Objective:To evaluate the clinical diagnosis and laparoscopic surgical management of diaphragmatic rupture.Methods:Clinical data of 19 patients diagnosed with diaphragmatic hernia secondary to diaphragmatic rupture, admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from Jan 2022 to Sep 2024 was retrospectively analyzed.Results:There were 7 males and 12 females. Traumatic etiology was confirmed in 9 cases, all developed after closed injuries, including one vehicular accident, seven blunt traumas, and one fall from height. Iatrogenic factors accounted for the remaining 10 cases. Left-sided diaphragmatic hernias were observed in 13 patients, while right-sided hernias occurred in 6 patients. Hiatal hernias were complicated in 5 patients. All patients underwent elective laparoscopic tension-free repair using composite patch for defect closure. Postoperatively, one patient was readmitted into ICU due to reexpansion pulmonary edema but was subsequently discharged following recovery. The median postoperative hospital stay was 10 days.Conclusions:The incidence of diaphragmatic rupture is relatively uncommon, primarily occurring as a result of traumatic or iatrogenic injuries. Early diagnosis coupled with prompt laparoscopic surgical intervention has proven to be effective in managing this condition.

Mitochondrial DNA(mtDNA)is a critical target in forensic genetic analysis,playing a pivotal role in deciphering population genetic structures,tracing maternal lineages,identifying complex kinship relationships,and deconvoluting mixed biological samples.For aged or severely degraded biological specimens where nuclear DNA profiling is impossible,mtDNA may emerge as the sole detectable DNA source due to its unique circular structure and multi-copy characteristics.With the continuous advancement of DNA sequencing technologies,mtDNA analysis has evolved from first-generation sequencing focusing on the control region to whole-genome approaches in second-generation sequencing,simultaneously enhancing haplotype resolution and promoting forensic mtDNA applications.Recently,long-read third-generation sequencing technologies have introduced a novel methodological paradigm for mtDNA analysis,enabling non-spliced acquisition of mtDNA control regions or full sequences.This approach not only mitigates the potential interference from nuclear-mitochondrial DNA sequences but also significantly improves heterogeneity recognition rates.This review will elucidate the principles of various sequencing technologies and comprehensively examine the research progress and applications of mtDNA in forensic science,including individual identification,kinship verification,mixed sample detection,and biogeographic ancestry inference,with the aim of providing valuable insights for future research and practical implementations.

Mitochondrial DNA(mtDNA)is a critical target in forensic genetic analysis,playing a pivotal role in deciphering population genetic structures,tracing maternal lineages,identifying complex kinship relationships,and deconvoluting mixed biological samples.For aged or severely degraded biological specimens where nuclear DNA profiling is impossible,mtDNA may emerge as the sole detectable DNA source due to its unique circular structure and multi-copy characteristics.With the continuous advancement of DNA sequencing technologies,mtDNA analysis has evolved from first-generation sequencing focusing on the control region to whole-genome approaches in second-generation sequencing,simultaneously enhancing haplotype resolution and promoting forensic mtDNA applications.Recently,long-read third-generation sequencing technologies have introduced a novel methodological paradigm for mtDNA analysis,enabling non-spliced acquisition of mtDNA control regions or full sequences.This approach not only mitigates the potential interference from nuclear-mitochondrial DNA sequences but also significantly improves heterogeneity recognition rates.This review will elucidate the principles of various sequencing technologies and comprehensively examine the research progress and applications of mtDNA in forensic science,including individual identification,kinship verification,mixed sample detection,and biogeographic ancestry inference,with the aim of providing valuable insights for future research and practical implementations.

Objective:To evaluate the clinical diagnosis and laparoscopic surgical management of diaphragmatic rupture.Methods:Clinical data of 19 patients diagnosed with diaphragmatic hernia secondary to diaphragmatic rupture, admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from Jan 2022 to Sep 2024 was retrospectively analyzed.Results:There were 7 males and 12 females. Traumatic etiology was confirmed in 9 cases, all developed after closed injuries, including one vehicular accident, seven blunt traumas, and one fall from height. Iatrogenic factors accounted for the remaining 10 cases. Left-sided diaphragmatic hernias were observed in 13 patients, while right-sided hernias occurred in 6 patients. Hiatal hernias were complicated in 5 patients. All patients underwent elective laparoscopic tension-free repair using composite patch for defect closure. Postoperatively, one patient was readmitted into ICU due to reexpansion pulmonary edema but was subsequently discharged following recovery. The median postoperative hospital stay was 10 days.Conclusions:The incidence of diaphragmatic rupture is relatively uncommon, primarily occurring as a result of traumatic or iatrogenic injuries. Early diagnosis coupled with prompt laparoscopic surgical intervention has proven to be effective in managing this condition.

