Abstract:Objective To investigate the diagnostic value of ultrasound combined with anti-mullerian hormone(AMH),insulin and three sex hormones in polycystic ovary syndrome(PCOS).Methods A total of 90 patients with PCOS treated from January 2024 to July 2025 were selected as the observation group,and 45 healthy physical examinees during the same period were selected as the control group for case-control study.The baseline data,ultrasound indexes[ovarian volume(OV),antral follicle count(AFC),total ovarian area(TA),ovarian stromal area(SA),peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI),pulsatility index(PI)],AMH,insulin[fasting insulin(FINS),Homeostatic Model Assessment for Insulin Resistance(HOMA-IR)]and three sex hormones[testosterone,luteinizing hormone(LH),follicle stimulating hormone(FSH)]were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the factors affecting the occurrence of PCOS.The receiver operating characteristic(ROC)curve was used to analyze the value of ultrasound indicators,AMH,insulin and sex hormones alone and in combination for the diagnosis of PCOS.The decision curve was used to evaluate the clinical utility of the combined diagnostic model,and the K-fold cross-validation was used to verify its generalization ability.Results There were significant differences in neutrophil(NEU),neutrophil/lymphocyte ratio(NLR),AMH,fasting plasma glucose(FPG),FINS,HOMA-IR,testosterone,LH,FSH and LH/FSH between the two groups(P<0.01).The values of OV,AFC,SA,PSV and EDV in the observation group were higher than those in the control group,and the values of RI and PI were lower than those in the control group(P<0.05,P<0.01).Multivariate Logistic regression analysis showed that after adjusting for confounding factors,AMH,HOMA-IR,testosterone,LH/FSH,OV and RI were still the factors affecting the occurrence of PCOS(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of AMH,HOMA-IR,testosterone,LH/FSH,OV and RI in the diagnosis of PCOS was in the range of 0.717-0.781,and the AUC of combined diagnosis was 0.887(95%CI:0.821,0.935),which was greater than the AUC value of each indicator alone(P<0.05).The decision curve showed that the joint diagnosis model showed good clinical net income within the threshold probability range of 0.2-0.8 threshold;the K-fold cross-validation showed that the mean AUC value of the five validations was 0.8864,which was basically consistent with the AUC value(0.887)obtained by modeling,and the data were highly concentrated and the generalization ability was good.Conclusion Ultrasound combined with AMH,insulin and three sex hormones has certain diagnostic value for PCOS,which can be used as an auxiliary scheme to optimize the clinical diagnosis of PCOS.

Abstract:Objective To investigate the value of cysteine dioxygenase type1/adherens junctions associated protein1/galanin receptor1(CDO1/AJAP1/GALR1)triple-target DNA methylation detection in the early diagnosis of endometrial cancer.Methods A total of 154 patients with suspected endometrial cancer admitted to the hospital from February 2022 to February 2025 were selected as the case group,and 121 healthy individuals who underwent physical examinations during the same period were selected as the control group.During gynecological examinations,exfoliated cells from the cervical canal were collected for DNA methylation detection of CDO1/AJAP1/GALRA.The pathological results of endometrial biopsy were taken as the gold standard,and the early diagnostic efficacy was analyzed based on the area under the receiver operating characteristic(ROC)curve(AUC).Results Among the 154 patients in the case group,133 had endometrial cancer and 21 had atypical endometrial hyperplasia.There were significant differences in age,menopause status,body mass index,abnormal vaginal bleeding and family history of endometrial cancer between the control group and the case group(P<0.05),but there was no significant difference in endometrial thickness history of hypertension,or history of diabetes(P>0.05).The AUC value of CDO1/AJAP1/GALR1 was 97.11%,which was higher than that of AJAP1,GALR1,and CDO1 alone(93.05%,88.97%,and 94.92%,respectively).Moreover,the negative predictive value,positive predictive value,specificity,and sensitivity of the three-target combination were all higher than those of a single target alone(P<0.05).Conclusion In clinical practice,combined detection of CDO1/AJAP1/GALR1 triple-target DNA methylation has high diagnostic efficacy for the early diagnosis of endometrial cancer.

