Objective:To investigate the efficacy of a predictive model for differentiating benign and malignant renal tumors based on CT radiomic features and clinical features.Methods:A retrospective study was conducted on 1 395 patients with renal tumors admitted to the First Affiliated Hospital of Zhengzhou University from December 2011 to December 2021, including 842 males and 553 females. The median age was 55 (44, 59) years, and the median tumor diameter was 3.6 (2.7, 4.6) cm. All patients underwent contrast-enhanced CT scaning before surgery, and radiomic features were extracted from non-contrast, arterial, and venous phase images. Prediction models for distinguishing benign and malignant renal tumors were constructed using five machine learning algorithms (logistic regression, support vector machine, neural network, random forest, and extreme gradient boosting), and these models were then ensembled to construct a stacking classifier. All patients underwent partial nephrectomy, and they were divided into a training group (941 cases, December 2011 to June 2020) and a validation group (454 cases, July 2020 to December 2021) based on the date of surgery. A clinical-radiomic model was developed by combining the result of stacking classifier, clinical features and CT report results, and its predictive performance was evaluated in the validation group.Results:The radiomic signature based on the combined features and five machine learning algorithms(AUC 0.835-0.844) showed higher accuracy in predicting benign and malignant renal tumors compared to single phases (AUC 0.744-0.831). After integrating the five machine learning algorithms, the AUC of the three-phase combined radiomic model in the validation group improved to 0.847(95% CI 0.802-0.892). The clinical-radiomic model, incorporating radiomic features, clinical features, and CT report results, achieved a significantly higher AUC in the validation group compared to radiologists [0.919(95% CI 0.889-0.950)vs. 0.835(95% CI 0.786-0.883), P<0.01]. Conclusions:The predictive model integrating CT radiomics features, clinical characteristics, and CT report results demonstrates excellent discriminative ability in distinguishing benign and malignant renal tumors.

Objective To investigate the expression changes and clinical significance of serum pepsinogen(PG)and triggering receptor expressed on myeloid cells-1(TREM-1)in patients with reflux esophagitis(RE).Methods A total of 140 patients with RE who were treated from October 2021 to October 2023 were selected as the observation group,and 140 healthy adults who underwent physical examination during the same period were selected as the control group.Serum PG(PGⅠ and PGⅡ)and TREM-1 were detected by ELISA.Multivariate logistic regression was used to analyze the influencing factors of RE.Receiver operating characteristic(ROC)was used to analyze the diagnostic efficacy of serum PGⅠ,PGⅡ and TREM-1 levels for RE.Results The levels of interleukin(IL)-2,IL-6,Il-1β,PGⅡ,TREM-1 and tumor necrosis factor-α(TNF-α)in the observation group were significantly higher than those in the control group,while the level of PGⅠ was significantly lower than that in the control group(P<0.01).Serum IL-2,IL-6,IL-1β,TNF-α,PGⅡ and TREM-1 were risk factors for RE,while serum PGⅠ was a protective factor for RE(P<0.01).ROC curve analysis showed that the area under the ROC curve(AUC)of combined detection of PGⅠ,PGⅡ and TREM-1 in the diagnosis of RE was significantly higher than that of PGⅠ alone(Z=5.940,P<0.001)and PGⅡ alone(Z=6.764,P<0.001)and TREM-1 alone(Z=6.791,P<0.001).Conclusion The expression levels of serum PGⅡ and TREM-1 in patients with RE are increased,while the expression level of PGⅠ is decreased.The combined detection of the three can improve the diagnostic efficacy of RE.

