Peking University Research Articles

Simplifying ANCA-associated vasculitis classification with ANCA specificity: a retrospective analysis.

This study aimed to evaluate the utility of ANCA specificity as a primary criterion for classifying AAV subtypes to simplify the diagnostic process without compromising accuracy. A retrospective cohort study was conducted involving 310 patients diagnosed with AAV between January 2015 and December 2023 across three tertiary care centers affiliated with Peking University. Patients were reclassified using three methods: the European Medicines Agency (EMA) algorithm, the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) criteria, and ANCA specificity-based classification. Concordance between classification systems was assessed using Cohen's kappa coefficients. ANCA specificity-based classification demonstrated substantial to almost perfect agreement with the 2022 ACR/EULAR criteria for MPA/MPO-AAV (kappa = 0.806) and GPA/PR3-AAV (kappa = 0.663). Many patients initially classified as GPA under the EMA algorithm were reclassified as MPA when using ANCA specificity. EGPA classification remained consistent across all methods (kappa = 0.725 between EMA and ACR/EULAR), suggesting that ANCA specificity is less critical for EGPA. The use of ANCA specificity simplified the classification process, aligning closely with the underlying pathophysiology of AAV subtypes. ANCA specificity serves as a valuable adjunct in the classification of AAV, particularly for distinguishing between MPA and GPA. Utilizing ANCA serotypes can simplify the diagnostic process, potentially facilitating earlier diagnosis and targeted treatment. For EGPA, traditional classification criteria remain effective. Incorporating ANCA specificity into clinical practice may enhance diagnostic accuracy and improve patient outcomes in AAV management. Key Points • ANCA-based classification aligns strongly with the 2022 ACR/EULAR criteria for MPA and GPA, providing a simplified diagnostic approach. • Adopting this approach can streamline the classification process, reduce invasive procedures, and enable earlier diagnosis while maintaining high concordance with established systems.

Analysis on the efficacy and safety of transvenous lead extraction in the treatment of patients with cardiac lead perforation

To investigate the efficacy and safety of transvenous lead removal (TLR) in the treatment of patients with cardiac lead perforation. The case data of 82 patients who underwent TLR for lead perforation at Peking University People's Hospital from January 2014 to June 2024 were retrospectively analyzed. The patients' age was (68.0±12.6) years, with 38 males and 44 females. Clinical symptoms of patients with lead perforation, characteristics of the perforated leads, operation success rate, complication incidence, tools used in TLR, and follow-up situation were analyzed. Clinical symptoms related to lead perforation were present in 80.5% (66/82) of patients, with chest pain being the most common [57.3%(47/82)]. Among the perforated leads, 6.1%(5/82) penetrated outside the pericardium, 58.5%(48/82) were delayed perforations, 65.9%(54/82) were active fixation leads, 78.0%(64/82) of the perforation sites were at the right ventricular apex, and 76.8%(63/82) had abnormal programmed lead parameters. The diagnosis of all lead perforations was confirmed by imaging examinations. Eight high-risk patients received percutaneous dry pericardiocentesis before surgery. Eighty-two patients underwent TRL surgery successfully, and no major complications occurred. Among the perforated leads, 57.3% (47/82) of the perforated leads were successfully removed manually. New leads were implanted in 91.5% (75/82) of patients during the same operation. Follow-up was conducted until August 2024, with a total follow-up duration of (5.1 ± 2.7) years. During the follow-up period, a total of 7 patients reached the end events, including 5 deaths and 2 patients who underwent TLR again. In experienced centers, TLR is a safe and effective treatment approach for cardiac implantable electronic devices lead perforation. Prophylactic dry pericardiocentesis can be used as an unconventional option.

A predictive diagnostic model for refractory diffuse large B-cell lymphoma: a single-center retrospective cohort study.

