Objective:To investigate the predictive value of computed tomography(CT) based radiomics model for the prognosis of patients with pancreatic ductal adenocarcinoma(PDAC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 206 PDAC patients who were admitted to Zhongshan Hospital of Fudan University from August 2018 to December 2020 were collected. There were 115 males and 91 females, aged (64±9)years. All 206 pati-ents underwent enhanced CT examination. Based on radom number table, the 206 patients were randomly divided into a training set of 165 cases and a validation set of 41 cases with a ratio of 4∶1. The training set was used to construct the prediction model, and the test set was used to validate the performance of the prediction model. Observation indicators: (1) follow-up; (2) analysis of prognostic factors of PDAC patients in the training set; (3) construction and evaluation of prediction model for prognosis of PDAC patients. Comparison of measurement data with normal distribution between groups was conducted using the t test. Comparison of measurement data with skewed distribution between groups was conducted using the Wilcoxon W test. Comparison of count data between groups was conducted using the chi-square test or corrected chi-square test. The Kaplan-Meier method was used to calculate the survival rate and Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX regression model. The PyCharm software was used for the least absolute shrinkage and selection operator method (LASSO)-COX regression analysis. The receiver operating characteristic curve was plotted to evaluate the performance of radiomics model. Results:(1)Follow-up. Of the 206 patients,205 cases were followed up for 17.1(range, 12.0?40.1)months. The postoperative 1-, 2-, 3-year survival rates were 80.10%, 29.61% and 4.85%. (2) Analysis of prognostic factors for PDAC patients in the training dataset. Results of multivariate analysis showed that pathological N stage was an independent influencing factor for prognosis of PDAC patients in the training set ( hazard ratio=1.476, 95% confidence interval as 1.054?2.067, P<0.05). (3) Construction and evaluation of prediction model for prognosis of PDAC patients. A total of 1 595 radiomics features were finally extracted from the 206 patients. By intra-group feature selection and dimensionality reduction using LASSO-COX regression model, 10 radiomics features were obtained. Combined with 10 radiomics features and 11 clinical features, using the LASSO-COX regression analysis, 15 features were finally extracted to construct the CT based radiomics model for predicting prognosis of PDAC. The areas under receiver operating characteristic curve of the prediction model in predicting 2-year and 3-year overall survival rates of PDAC patients in the training set were 0.834 (95% confidence interval as 0.777?0.891) and 0.883 (95% confidence interval as 0.834?0.932), respectively. The area under curve of the prediction model for patients in the validation set was 0.606 (95% confidence interval as 0.456?0.756) and 0.625 (95% confidence interval as 0.477?0.773). Conclusion:The prediction model constructed on CT based radiomics features and clinical features for predicting the prognosis of PDAC patients shows a promising prediction efficiency.

