BACKGROUND: Postoperative pulmonary complications (PPCs) are major adverse events in neurosurgical patients. This study aimed to develop and validate machine learning models predicting PPCs after neurosurgery. METHODS: PPCs were defined according to the European Perioperative Clinical Outcome standards as occurring within 7 postoperative days. Data of cases meeting inclusion/exclusion criteria were extracted from the anesthesia information management system to create three datasets: The development (data of Huashan Hospital, Fudan University from 2018 to 2020), temporal validation (data of Huashan Hospital, Fudan University in 2021) and external validation (data of other three hospitals in 2023) datasets. Machine learning models of six algorithms were trained using either 35 retrievable and plausible features or the 11 features selected by Lasso regression. Temporal validation was conducted for all models and the 11-feature models were also externally validated. Independent risk factors were identified and feature importance in top models was analyzed. RESULTS: PPCs occurred in 712 of 7533 (9.5%), 258 of 2824 (9.1%), and 207 of 2300 (9.0%) patients in the development, temporal validation and external validation datasets, respectively. During cross-validation training, all models except Bayes demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.840. In temporal validation of full-feature models, deep neural network (DNN) performed the best with an AUC of 0.835 (95% confidence interval [CI]: 0.805-0.858) and a Brier score of 0.069, followed by Logistic regression (LR), random forest and XGBoost. The 11-feature models performed comparable to full-feature models with very close but statistically significantly lower AUCs, with the top models of DNN and LR in temporal and external validations. An 11-feature nomogram was drawn based on the LR algorithm and it outperformed the minimally modified Assess respiratory RIsk in Surgical patients in CATalonia (ARISCAT) and Laparoscopic Surgery Video Educational Guidelines (LAS VEGAS) scores with a higher AUC (LR: 0.824, ARISCAT: 0.672, LAS: 0.663). Independent risk factors based on multivariate LR mostly overlapped with Lasso-selected features, but lacked consistency with the important features using the Shapley additive explanation (SHAP) method of the LR model. CONCLUSIONS: The developed models, especially the DNN model and the nomogram, had good discrimination and calibration, and could be used for predicting PPCs in neurosurgical patients. The establishment of machine learning models and the ascertainment of risk factors might assist clinical decision support for improving surgical outcomes. TRIAL REGISTRATION ChiCTR 2100047474; https://www.chictr.org.cn/showproj.html?proj=128279 .
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Algorithms ; Lung Diseases/etiology* ; Machine Learning ; Neurosurgical Procedures/adverse effects* ; Postoperative Complications/diagnosis* ; Risk Factors ; ROC Curve

Objective To compare the colonoscopy results of patients with positive fecal SDC2,ADHFE1,and PPP2R5C gene methylation tests to those with positive fecal occult blood tests,and analyze the effectiveness of colorectal cancer(CRC)screening.This study aims to provide a scientific basis for risk assessment in CRC screening.Methods From December 2023 to May 2024,9 284 combined test kits for SDC2,ADHFE1,and PPP2R5C gene methylation were distributed to high-risk individuals aged 40～80 years.Among them,841 patients(9.1％)tested positive.These patients were encouraged via telephone to undergo colonoscopy,with colonoscopy combined with pathological diagnosis as the gold standard,a total of 495 positive patients completed electronic colonoscopy.Among them,the 251 patients who tested positive for fecal SDC2,ADHFE1,and PPP2R5C gene methylation and completed electronic colonoscopy were the observation group;concurrently,244 patients who tested positive for fecal occult blood tests and underwent electronic colonoscopy were selected as the control group.Compare two groups of patients with polyp,number,shape,pathological changes and pathological types.Results There was no statistically significant difference in number and lesion location of polyps between the two groups of patients(P>0.05).The proportion of Yamada type Ⅰ in the observation group was lower than that in the control group,while the proportion of Yamada type Ⅱ was higher than that in the control group.The difference was statistically significant(P<0.05).In the observation group,1 case(0.4％)of CRC,62 cases(24.7％)of advanced adenomas,78 cases(31.1％)of non-advanced adenomas,20 cases(8.0％)of hyperplastic polyps,and 90 cases(35.9％)with no dysplastic lesions were identified.In the control group,6 cases(2.5％)of CRC,38 cases(15.6％)of advanced adenomas,53 cases(21.7％)of non-advanced adenomas,19 cases(7.8％)of hyperplastic polyps,and 128 cases(52.5％)with no dysplastic lesions were identified.The proportions of non-advanced adenomas and advanced adenomas were lower in the control group than those in the observation group,while the no dysplastic lesions rate was higher in the control group,the differences were statistically significant(P<0.05).Conclusion The detection rate of colorectal non-advanced adenomas and advanced adenomas is higher with fecal SDC2,ADHFE1,and PPP2R5C gene methylation testing compared to the fecal occult blood test.

