Objective To explore the value of vesical imaging reporting and data system(VI-RADS)combined with absolute tumor-wall contact length(ABTCL)and actual tumor-wall contact length(ACTCL)in diagnosing muscle invasive bladder cancer(MIBC).Methods The MRI data of 113 patients with pathologically confirmed bladder cancer(BCa)were analyzed retrospectively.All patients underwent conventional MRI,diffusion weighted imaging(DWI)and dynamic contrast enhanced(DCE)MRI before sur-gery.Two radiologists independently evaluated MRI images based on VI-RADS score,and measured quantitative parameters,inclu-ding ABTCL and ACTCL.The Chi-square test was used to compare the difference of VI-RADS scores between MIBC and non-mus-cle invasive bladder cancer(NMIBC).Quantitative parameters between MIBC and NMIBC were compared by Mann-Whitney U test.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of VI-RADS,quantitative parameters and VI-RADS combined with quantitative parameters in the diagnosis of MIBC.Results VI-RADS,ABTCL and ACTCL had significant differences between MIBC and NMIBC(P＜0.05).The area under the curve(AUC)for VI-RADS,ABTCL and ACTCL in diagno-sing MIBC were 0.89,0.76 and 0.77,respectively.There was no significant difference between the AUC for ABTCL and ACTCL(P＞0.05).The AUC for VI-RADS combined with ABTCL or ACTCL in diagnosing MIBC was 0.93,higher than that of only VI-RADS(P＜0.05).Conclusion The combination of VI-RADS with either ABTCL or ACTCL can effectively improve the diagnostic performance of MIBC.ABTCL obtainedby linear measurement is easier to implement in clinical practice than ACTCL obtained by curved measurement.

The Menghe Medical School is a highly influential academic school of Chinese medicine in China.Its academic features are mainly learning from others'strengths,openness and tolerance;integrity as the foundation,communication as the strength;harmo-ny as the way,and agility as the technique.The Menghe Medical School originated in Menghe,developed in Shanghai,spread all over the country,and spread around the world.The reasons for the prosperity and development of the Menghe Medical School are analyzed.Among them,imperial doctors being rewarded and supported,the stars having their roots in Menghe,inheritance from teach-ers by blood,help from in-laws,and the establishment of education and leadership in development are the main factors.On the basis of inheriting the scholarship of Menghe Medical School,Professor Tong Xiaolin innovatively proposed academic ideas such as the train-ing path of Xiang thinking,state-target differentiation and treatment,and dosage and effectiveness of prescriptions and medicines,pushing the academic thought of Menghe Medical School to a new theoretical peak in the new era.Based on the majestic development path of the Menghe Medical School,the implications for the inheritance,innovation and development of modern Chinese medicine are analyzed.

Objective:To study the distribution characteristics of natural killer(NK)cells and their subsets in normal peripheral blood in China,and to explore their normal value and significance.Methods:In this study,peripheral blood was collected from 200 healthy adults.Their age range was 18-87 years.All the subjects were divided into 6 age groups:18-30,31-40,41-50,51-60,61-70,and 71-87 years.With CD16,CD56,CD4,CD19,as surface markers,fluid cytology detection tech-niques were used to detect NK cells and the relative and absolute counts.SPSS 27.0 was used for system-atic analysis of the data,and the measurement data were expressed as mean±standard deviations.A t test,variance analysis or rank sum test were performed to compare the differences between the age groups and the sex groups.The significance level was set at α=0.05,and P＜0.05 was considered statistically significant.Results:The range of NK B cells in the 200 healthy adult subjects was(0.46±0.24)× 106/L,that of CD3-CD56+NK cells was(13.14±7.56)× 106/L,that of CD56dimCD16+NK cells was(5.23±3.12)×106/L,that of CD56bright NK cells was(85.61±7.40)× 106/L,and that of NK T cells was(4.16±3.34)×106/L.There were no statistically significant differences in CD3-CD56+NK cells and NK T cells with respect to age(P=0.417,P=0.217).However,there was a decreasing trend in the number of NK B cells and CD56dimCD16+NK cells with increasing age(r=0.234,P＜0.001;r=0.099,P＜0.001),particularly after the age of 50.Conversely,CD56bright NK cells showed an increasing trend with age(r=0.143,P＜0.001).Conclusion:The detection of NK cells and their subsets has significant reference value for the diagnosis,treatment,and prognosis of autoimmune diseases,infectious diseases,and tumors.This study provides a preliminary reference range for clinical detection of NK cell subsets,but further research with a larger sample size and multi-center trials are needed to confirm these findings.

