Medical studies have found that tumor mutation burden (TMB) is positively correlated with the efficacy of immunotherapy for non-small cell lung cancer (NSCLC), and TMB value can be used to predict the efficacy of targeted therapy and chemotherapy. However, the calculation of TMB value mainly depends on the whole exon sequencing (WES) technology, which usually costs too much time and expenses. To deal with above problem, this paper studies the correlation between TMB and slice images by taking advantage of digital pathological slices commonly used in clinic and then predicts the patient TMB level accordingly. This paper proposes a deep learning model (RCA-MSAG) based on residual coordinate attention (RCA) structure and combined with multi-scale attention guidance (MSAG) module. The model takes ResNet-50 as the basic model and integrates coordinate attention (CA) into bottleneck module to capture the direction-aware and position-sensitive information, which makes the model able to locate and identify the interesting positions more accurately. And then, MSAG module is embedded into the network, which makes the model able to extract the deep features of lung cancer pathological sections and the interactive information between channels. The cancer genome map (TCGA) open dataset is adopted in the experiment, which consists of 200 pathological sections of lung adenocarcinoma, including 80 data samples with high TMB value, 77 data samples with medium TMB value and 43 data samples with low TMB value. Experimental results demonstrate that the accuracy, precision, recall and F1 score of the proposed model are 96.2%, 96.4%, 96.2% and 96.3%, respectively, which are superior to the existing mainstream deep learning models. The model proposed in this paper can promote clinical auxiliary diagnosis and has certain theoretical guiding significance for TMB prediction.
Humans ; Lung Neoplasms/pathology* ; Carcinoma, Non-Small-Cell Lung/genetics* ; Mutation ; Adenocarcinoma of Lung/genetics* ; Biomarkers, Tumor/genetics*

