Combined preoperative albumin bilirubin score and hepatectomy percentage for evaluate the liver regeneration after partial hepatectomy

Surgical resection is a pivotal therapeutic approach for addressing hepatic space-occupying lesions,with liver volume restoration and hepatic functional recovery being crucial for assessing surgical prognosis.The preoperative albumin-bilirubin(ALBI)score,encompassing serum albumin and bilirubin levels,can be determined via blood analysis,effectively mitigating human error and providing an accurate depiction of liver function.The hepatectomy ratio,which is the proportion of the liver volume removed to the total liver volume,is critical in preserving an adequate liver tissue volume to ensure postoperative hepatic functional compensation,minimize surgical complications,and reduce mortality rates.Incorporating the preoperative ALBI score and hepatectomy ratio aids surgeons in assessing the optimal timing and extent of partial hepatectomy.The introduction of preoperative albumin bilirubin score and hepatectomy percentage is beneficial for the surgeons to evaluate the timing and magnitude of partial liver resection.

Enhancing preoperative patient education through virtual reality:A leap forward in nursing practice

Integration of virtual reality(VR)technology into preoperative patient education has shown potential to improve nursing practice.The study by Kim et al examines the impact of VR on nurse satisfaction,usability,and burnout.A prospective study involving 20 nurses and 80 patients was conducted,comparing traditional paper-based education with VR-based education in the plastic surgery ward at Chungnam National University Hospital.Findings demonstrated that VR significantly enhanced satisfaction and usability among nurses,while also reducing emotional exhaustion,a critical factor in nurse burnout.Consistency in education quality was also improved,ensuring uniform patient care.These results underscore the importance of VR in reducing the stress of repetitive tasks,improving job satisfaction,and potentially enhancing nurse retention.Future research should explore the broader applications of VR in healthcare and address the logistical challenges of integrating this technology into routine clinical practice.The study by Kim et al highlights VR’s transformative potential in preoperative education for both patients and healthcare providers.

Virtual reality for preoperative patient education: Impact on satisfaction, usability, and burnout from the perspective of new nurses

BACKGROUND Traditional paper-based preoperative patient education is a struggle for new nurses and requires extensive training.In this situation,virtual reality technology can help the new nurses.Despite its potential benefits,there are studies on patient satisfaction but there is limited information on the usability of virtual reality(VR)technology for new nurses in giving preoperative education to patients.AIM To investigate the impact on satisfaction,usability,and burnout of a system using VR technology in preoperative patient education.METHODS The study involved 20 nurses from the plastic surgery ward and 80 patients admitted between April and May 2019.Each nurse taught four patients:Two using traditional verbal education and two using virtual reality.The System Usability Scale,After-Scenario Questionnaire,and Maslach Burnout Inventory(MBI)were employed to evaluate the impact of these education methods.RESULTS The VR education groups showed a statistically higher satisfaction than the traditional verbal education groups.Among the three subscales of the MBI,emotional exhaustion and personal accomplishment improved statistically significantly.VR was also better in terms of usability.CONCLUSION This study suggests VR enhances usability and reduces burnout in nurses,but further research is needed to assess its impact on depersonalization and objective measures like stress and heart rate.

Hepatic perivascular epithelioid cell tumors:The importance of preoperative diagnosis

Accurate preoperative diagnosis is highly important for the treatment of perivascular epithelioid cell tumors(PEComas)because PEComas are mainly benign tumors and may not require surgical intervention.By analyzing the causes,properties and clinical manifestations of PEComas,we summarize the challenges and solutions in the diagnosis of PEComas.

Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Tumour response following preoperative chemotherapy is affected by body mass index in patients with colorectal liver metastases

BACKGROUND Colorectal cancer is the third most prevalent malignancy globally and ranks second in cancer-related mortality,with the liver being the primary organ of metastasis.Preoperative chemotherapy is widely recommended for initially or potentially resectable colorectal liver metastases(CRLMs).Tumour pathological response serves as the most important and intuitive indicator for assessing the efficacy of chemotherapy.However,the postoperative pathological results reveal that a considerable number of patients exhibit a poor response to preoperative chemotherapy.Body mass index(BMI)is one of the factors affecting the tumori-genesis and progression of colorectal cancer as well as prognosis after various antitumour therapies.Several studies have indicated that overweight and obese patients with metastatic colorectal cancer experience worse prognoses than those with normal weight,particularly when receiving first-line chemotherapy regimens in combination with bevacizumab.AIM To explore the predictive value of BMI regarding the pathologic response following preoperative chemotherapy for CRLMs.METHODS A retrospective analysis was performed in 126 consecutive patients with CRLM who underwent hepatectomy following preoperative chemotherapy at four different hospitals from October 2019 to July 2023.Univariate and multivariate logistic regression models were applied to analyse potential predictors of tumour pathological response.The Kaplan-Meier method with log rank test was used to compare progression-free survival(PFS)between patients with high and low BMI.BMI<24.0 kg/m^(2) was defined as low BMI,and tumour regression grade 1-2 was defined as complete tumour response.RESULTS Low BMI was observed in 74(58.7%)patients and complete tumour response was found in 27(21.4%)patients.The rate of complete tumour response was significantly higher in patients with low BMI(29.7%vs 9.6%,P=0.007).Multivariate analysis revealed that low BMI[odds ratio(OR)=4.56,95%confidence interval(CI):1.42-14.63,P=0.011],targeted therapy with bevacizumab(OR=3.02,95%CI:1.10-8.33,P=0.033),preoperative carcinoembryonic antigen level<10 ng/mL(OR=3.84,95%CI:1.19-12.44,P=0.025)and severe sinusoidal dilatation(OR=0.17,95%CI:0.03-0.90,P=0.037)were independent predictive factors for complete tumour response.The low BMI group exhibited a significantly longer median PFS than the high BMI group(10.7 mo vs 4.7 mo,P=0.011).CONCLUSION In CRLM patients receiving preoperative chemotherapy,a low BMI may be associated with better tumour response and longer PFS.

Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy:A singlecenter retrospective study

BACKGROUND The population of elderly patients with gastric cancer is increasing,which is a major public health issue in China.Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer.AIM To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy.METHODS A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020.RESULTS The overall rate of malnutrition was 31.8%.The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group(P<0.001).Nutritional characteristics in the malnourished group,including body mass index,prognostic nutritional index(PNI),albumin,prealbumin,and hemoglobin,were all significantly lower than those in the well-nourished group.The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the wellnourished group(22.1%vs 33.5%,P=0.001).Age≥70 years(HR=1.216,95%CI:1.048-1.411),PNI<44.5(HR=1.792,95%CI:1.058-3.032),operation time≥160 minutes(HR=1.431,95%CI:1.237-1.656),and postoperative complications grade III or higher(HR=2.191,95%CI:1.604-2.991)were all recognized as independent risk factors associated with delayed discharge.CONCLUSION Malnutrition is relatively common in elderly patients undergoing gastrectomy.Low PNI is an independent risk factor associated with delay discharge.More strategies are needed to improve the clinical outcome of these patients.

Effects of fluid therapy combined with a preoperative glucose load regimen on postoperative recovery in patients with rectal cancer

