To evaluate long-term survival and clinical outcomes of patients with knee osteo-arthritis undergoing total knee arthroplasty (TKA) through long-term follow-up.

Objective To observe the efficacy and safety of 3 D video-assisted thoracoscopic segmentectomy in patients with stage Ⅰ lung cancer treated with indocyanine green(ICG)fluorescence reverse-staining.Methods A total of 132 patients with stage Ⅰ lung cancer who were admitted from May 2022 to September 2024 all underwent three-dimensional video-assisted thoracoscopic segmental resection of the lung.They were divided into the observation group(63 cases)and the control group(69 cases)according to the method of intersegmental plane exposure.The control group was treated with the modified expansion and collapse method,while the observation group was treated with the ICG fluorescence backstaining method.The surgical conditions,pulmonary function,postoperative pain degree,quality of life and complications of the two groups were compared.Results The postoperative chest tube retention time,surgical time,postoperative hospitalization time,total postoperative thoracic drainage volume,and inter-segmental plane exposure time in the observation group were as follows(2.13±0.37)d,(145.12±25.26)min,(5.21±0.95)d,(261.41±28.57)ml and(9.15±1.73)s,respectively.The data of the control groups were(3.29±0.48)d,(178.31±30.45)min,(6.34±1.36)d,(352.03±36.74)ml and(1 651.28±179.84)s,respectively.There was a statistically significant difference between the two groups(P＜0.05).There was no statistically significant difference in the number of intraoperative blood loss and intraoperative lymph node dissections between the two groups(P＞0.05).There was no statistically significant difference in the levels of maximal expiratory flow(PEF),forced expiratory volume in one second(FEV1),and FEV1/forced vital capacity(FVC)between the two groups before the operation and one month after the operation(P＞0.05).The Visual Analogue Scale(VAS)scores of the observation group at 12 hours,48 hours and 72 hours after the operation were(3.25±0.46)points,(2.13±0.35)points and(1.02±0.24)points respectively.The control groups were(4.11±0.59)points,(2.98±0.42)points,and(1.73±0.30)points,respectively.There was a statistically significant difference between the two groups(P＜0.05).There was no statistically significant difference in the scores of negative and positive items between the two groups before the operation and one month after the operation(P＞0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P＞0.05).Conclusion The modified dilatation collapse method and ICG fluorescence reverse staining method have no significant effects on lung function and complications in patients with stage Ⅰ lung cancer,and both can improve the quality of life.Compared with the modified dilatation collapse method,ICG fluorescence reverse staining method can shorten the plane exposure time between segments and the operation time,promote postoperative rehabilitation and alleviate postoperative pain.

Objective To observe the effect of automatic segmentation of prostate cancer(PCa)in 68Ga-prostate specific membrane antigen(PSMA)-11 PET/MRI based on diffusion models.Methods A dataset contained 68Ga-PSMA-11 PET/MRI of 125 cases of PCa was preprocessed.Segmentation network was designed based on Faster-RCNN and spatial and channel reconstruction convolution(SCConv)Diffusion cascade,in which the first-level was used to coarsely localize the prostate and seminal vesicle glands using Faster-RCNN,and the second-level SCConv Diffusion network based on diffusion model was used to segment PCa.The effect of the above models for segmenting PCa in 68Ga-PSMA-11 PET/MRI were observed.Results The Dice similarity coefficient(DSC),intersection over union(IoU),and 95％Hausdorff distance(HD)of the Faster-RCNN+SCConv Diffusion model for segmenting PCa in 68Ga-PSMA-11 PET/MRI was 0.76,0.63 and 20.02 mm,all superior to those of nnU-Net(0.73,0.62 and 21.20 mm)and Faster-RCNN+nnU-Net(0.75,0.62 and 20.70 mm)models,and the segmentation for both single and multiple PCa were all accurate,with less missegment non-tumor tissue.Conclusion Diffusion model based on Faster-RCNN+SCConv diffusion cascade network could be used to completely and accurately segment PCa in 68Ga-PSMA-11 PET/MRI.

Objective To observe the effect of automatic segmentation of prostate cancer(PCa)in 68Ga-prostate specific membrane antigen(PSMA)-11 PET/MRI based on diffusion models.Methods A dataset contained 68Ga-PSMA-11 PET/MRI of 125 cases of PCa was preprocessed.Segmentation network was designed based on Faster-RCNN and spatial and channel reconstruction convolution(SCConv)Diffusion cascade,in which the first-level was used to coarsely localize the prostate and seminal vesicle glands using Faster-RCNN,and the second-level SCConv Diffusion network based on diffusion model was used to segment PCa.The effect of the above models for segmenting PCa in 68Ga-PSMA-11 PET/MRI were observed.Results The Dice similarity coefficient(DSC),intersection over union(IoU),and 95％Hausdorff distance(HD)of the Faster-RCNN+SCConv Diffusion model for segmenting PCa in 68Ga-PSMA-11 PET/MRI was 0.76,0.63 and 20.02 mm,all superior to those of nnU-Net(0.73,0.62 and 21.20 mm)and Faster-RCNN+nnU-Net(0.75,0.62 and 20.70 mm)models,and the segmentation for both single and multiple PCa were all accurate,with less missegment non-tumor tissue.Conclusion Diffusion model based on Faster-RCNN+SCConv diffusion cascade network could be used to completely and accurately segment PCa in 68Ga-PSMA-11 PET/MRI.