To develop a baseline predictive model for refractory diffuse large B-cell lymphoma (DLBCL) utilizing imaging data including ultrasound findings and PET-CT in conjunction with clinical parameters. We retrospectively analyzed data from 140 patients with newly diagnosed DLBCL treated at Peking University Third Hospital between January 2018 and January 2023. All patients underwent ultrasound, histopathological examinations and PET-CT examinations. After completing 6-8 cycles of standardized chemotherapy, patients were categorized into refractory and non-refractory groups according to the Lugano International Response Assessment Criteria. Univariate analyses were performed using T-tests and Chi-Squared Tests, and independent risk factors for refractory DLBCL were identified through logistic regression. A nomogram predictive model was constructed using the R package "rms," and its predictive performance was subsequently validated. Univariate analysis and logistic regression identified that blurred margins of the affected lymph nodes in ultrasound images (P < 0.001, OR = 18.238) and IPI score(P = 0.051, OR = 3.131) were significant risk factors for disease progression. The predictive nomogram established for refractory diffuse large B-cell lymphoma demonstrated an area under the receiver operating characteristic curve (AUC) of 0.835, with a sensitivity of 85.5% and specificity of 79.5%. Following internal validation, the predictive model exhibited a high degree of alignment between the estimated risk of refractory diffuse large B-cell lymphoma and the actual observed progression events. The prediction model of the R-DLBCL prediction model, amalgamating ultrasonic characterizations and clinical indicators, proves instrumental in identifying high-risk DLBCL groups.

Effectiveness of finerenone in Chinese patients with type 2 diabetes mellitus and chronic kidney disease with microalbuminuria: A retrospective real-world study.

No studies have specifically examined the effects of finerenone in treating type 2 diabetes patients with chronic kidney disease (CKD) and microalbuminuria. This study aimed to evaluate the effectiveness of finerenone in this group of patients. This retrospective real-world study (ChiCTR2400087169) included type 2 diabetes outpatients with CKD from the Peking University First Hospital between March 2023 and March 2024. All patients in this study had a urinary albumin-to-creatinine ratio (UACR) of 30-299 mg/g. The effects of finerenone were assessed by comparing UACR, HbA1c, creatinine, serum potassium, eGFR, and blood pressure at baseline and after treatment. Sixty-four patients (39 males and 25 females), with a median age of 65.75 years and a median duration of T2DM of 15.21 years, were included. The baseline median UACR was 100.50 mg/g, significantly decreased to 61.27 mg/g (P < 0.001) at 3 months and 62.49 mg/g (P < 0.001) at 6 months after treatment. None of the other parameters differed significantly. Finerenone alone or in combination with ABS inhibitors, SGLT2 inhibitors, or GLP-1 agonists did not result in significant differences in UACR reduction. Patients with a >30% UACR decrease had significantly higher baseline systolic blood pressure (SBP) than those with a ≤30% decrease (P < 0.05). Furthermore, baseline SBP significantly decreased after 6 months of treatment in patients with a >30% UACR reduction (P < 0.05). Finerenone is effective in treating type 2 diabetes with CKD and microalbuminuria. Improved SBP control leads to a greater UACR reduction.

Knowledge, attitude, and practice toward cervical spondylosis among the healthy general population

BackgroundThis study aimed to investigate the knowledge, attitude and practice (KAP) of the healthy general population toward cervical spondylosis.MethodsA cross-sectional study was conducted among healthy individuals at Peking University Third Hospital between May and December 2023, utilizing a self-designed questionnaire.ResultsA total of 506 valid questionnaires were collected, of which 276 (64.94%) were completed by females. The mean scores for knowledge, attitudes, and practices were 4.07 ± 1.24 (range: 0–8), 35.69 ± 3.67 (range: 9–45), and 27.01 ± 4.38 (range: 9–36), respectively. Structural equation modeling (SEM) revealed that knowledge had a direct influence on both attitudes (β = 0.589, P = 0.002) and practices (β = 0.353, P = 0.020). Furthermore, attitudes had a direct effect on practices (β = 0.442, P < 0.001).ConclusionThe healthy general population demonstrated inadequate knowledge, a positive attitude, and suboptimal practices regarding cervical spondylosis. These findings highlight the need for targeted educational interventions to improve public awareness and foster healthier practices in managing cervical spondylosis.

VIPAS39 confers ferroptosis resistance in epithelial ovarian cancer through exporting ACSL4.

VIPAS39 confers ferroptosis resistance in epithelial ovarian cancer through exporting ACSL4.

