Objective To investigate the value of constructing a risk prediction model of brain metastasis in lung cancer based on clinical-CT imaging.Methods The clinical and CT imaging data of 208 patients with lung cancer confirmed by surgical pathology or puncture biopsy were analyzed retrospectively,including 98 patients in the metastasis group and 110 patients in the non-metastasis group.Univariable and binary logistic regression analyses were performed between the two groups,and the clinical,CT imaging,and clinical-CT imaging models were constructed according to the selected independent risk factors.Prediction model performance was eval-uated with receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA).Results Multivariate analysis showed that T stage,pathological type,radiotherapy and chemotherapy,surgery,long diameter(LD),short diameter(SD),minimum CT value(CTmin)were the independent risk factors for predicting brain metastasis in lung cancer(P<0.05).The area under the curve(AUC)of clinical,CT imaging and clinical-CT imaging models were 0.925,0.764,0.941,respectively.DeLong test analysis showed that the AUC of clinical-CT imaging model,clinical model and CT imaging model was statistical difference(Z=2.093,5.777,all P<0.05).The calibration curve suggested a good fit of the clinical-CT imaging model.The DCA suggested that the clinical-CT imaging model demonstrates good clinical benefits.Conclusion The clinical-CT imaging model can effectively predict the occurrence of brain metastasis in lung cancer,which is helpful to guide the development of accurate diagnosis and treatment plan.

Objective To investigate the value of constructing a risk prediction model of brain metastasis in lung cancer based on clinical-CT imaging.Methods The clinical and CT imaging data of 208 patients with lung cancer confirmed by surgical pathology or puncture biopsy were analyzed retrospectively,including 98 patients in the metastasis group and 110 patients in the non-metastasis group.Univariable and binary logistic regression analyses were performed between the two groups,and the clinical,CT imaging,and clinical-CT imaging models were constructed according to the selected independent risk factors.Prediction model performance was eval-uated with receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA).Results Multivariate analysis showed that T stage,pathological type,radiotherapy and chemotherapy,surgery,long diameter(LD),short diameter(SD),minimum CT value(CTmin)were the independent risk factors for predicting brain metastasis in lung cancer(P<0.05).The area under the curve(AUC)of clinical,CT imaging and clinical-CT imaging models were 0.925,0.764,0.941,respectively.DeLong test analysis showed that the AUC of clinical-CT imaging model,clinical model and CT imaging model was statistical difference(Z=2.093,5.777,all P<0.05).The calibration curve suggested a good fit of the clinical-CT imaging model.The DCA suggested that the clinical-CT imaging model demonstrates good clinical benefits.Conclusion The clinical-CT imaging model can effectively predict the occurrence of brain metastasis in lung cancer,which is helpful to guide the development of accurate diagnosis and treatment plan.

Objective:To investigate the effect of high-dose vitamin B6 on stress-induced liver cell death in rats with severe trauma and its possible mechanism.Methods:Thirty-two male SD rats were selected and divided into sham surgery group, sham surgery+B6 group, trauma group, and trauma+B6 group by using a random number table, with 8 rats in each group. Rat models of severe trauma were established by inducing abdominal wall injury, bilateral femoral fractures, unilateral cranial injury, and withdrawal of 4 ml blood from the femoral artery. The sham surgery+B6 group and trauma+B6 group were treated with saline solution plus high-dose vitamin B6, while the sham surgery group and trauma group with infusion of saline solution only. At 36 hours after injury, rat liver tissues were collected for the following experiments: (1) the genes differentially expressed in the liver tissues of the rats of the trauma group and the trauma+B6 group were screened with next-generation sequencing, followed by an analysis of the possible involvement of cell death pathways; (2) validation was conducted to ascertain whether high-dose vitamin B6 could influence various cell death pathways in the liver cells in the sham surgery group, sham surgery+B6 group, trauma group, and trauma+B6 group: apoptosis was confirmed through terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) staining; necroptosis was verified by mixed lineage kinase domain-like protein (MLKL) immunohistochemical staining; autophagy was examined via transmission electron microscopy; ferroptosis was confirmed by detecting oxidative malondialdehyde (MDA) levels, oxidized glutathione levels, Prussian blue staining with diaminobenzidine (DAB) enhancement, transmission electron microscopy, and immunohistochemical staining for acyl-CoA synthetase long-chain family member 4 (ACSL4); (3) Biological information analyses [Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Enrichment analysis (GSEA)] were performed for biological processes and signaling pathways represented by liver tissue sequencing results of rats between the trauma group and the trauma+B6 group.Results:(1) In the liver tissues of rats, there were 344 significantly differentially expressed genes between the trauma group and trauma+B6 group, comprising 137 upregulated genes and 207 downregulated genes, of which 18 genes were associated with apoptosis, autophagy, necroptosis, ferroptosis, and pyroptosis. (2) No significant differences were found in TUNEL staining among the sham surgery group, sham surgery+B6 group, trauma group or trauma+B6 group; MLKL protein expression levels in the liver tissues after trauma were improved, of which the trauma+B6 group was lower than that of the trauma group; Electron microscopy showed that autophagic activity in the liver cells were significantly increased after trauma, which was significantly lower of the trauma+B6 group than that of the trauma group; MDA levels in the rat liver tissues were (0.20±0.05)nmol/mg, (0.17±0.07)nmol/mg, (0.69±0.11)nmol/mg and (0.52±0.07)nmol/mg in the sham surgery group, sham surgery+B6 group, trauma group, and trauma+B6 group respectively ( P<0.01), with the trauma group having the highest MDA levels and trauma+B6 group having lower MDA levels than the trauma group; Oxidized glutathione levels in the liver tissues of the four groups were (11.75±2.09)μmol/g, (11.69±1.66)μmol/g, (19.75±3.40)μmol/g, and (14.51±1.46)μmol/g respectively ( P<0.01), with the trauma group having the highest levels and trauma+B6 group having lower levels than the trauma group; Significantly increased iron deposition was observed in the liver tissues after trauma, with lower iron deposition in trauma+B6 group than the trauma group; Electron microscopy revealed significantly lower mitochondrial membrane density in the trauma+B6 group compared to the trauma group. ACSL4 protein expression level was lower in the trauma+B6 group compared to the trauma group; (3) GO, KEGG and GSEA enrichment analyses suggested that high-dose vitamin B6 may enhance cholesterol synthesis metabolism in the liver cells and alleviate oxidative stress to reduce liver cell damage and restore normal liver cell function after trauma. Conclusions:High-dose vitamin B6 attenuates stress-induced liver injury in rats with severe trauma by inhibiting the progression of necroptosis, autophagy and ferroptosis. Its molecular mechanism may be associated with enhanced hepatic cholesterol synthesis metabolism and alleviation of oxidative stress in the liver cells.

Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Objective:To evaluate the efficacy and safety of lenvatinib combined with camrelizumab as the second-line treatment for advanced intrahepatic cholangiocarcinoma (ICC).Methods:The clinical data of patients with advanced ICC undergoing the second-line treatment of lenvatinib combined with camrelizumab in the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from June 2021 to June 2022 were screened and analyzed. A total of 12 patients were enrolled, including seven males and five females, aged (67.5±8.6) years. Response evaluation criteria in solid tumor 1.1 was used to evaluate the efficacy of treatment. The safety assessment adopts the Adverse Event Evaluation Standard 5.0. Kaplan-Meier method was conducted to plot survival curves.Results:Among the 12 patients (after 1-7 cycles of immune and targeted therapy), three achieved partial response, four achieved stable disease, and five were defined as progression disease. Adverse events of different degrees occurred in seven cases, among which three patients had adverse events of grade ≥ 3: one with hypertension, which was managed after antihypertensive and symptomatic treatment; one with elevated serum total bilirubin, which was improved after reducing the dose of lenvatinib; one with liver dysfunction, which was considered as immune-related liver toxicity and alleviated after discontinuing camrelizumab. The 1-month, 3-month, and 6-month survival rates and progression-free survival rates of the patients were 100.0%, 91.7%, 66.7%, and 83.3%, 41.7%, and 25.0%, respectively. The median overall survival of patients was 14.7 months (95% CI: 9.2-21.2) and the median time to progression was 8.0 months (95% CI: 4.1-11.9). Conclusion:Combination of lenvatinib and camrelizumab could bring survival benefits with controllable adverse events as the second-line treatment of patients with advanced ICC.

Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Objective To compare arthroscopic double-pulley knotless suture bridge with conven tional arthroscopic suture bridge in repair of rotator cuff tear.Methods From May 2013 to May 2015,70patients with rotator cuff tear were repaired at our department.They were 38 males and 32 females,with a mean age of 53.7 years.They were randomized into 2 equal groups to receive repair either using arthroscopic double-pulley knotless suture bridge (the experimental group) or using conventional arthroscopic suture bridge (the control group).The 2 groups were compared postoperatively in terms of VAS (visual analogue scale),Constant,ASES (American Shoulder and Elbow Surgeons) and UCLA (University of California at Los Angeles) scores,shoulder range of motion,and rotator cuff retear.Results The 2 groups were compatible with no significant differences in gender,age,laterality,tear type,or preoperative function or range of motion of the shoulder joint (P ＞ 0.05).At 12 months postoperatively,the VAS,Constant,ASES and UCLA scores and shoulder range of motion in the experimental group were respectively 1.1 ± 1.3,86.0 ±8.9,13.3 ± 0.8,32.0 ± 2.9,156.8° ± 15.0° and 55.9° ± 5.8°,significantly improved than the preoperative values (P ＜0.05).At 12 months postoperatively,the VAS,Constant,ASES and UCLA scores and shoulder range of motion in the control group were respectively 1.3 ± 1.3,86.6 ±4.2,13.1 ± 1.0,31.1 ±2.6,153.3°±10.0° and 55.7° ± 5.1 °,significantly improved than the preoperative values (P ＜ 0.05).At 12 months postoperatively,there were no significant differences between the 2 groups in VAS,Constant,ASES or UCLA scores or shoulder range of motion (P ＞ O.05).No case of rotator cuff retear occurred in the experimental group while 5 cases were observed in the control group,showing a significant difference (0 versus 14.3％) (P ＜ 0.05).Conclusions Compared with conventional arthroscopic suture bridge,arthroscopic double-pulley knotless suture bridge presents no significant differences in range of motion or function of the shoulder joint in repair of rotator cuff tear.However,the latter may lead to a lower incidence of rotator cuff retear and,additionally,is less skillfully demanding.

