Objective To externally validate a prediction model based on clinical and CT imaging features for the preoperative identification of high-grade patterns (HGP), such as micropapillary and solid subtypes, in early-stage lung adenocarcinoma, in order to guide clinical treatment decisions. Methods This study conducted an external validation of a previously developed prediction model using a cohort of patients with clinical stage ⅠA lung adenocarcinoma from the Fourth Hospital of Hebei Medical University. The model, which incorporated factors including tumor size, density, and lobulation, was assessed for its discrimination, calibration performance, and clinical impact. Results A total of 650 patients (293 males, 357 females; age range: 30-82 years) were included. The validation showed that the model demonstrated good performance in discriminating HGP (area under the curve>0.7). After recalibration, the model's calibration performance was improved. Decision curve analysis (DCA) indicated that at a threshold probability>0.6, the number of HGP patients predicted by the model closely approximated the actual number of cases. Conclusion This study confirms the effectiveness of a clinical and imaging feature-based prediction model for identifying HGP in stage ⅠA lung adenocarcinoma in a clinical setting. Successful application of this model may be significant for determining surgical strategies and improving patients' prognosis. Despite certain limitations, these findings provide new directions for future research.

BACKGROUND:Current studies have confirmed that Ganoderma lucidum polysaccharides can promote nerve regeneration in neurodegeneration-related diseases.The occurrence of neurodegenerative diseases is closely related to mitochondrial dysfunction,but the role of Ganoderma lucidum polysaccharides on the regulation of apoptosis and mitochondrial function in neurodegenerative diseases is not yet clarified. OBJECTIVE:To explore the regulatory effects and mechanisms of Ganoderma lucidum polysaccharides on apoptosis and mitochondrial dysfunction in H2O2-induced SH-SY5Y cells. METHODS:SH-SY5Y cells were divided into three groups:control group,H2O2 group,and Ganoderma lucidum polysaccharides group.Cells in the control group were normally cultured.Cells in the H2O2 group were treated with 300 μmol/L H2O2 for 24 hours.In the Ganoderma lucidum polysaccharides group,the intervention with 300 μg/L Ganoderma lucidum polysaccharides was conducted first for 1-2 hours,followed by the addition of 300 μmol/L H2O2 for 24 hours.The mitochondrial membrane potential was detected by JC-1 kit.Apoptosis was detected by TUNEL staining kit.The activities of malondialdehyde and superoxide dismutase were detected by malondialdehyde test kit and superoxide dismutase test kit,respectively.The apoptosis and expression of mitochondrial dynamics-related proteins were detected by immunofluorescence staining and western blot assay. RESULTS AND CONCLUSION:(1)Compared with the control group,the mitochondrial membrane potential and superoxide dismutase activity were significantly reduced,as well as apoptotic rate and malondialdehyde levels were significantly increased in the H2O2 group(P<0.05).After treatment with Ganoderma lucidum polysaccharides,the membrane potential and superoxide dismutase activities were significantly increased,and apoptotic rate and malondialdehyde levels were significantly reduced compared with the H2O2 group(P<0.05).(2)The expression levels of pro-apoptotic proteins Bax and Caspase-3 were significantly increased,but the expression of anti-apoptotic protein Bcl-2 was significantly decreased in the H2O2 group compared with the control group(P<0.05).Compared with the H2O2 group,the levels of Bax and Caspase-3 were significantly decreased,but the expression of anti-apoptotic protein Bcl-2 was significantly increased in the Ganoderma lucidum polysaccharides group(P<0.05).(3)Compared with the control group,the expression of mitochondrial splitting proteins Fis1 and p-Drp1 was significantly increased,but the expression of mitochondrial fusion proteins OPA1,Mfn1,and Mfn2 was decreased in the H2O2 group(P<0.05).Compared with the H2O2 group,Fis1 and p-Drp1 expression was significantly reduced,but the expression levels of OPA1,Mfn1,and Mfn2 were significantly increased in the Ganoderma lucidum polysaccharides group(P<0.05).(4)The above results confirm that Ganoderma lucidum polysaccharides can attenuate H2O2-induced oxidative stress damage and apoptosis in SH-SY5Y cells by ameliorating mitochondrial dysfunction.

