ObjectiveTo investigate the influencing factors for rebleeding after endoscopic therapy and the effect of the number of sequential treatment sessions on postoperative rebleeding in patients with liver cirrhosis receiving secondary prevention of gastroesophageal varices （GOV）. MethodsA total of 1 717 patients with liver cirrhosis who received secondary prevention of GOV and attended The 960th Hospital of the PLA Joint Logistice Support Force from January 2017 to December 2021 were enrolled， and according to the presence or absence of bleeding after endoscopic therapy， they were divided into non-bleeding group and rebleeding group. The influencing factors for rebleeding were analyzed， as well as the association between the number of endoscopic treatment sessions and rebleeding. The chi-square test was used for comparison of categorical data between groups； the independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between the two groups； the Kruskal-Wallis H test was used for comparison bertween multiple groups， and the Wilcoxon test was used for further comparison between two groups. The Cox regression model was used to investigate the influencing factors for rebleeding， and the Kaplan-Meier method was used to plot survival curves， while the Log-rank test was used for comparison between groups. ResultsOf all patients， 286 （16.7%） experienced rebleeding after endoscopic therapy， and 1 431 （83.3%） did not experience bleeding. There were significant differences between the two groups in history of smoking and drinking， etiology of liver cirrhosis， hemoglobin （Hb）， prothrombin time （PT）， prothrombin activity （PTA）， international normalized ratio （INR）， albumin （Alb）， fasting blood glucose， blood urea nitrogen， Child-Pugh class， aspartate aminotransferase-to-platelet ratio index （APRI） score， albumin-bilirubin （ALBI） score， use of non-selective beta-blocker （NSBB） before surgery， treatment modality， type of varices， and maximal varicose vein diameter （all P<0.05）. The univariate Cox regression analysis showed that in the patients with liver cirrhosis who received secondary prevention of GOV， rebleeding was associated with history of smoking and drinking， etiology of liver cirrhosis， use of NSBB before surgery， treatment modality， maximal varicose vein diameter， Hb， platelet count， PT， PTA， INR， Alb， total bilirubin （TBil）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase， blood glucose， Child-Pugh class， and ALBI score （all P<0.05）. The multivariate Cox regression analysis showed that Hb （hazard ratio ［HR］=0.989， 95% confidence interval ［CI］： 0.983‍ ‍—‍ ‍0.994， P<0.001）， TBil （HR=1.020， 95%CI： 1.006‍ ‍—‍ ‍1.034， P=0.005）， Alb （HR=0.868， 95%CI： 0.758‍ ‍—‍ ‍0.994， P=0.041）， treatment modality （sclerosing agent： HR=2.158， 95%CI： 1.342‍ ‍—‍ ‍3.470， P=0.002； tissue adhesive： HR=2.709， 95%CI： 1.343‍ ‍—‍ ‍5.462， P=0.005； ligation+sclerosing agent： HR=3.181， 95%CI： 1.522‍ ‍—‍ ‍6.645， P=0.002； sclerosing agent+tissue adhesive： HR=1.851， 95%CI： 1.100‍ ‍—‍ ‍3.113， P=0.020）， ALP （HR=1.003， 95%CI： 1.001‍ ‍—‍ ‍1.004， P=0.002）， and maximal varicose vein diameter （HR=1.346， 95%CI： 1.119‍ ‍—‍ ‍1.618， P=0.002） were independent influencing factors for rebleeding after endoscopic therapy. Comparison of rebleeding rate after different numbers of sequential treatment sessions showed that the patients treated for three sessions had a significantly lower rebleeding rate than those treated for one or two sessions （χ²=8.643 and 5.277， P=0.003 and 0.022）. The survival analysis showed that with the increase in the number of treatment sessions， there was a significantly longer interval between rebleeding （P=0.006） and a significantly lower mortality rate （P<0.001）. ConclusionThe levels of TBil， ALP， Hb， and Alb on admission， endoscopic treatment modality， and maximal varicose vein diameter were the main predictive factors for rebleeding after endoscopic therapy for GOV in liver cirrhosis， and such predictive factors should be closely monitored in clinical practice. Regular endoscopic therapy can reduce the rebleeding and mortality rates of patients with liver cirrhosis and GOV and prolonmg the interval between rebleeding.

