Objective:To investigate and validate the performance of a dosiomics model that utilized 3D dose distribution to forecast radiation-induced temporal lobe injury (RTLI) in nasopharyngeal carcinoma (NPC) patients following intensity-modulated radiotherapy (IMRT).Methods:Clinical data of 3578 patients diagnosed with NPC admitted to Jiangsu Cancer Hospital from January 2011 to December 2021 were retrospectively analyzed. According to the inclusion and exclusion criteria, 97 NPC patients who developed RTLI were assigned into the case group. A 1:1 propensity score matching (PSM) method was used to match 97 NPC patients without RTLI as the control group. Patients were assigned into the training cohort ( n=135) and the validation cohort ( n=59) at a 7:3 ratio by simple random method. Dosiomics features were extracted from the patients' three-dimensional dose distribution maps. Spearman rho and the least absolute shrinkage and selection operator regression were used to select dosiomics features. Clinical features were collected and screened by univariate and multivariate analyses. Eight machine learning classifiers were then trained to build dosiomics models and clinical models, respectively. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to compare the predictive performance of the dosiomics and clinical models. Multivariate analysis was conducted using logistic regression to assess the influencing factors, while comparisons of the ROC curves between two different models were performed using the DeLong test. Results:A total of 1130 dosiomics features were extracted from the three-dimensional dose distribution maps, and 14 features were retained for model building after feature selection. The model based on the support vector machine (SVM) classifier achieved the highest AUC value of 0.977 (95% CI: 0.949-1.000) in the validation cohort, with an AUC of 1.000 (95% CI: 1.000-1.000) in the training cohort. By conducting univariate and multivariate analyses of the patients' clinical features, 2 clinical features were retained to build the clinical model. The model based on the SVM classifier achieved the optimal AUC value of 0.667 (95% CI: 0.523-0.810) in the validation cohort, with an AUC of 0.804 (95% CI: 0.730-0.878) in the training cohort. DeLong test showed that the difference between the dosiomics and clinical models was statistically significant ( P<0.05). Conclusion:The dosiomics model based on 3D dose distribution yields high predictive performance for RTLI in NPC patients after IMRT, which surpasses the clinical feature model, providing a new approach for early clinical prediction of RTLI.

Objective:To investigate and validate the performance of a dosiomics model that utilized 3D dose distribution to forecast radiation-induced temporal lobe injury (RTLI) in nasopharyngeal carcinoma (NPC) patients following intensity-modulated radiotherapy (IMRT).Methods:Clinical data of 3578 patients diagnosed with NPC admitted to Jiangsu Cancer Hospital from January 2011 to December 2021 were retrospectively analyzed. According to the inclusion and exclusion criteria, 97 NPC patients who developed RTLI were assigned into the case group. A 1:1 propensity score matching (PSM) method was used to match 97 NPC patients without RTLI as the control group. Patients were assigned into the training cohort ( n=135) and the validation cohort ( n=59) at a 7:3 ratio by simple random method. Dosiomics features were extracted from the patients' three-dimensional dose distribution maps. Spearman rho and the least absolute shrinkage and selection operator regression were used to select dosiomics features. Clinical features were collected and screened by univariate and multivariate analyses. Eight machine learning classifiers were then trained to build dosiomics models and clinical models, respectively. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to compare the predictive performance of the dosiomics and clinical models. Multivariate analysis was conducted using logistic regression to assess the influencing factors, while comparisons of the ROC curves between two different models were performed using the DeLong test. Results:A total of 1130 dosiomics features were extracted from the three-dimensional dose distribution maps, and 14 features were retained for model building after feature selection. The model based on the support vector machine (SVM) classifier achieved the highest AUC value of 0.977 (95% CI: 0.949-1.000) in the validation cohort, with an AUC of 1.000 (95% CI: 1.000-1.000) in the training cohort. By conducting univariate and multivariate analyses of the patients' clinical features, 2 clinical features were retained to build the clinical model. The model based on the SVM classifier achieved the optimal AUC value of 0.667 (95% CI: 0.523-0.810) in the validation cohort, with an AUC of 0.804 (95% CI: 0.730-0.878) in the training cohort. DeLong test showed that the difference between the dosiomics and clinical models was statistically significant ( P<0.05). Conclusion:The dosiomics model based on 3D dose distribution yields high predictive performance for RTLI in NPC patients after IMRT, which surpasses the clinical feature model, providing a new approach for early clinical prediction of RTLI.

