AIM: To analyze the clinical outcomes of cyclosporine combined with lacrimal plug in the treatment of dry eye in patients with primary Sjögren's syndrome.METHODS: The clinical data of 60 patients(120 eyes)who were admitted to the ophthalmology department and rheumatology and immunology department of Baoding No.1 Central Hospital and were diagonosed with siogren's syndrome dry eye after multidisciplinary consultation from June 2022 to September 2023 were retrospectively analyzed. All the patients received regular treatment of primary Sjögren's syndrome, and they were divided into three groups according to treatment methods: A, B and C, with 20 cases(40 eyes)in each group. The group A received 0.3% sodium hyaluronate eyedrops, the group B received 0.3% sodium hyaluronate eyedrops plus 0.05% cyclosporine eyedrops, and the group C received 0.3% sodium hyaluronate eyedrops plus 0.05% cyclosporine eyedrops combined with binocular lacrimal plugs. The ocular surface disease index(OSDI)score, conjunctival hyperemia score, tear film breakup time(BUT), tear meniscus height(TMH), corneal fluorescein staining(FL)score and tear secretion of the three groups of patients were compared before and at 4, 8 and 12 wk after treatment. The contents of inflammatory factors such as interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)in tears were detected before and at 12 wk after treatment.RESULTS: At 4, 8 and 12 wk after treatment, the scores of OSDI, conjunctival hyperemia score and FL in the three groups of patients were lower than those before treatment, and the BUT, TMH and tear secretion were higher than those before treatment(all P<0.001). The OSDI score of the group C was lower than that of the group A and B, and the group B was lower than the group A(all P<0.001). The BUT, TMH and tear secretion of the group C were higher than those of the group A and B, with the group B higher than the group A(all P<0.001). At 12 wk after treatment, the levels of IL-6, TNF-α and IL-1β in the tears of the three groups of patients were lower than those before treatment, with the group C lower than the group A and B, and the group B lower than the group A(all P<0.001). There was no statistical significant difference in the incidence of adverse reactions among the three groups of patients(P>0.05).CONCLUSION: The combined use of cyclosporine and lacrimal plug is safe and effective in improving the clinical symptoms of patients with moderate and severe dry eye, promoting the function of tear film and cornea, increasing tears secretion, and reducing the level of tear inflammatory factors.

Background::Clinical opportunistic screening is a cost-effective cancer screening modality. This study aimed to establish an easy-to-use diagnostic model serving as a risk stratification tool for identification of individuals with malignant gastric lesions for opportunistic screening.Methods::We developed a questionnaire-based diagnostic model using a joint dataset including two clinical cohorts from northern and southern China. The cohorts consisted of 17,360 outpatients who had undergone upper gastrointestinal endoscopic examination in endoscopic clinics. The final model was derived based on unconditional logistic regression, and predictors were selected according to the Akaike information criterion. External validation was carried out with 32,614 participants from a community-based randomized controlled trial.Results::This questionnaire-based diagnostic model for malignant gastric lesions had eight predictors, including advanced age, male gender, family history of gastric cancer, low body mass index, unexplained weight loss, consumption of leftover food, consumption of preserved food, and epigastric pain. This model showed high discriminative power in the development set with an area under the receiver operating characteristic curve (AUC) of 0.791 (95% confidence interval [CI]: 0.750–0.831). External validation of the model in the general population generated an AUC of 0.696 (95% CI: 0.570–0.822). This model showed an ideal ability for enriching prevalent malignant gastric lesions when applied to various scenarios.Conclusion::This easy-to-use questionnaire-based model for diagnosis of prevalent malignant gastric lesions may serve as an effective prescreening tool in clinical opportunistic screening for gastric cancer.

