Objective:To develop and validate a predictive model of 28-day mortality in sepsis based on lactate dehydrogenase-to-albumin ratio (LAR).Methods:Sepsis patients diagnosed in the department of intensive care medicine of the First Affiliated Hospital of Soochow University from August 1, 2017 to September 1, 2022 were retrospective selected. Clinical data, laboratory indicators, disease severity scores [acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment (SOFA)] were collected. Patients were divided into death group and survival group according to whether they died at 28 days, and the difference between the two groups was compared. The dataset was randomly divided into training set and validation set according to 7∶3. Lasso regression method was used to screen the risk factors affecting the 28-day death of sepsis patients, and incorporating multivariate Logistic regression analysis (stepwise regression) were included, a prediction model was constructed based on the independent risk factors obtained, and a nomogram was drawn. The nomogram prediction model was established. Receiver operator characteristic curve (ROC curve) was drawn to analyze and evaluate the predictive efficacy of the model. Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA) were used to evaluate the accuracy and clinical practicability of the model, respectively.Results:A total of 394 patients with sepsis were included, with 248 survivors and 146 non-survivors at 28 days. Compared with the survival group, the age, proportion of chronic obstructive pneumonia, respiratory rate, lactic acid, red blood cell distribution width, prothrombin time, activated partial thromboplastin time, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, blood potassium, blood phosphorus, LAR, SOFA score, and APACHEⅡ score in the death group were significantly increased, while oxygenation index, monocyte count, platelet count, fibrinogen, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and blood calcium were significantly reduced. In the training set, LAR, age, oxygenation index, blood urea nitrogen, lactic acid, total cholesterol, fibrinogen, blood potassium and blood phosphorus were screened by Lasso regression. Multivariate Logistic regression analysis finally included LAR [odds ratio ( OR) = 1.029, 95% confidence interval (95% CI) was 1.014-1.047, P < 0.001], age ( OR = 1.023, 95% CI was 1.005-1.043, P = 0.012), lactic acid ( OR = 1.089, 95% CI was 1.003-1.186, P = 0.043), oxygenation index ( OR = 0.996, 95% CI was 0.993-0.998, P = 0.002), total cholesterol ( OR = 0.662, 95% CI was 0.496-0.865, P = 0.003) and blood potassium ( OR = 1.852, 95% CI was 1.169-2.996, P = 0.010). A total of 6 predictor variables were used to establish a prediction model. ROC curve showed that the area under the curve (AUC) of the model in the training set and validation set were 0.773 (95% CI was 0.715-0.831) and 0.793 (95% CI was 0.703-0.884), which was better than APACHEⅡ score (AUC were 0.699 and 0.745) and SOFA score (AUC were 0.644 and 0.650), and the cut-off values were 0.421 and 0.309, the sensitivity were 62.4% and 82.2%, and the specificity were 82.2% and 68.9%, respectively. The results of Hosmer-Lemeshow test and calibration curve showed that the predicted results of the model were in good agreement with the actual clinical observation results, and the DCA showed that the model had good clinical application value. Conclusion:The prediction model based on LAR has a good predictive value for 28-day mortality in patients with sepsis and can guide clinical decision-making.

Objective:To investigate the effects of transepithelial photorefractive keratectomy (TransPRK) and femtosecond small incision lenticule extraction (SMILE) on corneal biomechanics measured by the Ocular Response Analyzer in the early postoperative period.Methods:A cohort study was conducted.The right eyes of 56 patients who underwent TransPRK and 52 patients who underwent SMILE in Dalian Medical University Affiliated Dalian Third People's Hospital from November 2020 to June 2021 were continuously included.The postoperative follow-up was 3 months.The central corneal thickness (CCT) and keratometry (Km) were measured 1 month and 3 months after surgery.The corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF), corneal hysteresis (CH), and 19 repeatable mechanical infrared signal waveform parameters measured by the Ocular Response Analyzer were recorded before the surgery, 1 month and 3 months after the surgery, respectively.The measurement indexs at different time points between two groups were compared.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Dalian Medical University Affiliated Dalian Third People's Hospital (No.2019-KT-010). Written informed consent was obtained from each patient before surgery.Results:There was no significant difference in CCT, Km, and IOPcc between the two groups at 1 month and 3 months after the surgery (all at P>0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1, dive2 and mslew1 were decreased, while path1, path2, path11, and aplhf were increased at 1 month after the surgery compared with before surgery, showing statistically significant differences (all at P<0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1 decreased, while path1, path2, path11, and aplhf were increased at 3 months after the surgery in comparison with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, the dive2 were decreased at 3 months after the surgery compared with before surgery, and the difference was statistically significant ( P<0.01). At 1 month after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, dive1 and dive2 were higher, while CH, path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). At 3 months after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h2, h21, dive1 and dive2 were higher, while path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). Conclusions:Corneal biomechanics are weakened after both TransPRK and SMILE.In the early postoperative period, the mechanical infrared waveform parameters measured by the Ocular Response Analyzer are better after TransPRK than after SMILE.

