Objective To explore the application value of different deep learning models in predicting the lung cancer spread through air spaces(STAS).Methods A total of 203 patients with stage Ⅰ—Ⅱ primary lung cancer were included,of which 74 were STAS-positive and 129 were STAS-negative.Patients were randomly divided into training set(142 cases)and test set(61 cases)at a 7∶3 ratio.Region of interest(ROI)was outlined using ITK-SNAP software,facilitating the extraction of tumor and peritumoral images.The Resnet18,Inception_v3,and Vision Transformer(Vit)were employed for model training and feature extraction.Feature selection was performed by the least absolute shrinkage and selection operator(LASSO)algorithm and Spearman correlation coefficient,followed by the establishment of a predictive model using the Naive Bayes machine learning algorithm.The receiver operating characteristic(ROC)curve was drawn to compare the prediction performance of each model.The assessment of calibration was performed using calibration curves,and the evaluation of clinical application value was conducted using decision curve analysis(DCA).Results The area under the curve(AUC)for the training and test sets were as follows:the training set Resnet18 0.849-0.930,Inception_v3 0.848-0.888,Vit 0.747-0.842;and the test set Resnet18 0.796-0.846,Inception_v3 0.783-0.804,Vit 0.690-0.796.In tumor-peritumoral images,Resnet18 had a higher calibration and better clinical net benefit,while Vit showed superior calibration and clinical net benefit when only tumor tissue was considered.Conclusion Deep learning models can effectively predict lung cancer STAS,providing more decision support for the preoperative diagnosis and treatment of stages Ⅰ—Ⅱ lung cancer.

BACKGROUND:Osteoporotic fracture is the most serious complication of osteoporosis.Previous studies have demonstrated that gut microbiota has a regulatory effect on skeletal tissue and that gut microbiota has an important relationship with osteoporotic fracture,but the causal relationship between the two is unclear. OBJECTIVE:To explore the causal relationship between gut microbiota and osteoporotic fractures using Mendelian randomization method. METHODS:The genome-wide association study(GWAS)datasets of gut microbiota and osteoporotic fracture were obtained from the IEU Open GWAS database and the Finnish database R9,respectively.Using gut microbiota as the exposure factor and osteoporotic fracture as the outcome variable,Mendelian randomization analyses with random-effects inverse variance weighted,MR-Egger regression,weighted median,simple model,and weighted model methods were performed to assess whether there is a causal relationship between gut microbiota and osteoporotic fracture.Sensitivity analyses were performed to test the reliability and robustness of the results.Reverse Mendelian randomization analyses were performed to further validate the causal relationship identified in the forward Mendelian randomization analyses. RESULTS AND CONCLUSION:The results of this Mendelian randomization analysis indicated a causal relationship between gut microbiota and osteoporotic fracture.Elevated abundance of Actinomycetales[odds ratio(OR)=1.562,95%confidence interval(CI):1.027-2.375,P=0.037),Actinomycetaceae(OR=1.561,95%CI:1.027-2.374,P=0.037),Actinomyces(OR=1.544,95%CI:1.130-2.110,P=0.006),Butyricicoccus(OR=1.781,95%CI:1.194-2.657,P=0.005),Coprococcus 2(OR=1.550,95%CI:1.068-2.251,P=0.021),Family ⅩⅢ UCG-001(OR=1.473,95%CI:1.001-2.168,P=0.049),Methanobrevibacter(OR=1.274,95%CI:1.001-1.621,P=0.049),and Roseburia(OR=1.429,95%CI:1.015-2.013,P=0.041)would increase the risk of osteoporotic fractures in patients.Elevated abundance of Bacteroidia(OR=0.660,95%CI:0.455-0.959,P=0.029),Bacteroidales(OR=0.660,95%CI:0.455-0.959,P=0.029),Christensenellacea(OR=0.725,95%CI:0.529-0.995,P=0.047),Ruminococcaceae(OR=0.643,95%CI:0.443-0.933,P=0.020),Enterorhabdus(OR=0.558,95%CI:0.395-0.788,P=0.001),Eubacterium rectale group(OR=0.631,95%CI:0.435-0.916,P=0.016),Lachnospiraceae UCG008(OR=0.738,95%CI:0.546-0.998,P=0.048),and Ruminiclostridium 9(OR=0.492,95%CI:0.324-0.746,P=0.001)would reduce the risk of osteoporotic fractures in patients.We identified 16 gut microbiota associated with osteoporotic fracture by the Mendelian randomization method.That is,using gut microbiota as the exposure factor and osteoporotic fracture as the outcome variable,eight gut microbiota showed positive causal associations with osteoporotic fracture and another eight gut microbiota showed negative causal associations with osteoporotic fracture.The results of this study not only identify new biomarkers for the early prediction of osteoporotic fracture and potential therapeutic targets in clinical practice,but also provide an experimental basis and theoretical basis for the study of improving the occurrence and prognosis of osteoporotic fracture through gut microbiota in bone tissue engineering.

