Objective:To investigate the effect of triglyceride-glucose(TyG) index and alkaline phosphatase(ALP) on brachial-ankle pulse wave conduction velocity(baPWV) in postmenopausal women.Methods:A cross-sectional study was conducted, enrolling 3 483 postmenopausal women who underwent health checkup at Taihu Sanatorium in Jiangsu Province from March 2020 to June 2021. The physical activity, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, triglycerides, high-density lipoprotein-cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C), ALP, and baPWV were collected.Results:Age, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, and LDL-C levels were significantly lower in the normal baPWV group( n=1 971) than those in the elevated baPWV group( n=1 512; P<0.001). Logistic regression identified the TyG index( OR=1.75) and ALP level( OR=1.20) as independent risk factors for elevated baPWV( P<0.001), besides with age, body mass index, systolic blood pressure, diastolic blood pressure, and regular exercise. Individuals with both high TyG index and elevated ALP had a 2.51-fold higher risk of elevated baPWV(95% CI 2.01-3.14). Adjusted interaction measures(including age, body mass index, systolic blood pressure, diastolic blood pressure, and regular exercise) showed RERI=2.825(95% CI 1.255-3.905), AP=0.348(95% CI 0.180-0.875), and SI=1.657(95% CI 0.628-3.374). Conclusions:The TyG index and ALP levels are independent risk factors for elevated baPWV in postmenopausal women and exhibit an additive interaction effect on arterial stiffness in this population.

Objective To discuss the method of constructing TCM word network and the subsequent optimization method;To solve the problems of natural language processing in the TCM-clinical decision support system using TCM terminology.Methods This study was based on several national standards and terminology dictionaries of TCM,such as Zhong Yi Lin Chuang Zhen Liao Shu Yu Ji Bing Part and Zhong Yi Yao Xue Zhu Ti Ci Biao,supplemented with related corpus on the Internet,and the framework of TCM word network was constructed with ontology as the guide.Word2Vec was used to load pre-trained models for similarity calculation,statistical and rule-based new word discovery,bibliometric analysis,and other methods to add or delete concept words and synonyms such as symptom terms and prescription terms.Results The TCM word network contained 55 semantic types and 13 semantic relationships,more than 110 000 concept words,and more than 300 000 synonyms.In addition to classifying concept words by semantic types,more detailed semantic classification was carried out in the upper and lower tree structures,in which more than 30 000 concept words had superordinate words,and nearly 2 600 concept words had subordinate words.At the same time,a process-based terminology supplementation mechanism,update review mechanism and cleaning mechanism were created.Conclusion TCM word network can not only be applied to the natural language processing process of TCM-clinical decision support system,but also can be applied to the normalization of data and the automatic construction of knowledge graph.

Objective To discuss the method of constructing TCM word network and the subsequent optimization method;To solve the problems of natural language processing in the TCM-clinical decision support system using TCM terminology.Methods This study was based on several national standards and terminology dictionaries of TCM,such as Zhong Yi Lin Chuang Zhen Liao Shu Yu Ji Bing Part and Zhong Yi Yao Xue Zhu Ti Ci Biao,supplemented with related corpus on the Internet,and the framework of TCM word network was constructed with ontology as the guide.Word2Vec was used to load pre-trained models for similarity calculation,statistical and rule-based new word discovery,bibliometric analysis,and other methods to add or delete concept words and synonyms such as symptom terms and prescription terms.Results The TCM word network contained 55 semantic types and 13 semantic relationships,more than 110 000 concept words,and more than 300 000 synonyms.In addition to classifying concept words by semantic types,more detailed semantic classification was carried out in the upper and lower tree structures,in which more than 30 000 concept words had superordinate words,and nearly 2 600 concept words had subordinate words.At the same time,a process-based terminology supplementation mechanism,update review mechanism and cleaning mechanism were created.Conclusion TCM word network can not only be applied to the natural language processing process of TCM-clinical decision support system,but also can be applied to the normalization of data and the automatic construction of knowledge graph.

Objective:To investigate the effect of triglyceride-glucose(TyG) index and alkaline phosphatase(ALP) on brachial-ankle pulse wave conduction velocity(baPWV) in postmenopausal women.Methods:A cross-sectional study was conducted, enrolling 3 483 postmenopausal women who underwent health checkup at Taihu Sanatorium in Jiangsu Province from March 2020 to June 2021. The physical activity, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, triglycerides, high-density lipoprotein-cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C), ALP, and baPWV were collected.Results:Age, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, and LDL-C levels were significantly lower in the normal baPWV group( n=1 971) than those in the elevated baPWV group( n=1 512; P<0.001). Logistic regression identified the TyG index( OR=1.75) and ALP level( OR=1.20) as independent risk factors for elevated baPWV( P<0.001), besides with age, body mass index, systolic blood pressure, diastolic blood pressure, and regular exercise. Individuals with both high TyG index and elevated ALP had a 2.51-fold higher risk of elevated baPWV(95% CI 2.01-3.14). Adjusted interaction measures(including age, body mass index, systolic blood pressure, diastolic blood pressure, and regular exercise) showed RERI=2.825(95% CI 1.255-3.905), AP=0.348(95% CI 0.180-0.875), and SI=1.657(95% CI 0.628-3.374). Conclusions:The TyG index and ALP levels are independent risk factors for elevated baPWV in postmenopausal women and exhibit an additive interaction effect on arterial stiffness in this population.