A retrospective study of microwave ablation and thoracoscopic surgery for multiple primary lung cancer: a propensity score matching analysis

PurposeMicrowave ablation (MWA) is a minimally invasive local treatment with demonstrated safety and efficacy, but its role in managing multiple primary lung cancer (MPLC) is not well-established. This study retrospectively evaluates the clinical effectiveness of MWA compared to video-assisted thoracoscopic surgery (VATS) in treating MPLC.Materials and methodsA retrospective analysis was conducted using data from patients with non-small cell lung cancer (NSCLC) treated at Peking University Cancer Hospital Yunnan Hospital between January 2021 and April 2024. All patients had undergone surgical resection for their first primary lung cancer (FPLC) and subsequently received either MWA or VATS for second primary lung cancer (SPLC). After 1:1 propensity score matching (PSM), 202 patients per group were included. Study endpoints included progression-free survival (PFS), overall survival (OS), complications, and pulmonary function changes.ResultsMedian follow-up was 24.47 months. Survival analysis revealed a statistically significant difference in PFS between MWA and VATS groups (HR = 2.74, 95% CI: 1.40–5.36, p = 0.006), while OS showed no difference (HR = 1.41, 95% CI: 0.45–4.36, p = 0.56). The incidence of grade ≥ II complications was significantly lower in the MWA group (p &amp;lt; 0.001). Pulmonary function tests indicated no significant changes in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1%, maximal voluntary ventilation (MVV), and diffusion capacity of the lung for carbon monoxide%(DLCO%) before and 1–3 month post MWA (p &amp;gt; 0.05).ConclusionsIn MPLC patients with stage IA SPLC, VATS demonstrates a greater clinical efficacy advantage in terms of local tumor control compared to MWA. Additionally, MWA provided significant advantages in reducing complication severity and preserving pulmonary function. These findings suggest that the therapeutic approach combining surgery with MWA represents a safe and effective option for MPLC.

Predictive significance of microcystic elongated and fragmented (MELF) growth pattern in the prognosis of no specific molecular profile endometrial endometrioid carcinoma

Objective: To investigate the association between the microcystic, elongated, and fragmented (MELF) growth pattern and the prognosis of no specific molecular profile endometrial endometrioid carcinoma (NSMP-EEC). Methods: A retrospective study was conducted on 911 NSMP-EEC patients diagnosed at the Pathology Department of Peking University Third Hospital from January 2015 to September 2023. Complete hysterectomy specimens were obtained from these patients. Utilizing sanger sequencing, next generation sequencing and immunohistochemical techniques, we conducted endometrial carcinoma molecular classification according to WHO 2020 criteria, and identified clinical staging based on the International Federation of Gynecology and Obstetrics (FIGO) 2023 criteria. The primary endpoints were progression-free survival and disease-specific survival. Patients were divided into MELF (+) and MELF (-) groups based on the presence or absence of the MELF growth pattern, and clinicopathological characteristics were compared between the two groups. Kaplan-Meier survival curves were used to analyze the association between the MELF growth pattern and prognosis, and log-rank tests were performed to compare differences between groups. Results: The age of the 911 patients was (54.4±10.7) years, with a follow-up time [M (Q1,Q3)] of 24.0 (11.0, 41.0) months, and of which 147 patients (16.1%) belonged to the MELF (+) group. The MELF (+) group had a higher proportion of postmenopausal patients and G1/G2, deep myometrial invasion, lymphovascular space invasion, and lymph node metastasis, higher FIGO stages, higher ESGO risk groups, and higher tumor recurrence rates compared to the MELF (-) group (all P<0.05). The cumulative 5-year progression-free survival rate for MELF (-) and MELF (+) patients were 92.2% and 85.8%, respectively (P=0.015). In the G1/G2 NSMP-EEC cohort, the cumulative 5-year progression-free survival rate for MELF (-) and MELF (+) patients were 94.2% and 86.6%, respectively (P=0.003). The prognosis of NSMP-EEC patients with 2023 FIGO stage I was better, exhibiting a cumulative 5-year progression-free survival rate of 95.2% and a cumulative 5-year disease-specific survival rate of 99.1%, respectively, and MELF (+) was not associated with a decrease in either the cumulative progression-free survival rate (P=0.213) or the cumulative disease-specific survival rate (P=0.373) of patients. Conclusions: In NSMP-EEC patients, MELF (+) is associated with various adverse clinicopathological indicators and increased recurrence risk, providing a simple and rapid morphological indicator for risk stratification. The prognosis of NSMP-EEC patients with 2023 FIGO stage Ⅰis better, and the use of MELF alone is insufficient for risk stratification.

Risk management in POCT blood glucose monitoring: FMEA approach aligned with ISO 15189:2022.