BACKGROUND Patients with rectal cancer undergoing radical resection often have poor post-operative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue,and have a high risk of complications.Therefore,it is of great significance to apply appropriate rehydration regimens to patients un-dergoing radical resection of rectal cancer during the perioperative period to improve the postoperative outcomes of patients.AIM To analyze the effects of goal-directed fluid therapy(GDFT)with a preoperative glucose load regimen on postoperative recovery and complications in patients undergoing radical resection for rectal cancer.METHODS Patients with rectal cancer who underwent radical resection(n=184)between January 2021 and December 2023 at our hospital were randomly divided into either a control group or an observation group(n=92 in each group).Both groups received a preoperative glucose load regimen,and routine fluid replacement and GDFT were additionally implements in the control and observation groups,res-pectively.The operative conditions,blood levels of lactic acid and inflammatory markers,postoperative recovery,cognitive status,hemodynamic indicators,brain oxygen metabolism,and complication rates were compared between the groups.RESULTS The colloidal fluid dosage,total infusion,and urine volume,as well as time to first exhaust,time to food intake,and postoperative length of hospital stay,were lower in the observation group(P<0.05).No significant differences were observed between the two groups in terms of operation time,bleeding volume,crystalloid liquid consumption,time to tracheal extubation,complication rate,heart rate,or mean arterial pressure(P>0.05).Compared with the control group,in the ob-servation group the lactic acid level was lower immediately after the surgery(P<0.05);the Mini-Mental State Examination score was higher on postoperative day 3(P<0.05);the pulse pressure variability(PPV)was lower at 30 min after pneumoperitoneum(P<0.05),though the differences in the PPV of the two groups was not significant at the remaining time points(P>0.05);tumor necrosis factor-αand interleukin-6 levels were lower on postoperative day 3(P<0.05);and the left and right regional cerebral oxygen saturation was higher immediately after the surgery and 30 min after pneumoperitoneum(P<0.05).CONCLUSION GDFT combined with the preoperative glucose load regimen is a safe and effective treatment strategy for im-proving postoperative recovery and risk of complications in patients with rectal cancer undergoing radical re-section.

Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.

Influence of static cartoons combined with dynamic virtual environments on preoperative anxiety of preschool-aged children undergoing surgery

BACKGROUND Preschoolers become anxious when they are about to undergo anesthesia and surgery,warranting the development of more appropriate and effective interventions.AIM To explore the effect of static cartoons combined with dynamic virtual environments on preoperative anxiety and anesthesia induction compliance in preschool-aged children undergoing surgery.METHODS One hundred and sixteen preschool-aged children were selected and assigned to the drug(n=37),intervention(n=40),and control(n=39)groups.All the children received routine preoperative checkups and nursing before being transferred to the preoperative preparation room on the day of the operation.The drug group received 0.5 mg/kg midazolam and the intervention group treatment consisting of static cartoons combined with dynamic virtual environments.The control group received no intervention.The modified Yale Preoperative Anxiety Scale was used to evaluate the children’s anxiety level on the day before surgery(T0),before leaving the preoperative preparation room(T1),when entering the operating room(T2),and at anesthesia induction(T3).Compliance during anesthesia induction(T3)was evaluated using the Induction Compliance Checklist(ICC).Changes in mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)were also recorded at each time point.RESULTS The anxiety scores of the three groups increased variously at T1 and T2.At T3,both the drug and intervention groups had similar anxiety scores,both of which were lower than those in the control group.At T1 and T2,MAP,HR,and RR of the three groups increased.The drug and control groups had significantly higher MAP and RR than the intervention group at T2.At T3,the MAP,HR,and RR of the drug group decreased and were significantly lower than those in the control group but were comparable to those in the intervention group.Both the drug and intervention groups had similar ICC scores and duration of anesthesia induction(T3),both of which were higher than those of the control group.CONCLUSION Combining static cartoons with dynamic virtual environments as effective as medication,specifically midazolam,in reducing preoperative anxiety and fear in preschool-aged children.This approach also improve their compliance during anesthesia induction and helped maintain their stable vital signs.

Association of preoperative antiviral treatment with incidences of post-hepatectomy liver failure in hepatitis B virus-related hepatocellular carcinoma

