Objective:To compare the image quality and the diagnostic efficiency for breast malignant lesions using simultaneous multi-slice single shot echo planar imaging (SMS+SS-EPI) and readout segment of long variable echo trains (RESOLVE) for breast diffusion-weighted imaging (DWI).Methods:This study was a cross-sectional study. Clinical and imaging data of 102 patients with breast lesion from March 2021 to February 2023 in the First Hospital Affiliated to Ningbo University were prospectively analyzed. All patients underwent routine breast MRI scans and cross-sectional RESOLVE and SMS+SS EPI sequence DWI, and the image quality of 2 types sequences of DWI was evaluated. The subjective evaluation was based on a 5-point scale, including geometric distortion, artifact blurring, fat suppression, overall image quality, and lesion conspicuity of the breast. The objective evaluation included signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) value of the lesion. Wilcoxon signed rank sum test was used to compare the subjective and objective parameters between the two sequences. Finally, the receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the effectiveness of ADC values for diagnosing breast malignant lesions based on two sequence images.Results:All 102 female patients had single lesions, aged from 25 to 68 years and 60 lesions were malignant and 42 were benign. The acquisition time for SMS+SS-EPI sequence imaging was 1 min 50 s, and the acquisition time for RESOLVE sequence imaging was 3 min 43 s.The subjective scores from both SMS+SS-EPI and RESOLVE sequence were over than 3 points. The geometric distortion, artifact blurring, and overall image quality scores of RESOLVE sequence images were higher than those of SMS+SS-EPI (all P<0.001). The overall lesion conspicuity score, malignant lesion conspicuity score, and benign lesion conspicuity score of DWI and ADC images combined with SMS+SS-EPI sequence were higher than those of the RESOLVE sequence (all P<0.05). There were no statistically difference in SNR, CNR, overall ADC value, malignant ADC value, and benign ADC value between SMS+SS-EPI and RESOLVE sequence DWI images of breast lesions (all P>0.05). The AUC of RESOLVE sequence ADC value in diagnosis of breast cancer was 0.973, the sensitivity was 0.929, and the specificity was 0.915; The AUC of SMS+SSC-EPI sequence ADC value in diagnosis of breast cancer was 0.956, the sensitivity was 0.977, and the specificity was 0.850. Conclusions:In breast DWI, the subjective score of SMS+SS EPI image quality can basically meet the diagnostic requirements and the conspicuity of lesions is better than that of the RESOLVE sequence. Both have good diagnostic efficacy for malignant breast lesions.

By integrating the concept of narrative medicine and relevant models and tools into the Doctor-patient Communication course， this paper expounds the connotation of narrative medicine under the context of “new medicine” and “big health” and the practical significance of the shift to narrative in Doctor-patient Communication course in three aspects： academic frontier， social needs and practical needs. This paper analyzes the four dimensions of innovation that narrative medicine， as the frontier of the discipline， historical accumulation， educational philosophy and professional skills， provides for the Doctor-patient Communication course， and explores the effective path to realize the narrative transformation of the course. It is expected to achieve the purpose of forging students’ humanistic medical skills and literacy through teaching innovation， realizing the coordination of medical education and competency orientation， adapting to the psychological and social increase， the change of people and health， and promoting the reform of the supply side of medical talents.

Objective To evaluate the correction rate,accuracy of pedicle screw fixation and overall clinical efficacy of intravertebral osteotomy and internal fixation surgery with the assistance of 3D printing guide plates in treatment of severe kyphosis.Methods A single-center nonrandomized clinical pilot study was conducted on 19 patients(8 males and 11 females)with severe kyphosis undergoing intravertebral osteotomy between December 2018 and June 2023.Seven of them(CAD group)had preoperative planning with computer-aided design(CAD)and intraoperative guidance of individualized 3D printing guide plates.And another 12 patients(control group)were corrected with conventional pedicle screw placement.Postoperative evaluation included assessment of posterior Cobb angle,spinal angular correction rate,accuracy of pedicle screw placement and Oswestry Dysfunction Index(ODI)questionnaire.Results The 19 patients were at a mean age of 48.0 years,and followed up for 26.4(9～54)months.All of them achieved relatively satisfactory corrective results,with those of the CAD group having a correction rate of 96.83％and those of the control group of 86.61％.There were no statistical differences in average intraoperative blood loss(857 vs 1 045 mL)and average operative time(344 vs 402 min),but significant difference was observed in average length of hospital stay(11 vs 18 d,P＜0.05)between the 2 groups.A total of 278 nails were placed in this study,including 70 guide-assisted pedicle screws,97.1％of which were grade A or B.In the control group,208 pedicle screws were placed,93.8％of which were grade A or B.Postoperative CT/X-ray scanning displayed that both groups achieved certain correction for kyphosis.No obvious difference was found in the average spinal angular correction(43.37° vs 36.10°),and significantly higher correction rate was seen in the CAD group than the control group(96.83％vs 86.61％,P＜0.01).The ODI value was notably lower in the CAD group than the control group(P＜0.05).Conclusion CAD-assisted preoperative planning,surgical simulation and individualized 3D printing guide plates can promote surgical correction and accuracy of pedicle screw placement and improves the quality of life of patients with severe kyphotic deformity.

