Background::Acute pulmonary embolism (APE) is a fatal cardiovascular disease, yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs. A simple, objective technique will help clinicians make a quick and precise diagnosis. In population studies, machine learning (ML) plays a critical role in characterizing cardiovascular risks, predicting outcomes, and identifying biomarkers. This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods::This is a single-center retrospective study. Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets. A total of 8 ML models, including random forest (RF), Na?ve Bayes, decision tree, K-nearest neighbors, logistic regression, multi-layer perceptron, support vector machine, and gradient boosting decision tree were developed based on the training set to diagnose APE. Thereafter, the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies, including the Wells score, revised Geneva score, and Years algorithm. Eventually, the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic (ROC) analysis.Results::The ML models were constructed using eight clinical features, including D-dimer, cardiac troponin T (cTNT), arterial oxygen saturation, heart rate, chest pain, lower limb pain, hemoptysis, and chronic heart failure. Among eight ML models, the RF model achieved the best performance with the highest area under the curve (AUC) (AUC = 0.774). Compared to the current clinical assessment strategies, the RF model outperformed the Wells score ( P = 0.030) and was not inferior to any other clinical probability assessment strategy. The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726. Conclusions::Based on RF algorithm, a novel prediction model was finally constructed for APE diagnosis. When compared to the current clinical assessment strategies, the RF model achieved better diagnostic efficacy and accuracy. Therefore, the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

Objective To explore the influencing factors of gastric cancer and construct the clinical prediction model.Methods From December 2020 to October 2023,the clinical data of 1000 patients with stomach neoplasm admitted to Putuo Hospital,Shanghai U-niversity of Traditional Chinese Medicine and Shuguang Hospital,Shanghai University of Traditional Chinese Medicine were collected.Af-ter data cleaning and eliminating abnormal values,the patients were divided into gastric polyps group(n=487)and gastric cancer group(n=479).Non-parametric test was used to screen out meaningful indicators,Lasso regression to screen out the characteristic factors re-lated to gastric cancer with non-zero coefficient,and stepwise Logistic regression analysis to screen out the factors with significant correla-tion,and Lasso-Logistic regression model was constructed.The receiver operator characteristic(ROC)curve was plotted to calculate the area under the curve(AUC)and the confusion matrix to evaluate the model efficiency.Results The results of multivariate Logistic re-gression analysis showed that age,white blood cell(WBC)count,monocyte(M)count,alanine amiontransferase(ALT),cancer anti-gen 724(CA724),cancer antigen 242(CA242),cancer antigen 50(CA50)and carcinoembryonic antigen(CEA)were independent factors affecting gastric cancer.Based on the results of multivariate Logistic regression analysis,the risk prediction nomogram model of gas-tric cancer was constructed.The AUC of test set was 0.91,the accuracy rate was 100％,and the recall rate was 100％;the AUC of valida-tion set was 0.93,the accuracy rate was 93.63％,and the recall rate was 74.1％.The model has good prediction efficiency.Conclusion In this study,8 common predictors of gastric cancer were constructed,and the Lasso-logistic regression prediction model had good differen-tiation,which could be used to complete the early screening of gastric cancer based on the physical examination reports of patients.