BACKGROUND: Tumor microenvironment is a complex and dynamic community, which plays a crucial role in tumor progression via the co-evolution of cancer cells and tumor stroma. Among them, tumor-associated macrophages (TAMs) and tumor neo-vessels are two key components in the tumor microenvironment during cancer invasion. In addition, programmed cell death ligand 1/programmed cell death ligand 1 (PD-1/PD-L1) also plays an important role in tumorigenesis and development, and the clinical strategies to block PD-1/PD-L1 pathway could have great benefits for cancer patients. This study was aimed at analyzing the quantitative expression and prognostic significance of TAMs, tumor neo-vessels and PD-L1 in tumor microenvironment and exploring the relations between the expression of above components with the patients' prognosis of non-small cell lung cancer (NSCLC). METHODS: Clinico-pathological data and surgical specimens of 92 patients with NSCLC were collected, and immunohistochemistry was used to stain the expression of TAMs, tumor neo-vessels and PD-L1 on tumor tissue and peri-tumor tissues. The inverted microscopy was used to take pictures and Image-pro Plus 6.0 software was used for quantitative analysis. The clinicopathological characteristics and overall survival (OS) were analyzed. RESULTS: The median OS of 92 NSCLC cases was 22.5 month. The expression of TAMs, tumor neo-vessels and PD-L1 in tumor tissue and peri-tumor tissues were not statistically significant (P>0.05). According to the cutoff of above key three components in tumor microenvironment, all the cases could be classified into high, middle and low expression groups. The survival analysis demonstrated that the OS in high expression group of TAMs (P=0.016) and PD-L1 (P=0.002) was shorter than the other two groups, respectively, with statistical significance. The OS in high tumor neo vessels group was shorter than the other two groups. However, there was no statistical significance between these three group (P=0.626). Combined with above the three components, all the cases could be classified into low, middle and high density groups. The survival analysis demonstrated that the median OS of combined high density group was shorter than the other two groups (P=0.001). Multivariate analysis by Cox regression indicated that pathological type, TAMs and PD-L1 expression were the independent prognostic factors. CONCLUSIONS The key components of TAMs and PD-L1 in tumor microenvironment are closely related to the prognosis of NSCLC patients.

OBJECTIVE: observe the changes of localization and expression of acetylated tubulin alpha( Ac-tubulin α) in fibroblasts of silicosis fibrosis. METHODS: i) A total of 22 autopsy case with coal workers' pneumoconiosis( CWP) was selected as CWP group( autopsy lesion lung tissue) and their adjacent normal lung tissues surrounding fibrotic regions were selected as the control group using typical sampling method. ii) Specific pathogens free healthy male rats were randomly divided into control group and 5 dust-exposed groups with 10 rats in each group. In dust-exposed group,the rats were exposed to 2 000 mg/m~3 of silica dust for 0,2,4,8,12 and 16 weeks respectively by dynamic inhalation. The rats in control group were given no treatment. iii) Primary cultured rat lung fibroblasts were induced by Ang Ⅱ at a concentration of 100 nmol/L at different time points( 0,5,15 and 30 min,1,3,6,12,24 and 48 hours). iv) The expression of Ac-tubulin α and α-smooth muscle actin( α-SMA) were detected by immunohistochemical staining. The expression of Ac-tubulinα/Vimentin and Ac-tubulin α/α-SMA were observed by immunofluorescence staining. The relative expression ofα-SMA and Ac-tubulin α protein was detected by Western blot. RESULTS: The positive expression of Ac-tubulin α in lung tissue of CWP group was down-regulated while that of α-SMA was up-regulated compared with the control group( P < 0. 01). Immunofluorescence results showed that Vimentin positive expression in the CWP group was significantly increased in the lesion fibrosis area,while Ac-tubulin α expression was absent. The co-expression of Ac-tubulin α and Vimentin was detected in normal lung tissue of control group. The animal experiment results showed that the expression of Ac-tubulin αin lung tissue of rats was down-regulated and that of α-SMA was up-regulated with the prolongation of dust exposure time( P < 0. 01). The Ang Ⅱ induced the differentiation of fibroblasts into myofibroblasts,and the expression of Ac-tubulin α in fibroblasts gradually decreased and the expression of α-SMA gradually increased with the prolongation of Ang Ⅱ induction time( P < 0. 05). CONCLUSION: The lack of expression of Ac-tubulin α may be involved in the occurrence and development of silicotic fibrosis.

