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Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Background:With the development of endoscopic techniques,the incidence of rectal neuroendocrine neoplasms(R-NEN)is increasing year by year,and its atypical symptoms and risk of metastasis make early and accurate localization of its primary site essential for its diagnosis and treatment.Aims:To explore the endoscopic ultrasonographic manifestations of R-NEN,compare the consistency between endoscopic ultrasonography(EUS)and pathological diagnosis,and analyze the reasons for these differences.Methods:Patients with pathologically confirmed R-NEN from January 2016 to December 2023 at Renmin Hospital of Wuhan University were recruited retrospectively in this study.The clinical characteristics and the microscopic manifestations of the lesions were analyzed,the diagnostic ability of EUS and postoperative pathology on the infiltration depth of the lesions were compared,and the factors affecting the diagnostic accuracy of EUS were analyzed.Results:A total of 127 patients with R-NEN were included in this study,54.3%(69/127)were male patients,with an average age of(51.00±12.30)years old.Most of the lesions seen microscopically were smooth spherical or hemispherical elevations located in the mucosal-submucosal layer of the rectum,with an average size of(0.77±0.62)cm,and a distance of(6.58±2.51)cm from the anal verge.The diagnostic compliance rate of EUS for lesions involving the submucosa was 98.3%(116/118),and the diagnostic accuracy for the intrinsic muscular layer and above was 55.6%(5/9).The difference of Kappa's consistency test between the two was statistically significant(P<0.05).The diagnostic accuracy of EUS for lesions of 10-20 mm(OR=5.068,95%CI:1.34-19.12,P=0.017)was acceptable,whereas lesions located in the upper rectum(OR=0.05,95%CI:0.01-0.75,P=0.031)and involving to the intrinsic muscular layer of the intestinal wall and above(OR=0.05,95%CI:0.01-0.59,P=0.017)could negatively affect its diagnostic accuracy.Conclusions:EUS has a high localization accuracy for R-NEN lesions,and can be used as a key method for the initial diagnosis of suspected R-NEN.For lesions located in the upper rectum and with deeper infiltration levels,a more standardized operation with more detailed analysis are recommended.

Background:With the development of endoscopic techniques,the incidence of rectal neuroendocrine neoplasms(R-NEN)is increasing year by year,and its atypical symptoms and risk of metastasis make early and accurate localization of its primary site essential for its diagnosis and treatment.Aims:To explore the endoscopic ultrasonographic manifestations of R-NEN,compare the consistency between endoscopic ultrasonography(EUS)and pathological diagnosis,and analyze the reasons for these differences.Methods:Patients with pathologically confirmed R-NEN from January 2016 to December 2023 at Renmin Hospital of Wuhan University were recruited retrospectively in this study.The clinical characteristics and the microscopic manifestations of the lesions were analyzed,the diagnostic ability of EUS and postoperative pathology on the infiltration depth of the lesions were compared,and the factors affecting the diagnostic accuracy of EUS were analyzed.Results:A total of 127 patients with R-NEN were included in this study,54.3%(69/127)were male patients,with an average age of(51.00±12.30)years old.Most of the lesions seen microscopically were smooth spherical or hemispherical elevations located in the mucosal-submucosal layer of the rectum,with an average size of(0.77±0.62)cm,and a distance of(6.58±2.51)cm from the anal verge.The diagnostic compliance rate of EUS for lesions involving the submucosa was 98.3%(116/118),and the diagnostic accuracy for the intrinsic muscular layer and above was 55.6%(5/9).The difference of Kappa's consistency test between the two was statistically significant(P<0.05).The diagnostic accuracy of EUS for lesions of 10-20 mm(OR=5.068,95%CI:1.34-19.12,P=0.017)was acceptable,whereas lesions located in the upper rectum(OR=0.05,95%CI:0.01-0.75,P=0.031)and involving to the intrinsic muscular layer of the intestinal wall and above(OR=0.05,95%CI:0.01-0.59,P=0.017)could negatively affect its diagnostic accuracy.Conclusions:EUS has a high localization accuracy for R-NEN lesions,and can be used as a key method for the initial diagnosis of suspected R-NEN.For lesions located in the upper rectum and with deeper infiltration levels,a more standardized operation with more detailed analysis are recommended.

Background: The terminology of nonalcoholic fatty liver disease (NAFLD) was changed to metabolic dysfunction ⁃ associated fatty liver disease (MAFLD) in 2020. NAFLD has been confirmed to be a risk factor for colorectal neoplasms, but the association between MAFLD and colorectal neoplasms is conflicting. Aims: To investigate the correlation of MAFLD with colorectal adenoma and early colorectal cancer. Methods: The clinical information of 701 patients who met the criteria and were admitted to Renmin Hospital of Wuhan University from January 2021 to August 2021 was collected retrospectively. Among them, 274 colorectal adenoma patients with low ⁃ grade intraepithelial neoplasia or without intraepithelial neoplasia were classified as adenoma group, 21 patients with high ⁃ grade intraepithelial neoplasia, intramucosal carcinoma, and submucosal carcinoma were classified as early cancer group, and 406 patients with normal colonoscopy or non⁃adenomatous polyps were served as control group. The general information and prevalence of MAFLD between these groups were compared. Furthermore, the correlation of MAFLD with colorectal adenoma and early colorectal cancer, and the gender difference of these correlations were analyzed by Logistic regression models. Subgroup analysis was performed based on the clinicopathological characteristics of colorectal adenoma. Results: When adjusting the confounding variables including gender, age, smoking, alcohol drinking, diabetes, hypertension, and serum creatinine, MAFLD was significantly associated with the prevalence of colorectal adenoma (OR=1.83, 95% CI: 1.04 ⁃ 3.22, P=0.037) and early colorectal cancer (OR=3.91, 95% CI: 1.14⁃13.42, P=0.031). When stratified as gender, the significant association remained in females (OR=4.04, 95% CI: 1.56 ⁃ 10.47, P=0.004), but not in males. In addition, no correlation was found between MAFLD and the location, size, number, and advanced histology of colorectal adenoma (all P>0.05). Conclusions: MAFLD is an independent risk factor for colorectal adenoma and early colorectal cancer. MAFLD is specifically associated with increased risk of colorectal adenoma in females but not in males.