Abstract:Patients with positive results in the initial screening for high-risk human papillomavirus(HPV)may experience a range of adverse psychological states due to concerns about cervical lesions and canceration,which can negatively impact their quality of life.Furthermore,the long-term psychological state of patients is associated with disease progression,increasing the risk of cervical lesions and affecting prognosis outcomes.This study comprehensively analyzes the psychological status and potential trends of changes in patients with positive HPV screening results by reviewing relevant research reports from both domestic and international sources.It also summarizes the influencing factors and intervention strategies for patients'adverse psychological states,providing a reference for alleviating or eliminating these adverse psychological states in patients with positive HPV screening results.

Abstract:Objective To investigate the misdiagnosis causes of colorectal adenocarcinoma as benign polypoid lesions.Methods A retrospective analysis was conducted on the clinical data of 33 patients with misdiagnosed colorectal adenocarcinoma who were admitted from December 2023 to March 2025.Results Among the 33 patients,27(81.81%)were identified through asymptomatic screening.There were 2 cases(6.06%)of simple hematochezia and 4 cases(12.12%)with accompanying abdominal pain.For all of them,the initial diagnoses was colon polyps based on endoscopic examination.Of them,29 patients underwent endoscopic resection of the lesion,and 4 patients received surgical treatment.Postoperative pathological diagnosis revealed carcinoma in situ/intramucosal carcinoma in 20 patients,superficial submucosal infiltration in 5 patients,and deep submucosal infiltration into the muscular layer or deeper in 4 patients respectively.The misdiagnosis lasted(1.33±0.85)months.After diagnosis,individualized treatment plans were adopted based on tumor stage.Among the 20 patients in the pT1a stage,the lesions were completely removed by endoscopy,and no additional endoscopic treatment or surgery was required.Five patients with superficial submucosal invasion had negative margins in the postoperative pathology,and no additional surgical treatment was needed.Four patients who underwent endoscopic resection had pathological evidence of deep submucosal invasion and underwent laparoscopic radical surgery(D3 lymph node dissection),and 4 patients underwent surgical treatment.Follow-up showed that except for 1 patient who had tumor recurrence and received anti-tumor treatment,the others did not show recurrence.Conclusion The clinical manifestations of polypoid colorectal adenocarcinoma are atypical and prone to misdiagnosis.Clinicians should enhance their vigilance for this disease and optimize diagnostic strategies to reduce or avoid misdiagnosis.

Abstract:Objective To analyze the application value of comprehensive emergency trauma care model based on pre-hospital and post-hospital integration in patients with severe trauma.Methods A total of 104 patients with severe trauma admitted from January to December 2022 were selected.Among them,52 patients with severe trauma admitted from January to December 2022 were selected as the control group,who received conventional trauma care,while 52 patients with severe trauma admitted from January to September 2023 were selected as the observation group,who were received the comprehensive emergency trauma care model based on pre-hospital and post-hospital integration.The success rate of rescue,resuscitation time,Glasgow coma scale(GCS)score,Abbreviated Injury Scale-Injury Severity Score(AIS-ISS),and incidence of complication were compared between the two groups.Results The rescue success rate of the observation group[96.15%(50/52)]was higher than that of the control group[82.69%(43/52)](P<0.05).The pre-hospital emergency time,disease assessment time,vital signs evaluation time,intravenous access establishment time,and basic life support rescue time in the observation group were shorter than those in the control group(P<0.01).After treatment,the GCS score of the observation group was higher than that of the control group,and the AIS-ISS score was lower than that of the control group(P<0.01).The total incidence of complications in the observation group[10.00%(5/50)]was lower than that in the control group[30.23%(13/43)](P<0.05).Conclusion The comprehensive emergency trauma care model based on pre-hospital and post-hospital integration can improve the rescue success rate of patients with severe trauma,shorten the rescue time,and reduce the incidence of complications,thus effectively improvingthe prognosis.

Abstract:Objective To investigate the effects of Tirofiban combined with dual antiplatelet drugs on the neurological function and cerebral blood perfusion of patients with stroke warning syndrome(SWS),and to analyze its safety.Methods A retrospective analysis was conducted on 62 patients with SWS who were admitted from February 2020 to February 2022.These patients were divided into the combination group and the control group based on different treatment plans,with 31 patients in each group.The control group received treatment with dual antiplatelet drugs,while the combination group received treatment with dual antiplatelet drugs combined with Tirofiban.Neurological function,prognosis,cerebral blood perfusion parameters,serum biochemical markers and adverse reactions were compared between the two groups after treatment.Results After treatment,the scores of the National Institutes of Health Stroke Scale(NIHSS)and the Rankin Scale were lower in the combination group than in the control group(P<0.01).The peak systolic velocity and mean velocity were higher,while the resistance index and serum S100β protein level were lower in the combination group than in the control group(P<0.01).The total incidence of adverse reactions in the combination group[6.45%(2/31)]was not statistically different from that in the control group[9.68%(3/31)](P>0.05).Conclusion For SWS patients,Tirofiban combined with dual antiplatelet drugs can effectively improve neurological function and prognosis,with good safety profile.

