ObjectiveTo construct an automatic measurement model for palmar tilt and radial inclination suitable for traditional Chinese medicine （TCM） clinical scenarios， and to validate its accuracy and efficiency in TCM manipulative reduction settings. MethodsData on anteroposterior （AP） and lateral X-rays of distal radius fractures were collected from patients admitted to 18 TCM/ integrated TCM and western medicine hospitals in Jiangsu province between September 1st， 2023， and September 1st， 2024， via the Jiangsu Diagnosis and Treatment Big Data Platform for TCM Dominant Diseases. A medical image segmentation framework based on multi-scale feature fusion and edge-awareness was employed， combined with anatomical knowledge specific to TCM orthopedics， to optimize the feature extraction strategy of an artificial intelligence （AI） model. This framework enabled automatic segmentation of fracture regions and measurement of distal radius palmar tilt and radial inclination. The accuracy of the AI model in measuring radial inclination and volar tilt was validated， and the measurement time and average time gain rate of the AI model were compared to those of manual measurement. ResultsA total of 15,444 AP and lateral X-ray images of distal radius fractures were collected， and were divided into a training set （11,144 images， 5066 AP and 6078 lateral）， a validation set （3700 images， 1840 AP and 1860 lateral）， and an independent test set （600 images， 300 AP and 300 lateral） after preprocessing. In the measurement of 300 AP X-rays in the independent test set for radial inclination， when the degree error between AI measurement and manual measurement was ＜3° and ＜5°， AI measurement accuracy was 83% and 93%， respectively. In 300 lateral X-rays in the test set for palmar tilt， when AI measurements had an error of ＜3° and ＜5° compared to manual measurements， corresponding accuracy rate was 78% and 90%， respectively. For 50 X-ray images， AI measurement time was （1.37±0.05） min for radial inclination while manual measurement time was （22.57±2.52） min （P＜0.001）； in terms of palmar tilt， the AI measurement time was （1.33±0.14） min， shorter than （23.70±2.80） min for manual measurement time （P＜0.001）. Average time gain rates for manual and AI measurements were 93.93% and 94.39% respectively. ConclusionAn automatic measurement model for palmar tilt and radial inclination in distal radius fractures has been established， enabling more accurate and efficient assessment as well as providing a tool to support the quantitative evaluation of the efficacy of TCM manipulative reduction and large-sample clinical research.

Purpose To investigate the value of 18F-FDG PET/CT combined with MRI for detecting occult lymph node metastases in head and neck squamous cell carcinoma(HNSCC).Materials and Methods Eighteen patients with clinically node-negative,pathologically confirmed HNSCC were retrospectively enrolled from the Third Affiliated Hospital of Air Force Medical University from January 2022 to December 2023.All patients underwent preoperative 18F-FDG PET/CT and MRI,including 3D BRAVO high-resolution structural imaging,T2WI and diffusion-weighted imaging.Two nuclear medicine physicians qualitatively and semi-quantitatively assessed cervical lymph nodes for glucose metabolism and apparent diffusion coefficient(ADC)abnormalities.Using postoperative pathology as the gold standard,the diagnostic performance of PET,ADC and their combination for detecting occult metastases was compared.Results Among 54 dissected lymph nodes from 18 patients,12(22.2%)were pathologically confirmed as metastatic.Of 7 false-negative lymph nodes on diffusion weighted imaging,18F-FDG PET/CT correctly identified 4 as positive.18F-FDG PET/CT showed 6 false negatives and 6 false positives.The accuracies of 18F-FDG PET/CT and MRI for detecting occult metastases were 77.8%and 55.6%,respectively,while their combination achieved 91.1%accuracy(41/45).Metastatic lymph nodes exhibited higher maximum standardized uptake values(3.53±0.26 vs.2.71±0.14;t=3.17,P=0.008)and lower ADC values(0.91×10-3 mm2/s vs.1.07×10-3 mm2/s;t=4.15,P=0.001)compared with inflammatory nodes.Conclusion 18F-FDG PET/CT combined with diffusion weighted imaging improves detection of occult lymph node metastases in HNSCC and may guide surgical management.