Objective To investigate the diagnostic value of immunophenotype in distinguishing acute promyelocytic leukemia(APL)from HLA-DR negative acute myeloid leukemia(AML)using flow cytometry.Methods A retrospective observational study was con-ducted including 42 APL patients and 28 newly diagnosed or relapsed HLA-DR negative AML patients admitted to our hospital from 2014 to 2024.Immunophenotype analysis was performed on bone marrow aspirate samples using flow cytometry.The positive expression rates of CD64,MPO,CD7,CD11c,CD9,CD123 and other antigens were compared between the two groups using the Chi-square test.The diagnostic efficiency of the CD9/123 and CD64+MPO+CD7 CD11c-models for APL was evaluated using receiver operating charac-teristic(ROC)curves.Results The HLA-DR negative AML group exhibited significantly lower positive rates of CD64,CD9 and MPO(P＜0.05),and higher positive rates of CD11c and CD7(P＜0.05)compared to APL group.The CD64+MPO+CD7-CD11c-model had an area under the curve(AUCROC)of 0.859,sensitivity of 93.8％and specificity of 75.0％for distinguishing APL.The CD9/CD123 expression pattern had AUCROC of 0.919,sensitivity of 83.3％and specificity of 84.0％for APL diagnosis.The combined CD9/123 and CD64+MPO+CD7-CD11c-model had AUCROC of 0.955,sensitivity of 83.3％and specificity of 100％.Conclusion The combined CD9/123 and CD64+MPO+CD7-CD11c-expression pattern may serve as a helpful tool for differentiating APL from HLA-DR negative AML.

BACKGROUND: Sarcopenia is an age-related progressive skeletal muscle disorder involving the loss of muscle mass or strength and physiological function. Efficient and precise AI algorithms may play a significant role in the diagnosis of sarcopenia. In this study, we aimed to develop a machine learning model for sarcopenia diagnosis using clinical characteristics and laboratory indicators of aging cohorts. METHODS: We developed models of sarcopenia using the baseline data from the West China Health and Aging Trend (WCHAT) study. For external validation, we used the Xiamen Aging Trend (XMAT) cohort. We compared the support vector machine (SVM), random forest (RF), eXtreme Gradient Boosting (XGB), and Wide and Deep (W&D) models. The area under the receiver operating curve (AUC) and accuracy (ACC) were used to evaluate the diagnostic efficiency of the models. RESULTS: The WCHAT cohort, which included a total of 4057 participants for the training and testing datasets, and the XMAT cohort, which consisted of 553 participants for the external validation dataset, were enrolled in this study. Among the four models, W&D had the best performance (AUC = 0.916 ± 0.006, ACC = 0.882 ± 0.006), followed by SVM (AUC =0.907 ± 0.004, ACC = 0.877 ± 0.006), XGB (AUC = 0.877 ± 0.005, ACC = 0.868 ± 0.005), and RF (AUC = 0.843 ± 0.031, ACC = 0.836 ± 0.024) in the training dataset. Meanwhile, in the testing dataset, the diagnostic efficiency of the models from large to small was W&D (AUC = 0.881, ACC = 0.862), XGB (AUC = 0.858, ACC = 0.861), RF (AUC = 0.843, ACC = 0.836), and SVM (AUC = 0.829, ACC = 0.857). In the external validation dataset, the performance of W&D (AUC = 0.970, ACC = 0.911) was the best among the four models, followed by RF (AUC = 0.830, ACC = 0.769), SVM (AUC = 0.766, ACC = 0.738), and XGB (AUC = 0.722, ACC = 0.749). CONCLUSIONS: The W&D model not only had excellent diagnostic performance for sarcopenia but also showed good economic efficiency and timeliness. It could be widely used in primary health care institutions or developing areas with an aging population. TRIAL REGISTRATION Chictr.org, ChiCTR 1800018895.
Humans ; Aged ; Sarcopenia/diagnosis* ; Deep Learning ; Aging ; Algorithms ; Biomarkers

Objective:To investigate the effect of optimized catheter clipping training and automatic balloon retraction ureteral catheter removal on first urination of patients after neurosurgery, and provide guidance for postoperative micturition of these patients.Methods:From August 2020 to August 2021, 208 patients admitted to Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical University, undergoing craniocerebral surgery under general anesthesia and indurating catheter were selected as the study subjects by convenient sampling. They were divided into control group ( n=69), observation group A ( n=69) and observation group B( n=70) by random number table method. The control group received routine catheter clipping training and routine ureteral catheter removal, the observation group A received optimized catheter clipping training and routine ureteral catheter removal, and the observation group B received optimized catheter clipping training and automatic balloon retraction ureteral catheter removal. The first micturition time, first micturition volume, micturition circumstance, pain score and urethral irritation sign of the three groups were observed and compared. Results:The first urination time in observation group A and B were (11.58 ± 6.59) min and (10.06 ± 5.91) min, respectively, lower than (37.14 ± 13.74) min in control group, and the difference was statistically significant ( t=13.94, 15.07, both P<0.05); there was no significant difference between observation group B and observation group A ( P>0.05). The first urine volume were (303.66 ± 43.74) ml in control group, (299.06 ± 41.26) ml in observation group A and (299.28 ± 43.17) ml in observation group B, and the difference was not statistically significant ( P>0.05). The incidence of urination (spontaneous urination, induced urination and urinary retention) in observation group A was better than control group ( χ2=16.47), while observation group B was better than observation group A and control group ( χ2=8.59, 37.83), the differences were statistically significant (all P<0.05). There was no significant difference in pain score of ureteral catheter removal between observation group A (2.71 ± 0.67) and control group (2.87 ± 0.78) ( P>0.05). The score of observation group B (1.41 ± 0.65) was lower than that of control group and observation group A, the differences were statistically significant ( t=11.93, 11.62, both P<0.05). There was no significant difference of the incidence of urethral irritation (grade 0, 1, 2, and 3) between observation group A and control group ( P>0.05). Observation group B was lower than control group and observation group A, the differences were statistically significant ( t=38.81, 25.27, both P<0.05). Conclusions:Optimized catheter clipping training and automatic balloon retraction ureteral catheter removal can effectively shorten the first urination time of patients after neurosurgery, reduce the pain of ureteral catheter removal and urethral irritation during the first urination, improve the success rate of the first urination, and effectively prevent the occurrence of urinary retention.

