Objective To investigate the independent risk factors for postoperative deep vein thrombosis in lung cancer patients and to construct a risk prediction model.Methods Clinical data of 354 inpatients who underwent thoracoscopic surgery for lung cancer in Department of Thoracic Surgery of First Affiliated Hospital of Army Medical University between May 2019 and May 2023 were retrospectively collected and analyzed.LASSO regression was used to screen potential factors,followed by multivariate logistic regression to identify risk factors,and then a nomogram prediction model was constructed.Calibration curves,receiver operating characteristic(ROC)curves,and decision curves were drawn to evaluate the model's calibration,discrimination,sensitivity,specificity,and clinical utility.The net reclassification improvement(NRI)and integrated discrimination improvement(IDI)indices were employed to compare the predictive performance of the constructed model with the Caprini score for outcome events.Results LASSO regression identified 17 potential influencing factors.Multivariate regression analysis showed that D-dimer,central venous catheter(CVC)placement,and lower extremity varicose veins were independent risk factors for postoperative DVT in lung cancer patients(P＜0.05).Calibration curve analysis showed the model had good agreement between the predicted and observed values.ROC curve analysis indicated that the sensitivity and specificity of the model was 0.812 and 0.963,respectively,with an area under the curve(AUC)value of 0.912(95％CI:0.840～0.983).In comparison,the Caprini model had a sensitivity and specificity of 0.625 and 0.860,respectively,with an AUC value of 0.752(95％CI:0.657～0.846).The NRI and IDI for the model group compared to the Caprini model were 0.709 and 0.431,respectively.Decision curve analysis showed that the net benefit of applying the model from this study was higher than that of the Caprini model.Conclusion D-dimer,CVC,and varicose veins of lower extremities are independent risk factors for DVT after thoracoscopic surgery in patients with lung cancer.Our constructed nomogram model can effectively predict the risk of DVT after thoracoscopic surgery in patients with lung cancer.

Objective:To analyze the clinical characteristics, muscle imaging and pathological features of patients with anti-signal recognition particle positive immune-mediated necrotizing myopathy (SRP-IMNM).Methods:Nine patients with SRP-IMNM were collected in the Neuromuscular Disease Center of Jiaozuo People′s Hospital from May 2018 to May 2023, who were confirmed by skeletal muscle pathology and myositis-specific autoantibodies detection, and their clinical manifestations, muscle imaging and muscle pathology characteristics were systematically summarized.Results:Among the 9 patients with SRP-IMNM, there were 7 females and 2 males. The age of onset ranged from 18 to 59 years. All the patients presented proximal muscle weakness. Seven patients experienced neck weakness, and dysphagia was present in 5 patients. Laboratory examinations showed elevated serum creatine kinase levels in all 9 patients (1 866-6 725 U/L). Eight patients were combined with other antibodies positivity, except for anti-SRP antibody. Among them, 7 patients were combined with anti-Ro-52 antibody positivity, 4 patients combined with anti-Ro-52 antibody positivity alone, and 3 patients combined with 3 or more positive antibodies simultaneously. Those patients who presented with interstitial lung disease and cardiac involvement were all combined with other antibodies positivity. Seven patients completed thigh muscle magnetic resonance imaging (MRI), which showed diffuse skeletal muscle oedema, partial muscle atrophy and fatty replacement, primarily affecting the posterior thigh muscle group. Two patients underwent shank muscle MRI. The soleus involvement was evident, while the tibialis anterior muscle and gastrocnemius muscles were involved in 1 patient. All 9 patients showed varying degrees of scattered muscle fiber necrosis and regeneration on muscle biopsies. In 1 patient, a small amount of inflammatory cell infiltration was observed. Pipestem capillaries were observed in 4 patients. Immunohistochemical staining revealed a small number of CD68-positive lymphocytes in 8 patients. Additionally, 5 patients showed upregulation of major histocompatibility complex Ⅰ expression on the muscle fiber membrane, while 6 patients showed deposition of membrane attack complex (C5b-9) on non-necrotic muscle fibers and capillaries. P62 staining showed homogeneous fine-granular in sarcoplasm in 6 patients.Conclusions:In addition to proximal muscle weakness, patients with SRP-IMNM often experience neck weakness and dysphagia. Those with multiple antibodies are more likely to develop interstitial lung disease and cardiac involvement. SRP-IMNM patients have diffuse oedema in the affected muscles, and the posterior thigh muscles are more prone to atrophy and fatty tissue formation. C5b-9 deposition and pipestem capillaries are significant pathological features of SRP-IMNM, which provide additional evidence for clinical diagnosis.

This paper analyzes the literature on virtual reality(VR)technology interventions for autistic children published from 2014 to 2022.It shows that different VR systems in these studies have improved different symptoms of autism,and points out the feasibility of VR technology interventions for autistic children.

