With the widespread application of diving technology, the safety of long-term diving has become a research focus. Research on the chronic health effects of long-term diving on divers mainly focuses on the respiratory system, circulatory system, nervous system, skeletal system, urinary system, as well as psychological health and sleep. Long-term diving can lead to increased lung capacity, thickening of nasal mucosa, myocardial hypertrophy, changes in heart rhythm, and hearing loss in divers. The impact of long-term diving on health is influenced by diving exposure index such as diving mode, maximum diving depth, underwater stay time, diving frequency, and number of dives, as well as individual factors such as years of diving experience, age, and medical history of divers. However, research on the effects of diving on health are inconsistent, and the potential mechanisms of health damage are unclear. Future large-scale research should be conducted under strict experimental conditions and with standardized inclusion criteria for subjects. Establishing a scientific and systematic assessment method for decompression is crucial for studying the chronic health effects of divers and enhancing understanding of relevant mechanisms to promote the development of diving industry and sport.

Objective To study the correlation between carotid bifurcation geometry and atherosclerotic plaque vulnerability using high-resolution magnetic resonance vessel wall imaging(HRMR-VWI),and to seek the potential predictor for vulnerable plaque for-mation.Methods The clinical information and imaging data of 104 patients with carotid bifurcation plaque detected by HRMR-VWI were analyzed retrospectively.Carotid bifurcation geometric parameters was measured to determine whether the carotid bifurcation plaque was vulnerable plaque,and they were divided into vulnerable plaque group(69 cases)and stable plaque group(35 cases).The difference of carotid bifurcation geometry of various groups was investigated,and the influence of common traditional risk factors to obtain independent risk factors was adjusted.Receiver operating characteristic(ROC)curve was drawn.Results Among 104 carotid artery,vulnerable plaque group had larger bifurcation angle(54.00 vs 48.80,P＜0.001),less luminal expansion(1.76 vs 1.94,P=0.002)and less outflow/inflow area ratio(0.79 vs 0.88,P＜0.001)compared with stable plaque group.After adjusting,binary logistic regres-sion indicated that bifurcation angle[odds ratio(OR)1.132 per 10° increase;95％confidence interval(CI)1.044-1.225],luminal expan-sion(OR 0.084 per 1 increase;95％CI 0.014-0.492)and outflow/inflow area ratio(OR 0.357 per 0.01 increase;95％CI 0.177-0.723)were independent risk factors of vulnerable plaque formation.Bringing them into the final model,the area under the curve(AUC)was 0.878 above the basic model(AUC=0.664).Conclusion Bifur-cation angle,luminal expansion and outflow/inflow area ratio are independently associated with vulnerable plaque formation.Carotid bifurcation geometry have the certain predictive efficiency of vulnerable plaque formation and have the incremental diagnostic value to traditional risk factors,which are expected to be effective imaging makers for the formation of vulnerable plaque.

Objective:To construct a predictive model of radiomics based on laparoscopic grayscale ultrasound features and investigate its value in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) during laparoscopic liver resection.Methods:A total of 74 patients (74 lesions)with HCC confirmed by postoperative pathology, who underwent a laparoscopic ultrasonography during laparoscopic hepatectomy were prospectively enrolled in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from March 2022 to August 2023. The general clinical information of the patients was recorded, and the features were extracted and screened from tumor regions in gray-scale ultrasound images, and eventually the radiomics prediction models were constructed, respectively. Pathological results were used as gold standard to compare the effectiveness of different models in predicting MVI.Results:In the 74 HCC lesions, 12 lesions were MVI positive.The MVI imaging prediction model of HCC lesions was constructed from the screened clinical features, laparoscopic gray scale ultrasound image features, as well as combined screened clinical features, respectively. The obtained data sets were randomly divided into 5 parts (4 parts with 15 lesions, 1 part with 14 lesions), and the effectiveness of the model was trained and tested by the method of 5 folds interaction validation. The performance of support vector machine(SVM) radiomics model based on the characteristics of laparoscopic gray scale ultrasound in predicting the MVI of HCC was the best. Compared with clinical model and combined Adaboost model, the SVM, radiomics model had higher area under ROC curve (0.836 vs 0.696, 0.804), accuracy (0.852 vs 0.687, 0.838), sensitivity (0.900 vs 0.900, 0.833) and specificity (0.837 vs 0.644, 0.838). Conclusions:The radiomics model based on the characteristics of laparoscopic gray-scale ultrasound is an innovative potential approach to predict the MVI status of HCC lesions during laparoscopic hepatectomy.