Background and purpose:Single-week ultra-hypofractionated whole breast irradiation(WBI)after breast-conserving surgery could shorten the treatment duration while ensuring efficacy and safety,making it a viable option for WBI.However,ultra-hypofractionated WBI requires daily image-guided radiotherapy(IGRT),and its impact on setup errors remains unclear.This study aimed to identify factors associated with set-up errors in ultra-hypofractionated WBI guided with daily cone-beam computed tomography(CBCT)and calculate margin expanded from clinical target volume(CTV)to planning target volume(PTV).Methods:This study included patients enrolled in a prospective trial that explored the safety of single-week ultra-hypofractionated WBI(NCT04926766)in Shanghai Ruijin Hospital,which was approved by Shanghai Ruijin Hospital Ethics Committee(No.2020-352).All patients received CBCT1 after positioning.After correcting errors,patients received CBCT2.CBCT3 was conducted after radiotherapy was completed.The translational errors between CBCT1,CBCT2,and plan CT were initial and residual inter-fractional errors.The translational error between CBCT2 and CBCT3 was an intra-fractional error.The PTV margin was calculated according to the van Herk formula.Results:A total of 34 patients were enrolled in this study,and 510 CBCT images were collected.Daily CBCT significantly reduced set-up error in anterior-posterior(AP),superior-inferior(SI)and right-left(RL)directions(initial inter-fractional error vs residual inter-fractional error:AP,2.8 mm vs 0.4 mm;SI,1.6 mm vs 0.5 mm;RL,1.8 mm vs 0.3 mm,all P＜0.001).Higher CTV volume(＞402.5 cm3 vs≤402.5 cm3)was associated with larger residual inter-fractional error(0.5 mm vs 0.3 mm,P=0.023)and intra-fractional error(0.5 mm vs 0.2 mm,P=0.001)in AP direction.Higher CTV volume was also associated with larger residual inter-fractional error in the SI direction(0.6 mm vs 0.5 mm,P=0.037).Higher BMI(＞23.2 kg/m2 vs≤23.2 kg/m2)and larger weight(＞60.0 kg vs≤60.0 kg)were associated with larger intra-fractional error in AP direction:0.7 mm vs 0.2 mm(P＜0.001)and 0.5 mm vs 0.2 mm(P=0.033),respectively.Under guidance with daily CBCT,the recommended margins were 2.3 mm in AP direction,2.8 mm in SI direction,and 2.0 mm in RL direction.However,in patients with CTV volume＞402.5 cm3 and BMI＞23.2 kg/m2,a larger margin was recommended in SI direction:3.1 mm and 3.4 mm,respectively.Conclusion:The 3 mm margin was feasible under guidance with daily CBCT.The CTV to PTV margin should be larger in patients with higher BMI or CTV volume.

Objective To investigate the expression changes and clinical significance of serum pepsinogen(PG)and triggering receptor expressed on myeloid cells-1(TREM-1)in patients with reflux esophagitis(RE).Methods A total of 140 patients with RE who were treated from October 2021 to October 2023 were selected as the observation group,and 140 healthy adults who underwent physical examination during the same period were selected as the control group.Serum PG(PGⅠ and PGⅡ)and TREM-1 were detected by ELISA.Multivariate logistic regression was used to analyze the influencing factors of RE.Receiver operating characteristic(ROC)was used to analyze the diagnostic efficacy of serum PGⅠ,PGⅡ and TREM-1 levels for RE.Results The levels of interleukin(IL)-2,IL-6,Il-1β,PGⅡ,TREM-1 and tumor necrosis factor-α(TNF-α)in the observation group were significantly higher than those in the control group,while the level of PGⅠ was significantly lower than that in the control group(P<0.01).Serum IL-2,IL-6,IL-1β,TNF-α,PGⅡ and TREM-1 were risk factors for RE,while serum PGⅠ was a protective factor for RE(P<0.01).ROC curve analysis showed that the area under the ROC curve(AUC)of combined detection of PGⅠ,PGⅡ and TREM-1 in the diagnosis of RE was significantly higher than that of PGⅠ alone(Z=5.940,P<0.001)and PGⅡ alone(Z=6.764,P<0.001)and TREM-1 alone(Z=6.791,P<0.001).Conclusion The expression levels of serum PGⅡ and TREM-1 in patients with RE are increased,while the expression level of PGⅠ is decreased.The combined detection of the three can improve the diagnostic efficacy of RE.