Abstract:Objective To investigate the effects of preeclampsia on pregnancy outcomes,neonatal outcomes,and the expression level of SEMA3F.Methods A total of 200 term singleton pregnant women admitted from January 2022 to January 2024 were selected as the study subjects.Among them,100 patients underwent elective cesarean section(C-section)and 100 patients had natural delivery.Additionally,the patients were further divided into two groups based on whether they developed preeclampsia:the elective C-section+preeclampsia group(Study Group Ⅰ),the elective C-section+non-preeclampsia group(Study Group Ⅱ),the routine delivery+preeclampsia group(Study Group Ⅲ),and the routine delivery+non-preeclampsia group(Study Group Ⅳ).The pregnancy and neonatal outcomes of each group were statistically analyzed,and the levels of SEMA3F in different samples of pregnant women were compared.Results The ages of the pregnant women in Group Ⅰ and Group Ⅲ were greater than those in Group Ⅱ and Group Ⅳ,and the duration of hypertension was significantly longer than those in Group Ⅱ and Group Ⅳ(P<0.05).The incidence of adverse neonatal outcomes was higher in Group Ⅰ[68.42%(13/19)]than in Group Ⅱ[23.60%(21/81)],and higher in Group Ⅲ[72.73%(8/11)]than in Group Ⅳ[22.95%(14/89)],with significant differences(P<0.05).There was no significant difference in the incidence of adverse neonatal outcomes between Group Ⅱ and Group Ⅳ(P>0.05).The incidence of adverse pregnancy outcomes in pregnant women was higher in Group Ⅰ[63.16%(12/19)]than in Group Ⅱ[9.88%(8/81)],and higher in Group Ⅲ[41.03%(16/39)]than in Group Ⅳ[9.84%(6/61)],with significant differences(P<0.05).The expression levels of SEMA3F in peripheral blood(16 weeks),umbilical vein blood(16 weeks),and amniotic fluid(16 weeks)samples of pregnant women in Group Ⅰ and Group Ⅲ were higher than those in Group Ⅱ and GroupⅣ(P<0.05).Conclusion Preeclampsia has adverse effects on pregnancy and neonatal outcomes.Moreover,the expression level of SEMA3F is elevated in pregnant women with preeclampsia.In clinical practice,SEMA3F should be measured in high-risk pregnant women,so as to promptly take corresponding preventive and therapeutic measures for preeclampsia.

Abstract:Objective To investigate the clinical efficacy of adaptive radiotherapy with helical tomotherapy(TOMO)in the treatment of lung cancer.Methods Sixty patients with lung cancer who underwent radiotherapy between September 2020 and December 2023 were selected.They were divided into the control group(n=30)and the observation group(n=30)according to different radiotherapy methods.Thirty patients who underwent conventional non-adaptive radiotherapy with linear accelerator were included in the control group,and thirty patients who underwent adaptive radiotherapy with TOMO were included in the observation group.The short-term efficacy and the incidence of radiotherapy-related adverse reactions were compared between the two groups.K-M survival curve was drawn to analyze progression-free survival(PFS)and overall survival(OS)of the two groups.Univariate Cox regression analysis and multivariate analysis were used to identify factors affecting the survival of patients undergoing radiotherapy for lung cancer.Results The objective response rate and disease control rate of the observation group[83.33%(25/30)and 96.67%(29/30)]were higher than those of the control group[56.67%(17/30)and 73.33%(22/30)](P<0.05),while the total incidence of radiotherapy-related adverse reactions in the observation group[10.00%(3/30)]was lower than that in the control group[43.33%(13/30)](P<0.05).K-M survival curve showed that cumulative PFS and cumulative OS of the observation group(39.70% and 45.40%)were higher than those of the control group(16.20% and 21.70%)(P<0.05).Univariate and multivariate Cox regression analyses showed that TNM staging and radiotherapy method were factors affecting PFS and OS of patients undergoing radiotherapy for lung cancer(P<0.05).Conclusion Applying adaptive radiotherapy with TOMO to treat lung cancer can significantly improve short-term efficacy,reduce adverse reactions and enhance prognosis.However,TNM staging and radiotherapy method are factors affecting PFS and OS,which deserves close attention in clinical practice.

