Objective:To investigate the incidence and prothrombotic risk factors of postoperative venous thromboembolism(VTE) in Cushing′s disease and to further develop an assessment model to identify those at high risk of postoperative VTE events.Methods:A retrospective study was performed in 82 patients who were admitted to Huashan Hospital, Fudan University during January 2019 and January 2020 and diagnosed with Cushing′s disease. These patients underwent the evaluation about their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. The least absolute shrinkage and selection operator(LASSO) regression analysis was used to screen independent risk factors, and a nomogram model for postsurgical VTE risk assessment in Cushing′s disease was initially established, and Bootstrap method was used for internal verification. Finally, the predictive model was evaluated for calibration and clinical applicability in the study cohort.Results:Nineteen patients(23.17%) developed VTE events, with 14 cases occurring after endoscopic transsphenoidal surgery. Compared to patients without VTE, those in the VTE group were older( P<0.001), had longer postoperative bed rest, higher rates of current infection, higher HbA 1C levels, and more severe glucose tolerance impairment(all P<0.05). Through LASSO regression analysis, two independent risk factors for postoperative VTE were identified: Age and current infection. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In the nomogram model for VTE risk assessment, the area under the receiver operating characteristic curve was 0.868(95% CI 0.787-0.949), with the calibration curve closely aligning with the ideal diagonal line and the clinical decision curve exceeding the two extreme curves. Conclusions:Advanced perioperative assessment needs to be taken to screen those with high VTE risks in patients diagnosed with Cushing′s disease. Additionally, during the perioperative period, patients with Cushing′s disease should undergo mandatory physical activity or prophylactic anticoagulant therapy.

Objective To analyze the possible influencing factors of hematoma expansion in patients with hypertensive cerebral hemorrhage(HICH)during pre-hospital treatment.Methods The emergency clinical data of 169 cases patients with HICH treated in Lianyungang Emergency Center from January 2019 to June 2021 were collected retrospectively.According to the comparison of the two cranial CT bleeding volumes,they were divided into hematoma expansion group(42 cases)and hematoma non expansion group(127 cases).Multivariate Logistic regression were used to analyze the possible influencing factors of hematoma expansion.Results The change of systolic blood pressure,hematoma volume difference in the hematoma expansion group were higher than those in the non expansion group.The proportion of antihypertensive drugs,dehydrating drugs during transmission were lower than those in non expansion group.The transit time was higher than that in the non expansion group(P<0.05).Multivariate Logistic regression analysis showed that non antihypertensive drugs(OR=48.526,95%CI:7.778-302.737,P=0.001),non dehydrating drugs(OR=12.330,95%CI:3.084-49.296,P=0.001),systolic blood pressure at admission(OR=1.157,95%CI:1.082-1.238,P=0.001)were the risk factors of hematoma expansion in patients with HICH during pre-hospital care.Initial hematoma volume may be a protective factor(OR=0.893,95%CI:0.849-0.938,P=0.001).Conclusion Uncontrolled hypertension and longer transit time are related risk factors for hematoma enlargement in patients with HICH during pre-hospital care.

Purpose/Significance To apply the 5G ward round robot platform in primary hospitals,so as to effectively improve the treatment capability and management service level of patients with critical and severe diseases.Method/Process Based on technologies such as 5 G,internet of things(IoT)and robotics,the researchers build and deploy a 5 G ward round robot platform and collaborate with domestic experts to provide mobile ward round,remote consultation,intensive care,health education and other services for patients.Re-sult/Conclusion Real time sharing of patient clinical data and efficient collaboration in the diagnosis and treatment process can be a-chieved,multi-mode,accurate and standardized remote ward round and treatment guidance can be carried out according to patients'conditions.

Objective To analyze and compare the strength of titanium alloy crystalline porous scaffolds and porous scaffolds with a triply periodic minimal surface(TPMS)structure and explore the effect of porosity on the equivalent elastic modulus and permeability.Methods Crystalline porous scaffolds(cell 1-4)and TPMS porous scaffolds(P-,G-,D-,and FKS-type)with the same porosity were constructed,and the equivalent elastic modulus,equivalent yield strength,and permeability of the scaffolds were calculated using finite element simulation.Results The elastic modulus of eight scaffolds was in the range of 5.1-10.4 GPa,the yield strength was in the range of 69-110 MPa,and the permeability of 4 crystalline scaffolds was in the range of 0.015-0.030 mm2.Conclusions With an increase in porosity,the elastic modulus and yield strength of the scaffold gradually decreased,and the permeability gradually increased.The cell 2-type scaffold is suitable for repairing defects at load-bearing bone sites because of its high elastic modulus and yield strength.The cell 3-type scaffold with a uniform stress distribution and a longer linear elasticity phase may be suitable for designing porous tibial platforms for knee joint prostheses.

