Objective To evaluate the therapeutic effects of different intracranial pressure lower-ing regimens in patients with acute large-area cerebral infarction based on electrical impedance tomo-graphy(EIT)technology.Methods A total of 75 patients with acute large-area cerebral infarction were selected as the study subjects and randomly divided into study group(n=40,using mannitol combined with albumin to decrease intracranial pressure)and control group(n=35,using mannitol alone to decrease intracranial pressure).EIT technology was used to continuously monitor the changes in intracranial pressure within 48 hours in the patients.Clinical data of the two groups were collected,and the 24-hour intracranial pressure change rate,48-hour intracranial pressure change rate,ICU stay duration,hospitalization duration,antibiotic use duration,and National Institutes of Health Stroke Scale(NIHSS)score at discharge were observed and compared between the two groups.A 90-day sur-vival follow-up was also conducted.Results There was no statistically significant difference in the 24-hour intracranial pressure change rate between the two groups(P＞0.05).The 48-hour intracrani-al pressure change rate in the study group was higher than that in the control group,and the difference was statistically significant(P＜0.05).The ICU stay duration,hospitalization duration,and antibiotic use duration in the study group were all shorter than those in the control group,and the NIHSS score at discharge in the study group was lower than that in the control group,with statistically significant differences(P＜0.05).The follow-up results showed that the survival duration in the study group was longer than that in the control group,and the 90-day cumulative survival rate in the study group was higher than that in the control group,but the differences were not statistically significant(P＞0.05).The modified Rankin Scale score in the study group was lower than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion Compared with the use of mannitol alone,early use of mannitol combined with albumin can effectively decrease the in-tracranial pressure within 48 hours,shorten the hospitalization duration,and improve neurological function in patients with acute large-area cerebral infarction.

This study introduces the development of a 96-channel genetic analyzer and its application in forensic medicine.The instrument integrates a fluorescence excitation system,a fluorescence spectral imaging system,and a data acquisition and analysis system,enabling the simultaneous detection of 96 DNA samples.Performance validation in forensic science demonstrated that the analyzer can resolve DNA fragments differing by 1 bp,with accurate DNA typing and a detection sensitivity of 0.125 ng,while maintaining good repeatability.The system can effectively process various forensic samples,including blood cards,saliva cards,and shed cell swabs.In practical applications,the analyzer has significantly improved detection efficiency and shown excellent performance.Looking forward,by broadening the detection range of the nine-color fluorescence spectrum and enhancing the level of data intelligence,the instrument is expected to further strengthen its high-throughput multi-locus detection capability and efficiency,providing more powerful technical support for forensic DNA analysis.

This study introduces the development of a 96-channel genetic analyzer and its application in forensic medicine.The instrument integrates a fluorescence excitation system,a fluorescence spectral imaging system,and a data acquisition and analysis system,enabling the simultaneous detection of 96 DNA samples.Performance validation in forensic science demonstrated that the analyzer can resolve DNA fragments differing by 1 bp,with accurate DNA typing and a detection sensitivity of 0.125 ng,while maintaining good repeatability.The system can effectively process various forensic samples,including blood cards,saliva cards,and shed cell swabs.In practical applications,the analyzer has significantly improved detection efficiency and shown excellent performance.Looking forward,by broadening the detection range of the nine-color fluorescence spectrum and enhancing the level of data intelligence,the instrument is expected to further strengthen its high-throughput multi-locus detection capability and efficiency,providing more powerful technical support for forensic DNA analysis.