Abstract:Objective To investigate the effect of Remimazolam on circulatory function and echocardiographic parameters before and after anesthesia induction in patients undergoing surgery under general anesthesia.Methods A total of 120 patients who underwent elective surgery under general anesthesia from February 2023 to June 2024 and met the study requirements were selected as study subjects.They were divided into group A(n=60)and group B(n=60)by random envelope method.Group A received anesthesia induction with Propofol,while group B received anesthesia induction with Remimazolam.Circulatory function indicators[heart rate(HR),mean arterial pressure(MAP),blood pressure],echocardiographic parameters[left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),cardiac output,stroke volume]and sedative effect[onset time of anesthesia,time to discharge from the postanesthesia care unit,additional medication,eye opening time and Ricker sedation-agitation score(SAS)]before anesthesia induction(T0),at 3 min after anesthesia induction(T1)and immediately after intubation(T2),and adverse reactions were compared between groups.Results HR of both groups decreased at T1 compared with that at T0.However,group B had higher HR than group A,while group A had higher HR at T2 than at T1(P<0.05).MAP,systolic blood pressure(SBP)and diastolic blood pressure(DBP)of both groups gradually decreased at T0-T2.At T1 and T2,MAP,SBP and DBP of group B were higher than those of group A(P<0.05).At T2,LVEDV,LVEF,cardiac output and stroke volume in both groups increased compared with those at T0 and T1,which were lower in group B than in group A.In both groups,LVESV was lower at T2 than at T0 and T1,which was higher in group B than in group A(P<0.05).Compared with group A,group B showed reductions in the onset time of anesthesia,time to discharge from the post-anesthesia care unit,eye-opening time,incidence of additional medication and Riker SAS scores(P<0.05).The total incidence of adverse reactions in group B[3.33%(2/60)]was lower than that in group A[15.00%(9/60)](P<0.05).Conclusion Anesthesia induction with Remimazolam has little impact on hemodynamics,and offers good protection for cardiac structure.It can stabilize circulatory function in patients while shortening eye-opening time and reducing the risk of anesthesia agitation and the incidence of adverse reactions.

Abstract:Objective To investigate the relationship between plasma D-dimer(D-D),IgE and the severity and clinical prognosis of children with Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 300 children with MPP admitted from July 2022 to July 2024 were prospectively selected as the study subjects.According to the severity of the disease,the children with MPP were divided into mild group(n=109),severe group(n=149)and critical group(n=42).According to the clinical prognosis,they were divided into good prognosis group(n=259)and poor prognosis group(n=41).The levels of plasma D-D and IgE and clinical data were compared among the three groups.Spearman method was used to analyze the correlation between plasma D-D and IgE levels and the severity of MPP and clinical pulmonary infection score(CPIS)in children.The levels of plasma D-D and IgE in MPP children with different prognoses were compared.The relationship between plasma D-D,IgE levels and the prognosis of children with MPP was analyzed by restricted cubic spine(RCS)and receiver operating characteristic(ROC)curve.Results There were significant differences in the proportion of rash and wheezing,white blood cell(WBC)count,C-reactive protein(CRP),D-D,IgE and CPIS among the three groups(P<0.01).The results of correlation analysis showed that plasma D-D and IgE levels were positively correlated with the severity of MPP(r=0.531,0.587)and CPIS(r=0.508,0.519)in children(P<0.05).The levels of D-D and IgE in the poor prognosis group were higher than those in the good prognosis group(P<0.01).The RCS curve showed that plasma D-D and IgE levels were related to the poor prognosis of children with MPP(P<0.05),and there was a linear relationship(nonlinear P>0.05).ROC curve analysis showed that plasma D-D and IgE had certain predictive value for poor prognosis,and the combined predictive value was higher(P<0.01).Conclusion Plasma D-D and IgE levels are positively correlated with the severity of the disease,and the combined detection has some predictive efficacy for poor prognosis,which can be used as an auxiliary indicator for clinical assessment of the disease severity and prognosis prediction.