Objective:To investigate the predictive value of computed tomography(CT) based radiomics model for the prognosis of patients with pancreatic ductal adenocarcinoma(PDAC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 206 PDAC patients who were admitted to Zhongshan Hospital of Fudan University from August 2018 to December 2020 were collected. There were 115 males and 91 females, aged (64±9)years. All 206 pati-ents underwent enhanced CT examination. Based on radom number table, the 206 patients were randomly divided into a training set of 165 cases and a validation set of 41 cases with a ratio of 4∶1. The training set was used to construct the prediction model, and the test set was used to validate the performance of the prediction model. Observation indicators: (1) follow-up; (2) analysis of prognostic factors of PDAC patients in the training set; (3) construction and evaluation of prediction model for prognosis of PDAC patients. Comparison of measurement data with normal distribution between groups was conducted using the t test. Comparison of measurement data with skewed distribution between groups was conducted using the Wilcoxon W test. Comparison of count data between groups was conducted using the chi-square test or corrected chi-square test. The Kaplan-Meier method was used to calculate the survival rate and Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX regression model. The PyCharm software was used for the least absolute shrinkage and selection operator method (LASSO)-COX regression analysis. The receiver operating characteristic curve was plotted to evaluate the performance of radiomics model. Results:(1)Follow-up. Of the 206 patients,205 cases were followed up for 17.1(range, 12.0?40.1)months. The postoperative 1-, 2-, 3-year survival rates were 80.10%, 29.61% and 4.85%. (2) Analysis of prognostic factors for PDAC patients in the training dataset. Results of multivariate analysis showed that pathological N stage was an independent influencing factor for prognosis of PDAC patients in the training set ( hazard ratio=1.476, 95% confidence interval as 1.054?2.067, P<0.05). (3) Construction and evaluation of prediction model for prognosis of PDAC patients. A total of 1 595 radiomics features were finally extracted from the 206 patients. By intra-group feature selection and dimensionality reduction using LASSO-COX regression model, 10 radiomics features were obtained. Combined with 10 radiomics features and 11 clinical features, using the LASSO-COX regression analysis, 15 features were finally extracted to construct the CT based radiomics model for predicting prognosis of PDAC. The areas under receiver operating characteristic curve of the prediction model in predicting 2-year and 3-year overall survival rates of PDAC patients in the training set were 0.834 (95% confidence interval as 0.777?0.891) and 0.883 (95% confidence interval as 0.834?0.932), respectively. The area under curve of the prediction model for patients in the validation set was 0.606 (95% confidence interval as 0.456?0.756) and 0.625 (95% confidence interval as 0.477?0.773). Conclusion:The prediction model constructed on CT based radiomics features and clinical features for predicting the prognosis of PDAC patients shows a promising prediction efficiency.

Objective:To understand the current status of the use of aspirin in perioperative period of thoracic surgery in China and the awareness of thoracic surgeons on the prevention and treatment of arterial thromboembolic diseases during the perioperative period.Methods:A survey was conducted among thoracic surgeons nationwide using an electronic questionnaire through a software platform from January 20, 2024 to February 29, 2024. The questionnaire mainly included three parts: basic information, aspirin use, and awareness of arterial thromboembolic diseases, with a total of 27 questions.Results:A total of 1318 valid questionnaires were collected, covering all 33 provincial administrative regions except Taiwan. 69.7%(919/1 318) of thoracic surgeons stopped using aspirin for all patients before surgery; differences could be found in the timing of aspirin withdrawal before surgery and resumption after surgery. 65.1%(858/1 318) of surgeons made perioperative medication decisions based on domestic guidelines or consensus, while 20.9%(276/1 318) of surgeons based their decisions on departmental or personal experience. 87.9%(1 159/1 318) of surgeons believed that it is necessary to develop guidelines for the prevention of arterial thromboembolic diseases in the perioperative period of thoracic surgery.Conclusion:The current use strategy of aspirin in the perioperative period of thoracic surgery in China shows a high degree of inconsistency, and there are also significant differences in the awareness of arterial thromboembolic diseases. It is necessary to establish guidelines for the prevention and treatment of arterial thromboembolic diseases in the perioperative period.