Objective:To explore the relevant factors affecting the efficacy of microscopic spermatic cord surgery and build a predictive model for postoperative pain relief.Methods:A retrospective analysis was conducted on the clinical data of 324 patients with spermatic cord pain who visited the Department of Urology at Peking University People's Hospital between October 2015 and April 2023.This cohort included 212 patients with varicocele-related spermatic cord pain and 112 patients with idiopathic sper-matic cord pain.All the patients underwent microsurgical procedures:varicocele-related pain was treated with microsurgical varicocelectomy,and idiopathic pain was treated with microsurgical denervation of the spermatic cord.The patients were categorized into effective and ineffective groups based on whether their pain had decreased by more than 50％six months post-surgery compared with pre-surgery levels.Base-line data were preliminarily screened for clinical indicators using t tests and univariate analysis.Clinical predictor variables[age,duration of pain,diameter of varicocele,patient health questionnaire-9(PHQ-9)score,generalized anxiety disorder-7(GAD-7)score]were selected using Lasso regression.Aclini-cal prediction model for effective pain relief following microscopic spermatic cord surgery was constructed using Logistic regression and presented as a nomogram.The model's internal validation was performed using the bootstrap method.Its predictive power and clinical utility were evaluated through the concor-dance index,the area under the receiver operating characteristic curve,and calibration plots.Results:Post-microscopic varicocele ligation,156 patients(73.58％)experienced significant pain relief,as did 94 patients(83.93％)following microscopic denervation.Independent predictors for postoperative out-comes included age,PHQ-9 score,GAD-7 score,chronic pain duration,and varicocele diameter,diffe-ring slightly between varicocele-related and idiopathic pain groups.The models demonstrated excellent predictive ability,with areas under the curve of 0.909 and 0.913 for varicocele and idiopathic groups,respectively,and high concordance indices.Conclusion:The postoperative efficacy prediction model based on age,pain duration,PHQ-9 score,GAD-7 score,and varicocele diameter has good predictive ability and clinical applicability,and can be used in clinical practice.

Objective To explore the clinical application value of semiconductor laser combined with flat-panel CT guidance in foramen ovale puncture for trigeminal neuralgia(TN).Methods A total of 86 patients with primary TN were selected and randomly divided into control group(n=43)and observation group(n=43).The control group used empirical manual puncture,and the observation group used semiconductor laser combined with flat-panel CT-guided radiofrequency ablation.The first puncture success rate,puncture success time,total operation time,and intraoperative flat-panel CT scan times were carefully evaluated.Results The puncture success time,total operation time,and intraoperative flat-panel CT scan times in the observation group were significantly lower than those in the control group(P＜0.05).In addition,the first puncture success rate and surgical efficiency 12 months after surgery were significantly improved(P＜0.05).The incidence of facial congestion in the observation group was significantly lower than that in the control group(P＜0.05),but there was no statistically significant difference in the incidence of chewing weakness,cerebrospinal fluid leakage,and intracranial infection between the two groups(P＞0.05).Conclusion Minimally invasive foramen ovale puncture under the guidance of semiconductor laser combined with flat-panel CT for the treatment of TN has the advantages of simple operation,accurate positioning,low risk,and few complications,with important clinical application value.

The overuse of antibiotics has led to the severe contamination of water bodies,posing a considerable hazard to human health.Therefore,the development of an accurate and rapid point-of-care testing(POCT)platform for the quantitative detection of antibiotics is necessary.In this study,Cerium oxide(CeO2)and Ferrosoferric oxide(Fe3O4)nanoparticles were simultaneously encapsulated into N-doped nanofibrous carbon microspheres to form of a novel nanozyme(CeFe-NCMzyme)with a porous struc-ture,high surface area,and N-doped carbon material properties,leading to a considerable enhancement of the peroxidase(POD)-like activity compared with that of the CeO2 or Fe3O4 nanoparticles alone.The POD-like activity of CeFe-NCMzyme can be quenched using L-Cysteine(Cys)and subsequently restored by the addition of a quinolone antibiotic(norfloxacin,NOR).Therefore,CeFe-NCMzyme was used as a colorimetric sensor to detect NOR via an"On-Off"model of POD-like activity.The sensor possessed a wide linear range of 0.05-20.0 μM(R2=0.9910)with a detection limit of 35.70 nM.Furthermore,a smartphone-assisted POCT platform with CeFe-NCMzyme was fabricated for quantitative detection of NOR based on RGB analysis.With the use of the POCT platform,a linear range of 0.1-20.0 μM and a detection limit of 54.10 nM were obtained.The spiked recoveries in the water samples were ranged from 97.73％to 102.01％,and the sensor exhibited good accuracy and acceptable reliability.This study provides a portable POCT platform for the on-site and quantitative monitoring of quinolone antibiotics in real samples,particularly in resource-constrained settings.