Purpose To explore the feasibility of denoising algorithm-PixelShine algorithm based on deep learning to enhance the quality of abdominal arterial phase CT images rebuilt by 70 kVp combined with adaptive statistical iterative reconstruction-Veo (ASiR-V). Materials and Methods Abdominal arterial phase images of 33 patients [body mass index (BMI) BMI≤20 kg/m2] scanned by GE Revolution CT were retrospectively analyzed (group A) using 70 kVp tube voltage and 50% ASiR-V technique. PixelShine algorithm B2 mode was applied to post-process group A images to obtain PixelShine image (group B). Two observers rated the image quality of the two groups via a 5-point rating system. The consistency of the rating was analyzed. The difference in ratings, noise, virtual signal-to-noise ratio (SNR) of liver and pancreas and contrast noise ratio (CNR) were compared between the two groups of images. Results The image quality rating of group A and B were(3.12±0.33) scores and(3.97±0.53) scores respectively,noise value(14.50±1.42)HU vs(10.05±1.80)HU, liver virtual SNR 4.51±0.53 vs 6.78.±1.27,liver virtual CNR 0.89±0.55 vs 1.42±0.81,pancreatic virtual SNR 9.51±1.69 vs 13.87±3.26, and pancreatic virtual CNR 5.83±1.66 vs 8.48±2.46.The quality rating of images,liver and pancreas virtual SNR,CNR in group B were all higher than those in group A, and the image noise of group B decreased about 31% compared with that of group A, the difference was statistically significant (P<0.05). Conclusion Post-processing with PixelShine algorithm can improve the image quality of 70 kVp abdominal arterial phase, significantly reduce image noise, and increase image SNR and CNR.

Purpose To explore the influence of duration of scan acquisition on perfusion parameters in whole renal perfusion with Revolution CT.Materials and Methods Fortytwo patients without pathologic changes in bilateral kidneys were divided into group A (with short perfusion time) and group B (with long perfusion time) according to the duration time of the perfusion scan.The Revolution CT axial scan mode was used for perfusion scan,and the width of detector was 16 cm.The perfusion CT series were performed in 50 seconds,each comprising 25 volumes with identical parameters (80 kVp,200 mA) in group A.The perfusion CT series were performed in 594 seconds,each comprising 23 volumes with identical parameters (120 kVp,55 mA) in group B.The source datasets were post-processed with CT Perfusion 4D software,and the perfusion parameter maps were obtained when right renal abdominal aorta was taken as entry artery.Perfusion parameters of bilateral kidneys were compared within and between group A and group B,respectively.CT dosage index of volume (CTDIvol) and dose length product (DLP) were recorded.The effective dose (ED) was calculated and compared.Results There were no statistical difference in all parameters between bilateral kidneys within each group (P＞0.05).However,blood volume,time to peak,and permeability surface in the cortex and medulla of bilateral kidneys all showed differences between the above two groups (P＜0.05).The mean transit time in the medulla between the two groups was different (P＜0.05),but neither the blood flow in the medulla and cortex nor the mean transit time of the cortex had difference between the two groups (P＞0.05).The effective radiation doses were (23.10± 4.39)mSv in group A and (23.19±0.00) mSv in group B,respectively (without statistic difference:P＞0.05).Conclusion CT perfusion parameters with different duration time show differences in whole renal perfusion;therefore,scanning time needs to be set according to the clinical application.

