Epilepsy is a common neurological disease, has the characteristics of recurrent attacks and long-term treatment, thus bringing great pressure to patients and their families. Therefore, it is particularly important to do a good job of disability assessment. In recent years, with the development of the discipline, academic organizations such as the International League Against Epilepsy (ILAE) and China Association Against Epilepsy (CAAE) have successively updated the definition and diagnostic criteria of epilepsy and seizures. However, some items of epilepsy in the current Criteria for Disability Rating of Military Personnel (Trial) issued by People's Liberation Army (PLA) in 2011 can no longer meet the latest guidelines at home and abroad. Therefore, we suggest that the items related to epilepsy in the Criteria for Disability Rating of Military Personnel (Trial) should be revised to ensure that the disability evaluation being completed fairly and successfully.

At the beginning of this century, breakthroughs and innovations in disruptive technologies represented by artificial intelligence have profoundly affected the development of human society and have become a central component in leading the new global military transformation. Saving the lives of the wounded and technological innovation are the driving force behind the development of military medicine. How to fight a battle and how to save people is the question that military medicine must answer. Joint all-area combat is a new military concept, representing the development direction of the future combat style, it has a strong strategic guiding significance for the future war and also puts forward higher requirements for the treatment of war injuries. "Platinum ten minutes, gold one hour" is the fundamental law of the battlefield first-line time-saving treatment, the war injury treatment must serve in the joint all-area combat demand and service requirements. This paper discusses the issue of demand or war injury treatment capacity building under the joint all-area combat pasture for criticism and correction.

Objective To analyze the relationship between MyD88L265P and CD79B mutations in tumor tissue and the prognosis of primary central nervous system lymphoma (PCNSL). Methods 18 PCNSL patients with normal immune function (no history of HIV infection and immunosuppressants administration) who were diagnosed by craniotomy or stereotaxic biopsy in the Second Hospital of Lanzhou University from August 2018 to November 2020 were retrospectively analyzed. Real-time quantitative PCR and first-generation sequencing techniques were respectively used to detect MyD88L265P and CD79B mutations in tumor tissues of 18 PCNSL patients. Univariate analysis and Cox regression multivariate analysis were performed for indicators that may be associated with first progression-free survival (PFS) and overall survival in PCNSL. Results The mutation rate of MyD88L265P was 38.9%, the mutation rate of CD79B was 33.3%, and the co-mutation rate of MyD88L265P/CD79B was 27.8% in PCNSL tissue of 18 patients. Univariate analysis showed that the PCNSL patients with multiple lesions, deep involvement of lesions, and tissue CD79B mutation had a statistically significant shorter time of PFS (P<0.05). Multivariate analysis showed that deep lesion involvement(HR=0.135, 95%CI 0.023-0.799, P<0.05) and CD79B mutation (HR=0.149, 95%CI 0.028-0.800, P<0.05) in PCNSL tissue were independent prognostic factors for PCNSL patients. Conclusion The frequency of MyD88L265P and CD79B mutations was high in tumor tissues of 18 PCNSL patients, and these two gene mutations may be associated with poor prognosis of PCNSL, especially CD79B mutation.

Objective To evaluate the application value of hydrogel in image guided radiotherapy (IGRT) for prostate cancer (PCa). Methods Eighty PCa patients in the First Affiliated Hospital of Hebei North University from October 2022 to February 2023 were collected. The patients were divided into experiment group injected with hydrogel (n=33) and control group without hydrogel (n=47) by central random system allocation. The acute and advanced radiation proctitis (RP) incidence rate of the two groups were compared. Patients in experimental group were divided into RP group (n=5) and non-RP group (n=28). The independent risk factors leading to RP were analyzed by using logistic regression for PCa patients. Results In experiment group, 12.1% (4/33) of the patients developed acute grade Ⅰ RP, and 3.0% (1/33) developed advanced grade Ⅰ RP. In control group, 31.9% (15/47) of the patients developed acute grade Ⅰ RP, and 12.8% (6/47) developed acute grade Ⅱ RP; 19.1% (9/47) of patients developed advanced grade Ⅰ RP, 4.3% (2/47) developed advanced grade Ⅱ RP, and 2.1% (1/47) developed advanced grade Ⅲ RP. The incidence of acute and advanced RP in experiment group was lower than that in control group (P<0.05). The application of hydrogel effectively reduced rectal toxicity. Age, rectal volume, V₇₀ and V₇₈ were independent risk factors for the incidence of RP in PCa patients (P<0.05). The characteristics of hydrogel injection were not related to the incidence of RP for PCa patients. Conclusions Hydrogel can effectively reduce the rectal toxicity for PCa patients in IGRT and has little impact on the overall treatment. Hydrogel has certain clinical application and promotion value.

