Objective:To explore the risk factors for in-hospital death after complete recanalization by mechanical thrombectomy and establish a risk prediction model in patients with acute large vessel occlusion stroke of the anterior circulation.Methods:A total of 468 patients with anterior circulation acute large vessel occlusion stroke who underwent mechanical thrombectomy in Stroke Center (Second Affiliated Hospital of Dalian Medical University), Department of Interventional Therapy (First Affiliated Hospital of Dalian Medical University), and Department of Neurointervention and Neurocritical Care (Central Hospital Affiliated to Dalian University of Technology) from January 2016 to November 2023 were selected. All patients achieved complete recanalization (modified thrombolysis in cerebral infarction: grading 3) immediately after thrombectomy. The clinical data, laboratory and imaging results of the patients were collected, and these patients were divided into in-hospital death group ( n=52) and in-hospital survival group ( n=416) according to occurrence of in-hospital death (all-cause death). Univariate analysis and multivariate Logistic regression analysis were used to screen the risk factors for in-hospital death, and a risk prediction model was constructed. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of the model, calibration curve and Hosmer-Lemeshow test were used to evaluate the accuracy of the model, and decision curve was used to evaluate the clinical utility of the model. Results:Univariate analysis showed that the in-hospital death group had significantly higher proportions of female patients, patients with atrial fibrillation, and patients with symptomatic intracranial hemorrhage compared with the in-hospital survival group (50.0% vs. 31.3%; 57.7% vs. 41.6%; 38.5% vs.11.8%), and significantly higher baseline blood glucose, and National Institutes of Health Stroke Scale score, neutrophil count, and neutrophil/lymphocyte ratio within 24 hours of thrombectomy (8.10 [7.05, 11.79] vs. 7.31[6.46, 9.25], 20 [16, 32] vs. 15 [10, 22], 10.09 [7.87, 13.19] vs. 8.47 [6.73, 10.32], 10.63 [5.87, 15.69] vs. 7.13 [5.16, 10.91], P<0.05). Multivariate Logistic regression analysis showed that female ( OR=2.533, 95% CI: 1.306-4.910, P=0.006), atrial fibrillation history ( OR=1.999, 95% CI: 1.044-3.827, P=0.037), neutrophil count within 24 hours of thrombectomy ( OR=1.162, 95% CI: 1.055-1.279, P=0.002), and symptomatic intracranial hemorrhage ( OR=4.066, 95% CI: 1.897-8.718, P<0.001) were independent risk factors for in-hospital death after complete recanalization; risk prediction model, accordingly, was 0.929×female+0.692×atrial fibrillation history+0.150×neutrophil count+1.403×symptomatic intracranial hemorrhage-5.349 ( P: probability of event occurrence). Area under ROC curve of the model was 0.765 (95% CI: 0.689-0.842, P<0.001); calibration curve and Hosmer-Lemeshow test of the model showed good accuracy ( χ2=7.656, P=0.468); decision curve of the model showed good clinical utility at threshold probability of 0.05-0.90. Conclusion:For patients with acute large vessel occlusion stroke at the anterior circulation complicated with atrial fibrillation, symptomatic intracranial hemorrhage or elevated neutrophil count within 24 hours of thrombectomy, or female patients with acute large vessel occlusion stroke at the anterior circulation, in-hospital death still needs to be highly alert after complete recanalization by mechanical thrombectomy.

