Lung-diaphragmatic protective ventilation aims to limit damage to the lung and diaphragm during mechanical ventilation in critically ill patients. The dynamic monitoring of respiratory drive and inspiratory effort is the focus of the clinical strategies for implementating lung-diaphragm protective ventilation strategies. This paper reviews the existing indicators for dynamic monitoring of respiratory drive and inspiratory effort at the three levels of respiratory muscle, pressure change, and pulmonary ventilation according to the physiological pathway of respiratory drive and discusses their significance, acquisition methods, and thresholds.

Objective  To establish an experimental protocol for inducing human macrophages into scar-associated macrophages (SAMs) in vitro. To investigate the mechanism underlying SAMs regulating hepatic stellate cell (HSC) activation. Methods  Published single-cell RNA sequencing (scRNA-Seq) data, which were obtained from human or murine fibrotic liver tissues, were used to study the expression of fibrosis-related genes in SAMs. Phorbol-12-myristate-13-acetate (PMA) and plasminogen (PLG) were used to induce the transformation of human monocyte THP-1 into SAMs. SAM supernatant was collected to culture with LX-2. The expressions of SAM markers, fibrosis-related genes and HSC activation markers were detected by real-time quantitative polymerase chain reaction（RT-qPCR）. Results  scRNA-seq revealed that SAMs were detected in both mouse fibrotic livers or human injured liver. SAMs highly expressed fibrosis-related genes such as SPP1, CTSD. PMA and PLG increased the expressions of SAM markers CD9, TRME2, LGALS3, CD63 in THP-1. Fibrosis-related genes SPP1, CTSD were highly expressed by SAMs. The supernatant of SAMs activated LX-2. Conclusion  SAMs are accumulated in mouse or human liver injury/fibrosis caused by different causes, and represent similar characteristics and functions. PMA and PLG induce the transformation of human monocyte THP-1 into SAMs. SAMs promote the activation of HSCs via SPP1 and CTSD, thus promoting the occurrence and development of liver fibrosis.

Objective  To explore the association between systolic blood pressure variability and in-hospital mortality in patients with sepsis. Methods  This study was a prospective, multicenter, and cohort study. Data were derived from the China Critical Care Sepsis Trial, which was conducted from January 2013 to August 2014. Patients aged ≥18 years with length of stay of intensive care unit （ICU）more than 24 h were included. The patients who were diagnosed  as sepsis for more than 48 h and lack of blood pressure for 2 h or longer were excluded. Systolic blood pressure, diastolic blood pressure, fluid intake and output were collected. The systolic blood pressure coefficient of variation (SBP_cv) was calculated and divided into four groups (Q₁, Q₂, Q₃, Q₄) according to the interquartile of SBP_cv. The multivariable Logistic regression was applied to explore the association between systolic blood pressure variability and in-hospital mortality. Results  A total of  1 356 patients with sepsis were included, with 929 (68.5%) males and 427 (31.5%) females, median age 67.0 years (52.0, 78.0).Among them,  483 (35.6%) patients died during hospitalization. After adjusting for potential confounding factors, for every 10% of SBP_cv increasing, the risk of in-hospital mortality increased 43% (OR=1.43, 95%CI:1.11-1.98). Compared with Q1 group, patients in Q4 group had a 69% increased risk of in-hospital mortality (OR=1.69, 95%CI:1.31-2.25) and a 23% increased risk of 28 d mortality (OR=1.23, 95%CI:1.07-1.84). Conclusion  Higher systolic blood pressure variability was correlated with higher risks of in-hospital mortality and 28 d mortality.

Objective  To investigate the diagnostic and differential diagnostic value of ¹¹C-Pittsburgh compound B (¹¹C-PIB) positron emission tomography (PET) imaging for Alzheimer's disease (AD), mild cognitive impairment (MCI) and non- Alzheimer's disease induced cognitive impairment (NAD) by qualitatively and semi quantitatively evaluating the degree of β-amyloid (Aβ）deposition in the brain.  Methods  AD patients (AD, n=36), mild cognitive impairment (MCI, n=20), non-AD induced cognitive impairment (NAD, n=19), and normal controls (NC, n=10) admitted to the Department of Neurology, Xuanwu Hospital, Capital Medical University in 2022 were retrospectively analyzed. All 85 subjects underwent ¹¹C-PIB PET imaging. First, Aβ Negative or positive deposition was qualitatively estimated, and then taking the brainstem as the reference brain area, the maximum standardized uptake value ratio(SUVRmax）of the frontal, parietal, temporal, and occipital lobes of the cerebral cortex Aβ was semi-quantitative measured, and the differences of SUVRmax among AD, MCI, NAD. and NC groups were analyzed. Results  Qualitative judgment showed that there were significant differences between AD group ,NC group, and other groups , but no significant difference between MCI group and NAD group. Semi quantitative analysis showed that for all brain regions (frontal lobe, parietal lobe, temporal lobe, occipital lobe), the SUVRmax value of AD group was significantly higher than that of the other three groups, with a statistically significant difference. In all brain regions, the SUVRmax value of NC group was the lowest, but there was no significant difference in SUVRmax among MCI group,NAD and NC group. Conclusion  Both qualitative and semi quantitative analysis of ¹¹C-PIB PET imaging were of high value in the diagnosis of AD, and semi quantitative analysis showed certain significance in differentiating AD and MCI.

Objective  To compare the differences of clinical manifestation between odontogenic sinusitis (ODS) patients with and without sinusitis symptoms. Methods  The clinical data of totally 92 ODS patients’ clinical data were retrospectively collected, who underwent endoscopic sinus surgery in the Department of Otolaryngology, Head and Neck Surgery in Beijing TongRen Hospital, Capital Medical Uniersity, from June 2020 to June 2022. Among them, 77 cases had sinusitis symptoms（SS group）, and 15 cases had no sinusitis symptoms（non-SS group）. The survey items included medical history, symptoms, etiology, endoscopic examination and sinus computed tomography(CT)were compared.Results  Compared with the SS group, the non-SS group has a shorter course of disease ［(4.9 ± 3.4) months vs (10.4 ± 11.0) months, P=0.048)］, and a higher proportion of first consultation in Department of Stomatology (100% vs 24.7%, P=0.035). There was no statistically significant difference in the positive rates of reported toothache and tooth loosening symptoms between the two groups of patients (29.9% vs 53.3%, P=0.133; 18.2% vs 35.3%, P=0.085). The proportion of periodontal endodontic combined lesions (PECL), apical periodontitis (AP), periodontitis (PE), and iatrogenic factor, accounted for the etiology of the two groups of patients, were 53.2% vs 20% (P=0.024); 28.6% vs 33.3% (P=0.76); 11.7% vs 26.7% (P=0.215); and 6.5% vs 20% (P=0.119), respectively. CT of the sinuses showed that the SS group had a higher proportion of involvement in the ostiomeatal complex (OMC), ethmoid sinus, and frontal sinus than non-SS group did, with 83.1% vs 26.7% (P=0.000); 80.5% vs 20% (P=0.000);  and 41.6% vs 0% (P=0.002), based on the evaluation of CT opacification. Conclusions  The multidisciplinary cooperation between Otolaryngology and Stomatology could early identify ODS patients without sinusitis symptoms, diagnose and treat timely dental related diseases, such as PECL, reduce the probability of endoscopic sinus surgery, and improve life quality of  patients. 

