Objective:To predict pre-treatment clinical parameters that are associated with poor response and prognosis to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC) and to use second-line treatment drugs in the early stages to delay the progression of the disease so that patients can benefit from early-stage treatment.Methods:Patients diagnosed with PBC at the Second Affiliated Hospital of Kunming Medical University from 2013 to 2022 were collected. Two hundred fifty-seven cases were screened in accordance with the inclusion and exclusion criteria. The response and prognosis conditions one year after treatment were followed up in outpatient and inpatient departments, as well as through telephone calls. Statistical analyses were performed using t-tests, Mann-Whitney U test, χ2 test, Fisher's exact test, and logistic regression analysis according to different data. Results:A total of 257 PBC cases were included, with 223 females (86.80%) and 34 males (13.20%). Univariate and multivariate binary logistic regression analyses showed that baseline high albumin levels [odds ratio ( OR): 0.882, 95% confidence interval ( CI): 0.805～0.967, P=0.008] were a protective factor for PBC patients' response to UDCA treatment after adjusting for different confounding factors, while baseline high alkaline phosphatase ( OR: 1.012, 95% CI: 1.008～1.016, P<0.001) and baseline high neutrophil/lymphocyte ratio (NLR) level ( OR: 1.462, 95% CI:1.079～1.981, P=0.014) were risk factors for a poor response to UDCA. Trend analysis showed that the baseline NLR quantile was positively correlated with the risk of poor response to UDCA ( OR: 5.512, 95% CI: 1.040～29.216, P=0.045) in patients with PBC. Cox proportional hazards regression analysis identified that age [hazard ratio ( HR): 1.050, 95% CI: 1.019～1.082] and NLR value ( HR:1.089, 95% CI:1.021～1.161) were independent influencing risk factors for all-cause mortality in PBC patients ( P<0.05). Conclusion:Baseline high albumin levels are protective factors against a poor biochemical response to UDCA, while baseline high alkaline phosphatase levels and high NLR are risk factors for a poor biochemical response to UDCA in patients with PBC. Additionally, baseline high NLR values are positively correlated with poor biochemical response to UDCA treatment.

Objective:To establish a risk prediction model based on least absolute shrinkage and selection operator (LASSO) regression for procalcitonin (PCT), milk fat globule-epidermal growth factor 8 (MFG-E8) and CXC chemokine ligand 9 (CXCL9) in elderly patients with liver cancer after transcatheter arterial chemoembolization (TACE) .Methods:A total of 150 elderly patients with liver cancer who underwent TACE treatment in Shishi City Hospital, Fujian Province and 910th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from August 2020 to August 2023 were selected as the study subjects. Patients with infection after TACE were included in the infected group and those without infection were included in the non-infected group according to whether the patients had infection during the postoperative hospitalization. The baseline data of patients were collected and compared. LASSO regression was used to screen the factors that may affect the infection after TACE in elderly patients with liver cancer and binary logistic regression analysis was performed. According to the results of regression analysis, a nomogram model was constructed based on the regression analysis results and the nomogram was internally validated using Bootstrap and receiver operator characteristic (ROC) curves.Results:There were 18 cases of infection in 150 elderly patients with liver cancer after TACE, with an incidence of 12.00%. There were statistically significant differences in focal rupture and bleeding ( χ2=5.92, P=0.015), ascites ( χ2=6.70, P=0.010), skin or mucosal damage ( χ2=6.67, P=0.010) between the infected group ( n=18) and the non-infected group ( n=132). The levels of serum PCT [ (1.17±0.32 ) μg/L vs. (0.91±0.14) μg/L], MFG-E8 [ (194.29±45.85) pg/ml vs. (158.76±28.63) pg/ml] and CXCL9 [ (948.49±52.38) pg/ml vs. (886.05±50.07) pg/ml] were higher than those in the non-infected group, with statistically significant differences ( t=4.13, P<0.001; t=4.55, P<0.001; t=4.94, P<0.001). Four factors related to infection after TACE intervention in patients with liver cancer were finally selected by LASSO regression model, skin or mucosal damage, PCT, MFG-E8, CXCL9 levels. Binary logistic regression analysis showed that skin or mucosal damage ( OR=13.48, 95% CI: 1.29-140.47, P=0.030), high levels of serum PCT ( OR=1.13, 95% CI: 1.05-1.22, P=0.001), MFG-E8 ( OR=1.04, 95% CI: 1.01-1.07, P=0.003), CXCL9 ( OR=1.05, 95% CI: 1.02-1.08, P=0.001) were risk factors for infection after TACE in elderly patients with liver cancer. Based on skin or mucosa damage, PCT, MFG-E8 and CXCL9, a nomogram prediction model for postoperative infection in elderly patients with liver cancer after TACE intervention was established. Calibration curve showed that the C-index of postoperative infection predicted by the nomogram model in elderly patients with liver cancer after TACE intervention was 0.939, indicating the model had good discrimination. ROC curve analysis showed that the area under the curve (AUC) predicted by the nomogram model for infection after TACE intervention in elderly patients with liver cancer was 0.960 (95% CI: 0.926-0.995, P<0.001), which had certain predictive value. The specificity, sensitivity and Youden index were 0.864, 0.944 and 0.808, respectively. Conclusions:Skin or mucosal damage, high levels of serum PCT, CXCL9 and MFG-E8 are closely related to postoperative infection in elderly patients with liver cancer after TACE, and the prediction model constructed based on this has better predictive performance for postoperative infection.