Objective:To investigate the surgical techniques and advantages of Ti-Robot-assisted surgery for pelvic fragility fractures in the elderly.Methods:A retrospective review was performed on geriatric patients presenting with pelvic fractures at the Orthopedics Department of Trauma, China-Japan Union Hospital of Jilin University from September 2019 to December 2022. Minimally invasive procedures were executed with the assistance of the Ti-Robot, and the therapeutic outcomes were appraised. The cohort comprised 24 patients aged ≥60 years, consisting of 6 men and 18 women, with a mean age of 66.1±4.9 years (range, 60-77 years). Fourteen patients sustained high-energy trauma, while 10 encountered low-energy trauma. Fracture classification utilized the FFP system proposed by Rommens and Hofmann. The cohort included 20 patients with FFP II fractures (5 males, 15 females; 4 of type IIa, 12 of type IIb, and 4 of type IIc) and 4 patients with FFP III fractures (1 male, 3 females; all type IIIa). The Matta standard assessment scale gauged fracture reduction, while the Gras classification, with Ti-Robot assistance, assessed screw positioning. Postoperative functionality was holistically assessed based on the Majeed quantitative evaluation system, focusing on pain intensity, sitting, standing, walking, and daily activities. The visual analogue scale (VAS) gauged pain levels in patients with type II fractures, pre and 72 hours post-surgery.Results:According to the Matta standard assessment scale, postoperative fracture reduction quality in 24 elderly patients showed 18 as excellent, 4 as good, and 2 as fair, yielding a 92% (22/24) combined excellent and good rate. Based on the Gras classification, 52 screws were rated as excellent and 7 as good, achieving a 100% positive rate. Utilizing Majeed's modified pelvic fracture evaluation system, postoperative functional recuperation revealed 19 patients as excellent and 5 as good. There were no reports of severe internal disease exacerbations, neurological manifestations, infections, or intraoperative extensive hemorrhaging, with all patients remaining stable. Fractures exhibited robust healing during follow-ups, averaging a recovery time of 3.5±0.7 months (range, 3-5 months). The VAS for 20 patients with FFP type II fractures decreased from 6.3±2.0 pre-surgery to 4.1±1.4 post-surgery ( t=6.14, P=0.003), signifying substantial pain mitigation. Conclusion:In the elderly with pelvic fragility fractures, particularly type II, securing with channel screws is viable. The Ti-Robot-assisted minimally invasive approach is advocated due to its potential to diminish surgical risks and expedite postoperative recuperation.

Talents constitute key resources for the development of healthcare sector, and studying abroad is an important and effective means for their training. Based on the analysis of the current status of China′s international talents training project of hospitals, this study summarized existing problems in such training. The authors covered such six aspects as lawful standardization of project management methods, selection of trainees by levels and by types, innovation of the process tracking management mechanisms and strengthened full-process assessment, all dimensional institutional support, consolidation of the responsibilities by individual disciplines in talent team building, and measures to cope with the impact of COVID-19. In accordance with the research results, the study analyzed the exploration and practice of the international training project under the " Elite Talents Cultivation Project" of the Affiliated Hospital of Qingdao University, and raised targeted recommendations on attention to the strategic and forward-looking planning, precise setup of training goal categories, classified evaluation of study results, and lawful management among others.

Talents constitute core resource in the development of healthcare sector. Based on the situation of the talent team in the Affiliated Hospital of Qingdao University, the authors systematically constructed the hierarchical and classified system for talent cultivation, centering on three key areas of talent cultivation, evaluation and assessment. The authors analyzed the achievements since the implementation in 2016, namely the innovation of talent evaluation, the construction of discipline echelon, and the communication and inter-departmental cooperation. At the same time, the authors further put forward targeted suggestions to promote the development of talent teams in terms of transforming the human resource management model, increasing policy support and funding, implementing refined management, and improving talent evaluation indicators by the levels and types.

OBJECTIVE：To overview the systematic review on the effectiveness of indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis （PEP），and to provide reliable evidence-based reference for the prevention of PEP. METHODS ：Retrieved from PubMed ，the Cochrane Library ，Embase，CBM，CNKI，Wanfang database and VIP，systematic review on indomethacin in the prevention of PEP were collected during the inception to Nov. 2020. The methodological quality ，report quality and evidence quality of the included studies were evaluated by AMSTAR 2 scale，PRISMA statement and GRADE method. The effectiveness of PEP prevention was described. RESULTS ：Finally，23 systematic reviews were obtained ，including 12 in Chinese and 11 in English. Tweenty-two systematic reviews showed that compared with placebo ， indomethacin could effectively reduce the incidence of PEP. Eight systematic reviews showed that indomethacin significantly reduced the incidence of moderate and severe PEP compared with placebo. Five systematic reviews showed that indomethacin could reduce the incidence of postoperative hyperamylasemia compared with placebo. Three systematic reviews showed that indomethacin also had a good preventive effect on people with high risk of PEP. PRISMA score of included systematic reviews ranged from 15 to 25. The quality evaluation of AMSTAR 2 methodology included in systematic reviews was low ，and the key items of complete report were 4，9，11 and 13. The GRADE evidence quality evaluation of the included systematic reviews showed that the quality of the evidence was concentrated in the low level. CONCLUSIONS ：Indomethacin has a certain effect in the prevention of PEP ，but the overall evidence quality of the included literatures is generally not high. It needs to be further validated by high-quality clinical research.

