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[Risk factors analysis and prediction model establishment of contralateral central lymph node metastasis in intermediate-to-high risk unilateral papillary thyroid carcinoma]. [中高危单侧甲状腺乳头状癌对侧中央淋巴结转移的危险因素分析和预测模型建立]。
Q3 Medicine Pub Date : 2024-09-24 DOI: 10.3760/cma.j.cn112137-20240524-01180
S S Wang, S C Miao, J L Shan, D Zhang, Q Q Wang, Q C Ni, J Fang
<p><p><b>Objective:</b> To explore the risk factors of contralateral central lymph nodes (Cont-CLNs) metastasis in intermediate-to-high risk unilateral papillary thyroid carcinoma and establish a prediction model. <b>Methods:</b> The clinical data of 206 patients receiving thyroid cancer surgery at Nantong University Affiliated Hospital between January 2021 and June 2023 were retrospectively analyzed, including 50 males and 156 females, with an age of [<i>M</i>(<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] 49.0(33.8, 57.0) years old. The risk factors of Cont-CLNs metastasis were screened by univariate analysis and multivariate logistic regression analysis. A nomogram was constructed for predicting Cont-CLNs metastasis in intermediate-to-high risk uPTC. The area under the receiver operating characteristic (ROC) curve(AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the model's predictive ability, accuracy, and clinical applicability, respectively. R language was used to randomly select 70% of the patients to establish a validation group for internal validation of the model. <b>Results:</b> Patients were divided into a metastasis group (<i>n</i>=56) and a non-metastasis group (<i>n</i>=150) based on the occurrence of Cont-CLNs metastasis. The ages of the two groups were 39.0 (28.0, 56.8) years and 51.0 (38.8, 57.0) years, respectively. There were statistically significant differences in gender, maximum tumor diameter (>1 cm), ipsilateral central lymph nodes (Ipsi-CLNs) metastasis, number of Ipsi-CLNs metastases (≥4), and lateral lymph node metastasis and Cont-CLNs metastasis between the two groups (all <i>P</i><0.05). The results of multivariate logistic regression analyses showed that males(<i>OR</i>=2.926, <i>95%CI</i>: 1.063-8.051), maximum tumor diameter>1 cm(<i>OR</i>=4.471, <i>95%CI</i>: 1.344-14.877), and number of Ipsi-CLNs metastases≥4 (<i>OR</i>=5.011, <i>95%CI</i>: 1.815-13.834) were risk factors for Cont-CLNs metastasis (all <i>P</i><0.05). The AUC of the ROC curve, sensitivity, and specificity for predicting Cont-CLNs metastasis in intermediate-to-high risk uPTC by the prediction model in the modeling group were 0.821 (95%<i>CI</i>: 0.744-0.898), 82.5%, and 63.4%, respectively. In the internal validation group, the AUC of the ROC curve, sensitivity, and specificity for predicting Cont-CLNs metastasis in intermediate-to-high risk uPTC by the prediction model were 0.810 (95%<i>CI</i>: 0.717-0.902), 63.3%, and 83.7%, respectively. The calibration curves of the modeling group and the validation group showed that the model had good calibration ability. The DCA curves of the modeling group and the validation group indicated that the prediction model had good clinical adaptability. <b>Conclusions:</b> The prediction model constructed in this study has good predictive performance for Cont-CLNs metastasis in intermediate-to-high uPTC. When patient with intermediate-to-high risk uPTC is male, with maximum tumor dia
目的探讨中高危单侧甲状腺乳头状癌对侧中央淋巴结(Cont-CLNs)转移的风险因素,并建立预测模型。方法回顾性分析2021年1月至2023年6月在南通大学附属医院接受甲状腺癌手术的206例患者的临床资料,其中男50例,女156例,年龄[M(Q1, Q3)]49.0(33.8, 57.0)岁。通过单变量分析和多变量逻辑回归分析筛查了Cont-CLNs转移的风险因素。构建了预测中高危uPTC Cont-CLNs转移的提名图。接收者操作特征曲线(ROC)下面积(AUC)、校准曲线和决策曲线分析(DCA)分别用于评价模型的预测能力、准确性和临床适用性。使用 R 语言随机抽取 70% 的患者建立验证组,对模型进行内部验证。结果根据Cont-CLNs转移的发生情况,将患者分为转移组(n=56)和非转移组(n=150)。两组患者的年龄分别为 39.0(28.0,56.8)岁和 51.0(38.8,57.0)岁。两组在性别、肿瘤最大直径(>1 cm)、同侧中央淋巴结(Ipsi-CLNs)转移、Ipsi-CLNs转移数量(≥4)、侧淋巴结转移和Cont-CLNs转移方面差异有统计学意义(所有POR=2.926,95%CI:1.063-8.051)、肿瘤最大直径>1 cm(OR=4.471,95%CI:1.344-14.877)、Ipsi-CLNs转移≥4个(OR=5.011,95%CI:1.815-13.834)分别为Cont-CLNs转移的危险因素(所有PCI:0.744-0.898)、82.5%和63.4%。在内部验证组中,预测模型预测中高危uPTC的Cont-CLNs转移的ROC曲线AUC、灵敏度和特异度分别为0.810(95%CI:0.717-0.902)、63.3%和83.7%。建模组和验证组的校准曲线显示该模型具有良好的校准能力。建模组和验证组的 DCA 曲线表明,预测模型具有良好的临床适应性。结论:本研究构建的预测模型对中高危uPTC的Cont-CLNs转移具有良好的预测效果。当中高危uPTC患者为男性,肿瘤最大直径>1 cm,且Ipsi-CLNs转移灶数量≥4个时,应警惕Cont-CLNs转移,可考虑双侧中央淋巴结清扫术。
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引用次数: 0
[Changes in the expression of genes related to intestinal fatty acid oxidation and carnitine metabolism in patients with ulcerative colitis]. [溃疡性结肠炎患者肠道脂肪酸氧化和肉碱代谢相关基因表达的变化]。
