Objective:To construct and validate a nomogram prediction model for the recurrence of common bile duct stones after endoscopic retrograde cholangiopancreatography (ERCP) in patients with common bile duct stones.Methods:The clinical data of 515 patients with common bile duct stones treated in Yancheng First People's Hospital from January 2018 to December 2022 were retrospectively analyzed, including 273 males and 242 females, aged (65.5±12.1) years. According to the ratio of 8∶2, all cases were randomly divided into a training set ( n=412) and a validation set ( n=103). According to whether common bile duct stones recurred after ERCP, 412 patients in the training set were divided into two groups: the recurrence group ( n=72) and the non-recurrence group ( n=340). The patients' gender, age, length and diameter of stones, number of stones, diameter of common bile duct and other clinical data were recorded. The logistic regression model was used to analyze the risk factors of recurrence, and a nomogram was constructed based on the analysis results. The concordanceindex, area under the receiver operating characteristic (ROC) curve and calibration chart were used to evaluate the model. Bootstrap self sampling method was used to internally verify the prediction model. Results:The recurrence rate of common bile duct stones in the training set was 17.5% (72/412). Multivariate logistic regression analysis showed that stone length, stone number, mixed stones, periampullary diverticulum, postoperative cholecystectomy, nipple incision were risk factors for recurrence of common bile duct stones after ERCP (all P<0.05). Small incision of nipple assisted with large balloon dilatation, incision of nipple titanium splint synthesis, and postoperative ursodeoxycholic acid were protective factors for recurrence of common bile duct stones after ERCP (all P<0.05). The concordance index of the nomogram model based on the above influencing factors was 0.791(95% CI: 0.633-0.892), and the area under the ROC curve for predicting postoperative recurrence of common bile duct stones in the training set and the validation set were 0.905(95% CI: 0.819-0.987) and 0.873(95% CI: 0.809-0.935), respectively. The calibration curve was basically consistent with the ideal curve, and the concordanceindex of internal validation was 0.781(95% CI: 0.628-0.874). Conclusion:The nomogram model based on the influencing factors of common bile duct stone recurrence can predict the risk of common bile duct stone recurrence after ERCP.

Objective:To explore the relationship between depression, perfectionism and self-injurious function in adolescents with self-injury.Methods:A total of 6 149 adolescents from two middle schools were selected by multi-stage random sampling method to conduct a cross-sectional investigation, and 530 cases with self-injurious behaviors were screened out as the self-injury group, while the remaining 5 619 students served as the non-self-injury group.The self-rating depression scale, the Chinese-revised Frost multidimensional perfectionism scale, and the Ottawa self-injury inventory Chinese revised version were used for investigation.SPSS 24.0 software was used for descriptive statistics and Spearman correlation analysis, and the PROCESS 4.1 macro program was used for mediating effect test(model 4)and moderating effect test(model 7).Results:(1)The incidence of self-injury among adolescents was 8.62%(530/6 149), which was significantly different in gender( χ2=50.942, P<0.01) and grade( χ2=37.401, P<0.01). (2)The scores of depression(48(41, 55)) and maladaptive perfectionism(64(53, 76)) in the self-injury group were higher than those in the non-self-injury group(36(29, 43), 49(35, 61)), and the differences were statistically significant( Z=-23.233, -18.599, both P<0.01). (3)Adolescents with self-injury mostly had external emotion regulation(70.38%(373/530)) as the dominant function.(4)The results of Spearman correlation analysis showed that self-injurious function was significantly and positively correlated with depression( r=0.382, P<0.01) and maladaptive perfectionism( r=0.356, P<0.01), and depression was significantly and positively correlated with maladaptive perfectionism( r=0.352, P<0.01). (5)Maladaptive perfectionism partially mediated the relationship between depression and self-injurious function( β=0.086, P<0.001), and the mediating effect accounted for 21.88%(0.086/0.393)of the total effect.(6)Gender moderated the first stage of the mediation pathway(depression→maladaptive perfectionism)( β=0.180, P<0.05), which indicated that depression had a stronger predictive effect on maladaptive perfectionism in women( βsimple=0.105, 95% CI=0.063-0.154, P<0.05). Conclusion:In the prediction of depression on self-injurious function, maladaptive perfectionism plays a partial mediating role, and this mediating effect is moderated by gender.

