Background::Artificial intelligence (AI) technology represented by deep learning has made remarkable achievements in digital pathology, enhancing the accuracy and reliability of diagnosis and prognosis evaluation. The spatial distribution of CD3 + and CD8 + T cells within the tumor microenvironment has been demonstrated to have a significant impact on the prognosis of colorectal cancer (CRC). This study aimed to investigate CD3 CT (CD3 + T cells density in the core of the tumor [CT]) prognostic ability in patients with CRC by using AI technology. Methods::The study involved the enrollment of 492 patients from two distinct medical centers, with 358 patients assigned to the training cohort and an additional 134 patients allocated to the validation cohort. To facilitate tissue segmentation and T-cells quantification in whole-slide images (WSIs), a fully automated workflow based on deep learning was devised. Upon the completion of tissue segmentation and subsequent cell segmentation, a comprehensive analysis was conducted.Results::The evaluation of various positive T cell densities revealed comparable discriminatory ability between CD3 CT and CD3-CD8 (the combination of CD3 + and CD8 + T cells density within the CT and invasive margin) in predicting mortality (C-index in training cohort: 0.65 vs. 0.64; validation cohort: 0.69 vs. 0.69). The CD3 CT was confirmed as an independent prognostic factor, with high CD3 CT density associated with increased overall survival (OS) in the training cohort (hazard ratio [HR] = 0.22, 95% confidence interval [CI]: 0.12–0.38, P <0.001) and validation cohort (HR = 0.21, 95% CI: 0.05–0.92, P = 0.037). Conclusions::We quantify the spatial distribution of CD3 + and CD8 + T cells within tissue regions in WSIs using AI technology. The CD3 CT confirmed as a stage-independent predictor for OS in CRC patients. Moreover, CD3 CT shows promise in simplifying the CD3-CD8 system and facilitating its practical application in clinical settings.

Objective To investigate the clinical application value of MRI Radiomics score(Radscore)combined with clinicopatho-logical features in predicting postoperative progression-free survival(PFS)of patients with endometrial cancer(EC).Methods A total of 127 patients with EC were selected.The radiomic features of the lesions were extracted from T2 WI,diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)images.The features were screened by random forest model and Radscore was calcu-lated.Simultaneously,clinical and pathological characteristics of patients were collected and incorporated,and multivariate Cox regression analysis was used to screen the risk factors related to PFS.The MRI Radscore and clinicopathological features were mapped to the nomogram,and the performance of nomogram was evaluated by receiver operating characteristic(ROC)curve and calibration curve.Results Multivariate Cox regression analysis showed that progesterone receptor(PR),human epididymis protein 4(HE4)and MRI Radscore were independent risk factors for predicting PFS in patients with EC(P＜0.05).The area under the curve(AUC)of the predicted PFS at 1,3 and 5 years after surgery were 0.91,0.804 and 0.776,respectively.Calibration curves showed that nomogram had a good fit in predicting PFS in patients with EC 1,3 and 5 years after surgery.Conclusion The nomogram con-structed based on multi-sequence MRI Radscore and clinicopathological features has favorable accuracy and stability in predicting postoperative PFS in individuals diagnosed with EC.