Objective:To investigate the clinical value of contrast-enhanced ultrasound and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) in the diagnosis of hepatocellular carcinoma (HCC).Methods:The clinically diagnostic test was conducted. The clinicopathological data of 274 lesions in 250 patients with liver neoplasms who were admitted to the First Hospital Affiliated to Army Medical University from January 2017 to December 2018 were collected. There were 204 males and 46 females, aged (52±11)years, with a range from 22 to 78 years. Patients underwent contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, and they received surgical resection or biopsy within one month. Images was read and analyzed by two senior radiologists for diagnosis. Observation indicators: (1) imaging features of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, including ① imaging features of contrast-enhanced ultrasound, ② imaging features of Gd-EOB-DTPA MRI, ③ enhanced imaging manifestation in different phases of 223 HCC lesions; (2) dignostic performance of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis, including ① sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis and ② sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis in lesions with different diameters. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. With the pathological examination as the golden criteria of diagnosis, the sensitivity, specificity and accuracy rate of the contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were calculated.Results:(1) Imaging features of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI. ① Imaging features of contrast-enhanced ultrasound: of the 223 HCC lesions on contrast-enhanced ultrasound, 167 lesions were accorded with fast in fast out of HCC, 7 were missed diagnosed and 49 were misdiagnosed. Of the 51 non-HCC lesions on contrast-enhanced ultrasound, 7 lesions were accorded with fast in fast out, including 3 of combined hepatocellular-cholangiocarcinoma, 2 of intrahepatic cholangiocarcinoma, 1 of neuroendocrine tumor, 1 of inflammatory granuloma, 44 lesions were no fast in fast out. ② Imaging features of Gd-EOB-DTPA MRI: of the 223 HCC lesions on Gd-EOB-DTPA MRI, 178 lesions were accorded with fast in fast out of HCC, 1 was missed diagnosed and 44 were misdiagnosed. Of the 51 non-HCC lesions on Gd-EOB-DTPA MRI, 5 lesions were accorded with fast in fast out, inlcuding 2 of intrahepatic cholangiocarcinoma, 1 of combined hepatocellular-cholangiocarcinoma, 1 of neuroendocrine tumor, 1 of inflammatory granuloma, 46 lesions were no fast in fast out. ③ Enhanced imaging manifestation in different phases of 223 HCC lesions. In arterial phase, 92.83%(207/223) of the lesions displayed hyper-enhanced on contrast-enhanced ultrasound, and 80.72%(180/223) of the lesions displayed hyper-enhanced on Gd-EOB-DTPA MRI, showing a significant difference ( χ2=14.240, P<0.05). In portal vein phase or late phase, 78.48%(175/223) of the lesions displayed hypo-enhanced on contrast-enhanced ultrasound, and 96.41%(215/223) of the lesions displayed hypo-enhanced on Gd-EOB-DTPA MRI, showing a significant difference ( χ2=32.674, P<0.05). On Gd-EOB-DTPA MRI, 96.41%(215/223) of the lesions displayed low signals in portal-vein phase or late phase, and 98.21%(219/223) of the lesions displayed low signals in hepatobiliary phase, showing no significant difference ( χ2=1.370, P>0.05). (2) Dignostic performance of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis. ① Sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis: the sensitivities of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 74.89%(167/223), 79.82%(178/223), 94.62%(211/223), respectively. The specificities of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 86.27%(44/51), 90.20%(46/51), 80.39%(41/51). The accuracy rates of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 77.01%(211/274), 81.75%(224/274), 91.97%(252/274). There were significant differences in the sensitivity and accuracy rate among the three methods ( χ2=33.499, 23.345, P<0.05). There was no significant difference in the specificity among the three methods ( χ2=2.017, P>0.05). ② Sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis in lesions with different diameters: 128 of 274 lesions had the maximun diameter>3 cm and ≤5 cm, 92 lesions had the maximun diameter >2 cm and ≤3 cm, 54 lesions had the maximun diameter≤ 2 cm. The sensitivities of contrast-enhanced ultrasound for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 81.19%(82/101), 76.92%(60/78), 56.82%(25/44), the specificities were 92.59%(25/27), 71.43%(10/14), 90.00%(9/10), and the accuracy rates were 83.59%(107/128), 76.09%(70/92), 62.96%(34/54), respectively. The sensitivities of Gd-EOB-DTPA MRI for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 83.17%(84/101), 79.49%(62/78), 72.73%(32/44), the specificities were 96.30%(26/27), 85.71%(12/14), 80.00%(8/10), and the accuracy rates were 85.94%(110/128), 80.43%(74/92), 74.07%(40/54), respectively. The sensitivities of contrast-enhanced ultrasound combined with Gd-EOB-DTPA MRI for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 95.05%(96/101), 96.15%(75/78), 90.91%(40/44), the specificities were 92.59%(25/27), 57.14%(8/14), 80.00%(8/10), and the accuracy rates were 94.53%(121/128), 90.22%(83/92), 88.89%(48/54), respectively. There were significant differences in the sensitivities for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm among the three methods ( χ2=9.703, 12.777, 13.142, P<0.05). There were also significant differences in the accuracy rates ( χ2=8.051, 6.600, 9.826, P<0.05). There was no significant difference in the specificies ( P>0.05). Conclusions:There was no significant difference in the dignostic performance for HCC diagnosis between contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, and the combination of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI can improve the diagnostic sensitivity and accuracy rate of HCC.