Q3 Medicine Pub Date : 2024-09-24 DOI: 103760/cma.j.cn112137-20240626-01424
L J Jiang, M Y Guo, H Yang
<p><p><b>Objective:</b> To investigate the changes in gene expression related to intestinal fatty acid oxidation and carnitine metabolism in patients with ulcerative colitis (UC). <b>Methods:</b> A retrospective study was conducted involving patients with UC (UC group) and non-UC controls (control group) who underwent routine colonoscopy to exclude polyps at Peking Union Medical College Hospital between January 1, 2018, to December 31, 2023. Colon tissue samples were collected from both groups and RNA was extracted. Real-time fluorescence quantitative polymerase chain reaction technology was used to detect the mRNA expression levels of genes related to fatty acid oxidation and carnitine metabolism and to analyze their correlation with inflammatory gene expression. The expression of genes linked to fatty acid oxidation and carnitine metabolism was analyzed by analyzing the colonic mucosal transcriptome data of UC patients and controls in high-throughput gene expression database (GEO). Immunohistochemistry was used to examine the expression of the carnitine transporter SLC6A14 in the intestinal tissues of both groups at the protein level. Eight-week-old male C57BL/6 mice were selected and divided into a drinking water group (drinkind daily water) and a dextran sodium sulfate (DSS) group (drinking 2.5% DSS solution) with 4 mice in each group. DSS was used to induce an acute colitis model in mice and detect the difference in mRNA expression levels of SLC6A14 and interleukin-6 (IL-6) in the intestinal tissues of the both groups of mice. <b>Results:</b> A total of 22 patients were included in the UC group, with 12 males and 10 females, aged 16-64 (40±12) years. The control group consisted of 10 patients, with 3 males and 7 females, aged 43-72 (64±8) years. The UC group had lower mRNA expression levels of genes related to fatty acid oxidation and transport in the intestine compared to those in the control group, such as CD36 [0.40 (0.27, 0.55) vs 0.93 (0.39, 2.93)], CPT1A [0.39 (0.07, 0.54) vs 0.93 (0.41, 1.71)], CPT1B (0.37±0.36 vs 1.37±0.89), CPT2 [0.36 (0.30, 0.43) vs 1.14 (0.68, 1.34)], CRAT [0.31 (0.25, 0.41) vs 1.06 (0.64, 1.73)], CROT [0.14 (0.10, 0.21) vs 0.95 (0.77, 1.27)] (all <i>P</i><0.05). The mRNA expression levels of genes related to carnitine transport in the UC group were lower than those in the control group, such as OCTN1 [0.18 (0.10, 0.41) vs 0.83 (0.41, 1.47)], OCTN2 [0.01 (0.00, 0.01) vs 0.47 (0.35, 2.15)] (both <i>P</i><0.05). The mRNA expression levels of the carnitine transporter gene SLC6A14 in the intestine of UC patients was higher than that of the control group [11.31 (5.34, 23.50) vs 0.78 (0.07, 3.70), <i>P</i><0.001], and showed a positive correlation with the inflammatory gene IL-6 (<i>r</i>=0.425, 95%<i>CI</i>: 0.076-0.681, <i>P</i>=0.019). Analysis of the GEO database revealed lower expression levels of CD36, CPT1A, CPT2, CRAT and CROT in UC group compared to controls (all <i>P</i><0.05), while the expression levels of
目的:研究溃疡性结肠炎患者肠道脂肪酸氧化和肉碱代谢相关基因表达的变化:研究溃疡性结肠炎(UC)患者肠道脂肪酸氧化和肉碱代谢相关基因表达的变化。方法: 对溃疡性结肠炎患者进行回顾性研究:一项回顾性研究涉及 2018 年 1 月 1 日至 2023 年 12 月 31 日期间在北京协和医院接受常规结肠镜检查以排除息肉的 UC 患者(UC 组)和非 UC 对照组(对照组)。采集两组患者的结肠组织样本并提取 RNA。采用实时荧光定量聚合酶链反应技术检测脂肪酸氧化和肉碱代谢相关基因的mRNA表达水平,并分析其与炎症基因表达的相关性。通过分析高通量基因表达数据库(GEO)中 UC 患者和对照组的结肠粘膜转录组数据,分析了脂肪酸氧化和肉碱代谢相关基因的表达。免疫组化技术用于检测肉碱转运体 SLC6A14 在两组患者肠道组织中的蛋白水平表达。选取八周大的雄性 C57BL/6 小鼠,将其分为饮用水组(每天饮水)和右旋糖酐硫酸钠(DSS)组(饮用 2.5% DSS 溶液),每组 4 只。用 DSS 诱导小鼠急性结肠炎模型,并检测两组小鼠肠道组织中 SLC6A14 和白细胞介素-6(IL-6)mRNA 表达水平的差异。结果UC组共有22名患者,其中男性12名,女性10名,年龄为16-64(40±12)岁。对照组有 10 名患者,其中男性 3 名,女性 7 名,年龄为 43-72 岁(64±8)岁。与对照组相比,UC 组与肠道脂肪酸氧化和转运相关的基因 mRNA 表达水平较低,如 CD36 [0.40 (0.27, 0.55) vs 0.93 (0.39, 2.93)]、CPT1A [0.39 (0.07, 0.54) vs 0.93 (0.41, 1.71)], CPT1B (0.37±0.36 vs 1.37±0.89), CPT2 [0.36 (0.30, 0.43) vs 1.14 (0.68, 1.34)], CRAT [0.31 (0.25, 0.41) vs 1.06 (0.64, 1.73)]、CROT [0.14 (0.10, 0.21) vs 0.95 (0.77, 1.27)](所有 PPPr=0.425, 95%CI: 0.076-0.681, P=0.019)。GEO 数据库分析显示,与对照组相比,UC 组 CD36、CPT1A、CPT2、CRAT 和 CROT 的表达水平较低(PPP 均=0.019)。与饮用水组相比,直饮水组肠道中 SLC6A14 的 mRNA 表达量更高(1.83±0.90 vs 0.60±0.10,P=0.035)。结论UC患者肠道脂肪酸氧化和肉碱代谢相关基因(CD36、CPT1A、CPT1B、CPT2、CRAT、CROT、OCTN1和OCTN2)的表达水平降低,而同时能转运氨基酸和肉碱的基因SLC6A14的表达水平升高。
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引用次数: 0
[Chinese expert consensus on cardiac biomarkers for monitoring and management of cardiovascular toxicity in cancer therapy (2024 edition)]. [监测和管理癌症治疗中心血管毒性的心脏生物标志物中国专家共识(2024 年版)]。
Q3 Medicine Pub Date : 2024-09-24 DOI: 10.3760/cma.j.cn112137-20240510-01091

