Objective To construct a predictive model for the occurrence of lower extremity deep vein thrombosis(DVT)after internal fixation surgery for thoracolumbar fractures by using extreme gradient boosting(XGBoost).Methods Data of 220 patients who underwent internal fixation surgery for thoracolumbar fractures in the First Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2022 was collected.The dataset was divided into a training set(154 cases)and a testing set(66 cases).The training set was processed by using the synthetic minority over-sampling technique and the predictive model was build based on XGBoost.The performance was compared on the testing set by using area under receiver operating characteristic curve,accuracy,F1 score,sensitivity and specificity.The interpretability analysis base on SHAP was conducted to quantify the degree of contribution of influencing factors.Results The XGBoost model outperformed logistic regression,support vector machine and random forest models on multiple metrics,with an area under the curve of 0.761 on the original testing set.The decision curve indicated that the XGBoost model has clinical application value.Conclusion The XGBoost model based on factors such as age,body mass index,and postoperative albumin,D-dimer,total protein,erythrocyte sedimentation rate,prothrombin time can effectively predict the occurrence of lower extremity DVT after internal fixation surgery for thoracolumbar fractures,which has good potential for clinical application.

Immune checkpoint inhibitors(ICIs),including cytotoxic T-lymphocyte-associated protein 4(CTLA-4)inhibitors and programmed cell death receptor 1(PD-1)inhibitors and their ligand 1(PD-L1)inhibitors,have transformed the clinical outcomes of many patients with malignancies.programmed cell death receptor 1(PD-1)inhibitors and their ligand 1(PD-L1)inhibitors have changed the clinical outcomes of many patients with malignan-cies and have become the most important anti-tumor tools available.With the widespread use of immunotherapy,immune-related adverse events(irAEs)induced by ICIs have gradually attracted clinical attention,among which ICI-related colitis has become the most common adverse event in the gastrointestinal system.In this paper,we describe the epidemiology,pathogenesis and clinical management of ICI-related colitis,with the aim of providing reference for clinicians to identify and treat ICI-related colitis in a timely manner.

Oral diseases concern almost every individual and are a serious health risk to the popula-tion.The restorative treatment of tooth and jaw defects is an important means to achieve oral function and support the appearance of the contour.Based on the principle of"learning from the nature",Deng Xu-liang's group of Peking University School and Hospital of Stomatology has proposed a new concept of"microstructural biomimetic design and tissue adaptation of tooth/jaw materials"to address the worldwide problems of difficulty in treating dentine hypersensitivity,poor prognosis of restoration of tooth defects,and vertical bone augmentation of alveolar bone after tooth loss.The group has broken through the bottle-neck of multi-stage biomimetic technology from the design of microscopic features to the enhancement of macroscopic effects,and invented key technologies such as crystalline/amorphous multi-level assembly,ion-transportation blocking,and multi-physical properties of the micro-environment reconstruction,etc.The group also pioneered the cationic-hydrogel desensitizer,digital stump and core integrated restora-tions,and developed new crown and bridge restorative materials,gradient functionalisation guided tissue regeneration membrane,and electrically responsive alveolar bone augmentation restorative membranes,etc.These products have established new clinical strategies for tooth/jaw defect repair and achieved inno-vative results.In conclusion,the research results of our group have strongly supported the theoretical im-provement of stomatology,developed the technical system of oral hard tissue restoration,innovated the clinical treatment strategy,and led the progress of the stomatology industry.

Objective Discuss the safety and effectiveness of flow diverter device and traditional stent inthetreatment of unruptured ophthalmic segment aneurysms.Methods A retrospective analysis from January 2017 to January 2023 was performed on the clinical data of 70 cases of unruptured aneurysms in the Department of Neurosurgery of Southern Theater General Hospital treated with stent-assisted embolization.According to the type of implanted stents,theywere divided into flow diverter device group(n = 21)and traditional stent group(n = 49),and the postoperative clinical effects and complications of the two groups were compared.Results The two groups of patients followed 3 to 24 months,with an average of(14.4±1.82)months.The results of periopera-tive and follow-up showed that the inclusion rate was higher in the flow diverter device group and the traditional stent group(93.3%vs.87.9%),with no significant difference(P>0.05),and the incidence of perioperative and short-term complications was lower(0 vs.6.1%)in the flow diverter device group than in the traditional stent group,and there currencies rate in the flow diverter device group was lower than that in the traditional stent group(0 vs.6.1%),but the difference was not significant(P>0.05).Conclusion Flow diverter devices and traditional stents in the treatment of unruptured ophthalmic segment aneurysmsare feasible,safe and effective.Preliminary results suggest that the incidence of short-term complications and retreatment is lower after treatment with flow diverter devices,and the operation time is short,but further studies are needed to validate long-term complica-tions in patients.

