Objective To explore the utility of comprehensive geriatric assessment (CGA) in screening risk factors for osteosarcopenia (OS) among older adults (≥80 years old) and to evaluate the therapeutic efficacy of CGA-guided integrated interventions for OS. Methods A total of 420 patients aged ≥80 years, recruited from the Department of Geriatrics, General Practice of The Affiliated Jiangyin Hospital of Nantong University, and community health centers from January 2022 to October 2024, were enrolled. Participants were classified into OS (n＝139) and non-OS (n＝281) groups based on diagnostic criteria. CGA was utilized to compare differences in general characteristics, laboratory indicators, comorbidities between groups. Binary logistic regression analysis identified independent risk and protective factors. Subsequently, 40 OS patients were randomly assigned to an intervention group (n＝20) receiving integrated interventions including nutritional support, exercise training, and psychological management or a control group (n＝20, receiving routine care). Appendicular skeletal muscle mass index (ASMI), grip strength, gait speed, and bone mineral density (BMD) T-score were compared between groups after 3 months. Results The prevalence of OS in this cohort was 33.1%. Compared to the non-OS group, the OS group exhibited significant differences in age, body mass index (BMI), smoking history, comorbidity index, concomitant medication, cognitive impairment, visual and hearing impairment, sleep disorders, depression, marital status, social participation, activities of daily living, nutritional risk, total cholesterol, uric acid, and constipation (P＜0.05). Logistic regression analysis identified age and comorbidity index as significant risk factors for OS, while BMI, married status, total cholesterol, and activities of daily living (assisted and independent) served as protective factors. The intervention group demonstrated significant improvements in grip strength, gait speed, BMD T-score, and male ASMI compared to controls (P＜0.05). Conclusions CGA demonstrates clinical utility in systematically identifying risk factors for OS in the old population. Multimodal interventions guided by CGA effectively improve musculoskeletal function in elderly OS patients.

ObjectiveTo improve the response capabilities to disasters and prevent major epidemics， it is of practical use to study the capability evaluation system of the national emergency medical rescue team that combines theoretical training and practical exercises， to enhance the overall quality of the teams. MethodsFirst， a capability assessment system for the national emergency medical rescue team was constructed based on the INSARAG External Classification （IEC） standards of the national emergency medical rescue team. Then， based on the outcome based education （OBE） concept， we conducted innovative research on the curriculum design and exercise programs for team building and member training. Finally， an empirical analysis was conducted on the effectiveness of the evaluation system and training exercises based on the statistical analysis of the comprehensive quality evaluation of the Shanghai national emergency medical rescue team from 2020 to 2023， as well as the empirical analysis of the rescue exercise on the Cruise of spectrum. ResultsBased on the linear regression analysis of each core competency indicators， the five core competencies in the evaluation system， including rescue skills， medical and health knowledge， disaster coping ability， team cooperation ability， and mental resilience training， were positively correlated with the cumulative number of trainings （r=0.71， r=0.76， r=0.81， r=0.84， r=0.96，all P<0.05）， indicating that the training was effective and the course design was reasonable. Empirical cases showed that the three-dimensional rescue drill model had remarkable results in the actual combat application and ability improvement of team members. ConclusionThe training courses and drills designed based on the three-level assessment system are effective in improving the comprehensive capabilities of the national emergency medical rescue team.

Objective:To explore the significance of laparoscopic virtual reality simulation training by analyzing the learning curve of laparoscopic cholecystectomy among young general surgeons who had participated in laparoscopic skills training at our hospital.Methods:Fifty young surgeons were divided into two groups, with the intervention group participating in virtual reality simulation training and the control group participating in traditional laparoscopic clinical training. After completion of the training, 30 laparoscopic cholecystectomies were performed under the supervision of highly qualified surgeons with extensive laparoscopic experience. CUSUM analysis was applied to plot the trainees' surgical learning curve based on the completion rate, surgical score and operative time. " x" is the number of surgical cases and " k" is the slope. The value of x when k=0 was calculated and the surgical learning curves and intraoperative scores of the 2 groups of trainees were compared. SPSS 23.00 was performed for t-test and Chi-square test. Results:The intervention and control groups crossed the surgical learning curve at x=19.24±0.39 and x=21.72±0.73 respectively, with significant differences ( P<0.01); the intervention and control groups scored (10.82±2.73) and (9.71±2.69) for gallbladder exposure ( t=4.61, P<0.01), (12.59±3.12) and (8.87±2.99) for gallbladder dissection triangle ( t=6.21, P<0.01), and (10.69±3.38) and (8.80±3.55) for gallbladder dissection ( t=3.10, P<0.01). Conclusions:Virtual reality simulation training can facilitate the translation of basic laparoscopic training skills into clinical skills and can promote the growth of young general surgeons.

