In February 2024, a patient with left lumbar pain for over 1 month was admitted to Heze Municipal Hospital and was diagnosed as retroperitoneal mass by enhanced CT and PET/CT examination.Laparoscopic retroperitoneal mass resection was performed.The postoperative pathological diagnosis was Erdheim-Chester disease.The patient was treated with interferon (IFN) alpha after surgery and was followed up for 5 months with no recurrence or metastasis. Erdheim-Chester disease(ECD) is rare and prone to be misdiagnosed clinically. Biopsy or resection of the tumor should be performed to make a definite diagnosis.

In February 2024, a patient with left lumbar pain for over 1 month was admitted to Heze Municipal Hospital and was diagnosed as retroperitoneal mass by enhanced CT and PET/CT examination.Laparoscopic retroperitoneal mass resection was performed.The postoperative pathological diagnosis was Erdheim-Chester disease.The patient was treated with interferon (IFN) alpha after surgery and was followed up for 5 months with no recurrence or metastasis. Erdheim-Chester disease(ECD) is rare and prone to be misdiagnosed clinically. Biopsy or resection of the tumor should be performed to make a definite diagnosis.

Objective:To investigate the protective effect of calycosin on microgravity-induced muscle atrophy by using real-time shear wave elastography (RT-SWE).Methods:The potential key active compound calycosin of anti-muscular atrophy in Astragali Radix was screened by systematic pharmacology. Eighteen healthy male Sprague-Dawley rats were divided into the control group [0.5% carboxymethyl cellulose-Na (CMC-Na) gavage], the hind limb unloading (HLU)+CMC-Na group (HLU+0.5% CMC-Na gavage), and the HLU+calycosin group (HLU+calycosin gavage) according to the method of random number table, with 6 rats in each group. After 28 d of continuous administration, the organ index, the toxicity of liver and kidney, the wet weight of soleus muscle and the ratio of muscle weight to body weight was measured, respectively. The non-invasive RT-SWE was used to evaluate the thickness and elastic modulus of rectus femoris in each group and the one-way analysis of variance was used to compare the differences among groups.Results:There was no significant difference in organ index, liver and kidney toxicity among different groups of rats (all P>0.05). There were significant differences in the weight of soleus muscle and the ratio of muscle weight to body weight among different groups of rats ( F=60.66, 56.44, both P<0.001). Compared with the HLU+CMC-Na group, the weight of soleus muscle and the ratio of muscle weight to body weight in the HLU+calycosin group increased, and the differences were significant (both P<0.01). The thickness and elastic modulus of rectus femoris of rats in different groups were significantly different ( F=35.47, 14.68, both P<0.001). Compared with the HLU+CMC-Na group, the muscle thickness and elastic modulus of rats in HLU+calycosin group were increased, and the differences were significant (both P<0.01). Conclusions:The treatment of calycosin has no side effects on rats. It can improve the thickness and elastic modulus of rectus femoris, and effectively prevent microgravity-induced muscle atrophy, which may provide a new candidate drug for astronaut muscular atrophy.

Objective To develop a predictive model for postoperative acute kidney injury(AKI)in elderly patients using machine learning methods.Methods The preoperative information and postopera-tive follow-up information of elderly patients who underwent surgery from June 2019 to July 2020 were col-lected,and the laboratory examination results were extracted.A total of 115 preoperative variables were in-cluded.A model of postoperative AKI was constructed using five methods:extreme gradient boosting(XGB),gradient boosting machine(GBM),random forest(RF),support vector machine(SVM),and elastic net logistic regression(ELA).The performance of the model was evaluated using area under the re-ceiver operating characteristic curve(AUROC),area under the precision recall curve(AUPRC),and Brier score.To simplify the model for clinical application,the original model was obtained and some varia-bles with low correlation were removed,and the model was evaluated again using the above method.Results This study ultimately included 5 929 elderly patients,3 359 males(56.7％)and 2 570 females(43.3％),aged 65-99 years.Among them,154 patients(2.6％)experienced postoperative AKI.Among the prediction models constructed using five machine learning methods,XGB has the highest AUROC and AU-PRC,with values of 0.798(95％CI 0.705-0.888)and 0.230(95％CI 0.079-0.374),respectively.Its Brier score is the lowest among all models,the score is 0.023(95％CI 0.014-0.029).After simplifying the XGB model,72 variables were retained.The AUROC of the simplified model was 0.790(95％CI 0.711-0.861),slightly lower than that of the original model.The AUPRC was 0.176(95％CI 0.070-0.313),and the Brier score was 0.024(95％CI 0.017-0.033),and there was no significant statistical difference,indicating that there was no significant difference in the predictive ability of the simplified model compared to the original model.Conclusion Among the five machine learning methods used to construct postoperative AKI prediction models,XGB has the best predictive performance.The simplified XGB predic-tion model still retains high predictive performance and is easier to be promoted in clinical practice.