Objective:To analyze the correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis (ACAS).Methods:In this cross-sectional study, 40 consecutive elderly patients with ACAS treated in the Department of Neurology, Northern Jiangsu People′s Hospital from July 1, 2020 to June 30, 2021 (ACAS group), and 40 elderly healthy controls who accepted physical examination during the same period (control group) were included. Cognitive assessment was performed using the Mental State Examination Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA), and brain magnetic resonance imaging scanning was performed in the ACAS group. The artificial intelligence technique was applied for brain lobe segmentation and cortical volume calculation. The χ2-test, independent sample t-test and Wilcoxon non-parametric test were used to analyze the difference of clinical data and cognitive scores between the two groups. In the ACAS group, the cortical volumes of the side with carotid stenosis was compared with that of the normal side, and Spearman′s correlation analysis was used to assess the correlation between cognitive scores and cortical atrophy. Results:Compared with the control group, the ACAS group got significantly lower scores of MMSE and MoCA, as well as lower scores of visuospatial executive function, attention and calculation, language function, abstraction ability and delayed recall [(25.60±2.49) vs (27.18±1.01), (22.05±3.59) vs (25.60±1.43), (2.73±1.04) vs (4.08±0.62), (4.53±0.93) vs (5.03±0.66), 2.00 (0.00) vs 3.00 (0.00), 1.00 (1.00) vs 2.00 (0.00), and (2.95±0.96) vs (3.35±0.62)] (all P<0.05). There was not significant differences in naming and orientation ability between the two groups (both P>0.05). The volume of cortical, temporal lobe, frontal lobe, parietal lobe and insular lobe on the side with carotid stenosis in the ACAS group were significantly smaller than those on the normal side [186.23 (177.97, 202.53) vs 194.67 (185.65, 204.82) cm 3, 54.74 (50.66, 56.95) vs 55.61 (51.24, 58.49) cm 3, 72.98 (70.76, 78.34) vs 75.27 (72.34, 80.66) cm 3, 53.66 (51.11, 57.86) vs 56.59 (52.80, 60.09) cm 3, 6.57 (6.35, 7.07) vs 6.72 (6.46, 7.34) cm 3] (all P<0.05). The MoCA score in the ACAS group was positively related to the cortical volume ratio of the two sides ( r=0.427, P<0.01). The attention ( r=0.353) and abstraction ( r=0.226) ability scores were positively correlated with the temporal lobe volume ratios of the two sides (both P<0.05). The visuospatial executive ( r=0.187) and language ( r=0.373) ability scores were positively correlated with frontal lobe volume ratios of the two sides (both P<0.05), and visuospatial executive ( r=0.386), naming ( r=0.344), language ( r=0.517), abstraction ( r=0.335) and delayed recall ( r=0.333) ability scores were positively correlated with parietal lobe volume ratios of the two sides (all P<0.05). Conclusion:In elderly patients with ACAS, the cognitive impairment and cortical atrophy on the sides with carotid stenosis are significant and a positive correlation is detected between them.

Sjögren's syndrome （SS）， a disorder of immune system， is one of the dominant diseases treated by traditional Chinese medicine （TCM）. China Association of Chinese Medicine organized experts in the field of TCM and western medicine rheumatology and pharmacology to discuss the advantages and optimal regimens of TCM for the treatment of SS. The experts generally agreed on the low early diagnosis rate of SS and the lack of targeted therapeutic drugs. In addition， autoimmune abnormality is the key factor in the occurrence of SS and deficiency of both Qi and Yin is the core pathogenesis. SS has unique tongue manifestations， which is expected to allow for the early diagnosis and treatment with integrated traditional Chinese and western medicine. TCM has advantages in treating SS in terms of alleviating clinical symptoms and systemic involvement， individualized treatment， relieving sleep and mood disorders， preventing the occurrence in the early stage， and enhancing the effectiveness and reducing toxicity in the treatment by integrated TCM and western medicine. In general， TCM has advantages in different stages of SS. Internal and external use of TCM， acupuncture， and acupotome are all available options. The optimal regimens should be determined on the basis of pattern identification， stage of disease， and the advantages of TCM. Clinical characteristics and biomarkers of SS should be studied to classify patients， so as to design precision evidence-based TCM regimens for SS. On the basis of unique tongue manifestations of SS， models for early diagnosis and poor prognosis identification of SS should also be established to achieve early prevention and treatment and to improve the prognosis. In the future， we should vigorously carry out high-quality evidence-based medical research on the treatment of SS by TCM and integrated traditional Chinese and western medicine and develop relevant guidelines to optimize and standardize current diagnosis and treatment， thereby laying a basis for clarifying and explaining the advantages of TCM in treating SS.

