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Jingfei Weng,1,2,* Yuyao Xiao,1,* Jing Liu,3,* Xiaohua Liu,4 Yuqing He,2 Fei Wu,1 Xiaoyan Ni,1 Chun Yang1 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China; 3Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; 4Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chun Yang; Xiaoyan Ni, Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China, Tel +86 18702135336 ; +86 15201803582, Email dryangchun@hotmail.com; nixiaoyan1103@126.comPurpose: To study the MRI features (based on LI-RADS) and clinical characteristics of P53-mutated hepatocellular carcinoma (HCC) patients.Patients and Methods: This study enrolled 344 patients with histopathologically confirmed HCC (P53-mutated group [n = 196], non-P53-mutated group [n = 148]). We retrospectively evaluated the preoperative MRI features, clinical and pathologic features of the lesions and assigned each lesion according to the LI-RADS. MRI findings, clinical features, and pathologic findings were compared using the Student’s t test, χ 2 test, and multivariable regression analysis.Results: Most HCC patients were categorized as LR-5. On multivariate analysis, the Edmondson–Steiner grade (odds ratio, 2.280; 95% CI: 1.268, 4.101; p = 0.006) and rim enhancement (odds ratio, 2.517; 95% CI: 1.095, 5.784; p = 0.030) were found to be independent variables associated with P53-mutated HCC. In the group of HCC lesions with the largest tumor diameter (LTD) greater than or equal to 10mm and less than or equal to 20mm, enhancing capsule was an independent predictor of P53-mutated HCC (odds ratio, 6.200; 95% CI: 1.116, 34.449; p = 0.037). Among the HCC lesions (20 mm ˂ LTD ≤ 50 mm), corona enhancement (odds ratio, 2.102; 95% CI: 1.022, 4.322; p = 0.043) and nodule-in-nodule architecture (odds ratio, 2.157; 95% CI: 1.033, 4.504; p = 0.041) were found to be independent risk factors for P53 mutation. Among the HCC lesions (50 mm ˂ LTD ≤ 100 mm), diameter (odds ratio, 1.035; 95% CI: 1.001, 1.069; p = 0.044) and AFP ≥ 400 (ng/mL) (odds ratio, 3.336; 95% CI: 1.052, 10.577; p = 0.041) were found to be independent variables associated with P53-mutated HCC.Conclusion: Poor differentiation and rim enhancement are potential predictive biomarkers for P53-mutated HCC, while HCCs of different diameters have different risk factors for predicting P53 mutations.Keywords: liver neoplasms, magnetic resonance imaging, P53-mutated

Yi Chen,1,* Xiangsheng Xiong,2,* Rui Qin,1 Lei Guo,1 Yongqiang Shi,1 Xinli Ni1 1Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China; 2Department of Anesthesiology, the Fifth People’s Hospital of Huaian, Huaian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xinli Ni, Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China, Email xinlini6@nyfy.com.cnBackground: Fluid loading improves hemodynamic stability and reduces the incidence rate of post-spinal anesthesia hypotension when prophylactic vasopressors are administered. We investigated the impact of different crystalloid coload volumes on the 90% effective dose (ED) of prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension in non-hypertensive patients undergoing cesarean section.Methods: Patients were randomly allocated to receive one of the different crystalloid coload volumes (0mL/kg [0mL/kg Group], 5mL kg [5mL/kg Group], and 10mL kg [10mL/kg Group]) in combination with prophylactic norepinephrine infusion immediately after the induction of spinal anesthesia. The prophylactic norepinephrine infusion doses were determined using the up-and-down sequential allocation methodology, with an initial dose of 0.025 μg/kg/min and a gradient of 0.005 μg/kg/min. The primary endpoint was the effective dose at which 90% (ED 90) of patients responded to prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension.Results: The estimated effective dose of norepinephrine infusion, at which 90% (ED 90) of patients responded, was found to be 0.084 (95% CI, 0.070 to 0.86), 0.074 (95% CI, 0.059 to 0.077), and 0.063 (95% CI, 0.053 to 0.064) μg/kg/min in the three groups, respectively.Conclusion: A crystalloid coload of 5 mL/kg or 10 mL/kg, as opposed to the groups receiving 0 mL/kg crystalloid coloads, resulted in a reduction of approximately 11.9% and 25.0%, respectively, in the ED90 of prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension during cesarean section.Keywords: crystalloid, coload, norepinephrine, postspinal anesthesia hypotension, cesarean section

Cheng Wang,1,* Jiaoyang Pan,1,* Shaoqing Chen,2 Lin Qiu,1 Huaanzi Hu,1 Li Ji,3 Jianhao Wang,1 Wenjia Liu,4 Xinye Ni2 1School of Pharmacy, Changzhou University, Changzhou, Jiangsu Province, People’s Republic of China; 2Department of Radiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China; 3Department of Otorhinolaryngology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China; 4Department of Gastroenterology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenjia Liu; Xinye Ni, Email 13813016290@126.com; nxy@njmu.edu.cnBackground: The in vivo barriers and multidrug resistance (MDR) are well recognized as great challenges for the fulfillment of antitumor effects of current drugs, which calls for the development of novel therapeutic agents and innovative drug delivery strategies. Nanodrug (ND) combining multiple drugs with distinct modes of action holes the potential to circumvent these challenges, while the introduction of photothermal therapy (PTT) can give further significantly enhanced efficacy in cancer therapy. However, facile preparation of ND which contains dual drugs and photothermal capability with effective cancer treatment ability has rarely been reported.Methods: In this study, we selected curcumin (Cur) and doxorubicin (Dox) as two model drugs for the creation of a cocktail ND (Cur-Dox ND). We utilized polyvinylpyrrolidone (PVP) as a stabilizer and regulator to prepare Cur-Dox ND in a straightforward one-pot method.Results: The size of the resulting Cur-Dox ND can be easily adjusted by tuning the charged ratios. It was noted that both loaded drugs in Cur-Dox ND can realize their functions in the same target cell. Especially, the P-glycoprotein inhibition effect of Cur can synergistically cooperate with Dox, leading to enhanced inhibition of 4T1 cancer cells. Furthermore, Cur-Dox ND exhibited pH-responsive dissociation of loaded drugs and a robust photothermal translation capacity to realize multifunctional combat of cancer for photothermal enhanced anticancer performance. We further demonstrated that this effect can also be realized in 3D multicellular model, which possibly attributed to its superior drug penetration as well as photothermal-enhanced cellular uptake and drug release.Conclusion: In summary, Cur-Dox ND might be a promising ND for better cancer therapy. Keywords: one-pot synthesis, size-tunable, multifunctional, cancer

