Objective To construct and verify a risk prediction model of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer,and to screen the optimal model by using machine learning algorithm,so as to provide references for clinical formulation of a nursing risk management plan.Methods The convenience sampling method was used to retrospectively select 476 patients who underwent thoracoscopic radical resection of lung cancer in a tertiary hospital in Hangzhou,Zhejiang Province from January to December 2023 as a construction group.Logistic regression,decision tree,random forest and naive Bayesian model were constructed by SPSS 29.0 and R 4.3.0 software.The prediction performance of each model was compared by accuracy,precision,recall,F1 score and area under the receiver operating characteristic curve,and the optimal model was screened.From January to June 2024,204 patients in the unit were prospectively selected as the research subjects of an external validation group.The discrimination and calibration of the optimal model were evaluated by AUC value and calibration curve.Results A total of 680 patients completed the survey.All 4 models showed that multimodal analgesia,thoracic drainage tube type,pain score,tracheal intubation type,state anxiety and catheter indwelling time were the influencing factors of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer(P＜0.05).The 4 risk prediction models showed that the random forest prediction model had the best comprehensive performance.The external verification results showed that the AUC value was 0.913,and the calibration curve fitted well with the 45° ideal line.Conclusion Among the 4 risk prediction models,the random forest prediction model has the best performance,which is more suitable for the assessment of the risk of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer,and has good generalization and clinical application value.

Objective:To investigate the relationship between visual recovery and non-treponemal serologic test titers [tolulized red unheated serum test (TRUST) or rapid plasma reagin (RPR)] in patients with isolated ocular syphilis and those with ocular syphilis combined with neurosyphilis.Methods:A total of 35 ocular syphilis patients treated at the Department of Ophthalmology, the First Affiliated Hospital of Soochow University, and the Department of Dermatology, the Fifth People′s Hospital of Suzhou between 2016 and 2024 were enrolled. Pre-treatment serum TRUST/RPR and treponema pallidum particle agglutination (TPPA) assay results were collected for all 35 patients. Cerebrospinal fluid (CSF) biochemical, routine, TRUST/RPR, and TPPA results were obtained for 29 patients. Visual acuity (logMAR) before and after treatment was recorded for 21 patients (34 eyes). Pearson or Spearman correlation analysis was used to assess the relationship between pre-and post-treatment visual acuity, degree of visual recovery, and serum titers.Results:No significant differences in titer distribution were observed among the 35 ocular syphilis patients based on age or sex ( P>0.05). Among the 29 patients who underwent lumbar puncture, 17(58.62%) were diagnosed with ocular syphilis combined with neurosyphilis, while 12(41.38%) had isolated ocular syphilis. The proportion of patients with high pre-treatment serum titers did not differ significantly between the two groups ( P=0.294). The degree of post-treatment visual recovery showed a positive correlation with pre-treatment serum titers, indicating that higher initial titers were associated with better visual recovery (34 eyes, r=-0.302, P=0.081). Post-treatment visual acuity was positively correlated with pre-treatment visual acuity (34 eyes, r=0.547, P=0.001), suggesting that patients with poor baseline vision had worse post-treatment visual outcomes. The median visual improvement was logMAR 0.560 in the isolated ocular syphilis group and logMAR 0.202 in the neurosyphilis-combined group, with no significant difference between the two ( P=0.322). Conclusions:Ocular syphilis patients with higher pre-treatment titers exhibit better visual recovery, while poor post-treatment visual outcomes are associated with low baseline visual acuity.