In recent years, the treatment of malignant tumors has continually advanced, significantly extending the survival period of cancer patients. Tumors are increasingly present as chronic diseases over the long term, and the cardiovascular toxicity associated with cancer treatment has become increasingly prominent, severely affecting the effective treatment and survival of cancer patients. As a result, cardio-oncology has gained considerable attention as an emerging discipline. However, cardiovascular diseases in cancer patients often have an insidious onset, and early identification and treatment are frequently overlooked. Throughout the course of cancer treatment, it is crucial to reasonably apply cardiac biomarkers for risk stratification, early identification, and screening of cardiovascular diseases in patients, as well as to improve the early diagnosis and treatment levels of cardiovascular diseases in cancer patients. To this end, Cardio-Oncology Group, Chinese Society of Cardiology in conjunction with Cardiovascular Expert Committee, China Medical Doctor Association of Laboratory Medicine, organized experts in relevant fields to compile this consensus. It aims to provide a basis for clinicians to standardize the screening and management of cardiovascular toxicity related to cancer treatment through the reasonable application of cardiac biomarkers.

近年来,恶性肿瘤的治疗技术不断进步,大大延长了癌症患者的生存期。肿瘤越来越多地表现为长期慢性疾病,与癌症治疗相关的心血管毒性也日益突出,严重影响了癌症患者的有效治疗和生存。因此,心血管肿瘤学作为一门新兴学科受到了广泛关注。然而,癌症患者的心血管疾病往往起病隐匿,早期发现和治疗往往被忽视。在整个癌症治疗过程中,合理应用心脏生物标志物对患者进行心血管疾病的风险分层、早期识别和筛查,提高癌症患者心血管疾病的早期诊断和治疗水平至关重要。为此,中华医学会心血管病学分会心血管肿瘤学组联合中国医师协会检验医师分会心血管专家委员会,组织相关领域专家编写了本共识。旨在为临床医生通过合理应用心脏生物标志物,规范肿瘤治疗相关心血管毒性的筛查和管理提供依据。
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引用次数: 0
[Establishing a predictive model for the activity of idiopathic inflammatory myopathy based on MRI and clinical features]. [根据核磁共振成像和临床特征建立特发性炎症性肌病活动性预测模型]。
Q3 Medicine Pub Date : 2024-09-24 DOI: 10.3760/cma.j.cn112137-20240805-01790
Z J Wang, Z R Tian, Y Q Wang, B Tian, R Gong, S S Chi