Outpatient information management system is an important part of hospital information system,which plays an important role in hospital management,patient treatment,medical insurance reimbursement and settlement.This study integrated the application modes of big data,cloud computing,Internet of things and other cutting-edge technologies of artificial intelligence,focused on the intelligent decision support and whole-process simplified management of the diagnosis and treatment behavior of clinical TCM physicians,and developed a cloud intelligent TCM outpatient system for primary medical care.The system has intelligent medical functions such as intelligent prescription monitoring driven by the rule engine and intelligent recommendation of traditional Chinese medicine knowledge.It seamlessly connects with the intelligent four-diagnosis instrument for information collection and medical order input,and realizes the cloud storage,computing,distribution,management,service and outpatient process,multi-directional and convenient management mode.

Objective:To investigate the feasibility and safety of endoscopic ultrasound (EUS)-guided intrahepatic portal vein puncture through jugular vein implantation in transjugular intrahepatic portosystemic shunt (TIPS).Methods:As research subjects, 5 beagle dogs were anesthetized, and EUS was placed through the jugular vein to observe the intrahepatic portal vein. Under real-time guidance, the portal vein was punctured and a stent was placed to complete the TIPS.Results:Among the 5 beagles, EUS was unable to be placed in 1 due to the small diameter of the external jugular vein, and it was implanted successfully in 4 others through the external jugular vein who underwent real-time guidance of portal vein puncture. Subsequent stent placement and balloon dilation were completed. All animals survived after the experiment.Conclusion:EUS-guided intrahepatic portal vein puncture through jugular vein implantation is safe and feasible in TIPS.

Objective:To investigate the impact of lifestyle index (LSI) on serum uric acid levels in young and middle-aged men.Methods:This was a cross sectional study. A total of 8 067 subjects underwent check-up in Taihu Sanatorium of Jiangsu Province from March 2020 to June 2021 were enrolled, average age were(46.46±8.81) years. According to age, subjects were divided into young male group (18-44 years old, n=3 269) and middle-aged male group (45-60 years old, n=4 798). Height, weight, body mass index, alcohol drinking, smoking, diet, exercise, fasting blood glucose, total cholesterol, triglycerides, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol(LDL-C), serum uric acid and other data in all cases were measured and recorded. Results:The serum uric acid level in allsubjects was (376.80±74.43)μmol/L and the prevalence of hyperuricemia was 25.7%.The serum uric acid level in the young male group was higher than that in the middle-aged male group [(381.86±74.32)μmol/L vs (373.34±74.32)μmol/L, P<0.001]. The prevalence of hyperuricemia in the young male group was higher than that in the middle-aged male group (27.4% vs 24.5%), and the difference was statistically significant ( P<0.001). With the improvement of LSI scores, the serum uric acid levels in young and middle-aged men showed a decreasing trend ( P<0.01). Logistic regression analysis showed that after adjusting for age, fasting blood glucose, total cholesterol, triglyceride, HDL-C, LDL-C, hypertension, and diabetes, LSI was an independent factor for serum uric acid levels in young and middle-aged men. The risk of hyperuricemia in young and middle-aged male decreased ( OR 0.83 and 0.84, respectively, P<0.01) for every 1-point increase in LSI. Exercise and body mass index were independently associated with hyperuricemia in the young male group ( OR 0.83 and 0.54, respectively, P<0.05). Exercise, body mass index, and alcohol drinking were independently associated with hyperuricemia in the middle-aged male group ( OR 0.85, 0.51 and 0.65, respectively, P<0.05). Conclusion:LSI is an independent factor associated with hyperuricemia in young and middle-aged men and a healthy lifestyle has a protective effect on serum uric acid levels in young and middle-aged men.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

