Objective:To analyze clinical characteristics of primary pancreatic lymphoma (PPL) patients.Methods:Clinical features of 22 patients diagnosed as PPL admitted to Peking Union Medical College Hospital from January 2002 to May 2023 were analyzed retrospectively.Results:The median age was 56.4±13.3 years. The median time from onset to diagnosis was 1.0 (1.0, 3.0) months. The main clinical manifestations were abdominal pain (15/22), weight loss (14/22) and jaundice (10/22). Elevated lactate dehydrogenase (LDH) was observed in 15/20 (75%) patients. Only 2 (2/9, 22.2%) patients had increased CA199 levels and 2 (2/9, 22.2%) patients had increased CEA levels. The maximum tumor diameter was 5.0 (3.8, 6.9) cm. Contrast-enhanced CT mostly showed low enhancement lesions. Major pancreatic duct dilatation were rare on CT scan (4/20). Fifteen patients were confirmed by pancreatic pathology, of which 8 were obtained by surgery, 4 were obtained by CT or ultrasound-guided percutaneous biopsy, and 3 were obtained by EUS-FNA. The main pathological type was diffuse large B-cell lymphoma (14/22). 19 patients received chemotherapy, and 6 patients died with a median follow-up of 5.0 (1.5, 35.5) months.Conclusions:PPL is rare and easy to be misdiagnosed. Elevated LDH levels, normal tumor markers, and non-dilatation of main pancreatic duct are important diagnostic clues. It is important to obtain pathology by EUS-FNA and other methods for definite diagnosis.

Objective To investigate the application efficiency and potential of CT radiomics in differentiating malignant and benign sub-centimeter solid pulmonary nodules. Methods A retrospective study was performed on the sub-centimeter ( ≤ 10 mm) solid pulmonary nodules detected by enhanced CT in our hospital from March 2020 to January 2023. Malignancy was confirmed by surgical pathology, and benignity was confirmed by surgical pathology or follow-up. Lesions were manually segmented and radiomic features were extracted. The feature dimension was reduced via feature correlation analysis and least absolute shrinkage and selection operator (LASSO). The 5-fold cross validation was used to validate the model. Support vector machine, logistic regression, linear classification support vector machine, gradient boosting, and random forest models were established for CT radiomics. Receiver operating characteristic curves were drawn. Delong test was used to compare the diagnostic performance of the five classifiers. The optimal model was selected and compared to radiologists with medium and high seniority. Results A total of 303 nodules, 136 of which were malignant, were examined. Radiomics models were established after feature extraction and selection. On test set, the areas under the receiver operating characteristic curves of support vector machine, logistic regression, linear classification support vector machine, random forest, and gradient boosting models were 0.922 (95%CI: 0.893, 0.950), 0.910 (95%CI: 0.878, 0.942), 0.905 (95%CI: 0.872, 0.938), 0.899 (95%CI: 0.865, 0.933), and 0.896 (95%CI: 0.862, 0.930), respectively. Delong test indicated no significant differences in the performance of the five radiomics models, and the support vector machine model showed the highest accuracy and F1 score. The support vector machine model showed significantly higher diagnostic accuracy as compared to radiologists (83.8% vs. 55.4%, P < 0.001). Conclusion The radiomics models achieved high diagnostic efficiency and may help to reduce the uncertainty in diagnosis of malignant and benign sub-centimeter solid nodules by radiologists.