Objective:To explore the relationship between depression, perfectionism and self-injurious function in adolescents with self-injury.Methods:A total of 6 149 adolescents from two middle schools were selected by multi-stage random sampling method to conduct a cross-sectional investigation, and 530 cases with self-injurious behaviors were screened out as the self-injury group, while the remaining 5 619 students served as the non-self-injury group.The self-rating depression scale, the Chinese-revised Frost multidimensional perfectionism scale, and the Ottawa self-injury inventory Chinese revised version were used for investigation.SPSS 24.0 software was used for descriptive statistics and Spearman correlation analysis, and the PROCESS 4.1 macro program was used for mediating effect test(model 4)and moderating effect test(model 7).Results:(1)The incidence of self-injury among adolescents was 8.62%(530/6 149), which was significantly different in gender( χ2=50.942, P<0.01) and grade( χ2=37.401, P<0.01). (2)The scores of depression(48(41, 55)) and maladaptive perfectionism(64(53, 76)) in the self-injury group were higher than those in the non-self-injury group(36(29, 43), 49(35, 61)), and the differences were statistically significant( Z=-23.233, -18.599, both P<0.01). (3)Adolescents with self-injury mostly had external emotion regulation(70.38%(373/530)) as the dominant function.(4)The results of Spearman correlation analysis showed that self-injurious function was significantly and positively correlated with depression( r=0.382, P<0.01) and maladaptive perfectionism( r=0.356, P<0.01), and depression was significantly and positively correlated with maladaptive perfectionism( r=0.352, P<0.01). (5)Maladaptive perfectionism partially mediated the relationship between depression and self-injurious function( β=0.086, P<0.001), and the mediating effect accounted for 21.88%(0.086/0.393)of the total effect.(6)Gender moderated the first stage of the mediation pathway(depression→maladaptive perfectionism)( β=0.180, P<0.05), which indicated that depression had a stronger predictive effect on maladaptive perfectionism in women( βsimple=0.105, 95% CI=0.063-0.154, P<0.05). Conclusion:In the prediction of depression on self-injurious function, maladaptive perfectionism plays a partial mediating role, and this mediating effect is moderated by gender.

Objective:To construct and validate a nomogram prediction model for the recurrence of common bile duct stones after endoscopic retrograde cholangiopancreatography (ERCP) in patients with common bile duct stones.Methods:The clinical data of 515 patients with common bile duct stones treated in Yancheng First People's Hospital from January 2018 to December 2022 were retrospectively analyzed, including 273 males and 242 females, aged (65.5±12.1) years. According to the ratio of 8∶2, all cases were randomly divided into a training set ( n=412) and a validation set ( n=103). According to whether common bile duct stones recurred after ERCP, 412 patients in the training set were divided into two groups: the recurrence group ( n=72) and the non-recurrence group ( n=340). The patients' gender, age, length and diameter of stones, number of stones, diameter of common bile duct and other clinical data were recorded. The logistic regression model was used to analyze the risk factors of recurrence, and a nomogram was constructed based on the analysis results. The concordanceindex, area under the receiver operating characteristic (ROC) curve and calibration chart were used to evaluate the model. Bootstrap self sampling method was used to internally verify the prediction model. Results:The recurrence rate of common bile duct stones in the training set was 17.5% (72/412). Multivariate logistic regression analysis showed that stone length, stone number, mixed stones, periampullary diverticulum, postoperative cholecystectomy, nipple incision were risk factors for recurrence of common bile duct stones after ERCP (all P<0.05). Small incision of nipple assisted with large balloon dilatation, incision of nipple titanium splint synthesis, and postoperative ursodeoxycholic acid were protective factors for recurrence of common bile duct stones after ERCP (all P<0.05). The concordance index of the nomogram model based on the above influencing factors was 0.791(95% CI: 0.633-0.892), and the area under the ROC curve for predicting postoperative recurrence of common bile duct stones in the training set and the validation set were 0.905(95% CI: 0.819-0.987) and 0.873(95% CI: 0.809-0.935), respectively. The calibration curve was basically consistent with the ideal curve, and the concordanceindex of internal validation was 0.781(95% CI: 0.628-0.874). Conclusion:The nomogram model based on the influencing factors of common bile duct stone recurrence can predict the risk of common bile duct stone recurrence after ERCP.

[Objective] To summarize the clinical manifestations, pathological characteristics, treatment options and prognosis of the world's first case of prostate ductal adenocarcinoma (PDA) complicated with prostate mucinous adenocarcinoma (PMA). [Methods] The clinical and follow-up data of a patient with PDA and PMA treated in Zhongnan Hospital of Wuhan University were retrospectively analyzed, and relevant literature in PubMed and CNKI databases was retrieved. [Results] The patient sought medical attention due to dysuria, frequent urination, urinary urgency and urinary pain for more than half a year, and was admitted to hospital 3 times in total.The initial diagnosis upon the first admission was benign prostatic hyperplasia complicated with prostatic abscess.After 2 months, the patient was readmitted due to worsening symptoms, received transurethral bladder neck incision+ cystoscopy+ transurethral plasma resection of the prostate, and postoperative diagnosis confirmed PDA with local PMA.Three months after surgery, the patient had bleeding.After auxiliary examinations revealed extensive metastasis, he received hormonal therapy.After 9 months, the patient died due to multiple lung metastases. [Conclusion] Early diagnosis has a significant impact on the treatment and prognosis, but there have been no previous reports of PDA combined with PMA, so the lack of specific biomarkers in the early stage has led to missed diagnosis or misdiagnoses.There is no specific treatment for PDA with PMA. Radical prostatectomy was not satisfactory in the treatment of this case.