Objective To investigate the expression level of HNRNP A1 in colorectal cancer(CRC)and its prognostic implications.Methods We investigated HNRNP A1 expression level in CRC using HPA,TIMER,and GEPIA databases and analyzed its association with Ki-67 and VEGFA expressions.Kaplan-Meier Plotter database was used to analyze the correlation of HNRNP A1 mRNA levels with the survival rates of CRC patients.Pathway enrichment analysis was performed for predicting the biological roles of HNRNP A1 in CRC progression.Immunohistochemistry and Western blotting were used to examine the protein levels of HNRNP A1 in CRC versus adjacent tissues,and TIMER was used for assessing its expression in the infiltrating immune cells.In RKO/Caco2 cells,the effects of lentivirus-mediated knockdown of HNRNP A1 on cell proliferation and migration were observed,and the inhibitory effect of VPC-80051(a HNRNP A1 inhibitor)on cell proliferation was evaluated to assess its potential as a therapeutic agent.Results HNRNP A1 was significantly overexpressed in CRC tissues and correlated with a poor prognosis of the patients.HNRNP A1 expression level was correlated with the infiltrating immune cells in CRC microenvironment and positively correlated with MKI67 and VEGFA expressions in CRC.A high HNRNP A1 expression predicted a in survival and progression-free survival of CRC patients and was involved in multiple biological processes related with CRC progression.In RKO/Caco2 cells,HNRNP A1 knockdown significantly suppressed cell proliferation and migration,and treatment with VPC-80051 also effectively inhibited CRC cell proliferation.Immunohistochemical study demonstrated a close correlation of HNRNP A1 overexpression with tumor stage of CRC.Conclusion HNRNP A1 is overexpressed in CRC tissues to modulate cell proliferation and migration and is correlated with a poorer prognosis.VPC-80051 can effectively inhibit CRC cell proliferation,suggesting the potential of HNRNP A1 as a therapeutic target for CRC.

Objective To investigate the expression level of HNRNP A1 in colorectal cancer(CRC)and its prognostic implications.Methods We investigated HNRNP A1 expression level in CRC using HPA,TIMER,and GEPIA databases and analyzed its association with Ki-67 and VEGFA expressions.Kaplan-Meier Plotter database was used to analyze the correlation of HNRNP A1 mRNA levels with the survival rates of CRC patients.Pathway enrichment analysis was performed for predicting the biological roles of HNRNP A1 in CRC progression.Immunohistochemistry and Western blotting were used to examine the protein levels of HNRNP A1 in CRC versus adjacent tissues,and TIMER was used for assessing its expression in the infiltrating immune cells.In RKO/Caco2 cells,the effects of lentivirus-mediated knockdown of HNRNP A1 on cell proliferation and migration were observed,and the inhibitory effect of VPC-80051(a HNRNP A1 inhibitor)on cell proliferation was evaluated to assess its potential as a therapeutic agent.Results HNRNP A1 was significantly overexpressed in CRC tissues and correlated with a poor prognosis of the patients.HNRNP A1 expression level was correlated with the infiltrating immune cells in CRC microenvironment and positively correlated with MKI67 and VEGFA expressions in CRC.A high HNRNP A1 expression predicted a in survival and progression-free survival of CRC patients and was involved in multiple biological processes related with CRC progression.In RKO/Caco2 cells,HNRNP A1 knockdown significantly suppressed cell proliferation and migration,and treatment with VPC-80051 also effectively inhibited CRC cell proliferation.Immunohistochemical study demonstrated a close correlation of HNRNP A1 overexpression with tumor stage of CRC.Conclusion HNRNP A1 is overexpressed in CRC tissues to modulate cell proliferation and migration and is correlated with a poorer prognosis.VPC-80051 can effectively inhibit CRC cell proliferation,suggesting the potential of HNRNP A1 as a therapeutic target for CRC.

Objective    To investigate the surgical strategies and clinical efficacy of transmitral septal myectomy in the treatment of recurrent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation. Methods    The clinical data of patients with recurrent LVOTO after alcohol septal ablation from July 2020 to July 2021 in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were preoperatively evaluated by echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, 3D modeling and printing technology. A personalized surgical strategy was preoperatively developed according to multimodality imaging assessment, while visual exploration was performed on the digital model and simulated surgical resection was performed on the printed model. Results     Two female patients were enrolled, aged 62 years and 64 years, respectively. Totally endoscopic transmitral extended myectomy was successfully performed on both patients with aortic cross-clamping time of 96 min and 85 min, respectively. LVOTO was relieved immediately (subaortic peak pressure gradient decreased from 100 mm Hg to 4 mm Hg and from 84 mm Hg to 6 mm Hg, respectively) and the mitral regurgitation significantly improved after the procedure. No patient had complete atrioventricular block or required permanent pacemaker implantation. The patients were discharged uneventfully without postoperative complications. Conclusion    Personalized totally endoscopic transmitral extended myectomy combined with multimodality imaging assessment and 3D modeling and printing has an acceptable clinical effect in patients with recurrent LVOTO after alcohol septal ablation. The procedure can precisely resect the hypertrophic septal myocardium while avoiding serious complications such as septal perforation or complete atrioventricular block.

