BACKGROUND:During the treatment of posterolateral tibial plateau fractures through the fibular head approach,the gap between the fibular head and the lateral plateau cannot accommodate the posterior placement of a plate for all patients.OBJECTIVE:To analyze,via finite element analysis,the differences in fixation strength resulting from varying the angles and quantities of horizontal arm variable angle screws in the plate during the treatment of posterolateral tibial plateau fractures through the fibular head approach.METHODS:A finite element model was established based on CT images of the knee to ankle joints of a 30-year-old healthy adult male volunteer.The models were divided into two categories:posteriorly placed group and non-posteriorly placed group based on whether the lateral locking compression plate was posteriorly placed.The posteriorly placed group was further subdivided into groups A-D based on the offset angle of the two variable angle screws(0°,5°,10°,and 15°).The non-posteriorly placed group was subdivided into groups E and F based on offset angles(0° and 15°).Finite element analysis was used to evaluate the von Mises stress distribution,maximum von Mises stress,and compressive displacement under loads of 250,500,and 750 N,exploring the mechanical differences between the groups.RESULTS AND CONCLUSION:(1)Finite element analysis results showed that under a 750 N load,the maximum compressive displacement trend of the internal fixation device was D＜B=C=F＜A＜E.The trend for maximum von Mises stress was B＜C＜A＜D＜F＜E.The trend for maximum compressive displacement on the bone was C=D＜B＜A＜F＜E,and for maximum von Mises stress,it was B＜C＜A＜F＜D＜E.The displacement and stress trends for the six models were similar under loads ranging from 250 N to 750 N.(2)These results suggest that for posterolateral tibial plateau fractures fixed through the fibular head approach,posterior placement of the plate should aim to accommodate two screws.If only one screw can be fixed during surgery,variable angle screws should be offset in the range of 0-15° to increase the probability of securing two screws.

Objective:To investigate the application value of dual-energy computer tomo-graphy (CT) multi-parameter imaging in predicting the pathological grade of pancreatic ductal adeno-carcinoma (PDAC).Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 147 patients with PDAC who were admitted to The Fifth Affiliated Hospital of Wenzhou Medical University from January 2017 to August 2023 were collected. There were 102 males and 45 females, aged (59±10)years. All patients underwent preoperative dual-energy CT examination and postoperative histopathological examination. The 147 patients were divided into a training set of 103 cases and a test set of 44 cases by stratified random sampling at a ratio of 7∶3. The training set was used to construct the prediction model, and the test set was used to verify the effectiveness of prediction model. Observation indicators: (1) analysis of factors affecting the pathological grade of PDAC patients in the training set; (2) construction and evaluation of the fusion prediction model for pathological grade of PDAC. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The performance of the model was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), accuracy, sensitivity and specificity were calculated. The Delong test was used to analyze the effec-tiveness of model. The calibration curve and decision curve of Hosmer-Lemeshow test were used to evaluate the consistency and clinical application value of the nomogram, respectively. Results:(1) Analysis of factors affecting the pathological grade of PDAC patients in the training set. Results of multivariate analysis showed that tumor cystic necrosis, vascular invasion, standardized iodine concentration (NIC) in venous phase, effective atomic number (Zeff) in venous phase, and energy spectrum curve slope (λ HU) in venous phase were all independent factors affecting the pathological grade of PDAC patients in the training set ( odds ratio=4.326, 3.887, 4.155, 5.389, 3.164, 95% confidence interval as 1.167-16.033, 1.111-13.592, 1.707-10.113, 1.284-22.613, 1.247-8.028, P<0.05). (2) Construction and evaluation of the fusion prediction model for pathological grade of PDAC. Accor-ding to the results of multivariate analysis, tumor cystic necrosis, vascular invasion, NIC in venous phase, Zeff in venous phase and λ HU in venous phase were all included to construct the clinical-imaging fusion prediction nomogram model. The AUC, accuracy, sensitivity and specificity of the fusion prediction model in the training set were 0.938 (95% confidence interval as 0.896-0.981), 87.38%, 89.74% and 85.94%, respectively. The above indicators of the fusion prediction model in the test set were 0.893 (95% confidence interval as 0.802-0.985), 84.09%, 82.35% and 85.19%, respectively. Results of Delong test showed that there was no significant difference in AUC between the training set and the test set ( Z=0.343, P>0.05). Results of Hosmer-Lemeshow test showed that the fusion prediction model had a good fit in the training set and the test set ( χ2=3.042, 7.545, P>0.05). Results of calibration curve showed that the predictive ability of the fusion prediction model was good. Conclusions:Multiple parameters in venous phase of the dual-energy CT can be used as imaging markers for preoperative evaluation of the pathological grade of patients with PDAC. Establishing a clinical-imaging fusion prediction model can effectively predict the pathological grade of PDAC.