Objective:To study the mechanism of Carthami Flos- Paeoniae Raidx Alba herb pair in the treatment of migraine based on network pharmacology and experimental verification. Methods:TCMSP was queried to screen the drug components of Carthami Flos and Paeoniae Raidx Alba, and Swiss Target Prediction was used to predict the drug components. GeneCards was conducted to obtain disease targets for migraine, and Venny 2.1 was used to obtain intersection targets. PPI analysis with STRING and network diagrams with Cytoscape, GO and KEGG analysis with Metascape. The "drug-target-pathway" network was constructed by Cytoscape software. The migraine rat model was established by the nitroglycerin method, and the rats were divided into a model group and an observation group (5 rats in each group) according to the random number table method. The observation group was given 1.8 g/kg Carthami Flos- Paeoniae Raidx Alba solution, while the model group was given 0.9% sodium chloride solution, once a day, for 2 weeks. Symptom improvement was evaluated after treatment, and the core target of serum V-Rel endotheloproliferative virus oncogene homology A (RELA), protein kinase B1 (Akt1), mitogen-activated protein kinase 1 (MAPK1), tumor necrosis factor (TNF), cysteine aspartic protease-3 (Caspase-3), and interleukin-6 (IL-6) expression was detected. Results:It was found that 24 active ingredients in Carthami Flos- Paeoniae Raidx Alba herb pair directly act on 178 disease targets through multiple pathways to treat migraine. Among them, 6-hydroxykaempferol, beta-carotene, baicalin, beta-sitosterol and kaempferol were the core components. RELA, Akt1, MAPK1, TNF, Caspase-3, IL-6 were critical targets. The GO analysis showed 85 cellular component (CC), 228 biological process (BP) and 119 molecular function (MF). Enrichment analysis of KEGG signaling pathway suggested that Carthami Flos- Paeoniae Raidx Alba herb pair was mainly involved in advanced glycosylated end-product (AGE)-advanced glycosylated end-product receptor (RAGE), hypoxia-inducing factor-1 (HIF-1), phosphatidylinositol 3-kinase (PI3K)-protein kinase B (Akt) and MAPK signaling pathways. The experimental results showed that compared with the model group, the scores of Carthami Flos- Paeoniae Raidx Alba herb pair decreased at 0 ~ 30, 60 ~ 90, and 120 ~ 150 min (all P < 0.01), and the pain threshold of mechanical and thermal stimuli increased (all P < 0.01). Serum levels of RELA, Akt1, MAPK1, TNF, Caspase-3, and IL-6 were decreased (all P < 0.01). Conclusions:Carthami Flos- Paeoniae Raidx Alba herb pair can treat migraine by regulating RELA, Akt1, MAPK1, TNF, Caspase-3 and IL-6 signaling pathways including IL-17, TNF, Toll receptor, T cell receptor, AGE-RAGE, HIF-1, PI3K/Akt and MAPK.

Objective:To study the effect of visceral fat area (VFA) on postoperative complications and pancreatic fistula in patients undergoing laparoscopic assisted radical gastrectomy for gastric careinoma.Methods:Clnical data of 214 primary gastric cancer patients undergoing laparoscopic assisted radical gastrectomy between Jan 2017 and Jan 2022 at the Department of General Surgery, Shouguang People's Hospital were retrospectively reviewed.Results:There were 85 patients in high VFA group and 129 patients in the low VFA group. The body mass index (25.1±3.4) kg/m 2 and visceral fat area (143.4±41.1) cm 2 in the high VFA group were higher than those in the low VFA group (21.2±2.9) kg/m 2 and visceral fat area (58.7±31.9) cm 2. The operative time was (228.3±53.1) min vs. (206.3±62.9) min ( t=5.538, P=0.017). The intraoperative blood loss was (264.6±173.6) ml vs. (213.9±156.2) ml ( t=3.373, P=0.035). The postoperative hospital stay was (12.5±4.0) d vs. (10.3±3.7) d ( t=7.781, P=0.013). Twenty-three cases developed postoperative complications in the high VFA group vs. 20 cases in the low VFA group ( χ2=4.261, P=0.039). Patients in the high VFA group had an incidence of clinically relevant pancreatic fistula of 10.6% vs. 3.1% in patients in the low VFA group ( χ2=5.034, P=0.038). Univariate and multivariate analysis of clinically relevant pancreatic fistulas in patients with different VFA groups showed that men ≥134.6 cm 2 and women ≥91.1 cm 2 with VFA and operative time ≥250 min were independent risk factors for the occurence of clinically relevant pancreatic fistulas after laparoscopic assisted radical gastrectomy. Conclusions:VFA increases the difficulty of laparoscopic-assisted radical gastrectomy, resulting in increased postoperative complications. VFA and operation time are independent risk factors for clinically relevant pancreatic fistula after radical gastrectomy for gastric cancer.