Objective:To evaluate the relationship between preoperative pain threshold and chronic postsurgical pain (CPSP) in the patients undergoing thoracoscopic pneumonectomy.Methods:One hundred patients of both sexes, aged 18-75 yr, with body mass index of 18-35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for thoracoscopic pneumonectomy at West China Hospital of Sichuan University from December 2019 to February 2020, were selected. The pain threshold was measured using Pain Vision at 1 day before surgery. Telephone follow-up was implemented by a pain questionnaire to assess CPSP (numerical rating scale score ≥1) at 3 months after surgery. Multivariate logistic regression was used to identify the risk factors for CPSP, and the receiver operating characteristic curve was used to evaluate the accuracy of preoperative pain threshold in predicting CPSP. Results:Ninety-four patients were finally enrolled, of which 38 cases (40%) developed CPSP. The results of multivariate logistic regression analysis showed that low preoperative pain threshold was an independent risk factor for CPSP ( OR=0.899, 95% confidence interval 0.854-0.946, P<0.001). The area under the receiver operating characteristic curve was 0.882 (95% confidence interval 0.804-0.960), Youden Index was 0.673, the sensitivity was 0.816, and the specificity was 0.857. Conclusions:Low preoperative pain threshold is an independent risk factor for CPSP, and preoperative pain threshold can predict the occurrence of CPSP in the patients undergoing thoracoscopic pneumonectomy.

Objective:To investigate the protective effect of calycosin on microgravity-induced muscle atrophy by using real-time shear wave elastography (RT-SWE).Methods:The potential key active compound calycosin of anti-muscular atrophy in Astragali Radix was screened by systematic pharmacology. Eighteen healthy male Sprague-Dawley rats were divided into the control group [0.5% carboxymethyl cellulose-Na (CMC-Na) gavage], the hind limb unloading (HLU)+CMC-Na group (HLU+0.5% CMC-Na gavage), and the HLU+calycosin group (HLU+calycosin gavage) according to the method of random number table, with 6 rats in each group. After 28 d of continuous administration, the organ index, the toxicity of liver and kidney, the wet weight of soleus muscle and the ratio of muscle weight to body weight was measured, respectively. The non-invasive RT-SWE was used to evaluate the thickness and elastic modulus of rectus femoris in each group and the one-way analysis of variance was used to compare the differences among groups.Results:There was no significant difference in organ index, liver and kidney toxicity among different groups of rats (all P>0.05). There were significant differences in the weight of soleus muscle and the ratio of muscle weight to body weight among different groups of rats ( F=60.66, 56.44, both P<0.001). Compared with the HLU+CMC-Na group, the weight of soleus muscle and the ratio of muscle weight to body weight in the HLU+calycosin group increased, and the differences were significant (both P<0.01). The thickness and elastic modulus of rectus femoris of rats in different groups were significantly different ( F=35.47, 14.68, both P<0.001). Compared with the HLU+CMC-Na group, the muscle thickness and elastic modulus of rats in HLU+calycosin group were increased, and the differences were significant (both P<0.01). Conclusions:The treatment of calycosin has no side effects on rats. It can improve the thickness and elastic modulus of rectus femoris, and effectively prevent microgravity-induced muscle atrophy, which may provide a new candidate drug for astronaut muscular atrophy.