Point-of-care testing (POCT) blood glucose meters provide rapid and convenient monitoring for clinical care and chronic disease management. However, their accuracy is often compromised by risks associated with personnel, equipment, and procedural inconsistencies. This study systematically assesses these risks using the Failure Mode and Effects Analysis (FMEA) method and proposes control measures aligned with ISO 15189:2022 standards. This study evaluated the risks associated with POCT blood glucose meters in clinical laboratory settings, encompassing the pre-analytical, analytical, and post-analytical phases. A multidisciplinary team employed FMEA to identify potential failure modes and their impacts. A risk matrix classified risks based on probability and severity, with "unacceptable" risks prompting targeted control measures. A follow-up assessment conducted three months later evaluated the effectiveness of these measures through feedback collection and quality control data analysis, ensuring effective risk mitigation in POCT practices. The risk assessment identified distinct issues at each hospital: Peking University Shenzhen Hospital faced significant risks related to inadequate performance verification prior to hospital entry, insufficient personnel training, and data management problems, while Wuhan Third Hospital primarily encountered challenges with inadequate training and insufficient calibration and inadequate quality control. Control measures implemented at Peking University Shenzhen Hospital included stringent validation protocols, comprehensive training systems, and automated data management. At Wuhan Third Hospital, the focus was on enhancing training oversight and establishing rigorous quality control measures and calibration Schedule. These interventions effectively reduced unacceptable risks and improved the safety and reliability of the monitoring process. Integrating FMEA with ISO 15189:2022 provides a structured approach for identifying and mitigating risks in the use of POCT blood glucose meters. Implementing tailored measures significantly enhances POCT accuracy and reliability, offering clinical institutions effective strategies to improve quality and ensure better patient outcomes.

Association of uric acid to high-density lipoprotein cholesterol ratio with the presence or absence of hypertensive kidney function: results from the China Health and Retirement Longitudinal Study (CHARLS).

Some studies have shown that uric acid (UA) to high-density lipoprotein (HDL-C) ratio (UHR), as an indicator of inflammation, is associated with metabolic syndrome and hypertension, but its relationship with decreased renal function is unclear. This study intends to analyze the relationship between UHR and decline in renal function. Data were obtained from the 2011-2015 data of the China Health and Aging Tracking Survey (CHARLS) of Peking University, and 7,198 study participants were included and followed up until 2015. The eGFR (Total glomerular filtration rate) was estimated according to the CKD-EPI [1] creatinine equation. eGFR ≥ 60mL/min/1.73m² at baseline renal function was defined as normal renal function, and eGFR < 60mL/min/1.73m² at baseline renal function was defined as chronic kidney disease; new-onset eGFR < 60mL/min/1.73m² was defined as the occurrence of decline in renal function; in the chronic kidney disease population decrease in eGFR ≥ 5mL/min/1.73m²/year or 30% from baseline or admission to dialysis was defined as rapid progression of chronic kidney disease. eGFR slope was defined as the ratio of the difference between the final eGFR and the baseline eGFR over 4 years of follow-up. Binary logistic regression was used to analyze the relationship between UHR and renal function decline or progression, as well as linear regression and non-linear regression to clarify the relationship between UHR and GFR slope in hypertensive patients, and the correlation between UHR and CRP, and to assess the relationship between UHR levels and the risk of renal function decline in hypertensive people. (1) Hypertension was a risk factor for the decline of renal function (OR: 1.34, P = 0.03); (2) UHR was a risk factor for the decline of renal function in the hypertensive population (OR: 1.32, P = 0.02), and with the increasing level of UHR, the risk of developing CKD (Chronic Kidney Disease) in hypertension was higher (P for trend = 0.03); (3) The subgroup analyses showed that there was no interaction between hypertension and age, cystatin C and hemoglobin did not interact with each other; (4), In the hypertensive population, the slope of UHR and eGFR showed a J-shaped correlation, with UHR > 7.6% as the cut-off point, and the slope of eGFR tended to increase with increasing UHR; in the non-hypertensive population UHR and eGFR showed a linear correlation, and the slope of the decline in eGFR was smaller than that of the hypertensive population; (5), After adjusting for confounders, UHR and CRP were positive correlation (t = 3.56, P < 0.05); (6) In the hypertensive population with normal CRP, the risk of decline in renal function increased accordingly with increasing UHR (P = 0.003). UHR did not show a correlation with CRP in the hypertensive population with abnormal CRP (P = 0.24). In the hypertensive population, elevated UHR is associated with an increased risk of decline in renal function; with UHR > 7.6% as the cut-off point, the slope of eGFR tended to increase with increasing UHR, and UHR can be used as an indicator for risk stratification of renal injury in the hypertensive population.

