Objective To investigate the utility of dual-energy computed tomography(DECT)virtual non-contrast(VNC)images instead of true non-contrast(TNC)images in the quantitative analysis of emphysema.Methods A retrospective selection was con-ducted on 59 patients who underwent chest CT plain scan plus dual-phase enhanced scan on APEX-CT.VNC images of arterial phase(VNCart)and venous phase(VNCven)were generated on AW4.7 workstation.Volume CT dose index(CTDIvol)and dose length product(DLP)were recorded respectively.In a double-blind manner,two physicians graded the severity of each patient's emphysema according to the Fleischner Society's emphysema visual classification system.The"digital lung"detection and analysis platform was used to quantitatively measure emphysema at three thresholds(-950 HU,-930 HU and-910 HU),and the difference in meas-urement results between VNC images and TNC images was compared.Quantitative differences in low attenuation volume(LAV),percentage of low attenuation area(LAA%)and mean lung density(MLD)at the-950 HU threshold were compared using Bland-Altman plots.Results Using TNC images as the standard,there was no significant difference in the results of the visual classifica-tion evaluation of emphysema between TNC and VNC images(χ2=2.80,P=0.247).In quantitative measurement,there was no significant difference in total lung volume(TLV)(χ2=3.26,P=0.196)between the three groups images.Compared to TNC ima-ges,there were no statistically significant differences in LAV,LAA%and MLD of VNCven images at 15th percentile lung density(Perc 15%)and different thresholds(P>0.05).Compared to the TNC mode,the VNC mode could reduce the effective dose(ED)by approximately 32.6%.Conclusion The use of DECT VNCven images on chest has the potential to replace TNC for the quantitative analysis of emphysema,thereby streamlining scans and reducing radiation dose.

Epidural spinal cord stimulation (eSCS) represents an emerging neuromodulation technology that ameliorates motor dysfunction in patients with spinal cord injury, Parkinson's disease, and stroke by activating sensory afferent fibers, enhancing spinal cord neural network integration, optimizing brain-spinal cord information transmission, and inducing neural plasticity. This article reviews the mechanism, electrode implantation, and stimulation parameter of eSCS, and application of eSCS in spinal cord injury, Parkinson's disease, and stroke, aiming to provide valuable insight for its clinical implementation.

Objective To investigate the status of hearing impaired children's hearing device independence skills,and to explore the ways to improve their self-use of hearing equipment.Methods This study surveyed 64 re-habilitation teachers and 411 parents of children with hearing impairment aged 0-12 years.Through face-to-face or remote telephone interview,3 good habits(A asking parents for advice before removing the HA,B putting the de-vice into a moisture-proof box after removing it,C bringing batteries to school and knowing where are them)and 3 key abilities[D wearing the device independently,E replacing the battery independently,and F independently handle foreign bodies in the ear mold(Fa)and water vapor(Fb)]was investigated.The age when mastering skills or de-veloping habits difference of hearing impaired children in different groups were compared.Results ① The ratio of ability D in the bilateral CI group and the bilateral HA group of preschool children was 30.97％and 18.57％respec-tively.Among elementary school children,85.29％and 90.70％had this ability respectively.② The ratio of ability E in the bilateral CI group,the bilateral HA group and the bimodel group were 11.50％,15.71％and 16.49％,re-spectively.Among elementary school children,64.71％,53.49％and 68.52％had this ability,respectively.③Among preschool children,there was no statistical difference in age when different equipment groups developed the three good habits and acquired ability D and E(P＞0.05).④ Among primary school children,there was a statisti-cal difference in the age when different equipment groups formed habit A(P＜0.05),and the age when double CI group had this ability was slightly earlier than the double HA group.There was no significant difference in other abilities among age groups(P＞0.05).Conclusion The age at which hearing impaired children develop the three good habits precedes the age at which they master the key skills,which accords with the law of skill acquisition and development of ordinary children.Corresponding teaching process should be based on the age and ability of hearing-impaired children without considering the type of equipment.

