Objective: To develop a modified calculation formula for renal tumor volume and tumor contact surface area (CSA) based on the modeling results of 3D Slicer software, and to create a webpage of the calculation formula for use. Methods: The general information and tumor anatomical data of 98 patients who underwent partial nephrectomy during Jan.2021 and Jul.2023 in the Second Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed.The imaging data were input into 3D Slicer software in the form of Dicom files for tumor and ipsilateral kidney modeling to obtain tumor anatomical data.The relationship between tumor anatomical parameters and tumor volume and CSA was analyzed using multifactorial linear regression.The initial modified formulas (V2, C2) and the optimized modified formulas (V3, C3) for tumor volume over CSA were established, respectively, after insignificant variables were eliminated.The mean square error (MSE) and Akaike information criterion (AIC) of the modified and traditional formulas (V1, C1) were compared, and the formula with the smallest MSE and AIC was selected as the optimal tumor volume and CSA calculation formula.The median tumor volume and CSA obtained from 3D modeling were used as the cutoff values.The optimal formula and conventional formula were applied to calculate tumor volume and CSA for all patients, and risk stratification was performed for all patients based on these cutoff values, and the perioperative indicators of patients in the upper and lower groups were compared.Finally, an online calculation tool was developed based on HTML. Results: Based on multifactorial linear regression analysis, we obtained the modified tumor volume calculation formula: V=0.382abc+2.488a+2.372b－4.146c+1.948（V2）, V=0.469abc－4.586c+13.816（V3）; the modified tumor CSA calculation formula CSA=2.469a －2.262L －19.23a+6.206b+1.212c+18.017L+1.616h－3.97h －2.185h/h －0.388（C2）, CSA=2.376a －2.144L －20.157a+5.024b+1.128c+17.578L+2.525h－2.634（C3）.Both of the modified volume formula (MSE=151.298 vs. 127.807 vs. 104.106) and modified CSA formula (MSE=309.878 vs.23.556 vs.30.388) had smaller errors compared to the conventional formula.The modified volume calculation formula showed that bleeding was more and thermal ischemia time was longer in patients with larger tumor volumes than in patients with smaller tumor volumes (P<0.05); and the modified CSA calculation formula showed that bleeding was more, surgery and thermal ischemia time were longer in patients with high CSA than in patients with low CSA (P＜0.05).Finally, V3 and C3 are selected as the best calculation formula, and a web page (https://lizihao-bot.github.io/RCC-Calculate/) was established for easy use. Conclusion: This study combined data from a medical information technology platform with numerical modeling methods to provide a faster and more accurate method to calculate the renal tumor volume and CSA.Meanwhile, a webpage version of the tool was developed to enhance its practicability.

Microbial communities such as those residing in the human gut are highly diverse and complex, and many with important implications for health and diseases. The effects and functions of these microbial communities are determined not only by their species compositions and diversities but also by the dynamic intra- and inter-cellular states at the transcriptional level. Powerful and scalable technologies capable of acquiring single-microbe-resolution RNA sequencing information in order to achieve a comprehensive understanding of complex microbial communities together with their hosts are therefore utterly needed. Here we report the development and utilization of a droplet-based smRNA-seq (single-microbe RNA sequencing) method capable of identifying large species varieties in human samples, which we name smRandom-seq2. Together with a triple-module computational pipeline designed for the bacteria and bacteriophage sequencing data by smRandom-seq2 in four human gut samples, we established a single-cell level bacterial transcriptional landscape of human gut microbiome, which included 29,742 single microbes and 329 unique species. Distinct adaptive response states among species in Prevotella and Roseburia genera and intrinsic adaptive strategy heterogeneity in Phascolarctobacterium succinatutens were uncovered. Additionally, we identified hundreds of novel host-phage transcriptional activity associations in the human gut microbiome. Our results indicated that smRandom-seq2 is a high-throughput and high-resolution smRNA-seq technique that is highly adaptable to complex microbial communities in real-world situations and promises new perspectives in the understanding of human microbiomes.
Humans ; Gastrointestinal Microbiome/genetics* ; Bacteriophages/physiology* ; High-Throughput Nucleotide Sequencing ; Sequence Analysis, RNA/methods* ; Bacteria/virology*