Objective To study the clinical features,management,and outcomes of benign lesions of the vocal folds in children.Methods A retrospective study was conducted on 686 children diagnosed with benign lesions of vocal folds from 2010 to 2021.The clinical features were analyzed.One hundred children with follow-up records were divided in-to conservative observation group(66 cases)and surgical treatment group(34 cases),and the outcomes was analyzed.Results A total of 455(66.3％)children with benign lesions of vocal folds were boys,and most children(249 cases,36.3％)were within the age group of 6～10 years old.Vocal fold polyps were the most common cases(451 cases,65.7％).The long-term effective rates of the conservative observation and the surgery groups were 63.6％and 79.4％,respectively.The recurrence rate of vocal fold polyps was 31.8％in children aged 3 to 10 years.All the children with vocal fold cyst failed to respond to conservative treatment.Conclusion Benign lesions in children are more common in boys and those aged 6～10 years old,and vocal fold polyps being the most common lesions.Conservative observation is preferred when children with vocal fold polyps are under six years old,and surgical treatment is considered when they are aged 10 and above.Surgery is recommended for children with vocal fold cysts.

At the beginning of the 20 th century, Karl Landsteiner discovered the ABO blood group system, which is one of the most important blood good systems in clinical practice. ABO blood group antigens are widely present not only on red blood cells but also in various other tissues, making the association between this blood group system and cancers particularly significant. Numerous studies, both domestically and internationally, have explored the relationship between ABO blood group and cancer susceptibility. Therefore, this paper primarily reviews the research on the association between ABO blood group and susceptibility to lung cancer, gastric cancer, and pancreatic cancer, providing references for clinical practice.

With the acceleration of population aging, issues such as multimorbidity, functional decline, and insufficient social support among elderly patients have become increasingly prominent.The traditional single-disease-centered medical model can no longer meet their complex health needs.This paper proposes a novel model of geriatric multidisciplinary service with goal-oriented care (GOC) as the core concept, comprehensive geriatric assessment (CGA) as the transformational hub, and geriatric interdisciplinary team (GIT) as the practical vehicle.Through hierarchical GOC setting, interdisciplinary resource integration, and dynamic goal regulation, it promotes a shift in healthcare paradigm from disease-centered treatment to function maintenance and quality of life improvement.However, the widespread clinical adoption of this model still faces multiple challenges, including lagging medical insurance payment policies, insufficient integration of health data, and a shortage of interdisciplinary compound talents.Future efforts should focus on policy innovation, technological empowerment, and talent cultivation to optimize the geriatric care service system, thereby providing a scientific and sustainable practical pathway towards healthy aging.

Objective To compare the colonoscopy results of patients with positive fecal SDC2,ADHFE1,and PPP2R5C gene methylation tests to those with positive fecal occult blood tests,and analyze the effectiveness of colorectal cancer(CRC)screening.This study aims to provide a scientific basis for risk assessment in CRC screening.Methods From December 2023 to May 2024,9 284 combined test kits for SDC2,ADHFE1,and PPP2R5C gene methylation were distributed to high-risk individuals aged 40～80 years.Among them,841 patients(9.1％)tested positive.These patients were encouraged via telephone to undergo colonoscopy,with colonoscopy combined with pathological diagnosis as the gold standard,a total of 495 positive patients completed electronic colonoscopy.Among them,the 251 patients who tested positive for fecal SDC2,ADHFE1,and PPP2R5C gene methylation and completed electronic colonoscopy were the observation group;concurrently,244 patients who tested positive for fecal occult blood tests and underwent electronic colonoscopy were selected as the control group.Compare two groups of patients with polyp,number,shape,pathological changes and pathological types.Results There was no statistically significant difference in number and lesion location of polyps between the two groups of patients(P>0.05).The proportion of Yamada type Ⅰ in the observation group was lower than that in the control group,while the proportion of Yamada type Ⅱ was higher than that in the control group.The difference was statistically significant(P<0.05).In the observation group,1 case(0.4％)of CRC,62 cases(24.7％)of advanced adenomas,78 cases(31.1％)of non-advanced adenomas,20 cases(8.0％)of hyperplastic polyps,and 90 cases(35.9％)with no dysplastic lesions were identified.In the control group,6 cases(2.5％)of CRC,38 cases(15.6％)of advanced adenomas,53 cases(21.7％)of non-advanced adenomas,19 cases(7.8％)of hyperplastic polyps,and 128 cases(52.5％)with no dysplastic lesions were identified.The proportions of non-advanced adenomas and advanced adenomas were lower in the control group than those in the observation group,while the no dysplastic lesions rate was higher in the control group,the differences were statistically significant(P<0.05).Conclusion The detection rate of colorectal non-advanced adenomas and advanced adenomas is higher with fecal SDC2,ADHFE1,and PPP2R5C gene methylation testing compared to the fecal occult blood test.

