Objective:To analyze the epidemiological features of pediatric sepsis in the Kashgar region and investigate factors associated with its prognosis, thereby providing evidence for implementing regional public health prevention and control policies.Methods:A single-center, retrospective observational study was conducted on the clinical data of pediatric sepsis patients admitted to the pediatric intensive care unit (PICU) of The First People′s Hospital of Kashgar between January 2022 and December 2023. For the assessment of clinical outcomes, this study utilized a composite endpoint comprising "length of hospital stay and survival status", classifying patients into two groups: Group A (survived with hospital stay <28 days) and Group B (hospital stay ≥28 days or in-hospital mortality). Univariate and binary logistic regression analyses were performed to identify independent risk factors associated with prognosis.Results:This study included a total of 79 pediatric patients with sepsis, with an age range of 1 month to 14 years and a median age of 8 months. Males accounted for 62.0% (49 males, 30 females). The rates of comorbid septic shock, sepsis-associated encephalopathy, and acute kidney injury were 73.4% (58/79), 24.1% (19/79), and 16.5% (13/79), respectively. The primary site of infection was the gastrointestinal tract, accounting for 34.2% (27/79), followed by the respiratory tract at 30.4% (24/79). Pathogens were detected in 59.5% (47/79) of the patients, with Staphylococcus aureus identified in 11 cases, Acinetobacter baumannii and Escherichia coli in 6 cases each, Klebsiella pneumoniae in 5 cases, and Candida albicans in 3 cases. The mechanical ventilation rate was 59.5% (47/79). The total hospital length of stay ranged from 1 to 55 days, with a median of 14 days, while the ICU length of stay ranged from 1 to 29 days, with a median of 6 days. In-hospital mortality occurred in 15 cases (19.0%). Group A comprised 56 patients (70.9%), and Group B comprised 23 patients (29.1%). Univariate analysis revealed that Group A had significantly higher mean arterial pressure (MAP), pediatric critical illness score (PCIS), and Glasgow coma scale (GCS) (all P<0.05), and significantly lower pediatric risk of mortality Ⅲ (PRISM Ⅲ), pediatric logistic organ dysfunction-2 (PELOD-2), lactate levels, pediatric multiple organ dysfunction score (P-MODS), pediatric sequential organ failure assessment (pSOFA), septic shock rate, and mechanical ventilation rate compared to Group B (all P<0.05). Binary logistic regression analysis identified a high PELOD-2 score ( OR: 1.38, 95% CI: 1.16-1.64, P<0.001) as an independent risk factor for poor prognosis, while a high GCS ( OR: 0.81, 95% CI: 0.74-0.88, P<0.001) served as a protective factor against poor prognosis. The combination of PELOD2 and GCS demonstrated good predictive ability for in-hospital outcomes in pediatric sepsis patients, with an area under the ROC curve of 0.82 (95% CI: 0.72-0.92). Conclusion:In children with sepsis in the Kashgar region, gastrointestinal tract infection represents the most common source of infection. Elevated PELOD-2 scores and reduced GCS are both indicative of a poorer prognosis, and a combined model integrating these two scoring systems may serve as a valuable tool for prognostic assessment.

Radiotherapy is main method in treating cervical cancer,and the rapid advancement of artificial intelligence(AI)technique is providing entirely new solutions for radiotherapy for cervical cancer.The AI means that is represented by deep learning is deeply integrating into the whole process of diagnosis,treatment and management for cervical cancer,which can promote intelligent and precise development of radiotherapy workflows.Currently,the applied cores of AI in radiotherapy for cervical cancer include image registration,target delineation,optimization of radiotherapy planning and risk assessment,which can significantly enhance efficiency and precision of treatment.But,AI is facing some challenges in clinical applications include data quality,and algorithm's robustness and interpretability at the same time.Depended on the above analyses,this paper systematically reviewed the frontier applications and progress in practice of AI in radiotherapy for cervical cancer,which especially analyzed technical advantages and limitations of AI in key link,and explored its development path and coping strategy in clinical promotion and standard application in future.It is purpose to provide theoretical references for clinical practice of precise and accurate radiotherapy for cervical cancer.

