Objective To explore the application of artificial intelligence (AI) in the standardized training of thoracic surgery residents, specifically in enhancing clinical skills and anatomical understanding through AI-assisted lung nodule identification and lung segment anatomy teaching. Methods Thoracic surgery residents undergoing standardized training at Peking Union Medical College Hospital from September 2023 to September 2024 were selected. They were randomly assigned to a trial group and a control group using a random number table. The trial group used AI-assisted three-dimensional reconstruction technology for lung nodule identification, while the control group used conventional chest CT images. After basic teaching and self-practice, the ability to identify lung nodules on the same patient CT images was evaluated, and feedback was collected through questionnaires. Results A total of 72 residents participated in the study, including 30 (41.7%) males and 42 (58.3%) females, with an average age of (24.0±3.0) years. The trial group showed significantly better overall diagnostic accuracy for lung nodules (91.9% vs. 73.3%) and lung segment identification (100.0% vs. 83.70%) compared to the control group, and the reading time was significantly shorter [ (118.5±10.5) s vs. (332.1±20.2) s, P<0.01]. Questionnaire results indicated that 94.4% of the residents had a positive attitude toward AI technology, and 91.7% believed that it improved diagnostic accuracy. Conclusion AI-assisted teaching significantly improves thoracic surgery residents’ ability to read images and clinical thinking, providing a new direction for the reform of standardized training.

BACKGROUND:With the variation of disease treatment modes and the in-depth research on senile osteoporosis in recent years,increasing studies have confirmed that traditional Chinese medicine has a significant effect on the prevention and treatment of senile osteoporosis. OBJECTIVE:To investigate the effect of Yishen Gushu Formula on bone metabolic markers in patients with osteoporosis of kidney deficiency and blood stasis type. METHODS:102 patients with senile osteoporosis of kidney deficiency and blood stasis type who were treated at Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from July 2020 to March 2022 were enrolled,including 32 males and 70 females,aged 71-93 years.All patients were randomly divided into two groups,with 51 patients in each group.The control group was treated with calcium carbonate D3 granules and sodium alendronate tablets,while the treatment group was treated with Yishen Gushu Formula beyond the control group.Treatments in each group lasted 3 months.Bone mineral density of the L1-4 lumbar vertebrae and left femoral neck,visual analog scale score,and serum levels of osteocalcin,osteopontin,type Ⅰ collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were measured before and 3 months after treatment.Traditional Chinese medicine syndrome score and therapeutic efficiency were also assessed. RESULTS AND CONCLUSION:After 3 months of treatment,the bone mineral density of the lumbar vertebrae(L1-4)and left femoral neck was significantly increased in both two groups(P<0.05),and the bone mineral density of the lumbar vertebrae(L1-4)and left femoral neck was significantly higher in the treatment group than the control group(P<0.05).The visual analog scale scores of both groups after 3 months of treatment were lower than those before treatment(P<0.05),and the visual analog scores of the treatment group after 3 months of treatment were lower than those of the control group(P<0.05).After 3 months of treatment,the serum levels of osteocalcin,osteopontin,type Ⅰ collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were significantly improved in both two groups,while compared with the control group,the serum levels of osteocalcin and osteopontin were significantly higher(P<0.05)and the serum levels of type Ⅰ collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were significantly lower in the treatment group(P<0.05).After 3 months of treatment,the Traditional Chinese medicine syndrome scores were decreased in both two groups,while the Traditional Chinese medicine syndrome scores in the treatment group were lower than those in the control group.After 3 months of treatment,no significant adverse reactions occurred in both groups.The total effective rate was 88.2%and 70.6%in the treatment and control groups respectively,and there was a significant difference between the two groups(P<0.05).To conclude,Yishen Gushu Formula combined with anti-osteoporosis drugs can significantly improve the clinical symptoms of patients with senile osteoporosis of kidney deficiency and blood stasis type and prevent disease progression by regulating bone metabolism,increasing bone mineral density,and relieving pain.