Objective To investigate the Carabelli's traits on permanent maxillary molars in Han Chinese college students.Methods Intraoral photos and plaster models from 803 Han Chinese college students were observed and the Carabelli's traits on permanent maxillary molars were categorized by the Arizona State University Dental Anthropology System.Chi-square tests were performed for the comparison of the differences between male and female,permanent maxillary first and second molars.Kendall's tau-b correlation analy-ses were performed for the correlation between bilateral antimeric molars.Results The frequencies of Carabelli's traits on permanent maxillary first and second molars were 37.61％and 3.99％respectively,46.73％and 6.30％in males,27.95％and 1.54％in females,which were statistically significant between permanent maxillary first and second molars(P＜0.01),male and female(P＜0.01).In the positive expression,the low-grade expression(ASUDAS 1-4)was predominant and accounted for 67.37％and 59.52％on the perma-nent maxillary first and second molars.The correlation between bilateral antimeric teeth were statistically significant on permanent max-illary first molars(tau-b=0.756,P＜0.01)and second molars(tau-b=0.477,P＜0.01).Conclusion The Carabelli's traits on perma-nent maxillary molars in Han Chinese college students mostly occur on permanent maxillary first molars with low-grade expression,and understanding this has great anthropological and clinical significance.

Objective:To standardize the management of auditory hallucination symptoms in inpatients with mental illness and develop an expert consensus on the management of auditory hallucinations in hospitalized psychiatric patients.Methods:From March 2023 to July 2023, the Mental Health Committee of the Chinese Nursing Association focused on the key issues in the management of auditory hallucinations symptoms in inpatients with mental illness, based on clinical practice, using literature analysis combined with the work experience of mental health experts, and formed the first draft of the expert consensus on the management of auditory hallucinations in inpatients with mental illness (hereinafter referred to as the consensus). Through 3 rounds of expert consultation and 3 rounds of expert demonstration meeting, the draft was adjusted, revised, and improved.Results:37 experts were included in the Delphi expert consultation, 1 male and 36 females with 39-67(51.48 ± 6.61) years old. The positive coefficients of experts in 3 rounds of Delphi expert consultations were all 100%, and the degrees of expert authority were 0.924, 0.938 and 0.949, respectively. The average importance value of each item was higher than 4.00, the variation coefficient of each item was less than 0.25. The Kendall harmony coefficient of the experts were 0.179, 0.195 and 0.198, respectively (all P<0.05). There were 15, 12, 12 experts in the first, seeond, third rounds of expert demonstration meeting. Finally, a consensus was reached on the recommendation of 4 parts, included auditory hallucination assessment, management format, symptom management implementation, and precautions. Conclusions:The consensus covers all parts of the management of auditory hallucination symptoms in hospitalized patients with mental disorders, which is practical and scientific. It is helpful to guide mental health professionals to standardize the management of auditory hallucination symptoms, improve the quality of nursing and ensure the safety of patients.