BACKGROUND Post-hepatectomy liver failure(PHLF)is a common consequence of radical partial hepatectomy in hepatocellular carcinoma(HCC).AIMS To investigate the relationship between preoperative antiviral therapy and PHLF,as well as assess the potential efficacy of hepatitis B virus(HBV)DNA level in predicting PHLF.METHODS A retrospective study was performed involving 1301 HCC patients with HBV who underwent radical hepatectomy.Receiver operating characteristic(ROC)analysis was used to assess the capacity of HBV DNA to predict PHLF and establish the optimal cutoff value for subsequent analyses.Logistic regression analyses were performed to assess the independent risk factors of PHLF.The increase in the area under the ROC curve,categorical net reclassification improvement(NRI),and integrated discrimination improvement(IDI)were used to quantify the efficacy of HBV DNA level for predicting PHLF.The P<0.05 was considered statistically significant.RESULTS Logistic regression analyses showed that preoperative antiviral therapy was independently associated with a reduced risk of PHLF(P<0.05).HBV DNA level with an optimal cutoff value of 269 IU/mL(P<0.001)was an independent risk factor of PHLF.All the reference models by adding the variable of HBV DNA level had an improvement in area under the curve,categorical NRI,and IDI,particularly for the fibrosis-4 model,with values of 0.729(95%CI:0.705-0.754),1.382(95%CI:1.341-1.423),and 0.112(95%CI:0.110-0.114),respectively.All the above findings were statistically significant.CONCLUSION In summary,preoperative antiviral treatment can reduce the incidence of PHLF,whereas an increased preoperative HBV DNA level has a correlative relationship with an increased susceptibility to PHLF.

痛风基因表达谱的差异基因表达及免疫细胞浸润分析

目的:研究痛风患者的差异基因表达及免疫细胞浸润情况,寻找痛风发病的关键基因及免疫细胞,探究免疫细胞与痛风的关系。方法:从GEO数据库下载痛风的芯片GSE160170,借助R语言筛选差异基因,随后采用STRING数据库对差异基因进行分析,并借助Cytoscape软件筛选关键基因,再对其进行富集分析,同时对免疫细胞浸润情况进行分析。结果:研究发现IL-6、IL-1β、TNF、CCL3、CXCL8和CXCL1为痛风发病的关键基因,主要通过IL-17、Toll样受体、NOD样受体、NF-κB等信号通路发挥细胞对脂多糖、细菌来源分子及生物刺激的反应等过程导致疾病发生;免疫浸润结果表明记忆性B细胞、活化的NK细胞、活化的树突状细胞、活化的肥大细胞和嗜酸性粒细胞在痛风患者中表达显著;免疫细胞间的相关性分析结果表明滤泡辅助性T细胞与活化的肥大细胞表达呈正相关,未活化的NK细胞与单核细胞表达呈负相关。结论:关键基因和差异表达的免疫细胞与痛风发病机制密切相关,为痛风的免疫机制研究提供了新思路。

椎旁肌脂肪浸润对单侧双通道内镜手术治疗腰椎退行性疾病的影响

目的探讨椎旁肌脂肪浸润程度在单侧双通道内镜手术治疗腰椎退行性疾病中的影响。方法选取2020年1月~2022年6月该科室行单侧双通道内镜手术治疗的腰椎椎间盘退变性疾病患者89例。根据腰椎椎旁肌的脂肪浸润程度分为三组:A组22例(正常),0%~10%脂肪浸润;B组36例(轻微),10%~50%脂肪浸润;C组31例(严重),>50%脂肪浸润。所有患者术后随访至少3个月,比较围手术期指标、手术前后VAS评分和ODI指数、术后并发症及临床疗效等。结果所有患者均顺利完成单侧双通道内镜手术并完成随访。在手术时间、住院时间、并发症发生率等指标方面,三组之间无统计学差异(P>0.05)。术后1个月、3个月的腰腿痛VAS评分、腰椎ODI指数方面,三组均较术前显著改善(P<0.05);但C组术后3 d的腰痛VAS评分显著高于A、B组(P<0.05),C组术后1个月的腰痛VAS评分、腰椎ODI指数均显著高于A、B组(P<0.05);术后3个月腰痛VAS评分、腰椎ODI指数方面,三组之间无统计学差异(P>0.05)。术后3个月Fischgrund标准结果显示,优39例,良39例,可11例,优良率为87.6%,三组之间无统计学差异(P>0.05)。结论椎旁肌脂肪浸润程度严重的腰椎退变患者行单侧双通道内镜下减压手术,其腰痛症状及腰椎功能恢复相对较慢,但对总体疗效并无显著影响。