Objective In order to address the issues of inconvenience,high medical costs,and lack of universality associated with traditional knee rehabilitation equipment,a portable intelligent wheelchair for knee rehabilitation was designed in this study.Methods Based on the analysis of the knee joint's structure and rehabilitation mechanisms,an electric pushrod-driven rehabilitation institution was developed.A multi-functional module was designed with a modular approach,and the control of the wheelchair body and each functional module was implemented using an STM32 single-chip microcomputer.A three-dimensional model was established using SolidWorks software.In conjunction with Adams and Ansys simulation software,kinematic and static analyses were conducted on the knee joint rehabilitation institution and its core components.A prototype was constructed to verify the equipment's actual performance.Results According to the prototype testing,the actual range of motion for the knee joint swing rod is 15.1°～88.9°,the angular speed of the swing rod ranges from-7.9 to 8.1°/s,the angular acceleration of the swing rod varies from-4.2 to 1.6°/s2,the thrust range of the electric pushrod is-82.6 to 153.1 N,and the maximum displacement of the load pedal is approximately 1.7 mm,with the leg support exhibiting a maximum deformation of about 1.5 mm.Conclusion The intelligent knee joint rehabilitation wheelchair meets the designed functions and its actual performance aligns with the design criteria,thus validating the rationality and feasibility of the structural design.

OBJECTIVE To investigate the expression and prognosis of SDHB gene in pan-cancer by bioinformatics analysis,and to explore SDHB-related genes,potential pathways and immune cell infiltration in pheochromocytoma paraganglioma(PPGL).METHODS The expression of SDHB gene in pan-cancer and its relationship with survival prognosis were analyzed in The Cancer Genome Atlas(TCGA)and genotype-tissue expression(GTEx)databases.The expression changes of other genes affected by SDHB mutations,the enrichment analysis and signaling pathway analysis in PPGL patients were carried out by analyzing the TCGA database and the TARGET database.In addition,the relationship between SDHB expression and immune cell infiltration in PPGL patients was explored.RESULTS Compared with normal tissues,the expression of SDHB in 21 tumors was higher than that in normal tissues(P<0.01):BLCA,BRCA,CESC,COAD,DLBC,ESCA,GBM,HNSCC,LGG,LUAD,LUSC,OV,PAAD,PRAD,READ,SKCM,STAD,THCA,THYM,UCEC and UCS.It was expressed lower than normal in 7 other tumors(P<0.01),including ACC,CHOL,KICH,KIRC,KIRP,LAML and PPGL.The relationship between SDHB expression and survival prognosis was analyzed,and it was found that in STAD,KIRC,MESO,OS,and KIR,lower SDHB expression predicted poor prognosis,while higher expression predicted good prognosis.In UCEC,LGG,HNSCC,LAML,OSCC,and ACC,lower SDHB expression predicted a better prognosis,and similarly,higher expression predicted a poor prognosis.In correlation and enrichment analysis,the expression of SDHB was mainly related to neuroactive ligand-receptor interaction,Cushing's syndrome,cortisol synthesis and secretion,peptide receptor activity,G protein-coupled peptide receptor activity,neuropeptide receptor activity,intrinsic components of the synaptic membrane,components of the synaptic membrane,components of the postsynaptic specialized membrane,cyclic nucleotide-mediated signaling pathways,neuropeptide signaling pathways,glucocorticoid metabolism processes and other signaling pathways.In immune infiltration analysis,it was found that the immune cells with the highest infiltration in the SDHB lower expression group were pDC cells and TReg cells,suggesting that pDC cells and TReg cells may play a certain role in PPGL patients.CONCLUSION SDHB gene is abnormally expressed in a variety of tumors,and it has a certain correlation with the prognosis of tumors.In PPGL patients,the signaling pathways affected by SDHB and highly infiltrating immune cells provide new insights for future mechanistic studies and immunotherapy.