Objective:To explore the efficacy of adjusting the dose of imatinib dose in the context of therapeutic drug monitoring (TDM) in patients with gastrointestinal stromal tumors (GISTs) who are receiving adjuvant therapy after complete resection of their tumors.Methods:This was a descriptive study. Inclusion criteria were (1) complete surgical resection with a pathological diagnosis of GIST, (2) postoperative adjuvant therapy with imatinib and dosage adjustment, (3) multiple TDM of imatinib, and (4) complete clinical, pathological, and follow-up data. The data of 70 patients with GISTs treated at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2015 and December 2023 were collected retrospectively. The study cohort comprised 15 (21.4%) men and 55 (78.6%) women of median age 60 years (range: 25–82). Of the eligible patients, 49 (70.0%) were at high-risk, 14 (20.0%) at intermediate-risk, six (8.6%) at low-risk, and one (1.4%) at very low risk. Patients were followed up by the gastrointestinal stromal tumor clinic every 2–3 months and their plasma concentrations of imatinib were checked. The dose was adjusted to 300 mg/d or 200 mg/d depending on whether they had had ≥ grade III adverse reactions, and whether the first plasma concentration of imatinib was ≥ 1,500 μg/L or between the expected range of 760 μg/L–1,100 μg/L. Studied indicators included adverse reactions, quality of life before and after dose adjustment, and overall survival and recurrence-free survival (RFS) after dose adjustment.Results:Before dose adjustment, all 70 patients received 400 mg of imatinib daily, with initial TDM values of 1,900 ± 568 μg/L, for a median duration of 8.3 months. After dose adjustment, 60 patients received 300 mg daily, with a TDM of 1,216 ± 350 μg/L, whereas 10 received 200 mg daily, with a TDM of 1,023 ± 269 μg/L. The median duration of treatment after dose adjustment was 23.4 months. Compared with those whose dosages were not adjusted, the incidence of bone marrow suppression was significantly lower (74.3% [52/70] vs. 51.4% [36/70], χ 2=9.202, P=0.010); as were the incidences of edema (95.7% [67/70] vs. 50.0% [35/70], χ 2=40.526, P<0.001); skin reactions (70.0% [49/70] vs. 32.9% [23/70), χ 2=22.495, P<0.001); and gastrointestinal reactions (38.6% [27/70] vs. 10.0% [7/70], χ 2=15.899, P<0.001) in those whose dosages were adjusted. The average total scores for physical health before and after dose adjustment were 76 ± 5 and 88 ± 4, respectively; whereas the mental health scores were 75 ± 6 and 89 ± 4, respectively. The median follow-up period was 36 months (range 6–126). During the first 3 years of follow-up, five high-risk patients with non-gastric GISTs developed recurrences. The 3-year overall survival rate was 100%, and the 3-year RFS rate was 92.8%, high-risk patients having a 3-year RFS rate of 89.8%. Conclusion:The adverse reactions and quality of life of GIST patients with severe adverse reactions to adjuvant imatinib therapy after complete resection can be mitigated by appropriately reducing the dosage of imatinib under the guidance of TDM.

Aortic stenosis(AS)is a structural change in aortic valve caused by congenital or acquired factors,and its incidence increases with age.Transcatheter aortic valve replacement(TAVR)is a safe and feasible minimally invasive treatment for severe AS.Since it was first approved by FDA in 2011 for severe AS which cannot be treated surgically,its indications have been extended to AS patients with low to moderate surgical risk.The placed prosthetic valves could compress the atrioventricular conduction system at the aortic root,leading to the development of postoperative cardiac conduction abnormalities,for which permanent pacemaker implantation(PPMI)is a treatment option.And post-TAVR PPMI is closely related to the prognosis of AS patients.Therefore,this article reviews predictors of conduction dysfunction and PPMI after TAVR.

