Objectives:To identify the core predictor variables for adolescent idiopathic scoliosis(AIS)pro-gression using machine learning algorithms and develop a risk prediction model.Methods:A cohort of 361 AIS patients initially diagnosed at the Second Hospital of Shanxi Medical University between January 2018 and June 2023 was enrolled and followed.Demographic data and imaging data of the patients were collected.The patients were stratified into progression(Cobb angle increased ≥6° in the primary curve)and non-pro-gression groups,and were randomly divided into training and test sets at an 8∶2 ratio.Predictor variables were selected using LASSO regression and random survival forest(RSF)algorithms.Three prediction models were developed:a RSF model,a survival support vector machine(SSVM)model,and an extreme gradient boosting(XGBoost)model.An optimal model was selected according to the concordance index(C-index)and integrated Brier score,and the discrimination,accuracy and clinical application value of the optimal model were assessed using receiver operating characteristic(ROC)and area under the curve(AUC),bootstrap-corrected C-index,calibration curves,integrated Brier score,and decision curve analysis(DC A)based on the training set.Results:The scoliosis progression rate of the 361 AIS patients was 41.27％.The predictors consistently identified with LASSO regression and RSF algorithm were initial Cobb angle,Risser sign,apical vertebral ro-tation,spinal growth rate,brace treatment or not,T1 tilt angle,and apical vertebra translation.The RSF model demonstrated superior performance with a C-index of 0.837(vs.0.790 for SSVM and 0.743 for XG-Boost)and the lowest integrated Brier score(0.084 vs.0.161 and 0.133).Time-dependent AUC values for the RSF model were 0.903(95％CI:0.829-0.977)at 6 months,0.870(95％CI:0.756-0.985)at 12 months,0.858(95％CI:0.742-0.973)at 18 months,and 0.862(95％CI:0.728-0.997)at 24 months.Bootstrap-corrected C-in-dex remained robust at 0.842(95％CI:0.749-0.917).Calibration curves showed close alignment between pre-dicted and observed outcomes,with an integrated Brier score of 0.084.DCA revealed clinical utility across threshold probabilities of 5％-20％(6-month),10％-80％(12-month),10％-70％(18-month),and 25％-85％(24-month).Conclusions:The RSF model incorporating initial Cobb angle,Risser sign,apical vertebra rotation,spinal growth rate,brace treatment or not,T1 tilt angle,and apical vertebra translation can effectively predict risk probability of scoliosis progression in future for AIS patients after initial diagnosis.

Objectives:To identify the core predictor variables for adolescent idiopathic scoliosis(AIS)pro-gression using machine learning algorithms and develop a risk prediction model.Methods:A cohort of 361 AIS patients initially diagnosed at the Second Hospital of Shanxi Medical University between January 2018 and June 2023 was enrolled and followed.Demographic data and imaging data of the patients were collected.The patients were stratified into progression(Cobb angle increased ≥6° in the primary curve)and non-pro-gression groups,and were randomly divided into training and test sets at an 8∶2 ratio.Predictor variables were selected using LASSO regression and random survival forest(RSF)algorithms.Three prediction models were developed:a RSF model,a survival support vector machine(SSVM)model,and an extreme gradient boosting(XGBoost)model.An optimal model was selected according to the concordance index(C-index)and integrated Brier score,and the discrimination,accuracy and clinical application value of the optimal model were assessed using receiver operating characteristic(ROC)and area under the curve(AUC),bootstrap-corrected C-index,calibration curves,integrated Brier score,and decision curve analysis(DC A)based on the training set.Results:The scoliosis progression rate of the 361 AIS patients was 41.27％.The predictors consistently identified with LASSO regression and RSF algorithm were initial Cobb angle,Risser sign,apical vertebral ro-tation,spinal growth rate,brace treatment or not,T1 tilt angle,and apical vertebra translation.The RSF model demonstrated superior performance with a C-index of 0.837(vs.0.790 for SSVM and 0.743 for XG-Boost)and the lowest integrated Brier score(0.084 vs.0.161 and 0.133).Time-dependent AUC values for the RSF model were 0.903(95％CI:0.829-0.977)at 6 months,0.870(95％CI:0.756-0.985)at 12 months,0.858(95％CI:0.742-0.973)at 18 months,and 0.862(95％CI:0.728-0.997)at 24 months.Bootstrap-corrected C-in-dex remained robust at 0.842(95％CI:0.749-0.917).Calibration curves showed close alignment between pre-dicted and observed outcomes,with an integrated Brier score of 0.084.DCA revealed clinical utility across threshold probabilities of 5％-20％(6-month),10％-80％(12-month),10％-70％(18-month),and 25％-85％(24-month).Conclusions:The RSF model incorporating initial Cobb angle,Risser sign,apical vertebra rotation,spinal growth rate,brace treatment or not,T1 tilt angle,and apical vertebra translation can effectively predict risk probability of scoliosis progression in future for AIS patients after initial diagnosis.

