Objective To investigate the value of magnetic resonance imaging (MRI) T₂-mapping in evaluating the activity of Graves ophthalmopathy (GO). Methods A total of 64 patients with GO in the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University from July 2019 to January 2021 were collected. Simple random grouping was performed by computer, with 49 cases as observation subjects, and 15 patients for diagnostic test. According to clinical activity score (CAS), 49 GO patients were divided into active group (CAS ≥3 points, 48 eyes) and inactive group (CAS <3 points, 50 eyes). Normal control group (NC group) included 31 patients (62 eyes). All subjects underwent 3.0T orbital MRI T₂-mapping. Measuring the T₂ relaxation time (T₂RT) of superior rectus, inferior rectus, medial rectus, and lateral rectus on five layers behind the eyeball on T₂-mapping coronal images, and select the maximum value of T₂RT in the five layers for each extraocular muscle to represent the T₂RT of this extraocular muscle. Finally, select the maximum T₂RT values of the four extraocular muscles, expressed as extraocular muscle maximum T₂RT. Compare the differences of the above 5 indicators (superior rectus T₂RT, inferior rectus T₂RT, medial rectus T₂RT, lateral rectus T₂RT, extraocular muscle maximum T₂RT) between active group, inactive group and NC group. ROC curve was used to analyze the diagnostic value of the above 5 indicators for GO activity assessment, and the diagnostic threshold was obtained. Then, another 15 GO patients were performed for diagnostic tests evaluation to determine the indicators of high diagnostic efficacy and the threshold of diagnostic activity. Results The T₂RT of all extraocular muscles in active group were significantly higher than those in inactive group and NC group, the difference was statistically significant (P<0.001). The threshold value of the five indicators were obtained by ROC curve analysis. The maximum T₂RT cut-off values of superior rectus muscle, inferior rectus muscle, medial rectus muscle, lateral rectus muscle and extraocular muscles for judging activity were 80.200 ms, 97.045 ms, 94.355 ms, 85.750 ms and 101.385 ms respectively. Another 15 GO patients were performed for diagnostic tests, the indexes with relatively high sensitivity, specificity, positive predictive value and negative predictive value were inferior rectus T₂RT and extraocular muscle maximum T₂RT, the cut-off values of GO activity were 97.045 ms and 101.385 ms, respectively; the sensitivity were 91.7% and 93.8%, respectively; the specificity all were 80.0%. Conclusions MRI T₂-mapping sequence has a good value in assessment of GO activity. The inferior rectus T₂RT and extraocular muscle maximum T₂RT can be choosed to evaluate the activity of GO.

Objective To compare the clinical efficacy of natural orifice specimen extraction surgery (NOSES) combined with enhanced recovery after surgery (ERAS) and conventional laparoscopic surgery in treatment of rectal cancer patients. Methods A hundred patients with rectal cancer in the Department of Colorectal and Anal Surgery, the 940th Hospital of Joint Logistics Support Force of PLA were selected as the research objects from January 2019 to December 2021, including 49 cases treated with NOSES combined with ERAS were set as the observation group, and 51 cases treated with conventional laparoscopic surgery of rectal cancer were set as the control group. Postoperative C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), white blood cell count (WBC), percentage of neutrophil (NEUT), K⁺ concentration, postoperative peristalsis recovery time, first time out-of-bed activity, first liquid feeding time, removal time of urinary, and drainage tubes, hospital stay and intraoperative blood loss, number of lymph node detection, positive margin rate, incidence of complications, and pain score were compared between the two groups. Results The observation group showed significant lower postoperative CRP, PCT, IL-6 levels when compared with control group(P<0.05), while no significant difference in K⁺ concentration between the two groups (P>0.05). The recovery time of intestinal peristalsis, the time of the first out-of-bed activity, the first liquid feeding time, the time of removal of the urinary tube and the drainage tube, and the number of days of hospitalization in observation group were all superior to the control group (P<0.05). The observation group with the duration of surgery was longer than the control group, and the difference was statistically significant (P<0.05). There were no significant differences in intraoperative bleeding, number of lymph nodes detected and positive rate of resection margins between the two groups (P>0.05). There was no significant difference in the incidence of complications between the two groups (4.1% vs. 7.8%, P>0.05). The observation group showed significant lower pain scores than control group on the 1st, 2nd and 3rd day after surgery (P<0.05). Conclusions NOSES combined with ERAS in treatment of rectal cancer patients is safe and feasible, can narrow the surgical incision, alleviate stress response and postoperative pain, improve postoperative efficacy and reduce the occurrence of complications, so is worthy of promotion and application.

