Objective To identify renal function and other readily accessible indicators influencing the prognosis of renal cell carcinoma (RCC) patients after nephrectomy, and to construct a prognostic prediction model based on them. Methods The clinical and pathological data of 624 RCC patients undergoing radical or partial nephrectomy in the First Hospital of Shanxi Medical University during Jan. 2013 and Dec. 2021 were retrospectively analyzed. The independent prognostic factors affecting postoperative overall survival (OS) were identified with LASSO algorithm combined with Cox regression analysis. Based on these factors, a nomogram was constructed to predict the 1-, 3-, and 5-year survival rates. The performance of the model was evaluated using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curves and the area under the curve (AUC), calibration plots, and decision curve analysis (DCA). Finally, the cutoff value of the nomogram was calculated to stratify patients into risk groups. Kaplan-Meier survival analysis with log-rank testing was performed to compare outcomes between the risk groups. Results Nine independent prognostic factors were identified, including age, smoking history, diabetes mellitus history, maximum tumor diameter, tumor subtype, N stage, Fuhrman grade, preoperative serum creatinine and cystatin C (P＜0.05). The nomogram achieved a C-index of 0.891, with time-dependent AUC of 0.920, 0.903, and 0.867 for 1-, 3-, and 5-year OS, respectively. Calibration curves showed excellent agreement with actual observations, and DCA demonstrated significant clinical net benefits across a wide threshold probability range. Using a cutoff score of 110.4, Kaplan-Meier analysis revealed statistically significant survival differences between risk groups (P＜0.001). Conclusion The proposed nomogram, incorporating renal function and other readily accessible clinical indicators, exhibits strong predictive accuracy for postoperative survival in RCC patients and may serve as a practical tool for individualized clinical decision-making.

Objective To assess renal oxygen metabolism and iron deposition in type 2 diabetes mellitus(T2DM)patients using a combination of blood oxygen level-dependent(BOLD)and mDixon Quant techniques.Methods Clinical data of 58 T2DM patients from Tianjin First Central Hospital(September 2022-December 2023)were prospectively collected.According to urinary albumin-to-creation ratio(ACR),patients were divided into the normal albuminuria(NAU,ACR＜30 mg/g,n=35)group and the microalbuminuria(MAU,30 mg/g≤ACR＜300 mg/g,n=23)group.Thirty-three healthy volunteers were included as the control group during the same period.All participants underwent renal BOLD and mDixon Quant MRI to obtain cortical and medullary apparent relaxation rate(R2*)values.The differences of general data and image parameter values were compared between groups.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic efficacy of relevant parameters for early renal function changes.Results There were significant differences in body weight,estimated glomerular filtration rate(eGFR)and ACR between the control group,the NAU group and the MAU group(P＜0.01).The R2* value in renal cortex was lower than that in renal medulla(P＜0.01)in the same group.Apart from R2* value of BOLD renal cortex,which showed no significant difference between the three groups(P＜0.05),and the differences in the other parameters were statistically significant(P<0.05).When distinguishing between the control group and the NAU group,the NAU group and the MAU group,as well as between the control group and the early-stage T2DM(NAU+MAU)group,the combined two-sequence approach demonstrated higher area under the curve(AUCs)than any single sequence alone,with AUC value of 0.892(95%CI:0.809-0.975),0.785(95%CI:0.666-0.904)and 0.841(95%CI:0.756-0.926),respectively.Conclusion The combination of BOLD imaging with mDixon Quant enables noninvasive and quantitative assessment of alterations in renal oxygen metabolism and iron content in early-stage T2DM patients.The diagnostic performance of this combined approach surpasses that of individual methods.

