Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

This study explored how the human cortical folding pattern composed of convex gyri and concave sulci affected single-subject morphological brain networks, which are becoming an important method for studying the human brain connectome. We found that gyri-gyri networks exhibited higher morphological similarity, lower small-world parameters, and lower long-term test-retest reliability than sulci-sulci networks for cortical thickness- and gyrification index-based networks, while opposite patterns were observed for fractal dimension-based networks. Further behavioral association analysis revealed that gyri-gyri networks and connections between gyral and sulcal regions significantly explained inter-individual variance in Cognition and Motor domains for fractal dimension- and sulcal depth-based networks. Finally, the clinical application showed that only sulci-sulci networks exhibited morphological similarity reductions in major depressive disorder for cortical thickness-, fractal dimension-, and gyrification index-based networks. Taken together, these findings provide novel insights into the constraint of the cortical folding pattern to the network organization of the human brain.
Humans ; Cerebral Cortex/anatomy & histology* ; Male ; Female ; Magnetic Resonance Imaging ; Adult ; Connectome/methods* ; Young Adult ; Nerve Net/anatomy & histology* ; Neural Pathways ; Depressive Disorder, Major/diagnostic imaging*

Aeromedical evacuation, a crucial method for casualty transport, significantly enhances survival rates by providing exceptionally rapid transfer and thus gaining valuable treatment time. However, due to the contamination risks during the transport of radioactively contaminated casualties, aeromedical evacuation has not been widely adopted for this specific scenario. This paper reviews the current status of aeromedical evacuation for radioactively contaminated casualties and identifies several challenges. These include incomplete evacuation procedures and regulatory frameworks, difficulties in rapid triage and classification, inadequate evacuation and loading equipment, and the complexity of managing specific injuries during flight. We propose corresponding strategies to address these issues, aiming to provide a reference and guidance for the advancement of aeromedical evacuation for radioactively contaminated casualties.

Purpose To explore the value of conventional ultrasound combined with ultrasound radiomics in detecting triple-negative breast cancer(TNBC).Materials and Methods In this study,we retrospectively collected the preoperative conventional ultrasound images and clinic-pathological data of 682 patients with lumpy breast cancer from the Affiliated Cancer Hospital of Xinjiang Medical University from January 2015 to December 2021.All patients included 325 cases with TNBC and 357 cases with non-TNBC.Features were extracted from preoperative ultrasound images of patients,screened,dimensionally reduced,and a combined model was constructed with ultrasound features and clinicopathological features.The performance of the three single models and combined models was evaluated by receiver operating characteristic curve analysis.Results The area under the curve of conventional ultrasound model,clinicopathological model,ultrasound imaging omics and the combined model in training group and validation suite were 0.730,0.718,0.982,0.985,0.726,0.683,0.981 and 0.982,respectively.The area under the curve of TNBC detected by the combined model was significantly higher than that of the single model(Z=7.311,7.024,3.883,all P<0.01).Conclusion The combined model based on ultrasonography has good diagnostic efficacy in detecting TNBC.As a non-invasive examination,it can avoid unnecessary biopsy to the patient.

