Objective To establish a classification tree model for non-alcoholic fatty liver disease(NAFLD)among aircrews,screen for influencing factors of NAFLD,so as to provide scientific basis for prevention and intervention decisions for NAFLD.Methods Aircrews who underwent recuperation at a sanatorium from January 2019 to December 2023 were selected as the research objects.Their annual physical examination data were collected and the NAFLD detection rate was calculated.Age,body mass index(BMI),blood pressure,waist circumference,blood routine,biochemistry indexes,and thyroid function were incorporated,and a NAFLD risk model was constructed using classification regression tree method.The predictive performance of the NAFLD classification tree model was evaluated through model misclassification matrix,risk statistics,and receiver operating characteristic curve.Results A total of 4088 aircrews were included in the study,and NAFLD was detected in 380 persons(380/4088,9.30%).The NAFLD model consisted of three layers,and five explanatory variables affecting the onset of NAFLD were extracted,including BMI,triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),and total bilirubin(TBIL).BMI was located at the top of the classification tree and was the most important risk factor for NAFLD in aircrews.The area under the curve(AUC)of the model was 0.853.The predictive accuracy of NAFLD was 90.9%,indicating that the model has good accuracy and fitting effect.Conclusion In this study,the detection rate of NAFLD in aircrews was 9.30%.BMI,TG,HDL-C,ALT,and TBIL are risk factors for the onset of NAFLD.NAFLD is mainly related to weight gain and lipid metabolism disorders caused by unhealthy lifestyles.

Objective:To explore the activation characteristics and synergistic mode of lumbar and abdominal core muscle group during abdominal breathing training.Method:Thirty-two healthy college students were recruited and randomly divided into the control group and the experimental group with 16 cases in each group.The control group received stan-pile training,while the experimental group received abdominal breathing and stan-pile training 5 times a week for 8 weeks.The sur-face electromyography of the lumbar and abdominal core muscles was collected before and after the interven-tion.Non-negative matrix factorization(NMF)was used to extract extract muscle synergy patterns from the EMG data.Result:In terms of cooperative elements,the number of cooperative elements increased after intervention in both groups compared with baseline,but there was no significant difference in the number of cooperative ele-ments between the two groups before intervention(P>0.05),and there was a significant difference in the num-ber of cooperative elements after intervention(P<0.05).In terms of cooperative patterns,the cooperative pat-terns before intervention in the two groups were similar.After intervention,the cooperative patterns in the two groups were different,the control group showed coactivation of the right transversus abdominis,left internal oblique,right erector spinae,and bilateral multifidus throughout the breathing cycle.In contrast,the experimen-tal group exhibited pronounced activation of bilateral erector spinae and multifidus during inhalation,and bilater-al transversus abdominis,left external oblique,and left erector spinae during exhalation.The activation curves before intervention in the two groups were similar,and the activation curves after intervention in the two groups trended towards slowing down,with the time feature of the activation curve in the experimental group being more obvious.Conclusion:Abdominal breathing training can increase the number of cooperative tuples of the waist and abdo-men muscles,and the muscles perform efficient division of labor after training to form an adaptive coopera-tive mode.

Objective:To explore the activation characteristics and synergistic mode of lumbar and abdominal core muscle group during abdominal breathing training.Method:Thirty-two healthy college students were recruited and randomly divided into the control group and the experimental group with 16 cases in each group.The control group received stan-pile training,while the experimental group received abdominal breathing and stan-pile training 5 times a week for 8 weeks.The sur-face electromyography of the lumbar and abdominal core muscles was collected before and after the interven-tion.Non-negative matrix factorization(NMF)was used to extract extract muscle synergy patterns from the EMG data.Result:In terms of cooperative elements,the number of cooperative elements increased after intervention in both groups compared with baseline,but there was no significant difference in the number of cooperative ele-ments between the two groups before intervention(P>0.05),and there was a significant difference in the num-ber of cooperative elements after intervention(P<0.05).In terms of cooperative patterns,the cooperative pat-terns before intervention in the two groups were similar.After intervention,the cooperative patterns in the two groups were different,the control group showed coactivation of the right transversus abdominis,left internal oblique,right erector spinae,and bilateral multifidus throughout the breathing cycle.In contrast,the experimen-tal group exhibited pronounced activation of bilateral erector spinae and multifidus during inhalation,and bilater-al transversus abdominis,left external oblique,and left erector spinae during exhalation.The activation curves before intervention in the two groups were similar,and the activation curves after intervention in the two groups trended towards slowing down,with the time feature of the activation curve in the experimental group being more obvious.Conclusion:Abdominal breathing training can increase the number of cooperative tuples of the waist and abdo-men muscles,and the muscles perform efficient division of labor after training to form an adaptive coopera-tive mode.