Higher triglyceride-glucose index is associated with severe proteinuria and decreased renal function in patients with primary membranous nephropathy

BackgroundIn recent years, the triglyceride-glucose (TyG) index has emerged as a reliable surrogate marker of insulin resistance (IR). This study aimed to investigate the association between the TyG index and severe proteinuria or decreased renal function in patients with primary membranous nephropathy (PMN).MethodsWe consecutively enrolled 536 patients with PMN hospitalized at Peking University Third Hospital from January, 2014 to December, 2023. The TyG index was calculated as Ln[fasting triglyceride (mg/dL)×fasting blood glucose (mg/dL)/2]. All participants were categorized into quantiles according to the TyG index. Severe proteinuria was defined as 24 h urine protein > 3.5 g/d, and decreased renal function was defined as the estimated glomerular filtration rate < 90 mL/min/1.73m2. Multivariable logistic regression, restricted cubic spline (RCS) curves, and receiver operating characteristic (ROC) curves were used for analysis.ResultsAmong 536 patients with PMN, 355 patients had severe proteinuria and 149 patients had decreased renal function. The levels of TyG index was significantly elevated in PMN patients with severe proteinuria or decreased renal function. The RCS analysis revealed a positive linear relationship of the TyG index with the risk of severe proteinuria (P for non-linear = 0.317) or decreased renal function (P for non-linear = 0.199) in patients with PMN. Using the lowest quantile as the reference, multivariate-adjusted logistic regression indicated that patients in the highest quantile of the TyG index had a significantly increased risk of severe proteinuria [odds ratio (OR) = 2.08, 95% confidence interval (CI): 1.44–3.01, P < 0.001] and decreased renal function (OR = 1.57, 95% CI: 1.04–2.36, P = 0.032). The area under the ROC curve (AUC) of the TyG index is 0.613 (95% CI: 0.564–0.662) for severe proteinuria and 0.590 (95% CI: 0.536–0.643) for decreased renal function.ConclusionOur findings indicated that the TyG index has a positive linear correlation with severe proteinuria or decreased renal function in patients with PMN.

2024 Peking University Interdisciplinary nursing research (INR) Forum November 22-23, 2024

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Predicting postoperative neurological outcomes of degenerative cervical myelopathy based on machine learning.

This study aimed to develop machine learning models to predict neurological outcomes in patients with degenerative cervical myelopathy (DCM) after surgical decompression and identify key factors that contribute to a better outcome, providing a reference for patient consultation and surgical decision-making. This retrospective study reviewed 1,895 patients who underwent cervical decompression surgery for DCM at Peking University Third Hospital from 2011 to 2020, with 672 patients included in the final analysis. Five machine learning methods, namely, linear regression (LR), support vector machines (SVM), random forest (RF), XGBoost, and Light Gradient Boosting Machine (LightGBM), were used to predict whether patients achieved the minimal clinically important difference (MCID) in the improvement in the Japanese Orthopedic Association (JOA) score, which was based on basic information, symptoms, physical examination signs, intramedullary high signals on T2-weighted (T2WI) magnetic resonance imaging (MRI), and various scale scores. After training and optimizing multiple ML algorithms, we generated a model with the highest area under the receiver operating characteristic curve (AUROC) to predict short-term outcomes following DCM surgery. We evaluated the importance of the features and created a feature-reduced model. The model's performance was assessed using an external dataset. The LightGBM algorithm performed the best in predicting short-term neurological outcomes in the testing dataset, achieving an AUROC value of 0.745 and an area under the precision-recall curve (AUPRC) value of 0.810. The important features influencing performance in the short-term model included the preoperative JOA score, age, SF-36-GH, SF-36-BP, and SF-36-PF. The feature-reduced LightGBM model, which achieved an AUROC value of 0.734, also showed favorable performance. Moreover, the feature-reduced model showed an AUROC value of 0.785 for predicting the MCID of postoperative JOA in the external dataset, which included 58 patients from other hospitals. We developed models based on machine learning to predict postoperative neurological outcomes. The LightGBM model presented the best predictive power regarding the surgical outcomes of DCM patients. Feature importance analysis revealed that variables, including age, preoperative JOA score, SF-36-PF, SF-36-GH, and SF-36-BP, were essential factors in the model. The feature-reduced LightGBM model, designed for ease of application, achieved nearly the same predictive power with fewer variables.