Objective: To explore the association between greenness surrounding school and aggression among primary school students, and to explore the potential mediating roles of social support, loneliness, particulate matter (PM2.5) and Nitrogen Dioxide (NO2) in this association, in order to provide a scientific reference for preventing and ameliorating aggressive behaviors of primary school students. Methods: The data was used from a survey of children and adolescents conducted in 2015. The Chinese version of the Buss-Warren Aggression Questionnaire was used to assess total and subtypes of aggression, and the mean values of normalized difference vegetation index (NDVI) of 100 m, 500 m, 1 000 m circular buffers surrounding school were used to indicate the participants greenness exposure. PM2.5 and NO2 datas were obtained from the China High Air Pollutants Dataset.Generalized Linear Mixed Models were used to assess the associations of greenness surrounding school with total and subtypes of aggression. Results: Per IQR increment of NDVI-500 m [OR(95%CI)=1.09(1.03-1.15)] and NDVI-1 000 m[OR(95%CI)=1.07(1.02-1.13)] were positively correlated with physical aggression among primary school children, and per IQR increment of NDVI-100 m [OR(95%CI)=0.94(0.90-0.99)], NDVI-500 m [OR(95%CI)=0.93(0.89-0.98)] and NDVI-1 000 m [OR(95%CI)=0.95(0.91-1.00)] were negatively associated with verbal aggression (P<0.05). Mediation analyses revealed that social support partially mediated the association between the NDVI-500 m and physical aggression (mediation ratio:18.0%) and verbal aggression (mediation ratio:-8.3%) among primary school students, and loneliness partially mediated the association between the NDVI-500 m and physical aggression and verbal aggression among elementary school students effects, with proportion mediated ratios of -10.0% and 21.0%, respectively (P<0.05). Conclusions Exposure to school surrounding greenness is likely to associated with physical aggression and verbal aggression in primary school students, and social support and loneliness may partially mediate these associations.

Objective To investigate the clinical manifestations of familial adenomatous polyposis(FAP).Methods The clinical data of 100 patients with FAP diagnosed in the First Affiliated Hospital of Zhengzhou University from 2011 to 2021 were analyzed retrospectively.Results The main clinical manifestations were bloody stool(44.0%),abdominal pain(40.0%),changes of stool characteristics(25.0%),abdominal distension(18.0%)and diarrhea(17.0%);The most common types of adenomas were villous tubular adenoma(44.9%)and tubular adenoma(32.1%);Extraintestinal manifestations:3 cases of desmoid fibroma,2 cases of osteoma and 1 case of lipoma.47 cases of gastric polyps and the mostly pathological type was fundic gland polyp(34.0%).18 cases of duodenal polyps including 6 cases of adenomatous polyps and most were located at descending duodenum(61.1%).Adenoma canceration occurred in 21 patients.The average age was 38.7 and the canceration mainly occurs in the rectum.The gender,family history,age of onset,number of adenomas,diameter and pathological type of adenomas were statistically compared between patients with and without canceration.It was found that there were significant differences in gender,average age of onset,number of adenoma polyps,diameter of adenoma and pathological type between the two groups(P<0.05).Conclusions FAP is mainly characterized by bloody stool and abdominal pain,with high canceration rate.The risk factors include the age of onset,the number and size of adenomas and the pathological type.The main pathological types are villous tubular adenoma and tubular adenoma.At present,preventive colorectal resection is still the most effective way to treat FAP.No matter what type of methods patients choose,they should be followed up strictly under endoscopy in order to find the lesions in time and treat if necessary.

Objective:To predict the mechanism of Danggui Buxue Decoction for anti-myocardial ischemia-reperfusion injury and "treating different diseases with the same method" in ischemic stroke based on network pharmacology and molecular docking.Methods:The active components and targets of Danggui Buxue Decoction were screened by retrieving the database of TCMSP and literature; the corresponding targets of myocardial ischemia-reperfusion injury and ischemic stroke were found by OMIM and GeneCards database; the intersection targets of Danggui Buxue Decoction and disease were obtained by using Venny diagram, and the common target network and protein-protein interaction network were constructed by Cytoscape 3.7.1 software and STRING database. The GO and KEGG pathways were enriched by David Database, and the Bio GPS database was used to obtain the tissue distribution information of the key targets. The molecular docking technology was used to verify the results.Results:There were 21 active components in Danggui Buxue Decoction, 181 effective targets and 93 cross targets with diseases. The key components were quercetin, Kaempferol, β-sitosterol, formononetin and isorhamnetin. The key targets were AKT1, TNF, IL6, IL-1β and VEGFA. The enrichment results showed that the main action pathways were fluid shear force and arteriosclerosis, lipid and arteriosclerosis, AGE-RAGE signal pathway in diabetic complications, and the core targets were mainly located in the medullary cells, dendritic cell, smooth muscle, prostate, thyroid and other tissues. The results of molecular docking showed that quercetin had the best binding effect to IL-1β, while isorhamnetin had the best binding effect to IL-1β.Conclusion:Danggui Buxue Decoction is against myocardial ischemia-reperfusion injury and ischemic stroke through hemodynamics, lipid metabolism, inflammatory reaction, oxidative stress, immune reaction and cell apoptosis, plays the role of "treating different diseases with the same method".