Objective  To investigate the impact of Candida albicans colonization on the mortality, duration of antibiotic therapy, immune and inflammation status in patients with ventilator-associated pneumonia (VAP) caused by multidrug-resistant Pseudomonas aeruginosa. Methods  This prospective multicenter cohort study included patients with VAP caused by multidrug-resistant Pseudomonas aeruginosa (MDR-Pa) admitted to six tertiary teaching hospitals from June 2018 to June 2023. The patients were divided into colonization group and non-colonization group based on the presence of Candida albicans detected in the broncho-alveolar lavage fluid (BALF). The 30-d all-cause mortality, duration of antibiotic therapy, immune and inflammation status were compared between the two groups after VAP diagnosis on the day1, day3, day5, and day7. Results  During the five-year research period, a total of 232 VAP patients caused by MDR-Pa were included from six participating units in the intensive care unit (ICU), with 105 cases in the colonization group and 127 cases in the non-colonization group. The Pseudomonas aeruginosa detected in BALF samples from the non-colonization group showed higher sensitivity to aminoglycosides, cephalosporins, and carbapenems compared to the colonization group (P<0.05). However, both groups showed lower sensitivity to 16 antibiotics compared to China antimicrobial surveillance network (CHINET) 2022 (P<0.05).  Interleukin-17A and (1,3)-β-D glucan levels in the non-colonization group were consistently lower than those in the colonization group at various time points, and other inflammatory markers were more likely to return to normal values (P<0.05). Additionally, the absolute values of T and Th lymphocytes in the non-colonization group recovered to normal levels faster on the day 7 (P<0.05). There was no statistically significant difference in the 30-d all-cause mortality between the two groups (25.7% vs 22.8%, P=0.61), but the non-colonization group had a significantly shorter duration of antibiotic therapy compared to the colonization group ［(11.3±3.1)d vs （14.2±4.7)d, P<0.01］, with a trend towards shorter ICU hospitalization time. Conclusion  The colonization of Candida albicans in the airway does not affect the 30-d all-cause mortality of patients with VAP caused by MDR-Pa. However, it does prolong the inflammatory response and the duration of antibiotic use, as well as delay the recovery of immune function.

Objective  To summarize the clinical features of seizure-induced non-traumatic vertebral fractures and improve their recognition. Methods  Retrospective analysis was performed on the clinical data of patients who developed non-traumatic spinal fractures caused by seizure in Beijing Tiantan Hospital, Capital Medical University, from January 2020 to January 2023.  Results  In our retrospective analysis,we identified 4 patients who were diagnosed with non-traumatic vertebral fractures caused by seizure. Our patients were all males,with the average age of 36.3 years. In 3 of the cases,the multilevel vertebral compression fractures were located in the upper and midthoracic spine. There was only one instance of multilevel lumbar vertebral fractures. Local pain,with an atypical nature and scope,was the most common clinical symptom observed in these patients. In 75% of cases,the fracture diagnosis was missed at initial presentation. A bone density test was only performed on one patient at the time of the vertebral fracture occurred. Every patient experienced a complete recovery after conservative or surgical therapy. Conclusion  Seizure-induced non-traumatic vertebral fractures occur predominantly in young and middle-aged males,and the common pattern is thoracolumbar compression fractures. The clinical symptoms and signs of this particular type of fractures are atypical,which is prone to misdiagnosis or missed diagnosis. A detailed history and examination,including spinal imaging,are important for the diagnosis of these patients. Controlling seizure is considered to be the main preventive method. Chronic epilepsy patients should be advised to get a bone density test and they should take calcium and vitamin D supplements,when necessary,for preventing the incidence of new vertebral fracture.

Objective  To construct a bispecific antibody targeting epidermal growth factor receptor（EGFR） and OX40 and evaluate the function for tumor-specific T cell activation. Methods  The gene of anti-OX40/anti-EGFR bispecific antibody was cloned into eukaryotic expression vector, and then the constructed vector were transfected to 293F cells for the bispecific antibody purification. The binding activity of anti-OX40/anti-EGFR bispecific antibody with the cells expressing target proteins  were detected by flow cytometry. To identify the activation of T cells mediated by anti-OX40/anti-EGFR bispecific antibody, the activation of NF-κB signal activation was evaluated by Jurkat-OX40-NF-κB-GFP reporter cells and the activation of primary T cells was detected by interleukin-2（IL-2） and interferon-γ（IFN-γ） secretion of peripheral blood mononuclear cell(PBMC). Results  Anti-OX40/anti-EGFR bispecific antibody was successfully constructed and purified, and its binding ability to HEK293 cells expressing OX40 and EGFR was verified. Jurkat-OX40-NF-κB-GFP reporter cells were activated by the bispecific antibody with the crosslinking of A549 cells. Further, the anti-OX40/anti-EGFR bispecific antibody promoted the secretion of IL-2 and IFN-γ of PBMC. Conclusion  Anti-OX40/anti-EGFR bispecific antibody was successfully constructed which could specifically recognize OX40 and EGFR and activate tumor specific T cells.

Objective  To analyze the association between suicidality and biological parameters in patients with bipolar depression episodes and to provide a basis for evaluation and monitoring. Methods  A retrospective cross-sectional study was conducted on hospitalized patients with bipolar depression episodes at Beijing Anding Hospital,Capital Medical University,from January 2014 to December 2017. The patient data including demographic,clinical,and biological parameters were collected from the electronic medical records system and analyzed using R (version 4.2.2) statistical software.  Results  A total of 2 027 patients with bipolar depression episodes were included,with 417 (20.6%) exhibiting suicidal ideation or behavior. Compared to the non-suicidal group,the suicidal group had a higher proportion of females and comorbid medical conditions. Additionally,serum IgA and testosterone (TES) levels were higher in the suicidal group (all P < 0.05). Multivariate Logistic regression analysis revealed significant positive associations between IgA,comorbid medical conditions,and suicidal ideation and behavior. Conclusion  Elevated serum IgA levels and the presence of comorbid medical conditions are risk factors associated with suicidal ideation and behavior in patients with bipolar depression episodes. This finding contributes to more accurate risk identification and effective intervention strategies.

Objective  To explore the association between cumulative exposure indicators of serum uric acid to serum creatinine ratio (SUA/Scr) and incident carotid plaque. Methods  This study included 9 228 individuals who met the inclusion and exclusion criteria from the Beijing Health Management Cohort. The cumulative exposure, cumulative exposure burden and high exposure time of SUA/Scr were calculated based on the values of SUA/Scr in three physical examinations in 2010 to 2011 (visit 1), 2012 to 2013 (visit 2), and 2014 to 2015 (visit 3). Carotid plaque was diagnosed by carotid ultrasound, and the follow-up was until December 31, 2021. Logistic regression model was used to analyze the association between SUA/Scr cumulative exposure indicators and carotid plaque occurrence, and sensitivity analysis was performed by excluding the participants with the usage of antihypertensive drugs, or glucose-lowering drugs, or lipid-lowering drugs. Results  The mean age of the study population was (48.89±10.22) years, and 5 846(63.35%) participants were males. The participants were divided into four groups according to the quartiles of SUA/Scr cumulative exposure, namely Q1-Q4 groups. After adjusting for covariates in models, compared with Q1 group, the ORs (95%CIs) of incident carotid plaque in Q2, Q3 and Q4 groups were 1.221 (95%CI：1.066-1.400), 1.255(95%CI： 1.095-1.439) and 1.478 (95%CI：1.287-1.697). Cumulative exposure burden greater than 0 (OR=1.223，95%CI：1.109-1.349) and high exposure time of 6 years (OR=1.332，95%CI：1.171-1.515) were both associated with increased risk of carotid plaque occurrence. Sensitivity analysis excluded participants with the usage of any antihypertensive drugs, glucose-lowering drugs, or lipid-lowering drugs. The results were similar to those in main analysis. Conclusion Cumulative exposure, cumulative exposure burden and high exposure time of SUA/Scr were associated with increased risk of incident carotid plaque. In the primary prevention of carotid plaque, we should focus not only on SUA/Scr value at a single point time, but also on long-term monitoring of SUA/Scr values.