Objective: To investigate the achievement of the target for blood glucose control among community patients with type 2 diabetes mellitus (T2DM) and its influencing factors, so as to provide insights into developing blood glucose management strategies and intervention measures. Methods: Basic information, lifestyle, medication use, disease history, and HbA1c test results of T2DM patients aged 18 years and older and living in Jinshan District, Shanghai Municipality for more than 6 months were collected through Jinshan District Chronic Disease Follow up Management System and district-level information platform. The proportion of blood glucose achieving the control target (HbA1c<7%) was analyzed. Factors affecting the achievement of the target for blood glucose control were identified using a multivariable logistic regression model. Results: A total of 16 758 T2DM patients were included, with 7 844 males (46.81%) and 8 914 females (53.19%), and a median age of 69.00 (interquartile range, 12.00) years. There were 8 095 patients achieving the blood glucose control target, accounting for 48.31%. Multivariable logistic regression analysis showed that age (60-69 years, OR=0.749, 95%CI: 0.675-0.832; 70-79 years, OR=0.892, 95%CI: 0.801-0.993; ≥80 years, OR=1.238, 95%CI: 1.086-1.411), body mass index (overweight, OR=0.926, 95%CI: 0.863-0.993; obesity, OR=0.800, 95%CI: 0.718-0.891), disease course (6-10 years, OR=0.728, 95%CI: 0.673-0.787; ≥11 years, OR=0.534, 95%CI: 489-0.583), smoking (daily, OR=0.792, 95%CI: 0.730-0.860), drinking (daily, OR=0.788, 95%CI: 0.642-0.967), medication adherence (intermittent, OR=0.293, 95%CI: 0.271-0.317; self discontinuation, OR=0.074, 95%CI: 0.064-0.087), hypertension (OR=0.643, 95%CI: 0.588-0.703) and cardiovascular and cerebrovascular diseases (OR=0.671, 95%CI: 0.563-0.800) were the influencing factors for the achievement of the target for blood glucose control among T2DM patients. Conclusion The blood glucose control among T2DM patients is mainly affected by age, body mass index, disease course, smoking, drinking, medication adherence and comorbidities.

BACKGROUND:Studies have found that chondrocyte ferroptosis can be used as an important pathogenesis to induce the occurrence and development of osteoarthritis.With the continuous development of Chinese medicine,some scholars have found that some traditional Chinese medicine monomers and traditional Chinese medicine compounds can inhibit chondrocyte ferroptosis through various mechanisms of action,and finally play a role in the treatment of osteoarthritis. OBJECTIVE:To explore the relationship between ferroptosis and osteoarthritis and the mechanism by which traditional Chinese medicine deals with ferroptosis in the treatment of osteoarthritis,in order to provide new ideas for the treatment and prevention of osteoarthritis. METHODS:With"osteoarthritis,ferroptosis,chondrocytes,lipid metabolism,traditional Chinese medicine,ROS,GPX 4"as the English and Chinese search terms,CNKI,PubMed,WanFang,and VIP databases were searched for relevant articles regarding the relationship between ferroptosis and osteoarthritis and its traditional Chinese medicine intervention until 2022.Then,a systematic analysis was conducted. RESULTS AND CONCLUSION:Intracellular iron overload will cause lipid peroxidation,resulting in the accumulation of reactive oxygen species and eventually the occurrence of ferroptosis,while excessive iron will accelerate the apoptosis of chondrocytes and affect chondrocyte homeostasis,thereby inducing the development of osteoarthritis.When amino acid metabolism is abnormal,an imbalance in glutamate and cystine exchange causes the accumulation of glutamate outside the cells,and high extracellular concentration of glutamate will cause the depletion of glutathione,indirectly inhibiting the function of ferroptosis-related factors,and contributing to ferroptosis.When cellular lipid metabolism is abnormal,unsaturated fatty acids,an important component of the cell membrane,lose their diallyl hydrogen atoms,leading to the destruction of cells to induce ferroptosis,while lipid metabolism is closely involved in the progression of osteoarthritis.Traditional Chinese medicine can play a role in the prevention and treatment of osteoarthritis by inducing the occurrence of ferroptosis.The research on iron death is still immature,and further research on its action mechanism is expected to open up new ways for the clinical treatment of osteoarthritis.

Traditional Chinese Medicine has a long history and plays a decisive role in the fields of modern medicine and pharmacy.It is an important part of our country's traditional medicine.With the progress of the times,people are paying more and more attention to the innovation and development of traditional Chinese medicine.However,the current traditional Chinese medicine talents trained by major universities cannot meet the needs and requirements of society.This is closely related to the current talent training model of universities.Local high-level universities have unique advantages and potential in cultivating inno-vative talents in traditional Chinese medicine.They can incorporate traditional Chinese medicine culture with local characteristics into the teaching content and practical links of training traditional Chinese medicine talents,and build innovative traditional Chi-nese medicine talents integrating science and education.The training model is more conducive to cultivating top innovative talents that meet the needs of society and and the development of traditional Chinese medicine.This article analyzes and discusses how local high-level universities can develop innovative talent training models that suit the needs of traditional Chinese medicine by combining local characteristics and disciplinary advantages,so as to provide useful reference and inspiration for local high-level u-niversities in cultivating talents in traditional Chinese medicine.

