Objective To investigate the association between obstructive sleep apnea hypopnea syndrome （OSAHS） and white matter lesions （WMLs）. Methods A total of 91 patients who attended Department of Neurology and Department of Epilepsy and Sleep Disorders in The Second Affiliated Hospital of Harbin Medical University from June 2019 to December 2020 and met the diagnostic criteria for WMLs were enrolled as WMLs group， and 61 patients without WMLs were enrolled as control group. All subjects underwent brain MRI and PSG examinations， and related data were collected， including demographic data， past history， personal history， laboratory examination， and imaging findings. Results The WMLs group had a prevalence rate of OSAHS of 92.3% and an AHI of （32.85±19.86） events/hour on PSG， which were significantly higher than those in the control group （P<0.05）. The Spearman rank correlation analysis showed a strong positive correlation between WMLs severity and OSAHS severity（r=0.602 52，P<0.0001）. Conclusion The WMLs group is more susceptible to OSAHS than the control group， and the severity of WMLs is positively correlated with the severity of OSAHS.

With the intensification of population aging in our country, stroke incidence is increasing year by year, and most patients leave behind varying degrees of sequelae; and motor function disorder is one of the common sequelae, which seriously affects the quality of life of patients. Motor function rehabilitations have become indispensable treatments for stroke patients. Accurately and objectively assessing the performance of motor function trehabilitations in stroke patients will help to formulate more reasonable rehabilitation plans. This article reviews the existing rehabilitation assessment techniques and their advantages and disadvantages, aiming to provide guidance for the assessment of motor function rehabilitations in stroke patients and lay a foundation for future development of stroke rehabilitations.

Objective:To investigate the value of coronary CTA (CCTA)-based traditional features and radiomics of plaque in the identification of culprit lesions that caused acute myocardial infarction (AMI).Methods:This was a retrospective multicenter study. From July 2016 to November 2023, a total of 344 patients from the Affiliated Hospital of Qingdao University (training cohort, n=184), Shandong Provincial Hospital Affiliated to Shandong First Medical University (validation cohort, n=88) and Qilu Hospital of Shandong University (test cohort, n=72) who received percutaneous coronary intervention (PCI) due to AMI and underwent CCTA within 48 hours of AMI were enrolled. The culprit plaques and non-culprit plaques were identified using a combination of electrocardiogram, CCTA, and angiographic findings. The vessel, plaque location, plaque type, Coronary Artery Disease-Reporting and Data System (CAD-RADS) score, high-risk plaque characteristics, plaque length, plaque volume, and burden were analyzed, and 1 904 radiomics features were extracted for each plaque. The traditional imaging model, the radiomics model, and the combined model were established by using multivariate Logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each model in identifying culprit lesions. The DeLong test was used for the comparison of AUC between every two models. The net reclassification index (NRI) was used to evaluate the incremental value of the combined model to the traditional imaging model and the radiomics model. The decision curve analysis (DCA) was used to assess the clinical net benefit of these models. A correlation heatmap was used to evaluate the correlation between the radiomics score and traditional CCTA factors. The interpretable analysis of the decision process of the combined model was performed by the Shapley Additive exPlanations (SHAP). Results:In the validation cohort and the test cohort, the AUC of the traditional imaging model developed by the vessel, plaque type, positive remodeling and CAD-RADS score was 0.898 (95% CI 0.869-0.922) and 0.881 (95% CI 0.848-0.910), respectively. The radiomics model developed by six radiomics features was 0.863 (95% CI 0.831-0.891) and 0.863 (95% CI 0.827-0.864), respectively. The AUC of the combined model was 0.930 (95% CI 0.905-0.950)and 0.919 (95% CI 0.889-0.942), respectively. In the validation cohort and the test cohort, the AUC of the combined model was higher than that of the traditional imaging model ( Z=4.013, 4.272, P<0.001) and that of the radiomics model ( Z=4.819, 3.784, P<0.001), respectively. In the validation cohort, the combined model yielded an NRI of 20.43% (95% CI 10.43%-30.44%, P<0.001) and 20.21% (95% CI 9.62%-30.80%, P<0.001) for identifying culprit lesions compared with the traditional imaging model and the radiomics model, respectively. In the test cohort, the combined model yielded an NRI of 28.05% (95% CI 16.72%-39.38%, P<0.001) and 23.57% (95% CI 13.58%-33.56%, P<0.001) for identifying culprit lesions compared with the traditional imaging model and the radiomics model, respectively. DCA showed the combined model had the highest clinical net benefit. The correlation heatmap showed the radiomics score was not correlated or only weakly correlated with traditional CCTA factors. SHAP indicated the radiomics and CAD-RADS score contributed significantly to the model. Conclusion:The CCTA-based traditional features and radiomics of plaque have favorable performance for the identification of culprit plaques in patients with AMI.