Objective:To study the collapse of the contralateral femoral head after the total hip arthroplasty (THA) in patients with bilateral steroid-induced femoral head necrosis leg-length discrepancy (LLD) influences.Methods:A total of 108 patients with bilateral steroid-induced femoral head necrosis who were treated in Honghui Hospital Affiliated to Xi′an Jiaotong University from June 2014 to June 2016 underwent THA surgery on the hip joints that had symptoms and developed to Association Research Circulation Osseous (ARCO) Ⅲ. At the same time, the non-surgical hip-preserving treatment of the non-collapsed femoral head developed to the ARCO Ⅱ stage was performed. The follow-up period was 2 years, and 98 cases were finally included. According to the size of the leg-length discrepancy [LLD<3 mm group ( n=50), LLD≥3 mm group ( n=48)] and the type of leg-length discrepancy[non collapse side longer group ( n=58) and shorter group ( n=58)], the collapse of the femoral head and the THA were observed. Results:Finally, a total of 56 cases of femoral head collapse occurred in the non collapse side of the hip, of which 50 cases underwent THA within 24 months. There were significant statistical differences in THA and femoral head collapse between LLD<3 mm group and LLD≥3 mm group, non collapse side longer group and non collapse side shorter group ( P<0.05). The 2-year survival rate without collapse in the LLD<3 mm group and LLD≥3 mm group were 52.1% and 34.0%, respectively, and the 2-year survival rates in the longer and shorter non-collapsed limb groups were 56.9% and 22.5%, respectively. Compared with patients with moderate lesions, the survival rate of femoral heads in patients with larger lesions was lower ( OR: 4.25, 95% CI: 1.55-11.26; P=0.003). LLD<3 mm group ( OR: 0.24, 95% CI: 0.06-0.50; P<0.01) or non collapse side longer group ( OR: 0.13, 95% CI: 0.04-0.29; P<0.01) had lower risk of contralateral femoral head collapse after THA. Conclusions:For patients with bilateral steroid-induced femoral head necrosis who have collapsed lateral THA, postoperative leg-length discrepancy extremities is a potential risk factor for collapse of non-collapsed femoral head. LLD<3 mm and avoiding shortening of the uncollapsed limb may reduce the risk of collapse of the uncollapsed femoral head.

Objective To evaluate the value of perioperative multimodal stratified analgesia guided by PPRS-CYMZ 2.0. Methods One hundred and sixteen patients of both sexes, aged 16-85 yr, of A-merican Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective surgery in our hospital in August 2016, were included in this study and assigned into empirical analgesia group(group E, n=79) and stratified analgesia group(group S, n=73). The risk of postoperative pain was estimated by an expe-rienced associate chief anesthesiologist based on his clinical experience, and the perioperative analgesic protocol was determined in group E. The risk of postoperative pain was assessed using the perioperative pain risk scale PPRS-CYMZ 2.0 by another experienced associate chief anesthesiologist, the risk was stratified according to the scores, and the corresponding stratified analgesic protocol was determined in group S. Vis-ual analog scale scores and parents′satisfaction with analgesia were recorded on postoperative day 30. The requirement for preventive analgesia, total pressing times of patient-controlled analgesia(PCA)pump in 0-6 h, 6-24 h and 24-72 h periods, PCA background infusion dose and consumption of rescue analgesics were recorded. The development of adverse events during postoperative hospital stay and postoperative re-covery were also recorded. Analgesia-related parameters of medical economics were calculated. Results There was no significant difference in postoperative pain risk stratification between group E and group S(P>0.05), and the majority of patients were at moderate risk. Compared with group E, no significant change was found in visual analog scale scores on postoperative day 30, PCA background infusion dose or incidence of postoperative adverse effects(P>0.05), the requirement for preventive analgesia and satisfaction scores were significantly increased in high risk patients, the consumption of rescue analgesics was decreased in moderate risk patients(P<0.05), no significant change was found in the total pressing times of PCA pump in each time period in low risk patients(P>0.05), the total pressing times of PCA pump was significantly decreased, and the direct analgesic cost per patient and total analgesic cost were decreased in moderate and high risk patients, and the first ambulation time and length of postoperative hospital stay were shortened in high risk patients in group S(P<0.05). Conclusion PPRS-CYMZ 2.0 can achieve perioperative multi-modal stratified analgesia and individualized treatment.