Objective:To explore the intervention effect of Shumu Peitu herb-partitioned moxibustion on clinical signs and symptoms and negative emotions of diarrhea-predominant irritable bowel syndrome (IBS-D) patients with liver-stagnation and spleen-deficiency pattern.Methods:A total of 72 patients with IBS-D of liver-stagnation and spleen-deficiency pattern treated in the Department of Gastroenterology of Nanjing Vniversity of Chinese Medicine from September 2021 to June 2022 were selected for randomized controlled trial. The patients were randomly divided into the observation group (2 cases dropped off, 34 cases in total) and control group (1 case dropped off, 35 cases in total) by random number table method. The patients in control group were treated with Tongxieyaofang (TXYF). The patients in observation group were treated with oral administration of TXYF and Shumu Peitu herb-partitioned moxibustion, and both groups were treated for 4 weeks. The clinical efficacy, Traditional Chinese Medicine (TCM) syndrome integral, IBS Quality of Life Questionnaire (IBS-QOL), IBS Symptom Severity Scale (IBS-SSS), Bristol Stool Form Scale and Hospital Anxiety and Depression Scale (HADS) were compared before and after treatment.Results:After treatment, the total effective rate of the observation group was 94.12%(32/34), which was higher than the 71.43%(25/35) in the control group, the difference was significant ( χ2 = 6.18, P<0.05). After treatment, the TCM syndrome integral in the observation group was (7.62 ± 4.08), which was lower than the (9.89 ± 4.71) in the control group, the difference was significant ( t = 2.14, P<0.05). After treatment of 3 days, the scores of quality of life in the five dimensions of dysthymia, behavior disorder, health worry, avoidance of eating and social function in the observation group were (82.44 ± 11.46), (80.25 ± 11.67), (76.23 ± 12.67), (59.80 ± 15.14) and (79.23 ± 11.59) points, which were different with the (73.57 ± 12.39), (72.35 ± 15.48), (69.76 ± 13.11), (50.00 ± 16.17) and (73.04 ± 13.11) points in the control group, the difference were significant ( t values were -3.09 - -2.08, all P<0.05). Three days after treatment, the score of IBS-SSS and Bristol fecal character in the observation group were (118.24 ± 40.64) and (5.09 ± 0.62) points, which were lower than the (146.86 ± 60.09) and (5.51 ± 0.66) points in the control group, the difference were significant ( t = 2.31 and 2.76, both P<0.05). After treatment, the score of HADS-A and HADS-D in the observation group were (6.26 ± 1.75) and (5.29 ± 1.47), which were different with the (7.26 ± 2.19) and (6.17 ± 2.11) in the control group, the difference were significant ( t = 2.08 and 2.00, both P<0.05). Conclusions:Shumu Peitu herb-partitioned moxibustion can effectively improve IBS-D patients with liver-stagnation and spleen-deficiency pattern, relieve clinical symptoms, reduce negative emotions, and improve quality of life.

