Objective:To investigate the prognostic factors in patients with acute myocardial infarction (AMI) who underwent interventional therapy assisted by venous-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:This single-center retrospective cohort study enrolled AMI patients who received VA-ECMO-assisted interventional therapy in the Department of Cardiology at the Second Hospital of Jilin University from June 2018 to November 2022. Patients were divided into the in-hospital survival group and in-hospital death group based on the in-hospital survival. Data on patient demographics, laboratory tests, imaging examinations, coronary angiography results, VA-ECMO-related parameters, complications, and prognosis were collected through the electronic medical record system.Results:A total of 71 AMI patients were enrolled, with an age of (62.4±11.1) years, of whom 54 (76%) were male. There were 46 patients in the in-hospital survival group and 25 patients in the in-hospital death group. Compared to the in-hospital survival group, the in-hospital death group exhibited significantly higher levels of cardiac troponin I (36.08 (2.86, 100.00) μg/L vs. 2.75 (0.18, 13.86) μg/L, P=0.01) and B-type natriuretic peptide (1 724.50 (50.00, 4 200.50) vs. 460.85 (163.80, 1 862.33), P=0.01), and the left ventricular ejection fraction was lower ((35.0±12.9)% vs. (43.0±12.8)%, P=0.01), moreover the incidence of patients with left main coronary artery disease (80% (20/25) vs. 39% (18/46), P<0.01), cardiac arrest (56% (14/25) vs. 20% (9/46), P<0.01), cardiopulmonary resuscitation (52%(13/25) vs. 26%(12/46), P=0.03), and the time from cardiac arrest to ECMO initiation >24 hours (84% (21/25) vs. 9% (4/46), P<0.01) were higher. Conclusions:The prognosis of AMI patients undergoing VA-ECMO-assisted interventional therapy may be influenced by a number of related factors, including cardiac troponin I, B-type natriuretic peptide levels, left ventricular ejection fraction, combined with left main coronary artery disease, cardiac arrest and cardiopulmonary resuscitation, and the interval between cardiac arrest and the initiation of ECMO.

Objective:To investigate the prognostic factors in patients with acute myocardial infarction (AMI) who underwent interventional therapy assisted by venous-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:This single-center retrospective cohort study enrolled AMI patients who received VA-ECMO-assisted interventional therapy in the Department of Cardiology at the Second Hospital of Jilin University from June 2018 to November 2022. Patients were divided into the in-hospital survival group and in-hospital death group based on the in-hospital survival. Data on patient demographics, laboratory tests, imaging examinations, coronary angiography results, VA-ECMO-related parameters, complications, and prognosis were collected through the electronic medical record system.Results:A total of 71 AMI patients were enrolled, with an age of (62.4±11.1) years, of whom 54 (76%) were male. There were 46 patients in the in-hospital survival group and 25 patients in the in-hospital death group. Compared to the in-hospital survival group, the in-hospital death group exhibited significantly higher levels of cardiac troponin I (36.08 (2.86, 100.00) μg/L vs. 2.75 (0.18, 13.86) μg/L, P=0.01) and B-type natriuretic peptide (1 724.50 (50.00, 4 200.50) vs. 460.85 (163.80, 1 862.33), P=0.01), and the left ventricular ejection fraction was lower ((35.0±12.9)% vs. (43.0±12.8)%, P=0.01), moreover the incidence of patients with left main coronary artery disease (80% (20/25) vs. 39% (18/46), P<0.01), cardiac arrest (56% (14/25) vs. 20% (9/46), P<0.01), cardiopulmonary resuscitation (52%(13/25) vs. 26%(12/46), P=0.03), and the time from cardiac arrest to ECMO initiation >24 hours (84% (21/25) vs. 9% (4/46), P<0.01) were higher. Conclusions:The prognosis of AMI patients undergoing VA-ECMO-assisted interventional therapy may be influenced by a number of related factors, including cardiac troponin I, B-type natriuretic peptide levels, left ventricular ejection fraction, combined with left main coronary artery disease, cardiac arrest and cardiopulmonary resuscitation, and the interval between cardiac arrest and the initiation of ECMO.