Objective: To analyze MRI and clinical characteristics of idiopathic inflammatory myopathy (IIM) activity and construct a prediction model. Methods: A retrospective analysis was conducted on 326 patients with IIM from December 2019 to December 2023 at General Hospital of Ningxia Medical University, including 112 males and 214 females, aged(53.7±15.3) years. According to histopathology and electromyography, they were divided into active phase group(n=86) and inactive phase group (n=240). The two groups were randomly divided into the training set and the verification set according to the ratio of 7∶3. The single factor analysis, least absolute shrinkage and selection operator (Lasso), random forest algorithm, and multivariate logistic regression model were used to screen the risk factors of IIM activity and construct a prediction model. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the performance of prediction model. Results: There were significant differences in gender, age, T1 value, T2 value, creatine kinase-MB(CKMB), creatine kinase (CK) and lactate dehydrogenase (LDH) between the two groups(all P<0.05). Lasso and random forest algorithm screened 5 variables for analysis, age (λ=-0.009), T2 value (λ=-2.564), CKMB (λ=-0.256), CK (λ=-0.492), LDH (λ=-2.786) respectively. Multivariate logistic regression model showed that age (OR=1.603, 95%CI: 1.030-1.096), T2(OR=352.269, 95%CI: 13.303-9 328.053), CKMB (OR=2.470, 95%CI: 1.497-4.075), CK(OR=4.973, 95%CI: 2.583-9.575), LDH(OR=1 155.247, 95%CI: 152.387-8 757.954) were risk factors for active IIM patients. A prediction model nomograms were drawn with the above risk factors included. The area under the ROC curve (AUC) of the prediction model for the training set MRI combined with clinical indicators was higher than that of the clinical indicator model [0.914 (95%CI: 0.873-0.955) vs 0.901 (95%CI: 0.858-0.945), P<0.001], with sensitivity of 88.3% and 90.7%, and specificity of 81.7% and 75.0%, respectively. The AUC of the prediction model for the validation set MRI combined with clinical indicators was higher than that of the clinical model [0.982 (95%CI: 0.873-0.955) vs 0.934 (95%CI: 0.858-0.945), P<0.001], with sensitivity of 97.2% and 88.5%, and specificity of 100.0% and 92.3%, respectively. The calibration curves plotted in the training set and test set, respectively, fit well with the ideal curve. Conclusion: The nomogram model of MRI combined with clinical indicators can effectively predict the activity of IIM.

