ObjectiveTo investigate the clinical characteristics and risk factors of Mycoplasma pneumoniae pneumonia （MPP） in children based on a dual classification integrating imaging features and clinical severity. MethodsMedical records of 2 054 pediatric patients with MPP were retrospectively analyzed. The cohort was stratified into severe consolidation （n=253）， severe non-consolidation （n=118）， non-severe consolidation （n=393）， and non-severe non-consolidation groups （n=1 290） based on clinical and radiological findings. Inter group data and characteristics were compared and multiple regression analysis was conducted to construct a prediction model for severe consolidation group. ResultsSignificant differences were observed among the groups in terms of age， duration of fever， length of hospital stay， presence of pulmonary rales， inflammatory markers ［C-reactive protein （CRP） and lactate dehydrogenase （LDH）］， the use of hormones， and bronchoscopic treatment （all P < 0.05）. Compared with the severe non-consolidation group， non-severe consolidation group， and non-severe non-consolidation group， children in severe consolidation group exhibited the longest duration of fever ［8 （6， 11） days vs 6 （2， 9）， 7 （6， 9） and 6 （3， 8） days， respectively］ and the longest length of hospital stay ［7 （5， 8） days vs 6 （5， 8）， 6 （5， 8） and 6 （4， 7） days， respectively］. They also had the highest incidence of reduced breath sounds ［34 cases （13.4%） vs 2 cases （1.7%）， 29 cases （7.4%） and 13 cases （1.0%）， respectively］ and a substantially higher rate of coinfections， particularly viral infections ［63 cases （24.9%） vs 23 cases （19.5%）， 60 cases （15.3%） and 190 cases （14.7%）， respectively］. Multivariate analysis indicated that the independent risk factors for severe MPP （SMPP） were age > 4.5 years， length of hospital stay > 6.5 days， reduced breath sounds， neutrophil-to-lymphocyte ratio （NLR） > 1.66， LDH > 370.5 U/L， CRP > 9.5 mg/L， and coinfection with viruses. Reduced breath sounds （OR = 5.58， 95% CI： 2.45 - 12.69） and coinfection with bacteria （OR = 3.11， 95% CI： 1.43 - 6.75） were identified as the most significant risk factors for pulmonary consolidation in non-severe MPP children. Additionally， reduced breath sounds， coinfection with viruses， LDH > 365.5 U/L， and CRP > 32.1 mg/L were risk factors for severe pneumonia in children with pulmonary consolidation. For non-consolidation MPP children， the presence of pulmonary dry rales （OR = 2.28， 95% CI： 1.46 - 3.56） was the primary independent risk factor for the development of severe pneumonia. ConclusionThe chest imaging findings of MPP are associated with clinical severity， and the risk factor model constructed based on this imaging-clinical classification can assist in achieving precise hierarchical diagnosis and treatment in clinical practice.

Objective To explore the impact of number of positive regional lymph nodes (nPRLN) in N1 stage on the prognosis of non-small cell lung cancer (NSCLC) patients. Methods Patients with TxN1M0 stage NSCLC who underwent lobectomy and mediastinal lymph node dissection from 2010 to 2015 were screened from SEER database (17 Regs, 2022nov sub). The optimal cutoff value of nPRLN was determined using X-tile software, and patients were divided into 2 groups according to the cutoff value: a nPRLN≤optimal cutoff group and a nPRLN>optimal cutoff group. The influence of confounding factors was minimized by propensity score matching (PSM) at a ratio of 1 : 1. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate overall survival (OS) and lung cancer-specific survival (LCSS) of patients. Results A total of 1316 patients with TxN1M0 stage NSCLC were included, including 662 males and 654 females, with a median age of 67 (60, 73) years. The optimal cutoff value of nPRLN was 3, with 1165 patients in the nPRLN≤3 group and 151 patients in the nPRLN>3 group. After PSM, there were 138 patients in each group. Regardless of before or after PSM, OS and LCSS of patients in the nPRLN≤3 group were superior to those in the nPRLN>3 group (P<0.001). N1 stage nPRLN>3 was an independent prognostic risk factor for OS [HR=1.52, 95%CI (1.22, 1.89), P<0.001] and LCSS [HR=1.72, 95%CI (1.36, 2.18), P<0.001]. Conclusion N1 stage nPRLN>3 is an independent prognostic risk factor for NSCLC patients in TxN1M0 stage, which may provide new evidence for future revision of TNM staging N1 stage subclassification.