Objective To summarize the epidemiological and clinical features of infectious diseases of the central nervous system (CNS) by a single-center analysis. Methods A retrospective analysis was conducted on the data of 1247 cases of CNS infectious diseases diagnosed and treated in the First Medical Center of PLA General Hospital from 2001 to 2020. Results The data for this group of CNS infectious diseases by disease type in descending order of number of cases were viruses 743(59.6%), Mycobacterium tuberculosis 249(20.0%), other bacteria 150(12.0%), fungi 68(5.5%), parasites 18(1.4%), Treponema pallidum 18(1.4%) and rickettsia 1(0.1%). The number of cases increased by 177 cases (33.1%) in the latter 10 years compared to the previous 10 years (P<0.05). No significant difference in seasonal distribution pattern of data between disease types (P>0.05). Male to female ratio is 1.87︰1, mostly under 60 years of age.Viruses are more likely to infect students, most often at university/college level and above, farmers are overrepresented among bacteria and Mycobacterium tuberculosis, and more infections of Treponema pallidum in workers. CNS infectious diseases are characterized by fever, headache and signs of meningeal irritation, with the adductor nerve being the more commonly involved cranial nerve. Matagenomic next-generation sequencing improves clinical diagnostic capabilities. The median hospital days for CNS infectious diseases are 18.00(11.00, 27.00) and median hospital costs are ¥29,500(¥16,000, ¥59,200). The mortality rate from CNS infectious diseases is 1.6%. Conclusions The incidence of CNS infectious diseases is increasing last ten years, with complex clinical presentation, severe symptoms and poor prognosis. Early and accurate diagnosis and standardized clinical treatment can significantly reduce the morbidity and mortality rate and ease the burden of disease.

Premature ovarian insufficient (POI) is one of the important causes of infertility in woman of reproductive age. At present, the clinical treatment of POI is limited and the therapeutic effect is not ideal. Extracellular vesicles derived from stem cells have attracted the attention of many researchers at home and abroad as a new cell-free therapy. Many animal experiment study shows that a variety of extracellular vesicles from stem cells carry microRNAs, lncRNAs, lipids, proteins, and other bioactive substances, improve ovarian function, affect granulosa cell proliferation and apoptosis, promote ovarian angiogenesis, and reduce oxidative stress response, thus playing a therapeutic role on POI. This article will review the mechanisms of extracellular vesicles in treatment of POI, and provide evidence for the application of extracellular vesicles in clinical treatment of POI.

Non-puerperal mastitis (NPM) is a group of chronic inflammatory diseases with breast pain, lumps, abscesses and sinus tracts/fistulas as the main clinical manifestations, which is easily confused with breast cancer or other benign breast diseases. NPM always leads to a long treatment cycle and high recurrence rate, which may cause a large economic and psychological burden to patients. At present, the etiology and pathogenesis of NPM are still unclear, but it has a certain correlation with immune abnormality, bacterial infection, hormone disorder and other factors. Although several diagnostic methods available, the diagnosis of NPM relies on histopathological examination mainly. The treatment methods of the disease include observation and follow-up, pharmacotherapy, surgical treatment, etc., but there is still no unified standard for specific treatment timing and treatment selection. In view of the controversy over etiology and treatment selection of NPM, this paper comprehensively summarizes the latest research progress in disease characteristics, clinical diagnosis and treatment of NPM based on domestic and foreign literature, aiming to provide reference and inspiration for the selection of reasonable clinical diagnosis and treatment.

