Objective To explore the clinical value of artificial intelligence (AI) quantitative parameters in distinguishing pathological grades of stageⅠ invasive adenocarcinoma (IAC). Methods Clinical data of patients with clinical stageⅠ IAC admitted to Yantaishan Hospital Affiliated to Binzhou Medical University from October 2018 to May 2023 were retrospectively analyzed. Based on the 2021 WHO pathological grading criteria for lung adenocarcinoma, IAC was divided into gradeⅠ, grade Ⅱ, and grade Ⅲ. The differences in parameters among the groups were compared, and logistic regression analysis was used to evaluate the predictive efficacy of AI quantitative parameters for grade Ⅲ IAC patients. Parameters were screened using least absolute shrinkage and selection operator (LASSO) regression analysis. Three machine learning models were constructed based on these parameters to predict grade Ⅲ IAC and were internally validated to assess their efficacy. Nomograms were used for visualization. Results A total of 261 IAC patients were included, including 101 males and 160 females, with an average age of 27-88 (61.96±9.17) years. Six patients had dual primary lesions, and different lesions from the same patient were analyzed as independent samples. There were 48 patients of gradeⅠ IAC, 89 patients of grade Ⅱ IAC, and 130 patients of grade Ⅲ IAC. There were statitical differences in the AI quantitive parameters such as consolidation/tumor ratio (CTR), ect among the three goups. (P<0.05). Univariate analysis showed that the differences in all variables except age were statistically significant (P<0.05) between the group gradeⅠ+grade Ⅱand the group grade Ⅲ . Multivariate analysis suggested that CTR and CT standard deviation were independent risk factors for identifying grade Ⅲ IAC, and the two were negatively correlated. Grade Ⅲ IAC exhibited advanced TNM staging, more pathological high-risk factors, higher lymph node metastasis rate, and higher proportion of advanced structure. CTR was positively correlated with the proportion of advanced structures in all patients. This correlation was also observed in grade Ⅲ but not in gradeⅠand grade ⅡIAC. CTR and CT median value were selected by using LASSO regression. Logistic regression, random forest, and XGBoost models were constructed and validated, among which, the XGBoost model demonstrated the best predictive performance. Conclusion Cautious consideration should be given to grade Ⅲ IAC when CTR is higher than 39.48% and CT standard deviation is less than 122.75 HU. The XGBoost model based on combined CTR and CT median value has good predictive efficacy for grade Ⅲ IAC, aiding clinicians in making personalized clinical decisions.

Objective: To analyze the characteristics and trends of drowning mortality among Chinese residents from 2010 to 2021, so as to provide a basis for developing targeted prevention strategies and reducing the burden of drowning deaths. Methods: Data on drowning mortality among Chinese residents from 2010 to 2021 were collected from the China Cause of Death Surveillance Dataset (2010-2021). The crude mortality was calculated and then standardized using the data from the Sixth National Population Census in 2010. The characteristics of drowning mortality were analyzed by genders, regions, and ages. The average annual percent change (AAPC) was employed to assess the trend in drowning mortality. Results: From 2010 to 2021, the overall crude drowning mortality among Chinese residents was 3.53/100 000, with a standardized mortality of 3.34/100 000, both showed decreasing trends (AAPC=-2.438% and -3.739%, both P<0.05). The crude and standardized mortality were higher in males than in females (4.55/100 000 vs. 2.47/100 000, 4.43/100 000 vs. 2.16/100 000, both P<0.05). Both the crude drowning mortality (AAPC=-2.974% and -1.337%) and standardized drowning mortality (AAPC=-3.806% and -3.599%) among males and females showed decreasing trends, respectively (all P<0.05). The crude and standardized drowning mortality were higher in rural residents than in urban residents (4.13/100 000 vs. 2.35/100 000, 3.86/100 000 vs. 2.27/100 000, both P<0.05). Both the crude and standardized drowning mortality in rural residents showed decreasing trends (AAPC=-3.343% and -4.515%, both P<0.05), whereas no statistically significant trends were observed in urban residents (both P>0.05). Both the crude and standardized drowning mortality were higher in western residents than in eastern residents and central residents (4.30/100 000 vs. 2.89/100 000 and 3.66/100 000, 4.14/100 000 vs. 2.64/100 000 and 3.49/100 000, all P<0.05). The standardized mortality showed decreasing trends in eastern, central and western residents (AAPC=-3.237%, -2.344%, and -5.467%, all P<0.05). The groups aged ≥65 years and 1-<5 years experienced relatively high crude drowning mortality of 8.81/105 and 7.38/105, respectively. Decreasing trends were observed in groups aged <1 year, 1-<5 years, and 5-<15 years (AAPC=-14.126%, -11.452%, and -7.443%, all P<0.05). In contrast, no statistically significant trends were observed in the other age groups (all P>0.05). Conclusions The overall drowning mortality rate among Chinese residents showed a declining trend from 2010 to 2021. However, the risks of drowning mortality remained relatively high among males, rural residents, residents in the western region, children, and the elderly.