Objective To compare the clinical efficacy and safety of carbon dioxide (CO2) versus high-frequency electroacupuncture based on the assistance of drilling and blunt dissection in the treatment of steatocystoma multiplex.Methods A randomized,self-controlled study was performed in 15 patients.The median line of the body served as the dividing line,and the lesions on the two sides of the median line of the body were randomly divided into 2 groups to be treated with CO2 laser or high-frequency electroacupuncture,which left micropathways into the cyst cavity.After the above treatment,contents in the cysts were squeezed out or drawn out with a mosquito clamp,and the cysts were bluntly dissected.The decrustation time,erythema subsiding time,adverse reactions and recurrence were compared among lesions at different sites or with different sizes.Results For the lesions at the same sites or with similar sizes after treatment,the decrustation time and erythema subsiding time were both significantly shorter in the CO2 laser group than in the high-frequency electroacupuncture group (both P ＜ 0.05).There were significant differences in the decrustation time and erythema subsiding time among lesions at different sites or with different sizes (all P ＜ 0.05).Mild pain occurred in the 2 groups,and no hematoma or secondary infection occurred.There were significant differences in the incidence of scar formation or pigmentation between the 2 groups (both P ＜ 0.05).During the follow-up of 6-18 months,relapse occurred in 1 patient in each group.Conclusion Compared with the high-frequency electroacupuncture,CO2 laser assisted by drilling and blunt dissection shows better efficacy in the treatment of steatocystoma multiplex,and it can remove lesions at various sites at one time.

Objective To investigate the effect of vacuum-assisted closure(VAC)on the circulating number of endothelia progenitor cell(EPCs)in diabetic patients with mild to moderate degrees of ischemic foot ulcer and their related factors. Methods A total of 84 diabetic patients with foot ulcer duration for at least 4 weeks and ankle brachial index(ABI)0.5~0.9 were selected and divided into and assigned to two groups according to 2: 1 randomization:vacuum-assisted closure(VAC)treatment group(n=56)and Non-VAC treatment group(n=28). The control group (NC) was composed of 18 patients who had normal glucose tolerance and lower extremity ulcer without arteriovenous disease. VAC was performed on the ulcer wound after debridement for 1 week in both VAC group and NC group,and the patients in Non-VAC group received conventional treatment process. The circulating number of EPCs was measured before and after various treatments and the influencing factors of their changes were analyzed. Results After VAC treatment,the circulating number of EPCs significantly increased in both VAC group and NC group[(85.3 ± 18.1)vs(34.1 ± 12.5)/106cells,(119.9 ± 14.4)vs(66.1 ± 10.6)/106cells,both P<0.05]. By contrast,the circulating number of EPCs had no significant change in Non-VAC group[(45.2 ± 19.4)vs(34.7 ± 16.8)/106cells, P>0.05]. In addition,the circulating levels of vascular endothelial growth factor(VEGF)and the protein expressions of VEGF and stromal cell-derived factor-1α(SDF-1α)in the granulation tissue also significantly increased after VAC treatment in both VAC group and NC group,but no significant change in Non-VAC group. Compared with Non-VAC group,the changes of VEGF and SDF-1α levels in the sera and granulation tissue were all significantly higher in both VAC group and NC group(P<0.05 or P<0.01). There were no significant differences in changes of the circulating number of EPCs, and VEGF and SDF-1α in the sera and granulation tissue between VAC group and NC group. Correlation analysis showed that the change of the circulating number of EPCs was correlated with the changes of VEGF and SDF-1α levels in the sera and granulation tissue of VAC group and NC group(P<0.05). Conclusion VAC treatment may increase the circulating number of EPCs in diabetic patients with mild to moderate ischemic foot ulcer as in non-diabetic controls,which may be attributed to the upregulation of systemic and local VEGF and SDF-1α levels.