Objective To assess renal oxygen metabolism and iron deposition in type 2 diabetes mellitus(T2DM)patients using a combination of blood oxygen level-dependent(BOLD)and mDixon Quant techniques.Methods Clinical data of 58 T2DM patients from Tianjin First Central Hospital(September 2022-December 2023)were prospectively collected.According to urinary albumin-to-creation ratio(ACR),patients were divided into the normal albuminuria(NAU,ACR＜30 mg/g,n=35)group and the microalbuminuria(MAU,30 mg/g≤ACR＜300 mg/g,n=23)group.Thirty-three healthy volunteers were included as the control group during the same period.All participants underwent renal BOLD and mDixon Quant MRI to obtain cortical and medullary apparent relaxation rate(R2*)values.The differences of general data and image parameter values were compared between groups.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic efficacy of relevant parameters for early renal function changes.Results There were significant differences in body weight,estimated glomerular filtration rate(eGFR)and ACR between the control group,the NAU group and the MAU group(P＜0.01).The R2* value in renal cortex was lower than that in renal medulla(P＜0.01)in the same group.Apart from R2* value of BOLD renal cortex,which showed no significant difference between the three groups(P＜0.05),and the differences in the other parameters were statistically significant(P<0.05).When distinguishing between the control group and the NAU group,the NAU group and the MAU group,as well as between the control group and the early-stage T2DM(NAU+MAU)group,the combined two-sequence approach demonstrated higher area under the curve(AUCs)than any single sequence alone,with AUC value of 0.892(95%CI:0.809-0.975),0.785(95%CI:0.666-0.904)and 0.841(95%CI:0.756-0.926),respectively.Conclusion The combination of BOLD imaging with mDixon Quant enables noninvasive and quantitative assessment of alterations in renal oxygen metabolism and iron content in early-stage T2DM patients.The diagnostic performance of this combined approach surpasses that of individual methods.

Objective To explore the mediating role of activities of daily living (ADL) in pain and depressive symptoms in the elderly in China. Methods Utilizing the data from 2020 China Health and Retirement Longitudinal Study, 4403 Chinese elderly individuals aged ≥ 60 years old were selected as the research subjects. Depression Scale (CES-D 10) of the Center for Epidemiological Survey and ADL scale were used in the study. The PROCESS4.1 macro was used to test the mediating effect of daily living activities between pain and depressive symptoms, and the Bootstrap method was applied for verification of the mediating variables. Results A total of 2368 cases of depressive symptoms were detected in the elderly in China, with a detection rate of 53.78%. Pain was positively correlated with depressive symptoms (r=0.27, P<0.01), and activities of daily living were negatively correlated with pain and depressive symptoms (r=-0.27, -0.337, P<0.01). The results showed that the total effect value of pain on depressive symptoms was 0.33, the direct effect value was 0.24, and the mediating effect value of daily living activities was 0.09, accounting for 27.27%. Conclusion Pain and activities of daily living are important factors influencing depressive symptoms in the elderly, and activities of daily living play a partial mediating role in the relationship between pain and depressive symptoms in the elderly.

BACKGROUND:There are some problems such as bone fusion failure or peri-implant infection after implantation of pure titanium implants.Therefore,surface improvement of titanium implants has become a hot topic in research.Macrophages are an immune defense line of the body in response to external stimuli,and the relevant immune response of any biomaterials implanted in the body is related to macrophages. OBJECTIVE:The graphene oxide/hydroxyapatite composite coating on titanium alloy surface was prepared by electrochemical deposition method.The surface characteristics of the coating and the growth and polarization of macrophage RAW264.7 on the surface were analyzed. METHODS:The graphene oxide coating and graphene oxide/hydroxyapatite composite coating on titanium alloy surface was prepared by electrochemical deposition method.The physical properties of the coating were characterized.Pure titanium sheets(blank group),titanium sheets deposited with pure GO coating(control group)and titanium sheets deposited with graphene oxide/hydroxyapatite composite coating(experimental group)were co-cultured with macrophages RAW264.7,respectively.Cell proliferation was detected by CCK-8 assay and DAPI staining.Cell adhesion on the surface of titanium was observed by scanning electron microscopy,and cell polarization phenotype was detected by flow cytometry. RESULTS AND CONCLUSION:(1)Under scanning electron microscope,the pure titanium sheet showed directional scratches and a few punctate pits.After the pure graphene oxide coating was deposited,the surface of titanium sheet showed more cracks,gullies and particles of uneven size,and the wrinkle-like structure characterized by graphene oxide.After the composite coating was deposited,the surface of the titanium sheet was smooth,and the pellet size was more uniform.The water contact angle of composite coated titanium sheet was lower than that of pure titanium sheet and pure graphene oxide coated titanium sheet(P<0.05).(2)CCK-8 assay and DAPI staining showed that compared with the blank group and the control group,the cell proliferation in the experimental group was faster.Scanning electron microscopy showed that RAW264.7 cells all adhered to the surface of the three groups of titanium sheets.With the extension of culture time,cell morphology changed from round to spindle shape.After 7 days of culture,cells in the blank group extended short and few pseudopods;cells in the control group extended long and more pseudopods,and cells in the experimental group extended short and more pseudopods,and the overall cell fullness in the experimental group was the best.Flow cytometry results showed that the cells in the experimental group showed a higher proportion of M2 polarization in the anti-inflammatory direction.(3)These findings conclude that graphene oxide/hydroxyapatite composite coating has good physical,chemical,and biological properties.