Purpose To explore the value of conventional ultrasound combined with ultrasound radiomics in detecting triple-negative breast cancer(TNBC).Materials and Methods In this study,we retrospectively collected the preoperative conventional ultrasound images and clinic-pathological data of 682 patients with lumpy breast cancer from the Affiliated Cancer Hospital of Xinjiang Medical University from January 2015 to December 2021.All patients included 325 cases with TNBC and 357 cases with non-TNBC.Features were extracted from preoperative ultrasound images of patients,screened,dimensionally reduced,and a combined model was constructed with ultrasound features and clinicopathological features.The performance of the three single models and combined models was evaluated by receiver operating characteristic curve analysis.Results The area under the curve of conventional ultrasound model,clinicopathological model,ultrasound imaging omics and the combined model in training group and validation suite were 0.730,0.718,0.982,0.985,0.726,0.683,0.981 and 0.982,respectively.The area under the curve of TNBC detected by the combined model was significantly higher than that of the single model(Z=7.311,7.024,3.883,all P<0.01).Conclusion The combined model based on ultrasonography has good diagnostic efficacy in detecting TNBC.As a non-invasive examination,it can avoid unnecessary biopsy to the patient.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Objective:To investigate the association of urinary cadmium level with body mass index (BMI) and body circumferences among the older adults over 65 years old in 9 longevity areas of China.Methods:Subjects were older adults over 65 years old from the Healthy Aging and Biomarkers Cohort Study (HABCS) between 2017 and 2018 conducted in 9 longevity areas in China. A total of 1 968 older adults were included in this study. Information including socio-demographic characteristics, lifestyles, diet intake, and health status was collected by using questionnaires and physical examinations. Urine samples were collected to detect urinary cadmium and creatinine levels. Body circumferences included waist circumference, hip circumference and calf circumference. Subjects were divided into three groups (low:<0.77 μg/g·creatinine, middle:0.77-1.69 μg/g·creatinine, high:≥1.69 μg/g·creatinine) by tertiles of creatinine-adjusted urinary cadmium concentration. Multiple linear regression models were used to analyze the association of creatinine-adjusted urinary cadmium level with BMI and body circumferences. The dose-response relationship of creatinine-adjusted urinary cadmium concentration with BMI and body circumferences was analyzed by using restrictive cubic splines fitting multiple linear regression model.Results:The mean age of subjects was (83.34±11.14) years old. The median (Q1, Q3) concentration of creatinine-adjusted urinary cadmium was 1.13 (0.63, 2.09) μg/g·creatinine, and the BMI was (22.70±3.82) kg/m 2. The mean values of waist circumference, hip circumference, and calf circumference were (85.42±10.68) cm, (92.67±8.90) cm, and (31.08±4.76) cm, respectively. After controlling confounding factors, the results of the multiple linear regression model showed that for each increment of 1 μg/g·creatinine in creatinine-adjusted urinary cadmium, the change of BMI, waist circumference, hip circumference, and calf circumference in the high-level group was -0.28 (-0.37, -0.19) kg/m 2, -0.74 (-0.96, -0.52) cm, -0.78 (-0.96, -0.61) cm, and -0.20 (-0.30, -0.11) cm, respectively. The restrictive cubic splines curve showed a negative nonlinear association of creatinine-adjusted urinary cadmium with BMI ( Pnonlinear<0.001) and negative linear associations of creatinine-adjusted urinary cadmium with waist circumference ( Plinear<0.001), hip circumference ( Plinear<0.001), and calf circumference ( Plinear<0.001). Conclusion:Urinary cadmium level is significantly associated with decreased BMI, waist circumference, hip circumference and calf circumference among older adults over 65 years old in 9 longevity areas of China.

Objective:To investigate the association of urinary cadmium level with body mass index (BMI) and body circumferences among the older adults over 65 years old in 9 longevity areas of China.Methods:Subjects were older adults over 65 years old from the Healthy Aging and Biomarkers Cohort Study (HABCS) between 2017 and 2018 conducted in 9 longevity areas in China. A total of 1 968 older adults were included in this study. Information including socio-demographic characteristics, lifestyles, diet intake, and health status was collected by using questionnaires and physical examinations. Urine samples were collected to detect urinary cadmium and creatinine levels. Body circumferences included waist circumference, hip circumference and calf circumference. Subjects were divided into three groups (low:<0.77 μg/g·creatinine, middle:0.77-1.69 μg/g·creatinine, high:≥1.69 μg/g·creatinine) by tertiles of creatinine-adjusted urinary cadmium concentration. Multiple linear regression models were used to analyze the association of creatinine-adjusted urinary cadmium level with BMI and body circumferences. The dose-response relationship of creatinine-adjusted urinary cadmium concentration with BMI and body circumferences was analyzed by using restrictive cubic splines fitting multiple linear regression model.Results:The mean age of subjects was (83.34±11.14) years old. The median (Q1, Q3) concentration of creatinine-adjusted urinary cadmium was 1.13 (0.63, 2.09) μg/g·creatinine, and the BMI was (22.70±3.82) kg/m 2. The mean values of waist circumference, hip circumference, and calf circumference were (85.42±10.68) cm, (92.67±8.90) cm, and (31.08±4.76) cm, respectively. After controlling confounding factors, the results of the multiple linear regression model showed that for each increment of 1 μg/g·creatinine in creatinine-adjusted urinary cadmium, the change of BMI, waist circumference, hip circumference, and calf circumference in the high-level group was -0.28 (-0.37, -0.19) kg/m 2, -0.74 (-0.96, -0.52) cm, -0.78 (-0.96, -0.61) cm, and -0.20 (-0.30, -0.11) cm, respectively. The restrictive cubic splines curve showed a negative nonlinear association of creatinine-adjusted urinary cadmium with BMI ( Pnonlinear<0.001) and negative linear associations of creatinine-adjusted urinary cadmium with waist circumference ( Plinear<0.001), hip circumference ( Plinear<0.001), and calf circumference ( Plinear<0.001). Conclusion:Urinary cadmium level is significantly associated with decreased BMI, waist circumference, hip circumference and calf circumference among older adults over 65 years old in 9 longevity areas of China.

