In China,lung cancer ranks first in the incidence and death of malignant tumors.Early diagnosis and timely treatment can significantly improve the survival rate of lung cancer.However,75％of patients are already in the advanced stage at the time of initial diagnosis,missing the best treatment opportunity.Lung nodules are the manifestations of early lung cancer.How to accurately distinguish benign and malignant pul-monary nodules and avoid missing diagnosis of malignant lung nodules and over-treatment of benign lung nod-ules are important clinical problems.Liquid biopsy has the advantages of non-invasiveness,high reproducibili-ty,operability,easy dynamic monitoring and overcoming tumor heterogeneity,which can realize early detection and diagnosis of malignant tumors.Besides,it is the most potential precision tumor detection technology,which is expected to become a breakthrough in the diagnosis of benign and malignant lung nodules.This arti-cle reviews the research and application of liquid biopsy in the diagnosis of lung nodules in recent years,in or-der to provide ideas for clinical application and future research.

Objective:To observe any effect of supplementing basic swallowing training with balloon catheter dilation on the swallowing function of tracheostomy patients with pontine hemorrhage.Methods:A total of 40 pontine hemorrhage patients with tracheostomy and swallowing disorders were divided randomly into an observation group and a control group, each of 20. Both groups were given nutritional neurodrugs and basic swallowing training, but the observation group also received 25 minutes of balloon catheter dilation, five times a week for 6 weeks. Before and after the 6 weeks of treatment one swallowing therapist evaluated the feeding ability and leakage-aspiration status of each subject assigning functional oral intake (FOIS) ratings and Rosenbek Leakage/Aspiration Rating Scale (PAS) ratings double-blinded. The Watian water swallowing test was also applied.Results:After the treatment the average FOIS and PAS scores of both groups had improved significantly, with those of the observation group then significantly better than among the control group on average. The total treatment effectiveness rate was 70% in the observation group, significantly better than the 30% in the control group.Conclusion:Supplementing swallowing training with balloon catheter dilation can better improve the swallowing of patients recovering from a tracheotomy after pontine hemorrhage.

Objective To establish the method of simultaneous determination of four main components of Danggui Liuhuang Decoction,including phellodendrine,palmatine,calycosin,and ferulic acid and provide reference for the quality control of Danggui Liuhuang Decoction.Methods Based on the HPLC-MS/MS analysis method,the positive ion data acquisition mode were adopted for the mass spectrometry detection and the four main components were quantified with multiple reaction monitoring mode(MRM)by ESI source.The chromatographic column was Agilent Extend-C18(5 μm,4.6 mm×250 mm),and gradient elution was performed with methanol and 0.5%formic acid in water.Results The linear range of phellodendrine was from 2-200 nmol/ml,and the linear range of palmatine,calycosin and ferulic acid was from 20-2 000 nmol/ml.The contents of the four components in the seven batches of Danggui Liuhuang Decoction were relatively stable,among which ferulic acid was mainly found in Phellodendrine and Coptidis;Phellodendrine was only detected in cortex phellodendri;the content of calycosin in Scutellaria baicalensis and Astragalus was higher;palmatine was detected in both Phellodendron and Astragalus.Conclusion The method had high sensitivity,good specificity and sample stability,which could meet the requirements of quantitative analysis of Traditional Chinese Medicine compounds,and could provide reference for further pharmacokinetics study on the content changes of traditional Chinese medicine compounds in biological samples.

Objective To explore the preoperative predictive factors influencing microscopic positive proximal margin in upper gastric cancer,and to establish a nomogram prediction model and to validate it internally.Methods Retrospective analysis of 187 patients with upper gastric cancer operated in the Department of Gastrointestinal Surgery of Hengshui People's Hospital from January 2018 to October 2022 were included in this study.Patients were divided into the microscopic positive proximal margin(the R0 group,n=15)and the negative microscopic proximal margin group(the R1 group,n=172)according to histopathological diagnosis.Preoperative factors that may influence positive upper margin of proximal gastric cancer were collected,including patient age,gender,tumor size,tumor location,Borrmann staging,tumor differentiation,Lauren staging,cT stage and cN stage.Receiver operating characteristic(ROC)curve was used to figure out the optimal cut-off value for predicting positive margin of proximal gastric cancer by tumor length.Multivariate Logistic regression was used to analyze the variables with statistical difference between the two groups,and independent risk factors were screened out,and prediction mode was constructed.The prediction accuracy of the model was verified internally using Bootstrap method.Results The best threshold for predicting positive margin of proximal gastric cancer by tumor length was 4.85 cm.Univariate analysis showed that there were significant differences in tumor length,tumor location,Borrmann staging,Lauren staging,cT staging and cN staging between the two groups(all P＜0.05).Multivariate Logistic regression analysis showed that tumor length>4.85 cm(OR=4.000,95%CI:1.039-15.399),tumor located in esophagogastric junction(OR=7.108,95%CI:1.604-31.494),Borrmann staging Ⅲ—Ⅳ(OR=6.991,95%CI:1.538-31.782),Lauren staging as diffuse or mixed(OR=7.583,95%CI:1.814-31.701)and cT staging as cT4(OR=8.249,95%CI:1.890-36.007)were independent predictors of microscopic positive proximal margin of advanced upper gastric cancer before surgery,and a prediction model was established based on results of multivariate analysis.The area under ROC curve(AUC)value for subjects with the model was 0.862 after internal validation.The calibration curve showed that the model predicted the probability of microscopic positive proximal margin occurrence in good agreement with the probability of actual microscopic positive proximal margin occurrence(Hosmer-Lemeshow χ2=6.145,P=0.523).Conclusion The established nomogram prediction model can predict the probability of positive upper incisal margin of proximal gastric cancer before operation,and provide clinical guidance for formulating surgical strategy.