Objective To explore the application value of different deep learning models in predicting the lung cancer spread through air spaces(STAS).Methods A total of 203 patients with stage Ⅰ—Ⅱ primary lung cancer were included,of which 74 were STAS-positive and 129 were STAS-negative.Patients were randomly divided into training set(142 cases)and test set(61 cases)at a 7∶3 ratio.Region of interest(ROI)was outlined using ITK-SNAP software,facilitating the extraction of tumor and peritumoral images.The Resnet18,Inception_v3,and Vision Transformer(Vit)were employed for model training and feature extraction.Feature selection was performed by the least absolute shrinkage and selection operator(LASSO)algorithm and Spearman correlation coefficient,followed by the establishment of a predictive model using the Naive Bayes machine learning algorithm.The receiver operating characteristic(ROC)curve was drawn to compare the prediction performance of each model.The assessment of calibration was performed using calibration curves,and the evaluation of clinical application value was conducted using decision curve analysis(DCA).Results The area under the curve(AUC)for the training and test sets were as follows:the training set Resnet18 0.849-0.930,Inception_v3 0.848-0.888,Vit 0.747-0.842;and the test set Resnet18 0.796-0.846,Inception_v3 0.783-0.804,Vit 0.690-0.796.In tumor-peritumoral images,Resnet18 had a higher calibration and better clinical net benefit,while Vit showed superior calibration and clinical net benefit when only tumor tissue was considered.Conclusion Deep learning models can effectively predict lung cancer STAS,providing more decision support for the preoperative diagnosis and treatment of stages Ⅰ—Ⅱ lung cancer.

Objective To evaluate the correlation between MRI burden of cerebral small vessel disease and cognitive impairment in elderly hypertensive people.Methods Data of elderly hypertensive people with CSVD at Xingtai People's Hospital Affiliated to Hebei Medical University from January 2018 to September 2024 were analyzed.According to the total MRI burden score,patients were divided into mild to moderate(0-2)and severe(3-4)burden groups.The baseline data and cognitive impairment were compared between groups.The correlation between risk factors of MRI burden and cognitive impairment was analyzed.Results The severe burden group had higher systolic blood pressure[178(155,180)mmHg vs.159.50(147.75,170)mmHg,higher fasting blood glucose[5.70(5.37,5.92)mmHg vs.5.38(4.83,5.70)mmHg,P<0.05]and higher the proportion of cognitive impairment[8(28.1%)vs.3(6.8%),P<0.05]than the mild to moderate group.Multivariate logistic regression analysis revealed that systolic blood pressure(OR=1.033,95%CI:1.001-1.067,P<0.05)was the independent risk factor for total MRI burden.Spearman correlation analysis revealed that MRI total burden was negatively correlated with MMSE score(r=-0.315,P=0.011)and MoCA score(r=-0.662,P<0.001).Compared with the mild to moderate burden group,the severe group performed worse in the areas of orientation,attention and computation,language ability on the MMSE,and worse in visual space and executive ability,attention,language,delayed recall,and orientation on the MoCA(P<0.05).Conclusion Systolic blood pressure is the independent risk factor of MRI total burden in elderly hypertensive people.The higher the total MRI burden,the more severe the cognitive impairment,the worse performance in orientation,visual space and executive ability,attention and computation,language,and delayed recall.

Objective To evaluate the correlation between MRI burden of cerebral small vessel disease and cognitive impairment in elderly hypertensive people.Methods Data of elderly hypertensive people with CSVD at Xingtai People's Hospital Affiliated to Hebei Medical University from January 2018 to September 2024 were analyzed.According to the total MRI burden score,patients were divided into mild to moderate(0-2)and severe(3-4)burden groups.The baseline data and cognitive impairment were compared between groups.The correlation between risk factors of MRI burden and cognitive impairment was analyzed.Results The severe burden group had higher systolic blood pressure[178(155,180)mmHg vs.159.50(147.75,170)mmHg,higher fasting blood glucose[5.70(5.37,5.92)mmHg vs.5.38(4.83,5.70)mmHg,P<0.05]and higher the proportion of cognitive impairment[8(28.1%)vs.3(6.8%),P<0.05]than the mild to moderate group.Multivariate logistic regression analysis revealed that systolic blood pressure(OR=1.033,95%CI:1.001-1.067,P<0.05)was the independent risk factor for total MRI burden.Spearman correlation analysis revealed that MRI total burden was negatively correlated with MMSE score(r=-0.315,P=0.011)and MoCA score(r=-0.662,P<0.001).Compared with the mild to moderate burden group,the severe group performed worse in the areas of orientation,attention and computation,language ability on the MMSE,and worse in visual space and executive ability,attention,language,delayed recall,and orientation on the MoCA(P<0.05).Conclusion Systolic blood pressure is the independent risk factor of MRI total burden in elderly hypertensive people.The higher the total MRI burden,the more severe the cognitive impairment,the worse performance in orientation,visual space and executive ability,attention and computation,language,and delayed recall.

