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Objective To construct a machine learning prediction model for postoperative liver injury in patients with non-liver surgery based on preoperative and intraoperative medication indicators.Methods A case-control study was conducted on 315 patients with liver injury after non-liver surgery selected from the databases developed by 3 large general hospitals from January 2014 to September 2022.With the positive/negative ratio of 1 ∶3,928 cases in corresponding period with non-liver surgery and without liver injury were randomly matched as negative control cases.These 1243 patients were randomly divided into the modeling group(n=869)and the validation group(n=374)in a ratio of 7∶3 using the R language setting code.Preoperative clinical indicators(basic information,medical history,relevant scale score,surgical information and results of laboratory tests)and intraoperative medication were used to construct the prediction model for liver injury after non-liver surgery based on 4 machine learning algorithms,k-nearest neighbor(KNN),support vector machine linear(SVM),logic regression(LR)and extreme gradient boosting(XGBoost).In the validation group,receiver operating characteristic(ROC)curve,precision-recall curve(P-R),decision curve analysis(DCA)curve,Kappa value,sensitivity,specificity,Brier score,and F1 score were applied to evaluate the efficacy of model.Results The model established by 4 machine learning algorithms to predict postoperative liver injury after non-liver surgery was optimal using the XGBoost algorithm.The area under the receiver operating characteristic curve(AUROC)was 0.916(95%CI:0.883～0.949),area under the precision-recall curve(AUPRC)was 0.841,Brier score was 0.097,and sensitivity and specificity was 78.95%and 87.10%,respectively.Conclusion The postoperative liver injury prediction model for non-liver surgery based on the XGBoost algorithm has effective prediction for the occurrence of postoperative liver injury.

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The phosphatase and tensin homolog deleted on chromosome ten (PTEN) is a common oncogene located in the 10q23.3 region on the long arm of human chromosome l0, which regulates a variety of biological processes such as proliferation, survival, cell structure, motility, energy metabolism and genomic stability. Inactivation of PTEN is prevalent in almost all malignancies and correlates with tumor progression. Thyroid malignancies are among the most common endocrine malignancies, and PTEN has been shown to be critically associated with their development. The aim of this review is to describe the structural function of PTEN, as well as to summarize and discuss the recent findings of PTEN in thyroid malignancies.

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Triple-negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer, accounting for about 15%-20% of all breast cancer patients. Its characteristics such as young age of onset, high risk of recurrence and visceral metastasis, and poor prognosis make it an urgent problem to be solved in clinical practice. With the rapid progress of genomics and proteomics, more and more potential therapeutic targets of TNBC have been identified, and the preliminary results show that these targets are promising to transform the treatment mode of TNBC in the future. This article reviews the clinical trials and applications of TNBC targeted drugs, as well as gives a brief introduction to nanomedicine.

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Objective:To investigate the risk factors of central lymph node metastasis (CLNM) in cN0 paillary thyroicl microcarcinoma (PTMC) and to establish a nomogram model for predicting the probability of cN0 PTMC CLNM.Methods:The clinicopathological data of 192 patients with cN0 PTMC admitted to the Department of General Surgery of the Second Hospital of Lanzhou University from Aug. 2016 to Aug. 2020 were retrospectively analyzed. There were 41 males and 151 females, 50 with CLNM and 142 without CLNM. The patients were divided into 2 groups according to the presence or absence of pathologically confirmed CLNM. Patient’s age, gender, tumor diameter, multiple, with Hashimoto’s disease, with nodular goiter, with or without near the posterior dorsal membrane, aspect ratio >1, with or without extratumoral infiltration, with or without lymphadenopathy, TSH levels, and TG levels were statistically analyzed. Pearson chi-square test was used to analyze the count data of hypothesis test, and the R language software package was used for Logistic multivariate analysis. The entry conditions were screened by stepwise regression to establish a nomogram prediction model, and the Bootstrap method was used for model verification. P<0.05 was considered statistically significant. Results:Multivariate logistic analysis showed that extratumoral invasion ( P=0.032) , presence of lymphadenopathy ( P=0.010) , and TG>68 μg/L ( P=0.007) were risk factors for central lymph node metastasis. The optimal model was established by stepwise regression. The factors included tumor diameter ≥0.5 cm, nodular goiter, extratumoral invasion, lymphadenopathy and TG>68 μg/L (AIC: 212.27) . The nomogram model was established according to the above risk factors. The consistency index (c-index) was 0.711. The results of calibration graph drawing and internal and external validation demonstrated its good consistency and applicability. Conclusion:Extratumoral invasion, lymphadenopathy, and TG>68 μg/L are risk factors for cN0 PTMC CLNM, and the nomogram established in the study can effectively predict the CLNM rate in patients with cN0PTMC and contribute to clinicians’ diagnosis and treatment decisions.