Objective:We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods:This was a multicenter, retrospective, observational cohort study, including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1, 2015 to June 30, 2018. Baseline characteristics, histopathological data and nutritional status, as assessed using Nutrition Risk Screening 2002 (NRS 2002) score and the scored Patient-Generated Subjective Global Assessment, were collected. The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model. Internal and external validations were performed.Results:There were 681 and 127 patients in the training and validation cohorts, respectively. A total of 188 deaths were observed over a median follow-up period of 59 (range: 58 to 60) months. Two independent predictors of NRS 2002 and Tumor-Node-Metastasis (TNM) stage were identified and incorporated into the prediction nomogram model together with the factor of age. The model's concordance index for 1-, 3- and 5-year overall survival was 0.696, 0.724, and 0.738 in the training cohort and 0.801, 0.812, and 0.793 in the validation cohort, respectively.Conclusions:In this study, a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer. This model has good differentiation, calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

Purpose To explore the application value of deep learning image reconstruction(DLIR)algorithm combined with low tube voltage(70 kVp)in head and neck CT angiography imaging.Materials and Methods Retrospective analysis was performed on 40 patients who underwent head and neck CT angiography examination in People's Hospital of Ningxia Hui Autonomous Region from November 2021 to November 2022,the scanning tube voltage was 70 kVp and the current was in SmartmA mode.The original data were reconstructed with different algorithms and levels,including adaptive statistical iterative reconstruction-veo(ASiR-V60%and ASiR-V90%)and DLIR(DLIR-L,DLIR-M,DLIR-H).The subjective and objective evaluation of different algorithms and levels reconstructed images were compared.Results CT values of ASiR-V and DLIR reconstruction images at different levels in neck and intracalvarium had no statistical significance(P>0.05).With the increase of ASiR-V and DLIR reconstruction level,the image noise of neck and intracalvarium was reduced,compared with ASiR-V60%,DLIR-H decreased 24.30%and 29.42%,respectively(P<0.05).With the increase of ASiR-V and DLIR levels,signal to noise ratio(SNR)and contrast-to-noise ratio(CNR)of neck and intracalvarium images increased,the SNR and CNR of DLIR-H were the highest.The SNR and CNR of common carotid artery bifurcations,C4 segment of internal carotid artery and V4 segment of vertebral artery were statistically significant compared with ASiR-V60%(P<0.05),SNR increased by 55.60%,43.90%,44.66%,CNR increased by 55.57%,44.24%,45.10%,respectively.The SNR and CNR of middle cerebral artery were 45.39%and 45.89%higher than that of 6 ASiR-V60%,with statistical significance(P<0.05).The subjective score of ASiR-V90%was lower than that of ASiR-V60%,and there was no statistical significance(P>0.05).The subjective score of DLIR increased with the level of reconstruction,and DLIR-H was significantly higher than DLIR-M and DLIR-L(P<0.05),the subjective score of DLIR-H and DLIR-M was significantly higher than ASiR-V60%and ASiR-V90%(P<0.05).Conclusion In low tube voltage head and neck CT angiography imaging,compared with ASiR-V,DLIR can further reduce image noise,improve image quality and diagnostic confidence,among which DLIR-H performs best.

Objective:Using the established epilepsy patient database to validate the efficacy of the web-based epilepsy diagnosis and anti-seizure medications (ASM) selection tool, EpiPick, for domestic epilepsy patients.Methods:The retrospective collection of clinical data was conducted on patients aged 10 and above who were diagnosed with epilepsy at the Comprehensive Epilepsy Center of the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2020, with regular follow-up and complete information. According to the first ASM recommended by the EpiPick tool and whether they are consistent with the actual ASM used by patients, patients were divided into EpiPick group and clinical group to verify the effectiveness of the EpiPick tool in selecting ASM. The drug retention rate, Engel score, and cumulative probability of no consecutive episodes within 30 months after using the first ASM were compared between the 2 groups, and Kaplan-Meier survival curves were drawn. Finally, the diagnostic results provided by the EpiPick tool were compared with the actual types of epileptic seizures diagnosed clinically, and consistency tests were performed.Results:A total of 364 epilepsy patients were included, including 237 in the EpiPick group and 127 in the clinical group. The ASM retention rates of patients in the EpiPick group and clinical group were 67.9%(161/237) and 56.7%(72/127), respectively, with statistically significant differences (χ2=4.534, P=0.039). Grades Ⅰ, Ⅱ, Ⅲ and Ⅳ according to the Engel scores in the EpiPick group patients who took the first ASM after diagnosis accounted for 47.3%(112/237), 14.8%(35/237), 12.7%(30/237), and 25.3%(60/237), respectively, compared to the clinical group of 32.3%(41/127), 11.8%(15/127), 11.0%(14/127), and 44.9%(57/127), respectively. There was a statistically significant difference in Engel scores between the 2 groups (χ2=14.968, P=0.002). The cumulative seizure-free rates in the EpiPick group at the 1st, 6th, 12th, 30th month and above after starting the first ASM were 73.8%, 61.2%, 53.2%, and 50.6%, respectively, which in the clinical group were 52.0%, 44.1%, 40.2%, and 33.5%, respectively. The logrank test showed a statistically significant difference in the cumulative probability of consecutive seizure freedom between the 2 groups ( HR=0.644 ,95% CI 0.476-0.871 ,P<0.001). After grouping by seizure type [focal seizures (196 cases) and generalized seizures (168 cases)], the cumulative seizure-free rates at the 1st, 6th, 12th, 30th month and above after starting ASM were significantly higher in the EpiPick group than in the clinical group (comparison between the 2 groups in patients with focal seizures: HR=0.654, 95%CI 0.443-0.964, P=0.004; comparison between the 2 groups in patients with generalised seizures: HR=0.586, 95%CI 0.361-0.954, P=0.014). Among 364 patients, 293 cases were clinically diagnosed with seizure classification consistent with the classification results of EpiPick tool. Agreement between the algorithm and the experts in classifying generalized seizures was 83.9%(104/124), which in classifying focal seizures was 78.8%(189/240; Kappa=0.591, P<0.001). Conclusion:Web-based EpiPick tool is suitable to be used to select the first ASM, and is portable for Chinese non-epilepsy specialists to choose ASM for epilepsy patients.