Objective:To predict pre-treatment clinical parameters that are associated with poor response and prognosis to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC) and to use second-line treatment drugs in the early stages to delay the progression of the disease so that patients can benefit from early-stage treatment.Methods:Patients diagnosed with PBC at the Second Affiliated Hospital of Kunming Medical University from 2013 to 2022 were collected. Two hundred fifty-seven cases were screened in accordance with the inclusion and exclusion criteria. The response and prognosis conditions one year after treatment were followed up in outpatient and inpatient departments, as well as through telephone calls. Statistical analyses were performed using t-tests, Mann-Whitney U test, χ2 test, Fisher's exact test, and logistic regression analysis according to different data. Results:A total of 257 PBC cases were included, with 223 females (86.80%) and 34 males (13.20%). Univariate and multivariate binary logistic regression analyses showed that baseline high albumin levels [odds ratio ( OR): 0.882, 95% confidence interval ( CI): 0.805～0.967, P=0.008] were a protective factor for PBC patients' response to UDCA treatment after adjusting for different confounding factors, while baseline high alkaline phosphatase ( OR: 1.012, 95% CI: 1.008～1.016, P<0.001) and baseline high neutrophil/lymphocyte ratio (NLR) level ( OR: 1.462, 95% CI:1.079～1.981, P=0.014) were risk factors for a poor response to UDCA. Trend analysis showed that the baseline NLR quantile was positively correlated with the risk of poor response to UDCA ( OR: 5.512, 95% CI: 1.040～29.216, P=0.045) in patients with PBC. Cox proportional hazards regression analysis identified that age [hazard ratio ( HR): 1.050, 95% CI: 1.019～1.082] and NLR value ( HR:1.089, 95% CI:1.021～1.161) were independent influencing risk factors for all-cause mortality in PBC patients ( P<0.05). Conclusion:Baseline high albumin levels are protective factors against a poor biochemical response to UDCA, while baseline high alkaline phosphatase levels and high NLR are risk factors for a poor biochemical response to UDCA in patients with PBC. Additionally, baseline high NLR values are positively correlated with poor biochemical response to UDCA treatment.

To investigate the influencing factors of postoperative complications following thoracoscopic lung resection in elderly patients and to provide a scientific basis for developing preoperative prehabilitation strategies for high-risk elderly populations.