Objective To investigate the correlation between serum microRNA(miR)-24-3p,microtubule affinity-regulating kinase 4(MARK4)level expression and cardiac function in serum of patients with coronary atherosclerotic heart disease(CHD).Methods From August 2021 to April 2023,138 CHD patients who visited Sichuan Provincial People's Hospital were collected as the study subjects(CHD group).According to the New York Heart Association(NYHA)grading,patients in the CHD group were separated into grade Ⅱ(n=39),grade Ⅲ(n=68),and grade Ⅳ(n=31).Additionally,123 individuals who underwent physical examinations were selected as the health group during the same period.Real-time fluorescence quantitative PCR(qRT-PCR)method was applied to detect the expression levels of miR-24-3p and MARK4.Cardiac function indicators in the CHD and health groups were detected.Pearson method was applied to analyze the correlation among serum miR-24-3p,MARK4,and cardiac function indicators.Results Compared with the healthy group,the levels of MARK4(1.19±0.21 vs 1.00±0.20),left ventricular end-systolic dimension(LVESd),left ventricular enddiastolic dimension(LVEDd),interventricular septal thickness(IVS),left ventricular end-diastolic volume(LVEDv),left ventricular end-systolic volume(LVESv),and left ventricular mass(LV mass)in the CHD group were increased(t=7.462,18.242,23.888,9.941,2.812,12.520,11.029),while the levels of miR-24-3p(0.62±0.11 vs 1.00±0.18),left ventricular ejection fraction(LVEF),and cardiac output(CO)were reduced(t=20.821,10.212,18.188),and the differences were statistically significant(all P＜0.05).As cardiac function grading increased,MARK4 expression levels(1.09±0.19,1.18±0.17,1.32±0.22),LVESd,LVEDd,IVS,LVEDv,LVESv and LV mass were increased(F=13.025,10.606,11.920,57.956,29.680,21.253,12.954),and miR-24-3p expression levels(0.84±0.15,0.61±0.11,0.37±0.08),LVEF and CO were decreased(F=139.227,9.720,13.411),and the differences were statistically significant(all P＜0.05).Pearson correlation analysis showed a negative correlation between miR-24-3p and MARK4 expression in the serum of patients with CHD(r=-0.540,P＜0.05).The relative expression of miR-24-3p in the serum of patients with CHD was negatively correlated with LVESd,LVEDd,IVS,LVEDv,LVESv and LV mass(r=-0.656,-0.636,-0.617,-0.576,-0.492,-0.687,all P＜0.05),but positively correlated with LVEF and CO(r=0.570,0.683,all P＜0.05).The relative expression level of MARK4 was positively correlated with LVESd,LVEDd,IVS,LVEDv,LVESv,and LV mass(r=0.503,0.542,0.508,0.624,0.516,0.560,all P＜0.05),but negatively correlated with LVEF and CO(r=-0.594,-0.525,all P＜0.05).Conclusion The expression of miR-24-3p in the serum of CHD patients was decreased,while the expression of MARK4 was increased.There was an obvious correlation between the two and cardiac function indicators.

Objective:To analyze the diagnosis, treatment and prognosis of patients with rare malignant tumors of the temporal bone. Methods:Four cases of rare temporal bone malignant tumors in our hospital between March 2014 and December 2020 were reviewed, including two cases of chondrosarcoma, one case of fibrosarcoma and one case of endolymphatic cystic papillary adenocarcinoma. There were three males and one female, ages between 28 and 56 years at the time of surgery. Common symptoms included hearing loss, facioplegia, tinnitus, and headache. All patients underwent imaging examinations to evaluate the extent of the lesions. Tumors were removed by subtotal temporal bone resection or infratemporal fossa approach, and postoperative adjuvant radiotherapy was applied if necessary. Results:One of the two chondrosarcoma patients was cured by complete resection of the tumor for 75 months, the other one recurred after the first excision of the tumor and underwent infratemporal fossa approach resection of skull base mass again with no recurrence found yet for 112 months. One patient with fibrosarcoma survived for 28 months after surgery with a positive margin and post-operative radiotherapy. One patient with endolymphatic cystic papillary adenocarcinoma recurred 12 months after subtotal lithotomy, and underwent subtotal temporal bone resection again, combined with radiotherapy. No recurrence was found for 63 months. Conclusion:The incidence of rare temporal bone malignant tumors is extremely low, the location is hidden, and the symptoms are atypical. Attention should be paid for early detection and early treatment. Surgical resection is the main treatment, and radiotherapy can be supplemented in the advanced stage or with a positive margin.
Adult ; Female ; Humans ; Male ; Middle Aged ; Chondrosarcoma/surgery* ; Fibrosarcoma ; Neoplasm Recurrence, Local ; Retrospective Studies ; Skull Base/surgery* ; Skull Base Neoplasms/surgery* ; Temporal Bone/pathology* ; Treatment Outcome

