Chinese-foreign joint education program of clinical medicine is an important means to achieve the globalization of medical education. Chongqing Medical University and University of Leicester in the UK have jointly established a Chinese-foreign joint education program of clinical medicine to achieve the integration of Chinese and British cultivation concepts, management systems, teaching resources, teacher teams, evaluation systems, and multiculturalism. They have also constructed an internal teaching quality assurance system with the main contents of the improvement of management mechanisms, the formulation of training programs, the construction of teaching staff, the design of syllabuses, the curriculum assessment system, and teaching quality evaluation, as well as an external teaching quality assurance system with the core components of clinical medicine accreditation, Chinese-foreign joint education program evaluations, international quality audits, and professional quality monitoring. Both systems can help to comprehensively improve teaching quality.

Objective To develop a combined model integrating radiomics and 3D deep learning features for improving the predictive efficacy of overall survival in non-small cell lung cancer(NSCLC)patients undergoing radiotherapy,thereby providing a foundation for optimizing individualized radiotherapy strategies.Methods A retrospective analysis was conducted on 522 NSCLC patients from 3 centers.Radiomics features were extracted from the tumor region of interest on radiotherapy planning CT scans,and a 3D-SE-ResNet was constructed to extract deep learning features.Following feature extraction,features were selected via univariate Cox analysis and Lasso-Cox regression,and a combined model was established by fusing the two feature types through principal component analysis.The discriminative ability of the model was evaluated using the concordance index(C-index)and the area under the receiver operating characteristic curve(AUC),while the risk stratification efficacy was verified by Kaplan-Meier survival analysis.Results The predictive performance of deep learning features was significantly superior to that of radiomics features(C-index:0.73 vs 0.65).The combined model achieved the highest predictive performance in the training set,internal test set,and external test set(C-index:0.74,0.69,0.72 respectively),with higher AUC values for predicting 1-year,2-year,and 3-year OS than either single model.Kaplan-Meier analysis showed significant differences in survival between the high-and low-risk groups(Log-rank test,P<0.001),and calibration curves indicated good consistency between predicted and actual survival outcomes.Conclusion The combined model integrating radiomics and 3D deep learning features can accurately predict survival outcomes in NSCLC patients undergoing radiotherapy.The multi-center validation results support its potential application in prognosis stratification for individualized radiotherapy.

Chinese-foreign joint education program of clinical medicine is an important means to achieve the globalization of medical education. Chongqing Medical University and University of Leicester in the UK have jointly established a Chinese-foreign joint education program of clinical medicine to achieve the integration of Chinese and British cultivation concepts, management systems, teaching resources, teacher teams, evaluation systems, and multiculturalism. They have also constructed an internal teaching quality assurance system with the main contents of the improvement of management mechanisms, the formulation of training programs, the construction of teaching staff, the design of syllabuses, the curriculum assessment system, and teaching quality evaluation, as well as an external teaching quality assurance system with the core components of clinical medicine accreditation, Chinese-foreign joint education program evaluations, international quality audits, and professional quality monitoring. Both systems can help to comprehensively improve teaching quality.

Objective To develop a combined model integrating radiomics and 3D deep learning features for improving the predictive efficacy of overall survival in non-small cell lung cancer(NSCLC)patients undergoing radiotherapy,thereby providing a foundation for optimizing individualized radiotherapy strategies.Methods A retrospective analysis was conducted on 522 NSCLC patients from 3 centers.Radiomics features were extracted from the tumor region of interest on radiotherapy planning CT scans,and a 3D-SE-ResNet was constructed to extract deep learning features.Following feature extraction,features were selected via univariate Cox analysis and Lasso-Cox regression,and a combined model was established by fusing the two feature types through principal component analysis.The discriminative ability of the model was evaluated using the concordance index(C-index)and the area under the receiver operating characteristic curve(AUC),while the risk stratification efficacy was verified by Kaplan-Meier survival analysis.Results The predictive performance of deep learning features was significantly superior to that of radiomics features(C-index:0.73 vs 0.65).The combined model achieved the highest predictive performance in the training set,internal test set,and external test set(C-index:0.74,0.69,0.72 respectively),with higher AUC values for predicting 1-year,2-year,and 3-year OS than either single model.Kaplan-Meier analysis showed significant differences in survival between the high-and low-risk groups(Log-rank test,P<0.001),and calibration curves indicated good consistency between predicted and actual survival outcomes.Conclusion The combined model integrating radiomics and 3D deep learning features can accurately predict survival outcomes in NSCLC patients undergoing radiotherapy.The multi-center validation results support its potential application in prognosis stratification for individualized radiotherapy.