Humans ; Parkinson Disease/diagnosis* ; Machine Learning

Objective:To investigate the clinical efficacy and prognosis of simultaneous resection of synchronous colorectal liver metastasis in patients admitted in different phases.Methods:The retrospective cohort study was conducted. The clinicopathological data of 346 patients who underwent simultaneous resection of synchronous colorectal liver metastasis in the First Affiliated Hospital of Naval Medical University (Changhai Hospital of Shanghai) from January 2000 to April 2021 were collected. There were 217 males and 129 females, aged (58±12)years. Patients under-went simultaneous resection of synchronous colorectal liver metastasis. Observation indicators: (1) clinicopathological features of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021; (2) surgical and postoperative situations of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021; (3) analysis of prognosis of patients with synchro-nous colorectal liver metastasis in 2000?2010 and 2011?2021. Follow-up was conducted using telephone interview or outpatient examination to detect survival of patients. The follow-up was performed once every 3 months, including blood routine test, liver and kidney function test, car-cinoembryonic antigen (CEA) test, CA19-9 test, abdominal B-ultrasound examination, and once every 6 months, including chest computed tomography (CT) plain scan, liver magnetic resonance imaging (MRI) and/or CT enhanced scan, abdominal or pelvic MRI and/or CT enhanced scan, within postoperative 2 year. The follow-up was performed once every 6?12 months within postoperative 2?5 years including above reexaminations. Electronic colonoscopy was performed once a year after operation. The follow-up was up to November 12, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distuibution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the rank sum test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used to conduct survival analysis. Results:(1) Clinicopathological features of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021. Of the 346 patients, 59 cases underwent simultaneous resection within 2000?2010 and 287 cases underwent simultaneous resection within 2011?2021. The gender (males and females), cases with or without fundamental diseases, cases with the number of lymph nodes harvested in primary lesion as <12 or ≥12, the tumor diameter of primary lesion, the tumor diameter of liver metastasis lesion, the number of liver metastasis lesions, cases with or without preoperative treatment, cases with or without postoperative treatment, cases with adjuvant therapy as perioperative treatment, surgery or other treatment were 47, 12, 36, 23, 19, 40, (5.5±2.4)cm, (2.1±0.7)cm, 1.6±0.5, 59, 0, 16, 16, 0, 16, 43 in patients admitted in 2000?2010, respectively. The above indicators in patients admitted in 2011?2021 were 170, 117, 121, 166, 58, 229, (4.2±2.0)cm, (3.0±2.0)cm, 1.9±1.4, 208, 79, 34, 235, 74, 29, 184, respectively. There were significant differences in the above indicators between patients admitted in 2000?2010 and 2011?2021 ( χ2=8.73, 7.02, 4.07, t= 4.40, ?6.04, ?3.10, χ2=21.05, 28.82, 26.68, P<0.05). (2) Surgical and postoperative situations of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021. Cases with surgical methods as complete open surgery or laparoscopy combined with open surgery, the operation time, time to postoperative initial liquid food intake, cases with or without postoperative complications, cases with postoperative duration of hospital stay as ≤10 days or >10 days were 58, 1, (281±57)minutes, (5±1)days, 33, 26, 14, 45 in patients admitted in 2000?2010, respec-tively. The above indicators in patients admitted in 2011?2021 were 140, 147, (261±82)minutes, (3±1)days, 233, 54, 198, 89, respectively. There were significant differences in the above indicators between patients admitted in 2000?2010 and 2011?2021 ( χ2=49.04, t=2.24, 7.53, χ2=17.56, 26.02, P<0.05). There was no death in the 346 patients. (3) Analysis of prognosis of patients with synchro-nous colorectal liver metastasis in 2000?2010 and 2011?2021. Of the 346 patients, 295 cases were followed up for 47(range, 1?108)months. Of the 29 patients admitted in 2000?2010 who were followed up, there were 27 cases died. The median survival time, 1-, 3-, 5-year overall survival rates, 1-, 3-, 5-year disease free survival rates of patients admitted in 2000?2010 were 18.0 months (95% confidence interval as 12.7?23.3 months), 82.8%, 11.5%, 3.8%, 53.6%, 8.3%, 4.2%, respec-tively. Of the 266 patients admitted in 2011?2021 who were followed up, there were 109 cases died. The median survival time, 1-, 3-, 5-year overall survival rates, 1-, 3-, 5-year disease free survival rates of patients admitted in 2011?2021 were 54.0 months (95% confidence interval as 38.1?70.4 months), 93.3%, 61.8%, 47.0%, 68.2%, 33.7%, 28.3%, respectively. There were significant differences in overall survival rate and disease free survival rate between patients admitted in 2000?2010 and 2011?2021 ( χ2=47.57, 9.17, P<0.05). Conclusions:With the increase of the operation volume of simultaneous resection of synchronous colorectal liver metastasis, the operation time, time to postoperative initial liquid food intake, postoperative duration of hospital stay and postoperative complications have significantly decreased, while the overall survival rate and disease free survival rate have significantly increased.

