Purpose To explore the value of dual-layer spectral detector CT(DLSCT)in evaluating preoperative tumor staging in rectal adenocarcinoma(RA).Materials and Methods A total of 78 patients with pathologically confirmed RA in Guangdong Provincial Hospital of Chinese Medicine from May 2021 to March 2022 were involved in this retrospective study.All the patients underwent plain and dual-phase contrast-enhanced scans by DLSCT within one week before surgery.Taking pathological results as the golden standard,the accuracy rates of tumor staging were calculated and compared between the multiple-parameter maps derived from DLSCT and 120 kVp polyenergetic image.The effective atomic number(Z-eff)from plain scan,iodine concentration(IC)from arterial phase(AP)and venous phase(VP)were measured.The normalized iodine concentration(NIC)in AP and VP were calculated.The differences of Z-eff,NICAP and NICVP were compared among the pT1-2,pT3 and pT4 groups.The correlation between the pT stages and above values was assessed and the diagnostic efficiencies were analyzed.Results The overall accuracy rate(88.46%vs.67.95%;χ2=9.628,P=0.002),the pT1-2 staging accuracy rate(80.00%vs.40.00%;χ2=6.667,P=0.01),and the pT3 staging accuracy rate(88.10%vs.69.05%;χ2=4.525,P=0.033)of multiple-parameter maps derived from DLSCT were significantly higher than those of 120 kVp polyenergetic image,respectively.The Z-eff,NICAP and NICVP were significantly different among pT stage groups(F=6.456,11.029,12.698,all P<0.05)and exhibited a positive correlation with pT stages(r=0.371,0.367,0.363,all P<0.01).The areas under the curve of Z-eff,NICAP and NICVP to assess pT3-4 staging RA were 0.77,0.71 and 0.74,respectively.Conclusion The multiple-parameter maps derived from DLSCT can significantly improve the diagnostic accuracy of preoperative tumor staging of RA.Z-eff from plain scan and NIC from dual-phase helps differentiate pT1-2 from pT3-4 staging RA.

Objective:To explore the value of dual-layer detector spectral CT quantitative parameters in evaluating the treatment response of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC).Methods:The study was a cross-sectional study. From May 2021 to March 2023, a total of 52 patients with LARC who received complete nCRT and were pathologically confirmed rectal adenocarcinoma at the Guangdong Province Hospital of Traditional Chinese Medicine were retrospectively enrolled. Each patient underwent spectral CT examination before and after nCRT, including plain scan, arterial phase (AP), and venous phase (VP) scans. According to the tumor regression grade, the patients were divided into the good response ( n=20) and the poor response group ( n=32). Measurements of the primary tumor′s spectral CT parameters, including effective atomic number (Z eff) at plain scan, iodine concentration (IC), CT values of 40 keV and 100 keV virtual monochromatic image (VMI) at dual-enhanced phases, were taken before and after nCRT. Additionally, the normalized iodine concentration (NIC), spectral curve slope (λHU), and the change rate of the above parameters before and after nCRT were calculated. The independent sample t-test or Mann-Whitney U test was used to compare the differences between the two groups. The receiver operating characteristic (ROC) curve was used to assess the efficacy of various metrics in evaluating the tumor treatment response of nCRT. A binary logistic regression analysis of combined parameter results was performed for the parameters with the areas under curve (AUC)>0.75, and the AUC of the combined parameter was evaluated. Results:There were significant differences in NIC AP and λHU VP before nCRT, NIC VP and λHU VP after nCRT, and the change rates of Z eff, NIC AP, NIC VP and λHU AP between the good response group and the poor response group ( P<0.05). The remaining parameters showed no statistically significant difference ( P>0.05). The ROC curve results showed that the AUCs of the above 8 parameters for evaluating tumor treatment response of nCRT were 0.702, 0.655, 0.695, 0.769, 0.738, 0.807, 0.791, and 0.677, respectively. The AUC of the combined model of the three parameters with AUC>0.75 (λHU VP after nCRT, the change rate of NIC AP and NIC VP) was 0.869, with 80.0% sensitivity and 84.4% specificity. Conclusion:The quantitative parameters derived from spectral CT may provide new markers for evaluating the response to nCRT treatment in patients with LARC. The multi-parameter combined model can improve diagnostic efficacy.