Objective:To summarize the clinical, imaging, muscle pathological and gene mutational features of patients with late-onset mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS).Methods:Three patients with late-onset MELAS, admitted to Department of Neurology, Jiaozuo People's Hospital Affiliated of Xinxiang Medical University from January 1997 to December 2021 were chosen; all patients were screened for mitochondrial DNA (mtDNA) and nuclear DNA (nDNA) mutations by second-generation gene sequencing. The clinical, imaging, muscle pathological and gene mutational features of patients with late-onset MELAS were analyzed retrospectively.Results:The main clinical manifestations of these late-onset MELAS patients included stroke-like attacks, headache, hearing and vision loss, cognitive decline and mental disorder. The muscle tension and muscle strength of both upper extremities in these 3 patients were normal. Increased muscle tension and active tendon reflexes, and positive pathological signs in both lower extremities were noted in 2 patients. Head MRI showed abnormal long T1 and long T2 signals in temporal occipital parietal cortex and subcortex in 3 patients, and CT showed calcification in bilateral globus pallidus in 1 patient. Ragged red fibers (RRF) and ragged blue fibers (RBF) were found in the muscle biopsies of 3 patients, and cytochrome oxidase (COX)-negative muscle fibers were found in 2 patients. MT-TL1 gene m.3243A>G mutation was detected in all 3 patients by genetic testing, among which mutation in the blood of 2 patients was 15% and 17%, respectively, and mutation in the muscle tissues of 1 patient was 73%. Conclusion:Muscle pathology indicates high RRF percentage in patients with late-onset MELAS; and m.3243A>G spot mutation is the most common mutation type in late-onset MELAS, and m.3243A>G mutation ratio in muscle tissues is obviously higher than that in blood.

Objective:To summarize the characteristics of clinical, muscle pathology and gene mutation of late-onset reducing body myopathy caused by FHL1 gene mutation, in order to improve clinicians′ understanding of this disorder. Methods:The clinical, muscle pathology and muscle magnetic resonance imaging data of the proband from a family diagnosed as reducing body myopathy in Jiaozuo People′s Hospital in December 2021 were collected. Genetic tests and pedigree verification were conducted on the proband and her son.Results:The proband was a 59-year-old female with progressive, asymmetrical limb weakness and muscular atrophy. Her mother, sister and brother had similar symptoms. Electromyography showed myogenic and neurogenic damage. Muscle magnetic resonance imaging indicated that the lesion mainly involved the posterior muscles of the thigh and calf, as well as the gluteus maximus. The muscle pathology showed eosinophilic granular inclusion bodies and rimmed vacuoles in the muscle fibers of the lesion. The structure of myofibrils was disordered and abnormal protein deposition was observed. The gene sequencing showed the FHL1 gene p.C150S heterozygous variation. Conclusions:Late-onset reducing body myopathy is characterized by progressive asymmetric proximal limb muscle weakness, partially involving distal limb muscles and gluteus maximus. Muscle pathology shows the characteristic pathological changes of many kinds of myofibrillar myopathies. FHL1 gene mutation is an important basis for diagnosis.

Objective To investigate the recognition efficiency of AI model based on deep learning for cardiac conduction system(CCS).Methods HE staining sections of cardiac muscle and CCS of 17 cases of non-sudden death were selected,and the gold standard was unanimous recognition by 2 forensic pathologists with more than 20 years of CCS diagnosis experience.Inception V3 algorithm was used to establish AI model and complete CCS identification training and testing.Confusion matrix,accuracy,precision,recall,F1 score,ROC curve and AUC value were used to evaluate the effectiveness of AI model,and accuracy,sensitivity and specificity were used to evaluate the efficiency of manual independent and AI-assisted manual recognition for CCS.Results The accuracy of AI model was 87.3%,the precision was 91.9%,the recall was 81.9%,the F1 score was 86.6%,and the AUC value was 95.3%.The accuracy of AI model was higher than that of senior forensic pathologists.There was no statistical significance in the accuracy of AI-assisted senior forensic pathologists in identifying CCS compared with manual independent detection(P>0.05),while the accuracy of AI-assisted intermediate and junior forensic pathologists in identifying CCS was increased by 8%and 14.33%,respectively,with statistical significance(P<0.05).The accuracy rate of AI-assisted junior forensic pathologists to identify CCS was higher than that of intermediate forensic pathologists in self-diagnosis.Conclusion The AI model could be used for the automatic recognition of CCS,and could improve the diagnostic efficiency of CCS and narrow the gap between the forensic pathologists with low experience and that with high experience.