Objective To construct nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)knockout mice in order to investigate the effects of NLRP3 knockout on radiation-induced acute pneumonitis and pulmonary fibrosis.Methods Nlrp3+/+and Nlrp3-/-mice were randomly divided into the control group and irradiation group.To induce radiation-caused acute pneumonitis,the control group was exposed to sham irradiation while the irradiation group was exposed to 60Co γ-rays at a dose of 22 Gy at a dose rate of 184.30 R/min.At 14 days post-irradiation,the body weight of each mouse and the wet weight of its lung tissue were measured separately using an analytical balance to calculate the lung coefficient.Quantitative real-time PCR(qPCR)and cytometric bead array(CBA)were used to detect inflammatory responses in lung tissues and serum.Hematoxylin-eosin(HE)staining and F4/80 immunohistochemical staining were used to assess pathological changes and inflammatory cell infiltration in lung tissues.Cysteinyl aspartate specific proteinase-1(caspase-1)activation was analyzed by Western blotting.To establish a model of radiation-induced pulmonary fibrosis,mice were irradiated with 60Co γ-rays at a dose of 18 Gy at a dose rate of 174.67 R/min.At 24 weeks post-irradiation,HE staining and Masson staining were performed to evaluate pulmonary fibrosis.Results NLRP3 knockout inhibited caspase-1 activation,reduced inflammatory responses in lung tissues and serum,suppressed macrophage infiltration,alleviated pulmonary edema,and thereby protected against acute radiation-induced lung injury.Additionally,NLRP3 knockout significantly ameliorated late-stage radiation-induced pulmonary fibrosis.Conclusion NLRP3 knockout can mitigate both early radiation-induced pneumonia and lateradiation-induced pulmonary fibrosis.

Objective To analyze the difference of diseases between the coal mine workers and the general population inpatients by the disease spectrum in Datong City. Methods A total of 282 639 hospitalized patients in Datong City in 2023 were included as the study subjects. Participants were divided into a general population group and a coal mine workers group based on health insurance types, with 247 897 and 34 742 cases, respectively. The disease spectrum of participants in both groups was coded and analyzed according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). The standardized constituent ratios of disease categories were calculated and compared between the two groups. Results Patients aged 60-<70 years had the largest standardized proportion in both cohorts (29.02% in the general population group and 33.08% in coal mine workers group). Circulatory system diseases had the highest standardized proportion in both groups. Within the top six disease categories ranked by standardized composition ratio in the coal mine workers, three demonstrated a higher burden, including neoplasms (C00-D48), symptoms, signs and abnormal clinical/laboratory findings not elsewhere classified (R00-R99), and factors influencing health status/contact with health services (Z00-Z99), compared with the general population (11.82% vs 10.44%, 12.99% vs 8.03%, and 6.17% vs 2.04%, respectively). In both groups, male workers had higher standardized constituent ratios of circulatory, respiratory, and digestive system diseases than females (coal mine workers group, 19.53% vs 14.31%, 13.56% vs 9.10%, 10.61% vs 8.43%; general population group, 26.15% vs 22.42%, 15.45% vs 11.87%, 11.52% vs 10.41%). Conversely, the ratios for conditions classified under symptoms, signs and abnormal clinical/laboratory findings not elsewhere classified (R00-R99). and factors influencing health status/contact with health services (Z00-Z99) were higher in females than males (coal mine workers group, 13.31% vs 12.68%, 7.26% vs 5.13%; general population group, 8.91% vs 7.18%, 2.35% vs 1.74%). Mental and behavioral disorders (F00-F99) were most prevalent in the 22-<50-year age group in the general population (9.92%) and in the 50-<60-year age group in coal mine workers (8.58%). The standardized proportion of respiratory system diseases ranked first in≥80-year age workers in general population group and coal mine workers group (29.54% and 26.46%, respectively). Regarding specific malignancies, unspecified malignant neoplasm of the bronchus or lung was the most common cancer among males in both groups (3.44% and 3.62%). Among females, the standardized proportion of unspecified malignant neoplasm of breast was higher in coal mine workers group than in the general population group (2.60% vs 2.09%). Conclusion Neoplasms, abnormal symptoms, and mental health disorders should be prioritized in disease prevention strategies for coal mine workers. Greater attention should be paid to mental health screening in younger populations, and medical resource allocation should be optimized according to sex-specific high-incidence cancers.