Objective To observe the value of body mass and body mass index(BMI)for calculating size specific dose estimate(SSDE)value of chest and abdominal CT in children.Methods Totally 486 children who underwent chest and abdominal CT scanning were retrospectively enrolled,including 201 underwent chest and 285 underwent abdominal CT scanning.SSDE value was calculated with software,body mass and BMI and recorded as SSDEstandard,SSDEweight and SSDEBMI,respectively,and the correlation and consistency between the former and the latter two were analyzed.Results SSDEweight(chest r=0.974,abdomen r=0.972)and SSDEBMI(chest r=0.933,abdomen r=0.950)were both highly correlated with SSDEstandard(all P＜0.01)and had good consistency.The root mean square error between SSDEweight and SSDEstandard of chest and abdominal CT was 0.245 and 0.249,between SSDEBMI and SSDEstandard was 0.653 and 0.956,respectively.Conclusion Body mass and BMI could be used to conveniently calculate SSDE value of chest and abdominal CT scanning in children,and the results had good consistency with that based on software.

Objective:To explore the effect of the combination of robot-assisted total knee arthroplasty and pressure sensor on early postoperative outcomes.Methods:Twenty patients who underwent YUANHUA robot-assisted TKA between September 2024 and December 2024 were prospectively enrolled. After randomization and exclusion of one patient lost to follow-up, 10 patients were included in the pressure-sensor group and 10 in the control (no-pressure) group. In the pressure-sensor group, surgeons used a pressure sensor to assist in soft tissue balancing after osteotomy, whereas in the control group, balancing was performed empirically. In both groups, medial and lateral compartment pressures of the knee at 10°, 45°, 90°, and 120° of flexion were recorded using a pressure sensor prior to component implantation. Clinical outcomes were evaluated preoperatively and at 1 day, 3 days, 1 week, 2 weeks, 6 weeks, and 3 months postoperatively using the visual analog scale (VAS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Score (FJS).Results:All 20 procedures were completed successfully, and patients were followed for at least 3 months. At 10° of knee flexion, the difference between medial and lateral compartment pressures was significantly smaller in the pressure-sensor group (0.99±59.44 N) than in the control group (97.18±84.34 N; t=-2.948, P=0.009). At 45° of flexion, the corresponding differences were -12.99±36.20 N and 51.48±76.40 N, respectively ( t=-2.411, P=0.032). No significant differences in VAS, KSS, or WOMAC scores were observed between groups preoperatively ( P>0.05). At 3 months postoperatively, the KSS was significantly higher in the pressure-sensor group (174.40±16.39) compared with the control group (138.50±38.35, t=2.722, P=0.014). The WOMAC and VAS scores were significantly lower in the pressure-sensor group (12.70±11.00 and 1.20±0.92, respectively) than in the control group (27.30±18.54 and 2.70±2.00; t=-2.142, P=0.046; t=-2.153, P=0.045). At 2 weeks and 3 months postoperatively, the FJS scores in the pressure-sensor group [70.00±26.06 and 88.07(83.52, 95.83)] were significantly higher than those in the control group [37.92±32.42 and 50.00(32.50, 67.75); t=2.439, P=0.025; Z=-2.466, P=0.014]. Conclusion:The combination of precise osteotomy using robot-assisted TKA and soft tissue balancing guided by a pressure sensor provided more accurate medial-lateral compartment balance and significantly enhanced early postoperative clinical outcomes.

Objective To observe the value of automated fiber quantification(AFQ)for analyzing relationships of abnormal white matter microstructures and executive dysfunction in children with attention deficit hyperactivity disorder(ADHD).Methods Brain diffusion tensor imaging(DTI)and white matter structure AFQ analysis were prospectively performed on 83 children with ADHD(ADHD group)and 52 healthy children(healthy control[HC]group).The axial diffusivity(AD),radial diffusivity(RD),mean diffusivity(MD),and fractional anisotropy(FA)of complete fiber bundles and respective segments were obtained and compared between groups.Partial correlation analysis was conducted of fiber bundle diffusion parameters and the scores of Swanson Nolan and Pelham-Ⅳ(SNAP-Ⅳ)and behavior rating inventory of executive function(BRIEF)in ADHD group.Receiver operating characteristic curves were applied to assess the efficacy of each diffusion parameter for evaluating ADHD.Results AD and MD of right anterior thalamic radiation(ATR),and AD of right cingulum bundle(CB)in ADHD group were all higher than those in HC group(FWE corrected,all P＜0.000 7).Significant differences of AD of the 54-78 segments of right ATR,MD of the 13-24 and 53-77 segments of right ATR,AD of the 24-26,53-56 and 93-97 segments of right CB,as well as MD of the 72-85 segments of left inferior longitudinal fasciculus(ILF)were found between groups(FWE corrected,all P＜0.001).In ADHD group,AD of 54-78 segments of right ATR were negatively correlated with the attention deficit scores,while of 24-26 segments of right CB were negatively correlated with the emotional control scores.MD of right ATR and some segments,AD of right CB and some segments in ADHD group were positively correlated with the scores of task initiation,planning,organization,monitoring and metacognitive index(all P＜0.05).The area under the curve(AUC)of segmental fiber bundle diffusion parameter and intact fiber bundle diffusion parameter for evaluating ADHD was 0.881 and 0.808,respectively,the former was higher than the latter(Z=2.435,P＜0.05).Conclusion AFQ could be used to analyze relationships of abnormal white matter microstructures and executive dysfunction in ADHD,which could be effectively evaluated based on specific fiber bundle segments.