Objective:To develop a risk prediction model for identifying bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) in very premature infants.Methods:This was a retrospective cohort study. The clinical data of 626 very premature infants whose gestational age <32 weeks and who suffered from BPD were collected from October 1 st, 2015 to December 31 st, 2021 of the Seventh Medical Center of the People′s Liberation Army General Hospital as a modeling set. The clinical data of 229 very premature infants with BPD of Hunan Children′s Hospital from January 1 st, 2020 to December 31 st, 2021 were collected as a validation set for external verification. The very premature infants with BPD were divided into PH group and non PH group based on the echocardiogram after 36 weeks′ corrected age in the modeling set and validation set, respectively. Univariate analysis was used to compare the basic clinical characteristics between groups, and collinearity exclusion was carried out between variables. The risk factors of BPD associated PH were further screened out by multivariate Logistic regression, and the risk assessment model was established based on these variables. The receiver operating characteristic (ROC) area under curve (AUC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model′s discrimination and calibration power, respectively. And the calibration curve was used to evaluate the accuracy of the model and draw the nomogram. The bootstrap repeated sampling method was used for internal verification. Finally, decision curve analysis (DCA) to evaluate the clinical practicability of the model was used. Results:A total of 626 very premature infants with BPD were included for modeling set, including 85 very premature infants in the PH group and 541 very premature infants in the non PH group. A total of 229 very premature infants with BPD were included for validation set, including 24 very premature infants in the PH group and 205 very premature infants in the non PH group. Univariate analysis of the modeling set found that 22 variables, such as artificial conception, fetal distress, gestational age, birth weight, small for gestational age, 1 minute Apgar score ≤7, antenatal corticosteroids, placental abruption, oligohydramnios, multiple pulmonary surfactant, neonatal respiratory distress syndrome (NRDS)>stage Ⅱ, early pulmonary hypertension, moderate-severe BPD, and hemodynamically significant patent ductus arteriosus (hsPDA) all had statistically significant influence between the PH group and the non PH group (all P<0.05). Antenatal corticosteroids, fetal distress, NRDS >stage Ⅱ, hsPDA, pneumonia and days of invasive mechanical ventilation were identified as predictive variables and finally included to establish the Logistic regression model. The AUC of this model was 0.86 (95% CI 0.82-0.90), the cut-off value was 0.17, the sensitivity was 0.77, and the specificity was 0.84. Hosmer-Lemeshow goodness-of-fit test showed that P>0.05. The AUC for external validation was 0.88, and the Hosmer-Lemeshow goodness-of-fit test suggested P>0.05. Conclusions:A high sensitivity and specificity risk prediction model of PBD associated PH in very premature infants was established. This predictive model is useful for early clinical identification of infants at high risk of BPD associated PH.

Objective To observe the effect of Renshen(ginseng)-Yuzhu(fragrant solomonseal rhizome)on inflammatory factors and inflammasomes in depression rats,and to explore the antidepressant mechanism of Renshen-Yuzhu.Methods Fifty male SD rats were divided into the blank group,model group,fluoxetine group(2.1 mg/kg),Renshen-Yuzhu low-dose group(1.89 g/kg),and Renshen-Yuzhu high-dose group(5.67 g/kg),with ten rats in each group.Except for the blank group,the rats in the other groups were treated with chronic unpredictable mild stress to establish a depression rat model.On the second day after the end of modeling,the rats in each group were given the corresponding drugs once daily for 14 days.After modeling and dosing,body weight,forced swimming immobility time,and sucrose preference rate were measured.After dosing,hematoxylin-eosin staining was used to detect neuronal damage in the cerebral cortex,enzyme-linked immunosorbent assay was used to detect the contents of interleukin-4(IL-4),interleukin-23(IL-23),and interleukin-27(IL-27)in cortex,real-time PCR was used to detect the mRNA expression of interleukin-24(IL-24)in cortex,and the protein expressions of nucleotide-binding oligomerization domain-like receptor protein 1(NLRP1),absent in melanoma 2(AIM2),and nucleotide-binding oligomerization domain-like receptor protein 4(NLRC4)were detected by Western blotting.Results After dosing,compared with the blank group,the body weight of the model group decreased,the sucrose preference rate decreased,the swimming immobility time was prolonged,the neuronal tissue in cortex was destroyed,the content of IL-4 in cortex decreased,the contents of IL-23 and IL-27 in cortex increased,and the protein expressions of NLRP1,AIM2 and NLRC4 in cortex increased(P＜0.01).Compared with the model group,the body weight of rats in each administration group increased,the sucrose preference rate increased,the swimming immobility time was shortened,the damage of neuronal tissues in cortex improved,the content of IL-4 in cortex increased,the contents of IL-23 and IL-27 in cortex decreased,and the protein expressions of NLRP 1,AIM2 and NLRC4 in cortex decreased(P＜0.05).Conclusion Renshen-Yuzhu couplet medicines can improve the depressive-like behavior and exert antidepressant effect in chronic stress rats,and its mechanism may be related to the inhibition of NLRP 1,NLRC4,AIM2 inflammasome activation and its mediated inflammatory response in cortex,reducing pro-inflammatory cytokines,and increasing the level of antiinflammatory cytokines.