目的分析特发性炎症性肌病(IIM)活动的磁共振成像和临床特征,并构建预测模型。方法回顾性分析宁夏医科大学总医院2019年12月至2023年12月收治的326例特发性炎症性肌病患者,其中男112例,女214例,年龄(53.7±15.3)岁。根据组织病理学和肌电图将其分为活动期组(n=86)和非活动期组(n=240)。两组按 7∶3 的比例随机分为训练集和验证集。采用单因素分析、最小绝对收缩和选择算子(Lasso)、随机森林算法和多元逻辑回归模型筛选 IIM 活动的危险因素并构建预测模型。采用接收者操作特征曲线(ROC)和校准曲线评估预测模型的性能。结果两组的性别、年龄、T1 值、T2 值、肌酸激酶-MB(CKMB)、肌酸激酶(CK)和乳酸脱氢酶(LDH)分别存在明显差异(所有 P2 值(λ=-2.564)、CKMB(λ=-0.256)、CK(λ=-0.492)、LDH(λ=-2.786))。多变量逻辑回归模型显示,年龄(OR=1.603,95%CI:1.030-1.096)、T2(OR=352.269,95%CI:13.303-9 328.053)、CKMB(OR=2.470,95%CI:1.497-4.075)、CK(OR=4.973,95%CI:2.583-9.575)、LDH(OR=1 155.247,95%CI:152.387-8 757.954)是活动性 IIM 患者的危险因素。绘制了包含上述风险因素的预测模型提名图。训练集 MRI 结合临床指标预测模型的 ROC 曲线下面积(AUC)高于临床指标模型[0.914(95%CI:0.873-0.955) vs 0.901(95%CI:0.858-0.945),PCI:0.873-0.955) vs 0.934(95%CI:0.858-0.945),PC结论:核磁共振成像的提名图模型结合临床指标可有效预测IIM的活动性。
{"title":"[Establishing a predictive model for the activity of idiopathic inflammatory myopathy based on MRI and clinical features].","authors":"Z J Wang, Z R Tian, Y Q Wang, B Tian, R Gong, S S Chi","doi":"10.3760/cma.j.cn112137-20240805-01790","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240805-01790","url":null,"abstract":"<p><p><b>Objective:</b> To analyze MRI and clinical characteristics of idiopathic inflammatory myopathy (IIM) activity and construct a prediction model. <b>Methods:</b> A retrospective analysis was conducted on 326 patients with IIM from December 2019 to December 2023 at General Hospital of Ningxia Medical University, including 112 males and 214 females, aged(53.7±15.3) years. According to histopathology and electromyography, they were divided into active phase group(<i>n</i>=86) and inactive phase group (<i>n</i>=240). The two groups were randomly divided into the training set and the verification set according to the ratio of 7∶3. The single factor analysis, least absolute shrinkage and selection operator (Lasso), random forest algorithm, and multivariate logistic regression model were used to screen the risk factors of IIM activity and construct a prediction model. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the performance of prediction model. <b>Results:</b> There were significant differences in gender, age, T<sub>1</sub> value, T<sub>2</sub> value, creatine kinase-MB(CKMB), creatine kinase (CK) and lactate dehydrogenase (LDH) between the two groups(all <i>P</i><0.05). Lasso and random forest algorithm screened 5 variables for analysis, age (λ=-0.009), T<sub>2</sub> value (λ=-2.564), CKMB (λ=-0.256), CK (λ=-0.492), LDH (λ=-2.786) respectively. Multivariate logistic regression model showed that age (<i>OR</i>=1.603, 95%<i>CI</i>: 1.030-1.096), T<sub>2</sub>(<i>OR</i>=352.269, 95%<i>CI</i>: 13.303-9 328.053), CKMB (<i>OR</i>=2.470, 95%<i>CI</i>: 1.497-4.075), CK(<i>OR</i>=4.973, 95%<i>CI</i>: 2.583-9.575), LDH(<i>OR</i>=1 155.247, 95%<i>CI</i>: 152.387-8 757.954) were risk factors for active IIM patients. A prediction model nomograms were drawn with the above risk factors included. The area under the ROC curve (AUC) of the prediction model for the training set MRI combined with clinical indicators was higher than that of the clinical indicator model [0.914 (95%<i>CI</i>: 0.873-0.955) vs 0.901 (95%<i>CI</i>: 0.858-0.945), <i>P</i><0.001], with sensitivity of 88.3% and 90.7%, and specificity of 81.7% and 75.0%, respectively. The AUC of the prediction model for the validation set MRI combined with clinical indicators was higher than that of the clinical model [0.982 (95%<i>CI</i>: 0.873-0.955) vs 0.934 (95%<i>CI</i>: 0.858-0.945), <i>P</i><0.001], with sensitivity of 97.2% and 88.5%, and specificity of 100.0% and 92.3%, respectively. The calibration curves plotted in the training set and test set, respectively, fit well with the ideal curve. <b>Conclusion:</b> The nomogram model of MRI combined with clinical indicators can effectively predict the activity of IIM.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 36","pages":"3409-3415"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Confirmatory factor analysis of the Chinese version of tinnitus handicap inventory]. [中文版耳鸣障碍量表的确认性因素分析]。
Q3 Medicine Pub Date : 2024-09-24 DOI: 10.3760/cma.j.cn112137-20240220-00354
Q Wang, C Diao, Y Zhao, Z L Meng