XiaoLiang Wang,1,* XiaoDong Ni,1,* YanYan Wei,1 LiHua Xu,1 XiaoChen Tang,1 HaiChun Liu,2 ZiXuan Wang,3 Tao Chen,4,5 JiJun Wang,1 Qing Zhang,1 TianHong Zhang1 1Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China; 2Department of Automation, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 3Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, People’s Republic of China; 4Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada; 5Labor and Worklife Program, Harvard University, Cambridge, MA, USA*These authors contributed equally to this workCorrespondence: TianHong Zhang; Qing Zhang, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, People’s Republic of China, Tel +86-21-34773065, Fax +86-21-64387986, Email zhang_tianhong@126.com; qing.zhang@smhc.org.cnIntroduction: Despite numerous studies investigating personality disorder (PD) and childhood maltreatment (CM) characteristics in individuals with schizophrenia (SZ), there remains a scarcity of research focusing on sex differences in PD and CM within large samples of SZ patients.Methods: A total of 592 participants (257 males, 335 females) were consecutively sampled from patients diagnosed with SZ at the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. PDs were assessed using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were evaluated using the Chinese version of the Child Trauma Questionnaire Short Form.Results: Male patients exhibited a prominent self-reported trait of antisocial PD (t=1.972, p=0.049), while female patients demonstrated a notable emphasis on histrionic PD traits (t=− 2.057, p=0.040). Structured interviews for PD diagnoses further indicated a higher comorbidity of schizotypal (χ2=4.805, p=0.028) and schizoid (χ2=6.957, p=0.008) PDs among male patients compared to female patients. Additionally, male patients reported a higher degree (t=2.957, p=0.003) and proportion (χ2=5.277, p=0.022) of experiences of physical abuse in their self-reported CM. Logistic regression analyses highlight distinct factors: higher antisocial PD traits and physical abuse are associated with male patients, while histrionic PD traits and emotional abuse are associated with female patients.Discussion: These findings underscore the importance of recognizing and addressing sex-specific manifestations of personality pathology and the nuanced impact of CM in the clinical management of individuals with SZ. The study advocates for tailored interventions that consider the distinct needs associated with sex differences in both personality traits and CM experiences among SZ patients.Keywords: personality disorder, psychosis, abuse, neglect, schizophrenia

Shaoqing Chen,1,2 Cheng Wang,3 Yanyan Meng,1– 3 Pengyin Li,1– 3 Yiwen Pan,1– 3 Mu He,1,2 Xinye Ni1,2 1Department of Radiotherapy, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213003, People’s Republic of China; 2Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, Jiangsu, 213003, People’s Republic of China; 3School of Pharmacy, Changzhou University, Changzhou, Jiangsu, 213164, People’s Republic of ChinaCorrespondence: Xinye Ni, Email nxy@njmu.edu.cnBackground: Radiation stimulates the secretion of tumor stroma and induces resistance, recurrence, and metastasis of stromal-vascular tumors during radiotherapy. The proliferation and activation of tumor-associated fibroblasts (TAFs) are important reasons for the production of tumor stroma. Telmisartan (Tel) can inhibit the proliferation and activation of TAFs (resting TAFs), which may promote radiosensitization. However, Tel has a poor water solubility.Methods: In this study, self-assembled telmisartan nanoparticles (Tel NPs) were prepared by aqueous solvent diffusion method to solve the insoluble problem of Tel and achieve high drug loading of Tel. Then, erythrocyte membrane (ECM) obtained by hypotonic lysis was coated on the surface of Tel NPs (ECM/Tel) for the achievement of in vivo long circulation and tumor targeting. Immunofluorescence staining, western blot and other biological techniques were used to investigate the effect of ECM/Tel on TAFs activation inhibition (resting effect) and mechanisms involved. The multicellular spheroids (MCSs) model and mouse breast cancer cells (4T1) were constructed to investigate the effect of ECM/Tel on reducing stroma secretion, alleviating hypoxia, and the corresponding promoting radiosensitization effect in vitro. A mouse orthotopic 4T1 breast cancer model was constructed to investigate the radiosensitizing effect of ECM/Tel on inhibiting breast cancer growth and lung metastasis of breast cancer.Results: ECM/Tel showed good physiological stability and tumor-targeting ability. ECM/Tel could rest TAFs and reduce stroma secretion, alleviate hypoxia, and enhance penetration in tumor microenvironment. In addition, ECM/Tel arrested the cell cycle of 4T1 cells to the radiosensitive G2/M phase. In mouse orthotopic 4T1 breast cancer model, ECM/Tel played a superior role in radiosensitization and significantly inhibited lung metastasis of breast cancer.Conclusion: ECM/Tel showed synergistical radiosensitization effect on both the tumor microenvironment and tumor cells, which is a promising radiosensitizer in the radiotherapy of stroma-vascular tumors.Keywords: telmisartan, tumor-associated fibroblasts, tumor hypoxia, G2/M arrest, radiosensitization

Shangren Qin,1 Xiaoyan Ni,2 Ye Ding3 1School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China; 2Cangqian Street Community Health Service Center, Hangzhou, Zhejiang, People’s Republic of China; 3School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Ye Ding, School of Public Health, Hangzhou Medical College, 8 Yikang Street, Hangzhou, 311399, People’s Republic of China, Tel +86-571-87692813, Email dingye729@126.comconvenienBackground: There have been few studies concerning delayed medical attention among middle-aged and older adults, and in-depth analyses of delay duration and symptoms have been lacking.Methods: In this cross-sectional study exploiting a face-to-face questionnaire survey, we investigated delays in seeing a doctor among ≥ 45-year-old people in Zhejiang, China over the past year, and analyzed relevant influencing factors through logistics regression.Results: A total of 1034 people aged ≥ 45 years were enrolled, whose overall occurrence of delay in seeing a doctor was 28.24% (23.00% for older adults aged ≥ 60 years). Factors like the presence of 2 chronic diseases, intense social loneliness, and more health care needs contributed to the occurrence of delay in seeing a doctor (OR (95% CI) = 2.102 (1.252– 3.529); OR (95% CI) = 1.030 (1.002– 1.059); OR (95% CI) = 1.049 (1.002– 1.099). Contrastively, factors like convenient access to medical care and good self-reported health status inhibited such occurrence OR (95% CI) = 0.321 (0.199– 0.519); OR (95% CI) = 0.369 (0.183– 0.745). The foremost reason was wanting to wait and see if the problem would get better on its own (117, 40.07%). Respiratory system disease (14.90%), dental problems (13.82%), and cardiac disease (13.61%) constituted the top 3 types of diseases whose treatments were delayed. Additionally, for the majority of older adults, the delay duration was 1– 2 weeks (99, 33.90%), and the economic burden was the cause of the longest delay in seeing a doctor among middle-aged and older adults.Conclusion: To alleviate the problem of delay in seeing a doctor among middle-aged and older adults, their families and society should enhance care for them and reduce their sense of social loneliness. Emphasis should be placed by the government on helping middle-aged and older adults with financial difficulties so that their medical convenience can be improved.Keywords: middle-aged, older adults, delaying doctor visits, China, cross-sectional study