Objective To propose a deep learning neural network approach for transforming megavoltage computed tomography(MVCT)images of cervical cancer into pseudo kilovoltage computed tomography(kVCT)images with high signal-to-noise ratio and contrast-to-noise ratio,thus providing three-dimensional anatomical images and localization information required for adaptive radiotherapy of cervical cancer,and guiding the accelerator to achieve precise treatment.Methods The MVCT and kVCT images of 54 patients treated with cervical cancer radiotherapy were collected,with 44 cases randomly selected as the training set,and the remaining 10 cases as the test set.A cyclic generative adversarial network with gating mechanism and multi-channel data input was used to synthesize pseudo-kVCT images from MVCT images.The network training results were evaluated with imaging quality evaluation parameters,such as mean absolute error(MAE),peak signal-to-noise ratio(PSNR),and structural similarity index(SSIM).Results The MAE,PSNR,and SSIM of MVCT imagesvspseudo-kVCT(5:5)images were(24.9±0.7)HUvs(17.8±0.3)HU,(29.8±0.2)dBvs(30.7±0.2)dB,and 0.841±0.007 vs 0.898±0.003,respectively.Conclusion The generated pseudo-kVCT images have advantages in noise reduction and contrast enhancement,and can reduce the need for additional MV-kVCT electron density calibration in dose calculations.The dose calculation ability of pseudo-kVCT is comparable to that of MVCT,providing a possibility for the application of pseudo-kVCT images in image-guided adaptive radiotherapy.

Objective:To explore the clinical characteristics of interstitial lung disease (ILD) caused by furazolidone.Methods:Clinical data of 7 patients with furazolidone-related ILD (hospital cases) hospitalized in the Department of Respiratory Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital from April 1, 2022 to April 1, 2023 were collected and retrospectively analyzed, including patient basic information, medication treatments, and characteristics, treatment and outcomes of ILD. Relevant databases at home and abroad were searched, and case reports of furazolidone-related ILD (literature cases) were collected. The basic information of literature, involving patient information, indications and treatment doses of furazolidone, as well as the latentperiod, main symptoms, laboratory tests, and auxiliary examination related to ILD was descriptively analyzed.Results:Among the 7 hospital cases, 2 were males and 5 were females, with a median age of 34 years. All patients were treated with a bismuth quadruple therapy containing furazolidone (0.2 g, once daily) due to Helicobacter pylori (HP)-associated gastritis. The median time from taking medicine to the onset of clinical symptoms of interstitial lung disease was 10 days. All patients had fever, and 6 had respiratory symptoms (dry cough, dyspnea, chest pain, etc.). ILD changes were found in all patients in their chest imaging, and pleural effusion was also found in 1 patient. Seven patients had normal eosinophil counts, and 1 had mild hypoxemia. The severity of ILD was grade 2 in 6 patients and grade 3 in 1 patient. All 7 patients stopped using furazolidone, and 4 received glucocorticoids additionally. After the hospitalization of 3-10 days, all the 7 patients recovered. Eighteen literature cases of furazolidone-related ILD were retrieved, of which 15 were from China and 14 used furazolidone to treat HP infection. The time from taking medicine to the onset of clinical symptoms was 2-14 days, and the time was >7 days in 13 patients. Sixteen patients had fever, 14 had respiratory symptoms, and 1 had respiratory failure. The peripheral blood eosinophil count or percentage increased in 12 patients. All 18 patients stopped using furazolidone; 7 received glucocorticoids and 1 received ventilator assisted ventilation. All patients recovered or were improved. ILD recured in rechallenge with furazolidone in 2 patients, and 1 of them had a strong positive reaction to furazolidone in vitro lymphocyte transformation test. Conclusions:ILD is a rare adverse reaction of furazolidone, main manifests as fever and respiratory symptoms and mostly occurs 7 days after furazolidone treatment. Early detection and timely withdrawal of furazolidone generally lead to a good prognosis.

Objective:To explore the clinical characteristics of interstitial lung disease (ILD) caused by furazolidone.Methods:Clinical data of 7 patients with furazolidone-related ILD (hospital cases) hospitalized in the Department of Respiratory Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital from April 1, 2022 to April 1, 2023 were collected and retrospectively analyzed, including patient basic information, medication treatments, and characteristics, treatment and outcomes of ILD. Relevant databases at home and abroad were searched, and case reports of furazolidone-related ILD (literature cases) were collected. The basic information of literature, involving patient information, indications and treatment doses of furazolidone, as well as the latentperiod, main symptoms, laboratory tests, and auxiliary examination related to ILD was descriptively analyzed.Results:Among the 7 hospital cases, 2 were males and 5 were females, with a median age of 34 years. All patients were treated with a bismuth quadruple therapy containing furazolidone (0.2 g, once daily) due to Helicobacter pylori (HP)-associated gastritis. The median time from taking medicine to the onset of clinical symptoms of interstitial lung disease was 10 days. All patients had fever, and 6 had respiratory symptoms (dry cough, dyspnea, chest pain, etc.). ILD changes were found in all patients in their chest imaging, and pleural effusion was also found in 1 patient. Seven patients had normal eosinophil counts, and 1 had mild hypoxemia. The severity of ILD was grade 2 in 6 patients and grade 3 in 1 patient. All 7 patients stopped using furazolidone, and 4 received glucocorticoids additionally. After the hospitalization of 3-10 days, all the 7 patients recovered. Eighteen literature cases of furazolidone-related ILD were retrieved, of which 15 were from China and 14 used furazolidone to treat HP infection. The time from taking medicine to the onset of clinical symptoms was 2-14 days, and the time was >7 days in 13 patients. Sixteen patients had fever, 14 had respiratory symptoms, and 1 had respiratory failure. The peripheral blood eosinophil count or percentage increased in 12 patients. All 18 patients stopped using furazolidone; 7 received glucocorticoids and 1 received ventilator assisted ventilation. All patients recovered or were improved. ILD recured in rechallenge with furazolidone in 2 patients, and 1 of them had a strong positive reaction to furazolidone in vitro lymphocyte transformation test. Conclusions:ILD is a rare adverse reaction of furazolidone, main manifests as fever and respiratory symptoms and mostly occurs 7 days after furazolidone treatment. Early detection and timely withdrawal of furazolidone generally lead to a good prognosis.

