BACKGROUND:Neuregulin 1 has been shown to be characterized in cell proliferation,differentiation,and vascular growth.Human amniotic mesenchymal stem cells are important seed cells in the field of tissue engineering,and have been shown to be involved in tissue repair and regeneration. OBJECTIVE:To construct human amniotic mesenchymal stem cells overexpressing neuregulin 1 and investigate their proliferation and migration abilities,as well as their effects on wound healing. METHODS:(1)Human amniotic mesenchymal stem cells were in vitro isolated and cultured and identified.(2)A lentivirus overexpressing neuregulin 1 was constructed.Human amniotic mesenchymal stem cells were divided into empty group,neuregulin 1 group,and control group,and transfected with empty lentivirus and lentivirus overexpressing neuregulin 1,or not transfected,respectively.(3)Edu assay was used to detect the proliferation ability of the cells of each group,and Transwell assay was used to detect the migration ability of the cells.(4)The C57 BL/6 mouse trauma models were constructed and randomly divided into control group,empty group,neuregulin 1 group,with 8 mice in each group.Human amniotic mesenchymal stem cells transfected with empty lentivirus or lentivirus overexpressing neuregulin-1 were uniformly injected with 1 mL at multiple local wound sites.The control group was injected with an equal amount of saline.(5)The healing of the trauma was observed at 1,7,and 14 days after model establishment.Histological changes of the healing of the trauma were observed by hematoxylin-eosin staining.The expression of CD31 on the trauma was observed by immunohistochemistry. RESULTS AND CONCLUSION:(1)Human amniotic mesenchymal stem cells overexpressing neuregulin-1 were successfully constructed.The mRNA and protein expression of intracellular neuregulin 1 was significantly up-regulated compared with the empty group(P<0.05).(2)The overexpression of neuregulin 1 promoted the migratory ability(P<0.01)and proliferative ability of human amniotic mesenchymal stem cells(P<0.05).(3)Human amniotic mesenchymal stem cells overexpressing neuregulin 1 promoted wound healing in mice(P<0.05)and wound angiogenesis(P<0.05).The results showed that overexpression of neuregulin 1 resulted in an increase in the proliferative and migratory capacities of human amniotic mesenchymal stem cells,significantly promoting wound healing and angiogenesis.

Objective To explore the feasibility of peritoneal dialysis catheter placement assisted by flexible ureteroscope.Methods A retrospective analysis was conducted on clinical data of 54 cases of end-stage renal disease receiving peritoneal dialysis catheter placement from May 2019 to March 2023.The placement method was chosen by the patient.In the conventional group,23 cases were guided by a metal guide wire for insertion of the peritoneal dialysis catheter,while in the flexible ureteroscope group,31 cases were guided by flexible ureteroscope instead of guide wire for insertion of the peritoneal dialysis catheter.The success rate of catheterization,surgical time,use of postoperative analgesic,complications related to peritoneal dialysis catheter,and postoperative creatinine decrease were compared between the two groups.Results The catheter placement was successfully performed in both groups.The total incidence of complications related to peritoneal dialysis catheter in the flexible ureteroscope group was lower than that in the conventional group[6.5%(2/31)vs.30.4%(7/23),χ2 =3.878,P =0.049].Between the conventional group and the flexible ureteroscope group,there were no statistically significant differences in the surgical time,postoperative analgesic usage,and the decrease of creatinine at 2 weeks after surgery(P>0.05).The median postoperative follow-up period was10 months(range,3-24 months)in the two groups,and there were no complications such as peritoneal leakage,intestinal perforation,or intraperitoneal bleeding.Conclusion The placement of peritoneal dialysis catheter guided by the flexible ureteroscope instead of metal guide wire is a safe,visible,and accurate method,which can reduce complications related to peritoneal dialysis catheter,and detect and manage comorbidities in the abdominal cavity.

Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

Using column chromatography methods including the macroporous adsorbent resin, MCI gel CHP 20P, ODS-A-HG, Sephadex LH-20, combined with chromatographic separation methods such as TLC and reversed-phase HPLC, three glycosides (1-3) and two peptides including two new compounds were isolated from the ethanol extract of arthropod Scolopendra subspinipes mutilans. Their structures were identified as colosides A and B (1 and 2), 3,4-dihydroxyquinoline-4-O-β-D-glucopyranoside (3), aurantiamide (4), cyclo (L-phe-L-val) (5) by UV, NMR and HR-ESI-MS spectroscopic techniques.