Objective: To explore the validity of the Chinese version of tinnitus handicap inventory (THI-CM) using confirmatory factor analysis. Methods: A cross-sectional study was carried out. The patients who complained of tinnitus and visited the Department of Otolaryngology, Head and Neck Surgery at West China Hospital of Sichuan University from March 15 to June 28, 2023 were included. All participants underwent pure tone audiometry and acoustic impedance testing before filling out THI-CM, and the results were subjected to confirmatory factor analysis. Results: A cross-sectional study was carried out. A total of 300 patients aged (47±13) years participated in this study. There were 175 females (58.3%) and 125 males (41.7%). The confirmatory factor analysis showed that χ2/df was 1.597<3.00, root mean square error of approximation (RMSEA) was 0.039<0.05, and standardized root mean square residual (SRMR) was 0.091>0.08. The incremental fit index (IFI), Tucker-Lewis index (TLI), comparative fit index (CFI), and goodness of fit index (GFI) were 0.960, 0.954, 0.960, and 0.902, respectively. The overall model fitted well. Except for one item with a load of 0.493, the load values of the other items were between 0.553 and 0.771. The composite reliability (CR) values of the three dimensions of the scale were between 0.769 and 0.901 (all CR>0.7). The average variance extracted (AVE) values ranged from 0.403 to 0.505 (all AVE<0.7), indicating poor convergent validity of the scale. The square value of AVE in each dimension of the scale was smaller than the correlation coefficient between factors, indicating poor discriminant validity of the scale. Conclusions: The THI-CM has good structural validity, which can be used as an effective tool to evaluate the overall severity of tinnitus. However, its convergent validity and discriminant validity are poor.

目的采用确证因素分析法探讨中文版耳鸣障碍量表(THI-CM)的有效性。方法:进行横断面研究:进行横断面研究。研究对象为 2023 年 3 月 15 日至 6 月 28 日在四川大学华西医院耳鼻咽喉头颈外科就诊的耳鸣患者。所有参与者在填写THI-CM前均接受了纯音测听和声阻抗测试,并对结果进行了确认性因子分析。研究结果这是一项横断面研究。共有 300 名年龄为(47±13)岁的患者参与了此次研究。其中女性 175 人(58.3%),男性 125 人(41.7%)。确证因子分析显示,χ2/df 为 1.5970.08。增量拟合指数(IFI)、塔克-刘易斯指数(TLI)、比较拟合指数(CFI)和拟合优度指数(GFI)分别为 0.960、0.954、0.960 和 0.902。整体模型拟合良好。除一个项目的负荷值为 0.493 外,其他项目的负荷值均在 0.553 至 0.771 之间。量表三个维度的综合信度(CR)值介于 0.769 和 0.901 之间(CR 均大于 0.7)。平均方差提取(AVE)值介于 0.403 和 0.505 之间(均为 AVEC 结论):THI-CM 具有良好的结构效度,可作为评估耳鸣整体严重程度的有效工具。但是,其收敛效度和判别效度较差。
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引用次数: 0
[Clinical practice guideline for autologous bone grafting in China (2024 edition)]. [中国自体骨移植临床实践指南(2024 年版)》。]
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240226-00413

Autogenous bone has always been the gold-standard bone graft material. As such, it is the primary choice for bony grafts. Autogenous bone grafting has been performed for hundreds of years, and more than 2 million cases of autogenous bone transplantation are performed each year worldwide. It has become the most commonly used surgical method in orthopedics. Numerous studies have suggested methods to select the appropriate donor area, standardize the surgical procedure, and reduce donor site complications, but clinical standards and guidelines remain to be established. To better guide the clinical practice of physicians in China, the Trauma Orthopedic Branch of the Chinese Orthopedic Association, the External Fixation and Limb Reconstruction Branch of the Chinese Orthopedic Association, and the Microsurgery Branch of the Beijing Orthopedic Association developed the "Clinical practice guideline for autogenous bone grafting in China (2024 edition)" based on current medical evidence. This guideline systematically evaluates recent domestically and internationally published literature and medical research evidence in the field of autologous bone grafting in the Chinese population. The guideline was produced with the aim of standardizing the indications and techniques for autogenous bone transplantation, as well as preventing complications at the harvesting site of autologous bone, in the Chinese population.