Objective:To explore the risk factors for in-hospital death after complete recanalization by mechanical thrombectomy and establish a risk prediction model in patients with acute large vessel occlusion stroke of the anterior circulation.Methods:A total of 468 patients with anterior circulation acute large vessel occlusion stroke who underwent mechanical thrombectomy in Stroke Center (Second Affiliated Hospital of Dalian Medical University), Department of Interventional Therapy (First Affiliated Hospital of Dalian Medical University), and Department of Neurointervention and Neurocritical Care (Central Hospital Affiliated to Dalian University of Technology) from January 2016 to November 2023 were selected. All patients achieved complete recanalization (modified thrombolysis in cerebral infarction: grading 3) immediately after thrombectomy. The clinical data, laboratory and imaging results of the patients were collected, and these patients were divided into in-hospital death group ( n=52) and in-hospital survival group ( n=416) according to occurrence of in-hospital death (all-cause death). Univariate analysis and multivariate Logistic regression analysis were used to screen the risk factors for in-hospital death, and a risk prediction model was constructed. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of the model, calibration curve and Hosmer-Lemeshow test were used to evaluate the accuracy of the model, and decision curve was used to evaluate the clinical utility of the model. Results:Univariate analysis showed that the in-hospital death group had significantly higher proportions of female patients, patients with atrial fibrillation, and patients with symptomatic intracranial hemorrhage compared with the in-hospital survival group (50.0% vs. 31.3%; 57.7% vs. 41.6%; 38.5% vs.11.8%), and significantly higher baseline blood glucose, and National Institutes of Health Stroke Scale score, neutrophil count, and neutrophil/lymphocyte ratio within 24 hours of thrombectomy (8.10 [7.05, 11.79] vs. 7.31[6.46, 9.25], 20 [16, 32] vs. 15 [10, 22], 10.09 [7.87, 13.19] vs. 8.47 [6.73, 10.32], 10.63 [5.87, 15.69] vs. 7.13 [5.16, 10.91], P<0.05). Multivariate Logistic regression analysis showed that female ( OR=2.533, 95% CI: 1.306-4.910, P=0.006), atrial fibrillation history ( OR=1.999, 95% CI: 1.044-3.827, P=0.037), neutrophil count within 24 hours of thrombectomy ( OR=1.162, 95% CI: 1.055-1.279, P=0.002), and symptomatic intracranial hemorrhage ( OR=4.066, 95% CI: 1.897-8.718, P<0.001) were independent risk factors for in-hospital death after complete recanalization; risk prediction model, accordingly, was 0.929×female+0.692×atrial fibrillation history+0.150×neutrophil count+1.403×symptomatic intracranial hemorrhage-5.349 ( P: probability of event occurrence). Area under ROC curve of the model was 0.765 (95% CI: 0.689-0.842, P<0.001); calibration curve and Hosmer-Lemeshow test of the model showed good accuracy ( χ2=7.656, P=0.468); decision curve of the model showed good clinical utility at threshold probability of 0.05-0.90. Conclusion:For patients with acute large vessel occlusion stroke at the anterior circulation complicated with atrial fibrillation, symptomatic intracranial hemorrhage or elevated neutrophil count within 24 hours of thrombectomy, or female patients with acute large vessel occlusion stroke at the anterior circulation, in-hospital death still needs to be highly alert after complete recanalization by mechanical thrombectomy.

Objective:To evaluate the diagnostic value of PSA and the f/t PSA ratio in prostate cancer screening in Chinese people.Methods:Original articles on the application of PSA and f/t PSA ratio in prostate cancer screening among Chinese population were retrieved from Pubmed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), Wanfang data and VIP databases from the establishment of the database to June 2023. The literature quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2) tool. A meta-analysis was performed with Stata 15.1 software.Results:A total of 26 articles were included, encompassing 18 407 individuals, of whom 4 095 were diagnosed with prostate cancer based on biopsy and postoperative pathological examination, while the rest were patients with other prostate diseases or healthy individuals. 24 used a PSA threshold of>4.0 ng/ml as the cutoff for prostate cancer screening, the pooled sensitivity was 0.88(95% CI: 0.84-0.91), the specificity was 0.42(95% CI: 0.34-0.50), and the area under the summary receiver operating characteristic (SROC) curve (AUC) was 0.7(95% CI: 0.73-0.81). Four articles considered a PSA threshold of>10.0 ng/ml for prostate cancer screening (three of which used the above two cutoff values), the pooled sensitivity was 0.83(95% CI: 0.74-0.89), the specificity was 0.67(95% CI: 0.45-0.84), and the AUC of the SROC was 0.79(95% CI: 0.75-0.83). Eleven articles used the f/t PSA ratio as a screening tool for prostate cancer. When the f/t PSA ratio was<0.16, the pooled sensitivity was 0.82(95% CI: 0.76-0.87), the specificity was 0.76(95% CI: 0.67-0.83), and the AUC of the SROC was 0.86(95% CI: 0.83-0.89). Conclusion:In the screening for prostate cancer in China, PSA has a relatively high sensitivity, and the f/t PSA ratio has a better specificity. Combined application of the two indices is recommended.