The clinical data of 14 patients with niacin deficiency diagnosed and treated in Department of Dermatology, Affiliated Hospital of Jining Medical College from 2012 to 2021 were retrospectively analyzed. There were 11 males and 3 females aged 26-65 years. The etiological factors were alcoholism in 8 cases, gastrointestinal disease in 3 cases, medication history in 1 case, and unknown etiology in 2 cases.Patients had typical skin lesions, 1 case also had both digestive system and nervous system symptoms, and 3 cases had combined digestive system symptoms and 2 cases had neurological symptoms. All patients were systematically treated with oral nicotinamide and vitamin B complex, and also with topical drugs; and they all improved after 14-52 days of treatment. During regular follow-up, 2 cases of alcoholics and 1 case with diarrhea had recurrence. It is suggested that the typical clinical triad of niacin deficiency is uncommon, and the diagnosis is based on the medical history, clinical manifestations and relevant laboratory test, and the treatment with nicotinamide and vitamin B complex is usually effective; alcoholism is the main cause in male patients and is prone to recurrence.

Objective The study aims to investigate the effects of different adaptive statistical iterative reconstruction-V（ ASiR-V） and convolution kernel parameters on stability of CT auto-segmentation which is based on deep learning. Method Twenty patients who have received pelvic radiotherapy were selected and different reconstruction parameters were used to establish CT images dataset. Then structures including three soft tissue organs (bladder, bowelbag, small intestine) and five bone organs (left and right femoral head, left and right femur, pelvic) were segmented automatically by deep learning neural network. Performance was evaluated by dice similarity coefficient（ DSC） and Hausdorff distance, using filter back projection(FBP) as the reference. Results Auto-segmentation of deep learning is greatly affected by ASIR-V, but less affected by convolution kernel, especially in soft tissues. Conclusion The stability of auto-segmentation is affected by parameter selection of reconstruction algorithm. In practical application, it is necessary to find a balance between image quality and segmentation quality, or improve segmentation network to enhance the stability of auto-segmentation.
Algorithms ; Humans ; Image Processing, Computer-Assisted ; Neural Networks, Computer ; Radiation Dosage ; Tomography, X-Ray Computed

Objective To investigate the effect of BIS-guided closed-loop target-controlled infusion on perioperative Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy under different anesthesia and sedation depths. Methods We applied random number table method to divide 73 elderly patients undergoing elective laparoscopic radical gastrectomy into BIS closed-loop target-controlled infusion group with BIS value of 55(group H, n=36) and BIS value of 45(group L, n=37).Intravenous blood samples were collected immediately before surgery (T1), 2h after surgery (T2), 24h after surgery (T3) and 72h after surgery (T4).IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ were determined by flow cytometry microsphere array.We compared operation duration, postoperative PACU stay time and postoperative hospitalization time between two groups. Results Compared with T1, IL-6 and IL-10 concentration in group H at T2, T3 and T4 significantly increased (P < 0.05), IL-4 and TNF-α in group H at T4 were significantly increased (P < 0.05), IL-2 and IFN-γ in group H at T2 and T4 were significantly increased (P < 0.05), the concentration of IL-6 and IL-10 in group L at T2, T3 and T4 were increased (P < 0.05), IL-2 in group L at T4 was decreased (P < 0.05), and IFN-γ/IL-6 in two groups were decreased at T2, T3 and T4(P < 0.05).Compared with group L, IL-6 and IL-10 in group H were significantly increased at T2(P < 0.05), IFN-γ/IL-6 in group H was significantly decreased (P < 0.05), IL-2 and IL-10 in group H were significantly increased at T4(P < 0.05).Operation duration, postoperative PACU stay time and postoperative hospitalization time had no statistical significance between two groups (P > 0.05). Conclusion The anesthesia and sedation depth of BIS-guided closed-loop target-controlled infusion set at 45 is better than 55 in maintaining Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy, but it has no obvious effect on long-term prognosis.

Objective:To assess the efficacy, safety of adding intralesional compound betamethasone injection to EEBD to reduce restricture.Methods:77 patients, treated in The first people's hospital of YancHeng from January, 2015 to December, 2018, were randomized to receive EEPD combined with either compound betamethasone injection or placebo injection. A total of 2 ml of compound betamethasone injection or an identical volume of normal saline solution as a placebo was injected per site using a 23-gauge needle immediately after EEPD. Patients and treating physicians were blinded to the treatment. The primary endpoint was the number of dilations required to resolve the stricture、restricture-free survival、time required to resolve the stricture and adverse events.Results:During the 4-years study period, Finally , 74 patients , who were randomized to either the steroid group (37 cases) or placebo group (37 cases), comprised the per-protocol population .The median number of EEPD required to resolve strictures was 2.0( IQR 1.0-3.0) in the steroid group and 3.0 ( IQR 3.0-4.5) in the placebo group ( P<0.001). After 6 months of follow-up, 27.0% of patients who had received steroid injections remained recurrence free compared with 3.5% of those who had received saline injections( P<0.001). The median time of EEPD required to resolve the stricture was 88 days( IQR 0-98 days)in the steroid group and 131 days( IQR 97-157 days)in the placebo group( P<0.001). No adverse events occurred related to the EEPD or steroid injection occurred. Conclusion:Endoscopic esophageal probe dilation combined with compound betamethasone injection shows promising results for the prevention of stricture recurrence in patients of anastomotic strictures.