Objective The goal of this study was to carry out a trial of a novel disposable vacuum drainage bottle with speed drainage adjustment and a threaded catheter connector,as well as to further explore the effectiveness in drainage.Methods Twenty-seven patients who underwent continuous fluid drainage in the Coronary Care Unit(CCU)of our hospital between February and August 2023 were put on the trial.The patients were randomly assigned into a control group(12 cases,with 76 replacements of traditional vacuum drainage bottles over the catheterisation and an trial group(15 cases,with 83 replacements of the novelly modified disposable vacuum drainage bottle)by a simple random method.Patients in the control group had the drainage catheter connected to a traditional vacuum drainage bottle,while the patients in the trial group had drainage catheter connected to the novelly modified vacuum drainage bottle.The two groups were compared in terms of the number of bottle replacement,incidence of exudation/leakage/detachment,time for bottle replacement,cost of consumables for drainage,and satisfaction of patients and nurses.Results All patients completed the trial.The trial group exhibited a significantly lower incidence rate in exudation/leakage/detachment,shorter time for bottle replacement and lower cost of consumables for bottle replacement in comparison with those in the control group(all P＜0.05).Moreover,both patients and nurses in the trial group reported significantly higher satisfaction with the modified disposable bottle than the bottle used in the control group(both P＜0.001).Conclusions The novelly modified disposable vacuum drainage bottle overcomes the deficiencies of the traditional bottle,reduces the incidence of exudation/leakage/detachment over the drainage,cut down the cost of bottle replacement,and shorten the time for bottle replacement.The novel and modified disposable vacuum drainage bottle has received great appreciations from the patients and nursing staff.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Objective:To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods:In this systematic review study, using “elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine” as the key words, the 6S evidence resource pyramid model was used to search in British Medical Journal best practice, Uptodate, World Health Organization, Guidelines International Network, National Institute for Health and Care Excellence, Chinese Medical Association, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, The Joanna Briggs Institute (JBI), New Zealand Guidelines Group, Polish Society of Gynecologists and Obstetricians, PubMed, Embase, Medline, Web of Science, SinoMed, China National Knowledge Infrastructure, WanFang Data, etc. The evidence retrieved included evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review, etc. Data were retrieved from January 1, 2017 to May 1, 2022, and collated from May 2, 2022 to May 25, 2022. Two researchers independently evaluated the quality of literature and extracted data using the AGREE Ⅱ and JBI evidence-based health care center assessment tools. The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence; and under the guidance of the evidence structure of JBI, the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results:A total of 9 articles were retrieved, including 7 guidelines and 2 systematic reviews; and 6 guidelines were classified as Grade A and 1 as grade B; both 2 systematic reviews were rated as Grade A; 84% (27/32) of the items were evaluated as “Yes”. Evidence were summarized as 34 pieces of best evidence from 6 dimensions, including “overall recommendation, evaluation of type and degree of urinary incontinence, lifestyle change, behavioral therapy, prevention of precipitating factors, intervention in special population”; the flow chart of screening, evaluation, special symptoms, life style and behavior therapy was combed, and the practical suggestions were formed.Conclusions:The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high, and the level of evidence is high. Early identification of urinary incontinence types and assessment of disease severity, lifestyle changes, avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.

Frailty, which predicts high dependency and mortality, is a major challenge for healthcare systems in nations that are rapidly aging and is receiving increasing attention. Cirrhosis is often combined with frailty, which has a significant impact on patient health outcomes. Understanding the risk factors for frailty, elucidating the mechanism of cirrhosis combined with frailty, and early recognition and slowing down the occurrence and development of frailty are of great significance for the prognosis of cirrhotic patients. This article reviews the current research status of cirrhosis combined with frailty, including the definition and risk factors, mechanism, correlation, and intervention measures, in order to improve understanding and provide assistance for strengthening early identification, management, and intervention.