This case report summarized the resuscitation and nursing care of a patient who experienced sudden syncope due to central venous catheter(CVC)removal distress syndrome following coronary artery bypass grafting.Nursing key points:rapidly recognize the patient's CVC removal distress syndrome;continuously monitor circulatory and respiratory functions,maintain circulatory stability,and ensure airway patency;Implement a multi-modal treatment strategy for neurological protection to improve neurological outcomes;Initiate early rehabilitation therapy to promote limb function recovery;Prevent CVC removal distress syndrome.Following emergency rescue and meticulous nursing care,the patient was discharged,on the 34th hospital day with recovery.

This case report summarized the resuscitation and nursing care of a patient who experienced sudden syncope due to central venous catheter(CVC)removal distress syndrome following coronary artery bypass grafting.Nursing key points:rapidly recognize the patient's CVC removal distress syndrome;continuously monitor circulatory and respiratory functions,maintain circulatory stability,and ensure airway patency;Implement a multi-modal treatment strategy for neurological protection to improve neurological outcomes;Initiate early rehabilitation therapy to promote limb function recovery;Prevent CVC removal distress syndrome.Following emergency rescue and meticulous nursing care,the patient was discharged,on the 34th hospital day with recovery.

Objective:To investigate the value of coronary CTA (CCTA)-based traditional features and radiomics of plaque in the identification of culprit lesions that caused acute myocardial infarction (AMI).Methods:This was a retrospective multicenter study. From July 2016 to November 2023, a total of 344 patients from the Affiliated Hospital of Qingdao University (training cohort, n=184), Shandong Provincial Hospital Affiliated to Shandong First Medical University (validation cohort, n=88) and Qilu Hospital of Shandong University (test cohort, n=72) who received percutaneous coronary intervention (PCI) due to AMI and underwent CCTA within 48 hours of AMI were enrolled. The culprit plaques and non-culprit plaques were identified using a combination of electrocardiogram, CCTA, and angiographic findings. The vessel, plaque location, plaque type, Coronary Artery Disease-Reporting and Data System (CAD-RADS) score, high-risk plaque characteristics, plaque length, plaque volume, and burden were analyzed, and 1 904 radiomics features were extracted for each plaque. The traditional imaging model, the radiomics model, and the combined model were established by using multivariate Logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each model in identifying culprit lesions. The DeLong test was used for the comparison of AUC between every two models. The net reclassification index (NRI) was used to evaluate the incremental value of the combined model to the traditional imaging model and the radiomics model. The decision curve analysis (DCA) was used to assess the clinical net benefit of these models. A correlation heatmap was used to evaluate the correlation between the radiomics score and traditional CCTA factors. The interpretable analysis of the decision process of the combined model was performed by the Shapley Additive exPlanations (SHAP). Results:In the validation cohort and the test cohort, the AUC of the traditional imaging model developed by the vessel, plaque type, positive remodeling and CAD-RADS score was 0.898 (95% CI 0.869-0.922) and 0.881 (95% CI 0.848-0.910), respectively. The radiomics model developed by six radiomics features was 0.863 (95% CI 0.831-0.891) and 0.863 (95% CI 0.827-0.864), respectively. The AUC of the combined model was 0.930 (95% CI 0.905-0.950)and 0.919 (95% CI 0.889-0.942), respectively. In the validation cohort and the test cohort, the AUC of the combined model was higher than that of the traditional imaging model ( Z=4.013, 4.272, P<0.001) and that of the radiomics model ( Z=4.819, 3.784, P<0.001), respectively. In the validation cohort, the combined model yielded an NRI of 20.43% (95% CI 10.43%-30.44%, P<0.001) and 20.21% (95% CI 9.62%-30.80%, P<0.001) for identifying culprit lesions compared with the traditional imaging model and the radiomics model, respectively. In the test cohort, the combined model yielded an NRI of 28.05% (95% CI 16.72%-39.38%, P<0.001) and 23.57% (95% CI 13.58%-33.56%, P<0.001) for identifying culprit lesions compared with the traditional imaging model and the radiomics model, respectively. DCA showed the combined model had the highest clinical net benefit. The correlation heatmap showed the radiomics score was not correlated or only weakly correlated with traditional CCTA factors. SHAP indicated the radiomics and CAD-RADS score contributed significantly to the model. Conclusion:The CCTA-based traditional features and radiomics of plaque have favorable performance for the identification of culprit plaques in patients with AMI.

With the intensification of population aging in our country, stroke incidence is increasing year by year, and most patients leave behind varying degrees of sequelae; and motor function disorder is one of the common sequelae, which seriously affects the quality of life of patients. Motor function rehabilitations have become indispensable treatments for stroke patients. Accurately and objectively assessing the performance of motor function trehabilitations in stroke patients will help to formulate more reasonable rehabilitation plans. This article reviews the existing rehabilitation assessment techniques and their advantages and disadvantages, aiming to provide guidance for the assessment of motor function rehabilitations in stroke patients and lay a foundation for future development of stroke rehabilitations.