Yunxiao Wu,1 Yan Wang,2,3 Changming Wang,4 Fujun Zhao,5 Dandi Ma,6 Zhifei Xu,6,7 Xin Ni5,7 1Beijing Key Laboratory of Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People’s Republic of China; 3Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China; 4Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 6Respiratory Department 1, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 7MOE Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of ChinaCorrespondence: Zhifei Xu, Respiratory Department 1, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Xicheng, Beijing, 100045, People’s Republic of China, Tel +8613521660077, Email zhifeixu@aliyun.com Xin Ni, Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Xicheng, Beijing, 100045, People’s Republic of China, Tel +8613370115099, Email nixin@bch.com.cnPurpose: To explore the characteristics of the attentional network and related factors in children with sleep-disordered breathing (SDB).Patients and Methods: A total 228 children (200 children aged 6– 10 years with snoring or mouth breathing, admitted to our hospital from May 2020 to July 2022, and 28 healthy children recruited from the community as the control group) were enrolled. All participants underwent polysomnography (PSG) and completed the ADHD rating scale and child version of the Attention Network Test. According to their SDB history and obstructive apnea hypopnea index (OAHI), the participants were divided into control (n = 28), primary snoring (PS; n = 67) and obstructive sleep apnea (OSA; n = 133) groups.Results: The OSA and PS groups were younger than controls (P < 0.05). The proportion of boys was higher in the OSA than control group (P < 0.05). Body mass index was higher in the OSA than control and PS groups (P < 0.01). Attention deficit and hyperactive impulsivity scores were independently associated with the OAHI (P < 0.001). The efficiency of the alerting network was higher in the OSA than in controls (P = 0.020), but was not correlated with OAHI after adjusting for age, sex and SDB history duration (P > 0.05).Conclusion: Children with OSA have impaired attention, characterized by excessive alerting network activation. However, alerting network efficiency did not change linearly with disease severity. More research is needed to elucidate the neural mechanisms underlying attention deficits in pediatric OSA.Keywords: child, obstructive sleep apnea, attention, alerting network

Yubo Li,1– 4 Xiaoyan Ni,2– 4 Xinai Liu,1 Chun Yang,2– 4 Yi Wang,2,4 Xin Lu,2– 4 Changwu Zhou2– 4 1Department of MRI, Henan Provincial Hospital of Traditional Chinese Medicine (the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine), Zhengzhou, People’s Republic of China; 2Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 3Shanghai Institute of Medical Imaging, Shanghai, People’s Republic of China; 4Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of ChinaCorrespondence: Xin Lu; Changwu Zhou, Shanghai Institute of Medical Imaging; Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86 18702135336 ; +86 13912121145, Email luxcn@163.com; changwu83@163.comObjective: The prognostic value of the Liver Imaging Reporting and Data System (LI-RADS) 2018 in differentiating hepatocellular carcinoma (HCC) from other primary liver cancers (PLC) with cirrhosis is unclear. We aim to evaluate the value of LI-RADS 2018 with agent-enhanced MRI in the postoperative prognosis of PLC patients with cirrhosis.Methods: Between 2016 and 2021, 432 patients with cirrhosis and surgically proven single primary liver cancer were retrospectively evaluated. Two radiologists evaluated the preoperative MRI features independently and assigned each lesion a LI-RADS category. Overall survival (OS), recurrence-free survival (RFS), and their associated factors were evaluated by using the Kaplan-Meier method, Log rank test, and Cox proportional hazards model.Results: The mean age of 432 patients (239 HCCs, 93 ICCs, and 100 cHCC-CCAs) was 57.27± 10.92 years. The LR-M category showed poorer OS and RFS than the LR-4 or LR-5 category did for all primary liver cancers (P < 0.001 for both), and so did HCCs with tumor size less than 30mm (P =0.003 and P =0.04, respectively). In the multivariable analysis, the LI-RADS category and tumor size > 30 mm had independent correlations with OS and RFS (all P < 0.05). Multivariable Cox analysis identified rim arterial phase hyperenhancement (APHE) as independent determinants of poor OS and RFS in primary liver cancers (all P < 0.05).Conclusion: The LI-RADS categories can predict the postsurgical prognosis of primary liver cancers independently.Keywords: hepatocellular carcinoma, magnetic resonance imaging, prognosis, liver cirrhosis

Peng Huang,1,2,&ast; Xiaoyan Ni,1,2,&ast; Changwu Zhou,1– 3 Zhang Shi,1,2 Fei Wu,1,2 Yuyao Xiao,1,2 Chun Yang,1,2 Mengsu Zeng1– 3 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 3Shanghai Institute of Medical Imaging, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mengsu Zeng, Shanghai Institute of Medical Imaging, Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86 13501922963, Email zeng.mengsu@zs-hospital.sh.cn Chun Yang, Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86 18702135336, Email dryangchun@hotmail.comObjective: To compare the pathologic diagnosis and survival of patients with subcentimeter and 1– 2 cm nodules that present with diagnostic hallmarks of hepatocellular carcinoma (HCC).Methods: Diagnostic hallmarks of HCC were defined as hyperintensity on T2 weighted imaging, restricted diffusion, arterial phase hyperenhancement, washout on portal venous phase, and hypointensity on hepatobiliary phase. We retrospectively included 139 patients undergoing curative resection with single nodules ≤ 2 cm that present imaging features described above on gadoxetic acid-enhanced MRI. The final diagnosis was confirmed by histopathological assessment. Recurrence-free survival (RFS) was compared using Kaplan–Meier analysis with the Log-rank test. Factors associated with overall and early recurrence were identified using Cox regression analysis.Results: Among 139 nodules (49 nodules < 1 cm), there was no significant difference in the percentage of HCC between subcentimeter and 1– 2 cm nodules (94.0% vs 94.4%, P > 0.999). Microvascular invasion (MVI) was less common in subcentimeter HCC (4.3% vs 17.6%, P = 0.032). There were 27 recurrences during a median follow-up time of 46.7 months. Patients with subcentimeter HCC achieved less recurrence, with a 5-year RFS rate of 87.3%. The MVI-positive patients had more early and overall recurrence. A tumor size < 1 cm was associated with lower overall recurrence (HR, 0.336; P = 0.047). No factors were independently associated with early recurrence.Conclusion: Subcentimeter nodules with diagnostic hallmarks of HCC are highly associated with HCC diagnosis and achieve less tumor recurrence after resection. Early diagnosis and treatment of subcentimeter HCC may be more appropriate.Keywords: carcinoma, hepatocellular, magnetic resonance imaging, gadolinium ethoxybenzyl DTPA