Objective  To train C57/6J wild-type mice and Sapap3 gene knockout mice to perform reversal learning induced by olfaction, tactility audition, respectively, and to explore the feasibility of reversal learning paradigm induced by olfaction, tactility audition and the cognitive flexibility of Sapap3 gene knockout mice. Methods  C57/6J wild-type mice and Sapap3 gene knockout mice (8-10 weeks old) were randomly divided into three groups and trained with the head fixed. The correct rate, error rate and learning rate of the licking events at each stage were analyzed to observe the learning ability of the mice under the three reversal learning paradigms. Results  The time required to reach the learning criterion was significantly different between Sapap3 knockout mice and C57/6J wild type mice in the reversal stage of olfactory and auditory reversal learning paradigm. Conclusion  The behavioral paradigm of reversal learning can be used to detect cognitive flexibility, which lays a behavioral foundation for the subsequent research on the diseases and brain regions related to cognitive flexibility.

Objective  To explore the correlation of simple measurement of inspiratory muscle pressure index from the ventilator (PMIvent) and reference measurement of inspiratory muscle pressure index on experimental condition (PMIref), the relationship between PMIvent and inspiratory effort, and further to determine the clinical feasibility and validity of PMI for assessing inspiratory effort during pressure support ventilation (PSV).  Methods  Adult acute respiratory failure patients undergoing mechanical ventilation were screened daily and enrolled 24 h after switching to PSV mode. Baseline ventilators were set according to the principle of keeping tidal volume/ predicted body weight(VT/PBW) at 6-8 mL/kg and respiratory rate (RR) at 20-30 breaths/min and the decision of the responsible ICU physician. A downward support pressure ( PS )titration was conducted from 20 cmH₂O to 2 cmH₂O. Three end-inspiratory holdings (EIO) and three end-expiratory holdings (EEO) were performed. PMIvent was calculated as the difference between plateau pressure (Pplat) within 2 s after EIO and the airway peak pressure (Ppeak) at EIO. PMIref was calculated as the difference between Pplat at one cardiac cycle after EIO and Ppeak at EIO. Flow, airway pressure (Paw), and esophageal pressure (Pes) signals were displayed continuously and saved. PMIref, PMIvent and esophageal pressure time product per breath (PTPes) were measured. PTPes per minute was calculated as the product of PTPes and RR. The “normal” range of PTPes per minute was defined as 50 to 200 cmH2O·s·min-1. The accuracy of PMIvent compared to PMIref was assessed with a Bland-Altman plot. The correlation between PMI and inspiratory effort was evaluated as the coefficient of determination (R²). The ability of PMI to detect high/low effort was assessed using the area under the receiver operating characteristics curve (ROC AUC). The optimal cut-off values were selected based on the Youden index. Results  The accuracy and precision of PMIvent compared to PMIref showed a low bias (0.18) with smaller 95% limits of agreements (-0.44,0.80). PMIref was significantly related to the PTPes per minute (between-patients R²=0.61, within-patients R²=0.80, respectively). PMIvent was also related to the PTPes per minute (between-patients R²=0.62, within-patients R²=0.81). For a cut-off PTPes<50 cmH₂O·s·min^-1, PMIvent showed an ROC AUC of 0.93 ［0.89,0.96］, and the best threshold was -0.77 cmH₂O. Conclusion  PMIvent can effectively replace PMIref. Like PMIref, PMIvent was significantly related to inspiratory effort and had the potential value to predict low inspiratory effort. 

Myocardial fibrosis is a common pathological basis of many cardiovascular diseases and is closely related to poor prognosis of the cardiac disease. At present,there are limitations in clinical evaluation techniques for myocardial fibrosis,such as being invasive,lacking specificity,and unable to diagnose early. In recent years,nuclide imaging targeting activated fibroblasts has received attention for its potential in detecting myocardial fibrosis and in evaluating disease progression and treatment response. Based on the existing studies,the present paper focuses on its application status,advantages and limitations,and discusses its prospects in cardiovascular diseases,aiming to provide reference and inspiration  to promote the application of targeted activated fibroblast radionuclide imaging in cardiovascular diseases.

Objective  To analyze the cognitive functional differences in patients with depressive episodes regarding suicidal ideation and suicidal behavior,  and further to explore the impact of cognitive functioning on suicidal behavior. Methods  A total of 133 patients with depressive episodes who sought treatment at Beijing Anding Hospital,Capital Medical University,were selected and divided into three groups based on the presence of suicidal behavior and ideation within the past two weeks: depression control (DC) group, suicidal ideation (SI) group, and suicide attempt (SA) group. The Hamilton Depression Scale-17 item (HAMD-17),the Scale for Suicide Ideation (SSI),and the MATRICS Consensus Cognitive Battery (MCCB) were used to assess the patients' clinical symptoms and cognitive functioning. Logistic regression analysis was applied to analyze various factors.  Results  The total HAMD-17 scores of the three groups (F=59.661,P<0.001) showed statistically significant differences,with post hoc comparisons revealing significantly higher scores in the SA and SI groups compared to the DC group. MCCB results indicated that the DC group had significantly higher scores in verbal learning and memory compared to the SI group (P<0.01),and both the DC and SA groups had significantly higher scores in reasoning and problem-solving compared to the SI group (P<0.05). Logistic regression results revealed that reasoning and problem-solving (P=0.022,OR=1.067,95% CI: 1.009-1.127) and cognitive impairment factors (P<0.001,OR=1.739, 95% CI: 1.128-2.2443) were independent risk factors for suicidal behavior in patients with depressive episodes，and recurrent (P=0.003,OR=0.100,95% CI: 0.022-0.458) and social cognition (P=0.033,OR=0.953,95% CI: 0.912-0.996) were protective factors for suicidal behavior in patients with depressive episodes. Conclusion  Cognitive impairment is a crucial factor influencing the occurrence of suicidal behavior in patients with depressive episodes. 