Objective To construct and evaluate the prediction model of maternal mortality in Yunnan Province,and predict the maternal mortality rate in Yunnan Province from 2024 to 2030.Methods Based on the maternal mortality rates in Yunnan Province from 1994 to 2023,a grey prediction model and a autoregressive integrated moving average model were constructed,The models were compared using mean absolute error,mean square error and root mean square error to assess their fitting performance,and the optimal model was used to predict the maternal mortality rate in Yunnan Province from 2024 to 2030.Resuls The maternal mortality rate in Yunnan Province showed a continuous decline from 1994 to 2023(χ2=50 170.0,P<0.05).The mean absolute error,mean-square error and root mean-square error for the grey prediction model were 2.424,12.389,3.519,respectively,while for the differential autoregressive moving average model,they were 3.966,27.651,5.258,respectively.The prediction effect of the grey prediction model is superior to that of the autoregressive integrated moving average model,with a posterior difference ratio C=0.079 and a low probability error P=1,indicating a prediction accuracy of level 1.Using the grey prediction model,the maternal mortality rates for Yunnan Province from 2024 to 2030 are 10.05/100 000,9.16/100 000,8.34/100 000,7.59/100 000,691/100 000,6.30/100 000 and 5.73/100 000,respectively.Conclusion The grey prediction model has a good prediction effect on maternal mortality in Yunnan Province.It is predicted that the maternal mortality rate in Yunnan Province in 2030 can meet the control targets outlined in the"Healthy China 2030 Plan",the"Outline of Chinese Women's Development(2021-2030)"and the"Yunnan Women's Development Plan(2021-2030)".

Objective To investigate the effect of Dex on neurological function in PD rats through the receptor interacting protein kinase 1(RIPK1)/RIPK3/mixed lineage kinase domain-like pro-tein(MLKL)pathway.Methods After rat PD model was constructed,the PD rats were assigned into PD group,L-,M-and H-Dex groups(intraperitoneal injection of 25,50,and 100 μg/kg Dex,respectively),and Dex+recombinant RIPK1 protein(rRIPK1)group(intraperitoneal injection of 100 μg/kg Dex+8 μg/kg rRIPK1),with 6 animals in each group.Another 6 rats served as sham-operation(Sham)group.The rats from the Sham group and PD group were intragastrically ad-ministered and injected with an equal amount of normal saline solution once a day.After 21 con-secutive days,the rotational behavior was observed of in each group rats.HE staining was per-formed to detect the pathological changes in dopaminergic neurons in the substantia nigra.TUNEL staining was conducted to measure the apoptosis of dopaminergic neurons.ELISA was used to determine the levels of neurotransmitters[DA,HVA,3,4-dihydroxyphenylacetic acid(DOPAC),5-hydroxytrptamine(5-HT)]and inflammatory factors(TNF-α,IL-1β)in the sub-stantia nigra.Western blotting was applied to detect the expression of RIPK1/RIPK3/MLKL pathway related proteins in the substantia nigra tissues.Results Intact and well-arranged mor-phology and structure were observed in the neurons of the Sham group.The PD group presented prominently less neurons,in scattered arrangement,with obviously reduced volume,irregular nu-clear deformation,indicating notably neuronal damage.The severity of neuronal damage was at-tenuated sequentially in the L-Dex,M-Dex,and H-Dex groups,but the damage in the Dex+rRIPK1 group was further worsened.The PD group had significantly larger number of rotations,longer escape latency,higher apoptotic rate,increased TNF-α and IL-1β contents,and elevated lev-els of p-RIPK1/RIPK1(1.07±0.18 vs 0.36±0.11),p-RIPK3/RIPK3(1.32±0.21 vs 0.47±0.14),and p-MLKL/MLKL(0.79±0.11 vs 0.18±0.05),but lower DA,DOPAC,5-HT,and HVA con-tents than the Sham group(P＜0.05).Dex treatment of low,medium and high doses reserved all above changes induced by PD modeling(P＜0.05).The Dex+rRIPK1 group obtained larger num-ber of rotations,longer escape latency,higher apoptotic rate,increased TNF-α and IL-1β contents,and elevated levels of p-RIPK1/RIPK1(0.95±0.17 vs 0.41±0.12),p-RIPK3/RIPK3(1.14±0.20 vs 0.51±0.15),and p-MLKL/MLKL(0.72±0.09 vs 0.24±0.06),but decreased DA,DOPAC,5-HT,and HVA contents when compared with the H-Dex group(P＜0.05).Conclusion Dex protects the neurological function of PD rats by inhibiting the RIPK1/RIPK3/MLKL pathway.