Objective:To explore the efficacy of adjusting the dose of imatinib dose in the context of therapeutic drug monitoring (TDM) in patients with gastrointestinal stromal tumors (GISTs) who are receiving adjuvant therapy after complete resection of their tumors.Methods:This was a descriptive study. Inclusion criteria were (1) complete surgical resection with a pathological diagnosis of GIST, (2) postoperative adjuvant therapy with imatinib and dosage adjustment, (3) multiple TDM of imatinib, and (4) complete clinical, pathological, and follow-up data. The data of 70 patients with GISTs treated at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2015 and December 2023 were collected retrospectively. The study cohort comprised 15 (21.4%) men and 55 (78.6%) women of median age 60 years (range: 25–82). Of the eligible patients, 49 (70.0%) were at high-risk, 14 (20.0%) at intermediate-risk, six (8.6%) at low-risk, and one (1.4%) at very low risk. Patients were followed up by the gastrointestinal stromal tumor clinic every 2–3 months and their plasma concentrations of imatinib were checked. The dose was adjusted to 300 mg/d or 200 mg/d depending on whether they had had ≥ grade III adverse reactions, and whether the first plasma concentration of imatinib was ≥ 1,500 μg/L or between the expected range of 760 μg/L–1,100 μg/L. Studied indicators included adverse reactions, quality of life before and after dose adjustment, and overall survival and recurrence-free survival (RFS) after dose adjustment.Results:Before dose adjustment, all 70 patients received 400 mg of imatinib daily, with initial TDM values of 1,900 ± 568 μg/L, for a median duration of 8.3 months. After dose adjustment, 60 patients received 300 mg daily, with a TDM of 1,216 ± 350 μg/L, whereas 10 received 200 mg daily, with a TDM of 1,023 ± 269 μg/L. The median duration of treatment after dose adjustment was 23.4 months. Compared with those whose dosages were not adjusted, the incidence of bone marrow suppression was significantly lower (74.3% [52/70] vs. 51.4% [36/70], χ 2=9.202, P=0.010); as were the incidences of edema (95.7% [67/70] vs. 50.0% [35/70], χ 2=40.526, P<0.001); skin reactions (70.0% [49/70] vs. 32.9% [23/70), χ 2=22.495, P<0.001); and gastrointestinal reactions (38.6% [27/70] vs. 10.0% [7/70], χ 2=15.899, P<0.001) in those whose dosages were adjusted. The average total scores for physical health before and after dose adjustment were 76 ± 5 and 88 ± 4, respectively; whereas the mental health scores were 75 ± 6 and 89 ± 4, respectively. The median follow-up period was 36 months (range 6–126). During the first 3 years of follow-up, five high-risk patients with non-gastric GISTs developed recurrences. The 3-year overall survival rate was 100%, and the 3-year RFS rate was 92.8%, high-risk patients having a 3-year RFS rate of 89.8%. Conclusion:The adverse reactions and quality of life of GIST patients with severe adverse reactions to adjuvant imatinib therapy after complete resection can be mitigated by appropriately reducing the dosage of imatinib under the guidance of TDM.

Objective To compare the efficacy of arthroscopic rotator cuff repair using single row,double row,and suture bridge techniques in treating rotator cuff injuries and analyze the influencing factors of postoperative chronic pain.Methods Clinical data of 106 patients with rotator cuff injury to receive arthroscopic rotator cuff repair from January 2021 to February 2023 were retrospectively collected,were divided into single row group(n=35),double row(n=32)and suture bridge group(n=39).All patients from the three groups were evaluated using the pain visual analogue scale(VAS)and the Constant-Murley shoulder score(CMS)before surgery and 3,6,and 12 months after surgery,and their external rotation and forward flexion range of motion were measured.The incidence of postoperative retearing and chronic pain after surgery were compared among the three groups.Patients were divided into chronic pain group(n=21)and non-chronic pain group(n=85)depending whether chronic pain was seen or not after surgery and the clinical data was compared.Risk factors for postoperative chronic pain in arthroscopic rotator cuff repair patients were assessed via binary Logistic regression analysis.Results The VAS in suture bridge group was significant lower than that in single row group and double row group at 3,6 months after surgery,the VAS at 3,6,12 months after surgery in three groups were lower than that before surgery,the differences were statistically significant(P<0.05).The CMS score in suture bridge group was significant higher than that in single row group,double row group at 3,6 months after surgery,and all groups at 3,6,12 months after surgery were higher than that before surgery.The external rotation range of motion,and forward bending range of motion in suture bridge group were larger than those in single row group,double row group at 3,6 months after surgery,and all groups at 3,6,12 months after surgery were larger than those before surgery,the differences was statistically significant(P<0.05).The incidence of postoperative retearing in suture bridge group was significant lower than that in single row group and double row group,the difference was statistically significant(P<0.0167),but there was no difference between single row group and double row group(P>0.0167).The chronic pain occurrence was no statistical difference among the three groups(P>0.05).The chronic pain group had higher proportions of women,tear diameter<1.0 cm,and severe postoperative pain than those of non-chronic pain group(P<0.05).Other clinical data[age,body mass index(BMI),course of disease,location of injury,cause of injury,smoking and drinking history]were comparable between the two groups,the differences were not statistically significant(P>0.05).According to binary Logistic regression analysis,after adjusting for confounding factors(age,BMI,disease course,location and cause of injury),female gender,tear diameter<1.0 cm,and severe postoperative pain were independent risk factors for chronic pain after arthroscopic rotator cuff repair surgery(P<0.05).Conclusion In treating patients with rotator cuff injury,arthroscopic suture bridge outperforms single row and double row techniques in alleviating shoulder joint pain,promoting functional recovery and increasing range of motion,and presents lower risk of retearing.However,all three have some risk of chronic pain after surgery.Female gender,tear diameter<1.0 cm,and severe postoperative pain are independent risk factors for postoperative chronic pain.

