Objective To use a physics-informed neural network(PINN)-based model to predict hemodynamics in intracranial aneurysms and address the problems of long simulation time and high computational cost in traditional computational fluid dynamics(CFD)simulations.Methods The PINN model was trained using only the computational domain coordinates and sparse velocity measurement points from CFD data of clinical patients.The predicted blood flow velocity,pressure,and wall shear stress(WSS)from the PINN model were compared with CFD simulation results.Results The proposed method was used to test and validate data from four different patients.For velocity prediction,the average mean absolute error(MAE),average mean relative error(MRE),average mean squared error(MSE)was 4.60％,6.61％,and 0.229％,respectively.For WSS prediction,the average MAE,MRE and MSE was 5.54％,8.58％,and 0.510％,respectively.The PINN model demonstrated a good generalization capability across different aneurysm models and could reduce the computation time of hemodynamics from several hours to just a few seconds.Conclusions The PINN model can effectively compensate for incomplete measurement data through physical constraints,even when boundary conditions are unknown and measurement data are sparse.It can rapidly and accurately simulate the hemodynamics of intracranial aneurysms.This method has the potential to provide effective support for clinical risk prediction in intracranial aneurysms.

Objective:To examine the prevalence of malnutrition and evaluate the impact of nutritional support on clinical outcomes in elderly patients diagnosed with gastric and colorectal cancer.Methods:A retrospective cohort study was conducted, analyzing elderly patients with gastrointestinal tumors who underwent surgical treatment in the general surgery department from January 2019 to June 2020.The Global Leadership Initiative on Malnutrition(GLIM)criteria were utilized to diagnose malnutrition, and the effects of malnutrition and nutritional support on clinical prognosis were investigated.Results:A total of 426 elderly hospitalized patients with gastric and colorectal tumors who underwent surgical treatment were included in this study.This cohort comprised 199 cases of gastric cancer and 227 cases of colorectal cancer, with ages ranging from 65 to 91 years(mean age: 72.05±5.99).According to the GLIM criteria, 43.7%(186/426)of the patients were diagnosed with malnutrition, of which 25.6%(109/426)were moderately malnourished and 18.1%(77/426)were severely malnourished.Among the gastric cancer patients, 73.4%(146/199)were identified as having nutritional risk, with 48.7%(97/199)being malnourished and 22.6%(45/199)experiencing severe malnutrition.In the colorectal cancer group, 63.9%(145/227)were at nutritional risk, 39.2%(89/227)were malnourished, and 14.1%(32/227)had severe malnutrition.Additionally, 60.3%(257/426)of the patients received nutritional support therapy: 25.4%(108/426)received parenteral nutrition(PN), 11.3%(48/426)received enteral nutrition(EN), 23.7%(101/426)received a combination of EN and PN, while 39.7%(169/426)did not receive any nutritional support.Regardless of the presence or degree of malnutrition, patients who received nutritional support had significantly shorter total hospital stays compared to those who did not receive nutritional support, and this difference was statistically significant( t=5.58, 3.69, 2.21, 3.03, all P<0.05). Conclusions:Providing nutritional support to malnourished patients can reduce the length of hospital stay and improve clinical outcomes.

Objective To evaluate the medical service performance of a hospital in 2023,providing references for the refined management and discipline advancement.Methods The DRG-related data of patients discharged from the sample hospi-tal in 2023 were obtained through the DRGs in Sichuan Province.A comprehensive evaluation was performed by using the inte-grated approach of TOPSIS and RSR with entropy weight.Results The top three specialties offering a wide range of medical services and handling more complex cases on average were neurosurgery,orthopedics,and cardiovascular medicine.The difficulty level of cases in these departments exceeded the average for both the city and the province.TOPSIS-RSR method was used to e-valuate six weights of the index,and the top three ones were CMI,total weight,and number of diagnostic-related groups.In the DRG performance evaluation,30 clinical departments were divided into 3 grades,with 5,21,and 4 departments in each grade,respectively,revealing differences in case structure across grades.Conclusion The combination of DRG-related indicators and comprehensive evaluation method can be effectively applied to the performance evaluation of medical service for inpatients,thus providing suggestions and strategies for promoting the improvement of medical service capacity,improving medical service effi-ciency,optimizing safety and quality assessment indicators,and achieving overall balanced development in wards.