Objective The aim of this study was to analyze the incidence and mortality of lung cancer in tumor registration areas of Yunnan province in 2020,as well as the changing trends from 2012 to 2020,in order to provide the data support for lung cancer prevention and control.Methods The reported cases of lung cancer from 2012 to 2020 in tumor registration areas of Yunnan province were collected,and SAS 9.4 software was used to calculate the incidence,mortality and other indicators to describe the cur-rent situation of lung cancer incidence and mortality.JoinPoint 4.9.0.0 software was used to calculate the annual percentage change(APC)to analyze the trend of lung cancer incidence and mortality.Results In 2020,the crude incidence of lung cancer in Yunnan province was 46.68/100,000(male 58.56/100,000 and female 34.21/100,000),age-standardized incidence rate by Chinese stand-ard population(ASIRC)was 30.83/100,000,age-standardized incidence rate by World standard population(ASIRW)was 30.61/100,000;The crude mortality was 33.88/100,000(male 45.94/100,000 and female 21.21/100,000),age-standardized mortality rate by Chinese standard population(ASMRC)was 21.70/100,000,age-standardized mortality rate by World standard population(ASMRW)was 21.61/100,000.In 2020,the incidence and mortality of lung cancer in Yunnan province showed an upward trend with the increase of age,and was at a low level before the age of 39,and increased rapidly after the age of 40.It reached its peak in the age groups of 75-79 and 80-84,respectively.The crude incidence of lung cancer in urban and rural areas was 47.21/100,000 and 46.52/100,000,respectively;The crude mortality of lung cancer was 32.66/100,000 and 34.27/100,000,respectively.From 2012 to 2020,the crude incidence of lung cancer in Yunnan province increased with the year(APC=2.94%,95%CI=0.29%-5.67%,P<0.05);The crude incidence of female lung cancer and ASIRW increased with the year(crude incidence rate:APC=6.30%,95%CI=2.52%-10.21%,P<0.05;ASIRW:APC=5.91%,95%CI=1.21%-10.82%,P<0.05).Conclusion In 2020,the incidence and mortality of lung cancer in Yunnan province increase significantly after the age of 40.The overall incidence and mortality of lung cancer in men are higher than those in women,and higher in rural areas than that in urban areas.At the same time,the incidence of lung cancer in women is increasing year by year.Therefore,males 40 years old and over above in rural areas should be identified as key populations for lung cancer prevention and control.Simultaneously,women lung cancer also pay attention to the prevention and control.

Objective To construct clinical imaging model,radiomics model,and a combined model based on the above two for predicting lymph node metastasis(LNM)of colon cancer(CC),and to compare the diagnostic performance of each model.Methods The data from 328 CC patients confirmed by surgical pathology were analyzed retrospectively,including 156 with LNM.All patients were randomly divided into training group(229 cases)and validation group(99 cases)at a ratio of 7∶3.The difference of clinical imaging indicators were compared between groups and a clinical imaging model for diagnosing LNM was constructed.The tumor three-dimensional volume of interest(VOI)was used for radiomics feature extraction,and after dimensionality reduction and selection,8 features were obtained to construct the Radiomics score(Radscore).A combined model of clinical imaging indicators and Radscore was built.The diagnostic performance of each model for LNM was compared,and the calibration and clinical benefit of the optimal model were evaluated.Results There were statistical differences in clinical imaging indicators between the two groups:carcinoembryonic antigen(CEA),CA199,tumor long diameter,and lymph node short diameter(P＜0.05).The area under the curve(AUC)of the clinical imaging model,radiomics model,and combined model were 0.721,0.814,0.854(training group),and 0.744,0.732,0.808(validation group),respectively.The AUC of the combined model was the highest,and both the training and validation groups were higher than that of the clinical imaging model(P＜0.05).The combined model demonstrated higher calibration,with a clinical benefit from decision curve analysis(DCA)threshold range of 0.09 to 0.91.Conclusion The nomogram constructed based on clinical imaging indicators and CT radiomics holds high value in diagnosing LNM of CC.

