ObjectiveThis study explored the risk factors for malignant risks of pulmonary nodules based on clinical data，constructed an integrated traditional Chinese and Western medicine model for predicting malignant risks of pulmonary nodules， and visualized the prediction results by using a nomogram. MethodsBased on a cross-sectional survey study design，patients with pulmonary nodules who were hospitalized in the Department of Respiratory and Cardiothoracic Surgery of Guangdong Provincial Hospital of Traditional Chinese Medicine from April 2023 to January 2024 were included. The dataset was randomly divided into a training set and a validation set according to 7∶3. In the training set，predictive factors were selected through univariate Logistic regression analysis and Least Absolute Shrinkage and Selection Operator （LASSO） regression analysis，and Logistic regression models were built. The discriminative ability，calibration，and clinical decision-making curves of the Western medicine model and the integrated traditional Chinese and Western medicine prediction model were compared to select the optimal model，which was then visualized in a nomogram. ResultsThis study included a total of 366 patients，and they were divided into a training set （258 cases） and a validation set （108 cases）. Seven predictive factors were considered including age，preference for fatty and greasy foods，history of environmental or occupational exposure，Qi deficiency，Yang deficiency，nodule density，and nodule diameter. A Logistic regression model was constructed. A Western medicine model，defined as model1，was created using only age，history of environmental or occupational exposure，nodule density，and nodule diameter as predictive factors. In addition，an integrated traditional Chinese and Western medicine model，defined as model2，was created by adding preference for fatty and greasy foods， Qi deficiency，and Yang deficiency as predictive factors. Model2 demonstrated better predictive performance in both the training and validation sets. Its accuracy in training set was 0.740，with precision of 0.825， recall of 0.829， F1 score of 0.827， the area under the curve （AUC）of 0.865 （95% confidence interval （CI）：0.815-0.915）， and a Brier score of 0.122. The accuracy in validation set was 0.731， with precision of 0.776， recall of 0.831， F1 score of 0.803， AUC of 0.852 （95%CI：0.776-0.927）， and a Brier score of 0.149. The calibration curve and decision-making curve analysis showed that this model exhibited good consistency and clinical utility in prediction. The equation for the malignant probability of pulmonary nodules was defined as p=eY/(1+eY)，where Y=-4.187+0.022×（age）+1.079×（history of environmental or occupational exposure）+0.718×（preference for fatty and greasy foods）+ 1.403×（Qi deficiency）+0.732×（Yang deficiency）+0.349×（pure ground glass density nodules）+1.304×（partially solid density nodules）+0.148×（nodule diameter）. A nomogram was used for intuitive representation. ConclusionThis study develops a comprehensive assessment model for the malignant risk of pulmonary nodules， which integrates factors from traditional Chinese medicine and Western medicine. Embedding traditional Chinese medicine elements in the prediction model allows for a multidimensional assessment of relevant risk factors for nodule malignancy. This demonstrates good diagnostic performance and provides a reference for early identification of lung cancer.

Objective:To investigate the efficacy and safety of liposomal amphotericin B (L-AmB) for the salvage treatment of invasive fungal disease (IFD) in patients with hematological diseases.Methods:Data were retrospectively collected from 80 patients with hematological issues treated with L-AmB between June 2023 and December 2023 after failure of previous antifungal therapy. Baseline patient information, clinical efficacy, and factors affecting the efficacy of L-AmB were analyzed by logistic regression. Moreover, adverse effects associated with L-AmB were evaluated.Results:Among the 80 patients, 9 (11.2%) had proven IFD, 43 (53.8%) had probable IFD, and 28 (35.0%) had possible IFD. The efficacy rate of L-AmB salvage therapy for IFD was 77.5%, with a median daily dose of 3 (range: 1-5) mg·kg -1·d -1 and a median dosing course of 14 (range: 8-25) days. Multivariate logistic regression analysis showed that the disease remission status ( OR=4.337, 95% CI 1.167-16.122, P=0.029) and duration of medication ( OR=1.127, 95% CI 1.029-1.234, P=0.010) were independent factors affecting the efficacy of L-AmB. The incidence of infusion reactions associated with L-AmB, including fever and chills, was 5.0%. The incidence of hypokalemia was 28.8% (predominantly grades 1-2), and the incidence of nephrotoxicity was 11.3% (predominantly grades 1-2) . Conclusion:L-AmB is safe and effective in the treatment of patients with IFD who are intolerant to or who have experienced no effect of previous antifungal therapy, with a low rate of adverse reactions.