Morphea alopecia is a rare secondary cicatricial alopecia, often caused by linear scleroderma of the scalp. When hair loss appears as the only symptom of morphea, it is easily confused with other localized alopecia. The diagnosis of morphea alopecia depends on histopathologic and dermoscopic examinations. In order to improve the understanding of morphea alopecia among clinicians, this review summarizes research progress in its pathogenesis, clinical and pathological characteristics, diagnosis and treatment.

Background Although current evidence suggests a link between outdoor air pollution and depressive symptoms, the effect of solid fuel use (a significant indoor air pollutant) on depressive symptoms in China's rural middle-aged and elderly population remains poorly understood. Objective To explore the association between solid fuel use for cooking and depressive symptoms among middle-aged and elderly people in rural areas of China, and to provide a basis for the prevention and control of depressive symptoms among residents in rural areas. Methods Data were obtained from the 2020 China Family Panel Studies (CFPS), depressive symptoms were assessed using 8-item Center for Epidemiologic Studies Depression Scale (CES-D), and cooking fuel type was self-reported. Subsequently, two-level binary unconditional logistic regression models were fitted to assess the impact of solid fuel use for cooking on depressive symptoms. Results A total of 7991 participants aged 45 years and older [mean age (58.52±9.18) years] were included in the study, with a mean CES-D score of 6.07±4.48 and a mean positive depressive symptoms rate of 34% (40.54% in the solid fuel group and 30.81% in the clean fuel group, χ²=74.40, P<0.001). After controlling for potential confounding covariates, rural middle-aged and elderly residents in the solid fuel group had a higher risk of reporting depressive symptoms than those in the clean fuel group (OR=1.36, 95%CI: 1.20-1.54), an association that was unaffected by participant characteristics and was positive across age and gender groups. Conclusion There is a positive association between solid fuel use for cooking and depressive symptoms in middle-aged and elderly people in rural areas of China. It is recommended that rural areas promote the upgrading of stoves through the installation of ventilation equipment or the switch from solid cooking fuel to clean fuel. This approach is directed toward reducing exposure to household air pollution, alleviating the prevalence of depression among middle-aged and elderly residents in vast rural areas, and enhancing their mental health.

Erosive pustular dermatosis of the scalp (EPDS) is a rare superficial skin inflammatory disease that occurs on the scalp, and its pathogenesis is still unclear. Its clinical manifestations are similar to those of infective inflammation and malignant tumors, and its diagnosis is highly dependent on non-specific pathological changes, so the diagnosis is relatively difficult. Clinically, topical glucocorticoids are the main treatment method, but treatment outcomes vary greatly among individuals, and patients with refractory EPDS need other treatment methods. EPDS generally requires long-term topical glucocorticoid therapy, and adverse drug reactions are common. This review summarizes research progress in EPDS in recent years, in order to improve clinicians' understanding of this disease.

Congenital triangular alopecia is a kind of non-inflammatory and non-cicatricial alopecia, and most cases develop this disease at the ages of 2 - 9 years. The pathogenesis of congenital triangular alopecia is still unclear, and there is a lack of effective treatments. Congenital triangular alopecia is rather liable to be misdiagnosed and erroneously treated, and dermoscopy helps confirm the diagnosis. This review summarizes the progress in the epidemiology, pathogenesis, clinical diagnosis, and treatment of congenital triangular alopecia.