Objective To observe the value of intraoperative ultrasound(IOUS)for microsurgical resection of primary supratentorial glioblastoma.Methods Totally 130 cases of central nervous system WHO grade 4 primary supratentorial glioblastoma confirmed by postoperative pathology were retrospectively enrolled and divided into IOUS group and control group(each n=65)based on whether IOUS was used during operation.The general information,resection related indicators and postoperative complications were compared between groups,and the application value of IOUS was analyzed.Results In IOUS group,the tumor depth was greater,while the intraoperative bleeding,duration of hospitalization and operation-duration were all less than those in control group(all P＜0.05).Postoperative complications occurred in 28 cases of IOUS group and 29 cases of control group,and the incidence of subdural effusion in IOUS group was lower than that in control group(P＜0.05).Conclusion IOUS could effectively reduce intraoperative bleeding,duration of hospitalization,operation-duration and incidence of postoperative subdural effusion in microsurgical resection of primary supratentorial glioblastoma.

Objective To investigate the value of intraoperative ultrasound radiomics for predicting isocitrate dehydrogenase 1(IDH1)mutation of high-grade glioma.Methods Ninety-five patients with high-grade glioma(WHO grade Ⅲ and Ⅳ)who underwent craniotomy glioma resection and ultrasound assisted tumor localization during operation and then confirmed by pathology were retrospectively enrolled.The patients were divided into training set(n=66,including 24 IDH1 mutation type and 42 IDH1 wild type)and validation set(n=29,including 11 IDH1 mutation type and 18 IDH1 wild type)at the ratio of 7∶3.Based on intraoperative ultrasound,radiomics features were extracted,the best ones were screened,and a radiomics model was established for predicting IDH1 mutation of high-grade glioma using random forest algorithm.Receiver operating characteristic(ROC)curve was plotted,the area under the curve(AUC)was calculated to evaluate the predictive efficacy of the model,and decision curve analysis(DCA)was used to evaluate the clinical value of the model.Results A total of 851 radiomics features were extracted based on intraoperative ultrasound,and finally 5 best ones were screened out to construct a radiomics model.The AUC of the radiomics model for predicting IDH1 mutation of high-grade glioma in training and validation sets was 0.902 and 0.707,respectively,with no significant difference(P=0.097).DCA maps showed that the clinical net benefit of the radiomics model was high.Conclusion Intraoperative ultrasound radiomics could effectively predict IDH1 mutation of high-grade glioma.