Objective:To compare the efficacy and safety of extended-field versus reduced-field radiotherapy in upper tract urothelial carcinoma (UTUC) patients after radical operation.Methods:A retrospective analysis was conducted on the data of 210 UTUC patients who underwent full-length nephrectomy and received postoperative adjuvant radiotherapy in Peking University First Hospital from January 2013 to November 2023, and follow-up continued until June 2024. According to the target area of postoperative radiotherapy, patients were divided into the extended-field radiotherapy group (127 cases) and the reduced-field radiotherapy group (83 cases). The overall survival (OS), distant metastasis free survival (DMFS), local recurrence free survival (LRFS) and adverse reactions were compared. In the same period, 114 patients with recurrent abdominal and pelvic lymph nodes who did not receive adjuvant therapy after surgery for UTUC in our center were prospectively collected, and the coverage of the reduced-field target area was analyzed. Chi square test was used to compare the clinical characteristics, Kaplan-Meier method was used to analyze survival outcomes, log-rank test was used to compare the survival rate, and Cox multivariate regression analysis was performed on the influencing factors of survival.Results:The median follow-up was 24.5 (range: 3-74) months. There were no significant differences between the extended-field and reduced-field radiotherapy groups in terms of 2-year LRFS (93.3% vs. 98.1%, P=0.156), 2-year DMFS (84.8% vs. 91.2%, P=0.176), and 2-year OS (90.4% vs. 90.7%, P=0.707). The most common toxicities of adjuvant radiotherapy were nausea and leukopenia, with significantly higher grade 1-2 incidence in the extended-field group compared to the reduced-field group ( P<0.05). According to the analysis of patients with retroperitoneal lymph node recurrence after surgery, the reduced-field target designed according to the location of the primary tumor can cover more than 90% of the postoperative metastatic lymph node area Multivariate analysis revealed that variant histology ( HR=2.180,95% CI: 1.021-4.658, P=0.044) was an independent predictor of worse DMFS, while variant histology ( HR=3.825,95% CI: 1.514-9.662, P=0.005) and T 3-4 stage ( HR=4.452,95% CI: 1.025-19.339, P=0.046) were independent predictors of poorer OS. Conclusions:Compared with extended-field radiotherapy, reduced-field radiotherapy designed based on primary tumor location significantly reduced treatment-related toxicities without compromising postoperative therapeutic efficacy, and the reduced-field can cover more than 90% of local recurrent lesions.