Although genome-wide association studies have identified more than eighty genetic variants associated with non-small cell lung cancer (NSCLC) risk, biological mechanisms of these variants remain largely unknown. By integrating a large-scale genotype data of 15 581 lung adenocarcinoma (AD) cases, 8350 squamous cell carcinoma (SqCC) cases, and 27 355 controls, as well as multiple transcriptome and epigenomic databases, we conducted histology-specific meta-analyses and functional annotations of both reported and novel susceptibility variants. We identified 3064 credible risk variants for NSCLC, which were overrepresented in enhancer-like and promoter-like histone modification peaks as well as DNase I hypersensitive sites. Transcription factor enrichment analysis revealed that USF1 was AD-specific while CREB1 was SqCC-specific. Functional annotation and gene-based analysis implicated 894 target genes, including 274 specifics for AD and 123 for SqCC, which were overrepresented in somatic driver genes (ER = 1.95, P = 0.005). Pathway enrichment analysis and Gene-Set Enrichment Analysis revealed that AD genes were primarily involved in immune-related pathways, while SqCC genes were homologous recombination deficiency related. Our results illustrate the molecular basis of both well-studied and new susceptibility loci of NSCLC, providing not only novel insights into the genetic heterogeneity between AD and SqCC but also a set of plausible gene targets for post-GWAS functional experiments.
Adenocarcinoma of Lung/genetics* ; Carcinoma, Non-Small-Cell Lung/genetics* ; Carcinoma, Squamous Cell/genetics* ; Genetic Heterogeneity ; Genetic Predisposition to Disease ; Genome-Wide Association Study ; Humans ; Lung Neoplasms/genetics* ; Polymorphism, Single Nucleotide

Non-small cell lung cancer (NSCLC) accounts for about 85% of lung cancer, with a 5-year survival rate of less than 15%-19%, and more than 80% of the patients with lung cancer have progressed to advanced stage (Stage IIIb-IV) when they are clearly diagnosed. The comprehensive treatment mainly based on chemotherapy as the primary form is now considered as the major therapy method for advanced NSCLC without actionable driver gene mutations. Pemetrexed plus platinum doublet as well as single-agent pemetrexed are respectively the first-line major regimens recommended by guidelines and the second-line optional regimens. Yet the third-line treatment or beyond in advanced NSCLC is not evidence-based but conducted based on patients' previous medications, which is one of the most commonly used clinical methods. As pemetrexed is a multi-target chemotherapy drug with high efficiency but low toxicity, pemetrexed re-challenge strategy in advanced NSCLC is also a reasonable choice. We report one effective individual case that adopted pemetrexed re-challenge strategy in advanced NSCLC for three times, and at the same time conduct the relevant literature review.
Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; drug therapy ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; Middle Aged ; Pemetrexed ; administration & dosage ; Positron Emission Tomography Computed Tomography

Objective To firstly report the clinical features,diagnosis and treatment response of patients with anti-γ-aminobutyric acid type A receptor (GABAAR) encephalitis in China,thus raising neurologists' awareness of this emerging type of autoimmune encephalitis.Methods Specific anti-GABAAR autoantibodies in the serum and cerebrospinal fluid (CSF) of patients with suspected autoimmune encephalitis but negative for commercial available antibody tests were detected by live cell-based assay (CBA).The clinical features,laboratory examinations and treatment of two cases of autoimmune encephalitis with anti-GABAAR autoantibodies were analyzed,who admitted to Huashan Hospital,Fudan University between 2013 and 2014.Results By using live CBA,serum and CSF of the two patients diagnosed with possible autoimmune encephalitis both contained autoantibodies targeted to the GABAAR.These two patients had onset symptom of seizure or refractory seizures.Memory impairment,psychiatric symptoms and decreased consciousness were also presented.One patient was combined with mass in anterior superior mediastinum.Both patients had multifocal cortical and subcortical T2 /fluid attenuated inversion recovery-weighted images hyperintensity signal on brain magnetic resonance imaging.The two patients had poor response to antiepileptic drugs,but showed noticeable recovery with sufficient immunotherapeutic treatments.Conclusions Anti-GABAAR encephalitis is characterized by prominent epilepsy and multifocal abnormalities on brain magnetic resonance imaging.Autoantibodies specifically against GABAAR could be detected by CBA in this group of patients.Early diagnosis and immunotherapy are critical to improve clinical symptoms and outcomes of the disease.