Objective To establish and validate the nomogram prediction model of degenerative lumbar disc disease in young and middle-aged people. Methods From January 2020 to March 2022, 232 young and middle-aged people who were examined with MRI of lumbar intervertebral disc and standard standing position lumbar anteroposterior and lateral X-ray films in Suzhou Ninth Hospital Affiliated to Soochow University were selected as the study subjects. Collecting the factors that may affect the occurrence of degenerative lumbar disc disease in young and middle-aged people, the people were divided into degenerative disease group (n=78) and non-degenerative disease group (n=154) according to the presence or absence of degenerative lumbar disc disease. Influencing factors were compared between the two groups, the independent influencing factors screened out by multifactor logistic regression, the nomograph model was constructed by R software, and the model verified. Results Among 232 young and middle-aged people included in this study, 78 (33.6%) had degenerative lumbar disc diseases. The results of multivariate logistic regression analysis showed that the increase of BMI, sedentariness, the increase of IL-1β level were the risk factors of degenerative lumbar disc disease in young and middle-aged people; the increase of pelvic incidence angle and the increase of miRNA-142-3p level were protective factors for degenerative lumbar disc disease in young and middle-aged people (P<0.05). The nomogram model was constructed according to the results of multifactor analysis. ROC results showed that AUC was 0.889 (95%CI 0.844-0.933, P<0.05), the average absolute error of internal validation was 0.017, the prediction curve was basically fitted with the standard curve, and the H-L goodness of fit test showed that the model was consistent (P>0.05). The decision curve shows that the clinical benefit rate is the highest when the model prediction probability threshold is 0.16-0.80. Conclusions Degenerative lumbar disc disease in young and middle-aged people is affected by such factors as BMI, sedentariness, and incidence angle of pelvis, and the nomogram model established based on this has high differentiation and accuracy of prediction.

Heat stroke (HS) is a serious life-threatening disease caused by heat injury and characterized by a core body temperature >40 ℃ with central nervous system dysfunction and multi-organ failure. The main pathophysiological manifestations of HS are the thermal acute phase response and thermoregulatory imbalance. Proteins are particularly sensitive to heat, and the thermal environment can cause massive protein denaturation, resulting in the deposition of unfolded and misfolded proteins in the cytoplasm, causing cellular dysfunction and even death. The unfolded protein response (UPR), mainly divided into the endoplasmic reticulum UPR and the mitochondrial UPR, is an important physiological process that helps proteins to fold correctly or degrade irretrievably denatured proteins. This paper summarizes the regulatory mechanisms of UPR, the relationship between UPR and severe diseases, as well as the relationship between HS and UPR to provide new ideas for the treatment of HS.

Metabolism-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is one of the most popular chronic liver diseases in the world, and has become one of the main causes of liver cirrhosis, end-stage liver disease, and primary liver cancer. In recent years, the prevalence of MAFLD has gradually increased in China, the Asia Pacific region, and even globally, increasing the medical and socio-economic burden. The exploration of the epidemiology and risk factors of this disease at home and abroad has also gradually increased. Meanwhile, due to the scarcity of MAFLD treatment drugs, their drug treatment has become a hot issue that needs to be urgently addressed in clinical practice. In recent years, there has been an increase in the number of drugs entering the clinical trial stage. Based on this, the current epidemiological status, risk factors, diagnostic criteria, and treatment research progress of MAFLD have been reviewed in order to provide new ideas and directions for the clinical diagnosis, treatment, and scientific research of MAFLD.

