Objective:To assess the predictive value of a combined multiclassification model for computed tomography(CT)in the patholo-gical analysis of ground-glass nodules(GGN).Methods:Pulmonary GGN lesions that were pathologically confirmed as invasive adenocar-cinoma(IAC),minimally invasive adenocarcinoma(MIA),adenocarcinoma in situ(AIS),and preinvasive lesions(PILs),were collected from pa-tients who were treated at The First Affiliated Hospital of Xinxiang Medical University between February 2019 and March 2023.A total of 324 nodules were retrospectively collected from 285 patients,and divided into three groups:infiltrating IAC,MIA,and PILs.Radiomics and clinical-CT features were selected through recursive feature elimination and univariate Logistic regression.Seven models were constructed using Logistic regression(LR),support vector machine(SVM),random forest(RF),and integrative learning(stacking).Results:The hybrid model combining clinical-CT-radiomics features and an integrative strategy showed superior predictive performance,with an accuracy of 0.791,precision of 0.788,specificity of 0.857,recall of 0.790,and F1-Score of 0.789.Conclusions:The multiclassification joint model based on CT-radiomics is effective in predicting pathological classification of pulmonary GGNs.This model aids in accurate imaging diagnosis and can provide a basis for optimizing treatment plans.

Objective:To observe and analyze the macular microvascular system changes in unilateral pediatric uveitis (PU) and healthy contralateral eyes.Methods:A cross-sectional case-control study. From January 2019 to July 2021, 21 eyes of 21 patients with PU diagnosed in one eye (PU group), 21 unaffected contralateral eyes (contralateral eye group), and 21 age-matched volunteers with 21 eyes (NC group) during the same period were examined in Peking Union Medical College Hospital. Optical coherence tomography angiography was used to scan the 6 mm × 6 mm fundus macular area in the three groups of selected eyes to measure the vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the retina, the area of the avascular zone (FAZ) in the fovea of the macula, the choroidal thickness under the fovea (SFCT), and the retinal thickness in the fovea of the macula (CRT). The device comes with a software choriocapillary flow measurement tool, which can obtain the macula's choriocapillary density (CCD) with the fovea as the center and the diameter of the annular area of 1.0 mm, 1.5 mm, and 3.0 mm, respectively. They were recorded as CCD-1.0, CCD-1.5, and CCD-3.0. The measurement data of multiple groups were compared by analysis of variance; if the variance of the three groups of data was not uniform, the Kruskal-Wallis test was used. Multiple linear regression analysis was used to evaluate the potentially related factors of CCD.Results:Compared with the contralateral eye group and the NC group, the vessel density of SCP ( H=-13.857,-25.500; P=0.043, P<0.001), DCP ( H=-15.333, -31.595; P=0.007, P<0.001) and CCD-1.0 ( H=-14.000,-16.214; P=0.040, 0.012) of the clinically quiescent PU group were significantly decreased. CRT and FAZ were not statistically different between PU and NC groups ( F=0.955; P=1.000, 0.661). Compared with the NC group, the mean vessel density of SCP and DCP in the contralateral eye group decreased, and the difference in DCP vessel density was statistically significant ( H=-16.262, P=0.004). There was no statistically significant difference between the CCD of two groups ( P=1.000). The SFCT of the PU group was significantly thicker than that of the NC group ( F=5.552, P=0.004), however, difference was not statistically significant from the fellow eye group ( F=5.552, P=0.270). The results of multiple linear regression analysis revealed that the CCD-1.0, CCD-1.5, and CCD-3.0 showed a linear correlation with the area of FAZ ( β=-0.494, -0.527, -0.566; P=0.015, 0.009, 0.010) and CRT ( β=-0.322, -0.466, -0.342; P=0.026, 0.002, 0.028). CCD-1.0 and CCD-1.5 showed a linear correlation with the vessel density of DCP ( β=0.277, 0.275; P=0.047, 0.045). Conclusion:Both retinal and choroidal microvasculature are abnormal in resting eyes with PU, and macular circulation disorders may be present in the unaffected fellow eye.