Abstract:Objective To investigate the application effect of Er:YAG laser in pulpotomy for deep caries of primary molars.Methods Forty children aged 4 to 8 years who visited the hospital due to deep caries of primary molars from January to June 2023 were selected and randomly divided into the laser group(n=20)and the control group(n=20).The laser group underwent pulp removal using Er:YAG laser,while the control group underwent pulp removal using a traditional high-speed dental drill.The intraoperative treatment time and postoperative clinical effects of the two groups were compared,and the anxiety levels of the children in both groups before and after treatment were recorded using the Facial Image Scale(FIS).Results The pulpotomy time was longer in the laser group than in the control group,while the hemostasis time was shorter(P<0.01).After treatment,the FIS score in the laser group was lower than that in the control group(P<0.05).At the 1st month of follow-up after pulpotomy,the postoperative success rate in the laser group[100%(20/20)]was higher than that in the control group[85%(17/20)](P<0.05).There was no significant difference in the treatment success rate between the two groups at the 3rd,6th,and 12th months after surgery(P>0.05).Conclusion For deep caries of primary molars,Er:YAG laser treatment can shorten the hemostasis time of pulpotomy,alleviate anxiety,and increase the postoperative success rate within the first month after the procedure.

Abstract:Objective To investigate the clinical characteristics,diagnosis,and treatment measures of immune-related adverse events(irAEs)in patients with postoperative recurrence of renal cell carcinoma,aiming to provide references for the early identification,diagnosis,treatment,and prevention of irAEs.Methods A retrospective analysis was conducted on the clinical data and treatment process of a patient with postoperative recurrence of renal cancer who developed irAEs after immunotherapy in 2025,and relevant literature was reviewed.Results A patient with renal cell carcinoma underwent laparoscopic robot-assisted operation combined with laparoscopic left nephrectomy.Three years afterwards,without any obvious cause,he experienced sudden lower back pain,accompanied by radiation pain in the right lower limb and limited mobility.After relevant examinations,bone metastasis in the left kidney after surgery and lymph node metastasis in the retroperitoneum were considered.After multidisciplinary discussion,it was recommended to use immunotherapy combined with targeted therapy and local radiotherapy for bone metastasis.Therefore,Sunitinib combined with Teprotumumab was given for treatment.At 10 d after the immunotherapy with Teprotumumab,symptoms such as nausea,vomiting,and fever occurred.Based on the comprehensive results of laboratory tests,several conditions were considered,including immune-induced liver injury grade 3,acute kidney injury stage 2,thrombocytopenia grade 4,and hyponatremia.The diagnosis of multiple organ dysfunction syndrome was made.After multidisciplinary consultation,corresponding treatment was administered,and the patient's condition improved.After stabilization,radiotherapy for bone metastases was initiated,which was administered over 3 weeks for a total of 12 fractions.The patient's lower back pain was completely relieved,liver and kidney functions as well as blood routine returned to normal.Targeted therapy was continued.Conclusion irAEs may involve various organ systems.Timely identification,diagnosis and effective treatment of adverse reactions in different systems and at different levels can achieve better results and improve the prognosis of patients.

Abstract:Objective To analyze the causes of clinical misdiagnosis of duodenal ulcer(DU)perforation and the preventive measures against such misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 3 patients with DU perforation that were initially misdiagnosed and admitted during the period from June 2022 to June 2024.Results One patient presented with sudden right abdominal pain for 3.5 h and was initially diagnosed as acute peritonitis.During the operation,it was confirmed as DU perforation.The misdiagnosis period was 1 d.After the diagnosis,repair of perforated DU and appendectomy were performed.The patient recovered well and there was no recurrence during follow-up.One patient had migratory right lower quadrant pain for 3 d,accompanied by fever,tenderness at McBurney's point,and elevated white blood cell count.The initial diagnosis was acute appendicitis.During the operation,it was confirmed as DU perforation.The misdiagnosis period was 1 d.After the diagnosis,drainage of fluid and catheter placement were performed during the operation,and postoperative gastrointestinal decompression and anti-inflammatory treatment were given.The patient recovered and was discharged 12 d afterwards.Postoperative gastroscopy confirmed ulcer healing.Another patient had persistent right lower quadrant pain for 3 d accompanied by diarrhea.The initial diagnosis was acute appendicitis.During the operation,mild congestion of the appendix was observed but no typical inflammation was present.Further exploration revealed DU perforation,accompanied by a small amount of abdominal cavity exudate.The misdiagnosis period was 1 d.After the diagnosis,repair of perforated DU and drainage were performed.Postoperatively,coffee-ground like gastric fluid was drained via nasogastric tube.After anti-inflammatory and acid-suppressing treatment,the patient recovered and was discharged.No recurrence was observed at 6-month follow-up.Conclusion DU perforation is prone to misdiagnosis as acute appendicitis or peritonitis.Clinicians should inquire in detail about the history and triggers,be vigilant for atypical signs,and,if necessary,expand the exploration scope to reduce misdiagnosis.