Objective To investigate the mechanism by which AGE receptor(RAGE)antagonist FPS-ZM1 inhibits AGE accumulation and promotes wound repair in rats with diabetic foot ulcer(DFU).Methods A total of 30 SD rats were divided into normal control(Con)group,sham operation group(Sham),DFU group,FPS-ZM1 treatment group(DFU+FPS-ZM1),and phosphate buffer saline treatment group(DFU+PBS),with 6 rats in each group.Masson staining was used to evaluate the wound surface structure.ELISA was used to detect the expression of AGE,TNF-α,matrix metalloproteinase 9(MMP-9),and VEGF proteins in serum and tissues,and Western blot method was used to test the expression of RAGE,VEGF receptor(VEGFR),CD31,and nuclear factor κB(NF-κB)proteins.Results Compared with the Con and Sham groups,the collagen fibers had less indigo staining,disordered arrangement and sparse distribution in DFU group.Compared with the DFU and DFU+PBS groups,the DFU+FPS-ZM1 group showed obvious blue staining of collagen fibers in the wound granulation tissue,and the number of deposition layers was relatively neat and orderly.Compared with Sham group,the expressions of AGE,TNF-α and MMP-9 proteins,NF-κB and RAGE proteins in serum and tissues were increased(P<0.05),and the expressions of VEGF protein and CD31 and VEGFR proteins in serum and tissues were decreased in DFU group(P<0.05).Compared with DFU group,the expressions of AGE,TNF-α and MMP-9 proteins,NF-κB and RAGE proteins in serum and tissues decreased(P<0.05),and the expression of VEGF protein and CD31 and VEGFR proteins in serum and tissues increased in DFU+FPS-ZM1 group(P<0.05).Compared with DFU+FPS-ZM1 group,the expressions of AGE,TNF-α and MMP-9 proteins,NF-κB and RAGE proteins in serum and tissues increased(P<0.05),and the expressions of VEGF protein,CD31 and VEGFR proteins in serum tissues decreased in DFU+PBS group(P<0.05).Conclusions The RAGE antagonist FPS-ZM1 down-regulates MMP-9 and up-regulates VEGF by inhibiting the NF-κB inflammatory signaling pathway,and promotes DFU wound healing.

This article reports the diagnosis and treatment process of a case with secondary infective femoral artery pseudoaneurysm after intervention surgery for cerebral infarction,who improved after anti-infection and surgical treatment and was discharged.The patient was a 52-year-old female who underwent percutaneous balloon dilatation of basilar artery due to basilar artery stenosis.After surgery,she developed secondary methicillin-resistant Staphy-lococcus aureus(MRSA)bloodstream infection and infective femoral artery pseudoaneurysm.After treatment with vancomycin and linezolid,femoral artery pseudoaneurysm resection,and autovascular replacement,the patient re-covered well after the surgery and discharged from hospital.CT angiography(CTA)re-examination showed artifi-cial blood vessel patency.This study is expected to provide experience for the diagnosis and treatment of such pa-tients in clinical work.

Objective To establish an individualized nomogram model and evaluate its efficacy to provide a possible evaluation basis for the prognosis of lower third and abdominal part of oesophageal adenocarcinoma (EAC). Methods Lower third and abdominal part of EAC patients from 2010 to 2015 were chosen from the SEER Research Plus Database (17 Regs, 2022nov sub). The patients were randomly allocated to the training cohort and the internal validation cohort with a ratio of 7∶3 using bootstrap resampling. The Cox proportional hazards regression analysis was used to determine significant contributors to overall survival (OS) in EAC patients, which would be elected to construct the nomogram prediction model. C-index, calibration curve and receiver operating characteristic (ROC) curve were performed to evaluate its efficacy. Finally, the efficacy to evaluate the OS of EAC patients was compared between the nomogram prediction model and TNM staging system. Results In total, 3945 patients with lower third and abdominal part of EAC were enrolled, including 3475 males and 470 females with a median age of 65 (57-72) years. The 2761 patients were allocated to the training cohort and the remaining 1184 patients to the internal validation cohort. In the training and the internal validation cohorts, the C-index of the nomogram model was 0.705 and 0.713, respectively. Meanwhile, the calibration curve also suggested that the nomogram model had a strong capability of predicting 1-, 3-, and 5-year OS rates of EAC patients. The nomogram also had a higher efficacy than the TNM staging system in predicting 1-, 3-, and 5-year OS rates of EAC patients. Conclusion This nomogram prediction model has a high efficiency for predicting OS in the patients with lower third and abdominal part of EAC, which is higher than that of the current TNM staging system.