Objective To evaluate predictive factors affecting the short-term efficacy of PD-1 inhibitors in non-small cell lung cancer (NSCLC) and to construct a prediction model. Methods From October 2019 to November 2021, 221 patients with advanced NSCLC who met the inclusion criteria and were treated with PD-1 inhibitors were prospectively enrolled. Patients who were enrolled before May 1st, 2021 were included inthe modeling group (n=149), whereas those who enrolled thereafter were included in the validation group (n=72). The general clinical data of patients, information of the four TCM diagnoses were collected, and TCM syndrome elements were identified. R software version 4.0.4 was used in constructing a nomogram clinical prediction model of objective response rate. The predictive ability and discrimination of the model were evaluated and externally validated by using a validation group. Results After two to four cycles of PD-1 inhibitor therapy in 221 patients, the overall objective response rate was 44.80%. Multivariate logistic regression analysis of the modeling group showed that the TPS score (OR=0.261, P=0.001), number of treatment lines (OR=3.749, P=0.002), treatment mode (OR=2.796, P=0.019), qi deficiency disease syndrome elements (OR=2.296, P=0.043), and syndrome elements of yin deficiency disease (OR=3.228, P=0.005) were the independent predictors of the short-term efficacy of PD-1 inhibitors. Based on the above five independent predictors, a nomogram prediction model for the short-term efficacy of PD-1 inhibitors was constructed. The AUC values of the modeling and validation groups were 0.8317 and 0.7535, respectively. The calibration curves of the two groups showed good agreement between the predicted and true values. The mean absolute errors were 0.053 and 0.039, indicating that the model has good predictive performance. Conclusion The nomogram model constructed on the basis of the syndrome elements of Qi-deficiency disease and Yin-deficiency syndrome of TCM, as well as TPS score, number of treatment lines and treatment mode, is a stable and effective tool for predicting the short-term efficacy of PD-1 inhibitors in advanced non-small cell lung cancer.

The CRISPR/Cas systems comprising the clustered regularly interspaced short palindromic repeats (CRISPR) and its associated Cas protein is an acquired immune system unique to archaea or bacteria. Since its development as a gene editing tool, it has rapidly become a popular research direction in the field of synthetic biology due to its advantages of high efficiency, precision, and versatility. This technique has since revolutionized the research of many fields including life sciences, bioengineering technology, food science, and crop breeding. Currently, the single gene editing and regulation techniques based on CRISPR/Cas systems have been increasingly improved, but challenges still exist in the multiplex gene editing and regulation. This review focuses on the development and application of multiplex gene editing and regulation techniques based on the CRISPR/Cas systems, and summarizes the techniques for multiplex gene editing or regulation within a single cell or within a cell population. This includes the multiplex gene editing techniques developed based on the CRISPR/Cas systems with double-strand breaks; or with single-strand breaks; or with multiple gene regulation techniques, etc. These works have enriched the tools for the multiplex gene editing and regulation and contributed to the application of CRISPR/Cas systems in the multiple fields.
Gene Editing ; CRISPR-Cas Systems/genetics* ; Bacteria/genetics* ; Archaea ; Bioengineering