Objective:To provide references for the health management of thyroid nodules in naval flying personnel by analyzing the ultrasound characteristics of naval flying personnel with thyroid nodules.Methods:A total of 306 naval flying personnel, who were diagnosed as thyroid nodules in yearly health examination in the Third Sanatorium of Air Force Healthcare Center for Special Services Hangzhou from January of 2019 to December of 2021, were selected as the research subjects. They were divided into 3 groups by age (20-29 years, 30-39 years, ≥40 years), 2 groups by flying hours (<3 000 h, ≥3 000 h) and 3 groups by aircraft types (helicopter, transporter, fighter). The characteristics of thyroid nodule ultrasound images were retrospectively analyzed and the size, quantity and classification which defined in Chinese-thyroid imaging reporting and data system (C-TIRADS) of thyroid nodule were compared among the groups of different ages, flying hours, and aircraft types.Results:Among 306 naval flying personnel with thyroid noedules, 280 cases (91.50%) were small nodules (diameter <1 cm), 26 cases (8.50%) were large nodules (diameter ≥1 cm). One hundred and fifty-one cases (49.35%) were single nodules and 155 cases (50.65%) were multiple nodules. There were 135 cases (44.12%) with C-TIRADS grade 2 thyroid nodules, 158 cases (51.63%) with C-TIRADS grade 3 nodules, and 13 cases (4.25%) with C-TIRADS grade 4 nodules. There were significant differences in the size, number, classification of composition ratio of thyroid nodules among different age groups ( χ2=8.86, 5.94, 46.20, P=0.013, 0.051,<0.001). There were significant differences in the size and classification of composition ratio of thyroid nodules between different flying hours groups ( χ2=16.91, 24.35, both P<0.001). The proportion of C-TIRADS grade 4 nodules in the flying hours ≥3 000 h group was higher than that in the <3 000 h group, with a significant difference ( χ2=4.77, P=0.029).There were no significant differences in the size, number, classification of composition ratio of thyroid nodules among different aircraft types groups (all P>0.05). Conclusions:Age and flying hours have effects on size and classification of composition ratio of thyroid nodules in flying personnel, and age also has the effect on quantity. A scientific and systematic follow-up mechanism would be helpful to assess the risk of thyroid cancer and give early warning for the timely intervention.

Background and purpose:With the aging population,the number of elderly patients with colorectal cancer(CRC)is increasing.To date,elderly patients with stage Ⅱ CRC often receive a weakened chemotherapy regimen or even no chemotherapy after radical surgery,and It is still unclear whether this will lead to adverse oncological outcomes.This study aimed to explore the prognostic impact of advanced age on stage Ⅱ CRC patients after removing bias through a multivariate COX regression approach.Methods:We retrospectively collected data of 3314 colorectal cancer patients with postoperative pathology of stage Ⅱ,no history of previous tumors,no secondary primary tumors within 5 years after surgery and no preoperative neoadjuvant therapy.This study was reviewed by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:050432-4-2108*).The optimal threshold for calculating age relative to survival using survminer package of R software(version 3.0)(surv_cutpoint algorithm)was 73 years.We compared the clinical and pathological characteristics,overall survival(OS)and disease-free survival(DFS)between the older group(age＞73 years)and the younger group(age≤73 years).The alignment diagram prediction model was drawn using the survival package and RMS package.Results:The elderly and non-elderly groups were evenly comparable in terms of gender,tumor location,differentiation,vascular invasion,perineural invasion and pT stage.Multivariate COX regression showed that advanced age was an independent prognostic risk factor for OS[hazard ratio(HR)=3.725(3.051-4.549),P＜0.001]and DFS[HR=2.431(2.029-2.912),P＜0.001].The nomogram(alignment diagram)prediction model constructed based on multivariate COX regression could effectively evaluate the prognosis of stage Ⅱ CRC patients and provide guidance for practical clinical work.Conclusion:In stage Ⅱ CRC patients,older age is associated with shorter OS and DFS.Adequate intensity of adjuvant chemotherapy may be necessary.Treatment decisions can be adjusted based on the predicted model scores of the patient's alignment diagram.