Jiaming Hu,1 Lili Ji,2 Ping Li,3 Xinyu Ni,1 Ying Huang,1 Jinxin Tao,1 Hua Zhu1 1Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 2Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 3Department of Out-Patient, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of ChinaCorrespondence: Hua Zhu, Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China, Tel +86-13505777090, Fax +86-577-55578033, Email ZHwenzhou@126.comPurpose: This study aimed to investigate male HPV infection, re-examination rate, clearance rate and relevant influencing factors as well as HPV infection between heterosexual partners in Wenzhou, China.Methods: The study enrolled 2359 men who accepted ≥ 1 HPV detection in the First Affiliated Hospital of Wenzhou Medical University between June 2014 and June 2020. An outpatient follow-up was carried out for collecting HPV re-test results among males who were tested HPV positive. In addition, we collected female sexual partners’ HPV infection state through outpatient information system or telephone call. For males who had not re-tested HPV more than half a year after the first HPV positive result, a telephone follow-up would be provided.Results: Male HPV prevalence was 39.39% (928/2359) at baseline, of which the median age was 38.00 years. The percentage of co-infection and HR HPV infection was 35.24% (327/928) and 61.08% (874/1431). Genotype-specific concordance of HPV infection among heterosexual partners was 61.19% (123/201). The most common types were HPV6, HPV52, HPV16, HPV53, HPV11, HPV43 and HPV58. Percentage of males finishing HPV re-examination was low (40.09%). Infection with HR HPV, discomfort or HPV-related diseases and sexual partners with HPV infection were possible motivator for male HPV re-test. The medium time to male HPV clearance was 300.000 (95% CI=274.845– 325.155) days. Infection with HR HPV, sexual partners with HPV infection and growth of age might prolong HPV persistence time included.Conclusion: Males are susceptible population for genital HPV infection as well as females. Whereas, males are generally less aware of HPV and its influence on their couples. The study showed that male HPV testing as well as the role of males in the diagnosis and treatment of HPV-associated cervical diseases for females should be popularized and co-treatment of couples was necessary.Keywords: human papillomavirus, males, heterosexual couples, prevalence, persistence, re-test rate

Yunxiao Wu,1 Xuezhi Geng,2 Zhifei Xu,3 Xin Ni4 1Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2Department of infectious diseases, Tianjin Children’s Hospital, Tianjin, People’s Republic of China; 3Department of Respiratory Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 4Department of Otolaryngology Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of ChinaCorrespondence: Zhifei Xu, Department of Respiratory Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Xicheng District, Beijing, People’s Republic of China, Email zhifeixu@aliyun.com Xin Ni, Department of Otolaryngology Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Xicheng District, Beijing, People’s Republic of China, Email nixin@bch.com.cnObjective: To investigate the influence of obstructive sleep apnea (OSA) severity and weight on blood pressure (BP) during nighttime sleep in children.Methods: Habitually snoring children who were 3– 14 years old and from Beijing Children’s Hospital between 1 January 2018 and 31 December 2020 were recruited. All participants completed polysomnography (PSG) and BP monitoring during different sleep stages using pulse transit time analysis. Subjects were divided into three groups based on the obstructive apnea–hypopnea index (OAHI), ie, primary snoring (PS), mild-to-moderate OSA, and severe OSA group.Results: Totally, 284 habitually snoring children were enrolled, including 85 with PS, 152 with mild-to-moderate OSA, and 47 with severe OSA. The differences of age and sex ratio among groups were not statistically significant (all P> 0.05). For the normal weight group, compared with those in the PS group, children in the severe OSA group had higher BP, mainly in N2 and R stages, and children in the mild-to-moderate OSA group had lower BP in all sleep and wake stages (all P< 0.01). For the overweight/obese group, compared with the PS group, children in the severe OSA group had higher BP in all sleep and wake stages, and children in the mild-to-moderate group had higher BP mainly in sleep stages (all P< 0.01). Compared with normal weight children, those who were overweight/obese and had OSA had higher BP in all sleep and wake stages (all P< 0.01). There was a synergistic effect of OSA and weight status on BP (P< 0.01).Conclusion: The influence of OSA on both systolic and diastolic pediatric BP differs between children with normal weight and overweight/obese status. Overweight/obese status synergistically worsens nocturnal blood pressure in children with OSA. Early diagnosis and risk stratification are more important in overweight/obese children with OSA to achieve timely initiation of treatment.Keywords: sleep apnea, obstructive, child, blood pressure, obesity

Objective: To assess the association between adenomyosis volume, as a reflection of its severity, and the risk of adverse perinatal outcomes. Methods: This multicenter retrospective cohort study was conducted at a comprehensive tertiary care institution and a tertiary maternal and child healthcare hospital, which are the main types of hospital providing maternal medical care in China. The study included pregnant women without adenomyosis (non‐AD cohort) who delivered between 1 January 2021 and 31 December 2021, and women with pregnancy complicated by adenomyosis (AD cohort) who delivered between 1 January 2020 and 31 December 2022. Adenomyosis was diagnosed and measured using transvaginal or transabdominal ultrasound up to 14 weeks of gestation. The adenomyosis volume (V) was calculated based on the sonographic measurement of three dimensions, using the formula V = (length × width × thickness) × 4/3π. Univariate and multivariate logistic regression analyses were conducted to assess the association between adenomyosis and the risk of pregnancy complications. We also performed a sensitivity analysis among 226 pregnancies complicated by adenomyosis that had volume measurements available and 10 507 pregnancies without adenomyosis, using as a threshold for severe adenomyosis the 3rd quartile of adenomyosis volume. Results: The study group included 10 507 pregnant women in the non‐AD cohort and 321 in the AD cohort. Pregnancies complicated by adenomyosis had an increased risk of preterm birth < 37 weeks of gestation (adjusted odds ratio (aOR), 2.39 (95% CI, 1.65–3.48)), spontaneous preterm birth < 37 weeks of gestation (aOR, 2.57 (95% CI, 1.54–4.28)), placenta previa (aOR, 2.57 (95% CI, 1.41–4.67)), cervical incompetence (aOR, 9.70 (95% CI, 4.00–23.55)) and abnormal fetal presentation (aOR, 2.04 (95% CI, 1.39–3.00)), and there was also a non‐significant trend toward increased risk of pre‐eclampsia (aOR, 1.64 (95% CI, 0.94–2.85)). Sensitivity analysis revealed there was a greater risk in pregnancies with severe (≥ 757.5 cm3) vs mild adenomyosis of preterm birth < 37 weeks of gestation (aOR, 5.50 (95% CI, 2.80–10.82) vs aOR, 1.73 (95% CI, 0.98–3.05)), pre‐eclampsia (aOR, 4.94 (95% CI, 2.11–11.58) vs aOR, 1.03 (95% CI, 0.41–2.58)), placenta previa (aOR, 6.37 (95% CI, 2.39–17.04) vs aOR, 1.58 (95% CI, 0.60–4.19)) and cervical incompetence (aOR, 12.79 (95% CI, 2.87–56.93) vs aOR, 4.97 (95% CI, 1.25–19.77)) compared to pregnancies without adenomyosis. The risk of spontaneous preterm birth < 37 weeks and the risk of abnormal fetal presentation was similar between the two subgroups. Conclusion: Pregnancies complicated by adenomyosis, particularly those with severe adenomyosis, have an increased risk of pregnancy complications, including preterm birth, spontaneous preterm birth, placenta previa, cervical incompetence and abnormal fetal presentation. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Lin Mei,1,&ast; Xiaodan Li,1,&ast; Shengcai Wang,1,&ast; Run Si,2 Tingting Ji,1 Zhifei Xu,3 Yun Peng,4 Yue Liu,4 Hongbin Li,1 Jie Zhang,1 Yongli Guo,5 Jinghong Tian,6 Guifei Zhou,2 Huifang Huang,2 Jun Tai,1,7,&ast; Jiangang Liu,8,9 Xin Ni1 1Department of Otolaryngology, Head and Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2School of Computer and Information Technology, Beijing Jiaotong University, Beijing, People’s Republic of China; 3Department of Respiration, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing, People’s Republic of China; 4Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 5Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health (NCCH), Beijing, People’s Republic of China; 6Department of Neurorehabilitation, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 7Department of Otorhinolaryngology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 8Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, People’s Republic of China; 9Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiangang LiuBeijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, 100191, People’s Republic of ChinaEmail jgliu@buaa.edu.cnXin NiDepartment of Otolaryngology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56 Nanlishilu, Beijing, People’s Republic of ChinaTel +86-139-1011-1999Email nixin@bch.com.cnObjective: To investigate the impacts of obstructive sleep apnea (OSA) on white matter (WM) integrity and cognitive functions of pediatric patients with different levels of OSA severity.Methods: Fifty-eight children with OSA and thirty-four healthy controls (HC) were recruited. All participants underwent diffusion tensor imaging (DTI) examination, polysomnography (PSG), and neurocognitive assessments. Patients were divided into mild OSA (MG) and moderate-severe OSA (SG) groups. WM integrity, PSG data, and neurocognitive assessment scores were compared among those groups.Results: For apnea hypopnea index (AHI), obstructive apnea hypopnea index (OAHI), arousal index, SpO2 nadir, and attention, SG was worse than both MG and HC with MG worse than HC. For baseline SpO2 and intelligence, SG was worse than both MG and HC with no significant difference between MG and HC. Impaired WM integrity was observed in bilateral anterior thalamic radiation, bilateral inferior fronto-occipital fasciculus, bilateral inferior longitudinal fasciculus, right superior longitudinal fasciculus, right hippocampus, left cingulate gyrus, right uncinate fasciculus, callosum forceps major, and callosum forceps minor only for SG than for HC. WM integrity was significantly correlated with OSA severity and neurocognitive assessment scores only for SG, but not for MG.Conclusion: Decreased baseline SpO2, WM impairment, and intelligence decline were all observed only for SG, but not for MG, implying an associated relationship among decreased SpO2, WM impairment and WM impairment. Thus, for SG, additional assessments of brain damage and cognitive function decline are needed for prognostic evaluation of OSA.Keywords: diffusion tensor imaging, obstructive sleep apnoea, children, tract-based spatial statistics, white matter