Objective To observe the value of intraoperative ultrasound(IOUS)for microsurgical resection of primary supratentorial glioblastoma.Methods Totally 130 cases of central nervous system WHO grade 4 primary supratentorial glioblastoma confirmed by postoperative pathology were retrospectively enrolled and divided into IOUS group and control group(each n=65)based on whether IOUS was used during operation.The general information,resection related indicators and postoperative complications were compared between groups,and the application value of IOUS was analyzed.Results In IOUS group,the tumor depth was greater,while the intraoperative bleeding,duration of hospitalization and operation-duration were all less than those in control group(all P＜0.05).Postoperative complications occurred in 28 cases of IOUS group and 29 cases of control group,and the incidence of subdural effusion in IOUS group was lower than that in control group(P＜0.05).Conclusion IOUS could effectively reduce intraoperative bleeding,duration of hospitalization,operation-duration and incidence of postoperative subdural effusion in microsurgical resection of primary supratentorial glioblastoma.

Objective To investigate the value of intraoperative ultrasound radiomics for predicting isocitrate dehydrogenase 1(IDH1)mutation of high-grade glioma.Methods Ninety-five patients with high-grade glioma(WHO grade Ⅲ and Ⅳ)who underwent craniotomy glioma resection and ultrasound assisted tumor localization during operation and then confirmed by pathology were retrospectively enrolled.The patients were divided into training set(n=66,including 24 IDH1 mutation type and 42 IDH1 wild type)and validation set(n=29,including 11 IDH1 mutation type and 18 IDH1 wild type)at the ratio of 7∶3.Based on intraoperative ultrasound,radiomics features were extracted,the best ones were screened,and a radiomics model was established for predicting IDH1 mutation of high-grade glioma using random forest algorithm.Receiver operating characteristic(ROC)curve was plotted,the area under the curve(AUC)was calculated to evaluate the predictive efficacy of the model,and decision curve analysis(DCA)was used to evaluate the clinical value of the model.Results A total of 851 radiomics features were extracted based on intraoperative ultrasound,and finally 5 best ones were screened out to construct a radiomics model.The AUC of the radiomics model for predicting IDH1 mutation of high-grade glioma in training and validation sets was 0.902 and 0.707,respectively,with no significant difference(P=0.097).DCA maps showed that the clinical net benefit of the radiomics model was high.Conclusion Intraoperative ultrasound radiomics could effectively predict IDH1 mutation of high-grade glioma.

Objective:To analyse the correlation between depression and hip fracture in the middle-aged and elderly population in the Chinese community.Methods:The study data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) database. A total of 16,831 respondents from 12,400 households in the fourth national follow-up data in 2018 were selected as the research sample. The samples were divided into a training set and a test set at a ratio of 7∶3, and the test set data were used for internal validation. For external validation, 2,337 subjects recruited from the Institute of Orthopaedics, the First Affiliated Hospital of Zhejiang Chinese Medical University from 2018 to 2023 were selected as the survey subjects. The Center for Epidemiological Studies Depression Scale (CESD) was used to assess depression. CESD≥16 points were defined as depression, and CESD<16 points were defined as no depression. Binary logistic regression was used to gradually analyze the correlation between depression and hip fracture after adjusting for different covariates.Results:In the training set, statistically significant differences were observed between patients with and without hip fractures in terms of depression prevalence (χ 2=16.310, P<0.001), age (χ 2=9.417, P=0.009), education level ( P<0.001), marital status ( P=0.019), and place of residence ( P=0.035). In the testing set, statistically significant differences were found in depression prevalence (χ 2=10.130, P=0.001), gender (χ 2=4.368, P=0.037), education level ( P=0.013), and smoking history (χ 2=8.804, P=0.012). In the external validation set, significant differences were noted in depression prevalence (χ 2=337.885, P<0.001), age (χ 2=29.475, P<0.001), and smoking history ( P=0.020). After controlling for demographic characteristics, exercise, smoking and drinking history, binary logistic regression showed that the risk of hip fracture in depressed patients was 1.78 times higher in the training set ( OR=1.78, P<0.001), 2.73 times higher in the testing set ( OR=2.73, P=0.002), and 15.21 times higher in the external validation set ( OR=15.21, P<0.001) than that of non-depressed patients, indicating good internal and external validation results. Conclusion:Depression is an independent risk factor for hip fractures among middle-aged and elderly populations in Chinese communities. Early identification and active intervention for depression in this population can help reduce the risk of hip fractures.