Objective:To investigate the prognosis and risk factors of IgA vasculitis nephritis (IgAVN) in children.Methods:A retrospective cohort study was conducted. Clinical data were collected from 264 children who were pathologically diagnosed with IgAVN at Department of Pediatric Nephrology, Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology, between January 2011 and December 2017. All patients had a follow-up period of more than 3 years. Clinical characteristics, renal pathology, 3-year and 5-year prognosis were analyzed. The patients were grouped based on gender, age of onset (≤6 years, >6-9 years, and >9 years), pathological classification (≤Ⅲ and>Ⅲ),whether the prognosis was complete remission at 3 and 5 years. Independent sample t-tests, ANOVA or chi-squared test were used for intergroup comparisons. Spearman correlation analysis was applied for ordinal data, and multivariate Logistic regression was used to analyze factors affecting the prognosis. Receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of these factors. Results:Of the 264 children with IgAVN, 153 were male and 111 were female, the age of onset was 8.3 (6.7, 10.3) years, 118 patients (45%) with onset age >6-9 years accounted for the highest proportion. All patients presented with skin purpura and renal involvement, primarily manifesting as hematuria and/or proteinuria. Microscopic hematuria was observed in 253 patients (95.8%), while 246 patients (93.2%) showed proteinuria. In 256 patients (97.0%), hematuria or proteinuria urinalysis was detected within 6 months of skin purpura onset, and 243 patients (92.0%) underwent renal biopsy within 6 months of renal involvement. The most common clinical subtype in 264 IgAVN children was hematuria and proteinuria (204 cases, 77.3%), with grade Ⅲ being the predominant pathological classification (181 cases, 68.6%). Among children ≤6 years old, the 3-year complete remission rate was higher in males than in females (83.9% (26/31) vs. 7/16, χ2=8.12, P=0.012). Factors independently associated with poor 5-year prognosis included time from hematuria or proteinuria urinalysis to renal biopsy >6 months, elevated serum cholesterol levels, and incomplete remission 3 years post-biopsy ( OR=5.41, 1.39, 6.02, 95% CI 1.40-20.86, 1.04-1.84, 2.61-13.88, all P<0.05). The serum cholesterol has a predictive value for 5-year prognosis ( P=0.020, AUC=0.62, 95% CI 0.52-0.71, Youden index=0.27, cutoff=4.37). Conclusions:For children with IgAVN aged≤6 years, the 3-year prognosis is better in males than in females. Time from hematuria or proteinuria urinalysis to renal biopsy >6 months, elevated serum cholesterol levels, and incomplete remission at 3 years post-biopsy may be independent risk factors for poor 5-year prognosis in children with IgAVN.

Objective To explore the correlation between lipid metabolism disorder in bone marrow and primary osteoporosis(OP),and to evaluate the regulation and clinical significance of lipid metabolism-related genes in primary OP.Methods The differentially expressed genes(DEGs)of OP were obtained from GSE35959 dataset,and combined with human lipid metabolism-related genes to screen the differentially expressed lipid metabolism genes of OP patients.The STRING 11.0 database was used to establish a protein-protein interaction(PPI)network,and the receive operation characteristic curve was used to explore the significance of key proteins in PPI in the differential diagnosis of OP.Results A total of 2105 DEGs(1940 up-regulated genes and 165 down-regulated genes)were identified in the mesenchymal stem cells of OP patients.Of them,75 DEGs were related to lipid metabolism and mainly involved in the cellular lipid metabolism and small molecule lipid metabolism through arachidonic acid and glycerophospholipid metabolism related signaling pathways.The PPI of lipid metabolism-related genes in OP patients contained 75 nodes and 65 interaction relationships(P<0.01).There were 7 nodes(HELZ2,CYP4A11,ALOX5,PTGS2,CYP4F2,ALOX12B,FABP4)with an interaction relationship≥5.The expression levels of these genes in OP patients were significantly higher than those in the control group(P<0.05).ALOX5 expression was negatively correlated with HELZ2 expression(P<0.05).HELZ2,CYP4A11,ALOX5,PTGS2,CYP4F2,ALOX12B and FABP4 all showed differential diagnosis significance for OP,and the area under the AUC curve was all>0.80(P<0.05).Conclusion Primary OP patients have lipid metabolism disorders in bone marrow,and lipid metabolism-related genes have a certain regulatory effect on the above process.Seven lipid metabolism-related genes screened in this study have certain differential diagnosis ability for primary OP.