Nuclear medicine plays an indispensable role in the diagnosis,treatment,and prognosis of a wide range of diseases.Nuclear medicine using radionuclides for diagnosis has the advantages of accuracy,speed,high sensitivity and high resolution.Currently,several radionuclides play pivotal roles in disease diagnosis.This article primarily examines the clinical application and research of diagnostic radionuclides,including 18 F,89 Zr,68 Ga,99m Tc,131 I,123 I,and 11 C.The objective is to offer valuable insights for disease diagnosis and staging of diseases.

Objective:To investigate the necessity and feasibility of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology in the clinical application of radiotherapy.Methods:This study developed a 3D virtual operation and interactive system using the Unity3D engine, tools including 3Dmax and Maya, and the SQL database. The scenes in the system were produced using the currently popular next-generation production process. Targeting the priorities and difficulties in the implantation of fiducial markers, the system developed in this study allowed for simulated demonstration and training based on 12 steps and 10 knowledge points. Internal tests and remote evaluation tests were adopted in this system to obtain the test result of each subject. Then, the application value of the system was analyzed based on the test result.Results:As of May 1, 2022, the system had received 2 409 views and 425 test participants, with an test completion rate of 100% and an experiment pass rate of 96.5%. Moreover, this system won unanimous praise from 167 users, primarily including the students majoring in multilevel medical imaging technology and medical imaging science from the Fujian Medical University, as well as the radiotherapy-related staff of this university.Conclusions:The virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology can be applied to the teaching of students and the training of related professionals.

In recent years, the corona virus disease 2019 (COVID-19) pandemic has had a huge impact on the global medical, political and economic fields. Since the beginning of the COVID-19 epidemic, our understanding of the impact of COVID-19 has grown exponentially. Recently, the COVID-19 epidemic has changed rapidly in China, and there has been controversy over how to carry out surgical operations for patients with lung neoplastic lesions. Some studies have shown that lung cancer patients undergoing surgery are more likely to experience respiratory failure and perioperative death after contracting COVID-19 than the general population, however, delays in cancer treatment are also associated with increased mortality among these patients. In particular, the novel coronavirus Omikron variant has a higher transmissibility and may escape the immunity obtained through the previous novel coronavirus infection and vaccination. In order to minimize the risk of novel coronavirus infection in surgical patients, it is necessary to develop new treatment guidelines, expert consensus and preventive measures. However, the current rapid change of the epidemic situation has led to insufficient time and evidence to develop guidelines and consensus. Therefore, thoracic surgeons need to evaluate specific patient populations at higher risk of severe complications before surgery and weigh the benefit of surgical treatment against the risk of novel coronavirus infection. We try to give some recommendations on lung surgery during the current domestic epidemic situation based on the guidelines and consensus of oncology and thoracic surgery organizations in different regions on lung surgery.
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Humans ; Lung Neoplasms/complications* ; COVID-19 ; SARS-CoV-2 ; Multiple Pulmonary Nodules ; Pandemics/prevention & control* ; Lung

There is a shared problem in current optical imaging technologies of how to obtain the optical parameters of biological tissues with complex profiles. In this work, an imaging system for obtaining the optical parameters of biological tissues with complex profile was presented. Firstly, Fourier transformation profilometry was used for obtaining the profile information of biological tissues, and then the difference of incident light intensity at different positions on biological tissue surface was corrected with the laws of illumination, and lastly the optical parameters of biological tissues were achieved with the spatial frequency domain imaging technique. Experimental results indicated the proposed imaging system could obtain the profile information and the optical parameters of biological tissues accurately and quickly. For the slab phantoms with height variation less than 30 mm and angle variation less than 40º, the maximum relative errors of the profile uncorrected optical parameters were 46.27% and 72.18%, while the maximum relative errors of the profile corrected optical parameters were 6.89% and 10.26%. Imaging experiments of a face-like phantom and a human's prefrontal lobe were performed respectively, which demonstrated the proposed imaging system possesses clinical application value for the achievement of the optical parameters of biological tissues with complex profiles. Besides, the proposed profile corrected method can be used to combine with the current optical imaging technologies to reduce the influence of the profile information of biological tissues on imaging quality.
Diagnostic Imaging ; Humans ; Light ; Optical Imaging ; Phantoms, Imaging