Objective:To construct a column-line diagram diagnostic model based on serum and joint fluid inflammatory markers for the diagnosis of periprosthetic joint infections (PJI) after joint arthroplasty and to validate its predictive ability.Methods:The clinical data of 181 patients diagnosed with PJI or aseptic loosening in the Department of Orthopedics of the First Affiliated Hospital of Chongqing Medical University from January 2015 to June 2020 were retrospectively collected as a modeling group. The best indicators for diagnosing PJI were screened by lasso regression, single-factor and multifactor analysis. By comprehensively considering the weights and intrinsic connections of the indicators, a column-line diagram diagnostic model was constructed and used to develop a clinical decision support system (CDSS). Prospectively, the clinical data of patients diagnosed with PJI or aseptic loosening in the Department of Orthopedics of the First Hospital of Chongqing Medical University from July 2020 to December 2022 were collected as a validation group, and the diagnostic performance of the column-line diagram model was externally validated by methods such as receiver operating characteristic curve (ROC).Results:There were 85 cases of PJI in the 181 cases modeling group and 23 cases of PJI in the 49 cases validation group. Among the 27 potential factors analyzed by lasso regression analysis, body mass index (BMI), blood tests including platelet (PLT), absolute lymphocyte value, interferon γ (IFN-γ), ESR, IL-6, C-reactive protein, D-dimer, and joint fluid tests including C-reactive protein, IL-1, IL-4, IL-6, percentage of multinucleated neutrophils (PMN%), and CD64 may be potential indicators for the diagnosis of PJI. Univariate found significant differences between hematologic tests including sedimentation, C-reactive protein, IL-6, D-dimer and joint fluid tests including C-reactive protein, joint fluid CD64 index, C-reactive protein, IL-1, IL-4, IL-6, PMN%( P<0.05). Further multifactorial regression analysis screened serum IL-6, D-dimer, joint fluid CD64 index, C-reactive protein, IL-1, IL-4, IL-6, and percentage of multinucleated neutrophils, and based on that, the column-line graph model and CDSS system were constructed. The area under the ROC in the validation group was 0.978, and the AUC in the internal validation was 0.995; the C-index of the calibration curve was 99.50%, and the C-index of the internal validation was 99.53%, suggesting that the column-line diagram model has a good predictive ability. Conclusions:The column-line diagram for diagnosing PJI based on multiple diagnostic indicators showed good diagnostic performance. The CDSS system constructed by column-line diagrams could assist clinicians in diagnosing PJI and making reasonable strategies in time.

Objective:To analyze the risk factors and prognosis of endoleak after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm.Methods:The clinical data of patients with infrarenal abdominal aortic aneurysms treated by endovascular repair at the Department of Vascular Surgery,the First Affiliated Hospital of Guangxi Medical University from Jun 2012 to Nov 2021 were retrospectively analyzed.Results:During the first follow-up CTA after surgery,136 out of 299 patients had endoleak.A total of 186 patients had at least one CTA reexamination after discharge. Statistical analysis showed that excessive neck angulation was an independent risk factor for type Ⅰa endoleak ( t=-6.108, P<0.001), wider common iliac artery diameter (left Z=-2.787, P=0.005, Right Z=-2.381, P=0.017) and iliac aneurysm ( χ2=6.398, P=0.011) were risk factors for type Ⅰb endoleak. The survival time of patients in endoleak group was similar to no endoleak group. Conclusions:Excessive neck angulation is an independent risk factor for type Ⅰa endoleak. Most leaks resolve spontaneously ,the prognosis is fair.