Objective  To explore the correlation between suicide attempt (SA) in adolescents with non-suicidal self-injury (NSSI)and  the function change of the hypothalamic-pituitary-thyroid (HPT) axis and the hypothalamic-pituitary-adrenal (HPA) axis function change. Methods  A cross-sectional survey was conducted among adolescents aged 13-19 years with a history of NSSI who were hospitalized in Beijing Anding Hospital,Capital Medical University from December 2020 to May 2022. The clinical features,thyroid function ［free triiodothyronine (FT3),free thyroxine (FT4),total T3 (TT3),total T4 (TT4),thyroid stimulating hormone (TSH)］, adrenocorticotropin (ACTH) and cortisol (CORT) levels were collected. The patients were divided into non-SA group and SA group according to the  absence or presence of SA in the last one year. According to the time period of SA occurrence (1 month),patients in the SA group were divided into recent SA and past SA. The multivariate logistic regression model was used to analyze the influencing factors of SA behavior.  Results  A total of 79 adolescent patients of mood disorder with NSSI were enrolled.Among them, 49 (62.03%) patients had SA and 29(59.18%) patients had attempted suicide within the past month. The univariate analysis showed that there were statistical differences in age of disease onset,gender,and education level between the SA and non-SA groups (P<0.05). There were statistical differences in age,TSH, and ACTH level between the recent SA group and past SA group (P<0.05). The logistic regression analysis showed that female (P=0.027,OR=2.941,95%CI: 1.131-7.649) was risk factor for SA behavior. Low ACTH level（P=0.043，OR=1.019，95%CI：1.001-1.037）was related factor for recent SA. Conclusion  Female adolescents of mood disorders with NSSI were more likely to attempt suicidality and ACTH was related with recent SA.

Objective  To deepen the understanding of acute cerebral infarction with the onset of isolated vertigo. Methods  We retrospectively analyzed the patients with the onset of isolated vertigo that were previously treated in Department of Neurology,  China Civil Aviation General Hospital. They were divided into acute cerebral infarction group(25 cases in the case group) and non-acute cerebral infarction group(25 cases in the control group). The demographic characteristics, risk factors of cerebrovascular disease and imaging characteristics were analyzed. Results  In the case group, the proportions of males and the patients who were over 55 years old were significantly higher than those of control group  (72% vs  44% and 80% vs  52%, respectively, P<0.05 ). The proportions of patients with hypertension and diabetes in the case group were higher than those in the control group(72% vs  56%, 52% vs  40%, respectively), and the proportion of patients with hyperlipidemia was lower than those in the control group (84% vs 96%). There was no significant difference between the two groups(P＞0.05). The proportions of clinical manifestations with nausea, vomiting, hearing loss and nystagmus in the case group were higher than those in the control group (68% vs  56%, 52% vs  40%, 16% vs  4%, and 24% vs  16%, respectively), while the proportion of tinnitus was lower than that in the control group (8% vs 16%). There was no significant difference between the two groups (P >0.05). In the case group, there were 18 cases（72%） of cerebellar infarction, 5 cases（20%） of brainstem infarction, 1 case（4%） of occipital lobe infarction and 1 case（4%） of hippocampus infarction. Conclusion  Among patients with acute cerebral infarction who started with isolated vertigo，Men had a significantly higher risk of acute cerebral infarction than women, and patients over 55 years old had a significantly higher risk than the adult patients under 55 years old. 2.Head magnetic resonance imaging showed most of the infarction sites were in the blood supply area of the vertebrobasilar artery system: located mainly in the cerebellum and brainstem.

Objective  To preliminarily study the value of fluorine-18 deoxyglucose (¹⁸F-FDG) positron emission tomography (PET) imaging in the metabolic characteristics of various brain regions of new daily persistent headache (NDPH) patients. Methods  ¹⁸F-FDG PET images of patients with NDPH who underwent ¹⁸F-FDG PET examination at the  Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University from May 2021 to July 2023 were collected retrospectively. Cortex ID (GE Healthcare) was used to analyze the PET images and to obtain the Z-score distribution of 26 brain regions of  the NDPH patient group. The z-score distribution was applied to evaluate the metabolic characteristics of brain regions of NDPH patients.Results  NDPH patients showed reduced metabolism in multiple brain regions such as left/right prefrontal medial region（P=0.004、P=0.009）, right posterior cingulate （P=0.003）, right precuneus （P=0.003）, left sensorimotor（P=0.036）, right anterior cingulate（P=0.040）, left anterior cingulate（P=0.037）, left posterior cingulate （P=0.037）, right parietal superior （P=0.002）, left parietal superior（P=0.019）, left prefrontal lateral （P＜0.001）, left/right parietal inferior（P＜0.001）, left/right temporal mesial （P＜0.001 ）, right temporal lateral （P＜0.001）and pons（P＜0.001）. Conclusion  ¹⁸F-FDG PET can display metabolic characteristics in different brain regions of NDPH patients, which may provide metabolic information for the pathological mechanism of NDPH and its complications.

目的 探讨经阴道三维超声(three-dimensional transvaginal ultrasound, 3D-TVUS)评估宫腔镜下宫腔粘连分离术(hysteroscopic adhesiolysis, HA)后子宫内膜相关指标对妊娠结局的预测价值。方法 收集2020年6月至2022年2月间就诊于首都医科大学附属复兴医院，因有生育要求行HA的患者278例作为研究对象。术后在黄体中期应用3D-TVUS进行子宫内膜厚度、容积及血流的测定，随访术后宫腔情况及妊娠结局等。根据妊娠结局分为妊娠组与非妊娠组，通过单因素分析和多因素Logistic回归分析，确定患者术后临床妊娠的影响因素。根据受试者工作特征曲线评价上述因素对临床妊娠的预测价值。结果 278例患者失访8例、临床妊娠143例、异位妊娠4例、未妊娠123例。多因素分析显示术后宫腔镜探查评分、术后子宫内膜厚度及子宫内膜容积是临床妊娠的独立影响因素(P<0.05)。Logistic预测模型对预测宫腔粘连术后妊娠的曲线下面积为0.827,约登指数为58.5%,灵敏度为74.8%,特异度为83.7%。术后子宫内膜厚度、内膜容积的最佳界值分别为6.22 mm及1.42 mL。结论 术后宫腔镜探查评分、子宫内膜厚度及子宫内膜容积对宫腔粘连术后的妊娠结局具有一定预测价值，可作为患者术后妊娠计划及辅助治疗的参考指标。

目的 分析老年嗜酸性肉芽肿性多血管炎（eosinophilic granulomatosis with polyangiitis, EGPA）患者的临床特征。方法 回顾性分析2007年2月至2022年2月首都医科大学附属北京朝阳医院确诊的EGPA患者的临床资料，根据年龄分为老年组（年龄≥60岁）和非老年组（年龄<60岁）,比较两组患者临床特征的差异并随访预后。结果 共纳入101例EGPA患者，其中老年组42例（41.6%）,非老年组59例（58.4%）。老年组与非老年组比较，合并高血压病（40.5%vs 16.9%,P=0.008）、血嗜酸性粒细胞>10%（90.5%vs 72.9%,P=0.029）及估算肾小球滤过率（estimated glomerular filtration rate, eGFR）降低[eGFR<80 mL·min^-1·（1.73 m²）^-1]（61.9%vs 16.9%,P<0.001）的患者比例更高，老年组红细胞沉降率（erythrocyte sedimentation rate, ESR）[20（10,56.25）mm/h vs 12（5,32.25）mm/h,P=0.028)]及肺功能指标残气量/肺总量（residual volume/total lung capacity, RV/TLC）[（48.84±11.43）%vs（41.92±9.06）%,P=0.009]更高。老年组与非老年组相比，心脏受累（73.8%vs 32.2%,P<0.001）、中枢神经系统受累（23.8%vs 5.1%,P=0.006）、周围神经系统病变（83.3%vs 64.4%,P=0.036）、肾脏受累（69.0%vs 47.5%,P=0.031）及五因子评分（five-factor score, FFS）≥2分（61.9%vs 15.3%,P<0.001）的发生率均更高。随访中位时间41（19,59）个月，6例患者死亡，老年组病死率高于非老年组（13.9%vs 1.92%,P=0.032）。结论 老年EGPA患者合并高血压病、血嗜酸性粒细胞>10%、eGFR降低、脏器受累及FFS≥2分的患者比例更高，ESR、RV/TLC及病死率更高。临床医生应加强对老年EGPA患者疾病特征的认识，以提高诊断和治疗水平。