【Objective】 To investigate the resource allocation status of blood testing laboratories in 14 blood stations in Gansu Province, explore the impact of differences in basic conditions on the comprehensive testing ability of laboratories, so as to promote the homogenization and standardization of blood screening capacity in blood stations in Gansu and improve blood safety and effectivenes. 【Methods】 An evaluation index system of laboratory resource allocation was constructed and a question-naire was designed. The data of human resources, infrastructure and key equipment of 14 blood stations were collected. The entropy weight -TOPSIS method was used to evaluate and rank the resource allocation of 14 blood stations. 【Results】 In the comprehensive evaluation of blood testing laboratory resource allocation in 14 blood stations in Gansu, the top three were laboratories A, B and I, and the last three were laboratories G, M and J. On the whole, the main issue was unreasonable structure of human resources: most laboratories had unreasonable age structure; except for Laboratory A, there was no personnel with bachelor's degree or above in laboratories; most laboratories had not established a team with intermediate professional titles. In terms of infrastructure, the size of seven laboratories could not meet the needs of modern laboratory testing, and all eight blood stations had no spare nucleic acid laboratories nor a mutual spare laboratory with other blood stations As for the key equipment, 5 laboratories had no automatic blood grouping diagnostic instrument, 5 laboratories only had one set of enzyme immunoassay detection system, 3 laboratories had no spare equipment for the key equipment, which means if the equipment failure could not be repaired in time, the release of results would be affected. 【Conclusion】 There were significant differences in human resources, infrastructure and key equipment of blood testing laboratories in 14 blood stations in Gansu, which had a great impact on laboratory testing capacity and subsequent development. It is suggested that governments at all levels and health administrative departments optimize the input of laboratory resource allocation according to the blood collection volume of blood stations to gradually narrow the differences in resource distribution between different regions, improve the degree of laboratory automation and optimize the personnel structure, so as to build high-quality and efficient blood testing laboratories and ensure the safety of clinical blood use.

Objective:To evaluate the safety and tolerance of sequential thoracic radiotherapy combined with PD-1/PD-L1 inhibitors in patients with extensive-stage small cell lung cancer (ES-SCLC) after induction systemic therapy.Methods:ES-SCLC patients from a phase I trial and a real-world study were enrolled for those who received thoracic radiotherapy after induction systemic treatment (chemotherapy/chemotherapy combined with PD-1/PD-L1 inhibitors) and consolidated with PD-1/PD-L1 inhibitors. These two studies were both approved by the Ethics Committee of Chinese Academy of Medical Sciences Cancer Hospital (Clinical Trials.gov number, NCT03971214, NCT04947774).Results:Between January 2019 and March 2021, a total of 11 patients with ES-SCLC were analyzed, aged 52-73 years, with a median age of 62 years. Among them, five patients (45.5%) received induction chemotherapy and six patients (54.5%) received chemotherapy combined with PD-1/PD-L1 inhibitor, and then all received intensity-modulated thoracic radiotherapy after evaluation of systemic treatment efficacy. Two patients developed treatment-related grade G3-5 toxicity (18.2%, 1 treatment-related pneumonitis and 1 radiation esophagitis). G 1-G 2 hematologic toxicity, pneumonia, and anorexia were common mild toxicities. Only one patient (9.1%) terminated immunotherapy due to immune-related pneumonitis. During a median follow-up time of 12.5 months (range: 3.5-16.4 months), the median disease progression-free survival and overall survival was 7.4 months (95% CI: 6.9-8.0 months) and 14.6 months (95% CI: 9.0-20.2 months), respectively. Conclusions:Sequential thoracic radiotherapy followed by PD-1/PD-L1 inhibitor is safe and feasible in patients with ES-SCLC after induction therapy. Given that both thoracic radiotherapy and immunotherapy benefits the ES-SCLC in survival, this comprehensive treatment modality warrants further investigation.

A new coronavirus (SARS-CoV-2) has been identified as the etiologic agent for the COVID-19 outbreak. Currently, effective treatment options remain very limited for this disease; therefore, there is an urgent need to identify new anti-COVID-19 agents. In this study, we screened over 6,000 compounds that included approved drugs, drug candidates in clinical trials, and pharmacologically active compounds to identify leads that target the SARS-CoV-2 papain-like protease (PLpro). Together with main protease (M
Antiviral Agents/therapeutic use* ; Binding Sites ; COVID-19/virology* ; Coronavirus Papain-Like Proteases/metabolism* ; Crystallography, X-Ray ; Drug Evaluation, Preclinical ; Drug Repositioning ; High-Throughput Screening Assays/methods* ; Humans ; Imidazoles/therapeutic use* ; Inhibitory Concentration 50 ; Molecular Dynamics Simulation ; Mutagenesis, Site-Directed ; Naphthoquinones/therapeutic use* ; Protease Inhibitors/therapeutic use* ; Protein Structure, Tertiary ; Recombinant Proteins/isolation & purification* ; SARS-CoV-2/isolation & purification*