Objective To investigate the incidence and risk factors of chronic cough in children aged 6-14 years. Methods The incidence of chronic cough in children aged 6-14 years in Qinhuangdao city was investigated by questionnaire. Results A total of 4 000 questionnaires were distributed, 3 785 of them were effectively recovered, with the recovery rate of 94.6%. The incidence of chronic cough in children aged 6-14 was 5.1% (194/3 785). The prevalence rates of boys and girls were 5.4% (101/1 859) and 4.8% (93/1 926), respectively, with no significant difference (χ²=0.641，P=0.873). The incidence rate of children in industrial town area 6.7% (64/955) was significantly higher than that in urban area 4.4% (85/1 917) and agricultural town 4.9% (45/913) (χ²=55.082，P=0.000). The risk factors showed that chronic cough was associated with long-term allergen exposure, allergic constitution, asthma, rhinitis, reflux esophagitis and other nasopharynx diseases (χ²=17.833，43.370，194.466，27.773，101.92，11.268，P =0.000). Regression model analysis showed that asthma, rhinitis and allergen long-term exposure were independent risk factors of chronic cough (Wald=15.352，10.174，12.625，12.659，P =0.000). Conclusion The incidence rate of children in industrial town is higher in Qinhuangdao City than those in other urban areas, 6~14 years old children. Asthma, rhinitis and allergen exposure are the main causes of chronic cough.

OBJECTIVE: To summarize the clinical phenotype and genotype of a Chinese child affected with Mowat-Wilson syndrome (MWS). METHODS: Clinical data of the patient were collected. The patient was analyzed by whole-exome sequencing (WES) as well as Sanger sequencing. RESULTS: The patient was a male infant with recurrent fever and slow growth. He also had characteristic facies, recurrent spasm, and growth retardation. WES revealed that he has carried a heterozygous nonsense c.2609C>G (p.Ser870X) variant of the ZEB2 gene (30% mosaicism). Based on the American College of Medical Genetics and Genomics standards and guidelines, the variant was predicted to be pathogenic (PVS1+PS1+PS2+PM2). CONCLUSION The c.2609C>G variant of the ZEB2 gene probably underlay the MWS in this child. The mosaicism of the variant may explain his mild symptoms.
Child ; Facies ; Hirschsprung Disease/genetics* ; Humans ; Infant ; Intellectual Disability/genetics* ; Male ; Microcephaly/genetics* ; Mutation

Objective: To observe the application of ultrasound-guided fascia iliaca compartment block(FICB) and proximal popliteal sciatic nerve block(PPSNB) on patients undergoing total knee arthroplasty. Methods: From January 2015 to January 2018, 60 patients scheduled for total knee arthroplasty undergoing laryngeal mask airway(LMA) general anesthesia in the People′s Hospital of Langfang were divided into three groups by the random number table, with 20 cases in each group.Before general anesthesia, every patient received dezocine 5mg iv, group A received FICB, group B received FICB combined with PPSNB(extraparaneural), group C received FICB combined with PPSNB(subparaneural).40mL of 0.375% ropivacaine was injected guiding by ultrasound.The dosage of propofol and remifentanil, time of awake, awake visual analogue scale(VAS), mean arterial blood pressure(MAP) and heart rate(HR) at pre-block(T1), LMA insert(T2), skin incision(T3), femoral bone cutting(T4), LMA remove(T5), and awake stage(T6) were recorded.The incidence of using vasoactive drugs and adverse reaction were also recorded. Results: The dosage of propofol and remifentanil, the time of awake and awake VAS in group A, group B and group C were: group A (768.0±8.5)mg, (977±21)μg, (18.4±2.1)min, (4.2±0.7)points; group B (554.0±7.1)mg, (775±12)μg, (12.3±1.6)min, (2.4±0.6)points; group C (530±8.2)mg, (738±15)μg, (11.8±1.7)min, (1.3±0.5)points.The dosage of propofol and remifentanil, time of awake, awake VAS in group B and group C were significantly lower than those in group A (F=29.23, 42.56, 32.42, 19.31, all P<0.05). The awake VAS in group C was lower than that in group B (q=8.12, P<0.05). MAP and HR at T2, T3, T4, T5 and T6 in group B or group C were significantly lower than those in group A (MAP: F=85.66, 78.46, 86.04, 62.75, 61.31; HR: F=26.03, 42.75, 38.04, 29.31, 31.50, all P<0.05). The number of patients who required vasoactive drugs and adverse reaction in group B or group C were significantly lower than those in group A (χ²=11.32, 12.81, 15.24, 15.24, 10.15, all P<0.05). The incidence rates of incision pain at awake stage in group A, group B and group C were: group A(30%), group B(20%), group C(0%), that in group C was lower than group B (χ²=9.87, P<0.05). Conclusion The ultrasound-guided FICB and PPSNB(subparaneural) can obviously reduce the dosage of general anaesthetic and maintain the stability of hemodynamics in patients undergoing total knee arthroplasty.It has effective analgesia and less adverse reactions during sober.