Objective: To investigate the impact of COVID-19 infection and health related behaviors on the health related quality of life of children and adolescents aged 8-15 years in Nanjing, so as to provide a theoretical basis for improving HRQoL in children and adolescents. Methods: From December 2022 to January 2023, a total of 2 398 students aged 8-15 years from the third grade of primary school to junior middle school in Nanjing were selected by multistage random cluster sampling. The 3 level EuroQol 5 dimension Questionnaire Youth Vension (EQ-5D-Y-3L) was completed by the respondents on their own, and the parents assisted in completing the rest of the questionnaire. Results: The EuroQol-index(EQ-index) and Visual Analogue Scale (VAS) scores of being infected individuals were lower than those of uninfected and previously infected ( P <0.05). The proportion of being infected individuals reporting difficulty on "Pain/Discomfort" was higher than that of uninfected and previously infected individuals, and the proportion of reporting difficulty on "Mobility" was also higher than that of uninfected individuals ( P <0.05). Lack of parental companionship( OR=10.19, 95%CI =3.12-33.22), irregular breakfast consumption ( OR=10.63, 95%CI =3.20-35.25), and excessive screen time ( OR=8.24, 95%CI =3.02-22.51) increased the risk of difficulty on "Mobility" in being infected individuals ( P <0.05). Irregular breakfast consumption ( OR=1.93, 95%CI =1.31-2.84) and consumption of sweetened beverages and snacks (OR=1.56, 95%CI =1.17-2.10) increased the risk of having lower EQ index in previously infected individuals compared to uninfected individuals. Furthermore, consumption of sweetened beverages and snacks ( OR=1.57, 95%CI =1.21-2.05) and excessive screen time ( OR=1.49, 95%CI =1.12-1.98) also increased the risk of VAS scores being lower in previously infected individuals compared to uninfected individuals ( P <0.05). Conclusion The COVID-19 infection impairs HRQoL, and unhealthy behaviors deteriorate its negative impact. Healthy behaviors and lifestyles should be advocated to reduce the impact of COVID-19 infection on HRQoL.

Objective To construct a nomogram prediction model for the treatment effect of anlotinib with the participation of traditional Chinese medicine syndrome elements on the patients with extensive-stage small cell lung cancer (ES-SCLC) who previously received multiple lines of chemotherapy. Methods The clinical data of 127 patients with ES-SCLC who received at least two cycles of anlotinib treatment were retrospectively studied. Kaplan-Meier method was used to analyze the relationship between each factor and the overall survival time. Cox regression analysis was applied to screen the independent influencing factors of the prognosis of patients with ES-SCLC. R language was employed to build a nomogram prediction model, C-index was used to evaluate the model, and calibration curve was adopted to verify the accuracy of the model. Results Age, PS score, brain metastases, qi deficiency syndrome, yin deficiency syndrome, and blood stasis syndrome were related risk factors for ES-SCLC treated with anlotinib. PS score, brain metastasis, and blood stasis syndrome were independent prognostic factors. On the basis of these three independent influencing factors, a nomogram model was established to predict the prognosis of patients with ES-SCLC treated with anlotinib. The predicted risk was close to the actual risk, showing a high degree of coincidence. Conclusion The nomogram model established with PS score, blood stasis syndrome elements, and brain metastasis as independent factors can predict the prognosis of patients with ES-SCLC receiving second- and third-line treatment of anlotinib.

Objective:To explore the effects of cough remodeling exercise in postoperative tracheal intubation nursing among patients with craniocervical junction malformation.Methods:From January 2015 to December 2016, convenience sampling was used to select 40 craniocervical junction malformation patients admitted to the Department of Neurosurgery of the Chinese People's Liberation Army General Hospital and treated with posterior cervical 1 side mass-cervical 2 pedicle screw reduction and internal fixation, and with tracheal intubation as the control group, using traditional breathing exercise. From January 2017 to December 2019, 40 craniocervical junction malformation patients with posterior cervical 1 side mass-cervical 2 pedicle screw reduction and internal fixation and internal fixation, and with tracheal intubation were selected as the experimental group, implementing cough remodeling exercise on the basis of traditional breathing exercise. The cough strength, white card test and tracheal intubation time, average hospital stay, reintubation rate 24 hours after extubation, tracheotomy rate, lung infection rate and other airway management effect indexes were compared between the two groups of patients.Results:After intervention, the cough strength of experimental group was greater than that of control group, and the difference was statistically significant ( Z=-2.158, P=0.031) . The white card test positive rate of experimental group (82.5%, 33/40) was higher than that of control group (55.0%, 22/40) , and the difference was statistically significant (χ 2=7.040, P=0.008) . The median time of intubation in experimental group was 18.25 h, which was shorter than 43.00 h in control group ( Z= -2.728, P=0.006) ; the average hospital stay of experimental group was shorter than that of control group, and the differences were all statistically significant ( Z=-2.848, P=0.004) . There was no significant difference in the reintubation rate 24 hours after extubation, tracheotomy rate, and lung infection rate of the two groups of patients ( P>0.05) . Conclusions:Cough remodeling exercise can enhance the cough strength of patients with craniocervical junction malformation, shorten the time of tracheal intubation and the average hospital stay, which is worthy of clinical application.