Objective:To analyze the stress and displacement distribution of mandibular reconstruction with fibular flap by fixation based on mortise and tenon joint structure with three-dimensional finite element analysis.Methods:A 66-year-old male patient with no fracture or deformity of the mandible was admitted to the Department of Oral and Maxillofacial Head and Neck Oncology of the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in August 2020. The imaging data of the mandible and fibula of the patients were obtained with CT scan. Three-dimensional reconstruction and reverse reconstruction were performed with software Mimics 17.0 and GeomagicWrap 2017 to obtain the three-dimensional models of the mandible and fibula. The model of mandibular reconstruction with fibular flap was obtained by software Solidworks 2017 and Geomagic Design X 64. The cortical bone and cancellous bone were segmented by Boolean operation. The vertical occlusal state was simulated (the loading condition was 125 N downward along the axis of the central incisor and 250 N downward along the axis of the second and third molars). Three dimensional finite element analysis was used to compare and analyze the stress and displacement distribution characteristics of the mandible and internal fixation before and after bone healing with the mortise and tenon joint structure combined with lag screws and traditional titanium plates. After optimized the boundary conditions of the mandible based on the mortise and tenon joint structure, the stress and displacement distribution of the internal fixation and mandible were measured.Results:In terms of stress distribution, under the condition of bone non-union, the stress peak of the internal fixator fixed by mortise and tenon structure was distributed at the junction of bone section and internal fixator, which was 304.07 MPa. The peak stress of the titanium plate fixation was 345.39 MPa at the broken end of the posterior bone. After bone healing, the stress peak distributions of the internal fixator fixed by mortise and tenon structure remained unchanged, which was 58.47 MPa. The stress of the internal fixator was concentrated to the contact point between the titanium nail and the titanium plate, which was 92.06 MPa.In addition, after the boundary conditions were optimized, the stress distribution of the bones was uniform, and the peak stress of internal fixation was 88.56 MPa, which was significantly lower than the maximum yield strength of titanium (860 MPa). In terms of displacement, under the condition of bone non-union, the displacement peaks of the two fixation methods were both located in the right mental foramen in the middle of the lower margin of the mandible and involved the anterior osteotomy surface. The peak value of mandible displacement in tenon and mortise fixation was 1.307 mm, which was slightly lower than that in titanium plate fixation, 1.447 mm.After bone healing, the main displacements of the two fixation methods were located close to the middle of the lower margin of the mandible and did not involve the osteotomy surface. The displacement peak value of titanium plate fixed mode was 0.518 mm, which was less than that of tenon and mortise fixed mode. Under the condition of bone non-union, the peak displacement of the mandible was 0.212 mm after the boundary of the tenon and mortise fixation model was optimized.Conclusions:The tenon and mortise design combined with lag screw fixation is a safe and effective method for the mandible reconstruction with a fibular flap.