Data analysis models may assist the transmission of traditional Chinese medicine （TCM） experience and clinical diagnosis and treatment， and the possibility of constructing a “data-knowledge” dual-drive model was explored by taking gastric precancerous state as an example. Data-driven is to make clinical decisions around data analysis， and its syndrome-differentiation decision-making research relies on hidden structural models and partially observable Markov decision-making processes to identify the etiology of diseases， syndrome elements， evolution of pathogenesis， and syndrome differentiation protocols； knowledge-driven is to make use of data and information to promote decision-making and action processes， and its syndrome-differentiation decision-making research relies on convolutional neural networks to improve the accuracy of local disease identification and syndrome differentiation. The “data-knowledge” dual-driven model can make up for the shortcomings of single-drive numerical simulation accuracy， and achieve a balance between local disease identification and macroscopic syndrome differentiation. On the basis of previous research， we explored the construction method of diagnostic assisted decision-making platform for gastric precancerous state， and believed that the diagnostic and decision-making ability of doctors can be extended through the assistance of machines and algorithms. Meanwhile， the related research methods were integrated and the core features of gastric precancerous state based on TCM syndrome differentiation and endoscopic pathology diagnosis and prediction were obtained， and the elements of endoscopic pathology recognition based on TCM syndrome differentiation were explored， so as to provide ideas for the in-depth research and innovative application of cutting-edge data analysis technology in the field of intelligent TCM syndrome differentiation.

IKBKG is the essential modulator for nuclear factor-κB(NF-κB) signaling pathway, and mutations within this gene can lead to anhidrotic ectodermal dysplasia and immunodeficiency (EDA-ID). Here we report a male patient, who presented with mild frontal bossing, sparse hair, skin pigmentation, conical teeth, and recurrent infections involving bacteria, fungi, and viruses after one month of age, together with hypogammaglobulinemia. These symptoms were consistent with the phenotype of EDA-ID. Genetic analysis revealed a hemizygous mutation c.1249T > G (p.Cys417Gly) in exon 10 of the IKBKG gene in the patient. The mother of the patient was identified as heterozygous carriers of the same mutation. Immunological assessment revealed a significant reduction in memory B cells. The patient showed no skewed TCR diversity. PHA-induced T-cell proliferation was impaired. IFN-γ secretion by Th cells was significantly reduced after PHA stimulation. IκBα degradation rate retained the same in the patient. We summarized the clinical features of the patient and conducted immunological analysis, in order to increase pediatricians′awareness of this rare disease. For boys with early-onset recurrent infections together with ectodermal dysplasia, IKBKG mutation should be considered. In addition, genetic analysis is needed to exclude pseudogene interference and functional evaluations are required.

Objective To investigate the relationship between serum periostin (POSTN) level and bone mineral density in patients undergoing maintenance hemodialysis (MHD). Methods Ninety-five patients who had received MHD treatment for more than 3 months in the Hemodialysis Center of Qingdao Municipal Hospital from October 2022 to October 2023 were enrolled as experimental group. Meanwhile, 50 healthy individuals undergoing health examinations in the Physical Examination Center of the same hospital during the same period were selected as the control group. Clinical data such as gender and age were collected for both groups. Fasting venous blood samples were collected before dialysis to measure parathyroid hormone (PTH), alkaline phosphatase (ALP), urea nitrogen, serum creatinine, serum calcium, serum phosphorus, and other indicators. Serum POSTN levels in MHD patients and healthy individuals were determined using enzyme-linked immunosorbent assay (ELISA). The correlation between serum POSTN levels and bone mineral density in MHD patients was explored. Univariate and multivariate binary Logistic regression analyses were performed to identify risk factors for low bone mineral density in MHD patients and assess the clinical value of serum POSTN level in predicting low bone mineral density in these patients. Results The serum POSTN level in the experimental group were significantly higher than those in the control group (P < 0.05). These patients were divided into two groups based on T-values: normal bone mass group(47 cases, T value >-1.0) and low bone mineral density (48 cases, T value≤-1.0). The low bone mineral density group had significantly higher serum POSTN levels, dialysis vintage, PTH, ALP, serum phosphorus, β₂-microglobulin levels, and a higher proportion of females compared to the normal bone mass group (P < 0.05). Pearson correlation analysis revealed negative correlations of bone mineral density T values with serum POSTN, dialysis vintage, C-reactive protein, PTH, ALP, serum phosphorus, and β₂-microglobulin in MHD patients (r=-0.695, -0.688, -0.246, -0.528, -0.216, -0.309, -0.293; P < 0.05). Multivariate binary Logistic regression analysis showed that after adjusting for confounding factors such as dialysis vintage, PTH, and ALP, high serum POSTN level was an independent risk factor for low bone mineral density in MHD patients. The receiver operating characteristic (ROC) curve indicated that the area under the curve (AUC) for serum POSTN level in predicting low bone mineral density in MHD patients was 0.901, with a cut-off value of 29.66 ng/L. Conclusion MHD patients have higher serum POSTN levels than healthy individuals, and this marker is associated with low bone mineral density in MHD patients.