Background::Histological healing is closely associated with improved long-term clinical outcomes and lowered relapses in patients with ulcerative colitis (UC). Here, we developed a novel diagnostic criterion for assessing histological healing in UC patients.Methods::We conducted a retrospective cohort study in UC patients, whose treatment was iteratively optimized to achieve mucosal healing at Shanghai Tenth People’s Hospital of Tongji University from January 2017 to May 2022. We identified an inflammatory cell enumeration index (ICEI) for assessing histological healing based on the proportions of eosinophils, CD177 + neutrophils, and CD40L + T cells in the colonic lamina propria under high power field (HPF), and the outcomes (risks of symptomatic relapses) of achieving histological remission vs. persistent histological inflammation using Kaplan-Meier curves. Intrareader reliability and inter-reader reliability were evaluated by each reader. The relationships to the changes in the Nancy index and the Geboes score were also assessed for responsiveness. The ICEI was further validated in a new cohort of UC patients from other nine university hospitals. Results::We developed an ICEI for clinical diagnosis of histological healing, i.e., Y = 1.701X 1 + 0.758X 2 + 1.347X 3 - 7.745 (X 1, X 2, and X 3 represent the proportions of CD177 + neutrophils, eosinophils, and CD40L + T cells, respectively, in the colonic lamina propria under HPF). The receiver operating characteristics curve (ROC) analysis revealed that Y <-0.391 was the cutoff value for the diagnosis of histological healing and that an area under the curve (AUC) was 0.942 (95% confidence interval [CI]: 0.905-0.979) with a sensitivity of 92.5% and a specificity of 83.6% ( P <0.001). The intraclass correlation coefficient (ICC) for the intrareader reliability was 0.855 (95% CI: 0.781-0.909), and ICEI had good inter-reader reliability of 0.832 (95% CI: 0.748-0.894). During an 18-month follow-up, patients with histological healing had a substantially better outcome compared with those with unachieved histological healing ( P <0.001) using ICEI. During a 12-month follow-up from other nine hospitals, patients with histological healing also had a lower risk of relapse than patients with unachieved histological healing. Conclusions::ICEI can be used to predict histological healing and identify patients with a risk of relapse 12 months and 18 months after clinical therapy. Therefore, ICEI provides a promising, simplified approach to monitor histological healing and to predict the prognosis of UC.Registration::Chinese Clinical Trial Registry, No. ChiCTR2300077792.

BACKGROUND:Studies have found that activation of nuclear factor-erythroid 2-related factor 2/heme oxidase-1(Nrf2/HO-1)pathway can alleviate oxidative stress caused by cerebral ischemia-reperfusion injury,but whether human bone marrow mesenchymal stem cells(hBMSC)can activate Nrf2/HO-1 pathway to alleviate cerebral ischemia-reperfusion injury is still lacking relevant studies. OBJECTIVE:To investigate whether intracranial transplantation of hBMSC alleviates oxidative stress injury in cerebral ischemia-reperfusion animal models by activating Nrf2/HO-1 pathway. METHODS:Totally 40 male SPF SD rats were randomly divided into sham operation group,model group,hBMSC transplantation group,hBMSC+solvent group and hBMSC+Nrf2 inhibitor group.Each group consisted of eight animals.In the model group and the hBMSC transplantation group,middle cerebral artery occlusion model was prepared by thread embolization method.The thread embolization was removed 1 hour later,and 30 μL PBS or hBMSC cultured to at least passage 5 was injected into the right cortex and striatum of rats.In the hBMSC+Nrf2 inhibitor group and hBMSC+solvent group,the left ventricle was injected with Nrf2 inhibitor Brusatol and its solvent dimethyl sulfoxide respectively 24 hours before model establishment,then the middle cerebral artery occlusion model was prepared,and hBMSC was injected.Relevant indexes were detected 3 days after transplantation. RESULTS AND CONCLUSION:(1)CT and TTC staining showed the same area and volume of cerebral infarction:model group>hBMSC+Nrf2 inhibitor group>hBMSC+solvent group>hBMSC transplantation group>sham operation group.