OBJECTIVES: Microvascular invasion (MVI) is an important predictor of postoperative recurrence or poor outcomes of hepatocellular carcinoma (HCC). Radiomics is able to predict MVI in HCC preoperatively. This study aims to investigate the influence of different region of interest (ROI) sizes on CT-based radiomics model for MVI prediction in HCC. METHODS: Patients with HCC with or without MVI confirmed by pathology and those who underwent preoperative plain or enhanced abdominal CT scans in the Third Xiangya Hospital of Central South University from January 2010 to December 2020 were retrospectively and consecutively included. According to the ratio of 7 to 3, the patients were randomly assigned into a training set and a validation set. Clinical data were collected from medical records, and radiomics features were extracted from the arterial phase (AP) and portal venous phase (PVP) of preoperatively acquired CT in all patients. Six different ROI sizes were employed. The original ROI (OROI) was manually delineated along the visible borders of the tumor layer-by-layer. The OROI was expanded out by 1-5 mm. The OROI was combined with 5 different peritumoral regions to generate the other 5 ROIs, named Plus1-Plus5. Feature extraction, dimension reduction, and model development were conducted in 6 different ROIs separately. Supporter vector machine (SVM) was used for model construction. Model performance was assessed via receiver operating characteristic (ROC) curve. RESULTS: A total of 172 HCC patients were included, in which 83 (48.3%) were MVI positive, and 89 (51.7%) were MVI negative. Three hundred and ninety-six features based on AP or PVP images were extracted from each ROI. After feature selection and dimension reduction, 4, 5, 15, 11, 6, and 3 features of OROI, Plus1, Plus2, Plus 3, Plus4, and Plus5 were selected for model construction, respectively. In the training set, the sensitivity, specificity, and area under the curve (AUC) of OROI were 0.759, 0.806, and 0.855, respectively. The AUC values of Plus2 (0.979) and Plus3 (0.954) were higher than that of OROI. The AUC values of Plus1 (0.802), Plus4 (0.792), and Plus5 (0.774) were not significantly different from those of OROI. In the validation set, the sensitivity, specificity, and AUC value of OROI were 0.640, 0.630, and 0.664, respectively. The AUC value of Plus3 was 0.903, which was higher than that of OROI. The AUC values of Plus1 (0.679), Plus2 (0.536), Plus4 (0.708), and Plus5 (0.757) were not significantly different from that of OROI (P>0.05). CONCLUSIONS The size of ROI significantly inflluences on the performance of CT-based radiomics model for MVI prediction in HCC. Including appropriate area around the tumor into ROI could improve the predictive performance of the model, and 3 mm might be appropriate distance.
Carcinoma, Hepatocellular/pathology* ; Humans ; Liver Neoplasms/pathology* ; Predictive Value of Tests ; Retrospective Studies ; Tomography, X-Ray Computed/methods*

In recent years, the task of object detection and segmentation in medical image is the research hotspot and difficulty in the field of image processing. Instance segmentation provides instance-level labels for different objects belonging to the same class, so it is widely used in the field of medical image processing. In this paper, medical image instance segmentation was summarized from the following aspects: First, the basic principle of instance segmentation was described, the instance segmentation models were classified into three categories, the development context of the instance segmentation algorithm was displayed in two-dimensional space, and six classic model diagrams of instance segmentation were given. Second, from the perspective of the three models of two-stage instance segmentation, single-stage instance segmentation and three-dimensional (3D) instance segmentation, we summarized the ideas of the three types of models, discussed the advantages and disadvantages, and sorted out the latest developments. Third, the application status of instance segmentation in six medical images such as colon tissue image, cervical image, bone imaging image, pathological section image of gastric cancer, computed tomography (CT) image of lung nodule and X-ray image of breast was summarized. Fourth, the main challenges in the field of medical image instance segmentation were discussed and the future development direction was prospected. In this paper, the principle, models and characteristics of instance segmentation are systematically summarized, as well as the application of instance segmentation in the field of medical image processing, which is of positive guiding significance to the study of instance segmentation.
Imaging, Three-Dimensional/methods* ; Image Processing, Computer-Assisted ; Tomography, X-Ray Computed/methods* ; Algorithms