Objective: To assess the clinical efficacy of Xuebijing injection in the prevention of postoperative systemic inflammatory response syndrome (SIRS) in the patients with ureteral stones and urinary tract infection during the perioperative period of ureteroscopy.Methods: Totally 64 cases with ureteral stones complicated with urinary tract infection treated with ureteroscopy were selected as the subjects and divided into two groups according to the digital method.The 32 cases in the control group were given the conventional antibiotics during the perioperative period for preventing the incidence of SIRS, and the observation group was given 500ml Xuebijing added to 100ml normal saline for intravenous drip additionally.The incidence of SIRS and the laboratory indicators after the operation were observed and compared between the groups.Results: The incidence of postoperative SIRS of the observation group was 9.38% , which was lower than that of the control group (34.38% , P <0.05);the incidence of sepsis of the observation group was 0%, while there was no statisticcally difference bettween the two groups(P＞0.05).The C-reactive protein (CRP), procalcitonin (PCT), leucocyte count and endotoxin in the observation group on the 2nd, 4th and 6th day after the operation were better than those in the control group, and the difference was statistically significant (P＜0.05).Conclusion: Xuebijing injection combined with antibiotics has significant clinical effect on the incidence of SIRS after ureteroscopy in the patients with ureteral stones and urinary tract infection, which can effectively improve the clinical indicators and reduce the incidence of sepsis, and is worthy of clinical promoted application.

Objective:To systematically review the efficacy and safety of acid-suppressive therapy including proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) and compare with those of placebo or blank control in the postoperative patients with stress ulcer bleeding (SUB) to provide evidence-based reference for clinical practice.Methods:The Cochrane library,Medline,Embase,CBM,CNKI,VIP,Wan Fang Data,clinicaltrials.gov,ISRCTN Register and WHO ICTRP were searched.Only randomized controlled trials (RCTs) of acid-suppressive therapy compared with placebo or blank control for postoperative stress ulcer bleeding were selected with bleeding rate,mortality,adverse drug reactions,gastric juice pH and length of stay as the indices.After the quality evaluation and data extraction,Meta-analysis was performed by using Stata12.0 statistics software.The results were expressed as relative risk(RR) and its corresponding 95% confidence interval(CI).Funnel plot and Eggers test were used to determine the publication bias;and then Grade approach was applied to assess the confidence in the evidence for each outcome.Results:Totally 15 trials enrolling 971 patients were selected,and acid-suppressive therapy was more effective than placebo or blank control in reducing the risk of stress ulcer bleeding,overt upper gastrointestinal bleeding and clinical important bleeding(RR 0.29,95% CI:0.19-0.45;RR 0.25,95%CI:0.10-0.64;RR 0.36,95%CI:0.17-0.77)(moderate),however,there was no statistical significance in the incidence of occult bleeding,mortality and adverse drug reactions (RR 0.79,95%CI:0.41-1.50;RR 0.49,95%CI:0.17-1.38;RR 0.78,95%CI:0.33-1.85,very low confidence).The subgroup analysis of drug classification,operation types and administration juncture showed that the incidence of SUB using PPI (RR=0.27) was lower than that using H2RA (RR=0.33);that of heart surgery (RR=0.20) was lower than that of general surgery (RR=0.31) and neurosurgery(RR=0.37);that of postoperative administration (RR=0.26) was lower than that of preoperative administration (RR=0.23).Conclusion:Acid-suppressive drugs seem to be more effective than placebo or blank control in reducing the risk of bleeding without significant increase of the risk of mortality or adverse drug reactions.The robustness of the conclusion is limited because of the low quality of the trial methodology,incomplete outcome indicators and lack of safety indices for pneumonia and clostridium diffcile-associated infection.Trials with high-quality and larger sample size are still needed to verify its clinical effects.