Objective To investigate the relationship between the serum FMS-like tyrosine kinase 3 ligand(Flt3L),progranulin(PGRN)levels and the disease risk and disease outcome of patients with acute lympho-blastic leukemia(ALL).Methods A total of 104 patients with ALL admitted to the hospital from September 2019 to September 2021 were selected as the research subjects.ALL patients were divided into the low-risk group(n=34),the medium-risk group(n=39),and the high-risk group(n=31)according to the disease risk.The levels of serum Flt3L and PGRN of the patients at admission were detected by enzyme-linked immu-nosorbent assay.Pearson correlation analysis was used to analyze the relationship between serum Flt3L,PGRN in ALL patients and the risk of ALL disease.According to the follow-up results of ALL patients,they were divided into the good prognosis group(n=81)and the poor prognosis group(n=23).The receiver oper-ating characteristic curve and the area under the curve(AUC)were used to analyze the evaluation value of se-rum Flt3L and PGRN for the prognosis of ALL patients,and multivariate Cox regression was used to analyze the prognostic risk factors of ALL patients.Results The serum Flt3L levels in the low-risk group and the medium-risk group were higher than those in the high-risk group,and the difference was statistically signifi-cant(P＜0.05).The serum PGRN levels in the low-risk group and the medium-risk group were lower than those in the high-risk group,and the difference was statistically significant(P＜0.05).Serum Flt3L in ALL patients was negatively correlated with the risk of ALL disease(r=-0.461,0.593,P＜0.05).Serum PGRN in ALL patients was positively correlated with the risk of ALL disease(r=0.593,P＜0.05).The proportions of white blood cell count ≥50 × 109/L,hemoglobin＜90 g/L,and serum PGRN level in the poor prognosis group were higher than those in the good prognosis group,while the serum Flt3L level was lower than that in the good prognosis group,and the differences were statistically significant(P＜0.05).The AUC of serum Flt3L and PGRN in evaluating the prognosis of ALL patients were 0.762(95％CI:0.717-0.816),0.815(95％CI:0.764-0.863),and 0.915(95％CI:0.866-0.964),respectively.White blood cell count ≥50 × 109/L,hemoglobin＜90 g/L,Flt3L＜92.07 pg/mL,and PGRN≥335.14 pg/mL were risk factors affecting the prognosis of ALL patients(P＜0.05).Conclusion The levels of serum Flt3L and PGRN in ALL patients are related to the disease risk and disease outcome of ALL.The combined detection of the two has a good eval-uation value for the prognosis of adult ALL patients.

From the natural-philosophical model of medicine in ancient Greece to the modern bio-psycho-social par-adigm,the evolution of medical models has always been shaped by philosophy.In classical antiquity,medicine and philosophy were closely intertwined;the natural-philosophical model,exemplified by Hippocrates,emphasized the human body as an integrated whole.During the Renaissance,the rise of experimental science challenged traditional philosophical systems and pushed medicine toward empirical investigation.In the late twentieth century,the bio-psycho-social model emerged to address the limitations of the purely biomedical approach.In the twenty-first centu-ry,the advent of artificial intelligence is driving a new transformation in medicine and continually prompting reflec-tion on the future direction of medical models and their underlying philosophical significance.

Objective:To analyze the dietary patterns of Chinese adults and explore the relationship with serum uric acid (SUA) and hyperuricemia (HUA).Methods:A total of 9 358 adults were selected in the 2018 China Health and Nutrition Survey. Dietary intake data were collected by three consecutive 24-hour dietary recalls and weighing method. The social demographic information of the survey subjects was obtained through questionnaire surveys. The dietary patterns were extracted using factor analysis, and the relationship between dietary patterns and SUA was analyzed using multiple linear regression analysis. The correlation between HUA and dietary patterns was analyzed using logistic regression analysis models.Results:Four dietary patterns were identified: northern (high intakes of wheat, other cereals,and tubers); modern (high intakes of fruit, dairy, eggs, and nuts); southern (high intakes of rice and vegetables);animal food-wine (high intake of organ meats, seafood, and wine). The multiple linear regression analysis results showed that the northern pattern was negatively correlated with SUA ( β=-0.438, 95% CI: -0.500--0.376); the modern pattern was negatively correlated with SUA ( β=-0.134, 95% CI: -0.219--0.049); the southern model was significantly correlated with higher SUA ( β=0.146, 95% CI: 0.079-0.214); the animal food-wine pattern was positively correlated with SUA ( β=0.188, 95% CI: 0.123-0.252). Logistic regression analysis showed that compared with the northern model score Q1 group, the risk of developing HUA was reduced in Q3 and Q4 groups, with ORs values of 0.777 (95% CI: 0.650-0.929) and 0.509 (95% CI: 0.423-0.613), respectively; and compared with the modern model score Q1 group, the higher the scores in Q3 and Q4 groups, the HUA was lower, with ORs of 0.793 (95% CI: 0.660-0.953) and 0.768 (95% CI: 0.631-0.934), respectively. Compared with the animal food-wine pattern score Q1 group, the risk of developing HUA was increased in both Q3 and Q4 groups ( Q3 group: OR=1.224, 95% CI: 1.012-1.480; Q4 group: OR=1.312, 95% CI: 1.086-1.584). Conclusions:Dietary patterns are associated with HUA. The northern and modern patterns are related to lower SUA levels and reduced risk of HUA, while the animal food-wine pattern increases the risk of HUA.