The International Federation of Gynecology and Obstetrics (FIGO) staging of endometrial cancer (EC) is regarded as a crucial tool for guiding treatment, evaluating prognosis, and advancing clinical research. It is a concept of shared importance among gynecologic oncologists, pathologists, and patients with EC. In June 2023, the International Federation of Gynecology and Obstetrics released a new staging system for EC. This review aims to discuss comprehensively the developmental trajectory of FIGO staging for EC, focusing on the differences between the 2023 FIGO and earlier staging systems, and delineating the advantages and disadvantages of incorporating various pathological factors and molecular subtypes into staging. The article emphasizes the progress made with the updated 2023 FIGO version in improving prognostic prediction accuracy for patients with EC. However, as the staging categories expand, their complexity becomes increasingly apparent, potentially impacting health care professionals’ accurate understanding and application of staging. Moreover, unresolved issues persist regarding histological types and grading, lymphovascular space invasion, and molecular subtypes, as well as distinguishing between low-grade endometrioid carcinomas confined to the uterus and ovaries, which may affect the personalized management of patients with EC. In the future, these issues still require extensive clinical research and specific data for validation or confirmation, presenting a challenge shared by gynecologic oncologists and pathologists.

Objective: In the present study, molecular subtypes were determined, programmed deathligand 1 (PD-L1) and tumor-associated immune cells (TAICs) were quantitatively detected, and their effect on prognosis in uterine carcinosarcoma (UCS) was analyzed. Methods: The study included 65 UCS cases. Direct sequencing of POLE exonuclease domain and immunohistochemistry of mismatch repair (MMR) deficiency proteins and p53 were used to stratify molecular subtypes. QuPath was used for quantitative immunohistochemical detection of PD-L1 and TAICs. The chi square test was used to determine the association between molecular subtypes and expression of PD-L1 and TAICs. The Kaplan–Meier method and Cox proportional hazards regression were used for plotting and survival analysis. Results: In 65 UCS cases, 1 case (1.5%) was POLE ultramutated (POLEmut) subtype, 11 cases (16.9%) were deficient MMR (dMMR) subtype, 32 cases (49.3%) were p53 mutant (p53mut) subtype, and 21 cases (32.3%) were nonspecific molecular profile (NSMP) subtype. The positive density of PD-L1 in tumor (p=0.022), CD8 in stroma (p=0.036), and CD163 in stroma (p=0.025) were significantly associated with molecular subtypes. The patients with POLEmut and dMMR subtypes had a relatively better prognosis trend than patients with NSMP and p53mut subtypes. The patients with high positive density of PD-L1 in tumor had significantly better prognosis; however, high positive density of CD163 in stroma showed significantly worse prognosis. Conclusion UCS could be classified into four molecular subtypes associated with prognosis.PD-L1 and M2 macrophages could effectively predict the prognosis of patients with UCS.

ObjectiveTo investigate the efficacy of percutaneous transhepatic variceal embolization （PTVE） alone or in combination with partial splenic embolization （PSE） in the treatment of portal hypertensive hemorrhage in liver cirrhosis through a meta-analysis. MethodsThis study was conducted according to PRISMA guideline， with a PROSPERO registration number of CRD42023396690. Wanfang Med Online， CNKI， CBM， VIP Databases， PubMed， Embase， the Cochrane Library， and Web of Science databases were searched for articles on PTVE alone or in combination with PSE in the treatment of portal hypertensive hemorrhage in liver cirrhosis published up to December 23， 2022. The articles were selected based on inclusion and exclusion criteria， and related data were extracted. The RevMan 5.4.1 statistical analysis software was used to perform the meta-analysis. ResultsEight articles were finally included， with a total sample size of 592 cases， among which there were 316 cases in the PTVE+PSE group and 276 cases in the PTVE group. The meta-analysis showed that compared with the PTVE group， the PTVE+PSE group had significantly lower postoperative portal vein pressure （standardized mean difference ［SMD］=-1.75， 95% confidence interval ［CI］： -2.33 to -1.16， P<0.05）， postoperative diameter of the portal vein （SMD=-0.87， 95%CI： -1.64 to -0.10， P<0.05）， postoperative rebleeding rate （odds ratio ［OR］=0.17， 95%CI： 0.11 — 0.28， P<0.05）， mortality rate （OR=0.13， 95%CI： 0.04 — 0.37， P<0.05）， and incidence rate of postoperative portal hypertensive gastrointestinal disease （OR=0.17， 95%CI： 0.07 — 0.45， P<0.05］， as well as a significantly higher postoperative platelet level （SMD=0.79， 95%CI： 0.52 — 1.06， P<0.05）， while there were no significant differences between the two groups in the incidence rates of postoperative ascites. ConclusionCompared with PTVE alone， PTVE combined with PSE can effectively reduce the rebleeding rate and mortality rate of portal hypertensive hemorrhage in liver cirrhosis， the incidence rate of portal hypertensive gastrointestinal disease， and portal vein pressure， and it can also shorten the diameter of the portal vein and increase platelet level. Therefore， it is an effective interventional method for the treatment of portal hypertension hemorrhage in liver cirrhosis.