Objective To analyze the correlation between the pulmonary immune prognostic index(LIPI)and the prognosis of patients with advanced non-small cell lung cancer(NSCLC)treated with sintilimab.Methods A total of 145 patients with advanced NSCLC were selected as study subjects.All patients received treatment with sintilimab,and their clinical baseline data were recorded.Accord-ing to the LIPI score,patients were divided into low-risk,intermediate-risk,and high-risk groups.The correlation between LIPI and the prognosis of advanced NSCLC patients was analyzed.Factors in-fluencing progression-free survival(PFS)and overall survival(OS)were identified.Results Univa-riate analysis showed that patient age,smoking status,pathological type,clinical stage and LIPI were factors affecting PFS(P＜0.05);age,pathological type,clinical stage and LIPI were factors affecting OS(P＜0.05).Multivariate Logistic regression analysis revealed that age of 60 to 70 years,age＞70 years,adenocarcinoma,stage Ⅳ and high-risk LIPI were independent prognostic factors of PFS(P＜0.05);age＞70 years,poor stage Ⅳ,adenocarcinoma and high-risk LIPI were independent prognos-tic factors of OS(P＜0.05).LIPI influenced patient's prognosis,with low-risk patients showing better outcomes and longer median PFS and OS.Conclusion LIPI is correlated with the prognosis of advanced NSCLC patients treated with sintilimab.Patients with a low-risk LIPI assessment benefit more from sintilimab treatment.

Objective To observe the efficacy and safety of 3 D video-assisted thoracoscopic segmentectomy in patients with stage Ⅰ lung cancer treated with indocyanine green(ICG)fluorescence reverse-staining.Methods A total of 132 patients with stage Ⅰ lung cancer who were admitted from May 2022 to September 2024 all underwent three-dimensional video-assisted thoracoscopic segmental resection of the lung.They were divided into the observation group(63 cases)and the control group(69 cases)according to the method of intersegmental plane exposure.The control group was treated with the modified expansion and collapse method,while the observation group was treated with the ICG fluorescence backstaining method.The surgical conditions,pulmonary function,postoperative pain degree,quality of life and complications of the two groups were compared.Results The postoperative chest tube retention time,surgical time,postoperative hospitalization time,total postoperative thoracic drainage volume,and inter-segmental plane exposure time in the observation group were as follows(2.13±0.37)d,(145.12±25.26)min,(5.21±0.95)d,(261.41±28.57)ml and(9.15±1.73)s,respectively.The data of the control groups were(3.29±0.48)d,(178.31±30.45)min,(6.34±1.36)d,(352.03±36.74)ml and(1 651.28±179.84)s,respectively.There was a statistically significant difference between the two groups(P＜0.05).There was no statistically significant difference in the number of intraoperative blood loss and intraoperative lymph node dissections between the two groups(P＞0.05).There was no statistically significant difference in the levels of maximal expiratory flow(PEF),forced expiratory volume in one second(FEV1),and FEV1/forced vital capacity(FVC)between the two groups before the operation and one month after the operation(P＞0.05).The Visual Analogue Scale(VAS)scores of the observation group at 12 hours,48 hours and 72 hours after the operation were(3.25±0.46)points,(2.13±0.35)points and(1.02±0.24)points respectively.The control groups were(4.11±0.59)points,(2.98±0.42)points,and(1.73±0.30)points,respectively.There was a statistically significant difference between the two groups(P＜0.05).There was no statistically significant difference in the scores of negative and positive items between the two groups before the operation and one month after the operation(P＞0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P＞0.05).Conclusion The modified dilatation collapse method and ICG fluorescence reverse staining method have no significant effects on lung function and complications in patients with stage Ⅰ lung cancer,and both can improve the quality of life.Compared with the modified dilatation collapse method,ICG fluorescence reverse staining method can shorten the plane exposure time between segments and the operation time,promote postoperative rehabilitation and alleviate postoperative pain.