Objective To evaluate the effects of pregabalin combined with hydrochloric oxycodone on patients with ma-lignant neuropathic pain (MNP). Methods A total of 66 patients with MNP was divided into control group or treatment group randomly. The patients in control group received only hydrochloric oxycodone, and treatment group were treated with the combina-tion of pregabalin and hydrochloric oxycodone. Numeric rating scale (NRS) score was used to evaluate the analgesic effects. Med-ical outcomes study sleep scale (MOS-SS,Chinese version) was used to evaluate the improvement of sleep disorder. The changes of depression or anxiety were investigated by 17-item Hamilton Depression Rating Scale (HAMD-17) or Hamilton Anxiety Scale (HAMA), respectively. Side effects were accessed by Acute and Subacute Toxicity Grading Criteria of Anticancer Drugs (WHO). Results The pain control rate of treatment group was 87. 1% , which was superior to that of control group (58. 6% ) (P<0. 05). The improvement of sleep interference, and the quality and quantity of sleep in treatment group were also superior to that in control group (P<0. 05). After the treatment, depression and anxiety was attenuated in both groups, and the improvement degree in treatment group was higher than that in control group (P<0. 05). No obvious side effects were found in either groups. Conclusion The combination therapy of pregabalin and hydrochloric oxycodone is the better way to treat MNP.

BACKGROUND: Donor complications have been detected following autologous tendon transplantation for posterior cruciate ligament reconstruction. Although artificial tendon development and tissue-engineered tendon have achieved great progresses, there are some issues in clinical application. Since 1980's, allogenic tendon transplantation has aroused increasing attention. OBJECTIVE: To explore the selection of allogenic tendon materials and the effect of their application on reconstructing posterior cruciate ligament. METHODS: A total of 17 patients with posterior cruciate ligament injury of knee joint were treated with cryopreserved allogenic tendon by Tibial-inlay technique. During the operation, two tracts of tendons soaked in gentamicin saline for 15 minutes were conduplicated, and one end of the tendon was cancellous bone screw and fixed to the tibia attachment point of posterior cruciate ligament, and the other end was introduced into the joint through retention suture. The posterior joint capsule was repaired. The patient was placed at supine position, and the knee was flexed for 90°. The other end of the graft was introduced to femoral tunnel, and anterior drawer was tensed, and fixed by screw. RESULTS AND CONCLUSlN: The preoperative posterior drawer test of patients was >2+, including 7 cases of 3+ and 6 of 4+. The postoperative posterior drawer test was 0 in 4 cases, 1+ in 8 cases, 2+ in 4 cases and 3+ in 1 case, suggesting the posterior movement of the knee joint was significantly improved. Lysholm scores of patients were (48.5±4.3) points before operation and (88.3±5.4) points after operation. Results show that cryopreserved allogenic tendon by Tibial-inlay technique could restored function of posterior cruciate ligament with a favorable effect.

BACKGROUND:Obsolete lateral ankle ligament injury is frequently treated by Chrisman-Snook operation.However,this operation destructs some peroneus brevis tendon,and affects the function of peroneus brevis tendon for foot valgus.OBJECTIVE:Based on previous research,to investigate the effect of allogeneic tendon for reconstruction of ankle lateral ligaments.METHODS:A total of 17 cases of ankle lateral ligament injured were selected,with a course of disease from 3 to 6 months.All lateral ligaments were reconstructed by allogeneic tendon & anchors.During the operation,a drill,4.5 rnm diameter,was used to drill a hole on the lateral ankle;one anchor was drilled into the talus at the end of anterior talofibular ligament,another one was threaded on the calcaneus;the allogeneic tendon was permeated through the hole on the lateral ankle,maintaining ankle neutral and moderate valgus position.The allogeneic tendon was sutured with the thread of the anchors.Following operation,the ankle was fixed in neutral position and slightly valgus position;wound healing,AOFAS score and stress radiograph were observed.RESULTS AND CONCLUSION:All 17 patients showed no rejection,and the wound healing well at the primary stage.At 6,12,24 after operation,all patients were followed-up.According to AOFAS criteria,function of ankle in all patients was significantly improved.No patients complained of instability of the ankle,end stress radiograph confirmed this improvement.Reconstruction of lateral ligaments of the ankle with allogeneic tendon and anchors is a practical treatment,which restores stability and function of ankle without long incision or damaging normal tendons.