Objective:To investigate the relationship between visual recovery and non-treponemal serologic test titers [tolulized red unheated serum test (TRUST) or rapid plasma reagin (RPR)] in patients with isolated ocular syphilis and those with ocular syphilis combined with neurosyphilis.Methods:A total of 35 ocular syphilis patients treated at the Department of Ophthalmology, the First Affiliated Hospital of Soochow University, and the Department of Dermatology, the Fifth People′s Hospital of Suzhou between 2016 and 2024 were enrolled. Pre-treatment serum TRUST/RPR and treponema pallidum particle agglutination (TPPA) assay results were collected for all 35 patients. Cerebrospinal fluid (CSF) biochemical, routine, TRUST/RPR, and TPPA results were obtained for 29 patients. Visual acuity (logMAR) before and after treatment was recorded for 21 patients (34 eyes). Pearson or Spearman correlation analysis was used to assess the relationship between pre-and post-treatment visual acuity, degree of visual recovery, and serum titers.Results:No significant differences in titer distribution were observed among the 35 ocular syphilis patients based on age or sex ( P>0.05). Among the 29 patients who underwent lumbar puncture, 17(58.62%) were diagnosed with ocular syphilis combined with neurosyphilis, while 12(41.38%) had isolated ocular syphilis. The proportion of patients with high pre-treatment serum titers did not differ significantly between the two groups ( P=0.294). The degree of post-treatment visual recovery showed a positive correlation with pre-treatment serum titers, indicating that higher initial titers were associated with better visual recovery (34 eyes, r=-0.302, P=0.081). Post-treatment visual acuity was positively correlated with pre-treatment visual acuity (34 eyes, r=0.547, P=0.001), suggesting that patients with poor baseline vision had worse post-treatment visual outcomes. The median visual improvement was logMAR 0.560 in the isolated ocular syphilis group and logMAR 0.202 in the neurosyphilis-combined group, with no significant difference between the two ( P=0.322). Conclusions:Ocular syphilis patients with higher pre-treatment titers exhibit better visual recovery, while poor post-treatment visual outcomes are associated with low baseline visual acuity.

Objective To construct and verify a risk prediction model of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer,and to screen the optimal model by using machine learning algorithm,so as to provide references for clinical formulation of a nursing risk management plan.Methods The convenience sampling method was used to retrospectively select 476 patients who underwent thoracoscopic radical resection of lung cancer in a tertiary hospital in Hangzhou,Zhejiang Province from January to December 2023 as a construction group.Logistic regression,decision tree,random forest and naive Bayesian model were constructed by SPSS 29.0 and R 4.3.0 software.The prediction performance of each model was compared by accuracy,precision,recall,F1 score and area under the receiver operating characteristic curve,and the optimal model was screened.From January to June 2024,204 patients in the unit were prospectively selected as the research subjects of an external validation group.The discrimination and calibration of the optimal model were evaluated by AUC value and calibration curve.Results A total of 680 patients completed the survey.All 4 models showed that multimodal analgesia,thoracic drainage tube type,pain score,tracheal intubation type,state anxiety and catheter indwelling time were the influencing factors of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer(P＜0.05).The 4 risk prediction models showed that the random forest prediction model had the best comprehensive performance.The external verification results showed that the AUC value was 0.913,and the calibration curve fitted well with the 45° ideal line.Conclusion Among the 4 risk prediction models,the random forest prediction model has the best performance,which is more suitable for the assessment of the risk of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer,and has good generalization and clinical application value.

Objective:To observe the efficacy of trigeminal nerve microvascular decompression in the treatment of elderly trigeminal neuralgia.Methods:A total of 96 elderly patients with trigeminal neuralgia admitted to our hospital from January 2015 to June 2016 were selected.48 patients were treated with percutaneous trigeminal semilunar ganglion radiofrequency thermocoagulation as a control group, and the other 48 patients were treated with trigeminal nerve microvascular decompression as the observation group.Efficacy indicators of post-operative pain severity scores, severity scores of post-operative complications, a sum of two categories of severity scores, which were compared between the two groups at one month and at 1, 3, 5 years after surgery.Results:One month after the operation, there was no significant differences in pain severity score, surgical complications severity scores, and a sum of two categories severity scores between the two groups of patients(all P>0.05). In the observation group versus the control group, pain severity scores were[(0.55±0.39)scores versus(0.94±0.61)scores, t=7.572, P=0.011 at 1 year after operation], [(0.81±0.61)versus(1.19±0.83)scores, t=7.513, P=0.012 at 3 years after operation]and[(1.13±0.65)and(1.55±0.91)scores, t=7.837, P=0.010 at 5 years after operation]respectively, showing more efficacy in observation group.In the observation group versus the control group, severity scores of surgical complications were[(0.39±0.28)and(0.67±0.49)scores, t=7.290, P=0.014, at 1 year after operation], [(0.65±0.37)and(0.94±0.55)scores, t=7.353, P=0.013 at 3 years after operation]and[(0.80±0.35)and(1.13±0.64)scores, t=7.475, P=0.012 at 5 years after operation], respectively, showing more efficacy in observation group.In the observation group versus the control group, overall efficacy from a sum of the two categories of severity scores were[(0.72±0.35)and(1.33±0.56)scorets, t=7.701, P=0.009 at 1 year after operation], [(1.21±0.49)and(1.78±0.70)scores, t=7.580, P=0.011 at 3 years after operation]and[(1.46±0.55)and(2.24±1.03)scores, t=8.026, P=0.007 at 5 years after operation], respectively, showing more efficacy in observation group.Overall, above three severity scores were lower than in the observation group than in the control group(all P<0.05). Conclusions:For elderly patients with trigeminal neuralgia, trigeminal nerve microvascular decompression has definite efficacy, long duration of pain relief, low incidence of surgical complications, and is safe and reliable, which is worthy of clinical application.