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Objective To investigate the prediction of axillary lymph node metastasis in patients with early breast cancer by sentinel lymph node biopsy (SLNB) combined with preoperative ultrasound.Methods From Jun 2014 to Oct 2018,340 patients with early breast cancer were enrolled in the 5th Department of General Surgery of Second Hospital of Lanzhou University.113 cases were grouped into ultrasound examing,75 patients in the SLNB,and 152 patients in the SLNB combined with preoperative ultrasound.Using the results of axillary lymph node dissection as gold standard,the 3 groups were compared.Results The sensitivity of SLNB,ultrasound and SLNB combined with ultrasound for suspicious axillary lymph node biopsy were 90.1％,85.7％,and 96.4％,respectively.The specificity was 84.0％,76.3％,and 100％,and the accuracy was 91.6％,83.0％,and 97.4％,respectively.The false negative rates were 8.6％,14.3％,and 3.6％,respectively.Conclusion Preoperative ultrasound diagnosis of axillary lymph node status combined with sentinel lymph node biopsy can significantly improve the diagnosis rate of axillary lymph node metastasis in early breast cancer.

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Objective@#To investigate the prediction of axillary lymph node metastasis in patients with early breast cancer by sentinel lymph node biopsy (SLNB) combined with preoperative ultrasound.@*Methods@#From Jun 2014 to Oct 2018, 340 patients with early breast cancer were enrolled in the 5th Department of General Surgery of Second Hospital of Lanzhou University. 113 cases were grouped into ultrasound examing, 75 patients in the SLNB, and 152 patients in the SLNB combined with preoperative ultrasound.Using the results of axillary lymph node dissection as gold standard, the 3 groups were compared.@*Results@#The sensitivity of SLNB, ultrasound and SLNB combined with ultrasound for suspicious axillary lymph node biopsy were 90.1%, 85.7%, and 96.4%, respectively. The specificity was 84.0%, 76.3%, and 100%, and the accuracy was 91.6%, 83.0%, and 97.4%, respectively. The false negative rates were 8.6%, 14.3%, and 3.6%, respectively.@*Conclusion@#Preoperative ultrasound diagnosis of axillary lymph node status combined with sentinel lymph node biopsy can significantly improve the diagnosis rate of axillary lymph node metastasis in early breast cancer.

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Objective To explore the diagnostic value of CEUS for thyroid TI-RADS 3,4 nodules.Methods The CEUS performence of 95 patients with thyroid TI-RADS 3,4 nodules (all were confirmed by surgery pathology) diagosed by conventional ultrasound were reviewed retrospectively,and the value of CEUS in the revision and differential diagnosis of thyroid TI-RADS 3,4 nodules were analyzed.Results Compared with pathological pattern,conventional ultrasound TI-RADS classifications in assessing the property of thyroid nodule had no statistical differences (χ2 =3.56,P =0.06).For thyroid TI-RADS 3,4 nodules,compared with conventional ultrasound TI-RADS classifications,the diagnosis accuracy of CEUS score and revised CEUS TI-RADS classifications showed significant differeces respectively (P=0.03,＜0.01) for thyroid papillary carcinoma greater than 1 cm.But no statistical difference were found respectively (P=0.25,1.00) for thyroid papillary carcinoma smaller than 1 cm.According to the ROC curve analysis,the area under the curve of traditional ultrasound TI-RADS classifications,CEUS score and revised CEUS TI-RADS classifications were 0.64,0.75,0.81 respectively,cut-off value was TI-RADS 4a,1 score,TI-RADS 4a respectively,the sensitivity and specificity of evaluating benign and malignant nodules was 45.3％ and 80.0％,69.3％ and 65.0％,82.7％ and 60.0％,respectively.The area under the ROC curve were statistical difference between CEUS score,revised CEUS TI-RADS classifications and conventional ultrasound TI-RADS classifications (both P＜0.05),while CEUS score and revised CEUS TI-RADS classifications without statistical difference.Conclusion CEUS had the revised and improved identification value for thyroid TI-RADS 3,4 nodules.

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Background and purpose:It has confirmed that docetaxel, in combination with cisplatin or oxaliplatin have good effect in the treatment of advanced gastric cancer. This study in order to observe the clinical efficacy and adverse reaction of weekly docetaxel combined with cisplatin (DP) versus weekly docetaxel combined with oxaliplatin (DO) as the firrst-line treatment of advanced gastric cancer.Methods:A total number of 76 cases of advanced gastric cancer were randomly assigned 2 arms, 38 per arm. DP regimen group (docetaxel 35 mg/m2,ivgtt,dl,d8 combined with cisplatin 60 mg/m2, ivgtt,dl,repeated every 3 weeks) and DO regimen group(docetaxel 35 mg/m2,ivgtt,dl,d8 combined with oxaliplatin 120 mg/m2 ivgtt,dl,repeated every 3 weeks). Results:No significant difference was found between DP regimen group and DO regimen group on the objective RR(37%vs 41%),PFS (4.9vs 4.4 months) and OS (9.7vs 12.3 months). The main grade 3 or 4 toxicity in the DP and DO groups was neutropenia, DO was less associated with nausea and vomiting, but more associated with peripheral neuropathy than DP group. No signiifcant difference was found between DP regimen group and DO regimen group on the anemia, thrombocytopenia, diarrhea, alopecia (P>0.05).Conclusion:Weekly docetaxel combined with cisplatin (DP) shows similar efifcacy and toxicity compared with weekly docetaxel combined with oxaliplatin (DO) as the ifrst-line treatment of advanced gastric cancer and worthy of further study.