Objective To explore the risk factors of central venous catheter related thrombosis in the patients undergoing gastrointestinal tract surgery,and to construct a risk prediction model based on machine learning algorithms.Methods A total of 385 patients receiving gastrointestinal tract surgery and central ve-nous catheter indwelling in this hospital from May 2018 to March 2024 were selected as the study subjects and divided into the thrombus group(n=62)and non-thrombus group(n=323)based on whether or not the catheter-related thrombosis forming.The age,body mass index(BMI),comorbidities,current tumors,neutro-phil/lymphocyte ratio(NLR),surgery time,catheterization vein,systemic immune inflammation index(SII),D-dimer and catheter indwelling time of the patients were collected,and the differences in baseline data were compared between the two groups.The research subjects were randomly divided into the training set and tes-ting set by a 7∶3 ratio.Based on the training set,the logistics regression model,random forest,support vector machine,decision tree and naive Bayes risk prediction models were established.The area under the operating characteristic curve(AUC),accuracy,sensitivity,specificity and F1 value in predicting catheter-related throm-bosis were compared among different models in the testing set.The importance of the predictive factors in the best prediction model conducted the visualized ranking.Results There were statistically significant differences in the proportion of tumor patients,NLR,surgical time and D-dimer level in the baseline data between the two groups(all P＜0.05).The AUC values of the five risk prediction models from great to small were the random forest(0.773),logistics regression model(0.734),support vector machine(0.680),naive Bayes(0.666)and decision tree(0.650).Among them,the accuracy(0.853),sensitivity(0.599),specificity(0.877)and F1 val-ue(0.414)of the random forest model were the highest.D-dimer,surgery time,current tumor and NLR were the top four important predictive factors in the random forest model.Conclusion The constructed random forest model for central venous catheter-related thrombosis in the patients undergoing gastrointestinal tract surgery demonstrates good performance,and the D-dimer,surgery time,current tumor and NLR are the main predictive factors.

Objective To explore the preoperative predictors of lymphovascular invasion(LVI)in patients with advanced gastric cancer,and establish the corresponding nomogram prediction model and conduct internal validation.Methods A total of 246 cases of advanced gastric cancer who underwent surgical resection in the Department of Gastrointestinal Surgery of Hengshui People's Hospital from January 2018 to December 2021 were selected.Patients were divided into the LVI positive group and the LVI negative group according to postoperative pathological diagnosis.The age,gender,tumor differentiation,tumor size,tumor site,Borrmann classification,Lauren's classification,cT stage,cN stage and systemic immune-inflammation index(SII)of patients were collected and compared between the two groups.The predictors that were statistically different between the two groups were subjected to multivariate Logistic regression and further developed into a visual prediction model.Bootstrap method was applied for internal validation of the prediction efficiency of the model.Results The differences of tumor size,Borrmann classification,tumor differentiation,Lauren classification,cT staging,cN staging and SII were statistically significant between the two groups(P＜0.05).Multivariate Logistic regression analysis showed that tumor size(OR=2.184,95%CI:1.224-3.898),Borrmann classification(OR=2.517,95%CI:1.294-4.896),cT staging(OR=1.860,95%CI:1.045-3.308),cN staging(OR=1.816,95%CI:1.004-3.285)and SII(OR=1.001,95%CI:1.000-1.002)were independent predictors of LVI in advanced gastric cancer.A preoperative nomogram prediction model for advanced gastric cancer LVI was developed based on results of multivariate analysis.By internal validation,the area under curve(AUC)value of the subject operating characteristic(ROC)curve of the nomogram was 0.735,which was higher than that of tumor size(0.599),Borrmann staging(0.564),cT staging(0.604),cN staging(0.582)and SII(0.615),respectively.The calibration curve showed that the probability of predicted LVI by the nomogram was in a good agreement with the probability of actual LVI occurrence.The Hosmer-Lemeshow test showed good model fit(χ2=4.387,P=0.821).Conclusion The established nomogram prediction model can help to predict the probability of LVI in advanced gastric cancer preoperatively,which can provide a guideline for clinical individualized treatment.