Background and purpose:Single-week ultra-hypofractionated whole breast irradiation(WBI)after breast-conserving surgery could shorten the treatment duration while ensuring efficacy and safety,making it a viable option for WBI.However,ultra-hypofractionated WBI requires daily image-guided radiotherapy(IGRT),and its impact on setup errors remains unclear.This study aimed to identify factors associated with set-up errors in ultra-hypofractionated WBI guided with daily cone-beam computed tomography(CBCT)and calculate margin expanded from clinical target volume(CTV)to planning target volume(PTV).Methods:This study included patients enrolled in a prospective trial that explored the safety of single-week ultra-hypofractionated WBI(NCT04926766)in Shanghai Ruijin Hospital,which was approved by Shanghai Ruijin Hospital Ethics Committee(No.2020-352).All patients received CBCT1 after positioning.After correcting errors,patients received CBCT2.CBCT3 was conducted after radiotherapy was completed.The translational errors between CBCT1,CBCT2,and plan CT were initial and residual inter-fractional errors.The translational error between CBCT2 and CBCT3 was an intra-fractional error.The PTV margin was calculated according to the van Herk formula.Results:A total of 34 patients were enrolled in this study,and 510 CBCT images were collected.Daily CBCT significantly reduced set-up error in anterior-posterior(AP),superior-inferior(SI)and right-left(RL)directions(initial inter-fractional error vs residual inter-fractional error:AP,2.8 mm vs 0.4 mm;SI,1.6 mm vs 0.5 mm;RL,1.8 mm vs 0.3 mm,all P＜0.001).Higher CTV volume(＞402.5 cm3 vs≤402.5 cm3)was associated with larger residual inter-fractional error(0.5 mm vs 0.3 mm,P=0.023)and intra-fractional error(0.5 mm vs 0.2 mm,P=0.001)in AP direction.Higher CTV volume was also associated with larger residual inter-fractional error in the SI direction(0.6 mm vs 0.5 mm,P=0.037).Higher BMI(＞23.2 kg/m2 vs≤23.2 kg/m2)and larger weight(＞60.0 kg vs≤60.0 kg)were associated with larger intra-fractional error in AP direction:0.7 mm vs 0.2 mm(P＜0.001)and 0.5 mm vs 0.2 mm(P=0.033),respectively.Under guidance with daily CBCT,the recommended margins were 2.3 mm in AP direction,2.8 mm in SI direction,and 2.0 mm in RL direction.However,in patients with CTV volume＞402.5 cm3 and BMI＞23.2 kg/m2,a larger margin was recommended in SI direction:3.1 mm and 3.4 mm,respectively.Conclusion:The 3 mm margin was feasible under guidance with daily CBCT.The CTV to PTV margin should be larger in patients with higher BMI or CTV volume.

Objective:To investigate the efficacy of a predictive model for differentiating benign and malignant renal tumors based on CT radiomic features and clinical features.Methods:A retrospective study was conducted on 1 395 patients with renal tumors admitted to the First Affiliated Hospital of Zhengzhou University from December 2011 to December 2021, including 842 males and 553 females. The median age was 55 (44, 59) years, and the median tumor diameter was 3.6 (2.7, 4.6) cm. All patients underwent contrast-enhanced CT scaning before surgery, and radiomic features were extracted from non-contrast, arterial, and venous phase images. Prediction models for distinguishing benign and malignant renal tumors were constructed using five machine learning algorithms (logistic regression, support vector machine, neural network, random forest, and extreme gradient boosting), and these models were then ensembled to construct a stacking classifier. All patients underwent partial nephrectomy, and they were divided into a training group (941 cases, December 2011 to June 2020) and a validation group (454 cases, July 2020 to December 2021) based on the date of surgery. A clinical-radiomic model was developed by combining the result of stacking classifier, clinical features and CT report results, and its predictive performance was evaluated in the validation group.Results:The radiomic signature based on the combined features and five machine learning algorithms(AUC 0.835-0.844) showed higher accuracy in predicting benign and malignant renal tumors compared to single phases (AUC 0.744-0.831). After integrating the five machine learning algorithms, the AUC of the three-phase combined radiomic model in the validation group improved to 0.847(95% CI 0.802-0.892). The clinical-radiomic model, incorporating radiomic features, clinical features, and CT report results, achieved a significantly higher AUC in the validation group compared to radiologists [0.919(95% CI 0.889-0.950)vs. 0.835(95% CI 0.786-0.883), P<0.01]. Conclusions:The predictive model integrating CT radiomics features, clinical characteristics, and CT report results demonstrates excellent discriminative ability in distinguishing benign and malignant renal tumors.