Objective This study aims to construct a network of post-traumatic stress disorder(PTSD)symptoms in first stroke patients,to explore the network characteristics and identify core symptom through network analysis,and provide a basis for precise intervention of symptoms.Methods From October 2022 to April 2023,we recruited 232 first stroke patients by using convenience sampling from a tertiary hospital in Qingdao.PTSD checklist for DSM-5 was used to investigate 20 symptoms,construct a symptom network,and analyze the accuracy and stability of core symptom and network structure.Statistical analysis of the network and data visualization were achieved by R software.The test shows that the accuracy and stability of the network are good,and the network model is reliable.Results The PTSD network shows symptoms of"hypervigilance"and"hyperactive startle response","avoidance of memories,thoughts,or feelings related to the traumatic event"and"avoidance of extemal cues related to the traumatic event","negative beliefs"and"blaming oneself or others"had the strongest association between these 2 symptoms of all.Their regularized partial correlation coefficients were 0.650,0.635,0.381.The symptom"trauma-related forgetting"had the highest predictability.The expected influence results indicated that the symptom"restriction of positive emotion"had the highest centrality.This symptom was more closely related to other symptoms.Conclusion In this study,symptom network analysis was used to explore the symptom network of PTSD in first stroke patients.According to the symptoms with the strongest relationship and the high predictability value in the results,it is suggested that the strong connection between these symptoms should be cut off preventatively during the intervention process to improve the intervention efficiency.The results of PTSD symptom network show that"restriction of positive emotion"is the most core symptom of PTSD.This suggests that clinical health care personnel should take this symptom as the target point of intervention and use it as a breakthrough point to formulate scientific psychological interventions to effectively improve patients'mental health,enhance the control effect of PTSD and promote psychological recovery.

Background::Cancer immunotherapy has emerged as a promising strategy against triple-negative breast cancer (TNBC). One of the immunosuppressive pathways involves programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1), but many patients derived little benefit from PD-1/PD-L1 checkpoint blockades treatment. Prior research has shown that MYC, a master transcription amplifier highly expressed in TNBC cells, can regulate the tumor immune microenvironment and constrain the efficacy of immunotherapy. This study aims to investigate the regulatory relationship between MYC and PD-L1, and whether a cyclin-dependent kinase (CDK) inhibitor that inhibits MYC expression in combination with anti-PD-L1 antibodies can enhance the response to immunotherapy. Methods::Public databases and TNBC tissue microarrays were used to study the correlation between MYC and PD-L1. The expression of MYC and PD-L1 in TNBCs was examined by quantitative real-time polymerase chain reaction and Western blotting. A patient-derived tumor xenograft (PDTX) model was used to evaluate the influence of a CDK7 inhibitor THZ1 on PD-L1 expression. Cell proliferation and migration were detected by 5-ethynyl-2′-deoxyuridine (EdU) cell proliferation and cell migration assays. Tumor xenograft models were established for in vivo verification. Results::A high MYC expression level was associated with a poor prognosis and could alter the proportion of tumor-infiltrating immune cells (TIICs). The positive correlation between MYC and PD-L1 was confirmed by immunostaining samples from 165 TNBC patients. Suppression of MYC in TNBC caused a reduction in the levels of both PD-L1 messenger RNA and protein. In addition, antitumor immune response was enhanced in the TNBC cancer xenograft mouse model with suppression of MYC by CDK7 inhibitor THZ1. Conclusions::The combined therapy of CDK7 inhibitor THZ1 and anti-PD-L1 antibody appeared to have a synergistic effect, which might offer new insight for enhancing immunotherapy in TNBC.

