Objective:To evaluate the diagnostic performance of radiomics model based on contrast-enhanced ultrasound(CEUS) in predicting pathological complete response(pCR) after neoadjuvant chemoradiotherapy(nCRT) in patients with locally advanced rectal cancer(LARC).Methods:One hundred and six patients with LARC who underwent total mesorectal excision after nCRT between April 2018 and April 2023 in the First Affiliated Hospital of Guangxi Medical University were retrospectively included, the patients were randomly divided into a training set of 63(14 pCR patients) and a validation set of 43(12 pCR patients) in a 6∶4 ratios. Radiomics features were extracted from the tumors′ region of interest of CEUS images based on PyRadiomics. Intra-class correlation coefficient(ICC), Mann-Whitney U test, and least absolute shrinkage and selection operator(LASSO) algorithms were used to reduce features dimension. Finally, 7 radiomics features relevanted to pCR were selected to construct an ultrasomics model using elastic network regression, based on the R language. A combined model was constructed by jointing clinical feature. The performance of the models was assessed with the area under the ROC curve(AUC). Results:The AUC of the ultrasomics model and the combined model was 0.695(95% CI=0.532-0.859) and 0.726(95% CI=0.584-0.868) respectively in the training set. The AUC of the ultrasomics model and the combined model was 0.763(95% CI=0.625-0.902) and 0.790(95% CI=0.653-0.928) respectively in the validation set. Both univariate and multivariate Logistic regression analyses showed that CA199( P<0.05) and ultrasomics score( P<0.001) could be an independent predictor of pCR after nCRT in patients with LARC. Conclusions:The CEUS-based radiomics scores has certain predictive value for whether LARC patients achieve pCR after nCRT, and may provide a non-invasive imaging biomarker for predicting LARC patients achieve pCR after nCRT.

Adjacent segment disease(ASD) refers to the degeneration of adjacent segments after lumbar fusion surgery, including intervertebral disc herniation, stress vertebral fractures, slippage, segmental scoliosis, spinal canal stenosis, and facet joint degeneration, which can lead to corresponding clinical symptoms such as lumbosacral pain, root lower limb pain, or intermittent claudication. The treatment of different pathological types of ASD varies. The patients with mild symptoms require conservative treatment and patients with severe symptoms require surgical treatment. In the past, open fusion surgery with posterior approach or intervertebral foramen approach was commonly used for surgical treatment, which had definite therapeutic effects. However, there were drawbacks such as large surgical trauma, excessive intraoperative blood loss, and slow postoperative recovery. With the booming development of minimally invasive spinal surgery technology in recent years, spinal surgeons actively use minimally invasive surgery for the treatment of ASD. It has advantages such as less bleeding, short hospital stay, fast recovery, and fewer complications (such as deep vein thrombosis and pulmonary embolism), but its indications are limited. Therefore, this article provides a reference for the choice of ASD treatment by reviewing the treatment modalities of ASD with different pathological types.

A method capable of retinal vessel segmentation and three-dimensional(3D)reconstruction is proposed for the early diagnosis of diabetic retinopathy.The 3D reconstruction can avoid the misjudgments of blood vessel length,curvature and branch angle after segmentation,which will affect the early diagnosis.IAAnet algorithm for retinal image segmentation combines traditional Unet with Inception V3,atrous spatial pyramid pooling and AttentionGates to reduce information loss and avoid over-fitting,thereby improving the network's ability to extract features.The projection reconstruction method is used to restore the 3D information of blood vessels,and supports the adjustments of brightness and contrast,so that doctors can better observe the real state of blood vessels.The proposed algorithm has an accuracy,recall rate,F1 score,intersection over union and area under ROC curve of 97.68%,96.07%,97.26%,92.79%and 94.00%,respectively.Compared with other networks,IAAnet algorithm exhibits higher segmentation accuracy,and can obtain more vascular information in 3D image after 3D projection reconstruction to assist in the early diagnosis.

Objective To assess the comparative efficacy of different methods for difficult biliary cannulation in endoscopic retrograde cholangio-pancreatography(ERCP)through a network meta-analysis.Methods Randomized controlled trials(RCTs)that compared the efficacy of different adjunctive methods(early or late needle-knife technique,pancreatic guidewire-assisted technique,pancreatic stent-assisted technique,transpancreatic sphincterotomy,persistent standard cannulation technique)for difficult biliary cannulation with each other were identified.The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis(PEP)were the outcomes of interest.Pairwise and network meta-analysis and ranking according to surface under the cumulative ranking curve(SUCRA)for all methods were performed.Results Eighteen RCTs were identified according to selection criteria,and 2 033 patients were enrolled.The use of transpancreatic sphincterotomy over persistent standard cannulation technique(RR=1.34,95%CI:1.02-1.77)and over pancreatic guidewire-assisted technique(RR=1.26,95%CI:1.00-1.60)significantly increased the success rate of biliary cannulation.Based on SUCRA ranking,transpancreatic sphincterotomy followed by early needle-knife techniques were ranked highest in terms of increasing the success rate of biliary cannulation.Only early needle-knife technique significantly decreased PEP rate when compared with persistent standard cannulation technique(RR=0.53,95%CI:0.30-0.94),whereas both early needle-knife techniques and transpancreatic sphincterotomy led to lower PEP rates as compared with pancreatic guidewire-assisted technique(RR=0.41,95%CI:0.17-0.99;RR=0.49,95%CI:0.25-0.96;respectively).Based on SUCRA ranking,early needle-knife technique followed by transpancreatic sphincterotomy were ranked highest for decreasing the PEP rate of biliary cannulation.Conclusions Transpancreatic sphincterotomy increases the success rate of difficult biliary cannulation in ERCP;early needle-knife technique and transpancreatic sphincterotomy are superior to other interventions in decreasing PEP rates and should be considered as a choice of difficult biliary cannulation.