【Objective】 To investigate the clinicopathological characteristics and prognosis of solitary fibrous tumor (SFT) in the retroperitoneum. 【Methods】 We summarized the clinical and prognostic data of nine patients admitted to The First Affiliated Hospital of Xi’an Jiaotong University between January 2007 and December 2017 who were diagnosed with SFT by surgical resection and pathological examination. Nine cases of retroperitoneal SFT were detected by HE and immunohistochemical SP method. The expressions of Vimintin (Vim), CD34, CD99, Ki-67, Bcl-2 and S-100 in tumor cells were analyzed for their clinicopathological characteristics and prognosis. 【Results】 Among the nine patients, four were male and five were female, aged 37-69 years old. Five of them showed abdominal distension, while the other four had no obvious clinical symptoms. The tumor size was (1.0 cm×1.0 cm×2.0 cm)-(30.0 cm×25.0 cm×10.0 cm). There were seven single cases and two multiple cases. Histology showed bundle-shaped, braided spindle cells and collagen fibers of varying degrees, accompanied by mucinous degeneration and hemangiopericytoma-like morphology. Immunohistochemical results were as follows: The positive rate was 100% (9/9) for Vim, CD34 and CD99, 77% (7/9) for Ki-67, 67% (6/9) for Bcl-2, and 22% (2/9) for S-100. All the patients were followed up effectively. Two of them died (the cause of death was not related to the disease studied, and the survival time from postoperative to death was 6.5 years and 8.3 years, respectively). One surviving case relapsed 3 years after the operation, but did not recur after the second operation. No recurrence or metastasis was found in the remaining cases. 【Conclusion】 Retroperitoneal SFT is rare in the clinic, and there are no typical clinical symptoms in the early stage. Most of them are detected in physical check-ups. Ultrasound and CT examinations are the main preoperative examination methods, but they are not specific to SFT. Pathological examination is the only method for diagnosis. Radical resection is the first-choice of treatment. The preferred method for this disease is effective in early radical surgery and regular postoperative review.

Objective To explore the cognitive and psychological experience of medical staff as the second victims in serious adverse events,so as to provide the basis for the related research on the management system of medical adverse events. Methods Using the phenomenological approach in qualitative research, from January to February 2019,9 medical staff from 3 Class Ⅲ hospitals who had experienced adverse events were interviewed as the second victims. The data were analyzed according to Colaizz 7 steps analysis method. Results A total of 4 themes were refined,including the experiences of various negative experiences,the change of occupational cognition,the importance of identifying and improving the system of prevention of adverse events and the desire to establish a support system for the second victims. Conclusions The competent authorities should pay attention to the plight of medical personnel involved in medical adverse events, and actively construct a support system for the second victim,so as to reduce the harm of the second victims in medical adverse events and ensure medical safety.

ObjectiveTo explore the nursing managers' cognition, willingness, pros and cons, and suggestions on nurses' multi-site practice, aiming at providing reference for the policy formulation, implementation and effective management in related institutions. MethodsBased on the phenomenological research method in qualitative research, in-depth interviews were conducted with 10 nursing deans in 10 ClassⅢ hospitals in Jiangsu Province from January to April 2018, and analyzed by Colaizzi analysis program. The nursing managers in Jiangsu Province were investigated in detail about their cognition, willingness, evaluation and suggestions on the pros and cons of nurses' multi-site practice. ResultsThe themes summarized included:"four areas of influences of nurses' multi-site practice on the society, government, hospital, and nurses themselves" "obstacles and difficulties in conducting nurses' multi-site practice" and "suggestions on nurses' multi-site practice". ConclusionsThe nursing managers have a high level of perception towards the nurses' multi-site practice, however, the medical institutions are still at a wait-and-see stage. To prepare for multi-site practice, relevant laws and legislation should be established and regulated as soon as possible, meanwhile, the management ideology and human resources management should be renovated, the admission standards of the qualification of nurses' multi-site practice should be made more strict, and the good conditions for multi-site practice should be created through interdisciplinary cooperation and great efforts.