Objective:To describe our experiences in application of the 2019 revision of "CCCG-WT-2016" for the diagnosis of Wilms tumors.Methods:Ninety-one cases of Wilms tumor diagnosed at Shanghai Children′s Medical Center from January 2015 to December 2018 were collected. All cases were reviewed by two senior pathologists, including one from China and the other from Singapore, according to the 2019 revision of "CCCG-WT-2016."Results:The specimens were obtained by core biopsy ( n=21), primary nephrectomy ( n=41), post-chemotherapy nephrectomy/resection ( n=18), or biopsy/resection of metastatic/relapse/post-chemotherapy metastatic lesion(s) ( n=11). The specimens of core biopsy and primary nephrectomy ( n=62) all had favorable histology.Twelve post-chemotherapy nephrectomy cases were subdivided into three risk groups: low risk ( n=0), intermediate risk ( n=10) and high risk ( n=2). Six post-chemotherapy resection cases were subdivided into 3 risk groups:low risk ( n=0), intermediate risk ( n=5) and high risk ( n=1). The remaining 11 cases were comprised of metastatic, relapse, and post-chemotherapy metastatic lesions. The concordance rate of the two senior pathologists was 100%(91/91). Conclusions:The 2019 revision of "CCCG-WT-2016" is clearly written and easy to use. It can serve as the basis of accurate classification for clinical treatment.

Objective:To investigate the clinical and pathological features of pediatric NTRK-rearranged tumors.Methods:Four NTRK-rearranged soft tissue tumors and one renal tumor at Shanghai Children′s Medical Center, Shanghai Jiaotong University and Singapore KK Women′s and Children′s Hospital from January 2017 to September 2019 were identified. Pan-TRK immunohistochemistry, and the ALK and ETV6 gene break-apart fluorescence in situ hybridizations (FISH) were performed. NTRK gene rearrangement was detected using sequencing-based methods.Results:There were 3 males and 2 females in this study. The patients were between 3 months and 13 years of age. Histologically, the tumors were infiltrative spindle cell tumors with variable accompanying inflammatory cells. Immunohistochemistry showed positive reactivity for pan-TRK in all tumors, with nuclear staining for NTRK3 fusion, and cytoplasmic staining for NTRK1 fusion. The molecular testing revealed NTRK gene fusions (one each of TPM3-NTRK1, ETV6-NTRK3 and DCTN1-NTRK1, and two cases of LMNA-NTRK1). Two patients were receiving larotrectinib. The others were are well without disease, with follow-up durations of 9 to 29 months.Conclusions:NTRK-rearranged mesenchymal tumors from soft tissue sites and kidney are identified. A novel DCTN1-NTRK1 fusion is described. Pan-TRK immunohistochemistry is useful for diagnosis. NTRK-targeted therapy may be an option for unresectable, recurrent or metastatic cases.