With the acceleration of population aging, issues such as multimorbidity, functional decline, and insufficient social support among elderly patients have become increasingly prominent.The traditional single-disease-centered medical model can no longer meet their complex health needs.This paper proposes a novel model of geriatric multidisciplinary service with goal-oriented care (GOC) as the core concept, comprehensive geriatric assessment (CGA) as the transformational hub, and geriatric interdisciplinary team (GIT) as the practical vehicle.Through hierarchical GOC setting, interdisciplinary resource integration, and dynamic goal regulation, it promotes a shift in healthcare paradigm from disease-centered treatment to function maintenance and quality of life improvement.However, the widespread clinical adoption of this model still faces multiple challenges, including lagging medical insurance payment policies, insufficient integration of health data, and a shortage of interdisciplinary compound talents.Future efforts should focus on policy innovation, technological empowerment, and talent cultivation to optimize the geriatric care service system, thereby providing a scientific and sustainable practical pathway towards healthy aging.

At the beginning of the 20 th century, Karl Landsteiner discovered the ABO blood group system, which is one of the most important blood good systems in clinical practice. ABO blood group antigens are widely present not only on red blood cells but also in various other tissues, making the association between this blood group system and cancers particularly significant. Numerous studies, both domestically and internationally, have explored the relationship between ABO blood group and cancer susceptibility. Therefore, this paper primarily reviews the research on the association between ABO blood group and susceptibility to lung cancer, gastric cancer, and pancreatic cancer, providing references for clinical practice.

Objective To study the clinical features,management,and outcomes of benign lesions of the vocal folds in children.Methods A retrospective study was conducted on 686 children diagnosed with benign lesions of vocal folds from 2010 to 2021.The clinical features were analyzed.One hundred children with follow-up records were divided in-to conservative observation group(66 cases)and surgical treatment group(34 cases),and the outcomes was analyzed.Results A total of 455(66.3％)children with benign lesions of vocal folds were boys,and most children(249 cases,36.3％)were within the age group of 6～10 years old.Vocal fold polyps were the most common cases(451 cases,65.7％).The long-term effective rates of the conservative observation and the surgery groups were 63.6％and 79.4％,respectively.The recurrence rate of vocal fold polyps was 31.8％in children aged 3 to 10 years.All the children with vocal fold cyst failed to respond to conservative treatment.Conclusion Benign lesions in children are more common in boys and those aged 6～10 years old,and vocal fold polyps being the most common lesions.Conservative observation is preferred when children with vocal fold polyps are under six years old,and surgical treatment is considered when they are aged 10 and above.Surgery is recommended for children with vocal fold cysts.

Objective:To explore the relationship between ultrasound characteristics and invasiveness in the follicular variant of papillary thyroid carcinoma (FVPTC), and to integrate multiple ultrasound parameters for visual assessment of predictive outcomes by using Nomogram.Methods:A total of 312 FVPTC patients who were pathologically confirmed through surgery in Zhejiang Cancer Hospital and Zhejiang Provincial People′s Hospital from January 2013 to December 2023 were retrospectively collected.Based on defined criteria, FVPTC patients were categorized into high-invasion and low-invasion groups. The dataset was divided into a training set and a validation set in a ratio of 7 to 3. Clinical information and ultrasound feature parameters were collected. Univariate and multivariate Logistic regression analyses were performed on the training set. A predictive model for FVPTC invasiveness was constructed based on ultrasound features. The model′s discriminative ability and calibration were evaluated in the validation set, and a nomogram was generated.Results:The training set included a total of 218 patients with FVPTC, among which 131 were classified as high invasive.The validation set consisted of 94 patients, with 53 cases of high invasive FVPTC patients. Multivariate logistic regression analysis on the training set revealed that tumor multifocality ( OR=6.505, P=0.016), hypoechoic ( OR=3.235, P=0.103), shape ( OR=0.521, P=0.049), and microcalcifications ( OR=2.479, P=0.004) were independent influencing factors for predicting invasiveness in FVPTC. In the training set, the area under the curve (AUC) of the ultrasound predictive model was 0.704 (95% CI=0.634-0.771), and in the validation set, the AUC was 0.650 (95% CI=0.531-0.770), indicated good discriminative ability.The calibration curve showed good alignment with the ideal curve, demonstrating favorable calibration performance. Conclusions:Ultrasound features provide valuable information for assessing the invasiveness of FVPTC, and the model constructed by combining ultrasound features demonstrates good predictive efficacy for the invasiveness of FVPTC.