Objective:To observe the feelings of listening to music and the importance of music in the daily life of post-lingual deaf adults with cochlear implants, and to explore the relevant influencing factors.Methods:This was a cross-sectional survey study. From January 2021 to August 2021,the Music-Related Quality of Life Scale was used to evaluate the music needs and music experiences of 63 post-lingual deaf adults who met the inclusion criteria, including 27 males and 36 females, aged (40.7±12.3) years, at the time of surgery (36.8±13.1) years, and with a preoperative hearing aid ineffective time of (3.9±5.8) years. Indicators analyzed included age, duration of ineffective preoperative hearing aid wear, preoperative music preference, duration of postoperative cochlear implant use, current hearing aid modality, and auditory rehabilitation outcomes. Whether the six factors mentioned above constituted an influence on the subjects′ music listening was investigated using SPSS 25.0 statistical software.Results:All of the observations in the scale were correlated with a single factor. The two sub-dimensions of music experience section were related to the effect of auditory rehabilitation. In the importance section, the effect of auditory rehabilitation was the influential factor of the dimension of "participation importance", and the preoperative enjoyment of music was the relevant influential factor of the dimension of "perceived importance". There was a significant difference between the groups when they were grouped by the above factors ( P value<0.05), while there was no statistically significance between the groups when they were grouped by other factors ( P value>0.05). Conclusions:Post-lingual deaf adults show the need and attempt to listen to music after cochlear implantation. The effectiveness of auditory rehabilitation and the degree of music preference preoperatively are two important factors that influence music listening in implant recipients. Once the level of auditory communication has been restored to a certain degree, it is important to pay more attention to the needs of music for implant recipients and train them in time, especially for those with music preferences preoperatively.

Objective:To investigate the application value of intraoperative motor nerve monitoring in cervical neurogenic tumor surgery.Methods:The efficacy of intraoperative neuromonitoring (IONM) was analyzed retrospectively in 18 patients, including 6 males and 12 females, aged from 15 to 74 years, treated in Affiliated Drum Tower Hospital, Medical School of Nanjing University from June 2019 to September 2022 who underwent total cystectomy of cervical neurogenic tumors under intraoperative nerve monitoring.Results:All 18 patients had complete tumor removal, including 8 patients with tumors from the vagus nerve and 10 patients with tumors from the brachial plexus nerve. Postoperative nerve functions were normal in patients with tumors from brachial plexus nerve, and incomplete vocal cord paralysis occurred in 2 patients with tumors from vagus vagus nerve. The total incidence of motor nerve injury was 11.1% (2/18). All patients were followed up for 6 to 45 months, with no tumor recurrence.Conclusion:Intraoperative neuromonitoring has significant values in surgery of cervical neurogenic tumors, which is helpful to remove completely the tumors on the basis of protecting the nerve functions to the maximum extent.

Objective:To explore the prognostic factors of primary plasma cell leukemia (pPCL) in the era of novel agents.Methods:The clinical data of 66 patients with pPCL treated at the Department of Haematology, Beijing Chao-Yang Hospital, Capital Medical University from 2011 to 2022 were retrospectively collected to analyze their prognostic factors.Results:Among the 66 patients with pPCL, the median age was 59 (range: 29-79) years. The median overall survival (OS) duration was 19.0 (95% CI 10.4-27.6) months, and the median progression-free survival (PFS) duration was 11.0 (95% CI 6.5-15.6) months. The median OS and PFS were significantly longer in patients with the best post-treatment response of very good partial remission (VGPR) or better than in patients with a response of partial remission (PR) or worse (median OS: 33.0 months vs 6.0 months, P<0.001; median PFS: 16.0 months vs 3.0 months, P<0.001). OS was significantly longer in patients who underwent autologous hematopoietic stem cell transplantation than in those who did not undergo transplantation (49.0 months vs 6.0 months, P=0.002), and there was a trend toward a longer PFS in patients who underwent transplantation than in those who did not undergo transplantation (19.0 months vs 8.0 months, P=0.299). The median OS and PFS were significantly longer in patients who received maintenance therapy than in those who did not receive maintenance therapy (median OS: 56.0 months vs 4.0 months, P<0.001; median PFS: 20.0 months vs 2.0 months, P<0.001). Multivariate analysis showed that hypercalcemia was an independent risk factor ( HR=3.204, 95% CI 1.068-9.610, P=0.038) for patients with pPCL, while receiving maintenance therapy ( HR=0.075, 95% CI 0.022-0.253, P<0.001) and post-treatment response of VGPR or better ( HR=0.175, 95% CI 0.048-0.638, P=0.008) were independent protective factors for patients with pPCL. Conclusions:In the era of novel agents, hypercalcemia, receiving maintenance therapy, and post-treatment response of VGPR or better are independent prognostic factors for pPCL.

