to a modeling cohort and a validation cohort with a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to analyze the relevant risk factors for sepsis in the modeling cohort. Three types of diagnostic models were constructed in the modeling cohort: model A (qSOFA model), model B (the combined model of AGI grading and qSOFA score), and model C (the combined model of clinical parameters). The clinical usefulness of the diagnostic models was assessed by receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA) in the validation cohort. The nomograms were developed based on these models.Results:A total of 2 553 patients were enrolled in the study, 1 789 patients in the modeling cohort and 764 patients in the validation cohort. and 326 were diagnosed with sepsis. There was no statistical difference in the basic conditions of patients in the two groups. Univariate analysis showed that age, gender, the source of infection, temperature, heart rate, polypnea, changes in consciousness, severe edema, hyperglycemia, white blood cell, C-reactive protein and procalcitonin, hypotension, hypoxemia, acute oliguria, coagulation disorders, hyperlacticemia, capillary filling damage or piebaldskin, AGI grading and qSOFA score were significantly correlated with sepsis (all P<0.01). Multivariate logistic regression analysis showed that age ( OR=1.027, P<0.01), source of infection ( OR=2.809, P=0.03), hypotension ( OR=35.449, P<0.01), hypoxemia ( OR=57.018, P<0.01), and AGI grading ( OR=19.313, P<0.01) were significantly associated with sepsis. ROC analysis showed that the area under the curve (AUC) of model A, B and C were 0.784, 0.944 and 0.971 in the modeling cohort, and 0.832, 0.975 and 0.980 in the validation cohort, respectively. The sensitivities were 63.9%, 89.5% and 97.5% in the modeling cohort, and 72.7%, 90.9% and 96.6% in the validation cohort; and the specificities were 90.8%, 90.3% and 88.1% in the modeling cohort, and 92.2%, 94.5% and 92.8% in the validation cohort, respectively. AUC of model B and C were significantly higher than that of model A ( P<0.01). Model A in the validation cohort was poorly calibrated, with low accuracy and high risk of missed sepsis diagnosis ( P=0.044). The net benefits of model B and C were better than that of model A. Conclusions:AGI grading combined with qSOFA score has a high predictive value and accuracy in the diagnosis of sepsis.