Objective:To evaluate the relationship between prognostic nutritional index (PNI) and risk of functional dependence in patients receiving maintenance hemodialysis (MHD).Methods:It was a cross-sectional survey study. The clinical data of MHD patients in the Second Affiliated Hospital of Soochow University from June to December 2023 were collected. The Katz and Lawton-Brody questionnaires were used to assess the functional status. The patients were divided into normal functional status group and functional dependence group, and the differences of the clinical data between the two groups were compared. Serum albumin and lymphocytes were used to determine PNI, and the patients were divided into four subgroups: Q1 group (PNI≤44.3), Q2 group (44.349.8) according to the quartile of PNI. Logistic regression analysis method was used to analyze the relationship between PNI and risk of functional dependence in MHD patients, and subgroup analysis was conducted. The receiver-operating characteristic (ROC) curve was used to assess the efficacy of PNI, serum albumin, and lymphocytes in predicting the risk of functional dependence in MHD patients.Results:A total of 206 MHD patients were included in this study, with age of (58.35±0.98) years old, and 132 (64.1%) males. There were 58 (28.2%) patients with diabetes, 179 (86.9%) patients with hypertension, and 36 (17.5%) patients with cardiovascular diseases. There were 95 (46.1%) patients developing functional dependence. Compared with normal functional status group, functional dependence group had higher age ( t=-6.87, P<0.001), proportion of diabetes ( χ2=6.58, P=0.010), and pulse pressure ( t=-3.17, P=0.002), and lower diastolic pressure ( t=3.88, P<0.001), serum creatinine ( t=3.44, P=0.001), serum albumin ( t=4.09, P<0.001) and PNI ( t=3.92, P<0.001). The incidence of functional dependence in PNI Q1 group (69.2%, 36/52) was significantly higher than those in Q2 group (49.0%, 25/51), Q3 group (34.0%, 18/53) and Q4 group (32.0%, 16/50), and the differences among groups were statistically significant (all P<0.05). Logistic regression analysis showed that after adjusting for confounding factors: age, diabetes, pulse pressure, and serum creatinine, the risk of functional dependence of PNI Q1 group was 3.217 folds higher than that in Q4 group ( OR=3.217, 95% CI 1.229-8.422, P=0.017). The risk probability model of PNI predicting the occurrence of functional dependence in MHD patients: logit (odds)=5.854-0.128 3×PNI. The area under the ROC curve ( AUC) for PNI predicting the risk of functional dependence in MHD patients was 0.66 (95% CI 0.58-0.73, P<0.001), slightly higher than that of serum albumin ( AUC=0.64, 95% CI 0.54-0.73, P<0.001). The optimal cutoff value of PNI predicting the occurrence of functional dependence was 46.15, with sensitivity of 72.07% and specificity of 57.89%. Conclusion:Low PNI is associated with high risk of functional dependence in MHD patients.