Objective:To analyze the efficacy and safety of CLAG regimen (cladribine, cytarabine, granulocyte colony-stimulating factor) in treatment of relapsed/refractory acute myeloid leukemia (AML).Methods:The clinical data of 30 patients with relapsed/refractory AML who were admitted to Suzhou Hongci Blood Disease Hospital from January 2018 to February 2021 were retrospectively analyzed, and the efficacy and adverse reactions were observed.Results:Among 30 patients, 1 patient was not evaluated for efficacy due to treatment-related death. Among the 29 evaluable patients, 17 patients (58.6%) achieved complete remission (CR), 5 patients (17.3%) achieved partial remission (PR) and 7 patients (24.1%) had no remission (NR). One patient in low-medium-risk group achieved CR; the CR rate in medium-risk group was higher than that in high-risk group [68.8% (11/16) vs. 41.7% (5/12)], but the difference was not statistically significant ( P = 0.250). Seven patients with M 5 achieved CR. Five patients with positive MLL gene rearrangement achieved CR. Among 6 patients with extramedullary invasion of leukemia cells, 4 patients achieved CR, and among them 3 patients with central nervous system invasion achieved CR. Among 6 patients with cladribine 3.5 mg·m -2·d -1×5 d, 1 patient died of infection after chemotherapy, 1 patient had NR, and the rest achieved CR. Among 24 patients with cladribine 5 mg·m -2·d -1×5 d, the CR rate in patients with cytarabine 2 g·m -2·d -1×5 d was higher than that in patients with cytarabine 1 g·m -2·d -1×5 d [70.0% (7/10) vs. 42.9% (6/14)], but the difference was not statistically significant ( P = 0.240). All patients developed grade Ⅳ myelosuppression after chemotherapy. 12 patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) after CR, and 9 patients were still alive. Conclusions:CLAG regimen is effective and well tolerated in the treatment of relapsed/refractory AML. In order to improve the prognosis, allo-HSCT should be performed as soon as possible after CR.

Objective To investigate the role of network platform for treatment and rescue of acute and severe cerebrovascular diseases in improving treatment level of patients with acute ischemic stroke.Methods The differences of number of patients accepted venous thrombolysis, number of patients accepted emergency intravascular interventional treatment, and time from admission to intravenous thrombolysis (door to needle time [DNT]) were analyzed in patients with acute ischemic stroke admitted to our hospital in the first year (2016) and the second and third years (2017 and 2018) of construction of network platform for treatment and rescue of acute and severe cerebrovascular diseases in Yunfu city. The National Institutes of Health Stroke Scale (NIHSS) scores were compared in 120 patients selected randomly from online referral (study group,n=60) and non-online referral (control group,n=60) within the same time periods in 2018.Results In 2017 and 2018, the number of patients accepted intravenous thrombolysis was 85 and 103, respectively, and the rate of intravenous thrombolysis was 9.92％ and 9.83％; they were all significantly larger/higher than those in 2016 (n=50, 6.97％,P<0.05). In 2017 and 2018, the number of patients accepted emergency endovascular treatment was 56 and 129, respectively, and the emergency endovascular treatment rate was 6.53％ and 12.31％; they were all higher than those in 2016 (n=44 and 6.14％), and the differences between those in 2018 and 2016 were statistically significant (P<0.05). The DNT ([82.00±18.75] min in 2017 and [77.00±32.17] min in 2018) was significantly shorter than that in 2016 ([109.00±30.58] min,P<0.05). The NIHSS scores of the study group and control group were 4.70±3.64 and 8.90±5.62, respectively, after one week of treatment, both of which were lower than those before treatment (14.30±6.29 and 13.60±6.37); and after treatment, the NIHSS scores of the treatment group were statistically lower than those of the control group (P<0.05). Conclusion Construction and effective operation of network platform for treatment and rescue of acute and severe cerebrovascular diseases is an effective guarantee to improve the success rate of treatment for patients with acute ischemic stroke.