Objective:To explore the differences between the Phoenix sepsis scoring system including Phoenix sepsis score (PSS) and Phoenix-8 organ dysfunction score (hereinafter referred to as Phoenix-8) and the commonly used pediatric sepsis scores in evaluating clinical characteristics and prognostic analysis of pediatric patients with severe sepsis diagnosed under traditional standards, namely the diagnostic criteria from the 2005 International Pediatric Sepsis Consensus Conference.Methods:This study was a retrospective observational study. From December 2020 to March 2023, 202 pediatric patients with severe sepsis meeting the inclusion criteria were admitted to the Children's Hospital of Nanjing Medical University. Based on the sepsis diagnostic criteria outlined in the International Consensus Criteria for Pediatric Sepsis and Septic Shock (2024), the pediatric patients were categorized into a sepsis group and a non-sepsis group. Sepsis group was further subdivided into a death subgroup and a survival subgroup based on the outcomes. The age, hospitalization costs, disease outcome indicators (e.g., mortality rate and incidence of septic shock), major organ (e.g., heart, liver, lungs, and kidneys) damage and their correlations, as well as PSS, Phoenix-8 and commonly used pediatric sepsis scores (e.g., pediatric sequential organ failure assessment (pSOFA), pediatric risk of mortality score Ⅲ (PRISM Ⅲ), pediatric logistic organ dysfunction-2 score (PELOD-2), pediatric multiple organ dysfunction score (P-MODS), pediatric critical illness score (PCIS), and pediatric early warning score (PEWS)) were collected and compared. Receiver operating characteristic (ROC) curve and precision-recall curve were plotted to evaluate the predictive ability of PSS, Phoenix-8, and commonly used pediatric sepsis scores for mortality risk in pediatric patients with severe sepsis under traditional standards. Predictive performance was quantified using the area under the ROC curve (AUROC). Univariate logistic regression analysis was employed to quantify the odds ratios of PSS and Phoenix-8 for predicting mortality risk. Patients with severe sepsis under traditional standards were further stratified into subgroups based on complications and comorbidities, including central nervous system (CNS) diseases, multiple infections, cardiovascular system diseases, shock, and malignancies. The Hosmer-Lemeshow goodness-of-fit test was used to assess calibration of PSS and Phoenix-8, and the DeLong test was used to compare whether there were statistically significant differences in the AUROC of PSS and Phoenix-8 for predicting mortality risk among different subgroups of pediatric patients. Results:Compared with those in non-sepsis group, pediatric patients in sepsis group were significantly older ( Z=-2.92, P<0.05) with higher incidences of septic shock and mortality, hospitalization costs, PRISM Ⅲ, PEWS, pSOFA, PELOD-2, PSS, and Phoenix-8 (with χ2 values of 21.28 and 13.64, respectively, Z values of -1.99, -5.33, -5.10, -8.55, -6.91, -10.98, and -9.93, respectively, P<0.05), and lower PCIS ( Z=-3.34, P<0.05). Compared with those in survival subgroup, hospitalization costs, PSS, Phoenix-8, PRISM Ⅲ, PEWS, pSOFA, PELOD-2, and P-MODS of pediatric patients in death subgroup was significantly higher (with Z values of -2.50, -3.50, -2.47, -5.11, -3.84, -2.94, -3.61, and -3.04, respectively, P<0.05). Compared with those in survival subgroup, the incidences of lung damage and liver damage of pediatric patients in death subgroup were also significantly higher (with χ2 values of 6.20 and 10.94, respectively, P<0.05), and 64.7% (97/150) of patients exhibited two or more concurrent organ damage. For predicting mortality risk in pediatric patients with severe sepsis under traditional standards, the AUROC values for PRISM Ⅲ, PCIS, PEWS, pSOFA, PELOD-2, P-MODS, PSS, and Phoenix-8 were approximately 0.70, with optimal cutoff values of 17.5, 91.0, 5.5, 4.5, 2.5, 4.5, 3.5, and 4.5, respectively; PELOD-2 demonstrated the highest sensitivity (0.83); while PRISM Ⅲ, PSS, and Phoenix-8 showed high specificity (>0.80). Univariate logistic regression analysis showed that for every 1-point increase in the PSS within 24 hours of pediatric intensive care unit admission, the relative risk of mortality increased by 63.7% (with odds ratio of 1.64, 95% confidence interval of 1.34-1.99, P<0.05). Similarly, for every 1-point increase in the Phoenix-8, the relative risk of mortality increased by 37.5% (with odds ratio of 1.38, 95% confidence interval of 1.18-1.60, P<0.05). The AUROC values (around 0.80) of PSS and Phoenix-8 for predicting mortality risk in pediatric patients with severe sepsis combined with CNS diseases, multiple infections, and cardiovascular system diseases were relatively high. In contrast, the AUROC values (0.60-0.80) for predicting mortality risk in pediatric patients with severe sepsis combined with shock or malignant tumors were moderate. All models passed the Hosmer-Lemeshow goodness-of-fit test ( P>0.05). The DeLong test indicated no statistically significant differences in predictive ability between PSS and Phoenix-8 across subgroups of pediatric patients ( P>0.05). Conclusions:PSS and Phoenix-8 exhibited higher specificity than most of the commonly used pediatric sepsis scores in predicting mortality risk under traditional standards. Both scores performed much better in predicting the mortality risk in pediatric patients with severe sepsis combined with CNS diseases, multiple infections, and cardiovascular system diseases.