Objective:To investigate the long-term efficacy and complications of augmentation uretero-enterocystoplasty (AUEC).Methods:The clinical data of 262 patients with lower urinary tract dysfunction who underwent AUEC at our center from January 2003 to June 2022 were analyzed retrospectively. There were 193 males and 69 females, the median age was 24 (4, 67) years, the median disease duration was 12.0 (0.2, 56.0) years and the preoperative creatinine was 91.5 (68.1, 140.0) μmol/L. 320 ureters had high-grade UUTD, 216 ureters had VUR, 14 of which had low-pressure reflux.The number of low-grade VUR ureter was 22 (10.2%) and the number of high-grade VUR ureter was 194 (89.8%). Video-urodynamics showed that the maximum bladder capacity was 102 (47, 209) ml, the maximum detrusor pressure was 33.0 (15.5, 50.5) cmH 2O, and the bladder compliance was 6.4 (3.0, 12.3) ml/cmH 2O. All patients underwent AUEC. The surgical method is to cut a segment of sigmoid colon, open the sigmoid colon along the mesenteric margin, fold and suture it into " U" or " S" shaped intestinal mesh according to the principle of " detubulization" . At the same time, perform ureteroplasty and replanting, and then anastomosis the intestinal mesh with the opened bladder flap to form an expanded new bladder. Follow-up was performed via outpatient clinic or telephone. The creatinine, maximum bladder capacity, maximum detrusor pressure, bladder compliance, ureteral reflux and upper urinary tract dilatation were compared preoperatively and postoperatively. The postoperative complications were also evaluated. Results:The median follow-up time was 57.4 (4, 151) months after surgery. At 1-3 months after surgery, the maximum bladder capacity and bladder compliance increased to 303.9% and 189.9% of the preoperative level, and the maximum detrusor pressure decreased to 63.6% of the preoperative level. At 6-10 years after surgery, the maximum bladder capacity and bladder compliance increased to 490.2% and 627.9% and the maximum detrusor pressure decreased to 25.8% of the preoperative level. The UUTD of the patients was significantly reduced after surgery. The number of the high grade UUTD decreased to 116 (116/398, 29.2%) at 1-3 months and 51 (51/274, 18.6%) at 4-6 months. At 6-10 years, the number of the high-grade UUTD decreased to 4 (4/76, 5.3%) ( P<0.001), which was significantly lower than that before operation. The VUR was significantly relieved after operation, and 393 ureters had no VUR at 1-3 months, accounting for 97.8% (393/402) of the total ureters. Sustained remission of VUR was observed during follow-up. 73 ureters had no VUR at 6-10 years, accounting for 96.1% (73/76) of total ureters ( P<0.001). Patients' creatinine decreased to 79.0 (65.0-128.2) μmol/L at 1-3 months postoperatively, with a downward trend but no statistical difference, and creatinine levels were not significantly elevated at any postoperative time point compared with preoperative levels ( P>0.05). Postoperative complications included metabolic acidosis in 26 cases (9.9%), vesicoureteral anastomosis stenosis in 15 cases (5.7%), recurrent urinary tract infection in 16 cases (6.1%), and urinary calculi in 20 cases (7.6%), and intestinal obstruction requiring laparotomy in 8 cases (3.1%), all of them could be improved after treatments. Conclusions:AUEC is a safe and effective method for treating high-grade VUR or VUR with impaired anti-reflux mechanism, high-grade UUTD or UUTD with ureteral or vesicoureteral junction obstruction, and all of the complications can be improved after treatment. This technique can increase the bladder capacity and compliance, reconstruct the anti-reflux mechanism, and release upper urinary tract obstruction. It may play an important role in stabilizing and protecting the residual renal function from further deterioration.