Turner syndrome (TS) complicated with Madelung deformity and complex brachydactyly are rare clinically, and it is even rarer to combine with ankylosing spondylitis (AS). This article reports a case of a 36 year-old female patient who was admitted to the hospital with "ankylosing spondylitis" due to repeated back, hip and knee pain for 11 years and aggravated for 1 month. After admission, the karyotype showed "46, X, i (Xq)" due to short stature, dysplasia of secondary sexual characteristics, limb deformity etc, thus confirming TS. Further examination revealed bilateral Madelung deformity and complex brachydactyly characterized by shortening of the fourth metacarpal, multiple missing and shortened middle phalanxes. By reviewing the relevant literature, we believe that autoimmune diseases such as AS should be excluded in TS patients. TS aggravates the inflammatory response of AS, but the combination of TS and AS is more likely to be an accidental event. Patients with Madelung deformity should be careful to exclude TS. Madelung deformity and shortening of the fourth metacarpal are mainly associated with haploinsufficiency of SHOX gene. Brachydactyly characterized by multiple loss and shortening of the middle phalanx may be a new clinical manifestation of TS, especially the karyotype of 46, X, i (Xq). It is possible that there are some genes on the short arm of X chromosome, which regulate the number, growth and development of fingers. Early estrogen replacement therapy can greatly benefit patients.

Objective:To explore the value of bedside chest radiograph in the diagnosis and follow-up of severe and critical COVID-19.Methods:Twenty-nine patients with severe or critical COVID-19 were collected from January 23 to February 23, 2020，from four COVID-19 designated hospitals in Guangdong Province. Bedside radiography was taken in all the 29 patients, ranged from 1 to 16 times for each patient. Twenty-seven patients underwent follow-up, and the number of re-examination ranged 1 to 15 times, and the interval of review is 1 to 8 days.The imaging findings of bedside chest radiography and the imaging changes on follow-up chest radiography were analyzed retrospectively.Results:Twenty-nine patients were collected. The radiography showed the lesions involved all more than 3 lung fields. The films showed consolidation shadow in 19 cases, multiple patches of shadow in 23 cases, reticular pattern in 12 cases, strips shadow in 14 cases, interlobar fissure thickening in 18 cases, and "white lung" in 4 cases.The complications included pleural effusion in 4 cases, pneumothorax in 2 cases, mediastinal and subcutaneous emphysema in 1 case. The radiography showed the lesions progressed in 15 cases, with expanded involvement of the lung.The increase of lesion density was found in 6 cases, new lesions were noted in 5 cases, while both of them were found in 4 cases. Nine cases showed improvement, with reduced range and decreased density. Patchy or consolidation shadow turned to strips shadow or articular pattern shadow in 8 cases.There was no significant change in 3 cases with large consolidation shadow.Conclusions:Bedside chest radiography has a good value in the follow-up of severely and critically ill patients with COVID-19, and can provide great help for clinicians to evaluate their condition.

Objective: To analyze the effect of recombinant human brain natriuretic peptide (rhBNP) on the cardiac function and serum N terminal pro-B-type natriuretic peptide (NT-proBNP) level in elderly patients with heart failure. Methods: From January 2015 to December 2017, 150 elderly patients (aged 80 years) with heart failure in the 117th Hospital of the Chinese People′s Liberation Army were selected in the research.According to the digital random list method, the patients were divided into two groups, with 75 cases in each group.The control group was given nitroglycerin treatment, and the observation group was given rhBNP treatment.The levels of serum NT-proBNP, left ventricular ejection fraction (LVEF), clinical efficacy and complications were compared between the two groups. Results: After treatment, the levels of serum NT-proBNP in the two groups were significantly lower than before treatment, and the level of NT-proBNP in the observation group [(2 964.42±607.25)pg/mL] was significantly lower than that in the control group [(4 213.57±524.07)pg/mL] (t=13.49, P<0.01). After treatment, the levels of LVEF in the two groups were significantly higher than those before treatment, and the level of LVEF in the observation group [(51.26±4.77)%] was significantly higher than that in the control group [(46.03±5.22)%] (t=6.41, P<0.01). The total effective rate of the observation group was 94.67%(71/75), which was significantly higher than 70.67%(53/75) of the control group (χ²=13.45, P<0.01). There was no statistically significant difference in the incidence rate of complications such as headache, blood pressure drop, renal function deterioration and tachycardia etc.in the two groups (P>0.05). Conclusion rhBNP in the treatment of elderly patients with heart failure can effectively improve the symptoms of dyspnea and systemic symptoms, reduce serum NT-proBNP levels, improve heart function, and will not cause serious complications, with good safety, so it is worthy of clinical promotion and application.

