Objective:To establish a nomogram for preoperative differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) based on clinical, ultrasound, and contrast-enhanced ultrasound (CEUS) data.Methods:A retrospective analysis was conducted on ultrasound and CEUS data of 462 patients who underwent hepatectomy in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2023, including 262 cases of HCC (56.7%) and 200 cases of ICC (43.3%). The data were randomly divided into training set ( n=324) and validation set ( n=138) in a 7∶3 ratio. Univariate analysis was used to initially screen for variables with statistically significant differences between HCC and ICC groups in the training set, and LASSO regression was performed to select the variables with higher coefficients. Logistic regression analyses were then used to predict independent risk factors for ICC. A nomogram was drawn using R software. The performance of the nomogram was then validated using ROC curve, calibration curve, and decision curve analysis (DCA). Results:Univariate analysis showed that there were significant differences in age, gender, liver cirrhosis, HBsAg (+ ), ALP >185 U/L, CA19-9 >27 kU/L, CA242>10 kU/L, irregular shape, border, cholangiectasis, portal vein tumor thrombus, enhanced pattern in arterial phase, clearance time <60 s, intra-tumoral vein between ICC and HCC groups (all P<0.05). The top 10 features were selected for LASSO regression analysis. Logistic regression analysis revealed that gender, cirrhosis, CA19-9>27 kU/L, CA242>10 kU/L, cholangiectasis, clearance time <60 s, intra-tumoral vein and enhanced pattern in arterial phase were risk factors for ICC (all P<0.05). The area under the ROC curve in the training and validation groups were 0.963 and 0.914, respectively. In the training group, the specificity and sensitivity of the nomogram were 0.926 and 0.917, respectively, and in the validation group, they were 0.875 and 0.871, respectively. The calibration curve showed that the prediction effect of the model was in good agreement with the actual situation. DCA showed that the nomogram could increase the net benefit to the different diagnosis of ICC in patients. Conclusions:The nomogram based on clinical, ultrasound and CEUS features has a good predictive value for preoperative identification of ICC and provides reliable evidence for clinical practice.

Objective:To establish and evaluate a clinical and ultrasound parameters-based nomogram for the preoperative differentiating diagnosis of intrahepatic cholangiocarcinoma (ICC).Methods:A total of 723 patients undergoing hepatectomy in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2016 to August 2022 were retrospectively screened. A total of 399 patients with hepatocellular carcinoma (HCC, 198 cases) or ICC (201 cases) were enrolled in this study, including 284 males and 115 females, aged (60.5±10.5) years. Through random sampling using computer-generated random numbers, patients were divided into training ( n=279) and validation groups ( n=120) in a ratio of 7∶3. Univariate and multivariate logistic regression were performed to identify factors differentiating ICC, and a nomogram was established using R software based on independent risk factors for ICC. The accuracy of the nomogram was evaluated by receiver operating characteristic curve and calibration curves. Decision curve analysis was performed to assess the net benefit of the model. Results:Multivariate logistic regression analysis showed that irregular shape, cholangiectasis, female, cirrhosis, carbohydrate antigen 242 >10 U/ml, carbohydrate antigen 125 >30 U/ml and alpha-fetoprotein >10 μg/L were independent differentiating factors for ICC (all P<0.05). A nomogram was constructed based on those factors. The nomogram showed a better discrimination between ICC and HCC. The area under the curve of the training group and the validation group were 0.966 and 0.956, respectively. The calibration curve showed that the prediction effect of the model is in good agreement with the actual situation. Decision curve analysis showed that the nomogram was more effective than diagnosing all patients as either HCC or ICC, which yielded a net benefit at the most reasonable threshold probabilities. Conclusion:The nomogram for the preoperative diagnosis of ICC based on clinical and ultrasound features showed a good diagnostic performance.

