ObjectiveTo establish and internally validate a predictive model for poorly differentiated adenocarcinoma based on CT imaging and tumor marker results. MethodsPatients with solid and partially solid lung nodules who underwent lung nodule surgery at the Department of Thoracic Surgery, the Affiliated Brain Hospital of Nanjing Medical University in 2023 were selected and randomly divided into a training set and a validation set at a ratio of 7:3. Patients' CT features, including average density value, maximum diameter, pleural indentation sign, and bronchial inflation sign, as well as patient tumor marker results, were collected. Based on postoperative pathological results, patients were divided into a poorly differentiated adenocarcinoma group and a non-poorly differentiated adenocarcinoma group. Univariate analysis and logistic regression analysis were performed on the training set to establish the predictive model. The receiver operating characteristic (ROC) curve was used to evaluate the model's discriminability, the calibration curve to assess the model's consistency, and the decision curve to evaluate the clinical value of the model, which was then validated in the validation set. ResultsA total of 299 patients were included, with 103 males and 196 females, with a median age of 57.00 (51.00, 67.25) years. There were 211 patients in the training set and 88 patients in the validation set. Multivariate analysis showed that carcinoembryonic antigen (CEA) value [OR=1.476, 95%CI (1.184, 1.983), P=0.002], cytokeratin 19 fragment antigen (CYFRA21-1) value [OR=1.388, 95%CI (1.084, 1.993), P=0.035], maximum tumor diameter [OR=6.233, 95%CI (1.069, 15.415), P=0.017], and average density [OR=1.083, 95%CI (1.020, 1.194), P=0.040] were independent risk factors for solid and partially solid lung nodules as poorly differentiated adenocarcinoma. Based on this, a predictive model was constructed with an area under the ROC curve of 0.896 [95%CI (0.810, 0.982)], a maximum Youden index corresponding cut-off value of 0.103, sensitivity of 0.750, and specificity of 0.936. Using the Bootstrap method for 1000 samplings, the calibration curve predicted probability was consistent with actual risk. Decision curve analysis indicated positive benefits across all prediction probabilities, demonstrating good clinical value. ConclusionFor patients with solid and partially solid lung nodules, preoperative use of CT to measure tumor average density value and maximum diameter, combined with tumor markers CEA and CYFRA21-1 values, can effectively predict whether it is poorly differentiated adenocarcinoma, allowing for early intervention.
Organoids are three-dimensional structures formed by self-organizing growth of cells in vitro, which own many structures and functions similar with those of corresponding in vivo organs. Although the organoid culture technologies are rapidly developed and the original cells are abundant, the organoid cultured by current technologies are rather different with the real organs, which limits their application. The major challenges of organoid cultures are the immature tissue structure and restricted growth, both of which are caused by poor functional vasculature. Therefore, how to develop the vascularization of organoids has become an urgent problem. We presently reviewed the progresses on the original cells of organoids and the current methods to develop organoids vascularization, which provide clues to solve the above-mentioned problems.
Objective To analyze the trends in the disease burden of fall-related fractures among elderly Chinese from 1990 to 2023, and to examine the disparities by age, gender, and fracture site, in order to inform the development of targeted strategies for the prevention of such fractures. Methods Data on the incidence, prevalence, and years lived with disability (YLDs) of fall-related fractures among elderly Chinese from 1990 and 2023 was sourced from the 2023 Global Burden of Disease (GBD) study. The disease burden across age groups, genders, and fracture sites was assessed. Furthermore, temporal trends by these strata were analyzed using Joinpoint 5.4.0.0 software. Results From 1990 to 2023, the average annual percent changes in the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized years of life lost rate (ASYR) for fall-related fractures among elderly Chinese were 1.81%, 1.03%, and 0.83%, respectively. In China, the disease burden of fall-related fractures among the elderly increased with advancing age, and the rate of this increase accelerated in older age groups. Females had higher values than males in terms of ASIR, the rates of increase for all burden measures were greater in males. Fall-related fractures among the elderly Chinese can be classified into 12 sites, among which hip fracture had the highest ASIR, with values of 538.15 and 963.57 per 100 000 in 1990 and 2023, respectively. Fractures of the patella, tibia, fibula, or ankle had the highest ASPR and ASYR. Their ASPR were14 836.73 and 19 727.74 per 100 000 in 1990 and 2023, respectively, and ASYR were 740.84 and 989.54 per 100 000, respectively. Conclusion The increasing and heterogeneous burden of fall-related fractures among elderly Chinese calls for targeted management strategies, in addition to enhanced osteoporosis prevention, that address the distinct risks by gender, age, and fracture site.
Objective To evaluate the diagnosis value of radial probe endobronchial ultrasound guide sheath transbronchial lung biopsy (RP-EBUS-GS-TBLB) combination with rapid on-site evaluation (ROSE) in peripheral pulmonary lesions (PPLs). Methods One hundred and fifty-eight patients with PPLs identified by computed tomography in Nanjing Chest Hospital underwent RP-EBUS-GS-TBLB with or without ROSE randomly between February 2016 and August 2017. The sensitivity, the procedure time, the biopsy times, and the complications were evaluated in the two groups. Results The diagnostic yield was 85.7% (72/84) in ROSE group and 70.3% (52/74) in No-ROSE group. There was significant difference in diagnostic sensitivity between the two groups (P<0.05). The mean procedure time and number of biopsy in ROSE group were less than those in No-ROSE group (P<0.01). No severe procedure related complications such as pneumothorax and hemoptysis were observed. Conclusions ROSE can improve the diagnostic sensitivity, and shorten the procedure time. RP-EBUS-GS-TBLB combined with ROSE is a safe and effective technique for PPLs.