Objective: To describe the dermoscopic features of extramammary Paget′s disease (EMPD) and chronic eczema of the vulva, and to explore the value of dermoscopy in the diagnosis and differential diagnosis of the above diseases. Methods: Dermoscopic images were collected from 20 patients with histopathologically confirmed vulvar EMPD and 16 patients with clinically confirmed chronic eczema of the vulva in Hospital for Skin Diseases, Chinese Academy of Medical Sciences and Pekin Union Medical College from January 2017 to April 2018, and retrospectively analyzed. Fisher′s exact test was used to compare the prevalence of dermoscopic features between the two groups. Results: As dermoscopy showed, the milky red background was observed in 19 EMPD patients and in only 1 patient with chronic eczema, and there was a significant difference in the prevalence of milky red background between the two groups (P < 0.001) . White scales were the most common desquamation, and were observed in 9 EMPD patients and 13 patients with chronic eczema (P = 0.128) . Blood vessels were uniformly distributed in EMPD patients, including dotted-globular vessels in 19 and linear vessels in 14, while blood vessels were distributed in a patchy or clustered pattern in the patients with chronic eczema, including dotted-globular vessels in 16 and linear vessels in 7. There was a significant difference in the prevalence of different distribution patterns of blood vessels between the two groups (P < 0.001) . Bright white streaks, bright white structureless area and reticular structure were observed in 19, 20 and 19 EMPD patients respectively, and in 1, 1 and 1 patient with chronic eczema respectively, and there were significant differences in the prevalence of the above 3 structures between the two diseases (all P < 0.001) . Conclusion Vulvar EMPD and chronic eczema both show characteristic dermoscopic features, and dermoscopy is of great value to the diagnosis and differential diagnosis of EMPD.

Objective: To investigate the current status of brucella infection in major occupational groups in Bayannur, China, and to analyze the risk factors for brucellosis. Methods: From January to March, 2015, a questionnaire survey and the serological testing were performed to investigate the current status of brucella infection in 649 workers in 13 slaughter and breeding plants in 7 counties in Bayannur, China. The items in the questionnaire survey included general information, related occupational information, living habits, medical history, and awareness of related knowledge. Results: A total of 112 workers (17.26%) had brucella infection. Brucella infection was associated with sex, age, years of exposure to hazardous substances, job, educational background, usage of protective equipment, the presence or absence of a wound at the exposure site, and whether to smoke during the work clearance (P<0.05) . The multivariate analysis showed that the risk factors for brucellosis were meat processing work (OR=1.812) , >5 years of exposure to hazardous substances (OR=1.363) , improper use or nonuse of protective equipment (OR=1.957) , smoke during work (OR=2.027) , and the presence of a woundat the exposure site (OR= 1.231) ; the protective factors for brucellosis were high school and college education and above (OR=0.521) and high rate of awareness of brucella-related knowledge (OR=0.648) . Conclusion The brucella infection rate is high in the major occupational groups in Bayannur, China. The main influencing factors for brucellosis are job, years of exposure to hazardous substances, usage of protective equipment, whether to smoke during work, and the presence or absence of a wound at the exposure site.

Objective To investigate the efficiency, safety and application value of early utilization of nutrient of home-made formula in post-operation of gastric fundic cardia cancer patients. Methods One hundred and forty-five cases of gastric fundic cardia cancer patients were randomly divided into two groups,early enteral-intestinal nutrient formula of home-made (enteral-intestinal group,73 cases) and intra-venous nutrition (intra-venous group,72 cases). Patients in enteral-intestinal group were given home-mada nutrition-liquid plus nutrison fibre for 6-8 days from the first post-operation day, intravenous group were given venousnutrition injection for 6-8 days from the first post-operation day. The average residential day, spends,complications and recovery situation were recorded and compared between the two groups. Results The average residential day in enteral-intestinal group was less than that in intra-venous group, average spends /drugs cost were (9433.1±1024.6)/(3271.8±420.9) yuan vs (12 953.4±2919.7 )/(4832.9±872.6) yuan respectively (P < 0.01 ),the complication in enteml-intestinal group was less than that in intra-venous group (P < 0.01 ). Time of revive testinal function in enteral-intestinal group was earlier than that in intra-venous group,ALB in enteral-intestinal group was higher than that in intra-venous group (P < 0.01 ). Conclusion Early enteral-intestinal nutrient utilization of home-made formula in post-operation of gastric fundic cardia cancer patients is safe and applicable, it can improve patients' post-operation nutrition situation and intestinal function.