BACKGROUND:During the treatment of posterolateral tibial plateau fractures through the fibular head approach,the gap between the fibular head and the lateral plateau cannot accommodate the posterior placement of a plate for all patients.OBJECTIVE:To analyze,via finite element analysis,the differences in fixation strength resulting from varying the angles and quantities of horizontal arm variable angle screws in the plate during the treatment of posterolateral tibial plateau fractures through the fibular head approach.METHODS:A finite element model was established based on CT images of the knee to ankle joints of a 30-year-old healthy adult male volunteer.The models were divided into two categories:posteriorly placed group and non-posteriorly placed group based on whether the lateral locking compression plate was posteriorly placed.The posteriorly placed group was further subdivided into groups A-D based on the offset angle of the two variable angle screws(0°,5°,10°,and 15°).The non-posteriorly placed group was subdivided into groups E and F based on offset angles(0° and 15°).Finite element analysis was used to evaluate the von Mises stress distribution,maximum von Mises stress,and compressive displacement under loads of 250,500,and 750 N,exploring the mechanical differences between the groups.RESULTS AND CONCLUSION:(1)Finite element analysis results showed that under a 750 N load,the maximum compressive displacement trend of the internal fixation device was D＜B=C=F＜A＜E.The trend for maximum von Mises stress was B＜C＜A＜D＜F＜E.The trend for maximum compressive displacement on the bone was C=D＜B＜A＜F＜E,and for maximum von Mises stress,it was B＜C＜A＜F＜D＜E.The displacement and stress trends for the six models were similar under loads ranging from 250 N to 750 N.(2)These results suggest that for posterolateral tibial plateau fractures fixed through the fibular head approach,posterior placement of the plate should aim to accommodate two screws.If only one screw can be fixed during surgery,variable angle screws should be offset in the range of 0-15° to increase the probability of securing two screws.

Objective:To investigate the application value of dual-energy computer tomo-graphy (CT) multi-parameter imaging in predicting the pathological grade of pancreatic ductal adeno-carcinoma (PDAC).Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 147 patients with PDAC who were admitted to The Fifth Affiliated Hospital of Wenzhou Medical University from January 2017 to August 2023 were collected. There were 102 males and 45 females, aged (59±10)years. All patients underwent preoperative dual-energy CT examination and postoperative histopathological examination. The 147 patients were divided into a training set of 103 cases and a test set of 44 cases by stratified random sampling at a ratio of 7∶3. The training set was used to construct the prediction model, and the test set was used to verify the effectiveness of prediction model. Observation indicators: (1) analysis of factors affecting the pathological grade of PDAC patients in the training set; (2) construction and evaluation of the fusion prediction model for pathological grade of PDAC. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The performance of the model was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), accuracy, sensitivity and specificity were calculated. The Delong test was used to analyze the effec-tiveness of model. The calibration curve and decision curve of Hosmer-Lemeshow test were used to evaluate the consistency and clinical application value of the nomogram, respectively. Results:(1) Analysis of factors affecting the pathological grade of PDAC patients in the training set. Results of multivariate analysis showed that tumor cystic necrosis, vascular invasion, standardized iodine concentration (NIC) in venous phase, effective atomic number (Zeff) in venous phase, and energy spectrum curve slope (λ HU) in venous phase were all independent factors affecting the pathological grade of PDAC patients in the training set ( odds ratio=4.326, 3.887, 4.155, 5.389, 3.164, 95% confidence interval as 1.167-16.033, 1.111-13.592, 1.707-10.113, 1.284-22.613, 1.247-8.028, P<0.05). (2) Construction and evaluation of the fusion prediction model for pathological grade of PDAC. Accor-ding to the results of multivariate analysis, tumor cystic necrosis, vascular invasion, NIC in venous phase, Zeff in venous phase and λ HU in venous phase were all included to construct the clinical-imaging fusion prediction nomogram model. The AUC, accuracy, sensitivity and specificity of the fusion prediction model in the training set were 0.938 (95% confidence interval as 0.896-0.981), 87.38%, 89.74% and 85.94%, respectively. The above indicators of the fusion prediction model in the test set were 0.893 (95% confidence interval as 0.802-0.985), 84.09%, 82.35% and 85.19%, respectively. Results of Delong test showed that there was no significant difference in AUC between the training set and the test set ( Z=0.343, P>0.05). Results of Hosmer-Lemeshow test showed that the fusion prediction model had a good fit in the training set and the test set ( χ2=3.042, 7.545, P>0.05). Results of calibration curve showed that the predictive ability of the fusion prediction model was good. Conclusions:Multiple parameters in venous phase of the dual-energy CT can be used as imaging markers for preoperative evaluation of the pathological grade of patients with PDAC. Establishing a clinical-imaging fusion prediction model can effectively predict the pathological grade of PDAC.