Objective To explore the source of endothelial cells in tumor vessels by A 549 tumor model with GFP nude mouse.Methods To establish the A 549 lung cancer models with GFP nude mice, expression of CD 31 was determined by immunofluorescence to label tumor vessels; to observe and take a picture of the tumor frozen section by confocal microscopy and invert microscope;expression of GFP in tumor vessels was determined by immunohistochemistry. Result The results of immunofluorescence showed:Tumor interstitial vascular endothelial cells or endothelial cells clusters and micro-vascular lumen size and shape are clearly visible by immunofluorescence, and part of vessels with no obvious lumen or irregular lumen.We can see green fluorescent in tumor cells of tumor tissue and endothelial cells which form of tumor vessels.The results of immunohistochemistry showed: expression of GFP was determined in cytoplasm of tumor stromal cells and endothelial cells in tumor vessels.Conclusion The endothelial cells which formed tumor neovessels that derived from GFP nude mice partly and the other part derived from tumor cells.

OBJECTIVETo observe the influence of electroacupuncture (EA) at lower-sea points of stomach, large intestine, small intestine and gallbladder on interleukin-1β (IL-1β), high mobility group protein 1 (HMGB 1) and alpha 7 nicotinic acetylcholine receptor (nAchR α7) in rats with acute gastric mucosal lesion (AGML), so as to explore whether there is relative specificity in treating gastric viscera disease by stimulating Zusanli (ST 36).

METHODSSixty healthy SD rats were randomly assigned into a blank group, a model group, a Zusanli group, a Shangjuxu group, a Xiajuxu group and a Yanglingquan group, ten rats in each one (half male and half female). The WRS method was applied to induce the AGML model except the rats in the blank group. The rats in the blank group were treated with routine diet; the rats in the model group were treated with immobilization at rat platform, 30 min per time; the rats in the Zusanli group, Shangjuxu group, Xiajuxu group and Yanglingquan group were treated with acupuncture and connected with EA device (dilatational wave 10 Hz/50 Hz, positive electrode on the left side and negative electrode on the right side, intensity was appropriate when rat hind leg slightly shook), 30 min per time. The treatment was given once a day. After consecutive 10-day treatment, the gastric tissue was collected and the damage of gastric mucosa was evaluated; ELISA method was applied to measure the content of serum IL-1β and tissue HMGB 1; the Western blot method was applied to measure the expression of nAchR α7 receptor.

RESULTS(1) Compared with the model group, the ulcer index (UI) of gastric mucosa, serum IL-1β and tissue HMGB 1 were lower, and the expression of nAchR α7 was increased in the remaining groups (<0.05,<0.01). (2) Compared with the Zusanli group, the UI of gastric tissue, serum IL-1β and tissue HMGB 1 were higher in the Shangjuxu group, Xiajuxu group and Yanglingquan group (<0.05,<0.01), and the expression of nAchRα7 was reduced in the Yanglingquan group (<0.01).

CONCLUSIONS(1) EA at digestive system-related lower-sea points, through IL-1β, HMGB 1 and nAchR α7, could regulate immune response, lighten inflammatory reaction and reduce mucosal injury, which could realize the intervention effect on AGML rats. (2) From the comparison, it is concluded the intervention effect of Zusanli group is superior to the other groups, partly indicating the relative specificity between Zusanli and stomach.

Objective To evaluate the effect of palliative care in the treatment of pain and life quality in later period tumor patients.Methods 103 patients with advanced tumors in our hospital were selected and divided into group A(51 patients) and group B(52 patients) based on the methods of treatment.The patients in group A were given conventional treatment,and the patients in group B were given palliative care program on the basis of the treat-ment in group A.The effects of the groups A and B were observed and compared.Results The pain levels of group A and B before treatment had no statistically significant difference (P>0.05).The pain level score of group B after treatment was (26.41 ±3.55)points,which was lower than (32.56 ±7.12)points in group A,and the difference was statistically significant (t=6.430,P<0.05).The difference in life quality of the two groups before treatment was not significant (P>0.05).After treatment,the life quality score of group B was (66.85 ±6.75)points,which was higher than (53.39 ±6.74)points in group A,and the difference was statistically significant (P<0.05).Conclusion It is effective for palliative care to treat the patients with advanced tumors on their pain management and quality of life, which is worthy of clinical application.