PURPOSE: To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures. METHODS: A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18 - 65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥ 2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American Orthopedic Foot and Ankle Society ankle hindfoot score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test. RESULTS: During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, diabetes, or smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American Orthopedic Foot and Ankle Society ankle hindfoot score revealed no significant difference between dislocation and no-dislocation patients. CONCLUSION Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.
Humans ; Ankle Fractures/physiopathology* ; Male ; Female ; Retrospective Studies ; Adult ; Middle Aged ; Supination ; Aged ; Young Adult ; Rotation ; Joint Dislocations/surgery* ; Fracture Fixation, Internal/methods* ; Adolescent ; Recovery of Function ; Treatment Outcome

BACKGROUND: Based on the China-VHD database, this study sought to develop and validate a Valvular Heart Disease- specific Age-adjusted Comorbidity Index (VHD-ACI) for predicting mortality risk in patients with VHD. METHODS & RESULTS: The China-VHD study was a nationwide, multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018. After excluding cases with missing key variables, 11,459 patients were retained for final analysis. The primary endpoint was 2-year all-cause mortality, with 941 deaths (10.0%) observed during follow-up. The VHD-ACI was derived after identifying 13 independent mortality predictors: cardiomyopathy, myocardial infarction, chronic obstructive pulmonary disease, pulmonary artery hypertension, low body weight, anaemia, hypoalbuminaemia, renal insufficiency, moderate/severe hepatic dysfunction, heart failure, cancer, NYHA functional class and age. The index exhibited good discrimination (AUC, 0.79) and calibration (Brier score, 0.062) in the total cohort, outperforming both EuroSCORE II and ACCI (P < 0.001 for comparison). Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694 (95% CI: 0.665-0.723) for 2-year mortality prediction. VHD-ACI scores, as a continuous variable (VHD-ACI score: adjusted HR (95% CI): 1.263 (1.245-1.282), P < 0.001) or categorized using thresholds determined by the Yoden index (VHD-ACI ≥ 9 vs. < 9, adjusted HR (95% CI): 6.216 (5.378-7.184), P < 0.001), were independently associated with mortality. The prognostic performance remained consistent across all VHD subtypes (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid valve disease, mixed aortic/mitral valve disease and multiple VHD), and clinical subgroups stratified by therapeutic strategy, LVEF status (preserved vs. reduced), disease severity and etiology. CONCLUSION The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.

