ObjectiveThis study aims to develop and validate a novel multimodal predictive model， termed criss-cross network（CCNet）-directed graph neural network（DGNN）（CGN）， for accurate assessment of pulmonary nodule progression in high-risk individuals for lung cancer， by integrating longitudinal chest computed tomography（CT） imaging with both traditional Chinese and western clinical evaluation data. MethodsA cohort of 4 432 patients with pulmonary nodules was retrospectively analyzed. A twin CCNet was employed to extract spatiotemporal representations from paired sequential CT scans. Structured clinical assessment and imaging-derived features were encoded via a multilayer perceptron， and a similarity-based alignment strategy was adopted to harmonize multimodal imaging features across temporal dimensions. Subsequently， a DGNN was constructed to integrate heterogeneous features， where nodes represented modality-specific embeddings and edges denoted inter-modal information flow. Finally， model optimization was performed using a joint loss function combining cross-entropy and cosine similarity loss， facilitating robust classification of nodule progression status. ResultsThe proposed CGN model demonstrated superior predictive performance on the held-out test set， achieving an area under the receiver operating characteristic curve（AUC） of 0.830， accuracy of 0.843， sensitivity of 0.657， specificity of 0.712， Cohen's Kappa of 0.417， and F₁ score of 0.544. Compared with unimodal baselines， the CGN model yielded a 36%-48% relative improvement in AUC. Ablation studies revealed a 2%-22% increase in AUC when compared to simplified architectures lacking key components， substantiating the efficacy of the proposed multimodal fusion strategy and modular design. Incorporation of traditional Chinese medicine （TCM）-specific symptomatology led to an additional 5% improvement in AUC， underscoring the complementary value of integrating TCM and western clinical data. Through gradient-weighted activation mapping visualization analysis， it was found that the model's attention predominantly focused on nodule regions and effectively captured dynamic associations between clinical data and imaging-derived features. ConclusionThe CGN model， by synergistically combining cross-attention encoding with directed graph-based feature integration， enables effective alignment and fusion of heterogeneous multimodal data. The incorporation of both TCM and western clinical information facilitates complementary feature enrichment， thereby enhancing predictive accuracy for pulmonary nodule progression. This approach holds significant potential for supporting intelligent risk stratification and personalized surveillance strategies in lung cancer prevention.

Objective To understand the health-related quality of life (HRQOL) of migrant workers with pneumoconiosis who received basic medical treatment in Hunan Province. Methods A total of 613 migrant workers with pneumoconiosis who received basic medical treatment and assistance in Hunan Province was selected as the study subjects using stratified random sampling method. The European Quality of Life-5 Dimensions (EQ-5D) questionnaire was used to assess their HRQOL. Results The abnormality of the five dimensions of the EQ-5D health description system, from high to low, were as follows： daily activities, mobility, pain/discomfort, anxiety/depression, and self-care, with the abnormal rates of 50.9%, 46.8%, 41.1%, 21.0%, and 14.5%, respectively. The visual analogue scale (VAS) score of EQ-5D was (63.5±18.6) points. Patients with stage Ⅲ pneumoconiosis had high abnormality in mobility, daily activities, and pain/discomfort compared with those with stage Ⅰ and Ⅱ disease (all P<0.02). Patients in stage Ⅱ and Ⅲ of pneumoconiosis had higher incidence of anxiety/depression compared with those with stage I disease (all P<0.02). Patients with complications in addition to pneumoconiosis had higher abnormality in mobility, self-care, and pain/discomfort compared to those with simple pneumoconiosis or those eligible for lung lavage treatment (all P<0.02). Patients with simple pneumoconiosis had a higher incidence of anxiety/depression compared with those eligible for lung lavage treatment (P<0.02). Patients with stage Ⅲ pneumoconiosis had lower average VAS scores compared with stage Ⅰ and Ⅱ patients (all P<0.02). Patients with simple pneumoconiosis or those with complications had lower average VAS scores compared with those eligible for lung lavage treatment (all P<0.05). Conclusion The HRQOL of pneumoconiosis patients among migrant workers needs improvement, especially for patients with stage Ⅲ disease and those with complications. This study indicates the need of optimizing policies, raising the hospitalization expense limit for critically ill patients with stage Ⅲ pneumoconiosis or with complications, and improving their HRQOL.

Objective:To analyze the epidemiological characteristics of pneumoconiosis in Hunan Province.Methods:In November 2018, we collected the type of work, pneumoconiosis type, pneumoconiosis stage, length of service, age of onset and complications of pneumoconiosis cases diagnosed by Hunan occupational disease prevention and control hospital from January 2017 to October 2018. A total of 3 325 cases of pneumoconiosis were collected, including 651 cases (19.58%) of occupational pneumoconiosis and 2674 cases (80.42%) of clinically diagnosed pneumoconiosis. The measurement data were expressed by ± s. The comparison between groups was performed by independent sample t test and one-way ANOVA. Results:The age of 651 patients with occupational pneumoconiosis was 35.59-85.15 years old, the average age of onset was (54.27±8.29) years, and the average exposure to dust was (14.74±8.60) years. 2 674 cases of clinically diagnosed pneumoconiosis were 26.85~87.02 years old. The average age of onset was (55.26±7.38) years, and the average exposure time was (18.83±9.35) years. Compared with silicosis patients, coal workers' pneumoconiosis patients had longer exposure time, the difference was statistically significant ( P<0.05) , and the difference was statistically significant ( F=3.678, P<0.05) . There were no complications in 651 cases of occupational pneumoconiosis. Among 2 674 cases of clinically diagnosed pneumoconiosis, 710 cases (26.55%) had complications. Conclusion:Further attention should be paid to the clinical diagnosis of pneumoconiosis in Hunan Province.