Humans ; Waldenstrom Macroglobulinemia/genetics* ; East Asian People ; Chromosome Aberrations ; Lymphoma

Objective:To investigate the clinical application value of left ventricular myocardial strain obtained by cardiac MR (CMR) in recent major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods:From January 2020 to December 2020, a total of 163 patients successfully underwent primary PCI and underwent CMR examination within one week after surgery at Affiliated Hospital of Xuzhou Medical University. The scan sequences included rapid balance-fast field echo and late-gadolinium enhancement. CVI42 post-processing software was used to analyze and measure the left ventricular myocardial strain indices, including left ventricular global longitudinal strain (GLS), left ventricular global circumferential strain (GCS), and left ventricular global radial strain (GRS). According to the results of the 1-year follow-up after surgery, the patients were divided into the MACE group ( n=28) and the non-MACE group ( n=135). For continuous variables with a normal distribution, the t test of two independent samples was used for comparisons between groups. For continuous variables with an abnormal distribution, the variables were compared and analyzed by the rank sum test. For categorical variables, the χ 2 tests were used for between-group comparisons. Cox regression was used to analyze the prognostic value of myocardial strain on the development of MACE in patients with STEMI. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of myocardial strain parameters, and the optimal cut-off value was evaluated by calculating the Youden index. Results:The GLS, GCS, and GRS of the MACE group were (-10.4±3.3)%, [-11.9 (-14.5, -9.3)]%, and (18.3±6.3)%, respectively, and those of the non-MACE group were (-13.7±3.4)%, [-14.6 (-16.4, -11.7)]%, and (22.3±6.1)%, respectively. The difference between the two groups was statistically significant ( t/ Z=-4.71, -3.04, 3.21, P<0.05). Multivariate Cox regression analysis showed that GLS was an independent predictor of MACE (HR=1.546, 95%CI 1.180-2.027, P=0.002). The ROC curve analysis showed that GLS had the largest area under the curve (AUC) (AUC=0.754, 95%CI 0.658-0.851, P<0.001), with a cut-off value of -12.45%. Its diagnostic sensitivity was 71.4%, and the specificity was 67.4%. The value was better than that of the traditional predictor of STEMI prognosis, namely, left ventricular ejection fraction (AUC=0.680, 95%CI 0.567-0.793, P=0.003). Conclusion:GLS of CMR is an independent predictor of MACE in STEMI patients undergoing primary PCI.

Objective:To investigate the conversion of low-energy CBCT images into high-energy CBCT images in clinical radiotherapy based on the deep learning method of U-Net network, in order to provide dual-energy CBCT images and reduce radiation dose.Methods:The CBCT image data of CIRS electron density phantom and CIRS head phantom at 80 and 140 kV were collected by the on-board CBCT in radiotherapy equipment. The dataset was divided into training set and test set according to 10∶1. The U-Net network was used to predict CBCT images at high energy (140 kV) from low-energy (80 kV) CBCT images. Four parameters, including mean absolute error (MAE), structural similarity index (SSIM), signal-to-noise ratio (SNR) and peak signal-to-noise ratio (PSNR) were used to quantitatively evaluate predicted high-energy CBCT images.Results:The overall structural difference between the predicted high-energy image and the real high-energy image was smaller (SSIM: 0.993 ±0.003). The noise of predicted high-energy image was lower (SNR: 15.33±4.06), but there was a loss of inter-tissue resolution. Predicted high-energy images had slightly lower average CT values than real high-energy images, with less difference in low-density tissues (<10 HU, P > 0.05) and greater differences in high-density tissues (<21 HU, t = -7.92, P < 0.05). Conclusions:High-energy CBCT images with high structural similarity can be obtained from energy CBCT images by using deep learning method. The predicted high energy CBCT images have the potential to be applied to clinical dual-energy CBCT imaging technology in radiotherapy.