<正>自发性颈椎硬膜下血肿（spontaneous cervical subdural hematoma, SCSDH）,即非创伤性颈椎硬膜下血肿，临床上较为罕见，其典型的临床表现为快速进展的脊髓神经压迫症状，患者短时间内会出现截瘫；其低发病率使其容易漏诊、误诊及延误病情^[1-2],如未能有效发现并诊治，最终可导致患者遗留不可逆的神经损伤，甚至死亡^[3]。近年来，随着抗凝药物的广泛使用，对其报道逐渐增多^[4]。其主要治疗措施为手术治疗，通过保

随着人工智能(artificial intelligence, AI)在医学领域的广泛应用与迅猛发展，生殖内分泌亚专科作为妇产科重要的一部分，也越来越多地应用AI技术解决生殖内分泌疾病的诊断、治疗、健康管理、监督及预防等问题。本文将从AI发展简史及AI在生殖内分泌领域中的应用进行阐述，总结AI在生殖内分泌领域应用中的现状、可行性及局限性，为AI在生殖内分泌领域的研究提供更广阔的思路。

非小细胞肺癌(non-small cell lung cancer, NSCLC)有较高的发病率和病死率，使其治疗成为全球急需应对的重大健康挑战。随着免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)的引入，治疗NSCLC的新思路不断涌现，并且在晚期NSCLC患者中已显示出显著的生存获益。近年来，研究人员开始探索将ICIs引入新辅助治疗的可行性，并发现其在新辅助治疗中同样可为患者带来治疗获益。本文旨在综述近期关于ICIs在NSCLC新辅助治疗中的研究进展，重点讨论其对患者生存期、病理反应等方面的影响。这些研究成果有望为改善NSCLC患者的新辅助治疗效果提供新的策略和思路。

王拥军,神经病学教授,主任医师,博士生导师,现任首都医科大学附属北京天坛医院院长,兼任国家神经系统疾病医疗质量控制中心主任、国家神经系统疾病临床医学研究中心副主任、北京脑保护高精尖创新中心主任、中华医学会神经病学分会主任委员、Stroke&Vascular Neurology杂志主编。长期致力于脑血管病复发预防策略研究。国家“十二五”科技支撑计划脑血管病领域首席专家、国家“十三五”重点研发专项非传染性慢病领域首席专家、国家重大新药创制科技重大专项总体专家组成员。以通信或共同通信作者在New Engl J Med、Lancet、JAMA、BMJ等期刊发表论文200余篇,并作为第一完成人于2016年和2020年两次获得国家科技进步二等奖。此外,还获得首届全国创新争先奖章、吴阶平医药创新奖、谈家桢生命科学临床医学奖、世界卒中组织最高成就奖——“主席奖”、2022年度何梁何利基金科学与技术进步奖。

目的 研究治疗后叶酸受体阳性循环肿瘤细胞(folate receptor-positive circulating tumour cells, FR+-CTCs)对可切除Ⅲ期鳞癌患者新辅助化学药物治疗(以下简称化疗)联合免疫治疗疗效的预测价值。方法 收集首都医科大学附属北京胸科医院2021年6月至2023年6月入院可切除Ⅲ期鳞癌患者，经过2周期新辅助化疗联合免疫治疗，记录患者以下指标：(1)一般临床资料：年龄、性别、临床分期、肿瘤位置、治疗前后白细胞计数；(2)治疗前后肿瘤标志物——血清癌胚抗原(carcinoembryonic antigen, CEA)、细胞角蛋白19片段(cytokeratin 19 fragment, CYFRA 21-1)、鳞状上皮细胞癌抗原(squamous cell carcinoma antigen, SCC)、FR+-CTCs数据；(3)患者术后病理结果，根据术后病理结果将患者分为两组，肿瘤病灶在病理层面上残存肿瘤细胞占比≤10%(缓解组，E组),肿瘤病灶在病理层面上残存肿瘤细胞占比>10%(NE组),比较E组和NE组患者的一般临床资料，治疗前后白细胞计数、肿瘤标志物和FR+-CTCs水平，将组间比较差异有统计学意义的变量纳入二元Logistic回归分析，统计分析出可切除Ⅲ期鳞癌患者新辅助化疗联合免疫治疗疗效的影响因素，采用受试者工作特征(receiver operating characteristics, ROC)曲线分析FR+-CTCs对其的预测价值。结果 最终纳入24例患者，E组15例，NE组9例，两组患者一般临床资料、治疗前CEA、CYFRA 21-1、SCC、FR+-CTCs比较差异均无统计学意义(P>0.05),治疗后CEA、CYFRA 21-1、SCC差异无统计学意义(P>0.05),E组治疗后FR+-CTCs显著低于NE组(P<0.05),二元Logistic回归分析显示，治疗后FR+-CTCs(OR=1.28,95%CI:1.00～1.63,P=0.047)是新辅助化疗联合免疫治疗的影响因素，ROC分析显示，治疗后FR+-CTCs截点值为10.10,特异度0.87,灵敏度0.89,曲线下面积(area under the curve, AUC)0.837。结论 对可切除Ⅲ期鳞癌患者，治疗后FR+-CTCs低于10.10 FU/3 mL是预测新辅助化疗联合免疫治疗缓解效果的可靠指标。

目的 观察新辅助程序性死亡受体1(programmed receptor 1, PD-1)单抗免疫治疗联合化学药物治疗(以下简称化疗)在非小细胞肺癌(non-small cell lung cancer, NSCLC)中的近期疗效。方法 纳入接受新辅助免疫联合化疗的IB～Ⅲ期NSCLC患者176例，之后159例(90.34%)患者接受手术治疗，包括腺癌42例、鳞癌115例和混合癌2例。结果 所有患者接受新辅助治疗的中位周期数为2个周期，4例(2.5%)患者术前达到完全缓解(complete response, CR),115例(72.3%)患者达到部分缓解(partial response, PR),40例(25.2%)患者评估为疾病稳定(stable disease, SD)且仅有2例病灶增大；术后96例(60.4%,95%CI:52.7%～68.1%)患者达到显著病理缓解(major pathological response, MPR), 74例(46.5%,95%CI:38.7%～54.4%)患者达到病理完全缓解(pathological complete response, pCR);多因素分析显示，性别和程序性死亡配体1(programmed ligand 1, PD-L1)显著影响MPR率和pCR率。结论 新辅助免疫联合化疗在IB～Ⅲ期NSCLC治疗中初现疗效，PD-L1的表达水平可能是MPR和pCR的预测因素。