The study aims to explore the effect of mesenchymal stem cells-derived exosomes (MSCs-Exo) on staurosporine (STS)-induced chondrocyte apoptosis before and after exposure to pulsed electromagnetic field (PEMF) at different frequencies. The AMSCs were extracted from the epididymal fat of healthy rats before and after exposure to the PEMF at 1 mT amplitude and a frequency of 15, 45, and 75 Hz, respectively, in an incubator. MSCs-Exo was extracted and identified. Exosomes were labeled with DiO fluorescent dye, and then co-cultured with STS-induced chondrocytes for 24 h. Cellular uptake of MSC-Exo, apoptosis, and the protein and mRNA expression of aggrecan, caspase-3 and collagenⅡA in chondrocytes were observed. The study demonstrated that the exposure of 75 Hz PEMF was superior to 15 and 45 Hz PEMF in enhancing the effect of exosomes in alleviating chondrocyte apoptosis and promoting cell matrix synthesis. This study lays a foundation for the regulatory mechanism of PEMF stimulation on MSCs-Exo in inhibiting chondrocyte apoptosis, and opens up a new direction for the prevention and treatment of osteoarthritis.
Animals ; Rats ; Apoptosis ; Chondrocytes ; Electromagnetic Fields ; Exosomes/physiology* ; Mesenchymal Stem Cells/metabolism*

ObjectiveTo clone coumarate-3-hydroxylase gene （C3H） from Angelica sinensis， and analyze the correlation between its bioinformatics， expression patterns and content of ferulic acid， and to explore the functions of ASC3H. MethodReal-time polymerase chain reaction （Real-time PCR） was used to clone the full-length cDNA of ASC3H based on the transcriptome dataset of A. sinensis， and the bioinformatics analysis of the gene sequence was carried out. Real-time PCR and high performance liquid chromatography （HPLC） were used to determine relative expression of ASC3H and content of ferulic acid in different root tissues of A. sinensis （periderm， cortex and stele）. ResultThe open reading frame （ORF） of ASC3H （GenBank accession number： MN2550298） was 1 530 bp， encoding 509 amino acids， with a theoretical molecular weight of 57.86 kDa and an isoelectric point of 8.36. It was a hydrophilic protein that was located in the chloroplast with multiple phosphorylation sites and a transmembrane region， and contained a conserved domain CGYDWPKGYGPIINVW_P450 （383-399 aa） in cytochrome P450. Multiple amino acid sequence alignment analysis showed that ASC3H had high similarity with C3H from other plants， especially Ammi majus in Umbelliferae. The Real-time PCR revealed that ASC3H had different expressions in periderm， cortex and stele tissues of A. sinensis roots. It was found from HPLC that the cortex tissues had the highest content of ferulic acid， and the stele tissues had the lowest. ConclusionASC3H was successfully cloned from A. sinensis， and its sequence characteristics were understood more clearly， suggesting that ASC3H might be involved in the ferulic acid biosynthesis pathway of A. sinensis. This paper provided a basis for further studying the functions of the gene and exploring the biosynthesis and regulation mechanism of ferulic acid in A. sinensis， while laying the foundation for the genetic improvement of A. sinensis．

Background: Red blood cell distribution width/platelet count ratio (RPR) is a reliable prognostic assessment indicator for numerous diseases. However, no studies to date have examined the relationship between RPR and the prognosis of diffuse large B-cell lymphoma (DLBCL).Therefore, this study aimed to investigate the correlation between RPR and the clinical characteristics and prognosis of patients with diffuse large B-cell lymphoma. Methods: We retrospectively studied 143 patients with newly diagnosed DLBCL and used the median value as the RPR threshold. We also investigated the correlation of pretreatment RPR level with clinical characteristics and its impact on DLBCL prognosis. Results: Using the median value as the cut-off, patients with DLBCL were divided into a low RPR group (＜0.0549) and a high RPR group (≥0.0549). Patients in the high RPR group were older, had a later Ann Arbor stage, were prone to bone marrow invasion, and had a higher National Comprehensive Cancer Network International Prognostic Index score (P ＜ 0.05). A survival analysis showed that progression-free survival (PFS) (P =0.003) and overall survival (OS) (P ＜0.0001) were significantly shorter in the high versus low RPR group. A multifactorial Cox analysis showed that bone marrow invasion and elevated lactate dehydrogenase (LDH) were separate risk factors for PFS (P ＜0.05), while an RPR ≥0.0549 and elevated LDH were separate risk factors for OS (P ＜0.05). Conclusion A high RPR (≥0.0549) in patients with newly diagnosed DLBCL is an independent risk factor for a poor prognosis.