Background and purpose:According to current consensus,adverse high-risk pathological features are only associated with adjuvant therapy for stage Ⅱ colorectal cancer(CRC).As important prognostic factors,we further explored the possibility of identifying patients with potential recurrence and poor prognosis based on these incorporating high-risk pathological features.Methods:This is a cohort study.A retrospective analysis was conducted on clinical data of CRC patients who underwent surgical treatment at the Second Department of Colorectal Surgery,Fudan University Affiliated Shanghai Cancer Center from 2008 to 2018.This study was approved by the Ethics Committee of the Fudan University Shanghai Cancer Center(approval No.:050432-4-2108*),and the study complies with the Declaration of Helsinki.A total of 9875 patients were enrolled,including 5859 males and 4016 females,aged[M(IQR)]60(16)years(range:16 to 94).Median follow-up time was 1779.0 days[95%CI:1750.1-1807.9].We used the Kaplan-Meier method to plot survival curves for different groups.Cox multivariate analysis was used to identify independent risk factors for 5-year overall survival(OS),disease-free survival(DFS)and recurrence-free survival(RFS).Finally,a column chart model was constructed to evaluate and stratify patient prognosis.The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)checklist was followed for this cohort study.Results:According to the number of incorporating high-risk pathological features,patients were divided into five groups:Hr_0 group(0 incorporating high-risk pathological feature),Hr_1 group(1 incorporating high-risk pathological feature),Hr_2 group(2 incorporating high-risk pathological features),Hr_3 group(3 incorporating high-risk pathological features),and Hr_4 group(4 or more incorporating high-risk pathological features).The Kaplan-Meier survival curve results indicated significant differences in OS,DFS and RFS among different groups(all P<0.001).Subgroup analysis was conducted on stage Ⅱ colorectal cancer,and the survival curves of OS,DFS and RFS in different Hr groups overlapped with each other.Compared to the overall population,the survival differences in different groups were significantly reduced,indicating that stage Ⅱ colon cancer patients with incorporating high-risk pathological features may benefit from adjuvant chemotherapy.The independent prognostic factors for RFS included age,pT stage,pN stage and Hr group.The survival curves of OS,DFS and RFS indicated that the prognosis of Hr_4 group was significantly worse than that of stage Ⅲc patients;5.2%and 14.1%of stage Ⅰ and Ⅱ patients had two or more incorporating high-risk pathological features(Hr group≥2),respectively.Finally,a column chart model was constructed by incorporating the independent prognostic risk factors for CRC mentioned above.The calibration curve showed a good consistency between the actual observations and the predictions made by the nomogram,and the decision curve analysis(DCA)indicated that the model constructed in this study had good efficacy in stratifying recurrence.Conclusion:The number of incorporating high-risk pathological features is an independent prognostic factor for RFS in patients with stage Ⅰ-ⅢCRC.Combining it as a multiclass variable with age,pT and pN stage has good prognostic stratification and recurrence stratification efficacy,which is expected to guide clinical treatment.