Objective To investigate the invasion situation of cardinal ligaments(CL) in stage Ⅰ A2 - ⅡA2 cervical cancer and to find the high risk clinicopathological factors affecting its invasion .Methods The retrospective analysis was performed on the clinicopathological data in 2 982 patients with cervical cancer treated by operation extracted in 5 hospitals from January 2004 to De‐cember 2014 .Results (1) Totally 855 cases according with the research condition were included .The CL invasion was found in 20 cases(2 .3% ) .No CL invasion occurred in the stage ⅠA2 ,the CL invasion rate in the stage ⅠB1 was 1 .7% ,in the stage ⅠB2 was 1 .2% ,in the stage ⅡA1 was 5 .7% and in the stage ⅡA2 was 2 .9% .With the increase of FIGO staging ,the CL invasion rate had no significant increase(P=0 .269) .(2) The infiltration rate of left CL and right CL had no statistical difference among the stageⅠA2- ⅡA2(P=1 .000) .And the invasion rate of the left CL with different FIGO stages had no statistical difference(P=0 .286) , while the right one had statistical difference(P=0 .005) ,in which the highest was in the stage ⅡA1 (4 .3% ) .(3)The univariate a‐nalysis found that lymph‐vascular invasion ,cervical stroma infiltration depth ,pelvic lymph node metastasis ,uterus body infiltration and vaginal fornix infiltration were the risk factors of CL invasion(P<0 .01);the further multivariate analysis determined that the invasion of uterine body(OR=11 .858) ,pelvic lymph node metastasis(OR=6 .359 ,) ,vaginal fornix infiltration(OR=6 .012 ,) were the risk factors for CL invasion(P<0 .05) .Conclusion The invasion rate of CL invasion in early stage cervcial cancer is low .The invasion of uterine body ,pelvic lymph node metastasis and vaginal fornix filtration are the risk factors for CL invasion in the stageⅠA2- ⅡA2 cervical cancer .

Objective To explore the relationship between semen leukocyte and liquefaction and sperm motility through the anal‐ysis of routine semen examination results .Methods Retrospectively analyze on 8 666 cases of routine semen examination .Accord‐ing to the leukocyte count the semen samples which had sperms were divided into three groups ,Group A :white blood cells≤1 × 106/mL ,Group B:(1-4)× 106/mL ,Group C :>4 × 106/mL .Then compare the liquefaction time and sperm motility of these three groups .Results Among the 8 666 cases of semen analysis ,there were 164 cases of azoospermia(accounting for 1 .9% ) and 8 502 fine cases(accounting for 98 .1% ) .There were 7 419 ,1 014 and 69 cases in Group A ,B ,C respectively .In the three groups ,there were 5 323 ,740 and 50 cases of normal sperm motility respectively ;there were 2 096 ,274 and 19 cases of the abnormal motility ca‐ses respectively .In the three groups ,the normal cases of semen liquefaction time were 4 593 ,608 and 43 respectively ;the abnormal were 2 826 ,406 and 26 cases respectively .Statistical analysis showed no significant correlation between semen leukocyte and lique‐faction(P=0 .712) ,and between semen leukocyte and sperm motility(P=0 .486) .There were 1 217 cases of normal sperm motility and 4 027 cases of abnormal sperm motility in normal liquefaction group;there were 1 172 cases of normal sperm motility and 2 086 cases of sperm motility in abnormal liquefied group .There was statistically significant difference between the two groups(P=0 .000<0 .05) .Conclusion There were no correlation between semen leukocyte count and liquefaction or sperm motility ,but sperm mo‐tility and liquefaction are correlated .

AIM: To investigate the effect of cobalt chloride (CoCl2) on the apoptosis of neural stem cells (NSCs) and the expression of microRNA-26a (miR-26a) in vitro, and to explore the mechanisms of NSC apoptosis in-duced by CoCl 2 .METHODS:NSCs were exposed to CoCl 2 at different doses (200~600μmol/L) for 24 h.The cell via-bility and apoptosis were measured by CCK-8 assay and TUNEL method.The expression of miR-26a-3p, miR-26a-5p, GSK-3β, caspase-3, Bcl-2 and Bax was examined by real-time PCR.The protein levels of Bcl-2 and Bax were detected by Western blotting .RESULTS: The cell viability was inhibited and the apoptosis of NSCs was increased significantly by CoCl2 in a dose-dependent manner (P<0.05).CoCl2 at concentration of 400μmol/L for 24 h was used to induce apopto-sis and the expression of miR-26a was down-regulated compared with control (P<0.05).Exposure to CoCl2 at concentra-tion of 400μmol/L up-regulated the expression of GSK-3β, caspase-3 and Bax , down-regulated the expression of Bcl-2 and Bcl-2/Bax (P<0.05).CONCLUSION:CoCl2 at concentration of 400μmol/L induces the apoptosis of NSCs obviously . CoCl2 may induce the NSC apoptosis by mitochondrial apoptotic pathway .Declining miR-26a may be related to NSC apopto-sis.