Objective:To evaluate the feasibility and accuracy of surgical template guides to assist mandibular osteotomies in craniofacial microsomia.Methods:Ten children diagnosed with craniofacial microsomia (Pruzansky Ⅱ) from May 2018 to November 2018, at the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, were selected for this study. First, pre-operative CT scans were prescribed, osteotomy plans were designed by Mimics 19.0, and individualized template guides were manufactured before surgery. Under the guidance of the surgical template, distraction osteotomy of craniofacial microsomia and distractor implantation surgeries were performed until the proposed length was reached. Then, another CT scan was performed. Based on the registration of pre- and post-surgery mandible statistics harvested by Geomagic Control, six points were randomly chosen on the osteotomy surface to estimate deviations, the mean value of which was calculated as distance deviation between the osteotomy surfaces. Meanwhile, the angle between the osteotomy surfaces was considered as angular deviation. Considering the deviation of 2 mm in distance and 5 degrees in angles as references, a single-sample t-test was conducted in SPSS 25.0 and it was considered as statistically significant when P<0.05. Results:A total of 10 children, six males and four females, diagnosed with craniofacial microsomia, with an average age of 4.9 years, were included in this study. The left-to-right ratio of the afflicted mandibles was 3∶7. The implantation surgeries were successfully conducted on all the patients and no complications were observed. All patients underwent follow-up visits for one year. The results were consistent with the pre-surgery designs, including satisfactory effects of distraction osteogenesis, obvious improvements of facial asymmetries, and corrections of occlusal surface inclinations. The deviation distribution before and after the surgeries could be distinctly visualized, in which the deviation of two matching groups of mandibles was (0.94±0.92) mm, the distance deviation between the osteotomy surfaces was (2.05±0.40) mm, and the angular deviation was (4.76±1.95)°. Compared with references, all the deviations were not statistically significant ( P>0.05). Conclusions:Metal surgical template guides are applicable to assist mandibular osteotomies of craniofacial microsomia with relatively high accuracy, which is beneficial to the intraoperative application of preoperative design so that satisfying effects could be achieved after surgeries.

Objective:To summarize survival outcomes and prognostic factors in esophageal cancer (EC) patients treated with intensity-modulated radiotherapy (IMRT).Methods:A retrospective analysis was performed on the clinical and follow-up data of 1 637 patients with EC who were admitted to our hospital from January 2005 to December 2017 and met the inclusion criteria.The 5-year overall survival (OS), progression-free survival (PFS) and pattern of recurrence were analyzed. The Kaplan-Meier method was used to calculate survival rates, Log-rank test for univariate analysis and Cox method for multivariate analysis were used to detect survival difference.Results:1-year, 3-year and 5-year OS and PFS of the entire group were 65.9% and 45.8%, 34.2% and 25.0%, 27.0% and 18.5%, respectively. Median OS and PFS were 19.4 months (95% CI=18.0-20.7 months) and 10.4 months (95% CI=9.3-11.3 months), respectively. Univariate analysis showed that the sex, KPS, tumor location, T stage, N stage, M stage, TNM stage, radiation dose and treatment modality were prognostic factors for 5-year OS and PFS of EC patients ( P<0.05). Multivariate analysis indicated that the sex, KPS, TNM stage, radiation dose and treatment modality were independent prognostic factors for 5-year OS and PFS ( P<0.05). Conclusions:EC patients treated with IMRT can obtain a promising survival. The sex, KPS, TNM stage, radiation dose and treatment modality are independent prognostic factors for prognosis.