Objective To summarize the experiences of endovascular aortic repair (EVAR) for isolated iliac artery aneurysm (ⅡAA).Methods The clinical data of 23 patients with ⅡAA undergoing EVAR from Aug 2008 to Mar 2016 were retrospectively analyzed.There were 5 cases of internal iliac artey (internal iliac artery ⅡA) aneurysm,10 cases of unilateral common iliac artery(common iliac artery CIA) aneurysm,6 cases of bilateral CIA aneurysms.Unilateral ⅡA aneurysm was treated by coil embolization and covering the entrance;CIA aneurysm without involving ⅡA was treated by EVAR with covered stent,those involved unilateral ⅡAs or combined ⅡA aneurysms were treated by EVAR after ⅡA embolization.Those with bilateral ⅡA involvement were repaired by Sandwich technique;Bilateral ⅡA was treated in two phases.Results All endovascular procedures were successfully performed;No patients died during the perioperation period.Intraoperative endoleak found in 5 cases managed by balloon dilatation,or conservatively were cured.23 patients were followed-up for 2-60 months,one rebuilding ⅡA was occluded.One CIA anurysm complicated with endoleak was cured by coils embolization and stenting.Gluteal claudication and erectile dysfunction occured in 4 out of 15 cases with unilateral or bilateral ⅡAs occlusion.Conclusion EVAR is a safe and effective treatment for ⅡAA,after a proper management for ⅡA.

BACKGROUND:The endothelial dysfunction is the pathogenesis of arteriosclerotic disease, the quantity and function of endothelial progenitor cells are decreased within the cycle, leading to a poor capacity of neovascularizatio, the efficacy of stem celltransplantation alone is unclear, the combination of cytokines and gene-modified stem cells is the hotspot.
OBJECTIVE:To observe the effect of stromal cel-derived factor-1 on the neovascularization after endothelial progenitor cells transplantation.
METHODS:Unilateral hindlimb ischemia model was established in 20 athymic nude mice, and the mice were randomly divided into four groups:combined group (intravenous endothelial progenitor cells+intramuscular stromal cel-derived factor-1), endothelial progenitor cells group (intravenous injection of endothelial progenitor cells), stromal cel-derived factor-1 group (intramuscular injection of stromal cel-derived factor-1), and blank control group (intramuscular M199). The skin temperature of ischemic hindlimbs and survival of animals after transplantation were observed. The ratio of capil ary/skeletal muscle fiber was counted. The expression of CD31 and endothelial nitric oxide synthase were detected.
RESULTS AND CONCLUSION:The fluorescence-labeled endothelial cells were embedded in ischemic hindlimb muscles after celltransplantation. Of the 20 nude mice, two mice died. The rate of ischemic hindlimb reserving was respectively 80%, 75%, 20%and 0 in combined group, endothelial progenitor cells group, stromal cel-derived factor-1 group, and blank control group. The capil ary/muscle fiber ratio in combined group and endothelial progenitor cells group was higher than that of blank control group (P<0.01). The combined group was greater than endothelial progenitor cells group, and endothelial progenitor cells group was greater than stromal cel-derived factor-1 group (P<0.05). The capil ary density in combined group and endothelial progenitor cells group were higher than that in blank control group (P<0.01), and stromal cel-derived factor-1 group was also more than blank control group (P<0.05). The combined group was greater than endothelial progenitor cells group, and endothelial progenitor cells group was greater than stromal cel-derived factor-1 group (P<0.05). The positive rate of endothelial nitric oxide synthase was 73.33%and 53.33%in combined group and endothelial progenitor cells group respectively (P>0.05). Endothelial progenitor cells can migrate to ischemic tissues, endothelial progenitor cells transplantation can promote neovascularization, and stromal cel-derived factor-1 augments the neovascularization after celltransplantation, in which endothelial nitric oxide synthase is involved.