Objective:To summarize the technical points of laparoscopic pancreaticoduodenectomy (LPD) carried out in a single center.Methods:The clinical data of 102 patients who underwent laparoscopic pancreaticoduodenectomy in 2018 at the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University were retrospectively analyzed, and the general conditions, operation time, intraoperative blood loss, and surgical operation were analyzed. Post-operative complications, hospital stay and other indicators were studied.Results:Of the 102 patients who were included, there were 57 males and 45 females, aged 15.0 to 79.0 (59.9±11.8) years old, with a body mass index (23.6±3.6) kg/m 2. For the 102 patients who underwent LPD, 6 were total pancreatic resection. Three were combined with vascular resection in the form of portal vein-superior mesentery vein segmental resection. The operation time was (376.6±87.2) min, the intraoperative blood loss was 350 (100, 800) ml, and the postoperative hospital stay was (17.0±5.9) days. Postoperative complications occurred in 26 of the 102 patients (25.5%), and more than two complications occurred in 17 patients. B/C grade pancreatic fistula occurred in 9 patients (9.4%), abdominal bleeding in 8 patients (7.8%), gastrointestinal bleeding in 2 patients (2.0%), biliary fistula in 4 patients (3.9%), and gastric emptying disorder in 5 patients (4.9%), 8 patients had pulmonary infection (7.8%). Five patients (4.9%) died during the perioperative period. Conclusion:The main technical points of LPD included en bloc resection, pancreaticojejunostomy, and vascular reconstruction. The basis of LPD is en bloc resection. Combined resection and reconstruction of vascular segments is a sign of maturity of LPD technology and a prerequisite for further development as a routine procedure.

Objective To observe DTI manifestations of secondary damage of the somatic sensation conduction fiber bundles in patients with chronic thalamic infarction (TI).Methods Routine MRI and DTI were obtained in 28 patients with unilateral chronic TI (TI group) and 28 healthy volunteers (control group).The fractional anisotropy (FA) value,mean diffusivity (MD) value,primary eigenvalue (λ1) and transverse eigenvalue (λ23) of both spinothalamic tract and central thalamic radiation were calculated,and statistical analysis was performed.Results Compared with those in control group,the FA value of spinothalamic tract and central thalamic radiations significantly decreased (all P＜0.001),while MD,λ1 and λ23 value significantly increased in TI group (all P＜0.05).Conclusion TI can not only result in damage in spinothalamic tract below the infarct,but also cause deterioration in central thalamic radiations above the infarct.Moreover,the secondary damage of spinothalamic tract and central thalamic radiations present the same DTI manifestations in the chronic period.

OBJECTIVETo evaluate the diagnostic value of dynamic monitoring of C-reactive protein (CRP) in drainage fluid in predicting early anastomotic leakage after colorectal surgery.

METHODSThis study enrolled 172 patients, who were diagnosed as colorectal cancer before operation and underwent radical surgery, without residual tumor tissues by postoperative pathology and perioperative infection, at the Tianjin Medical University Cancer Hospital between July 2015 and January 2016. The C-reactive(CRP) protein level in drainage fluid was continuously monitored from postoperative days (POD) 1 to 5. CRP level was compared between anastomotic leakage (AL) group and non-anastomotic leakage (NAL) group. Receiver operating characteristics (ROC) curve was used to estimate the value of monitoring CRP in drainage fluid to predict anastomotic leakage after colorectal surgery.