Objective:To evaluate the impact of bladder volume on dosimetric parameters of clinical target volume (CTV) and organs at risk (OAR) of intensity modulated proton therapy (IMPT) for localized prostate cancer during the treatment planning and daily treatment.Methods:Clinical data of 25 patients with localized prostate cancer admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 and enrolled in the "Proton Therapy System" (SAPT-PS-01) registered clinical trial were retrospectively analyzed. All patients were male and the median age was 72 years old. A total of 30 sets of IMPT plans were obtained. Based on the planning CT (30 sets) and weekly verification CT during treatment (172 sets), bladder volume, CTV and OAR dose parameters were collected. Spearman correlation analysis was used to evaluate the correlation between bladder volume in CT and the dosimetric parameters of CTV and OAR during IMPT plans, and Wilcoxon-Mann-Whitney test was adopted to compare the dosimetric parameters of CTV and OAR among different bladder volume change groups.Results:The V 95% of CTV1 and CTV2 were both 100.0%±0.0% in IMPT plans. Bladder volume was significantly negatively correlated with D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder ( P<0.001, 0.003, <0.001, <0.001,<0.001), and D mean, V 50 Gy(RBE) of the small intestine (both P<0.001). During treatment, bladder D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE)( P<0.001, 0.001, <0.001, <0.001, <0.001), rectal D mean, V 50 Gy(RBE), V 40 Gy(RBE) (all P<0.001), small intestine D mean, V 50 Gy (RBE) (both P<0.001) of patients with bladder volume increase >20% compared to baseline were significantly decreased compared to those in IMPT plans. But CTV1 V 100%, and CTV2 V 95% were significantly decreased too( P=0.029, 0.020). In the bladder volume decreased>20% patients, the D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder were significantly increased compared to those in IMPT plans (all P<0.001). However, a bladder volume reduction of ≤20% and increase of ≤20% from baseline had no significant impact on CTV and OAR dosimetric parameters during treatment. Conclusions:For patients with localized prostate cancer undergoing proton therapy, a certain bladder volume should be ensured during planning CT scans. During the daily treatment, the bladder volume should be maintained between 80%-120% of the baseline level to ensure CTV coverage and good dose sparing to OAR.

Clinical data of a teenager with slipped capital femoral epiphysis (SCFE) combined with primary hyperparathyroidism (PHPT) treated in the Children′s Hospital of Soochow University in May 2022 were retrospectively analyzed.A girl, aged 13 years and 5 months, had claudication of both lower limbs for 1.5 years, and the symptom was aggravated for 1 month.X-ray examination of the hip joint showed bilateral SCFE.However, the patient had a body mass index of 18.2 kg/m 2 and no trauma, which did not meet the typical characteristics of SCFE.Further ultrasound examination of the parathyroid gland shows parathyroid adenoma.And parathyroid adenoma was considered to cause PHPT, which in turn triggered SCFE.After surgical resection of the PHPT, the patient had a better fusion of the femoral head and femoral neck and improved hip joint function.Therefore, SCFE fixation was not performed.The diagnosis and treatment of this patient indicated that for similar patients with SCFE and PHPT, SCFE may not be treated with internal fixation, if the femoral head and femoral neck have been fused, the hip joint function has improved, and the pain has been relieved after resection of PHPT.In patients with SCFE and PHPT, the management of hyperparathyroidism takes precedence over the treatment of SCFE.Acute and acute-on-chronic slip, with or without PHPT-induced hypercalcemia, should be treated first by SCFE fixation, and excising parathyroid adenoma should be performed simultaneously or as soon as possible.For chronic slip patients who have mild to moderate hypercalcemia and one or more related symptoms, parathyroidectomy should be performed firstly, and then the SCFE fixation should be considered after parathyroid hormone and blood calcium levels become stable.