Objective:To analyze the clinical characteristics and prognosis of acute pancreatitis (AP) in children, and provide reference for clinical prevention and treatment of AP in children.Methods:Based on the electronic medical record system of the Affiliated Hospital of Zunyi Medical University, the clinical data of children with AP in the hospital from January 2011 to December 2020 were retrospectively analyzed. According to the severity of the disease, the children were divided into mild acute pancreatitis (MAP) group and severe acute pancreatitis (SAP) group. The general data, laboratory tests and outcomes indicators of the two groups were collected and compared. The epidemiological characteristics of children with AP were analyzed. Multivariate Logistic regression was used to analyze the risk factors of SAP in children.Results:A total of 227 children with AP were enrolled, including 161 in MAP group and 66 in SAP group. The median age of children with AP was 12.00 (8.00, 16.00) years old, and 126 cases (55.51%) were male. The main initial clinical symptoms were abdominal pain, nausea, vomiting and abdominal distension (97.36%, 61.67% and 14.10%, respectively), 21 cases (9.25%) were admitted to intensive care unit (ICU), and 4 cases (1.76%) died in hospital due to sepsis, multiple organ dysfunction or traumatic shock. The epidemiological characteristics showed that the first onset age of AP was mainly 7-17 years old (85.02%); the main etiologies were biliary tract disease (29.96%), viral infection (29.07%) and idiopathic factors (19.82%). From 2011 to 2020, the number of children with AP showed a fluctuating trend, and from 2018 to 2020, the number of children with AP increased for three consecutive years. Compared with MAP group, the age of SAP group was significantly older, the proportion of female, the proportion of rural source, acute physiology and chronic health evaluationⅡ(APACHEⅡ), body mass index (BMI), and the levels of white blood cell count (WBC), C-reactive protein (CRP), hospitalization expenses, the proportion of AP caused by traumatic factors and drug factors in SAP group were significantly higher (all P < 0.05). The level of blood calcium and the proportion of AP caused by virus infection were significantly lower, and the length of hospital stay in SAP group was significantly longer (all P < 0.05). The multivariate Logistic regression analysis showed that APACHEⅡscore [odds ratio ( OR) = 1.495, 95% confidence interval (95% CI) was 1.293-1.728] and age ( OR = 1.352, 95% CI was 1.182-1.546) were closely related to SAP in children (all P < 0.001). Conclusion:Children with AP mostly occurs in preschool and adolescence, and the overall mortality is relatively low; biliary tract disease, viral infection and idiopathic factors are common causes; APACHEⅡ score and age may be risk factors for SAP in children.

Objective To propose a deep learning neural network approach for transforming megavoltage computed tomography(MVCT)images of cervical cancer into pseudo kilovoltage computed tomography(kVCT)images with high signal-to-noise ratio and contrast-to-noise ratio,thus providing three-dimensional anatomical images and localization information required for adaptive radiotherapy of cervical cancer,and guiding the accelerator to achieve precise treatment.Methods The MVCT and kVCT images of 54 patients treated with cervical cancer radiotherapy were collected,with 44 cases randomly selected as the training set,and the remaining 10 cases as the test set.A cyclic generative adversarial network with gating mechanism and multi-channel data input was used to synthesize pseudo-kVCT images from MVCT images.The network training results were evaluated with imaging quality evaluation parameters,such as mean absolute error(MAE),peak signal-to-noise ratio(PSNR),and structural similarity index(SSIM).Results The MAE,PSNR,and SSIM of MVCT imagesvspseudo-kVCT(5:5)images were(24.9±0.7)HUvs(17.8±0.3)HU,(29.8±0.2)dBvs(30.7±0.2)dB,and 0.841±0.007 vs 0.898±0.003,respectively.Conclusion The generated pseudo-kVCT images have advantages in noise reduction and contrast enhancement,and can reduce the need for additional MV-kVCT electron density calibration in dose calculations.The dose calculation ability of pseudo-kVCT is comparable to that of MVCT,providing a possibility for the application of pseudo-kVCT images in image-guided adaptive radiotherapy.