Abstract:Objective To investigate the impact of gasless transaxillary endoscopic surgery on the cosmetic outcomes and complications for thyroid nodules.Methods A total of 94 patients with thyroid nodules who underwent surgery from January 2023 to October 2024 were selected.Among them,50 patients received gasless transaxillary complete endoscopic thyroid surgery,and 44 patients received conventional laparoscopic surgery.Propensity score matching(PSM)was performed based on the baseline data of the two groups,resulting in 42 matched pairs,and they were assigned to the gasless surgery group and the traditional group.The surgical indicators,thyroid function,cosmetic outcomes,and postoperative complications of the two groups were compared.Results The length of the surgical incision and the length of hospitalization were shorter,the duration of operation was longer and the intraoperative blood loss was less in gasless surgery group,as compared with those in the traditional group(P<0.05).There was no significant difference in thyroid function between the two groups before and at 1 month after surgery(P>0.05).At six months and one year after surgery,the Vancouver Scar Scale(VSS),Patient Scar Self-Assessment Scale(PSAS),and Observer Scar Assessment Scale(OSAS)scores of the patients in the gasless surgery group were all lower than those in the traditional group(P<0.01).The complication rate of the patients in the gasless surgery group[2.38%(1/42)]was lower than that of the traditional group[23.81%(10/42)](P<0.05).Conclusion Gasless transaxillary endoscopic surgery can reduce the intraoperative blood loss in patients with thyroid nodules,accelerate postoperative recovery,and have minimal impact on the patient's thyroid function,with better cosmetic outcomes,and a low incidence of complications.

Abstract:Objective To analyze the predictive value of inflammatory factors combined with intra-abdominal pressure(IAP)for the timing of surgical intervention for neonatal necrotizing enterocolitis(NEC).Methods A total of 60 neonates with NEC admitted to A from January 2020 to December 2024 were selected as the study subjects.Inflammatory factors and IAP were measured within 24 h after confirmed diagnosis of NEC.According to whether the neonates had surgical indications during hospitalization and underwent surgery or not,they were divided into the surgical group(n=32)and the non-surgical group(n=28).Inflammatory factors and IAP of the two groups were compared,and their predictive value for the timing of surgery for NEC was analyzed.Results The levels of C-reactive protein(CRP),procalcitonin(PCT),and soluble CD14 subtype(sCD14-ST)in the surgical group were higher than those in the non-surgical group(P<0.01).IAP of the surgical group was higher than that of the non-surgical group(P<0.01).Multivariate logistic regression analysis showed that PCT(OR=2.542,95%CI:1.243-5.199),sCD14-ST(OR=1.548,95%CI:1.058-2.264)and IAP(OR=1.201,95%CI:1.023-1.410)were independent factors affecting the timing of surgery(P<0.05).ROC analysis showed that the areas under the ROC curve(AUC)of PCT,sCD14-ST,and IAP for predicting the timing of surgery in neonates with NEC were 0.886(0.778,0.954),0.884(0.775,0.952),and 0.931(0.835,0.980),respectively,with no significant differences in pairwise comparisons among the three groups(P>0.05).The AUC of joint prediction using the three indicators was 0.990(0.922-1.000),significantly larger than that of PCT,sCD14-ST,or IAP alone(Z=2.404,2.486,2.183,respectively,P<0.05).Conclusion Inflammatory factors PCT,sCD14-ST,and IAP all exhibit certain predictive value for the timing of surgery in neonates with NEC,and combined detection of the three demonstrates higher predictive value.