OBJECTIVE To investigate the effects of evolocumab combined with atorvastatin on post-percutaneous coronary intervention （PCI） efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction （STEMI）. METHODS This retrospective cohort study included 194 hospitalized patients with acute STEMI who underwent PCI in the First Affiliated Hospital of Nanyang Medical College from Jan. 2022 to Dec. 2024. The patients were divided into control group （100 cases） and combination therapy group （94 cases） according to the different therapy plans. The control group was given Atorvastatin calcium tablets orally， at a dose of 20 mg， once a day. On the basis of the control group， the combination therapy group received an initial injection of Evolocumab injection 140 mg within 24 hours after PCI， followed by subsequent injections every 2 weeks. Both groups received continuous treatment for at least 30 days. Blood lipid indicators [total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C） and high-density lipoprotein cholesterol]， inflammation indicators [C-reactive protein （CRP） and interleukin-6 （IL-6）]， vascular Δ 基金项目河南省医学科技攻关计划项目（No.LHGJ20230971） endothelial function and microcirculation indicators [fibrinogen， ankle-brachial index （ABI） and nitric oxide （NO）]， cardiac function indicators [left ventricular ejection （LVEF）， left ventricular end-diastolic diameter and left ventricular end-systolic diameter] before treatment and after 30 days of treatment， as well as the occurrence of adverse reactions during the treatment， were compared between the two groups. RESULTS Before treatment， there were no statistically significant differences in the levels of the indicators of blood lipid， inflammation， vascular endothelial function and microcirculation， and cardiac function between the two groups （P＞0.05）. After 30 days of treatment， the levels of TC， TG， LDL-C， CRP， IL-6 and fibrinogen in both groups were significantly reduced compared to those before treatment within the same group. The levels of NO and LVEF in both groups， as well as ABI in the combination therapy group， were significantly elevated compared to those before treatment within the same group. Moreover， the improvements in the levels of TC， LDL-C， CRP， IL-6， fibrinogen and NO in the combination therapy group were more pronounced than those in the control group during the same period （P＜0.05）. There were no statistically significant differences in the incidence of liver function impairment， gastrointestinal adverse reactions， or the overall incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS Compared with atorvastatin alone， evolocumab combined with atorvastatin more effectively reduces the blood lipid levels， improves the inflammatory status， vascular endothelial function and coronary microcirculation in patients with acute STEMI after PCI， while the safety is comparable to that of atorvastatin alone.

Objective:To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) among acute respiratory infection (ARI) cases in 16 provinces of China from 2009 to 2023.Methods:The data of this study were collected from the ARI surveillance data from 16 provinces in China from 2009 to 2023, with a total of 28 278 ARI cases included in the study. The clinical specimens from ARI cases were screened for HRSV nucleic acid from 2009 to 2023, and differences in virus detection rates among cases of different age groups, regions, and months were analyzed.Results:A total of 28 278 ARI cases were enrolled from January 2009 to September 2023. The age of the cases ranged from<1 month to 112 years, and the age M ( Q1, Q3) was 3 years (1 year, 9 years). Among them, 3 062 cases were positive for HRSV nucleic acid, with a total detection rate of 10.83%. From 2009 to 2019, the detection rate of HRSV was 9.33%, and the virus was mainly prevalent in winter and spring. During the Corona Virus Disease 2019 (COVID-19) pandemic, the detection rate of HRSV fluctuated between 6.32% and 18.67%. There was no traditional winter epidemic peak of HRSV from the end of 2022 to the beginning of 2023, and an anti-seasonal epidemic of HRSV occurred from April to May 2023. About 87.95% (2 693/3 062) of positive cases were children under 5 years old, and the difference in the detection rate of HRSV among different age groups was statistically significant ( P<0.001), showing a decreasing trend of HRSV detection rate with the increase of age ( P<0.001). Among them, the HRSV detection rate (25.69%) was highest in children under 6 months. Compared with 2009-2019, the ranking of HRSV detection rates in different age groups changed from high to low between 2020 and 2023, with the age M (Q1, Q3) of HRSV positive cases increasing from 1 year (6 months, 3 years) to 2 years (11 months, 3 years). Conclusion:Through 15 years of continuous HRSV surveillance analysis, children under 5 years old, especially infants under 6 months old, are the main high-risk population for HRSV infection. During the COVID-19 pandemic, the prevalence and patterns of HRSV in China have changed.