Traditional Chinese medicine (TCM) has played an important role in the prevention and treatment of Coronavirus disease 2019 (COVID-19) epidemic in China. The integration of Chinese and Western medicine is an important feature of Chinese COVID-19 prevention and treatment. According to a series of evidence-based studies, TCM can reduce the infection rate of severe acute respiratory syndrome coronavirus 2 in high-risk groups. For patients with mild and moderate forms of COVID-19, TCM can relieve the related signs and symptoms, shorten the period of nucleic-acid negative conversion, and reduce conversion rate to the severe form of the disease. For COVID-19 patients with severe and critical illnesses, TCM can improve inflammatory indicators and blood oxygen saturation, shorten the hospital stay, and reduce the mortality rate. During recovery, TCM can improve patients' symptoms, promote organ function recovery, boost the quality of patients' life, and reduce the nucleic-acid repositive conversion rate. A series of mechanism research studies revealed that capability of TCM to treat COVID-19 through antiviral and anti-inflammatory effects, immune regulation, and protection of organ function via a multicomponent, multitarget, and multipathway approach.
Humans ; COVID-19 ; Medicine, Chinese Traditional ; Drugs, Chinese Herbal/therapeutic use* ; SARS-CoV-2 ; Epidemics

Epidemic cerebrospinal meningitis shows a high degree of consistency with the law of transmission among wei （卫）-qi-ying （营）-blood， in terms of the onset of the season， contagiousness， symptoms， pathogenesis， as well as characteristics of the transmission. It is proposed to use epidemic cerebrospinal meningitis as an example to explore the underlying disease of wei-qi-ying-blood syndrome differentiation system. Epidemic meningitis invades the brain from the upper respiratory tract along the nervous system， and its overall pathogenesis follows from entering the lung system （prodromal period） to entering the blood （bacteremia period， sepsis period） and then entering the brain （shock period）. According to the four-dimensional qualitative principle of epidemic pathogen tropism， it corresponds to disease of both wei and qi syndrome， then blazing of both qi and ying syndrome， and then heat blocking pericardium， exuberant heat stirring wind， and internal block and external collapse syndrome. This article explored the laws of transmission among wei-qi-ying-blood and its underlying diseases described in On Warm Heat （《温热论》）， and revealed the original appearance of the disease model under the laws of transmission among wei-qi-ying-blood to guide the clinical practice.

Objective:To investigate the risk factors of acute lung injury (ALI) caused by Staphylococcus aureus infection, and to construct a risk warning model. Methods:Patients with Staphylococcus aureus infection confirmed by sputum or blood culture admitted to the Affiliated Hospital of Jiangnan University from January 1, 2020 to May 10, 2022 were enrolled and divided into ALI group and non-ALI group. The age, smoking status, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), albumin, oxygenation index and other clinical data were compared between the two groups. Univariate analysis was performed by using independent sample t test and chi-square test. Binary logistic regression analysis was used to screen the independent risk factors of ALI caused by Staphylococcus aureus infection, and a risk warning model was constructed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of the model. Results:There were 96 cases of Staphylococcus aureus infection, including 68 cases (70.8%) in ALI group, of which 41 cases (60.3%) were positive in sputum culture and 27 cases (39.7%) were positive in blood culture. Compared with the non-ALI group, the proportion of patients aged ≥60 years in ALI group was lower (58.8%(40/68) vs 64.3%(18/28)), the proportion of smoking was higher (58.8%(40/68) vs 35.7%(10/28)), and the differences were both statistically significant ( χ2=0.76 and 0.03, respectively, both P<0.05). The levels of CRP, PCT and NLR in the ALI group were all higher than those in non-ALI group, while oxygenation index and albumin level were both lower, and the differences were all statistically significant ( t=-5.28, -3.46, -9.87, 12.83 and 3.08, respectively, all P<0.05). Binary logistic regression analysis showed that CRP (odds ratio ( OR)=1.973, 95% confidence interval (95% CI) 0.956 to 2.989), PCT ( OR=3.734, 95% CI 1.014 to 13.746), NLR ( OR=1.152, 95% CI 1.058 to 2.254) and albumin ( OR=1.527, 95% CI 1.110 to 2.102) were independent risk factors for ALI caused by Staphylococcus aureus infection. The areas under the ROC curve of CRP, PCT, NLR, albumin and the risk warning model constructed from the combination of four risk factors were 0.69, 0.81, 0.83, 0.78 and 0.93, respectively. The sensitivities were 65.14%, 89.91%, 84.40%, 56.88% and 98.17%, respectively. The specificities were 62.37%, 60.22%, 65.59%, 80.64% and 93.55%, respectively. The accuracy of the effectiveness test of the risk warning model was 84.97%. Conclusions:CRP, PCT, NLR and albumin are the independent risk factors for ALI caused by Staphylococcus aureus infection. The risk warning model based on the above factors has a good early warning effect on ALI caused by Staphylococcus aureus infection.