自体骨一直是黄金标准的骨移植材料。因此,它是骨移植的首要选择。自体骨移植已有数百年的历史,全世界每年进行的自体骨移植手术超过 200 万例。它已成为矫形外科最常用的手术方法。大量研究提出了选择合适供体区域、规范手术过程和减少供体部位并发症的方法,但临床标准和指南仍有待建立。为了更好地指导中国医师的临床实践,中华医学会骨科学分会创伤骨科学组、中华医学会骨科学分会外固定与肢体重建学组和北京骨科学会显微外科分会根据目前的医学证据制定了《中国自体骨移植临床实践指南(2024年版)》。该指南系统评估了近期国内外发表的自体骨移植在中国人群中的应用文献和医学研究证据。该指南旨在规范中国人群自体骨移植的适应症和技术,预防自体骨获取部位的并发症。
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引用次数: 0
[Super minimally invasive surgery changing the treatment paradigm for rectal cancer]. [超微创手术改变直肠癌治疗模式]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240205-00278
Q Q Chen, E Q Linghu

The treatment mode for patients with low rectal cancer (LRC) is still mainly surgical treatment. With the advancement of medical technology, the current surgical mode is more inclined towards super minimally invasive surgery (SMIS) that preserves organs and functions. SMIS belongs to organ preservation surgery, including non-full thickness and full-thickness resection under digestive endoscopy, laparoscopic or robotic full-thickness resection, and transanal minimally invasive surgery, which can cover all stages of TNM staging. The paper elaborates on the importance of preoperative accurate diagnosis and risk stratification in selecting appropriate SMIS methods, the new progress of imaging technology in accurately predicting lymph node metastasis, providing preoperative TNM staging and risk stratification, and guiding SMIS treatment. Finally, the paper introduces the SMIS surgical options for the treatment of LRC that have been developed and are currently in the clinical research stage, with the aim of maximizing the quality of life for LRC patients.

低位直肠癌(LRC)患者的治疗模式仍以手术治疗为主。随着医疗技术的进步,目前的手术模式更倾向于保留器官和功能的超微创手术(SMIS)。SMIS属于保留器官手术,包括消化内镜下非全厚和全厚切除术、腹腔镜或机器人全厚切除术、经肛门微创手术等,可覆盖TNM分期的所有阶段。本文阐述了术前准确诊断和风险分层对选择合适的 SMIS 方法的重要性,以及影像技术在准确预测淋巴结转移、提供术前 TNM 分期和风险分层、指导 SMIS 治疗方面的新进展。最后,本文介绍了已经开发并正在临床研究阶段的治疗 LRC 的 SMIS 手术方案,旨在最大限度地提高 LRC 患者的生活质量。
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引用次数: 0
[Chinese guideline for clinical application of fluid biomarkers for Alzheimer's disease(2024 edition)]. [中国阿尔茨海默病体液生物标志物临床应用指南(2024 年版)]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240523-01174

Alzheimer's disease is the most prevalent neurodegenerative disorder leading to cognitive impairment, but its progression is subtle and the early recognition is difficult. With advancements in disease-modifying therapies, the need for precise early diagnosis of Alzheimer's disease is increasingly pressing. Fluid biomarkers of Alzheimer's disease, detectable in bodily fluid samples, are intricately associated with the disease.It can be used for screening, diagnosis, staging, prediction of disease progression, and clinical trials, playing an increasingly critical role in clinical practice.. This guideline systematically reviews and evaluates the spectrum of fluid biomarkers for Alzheimer's disease, propose standardized protocols for sample collection and processing, and delineates the application standards of fluid biomarkers in disease screening, diagnosis, staging, prognosis of disease progression, and clinical trials. A total of 24 recommendations have been formulated. The publication of this guideline aims to standardize the application of fluid biomarkers in clinical practice, thereby advancing research in Alzheimer's disease fluid biomarkers.

阿尔茨海默病是导致认知障碍的最常见的神经退行性疾病,但其进展十分微妙,早期识别十分困难。随着改变疾病疗法的发展,对阿尔茨海默病早期精确诊断的需求日益迫切。可在体液样本中检测到的阿尔茨海默病体液生物标志物与该病有着错综复杂的联系,可用于筛查、诊断、分期、预测疾病进展和临床试验,在临床实践中发挥着越来越关键的作用。本指南系统地回顾和评估了阿尔茨海默病体液生物标志物的范围,提出了样本采集和处理的标准化方案,并划定了体液生物标志物在疾病筛查、诊断、分期、疾病进展预后和临床试验中的应用标准。共制定了 24 项建议。该指南的发布旨在规范体液生物标志物在临床实践中的应用,从而推动阿尔茨海默病体液生物标志物的研究。
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引用次数: 0
[The development, implementation principles and application of the endoscopic super minimally invasive surgery]. [内窥镜超微创手术的发展、实施原则和应用]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240205-00275
Q Q Chen, E Q Linghu