Objectives To analyze the risk factors and their predictive value for postoperative hypoxemia in Type-A aortic dissection (TAAD). Methods A single-center retrospective study was conducted among 146 consecutive patients diagnosed as TAAD and undergone aortic arch surgery from January 2018 to June 2021 in Nanfang Hospital of Southern Medical University. According to the lowest postoperative PaO₂/FiO₂ ratio within 24 hours, the patients were classified into two groups: hypoxemia group (PaO₂/FiO₂ ≤200 mmHg) and non-hypoxemia group (PaO₂/FiO₂ >200 mmHg). The difference of preoperative oxygen index, duration of mechanical ventilation and mortality in hospital were analyzed between the two groups. The independent risk factors for postoperative hypoxemia were evaluated by multivariate logistic regression and the predictive value was analyzed by receiver operator character (ROC) curves. Results For TAAD patients, the incidence of postoperative hypoxemia was 45.9%. Compared to non-hypoxemia group, hypoxemia group exhibited longer duration of mechanical ventilation (P<0.001) and longer intensive care unit (ICU) length of stay (P<0.05). Moreover, patients with hypoxemia presented higher mortality during hospital (P=0.011). Multivariate regression analysis identified BMI as independent risk factor (OR=1.701, P<0.001) and preoperation PaO₂/FiO₂ ratio as protective factors for postoperative hypoxemia in patients with TAAD (OR=0.987, P=0.004). Area under the ROC curve of BMI was 0.848, the optimal cut-off point of BMI was 25.8 kg/m². Area under the ROC curve of pre-operation PaO₂/FiO₂ ratio was 0.808, the optimal cut-off point of preoperation PaO₂/FiO₂ ratio was 265 mmHg. Conclusions BMI higher than 25.8 kg/m² is an independent risk factor and preoperation PaO₂/FiO₂ ratio higher than 265 mmHg is a protective factor for postoperative hypoxemia in patients with TAAD. Subjects with hypoxemia had longer duration of mechanical ventilation, ICU stay and higher mortality.

Objective To investigate the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with camrelizumab and apatinib in treatment of advanced hepatocellular carcinoma (HCC). Methods The clinical data were retrospectively analyzed of 85 patients with advanced HCC treated in the Fifth Affiliated Hospital of Zhengzhou University and People's Hospital of Zhengzhou from January 2019 to September 2021. They were divided into observation group (n=31, SBRT combined with camrelizumab and apatinib) and control group (n=54, treated with camrelizumab and apatinib) according to whether they received SBRT. The propensity score matching (PSM) was used to balance the influence of confounding factors. The objective remission rate (ORR) and disease control rate (DCR) were compared between the two groups. The 6-month overall survival rate, 1-year overall survival rate and progression-free survival (PFS) were compared between the two groups by Kaplan-Meier method. The safety of the two groups was evaluated by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results Before PSM, there were significant differences in age (P=0.043), number of extrahepatic metastasis (P=0.028), and previous surgical treatment (P=0.038) between the two groups. After PSM, there was no significant difference in baseline characteristics between the two groups (P>0.05). After PSM, 27 cases were included in each groups, and three months after treatment, the ORR in observation group and control group were 66.7% and 29.6%, respectively, showed difference with statistically significant (P=0.006); and the DCR in the both groups were 96.3% and 85.2% respectively, showed no statistically significant difference (P=0.175). There were statistical differences in 6-month overall survival rate (96.3% vs. 80.9%, P=0.001), 1-year overall survival rate (75.0% vs. 61.4%, P=0.034) and median PFS (8 months vs. 5 months, P=0.003) between the observation group and control group. Multi-factor Cox regression analysis showed that baseline alpha-fetoprotein (AFP) ≥400 ng/ml was an independent risk factor for affecting the survival of patients with advanced HCC (HR>1, P<0.05), while the triple therapy and previous targeted drugs therapy were the protective factors for the survival of patients with advanced HCC (HR<1, P<0.05). In the observation group, 4 patients had grade 3 adverse reactions, and the common adverse reactions were dyspepsia (14.8%). One case of grade 3 adverse reactions occurred in control group, and there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.639). Conclusion SBRT combined with camrelizumab and apatinib is a safe and effective treatment for advanced HCC with significant clinical effect and controllable adverse reactions.