Small cell carcinoma of the prostate is a rare and highly malignant tumor of the urinary system. It is less common for prostate small cell carcinoma coexisting with bladder carcinoma. One such case was reported in this paper. The patient underwent ultrasound-guided transrectal prostate biopsy, and transurethral bladder endoscopy + bladder tumor electric resection. Postoperative pathology and immunohistochemistry showed prostate small cell carcinoma accompanied by high-grade invasive urothelial carcinoma of the bladder and small cell carcinoma. The patient underwent local bladder perfusion chemotherapy, relying on etoposide plus lobaplatin systemic chemotherapy and toripalimab immunotherapy. Prostate MRI, cystoscopy, and prostate-specific antigen (PSA) were performed 12 months after operation. The size of the lesions in the prostate and seminal vesicles had decreased, and there was a significant reduction in PSA levels. Additionally, no masses were detected in the bladder.

Objective To explore the related factors of lymph node metastasis in early gastric cancer and to analyze the clinical efficacy between laparoscopic D2 radical resection and endoscopic submucosal dissection(ESD).Methods A retrospective cohort study was conducted on 404 patients with early gastric cancer undergoing surgical treatment in our hospital from June 2018 to June 2022 were recruited in this study.According to their surgical treatment,they were divided into laparoscopy group(n=271)and ESD group(n=133).The lymph node metastases were compared in the patients with different clinical features,and the factors affecting lymph node metastasis were analyzed with multivariate logistic regression analysis.The lymph node metastasis rate of patients with absolute and expanded indications of ESD was calculated.Kaplan-Meier survival analysis was used to compare the long-term efficacy of ESD and laparoscopic D2 radical resection in these patients.Stratified regression analysis was applied to explore the relationship between surgical methods and long-term outcome in them.Results In the 404 patients with early gastric cancer,the rate of lymph node metastasis was 12.38％(50/404).Univariate analysis showed that 7 clinical features,such as ulcer,tumor pathological features and pathological differentiation,were related to lymph node metastasis.Multivariate logistic regression analysis revealed that low differentiation and tumor infiltration depth of submucous membrane(SM)were related factors affecting lymph node metastasis in early gastric cancer.The overall survival rate was 96.29％(389/404)in the 404 patients,96.31％in the laparoscopic group and 96.24％in the ESD group,and no statistical difference was seen between the 2 groups(P＞0.05).There was no obvious difference in 5-year survival rate between the patients who met the absolute indications for ESD and underwent laparoscopic D2 radical surgery and those receiving ESD treatment(96.00％vs 96.55％),and between those who were in accordance with the expanded indications for ESD and underwent laparoscopic D2 radical surgery and those receiving ESD treatment(94.74％vs 91.67％).After adjusting the clinical features such as lesion size,pathological differentiation and depth of tumor invasion by stratified regression analysis,the mode of operation for early gastric cancer was still correlated with the long-term efficacy(β=1.173,P=0.003).Conclusion The depth of tumor infiltration and differentiation are closely related to lymph node metastasis in early gastric cancer patients.The efficacy of laparoscopic D2 radical surgery on the patients with absolute and expanded indications for ESD is comparable to that of ESD treatment.