Objective To find out the prevalence of antiretroviral therapy(ART)drugs among treponema pallidum(TP)antibody(anti-TP)positive blood donors in Shenzhen,and to assess the blood safety risks brought about by the new trends of human immunodeficiency virus(HIV)diagnosis and treatment.Methods A stratified random sampling method was used to select 60 repeat blood donors(negative control group)who passed blood screening in Shenzhen from March 2019 to January 2023,and 3 people who regularly took known ART drugs were named positive control group,358 anti-TP positive/anti-HIV negative blood do-nors were named experimental group 1,20 anti-TP positive/anti-HIV positive blood donors were named ex-perimental group 2.The liquid chromatography-mass spectrometry(HPLC-MS/MS)was applied to detect the concentration of 8 ART drugs in plasma samples of each group,and the use of ART drugs was analyzed.Re-sults After the positive control group's plasma was diluted with a 1:6 dilution mixture,the ART drugs could still be detected.The positive mixed plasma samples of 1:6 people in Group 1 and Group 2 were split and validation,one ART drug positive sample was detected in Group 2,which was positive for anti-HIV,pro-tein immunoblotting,and HIV RNA.The detection rate of ART drugs in anti-TP positive blood donors was 0.26％,0.00％in Group 1 and 4.00％in Group 2.Conclusion The use of ART drugs has been found among anti-TP positive blood donors in Shenzhen,and people with HIV infection and high-risk sexual behavior are more likely to use antiretroviral drugs.

The effective local management of oligometastatic non-small cell lung cancer (NSCLC) has the potential to prolong patients' survival. The role of radiotherapy as a local treatment modality in patients with oligometastatic NSCLC, whether as first-line therapy or consolidation therapy, remains uncertain. Several studies have demonstrated that stereotactic ablative radiotherapy can offer clinical benefits for patients with oligometastatic NSCLC without increasing adverse reactions. Furthermore, the exploration of the potential synergistic effects of combining radiotherapy and immunotherapy on extending progression-free survival and overall survival in patients with oligometastatic NSCLC is also a topic worthy of attention.

Objective To investigate the application effect of evidence-based practice in preventing silent aspiration in elderly hospitalized patients. Methods A total of 70 nurses and elderly patients aged ≥65 years old in the geriatric department were selected as the subjects of evidence-based practice. A total of 704 patients assessed before the application of evidence (November 2021 to April 2022) were included in baseline review group, and 744 patients assessed after the application of evidence (May 2022 to October 2022) were included in evidence application group. After the application of evidence, the nurses′ performance of relevant audit indicators and the incidence of silent aspiration in both groups were evaluated. Results After the application of evidence, the nurses′ performance rates of 11 audit indicators for reducing incidence of silent aspiration were higher than those before the application; the incidence of silent aspiration among patients decreased significantly from 12.5% before the application of evidence to 7.8% after the application (P < 0.05). Conclusion The quality audit project based on evidence is conducive to standardizing nurses′ nursing behaviors for preventing silent aspiration. The implementation of evidence-based practice to reduce the incidence of silent aspiration in elderly hospitalized patients is beneficial to reduce the occurrence of adverse events.

Small bowel capsule endoscopy and double-balloon enteroscopy have become new methods for clinical diagnosis of radiation enteritis (RE) , especially for abnormal intestinal tissue. Targeted biopsy or interventional therapy is expected to achieve precision treatment of RE. The screening of molecular markers in biological samples has also become a new direction for RE diagnosis. Fecal microbiota transplantation has become one of the promising treatments for RE. In addition, mechanism studies based on traditional Chinese medicine, targeted cell death, and omics analysis provide rich strategies for the diagnosis and treatment of RE.