Objective To identify the N6-methyladenosine (m6A)-related characteristic genes analyzed by gene clustering and immune cell infiltration in myocardial ischemia-reperfusion injury (MI/RI) after cardiopulmonary bypass through machine learning. Methods The differential genes associated with m6A methylation were screened by the dataset GSE132176 in GEO, the samples of the dataset were clustered based on the differential gene expression profile, and the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of the differential genes of the m6A cluster after clustering were performed to determine the gene function of the m6A cluster. R software was used to determine the better models in machine learning of support vector machine (SVM) model and random forest (RF) model, which were used to screen m6A-related characteristic genes in MI/RI, and construct characteristic gene nomogram to predict the incidence of disease. R software was used to analyze the correlation between characteristic genes and immune cells, and the online website was used to build a characteristic gene regulatory network. Results In this dataset, a total of 5 m6A-related differential genes were screened, and the gene expression profiles were divided into two clusters for cluster analysis. The enrichment analysis of m6A clusters showed that these genes were mainly involved in regulating monocytes differentiation, response to lipopolysaccharides, response to bacteria-derived molecules, cellular response to decreased oxygen levels, DNA transcription factor binding, DNA-binding transcription activator activity, RNA polymerase Ⅱ specificity, NOD-like receptor signaling pathway, fluid shear stress and atherosclerosis, tumor necrosis factor signaling pathway, interleukin-17 signaling pathway. The RF model was determined by R software as the better model, which determined that METTL3, YTHDF1, RBM15B and METTL14 were characteristic genes of MI/RI, and mast cells, type 1 helper lymphocytes (Th1), type 17 helper lymphocytes (Th17), and macrophages were found to be associated with MI/RI after cardiopulmonary bypass in immune cell infiltration. Conclusion The four characteristic genes METTL3, YTHDF1, RBM15B and METTL14 are obtained by machine learning, while cluster analysis and immune cell infiltration analysis can better reveal the pathophysiological process of MI/RI.

BACKGROUND:At present,open reduction and internal fixation and minimally invasive needle aspiration are commonly used in patients with Sanders types Ⅱ and Ⅲ calcaneal fractures.However,there is little comparison between the clinical efficacy of the two methods and high-level clinical evidence is still available. OBJECTIVE:To compare the curative effect of Sanders types Ⅱ and Ⅲ calcaneal fractures treated by three-dimensional digital model-assisted minimally invasive needle penetration and tarsal sinus incision and manual reduction and internal fixation with steel plate. METHODS:From January 2021 to October 2022,80 patients with Sanders types Ⅱ and Ⅲ calcaneal fractures who were treated in the Department of Orthopedics,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were randomly divided into control group(40 cases)and observation group(40 cases).The control group was treated with manual reduction and internal fixation with steel plate through the traditional tarsal sinus incision,while the observation group was treated with a three-dimensional digital model assisted with minimally invasive needle penetration fixation.The operation time,blood loss,hospitalization time and fracture healing time of the two groups were recorded.The changes in Maryland score,AO-FAS score,pain visual analog scale score,quality of life score(SF-36 score),and imaging parameters(B?hler angle,Gissane angle,calcaneal length,width and height)were observed before and 12 months after operation in the two groups.The complications during the follow-up were recorded. RESULTS AND CONCLUSION:(1)Operation time,blood loss,hospitalization time and fracture healing time in the observation group were lower than those in the control group(all P<0.05).(2)The Maryland score,AO-FAS score,SF-36 score,B?hler angle,Gissane angle,calcaneal length and height of the two groups after treatment were significantly higher than those before treatment(all P<0.05).Visual analog scale score and calcaneal width were significantly lower than those before treatment(all P<0.05).(3)After 12 months of follow-up,the incidence of complications in the observation group was lower than that in the control group(all P<0.05).(4)In conclusion,the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures with three-dimensional digital model-assisted minimally invasive needle penetration fixation can significantly improve the operation time,bleeding volume and other perioperative indicators,and can reduce the occurrence of multiple complications.The recovery of ankle function,relief of pain symptoms,and improvement of quality of life are equivalent to traditional therapy.