Objective:To investigate the clinical characteristics and prognosis of acute myeloid leukemia (AML) patients with positive TLS-ERG fusion gene.Methods:The clinical data of 9 AML patients with positive TLS-ERG fusion gene in the First Hospital of Jilin University from June 2013 to August 2020 were retrospectively analyzed, and the relevant literature was reviewed.Results:Among 9 patients with positive TLS-ERG fusion gene, there were 5 males and 4 females, with a median age of 16 years old (6-40 years old). Five patients received chemotherapy alone, 3 patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT), and 1 patient did not receive systematic treatment. Among 8 patients with systematic treatment, 1 patient had complete remission after the first induction chemotherapy and 5 patients had complete remission after induction therapy. The median overall survival time of 5 patients with chemotherapy alone was 1.5 months (1-11 months), of which 3 patients did not respond to the first course of treatment and died of infection, and 2 patients died after relapse. The median overall survival time of 3 patients with allo-HSCT was 16 months (13-17 months), of which 2 patients died after relapse and 1 patient had sustained molecular complete remission by the end of follow-up.Conclusions:AML with positive TLS-ERG fusion gene has low incidence rate and poor induction efficacy. Hematopoietic stem cell transplantation may partially improve the survival prognosis of patients, but it cannot overcome the adverse effect of positive TLS-ERG fusion gene on prognosis.

As an important branch of artificial intelligence, machine learning is widely used in various fields. Machine learning has similarity to classical statistical methods, but can solve many problems which are difficult for traditional statistics, so it is one of the important tools in epidemiological research. This paper introduced 9 common algorithms of machine learning and summarized their characteristics and applications in epidemiological research. Readers could choose appropriate machine learning method according to the research purpose for the better application of machine learning in epidemiological research.

Objective:To evaluate the prognostic value of plasma microRNA-30b-5p (miR-30b-5p) combined with extravascular lung water index (EVLWI) in patients with acute respiratory distress syndrome (ARDS).Methods:120 ARDS patients admitted to Danzhou People's Hospital from January 2016 to June 2019 were enrolled. The gender, age, body mass index (BMI), underlying diseases, etiology and baseline values of heart rate (HR), respiratory rate (RR), oxygenation index (OI), arterial partial pressure of carbon dioxide (PaCO 2) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were collected. According to the survival outcome during hospitalization, the patients were divided into survival group and death group. According to OI, the patients were divided into mild-moderate group (OI > 100 mmHg, 1 mmHg = 0.133 kPa) and severe group (OI ≤ 100 mmHg). The expression of plasma miR-30b-5p was detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR), and EVLWI was measured. The receiver operating characteristic (ROC) curve was drawn to analyze the value of plasma miR-30b-5p and EVLWI in predicting the death of patients with ARDS. Pearson correlation method was used to analyze the correlation between miR-30b-5p and EVLWI in ARDS patients with different prognosis during hospitalization. Results:120 patients with ARDS were enrolled in the analysis, with 42 patients in the death group, and 78 in the survival group; with 67 patients in the mild-moderate group, and 53 in the severe group. APACHE Ⅱ score in the death group was higher than that in the survival group, but there was no significant difference in gender, age, BMI, underlying diseases, etiology or baseline values of HR, RR, OI, or PaCO 2 between the two groups. The expression of plasma miR-30b-5p and EVLWI level in the death group were significantly higher than those in the survival group [miR-30b-5p (2 -ΔΔCt): 2.28±0.74 vs. 0.52±0.06, EVLWI (mL/kg): 15.38±4.60 vs. 10.24±2.15, both P < 0.01]. The expression of plasma miR-30b-5p, EVLWI and mortality during hospitalization in the severe group were significantly higher than those in the mild-moderate group [miR-30b-5p (2 -ΔΔCt): 2.05±0.65 vs. 0.93±0.17, EVLWI (mL/kg): 14.65±4.20 vs. 11.36±2.28, mortality during hospitalization: 58.5% (31/53) vs. 16.4% (11/67), all P < 0.01]. ROC curve analysis showed that the best cut-off value of plasma miR-30b-5p and EVLWI in predicting the death during hospitalization of ARDS patients were 1.62 and 13.28 mL/kg, respectively. Moreover, the area under ROC curve (AUC) of the combination of two parameters was significantly higher than that of the two alone (0.897 vs. 0.827, 0.785), with high sensitivity and specificity, 90.5% and 84.2%, respectively. Pearson correlation analysis showed that plasma miR-30b-5p in dead ARDS patients was significantly positively correlated with EVLWI ( r = 0.768, P < 0.01), but the correlation was not found in surviving patients ( r = 0.118, P > 0.05). Conclusion:The expression of plasma miR-30b-5p and EVLWI are related to the severity and prognosis of patients with ARDS, and the combination of the two has certain evaluation value for the prognosis of ARDS patients.

In prospective cohort study, multi follow up is often necessary for study subjects, and the observed values are correlated with each other, usually resulting in time-dependent confounding. In this case, the data generally do not meet the application conditions of traditional multivariate regression analysis. Sequential conditional mean model (SCMM) is a new approach that can deal with time-dependent confounding. This paper mainly summarizes the basic theory, steps and characteristics of SCMM.