Objective:To summarize the best evidence for radiotherapy injury prevention and nursing in patients with advanced esophageal cancer undergoing radiotherapy.Methods:Evidence for radiotherapy injury prevention and nursing in patients with advanced esophageal cancer undergoing radiotherapy were searched through Australian Joanna Briggs Institute (JBI) Evidence-Based Health Care Center Database, National Institute for Health and Care Excellence, National Guideline Clearinghouse, Registered Nurses ' Association of Ontario, New Zealand Guidelines Group, PubMed, Cochrane Library, UpToDate, China Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang Data. The search period was from the establishment of the database to January 31, 2022. Evidence retrieval, and evidence extraction were performed by 2 researchers. Evidence was graded and recommended according to the JBI evidence pre-grading system (2014 edition) . Results:A total of 11 articles were included, including 2 systematic reviews, 2 guidelines, 2 systematic assessments, 3 randomized controlled trials and 2 quasi-experimental studies. A total of 28 pieces of evidence were collected from 8 aspects, including oral mucositis, taste change or loss, malnutrition, radiation-induced esophagitis, radiation pneumonitis, radiation dermatitis, nausea and vomiting, and bone marrow suppression.Conclusions:The evidence extracted in this study can provide an evidence-based basis for prevention and nursing of radiotherapy injury in patients with advanced esophageal cancer, and hospitals can transform and apply the evidence according to their actualities.

Objective:To establish a rapid and quantitative method for the determination of immunoglobulin G4 (IgG4) by fluorescence immunochromatography and to analyze its clinical application value.Methods:Fluorescence immunoassay for quantitative detection of IgG4 was obtained by means of preparation of kits in a competitive reaction mode and combining immunoassay with fluorescence quantitative assay. The linearity, precision, accuracy, anti-interference ability and stability of the method were evaluated, and compared with immune-scattering turbidimetry, receiver operating characteristic curve (ROC) was plotted, area under the curve (AUC) was calculated, and the critical value for the diagnosis of pancreatitis related diseases was determined, and sensitivity and specificity were calculated.Results:The linear range of fluorescence immunoassay for IgG4 was 0.2-10.0 g/L. The accuracy coefficient of variation was less than 15%, and the accuracy deviation was within ±15%. Bilirubin (2.5 g/L), triglyceride (10 g/L) and hemoglobin (10 g/L) had no significant effect on the quantitative determination. Within 14 months, 1.20 g/L and 2.65 g/L reference samples were detected with concentration deviations within ±15%. The kit validity period was >12 months. Serum samples of 200 healthy people were detected by fluorescence immunochromatography, and the normal reference value of IgG4 was <2.03 g/L. fluorescence immunochromatography and Immunoturbidimetry were used to detect IgG4 concentrations in 383 clinical serum samples. The results showed that the two methods were consistent ( P>0.05). Using 2.01g/L IgG4 as the critical value, the sensitivity and specificity of fluorescence immunochromatography were 96.3% and 95.5% by ROC curve analysis, respectively. Conclusions:Fluorescence immunochromatography was a simple, rapid and accurate method for the quantitative detection of IgG4, and had high sensitivity and specificity for the diagnosis of pancreatitis related diseases. It was suitable for quantitative detection of bulk samples in outpatient and emergency departments.

【Objective】 To investigate the feasibility of using surface electromyography （SEMG） for the detection of abnormal muscle response （AMR） in patients with hemifacial spasm （HFS）. 【Methods】 We retrospectively reviewed the clinical data of HFS patients who underwent microvascular decompression （MVD） in our hospital between June 2019 and December 2020. Patients who received both surface electrode （preoperative） and needle electrode （intraoperative） detection of AMR were included. SEMG recorded from two stimulation-recording sites， namely， zygomatic-mentalis and mandibular marginal-orbicularis oculi， was selected for analyzing the characteristics of AMR. The positive rates of AMR detected by these two kinds of electrodes were comprehensively compared. 【Results】 Totally 77 patients were included in this study. When detected with surface electrodes， the positive rate， latency and amplitude of AMR recorded at zygomatic-mentalis oculi were 90.9% （70/77）， （10.87±1.86） ms and （202.8±47.4） μV， and at mandibular marginal-orbicularis oculi were 92.2% （71/77）， （10.41±1.83） ms and （211.1±54.1） μV， respectively. AMR was detected in 74 patients （96.1%） with surface electrodes. There was no significant difference in positive rate， latency and amplitude of AMR between these two stimulation-recording methods. When detected with needle electrodes， the positive rate of AMR recorded at zygomatic-mentalis oculi was 98.7% （76/77）， which was significantly higher than the rate 89.6% （69/77） recorded at mandibular marginal-orbicularis oculi （P=0.016）. The latency and amplitude of AMR recorded at zygomatic-mentalis were （10.63±1.39） ms and （83.5±27.2） μV， and at mandibular marginal-orbicularis oculi were （10.31±1.18） ms and （58.6±21.4） μV. There was no significant difference in latency between the two stimulation-recording methods， but the amplitude recorded at mandibular marginal-orbicularis oculi was significantly lower （P=0.041）. AMR was detected in 76 patients （98.7%） with needle electrodes. There was no significant difference in the detection rate of AMR between surface electrodes and needle electrodes （P=0.500）， the results were moderately consistent （Kappa=0.490， P<0.001）. 【Conclusion】 The detection efficiency of surface electrodes for AMR is similar to that of needle electrode. With its non-invasive characteristic， the surface electrode can be routinely used for electrophysiological evaluation of HFS.