Purpose To evaluate the efficacy of T2-weighted imaging combined with diffusion weighted imaging in differential diagnosis of peripheral lung cancer(PLC)and focal organizational pneumonia(FOP).Materials and Methods A total of 36 patients with FOP and PLC diagnosed pathologically in the Affiliated Hospital of Shaanxi University of Chinese Medicine from November 2016 to December 2021 were retrospectively included.Two experienced radiologists independently read MR Images,and measured T2 contrast ratio(T2CR)and apparent diffusion coefficient(ADC)respectively.The T2CR and ADC values of the two groups were compared,and the diagnostic efficacy of MR-T2WI and diffusion weighted imaging was evaluated using the receiver operating characteristic curve.Results Two radiologists demonstrated good inter-observer agreement for T2CR and ADC values(ICC values of 0.951 and 0.955,respectively).The FOP group exhibited significantly higher T2CR and ADC values compared to the PLC group(t=3.920 and 5.819,both P<0.001),with threshold values of 2.29 for T2CR and 1 048×10-6 mm2/s for ADC being identified.ADC values accurately diagnosed FOP in 33 cases and PLC in 28 cases,while T2CR correctly diagnosed FOP in 20 cases and PLC in 33 cases.Combining both T2CR and ADC values resulted in accurate diagnoses of FOP in 29 cases and PLC in 33 cases.The diagnostic accuracy and area under the curve were improved by combining ADC and T2CR values compared with using them alone(accuracy:86.1%vs.84.7%,73.6%;AUC:0.924 vs.0.879,0.740;Z=2.208,P<0.05).Conclusion The combination of T2CR and ADC values aids in distinguishing FOP from PLC,exhibiting a higher diagnostic efficiency compared to their individual use.

We report a case of type A insulin resistance syndrome. A 16-year-old girl with BMI of 19.1 kg/m 2 presented with primary amenorrhea and hyperglycemia for two years. Baseline HbA 1C was 10.8%, along with severe hyperinsulinemia, increased total testosterone and free androgen index(FAI). Ultrasonography showed polycystic ovaries. Next generation sequencing identified a novel and de novo heterozygous missense mutation of Trp1220Gly in the insulin receptor gene. Short-term intensive insulin pump treatment was initiated, followed by insulin glargine, pioglitazone and acarbose combination regiment. Fasting blood glucose and insulin levels decreased significantly, but post-load hyperglycemia and hyperinsulinemia remained unsatisfactory. HbA 1C dropped to 7.6% at 1-year follow up. Patients with polycystic ovarian syndrome who are adolescent-onset and with lean body type should be taken into account of type A insulin resistance syndrome. Currently, there is no standardized treatment protocol, and therapy should be individualized based on the specific gene mutation of each patient.