Objective:To identify serum metabolic markers for early prediction and diagnosis of gestational diabetes mellitus (GDM).Methods:A retrospective case-control study was conducted.The study subjects were from pregnant women enrolled in the Birth Cohort Study of the Women′s Hospital, Zhejiang University, from1 November 2018 to 30 March 2020.100 cases of GDM (GDM group, Age 36.03±3.91) and 150 non-GDM pregnant women matched for clinical information (control group, Age35.49±3.46) were retrospectively selected for the study. Fasting serum samples were collected at 15-20 weeks of gestation (prior to GDM diagnosis, T1 period) and 24-28 weeks of gestation (during GDM diagnosis, T2 period). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to quantify GDM-related serum metabolic small molecules, including 1, 5-anhydroglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine. These molecules, along with basic clinical information (age, gestational week, BMI) and standard biochemical indicators (FPG), were used to develop predictive models for the early detection of GDM at T1 and the diagnosis of GDM at T2. Statistical analysis was performed using t-tests or Mann-Whitney U-tests.Result:The results of the targeted quantitative validation study indicate: At the T1 stage, the level of 1, 5-anhydroglucitol was found to be significantly lower ( P=0.001) in the GDM group compared to the control group. Conversely, the level of isoleucine was significantly higher ( P=0.027) in the GDM group. There were no significant differences in the levels of 3-hydroxybutyrate and phenylalanine between the two groups ( P>0.05). The combination of the 4 metabolites yielded the highest predictive value (AUC) for GDM at T1, with an AUC of 0.670 (95% CI: 0.602-0.739), P<0.001.At the T2 stage, the GDM group had significantly lower levels of 1, 5-anhydroglucitol ( P<0.05) and significantly higher levels of 3-hydroxybutyric acid and isoleucine ( P<0.05) than the control group, with no significant differences in phenylalanine levels ( P=0.626). The combination of the four metabolites had the highest diagnostic value (AUC) for GDM, 0.717 (95% CI 0.651-0.783), P<0.001.The analysis of seven different combinations of GDM prediction/diagnostic models created by combining four metabolites with basic clinical information and routine biochemical indicators showed: We found that the AUC value of the GDM diagnostic model built with FPG, BMI, pre-pregnancy BMI, age, gestational week, and the 4 metabolite indicators in T2 stage was the best, 0.794 (95% CI 0.736-0.851), P<0.001, with a sensitivity of 72%;The best AUC value for the GDM prediction model built with the same indicators at T1 was 0.711(95% CI 0.646-0.776), P<0.001, with a sensitivity of 77%. Conclusions:Four metabolic small molecules, 1, 5-anhydroxyglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine, were integrated with clinical indicators (FPG) and clinical information (age, gestational week, BMI) to develop a predictive model for GDM at gestation (T1) and a diagnostic model for GDM at gestation (T2), demonstrating promising clinical prediction and diagnostic capabilities. 1, 5-Anhydroglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine show potential as valuable markers for the prediction and diagnosis of GDM.

Gestational diabetes mellitus (GDM) is characterized by glycemia and insulin disorders. Bile acids (BAs) have emerged as vital signaling molecules in glucose metabolic regulation. BA change in GDM is still unclear, which exerts great significance to illustrate the change of BAs in GDM. GDM patients and normal pregnant women were enrolled during the oral glucose tolerance test (OGTT) screening period. Fasting serums were sampled for the measurement of BAs. BA metabolism profiles were analyzed in both pregnant women with GDM and those with normal glucose tolerance (NGT). Delivery characteristics, delivery gestational age, and infant birthweight were extracted from medical records. GDM patients presented distinctive features compared with NGT patients, including higher body mass index (BMI), elevated serum glucose concentration, raised insulin (both fasting and OGTT), and increased hemoglobin A1c (HbA1c) levels. Higher homeostasis model assessment of insulin resistance (HOMA-IR) and decreased β-cell compensation (i.e., oral disposition index (DI

TORCH, represented by the Toxoplasmosis, Rubella virus, Cytomegalovirus, Herpes simplex virus or Human Parvovirus B19, is considered as a series of pathogens which might lead to the miscarriage, premature birth, teratogenesis, stillbirth, intrauterine growth retardation or multiple-organic damage in newborns. Serological examination of the pathogen-specific antibodies, including IgM and IgG, is currently the foremost laboratorial strategy for clinical laboratory of TORCH. Although the serum-IgM level often indicates the acute infection period of patients and is of the great clinical concern, the combination of different strategies, such as immunological methods or clinical manifestations is valuable to ensure the accuracy and specificity. Normative TORCH serological screening and systematic laboratory testing can assist pre-pregnancy guidance and fetal risk assessment during pregnancy, help to prevent the pregnancy risks and reduce the birth defects.