RESULTSAmong 172 patients, 101 cases were male and 71 cases were female, with age of (59.9±10.3) years. Anastomotic leakage occurred after colorectal surgery in 24 cases(14.0%, AL group ) and other 148 cases were defined as NAL group. Other than body mass index (BMI), differences in baseline data were not statistically significant between two groups. The CRP lever in AL group and NAL group showed rising trend from POD1 to POD4 [Day 1: (6.7±8.4) g/L vs. (8.0±10.6) g/L; Day 2: (24.8±14.6) g/L vs. (28.3±21.1) g/L, Day 3: (54.8±26.5) g/L vs. (53.8±27.6)g/L, Day 4: (62.0±32.2) g/L vs. (58.4±30.7) g/L], while the differences were not significant (all P>0.05). At POD 5, the CRP lever of AL group increased continuously, while that of NAL group decreased with significant difference [(65.3±38.9) g/L vs. (44.7±39.5) g/L, t=-2.85, P=0.005]. Further stratification analysis on AL group revealed CRP level in early AL (AL occurrence POD 10) showed rising trend from POD 1 to 4, then decreased slightly at POD 5, but whose differences were not significant (all P>0.05). ROC curve was drawn with AL condition as state variables and CRP level as test variables. The AUC of POD 1 to 4 was 0.425, 0.487, 0.510, 0.522 respectively and the AUC of POD 5 was the largest, 0.657 (95%CI:0.537-0.777). The largest Youden Index was 0.274. The critical value of CRP was 27.15 g/L. When this value was used as the point of tangency to predict the occurrence of AL, the sensitivity was 87.5%, the specificity was 39.9%, positive predictive value was 19.1%, and negative predictive value was 95.2%.

CONCLUSIONContinuous increase of CRP level in abdominal drainage fluid from POD 1 to POD 5 indicates the occurrence of AL after colorectal cancer operation, especially the detection of CRP level at POD 5 is important.

Objective To review our experience in laparoscopic pancreaticoduodenectomy combined with major vascular resection and reconstruction.Methods Of 183 patients who underwent laparoscopic pancreaticoduodenectomy in our department from November 2013 to January 2017,major vascular resection and reconstruction using the SMA first approach for total mesopancreas excision was performed in 7 patients.The clinical data of these 7 patients were retrospectively analyzed.Results Total 3D laparoscopic surgery was performed in all these 7 patients.The mean operation time,mean blood loss and blood flow occlusion time were (551.4 ± 83.8) min,(671.3 ± 256.3) ml and (45.8 ± 6.7) min,respectively.Six out of 7 patients were pathologically diagnosed to have pancreatic adenocarcinoma with negative surgical margins.Two patients had lymphatic metastasis (the number of metastatic lymph node was 1 in each patient).The mean number of lymph nodes resected was (12.7 ± 5.8).The portal vein-superior mesenteric vein (PV-SMV) was segmentally resected and reconstructed using an end to end anastomosis following the preoperative plan in 4 patients.These included 2 patients who underwent total pancreatectomy.The portal vein was wedge-resected and reconstructed by venorrhaphy in 2 patients.The remaining 1 patient was histopathologically diagnosed to have a mass-type chronic pancreatitis.Only 1 patient was treated in the ICU for 1 day after surgery.Post-operative complications occurred in 2 patients and they were managed with nonsurgical treatment (PV-SMV thrombosis and gastric emptying disorder in 1 and a pancreatic leakage (level A) in 1).The mean length of post-operative hospital stay was (13.7 ± 3.2) days with no in-hospital mortality.Seven patients were alive by April 2017.The mean follow-up for the 6 patients with pancreatic adenocarcinoma was 4.5 (3.5 ～9) months.Conclusions Based on our experience in skillful and masterly major vascular resection and reconstruction in open surgery and on our experience in standard laparoscopic pancreaticoduodenectomy,laparoscopic pancreatieoduodenectomy combined with major vascular resection and reconstruction was feasible and safe.This surgery requires very mature skills in laparoscopic surgery.