Abstract:Objective To analyze the causes of misdiagnosis related to acute cerebral infarction(ACI)and to investigate preventive measures to reduce such misdiagnoses.Methods A retrospective analysis was conducted on the clinical data of 2 patients with ACI-related misdiagnosis admitted from May 2024 to February 2025.Results A 22-year-old female patient presented with disturbance of consciousness and limb convulsions.Initially,the diagnosis was considered to be poisoning or infection,and corresponding treatments were given but with poor effect.Subsequently,after comprehensive vascular assessment,a diagnosis of left vertebral artery dissection with secondary basilar artery occlusion was confirmed.The misdiagnosis lasted 15 h.After diagnosis,endovascular treatment was performed,and the blood vessels were successfully recanalized,but the prognosis was poor.An 82-year-old male patient presented with stroke-like symptoms.Initially,he was diagnosed with ischemic stroke and underwent whole-brain angiography.Subsequently,it was confirmed as a brain abscess through multimodal magnetic resonance imaging.The misdiagnosis period was 3 d.After diagnosis,he was treated with anti-infection therapy and the condition stabilized.The follow-up prognosis was good.Conclusion The misdiagnosis related to ACI involves two aspects:missed diagnosis of true cerebral infarction and misjudgment of stroke mimics.Enhancing the diagnostic vigilance of medical staff,optimizing the identification of imaging signs,and standardizing the diagnosis and treatment process are important measures to reduce the misdiagnosis rate of this disease.

Abstract:Objective To investigate the application outcomes of axillary lymph node dissection(ALND)versus sentinel lymph node biopsy(SLNB)in breast cancer treatment and their impact on postoperative upper limb lymphedema.Methods A total of 120 patients with breast cancer treated between February 2021 and February 2023 were enrolled.According to random number table method,they were divided into ALND group(n=60)and SLNB group(n=60).The ALND group received ALND,while the SLNB group received SLNB.The clinical effect at 6 months and 1 year after surgery,positive rate of sentinel lymph nodes,upper limb lymphedema and dysfunction within 1 year after surgery,and improvement of upper limb function and quality of life before and at 1 year after surgery were compared between the two groups.Results At 6 months and 1 year after surgery,there was no significant difference in response rates of treatment between SLNB group[88.33%(53/60)and 85.00%(51/60)]and ALND group[91.67%(55/60)and 80.00%(48/60)](P>0.05).The positive rate of sentinel lymph nodes in SLNB group was lower than that in ALND group[3.33%(2/60)vs.16.67%(10/60),P<0.05].At 1 year after surgery,incidence of upper limb lymphedema in SLNB group was lower than that in ALND group(P<0.05).At 1 year after surgery,there was no significant difference in upper limb dysfunction between the two groups(P>0.05).At 1 year after surgery,scores of upper limb function index and quality of life in SLNB group were higher than those in ALND group(P<0.05,P<0.01).Conclusion SLNB has significant advantages in reducing postoperative lymphedema and improving postoperative quality of life.However,both ALND and SLNB achieve comparable short-term tumor control effects.

Abstract:Objective To investigate the causes of misdiagnosis of primary breast lymphoma(PBL)as breast cancer and essential points for differential diagnosis.Methods A retrospective analysis was conducted on the clinical data of 4 patients with PBL misdiagnosed as breast cancer who were admitted to the hospital from April 2022 to October 2024.Results All of the 4 patients with PBL visited the hospital due to breast masses and were initially diagnosed as breast cancer through physical examination and relevant examinations,including 2 cases of left-sided breast cancer,1 case of left-sided breast cancer with left axillary lymph node metastasis,and 1 case of right-sided breast cancer.All 4 patients underwent surgical treatment and were diagnosed with PBL by postoperative pathology and immunohistochemistry.Among them,there were 3 cases of stage II B-cell non-Hodgkin lymphoma and 1 case of stage III.The time of misdiagnosis ranged from 5 to 40 d,with an average of(16.36±2.89)d.Patients were given adjuvant radiotherapy and chemotherapy after surgery.The patients were followed up for 3-22(11.69±2.30)months.Of them,3 patients survived,while 1 patient died after recurrence at 1 year postoperatively.Conclusion PBL lacks specific clinical manifestations,and related medical examination results are complex,making it prone to misdiagnosis as breast cancer.It is recommended to enhance clinical recognition of PBL.Comprehensive analysis combining medical history,physical examination,and relevant laboratory and imaging findings should be conducted during diagnosis,along with careful differential diagnosis.Timely breast mass biopsy with pathological and immunohistochemical examinations should be conducted for suspicious cases to reduce the misdiagnosis rate.