Cathartic colon （CC） is a common and refractory digestive system disease， with the pathogenesis not fully clarified. The effective therapies other than laxatives and surgery remain to be developed for CC. Therefore， establishing the CC animal models that fit the disease characteristics of western medicine and syndrome characteristics of traditional Chinese medicine （TCM） is an important link to promote the research on this disease. The fitting degree of animal models with the latest Chinese and western medical diagnostic criteria is an indicator to assess the effectiveness of the animal models in simulating the disease characteristics of western medicine and syndrome characteristics of TCM. The literature review showed that the model animals， drugs and their dosage forms， doses， administration methods， and modeling period of CC varied in different studies， and the available CC animal models presented different fitting degrees with the disease characteristics of western medicine and syndrome characteristics of TCM. Rats were the preferred animals for the modeling of CC. Rhei Radix et Rhizoma preparations were commonly used for model inducing， which， however， may cause water electrolyte disorders， decreased immunity， and even death of animals at the late stage of modeling. The animals were modeled by gradually increasing the starting dose， while the starting dose and increasing dose varied. The maintenance dose was determined based on 50% of the animals having loose stools， and the end for a cycle was determined as the time when loose stools disappeared in 80% of animals. The modeling always lasted for 2-3 cycles， approximately 2-4 months. The CC models established with Rhei Radix et Rhizoma granules and rhein had high fitting degrees with the disease and syndrome characteristics. In addition， the CC animal models of TCM syndromes were still in the exploration stage. There were only the animal models of four TCM syndromes： liver depression and spleen deficiency， both Qi and Yin deficiency， Qi stagnation and blood stasis， and spleen and kidney deficiency. Efforts should be made to establish the animal models that meet the characteristics of disease of western medicine and syndromes of TCM， so as to facilitate the research on CC mechanism and drug development.

Objective:To explore the predictive value of the systemic immune inflammation index (SII) for the risk of bone metastases in patients with newly diagnosed prostate cancer (PCa).Methods:From Jun. 2012 to Jul. 2019, the clinical features of 308 patients were retrospectively analyzed. For the baseline clinical data of the patients with newly diagnosed PCa, the median age was 71(65-76) years, there were 59(19.2%) patients with a positive digital rectal examination (DRE). In addition, the median serum total prostate-specific antigen (tPSA), prostate volume (PV) and prostate-specific antigen density(PSAD)were 60.55(23.55-100.00) ng/ml, 39.35(28.29-56.66)ml and 1.27(0.58-2.52)ng/(ml·cm 3), respectively. There were 33(10.7%)patients with prostate biopsy Gleason score≤6, 115(37.3%)patients with a Gleason score=7 and 160(52.0%)patients with a Gleason score≥8. The T clinical stage also obtained, including 21(6.8%)diagnosed as T 1 stage, 87(28.2%)T 2 stage, 65(21.1%)T 3stage, 135(43.9%)T 4 stage. SII was calculated by the formula platelet×neutrophil/lymphocyte, and the median(interquartile range)of SII was 458.60(300.42-727.11)/L. According to the results of bone scanning, the patients were divided into bone metastasis(146, 47.4%)and a non-bone metastasis groups(162, 52.6%). The differences in the baseline clinical characteristics between the two groups were analyzed. The risk factors of bone metastasis were analyzed by univariate and multivariate logistic regression analysis. The diagnostic efficiency of the risk factors were evaluated by receiver operating characteristic(ROC)curve. Results:The median(interquartile range)of SII was 564.78/L(333.85-961.93/L)in patients with bone metastasis which were higher than those without bone metastasis 413.01(267.63-601.79)/L( P<0.001). The median(interquartile range)of tPSA were 97.79(48.20-119.10)ng/ml in bone metastasis group and 32.56(17.89-72.70)ng/ml in non-bone metastasis group ( P<0.001). The median(interquartile range)of PSAD were 1.91(0.97-3.55)ng/(ml·cm 3)and 0.90(0.45-1.77)ng/(ml·cm 3)in these two groups( P<0.001), respectively. In bone metastasis group, there were 132(90.4%)patients with a positive DRE, yet there were only 117(72.2%) patients with a positive DRE in the other group ( P<0.001). There were 7(4.8%)patients with prostate biopsy Gleason score≤6, 50(34.2%)patients with a Gleason score=7 and 89(61.0%)patients with a Gleason score≥8 in bone metastasis group. There were 26(16.1%)patients with prostate biopsy Gleason score≤6, 65(40.1%)patients with a Gleason score=7 and 71(43.8%)patients with a Gleason score≥8 in non-bone metastasis group ( P<0.001). There were statistically significant difference between the two groups in T clinical stage( P<0.001). In bone metastasis group, there were 2(1.4%)T 1 stage, and 19(13.0%)T 2 stage, 25(17.1%)T 3stage, and 100(68.5%)T 4 stage. Comparatively, there were 19(11.7%)T 1 stage, 68(42.0%)T 2 stage, 40(24.7%)T 3stage, and 35(21.6%)T 4 stage in the other group. There were no statistically significant difference between the two groups in term of age( P=0.057) and TPV( P=0.222). Univariate and multivariate logistic regression analysis showed that tPSA( P=0.003), SII( P<0.001), T clinical stage( P<0.001)could be regarded as independent risk factors of bone metastasis of PCa. Area under the curve of SII+ tPSA was 0.770, which was higher than SII(0.653)or tPSA(0.729) alone( P<0.05). When the cut-off value was 727.72/L, the sensitivity and specificity of the diagnosis of SII alone were 38.4% and 87.7%. The sensitivity and specificity of tPSA alone were 67.1%and 75.9% when the cut-off value was 73.02ng/ml. The sensitivity was 72.6% and the specificity was 71.6% when SII and tPSA was combined. Conclusions:SII is an independent predictor of bone metastasis of newly diagnosed with PCa. , and the patients were at high risk when SII exceeded 727.72/L. The combination of SII and tPSA can improve its predictive validity for the risk of bone metastasis.