Changwu Zhou,1,2,&ast; Xiaoyan Ni,2,&ast; Xin Lu,2 Yi Wang,2 Xianling Qian,2 Chun Yang,2 Mengsu Zeng1,2 1Shanghai Institute of Medical Imaging, Shanghai, People’s Republic of China; 2Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chun YangDepartment of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of ChinaTel +86 18702135336Email dryangchun@hotmail.comMengsu ZengShanghai Institute of Medical Imaging, Shanghai, People’s Republic of ChinaTel +86 13501922963Email zeng.mengsu@zs-hospital.sh.cnPurpose: To investigate the significance of MR features based on the Liver Imaging Reporting and Data System (LI-RADS ver. 2018) for identifying the expression of cytokeratin 19 (CK-19) in patients with combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) before surgery.Patients and Methods: The study enrolled 174 patients pathologically confirmed to have cHCC-CCA according to the 2019 WHO classification. The preoperative MR imaging features and clinicopathological findings were retrospectively evaluated and compared between the CK-19-positive and CK-19-negative cHCC-CCA groups.Results: One hundred seventy-four patients (mean age, males vs females: 56.6 ± 10.0 years vs 54.7 ± 14.2 years) were evaluated. The presence of mosaic architecture, targetoid appearance, cholangiectasis, hepatic capsule retraction, and corona enhancement was significantly higher in the CK-19-positive group (all p < 0.05), while nonrim arterial phase hyperenhancement (APHE) was more common in the CK-19-negative group (p = 0.04). The univariate analysis showed that hepatitis B virus infection, CEA > 5 ng/mL, tumor size, nonrim APHE, mosaic architecture, targetoid appearance, cholangiectasis, hepatic capsule retraction, and corona enhancement were significant risk factors for CK-19-positive cHCC-CCA (all p < 0.05). Unfortunately, the multivariate analysis revealed that only corona enhancement (OR = 2.359, p = 0.03) was an independent risk factor associated with CK-19-positive cHCC-CCA.Conclusion: Corona enhancement is significantly correlated with CK-19 positivity in patients with cHCC-CCA.Keywords: liver neoplasms, magnetic resonance imaging, cytokeratin 19

Zhaoping Wang,1 Xiaolin Ni,1,2 Danni Gao,2,3 Liang Sun,1 Xiaoquan Zhu,1 Juan Jiao,4 Qi Zhou,1 Chen Chen,1 Nan Zhang,1 Zhu Wu,1 Ze Yang,1 Huiping Yuan1 1The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China; 2Graduate School of Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 3Peking University Fifth School of Clinical Medicine (Beijing Hospital), Beijing, 100730, People’s Republic of China; 4Clinical Laboratory Department, The Seventh Medical Center, PLA General Hospital, Beijing, 100730, People’s Republic of ChinaCorrespondence: Huiping YuanThe MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Dongdan DaHua Road 1#, Beijing, 100730, People’s Republic of ChinaTel +86-10-58115043Fax +86-10-65237929Email yuanhuiping@126.comPurpose: To our knowledge, the normal fasting plasma glucose (FPG), blood pressure (BP), and blood lipids (BL) interval values have not been well-established in the longevity population. This study aims to provide a reference for the establishment of normal BP, FPG, and BL interval values in the longevity people in China.Patients and Methods: A total of 7417 people were selected from the natural longevity cohort in Guangxi, with an age range of 20– 110 years old, including 7093 classified as the non-longevity (20– 89 years old) (94.02%) and 324 classified as the longevity (≥ 90 years old) (5.98%); there were 4309 men (58.1%) and 3108 women (41.9%). FPG, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), and low-density lipoprotein (LDL-C) levels were defined as desirable levels when they were below the 75th percentile (P75), borderline levels from the 75th to 90th percentile (P75–P90), and high levels above P90; triglyceride (TG) levels above P90 were defined as high; and high-density lipoprotein cholesterol (HDL-C) levels below the 5th percentile (P5) were defined as low levels.Results: The reference interval values of FPG in the longevity were as follows: desirable levels < 6.15 mmol/L, borderline levels 6.15– 7.45 mmol/L, high levels ≥ 7.45 mmol/L. Reference interval values of systolic blood pressure (SBP) were as follows: desirable levels < 160.00 mmHg, borderline levels 160.00– 174.50 mmHg, high levels ≥ 175.00 mmHg. DBP reference interval values were as follows: desirable levels < 88.00 mmHg, borderline levels 88.00– 90.00 mmHg, high levels ≥ 90.00 mmHg. TC reference interval values were as follows: desirable levels < 5.59 mmol/L, borderline levels 5.59– 6.45 mmol/L, high levels ≥ 6.45 mmol/L. LDL-C reference interval values were as follows: desirable levels < 3.30 mmol/L, borderline levels 3.30– 3.85 mmol/L, high levels ≥ 3.85 mmol/L. TG reference interval values were as follows: desirable levels < 2.82 mmol/L, high levels ≥ 2.82 mmol/L. HDL-C reference interval values were as follows: low levels < 0.80 mmol/L, desirable levels ≥ 0.80 mmol/L.Conclusion: The reference interval values of BP, FPG, and BL are different between the longevity population and the non-longevity population, and the interval values change with increasing age.Keywords: longevity, blood pressure, fasting plasma glucose, blood lipids, reference interval values