Objective To investigate the relationship between cerebral atrophy and total burden of cerebral small vessel disease in patients with recent small subcortical infarct(RSSI).Methods A total of 194 elderly RSSI patients admitted to Department of Neurology of Changzhou Second People's Hospital Affiliated to Nanjing Medical University from September 2021 to November 2022 were recruited in this study.All patients completed cranial MRI examination and were divid-ed into a non-mild group 1(97 cases)and a moderate to severe group 1(97 cases)based on the to-tal burden of cerebral small vessel diseases(CSVD)imaging.Visual assessment scale was used to assess the severity of brain atrophy in the whole brain and various regions of the brain.According to the global cortical atrophy scale(GCA)score,all patients were divided into a non-mild group 2(88 cases)and a moderate to severe group 2(106 cases).Brain atrophy in various regions,medial temporal lobe atrophy(MTA)score,frontal temporal lobe atrophy(FTA)score,and posterior cortical atrophy(PA)score were evaluated.Their general clinical and imaging data were collected,multivariate logistic regression analysis was employed to analyze the relationship between GCA score and total burden of CSVD imaging in RSSI patients,and Spearman correlation analysis was further adopted to explore the correlation of GCA score and different parts of brain atrophy with total burden of CSVD imaging.Results When compared with the non-mild group 1,the moderate to severe group 1 had significantly larger proportions of having GCA score of 2-3 points,PA score of 2-3 points,MTA score of 2-4 points and FTA score of 2-4 points(P＜0.01).The ra-tio of having 2-4 points in total imaging burden score of CSVD was obviously higher in the mod-erate to severe group 2 than the non-mild group 2(P＜0.01).Multivariate logistic regression anal-ysis showed that age and total burden of CSVD imaging were independent risk factors for brain atrophy in RSSI patients(OR=1.184,95％CI:1.099-1.276,P=0.000;OR=3.537,95％CI:1.664-7.518,P=0.001).Spearman correlation analysis revealed that the total burden score of CSVD imaging was positively correlated with GCA,MTA,FTA and PA scores in RSSI patients(r=0.518,r=0.382,r=0.471,r=0.388,P=0.000).Conclusion The total burden of CSVD is an independent risk factor for GCA in elderly RSSI patients.The more serious the total burden of CSVD is,the higher the grade of GCA is.The total burden of CSVD is related to the whole brain and brain atrophy in other different regions of the brain.

OBJECTIVE To investigate the causal association between ticagrelor and risk of infection METHODS Two-sample Mendelian randomization was adopted. Genetic instrumental variables were selected based on the results of the largest genome-wide association analysis to in vivo exposure of ticagrelor and its major active metabolite AR-C124910XX. The causal associations of ticagrelor and its major active metabolite AR-C124910XX with drug indications （coronary artery disease， unstable angina pectoris， myocardial infarction， stroke and ischemic stroke）were analyzed by inverse variance weighted Mendelian randomization model as a positive control for genetic instrumental variables. The causal relationship between ticagrelor and bacterial infection， acute lower respiratory infection， bacterial pneumoniae， pneumoniae，acute upper respiratory infection and sepsis were furtheranalyzed by using this method， and the robustness of the results was assessed by using heterogeneity tests and horizontal 202002030415） pleiotropy tests. RESULTS The increase of area under the curve at steady state （AUCss） of the genetic surrogated ticagrelor significantly reduced the risk of coronary artery disease， myocardial infarction and unstable angina pectoris （P＜0.001）. AUCss genetic instrument variables of its main active metabolite AR-C124910XX failed to pass positive control. Further analysis showed that the increase of the genetic surrogated ticagrelor exposure suggestively reduced the risk of bacterial infection [OR（95%CI）＝0.80（0.65，0.99），P＝0.040] and sepsis [OR （95%CI）＝0.84（0.73， 0.98）， P＝0.023]. The results of the heterogeneity tests showed that there was no heterogeneity in the causal association of the genetic surrogated ticagrelor AUCss with bacterial infection and sepsis （P＞0.05）. The results of horizontal pleiotropy tests showed that the causal association of genetic surrogated ticagrelor AUCss with bacterial infection and sepsis had no effects on horizontal pleiotropy （P＞0.05）. CONCLUSIONS Ticagrelor has a potential role in reducing the risk of sepsis and bacterial infections.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective:To search and summarize the literature in the field of joint replacement tele-rehabilitation at home and abroad and carry out visual analysis to discuss the development status, research hotspots and development trends in this field.Methods:Based on the Web of Science index database, literature related to application of tele-rehabilitation in joint replacement was searched from the establishment of the database to December 31, 2022. The literature metrology and knowledge visualization analysis of tele-rehabilitation after joint replacement were carried out by using the cooperative network and co-occurrence network analysis function of CiteSpace visual analysis tool and the result analysis report of Web of Science database.Results:As of December 2022, a total of 1 042 articles were published on research related to remote rehabilitation after joint replacement surgery, with an increasing number of articles published year by year. From 2020 to 2022, the annual number of articles published exceeded 100. The United States ranked first in both the number of articles published (404) and the H-index (44). The journal with the highest publication volume was Journal of Arthroplasty (106 articles), and the author with the highest publication volume was Mont (22 articles). Research hotspots focused on rehabilitation content, outcome evaluation and intervention implementation forms. Conclusions:The application of tele-rehabilitation in the field of joint replacement is becoming increasingly widespread. Foreign countries have started this research field early, while China is still in its infancy, and it is urgent to enrich the implementation of intervention forms, feasibility and effectiveness evaluation. The content optimization of tele-rehabilitation program, the accurate evaluation of curative effect and the optimization of implementation approach are the future research hotspots, and the study of cost effectiveness of tele-rehabilitation is the future research direction.