Objective:To investigate the efficacy of microsurgical decompression in carpal tunnel syndrome (CTS) caused by different etiologies.Methods:A retrospective analysis was performed. The clinical data of 54 patients with CTS, admitted to our hospital from January 2018 to December 2018, were chosen; 20 patients were with idiopathic CTS (20 laterals), 16 patients were with diabetic-related CTS (26 laterals), and 18 patients were with dialysis-related CTS (22 laterals). All patients were treated with median nerve microsurgical decompression. Before surgery and 2 weeks after surgery, Boston carpal tunnel questionnaire (BCTQ) was used to evaluate the symptom and function scores, and median nerve conduction velocity was detected.Results:Intraoperatively, there was definite nerve entrapment in all three groups, but the neuropathy scopes in the diabetic-related CTS group were more extensive than those in the idiopathic group and dialysis-related CTS group. The postoperative BCTQ symptom and functional scores in the three groups were significantly decreased as compared with the preoperative ones ( P<0.05); however, there were no significant differences among the three groups in the postoperative BCTQ symptom and functional scores ( P>0.05). The postoperative sensory nerve conduction velocity and motor nerve conduction velocity in the three groups were significantly improved as compared with the preoperative ones ( P<0.05). There were significant differences among the three groups in postoperative sensory nerve conduction velocity and motor nerve conduction velocity ( P<0.05); the sensory nerve conduction velocity and motor nerve conduction velocity in the diabetic-related CTS group were significantly decreased as compared with those in idiopathic CTS group, and the sensory nerve conduction velocity and motor nerve conduction velocity in dialysis-related CTS group were significantly increased as compared with those in the diabetic-related CTS group ( P<0.05). The main surgical complications in three groups included poor incision healing: the incidence was 5% (1/20) in the idiopathic group, 15.3% (4/26) in the diabetic-related CTS group, and 18.1% (4/22) in dialysis-related CTS group, without significant differences ( χ2=1.755, P=0.416). Conclusion:Microsurgical decompression can achieve satisfactory results in the treatment of dialysis-related CTS, diabetes-related CTS and idiopathic CTS.

Objective:To investigate the clinical application value of frameless stereotactic electroencephalography (SEEG) electrode implantation assisted by domestic Remebot robot in patients with drug-refractory epilepsy.Methods:Ten patients with medically-refractory epilepsy, admitted to and accepted SEEG electrode implantation assisted by domestic Remebot robot in our hospital from October 2021 to March 2022, were chosen in our study. Epileptogenic focuses of these patients were determined. Bone Fiducial Markers were used for registration during surgery, and the registration error and implantation time of each electrode were recorded in detail. Thin-layer CT scan was performed immediately after surgery to observe the occurrence of complications. Three-dimensional reconstruction of all implanted electrodes was performed postoperatively, which was fused with the preoperative surgical planning paths and targets, and the electrode entry point error and target error were calculated.Results:SEEG electrodes were implanted in all 10 patients with the assistance of frameless surgical robot, and the resection areas were accurately determined according to the results of SEEG records. The registered error of these 10 patients was (0.24±0.03) mm. A total of 97 SEEG electrodes were implanted, and the average effective implantation time of each electrode was (6.3±1.2) min. After the fusion of three-dimensional electrode reconstruction with preoperative surgical plan, the mean entry point error of 97 electrodes was (1.9±1.2) mm, and the mean target error was (2.1±1.2) mm. Immediate postoperative head CT showed that none of the 10 patients had surgical complications such as intracranial hemorrhage or severe pneumoencephalos.Conclusion:The SEEG electrode implantation assisted by Remebot frameless robot is safe, accurate, and effective, which can meet the clinical needs.

Objective:To study the efficiency and safety of domestic Remebot robot (neurosurgical positioning and navigation system) in the resection of craniocerebral microlesions and functional area lesions.Methods:Twelve patients accepted resection of craniocerebral microlesions and functional area lesions in our hospital from October 2021 to March 2022 were chosen in our study; navigation, localization and resection of craniocerebral microlesions and functional area lesions were performed with assistance of Remebot robot. Surface Markers were used for optical registration during the surgery, and the registration error was recorded in detail. Scalp incision and bone flap boundary were designed by laser navigation. Postoperative head CT and MRI scan were performed to observe intracranial hemorrhage and lesion resection. The postoperative image was fused with the preoperative surgical plan to calculate the deviation between the planned and actual flap centers.Results:The patient registration error was 0.6-1.5 mm, with an average of (0.9±0.12) mm. The registration error of the manipulator was 0.09-0.12 mm. Preoperative and postoperative image fusion showed that the deviation between the planned and actual flap centers was 1.4-4.5 mm, with an average of (1.9±1.1) mm. All surgical procedures were performed with robot laser navigation to find the lesion boundary along the planned path at one time, which was less destructive to the cortex and surrounding tissues. Postoperative head CT or MRI examination showed that all lesions were completely resected. No serious complications occurred in these 12 patients.Conclusion:Domestic robot can provide precise localization and navigation function for the resection of craniocerebral microlesions and functional area lesions, improving the surgical efficiency and ensuring the safety of surgery.