The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities.Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality.Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit a typical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention.The general condition of the elderly should be considered during diagnosis and treatment.In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients.Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population.

Objective:To investigate the risk factors for delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD).Methods:Clinical data of 385 patients who underwent PD in Changhai Hospital of Navy Medical University from January 2017 to November 2017 were retrospectively analyzed, including 235 men and 150 women. According to the definition of DGE by the International Study Group of Pancreatic Surgery (ISGPS), patients were divided into-clinically irrelevant DGE (non CR-DGE) group and clinically relevant DGE(CR-DGE) group. Univariate analysis and multivariate logistic analysis were used to identify the risk factors of CR-DGE after PD.Results:Of the 385 patients, 78 cases (20.3%) developed DGE. There were 35 cases of CR-DGE (9.1%). In the multivariate analysis, BMI( OR=1.117, 95% CI1.006-1.240, P=0.038), preoperative serum albumin( OR=0.902, 95% CI 0.832-0.977, P=0.012), the main pancreatic duct diameter (MPD)≤3 mm( OR=2.397, 95% CI 1.016-5.653, P=0.046), soft texture of pancreas( OR=2.834, 95% CI 1.093-7.350, P=0.032), clinically relevant postoperative pancreatic fistula (CR-POPF)( OR=4.498, 95% CI 1.768-11.441, P=0.002) were independent risk factors for CR-DGE after PD. Conclusions:High BMI, low preoperative serum albumin, MPD ≤3 mm, soft texture of pancreas and CR-POPF after surgery were independent risk factors for CR-DGE, and early clinical interventions should be performed.

Secalonic acid D (SAD) could inhibit cell growth in not only sensitive cells but also multidrug resistant (MDR) cells. However, the molecular mechanisms need to be elucidated. Here, we identified that SAD possessed potent cytotoxicity in 3 pairs of MDR and their parental sensitive cells including S1-MI-80 and S1, H460/MX20 and H460, MCF-7/ADR and MCF-7 cells. Furthermore, SAD induced cell G2/M phase arrest the downregulation of cyclin B1 and the increase of CDC2 phosphorylation. Importantly, JNK pathway upregulated the expression of c-Jun in protein level and increased c-Jun phosphorylation induced by SAD, which was linked to cell apoptosis c-Jun/Src/STAT3 pathway. To investigate the mechanisms of upregulation of c-Jun protein by SAD, the mRNA expression level and degradation of c-Jun were examined. We found that SAD did not alter the mRNA level of c-Jun but inhibited its proteasome-dependent degradation. Taken together, these results implicate that SAD induces cancer cell death through c-Jun/Src/STAT3 signaling axis by inhibiting the proteasome-dependent degradation of c-Jun in both sensitive cells and ATP-binding cassette transporter sub-family G member 2 (ABCG2)-mediated MDR cells.

Keshan disease is an endemic cardiomyopathy of unclear cause.The major clinical manifestations are cardiac dysfunction and arrhythmia.Based on time course of onset and cardiac function of a suffering patient,Keshan disease is generally classified into four types:acute,sub-acute,chronic and latent types.This article elaborates on the pharmacological mechanisms and dosages of drug treatment for heart failure:diuretics,neurohormonal antagonists,ivabradine,positive inotropic drugs,vasodilators,etc,in order to provide basis for clinical treatment of chronic Keshan disease.