Objective:To investigate the serum levels of myonectin, corticostatin and Delta like ligand 4 (DLL4) in patients with type 2 diabetes mellitus (T2DM) diabetes retinopathy (DR) and their clinical significance.Methods:A prospective selection of 341 T2DM patients admitted to Beijing Hospital of Traditional Chinese Medicine, Huairou Hospital from May 2020 to March 2022 was conducted. The patients underwent fundus examination and were divided into a non DR group ( n=85 cases) and a DR group ( n=256 cases) based on DR diagnostic criteria. The DR group was divided into non proliferative and proliferative types according to the staging criteria in China′s DR clinical diagnosis and treatment guidelines, with 142 cases and 114 cases, respectively; 190 healthy individuals who underwent physical examinations in our hospital during the same period were selected as the control group. Enzyme linked immunosorbent assay was used to detect the levels of serum sarconectin, corticostatin, and DLL4 in three groups, collect patient data, and detect biochemical indicators. Logistic regression analysis was used to analyze the influencing factors of DR, and Pearson correlation analysis was used to investigate the relationship between serum sarconectin, corticostatin, DLL4, glucose and lipid metabolism, and insulin resistance; Logistic regression analysis was used to analyze the influencing factors of DR, and Pearson correlation analysis was used to investigate the relationship between serum sarconectin, corticostatin, DLL4, glucose and lipid metabolism, and insulin resistance; The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of serum sarconectin, corticostatin, and DLL4 in DR. Results:The levels of serum sarconectin and DLL4 in the DR group and non DR group were higher than those in the control group, while the levels of corticostatin were lower than those in the control group (all P<0.05); The levels of sarconectin and DLL4 in the DR group were higher than those in the non DR group, while the levels of corticostatin were lower than those in the non DR group (all P<0.05). The serum levels of sarconectin and DLL4 in proliferative DR patients were higher than those in non proliferative DR patients, while the levels of corticostatin were lower than those in non proliferative DR patients (all P<0.05). The duration of T2DM in the DR group was longer than that in the non DR group, with smoking and alcohol consumption, systolic blood pressure, fasting blood glucose, glycated hemoglobin, triglyceride and insulin resistance index (HOMA-IR) were higher than those in non DR group (all P<0.05). Logistic regression analysis showed that the course of T2DM, systolic blood pressure, smoking and alcohol consumption, glycated hemoglobin, triglycerides, myonectin, corticostatin and DLL4 were the influencing factors of DR (all P<0.05). Pearson correlation analysis results showed that serum sarconectin, DLL4, and fasting blood glucose, glycated hemoglobin, fasting insulin and HOMA-IR were positively correlated (all P<0.05), while cortisol was negatively correlated with fasting blood glucose, glycated hemoglobin and HOMA-IR (all P<0.05). The ROC analysis results showed that the area under the curve (AUC) for the diagnosis of DR was 0.691, 0.745, 0.749, and 0.861 for sarconectin, corticostatin, and DLL4 alone and in combination, respectively. The combined application had higher diagnostic value. Conclusions:Patients with T2DM complicated with DR have elevated levels of serum sarconectin and DLL4, while decreased levels of corticostatin, which are closely related to glucose and lipid metabolism and insulin resistance, and are influencing factors for the occurrence of DR. Combined detection of the three can improve the value of predicting DR.

Objective:To investigate the changes of thickness and area of the ligamentum flavum after lateral lumbar interbody fusion (LLIF) for lumbar degenerative diseases.Methods:From 2019 to 2021, a total of 54 patients with lumbar degenerative diseases who underwent LLIF combined with percutaneous pedicle screw internal fixation were retrospectively analyzed. There were 9 males and 45 females, aged 59.46±6.91 years (range, 45-76 years), followed up for 14.69±6.87 months (range, 12-33 months). The disc height (DH), midsagittal canal diameter (CD), dural sac axial cross-sectional area (DCSA), ligamentum flavum area (LFA) and ligamentum flavum thickness (LFT) before and after surgery and at the last follow-up were evaluated and compared. Pearson correlation analysis was used to assess the relationship between the amount of change in the DCSA and LFA in the immediate postoperative period and at the last follow-up, as well as the correlation between the two and the amount of change in the DH. The data of patients at the last follow-up of 12 months after operation were extracted. Pearson correlation was used to evaluate the changes in DCSA and LFA at the last follow-up and the visual analogue scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI) at 1 year after surgery.Results:All patients were followed up for 14.69±6.87 months (range, 12-33 months). The differences in DH ( F=354.93, P<0.001), sagittal CD ( F=44.78, P<0.001) and DCSA ( F=130.97, P<0.001) before, immediately after surgery and at the last follow-up were statistically significant. The DH, sagittal CD, and DCSA immediate after surgery and last follow-up were higher than those before surgery ( P<0.05). The differences in LFA ( F=51.59, P<0.001) and bilateral LFT ( F=53.49, P<0.001; F=50.53, P<0.001) before and after surgery and at the last follow-up were statistically significant, and both LFA and bilateral LFT at immediate after surgery and last follow-up were smaller than those before surgery ( P<0.05). Pearson correlation analysis showed that the change of DH immediately after surgery was moderately correlated with the change of DCSA ( r=0.57, P<0.001), and was strongly correlated with the change of LFA ( r=0.65, P<0.001). The change of DH at the last follow-up was moderately correlated with the change of DCSA ( r=0.43, P<0.001), and was weakly correlated with the change of LFA ( r=0.25, P=0.042). The differences in VAS-leg ( F=199.51, P<0.001), VAS-low back ( F=233.90, P<0.001), and ODI ( F=199.17, P<0.001) were statistically significant in patients before operation, 3 months after operation and 12 months after operation. There was no correlation between the changes of DCSA and LFA at the last follow-up and the changes of VAS and ODI at 1 year after operation ( P>0.05). Conclusion:LFA and LFT decrease and DCSA increase in patients with lumbar degenerative diseases after LLIF. LFA and LFT gradually decrease with time, and VAS and ODI are significantly improved compared with those before surgery. The DH loss caused by a certain degree of cage subsidence after surgery does not affect the clinical efficacy. There is no correlation between the improvement of DCSA and LFA and the improvement of clinical symptoms.