Objective: To observe the application of ultrasound-guided femoral nerve block(FNB) and popliteal sciatic nerve block(PSNB) in patients undergoing foot and ankle surgery. Methods: From August 2015 to August 2017, 60 patients scheduled for foot and ankle surgery undergoing laryngeal mask airway (LMA) general anesthesia in the People′s Hospital of Langfang were randomly divided into 3 groups by the random number table, with 20 cases in each group.Before transfer patients from bed to operating table, A group received dezocine 5 mg iv, B group received FNB combined with PSNB(distal to the sciatic nerve bifurcation), C group received FNB combined with PSNB(proximal to the sciatic nerve bifurcation). A total of 40 mL of 0.375% ropivacaine were injected guided by ultrasound in B group and C group.The time of sufficient sensory block and awake, the dosage of remifentanil and propofol were recorded.Pain was assessed using visual analogue scale (VAS) pre- and post block.The incidence of sleepiness, postoperative nausea and vomiting (PONV), agitation, pain and adverse reaction were also recorded. Results: The time of sufficient sensory block and awake, the dosage of remifentanil and propofol in A, B and C group: A group(not measured), (21.6±1.6)min, (1183±17)μg, (665.0±6.7)mg; B group (25.5±2.5)min, (15.3±1.4)min, (635±16)μg, (455.0±6.5)mg; C group (19.6±2.3)min, (14.9±1.5)min, (598±14)μg, (438.0±9.9)mg.The time of awake, the dosage of remifentanil and propofol in B group and C group were significantly lower than those in A group (F=44.07, 52.41, 62.45, all P<0.05). The time of sufficient sensory block in C group was lower than that in B group(t=15.69, P<0.05). The VAS scores at T2, T3 and T4 in A, B and C group: A group (4.5±0.6)point, (8.4±0.5)point, (6.1±0.9)point; B group (2.6±0.5)point, (3.9±0.3)point, (2.4±0.6)point; C group (2.5±0.4)point, (2.3±0.5)point, (1.1±0.5)point.The VAS scores in B group or C group were significantly lower than those in A group (F=52.36, 72.82, 75.41, all P<0.05). The VAS scores at T3 and T4 in C group were significantly lower than those in B group (t=18.42, q=14.55, all P<0.05). The incidence rates of sleepiness, PONV, agitation and incision pain in A, B and C group: A group (25%, 25%, 15%, 15%, 50%); B group(0%, 5%, 0%, 0%, 10%); C group(0%, 5%, 0%, 0%, 0%). The number of patients who had adverse reactions in B or C group were significantly lower than those in A group (χ²=8.51, 8.73, 10.11, 10.11, 9.69, all P<0.05). The incidence rate of incision pain at sober in C group was lower than that in B group(χ²=10.89, P<0.05). Conclusion The ultrasound-guided FNB and PSNB(proximal to the sciatic nerve bifurcation) can obviously shorten the onset time, reduce the dosage of general anaesthetic.It has effective analgesia during transfer of patients from bed to operating table and sober.