Objective:To provide a new morning check method for the output dose stability of the multileaf collimator (MLC) of the CyberKnife M6 (CK-M6) system.Methods:The CT images of a verification phantom with a size of 20 cm × 20 cm × 10 cm were transmitted into the Precision Treatment Plan ning System (ver. 1.1.1.1). The high-precision alignment between the accelerator output front and the fixed position of the phantom surface was achieved using the fiducial tracking method. A 10 cm × 10 cm radiation field was formed by the MLC and a DailyCheck plan with an output of 200 MU was designed. The repeatability, sensitivity, and accuracy of the DailyCheck plan were measured, and the CK-M6 system was continuously tested for one month using the artificial fixed method and the DailyCheck plan designed in this study. Results:The average and the standard deviation of 10 repeated measurements by the DailyCheck plan were 492.28 pC and 0.09, respectively, indicating good stability. There was a linear correlation between the measured values and the output dose, with a correlation coefficient of R2 > 0.999. Moreover, there was a position deviation of 2 mm between the phantom and the accelerator output front, and the result ant effect on the measured values was equivalent to a dose deviation caused by an output of 1.24 MU. The result from the continuous measurement of both the artificial fixed method and the DailyCheck plan fell within permissible limits, showing high consistency. Conclusions:The DailyCheck plan established through the fiducial tracking of a verification phantom can achieve the convenient, quick, and accurate daily detection of the output dose stability of the MLC of CK-M6. Therefore, this method can be widely applied in the clinical quality control of the CK-M6 system.

Objective:To evaluate the relationship between abdominal amylase, C-reactive protein (CRP), procalcitonin (PCT) and clinically relevant pancreatic fistula in the early stage after radical gastrectomy for gastric cancer, and to explore whether they can be used as early predictors of pancreatic fistula and their accuracy, in order to help identify pancreatic fistula in the early stage after gastrectomy.Methods:The clinical data of 372 patients diagnosed as gastric cancer and underwent gastrectomy in Shouguang People′s Hospital from January 2017 to December 2021 were retrospectively analyzed, including 190 males and 182 femals, aged from 28 to 32 years old, with the average years of 63.5±10.6. The receiver operating characteristic (ROC) curves of abdominal amylase on the first day and serum CRP and procalcitonin on the third day after surgery for gastric cancer were analyzed. The ROC curve was used to determine the optimal cutoff value and the sensitivity, specificity, positive and negative predictions, and accuracy of the optimal cutoff value were calculated. Single factor and multivariate analysis were used to analyze the risk factors of pancreatic fistula after gastric cancer surgery. SPSS 25.0 software was used for statistical analysis.Results:The incidence of clinically relevant pancreatic fistula after surgery for gastric cancer was 5.37%(20/372), including 18 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula. The critical values of amylase on the first postoperative day of clinically relevant pancreatic fistula after surgery for gastric cancer are predicted to be 2036 U/L, serum CRP 18 mg/dL, and procalcitonin 0.85 μg/L. In univariate analysis, body mass index, abdominal amylase concentration on the 1st postoperative day, serum CRP and procalcitonin on the 3rd postoperative day were the influencing factors for the occurance of pancreatic fistula after gastric cancer surgery. Multivariate Logistic regression analysis showed that body mass index>25 kg/m 2, abdominal amylase >2036 U/L on the first postoperative day and serum CRP>18 mg/dL on the third postoperative day were the independent predictors for pancreatic fistula. The sensitivity and specificity of the combination of intraperitoneal amylase on the first day and serum CRP on the third day after surgery for gastric cancer in predicting the occurrence of clinically relevant pancreatic fistula were 87.6% and 90.4%, respectively. Conclusions:The combination of amylase in abdominal cavity on the 1st day and CRP on the 3rd day after radical gastrectomy has high sensitivity and specificity in predicting clinically related pancreatic fistula. PCT on the 3rd day after gastric cancer surgery has limited accuracy in predicting clinically related pancreatic fistula, so it is not recommended as an early prediction index of pancreatic fistula after gastric cancer surgery.