(2)Hematoxylin-eosin staining and Nissl's staining showed that the ischemic brain tissue was intact and the neurons were normal in the sham operation group.Compared with the model group,the pathological morphology and neuronal injury of the hBMSC transplantation group and the hBMSC+solvent group were significantly improved.Compared with the hBMSC+solvent group,the hBMSC+Nrf2 inhibitor group had more serious pathological morphology and neuronal damage.(3)Western blot assay and oxidative stress index detection results showed that compared with the sham operation group,Nrf2 and HO-1 proteins were decreased(all P<0.05),malondialdehyde was increased and superoxide dismutase was decreased(all P<0.05)in the model group.Compared with the model group,the expression levels of Nrf2 and HO-1 proteins were increased(all P<0.05),malondialdehyde was decreased and superoxide dismutase was increased(all P<0.05)in the hBMSC transplantation group and the hBMSC+solvent group.Compared with the hBMSC+solvent group,the expression levels of Nrf2 and HO-1 proteins were simultaneously decreased(all P<0.05),and malondialdehyde was increased and superoxide dismutase was decreased(all P<0.05)in the hBMSC+Nrf2 inhibitor group.(4)These results indicate that hBMSC can alleviate cerebral ischemia-reperfusion injury possibly by activating Nrf2/HO-1 pathway.

Objective The aim of this study was to analyze the incidence and mortality of lung cancer in tumor registration areas of Yunnan province in 2020,as well as the changing trends from 2012 to 2020,in order to provide the data support for lung cancer prevention and control.Methods The reported cases of lung cancer from 2012 to 2020 in tumor registration areas of Yunnan province were collected,and SAS 9.4 software was used to calculate the incidence,mortality and other indicators to describe the cur-rent situation of lung cancer incidence and mortality.JoinPoint 4.9.0.0 software was used to calculate the annual percentage change(APC)to analyze the trend of lung cancer incidence and mortality.Results In 2020,the crude incidence of lung cancer in Yunnan province was 46.68/100,000(male 58.56/100,000 and female 34.21/100,000),age-standardized incidence rate by Chinese stand-ard population(ASIRC)was 30.83/100,000,age-standardized incidence rate by World standard population(ASIRW)was 30.61/100,000;The crude mortality was 33.88/100,000(male 45.94/100,000 and female 21.21/100,000),age-standardized mortality rate by Chinese standard population(ASMRC)was 21.70/100,000,age-standardized mortality rate by World standard population(ASMRW)was 21.61/100,000.In 2020,the incidence and mortality of lung cancer in Yunnan province showed an upward trend with the increase of age,and was at a low level before the age of 39,and increased rapidly after the age of 40.It reached its peak in the age groups of 75-79 and 80-84,respectively.The crude incidence of lung cancer in urban and rural areas was 47.21/100,000 and 46.52/100,000,respectively;The crude mortality of lung cancer was 32.66/100,000 and 34.27/100,000,respectively.From 2012 to 2020,the crude incidence of lung cancer in Yunnan province increased with the year(APC=2.94%,95%CI=0.29%-5.67%,P<0.05);The crude incidence of female lung cancer and ASIRW increased with the year(crude incidence rate:APC=6.30%,95%CI=2.52%-10.21%,P<0.05;ASIRW:APC=5.91%,95%CI=1.21%-10.82%,P<0.05).Conclusion In 2020,the incidence and mortality of lung cancer in Yunnan province increase significantly after the age of 40.The overall incidence and mortality of lung cancer in men are higher than those in women,and higher in rural areas than that in urban areas.At the same time,the incidence of lung cancer in women is increasing year by year.Therefore,males 40 years old and over above in rural areas should be identified as key populations for lung cancer prevention and control.Simultaneously,women lung cancer also pay attention to the prevention and control.