Abstract:Objective To investigate the magnetic resonance imaging(MRI)findings of elbow ligament injuries in children and adolescents,and to assess the diagnostic value of MRI for this condition.Methods A total of 90 children and adolescents with elbow joint injuries who were admitted from January 2022 to January 2024 were selected as the study subjects.All patients underwent high-frequency ultrasound and MRI examinations.With the follow-up and surgical results as the gold standard,the consistency of the diagnostic results of high-frequency ultrasound and MRI for elbow ligament injuries was compared.The MRI imaging features were recorded,and the diagnostic efficacy of the two methods was analyzed using the receiver operating characteristic(ROC)curve.The detection rates of different examination methods for the severity of elbow ligament injuries in children were compared.Results Among the 90 patients who were confirmed through follow-up and surgery,67 patients(74.44%)were diagnosed with ligament injuries of the elbow joint,14 patients(15.56%)had tendon injuries,and 9 patients(10.00%)had fractures of the elbow joint.The MRI findings of ligament injuries of the elbow joint showed that on T1-weighted imaging(T1WI),the injured ligaments appeared blurred and thickened,with partial continuity of the fibers.On proton density-weighted fat-suppressed(PDWI-FS)sequences,it presented as heterogeneous hyperintensity.The torn ligaments presented as blurred fibrous structure,with fibers that were thickened,discontinuous,and local fractures,and the original band-like low-signal areas showed high-signal changes.Complete torn ligaments presented as retraction and disruption of the fibers,loss of ligamentous structure at the torn ends,and the presence of surrounding tissue edema.The Kappa value of high-frequency ultrasound for detecting elbow ligament injuries was 0.580,and the Kappa value of MRI for elbow ligament injuries was 0.733.Through ROC curve analysis,the area under the ROC curve of high-frequency ultrasound and MRI for diagnosing elbow ligament injuries was 0.802 and 0.861 respectively,with sensitivities of 86.57% and 73.91%,and specificities of 94.03% and 78.26%;there was no significant difference in the detection rate of the severity of elbow ligament injuries between high-frequency ultrasound and MRI(P>0.05).Conclusion MRI has a high diagnostic value for elbow ligament injuries in children and adolescents.It can provide typical imaging findings and offer reliable references for clinical diagnosis.

Abstract:Objective To investigate the causes and prevention strategies of complications in the treatment of adult patients with painful accessory navicular syndrome treated with posterior tibial tendon reconstruction using TwinFix anchor.Methods The clinical data of 32 adult patients with painful accessory navicular syndrome who underwent posterior tibial ten-don reconstruction using TwinFix anchor from January 2013 to January 2023 were retrospectively analyzed.Results Postoper-ative pain occurred in 12 of the 32 patients(37.5%),including pain in the incision,around the incision and other areas of the medial foot in 10 patients,and the anchor strapping into the joint and the exposed nail tail irritating the skin in 1 patient respectively.After symptomatic treatment such as anti-infection,detumescence,pain relief or surgical revision treatment,the symptoms were relieved.Peripheral nerve injury-related plantar-numbness occurred in 5 patients(15.6%),and the symp-toms were improved after symptomatic treatment including detumescence and nutritional nerve.Postoperative incision infection and skin necrosis were found in 3 patients(9.4%).The infection was controlled and the incision healed after anti-infection treatment and incision expansion surgery.There were9 patients(28.1%)with limited foot function,and symptoms were re-lieved after rehabilitation exercise.There were3 patients(9.4%)of anchor loss.After the second operation and rehabilita-tion exercise,the patients'condition improved.At 12 months after operation,AOFAS ankle-posterior foot function score[(86.03±4.83)points]was significantly improved compared with that before operation[(49.34±8.41)points](P＜0.01).Conclusion Posterior tibial tendon reconstruction using TwinFix anchor in the treatment of adult patients with painful accessory navicular syndrome can cause symptom-related complications and complications related to poor postoperative function improvement,which are related to long duration of operation,rough operation and anchor loss.Careful operation should be performed during the the procedure to shorten the duration of operation as much as possible,and postoperative complications should be actively managed to avoid serious consequences.