To investigate the epidemiology of avian infectious bronchitis virus(IBV)and study the pathogenicity of IBV isolate,we isolated the IBV field strain from a clinical sample of chickens sus-pected to be infected with infectious bronchitis virus(IBV)from Hefei,Anhui Province,named HF210416.Sequencing analysis of the S1 gene showed that HF210416 belonged to the GI-22 geno-type,which was significantly differed from that of the reference GI-22-type strains,with homology ranging only from 84.5％to 87.8％.Recombinant analysis showed that HF210416 was a recombi-nant strain,with YX10(GI-19)as the major parent and YN(GI-19)as the minor parent.2-day-old SPF chicks infected with the HF210416 isolate showed clinical symptoms such as breathing with difficulty,depression and excreting watery droppings;the infected chicks had a rapid onset of dis-ease,with mortality occurring on the second day of inoculation,and mortality persisted until the fifth day,with 33.33％(5/15)mortality rate.The infected chicks recovered the 14th day after inoculation.RT-PCR detection of pharyngeal-anal swabs showed that the virus shedding by infected chicks could be continuously detected within 14 days of the test period;Enlarged and pale kidney as well as urate deposition in the kidney were observed in infected dead and undead chicks;and the HE staining of histopathological slices showed that the cilia of trachea were removed.Immunohis-tochemistry showed that obvious viral signals were observed in the trachea,lungs,and kidneys.The viral load of various tissues was detected by RT-qPCR and it showed that HF210416 had the high-est replication efficiency in kidney tissues,then in cecum tonsils and trachea.The results of serum neutralization test showed that HF210416 had a better neutralization effect on GI-22 homologous strains,but poorer neutralization effect on other genotypes strains,suggesting that HF210416 is not suitable for vaccine candidate.In conclusion,the GI-22 isolate HF210416 is highly pathogenic and nephrotropic to chicks,and its genomic genetic characteristics and immunogenicity are differ-ent from those of other strains.This study enriches the resources of IBV strains and provides refer-ence data for understanding of the prevalence and pathogenicity of GI-22 genotypes in China.

Magnetic resonance imaging(MRI) can obtain multi-modal images with different contrast, which provides rich information for clinical diagnosis. However, some contrast images are not scanned or the quality of the acquired images cannot meet the diagnostic requirements due to the difficulty of patient's cooperation or the limitation of scanning conditions. Image synthesis techniques have become a method to compensate for such image deficiencies. In recent years, deep learning has been widely used in the field of MRI synthesis. In this paper, a synthesis network based on multi-modal fusion is proposed, which firstly uses a feature encoder to encode the features of multiple unimodal images separately, and then fuses the features of different modal images through a feature fusion module, and finally generates the target modal image. The similarity measure between the target image and the predicted image in the network is improved by introducing a dynamic weighted combined loss function based on the spatial domain and K-space domain. After experimental validation and quantitative comparison, the multi-modal fusion deep learning network proposed in this paper can effectively synthesize high-quality MRI fluid-attenuated inversion recovery (FLAIR) images. In summary, the method proposed in this paper can reduce MRI scanning time of the patient, as well as solve the clinical problem of missing FLAIR images or image quality that is difficult to meet diagnostic requirements.
Humans ; Deep Learning ; Magnetic Resonance Imaging/methods* ; Image Processing, Computer-Assisted/methods*