基于多模态MRI定量分析诊断宫颈癌宫旁浸润的研究

目的探讨多模态MRI定量分析诊断宫颈癌宫旁浸润的价值。方法回顾性分析2019年1月~2021年12月新疆维吾尔自治区人民医院收治的86例宫颈癌患者临床资料,根据病理结果分为宫旁浸润组31例与非宫旁浸润组55例。所有患者均接受MRI常规平扫及扩散加权成像(DWI)扫描、动态对比增强磁共振成像(DCE-MRI)扫描,获得感兴趣区表观弥散系数(ADC)值和对比剂容积转换常量(K^(trans))、速率常数(K_(ep))、血管外细胞间隙容积分数(V_(e))值等多模态MRI定量参数。比较宫旁浸润组和非宫旁浸润组临床特征、ADC值和DCE-MRI定量参数;Pearson相关性分析宫颈癌宫旁浸润患者ADC值和K^(trans)、K_(ep)、V_(e)的关系;受试者工作特征曲线(ROC)分析ADC值和K^(trans)、K_(ep)、V_(e)对宫颈癌宫旁浸润的诊断效能。结果宫旁浸润组与非宫旁浸润组肿瘤直径和病理分级的分布差异比较,差异有统计学意义(P<0.05);宫旁浸润组K^(trans)、K_(ep)和V_(e)均明显高于非宫旁浸润组(P<0.05);Pearson相关性显示,宫颈癌宫旁浸润患者ADC值与V_(e)值呈明显的正相关(P<0.05);ROC显示,K^(trans)、K_(ep)、V_(e)值诊断宫颈癌宫旁浸润的曲线下面积(AUC)分别为0.876、0.821和0.864(P<0.05)。结论多模态MRI定量参数对宫颈癌宫旁浸润具有较好的诊断价值,可为宫颈癌宫旁浸润的影像诊断提供量化参考。

囊腔型肺腺癌临床多特征分析及浸润性风险预测模型的构建

背景与目的囊腔型肺癌作为一种特殊类型的肺癌逐步得到人们的关注,其最常见的病理类型为腺癌。囊腔型肺腺癌的浸润性对诊疗方案的选择和预后至关重要。本研究旨在分析囊腔型肺腺癌临床多特征,探讨其浸润性的独立危险因素并建立风险预测模型。方法回顾性分析2021年1月至2022年7月于南京医科大学第一附属医院胸外科行手术治疗的129例囊腔型肺腺癌患者,根据病理结果分成浸润前组:非典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)、原位腺癌(adenocarcinoma in situ,AIS)、微浸润型腺癌(minimally invasive adenocarcinoma,MIA)与浸润组:浸润性腺癌(invasive adenocarcinoma,IAC)。其中浸润前组47例,男性19例,女性28例,平均年龄(51.23±14.96)岁;浸润组82例,男性60例,女性22例,平均年龄(61.27±11.74)岁。收集两组病例多组临床特征,采用单因素分析、LASSO回归、多因素Logistic回归分析得出囊腔型肺腺癌浸润性的独立危险因素,建立浸润性风险预测模型。结果单因素分析显示年龄、性别、吸烟史、肺气肿、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、囊腔数、病灶直径、囊腔直径、结节直径、实性成分直径、囊壁结节、囊壁光滑程度、囊腔形状、分叶征、短毛刺征、胸膜牵拉、血管穿行与支气管穿行在囊腔型肺腺癌浸润前组与浸润组间存在统计学差异(P<0.05)。上述变量经LASSO回归降维处理,进一步筛选出的变量包括:年龄、性别、吸烟史、NSE、囊腔数、病灶直径、囊腔直径、囊壁结节、囊壁光滑程度与分叶征,并纳入多因素Logistic回归分析,发现囊壁结节(P=0.035)与分叶征(P=0.001)是囊腔型肺腺癌浸润性的独立危险因素(P<0.05)。建立预测模型如下:P=e^x/(1+e^x),x=-7.927+1.476*囊壁结节+2.407*分叶征,曲线下面积(area under the curve,AUC)为0.950。结论囊壁结节及分叶征为囊腔型肺腺癌浸润性的独立危险因素,对囊腔型肺腺癌的浸润性预测具有一定的指导意义。