Background and purpose:Currently,for patients with mid-to-low locally advanced rectal cancer and potentially resectable T4bM0 colon cancer,guidelines recommend neoadjuvant therapy strategies to enhance the response rate and increase the likelihood of conversion surgery.Among these patients,ypⅢ stage colorectal cancer(CRC)is assessed using the Union for International Cancer Control(UICC)/American Joint Committee on Cancer(AJCC)TNM staging system for postoperative pathological features.However,neoadjuvant therapy can lead to lymph node regression in the surgical area,resulting in an insufficient number of detected lymph nodes(less than 12),preventing classification according to conventional TNM staging.Thus,TNM staging often fails to predict the prognosis of ypⅢ patients who have undergone neoadjuvant therapy.This study aimed to evaluate the prognostic value of the positive lymph node ratio(LNR)in ypⅢ stage CRC patients treated with neoadjuvant therapy.Methods:Retrospective data was collected from ypⅢ stage CRC patients who received neoadjuvant therapy and underwent radical surgery at Fudan University Shanghai Cancer Center between 2008 and 2018.Collect clinical pathological characteristics such as age,gender,primary tumor location,tumor differentiation grade,pathological staging,and whether the patient has relapsed or died during follow-up at the time of surgery.Inclusion criteria:CRC patients who have received neoadjuvant therapy and surgery and have been confirmed to be stage Ⅲ by postoperative pathological examination.Exclusion criteria:① Preoperative imaging examination or intraoperative exploration reveals distant organ metastasis;② History of malignant tumors in the past;③ Multiple primary CRC.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:050432-4-2108*).The R software survminer package(surv_cutpoint algorithm)was used to calculate the optimal cutoff value for LNR relative to disease-free survival(DFS),and patients were divided into low and high LNR groups accordingly.Clinical pathological characteristics and DFS were compared between the two groups.COX proportional hazards regression models were employed to identify adverse pathological features,and survival plots along with prediction models for DFS were generated using the survival and rms packages.Results:A total of 489 patients were included,comprising 289 males and 200 females,with a median age of 56 years(23-80 years)and a median follow-up time of 1 062 d.During the follow-up period,164 patients(33.5%)died.In the entire cohort,204(41.7%)patients had fewer than 12 lymph nodes detected.The optimal cutoff value for LNR was 0.29,classifying 317 patients into the low LNR group(LNR≤0.29)and 172 patients into the high LNR group(LNR＞0.29).The high LNR group exhibited shorter DFS compared to the low LNR group[hazard ratio(HR)=2.103,95%CI:1.582-2.796,P＜0.000 1].Multivariate COX regression indicated that LNR was an independent prognostic factor for DFS(HR=1.825,95%CI:1.391-2.394,P＜0.001).The inclusion of LNR in a multicategory DFS nomogram prediction model effectively assessed DFS in stage Ⅲ CRC patients who had undergone neoadjuvant therapy.Conclusion:LNR is an independent prognostic factor for ypⅢ stage CRC patients,showing good predictive power for DFS when combined with other adverse pathological features.Therefore,incorporating LNR as a supplement to TNM staging can improve the accuracy of CRC prognosis assessment.

Fluorescence imaging technology was initially used for liver reserve function assessment and sentinel lymph node biopsy in breast cancer.Subsequently,its application across various fields of oncologic surgery has gained widespread recognition.Fluorescence laparoscopy combines the advantages of fluorescence imaging and minimally invasive techniques,demonstrating significant research value and promising application prospects in the auxiliary diagnosis and treatment of colorectal cancer(CRC).In laparoscopic CRC surgery,indocyanine green-near infrared imaging technology enhances the visualization of tumor lesions,facilitates lymph node tracing,and assesses anastomotic blood supply.In recent years,fluorescence laparoscopy has developed rapidly but remains in the exploratory stage.Minimally invasive surgical experts at home and abroad have summarized existing clinical experiences and developed a series of expert consensus guidelines for laparoscopic colorectal surgery.However,there is still no fully standardized protocol regarding indocyanine green dosage,concentration,administration method and timing,injection site,and learning curve.Therefore,further multicenter,large-scale clinical trials are needed to establish consistent guidelines,promoting the standardized and widespread application of this technology in disease diagnosis and treatment.Here,the authors introduce the development background,application progress,technical debates,and future prospects of fluorescence laparoscopy in colorectal surgery.