Peripheral pulmonary lesions(PPL),including peripheral pulmonary nodules,are common lung problems.As the increase of patients with lung nodules,the demand for tissue sampling also increases.Safe and accurate biopsy techniques are very important for patients to identify benign and malignant lesions.Electronic bronchoscopy is one of the biopsy techniques for the diagnosis of PPL in recent decades.Various guiding techniques,such as radial probe endobronchial ultrasound and virtual navigation bronchoscope,have been proved to improve the performance of conventional bronchoscopy.This paper aims to provide an review of the available data on advanced bronchoscopic techniques and explore their application in diagnosing PPL.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective:To investigate the effect of spinopelvic sagittal alignment and lordosis distribution index on adjacent segment degeneration (ASD) after short-segment lumbar interbody fusion.Methods:A total of 234 patients who underwent posterior lumbar interbody fusion due to lumbar degenerative diseases in the Affiliated Changzhou Second People's Hospital of Nanjing Medical University and Affiliated Drum Tower Hospital, Medical School of Nanjing University from January 2009 to January 2019 were retrospectively analyzed. There were 102 males and 132 females, aged 60.1±10.0 years (range, 41-78 years). The patients were divided into ASD group and non-ASD group according to whether ASD occurred after operation. The general data, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), distal lordosis (DL), segmental lordosis (SL), lordosis distribution index (LDI) and sagittal vertical axis (SVA) before and after operation were compared between the two groups. Independent risk factors for the occurrence of ASD after lumbar fusion were analyzed using binary logistic regression. The receiver operating characteristic curve (ROC) was plotted, and the area under the curve was calculated for each independent risk factor.Results:All patients successfully completed the operation and were followed up for 70.6±11.9 months (range, 60-121 months). Among the 234 patients, 116 patients developed ASD after operation. Age ( t=2.697, P=0.008), fusion segment (χ 2=16.439, P<0.001), preoperative PT ( t=2.268, P=0.024), preoperative LL ( t=2.042, P=0.042), preoperative DL ( t=2.724, P=0.007), postoperative DL ( t=3.104, P=0.002), postoperative LDI ( t=2.063, P=0.040) and the difference of SVA before and after operation ( Z=2.001, P=0.045) were statistically significant. Binary logistic regression analysis showed that LDI decreased ( OR=0.971, P=0.002), two-level fusion ( OR=3.477, P<0.001), and increased SVA difference before and after operation ( OR=0.992, P=0.039) were independent risk factors for ASD after lumbar fusion. The ROC curve showed that the area under the curve and 95% CI of the number of fusion segments, postoperative LDI, and the difference of SVA before and after operation were 0.633 (0.561, 0.704), 0.583 (0.510, 0.656) and 0.576 (0.502, 0.649), respectively. The area under the curve of the combined prediction model was 0.702, and the prediction value was medium. Conclusion:Two-level fusion, decreased LDI after operation, and increased SVA difference before and after operation are independent risk factors for ASD after lumbar fusion, and the combined prediction of the three has good predictive efficiency.