Objective:To analyze the stress and displacement distribution of mandibular reconstruction with fibular flap by fixation based on mortise and tenon joint structure with three-dimensional finite element analysis.Methods:A 66-year-old male patient with no fracture or deformity of the mandible was admitted to the Department of Oral and Maxillofacial Head and Neck Oncology of the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in August 2020. The imaging data of the mandible and fibula of the patients were obtained with CT scan. Three-dimensional reconstruction and reverse reconstruction were performed with software Mimics 17.0 and GeomagicWrap 2017 to obtain the three-dimensional models of the mandible and fibula. The model of mandibular reconstruction with fibular flap was obtained by software Solidworks 2017 and Geomagic Design X 64. The cortical bone and cancellous bone were segmented by Boolean operation. The vertical occlusal state was simulated (the loading condition was 125 N downward along the axis of the central incisor and 250 N downward along the axis of the second and third molars). Three dimensional finite element analysis was used to compare and analyze the stress and displacement distribution characteristics of the mandible and internal fixation before and after bone healing with the mortise and tenon joint structure combined with lag screws and traditional titanium plates. After optimized the boundary conditions of the mandible based on the mortise and tenon joint structure, the stress and displacement distribution of the internal fixation and mandible were measured.Results:In terms of stress distribution, under the condition of bone non-union, the stress peak of the internal fixator fixed by mortise and tenon structure was distributed at the junction of bone section and internal fixator, which was 304.07 MPa. The peak stress of the titanium plate fixation was 345.39 MPa at the broken end of the posterior bone. After bone healing, the stress peak distributions of the internal fixator fixed by mortise and tenon structure remained unchanged, which was 58.47 MPa. The stress of the internal fixator was concentrated to the contact point between the titanium nail and the titanium plate, which was 92.06 MPa.In addition, after the boundary conditions were optimized, the stress distribution of the bones was uniform, and the peak stress of internal fixation was 88.56 MPa, which was significantly lower than the maximum yield strength of titanium (860 MPa). In terms of displacement, under the condition of bone non-union, the displacement peaks of the two fixation methods were both located in the right mental foramen in the middle of the lower margin of the mandible and involved the anterior osteotomy surface. The peak value of mandible displacement in tenon and mortise fixation was 1.307 mm, which was slightly lower than that in titanium plate fixation, 1.447 mm.After bone healing, the main displacements of the two fixation methods were located close to the middle of the lower margin of the mandible and did not involve the osteotomy surface. The displacement peak value of titanium plate fixed mode was 0.518 mm, which was less than that of tenon and mortise fixed mode. Under the condition of bone non-union, the peak displacement of the mandible was 0.212 mm after the boundary of the tenon and mortise fixation model was optimized.Conclusions:The tenon and mortise design combined with lag screw fixation is a safe and effective method for the mandible reconstruction with a fibular flap.

Objective:To evaluate the feasibility and accuracy of surgical template guides to assist mandibular osteotomies in craniofacial microsomia.Methods:Ten children diagnosed with craniofacial microsomia (Pruzansky Ⅱ) from May 2018 to November 2018, at the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, were selected for this study. First, pre-operative CT scans were prescribed, osteotomy plans were designed by Mimics 19.0, and individualized template guides were manufactured before surgery. Under the guidance of the surgical template, distraction osteotomy of craniofacial microsomia and distractor implantation surgeries were performed until the proposed length was reached. Then, another CT scan was performed. Based on the registration of pre- and post-surgery mandible statistics harvested by Geomagic Control, six points were randomly chosen on the osteotomy surface to estimate deviations, the mean value of which was calculated as distance deviation between the osteotomy surfaces. Meanwhile, the angle between the osteotomy surfaces was considered as angular deviation. Considering the deviation of 2 mm in distance and 5 degrees in angles as references, a single-sample t-test was conducted in SPSS 25.0 and it was considered as statistically significant when P<0.05. Results:A total of 10 children, six males and four females, diagnosed with craniofacial microsomia, with an average age of 4.9 years, were included in this study. The left-to-right ratio of the afflicted mandibles was 3∶7. The implantation surgeries were successfully conducted on all the patients and no complications were observed. All patients underwent follow-up visits for one year. The results were consistent with the pre-surgery designs, including satisfactory effects of distraction osteogenesis, obvious improvements of facial asymmetries, and corrections of occlusal surface inclinations. The deviation distribution before and after the surgeries could be distinctly visualized, in which the deviation of two matching groups of mandibles was (0.94±0.92) mm, the distance deviation between the osteotomy surfaces was (2.05±0.40) mm, and the angular deviation was (4.76±1.95)°. Compared with references, all the deviations were not statistically significant ( P>0.05). Conclusions:Metal surgical template guides are applicable to assist mandibular osteotomies of craniofacial microsomia with relatively high accuracy, which is beneficial to the intraoperative application of preoperative design so that satisfying effects could be achieved after surgeries.