Objective To evaluate the clinical effect of the endovascular treatment of iliac vein compression syndrome.Methods Thirty-three patients with iliac vein compression syndrome were treated with endovascular treatment.Of which,edema and varicose vein of the left lower extremity in 29 patients,complicated with acute deep vein thrombosis of left lower extremity in 3 patients,post deep venous thrombosis syndrome in 1 patient.Balloon dilatation and stent implantation were performed in all 33 patients.The diameter of balloon was 10-12 mm,diameter 12-14 mm Bard self expandable stent.Five patients with varicose vein and ulcer of left lower extremity were treated with two stage operation.Results The diagnosis was confirmed by left lower extremity deep veins angiography.There was no death patient,and no hematoma of hematoma locus.Follow-up for 3-30 months,the rate of follow-up was 100％(33/33).The edema of the lower extremity was markedly reduced or disappeared in 28 patients.Color Doppler ultrasound and left lower extremity angiography showed that the stent was unobstructed,no stent occlusion and new onset thrombosis cases.Conclusion Endovascular treatment is safe,effective with few complications,and is the first choice for the treatment of iliac vein compression syndrome.

Objective To review reoperation on blood vessel prosthesis occlusion after arterial bypass graft in lower limbs. Method The treatment effect of 21 patients with reoperation on blood vessel prothesis occlusion after arterial bypass graft in lower limbs was analyzed retrospectively. Results All the cases were followed up 6-36 (12 ±3) months. The limb salvage rate was 71.4%(15/21) ,the amputation rate was 28.6% (6/21). All 9 limbs that underwent revascularization from deep femoral artery reserved. Conclusions Endomembrane hyperplasy, occlusion of the inflow and outflow tracts are the major reasons for the occlusion of blood vessel prosthesis after arterial bypass graft in lower limbs. Appropriate procedures should be based on careful consideration of the occlusion reasons. Profundaplasty is an effective therapy for those who are treated by reoperation on blood vessel prosthesis occlusion in lower limbs.

Objective To summarize experiences in treatment of traumatic aortic rupture. Methods Between July 2001 and December 2008, 17 patients with acute traumatic aortic rupture were treated in our department. One patient died of hemorrhagic shock one hour after admission before opera-tion. Nine patients underwent thoracotomy under general anesthesia with double lumen endotracheal tube and normothermic femoral-femoral partial cardiopulmonary bypass, with bypass time for 35-139 minutes and aortic clamping time for 25-87 minutes. Successful operation was performed in seven patients inclu-ding one treated with simple repair and the other six with partial replacement of thoracic aorta with artifi-cial vascular graft. The other seven patients underwent endovascular repair and received stent grafts at the site of thoracic injury via right lilac-femoral artery under general or local anesthesia. Results One pa-tient free from operation was died of hemorrhagic shock. Of nine patients treated with thoracotomy, two patients died of hemorrhagic shock during operation and the other seven survived, with operation time ran-ging from 100 to 180 minutes. Seven survivors were followed-up for 2-6 years, with no death during fol-low-up period. Seven patients in endovascular repair group recovered, wiht operation time ranging from 50 to 70 minutes. All these seven patients were followed up for 3-14 months, which showed no death. Reex-amined CT in six patients showed no mediastinal hematoma or leakage of contrast medium from the aorta isthmus at 2-5 months after operation. Conclusions Endovascular repair is simple, safe and effective for traumatic aortic rupture. The selection of thoracotomy and endovascular repair is based on following conditions: the combined injuries of patients, the equipments of hospital and the skills of operators.

Objective To explore the feasibility of one-stage operation in periappendicural abscess.Methods The clinical data of 111 patients with periappendicural absecess from 1990 to 2007 were analyzed retrospectively.Results A1l operation were successful.the rate of wound infection was 7.2%(8/111),there was no operative death and no severe complication occurred.Conclusion Timely and appropriate one-stage operation in early periappendicural absecess is safe and feasible.