Objective:This study aims to analyze the prognosis of patients who underwent a simultaneous operations for colorectal cancer and liver metastases, and to establish a prognostic scoring system for these patients.Methods:From January 2010 to March 2019, the clinicopathological data of patients with colorectal cancer and liver metastases simultaneously operated at Shanghai Changhai Hospital were collected. The clinicopathological prognostic factors on tumor recurrence and survival outcomes on follow-up were analyzed. Single and multiple factors Cox regression analyses were used to determine the risk factors which affected the prognosis of patients. Using the risk factors of poor prognosis on Cox analysis, 1 point was given to each risk factor. Patients were then divided into different groups according to the different total scores. The median overall survival and disease-free survival of each group were analyzed.Results:Of 234 patients included in this study, there were 126 males and 108 females. The average age was (57.4±10.8) years. The median survival was 44.85 months. The 1-, 3-, and 5-year survival rates of the whole group were 87.3%, 55.2%, and 22.9%, respectively. Primary tumor in right colon, preoperative carcinoembryonic antigen ≥200 ng/ml, multiple liver metastases, and poorly differentiated adenocarcinoma/mucinous adenocarcinoma were independent risk factors of poor prognosis. After 1 point was given to each of the above 4 items, patients were then divided into the low-risk (0-1) and high-risk (2-4) groups. The median survivals of patients in the low-risk group ( n=174) and high-risk group ( n=60) were 53 months and 29 months, respectively. The corresponding median disease-free survivals were 21.34 months and 8.48 months, respectively. The differences between the 2 groups were significant ( P<0.05). Conclusion:The results of this study preliminary established a predictive scoring system for patients with simultaneous colorectal cancer and liver which can play a role in selecting treatment options for these patients.

Since the establishment of eight-year clinical medicine specialty, in line with the princi-ple of "eight-year consistency and fusion of the bachelor and doctor degree", the training mode of "strength-ening the foundation, focusing on quality, overall optimization, facing the clinical" has been implemented. In order to reach the standard of professional doctorate, a series of courses of professional doctorate need to be fused in limited time and designed carefully by medical schools. However, grasping proper teaching time and opportunity is particularly important for students' learning and development. By collecting the courses information of 11 medical colleges and universities offering eight-year clinical medicine specialty, we have analyzed the teaching time, methods and course categories of scientific research training courses and graduate degree courses, aiming to find the appropriate teaching program.

Objective To investigate the influences of anterior thalamic nucleus (ANT) stimulation on neurogenesis in hippocampus of epileptic rats. Methods Thirty-two male SD rats were randomly alloca-ted to normal-control group ( n＝8),control-stimulation group ( n＝8),sham-stimulation group ( n＝8) and model-stimulation group(n＝8).Eqileptic SD rat model was established by using microinjection of kainic acid in hippocampal CA3 area,and administered 48 h continuous ANT stimulation in the chronic stage.Epileptic seizures were monitored and counted.The levels of Ki-67,a neurogenesis protein in hippocampus was deter-mined by Western blot and quantitative real-time polymerase chain reaction (qRT-PCR). Results The epi-lepsy seizure rate was (5.9±2.2) per week in the sham-stimulation group and (2.9±1.1) per week in model-stimulation group.Compared with sham-stimulated rats, ANT stimulation reduced seizures by 50.8%(P＜0.05).Western blot analysis revealed that the relative levels of Ki-67 in the hippocampus of model-stimula-tion group significantly higher than that of the sham-stimulation group((0.44±0.15) vs (0.19±0.73),P＜0.05).qRT-PCR analysis showed that relative levels of Ki-67 mRNA in the hippocampus of model-stimula-tion group were significantly higher than that of the sham-stimulation group((0.45±0.10) vs (0.15±0.06), P＜0.05). Conclusion Chronic ANT stimulation can promote neurogenesis in epileptic rats,which may be a principle mechanism of the beneficial effect of ANT stimulation on epilepsy.