Objective:To investigate the factors affecting the efficacy of 131I treatment for Graves′ disease (GD) and to construct a predictive model for the treatment outcomes of 131I therapy. Methods:Retrospective analysis of the treatment efficacy was performed on 2 190 patients (547 males, 1 643 females, age (42.9±12.4) years) with GD, who received initial 131I treatment in Tianjin Medical University General Hospital between October 2013 and May 2018. Univariate analysis ( χ2 test, et al) and logistic regression were performed to analyze the possible factors affecting the efficacy of 131I treatment. An efficacy prediction model for 131I treatment of GD was constructed, and decision curve analysis (DCA) was used to evaluate the clinical utility of the prediction model. Results:The overall effectiveness rate of 131I treatment for GD patients was 99.95%(2 189/2 190), with a total cure rate of 83.74%(1 834/2 190), among which 94.11%(1 726/1 834) were cured after a single treatment. Pre-treatment thyroid mass was identified as an independent risk factor affecting the efficacy of initial 131I treatment (odds ratio ( OR)=0.983(95% CI: 0.977-0.989), P<0.001). The clinical cure rate was higher in patients who received an adequate dose of 131I compared with that in patients who didn′t receive an adequate dose (79.97%(1 537/1 922) vs 70.52%(189/268); χ2=12.57, P<0.001), but it did not increase the incidence of hypothyroidism within one year. A predictive model was constructed, and it was found that thyroid mass and disease duration had a relatively high impact on the clinical cure rate. The concordance index (C-index) of the predictive model was 0.623(95% CI: 0.593-0.654). DCA indicated that the predictive model offered substantial net benefits across a wide range of probability thresholds. Conclusions:131I treatment is effective in most patients with GD. The predictive model for efficacy of initial 131I treatment developed in this study can assist in evaluating treatment outcomes and help clinicians select the most suitable 131I treatment dose, enhancing clinical decision-making.