Objective A three-dimensional （3D） printing precise pressure device was designed specifically targeted at cambered limbs according to the requirement of postoperative rehabilitation of total knee replacement(TKR), and its effectiveness and safety was verified by finite element analysis. Methods Based on gastrocnemius muscle of lower limbs as the pressurized objects, the precise pressure device was designed, which contained an air pressure generating module, an inflatable airbag and a 3D printing brace. Through the closed loop control algorithm, the device stably supplied different pressures in the airbag. Distributed pressure data of the airbag-skin within contact surface were collected under different experimental conditions and imported into biomechanical simulation software which combined CT images to reconstruct 3D model of the lower limb mechanics. Finally, the effective compression area fraction and the joint micro-motion angle under each condition were obtained, to verify the effectiveness and safety of the system. Results Using generally preferred 4 cm-size offset and 4-barrel airbag configurations, under different intracapsular pressure of 5.32，6.65，7.98，9.31，10.64 kPa, the simulated knee joint micro-motion angles were 5.3°, 6.1°, 7.2°, 9.5°, 10.6°， respectively, and the effective compression area fraction could be up to 90-8%-95-2%. Conclusions For the optimized scheme, the dynamic range of joint micro-motion angle and the effective compression area fraction caused by different airbag pressure values were the best and met the design requirements of effectiveness and safety. The research findings can contribute to analyzing the influence of compression system on limb biomechanics, which are of great significance for effective and safe rehabilitation training after TKR.

Objective:To investigate whether the bladder neck descent and the area of levator ani hiatus obtained on the maximum Valsalva were consistent at the lithotomy position and separating-legs-holding-knees position.Methods:Forty four subjects who underwent perineal pelvic floor four-dimensional ultrasound at 6-8 weeks postpartum in Third Hospital of Longgang Shenzhen from November 2019 to January 2020 were enrolled in this study. All subjects were able to effectively complete the maximum Valsalva maneuver both at the lithotomy position and the separating-legs-holding-knees position. The bladder neck descent and hiatus area of the levator Ani on the maximum Valsalva at these two positions were measured and compared.Results:The bladder neck descent at the separating-legs-holding-knees position was higher than that at the lithotomy position [(41.06±8.25)mm vs (39.96±8.10)mm; t=-2.965, P=0.005], and the hiatus area of levator Ani at the separating-legs-holding-knees position was larger than that at the lithotomy position[(27.55±4.90)cm 2 vs (26.32±4.76)cm 2; t=-3.820, P<0.001]. Conclusions:The bladder neck descent and the area of levator Ani hiatus on the maximum Valsalva at separating-legs- holding-knees position are larger than those on the maximum Valsalva at the lithotomy position.