Interactions among dyadic coping, self-efficacy, and negative emotions in Chinese parents of children with leukemia

Background and aimThe prevalence of childhood leukemia in China has been on the rise, imposing significant psychological burden on parents. Currently, few studies have explored the dyadic coping status of parents of children with leukemia and its influencing factors. This study aimed to investigate the associations among dyadic coping, self-efficacy, anxiety and depression in parents of children with leukemia.MethodsA cross-sectional design was performed to conveniently sample 342 parents from the pediatric hematology ward of Peking University People’s Hospital. The general demographic information, dyadic coping inventory, general self-efficacy scale, and hospital anxiety and depression scale were collected and analyzed using SPSS.22.0 software.ResultsThe average age of the parents was (37.29 ± 5.73) years, while the total score of dyadic coping was 122.95 ± 16.68, the self-efficacy score was 25.03 ± 3.93, anxiety score was 15.58 ± 3.59, and depression score was 16.27 ± 3.86. Dyadic coping was significantly positively correlated with self-efficacy (r = 0.386, P < 0.01), and negatively correlated with parental anxiety and depression scores (r=-0.372; r=-0.264; P < 0.01). Multiple linear regression revealed that self-efficacy(β = 0.262), anxiety(β=-0.242), income per month (RMB,β = 0.182), knowledge of the child’s illness(β = 0.138), number of relapses(β=-0.135), current treatment programs(β=-0.149), education level(β = 0.101) and the duration of diagnosis(β = 0.092) were significant factors influencing the parents’ dyadic coping level (R2 = 0.378, P < 0.01).ConclusionThe dyadic coping level of parents of children with leukemia is generally moderate, is positively correlation with self-efficacy and negatively correlated with anxiety. Therefore, interventions targeting dyadic interactions between parents should be established to improve parental communication, foster coping mechanisms under stress, and alleviate the negative emotional responses.

Application feasibility of virtual models and computational fluid dynamics for the planning and evaluation of aortic repair surgery for Williams syndrome

BackgroundAccurate diagnosis and evaluation of Williams Syndrome (WS) are essential yet challenging for effective surgical management. This study aimed to quantify the hemodynamic changes of surgical repair for WS through virtual surgery and computational fluid dynamics (CFD) for surgical guidance and postoperative evaluation.MethodsA patient preliminarily diagnosed with WS was included in this study. 3D model alongside hemodynamic analysis was used to guide and evaluate the surgical procedure. Preoperative, predictive and postoperative models were created and analyzed using CFD. Key parameters, including blood flow velocity, pressure differences, wall shear stress, and other critical factors, were assessed to evaluate the surgery’s effectiveness.ResultsIn the hemodynamics analysis, the CFD results of predictive model and postoperative model demonstrated a high level of consistency, and showed significant differences compared to the preoperative model. The velocity at the stenosis on the aorta decreased from 5.6 m/s before the operation to 1.6 m/s in the virtual model and 1.5 m/s in the postoperative model. Surgical repair increased the proportion of outlet flow of the descending aorta (dAo) from 28.7% to 35.5%.ConclusionsVirtual surgery and CFD can predict surgical outcomes, enabling doctors to optimize and rehearse the procedure before the actual surgery. The method of predicting surgery through virtual surgery and CFD is accurate and feasible.Trial registrationRegistered by the Ethics Committee of Peking University International Hospital (No. IRB2019-062).

Applications and Predictors of Outcomes Following Stereo-Electroencephalography in Pediatric Patients With Drug-Resistant Epilepsy.