Objective:Based on the principle that the aggregation-induced emission (AIE) fluorescent probe 6PD-DPAN could bind and aggregate with bacteria, and the fluorescence intensity could reflect the quantity of bacteria, a new method for rapid, convenient, and accurate bacterial drug sensitivity testing was established, which provided a basis for rapid and accurate clinical drug use.Methods:This was a methodological evaluation study. A total of 107 clinical isolates were collected from Houjie Hospital of Dongguan City from January to December 2022, among which 46 isolates were used for the establishment of the new method, and 61 isolates were used for methodological validation. The minimum inhibitory concentration (MIC) determined by broth microdilution method was used as the gold standard, and three antibacterial drugs, gentamicin, levofloxacin, and cefotaxime, were used as experimental drugs. The AIE plate was incubated for 4 hours, and the fluorescence intensity was measured every half an hour to draw a fluorescence change curve. The MIC results were compared with the CLSI breakpoints to determine the bacteria as sensitive, intermediate, or resistant. To simplify the detection process, the ratio of fluorescence intensity at 4 hours(R) was calculated, and the ROC curve was used to analyze the efficacy of R in determining bacterial growth and establish its cutoff value. The new method was used to determine the MIC of 61 clinical isolates, with broth microdilution method as the gold standard. The basic consistency, categorical consistency, very major errors, and major errors of the new method were analyzed, and the consistency between the two methods was determined by the Kappa test.Results:ROC curve analysis of the R after 4 hours of culture: The cut-off value was 3.0, with both sensitivity and specificity for determining bacterial growth being 100%. The median (interquartile) R for bacterial growth inhibition was 11.1 (8.6, 14.4); the median R-value for bacterial growth was 1.1 (1.0, 1.2). Compared to the gold standard, the newly established method showed 100% (61/61) essential agreement in detecting MICs of 61 clinical isolates, with a categorical agreement of 96.7% (59/61). There were no very major or major errors, and the Kappa value was 0.94, indicating good consistency between the newly established method and the microbroth dilution method.Conclusions:This study successfully established a new method for bacterial drug sensitivity testing based on AIE technology, which could obtain satisfactory results within 5 hours, providing a basis for early precision drug treatment in clinical practice.

68Ga-PSMA PET/CT has a higher detection rate for the diagnosis of prostate cancer than traditional imaging methods. Therefore, the application of 68Ga-PSMA PET/CT in prostate targeted puncture biopsy may improve its detection rate. This paper reports two patients who underwent 68Ga-PSMA-11 PET/CT and transrectal ultrasound cognitive fusion-targeted prostate biopsy.By comparing patient MRI and PET/CT images, it was found that PET/CT targets were less than MRI, perform transrectal ultrasound cognitive fusion-targeted prostate biopsy separately.Targeted prostate puncture with cognitive fusion of 68Ga-PSMA-11 PET/CT and transrectal ultrasound is more accurate.

Considering the small differences between different types in the diabetic retinopathy (DR) grading task, a retinopathy grading algorithm based on cross-layer bilinear pooling is proposed. Firstly, the input image is cropped according to the Hough circle transform (HCT), and then the image contrast is improved by the preprocessing method; then the squeeze excitation group residual network (SEResNeXt) is used as the backbone of the model, and a cross-layer bilinear pooling module is introduced for classification. Finally, a random puzzle generator is introduced in the training process for progressive training, and the center loss (CL) and focal loss (FL) methods are used to further improve the effect of the final classification. The quadratic weighted Kappa (QWK) is 90.84% in the Indian Diabetic Retinopathy Image Dataset (IDRiD), and the area under the receiver operating characteristic curve (AUC) in the Messidor-2 dataset (Messidor-2) is 88.54%. Experiments show that the algorithm proposed in this paper has a certain application value in the field of diabetic retina grading.
Humans ; Diabetic Retinopathy/diagnostic imaging* ; Algorithms ; ROC Curve ; Diabetes Mellitus