Objective:To analyze the efficacy, safety and prognostic factors of immune checkpoint inhibitors in the treatment of recurrent and metastatic cervical cancer.Methods:A total of 87 patients with recurrent and metastatic cervical cancer admitted to the First Affiliated Hospital of Soochow University from January 2018 to June 2022 were retrospectively analyzed. They were divided into non immunotherapy group ( n=32) and immunotherapy group ( n=55) according to whether immune checkpoint inhibition was applied after recurrence and metastasis. The disease control rate (DCR), progression free survival (PFS), overall survival 1 (OS1, date of pathology diagnosis to the end of follow-up or time of death), overall survival 2 (OS2, time of first immunotherapy/non-immunotherapy to the end of follow-up or time of death), safety and prognostic factors of the two groups were analyzed and compared. Results:In 87 patients with recurrent and metastatic cervical cancer, the DCR of the non immunotherapy group and immunotherapy group were 53.1% (17/32) and 72.7% (40/55) respectively ( χ2=3.44, P=0.064). The median OS1 of the non immunotherapy group was 51.0 months, while the immunotherapy group did not reach the median OS1, with a statistically significant difference ( χ2=7.50, P=0.006). The median OS2 of the non immunotherapy group was 28.0 months, while the immunotherapy group did not reach the median OS2, with a statistically significant difference ( χ2=7.07, P=0.008). The median PFS of the non immunotherapy group and immunotherapy group were 18.0 months and 23.0 months respectively, with no significant difference ( χ2=0.01, P=0.915). In the immunotherapy group, 70.9% (39/55) of patients received immune checkpoint inhibitors as first-line treatment and 29.1% (16/55) received as second-line and above treatment. Both groups of patients did not achieve median OS2, with median PFS of 23.0 and 17.0 months respectively, and there were no statistically significant differences ( χ2=0.94, P=0.333; χ2=2.00, P=0.158) ; 38.2% (21/55) of patients received immune checkpoint inhibitor combined with local radiotherapy, 61.8% (34/55) patients did not receive radiotherapy. And neither group of patients achieved median OS2, with median PFS of 19.0 and 25.0 months respectively, with no statistically significant differences ( χ2=0.62, P=0.432; χ2=0.01, P=0.906). The incidences of grade 1-2 hematuria and hypothyroidism in the non immunotherapy group and immunotherapy group were 53.1% (17/32) vs. 27.3% (15/55, χ2=5.82, P=0.016), 3.1% (1/32) vs. 21.8% (12/55, χ2=4.19, P=0.041) respectively. The incidence of myelosuppression in the non immunotherapy group [grade 1-2: 59.4% (19/32), grade 3-4: 34.4% (11/32) ] was significantly different from that in the immunotherapy group [grade 1-2: 80.0% (44/55), grade 3-4: 3.6% (2/55) ; Z=3.50, P<0.001]. There were no statistically significant differences between creatinine increase, glutamic-oxaloacetic transaminase and glutamic-pyruvic transaminase increase, lymphocyte decrease, hypoproteinemia, proteinuria, rash, fatigue (all P>0.05). Univariate regression analysis showed that the use of immune checkpoint inhibitor was an independent protective factor affecting the prognosis of patients ( HR=0.31, 95% CI: 0.12-0.77, P=0.012) . Conclusion:Whether used as first-line or second-line or above treatment, the use of immune checkpoint inhibitors in patients with recurrent and metastatic cervical cancer prolongs their OS1, OS2, and has good safety. The application of immune checkpoint inhibitors is an independent protective factor affecting the prognosis of patients.

Cisplatin-based systemic chemotherapy combined with external beam radiation followed by intracavitary brachytherapy (ICBT) has become the standard treatment modality for locally advanced cervical cancer. Benefiting from the improvement in the imaging accuracy of medical imaging equipment and the development of image fusion technology, ICBT has developed into image-guided brachytherapy (IGBT) rather than the mode relying only on single image guidance. Factors such as the selection of a suitable image acquisition technology and the optimization of the multimodal imaging fusion strategy to reduce the dose deviation of IGBT are the key to the success of cervical cancer treatment. Radiotherapy practice is also plagued by these factors. Deep learning-based artificial intelligence technology has emerged in constructing intelligent radiotherapy platforms and solutions and has become an important means of solving the key problems in the multi-modal fusion IGBT for cervical cancer. Moreover, this technology is also a new way to improve the overall diagnosis and treatment level of cervical cancer, reduce the workload of physicians, and popularize the radiotherapy experience in grassroots organizations.