Objective To develop the'E-Bone',a comprehensive one-stop preoperative planning system for reverse total shoulder arthroplasty with improved accuracy and efficiency.Methods The nnU-net deep neural network was utilized for scapula segmentation to obtain precise scapula segmentation results.Based on the 3 key factors,namely bone density,upward and downward angle and nail length,the base was automatically positioned.The quantitative parameters required for surgical planning were calculated.A personalized guide plate was generated by combining glenoid morphology and base positioning information.The system interface was developed to modularize various functions for easy use,providing interactive operation and real-time display.Results Compared with the Mimics system,the'E-bone'preoperative planning system reduced complex manual adjustments during the planning process.The average planned nail length was longer than that of the Mimics system,and the planning time was reduced by 86%.The scapula segmentation accuracy of this system reached 99.93%,better than that of Mimics to achieve a higher precision.Conclusion The"E-bone"system provides a one-stop,efficient,and accurate preoperative planning system for reverse shoulder replacement and potentially broader clinical applications.

Objective To develop the'E-Bone',a comprehensive one-stop preoperative planning system for reverse total shoulder arthroplasty with improved accuracy and efficiency.Methods The nnU-net deep neural network was utilized for scapula segmentation to obtain precise scapula segmentation results.Based on the 3 key factors,namely bone density,upward and downward angle and nail length,the base was automatically positioned.The quantitative parameters required for surgical planning were calculated.A personalized guide plate was generated by combining glenoid morphology and base positioning information.The system interface was developed to modularize various functions for easy use,providing interactive operation and real-time display.Results Compared with the Mimics system,the'E-bone'preoperative planning system reduced complex manual adjustments during the planning process.The average planned nail length was longer than that of the Mimics system,and the planning time was reduced by 86%.The scapula segmentation accuracy of this system reached 99.93%,better than that of Mimics to achieve a higher precision.Conclusion The"E-bone"system provides a one-stop,efficient,and accurate preoperative planning system for reverse shoulder replacement and potentially broader clinical applications.

Objective:To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) among acute respiratory infection (ARI) cases in 16 provinces of China from 2009 to 2023.Methods:The data of this study were collected from the ARI surveillance data from 16 provinces in China from 2009 to 2023, with a total of 28 278 ARI cases included in the study. The clinical specimens from ARI cases were screened for HRSV nucleic acid from 2009 to 2023, and differences in virus detection rates among cases of different age groups, regions, and months were analyzed.Results:A total of 28 278 ARI cases were enrolled from January 2009 to September 2023. The age of the cases ranged from<1 month to 112 years, and the age M ( Q1, Q3) was 3 years (1 year, 9 years). Among them, 3 062 cases were positive for HRSV nucleic acid, with a total detection rate of 10.83%. From 2009 to 2019, the detection rate of HRSV was 9.33%, and the virus was mainly prevalent in winter and spring. During the Corona Virus Disease 2019 (COVID-19) pandemic, the detection rate of HRSV fluctuated between 6.32% and 18.67%. There was no traditional winter epidemic peak of HRSV from the end of 2022 to the beginning of 2023, and an anti-seasonal epidemic of HRSV occurred from April to May 2023. About 87.95% (2 693/3 062) of positive cases were children under 5 years old, and the difference in the detection rate of HRSV among different age groups was statistically significant ( P<0.001), showing a decreasing trend of HRSV detection rate with the increase of age ( P<0.001). Among them, the HRSV detection rate (25.69%) was highest in children under 6 months. Compared with 2009-2019, the ranking of HRSV detection rates in different age groups changed from high to low between 2020 and 2023, with the age M (Q1, Q3) of HRSV positive cases increasing from 1 year (6 months, 3 years) to 2 years (11 months, 3 years). Conclusion:Through 15 years of continuous HRSV surveillance analysis, children under 5 years old, especially infants under 6 months old, are the main high-risk population for HRSV infection. During the COVID-19 pandemic, the prevalence and patterns of HRSV in China have changed.