Objective:To analyze the epidemiological characteristics of pneumoconiosis in Hunan Province.Methods:In November 2018, we collected the type of work, pneumoconiosis type, pneumoconiosis stage, length of service, age of onset and complications of pneumoconiosis cases diagnosed by Hunan occupational disease prevention and control hospital from January 2017 to October 2018. A total of 3 325 cases of pneumoconiosis were collected, including 651 cases (19.58%) of occupational pneumoconiosis and 2674 cases (80.42%) of clinically diagnosed pneumoconiosis. The measurement data were expressed by ± s. The comparison between groups was performed by independent sample t test and one-way ANOVA. Results:The age of 651 patients with occupational pneumoconiosis was 35.59-85.15 years old, the average age of onset was (54.27±8.29) years, and the average exposure to dust was (14.74±8.60) years. 2 674 cases of clinically diagnosed pneumoconiosis were 26.85~87.02 years old. The average age of onset was (55.26±7.38) years, and the average exposure time was (18.83±9.35) years. Compared with silicosis patients, coal workers' pneumoconiosis patients had longer exposure time, the difference was statistically significant ( P<0.05) , and the difference was statistically significant ( F=3.678, P<0.05) . There were no complications in 651 cases of occupational pneumoconiosis. Among 2 674 cases of clinically diagnosed pneumoconiosis, 710 cases (26.55%) had complications. Conclusion:Further attention should be paid to the clinical diagnosis of pneumoconiosis in Hunan Province.

A 22-year-old male patient received magnesium valproate sustained release tablets with increased dosage of 1 000 mg/d and quetiapine fumarate 600 mg/d due to recurrence of bipolar disorder, on the basis of previous treatment with magnesium valproate sustained release tablets 500-750 mg/d and quetiapine fumarate 400-600 mg/d. Seventeen days later, the patient developed abdominal pain suddenly. Laboratory tests showed blood amylase 4 710 U/L, lipase 649 U/L, and urine amylase 9 116 U/L. Abdominal CT examination showed blurred images around the pancreas. Acute pancreatitis induced by magnesium valproate sustained release tablets was considered. The drug was discontinued and quetiapine fumarate was continued. At the same time, symptomatic and supportive treatments such as fasting, omeprazole, somatostatin, and ceftazidime were given. Three days later, the patient′s abdominal pain basically disappeared; 10 days later, his blood amylase was 101 U/L and lipase was 118 U/L.

A 22-year-old male patient received magnesium valproate sustained release tablets with increased dosage of 1 000 mg/d and quetiapine fumarate 600 mg/d due to recurrence of bipolar disorder, on the basis of previous treatment with magnesium valproate sustained release tablets 500-750 mg/d and quetiapine fumarate 400-600 mg/d. Seventeen days later, the patient developed abdominal pain suddenly. Laboratory tests showed blood amylase 4 710 U/L, lipase 649 U/L, and urine amylase 9 116 U/L. Abdominal CT examination showed blurred images around the pancreas. Acute pancreatitis induced by magnesium valproate sustained release tablets was considered. The drug was discontinued and quetiapine fumarate was continued. At the same time, symptomatic and supportive treatments such as fasting, omeprazole, somatostatin, and ceftazidime were given. Three days later, the patient′s abdominal pain basically disappeared; 10 days later, his blood amylase was 101 U/L and lipase was 118 U/L.

Objective To systematically review reports dealing with the efficacy of pulmonary rehabilitation for patients with acute exacerbation of chronic obstructive pulmonary disease.Methods The PubMed,EMbase,China National Knowledge Infrastructure,VIP and Wan Fang databases were searched to collect reports of randomized and controlled trials of pulmonary rehabilitation for patients with acute exacerbation of chronic obstructive pulmonary disease.The search covered from each database's inception to August 1,2016.Two reviewers screened the literature independently,extracted data and assessed the risk of bias for the studies eventually included.A meta-analysis was performed using version 5.3 of the RevMan software.Results After the initial selection,a total of 7 reports covering 486 patients were included in the meta-analysis.The results of the meta-analysis showed that the average mMRC score,the 6-minute walk distance and Borg score in the pulmonary rehabilitation group were all significantly higher than in the control group.There was,however,no significant difference between the two groups' average pulmonary function values.Conclusion Pulmonary rehabilitation is safe for patients experiencing an acute exacerbation of chronic obstructive pulmonary disease.It can effectively improve their exercise tolerance,expiratory dyspnea and daily living ability.