Objective To explore the application value of deep learning image reconstruction(DLIR)algorithm in low-dose deep inferior epigastric artery(DIEA)computed tomography angiography(CTA).Methods A total of 59 patients undergoing DIEA CTA were prospectively selected and randomly divided into two groups:group A(29 cases)and group B(30 cases).Group A was the conventional radiation dose group(tube voltage 120 kVp),the tube current was dose modulation 3,and the iterative reconstruction algo-rithm was Karl 5.Group B was the low radiation dose group(tube voltage 120 kVp),the tube current was dose modulation 2,with DLIR reconstruction algorithm,and four levels of DLIR(1-4)were reconstructed and labeled as groups B1 to B4.The mean tube current,vol-ume CT dose index(CTDIvol),and dose length product(DLP)of group A and group B were recorded,and the effective dose(ED)was calculated.The CT and standard deviation(SD)values of the external iliac artery and psoas major muscle were measured on axial images of each group,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.Two observers using double-blind method independently evaluated the DIEA on volume rendering(VR)and maximum intensity projection(MIP)images of each group using a 3-point scale,and a 5-point scale was used to evaluate the overall image quality on axial images.Results Compared with group A,the mean tube current and ED in group B were decreased by 39.33％and 44.09％,respectively(P＜0.05).With the increasing of DLIR level from groups B1 to B4,the SD value of the image gradually decreased,while SNR and CNR gradually increased(P＜0.05).The CNR in groups B3 and B4 was higher than that in group A(P＜0.05).The subjective scores of the two observers were consistent(Kappa value 0.779-0.889,P＜0.05),and there was no statistical significance between group A and group B in the perforating vessels from the DIEA,intramuscular course,and the point of emergence(P＞0.05).With the increase in DLIR level,the subjective score of the overall image quality from group B1 to group B4 showed a trend of first increasing and then decreasing,and the score of group B3 was the highest(4.50±0.51)points,which had no statistical significance compared with group A(4.45±0.51)points(P＞0.05).Conclusion DLIR can effectively reduce the radiation dose of the DIEA CT A scan and ensure the image quality,among which DLIR 3 is the recommended best reconstruction grade.

Objective To explore the application value of 1 024×1 024 reconstruction matrix combined with iterative reconstruc-tion algorithm(Karl)in deep inferior epigastric artery(DIEA)computed tomography angiography(CTA).Methods A total of 40 patients who underwent DIEA CTA were prospectively selected and the original data were reconstructed by grouping.Group A was reconstructed using a conventional 512×512 matrix combined with Karl 5 grade.Group B was reconstructed using 1 024×1 024 recon-struction matrix combined with Karl 5,7,and 9 grades,respectively,and 3 subgroups B1-B3 were obtained.The CT and standard devia-tion(SD)values of the external iliac artery and psoas major muscle were measured on axial images,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.A 3-point scale was used to evaluate the perforating vessels from the DIEA,intramuscular course,point of emergence,superficial inferior epigastric artery(SIEA)and superficial inferior epigastric vein(SIEV)on volume ren-dering(VR)and maximum intensity projection(MIP)images by two observers,and a 5-point scale was used to evaluate the overall image quality on axial images.Results With the increase of Karl grade in groups B1 to B3,the SD value of the external iliac artery decreased gradually(P＜0.05),while SNR and CNR increased gradually(P＜0.05).The SD values of the external iliac artery in group B2 and group B3 were lower than those in group A(P＜0.05),and SNR and CNR were higher than those in group A(P＜0.05).There was a good consistency in the subjective evaluation between the two observers(Kappa values=0.773-0.872,P＜0.05).The perforating vessels from the DIEA,intramuscular course,point of emergence,SIEA and SIEV display and overall image quality subjective scores of group B2 and group B3 were better than those of group A(P＜0.05),and the scores of group B2 showed the greatest improvement.Conclusion The 1 024 × 1 024 reconstruction matrix combined with the Karl 7 reconstruction algorithm can optimize the image quality and improve the display of the DIEA and perforator microvessels.