BACKGROUND: Bronchopleural fistula (BPF) is one of the most serious and rare postoperative complications, especially the bronchial stump fistula after lobectomy/pneumonectomy. Common treatment options include conservative medical treatment combined with surgery. However, due to the delayed healing of the fistula, the chest cavity continues to communicate with the outside world, and the patient is prone to complicated with severe thoracic infection and respiratory failure, so that the physical condition can hardly tolerate the second surgical procedure. Endoscopic treatment provides a new option for the treatment of this complication. METHODS: A case of right pulmonary squamous cell carcinoma was admitted to the Department of Thoracic Surgery II, Peking University Cancer Hospital in June 2016. The diagnosis and treatment was retrospectively analyzed, and the literature was reviewed. RESULTS: A 65 year old male patient was admitted to hospital because of "cough with blood in sputum for 3 months". Chest computed tomography (CT) showed soft tissue density mass shadow in the right lower lobe. A tumor could be seen in the opening of the right middle lobe and basal segment of lower lobe. Biopsy confirmed squamous cell carcinoma. Diagnosis consideration: squamous cell carcinoma of the middle and lower lobe of the right lung (cT2aN2, IIIa). Patients received gemcitabine plus cisplatin neoadjuvant chemotherapy for 2 cycles, and the effect of chemotherapy showed stable disease (SD). Four weeks after chemotherapy, the patient underwent video-assisted thoracic surgery (VATS) assisted right middle and lower lobectomy and mediastinal lymph node dissection. On the 5th day after operation, the patient developed acute respiratory distress syndrome (ARDS) and was transferred to intensive care unit (ICU) again after endotracheal intubation. On the 7th day after operation, the patient developed a right intermediate trunk bronchial stump fistula, but due to ARDS, the patient's physical condition could not tolerate the second operation. Under the support of extracorporeal membrane oxygenation (ECMO), a membrane covered, expandable, hinged stent was inserted into the intermediate trunk bronchial stump through rigid bronchoscope, and was successfully blocked. Due to no improvement in ARDS and irreversible pulmonary interstitial fibrosis, the patient received double lung transplantation successfully after systemic anti-infection treatment. CONCLUSIONS Endoscopic implantation of covered stent is a simple, safe and effective method for closure of bronchial stump fistula. When the patient's clinical situation is not suitable for immediate surgery, endoscopic stent implantation can be used as a preferred treatment method to create opportunities for follow-up treatment.

Objective:By comparing the volume% (V% GGOs) of ground glass opacities (GGOs) in high resolution CT (HRCT) of patients with acute paraquat (PQ) poisoning at different time points, its value in the early prognosis of patients with PQ poisoning was analyzed. Methods:The data of patients with PQ poisoning admitted to Department of Respiratory and Critical Care Medicine of Chinese Armed Police Forces from June 2017 to December 2018 were prospectively analyzed. According to the follow-up results after poisoning at 90 days, the patients were divided into the survival group and death group. Three-dimensional reconstruction technology was used to calculate the change of V% GGOs on the 3rd, 5th, and 7th day after poisoning. Chi-square test and One-Way ANOVA of variance were used to compare sex, age, and time of poisoning between the two groups. The Student's t test was used to compare V% GGOs between the two groups at different time points. The receiver operating characteristic curve (ROC) was used to determine the guiding significance of the indicator on the prognosis of patients with PQ poisoning at different time points. Results:A total of 89 patients with PQ poisoning were included in the study, 49 in the survival group and 40 in the death group. There were no statistical differences between the two groups of patients in sex, age, poisoning time, oxygenation index, mean arterial pressure, total bilirubin, blood urea nitrogen, alanine aminotransferase, and aspartate aminotransferase at admission (all P>0.05). The blood PQ concentration (mg/L) in the death group was significantly higher than that in the survival group (6.35 ±0.51 vs 3.49 ±0.21, P= 0.013). On the 3rd, 5th and 7th day after admission, the V% GGOs was significantly higher than that in the survival group (3rd day: 0.062±0.020 vs 0.049±0.007, P= 0.013; 5th day: 0.292±0.130 vs 0.123±0.044, P<0.01; 7th day: 0.334±0.116 vs 0.138±0.034, P=0.019). The area under the ROC curve showed that the prognosis AUC of the 7th day V% GGOs after poisoning was 0.967, the sensitivity was 100% and the specificity was 83.33% when the threshold was 0.16, but the time point was late. On the 5th day after poisoning, the V% GGOs judged the prognosis AUC was 0.842, the sensitivity was 82.35% and the specificity was 89.47% when the threshold was 0.14. On the 3rd day after poisoning, the V% GGOs judged the prognosis AUC was 0.708, the sensitivity was 55.00% and the specificity was 78.95% when the threshold was 0.05. At this time, the sensitivity and specificity were lower than those on the 5th and 7th day. Conclusions:The proportion of ground glass opacity volume in patients with PQ poisoning can be used to evaluate their prognosis, and the best time point is the 5th day after poisoning.