机器学习优化能谱CT预测胃腺癌的浸润性

目的探讨机器学习(ML)算法结合能谱CT定量参数和临床模型在预测胃腺癌(GAC)患者淋巴血管浸润(LVI)和神经周围浸润(PNI)的潜在价值。方法收集2017年12月—2022年5月经病理证实的GAC患者114例。研究参数涉及血清肿瘤标志物、CT-TN分期、CT评估壁外血管浸润(CT-EMVI)以及能谱CT定量参数。通过WEKA软件的Best-First算法进行特征筛选,并运用贝叶斯网络(BN)及支持向量机(SVM)算法建立模型。结果相较于LVI/PNI阴性组,LVI/PNI阳性组中CT-T_(3~4)期、CT-N阳性、CT-EMVI阳性、血清肿瘤标志物[糖类抗原(CA)72-4和CA19-9]更为常见,能谱CT参数也更高,差别均有统计学意义(P<0.05)。经特征选择,关键变量包括CT-T分期、CT-EMVI、VP-NIC和EP-70 keV CT值。基于这些变量,分别使用BN和SVM构建临床参数模型、能谱CT参数模型和混合模型,共6个模型。6个模型均展现了高预测性能,无过拟合现象。BN的混合模型预测性能最佳,AUC值为0.890~0.933,Delong检验显示其在统计学上具有显著优势(P<0.05);而SVM的混合模型与另外2种模型间的差别无统计学意义(P>0.05)。结论结合临床和能谱CT参数的ML模型能够高效能评估GAC患者的LVI和PNI状态,其中BN混合模型的准确性最高。

长期浸润状态下煤岩损伤机制研究

富水状态下煤岩力学性能的持续劣化是导致煤矿水害的重要原因,为探究长期浸润作用下煤岩的渐进损伤特征,以神木地区弱黏煤为研究对象,首先以无压力水浸泡的方式模拟煤岩的长期浸润(15,30,60,120,240 d);然后对干燥及浸润试样进行渐进破坏试验,辅以声发射(AE)监测,定量分析煤岩的软化特性;最后利用扫描电镜(SEM)和核磁共振(NMR)研究不同浸润时长下煤岩孔隙结构的劣化规律。研究表明:(1)煤岩饱和度随浸润时长的增加而增加,增加速度先快后慢,最后达到稳定。(2)随饱和度的增加,煤岩力学性能劣化;饱和后,随浸润时长的持续增加,煤岩力学性能仍持续劣化,表现为抗压强度、弹性模量的减小和累计振铃数的增加;(3)干燥处理后,原状煤岩表面干燥收缩,浸水后吸水膨胀,随着浸润时间的增加,小孔隙逐渐增多,孔隙结构趋于复杂。研究结果可为浸水煤岩失稳破坏问题提供有益参考。

课程美育:实施学校美育浸润行动的重要路径

课程美育是学校教育的新理念,课程与美育的深度融合是学校美育浸润行动实施的重要路径。课程美育具有目标的整合性、资源的丰富性、过程的情智性、方式的浸润性、境界的超越性等特征。课程美育的价值是多方面的,其有助于课程美育价值的实现、美育课程资源的开发、学生审美素养的提升、教师职业体验的积极化等。课程美育的类型有学科课程美育、活动课程美育和隐性课程美育,课程美育的层级包括国家课程美育、地方课程美育和校本课程美育。课程美育的实施策略多种多样,包括理念引领策略、资源开发策略、活动组织策略、氛围营造策略、技术赋能策略、评价激励策略等。