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<p><b>OBJECTIVE</b>To observe the impact of PDE5shRNA on cardiac remodeling and heart function following myocardial infarction in mice.</p><p><b>METHODS</b>Myocardial infarction (MI) was induced in mice by left coronary artery ligation. Mice were randomly assigned to sham group (n = 6), PDE5shRNA group (n = 12), common adenovirus group (n = 15) and DMEM group (n = 8). Four weeks post-MI, the survival rate was evaluated. Cardiac function was examined by echocardiography. HE staining and Masson staining were used to evaluate the myocardial infarction size and fibrosis. The number of blood vessels was evaluated by immunohistochemistry, PDE5 protein expression in the left ventricular was detected using Western blot, level of cGMP or PKG activity in the left ventricle was evaluated with ELISA.</p><p><b>RESULTS</b>Four weeks post-MI, all mice survived in the sham group, 3(37%) mice died in the DMEM group, 1 (8%) died in the PDE5shRNA group and 5 died in the common adenovirus group (33%). Infarct size was significantly reduced in PDE5shRNA group compared with the common adenovirus group and DMEM group [(25.4 ± 2.9)% vs. (42.0 ± 3.2)% and (43.4 ± 2.6) %, P < 0.05]. Cardiac function was significantly improved in PDE5shRNA group compared to common adenovirus group and DMEM group[LVFS: (21.1 ± 3.7)% vs. (14.2 ± 2.9)% and (14.22 ± 2.91)%, all P < 0.05; LVEF: (48.2 ± 7.1)% vs. (34.6 ± 6.2)% and (38.1 ± 2.8)%, all P < 0.05; LVESD: (3.87 ± 0.45) mm vs.(4.91 ± 0.62) mm and (4.63 ± 0.37) mm, all P < 0.05]. The blood vessel density was also higher in PDE5shRNA group compared with common adenovirus group (infarct area:14.3 ± 2.0 vs. 6.6 ± 1.2, P < 0.05; periinfarct area: 23.6 ± 2.1 vs. 13.7 ± 2.4, P < 0.05). Compared with common adenovirus group, level of PDE5 was significantly downregulated and level of cGMP or PKG was significantly upregulated in PDE5shRNA group (all P < 0.05).</p><p><b>CONCLUSIONS</b>Present study suggests PDE5shRNA improves cardiac function and attenuates cardiac remodeling through reducing infarction size and cardiac fibrosis and these beneficial effects are possibly mediated by activating cGMP/PKG signaling pathway.</p>

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Objective To study the changes of insulin-like growth factor-1(IGF-1) in serum of patients with obstructive jaundice.Methods The clinical data of 20 patients with obstructive jaundice were collected and the measurement of serum TNF-?,ALT, ALP, endotoxin and IGF-1 were performed. Results The serum IGF-1 in obstructive jaundice was significantly lower than that in gallbladder stone(P

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ObjectiveTo study the diagnostic value of alteration of serum enzyme in acute intestinal ischemia(AII). MethodsChanges of serum levels of CPK, CKMB, LDH, LA, CRP and CO2CP of venous blood of 40 rabbits and 53 patients in different ischemia conditions at different time before and after operation were measured to determine the relationship between the changes and ischemia degree of intestine. ResultsThe serum levels of CPK, CKMB, LDH, LA and CRP increased gradually with the severity of AII and decreased with the improvement of AII, but CO2CP was the reverse.The 6 assay values mentioned above in animals of AII compared with the control group, and in patients in pretreatment compared with the control group, and in reversible intestinal necrosis compared with irreversible intestinal necrosis, and in nonoperation group 1 h after hospitalization compared with reversible intestinal necrosis group 2 h before operation(except CO2CP)all had remarkable difference(P

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Objective To analyse the significance and relation between soluble P-selectin (sP-selectin),D-dimer (D-d) and endotoxin (ET) in the patient with obstructive jaundice (OJ). Methods Blood plasma sP-selectin and D-d in OJ group,acute cholecystitis group and healthy group were detected by ELISA and ET was detected by the colorimetric method, Results In healthy group,the concentration of blood plasma sP-selectin was ( 93.43 ? 17.65 ) ng/ml,ET(0.0030?0.0004)EU/ml,and D-d(0.39?0.21)mg/L; in acute cholecystitis group,sP-selectin was (233.32?82.12) ng/ml, ET(0.4012?0.1506) EU/ml,and D-d(0.76?0.27)mg/L; in OJ group,sP-selectin was (351.90?93.83) ng/ml ,ET (0.3814?0.1430)EU/ml,and D-d(2.14?0.37)mg/L.The sP-selectin, D-d and ET in the acute cholecystitis group and the OJ group were higher than those in healthy group (P 0.05). sP-selectin and D-d in the OJ group were significantly higher than that in the acute cholecystitis group (P