Obesity, sleep disorders, psychological stress, sedentary are modifiable cardiovascular risk factors. There is growing evidence that these risk factors may accelerate the chronic inflammatory process of atherosclerosis and lead to myocardial infarction. Studies on the role of immune cells and their related immune mechanisms in atherosclerosis have shown that the above modifiable risk factors can affect the hematopoiesis of the bone marrow system, affect the production of immune cells and phenotypes, and then affect the progress of atherosclerosis. This review will focus on the effects of modifiable cardiovascular risk factors on the progression of atherosclerosis through the role of the innate immune system.

Ischemic stroke(IS)is a multifactorial and heterogeneous disease.Despite years of studies,effective strategies for the diagnosis,management and treatment of stroke are still lacking in clinical practice.Metabolomics is a growing field in systems biology.It is starting to show promise in the identification of biomarkers and in the use of pharmacometabolomics to help patients with certain disorders choose their course of treatment.The development of metabolomics has enabled further and more biological appli-cations.Particularly,metabolomics is increasingly being used to diagnose diseases,discover new drug targets,elucidate mechanisms,and monitor therapeutic outcomes and its potential effect on precision medicine.In this review,we reviewed some recent advances in the study of metabolomics as well as how metabolomics might be used to identify novel biomarkers and understand the mechanisms of IS.Then,the use of metabolomics approaches to investigate the molecular processes and active ingredients of Chinese herbal formulations with anti-IS capabilities is summarized.We finally summarized recent developments in single cell metabolomics for exploring the metabolic profiles of single cells.Although the field is relatively young,the development of single cell metabolomics promises to provide a powerful tool for unraveling the pathogenesis of IS.

The World Health Organization (WHO) released the WHO 2020 guidelines on physical activity and sedentary behaviour in November 2020. Compared with the 2010 WHO guidelines, this guideline has incorporated more extensive medical evidence and made targeted recommendations for special populations. The main content includes physical activity and sedentary behaviour advice for children and adolescents, adults, older adults, pregnant and postpartum women, people with chronic conditions, and disability. This review will interpret the 2020 WHO guidelines in detail.

Sepsis is defined as life-threatening organ dysfunction secondary to a dysregulated host response to infection.It is considered a major cause of death and health loss worldwide.Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021, released in October 2021, included 93 total statements, which addressed screening and initial resuscitation, infection, hemodynamics, ventilation, additional therapies, and goals of care and long-term outcomes.This review interpreted the content ofthe guidelines and also analyzed the underlying issues.The guidelines provide a more accurate framework and guidance for the diagnosis and treatment of sepsis, and may also provide an opportunity to urge researchers in the field of sepsis worldwide to implement further individualized research.

Objective To obtain the distribution of stress concentration on the microporous structure of 3D-printed materials through a mapping algorithm with low calculation cost, so as to provide a new method of finite element calculation of 3D-printed materials for the prediction of fatigue life and the optimization of structural design. Methods Node coordinates and stress values within the influential region of the single pore were extracted to calculate the stress concentration coefficients of different nodes. The nearest node to each node on the ideal model was determined by distance, and the corresponding coefficient was multiplied by its stress value. When the nearest nodes of several nodes were the same, the average of these coefficients was assigned. For the pores close to the edge, an edge coefficient must be multiplied to reduce the error. Results An error of less than 8% between the mapping result and the calculation result was achieved for the case in which the pores were not near the edge, but for the case in which the pores were close to each other near the edge, the error was less than 15%. Conclusions The mapping algorithm can effectively characterize the stress concentration of the microporous structure of 3D-printed materials, and determine the stress distribution with low cost. This novel algorithm provides the finite element result for the optimization design and fatigue analysis of implants in clinical applications.

Background and purpose:Risk of invasive cervical carcinoma (ICC) and its precancerous lesions following high risk human papillomavirus (hrHPV) infection may vary according to HPV types and geographic regions. Analyzing HPV-type distribution in cervical samples from local women aged 30 years and older, this study aimed to identify HPV types with higher risk of developing CIN2+, and to compare diagnostic performance for CIN2+using these types and type combinations. Methods:Cervical samples with histology follow-up from patients of a tertiary cancer center in Shanghai were collected for HPV genotyping by PCR-RDB. The risk associations of HPV types with CIN2+were estimated by logistic regression analysis, and ROC curves were plotted for diagnostic performance evaluation. Results:A total number of 413 specimens were obtained, including 38 CIN1, 184 CIN2/3, 126 ICC patients and 65 negative control people. The 4 most common HPV types in CIN2+were HPV16, 58, 33 and 18, in descending order. And only HPV16 (P<0.000 1), 58 (P=0.002), 33 (P=0.015) were signiifcantly associated with CIN2+lesions. Besides, the area under the ROC curve of the HPV16/18/33/58 test scored statistically higher than the HPV16/18 test did (P=0.006 6). Conclusion:A combined test of HPV16/18/33/58 may offer better performance for detecting CIN2+lesions in our geographic region.