Objective:In this study,we explored the application prospects and mechanisms of action of co-inhibiting fibroblast growth factor receptor 2(FGFR2)and Src homology region 2-containing protein tyrosine phosphatase 2(SHP2)in gastric cancer with the TACC2-FGFR2 fu-sion gene.Methods:We established human gastric cancer cell lines overexpressing the TACC2-FGFR2 fusion gene(MKN45TACC2-FGFR2 and NUGC4TACC2-FGFR2 cells)or a control lentiviral virus(MKN45NC and NUGC4NC cells).The cells were treated with the FGFR2 inhibitor AZD4547,the SHP2 inhibitor SHP099,or a combination of both.The proliferation and migration of tumor cells were detected using cell counting Kit-8(CCK-8)and scratch assays.After treating MKN45TACC2-FGFR2 and NUGC4TACC2-FGFR2 cells with different formulations for 1 or 48 h,Western blot was used to detect variations in the levels of FGFR2,SHP2,and proteins downstream of the RAS/ERK and PI3K/AKT signaling pathways.Results:Com-pared to monotherapy,the combination of AZD4547 and SHP099 significantly inhibited the proliferation and migration of MKN45TACC2-FGFFR2 and NUGC4TACC2-FGFFR2 cells.After 1 h of treatment,the combination therapy inhibited the RAS/ERK and PI3K/AKT pathways in MKN45TACC2-FGFFR2 cells to a greater extent than the AZD4547 monotherapy.Forty-eight hours of AZD4547 monotherapy resulted in feedback activation of p-FGFR and p-SHP2,but failed to inhibit the RAS/ERK pathway.However,combination therapy continuously suppressed upstream FGFR2 and SHP2 signaling,as well as downstream RAS/ERK and PI3K/AKT pathways.Conclusions:Co-inhibiting FGFR2 and SHP2 further inhibit gastric cancer with the TACC2-FGFR2 fusion gene by suppressing the RAS/ERK and PI3K/AKT pathways.These findings provide a new treatment mode for patients with gastric cancer with the TACC2-FGFR2 fusion gene.

During radiotherapy of lung tumors, patients′respiration will lead to tumor displacement, making it difficult to accurately expose target volumes to radiation. This will cause damage to the physiological structures of surrounding healthy tissues and reduce the efficacy. Therefore, it is critical to accurately predict the motion trajectories of lung tumors and adjust the positions of electron beams in a real-time manner. Currently, primary methods to predict the motion trajectories of lung tumors include marker-based and marker-free predictions. This review explores the advances in research on both prediction methods and analyzes their basic principles, application scenarios, current challenges, and future trends. It is expected to provide comparatively comprehensive insights for researchers and clinicians in related fields to facilitate the improvement and optimization of radiotherapy for lung tumors.

Objective To study the application value of 3.0T MRI T2 mapping quantitative technology in the diagnosis of anterior cruciate ligament sprain and chronic injury of knee joint.Methods A total of 82 subjects were studied,and the experimental group 72 cases was divided into grade Ⅰ injury group(25 cases),grade Ⅱ injury group(25 cases),chronic injury group(22 cases),and control group 10 cases.The experimental group met the criteria of arthroscopy.The proximal,middle,and distal segments of the anterior cruciate ligament were selected as the region of interest(ROI),and T2 mapping values were measured.The differences in T2 mapping values of each area were compared between and within the groups,while compared with arthroscopy.Results The T2 mapping values in grade Ⅰ,Ⅱ,and chronic injury groups were higher than those in control group(P<0.05).Comparison within the experimental group:the T2 mapping values of each area in grade Ⅱ injury group were higher than those in grade Ⅰ injury group and chronic injury group(P<0.05).The T2 mapping values of each area in grade Ⅰ injury group were higher than those in chronic injury group(P<0.05).The specificity,sensitivity,positive predictive value,negative predictive value and accuracy of T2 mapping in diagnosing anterior cruciate ligament grade Ⅰ injury were 94.7%,95.5%,89.7%,96.6%,and 90.2%respectively.The specificity,sensitivity,positive predictive value,negative predictive value,and accuracy of grade Ⅱ injury were 89.4%,87.9%,92.1%,93.4%,and 93.8%respectively.The specificity,sensitivity,positive predictive value,negative predictive value,and accuracy of chronic injury were 92.2%,95.4%,90.3%,87.6%,and 91.5%respectively.Kappa test showed a good con-sistency between T2 mapping results and arthroscopic results,with a Kappa value of 0.763(P<0.01).Conclusion The value of MRI T2 mapping can provide a reference for the clinical diagnosis of anterior cruciate ligament sprain and chronic injury of knee joint,and the results are in good agreement with the control of arthroscopy.