Objective To investigate the clinical application value of posterior adaptive statistical iterative reconstruction-Veo(ASIR-V)algorithm combined with full-field organ dose modulation(ODM)technique in low-dose computed tomography urography(CTU).Methods Ninety patients who underwent urological contrast-enhanced and CTU examination were prospectively selected and divided into conventional dose group(group A,NI=11,posterior ASIR-V of 60％),low-dose group(group B,NI=15,posterior ASIR-V of 60％-100％with 10％interval,denoted as B1-B5 groups);full-field ODM low-dose group(group C,NI=15,posterior ASIR-V of 60％-100％with 10％interval,denoted as C1-C5 groups)according to the noise index(NI).The volume rendering(VR)and maximum intensity projection(MIP)images were reconstructed.The CT values and standard deviation(SD)values of the renal cortex and para-spinal muscles were measured,and the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were cal-culated.The CT values of the renal pelvis,ureter,and bladder were measured,and the SNR and CNR were calculated with the para-spinal muscles as background.The subjective score was performed on the two-dimensional and three-dimensional images to evaluate the ability of CTU to display lesions.The volume CT dose index(CTDIvol),dose length product(DLP),and effective dose(ED)of the three groups were compared.Results The bladder SNR and CNR of groups B1,C1,and C2 were lower than those of group A(P＜0.05).There was no statistically significant difference in the SNR and CNR of each tissue between groups B2,C3 and group A(P＞0.05).The SNR and CNR of each tissue in groups B4,B5,and C5 were higher than those in group A(P＜0.05).The display rate of lesions in urinary system in groups B2 and C3 could reach 100％.There was no statistically significant difference in the axial image scores between groups B2,C3 and group A(P＞0.05),while the VR and MIP image scores in each group were comparable to those in group A(P＞0.05).The CTDIvol of groups A,B and C were(6.08±2.11)mGy,(3.15±1.15)mGy,and(2.9±0.92)mGy,respectively.Conclusion CTU using the full-field ODM technique combined with posterior 80％ASIR-V can reduce the CTDIvol by 52.30％,and further reduce by 7.93％compared with group B,which is effective to reduce radiation to the gonads.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To compare the efficacy of amide proton transfer-weighted (APTw) imaging with time-dependent diffusion MRI (td-dMRI) in the diagnosis of malignant breast lesions.Methods:This study was a cross-sectional study. The clinical, pathological and imaging data of patients with breast lesions admitted to the First Affiliated Hospital of Zhengzhou University from March to August 2023 were prospectively analyzed. All patients firstly underwent T 2WI, diffusion-weighted imaging, followed by dynamic contrast-enhanced MRI (DCE-MRI), and finally APTw imaging and td-dMRI were performed for breast lesions using DCE-MRI as reference. Reconstructed images from APTw imaging measured lesions with a frequency shift of 3.5 ppm asymmetric magnetic susceptibility MTR asym(+3.5 ppm). The apparent diffusion coefficient (ADC) values at different oscillating frequency gradients (ADC PGSE, ADC 17 Hz, ADC 33 Hz values) were measured using reconstructed td-dMRI images. Independent sample t-test was used to compare APTw imaging, td-dMRI parameter differences between benign and malignant breast tumors, breast malignant tumors with different molecular types [estrogen receptor (ER) negative and positive, progesterone receptor (PR) negative and positive, human epidermal growth factor receptor (HER-2) negative and positive, proliferation index (Ki-67) low and high expression] and different histological grades (grade Ⅱ and Ⅲ). Receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the efficacy of APTw imaging and td-dMRI parameters in differentiating benign and malignant breast tumors, molecular classification and histological grading of malignant breast lesions. Results:There were 171 lesions in 171 patients, including 103 malignant lesions and 68 benign lesions. Histological grades were grade Ⅱ in 51 cases and grade Ⅲ in 38 cases of 89 cases of invasive carcinoma. Totally 98 cases of malignant lesions were included in molecular typing analysis, 36 cases were ER negative and 62 cases were ER positive. PR was negative in 51 cases and positive in 47 cases. There were 33 negative HER-2 patients, 65 positive HER-2 patients. There were 50 cases of low Ki-67 expression and 48 cases of high Ki-67 expression. The MTR asym(+3.5 ppm) value of malignant breast lesions was higher than that of benign lesions ( t=5.76, P<0.001), and the ADC PGSE, ADC 17 Hz and ADC 33 Hz values were lower than those of benign breast lesions ( t was 4.84, 4.62, 4.01, respectively, all P<0.001). MTR asym(+3.5 ppm) had the highest AUC value (0.83) and the highest specificity (90.38%), and ADC PGSE had the highest sensitivity (85.86%). There were no significant differences in MTR asym(+3.5 ppm), ADC PGSE, ADC 17 Hz and ADC 33 Hz between grade Ⅱ and grade Ⅲ histological grades of malignant breast lesions (all P>0.05). The ADC PGSE value of ER negative was higher than that of ER positive ( t=2.34, P=0.018), and the AUC for distinguishing ER positive from negative was 0.64. The ADC PGSE and ADC 17 Hz values of PR negative were higher than those of PR positive ( t=2.87, 2.81, P=0.004, 0.006, respectively), and their AUCs for identifying PR positive versus negative breast malignant lesions were 0.68 and 0.67, respectively. The ADC 33 Hz value of negative HER-2 was lower than that of positive HER-2 ( t=3.00, P=0.003), and the AUC for distinguishing positive and negative HER-2 was 0.67. There were no significant differences in other parameters among different subtypes of breast malignant lesions (all P>0.05). Conclusion:Compared with td-dMRI, APTw imaging is more effective in differentiating benign and malignant lesions of breast tumors, and ADC values at different gradient oscillation frequencies obtained by td-dMRI show better diagnostic efficacy in differentiating different molecular types of breast malignant lesions.