目的 提高对肺毛霉菌病临床特征的认识，进一步分析肺毛霉菌病患者死亡的危险因素。方法 回顾性收集2017年1月至2023年6月于首都医科大学附属北京朝阳医院住院的25例肺毛霉菌病病例的易患因素、临床表现、实验室检查、影像学特征、治疗预后等资料，其中易患因素、临床表现、影像学特征及预后资料分析应用Fisher精确检验，实验室检查数据应用独立样本t检验或Mann-Whitney U检验进行分析，对差异有统计学意义的参数进行单因素回归分析，以寻找肺毛霉菌病死亡的危险因素。结果 25例患者中男性15例，平均年龄(52.64±13.74)(32～76)岁，住院时间15(10.5,21.5)d,最常见的肺毛霉菌病易患因素有糖尿病(20/25)、糖皮质激素暴露(13/25)、毛霉不敏感抗真菌药物应用(10/25)和实体器官移植(5/25)。最常见的临床症状为发热(21/25)和咳嗽(21/25),其次为呼吸困难(10/25)、咯血或痰中带血(9/25)。其中死亡患者8例，与存活患者相比，死亡组患者住院时间较短(P=0.003),有实体器官移植史占比更高(P=0.023),余一般情况及易患因素在两组间差异无统计学意义。死亡组患者血小板水平低于存活组患者[174 (78,227)×10～9/L vs 310 (229,347)×10～9/L],两组间差异有统计学意义(P=0.030)。25例患者中最常见的毛霉目真菌为根霉属(包括少根根霉、小孢根霉等)和根毛霉属(主要为微小根毛霉)。肺内多发结节影是存活组患者更为多见的影像学改变，两组间差异有统计学意义(P=0.042)。肺毛霉菌治疗包括敏感的抗真菌药物和手术或介入治疗，存活组和死亡组患者治疗方案无明显差异。实体器官移植增加了肺毛霉菌病患者的死亡风险(OR=16.000,95%CI:1.381～185.405,P=0.027)。结论 肺毛霉菌病病死率高，存在糖尿病以及糖皮质激素暴露、使用免疫抑制剂、实体器官移植等是目前较常见的易患因素，其临床表现和实验室检查大多无特异性，多叶病变、胸腔积液、气管狭窄或闭塞、楔形实变、肺内多发结节等是常见的影像学特征。在上述临床特征中，实体器官移植受者、血小板水平偏低的患者病死率更高，其中实体器官移植增加了肺毛霉菌病患者死亡的风险。

目的 探讨新辅助化学药物治疗(以下简称化疗)联合免疫抑制剂对Ⅲ期非小细胞肺癌的短期治疗效果及安全性。方法 选取2021年1月至2024年2月解放军总医院第六医学中心的Ⅲ期非小细胞肺癌患者53例，均行新辅助化疗联合免疫治疗，以21 d为一个周期，治疗中评估安全性及治疗结束时评估疗效。结果 影像学评估显示，完全缓解8例，部分缓解34例，疾病稳定8例，疾病进展3例，客观缓解率为79.2%,疾病控制率为94.3%。新辅助治疗后经影像学评估及科室讨论后53例患者均实施微创胸腔镜肿瘤切除术，无中转开胸患者，术后并发症10例，发生率18.7%,1例患者术后出现严重肺部感染致呼吸衰竭死亡。术后组织病理学评估显示，完全缓解15例、部分缓解32例、疾病稳定5例、疾病进展1例，主要病理缓解33例(62.3%),客观缓解率为88.7%,疾病控制率98.1%。不良反应主要为1、2级，仅出现3例3级不良事件，无4级不良反应。结论 新辅助化疗联合免疫治疗对于局部晚期非小细胞肺癌具有较好的疗效及安全性，值得进一步推广应用。

目的 基于眼底彩照，分别应用经典卷积神经网络DenseNet121和轻量级网络GhostNet训练糖尿病视网膜病变(diabetic retinopathy, DR)的诊断模型(将DR和正常眼底做区分)和鉴别诊断(将DR和其他眼底病做区分)模型，评价基于轻量级网络GhostNet的DR诊断模型的应用价值。方法 收集大样本的眼底彩照29 535张(含DR 9 883张、正常眼底2 000张、用于做鉴别诊断的其他致盲性眼底病17 652张)。分别采用经典卷积神经网络DenseNet121和轻量级网络GhostNet建模，并借助迁移学习做模型训练。采用受试者工作特征(receiver operating characteristic, ROC)曲线及其曲线下面积(area under the curve, AUC)、灵敏度、特异度、准确率评价模型性能。结果 与基于DenseNet121的模型相比，基于GhostNet的模型对单张眼底照的诊断时间缩短了60.3%。在DR的诊断方面，基于GhostNet的模型的AUC值、灵敏度、特异度、准确率分别为0.911、0.888、0.934、91.3%,基于DenseNet121的模型的AUC值、灵敏度、特异度、准确率分别为0.954、0.921、0.986、95.5%。在DR与其他眼底病的鉴别诊断方面，基于GhostNet的模型的AUC值、灵敏度、特异度、准确率分别为0.862、0.856、0.901、87.8%;基于DenseNet121的模型的AUC值、灵敏度、特异度、准确率分别为0.899、0.871、0.935、90.2%。结论 基于GhostNet轻量级神经网络构建的DR诊断模型和鉴别诊断模型，其诊断效率较经典模型DenseNet121有显著提升，并且模型兼具较高的准确率。对于社区医院等缺乏眼科医师且设备性能不高的基层医疗机构，可考虑应用该技术开展DR的初筛。

目的 评估机器人辅助逆行弹性髓内钉治疗移位型锁骨中段骨折的临床效果。方法 2022年12月1日至2023年5月31日在首都医科大学附属北京积水潭医院诊断为移位型锁骨中段骨折的60例患者纳入本前瞻性研究。所有手术均由一名经验丰富的外科医生使用新型天玑(TiRobot)机器人系统进行导航和规划最佳逆行髓内钉入点和轨迹。记录患者人口统计学资料和术中参数。分别于术后2周、4周、6周、8周、12周、6个月和12个月，进行临床随访。由一名骨科医生评估骨折愈合时间，一名康复治疗师评估包括Constant Murley肩功能(CM)评分、手臂、肩部和手部快速残疾(quick Disabilities of the Arm, Shoulder and Hand, q-DASH)评分、疤痕美容评定量表(Scar Cosmesis Assessment and Rating, Scar)和视觉模拟量表(Visual Analogue Scale, VAS)评分。结果 60例患者锁骨骨折根据AO分型，A型16例，B型26例，C型18例。平均手术时间为(53.47±21.63) min, 50例患者闭合复位，10例局部有限切开复位。所有患者均得到随访，随访时间为(60.50±6.69)周。骨折愈合时间为(7.43±2.19)周。与健侧相比，锁骨短缩率明显好转，由术前6.44%±5.00%显著改善至术后2.09%±2.95%(P<0.01)。肩部活动恢复运动范围时间为(9.13±2.20)周，恢复运动锻炼时间为(12.73±2.39)周。所有患者均对瘢痕满意，瘢痕评分为(9.80±0.48)分。CM评分在2周、6周、6个月时分别为53.67±9.52、83.22±6.28、97.85±2.60。q-DASH评分在2周、6周、6个月时分别为33.17±5.37、17.07±5.37、11.42±0.69。5例(8.33%)患者出现钉尾突出引起皮肤疼痛刺激，1例(1.67%)出现短暂性神经丛刺激，术后28周消失。结论 机器人辅助逆行弹性髓内钉是一种安全、微创的治疗移位型锁骨中段骨折的手术，具有愈合快、美观性好、功能预后好、并发症少等优点。