Objective:To investigate the clinical characteristics of patients with high-myopia macular hole retinal detachment (MHRD) combined with choroidal detachment and to preliminarily analyze factors associated with postoperative hole closure.Methods:A retrospective clinical case series study. A total of 68 patients with high myopia (68 eyes) with MHRD diagnosed by Department of Ophthalmology, Peking University People’s Hospital from January 2019 to April 2024 were included in this study. Among them, there were 14 males (14 eyes) and 54 females (54 eyes). The mean age was (61.10±9.66) years. All eyes were treated with pars plana vitrectomy (PPV) combined with silicone oil or gas filling. Best corrected visual acuity (BCVA), intraocular pressure, and B-mode ultrasonography were performed. The BCVA test was performed using the Snellen visual acuity chart, which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The range of choroidal detachment was defined according to the number of involved quadrants observed in B-mode ultrasound or surgery, which was divided into 1 to 4 quadrants. Axial length (AL) was measured under retinal reattachment. In 68 eyes, there were 17 eyes with choroidal detachment and 51 eyes without choroidal detachment, respectively. There were 17 eyes with choroidal detachment, and the detachment range involved 1, 2, 2 and 12 eyes in 1, 2, 3 and 4 quadrants, respectively. During operation, 13% C 3F 8 was filled in 2 eyes, all of which were not complicated with choroidal detachment. 66 eyes were filled with silicone oil. According to whether the patients were complicated with choroidal detachment, the patients were divided into the group without choroidal detachment and the group with choroidal detachment. Independent sample t test, Welch two-sample t test or Mann-Whitney U test were used for comparison between groups. Generalized linear regression and logistic regression were used to analyze the relationship between the aperture size of postoperative unclosed holes and the closed hole after surgery and clinical factors. Results:At 3 months after surgery, the logMAR BCVA of the affected eye was 1.29±0.43, with a preoperative to postoperative difference ranging from -1.60 to 0.70 (-0.51±0.51) logMAR units. The AL ranged from 26.6 to 34.3 (29.60±2.12) mm. Among 68 eyes, macular hole of 37 (54.4%, 37/68) eyes were open and 31 (45.6%, 31/68) eyes were closed, respectively. The hole diameter of the open eye was (753±424) μm. There was no significant difference in age, course of disease and AL between the two groups ( W=412.0, 477.5, 427.0; P>0.05). Before operation, BCVA in patients with choroidal detachment was worse ( W=257.5) and intraocular pressure was lower ( t=4.051) in patients with choroidal detachment compared with those without choroidal detachment, with statistical significance ( P<0.05). At 3 months after surgery, BCVA in patients with choroidal detachment was significantly worse than that in patients without choroidal detachment, with statistical significance ( W=284.0, P<0.05). There were no significant differences in logMAR BCVA difference ( t=0.616) and macular hole closure rate ( χ 2=0.000) before and after surgery ( P>0.05). The reoperation rate of retinal detachment due to persistent or recurrent retinal detachment was significantly higher in the group with choroid detachment than in the group without choroid detachment, and the difference was statistically significant (odds ratio=6.424, P<0.05). Logistic regression analysis showed that young age was significantly correlated with macular hole closure failure after surgery ( β=0.077, P=0.015). There was no correlation between AL, duration of disease, BCVA before surgery, intraocular pressure, wether combined with choroid detachment range and postoperative hole closure ( β=-0.072, 0.000, 0.672, -0.085, -0.391; P>0.05). Conclusions:Concomitant choroidal detachment adversely affected on both pre-operative and post-operative visual acuity in high myopia MHRD. It is closely associated with the risk of recurrent retinal detachment and the needs of multiple operations, but has no significant effect on hole closure rate. Lower age of onset may be a risk factor for macular hole closure.

Objective:To observe and analyze the correlation between ectopic foveal inner layer (EIFL) and the EIFL-based idiopathic epiretinal membrane (ERM) staging system and the anatomic and functional prognosis of ERM eyes post pars plana vitrectomy (PPV).Methods:A retrospective study. From January 1, 2020 to October 30, 2023, 345 eyes of 330 patients diagnosed with idiopathic ERM in Department of Ophthalmology of Peking University People's Hospital and treated with standard transciliary flat three-channel 25G PPV combined with ERM and internal limiting membrane exfoliation were included in the study. Among them, 96 were males (111 eyes) and 234 were females (234 eyes). The mean age was (66.8±7.7) years. All study eyes received standard three-port 25G PPV combined with ERM and internal limiting membrane peeling. All study eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. BCVA was performed using a standard logarithmic visual acuity chart and converted to logarithm of the minimum angle of resolution visual acuity for statistical analysis. EIFL thickness and central foveal thickness (CFT) on OCT were measured. ERM eyes were grouped into stage Ⅰ, Ⅱ, Ⅲ and Ⅳ according to ERM staging scheme based on EIFL; disorganization of the retinal inner layers (DRIL) of study eyes were assessed and grouped into no, mild and severe groups. The correlation between ERM staging as well as EIFL thickness and the anatomical and functional prognosis 6 months post-PPV were analyzed.Results:Among 345 study eyes, 12, 87, 174 and 72 eyes were stage Ⅰ-Ⅳ ERM respectively, 63 with no DRIL, 216 with mild DRIL and 66 with severe DRIL. Among the 153 eyes with macular edema, the edema subsided in 66 eyes (43.1%, 66/153) 6 months after the operation. Eighty-seven eyes (56.9%, 87/153) did not regress. The edema subsided 6 months after the operation was not significantly correlated with the ERM stage before the operation ( χ2=3.331, R=?0.145, P=0.304) or the degree of DRIL ( χ2=0.655, R=?0.108, P=0.445). The results of the correlation analysis showed that logMAR BCVA 6 months after the surgery was positively correlated with the degree of DRIL before the surgery ( Tau-b=0.236), ERM stage ( Tau-b=0.194), CFT ( r=0.383), and EIFL thickness ( r=0.317) ( P<0.05). There was no significant correlation with the thickness of the outer nuclear layer before the operation ( r=0.004, P>0.05). Preoperative ERM stage ( Tau-b=0.303, P<0.001) and DRIL severity ( Tau-b= 0.238, P=0.001) were positively correlated with CFT at 6 months after surgery. Conclusion:The ERM stage and EIFL thickness before the operation are positively correlated with logMAR BCVA and CFT 6 months after the operation.