Objective:To develop a simple and effective subretinal injection pipeline system to enhance the accuracy and precision of subretinal injection volume control.Methods:A retrospective case series study. From May to October 2023, 18 patients (18 eyes) with submacular hemorrhage (SMH) who continuously received modified subretinal injection treatment in Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 10 males and 8 females. The mean age was (60.00±7.41) years. The primary causes included polypoid choroidal vasculopathy (14 cases), retinal macroaneurysm (2 cases), traumatic retinopathy (1 case), and Valsalva retinopathy (1 case). Hemorrhage affected 14 eyes of the fovea centralis. All affected eyes underwent standard three-channel 25G vitrectomy via the flat part of the ciliary body combined with modified subretinal injection of recombinant tissue plasminogen activator. The improved injection system consisted of a 1 ml syringe, a Q-Syte TM connector, a 41G subretinal microinjection needle, a converter and a viscoelastic substance control pipeline. The drug preparation time for subretinal injection (i.e., the time consumed by the system connection step), the injection time, whether bubbles occur during the injection process, and the perioperative complications were recorded and analyzed. Results:The preparation time prior to drug injection ranged from 230 to 335 seconds, while the injection completion time varied between 43 and 75 seconds. Both times decreased progressively as operator proficiency improved. Among the treated eyes, five received a target injection dose of 0.05 ml and thirteen received 0.10 ml, with all eyes achieving the preset dose accurately. No subretinal bubbles were observed during the injection procedure. Additionally, no intraoperative complications such as retinal hemorrhage or tear secondary to mechanical trauma at the injection site were recorded. Postoperatively, one eye developed anterior chamber hemorrhage, which resolved following intraocular pressure-lowering treatment. No other postoperative complications, including hemorrhage, rhegmatogenous retinal detachment, or infection, were observed in the remaining eyes.Conclusion:The retinal drug injection system developed in this study has a simple structure, safe and stable operation, can achieve precise drug injection, and effectively avoid the formation of bubbles.

Objective To address the challenges of constructing large language models for traditional Chinese medicine(TCM)classics,which are complex and expensive to fine-tune,this study explores a lightweight fine-tuning method for such models,aiming to develop a question-answering model centered on TCM classics,particularly various editions of Shang Han Lun through the ages.Methods Dataset construction involved designing prompts to guide GPT-4 in generating Q&A pairs based on Shang Han Lun and integrating them with the ShenNong_TCM_Dataset and cMedQA2 datasets.Five general-purpose large models were selected for Lora fine-tuning.The best model was chosen through evaluation,and the performance of multiple quantized versions was validated.Results After fine-tuning,the BLEU,ROUGE-1,ROUGE-2,and ROUGE-L metrics for the Qwen-7B-Chat model improved by 17.61,19.63,14.3,and 21.4,respectively,compared to the base model.Conclusion The selected model in this study is capable of effectively understanding and utilizing professional terms and concepts from TCM classics,such as Shang Han Lun,to provide accurate answers to user queries.Compared to similar models,it requires lower fine-tuning costs and computational power,contributing to the dissemination of TCM knowledge and the development of intelligent systems.

Objective To propose a novel mechanical method and index to in-vivo characterize the health status of cancellous bone during the percutaneous kyphoplasty(PKP),and validate its feasibility and consistency.Methods According to the theory of elasticity,the expression and physical significance of the mechanical index K were given.Then using clinical images of the lumbar spine L4,three-dimensional finite element simulations were conducted to verify the validity of the theoretical results,as well as the consistency of the methodology and the indexes were verified for studies of different balloon shapes and puncture routes.Results The internal pressure of the balloon linearly varied with the injected fluid volume.The mechanical index K was closely related to the bone shear modulus and could well reflect the health status of cancellous bones.The balloon shape had a trivial influence on the Kresults,and the relative difference between the cylindrical and ellipsoidal shapes was less than 2％.The influence of surgical access route on the K results was also very small,and the relative difference between the routes by vertebral pedicle and by lateral margin of vertebral pedicle was less than 0.5％.Conclusions The in-vivo mechanical method and the mechanical index K can characterize the bone health of patients with good consistency.This study has a great significance for providing guidelines of the optimization of PKP operation plan and postoperative rehabilitation,collecting in vivo data of bone mechanical properties,and improving the diagnosis and treatment of osteoporosis in clinic.

The detection of minimal residual lesions represented by circulating tumor DNA can detect residual cancer lesions that cannot be displayed by traditional imaging in advance. The positive status and dynamic changes are closely related to the prognosis evaluation of various solid tumors, the effectiveness of neoadjuvant therapy, the prediction of postoperative recurrence risk, and the precise implementation of adjuvant therapy. This article summarizes the advantages and challenges faced by the application of circulating tumor DNA testing in individualized multidisciplinary diagnosis and treatment of esophageal cancer, in order to better carry out precise diagnosis and treatment of esophageal cancer under the guidance of minimal residual lesion detection.