Background and purpose:Adenosine triphosphate-binding cassette superfamily G member 2 (ABCG2), which has been found over-expressed in a variety of cancer cells, takes part in the drug resistance of cancer through effux of anticancer drugs. The purpose of this study was to investigate the mechanisms of human glioblastoma cells sensitivity to pyropheophorbide-a methyl ester (MPPa)-mediated photodynamic therapy (PDT) eradicating tumour cells and its relationship to ABCG2.Methods:U87 and A172 glioma cell lines in the logarithmic growth phase were selected and exposed to the treatment of MPPa-PDT and MPPa-PDT+fumitremorgin C (FTC) respectively. The cell viability was measured with the use of CCK-8 assay. The expression of ABCG2 was detected by Western blot. The intracellular contents of MPPa in each group without illumination were tested by lfow cytometry. Flow cytometry with AnnexinⅤ-FITC/PI double staining was used to detect the cell apoptotic rate. DCFH-DA staining was used to assess the generation of intracellular reactive oxygen species (ROS).Results:The MPPa-mediated PDT could eradicate A172 and U87 cancer cells in an energy-dependent manner. The light energy density in A172 was 8 times of that in U87 when the cell viability reached median lethal dose after MPPa-mediated PDT. The high expression of ABCG2 in A172 cells affected the accumulation of intracellular MPPa. Inhibition of ABCG2, not only could enhance the eradicating effect of MPPa-PDT on A172 cells, but also could increase the yield of ROS triggered by MPPa-PDT and the accumulation of intracellular MPPa.Conclusion:The human glioblastoma cell line A172 is insensitive to MPPa-mediated PDT. The mechanism may relate to ABCG2, which decreases the MPPa content in cancer cells through effux of MPPa, resulting in decline of cytotoxicity.

Objective To explore the efficacy of neuromuscular electrical stimulation (NMES) in treating severe and chronic obstructive pulmonary disease (COPD).Methods Seventy-eight COPD patients were randomly divided into an NMES group of 38 and an exercise therapy group of 32.In addition to the routine drug therapy and basic rehabilitation training,the NMES group received 8 weeks of NMES of the lower limbs while the exercise group was provided with strength and endurance training of the lower limbs,also for 8 wceks.Before and after the 8 weeks of treatment,pulmonary function was tested along with isokinetic quadriceps strength,cardiopulnonary capacity,and lung capacity using Saint George's respiratory questionnaire (SGRQ).Results The two groups showed no significant difference in any of the measurements before the treatment.After the treatment,forced expiratory volume in 1 second of (FEV1),FEV1/forced vital capacity (FVC),FEVI in percentage of the predicted value,medical research council dyspnea scale (MRC) score and the 6-minute walk distance (6MWD) improved in both groups.However,the average body mass index and 6 minute walk distance differed significantly between the groups after the treatment.The quadriceps' peak torque increased after the treatment in both groups,but the average in the exercise group was significantly higher than that in the NMES group.VO2max and Wmax also increased significantly in both groups,and the average time to exhaustion increased significantly in the exercise group.Significant improvement was observed in the BODE assessment after the intervention for both groups.Conclusion Neuromuscular electrical stimulation is as effective as therapeutic exercise in promoting the rehabilitation of severe COPD patients.However,lower limbs exercise is still the first choice in managing such patients.

Objective To test using musculoskeletal ultrasound (MSUS) to observe uncovertebral joints (UJs) and to explain the ultrasound images of UJs and their adjacent tissues,especially the vertebral artery (VA).Methods MSUS was used first with human skeletons and cadavers to localize the UJs and VA on the MSUS images with the aid of implanted needles.MSUS was then used with a patient clinically diagnosed with cervical spondylosis of the vertebral artery type (CSA) to detail the image of a normal UJ and its relationship with the adjacent tissues,especially the VA.Whether there was a lateral spur from the uncinate process (UP) was assessed to try to establish a method for measuring osteophytes.Results During the examination the patient was in supine,the neck was elevated 15cm with a pillow and was at 45 degrees of rotation to the contralateral side.The probe was placed at the medial border of the sternocleidomastoid muscle.When the longitudinal section of the common carotid artery was shown,the probe was slowly moved laterally until the VA first appeared,and then was moved up along the VA.Once the VA entered the transverse foramen,moving the probe slightly allowed the UJ behind the VA to be seen between two transverse processes.The UJ thus lies between two transverse processes,that is,between the lateral margins of two vertebral bodies and outside the intervertebral disc.The echo of the lateral border of the UP is on a straight line with the echo of the lateral margin of the vertebral body,with the VA in front of the line.It was noticed that the image of a UP with lateral osteophyte formation crossed the line and reached closer to the VA.The transverse diameter of the UJ was measured as the distance from a line cutting the lateral cortical margin of the cervical vertebra to the outer cortical margin of the lateral UP.Conclusion MSUS can clearly show the UJ and its adjacent tissues,especially the VA.It can be used to assess and measure UJs with lateral osteophyte formation.