BACKGROUND:There is a high risk for the elderly cervical spine surgery combined with cerebral infarction, whereas conservative treatment is often unable to resolve serious cervical lesions.
OBJECTIVE:To discuss the surgical effects of anchor fixation via posterior approach on cervical spinal canal stenosis combined with cerebral infarction.
METHODS:A total of 21 patients with cervical spinal canal stenosis combined with cerebral infarction who were admitted over the past 5 years accepted cervical posterior expensive open-door laminoplasty and fixation with wire anchors. Therapeutic effects were evaluated according to the Japanese Orthopaedic Association (JOA) scores.
RESULTS AND CONCLUSION:Al the patients were fol owed up 6 to 24 months, averagely 15 months. Al patients were smoothly through the perioperative period. There were no acute severe cerebral infarction cases. Preoperative JOA score was (7.6±2.0) points averagely, and postoperative JOA score was (13.3±1.8) points averagely, showing a significant difference (P<0.01). Of the 21 patients, excellent effects were in 11 cases and good in 7 cases. The effective rate was 95%(20/21), and the excellent-good rate was 86%(18/21). The risk of surgical treatment of patients with cerebral infarction is higher, but it is not the absolute contraindication. Choosing the proper operation way is highly important. Cervical posterior expensive open-door laminoplasty and fixation with wire anchors can be used to reduce the risk of cerebrovascular accidents to some extent, and obtain an excellent clinical effect.

BACKGROUND:Col agen/bioactive glass composite materials possess excellent osteogenic potential and biocompatibility, but its application in bone tissue engineering is limited by mechanical property and degradation. OBJECTIVE:To construct col agen/bioactive glass/chitosan composite scaffolds with good mechanical property, anti-degradation ability and bone repair property.
METHODS:Bioactive glass/col agen composite scaffolds with chitosan as dispersant were prepared by lyophylization. Fourier transform infrared spectroscopy, scanning electron microscope, X-ray diffraction, and dynamic biomechanical testing were used to characterize the structure and properties of the composite scaffolds. RESULTS AND CONCLUSION:Results show that charge-attractions in pre-prepared bioactive glass/chitosan solution increased the homogeneity of bioactive glass dispersed in col agen gel and the compressive modulus and strength increased significantly due to the homogeneity and intermolecular interactions between chitosan and col agen. The enzymatic degradation rate and mineralization activity in the simulated body fluid were also lower because of a high degree of embedment of bioactive glass in col agen/chitosan matrix, and entanglement of col agen in chitosan at molecular level, which decreased the exposure of bioactive glass to the simulated body fluid, and col agen to enzyme solution.

Objective To discuss the effect of role reversal in the level management mode of clinical nursing on the growth of nurses .Methods N1 and N2 nurses were chosen to conduct role reversal and compare the effect before and after.Results The score of basic nursing quality was (94.20 ±1.87)after role reversal and (93.71 ±2.12)before, and the difference was not statistically significant (t=0.671,P>0.05).Patients'satisfaction was 96.5%before role reversal and 97.8%after, and the difference was not statistically significant (χ2 =1.683,P>0.05).The score of knowledge and skill , occupation morality, psychological traits, cognitive ability and social ability of 3 N1 nurses was respectively (94.49 ±3.81),(96.97 ±7.63),(91.90 ±3.78) , (96.76 ±4.44),(85.99 ±5.43)after role reversal, higher than (91.21 ±3.39),(90.41 ±7.62),(86.22 ± 4.29),(92.44 ±3.18),(80.29 ±4.39)before, and the differences were statistically significant (t=2.228, 2.107,3.441,2.740,2.828, respectively;P<0.05).Conclusions Role reversal in the level management mode of clinical nursing can shorten training period of junior nurses and promote their growth , so as to further expand and upgrade the advantage of level effect .