Xuefeng Ni,1 Li Jiao,1 Ye Zhang,1 Jin Xu,2 Yunqing Zhang,2 Xiaona Zhang,2 Yao Du,2 Zhaoyong Sun,2 Shitian Wang2 1Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China; 2Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of ChinaCorrespondence: Li JiaoDepartment of Healthcare, Peking Union Medical College Hospital, No. 1 of Shuaifuyuan Street, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86-010-69156114Email jiaoli_569@163.comObjective: The present study aimed to explore the relationship between non-alcoholic fatty liver disease (NAFLD) and abdominal and pericardial adipose tissue in middle-aged and elderly subjects.Methods: Between July 2019 and July 2020, 471 subjects attending the Health Care Medical Department of Peking Union Medical College Hospital for a medical examination were enrolled in the study. The volume and distribution of abdominal adipose tissue together with the volume of pericardial adipose tissue were calculated according to the results of the abdominal computed tomography. The differences between subjects with NAFLD and the normal population were analyzed.Results: The volume of pericardial adipose tissue, abdominal visceral and subcutaneous adipose tissue, the total volume of abdominal adipose tissue, and volume of pelvic visceral adipose tissue were all significantly increased in subjects with NAFLD. For every 100 cm3 increase in the volume of abdominal visceral adipose tissue, the incidence of developing NAFLD increased by 9.4%. According to the results of the receiver operating curve, the cut-off point of abdominal visceral adipose tissue for the diagnosis of NAFLD was 2691.1 cm3.Conclusion: Overall, the risk of NAFLD increases significantly with the increase in the volume of adipose tissue.Keywords: fatty liver, abdominal adipose tissue, abdominal visceral adipose tissue, abdominal subcutaneous adipose tissue

Xuefeng Ni,1 Li Jiao,1 Ye Zhang,1 Jin Xu,2 Yunqing Zhang,2 Xiaona Zhang,2 Yao Du,2 Zhaoyong Sun,2 Shitian Wang2 1Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China; 2Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of ChinaCorrespondence: Li JiaoDepartment of Healthcare, Peking Union Medical College Hospital, No. 1 of Shuaifuyuan Street, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86 10 69157229Email li_jiao24@163.comObjective: The present study aimed to explore the relationships between the distribution of abdominal fat and muscle and age and gender in a middle-aged and elderly population.Methods: The levels of abdominal (visceral and subcutaneous) fat, pericardial fat, and psoas major muscle were measured in subjects who had physical examinations at the Health and Medical Department of Peking Union Medical College Hospital from July 2019 to June 2020. The relationship between fat in different areas (ie, different types of fat) and the relationship between different types of fat and the psoas major muscle were investigated in the context of different genders and ages.Results: The distribution of fat and muscle differed between males and females of the middle-aged and elderly study sample. Volumes of pericardial fat, total abdominal fat, and visceral fat were significantly lower in females than in males, and the area of the psoas major muscle was also significantly lower in females than in males. Levels of subcutaneous fat and total abdominal fat showed no significant correlation with age. The level of muscle showed a significant negative correlation with age.Conclusion: 1) Within the middle-aged and elderly sample, male subjects had higher levels than females of all types of fat except for abdominal subcutaneous fat, and had higher levels of psoas muscle than females. 2) Pericardial fat increased with age, whereas levels of abdominal fat did not change significantly with age. 3) The area of psoas major muscle appears to be positively correlated with volumes of all types of fat: subjects with more fat tended to have higher levels of psoas major muscle.Keywords: middle-aged and elderly, abdominal fat, pericardial fat, psoas major muscle, age, gender

Min Li,1,* Kun Fan,1,* Bohao Zheng,1,* David Zekria,2 Tao Suo,1 Han Liu,1 Sheng Shen,1 Houbao Liu,1 Xiaoling Ni1 1Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 2Department of Radiology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK*These authors contributed equally to this workCorrespondence: Xiaoling Ni; Houbao LiuDepartment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of ChinaTel +86 21 64041998; +86 21 64041997Email ni.xiaoling@zs-hospital.sh.cn; liu.houbao@zs-hospital.sh.cnPurpose: Gallbladder cancer (GBC) is a common malignancy of the biliary tract and is characterized by rapid progression and early metastasis. Elucidating the molecular mechanisms of GBC could help to develop better treatment strategies.Materials and Methods: Human GBC cell lines (GBC-SD and NOZ) were applied to determine the capacity of the proliferation and migration of cells using the MTT assay, colony formation, wound-healing assay as well as the Transwell™ assay. A nude xenograft was used to evaluate tumor growth in vivo.Results: Using two types of GBC cell lines, we found that absence of solute carrier family (SLC) 39A4 (which encodes the zinc transporter ZRT/IRT-like protein [ZIP]4), could suppress the proliferation and migration of cells. Additionally, absence of ZIP4 could impair growth of xenografts in nude mice. While, over-expression of SLC39A4 could promote the GBC cell proliferation and migration, and inhibit apoptosis. We revealed that SLC39A4 might affect GBC progression by modulating the signaling pathways responsible for the survival, energy supply and metastasis of cells, and indicated that SLC39A4 could serve as a novel therapeutic target for GBC.Conclusion: SLC39A4 promoted the viability and motility of GBC cells, and tumor formation in nude mice. We demonstrated an oncogenic potential for SLC39A4.Keywords: gallbladder cancer, SLC39A4 (ZIP4), proliferation, migration, potential therapeutic target