Objective:To explore the blocking effect of temporary epiphysiodesis technique with "8"-plate in the treatment of leg length discrepancy (LLD) in children.Methods:From January 2013 to July 2020, 49 children (27 males and 22 females) with leg length discrepancy treated with "8"-plate in Pediatric Orthopedics Department of Beijing Jishuitan hospital were analyzed retrospectively. The average age at the time of surgery was 8.8±2.6 years (ranging from 3.8 to 13.1 years). The length difference between femur and tibia was measured before operation on full-length X-ray films of lower limbs, and the "8"-plate was placed on both medial and lateral sides of the distal femur and/or the proximal tibia. During the follow-up, the shape of epiphyseal plate and internal fixation change were evaluated on X-ray films of the knee joint, and the length difference before and after the operation was compared to evaluate the blocking effect. The blocking rate was compared according to the following conditions: the blocking position (femur, tibia), classification of LLD (constant or increasing), screw diameter (3.5 mm or 4.5 mm) and the age at operation (≥8 or <8 years).Results:49 patients were successfully operated. The follow-up time was 39.6±18.5 months (range 16-91 months) with the fixing time of 24.3±11.8 months (range 7-66 months). A total of 76 independent data of single bone were obtained. The correction range was 8.6±6.4 mm (range -8-37 mm). The correction rate was 0.35±0.31 mm/month. The correction rate of 52 femurs was 0.41±0.32 mm/month, which was significant higher than that of 24 tibias with 0.20±0.14mm/month ( t=5.323, P=0.008). The correction rate of the constant group with 0.54±0.32 mm/month was obviously better than the increasing group with 0.26±0.21 mm/month ( t=7.362, P=0.001). The average correction rate of 4.5 mm diameter screw group was 0.46±0.23 mm/month, which was significantly better than that of 3.5 mm diameter screw group with 0.26±0.24 mm/month ( t=3.467, P=0.022). The correction rate in the group of <8 years old was 0.32±0.25 mm/month, which was not significantly different from that in the group of ≥8 years old with 0.37±0.31 mm/month ( t=1.026, P=0.548). Conclusion:The blocking effect of "8" -plate temporary epiphysiodesis technique in the treatment of leg length discrepancy was related to the LLD classification and blocking position. Distal femoral block was better than proximal tibia block. Block effect of patients with constant unequal distance between lower limbs was better than that of patients with increased distance. 4.5 mm diameter screw was better than 3.5mm. Because the blocking effect was slow, early treatment and a firm stick to indications was of great importance.

ObjectiveTo explore the current status and issues regarding the application of ancient books in clinical practice guidelines and expert consensus of traditional Chinese medicine （TCM） published in China， and to provide methodological recommendations for the incorporation of ancient books in the development of TCM guidelines. MethodsWe searched China National Knowledge Infrastructure （CNKI）， WanFang Data， VIP， SinoMed， PubMed， Embase， as well as six industry websites including China Association of Chinese Medicine， National Group Standards Information Platform， and Chinese Association of the Integration of Traditional and Western Medicine，etc. TCM clinical practice guidelines or expert consensus issued during January 1st， 2017， to November 26th， 2022 were searched. Clinical practice guidelines or expert consensus that explicitly referred to ancient books were included， and the content regarding the searching for ancient books， sources of access to ancient books， methods of evaluating the level of evidence， methods of evaluating the level of recommendation， and methods of evaluating the evidence for the ancient books were analysed. ResultsA total of 1,215 TCM clinical practice guidelines or expert consensus were retrieved， with 442 articles explicitly mentioning the application of ancient books， including 300 （67.87%） clinical practice guidelines and 142 （32.13%） expert consensus. Sixty of the 442 publications explicitly reported that ancient books searching had been conducted （13.57%）； among these 60 publications 27 （45.00%） explicitly reported ancient books searching strategies， and the most frequent method was manual searching with a total of 24 articles （40.00%）. The most popular search source was Chinese Medical Dictionary， a TCM classics database， with a total of 18 articles. 197 articles （44.57%） explicitly reported the evaluation criteria for the level of evidence， of which 141 articles （71.57%） involved the evaluation criteria for the ancient books； 413 articles （93.44%） mentioned ancient books in the recommendations， and only the source of formula name was mentioned in 409 （99.03%） of the publications. ConclusionThe current application of ancient books in TCM clinical practice guidelines and expert consensus is limited， with issues of non-standard searching and evaluation methods. Standar-dization and uniformity are needed in evidence grading and recommendation standards. Future research should clarify the scope and methods of applying ancient book， emphasize their integration with modern research evidence， and enhance their value and quality in the development of TCM clinical practice guidelines.