Objective To evaluate the value of postoperative radiotherapy (PORT) in patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy. Methods Patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy were chosen from the SEER Research Plus Database [17 Registries, November 2012 Submission (2000-2019)]. The patients were divided into a PORT group and a non-PORT group according to whether the PORT was used. To balance baseline characteristics between non-PORT and PORT groups, R software was used to conduct a propensity score matching (PSM) with a ratio of 1 : 1 and a matching tolerance of 0.01. Both the Cox regression analysis and Kaplan-Meier survival analysis were conducted to evaluate the value of PORT in terms of overall survival (OS) and disease-specific survival (DSS). Results In total, 2468 patients with stage ⅢA-N2 non-small cell lung cancer were enrolled, including 1078 males and 1390 females with a median age of 65 (58-71) years. There were 1336 patients in the PORT group, and 1132 patients in the non-PORT group. Cox regression analysis showed that PORT was not significantly associated with OS (multivariate analysis: HR=1.051, 95%CI 0.949-1.164, P=0.338) and DSS (multivariate analysis: HR=1.094, 95%CI 0.976-1.225, P=0.123). No statistical difference was found in the OS or DSS between non-PORT group and PORT group after PSM analysis (P＞0.05). Conclusion PORT does not have a survival benefit for patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy.

Objective:To explore and practice the construction of an innovative ecosystem that integrates innovation in the National Clinical Research Center for Orthopedics and Sports Rehabilitation, providing references and insights for driving high-quality development of medical care.Methods:Guided by a national policy framework and Industry-Academia-Research-Government-Enterprise Collaborative Innovation, the Center had established six innovation platforms and three systemic pillars. The study analyzed its integrated strategy, which encompassed ecosystem design, platform-enabled empowerment, comprehensive system support, end-to-end coverage, a folded innovation approach, and a standardization-driven mechanism.Results:The Center had built a highly integrated innovation ecosystem, creating a powerful driver for technological advancement and commercialization in orthopedics and sports rehabilitation, accelerating the industrialization of key technologies like surgical robots and 3D-printed implants.Conclusions:Guided by the principle of ″simplifying complex surgeries and standardizing common procedures″, the Center will leverage digital intelligence throughout clinical care, aiming to bridge gaps in healthcare quality so that patients can receive top-tier treatment for major diseases within their home provinces. This commitment to homogenized, high-quality care presents a ″China Model″ for global health and advance the national ″Healthy China″ initiative.

Objective To construct a high-precision statistical shape model of the humerus and systematically describe its anatomical variation patterns.Methods In this study,a statistical shape model of the humerus was constructed using the three-dimensional model data of 60 collected humerus cases.The principal component analysis method was adopted to reveal the main patterns of humerus anatomical variations and their contribution rates.Results The results showed that the first five principal components(PC01-PC05)collectively explained 96.6%of the total anatomical variations.Among them,PC01 and PC02 were the main components,contributing 66.6%and 23.5%of the variations respectively.PC01 mainly reflects the scaling effect of the overall size(length/width)of the humerus,while PC02 reveals the length variation characteristics independent of the overall scaling,which may reflect individualized differences.The subsequent principal components(PC03-PC05)depicted the local morphological characteristics and fine changes of the proximal and distal humerus.Conclusion The statistical shape model constructed in this study provides a reliable digital basis for personalized prosthesis design,surgical planning and biomechanical simulation.

Objective To construct a high-precision statistical shape model of the humerus and systematically describe its anatomical variation patterns.Methods In this study,a statistical shape model of the humerus was constructed using the three-dimensional model data of 60 collected humerus cases.The principal component analysis method was adopted to reveal the main patterns of humerus anatomical variations and their contribution rates.Results The results showed that the first five principal components(PC01-PC05)collectively explained 96.6%of the total anatomical variations.Among them,PC01 and PC02 were the main components,contributing 66.6%and 23.5%of the variations respectively.PC01 mainly reflects the scaling effect of the overall size(length/width)of the humerus,while PC02 reveals the length variation characteristics independent of the overall scaling,which may reflect individualized differences.The subsequent principal components(PC03-PC05)depicted the local morphological characteristics and fine changes of the proximal and distal humerus.Conclusion The statistical shape model constructed in this study provides a reliable digital basis for personalized prosthesis design,surgical planning and biomechanical simulation.

This article reports the diagnosis and treatment process of a case with secondary infective femoral artery pseudoaneurysm after intervention surgery for cerebral infarction,who improved after anti-infection and surgical treatment and was discharged.The patient was a 52-year-old female who underwent percutaneous balloon dilatation of basilar artery due to basilar artery stenosis.After surgery,she developed secondary methicillin-resistant Staphy-lococcus aureus(MRSA)bloodstream infection and infective femoral artery pseudoaneurysm.After treatment with vancomycin and linezolid,femoral artery pseudoaneurysm resection,and autovascular replacement,the patient re-covered well after the surgery and discharged from hospital.CT angiography(CTA)re-examination showed artifi-cial blood vessel patency.This study is expected to provide experience for the diagnosis and treatment of such pa-tients in clinical work.