目的 观察被动可弯负压吸引鞘在复杂肾结石一期手术中的临床治疗效果。方法 采用随机数字表法将2023年3月至2024年3月在北京市大兴区中西医结合医院住院手术治疗的120例复杂肾结石患者分为观察组(60例)和对照组(60例)。观察组应用被动可弯负压吸引鞘联合经尿道输尿管软镜激光碎石取石术(flexible uretersocopic litotripsy, FURL),对照组应用普通输尿管鞘联合FURL。对比2组一期手术的平均手术时间、术后的净石率(stone free rate, SFR)、感染指标、出血情况、平均住院日。结果 观察组患者的平均手术时间(58.81±15.60) min,术后净石率91.67%(55/60),白细胞计数(7.43±0.52)×10～9/L,降钙素原(0.96±0.10) ng/mL,中位住院时间为2(2,3) d,与对照组相比较，差异有统计学意义(P<0.001)。2组血红蛋白下降情况相比，差异无统计学意义(P=0.075)。结论 被动可弯负压吸引鞘应用于复杂肾结石一期手术中，可显著提高净石率，减少平均手术时间和平均住院日，降低感染的发生率，值得推广应用。

目的 本实验通过建立早期帕金森病(Parkinson's disease, PD)小鼠模型，以探究PD模型出现运动学习障碍的时间特征。方法 选用6月龄Thy 1-SNCA转基因(transgenic, TG)小鼠作为早期PD模型，与同龄野生型(wild type, WT)小鼠进行对比分析。通过旷场实验、爬杆实验和Y迷宫等行为学手段来评估小鼠的运动功能和空间工作记忆能力，并以经典的匀加速转棒实验作为运动学习的行为学范式，来评估其运动学习能力。结果 6月龄的Thy 1-SNCA TG小鼠在运动功能和空间记忆能力方面并未显示出异常，却呈现出明显的运动学习障碍。结论 在早期PD模型小鼠上存在着特定的运动学习障碍，可作为早期PD的一个重要诊断指标；同时匀加速转棒测试可作为检测PD运动学习障碍的一种重要的行为学手段。

目的 探讨智能骨盆骨折复位机器人(Rossum Robot)联合天玑骨科手术机器人(TiRobot)治疗不稳定型骨盆骨折的早期疗效，并分析其临床优势与局限性。方法 回顾性分析2022年5月至2023年11月于佛山市中医院创伤骨科利用Rossum Robot联合TiRobot治疗的19例不稳定型骨盆骨折患者的病历资料。骨盆骨折Tile分型：B型5例、C型14例。从受伤到手术的中位时间为12(10,14)(6～34)d。在Rossum Robot和TiRobot的联合介入下完成骨盆骨折微创闭合复位内固定术。手术前后均进行骨盆电子计算机断层扫描(computed tomography, CT)并拍摄前后位、出口位、入口位X线片，根据X线及CT影像测量骨盆复位后的最大残余位移，采用Matta标准评估骨折复位质量。记录透视频率、透视时间、手术时间、术中出血量、术中导针调整次数、置入螺钉的数量及质量、复位后的最大残余位移。根据术后CT三维重建图像对螺钉位置进行分级。记录术后随访时间、骨折愈合时间及术后并发症发生率，并利用Majeed评分系统进行功能评价。结果 在Rossum Robot和TiRobot的联合介入下，19例患者都成功完成了骨盆骨折微创闭合复位内固定术。中位透视次数为28(18,55)(10～120)次，透视时间为25.2(16.2,33.0)(6.0～72.6)s,手术时间为206(203,212)(125～231)min,术中失血量为100(100,200)(50～400)mL,术中19例患者的导针调整次数一共为4次，平均每例患者调整0.21次。共置入67枚螺钉，螺钉置入位置的质量为优65枚，良0枚，差2枚。螺钉位置优良率为97.01%。复位后的最大残余位移为(6.59±3.68)(1.21～13.00)mm。根据Matta标准，骨盆的复位质量：优7例、良9例、可3例，优良率为84.21%。18例患者获得17.00(12.75,20.00)(6.00～21.00)个月随访，骨折愈合时间为3.55(3.35,4.18)(2.80～6.40)个月，随访期间并发症发生率为0%,末次随访时Majeed功能评分为(86.00±6.65)(74.00～98.00)分，其中优8例，良10例，优良率为100%。结论 Rossum Robot联合TiRobot可以为大多数不稳定型骨盆骨折患者完成智能、安全、精准、微创、均质的闭合复位内固定，可以获得良好的早期疗效。

目的 探讨反复静脉钙刺激对腺嘌呤饮食诱导的慢性肾脏病（chronic kidney disease, CKD）大鼠主动脉钙化的影响。方法 选择SD大鼠32只，采用数字表法随机分为对照组和模型组，基线时检测血清肌酐、尿素氮、钙、磷水平，分别给予正常饮食或0.75%腺嘌呤饮食喂养，6周后全部更换为普通饲料。对照组和模型组大鼠再分别随机分为两组，共四组：对照+氯化钙组（Cont+CaCl₂）、对照+0.9%（质量分数）氯化钠注射液（以下简称生理盐水）组（Cont+NaCl）、模型+氯化钙组（CKD+CaCl₂）、模型+生理盐水组（CKD+NaCl）,每组8只。分别采用隔日尾静脉注射氯化钙溶液（100 mg/kg）或等量生理盐水共8周，随后将大鼠处死，取血清检测肌酐、尿素氮、钙、磷水平；留取主动脉测定血管钙含量并进行Von Kossa染色观察有无钙化发生，采用免疫组织化学染色法观察成骨转分化指标成骨细胞特异性和转录因子（runt-related transcription factor 2, Runx2）的分布和表达情况，采用Western blotting法检测成骨转分化指标骨形态蛋白2（bone morphogenetic protein 2, BMP-2）的蛋白表达。结果 基线时各组大鼠体质量及生化指标差异无统计学意义（P>0.05）;第14周结束时与对照组相比，模型组大鼠血清肌酐、尿素氮水平升高，血钙降低、血磷升高，差异有统计学意义（P<0.05）;与CKD+NaCl组比较，CKD+CaCl₂组血清钙、磷水平及主动脉钙含量差异无统计学意义（P>0.05）,两组大鼠主动脉Von Kossa染色均为阴性；与对照组相比，模型组主动脉Runx2和BMP-2表达增加；与CKD+NaCl组比较，CKD+CaCl₂组主动脉Runx2和BMP-2表达差异无统计学意义。结论 在本实验条件下，反复静脉钙刺激对腺嘌呤饮食诱导的CKD大鼠无诱发主动脉钙化作用，对主动脉成骨转分化情况无明显影响。