Endoscopic therapy has gone through three stages of development: intraluminal treatment, endoscopic tunneling technology, and endoscopic super minimally invasive surgery (ESMIS). Compared to the drawbacks of traditional surgical methods"organ resection and anatomical reconstruction", super minimally invasive surgery (SMIS) emphasizes the surgical concept of"curing diseases while preserving organs and functions". SMIS conducts treatment through four channels: natural cavity channel, tunnel channel, puncture channel, and multi cavity channel. It offers dozens of surgical methods for diagnosing and treating gastrointestinal diseases. At present, relatively sound implementation principles for ESMIS treatment have been established to ensure the safety and effectiveness of surgery, and to continuously expand other diagnostic and therapeutic fields.

内镜治疗经历了三个发展阶段:腔内治疗、内镜隧道技术和内镜超微创手术(ESMIS)。与传统手术方法 "器官切除和解剖重建 "的弊端相比,超微创手术(SMIS)强调 "治疗疾病的同时保留器官和功能 "的手术理念。超微创外科通过自然腔道、隧道腔道、穿刺腔道和多腔道四个腔道进行治疗。它为诊断和治疗胃肠道疾病提供了数十种手术方法。目前,ESMIS 治疗已建立了相对完善的实施原则,以确保手术的安全性和有效性,并不断拓展其他诊断和治疗领域。
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引用次数: 0
[Clinical characteristics of appendix orifice polyps and the effect endoscopic super minimally invasive treatment]. [阑尾口息肉的临床特征及内镜超微创治疗效果]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240124-00181
S D He, S Q Zhang, C Y Ge, L Zhang, Q Q Chen, G G Teng

To analyze the clinical characteristics of appendiceal orifice polyps and the effect of endoscopic super minimally invasive treatment. A retrospective analysis was conducted on the general situation (age and sex), the classification of appendiceal orifice polyps, the treatment method under endoscope, postoperative pathology and postoperative complications in patients who underwent resection of appendiceal orifice polyps at the Peking University First Hospital and the First Medical Center of the PLA General Hospital from January 1, 2022, to December 31, 2023. A total of 47 patients were included, consisting of 28 males and 19 females, with 35-86 (61±12) years. Appendiceal orifice polyps were classified into four types: type 0 (14 cases), type 1 (15 cases), type 2 (12 cases), and type 3 (6 cases). Among the endoscopic morphologies, 22 cases were granular laterally spreading tumors. Endoscopic mucosal dissection was performed in 37 cases. Postoperative appendiceal stent placement was performed in 1 case. The pathological types of polyps included adenoma in 15 cases, high-grade intraepithelial neoplasia in 10 cases, intramucosal carcinoma in 4 cases, submucosal carcinoma in 5 cases, inflammatory polyps in 1 cases, and sessile serrated lesion in 12 cases. Curative resection was performed in 44 cases. There were no postoperative complications such as bleeding, perforation, or acute appendicitis. The pathology of appendiceal polyps is mostly precancerous lesions, and the treatment scheme of endoscopic super minimally invasive resection is both safe and effective.

分析阑尾孔息肉的临床特点和内镜超微创治疗的效果。对2022年1月1日至2023年12月31日在北京大学第一医院和解放军总医院第一医学中心接受阑尾孔息肉切除术的患者的一般情况(年龄、性别)、阑尾孔息肉的分类、内镜下的治疗方法、术后病理及术后并发症进行回顾性分析。共纳入47例患者,其中男性28例,女性19例,年龄35-86(61±12)岁。阑尾口息肉分为四种类型:0 型(14 例)、1 型(15 例)、2 型(12 例)和 3 型(6 例)。在内镜形态中,22 例为颗粒状侧向扩散肿瘤。37 例进行了内镜下粘膜剥离术。1 例术后进行了阑尾支架置入术。息肉的病理类型包括腺瘤(15 例)、高级别上皮内瘤变(10 例)、黏膜内癌(4 例)、黏膜下癌(5 例)、炎性息肉(1 例)和无柄锯齿状病变(12 例)。有 44 例进行了根治性切除。术后无出血、穿孔或急性阑尾炎等并发症。阑尾息肉的病理多为癌前病变,内镜超微创切除的治疗方案既安全又有效。
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引用次数: 0
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Zhonghua yi xue za zhi
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