Modern education emphasizes the improvement of the comprehensive quality of the educated,and medical ed-ucation has particularly high requirements for students'practical abilities.Therefore,it is necessary to continuously analyze and optimize the education work when conditions permit.This paper first introduces the"Trinity Teaching"model and the college student medical technology skills competition.Based on this,it analyzes the advantages and disadvantages of the current training for college student medical technology skills competition,the value of applying the"Trinity Teaching"model,and explores its specific application methods,including the use of group work mode and building a large-scale teaching service system to serve medical teaching work.

Modern education emphasizes the improvement of the comprehensive quality of the educated,and medical ed-ucation has particularly high requirements for students'practical abilities.Therefore,it is necessary to continuously analyze and optimize the education work when conditions permit.This paper first introduces the"Trinity Teaching"model and the college student medical technology skills competition.Based on this,it analyzes the advantages and disadvantages of the current training for college student medical technology skills competition,the value of applying the"Trinity Teaching"model,and explores its specific application methods,including the use of group work mode and building a large-scale teaching service system to serve medical teaching work.

Objective To evaluate the medical service performance of a hospital in 2023,providing references for the refined management and discipline advancement.Methods The DRG-related data of patients discharged from the sample hospi-tal in 2023 were obtained through the DRGs in Sichuan Province.A comprehensive evaluation was performed by using the inte-grated approach of TOPSIS and RSR with entropy weight.Results The top three specialties offering a wide range of medical services and handling more complex cases on average were neurosurgery,orthopedics,and cardiovascular medicine.The difficulty level of cases in these departments exceeded the average for both the city and the province.TOPSIS-RSR method was used to e-valuate six weights of the index,and the top three ones were CMI,total weight,and number of diagnostic-related groups.In the DRG performance evaluation,30 clinical departments were divided into 3 grades,with 5,21,and 4 departments in each grade,respectively,revealing differences in case structure across grades.Conclusion The combination of DRG-related indicators and comprehensive evaluation method can be effectively applied to the performance evaluation of medical service for inpatients,thus providing suggestions and strategies for promoting the improvement of medical service capacity,improving medical service effi-ciency,optimizing safety and quality assessment indicators,and achieving overall balanced development in wards.

Objective To use a physics-informed neural network(PINN)-based model to predict hemodynamics in intracranial aneurysms and address the problems of long simulation time and high computational cost in traditional computational fluid dynamics(CFD)simulations.Methods The PINN model was trained using only the computational domain coordinates and sparse velocity measurement points from CFD data of clinical patients.The predicted blood flow velocity,pressure,and wall shear stress(WSS)from the PINN model were compared with CFD simulation results.Results The proposed method was used to test and validate data from four different patients.For velocity prediction,the average mean absolute error(MAE),average mean relative error(MRE),average mean squared error(MSE)was 4.60％,6.61％,and 0.229％,respectively.For WSS prediction,the average MAE,MRE and MSE was 5.54％,8.58％,and 0.510％,respectively.The PINN model demonstrated a good generalization capability across different aneurysm models and could reduce the computation time of hemodynamics from several hours to just a few seconds.Conclusions The PINN model can effectively compensate for incomplete measurement data through physical constraints,even when boundary conditions are unknown and measurement data are sparse.It can rapidly and accurately simulate the hemodynamics of intracranial aneurysms.This method has the potential to provide effective support for clinical risk prediction in intracranial aneurysms.