OBJECTIVE To evaluate the cost-effectiveness of vitamin D analogue for postmenopausal osteoporotic women in China. METHODS A Markov microsimulation model was developed to analyze the clinical and economic outcomes of eldecalcitol， alfacalcidol and calcitriol for postmenopausal osteoporosis from the healthcare system perspective in China. The clinical parameters required for the model were derived from network meta-analysis， while cost and utility data were primarily obtained from the literature. The cycle length was 1 year ， the time horizon was life time， and the willingness-to-pay threshold was 0.5 times the gross domestic product per capita in China in 2023（44 679 yuan/QALY）. Model uncertainty was tested with one-way sensitivity analysis， probabilistic sensitivity analysis， and scenario analysis. RESULTS The quality-adjusted life years （QALYs） for eldecalcitol were calculated to be 12.03 QALYs， which were higher than those for alfacalcidol （11.94 QALYs） and calcitriol （11.92 QALYs）. Meanwhile， the direct medical cost associated with eldecalcitol treatment amounted to 38 805 yuan， which was lower than that of alfacalcidol （45 173 yuan） and calcitriol （45 821 yuan）. The results of the one-way sensitivity analysis showed that the risk ratio of hip fracture and vertebral fracture had a significant impact on the result. The probabilistic sensitivity analysis and scenario analysis showed the robustness of the findings from the base-case analysis. CONCLUSIONS Compared with alfacalcidol and calcitriol， eldecalcitol is likely to be a cost-effective treatment for postmenopausal osteoporotic women in China.

ObjectiveTo investigate the impact of preoperative frailty on the prognosis of patients with pancreatic cancer who underwent pancreaticoduodenectomy. MethodsA retrospective analysis was conducted on the clinical data of 435 pancreatic cancer patients who underwent pancreaticoduodenectomy at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Preoperative frailty was assessed using the FRAIL questionnaire. Binary logistics regression analysis was employed to identify factors influencing frailty， and Cox regression analysis was used to evaluate the effect of frailty on survival. According to the demographic characteristics， subgroup analyses were performed on the effect of frailty on prognosis of patients with pancreatic cancer with pancreaticoduodenectomy. ResultsAmong the 435 patients enrolled， 119 （27.4%） exhibited frailty， while 316 （72.6%） did not. Significant differences were observed between the two groups in various clinical parameters， including age， body mass index， American Society of Anesthesiologists （ASA） score， postoperative red blood cell transfusion， postoperative abdominal abscess， serum levels of glycoantigens 199， glycoantigens 125， and alpha fetoprotein， leukocyte count， neutrophil， high density lipoprotein （HDL） level， and pain intensity （P＜0.05）. Advanced age and an ASA score of Ⅲ were identified as risk factors for frailty， whereas HDL level was a protective factor. Non-frail patients had better postoperative survival times than frail patients. HDL was determined to be an independent protective factor for prognosis， while LDL was an independent risk factor. ConclusionsThis study demonstrates that preoperative frailty is a significant predictor of poor prognosis in pancreatic cancer patients who underwent pancreaticoduodenectomy.These findings suggest that preoperative frailty assessment and targeted interventions to improve nutritional and metabolic status could potentially enhance postoperative survival and quality of life in pancreatic cancer patients.

Objective     To construct a radiomics model for identifying clinical high-risk carotid plaques. Methods     A retrospective analysis was conducted on patients with carotid artery stenosis in China-Japan Friendship Hospital from December 2016 to June 2022. The patients were classified as a clinical high-risk carotid plaque group and a clinical low-risk carotid plaque group according to the occurrence of stroke, transient ischemic attack and other cerebrovascular clinical symptoms within six months. Six machine learning models including eXtreme Gradient Boosting, support vector machine, Gaussian Naive Bayesian, logical regression, K-nearest neighbors and artificial neural network were established. We also constructed a joint predictive model combined with logistic regression analysis of clinical risk factors. Results    Finally 652 patients were collected, including 427 males and 225 females, with an average age of 68.2 years. The results showed that the prediction ability of eXtreme Gradient Boosting was the best among the six machine learning models, and the area under the curve (AUC) in validation dataset was 0.751. At the same time, the AUC of eXtreme Gradient Boosting joint prediction model established by clinical data and carotid artery imaging data validation dataset was 0.823. Conclusion     Radiomics features combined with clinical feature model can effectively identify clinical high-risk carotid plaques.