目的 评估骨科手术机器人辅助下与徒手置钉治疗股骨颈骨折的疗效。方法 回顾性选取2018年1月至2023年6月期间吉林大学第一医院收治的股骨颈骨折患者共40例为研究对象，将其中采用机器人辅助下手术的21例患者为机器人组，徒手置钉手术的19例患者为徒手组。比较两组患者术中及术后临床指标。结果 机器人组患者的手术时间、术中透视次数、术中导针调整次数以及术后1年Harris评分等方面均优于徒手置钉组，组间差异具有统计学意义(P<0.05);两组患者的骨折愈合时间差异无统计学意义(P>0.05)。结论 天玑骨科手术机器人辅助股骨颈骨折治疗具有精准、高效、智能等显著优势，使用机器人辅助手术可缩短手术时间，减少手术相关副损伤发生的可能，值得进一步推广及应用。

目的 本研究旨在探讨新型无创示踪系统在静态和动态环境下的临床精度表现。方法 该系统由无创示踪装置和光学导航设备组成。在静态环境下，使用术中C臂电子计算机断层扫描(computed tomography, CT)扫描脊椎模型，通过CT图像空间中的标记点进行实时自动化配准，测量无创示踪装置配准精度和8个体表验证点的配准精度。将无创示踪装置与连接于椎体的刚性示踪装置进行比较，测量椎弓根螺钉导针在体表下3～4 cm处螺钉入点位置误差和体表下8～9 cm处螺钉终点位置误差，以及导针整体规划路径与实际路径的角度误差。本研究中前期构建了呼吸运动下脊柱椎体运动模型以仿真术中椎体的动态环境，通过机械臂进行伺服模拟呼吸运动构建术中动态环境，并在术中同法测量动态环境下的无创示踪器临床精度。结果 无创示踪器配准误差较小，静态环境下为(0.483±0.242)mm,动态环境下为(0.524±0.229)mm。无创示踪装置内部区域的配准误差低于外部区域的配准误差，静态环境下为[(0.472±0.202) mm vs(0.954±0.279)mm,P<0.001],动态环境下为[(0.516±0.188) mm vs(1.029±0.252)mm,P<0.001]。8条导针入路的骨表面入点精度高于骨内部终点精度，体表下3～4 cm处位置误差小于8～9 cm处，静态环境下为[(0.018±0.024) mm vs(0.061±0.061) mm,P=0.002],动态环境下为[(0.403±0.275) mm vs(0.938±0.640) mm,P<0.001]。导针入路的角度误差较小，静态环境下<0.25°,动态环境下<1.50°。结论 在静态环境下，无创示踪器对体表区域和深部区域均保持较高位置精度和角度精度，在动态环境中，体表区域和深部区域的定位精度和角度精度降低，但仍在可接受的范围内。

下尿路功能障碍(lower urinary tract dysfunctions, LUTD)是绝经期泌尿生殖系统综合征(genitourinary syndrome of menopause, GSM)症状中的关键问题，主要是由女性绝经后体内雌激素水平降低、泌尿生殖道结构改变、炎症反应、微生态菌群变化引起，严重影响女性生活质量。LUTD治疗涉及中西医防治及健康监测，其中阴道局部低雌激素用药是目前治疗的核心，任何单一药物不能替代。在诊疗过程中更要注重对GSM的综合、个体化、总体健康情况把控及长期管理。本文主要综述妇女绝经期与下尿路症状中西医诊疗的研究进展。

目的 研究活性氧自由基（reactive oxygen species, ROS）清除剂Eukarion-134 （EUK-134）对大脑中动脉梗死（middle cerebral artery occlusion, MCAO）再灌注大鼠脑内线粒体生物发生相关蛋白——过氧化物酶体增殖物激活受体γ辅激活因子-1α（peroxisome proliferator activated receptor gamma coactivator-1α,PGC-1α）,以及线粒体电压依赖性阴离子通道1（voltage-dependent anion channel 1,VDAC1）的影响，探讨脑缺血后ROS含量变化对线粒体结构和功能的影响。方法 将健康雄性SD大鼠采用随机数字表法分为3组：假手术（Sham）组、MCAO组和MCAO+EUK-134 （EUK-134）组，每组6只。使用改良线栓法构建大鼠中动脉梗死模型，模拟缺血90 min后拔出线栓进行再灌注24 h。手术期间持续监测大鼠心率、平均动脉压以及肛温，确保其生理指标维持在正常范围内。EUK-134组大鼠通过皮下注射的方式注射EUK-134（10 mg/kg）,Sham及MCAO组大鼠给予等体积溶剂。采用Western blotting法检测大鼠缺血脑组织中PGC-1α的表达。应用免疫荧光染色检测大鼠脑缺血半暗带区VDAC1的表达，利用氧化感应荧光探针（2′,7′-dichlorofluorescin diacetate, H₂DCF-DA）染色法标记ROS阳性细胞，并将VDAC1与ROS进行荧光双标染色。结果 （1） MCAO组大鼠再灌注24 h缺血侧脑组织PGC-1α蛋白水平比Sham组明显降低（P<0.05）;与MCAO组相比，EUK-134组缺血侧脑组织PGC-1α蛋白水平明显升高（P<0.05）。（2）与Sham组相比，MCAO组大鼠再灌注24 h缺血半暗带区VDAC1阳性细胞数量明显增多（P<0.05）,而给予EUK-134处理的脑缺血再灌注大鼠缺血半暗带区VDAC1阳性细胞数量显著低于MCAO组（P<0.05）。VDAC1与神经元标志物NeuN共定位。（3）在MCAO组大鼠缺血半暗带区，VDAC1阳性细胞与ROS共定位，且VDAC1/ROS双阳性细胞数量显著高于Sham组（P<0.05）,给予EUK-134的缺血大鼠VDAC1/ROS双阳性细胞数量较MCAO组明显降低（P<0.05）。结论 ROS清除剂EUK-134可以影响线粒体生物发生调节因子PGC-1α和物质运输通道VDAC1的表达，维持线粒体功能，改善脑缺血再灌注损伤。

目的 通过生物信息学法筛选口腔鳞状细胞癌（oral squamous cell carcinoma, OSCC）与干燥综合征（Sjogren's syndrome, SS）在转录水平的交叉免疫基因（cross immune genes, CIGs）并分析免疫浸润状态，为OSCC在SS患者中的诊断和治疗提供科学依据。方法 从GEO数据库下载OSCC和SS数据集，使用limma R软件包结合Venn图筛选OSCC和SS中的差异表达基因（differentially expressed genes, DEGs）,再与免疫基因数据集进行交叉筛选获得CIGs。采用最小绝对收缩和选择算子（least absolute shrinkage and selection operator, LASSO）回归算法筛选核心CIGs。利用CIBERSORT R软件包分析浸润的免疫细胞类型及比例。结果 从OSCC数据集中筛选出2 885个DEGs,从SS数据集中筛选出2 472个DEGs,交叉分析得到55个CIGs;经LASSO回归分析后二次交叉筛选出RASGRP3为潜在的核心CIGs,在OSCC和SS中表达均上调。另外，在OSCC和SS中，记忆CD4⁺T细胞、巨噬细胞和活化自然杀伤（natural killer, NK）细胞浸润均与RASGRP3相关。结论 癌基因RASGRP3可作为OSCC和SS的潜在治疗靶点，并对二者的诊断具有参考价值；RASGRP3与浸润的NK细胞、巨噬细胞、CD4⁺T细胞等密切相关，为探索针对SS患者OSCC的免疫治疗策略提供新思路。