Objective To compare the efficacy of mediastinoscope-assisted transhiatal esophagectomy (MATHE) and functional minimally invasive esophagectomy (FMIE) for esophageal cancer. Methods Patients who underwent minimally invasive esophagectomy at Jining No.1 Hospital from March 2018 to September 2022 were retrospectively included. The patients were divided into a MATHE group and a FMIE group according to the procedures. The patients were matched via propensity score matching (PSM) with a ratio of 1 : 1 and a caliper value of 0.2. The clinical data of the patients were compared after the matching. Results A total of 73 patients were include in the study, including 54 males and 19 females, with an average age of (65.12±7.87) years. There were 37 patients in the MATHE group and 36 patients in the FMIE group. Thirty pairs were successfully matched. Compared with the FMIE group, MATHE group had shorter operation time (P=0.022), lower postoperative 24 h pain score (P=0.031), and less drainage on postoperative 1-3 days (P<0.001). FMIE group had more lymph node dissection (P<0.001), lower incidence of postoperative hoarseness (P=0.038), lower white blood cell and neutrophil counts on postoperative 1 day (P<0.001). There was no statistically significant difference in the bleeding volume, R0 resection, hospital mortality, postoperative hospital stay, anastomotic leak, chylothorax, or pulmonary infection between the two groups (P>0.05). Conclusion Compared with the FMIE, MATHE has shorter operation time, less postoperative pain and drainage, but removes less lymph nodes, which is deficient in oncology. For some special patients such as those with early cancer or extensive pleural adhesions, MATHE may be a suitable surgical method.

Objective:To explore the effectiveness of a hysteroscopic endometrial lesion diagnosis model de-veloped based on deep learning(DL)algorithm combined with gradient-weighted class activation mapping(Grad-CAM)visualization technology.Methods:303 hysteroscopy videos(4781 images)of 291 patients who un-derwent hysteroscopy examination in the Department of Gynecology,Renmin Hospital of Wuhan University from June 1,2021 to December 31,2022 were selected.The dataset was divided into a training set(3703 images)and a test set(1078 images)by weight sampling method.After the training set was used for model learning and train-ing,two model architectures,residual neural network(ResNet18)and efficient neural network(EfficientNet-B0),were selected to verify the model in the test set by five-class and two-class classification tasks,respectively.Tak-ing histopathology as the gold standard,the diagnostic efficacy was evaluated to select the optimal model,and the Grad-CAM layer was embedded in the optimal model to output hysteroscopy images of Grad-CAM.Results:①In the five-class classification tasks,the accuracy of EfficientNet-B0 model(93.23％)was higher than that of Res-Net18 model(84.23％);the area under the curve(AUC)of EfficientNet-B0 model in the diagnosis of five disea-ses,including atypical endometrial hyperplasia,endometrial polyps,endometrial cancer,endometrial atypical hy-perplasia,and submucous myoma,was slightly higher than that of ResNet18 model,and the AUC of both models was almost above 0.980.②In the binary classification task of accuracy and the evaluation of specificity,the two models were similar,both above 93.00％,and the sensitivity of EfficientNet-B0 model(91.14％)was significantly better than that of ResNet18 model(77.22％).③EfficientNet-B0 model combined with Grad-CAM algorithm could identify the abnormal areas in the image.After biopsy and pathological examination,it was confirmed that about 95％of the marked areas in the model's output heatmap were lesion areas.Conclusions:The hysteroscopy di-agnostic model developed by EfficientNet-B0 model combined with Grad-CAM has high diagnostic accuracy,sen-sitivity,and specificity,and has application value in the diagnosis of endometrial lesions.

Objective:To explore the effectiveness of a hysteroscopic endometrial lesion diagnosis model de-veloped based on deep learning(DL)algorithm combined with gradient-weighted class activation mapping(Grad-CAM)visualization technology.Methods:303 hysteroscopy videos(4781 images)of 291 patients who un-derwent hysteroscopy examination in the Department of Gynecology,Renmin Hospital of Wuhan University from June 1,2021 to December 31,2022 were selected.The dataset was divided into a training set(3703 images)and a test set(1078 images)by weight sampling method.After the training set was used for model learning and train-ing,two model architectures,residual neural network(ResNet18)and efficient neural network(EfficientNet-B0),were selected to verify the model in the test set by five-class and two-class classification tasks,respectively.Tak-ing histopathology as the gold standard,the diagnostic efficacy was evaluated to select the optimal model,and the Grad-CAM layer was embedded in the optimal model to output hysteroscopy images of Grad-CAM.Results:①In the five-class classification tasks,the accuracy of EfficientNet-B0 model(93.23％)was higher than that of Res-Net18 model(84.23％);the area under the curve(AUC)of EfficientNet-B0 model in the diagnosis of five disea-ses,including atypical endometrial hyperplasia,endometrial polyps,endometrial cancer,endometrial atypical hy-perplasia,and submucous myoma,was slightly higher than that of ResNet18 model,and the AUC of both models was almost above 0.980.②In the binary classification task of accuracy and the evaluation of specificity,the two models were similar,both above 93.00％,and the sensitivity of EfficientNet-B0 model(91.14％)was significantly better than that of ResNet18 model(77.22％).③EfficientNet-B0 model combined with Grad-CAM algorithm could identify the abnormal areas in the image.After biopsy and pathological examination,it was confirmed that about 95％of the marked areas in the model's output heatmap were lesion areas.Conclusions:The hysteroscopy di-agnostic model developed by EfficientNet-B0 model combined with Grad-CAM has high diagnostic accuracy,sen-sitivity,and specificity,and has application value in the diagnosis of endometrial lesions.