Lipid metabolism disorders contribute to hyperlipidemia and hepatic steatosis. It is ideal to develop drugs simultaneous improving both hyperlipidemia and hepatic steatosis. Nitazoxanide is an FDA-approved oral antiprotozoal drug with excellent pharmacokinetic and safety profile. We found that nitazoxanide and its metabolite tizoxanide induced mild mitochondrial uncoupling and subsequently activated AMPK in HepG2 cells. Gavage administration of nitazoxanide inhibited high-fat diet (HFD)-induced increases of liver weight, blood and liver lipids, and ameliorated HFD-induced renal lipid accumulation in hamsters. Nitazoxanide significantly improved HFD-induced histopathologic changes of hamster livers. In the hamsters with pre-existing hyperlipidemia and hepatic steatosis, nitazoxanide also showed therapeutic effect. Gavage administration of nitazoxanide improved HFD-induced hepatic steatosis in C57BL/6J mice and western diet (WD)-induced hepatic steatosis in Apoe ^-/- mice. The present study suggests that repurposing nitazoxanide as a drug for hyperlipidemia and hepatic steatosis treatment is promising.

Objective:To investigate the risk factors of spinal cord injury after FET for ATAAD.Methods:We analyzed perioperative data of 111 patients with ATAAD who underwent FET in the First Affiliated Hospital of Nanjing Medical University from January 2020 to October 2021.Results:Eleven(9.9%)of 111 patients had postoperative spinal cord injury, which showed varying degrees of paralysis or paraplegia. There was no significant difference in age, sex, medical history, cardiopulmonary bypass time, aortic cross-clamping time, circulatory arrest time and FET length between spinal cord injury group and non-spinal cord injury group( P>0.05). Univariate analysis showed that aortic true lumen away from the spinal side( P<0.001) and the number of segmental arteries originating from the true lumen<3 in T9-L3( P<0.001), left subclavian artery involvement( P<0.05) and stent coverage at T8 or beyond( P<0.05) was associated with postoperative spinal cord injury. Multivariate Logistic analysis showed that aortic true lumen away from the spinal side( P<0.001) and the number of segmental arteries originating from the true lumen<3( P<0.001) in T9-L3 and left subclavian artery involvement( P<0.05) were independent risk factors for postoperative spinal cord injury. Conclusion:The pathogenesis of spinal cord injury is complicated. This study suggests that the occurrence of spinal cord injury is significantly related to aortic true lumen away from the spinal side and the number of segmental arteries originating from the true lumen<3 in T9-L3 and left subclavian artery involvement. It is of great clinical significance to identify the high risk factors of postoperative spinal cord injury as early as possible.

Objective:To introduce the early results of total aortic arch replacement (TAA) without cardiopulmonary bypass (CPB) and without interruption of cerebral blood supply, using the technique of arch branches preferential reconstruction and whole brain perfusion for brain protection.Methods:Between June 2020 and March 2021, a total of 9 Stanford type A aortic dissection patients we performed total arch replacement by using the technique of arch branches preferential reconstruction and whole brain perfusion without cardiopulmonary bypass and without interruption of blood supply to the brain. The method of this reconstruction technique is as follows: A 24F aortic cannula was inserted into the true lumen at the root of the transverse innominate artery (IA) to connect one end of the artery for cardiopulmonary bypass. The access was connected to 14F artery via Y-connector and inserted into IA cavity to maintain blood supply to brain. Without cardiopulmonary bypass, the 10 mm branch of the four branch artificial blood vessel was anastomosed with the innominate artery IA. The perfusion collateral was connected to the second end of the artery of CPB (single pump and double tubes) to continue to supply blood for IA. The left common carotid artery (LCA) and left subclavian artery (LSCA) were reconstructed by the same method. When IA and LCA were anastomosed, the distal blood supply was not interrupted. After the three branches of the aortic arch were anastomosed, we started to turn the machine, then cooled down and blocked the ascending aorta to further complete the operation of the aortic root and arch. During the period of lower body circulatory arrest, the whole brain was perfused with low flow.Results:No intraoperative death or perioperative complications occurred in all patients, and they were discharged smoothly. The cardiopulmonary bypass time was (192.4±58.1) min, the aortic clamping time was (128.3±52.4) min, the lower body circulatory arrest time was (29.1±1.3) min, and the postoperative awake time was (8.2±3.7) h.Conclusion:Off-pump arch branches preferential reconstruction can provide physiological whole brain perfusion, shorten the cardiopulmonary bypass time and aortic occlusion time, and the operation is safe and effective.