Objective To develop a list of high-alert medications for the Chinese children and provide reference for medication safety in children. Methods Based on the list of Children′s high-alert medications of the United States of America, the Netherlands, and Spain, and combined with the data of serious adverse drug reactions ( ADR) in children derived from literature published in China and abroad, serious ADR reports from ADR monitoring center of Beijing, Guangdong, Anhui, Hunan, and the People′s Liberation Army, medication errors in children from the International Network for the Rational Use of Drugs, prescription data from "Hospital Prescription Analysis Collaborative Project", we created a preliminary list of high-alert medications for children in China. The preliminary list was argued by expert consultation using Delphi technique. Thirty two experts were invited in the round 1 consultation, and according to the expert advices, the preliminary list was adjusted and the revised list formed. Thirty two experts were also invited in the round 2 consultation, according to the expert advices, the revised list was adjusted and the final version of the list of high-alert medications for Chinese children formed. Results A total of 17 classes and 55 kinds of drugs were entered into the list of high-alert medications for Chinese children, each drug had 1-4 risk points and one piece of advice. The average value of the familiarity of each expert with drugs was>0. 60;the average value of judgment basis for each expert was>0. 70;the average value of authority for each expert was >0. 70. The number of survey indexes in round 1 was 63, the expert coordination coefficient was 0. 18. The number of survey indexes in round 2 was 59, experts coordination coefficient was 0. 24. The difference between the coordinate coefficient in the 2 rounds of experts consultation was statistically significant (χ2=516. 424, P<0. 05;χ2=721. 635, P<0. 05). Conclusion The list of high-alert medications for children in China was developed preliminarily and may be used as a tool to promote medication safety and reduce the risk of medication for children in China.

Objective To understand the situation and influencing factors of potentially inappropriate medication ( PIM ) in elderly patients in outpatient and emergency departments in China. Methods Prescriptions for patients aged≥65 years with complete prescribing information from 79 hospitals in six cities including Beijing, Shanghai, Guangzhou, Tianjin, Hangzhou and Chengdu from February 1st,2014 to December 31st, 2014 were collected. All prescriptions for elderly patients of 10 working days in each quarter were collected and the basic information ( including region, hospital grade, gender, age, department, and major disease/disease status ) and medication information ( including drug name, drug specification, drug dosage form, drug dose, and the number of combined drugs ) were recorded. The situation and influencing factors of PIM in elderly patients based on the Chinese PIM list and 2012 Beers criteria were analyzed. Results A total of 2962232 prescriptions were collected, of them, 1499201 were for male patients and 1463031 ones for female patients. The ages were from 65 to 120 years and the average age was (75±7) years. The number of combined drugs were 1-15 and the average number was 2. 2± 1. 5. According to the Chinese PIM list ( Chinese list,including 72 drugs) and 2012 Beers criteria ( Beers criteria,including 124 drugs and 100 of them were in the Chinese market ) , the detection proportion of prescriptions for elderly patients containing PIM in outpatient and emergency departments were 15. 81%(468228/2962232)and 9. 16% (271250/2962232), respectively (P<0. 001); the detection proportion of PIM varieties in prescriptions were 90. 28%(65/72)and 70. 00% (70/100), respectively (P<0. 001);the detection proportion of PIM varieties with high risks or high recommendation and high evidence levels were 85. 71% (30/35) and 67. 50% (27/40), respectively (P=0. 065). The proportion of prescriptions with one inappropriate medication in all PIM prescriptions were 91. 83% ( 429977/468228 ) and 92. 79%(251696/271250), respectively. The top 10 drugs in PIM prescriptions were clopidogrel, estazolam, alprazolam, doxazosin, nicergoline, zolpidem, diclofenac, insulin, olanzapine, and warfarin according to the Chines PIM list, and estazolam, alprazolam, doxazosin, terazosin, zolpidem, diclofenac, meloxicam, olanzapine, clonazepam, and spironolactone according to 2012 Beers criteria. Multiple logistic regression analysis showed that the cities, hospital grade, gender, age, departments for treatment, the number of combined medica-tions, and disease or disease states were independent risk factors for PIM. The risks of PIM in patients with sleep disorder, depression, coronary heart disease, Alzheimer disease, prostate hyperplasia and arthritis or joint pain were higher than in patients with other diseases or disease status. Conclusions The prevalence of PIM use according to the Chinese PIM list and 2012 Beers criteria in elderly patients in outpatient and emergency departments in China were not optimistic. Risk factors of PIM use in elderly patients in China were the regional distribution, hospital grade, gender, age, the number of combined medications, department for treatment, and disease/disease status.