Objective To evaluated the efficacy of Supplemented Buyang Huanwu Decoction in preventing and treating postoperative abdominal adhesions.Methods One hundred and eight male SD rats were randomly divided into ordinary group,mold group,Sodium hyaluronate group and Supplemented Buyang Huanwu Decoction group.The animals were sacrificed 7,14 and 28 days after the operation,Visual scoring was performed,and samples were taken from the injury site for hematoxylin-eosin staining and Masson staining,and scanning electron microscope to observe the morphology of peritoneal mesothelial cells in the modeling site.Immunohistochemical method was used to observe the expression of epithelial mesenchymal transition(EMT)related cell marker proteins E-cadherin and α-SMA in the adhesive site.Results ①Efficacy of Supplemented Buyang Huanwu Decoction in the prevention and treatment of postoperative abdominal adhesions:The Supplemented Buyang Huanwu Decoction group can reduce the Diamod visual adhesion score(P<0.05),as well as the adhesion levels of HE staining and Masson staining(P<0.05).②Degree of damage to peritoneal mesothelial cells:Scanning electron microscopy showed that in the field of view of the Supplemented Buyang Huanwu Decoction group,paving like peritoneal mesothelial cells could be seen,indicating that the Supplemented Buyang Huanwu Decoction can improve the damage of peritoneal mesothelial cells on the serosal side of the cecum in PAA.③Expression of Epithelial mesenchymal transition-related indicators:The expression of E-Cadherin protein in the Supplemented BuyangHuanwu Decoction group increased(P<0.05).The expression of α-SMA protein in the Supplemented Buyang Huanwu Decoction group decreased(P<0.05).Conclusion The effect of Supplemented Buyang Huanwu Decoction in the prevention and treatment of postoperative abdominal adhesions is exact,which mechanism may be by reducing Epithelial mesenchymal transition of peritoneal mesothelial cells,reducing the deposition of extracellular matrix,thereby reducing peritoneal adhesion.

Objective To evaluate the application value of the three-point localization method in improving the quality and efficiency of four-chamber view acquisition in cardiac magnetic resonance(CMR)imaging.Methods A total of 215 patients who underwent four-chamber view in CMR imaging from January 2022 to October 2023 were retrospectively enrolled and divided into two groups.The control group(n=109)received traditional localization method while the study group(n=106)received three-point localization method.The image quality of mitral valve,tricuspid valve and cruciform structure in four-chamber view images were assessed by two radiologists using a Likert 4-piont scale.The time-consumption from scout imaging to the finish of four-chamber view imaging was recorded.Constituent data and numeral data were compared by Chi-square test and two-sample t test,respectively.Kappa test was used to analyze the inter-observer consistency.Results There were no significant inter-group differences in gender,age,disease profile,or the radiographers'experience.The mean quality scores of the mitral valve,tricuspid valve and cruciform structure in the control group and the study group were 3.44±0.64 and 3.63±0.49(P=0.023),3.43±0.67 and 3.53±0.60(P=0.202),3.71±0.49 and 3.83±0.35(P=0.047),respectively.The image quality score was higher in the study group than in the control group,with the differences in mitral valve and cruciform structure reaching statistical significance.The time-consumption for obtaining four-chamber view for the control group and the study group was 11.67±3.49 minutes and 7.212±1.83 minutes,respectively,with statistically significant differences(P＜0.001).Conclusion Compared with the traditional localization method,the three-point localization method provides better image quality in four-chamber view imaging with shortened imaging time.

Objective To investigate the value of abdominal aortic combined with routine one-stop triple rule-out computed tomography angiography(TRO-CTA)in the examination of patients with acute chest pain.Methods A total of 1 482 patients with nontraumatic chest pain were included in this retrospective study.Of them 414 patients underwent the conventional TRO-CTA scanning while 1 068 patients underwent TRO-CTA that included the abdominal aorta(TRO-CTAwAA)under the request of clinicians.All scanning parameters were the same,except the scanning range for the third phase in TRO-CTA:conventional TRO-CTA covered only the thoracic aorta,while TRO-CTAwAA extended to the entire aorta.Patient etiology was investigated and the detection rates of major vessel abnormalities(aortic dissection,aneurysm,penetrating ulcer,intramural hematoma,vascular occlusion,and thrombosis)between the two groups was compared using chi square tests.The radiation dose(CTDIvol and DLP)and scanning time between the two groups were compared using analysis of variance(ANOVA).Results The TRO-CTAwAA had significantly higher detection rate of major artery abnormalities than the TRO-CTA group(35.1％vs.4.8％,P＜0.001).In the TRO-CTAwAA group,26.5％of the vascular anomalies were detected in both the thoracic and abdominal aortas,and another 8.6％were seen only in the abdominal aorta.With regard to the radiation dose between the two groups,the total DLP was significantly higher in the TRO-CTAwAA group than in the conventional TRO-CTA group(P＜0.001).The two groups did not significantly differ in scanning time(P=0.410).Conclusion TRO-CTA with scan range including the abdominal aorta significantly improves the detection rate for major vessel abnormalities in patients with chest pain without increasing the examination process.