Objective: To apply high-throughput whole genome sequencing (WGS) and short tandem repeat (STR) typing to detect aneuploidies, heteroploidies and copy number variations(CNVs) in spontaneous abortic tissues. Methods: Chorionic villus samples from 145 patients with spontaneous abortion were subjected to detection of aneuploidies, heteroploidies and copy number variations by WGS and STR typing. Results: All testing was successful and the rate of chromosomal abnormalities among the patients was 22.07%. Among these, there were 11 trisomies, 3 monosomies, 2 triploidies, 5 autosomal mosaicisms, 4 sex chromosomal mosaicisms, 7 structural abnormalities (including 1 mosaicism). In 89 cases, there were 130 CNVs of uncertain significance, 47 likely benign CNVs, and 2 loss of one copy of pathogenic AR gene. One sample contained 6 fragment duplications and deletions. Only 24 samples had no abnormal finding. Conclusion The most important reason for spontaneous abortions is embryonic chromosomal abnormality. Combined STR typing and WGS is both comprehensive and fast, and may become a major means for the detection of chorionic villi tissue from spontaneous abortions.

Objective To explore the impact of butylphthalide soft capsules on the related factors and quality of life of Parkinson patients with dementia.Methods 90 Parkinson patients with dementia were selected,and they were divided into the study group and the control group by the random number table method,45 cases in each group.The control group was treated with donepezil hydrochloride combined with routine nursing method,and the study group was treated with butylphthalide soft capsules based on the treatment of the control group.Before and after treatment,the serum C-reactive protein(CRP),recombinant human Parkinson disease protein 7 (PARK7),neurotrophic factor -3 (NT-3) levels of all patients were detected.And the quality of life of patients at admission and discharge were evaluated by the scale of disease self management efficiency and quality of life scale WHO (WHO QOL-BREF),quality of life of the two groups was compared before and after treatment.The Parkinson's Disease Rating Scale (UPDRS) scores was compared between the two groups before and after treatment.Results Before treatment,the dementia related factors and quality of life score,UPDRS score of the two groups had no statistically significant differences (all P ＞ 0.05).After treatment,the dementia related factors of the two groups were all improved,which of the study group improved significantly [CRP:(3.24 ± 0.78) mg/L vs.(6.02 ± 0.95) mg/L,PARK7:(13.15 ± 1.51) μg/L vs.(24.93 ±2.02)μg/L,NT-3:(34.16 ± 3.47) μg/L vs.(26.23 ± 2.97) μg/L,all P ＜0.05].After treatment,the quality of life(QOL) and UPDRS score of the study group were significantly higher than those of the control group [(80.5 ± 12.5) points vs.(66.0 ± 10.3) points,(33.28 ± 2.18) points vs.(41.26 ± 2.54) points,all P ＜ 0.05].Conclusion Butylphthalide soft capsules can effectively improve the dementia related factor of Parkinson patients with dementia,and enhance the quality of life with good effect.

Objective To study the effect of curcumin on JAK2/STAT3 signaling pathway following ischemic cerebral injury in rats.Methods Sixty-eight SD rats were divided into sham opera tion group,cerebral ischemia group,curcumin treatment group and control group (17 in each group).After a rat focal cerebral hemmorrahge model was established,the changes of neurological behaviors in rats were recorded,expressions of TNF-α,IL-1β and IL-6 were detected by ELISA and those of JAK2,p-JAK2,STAT3,p-STAT3 and HMGB1 were detected by Western blot.Results The neurological behavior score was lower in curcumin treatment group than in cerebral ischemia group (1.53±0.62 vs 2.94±0.87,P＜0.05).No significant difference was found in expression levels of TNF-α,IL-1β and IL 6 between cerebral ischemia group and control group (P＞0.05).The expression levels of TNF α,IL 1β and IL 6 were lower in curcumin treatment group than in cerebral ischemia group (57.63±10.27 ng/L vs 99.35±8.97 ng/L,33.67 ± 9.10 ng/L vs58.43±7.22 ng/L,31.97±6.91 ng/L vs 49.23±6.28 ng/L,P＜0.01).The relative volume of p-JAK2/JAK2 and p-STAT3/STAT3 and the expression level of HMGB1 were lower in curcumin treatment group than in cerebral ischemia group (P＜0.05).Conclusion Curcumin can protect rats against cerebral injury following ischemia by inhibiting the JAK2/STAT3 signaling pathway and downregulating the HMGB1 expression,and can thus alleviate inflammatory reactions.