Objective:An automatic analysis system for radiotherapy planning was developed to realize the automatic analysis of dose parameters of radiotherapy planning through the intelligent analysis of the underlying data of Pinnacle 3 treatment planning system (TPS). Methods:The radiotherapy plans of 12 patients with esophagus cancer were analyzed. The automatic analysis system automatically retrieved the Pinnacle 3 TPS database, obtained the raw data of 12 cases of treatment plan, and automatically analyzed the underlying raw data, reconstructed contours, radiation fields, and dose parameters, and recalculated dose distribution and dose-volume histograms. The accuracy of the recalculation of the volume and dose data of the new system was evaluated by comparing with volume and dose data from the original plans of online TPS. Results:The automatic analysis system successfully parsed the underlying data of the treatment plan and reconstructed the parameters of the treatment plan. The volume deviation between the contour calculated by the new system and the original plans was ≤0.1%; Compared with the reference dose of the original plans, the deviations of dose parameters (D max, D mean, D 95, and D 50 for GTV, PGTV, CTV, and PTV) recalculated by the new analysis system were ≤1.0%; The deviations of D max and D mean of recalculated ROIs from the original plans were <5%. Conclusions:The automatic analysis system can directly analyze the underlying data of the Pinnacle 3 TPS treatment plan, reconstruct the treatment plan, calculate the contour volume and dose parameters, and the dose deviations from the original plans meet clinical requirements

Objective: Applying radiomics and dosimetry features to establish machine learning models, which is used to predict the 2-year survival of esophageal patients with radiotherapy. Methods: Retrospective analysis of 579 esophageal cancer patients who underwent radiotherapy from January 2013 to December 2017 in Tianjin Medical University Cancer Institute and Hospital. Radiomics and dosimetry features were extracted from the GTV of the radiotherapy plan for patients with esophageal cancer. The maximum correlation and minimum redundancy and manual methods were used to reduce the feature vector. A total of 14 radiomics and 14 dosimetry features were selected, then normalized to the range [0,1]. The machine learning models such as support vector machines (SVM), Logistic regression (LR), and random forest (RF) were used to train and test the radiomics and dosimetry features, respectively, then to predict the 2-year survival of esophageal cancer patients treated with radiotherapy. Results: When only the radiomics features were used to predict the 2-year survival after radiotherapy, the accuracy of SVM, LR and RF models were 84.98%, 85.92% and 84.51%, respectively. Furthermore, when the combined features of radiomics and dosimetry were used for prediction, the accuracy of the SVM, LR and RF models were 86.32%, 83.02% and 90.01%, respectively. Using the radiomics and dosimetry features, the predictive accuracy of SVM and RF models are effectively improved. Conclusions: For the SVM and RF models, the radiomics and dosimetry features can effectively improve the accuracy of predicting 2-year survival for esophageal cancer patients after radiation therapy.