Purpose To investigate the value of 18F-FDG PET/CT combined with MRI for detecting occult lymph node metastases in head and neck squamous cell carcinoma(HNSCC).Materials and Methods Eighteen patients with clinically node-negative,pathologically confirmed HNSCC were retrospectively enrolled from the Third Affiliated Hospital of Air Force Medical University from January 2022 to December 2023.All patients underwent preoperative 18F-FDG PET/CT and MRI,including 3D BRAVO high-resolution structural imaging,T2WI and diffusion-weighted imaging.Two nuclear medicine physicians qualitatively and semi-quantitatively assessed cervical lymph nodes for glucose metabolism and apparent diffusion coefficient(ADC)abnormalities.Using postoperative pathology as the gold standard,the diagnostic performance of PET,ADC and their combination for detecting occult metastases was compared.Results Among 54 dissected lymph nodes from 18 patients,12(22.2%)were pathologically confirmed as metastatic.Of 7 false-negative lymph nodes on diffusion weighted imaging,18F-FDG PET/CT correctly identified 4 as positive.18F-FDG PET/CT showed 6 false negatives and 6 false positives.The accuracies of 18F-FDG PET/CT and MRI for detecting occult metastases were 77.8%and 55.6%,respectively,while their combination achieved 91.1%accuracy(41/45).Metastatic lymph nodes exhibited higher maximum standardized uptake values(3.53±0.26 vs.2.71±0.14;t=3.17,P=0.008)and lower ADC values(0.91×10-3 mm2/s vs.1.07×10-3 mm2/s;t=4.15,P=0.001)compared with inflammatory nodes.Conclusion 18F-FDG PET/CT combined with diffusion weighted imaging improves detection of occult lymph node metastases in HNSCC and may guide surgical management.