Shuang Cao,1,2,* Xin Gao,1,* Guangjian Bai,1,* Baoquan Xin,1,* Tao Wang,1 Jiashi Cao,1 Kai Lv,1 Chengzhang Zhu,1 Xiangzhi Ni,1 Weiwei Zou,3 Yejin Zhou,2 Jianru Xiao,1 Tielong Liu1 1Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China; 2Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China; 3Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Tielong Liu; Jianru XiaoOrthopedic Oncology Center, Department of Orthopaedics, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, People’s Republic of ChinaTel +86-21-81886843Fax +86-21-63520020Email liutielongvip@163.com; xiaojianruvvip@163.comPurpose: Spinal tuberculosis (TB) and metastatic tumor (MT) are common diseases with similar manifestations. Although pathological evaluation is the gold standard to confirm diagnosis, performing biopsies in all patients is not feasible. This study is aimed to create a scoring system to facilitate the differential diagnosis of spinal TB and MT before invasive procedures.Methods: Altogether, 447 patients with spinal TB (n=198) and MT (n=249) were retrospectively analyzed. Patients were randomly assigned at 2:1 ratio to a training cohort and a validation cohort. Clinical, laboratory, and radiological diagnostic factors were identified by χ2 and multiple logistic regression analyses. The scoring system was then established based on the identified independent diagnostic factors scored by regression coefficient β value, with the cut-off value being determined by ROC curve. The sensitivity and specificity of the system was calculated by comparing the predicted diagnosis with their actual pathological diagnosis.Results: This scoring system was composed of 5 items: pain worsens at night (0 or 2 points), CRP value (0 or 3 points), tumor marker values (0 or 2 points), skip lesions (0 or 3 points), and intervertebral space destruction (0 or 3 points). Patients scoring higher than 7.5 could be diagnosed as spinal TB, otherwise, MT. According to the internal validation, the sensitivity and specificity of the system were 87.9% and 91.6%, respectively.Conclusion: This study established and validated a scoring system which could be used to differentiate spinal TB from MT, thus helping clinicians in quick and accurate differential diagnosis.Keywords: scoring system, differential diagnosis, spine, tuberculosis, metastatic tumor

Zhaoping Wang,1 Xiaolin Ni,1,2 Li Zhang,1 Liang Sun,1 Xiaoquan Zhu,1 Qi Zhou,1 Ze Yang,1 Huiping Yuan1 1The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China; 2Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of ChinaCorrespondence: Huiping YuanThe MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Dongdan DaHua Road 1#, Beijing 100730, People’s Republic of ChinaTel +86-10-58115043Fax +86-10-65237929Email yuanhuiping@126.comAbstract: Patients with type-2 diabetes mellitus (T2DM) display chronic low-grade inflammation induced by activation of the innate immune system. Toll-like receptor (TLR)4 is a pattern recognition receptor that plays a vital part in activation of the innate immune system. Results from animal and computer-simulation studies have demonstrated that targeting TLR4 to block the TLR4-nuclear factor-kappa B (NF-κB) pathway reduces the inflammatory response and complications associated with T2DM. Therefore, TLR4-targeted therapy has broad prospects. Here, we reviewed the role of TLR4 in inflammation during chronic hyperglycemia in T2DM and its therapeutic prospects.Keywords: T2DM, TLRS, TLR4, inflammation, TLR4 treatment

Xixiu Ni,1 Linglin Dong,2 Tian Tian,1 Lu Liu,1 Xiao Li,1 Fengmei Li,1 Ling Zhao1 1Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, People’s Republic of China; 2Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610075, People’s Republic of ChinaCorrespondence: Ling ZhaoAcupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shi’er Qiao Road, Chengdu, Sichuan 610075, People’s Republic of ChinaTel +86 13568801429Email zhaoling@cdutcm.edu.cnBackground: Migraine is defined as a recurrent headache of moderate to severe intensity that seriously affects the quality of life. Recent clinical trials have confirmed that acupuncture is effective in treating migraine. We aimed to review the effectiveness of acupuncture in the treatment of migraine by comparing treatment and various control groups in accordance with the newly published guidelines for systematic reviews.Materials and Methods: The following databases were searched for relevant articles published from January 1, 2010 to December 31, 2019: Embase, PubMed, Medline, Cochrane Library, and four Chinese databases. The present review included randomized controlled trials in which acupuncture was the sole treatment or an adjunctive treatment for migraine. Two researchers independently conducted the study selection, data extraction, and quality assessment processes. Disagreements between reviewers were solved by discussion and data reanalysis. The quality of each included study was evaluated using the Cochrane Collaboration risk-of-bias assessment method and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist.Results: Forty-nine studies were analyzed and ranked based on the latest STRICTA and Cochrane Collaboration risk-of-bias assessment standards. The analysis revealed that acupuncture reduced headache frequency compared with no treatment (mean difference [MD] = − 1.80, P < 0.00001, 95% confidence interval [CI] − 2.34 to − 1.26) and western medicine (MD = − 1.75, P = 0.003, 95% CI − 2.91 to − 0.58). Headache frequency did not significantly differ between patients who received real acupuncture versus those who received sham acupuncture (MD = − 0.64, P = 0.24, 95% CI − 1.70 to 0.42).Conclusion: The present review evaluated the current research on the use of acupuncture for migraine, compared with various control treatments. The evidence for the effectiveness of acupuncture in controlling migraine is still limited due to the low quality of the published studies.Keywords: acupuncture, migraine, review

Xiuying Shan,1,* Wenjun Yu,1,* Xuejun Ni,1,* Tingting Xu,1 Chen Lei,1 Zhaoliang Liu,1 Xuefeng Hu,2 Yanding Zhang,2 Beichen Cai,1 Biao Wang1 1Department of Plastic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People’s Republic of China; 2College of Life Sciences, Fujian Normal University, Fuzhou 350108, People’s Republic of China*These authors contributed equally to this workCorrespondence: Biao Wang Email wangbiao@fjmu.edu.cnPurpose: Angiopoietin-2 (Ang-2) has been proven to be a potential agent for malignant cancer treatment. The aim of the current study was to investigate the inhibitory effects of chitosan magnetic nanoparticles (CMNPs) loaded with Ang-2 small interfering RNA (Ang2-siRNA) plasmids (Ang2-CMNPs) on malignant melanoma.Materials and Methods: Melanoma-bearing nude mice were treated with Ang2-CMNPs and control CMNPs. Tumor volumes in each group were recorded. Real-time fluorescence quantitative-PCR was used to measure the relative Ang-2gene expression. Angiogenesis and Ang-2 expression in tumors were measured by immunohistochemistry. Cell apoptosis in each group was measured by TUNEL staining, and the expression of Bax, Bcl-2 and cleaved caspase-3 was analyzed by immunohistochemistry.Results: The progression of melanoma was significantly inhibited by Ang2-CMNP treatment. Ang2-CMNP treatment efficiently inhibited tumor growth and in-situ Ang-2 expression compared with those of the control group. Furthermore, Ang2-CMNP treatment significantly inhibited tumor angiogenesis and promoted cell apoptosis by regulating the Bax/Bcl-2 ratio and increasing cleaved caspase-3 expression in vivo.Conclusion: In summary, Ang2-CMNP treatment increased the regression of normal-appearing vessels in the tumor microenvironment and induced the melanoma cells apoptosis through the mitochondrial apoptotic pathway, suggesting the potential clinical use of Ang2-CMNPs in malignant melanoma treatment.Keywords: angiopoietin-2, small interfering RNA, malignant melanoma, chitosan magnetic nanoparticles, apoptosis