Objective:To explore the effects of the auto-prescription technique combined with noise index (NI) and adaptive statistical iterative reconstruction algorithm-veo (ASIR-V) on the radiation dose and image quality in the computed tomographic angiography (CTA) of the deep inferior epigastric artery (DIEA).Methods:The data of 150 cases who underwent DIEP CTA in the First Affiliated Hospital of Dalian Medical University were prospectively collected, and were randomized into groups A, B, and C, with 50 cases in each group. For group A, the conventional tube voltage was 120 kVp, and images were reconstructed using 40% ASIR-V. For group B, the tube voltage based on the auto-prescription technique was adopted, and images were reconstructed using 40%, 60%, and 80% ASIR-V (corresponding to the three subgroups B1-B3, respectively). For group C, the tube voltage based on the auto-prescription technique was employed, NI = 13, and images were reconstructed by 40%, 60%, and 80% ASIR-V (corresponding to subgroups C1, C2, and C3, respectively). Subsequently, the CT and SD values of the originating femoral artery of DIEA and the rectus abdominis at the same level as DIEA were measured on axial images of each group, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated, and the radiation doses of the three groups were recorded. Finally, the image quality and noise of DIEA in each group were independently and subjectively scored by two radiologists in a blinded manner.Results:Compared to group A, groups B and C exhibited higher CT values of femoral artery ( t= -5.18, -5.17, -5.06, -6.08, -6.08, -6.07, P < 0.05) and higher image SNR and CNR ( P < 0.05), which increased gradually with the upgrading of ASIR-V ( F = 55.45, 49.70, 53.47, 68.89, P < 0.05). The two radiologists offered consistent subjective evaluations (Kappa = 0.76-0.92, P < 0.05). The images of groups B and C displayed more distinct perforating branches and emerging points of DIEA and received higher subjective scores of intramuscular course compared to those of group A. The subjective scores of image noise in subgroups B2, B3, and C2 were not significantly different from those in group A. The radiation doses in groups B and C decreased by 15.10% and 52.85%, respectively compared to those in group A ( H = 75.21, P < 0.05). Conclusion:The combination of the auto-prescription technique with NI = 13 and 60% ASIR-V can reduce the radiation dose by 52.85% while ensuring a clear display of DIEA.