Objectives:To explore obesity prevalence and its association with dietary patterns among Tibetan pastoralists during the urbanization transition in Qinghai Province.Methods:Using an open cohort study design, 1 003 subjects were enrolled at baseline in 2018, 599 were followed up, and 1 012 were newly recruited in 2022. A total of 1 913 adults over 18 years were included in the study, and a questionnaire survey and health examination were conducted. Factor analysis was used to identify dietary patterns, and a mixed-effects model was used to analyze the association between dietary patterns and obesity.Results:From 2018 to 2022, the prevalence rates of overweight, obesity, and central obesity were 27.6%, 33.8%, and 54.6%, respectively. Age-sex-standardized prevalence of obesity and central obesity increased. Three dietary patterns were identified: the modern pattern was characterized by frequent consumption of pork, poultry, processed meat, fresh fruits, sugary drinks, salty snacks, etcetera; the urban pattern was characterized by frequent consumption of refined carbohydrates, beef and mutton, vegetables and eggs, etcetera; and pastoral pattern featured frequent consumption of tsamba, Tibetan cheese, buttered/milk tea, and whole-fat dairy products. After adjusting for demographic characteristics, socioeconomic status, and lifestyle factors, compared with the T1, subjects in the T3 of urban pattern scores were more likely to be overweight ( OR=2.09, 95% CI: 1.10-3.95) and overweight/obese ( OR=1.23, 95% CI: 1.00-1.51), whereas those in the T3 of pastoral pattern scores had a lower risk of overweight ( OR=0.45, 95% CI: 0.24-0.84), obesity ( OR=0.81, 95% CI: 0.69-0.95), overweight/obesity ( OR=0.75, 95% CI: 0.61-0.91) and central obesity ( OR=0.58, 95% CI: 0.38-0.89). Conclusions:Prevalence of obesity and central obesity was high among Tibetan pastoralists during the urbanization transition. Urban dietary pattern was a risk factor for overweight and overweight/obesity, whereas pastoral dietary pattern was a protective factor for overweight, obesity, overweight/obesity, and central obesity. Tailored interventions are needed to improve local people's health.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Objective:To compare the quality and diagnostic utility of the three sequences including fast spin echo (FSE), multi-acquisition variable resonance image combination selective (MAVRIC-SL), and isotropic MAVRIC-SL (iso MAVRIC-SL), in evaluating the intervertebral foramen and spinal canal in patients after lateral lumbar interbody fusion (LLIF).Methods:Totally 30 patients after LLIF were enrolled prospectively from May to June 2020 in the Second Hospital of Shanxi Medical University. The patients underwent MRI of the lumbar spine including sagittal MAVRIC-SL and iso MAVRIC-SL sequence three-dimensional volume imaging, and the axial spinal canal level images were reconstructed. FSE sequence sagittal T 1WI and axial T 2WI images were acquired simultaneously. The sagittal and axial images were subjectively graded for visualization of the intervertebral foramen and spinal canal. The artifact area and SNR were measured. The Friedman M test was used to compare the differences in image quality scores, artifact area and SNR among the three sequences. Results:Nonparametric test results showed significant differences in sagittal and axial image quality scores among the three sequences (both P<0.001). Sagittal image quality scores of MAVRIC-SL [4 (4, 4) points] and iso MAVRIC-SL [4 (4, 4) points] were higher than those of FSE T 1WI sequence [3 (3, 3) points, both P<0.001]. The quality scores of MAVRIC-SL and iso MAVRIC-SL showed no significant differences ( P=1.000). The axial image quality score of iso MAVRIC-SL[5 (5, 5) points] were higher than those of MAVRIC-SL [4 (4, 4) points] and FSE T 2WI [3 (3, 3) points, both P<0.05]. The iso MAVRIC-SL images enabled a significantly improved reduction in the artifact area and SNR compared to the MAVRIC-SL and FSE sequence (all P<0.05). Conclusion:The iso MAVRIC-SL acquisitions enhance visualization of the intervertebral foramen and spinal canal and decrease metal artifacts compared with MAVRIC-SL and FSE acquisitions.

Diabetic retinopathy (DR) is an important cause of blindness globally, and its prevalence is increasing. Early detection and intervention can help change the outcomes of the disease. The rapid development of artificial intelligence (AI) in recent years has led to new possibilities for the screening and diagnosis of DR. An AI-based diagnostic system for the detection of DR has significant advantages, such as high efficiency, high accuracy, and lower demand for human resources. At the same time, there are shortcomings, such as the lack of standards for development and evaluation and the limited scope of application. This article demonstrates the current applications of AI in the field of DR, existing problems, and possible future development directions.
Artificial Intelligence ; Blindness ; Diabetes Mellitus ; Diabetic Retinopathy/diagnosis* ; Humans ; Mass Screening