Objective To investigate the specific molecular mechanism through which microRNA-4488(miR-4488)regulates the proliferation,migration and invasion capabilities of glioblastoma(GBM)by modula-ting the expression level of scratch family transcriptional repressor 1(SCRT1).Methods Quantitative real-time PCR(qPCR)was performed to measure the expression levels of miR-4488 and SCRT1 in astrocyte SVG cells and GBM U87MG cells.Transient transfection was used to introduce miR-4488 mimic nc(mimic control group),miR-4488 mimic(mimic group),miR-4488 inhibitor nc(inhibitor control group),and miR-4488 inhib-itor(inhibitor group)into U87MG cells,which were then divided into four groups accordingly.Lentiviral transfection was used to establish U87MG cell lines transfected with SCRT1 empty vector(control group)and SCRT1 overexpression plasmid(overexpression group).Bioinformatics analysis was performed to identify and validate the binding site sequence between miR-4488 and SCRT1,and the dual-luciferase reporter gene as-say was conducted to verify their targeting relationship.The EdU assay was employed to assess cell prolifera-tion capacity,while the Transwell assay was used to analyze differences in migratory and invasive capacities a-mong groups.Results Compared with SVG cells,miR-4488 expression was upregulated(P＜0.001)and SCRT1 expression was downregulated in U87MG cells(P＜0.001).After transient transfection with miR-4488 mimic,the expression of SCRT1 in the mimic group decreased compared to the mimic control group,with no significant change in proliferative capacity(P＞0.05),but enhanced migration and invasion abilities(P＜0.01 and P＜0.001,respectively).Conversely,after transfection with miR-4488 inhibitor,the expression of SCRT1 in the inhibitor group increased compared to the inhibitor control group,with no significant change in proliferative capacity(P＞0.05),but weakened migration and invasion abilities(P＜0.01 and P＜0.001,re-spectively).The dual-luciferase reporter gene assay confirmed that SCRT1 is a target of miR-4488 in U87MG cells.The SCRT1 overexpression group showed reduced migration and invasion abilities compared to the con-trol group(P＜0.01 and P＜0.001,respectively).Conclusion MiR-4488 can specifically regulate the expres-sion of SCRT1 to affect the migration and invasion characteristics of GBM.

INTRODUCTION: Comparison of patient health-related quality of life (HRQOL) scores to a reference group is needed to quantify the HRQOL impact of disease or treatment. This study aimed to establish population norms for 2 HRQOL questionnaires-EuroQol 5-dimension 5-level questionnaire (EQ-5D-5L) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core Question-naire 30 (EORTC QLQ-C30) according to age, sex and ethnicity-and to explore relationships between the EQ-5D-5L, EORTC QLQ-C30 and sociodemographic characteristics. We used a representative sample of adult Singapore residents aged 21 years and above. METHOD: This study used data collected from a cross-sectional household survey in which 600 adult Singaporeans completed questions on sociodemo-graphic characteristics-the EQ-5D-5L and the EORTC QLQ-C30. Multiple linear regression analyses were conducted to explore associations between sociodemographic characteristics, the EQ-5D-5L scores and the EORTC QLQ-C30 scores. Regression-based population norms were computed for each subgroup using a post-stratification method. RESULTS: In multiple linear regression analysis, age was significantly associated with EQ-5D-5L index and visual analogue scale (VAS) scores, while no sociodemographic characteristics were significantly associated with EORTC QLQ-C30 summary scores. The normative EQ-5D-5L index and VAS scores decreased in adults aged 65 years and above, and EQ-5D-5L index scores were slightly lower in females than males and in non-Chinese than Chinese. The normative EORTC QLQ-C30 summary scores were slightly higher in Chinese than in the non-Chinese group and in the 45-64 age group than other age groups. CONCLUSION This study provides population norms for the EQ-5D-5L and EORTC QLQ-C30 for the general adult population in Singapore. Future studies of patient populations in Singapore using EQ-5D-5L or QLQ-C30 can use these normative data to interpret the HRQOL data collected.
Humans ; Quality of Life ; Singapore ; Male ; Female ; Middle Aged ; Adult ; Cross-Sectional Studies ; Aged ; Surveys and Questionnaires ; Young Adult ; Health Status ; Age Factors ; Linear Models ; Aged, 80 and over