Qin Yang, Yingxiao Zhang, Qinglian Zeng, Chan Yang, Jiale Shi, Chunlin Zhang, Xia Ni, Zhipeng Du, Ziwei Tang, Jinbo Hu, Xuemei Li, Jiahui Cai, Qifu Li, Qingfeng Cheng Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Qingfeng ChengThe First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400042, People’s Republic of ChinaTel +86-23-89011510Fax +86-23-890115540Email cqf19760516@163.comPurpose: The present study was designed to determine the relationships between sarcopenia and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM) and diabetic foot disease (DFD) respectively.Patients and Methods: A total of 1104 patients with T2DM and 257 patients with DFD were included in the study, which was designed as a cross-sectional study. Body composition was assessed using dual-energy X-ray-absorptiometry (DXA). The diagnosis of sarcopenia was based on the Baumgartner criteria. DPN was assessed by Neuropathy symptom score (NSS) and Neuropathy disability score (NDS), and the severity of neuropathy was divided into non-neuropathy symptom (NS), Mild NS, Moderate NS and Severe NS according to NSS. Logistic regression analyses were carried out to determine the relations of sarcopenia and DPN in patients with T2DM and NSS in patients with DFD, respectively.Results: The prevalence of DPN was 80.0% in T2DM patients with sarcopenia and 70.3% in non-sarcopenia patients (P=0.007). Logistic regression analyses showed DPN was one of the independent risk factors for sarcopenia in T2DM patients (OR 1.564 [95% CI: 1.004, 2.435], P=0.048). The prevalence of DPN had no statistical significance in DFD patients with or without sarcopenia. However, the NSS of DFD patients with sarcopenia was higher than that of non-sarcopenia patients. In the multivariate logistic regression analysis, NSS was determined to be associated with sarcopenia in DFD patients (OR 1.387[95% CI: 1.074, 1.789], P=0.012). The appendicular lean mass (ALM) of DFD patients without NS was higher than patients with mild, moderate and severe NS (20.71± 2.73 vs 16.57± 3.62 vs 17.99± 3.54 vs 17.23± 3.29 Kg, P=0.028).Conclusion: DPN is an independent risk factor for sarcopenia in patients with T2DM and NSS is also independently correlated with sarcopenia in patients with DFD, with the latter being more obvious with the aggravation of neurological symptoms in DFD patients.Keywords: type 2 diabetes mellitus, diabetic peripheral neuropathy, diabetic foot disease, sarcopenia, correlation

Yuan Cao, 1 Ming Zhong, 1 Yuke Zhang, 2 Zijie Zheng, 1 Yapeng Liu, 1 Xiaoning Ni, 1 Lu Han, 1, 3 Ming Song, 1 Wei Zhang, 1 Zhihao Wang 1, 4 1The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, and The Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China; 2The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Department of Critical Care Medicine, Jinan, Shandong, People’s Republic of China; 3Department of General Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China; 4Department of Geriatric Medicine, Qilu Hospital of Shandong University, and The Key Laboratory of Cardiovascular Proteomics of Shandong Province, Jinan, Shandong, People’s Republic of ChinaCorrespondence: Wei ZhangThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, and The Department of Cardiology, Qilu Hospital of Shandong University, No. 107, Wen Hua Xi Road, Jinan 250012, People’s Republic of ChinaTel +86 185 6008 6586Fax +86 531 8616 9356Email zhangweisdu7@163.com Zhihao WangThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, The Department of Geriatric Medicine, Qilu Hospital of Shandong University, and The Key Laboratory of Cardiovascular Proteomics of Shandong Province, No. 107, Wen Hua Xi Road, Jinan 250012, People’s Republic of ChinaTel +86 185 6008 2268Fax +86 531 8616 9356Email zhihao369@163.comPurpose: To investigate the impacts of skeletal muscle mass on carotid atherosclerosis in Chinese adults with metabolic syndrome (MetS).Methods: One hundred and ninety-five subjects with MetS had the waist-to-height ratio (WHTR)≥ 0.5 for all. One hundred and eighty-four subjects without MetS were divided into 2 groups: Non-Mets obese group (WHTR ≥ 0.5, n = 118) and Non-MetS control group (WHTR < 0.5, n = 66). All the groups had no difference in age. Appendicular skeletal muscle mass was acquired and skeletal muscle mass index (SMI) was calculated. Carotid intima-media thickness (IMT) was assessed by ultrasonography. Each group was stratified according to the presence or absence of presarcopenia.Results: While most parameters showed an increasing trend with WHTR and MetS in both genders, SMI and HDL-C showed a decreasing trend. The prevalence of carotid atherosclerosis showed the same increasing trend. Multivariate logistic regression analyses showed SBP and presarcopenia were both independent risk factors for carotid atherosclerosis in MetS (OR 1.026, P < 0.001; OR 2.788, P = 0.001, respectively). There was no significant difference in IMT among the three groups with preserved muscle mass whether the participants suffered from obesity or MetS, while there was a significant difference between the two groups with presarcopenia (in male P = 0.020, in female P = 0.009, respectively). The area under the ROC curve (AUC) was 0.641 (P< 0.001) for presarcopenia.Conclusion: Obesity was a risk factor for sarcopenia independent of age, especially in subjects with metabolic syndrome. In individuals with MetS, our findings suggest that presarcopenia may be an independent risk factor for atherosclerosis and appendicular skeletal muscle mass had potential protective effects for carotid atherosclerosis regardless of gender.Keywords: skeletal muscle mass, presarcopenia, metabolic syndrome, carotid atherosclerosis

OBJECTIVE: Although pure titanium (PT) and its alloys exhibit excellent mechanical properties, they lack biological activity as implants. The purpose of this study was to improve the biological activity of titanium implants through surface modification. MATERIALS AND METHODS: Titanium was processed into titanium discs, where the titanium discs served as anodes and stainless steel served as cathodes, and a copper- and cobalt-doped porous coating [pure titanium model (PTM)] was prepared on the surface of titanium via plasma electrolytic oxidation. The surface characteristics of the coating were evaluated using field emission scanning electron microscopy (FE-SEM), energy dispersive X-ray spectroscopy (EDS), X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM), and profilometry. The corrosion resistance of PTM was evaluated with an electrochemical workstation. The biocompatibility and bioactivity of coated bone marrow mesenchymal stem cells (BMSCs) were evaluated through in vitro cell experiments. RESULTS: A copper- and cobalt-doped porous coating was successfully prepared on the surface of titanium, and the doping of copper and cobalt did not change the surface topography of the coating. The porous coating increased the surface roughness of titanium and improved its resistance to corrosion. In addition, the porous coating doped with copper and cobalt promoted the adhesion and spreading of BMSCs. CONCLUSIONS: A porous coating doped with copper and cobalt was prepared on the surface of titanium through plasma electrolytic oxidation. The coating not only improved the roughness and corrosion resistance of titanium but also exhibited good biological activity. [ABSTRACT FROM AUTHOR]