Objective To explore the correlation between hypoglycemia and the increased mortality of patients with acute decompensated liver cirrhosis.Methods A retrospective study was conducted on the clinical data of 120 patients with acute decompensated liver cirrhosis admitted to the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from December 2011 to December 2014. The patients were divided into three groups: hypoglycemia group (glucose < 5.0 mmol/L, 21 cases), normoglycemia group (glucose 5.1 - 10.0 mmol/L, 84 cases), and hyperglycemia group (glucose > 10.0 mmol/L, 15 cases). The differences in hepatic carcinoma, decompensation symptoms, the incidence of known glycometabolic disorder, hospitalization situation, indicators of liver function and indexes of blood gas analysis were compared among three groups. The patients' age, hepatic carcinoma, ascites, hepatorenal syndrome, encephalopathy, bleeding, jaundice and glycometabolic disorder, etc were analyzed by the univariate analysis. The resulting risk factors with statistically significant differences were analyzed by multivariate logistic regression method in order to screen out the risk factors of increased mortality.Results The incidences of hepatorenal syndrome [42.9% (9/21) vs. 22.6% (19/84), 33.3% (5/15)] and jaundice [38.1% (7/21) vs. 20.2% (17/84), 13.3% (2/15)], rate of admission into intensive care unit (ICU) [14.3% (3/21) vs. 10.7% (9/84), 13.3% (2/15)] and in-hospital mortality [23.8% (5/21) vs. 10.7% (9/84), 20.0% (3/15)] in the hypoglycemia group were significantly higher than those in the normoglycemia group and hyperglycemia group (P < 0.05 orP < 0.01). The levels of aspartate-aminotransferase (AST), total bilirubin (TBil), serum creatinine (SCr) and international normalized ratio (INR) in hypoglycemia group were obviously higher than those in normoglycemia group and hyperglycemia group [AST (U/L): 628.412±78.625 vs. 170.167±87.035, 156.716±98.047; TBil (μmol/L): 154.122±34.201 vs. 86.712±48.905, 74.313±39.883; SCr (μmol/L): 160.243±56.341 vs. 107.211±59.692, 121.342±84.059; INR: 1.951±0.987 vs. 1.439±0.919, 1.423±0.653,P < 0.05 orP < 0.01]. The levels of HCO3- and base excess (BE) in hypoglycemia group were signicantly lower than those of normoglycemia group and hyperglycemia group [HCO3- (mmol/L): 18.154±10.937 vs. 23.135±11.119, 19.081±12.022; BE (mmol/L): -7.578±2.042 vs. -1.648±0.887, -5.402±2.005, allP < 0.01]. The pH value among three groups showed significant difference (7.352±2.878, 7.461±2.036, 7.219±2.017,P < 0.01). There were no statistically significant differences in alanine transaminase (ALT), blood ammonium, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) and lactate among the three groups (all P > 0.05). Univariate analysis showed that advanced age, hepatic carcinoma, hepatorenal syndrome, bleeding, jaundice and glycometabolic disorder hypoglycemia were the risk factors of the death in patients with acute decompensated liver cirrhosis (P < 0.05 orP < 0.01). Multivariate logistic regression analysis showed that advanced age [odds ratio (OR) = 2.101, 95% confidence interval (95%CI) = 1.297 - 3.403,P = 0.000], hepatorenal syndrome (OR = 3.032, 95%CI = 1.462 - 6.286,P = 0.000) and hypoglycemia (OR = 3.267, 95%CI = 2.135 - 4.999,P = 0.031) were the independent risk factors of the patients' death.Conclusion Hypoglycemia has certain correlation to the increase of mortality in patients with acute decompensated liver cirrhosis.