基于“天运当以日光明”探讨中晚期浸润性乳腺癌患者复发季节与预后关系的研究

目的基于“天运当以日光明”理论,探讨复发季节对中晚期浸润性乳腺癌病患者预后的影响。方法选取2012年1月—2022年1月期间辽宁中医药大学附属第二医院和广西医科大学附属民族医院收治的78例中晚期浸润性乳腺癌患者的临床资料,具体分组如下,将辽宁中医药大学附属第二医院的48例患者作为观察组,广西医科大学附属民族医院的30例患者作为对照组。根据患者乳腺癌复发的季节,第一步,观察组分为春夏季组、秋冬季组,对照组也如此。第二步,再次细化分层,观察组分为春季组、夏季组、秋冬季组;对照组分为春夏季组、秋季组、冬季组。预后结局事件分别设定为从复发(取首次复发)到死亡的生存期、总生存期、无进展生存期。应用Cox单因素、多因素回归分析及生存分析,探析相关不良预后影响因素及复发季节与预后的关系。结果中医证候、首次复发转移部位是影响观察组中晚期乳腺癌患者预后的独立危险因素。观察组春夏复发的患者中位总生存期55个月,秋冬复发的患者中位总生存期18个月,观察组中,春夏复发的患者,其从复发后的生存优势及总生存期均优于秋冬组(P<0.01),春夏及秋季复发的患者进展后生存期及总生存期均优于冬季复发者(P<0.01)。对照组春夏及秋季复发的患者进展后生存期优于冬季复发的患者(P<0.05)。结论复发季节对中晚期浸润性乳腺癌患者的生存期具有一定的影响。

基于人工智能技术的肺部CT扫描对肺纯磨玻璃结节浸润性病变及浸润程度的诊断价值

目的探讨基于人工智能技术的肺部CT扫描诊断肺纯磨玻璃结节浸润性病变及浸润程度的临床价值。方法回顾性分析2021年9月至2022年9月于天门市第一人民医院行手术治疗并经病理活检证实为肺纯磨玻璃结节的55例患者的临床资料,参考2021年世界卫生组织肺肿瘤新分类,根据病理结果分为非浸润性病变组(n=25,25个结节)与浸润性病变组(n=30,35个结节)。所有患者术前均行肺部CT检查,并利用人工智能系统对肺结节进行定性、定量参数分析。比较非浸润性病变组与浸润性病变组结节CT定性、定量参数;比较微浸润性腺癌、浸润性腺癌患者结节CT定性、定量参数;分析CT定性、定量参数对肺纯磨玻璃结节浸润程度预测的影响因素,并分析其预测效能。结果两组结节形态、分叶征、空泡征、支气管异常征、血管异常征、胸闷牵拉征占比及结节最长径、最短径、平扫CT值比较差异有统计学意义(P<0.05)。浸润性腺癌患者的结节形态规则占比低于微浸润性腺癌患者,分叶征、血管异常征、胸闷牵拉征占比均高于微浸润性腺癌患者,平扫CT值大于微浸润性腺癌患者,差异有统计学意义(P<0.05)。Logistic二元回归分析结果显示,分叶征、空泡征、血管异常征、平扫CT值增加是肺纯磨玻璃结节浸润性病变的危险因素(P<0.05);而分叶征、血管异常征、平扫CT值增加是肺纯磨玻璃结节浸润程度的危险因素(P<0.05)。ROC曲线分析结果显示,血管异常征诊断肺纯磨玻璃结节浸润性病变的效能最高(AUC为0.703,灵敏度92.00%,特异度48.60%),分叶征鉴别诊断肺纯磨玻璃结节浸润程度的效能最高(AUC为0.745,灵敏度75.00%,特异度73.90%)。结论基于人工智能技术的肺部CT扫描诊断肺纯磨玻璃结节浸润性及浸润程度有较高的临床价值,且人工智能技术CT扫描获得的内部血管征参数对诊断结节浸润性病变效能高,分叶征对鉴别诊断结节浸润程度效能更高,值得进一步深入研究。