Objective    To characterize surgical outcomes of supra-cardiac total anomalous pulmonary venous connection (TAPVC), investigate risk factors for postoperative death, and explore informed LASSO machine learning methods to solve "small sample size problem" in research of rare congenital heart diseases. Methods    A retrospective analysis of 241 patients with supra-cardiac TAPVC who underwent surgical repair in Guangdong Provincial People's Hospital from 2009 to 2019 was conducted, including 179 males and 62 females with a median surgical age of 71 (33, 232) d. Detailed clinical data of the postoperative death-related factors were extracted. Univariable Cox proportional hazard models were used to initially screen potential risk factors for postoperative death. Factors with P鈮?.05 were retained. To solve the limitation of small sample size and the "P>n" problem, we proposed a novel LASSO method for conducting multivariable Cox regression analysis that was capable of bringing in findings of related studies to improve analysis power and to reduce false-negative findings. Results 聽 聽Univariable Cox analyses showed several potential clinical risk factors, among which highly significant factors (P<0.001) included: surgical weight鈮?.5 kg (HR=16.00), main pulmonary artery diameter (HR=0.78), prolonged cardiopulmonary bypass time (HR=1.21), aortic block time (HR=1.28), and postoperative ventilator-assisted time (HR=1.13/d). LASSO multivariable analysis revealed that independent risk factors for postoperative death included cardiopulmonary bypass time (aHR=1.308/30 min), age (aHR=0.898), postoperative ventilator-assisted time (aHR=1.023/d), weight鈮?.5 kg (aHR=2.545), right vertical venous return (aHR=1.977), preoperative pulmonary venous obstruction (aHR=1.633) and emergency surgery (aHR=1.383). Conclusion 聽 聽Our proposed informed LASSO method can use previous studies' results to improve the power of analysis and effectively solve the "P>n" and small sample size limitation. Cardiopulmonary bypass time, surgical age, postoperative ventilator-assisted time, weight, right vertical venous return, preoperative pulmonary venous obstruction, and emergency surgery are risk factors for postoperative death of supra-cardiac TAPVC.

Objective:To compare the efficacy and safety of preoperative and postoperative concurrent chemoradiotherapies in the treatment of stage Ⅲ-Ⅳ A gastric cancer patients who underwent D2 lymphadenectomy with R0 resection. Methods:A retrospective analysis was conducted on the clinical data of patients with stage Ⅲ-Ⅳ A gastric cancer who underwent D2 lymphadenectomy with R0 resection in the Affiliated Cancer Hospital of Zhengzhou University from 2012 to 2019. Among these patients, 25 received preoperative chemoradiotherapy (group A) and 22 received postoperative chemoradiotherapy (group B). The disease-free survival (DFS), overall survival (OS), local recurrence rate, distant metastasis rate, and adverse reactions were compared between both groups. The total dose, single dose, fractions, and duration of radiotherapy for all the patients were 45-50.4 Gy, 1.8-2.0 Gy, 25-28 fractions, and 5-6 weeks, respectively. The target areas were delineated in accordance with the ASTRO and EORTC-ROG guidelines. Results:There was no statistical difference in clinical baseline characteristics between the two groups. The median follow-up was 48 months (3-72 months). The 1-year OS of group A was significantly higher than that of group B (92% vs. 54.5%, χ2= 5.68, P = 0.017). The 3-year OS and DFS of the two groups were 56% vs. 40.9% ( P> 0.05) and 51.4% vs. 31.8% ( P> 0.05), respectively. There was no significant difference in the local recurrence rate between both groups ( P> 0.05), but the distant metastasis rate of group A was significantly lower than that of group B ( χ2= 6.01, P = 0.014). There was no significant difference in digestive side effects and myelosuppression between both groups ( P> 0.05). Conclusions:For patients with stageⅢ-Ⅳ A gastric cancer after D2 lymphadenectomy with R0 resection, the preoperative and postoperative chemoradiotherapies yield similar efficacy and safety. However, compared to postoperative chemoradiotherapy, preoperative chemoradiotherapy improves the 1-year OS and reduces the distant metastasis rate.