Humans ; Fractures, Compression/surgery* ; Spinal Fractures/surgery* ; Multiple Myeloma/drug therapy* ; Vertebroplasty ; Osteoporotic Fractures/therapy* ; Treatment Outcome ; Bone Cements

Objective:To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease (COPD).Methods:A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics, The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them, 103 were complicated with COPD, and another 103 without COPD were selected as controls who were matched in age, gender and fracture site. The 2 groups were compared in terms of postoperative 30-day, 1-year and 5-year mortalities; the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results:The postoperative 30-day, 1-year and 5-year mortalities in the COPD group were 7.8%(8/103), 29.1%(30/103) and 48.5%(50/103), significantly higher than those in the control group except for the 30-day value [1.9%(2/103), 13.6%(14/103) and 31.1%(32/103)] ( P<0.05). Advanced age ( P=0.003), cardiovascular disease ( P=0.006), respiratory disease ( P=0.009), acute exacerbation of COPD (AECOPD) ( P<0.01), American Society of anesthesiologists (ASA) grades Ⅲ+Ⅳ ( P=0.001), delayed surgery (>48 h) ( P=0.015), pre-injury activities of daily living (ADL) score ( P=0.002) and mobility ( P=0.010) were related to an increased risk for 1-year mortality after operation. Advanced age ( OR=1.106, 95% CI: 1.016 to 1.210, P=0.021), AECOPD ( OR=5.053, 95% CI: 1.520 to 16.800, P=0.008), and ASA grades Ⅲ+Ⅳ ( OR=1.657, 95% CI: 1.072 to 3.912, P=0.040) were the risk factors for 5-year mortality in patients with COPD; pre-injury ADL ( OR=0.974, 95% CI: 0.987 to 0.967, P=0.043) was negatively correlated with 5-year mortality. Conclusions:COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease, AECOPD and ASA grades Ⅲ+Ⅳ are factors related to postoperative 1-year mortality in patients with hip fracture plus COPD. Advanced age, AECOPD and ASA grades Ⅲ+Ⅳ and delayed surgery (>48 h) are risk factors for postoperative 5-year mortality in patients with hip fracture plus COPD. ADL score before injury is negatively correlated with postoperative 1-year and 5-year mortalities.

Objective:To investigate the clinical effect of minimally invasive plate osteosynthesis (MIPO) through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018, including 12 males and 9 females, aged 18-68 years [(31.3±3.6)years]. All were closed fracture. According to AO classification, the fracture were classified as type A in 6 patients, type B in 10 and type C in 5. All patients were treated with anterolateral minimally invasive plate fixation. The operation time, intraoperative blood loss and hospital stay were recorded. The fracture healing was observed after operation. The visual analogue scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, and Mayo elbow performance score (MEPS) were used to evaluate the effectiveness before operation and at 2 weeks, 3 months and 12 months after operation.Results:All patients were followed up for 12-26 months [(18.2±2.4)months]. The operation time was 50-82 minutes [(68.2±19.4)minutes], with intraoperative blood loss of 40-95 ml [(60.2±21.3)ml]. The hospital stay was 6-16 days [(6.8±1.2)days]. There was no iatrogenic vascular or nerve injury during operation. The patients with radial nerve injury before operation were all adventitia contusion. The nerve function returned to normal within 3 months after operation. All fractures were healed within 5-10 months [(5.3±1.2)months]. At 2 weeks, 3 months and 12 months after operation, the VAS [(3.6±0.8)points, (2.1±0.4)points, (1.8±0.3)points] was lower than that before operation [(8.3±1.6)points] ( P<0.05); UCLA shoulder rating scale [(31.2±1.5)points, (33.6±0.8)points, (34.6±0.5)points] was higher than that before operation [(28.4±2.3)points] ( P<0.05); and MEPS [(80.2±3.4)points, (93.4±2.2)points, (96.4±3.5)points] was higher than that before operation [(60.5±4.5)points] ( P<0.05). At the last follow-up, the UCLA shoulder rating scale and MEPS showed excellent results. Conclusion:For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft, MIPO technique through anterolateral approach can attain satisfactory results in terms of pain, range of motion of shoulder and elbow joint, and joint function.