Objective To evaluate the effect of electroconvulsive therapy (ECT) on the expression of phosphorylated glutamate receptor 1 (p-GluR1) and Ca2+/calmodulin-dependent protein kinase Ⅱ α (p-CaMK Ⅱ α) under small dose ketamine combined with propofol anesthesia in the depressed rats.Methods Forty healthy adult male Sprague-Dawley rats,weighing 200-250 g,aged 2-3 months,were used in this study.Mental depression was induced by exposing the animals to chronic unpredictable mild stress (CUMS).Forty mentally depressed rats were divided randomly into 5 groups (n =8 each) using a random number table:M0-4 groups.Propofol 80 mg/kg and ketamine 10 mg/kg were injected intraperitoneally in M0-4 groups.After disappearance of righting reflex,M1-4 groups received ECT of 60,120,180 and 240 mC once a day for 7 consecutive days,respectively,by means of a current (frequency 50 Hz,sine-wave,pulse width 0.7 ms,1-s duration) delivered via ear-clip electrodes,while group M0 received ECT of no quantity of electric charge via ear-clip electrodes.Before CUMS,at 1 day after CUMS and at 1 day after ECT,sucrose preference test was applied to evaluate the depressive behavior.The sucrose preference percentage (SPP) was calculated.At 4 days after CUMS and 4 days after ECT,the learning and memory function was assessed using Morris water maze test.The rats were then sacrificed,and hippocampi were isolated to detect the expression of GluR1,p-GluRl,CaMK Ⅱ α and p-CaMK Ⅱ α by Western blot.Results The SPP was significantly lower after CUMS than before CUMS in M0-4 groups (P＜0.05).Compared with that after CUMS,the SPP was significantly increased,the escape latency was shortened,and the space exploration time was prolonged after ECT in M1-4 groups (P＜0.05).There was no significant difference in SPP after ECT between M1-4 groups (P＞0.05).Compared with group M0,the SPP was significantly increased,and the expression of pGluR1 and p-CaMK Ⅱ α was up-regulated in M1-4groups (P＜0.05).Compared with group M2,the escape latency was significantly prolonged,the space exploration time was shortened,and the expression of pGluR1 and p-CaMK Ⅱ α was down-regulated after ECT in the other groups (P＜0.05).There was no significant difference in GluR1 and CaMK Ⅱ α expression after ECT between the five groups (P＞ 0.05).Conclusion ECT can induce cognitive decline when applied for anti-depression under small dose ketamine combined with propofol anesthesia,and the mechanism is related to increased phosphorylation of GluR1 and CaMK Ⅱ α expression in rats.

Objective To explore the effect of low-dose ketamine combined with propofol anesthesia on expres?sion of glutamine receptor subunit 1 (GluR1) and 2 (GluR2) in the hippocampus of depressed rats after electroconvulsive therapy. Methods Healthy adult male Sprague-Dawley rats, weighing 200~250 g, were used in this study. Mental depres?sion was induced by chronic unpredictable mild stress. Thirty-two depressed rats were randomly divided into 4 groups (n=8): metal depression group (group A), ECT group (group B), ECT+propofol group (group C) and ECT+propofol+ket?amine group (group D). Eight normal rats served as control group. Control group received no treatment. Group A received intraperitoneal injection of normal saline 8 mL/kg plus sham ECT. Group B, C and D received ECT once a day for 7 con?secutive days following intraperitoneal injection of normal saline 8 mL/kg, propofol 80 mg/kg and propofol 80 mg/kg +ketamine 10mg/kg, respectively. Sucrose preference test and Morris water maze were performed to assess depressed be?havior and learning and memory function, respectively. RT-PCR and Western-blot assay were used to detect the expres?sion of GluR1 , GluR2 and their mRNA expression. Results After ECT, compared with control group and group A, changes of SPP in group B, C and D were obvious. The change of SPP in group D was much higher than all other groups (P<0.05). Rats in group B showed prolonged escape latency and shortened space exploration time, which were significantly different from all other groups (P<0.05). Rats in group D showed the most shortened escape latency and prolonged space exploration time (P<0.05). The expression of GluR1 was significantly increased in group B, C and D compared with group A (P<0.05). The expression of GluR2 and mRNA was significantly decreased in group B and C (P<0.05). The difference in GluR2 and mRNA expression was not significant among group A, D and control group (P>0.05). Conclusion Low-dose ketamine combined with propofol anesthesia exert effective antidepressive action and improve learning and memory function of depressed rats after electroconvulsive therapy. The beneficial effects of the ketamine combined with propofol anesthesia may be related to up-regulation expression of GluR1 and GluR2 in hippocampus.