Objective To investigate the effect of Dex on neurological function in PD rats through the receptor interacting protein kinase 1(RIPK1)/RIPK3/mixed lineage kinase domain-like pro-tein(MLKL)pathway.Methods After rat PD model was constructed,the PD rats were assigned into PD group,L-,M-and H-Dex groups(intraperitoneal injection of 25,50,and 100 μg/kg Dex,respectively),and Dex+recombinant RIPK1 protein(rRIPK1)group(intraperitoneal injection of 100 μg/kg Dex+8 μg/kg rRIPK1),with 6 animals in each group.Another 6 rats served as sham-operation(Sham)group.The rats from the Sham group and PD group were intragastrically ad-ministered and injected with an equal amount of normal saline solution once a day.After 21 con-secutive days,the rotational behavior was observed of in each group rats.HE staining was per-formed to detect the pathological changes in dopaminergic neurons in the substantia nigra.TUNEL staining was conducted to measure the apoptosis of dopaminergic neurons.ELISA was used to determine the levels of neurotransmitters[DA,HVA,3,4-dihydroxyphenylacetic acid(DOPAC),5-hydroxytrptamine(5-HT)]and inflammatory factors(TNF-α,IL-1β)in the sub-stantia nigra.Western blotting was applied to detect the expression of RIPK1/RIPK3/MLKL pathway related proteins in the substantia nigra tissues.Results Intact and well-arranged mor-phology and structure were observed in the neurons of the Sham group.The PD group presented prominently less neurons,in scattered arrangement,with obviously reduced volume,irregular nu-clear deformation,indicating notably neuronal damage.The severity of neuronal damage was at-tenuated sequentially in the L-Dex,M-Dex,and H-Dex groups,but the damage in the Dex+rRIPK1 group was further worsened.The PD group had significantly larger number of rotations,longer escape latency,higher apoptotic rate,increased TNF-α and IL-1β contents,and elevated lev-els of p-RIPK1/RIPK1(1.07±0.18 vs 0.36±0.11),p-RIPK3/RIPK3(1.32±0.21 vs 0.47±0.14),and p-MLKL/MLKL(0.79±0.11 vs 0.18±0.05),but lower DA,DOPAC,5-HT,and HVA con-tents than the Sham group(P＜0.05).Dex treatment of low,medium and high doses reserved all above changes induced by PD modeling(P＜0.05).The Dex+rRIPK1 group obtained larger num-ber of rotations,longer escape latency,higher apoptotic rate,increased TNF-α and IL-1β contents,and elevated levels of p-RIPK1/RIPK1(0.95±0.17 vs 0.41±0.12),p-RIPK3/RIPK3(1.14±0.20 vs 0.51±0.15),and p-MLKL/MLKL(0.72±0.09 vs 0.24±0.06),but decreased DA,DOPAC,5-HT,and HVA contents when compared with the H-Dex group(P＜0.05).Conclusion Dex protects the neurological function of PD rats by inhibiting the RIPK1/RIPK3/MLKL pathway.

To investigate the associations of serum gamma-glutamyl transferase (GGT) levels with the risk of cardiovascular disease (CVD) and its subtypes in patients with type 2 diabetes mellitus (T2DM) in Jiangsu Province.Methods:The participants were enrolled in the Comprehensive Research project regarding 'Prevention and Control of Diabetes' in Jiangsu Province. The baseline survey was conducted from 2013 to 2014, and follow-up until December 31, 2021. After excluding the participants who self-reported with chronic liver disease/stroke/coronary heart disease at baseline survey and those with incomplete information on GGT, a total of 16 147 T2DM patients were included in the final analysis. Cox proportional hazard regression models were used to calculate the hazard ratio ( HR) and their 95% CI of GGT for CVD, myocardial infarction, and stroke. Restricted cubic spline models were applied to analyze the dose-response relationship between GGT and the risk of CVD and its subtypes. Results:During the median follow-up time of 8.02 years, 2 860 CVD cases were registered, including 196 cases of myocardial infarction and 2 730 cases of stroke. Multivariate Cox proportional risk regression model indicated that compared to the lowest serum GGT level group, the highest GGT level group had a 24% increased risk of CVD ( HR=1.24, 95% CI: 1.09-1.41) and a 23% increased risk of stroke ( HR=1.23, 95% CI: 1.08-1.40). The restricted cubic spline model showed a nonlinear dose-response relationship between GGT and the risk of CVD, myocardial infarction, and stroke in T2DM patients. Conclusions:High levels of GGT may be associated with an increased risk of cardiovascular disease in T2DM patients, which needs further exploration and validation in future clinical practice.