Objective To analyze the cerebral blood flow changes in patients with newly diagnosed untreated early-onset depression(EOD),using three-dimensional pseudo-continuous arterial spin labeling(3D-pCASL),and to explore its relationship with clinical phenotypes.Methods The Hamilton Depression Scale(HAMD),Childhood Trauma Questionnaire(CTQ)scores,3D T1WI,and 3D-pCASL brain images of 65 untreated EOD patients and 55 healthy volunteers(HC group)were collected.SPM 12 and DPABI_V7.0 software were used to preprocess and analyze the whole brain images in two groups.Xjview software was used to analyze the value of cerebral blood flow(CBF)at the whole brain level of the two groups,and SPSS 25.0 software was used to evaluate the correlation of CBF values with HAMD scores and CTQ scores.Results Compared with the HC group,the CBF of the EOD group was reduced significantly[P＜0.05,cluster size＞50,false discovery rate(FDR)correction]in the right opercular inferior frontal gyrus(t=5.89),right temporo-parieto-occipital(TPO)region(t=6.49),and blood perfusion increased significantly(P＜0.05,cluster size＞50,FDR correction)in the left superior frontal gyrus(t=5.31)and left insular lobe(t=4.70).Conclusion The proportion of EOD patients with childhood trauma experience is relatively large.EOD patients have both reduced areas and increased areas in cerebral perfusion.The CBF value of the right TPO area is negatively correlated with HAMD scores;The CBF value of the left superior frontal gyrus is positively correlated with the total score of CTQ and the index of physical neglect score in CTQ,which is different from the result of studies that do not distinguish between early-onset and late-onset depression.

Objective:To study the survival and prognostic factors for the recurrent extracranial malignant germ cell tumors (MGCTs) in children, and to explore feasible salvage treatment.Methods:A retrospective study.Pediatric patients with recurrent extracranial MGCTs diagnosed in Shanghai Children′s Medical Center between January 2010 and January 2020 were retrospectively recruited.Comprehensive treatment regimens included surgery, chemotherapy and radiation.Kaplan-Meier survival analysis and Cox regression model were employed to analyze the survival and prognostic factors for children with recurrent extracranial MGCTs.Results:A total of 172 children with extracranial MGCTs were treated, including 21 (12.2%) recurrent cases.The median time of MGCT recurrence after the end of the first treatment was 11 months.Finally, 19 patients were recruited after excluding 2 non-eligible cases, including 10 boys and 9 girls with the age at recurrence of 26 (8-170) months.The follow-up time was 57 (13-122) months.Salvage chemotherapy, complete resection and radiotherapy were performed in 16, 14 and 4 patients, respectively.The 4-year overall survival (4yr-OS) rate was (82.5±9.2)%(19 cases). The 4yr-OS rate was significantly higher in patients managed with surgery but without adjuvant chemotherapy at the initial treatment (13 cases) than those managed with chemotherapy at the initial treatment (6 cases)[(92.3±7.4)% vs.(60.0%±21.9)%, P=0.002]. Univariant and Cox multivariant regression analyses showed that failure to achieve the normal range of alpha fetoprotein after 3 cycles of chemotherapy significantly influenced the survival of recurrent extracranial MGCTs. Conclusions:For patients with recurrent extracranial MGCTs, comprehensive treatment approaches like complete surgical resection, chemotherapy, and radiotherapy offer a favorable survival rate.Specifically, recurrent and re-treated patients who initially received surgery alone without adjuvant chemotherapy have a higher survival rate compared to those who received chemotherapy during the initial treatment.

Cases of complete occlusion of bilateral internal carotid arteries and bilateral vertebral arteries are relatively rare clinically.The authors reported a patient with bilateral internal carotid artery and bilateral vertebral artery occlusion.The patient had previously experienced cough induced syncope without any other neurological deficits,and cerebral angiography revealed extensive intracranial collateral circulation.The authors reported on this unique case and explored the condition of its intracranial collateral circulation.

Cases of complete occlusion of bilateral internal carotid arteries and bilateral vertebral arteries are relatively rare clinically.The authors reported a patient with bilateral internal carotid artery and bilateral vertebral artery occlusion.The patient had previously experienced cough induced syncope without any other neurological deficits,and cerebral angiography revealed extensive intracranial collateral circulation.The authors reported on this unique case and explored the condition of its intracranial collateral circulation.