Objective To understand the situation and influencing factors of potentially inappropriate medication ( PIM ) in elderly patients in outpatient and emergency departments in China. Methods Prescriptions for patients aged≥65 years with complete prescribing information from 79 hospitals in six cities including Beijing, Shanghai, Guangzhou, Tianjin, Hangzhou and Chengdu from February 1st,2014 to December 31st, 2014 were collected. All prescriptions for elderly patients of 10 working days in each quarter were collected and the basic information ( including region, hospital grade, gender, age, department, and major disease/disease status ) and medication information ( including drug name, drug specification, drug dosage form, drug dose, and the number of combined drugs ) were recorded. The situation and influencing factors of PIM in elderly patients based on the Chinese PIM list and 2012 Beers criteria were analyzed. Results A total of 2962232 prescriptions were collected, of them, 1499201 were for male patients and 1463031 ones for female patients. The ages were from 65 to 120 years and the average age was (75±7) years. The number of combined drugs were 1-15 and the average number was 2. 2± 1. 5. According to the Chinese PIM list ( Chinese list,including 72 drugs) and 2012 Beers criteria ( Beers criteria,including 124 drugs and 100 of them were in the Chinese market ) , the detection proportion of prescriptions for elderly patients containing PIM in outpatient and emergency departments were 15. 81%(468228/2962232)and 9. 16% (271250/2962232), respectively (P<0. 001); the detection proportion of PIM varieties in prescriptions were 90. 28%(65/72)and 70. 00% (70/100), respectively (P<0. 001);the detection proportion of PIM varieties with high risks or high recommendation and high evidence levels were 85. 71% (30/35) and 67. 50% (27/40), respectively (P=0. 065). The proportion of prescriptions with one inappropriate medication in all PIM prescriptions were 91. 83% ( 429977/468228 ) and 92. 79%(251696/271250), respectively. The top 10 drugs in PIM prescriptions were clopidogrel, estazolam, alprazolam, doxazosin, nicergoline, zolpidem, diclofenac, insulin, olanzapine, and warfarin according to the Chines PIM list, and estazolam, alprazolam, doxazosin, terazosin, zolpidem, diclofenac, meloxicam, olanzapine, clonazepam, and spironolactone according to 2012 Beers criteria. Multiple logistic regression analysis showed that the cities, hospital grade, gender, age, departments for treatment, the number of combined medica-tions, and disease or disease states were independent risk factors for PIM. The risks of PIM in patients with sleep disorder, depression, coronary heart disease, Alzheimer disease, prostate hyperplasia and arthritis or joint pain were higher than in patients with other diseases or disease status. Conclusions The prevalence of PIM use according to the Chinese PIM list and 2012 Beers criteria in elderly patients in outpatient and emergency departments in China were not optimistic. Risk factors of PIM use in elderly patients in China were the regional distribution, hospital grade, gender, age, the number of combined medications, department for treatment, and disease/disease status.