Objective:To observe the effect of combining biofeedback therapy (BFT) based on virtual reality technology with repeated transcranial magnetic stimulation (rTMS) on dysphagia among stroke survivors.Methods:Eighty patients were randomly divided into a control group, an rTMS group, a BFT group and a combined treatment group, each of 20. In addition to routine dysphagia rehabilitation, the rTMS and BFT groups were given those treatments, while the combined treatment group was given both for 4 weeks. Swallowing function was evaluated before and after the treatment using the standardized swallowing assessment (SSA) and the functional oral intake scale (FOIS). Videofluoroscopy was used to quantify the subjects′ oral and pharyngeal phases and their aspiration status.Results:Significant improvement was observed in the average FOIS and SSA scores, as well as in the average oral and pharyngeal phases and in aspiration. The combined treatment group′s results were significantly better in all those aspects than those of the other 3 groups.Conclusion:The combined application of biofeedback therapy based on virtual reality technology and repeated transcranial magnetic stimulation can improve the swallowing function of stroke survivors with dysphagia. It is worthy of clinical promotion.

Objective:To establish the biology reference interval (RI) of peripheral blood procalcitonin (PCT) for children between 3 days and 6 years old in China.Methods:Totally 3 353 reference individuals with apparent health or no specific diseases were recruited in 18 hospitals throughout the country during October 2020 to May 2021. Reference individuals were divided into four groups: 3-28 days, 29 days - 1 year, 1-3 years and 4-6 years. Vein blood or capillary blood were collected by percutaneous puncture from every reference individual. The PCT level in serum and the capillary whole blood were assayed by Roche Cobas e601 and Norman NRM411-S7 immunoanalyzer. Outliers were deleted and 95th percentiles of every group were provided as RIs. Man-Whitney U test or Kruskal-Wallis test were used performed to assess the difference among different gender, age or method groups. Results:The difference of PCT distribution between male and female is not statistically significant, but the difference between serum and capillary whole blood is statistically significant. The differences between age groups are significant too. For Roche e601, serum PCT RI of 3-28 days group is <0.23 μg/L, 29 days - 6 years are <0.11 μg/L. For NRM411, Serum PCT RI of 3-28 days group is <0.21 μg/L, 29 days - 1 year: <0.09 μg/L, 1 - 6 years: <0.10 μg/L. For whole blood PCT, RI of 3-28 days group is <0.26 μg/L, 29 days - 6 years is <0.15 μg/L.Conclusions:Serum and capillary whole blood PCT have different RIs, however, capillary whole blood PCT testing is valuable in pediatric application. Children in 3-28 days show higher PCT levels than other age group. To establish the RIs and understand the differences among different groups are essential for the interpretation and clinical application of peripheral blood PCT testing results.

Objective To explore the measure of the peri-operative care in patients undergoing nephroureterectomy with transvaginal NOTES-assisted hybrid endoscopy.Methods Nursing measures and the effect of 3 patients who underwent transvaginal NOTES-assisted hybrid endoscopy in nephroureterectomy were retrospectively analyzed.Results All procedures were successfully completed.There were no intraoperative or postoperative complications.All patients were cured and discharged.Conclusions For the patients receiving transvnginal NOTES-assisted hybrid endoscopy in nephroureterectomy,good psychological care,adequate preoperative preparation,postoperative care,and health education can reduce postoperative complications and play an important role in the success of the operation.

Objective To investigate the supplementary roles of MRI in the diagnosis of fetal abnormalities in twin fetuses.Methods MRI manifestations of 22 twins were retrospectively analyzed after abnormalities were found by prenatal ultrasonography (US) from Sep 2005 to Dec 2012.Two rapid scanning sequences were used in the study,fast-imaging employing steady-state acquisition (FIESTA) and fast inversion recovery motion insensitive (FIRM).MRI findings were compared with those of prenatal US,induced labour or postpartum diagnosis.Results A total of 22 twins were reported with 23 abnormal fetuses in 20 twins and 2 normal twins.MRI confirmed central nervous system abnormalities in 3 abnormal fetuses which were anencephalus,meningoencephalocele and enlargement of lateral ventricles respectively.The case of meningoencephalocele was showed brain tissue protruding from the occipital defect on MRI,which was misdiagnosed as a cystic lymphagioma by US.The MRI diagnosis of anencephalus and enlarged lateral ventricles were accordant with US.MRI made the definite diagnosis in 5 chest abnormalities,which were left congenital diaphragmatic hernia (CDH) in 5 abnormal fetuses.They were diagnosed as possible CDH by US.Abdominal abnormalities (n=7,8 abnormal fetuses) included two fetuses in one twin with expanded digestive tract,one fetus with expanded colon and rectus and five fetuses with omphalocele.MRI diagnosis was compatible with US diagnosis in the 7 cases.Twins micromelia were found in one case with 2 abnormal fetuses.Conjoined twins in chest and abdomen were found in another case,which manifested as two hearts,one shared liver and independent urinary tracts and gastrointestinal tracts on MRI.One fetus in twin was dead (n=1,1 abnormal fetus).MRI showed small size and skin edema of the dead fetus.One acephalus acardius of twins (n=2,2 abnormal fetuses) was proved.Normal MRI manifestations were indicated in 2 cases which were suspected by US for abnormal digestive tract and cryptorachischisis respectively.Conclusions MRI,an important supplementary method of prenatal US diagnosis,shows valuable advantages including multi-plane manifestations,more extensive visual field and good soft tissue contrast.It is especially helpful in the diagnosis and treatment of multiple pregnancy.