Objective To explore the value of probe-based confocal laser endomicroscopy(pCLE)in the differential diagnosis of fundic gland polyps.Methods A total of 63 patients who underwent conventional white light image(WLI)and suggested with gastric polyps in our gastroenterology endoscopy center during June and December 2023 were enrolled,and their clinical data,WLI,narrow band images(NBI),pCLE images and postoperative histopathological findings were collected.The characteristics of fundic gland polyps under pCLE were statistically verified,and the sensitivity,specificity,accuracy and consistency of different endoscopic diagnoses were calculated respectively.Results Under pCLE,fundic gland polyps were mainly manifested as elongated gastric pit opening,"hand-in-hand"gastric pit opening,well-arranged blood vessels around the pit opening,and no luciferin oozing.The sensitivity,specificity,accuracy of WLI were 72.73％,75.00％,73.13％and 0.343 for fundic gland polyps,and 81.82％,71.43％,71.64％and 0.354 for hyperplastic polyps,respectively.While,the above values of NBI were 87.27％,83.33％,86.57％and 0.673 for fundic gland polyps,and 81.82％,85.71％,85.07％and 0.554 for hyperplastic polyps;and those of pCLE were 92.73％,91.67％,92.53％and 0.769 for fundic gland polyps,and 90.91％,94.64％,94.03％and 0.797 for hyperplastic polyps pCLE had better sensitivity,specificity and accuracy than WLI and NBI,and had the results consistent with histopathological findings.Conclusion pCLE can be used in the differential diagnosis of fundic gland polyps.

ObjectiveTo explore the possible mechanism of Yiqi Yangyin Huoxue prescription in the prevention and treatment of kidney injury of diabetic kidney disease（DKD）rats based on NOD-like receptor protein 3（NLRP3）/cysteine protease-1（Caspase-1）/gasdermin D （GSDMD）pyroptosis pathway. MethodFifty male SD rats were randomly divided into normal group （n=8） and modeling group （n=42）. The modeling group was given a one-time intraperitoneal injection of streptozotocin （STZ） after high-sugar and high-fat diet for 6 weeks to induce the establishment of a DKD rat model. After successful modeling， the rats were randomly divided into model group， valsartan group （8.33 mg·kg^-1）， and Yiqi Yangyin Huoxue prescription low-dose and high-dose group （11，22 g·kg^-1）. After continuous gavage for 6 weeks， the fasting blood glucose （FBG）， total cholesterol （CHO）， triglyceride （TG）， blood urea nitrogen （BUN）， serum creatinine （SCr） and 24-hour urine protein quantification （24 h-UTP） were detected in each group of rats. Hematoxylin-eosin （HE） staining was used to observe the pathological changes of kidney tissue. Enzyme-linked immunosorbent assay （ELISA） was used to detect serum interleukin-1β （IL-1β） and interleukin-18 （IL-18） levels. The protein and mRNA expression levels of NLRP3/Caspase-1/GSDMD in kidney tissue of rats in each group were determined by Western blot and real-time quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the conditions in normal group， the levels of FBG， CHO， TG， BUN， SCr， 24 h-UTP and serum IL-1β and IL-18 as well as the protein and mRNA expression levels of NLRP3/Caspase-1/GSDMD in kidney tissue in model group were increased （P<0.01）， and the kidney tissue lesions were severe. Compared with the conditions in model group， the levels of FBG， CHO， TG， BUN， SCr， 24 h-UTP and serum IL-1β and IL-18 as well as the protein and mRNA expression levels of NLRP3/Caspase-1/GSDMD in kidney tissue in each intervention group were decreased （P<0.05， P<0.01）， and the degree of kidney tissue lesions was improved， with Yiqi Yangyin Huoxue prescription high-dose group showing the optimal effect. ConclusionYiqi Yangyin Huoxue prescription could inhibit pyroptosis by regulating the NLRP3/Caspase-1/GSDMD pathway， and thus relieve the inflammatory response of DKD rats and alleviate the pathological damage of the kidneys.

Chromatin modification contributes to pluripotency maintenance in embryonic stem cells(ESCs).However,the related mechanisms remain obscure.Here,we show that Npac,a"reader"of histone H3 lysine 36 trimethylation(H3K36me3),is required to maintain mouse ESC(mESC)pluripotency since knockdown of Npac causes mESC differentiation.Depletion of Npac in mouse embryonic fibroblasts(MEFs)inhibits reprogramming efficiency.Furthermore,our chromatin immunoprecipitation followed by sequencing(ChIP-seq)results of Npac reveal that Npac co-localizes with histone H3K36me3 in gene bodies of actively transcribed genes in mESCs.Interestingly,we find that Npac interacts with positive transcription elongation factor b(p-TEFb),Ser2-phosphorylated RNA Pol Ⅱ(RNA Pol Ⅱ Ser2P),and Ser5-phosphorylated RNA Pol Ⅱ(RNA Pol Ⅱ Ser5P).Furthermore,depletion of Npac disrupts transcriptional elongation of the pluripotency genes Nanog and Rifl.Taken together,we propose that Npac is essential for the transcriptional elongation of pluripotency genes by recruiting p-TEFb and interact-ing with RNA Pol Ⅱ Ser2P and Ser5P.