Objective To explore the features of multi-slice spiral computed tomography (MSCT) examination of indirect,direct and femoral inguinal hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 106 patients with indirect,direct and femoral inguinal hernia who were admitted to the First Affiliated Hospital of Xinxiang Medical University between December 2014 and August 2017 were collected.All the patients were diagnosed as inguinal hernia by MSCT examination and multi-planar reconstruction.Observation indicators:(1) sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT;(2) inguinal anatomic presentation in MSCT examination;(3) relationship between hernial sac and surrounding structures in MSCT examination;(4) hernia contents and quadrants of hernial sac in the quadrant partition with " cross intersect" method and complications.Count data were described as absolute number or percentage.Comparison of count data was done using the chi-square test with row multiplied by column.Results (1) Sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT:of 106 patients,66,22 and 18 were diagnosed as indirect hernia,direct hernia and femoral hernia with 70,27 and 20 hernial sacs respectively.Sensitivity,specificity,positive and negative predictive values of inguinal hernia by MSCT were respectively 95.7％,96.3％,98.5％,89.7％ in indirect hernia patients and 96.3％,95.7％,89.7％,98.5％ in direct hernia patients and 100.0％,100.0％,100.0％,100.0％ in femoral hernia patients,and diagnostic accordance rate of femoral hernia was also 100.0％.Diagnostic accordance rate of inguinal hernia was 95.9％,and correct index was 0.920.(2) Inguinal anatomic presentation in MSCT examination:transverse,coronal and sagittal imagings of inferior epigastric artery,inguinal ligament,musculus rectus abdominis,femoral vein and other anatomic structures can be identified,and internal ring of inguinal canal of 6 patients cannot be observed clearly.For relationship between internal ring of inguinal canal and inferior epigastric artery,coronal view was the best,transverse view was the next,and sagittal view was rarely observed.For relationship between inguinal ligament and hernial sac,sagittal view was the best,coronal view was also observed clearly by continuous planes,and transverse view was poor.The oblique coronal view was the best for the direct hernial triangle and internal ring of inguinal canal,and coronal view of femoral triangle was the best.The lateral crescent sign and quadrant partition of "ross intersect" method needed to be observed in transverse plane.(3) Relationship between hernial sac and surrounding structures in MSCT examination:indirect hernia entered into the inguinal canal through internal ring of inguinal canal,and hernial sac was located at the outside of inferior epigastric artery;direct hernia was out through triangle hernia,and hernial sac was located at the inside of inferior epigastric artery,92.6％ (25/27) patients were accompanied by lateral crescent sign.The indirect hernia and direct hernia went along the upper front of inguinal ligament;femoral hernia was out through femoral triangle hernia,and hernial sac was located at the lower back of inguinal ligament and the outside of the pubic tubercle.(4) The hernia contents and quadrants of hernial sac in the quadrant partition with "cross intersect" method and complications:the most common hernia content was small intestine,including partial patients with hernia content composed of various substances;indirect hernia contents included small intestine (35),mesentery (29),effusion (25),intraabdominal fat (9),colon (8) and ovary (1) in turn;direct hernia contents included small intestine (14),intraabdominal fat (11),effusion (6),mesentery (6),colon (3) and bladder (2) in turn;femoral hernia contents included small intestine (12),intraabdominal fat (8),effusion (3) and mesentery (2) in turn.There was a statistically significant difference in the hernia contents among indirect hernia,direct hernia and femoral hernia (x2=28.389,P＜0.05).The main hernial sac located at antero-external quadrant was respectively occurred in 70 hernial sacs of indirect hernia and 27 hernial sacs of direct hernia and 15 hernial sacs of femoral hernia,and 5 hernial sacs of femoral hernia were located at postero-external quadrant.There was a statistically significant difference in comparison of the quadrant partition with "cross intersect" method (x2 =78.904,P ＜ 0.05).The intestinal obstruction was respectively occurred in 8 patients with indirect hernia and 14 patients with direct hernia and 12 patients with femoral hernia,with a statistically significant difference (x2=26.674,P＜0.05).Conclusions Indirect hernia,direct hernia and femoral hernia have characteristic signs of imaging.MSCT can display precisely the anatomical details of inguinal region,which plays an important role in diagnosis and differential diagnosis of indirect hernia,direct hernia and femoral hernia,especially in display of hernia contents and diagnosis of complications,thus it can provide important information for evaluating risk and making operation plan.