Objective:To analyze the clinical application value of a novel magnetic navigation ultrasound (MNU) combined with digital subtraction angiography (DSA) dual-guided percutaneous transhepatic biliary drainage (PTCD) through the right hepatic duct for the treatment of malignant obstructive jaundice.Methods:Randomized controlled trial. The clinical data of 64 patients with malignant obstructive jaundice requiring PTCD through the right hepatic duct at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People′s Hospital) from December 2018 to December 2021 were retrospectively analyzed. The MNU group ( n=32) underwent puncture guided by a novel domestic MNU combined with DSA, and the control group ( n=32) underwent puncture guided by traditional DSA. The operation time, number of punctures, X-ray dose after biliary stenting as shown by DSA, patients' tolerance of the operation, success rate of the operation, pre- and post-operative total bilirubin, and incidence of postoperative complications were compared between the two groups. Results:The operation time of the MNU group was significantly shorter than that of the control group [(17.8±7.3) vs. (31.6±9.9) min, t=-6.35, P=0.001]; the number of punctures in the MNU group was significantly lower [(1.7±0.6) vs. (6.3±3.9) times, t=-6.59, P=0.001]; and the X-ray dose after biliary stenting as shown by DSA in the MNU group was lower than that in the control group [(132±88) vs. (746±187) mGy, t=-16.81, P<0.001]; Five patients in the control group were unable to tolerate the operation, and two stopped the operation, however all patients in the MNU group could tolerate the operation, and all completed the operation, with a success rate of 100% (32/32) in the MNU group compared to 93.8%(30/32) in the control group; the common complications of PTCD were biliary bleeding and infection, and the incidence of biliary bleeding (25.0%, 8/32) and infection (18.8%, 6/32) in the MNU group was significantly lower than that in the control group, 53.1% (17/32) and 28.1% (9/32), respectively. Conclusion:Magnetic navigation ultrasound combined with DSA dual-guided PTCD through the right biliary system for the treatment of malignant obstructive jaundice is safe and feasible.

Objective To quantitatively evaluate the structure and content of the long-term care policy for the older people in the 14th Five-Year Plan in China. Methods The primary indicators were constructed based on multi-source flow model,using Policy Modeling Consisten-cy(PMC)model,and the secondary indicators were constructed based on World Health Organization reports Long-term care for older people:Package for universal health coverage and Decade of healthy ageing:Plan of action.An evaluation system was formed,containing nine primary indicators and 35 secondary indicators.A total of eight policies issued by the nation between November,2021 and January,2024 were included.High-frequency words were extracted using ROSTCM 6.0,a semantic network map of keywords was created using Gephi,and the policies were analyzed using the evaluation system. Results The policies mainly focused on nursing,community,rehabilitation and nursing home,etc.The average PMC in-dex was 6.77.For the policy content coverage,one policy was perfect,five were excellent and two were accept-able.In the dimension of policy content,the indexes of three primary indicators of policy function,policy recep-tors and infrastructure construction were 0.85 or more;while the indexes of three primary indicators of caregiver assistance,support for the elderly and human resources building were 0.7 or less. Conclusion The content of long-term care policies for the older people issued in the 14th Five-Year Plan in China covers well in policy functions,policy recipients and infrastructure,and needs to be upgraded in the three dimensions of caregiver assistance,support for the elderly and human resource building.It is important to strengthen the policy content and measures in three areas,namely,the comprehensive care support network,the creation of an age-friendly environment and support for informal care.

Objective:To identify species type and analyze the homology of Brucella in a family cluster infection. Methods:Two patients with brucellosis from the same family who were treated at the First People's Hospital of Lianyungang City, Jiangsu Province in May 2022 were selected as the research subjects. Brucella strains (H4LYG01 and H2LYG02) were isolated through blood culture. The isolated strains were identified for species type and homology analysis using a fully automated microbial mass spectrometry detection system. Molecular typing of the isolated strains was performed using multiple locus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST). Results:H4LYG01 and H2LYG02 were both Brucella Maltese, and the credibility scores were 9.745 and 9.627, respectively, and the homology was 100%. The MLVA results showed that the gene loci of H4LYG01 and H2LYG02 were completely identical, with the same genotype. The MLST results showed that the sequence type (ST) of H4LYG01 and H2LYG02 were both ST8 types. Conclusion:The two isolated strains of Brucella from a family with clustered infections are both Brucella Maltese and from the same source.