This study aims to evaluate the role of stereo-electroencephalography (SEEG) in managing pediatric patients with drug-resistant epilepsy. We further explore prognostic factors influencing surgical outcomes following SEEG-guided resective or disconnective surgery. A retrospective review was conducted on pediatric patients who underwent SEEG at the Pediatric Epilepsy Center, Peking University First Hospital, between July 2017 and July 2022. Univariate and multivariate analyses identified key predictors for SEEG-guided surgery. Kaplan-Meier survival analysis was employed to estimate the seizure-free rate, and further statistical tests were applied to evaluate factors associated with seizure outcomes. Among the 148 children included in this study, 102 underwent SEEG-guided resective/disconnective surgery. Multivariate regression identified age at surgery (p < 0.05, 95% CI 0.190-0.997) as an independent predictor for selecting resective/disconnective surgery. The seizure-free rate in patients who underwent SEEG-guided surgery was 69.6%. Multivariate regression confirmed that total resection with lesional MRI (p < 0.05, 95% CI 0.012-0.186) and FCD type II (p < 0.05, 95% CI 0.051-0.851) were strong predictors of seizure freedom. SEEG plays a crucial role in pediatric epilepsy surgery, particularly in children under 6 years old. Total resection with lesional MRI and FCD type II was the most favorable prognostic predictor for achieving seizure freedom in children undergoing SEEG-guided surgery.

Beamline analysis for a laser-driven proton therapy accelerator using superconducting bends

Peking University is implementing new superconducting magnets in a laser-driven proton accelerator, resulting in a lighter and more compact proton therapy facility. To efficiently transport protons with a wide energy spread, we propose a double-bend achromat design that rotates particles by 90 degrees and suppresses dispersion. Two focusing options are considered: integrating quadrupole magnets within the dipole magnets to create a hybrid field, or separating the quadrupole for independent focusing and bending. We first delve into the related lattice design, followed by an in-depth analysis of coil selection for each option. The magnetic field of the coil is indeed calculated using a combination of the Biot–Savart law and the Multi-Level Fast Multipole Method (MLFMM). We assess field quality and feasibility using TraceWin and zgoubi simulations in fieldmap, accounting for dipole-induced dispersion and quadrupole-induced chromatic effect. Through the analysis of superconducting magnets and beam dynamics, and by considering the transmission requirements of laser-plasma-accelerated protons, we have indeed developed a beam transport scheme. This scheme is anticipated to integrate laser-accelerated protons into a compact proton therapy facility, and it will eventually be implemented.

Prognostic Factors and Nomogram for Klebsiella pneumoniae Infections in Intensive Care Unit.

Klebsiella pneumoniae infections pose a significant threat to public health with high morbidity and mortality rates. The early identification of risk factors for mortality and accurate prognostic evaluation are important. Therefore, we aimed to identify the risk factors for mortality in patients with K. pneumoniae infections and develop a nomogram model for prognosis. Patients diagnosed with K. pneumoniae infection were recruited from the intensive care unit of Peking University Third Hospital. The enrolled patients were categorized into survivor and non-survivor groups. Univariate and multivariate regression analyses were performed to identify independent risk factors for 30-day mortality, and a nomogram was constructed and validated. A total of 408 patients infected with K. pneumoniae at different sites were included in this study. PO2, lactate, respiratory failure, urinary tract infection, heart rate, 24h-urineoutput, neutrophil count, alkaline phosphatase, and vasoactive drug use were significant risk factors and were integrated into a nomogram to predict the risk of 7-day, 14-day, 21-day, and 28-day mortality. The nomogram demonstrated superior prognostic ability, achieving higher area under the receiver operating characteristic curve (AUC) (>0.8) and concordance index (C-index) (>0.8) values than the Pitt bacteremia, sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation (APACHE) II scores (all AUC and C-index < 0.75). Cross-validation of the nomogram confirmed its consistent performance, with both AUC and C-index values exceeding 0.75. The nomogram demonstrated a strong Hosmer-Leme-show goodness-of-fit and good calibration (p > 0.05). Additionally, decision curve analysis revealed that the nomogram provided significant clinical utility for prognostic prediction. The 30-day mortality risk factors for K. pneumoniae infections were identified, and a predictive nomogram model was developed. The nomogram demonstrated good accuracy and predictive efficiency, providing a practical tool for short-term risk assessment and potentially improving clinical outcomes by providing early intervention and personalized patient management.

Nomogram for predicting cemented vertebral refracture after percutaneous kyphoplasty in postmenopausal women with osteoporotic vertebral compression fractures.

Nomogram for predicting cemented vertebral refracture after percutaneous kyphoplasty in postmenopausal women with osteoporotic vertebral compression fractures.

Automated diagnosis and classification of temporomandibular joint degenerative disease via artificial intelligence using CBCT imaging.

Automated diagnosis and classification of temporomandibular joint degenerative disease via artificial intelligence using CBCT imaging.