Objective To evaluate the relationship between the pericoronary fat attenuation index(FAI)and the image reconstruction parameters of computed tomography(CT)coronary angiography,including reconstruction kernel,iterative reconstruction algorithm and image thickness.Methods Forty-four CT coronary angiography scans were prospectively enrolled.All scans were reconstructed by three means as follows:① Four different kernels(Soft_AA,Soft_BA,Soft_CA,and Soft_DA,sharpness from low to high)as the iterative reconstruction algorithm(KARL5)and image thickness(0.5 mm)remained unchanged.② Filtered back projection(FBP)and iterative reconstruction kernel(KARL5)as the kernel and image thickness(0.5 mm)remained unchanged.③ Different image thickness(0.5 mm and 1 mm)as the kernel(Soft_AA)and iterative reconstruction algorithm(KARL5)remained unchanged.The FAI of left anterior descending artery(LAD),left circumflex artery(LCX),and right coronary artery(RCA)was calculated using a dedicated software.Paired t-test and analysis of variance were used for statistical analysis.Results For LAD,LCX and RCA:① The differences of FAI among different reconstruction kernels reached statistical significance(P＜0.001),and FAI decreased as the sharper kernel was used.③ Compared with FBP,the FAI of KARL5-reconstructed images significantly increased(P＜0.001).③ Compared with 0.5 mm,the FAI of images with 1.0 mm thickness significantly decreased(P＜0.001).Conclusion The kernel,iterative reconstruction algorithms,and image thickness all have a significant impact on the FAI of each coronary artery.When using FAI for clinical diagnosis,the effect of CT reconstruction parameters should be taken into account.

A wireless wearable sleep monitoring system based on EEG signals is developed.The collected EEG signals are wirelessly sent to the PC or mobile phone Bluetooth APP for real-time display.The system is small in size,low in power consumption,and light in weight.It can be worn on the patient's forehead and is comfortable.It can be applied to home sleep monitoring scenarios and has good application value.The key performance indicators of the system are compared with the industry-related medical device measurement standards,and the measurement results are better than the special standards.

Pulse rate and blood oxygen levels are crucial physiological parameters that reflect physiological and pathological information within the human body.The system designs a wireless pulse wave monitoring system utilizing a flexible reflective probe and the AFE4490,which is capable of monitoring pulse wave and blood oxygen levels on the human forehead.The system is predominantly based on a reflective flexible probe,the AFE4490,a power supply module,a control microcontroller unit(MCU),and a Wi-Fi module.Post-processing by a slave computer,the collected pulse wave data is wirelessly transmitted to a smartphone.The real-time pulse waveform,pulse rate,and blood oxygen levels are displayed on an application.Following relevant tests and verifications,the system can accurately detect pulse wave signals,meet the requirements for wearable technology,and possesses significant market application potential.

Objective:To explore the related factors of thrombocytopenia (TCP) occurrence in patients with cirrhosis.Methods:A cross-sectional study was conducted. Inpatients with an initial diagnosis of cirrhosis at Peking University First Hospital from January 1, 2010 to December 31, 2020 were included. Clinical data such as demographic characteristics, etiology of cirrhosis, complications of cirrhosis, laboratory indicators, Child-Pugh grade, invasive procedures, and mortality during hospitalization were collected. A logistic regression model was used to explore the related factors of TCP occurrence in patients with cirrhosis. Categorical variables were compared by the χ2 test. The inter-group comparison was performed using continuous variables, a t-test, one-way analysis of variance (ANOVA), or a nonparametric test. Results:There were a total of 2 592 cases of cirrhosis. 75 cases with incomplete clinical data were excluded. 2 517 cases were included for analysis. The median age was 58 (50, 67) years. Males accounted for 64%. 1 435 cases (57.0%) developed TCP, and 434 cases (17.2%) had grade 3-4 TCP. Gender, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and concomitant esophagogastric varices (EGV) were the major factors associated with TCP. Females were more prone to combine with TCP ( OR=1.32, 95% CI: 1.12-1.56, P=0.001). Patients combined with EGV ( OR=3.09, 95% CI: 2.63-3.65, P<0.001) were more prone to develop TCP, which was associated with the increased incidence of hypersplenism ( P<0.001). Patients with PBC ( OR=0.64, 95% CI: 0.50-0.82, P<0.001) and PSC ( OR=0.23, 95% CI: 0.06-0.65, P=0.010) were less prone to develop TCP, which was due to the shorter prothrombin time and better coagulation function of PBC patients ( P<0.001), and the lower proportion of hypersplenism in combined PSC patients ( P=0.004). Patients with TCP and grade 3-4 TCP had a higher rate of hemostatic procedures ( P<0.05), but a lower rate of liver biopsy ( P<0.05). Patients with grade 3-4 TCP had a higher nosocomial mortality rate compared to those without ( P=0.004). Conclusion:TCP is common in patients with cirrhosis. However, TCP occurrence is higher in female patients with EGV and lower in patients combined with PBC and PSC. TCP affects invasive procedures and is associated with adverse outcomes.