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Objective:To monitor and evaluate in vivo dose changes of intensity-modulated radiotherapy (IMRT) in patients with cervical cancer in a real-time manner. Methods:Twelve patients with cervical cancer admitted to our hospital were enrolled in this study. The in vivo doses were monitored by PerFRACTION?. Electronic portal imaging device (EPID) were collected in each treatment fraction for two-dimensional in vivo dose verification[γ index and dose difference (DD) index]. Log files were recorded for three-dimensional in vivo dose verification (γ index). The correlation between in vivo dose and treatment duration was analyzed by Pearson correlation analysis. Results:A total of 206 sets of EPID images and corresponding Log files were collected. The three-dimensional in vivo dose verification γ 1%/1mm of all patients was not correlated with treatment fraction ( P>0.05). Among them, the absolute difference of γ 1%/1mm of 94.66% fractions was< 1%. The mean DD 3% of two-dimensional in vivo dose verification of all patients was negatively correlated with treatment fraction ( P<0.05). Among which, the average γ 3%/3mm of 9 patients was>89% in the treatment fractions, and the average γ 3%/3mm of 98.57% fractions of these 9 patients was>93%. The other 3 patients had an average γ 3%/3mm ranged from 38% to 100%. CBCT images showed that the bladder volume of these 3 patients was significantly decreased with the relative changes by 82.08%, 84.41% and 73.59%, respectively, and the target area was retracted significantly with the relative changes by 38.12%, 59.79% and 24.46%, respectively. Conclusion:Combined with γ index and DD index, PerFRACTION? can monitor the mechanical stability of accelerator and MU delivery accuracy during treatment fractions, and monitor the changes of in vivo dose in patients with cervical cancer, which can improve the safety and quality assurance of IMRT for cervical cancer patients and provide guidance for patients with adaptive radiotherapy.

Objective To investigate the efficacy of calf self weight traction reduction combined with locking plate fixation for the treatment of intertrochanteric fractures in the elderly.Methods A retrospective case series study was conducted on the clinical records of 174 elderly patients with the modified Evans Ⅰ-Ⅲ types of fresh intertrochanteric fractures treated with locking plate from January 2012 to December 2015.According to treatment method,the patients were assigned to traction bed reduction with locking plate fixation (Group A,62 patients) and calf self weight traction reduction with locking plate fixation (Group B,112 patients).Group A comprised 32 males and 30 females,with age range of 65-91 years [(72.47 ± 6.35) years].Group B comprised 68 males and 44 females,with age range of 65-95 years [(73.23 ± 6.05) years].The time of reduction,operation time,incision length,intraoperative blood loss,frequency of fluoroscopy,postoperative drainage volume,hospital stay,postoperative weightbearing standing time or walking time (ambulation time),surgical complications,and fracture healing were recorded.Harris and modified Barthel index score in Chinese (MBI-C) were used to evaluate the functional recovery of hip joint.Results All patients were followed up for 5-61 months (mean,15 months),and noted with fracture healing.The time of reduction in Group A was (13.27 ± 3.03) minutes,longer than that in Group B (0 minute) (P ＜0.05).The operation time in Group A was (63.63 ± 13.90)minutes,longer than that in Group B [(59.62 ± 8.38) minutes] (P ＜ 0.05).Fluoroscopy in Group A was (5.35 ± 2.36) times,more than (4.28 ± 3.11) times in Group B (P ＜ 0.05).There were no significant differences in the incision length,intraoperative blood loss,postoperative drainage volume,ambulation time,fracture healing time,Harris score,and MBI-C index between the two groups (P ＞0.05).There were no significant differences in the postoperative complications such as deep venous thrombosis,pulmonary infection,incisional infection,urinary tract infection,delirium,bed sores,cardiac insufficiency,electrolyte disturbance,and postoperative plate rupture between the two groups (P＞0.05).The incidence of deep vein thrombosis was 9.7％ (6/62) in Group A,and 4.5％ (5/112) in Group B (P ＞0.05).No screw fracture,nail and plate combination failure,bone nonunion,or screw cut out of the femoral head were observed in both groups.Conclusions For the modified Evans Ⅰ-Ⅲ types of intertrochanteric fractures,both traction bed reduction and calf weight reduction with locking plate have equivalent efficacy.However,the latter method has advantages of shorter reduction and operation time and less intraoperative X-ray exposure,and hence is worthy of clinical application.