Objective To investigate the correlation of vertebral bone quality(VBQ)and paraspinal muscle changes with adjacent segment degeneration(ASD)after transforaminal lumbar interbody fusion(TLIF)through a retrospective analysis of patients who have undergone TLIF for lumbar degenerative diseases(LDD).Methods A total of 98 patients who underwent TLIF surgical treatment for LDD between January 2016 and December 2022 at Shenzhen People's Hospital were selected.Well-established follow-up imaging data were available for all subjects who were divided into two groups,the ASD group(n=43)and the non-ASD(N-ASD)group(n=55),according to whether they met the ASD evaluation criteria.Data on the basic characteristics of the patients in both groups were collected,and the relevant parameters,including VBQ and the total cross-sectional area(TCSA)and the functional cross-sectional area(FCSA)of psoas major(PM),erector spinae(ES),and multifidus(MF),were measured by magnetic resonance imaging of the lumbar spine performed preoperatively and at the last follow-up.Then,the relative fat infiltration(RFI)was calculated from the above metrics accordingly.Logistic regression analysis was conducted to investigate the risk factors for ASD.Results The incidence of ASD was 43.9％(n=43)at the final follow-up.The mean follow-up time was(27.23±4.15)months.The age,body mass index(BMI),preoperative bone mineral density(BMD),preoperative VBQ,△RFIPM,and△RFIES+MF showed significant differences between the ASD and N-ASD groups(P＜0.05).According to the results of the logistic regression analysis,BMI(odds ratio[OR]=1.450,95％confidence interval[CI]:1.081-1.945,P=0.013),preoperative VBQ(OR=6.191,95％CI:1.692-22.657,P=0.006),and △RFIES+MF(OR=1.117,95％CI:1.007-1.238,P=0.037)were independent risk factors for ASD.Conclusion The incidence of postoperative ASD in patients who have undergone TLIF for LDD was found to be associated with higher BMI,preoperative VBQ,and increased postoperative relative fat infiltration of the ES and MF muscles.Consequently,it is advisable to prioritize the intraoperative protection of the paraspinal muscles during TLIF.In the postoperative period,it is essential to strengthen exercises of the lower back muscles and to optimize bone mass and weight management,which is conducive to reducing the risk of ASD in the postoperative period.

Objective:To investigate the prognostic factors for all-cause mortality in patients with muscle-invasive bladder cancer(MIBC)with intermediate-to-high-risk primary prostate cancer.Methods:From January 2012 to October 2023,the clinical data of the patients with MIBC with intermediate-to-high-risk primary prostate cancer in Peking University Third Hospital were retrospectively analyzed.All the patients were monitored and the occurrence of all-cause death was documented as the outcome event in the prognostic study.Univariate and multivariate Cox proportional risk regression analysis models were implemented to search for independent influences on the prognosis of patients.For significant influencing factors(pathological T stage,M stage and perineural invasion of bladder cancer),survival curves were plotted before and after multifactorial Cox regression adjusting for confounding factors.Results:A total of 32 patients were included in this study.The mean age was(72.5±6.6)years;the median preoperative total prostate specific antigen(tPSA)was 6.68(2.47,6.84)μg/L;the mean preoperative creatinine was(95±36)μmol/L,and the median survival time was 65 months.The majority of the patients(87.5％)had high-grade bladder cancer,53.1％had lymphatic invasion,and 31.3％had perineural invasion.Prostate involvement was observed in 25.0％of the cases,and the positive rate of soft-tissue surgical margin was 37.5％.Multivariate Cox analysis revealed that preoperative creatinine level(HR=1.02,95％CI:1.01-1.04),pathological stage of bladder cancer T3(HR=11.58,95％CI:1.38-97.36)and T4(HR=19.53,95％CI:4.26-89.52)metastasis of bladder cancer(HR=9.44,95％CI:1.26-70.49)and perineural invasion of bladder cancer(HR=6.26,95％CI:1.39-28.27)were independent prognostic factors(P＜0.05).Survival curves with Log-rank test after adjusting for confounding factors demonstrated that bladder cancer pathology T3,T4,M1,and perineural invasion were unfavorable factors affecting the patients'survival prognosis(P＜0.05).Conclusion:Patients with MIBC with intermediate-to-high risk primary prostate cancer generally portends a poor prognosis.High preoperative serum creatinine,T3 or T4 pathological stage of bladder cancer,metastasis of bladder cancer and bladder cancer perineural invasion are poor prognostic factors for patients with MIBC with intermediate-to-high risk primary prostate cancer.