TORCH, which is considered as a series of pathogens, including the Toxoplasma gondii, Rubella virus, Cytomegalovirus or Herpes simplex virus, often infects the pregnant women to induce the the fetus or newborn infection by transplacental infection or exposure to contaminated genital tract secretions at delivery. Increasing evidence have been confirmed that the infection of TORCH may cause the miscarriage, premature birth, malformed fetus, stillbirth, intrauterine growth retardation, neonatal multiple organ dysfunction and other adverse pregnancy outcomes. For most TORCH-infections cases may lacking the effective treatments during pregnancy, and it is important to achieve the effacing monitoring of TORCH infections before and during pregnancy. The laboratory testing of TORCH has the great significance. However, the consensus opinions still need to improve the the standardization of TORCH testing process and the correct interpretation. Based on the characteristics of the TORCH detection method, this article gives a consensus opinion on the standardized detection and clinical application of TORCH from the laboratory perspective according to the characteristics and types of infection of different pathogens.

Methods:A total of 1 152 amniotic fluid samples were collected from pregnant women who underwent prenatal diagnosis in the Nanjing Maternity and Child Health Care Hospital, Women′s Hospital School of Medicine Zhejiang University, West China Second University Hospital, Sichuan University/West China Women′s and Children′s Hospital, and Xiamen Maternal and Child Health Hospital from September 2014 to August 2016. These samples were examined with SD-HRM and karyotyping simultaneously. Clinical sensitivity and specificity of SD-HRM were calculated, and Kappa values were measured to evaluate the consistency of detection results of the two methods.Results:A total of 161 cases of trisomy 21, 60 cases of trisomy 18, and 5 cases of trisomy 13 were detected by SD-HRM in 1 152 prenatal samples, sensitivity and specificity were both up to 100%, and Kappa values is equal to 1 which were consistent with the results of karyotype analysis.Conclusion:SD-HRM is validated to be highly accurate for the prenatal diagnosis of common trisomies, which is promising in the clinical practice.

Prenatal screening has undergone from simple age screening, serological prenatal screening, multiple serological screening, to combined screening with cell-free fetal DNA in maternal blood (non-invasive prenatal testing, NIPT). prenatal screening plays an important role in the detection and prevention of birth defects, such as chromosomal abnormalities and open neural tube defects(ONTD). With the emergence of NIPT technology, serological test result in prenatal screening has been outgrowth from the functional surrogate of the development status of fetus and placenta to the predictors of pre-eclampsia and fetal growth retardation(FGR). Therefore, large scale screening program will further improve maternal safety and reduce birth defects.

Objective This study analyzed the expression of alpha-hydroxybutyrate dehydrogenase (α-HBDH) in serum and explored its predicative value in the diagnosis of ovarian cancer (OC). Methods A retrospective study was conducted on 319 OC patients (OC group), 400 patients with benign lesions (benign group), and 400 healthy controls (normal group). These subjects were treated or received physical examination in Women's Hospital, School of Medicine, Zhejiang University from January 2014 to August 2018. Each group was further stratified by menopausal status. The expression levels ofα-HBDH and carbohydrate antigen125 (CA125) and their associations with clinic-pathological characteristics of OC were evaluated, and their diagnostic efficacy in OC were explored. Wilcoxon Rank Test and Kruskal-Wallis H test were used for group comparison. Receiver operating curve(ROC) was plotted to evaluate the diagnostic capability of α-HBDH and CA125 in OC. Results The median of α-HBDH level was 134.0 U/L in OC group, 120.0 U/L in benign group, and 110.0 U/L in normal group. OC group was significantly different from other two groups (H=129.5, P<0.001). Serumα-HBDH was also correlated with the menopausal status, lymph node metastasis, and clinical stage of OC patients significantly(Z=-5.2, H=31.5,Z=-3.2,all P<0.001). In the ROC analysis in terms of OC risk, the area under curve (AUC) ofα-HBDH was lower than AUC of CA125 [premenopausal group (α-HBDH: AUC=0.685; CA125: AUC=0.796;menomenopausal group (α-HBDH:AUC=0.749;CA125:AUC=0.915)];and in the stage I of premenopausal group, α-HBDH performed similar to CA125, but with obviously higher sensitivity than CA125 (α-HBDH:AUC:=0.646, Se=79.41％, SP=41.61％;CA125:AUC=0.691, Se=58.82％, Sp=74.71％). Conclusions The expression level of serum α-HBDH level was increased in OC patients, and it was associated with menopausal stage, lymph node metastasis, and clinical stage of OC. In addition, α-HBDH showed higher sensitivity than CA125 in stage I premenopausal group, which was potentially beneficial for the diagnosis of stage I OC in premenopausal women.