Patients with lung cancer at the same stage may have markedly different overall outcome and a lack of specific biomarker to predict lung cancer outcome. Heat-shock protein 90 β (HSP90β) is overexpressed in various tumor cells. In this study, the ELISA results of HSP90β combined with CEA, CA125, and CYFRA21-1 were used to construct a recursive partitioning decision tree model to establish a four-protein diagnostic model and predict the survival of patients with lung cancer. Survival analysis showed that the recursive partitioning decision tree could distinguish the prognosis between high- and low-risk groups. Results suggested that the joint detection of HSP90β, CEA, CA125, and CYFRA21-1 in the peripheral blood of patients with lung cancer is plausible for early diagnosis and prognosis prediction of lung cancer.
Antigens, Neoplasm ; Biomarkers, Tumor ; CA-125 Antigen ; Carcinoembryonic Antigen ; Carcinoma, Non-Small-Cell Lung/pathology* ; Humans ; Keratin-19 ; Lung Neoplasms ; Prognosis

Objective:To evaluate the value of applying an artificial intelligence (AI) system for diabetic retinopathy (DR) detection and referral in community.Methods:A diagnostic test study was conducted.Four hundred and twenty-one patients (812 eyes) diagnosed with diabetes in three Dongguan community healthcare centers from January 1, 2020 to December 31, 2021 were enrolled.There were 267 males, accounting for 63.42% and 154 females, accounting for 36.58%.The subjects were 18-82 years old, with an average age of (51.72±11.28) years.The disease course of the subjects was 0-30 years, with an average course of 3.00 (1.00, 7.00) years.At least one macula-centered 50-degree fundus image was taken for each eye to build a DR image database.All the images were independently analyzed by an AI-assisted diagnostic system for DR, trained and qualified community physicians and ophthalmologists to make diagnosis including with or without DR, referable diabetic retinopathy (RDR) and referral recommendation or not.With diagnoses from ophthalmologists as the standard, sensitivity and specificity of the AI system in detecting DR and RDR were evaluated.The consistency and effective referral rate of the AI system and community physicians in detecting DR, especially in detecting RDR were evaluzted.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Dongguan Tungwah Hospital (No.2019DHLL046).Results:Of 812 eyes, 242 eyes were diagnosed with DR, including 23 with mild nonproliferative diabetic retinopathy (NPDR), 120 with moderate NPDR, 60 with severe NPDR and 39 with proliferative diabetic retinopathy (PDR). The other 570 eyes were diagnosed without DR.The sensitivity/specificity of AI system to detect DR and RDR was 87.60%/97.89% and 90.41%/96.29%, respectively.Compared with the ophthalmologists' diagnosis, the Cohen' s Kappa statistic of AI system to detect DR/RDR was 0.87/0.87, which was lower than 0.93/0.98 of community physicians.Among the referral-recommended cases by ophthalmologists, the effective referral rate of the AI system was 90.87% (199/219), which was higher than 89.50% (196/219) of community physicians, without statistically significant difference ( P=1.000). Conclusions:The AI system shows high sensitivity, specificity and consistency in DR detection, especially in RDR.The AI system is better in recognizing RDR than trained community physicians.