Diagnosis and treatment of locally advanced rectal cancer (LARC) must be completed by a collaborative model of a multi-disciplinary team. The neoadjuvant chemoradiotherapy significantly reduced the local recurrence rate of LARC, but did not affect the occurrence of distant metastases and overall survival. Total neoadjuvant therapy (TNT), by strengthening the intensity of chemotherapy and extending the time from radiotherapy to surgery, can improve the tumor response rate as well as disease-free survival rate and metastasis-free survival rate. It offers advantages such as enhancing the compliance with chemotherapy, maximizing tumor regression, improving survival and increasing the chance of organ preservation. TNT is a promising treatment model for LARC patients with high risk of distant metastasis or strong desire for organ preservation. With the application of immunotherapy in the field of TNT, the mode of TNT continues to expand. And the exploration of therapeutic predictive markers will help to provide a personalized treatment for patients.

Objective To investigate the association between body mass index (BMI), sex hormone and single nucleotide polymorphisms (SNPs) of follicle-stimulating hormone receptor (FSHR) gene rs2268361 and rs2349415 and its correlation with the risk of polycystic ovary syndrome (PCOS). Methods Peripheral blood was collected from 213 PCOS patients and 207 healthy controls, attending the Department of Reproductive Medicine at the First Hospital of Shanxi Medical University, and 32 follicular fluids were randomly collected from each of the PCOS and control groups from March to August 2021. Calculation of BMI of the PCOS and control groups; The levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E₂), testosterone (T), progesterone (P) and prolactin (PRL) in peripheral blood of the two groups were detected by immunochemiluminescence method. Polymerase chain reaction (PCR) and high-resolution melting curve (HRM) were used to analyze the polymorphisms of rs2268361 and rs2349415 in FSHR of the two groups. Quantitative real-time PCR was used to detect the expression of FSHR gene mRNA in peripheral blood and ovarian granulosa cells. Results There was a strong positive correlation between LH and LH/FSH(r=0.88, P<0.05); The levels of BMI, E₂, LH, LH/FSH and T in PCOS group were significantly higher than those in control group(P<0.05); FSH level was significantly lower than that of control group (P<0.001). HRM analysis showed the frequencies of CC, CT and TT genotypes at rs2349415 were 55.9%, 34.3% and 9.8% in PCOS group and 68.6%, 23.2% and 8.2% in control group, respectively. The frequencies of C and T alleles were 73.0% and 27.0% in PCOS group and 80.2% and 19.8% in control group, respectively. There were significant differences in genotype frequencies and allele frequencies between the two groups (P<0.05); The expression level of FSHR mRNA was higher in ovarian granulosa cells in PCOS group than in control group (P=0.004), the expression level of FSHR mRNA in rs2349415 TT genotype was higher than that in CC (P=0.002) and CT (P=0.035) genotype. Conclusion High levels of BMI, LH, E₂ and T allele of rs2349415 increased the risk of PCOS.

Objective To investigate the value of magnetic resonance imaging (MRI) T₂-mapping in evaluating the activity of Graves ophthalmopathy (GO). Methods A total of 64 patients with GO in the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University from July 2019 to January 2021 were collected. Simple random grouping was performed by computer, with 49 cases as observation subjects, and 15 patients for diagnostic test. According to clinical activity score (CAS), 49 GO patients were divided into active group (CAS ≥3 points, 48 eyes) and inactive group (CAS <3 points, 50 eyes). Normal control group (NC group) included 31 patients (62 eyes). All subjects underwent 3.0T orbital MRI T₂-mapping. Measuring the T₂ relaxation time (T₂RT) of superior rectus, inferior rectus, medial rectus, and lateral rectus on five layers behind the eyeball on T₂-mapping coronal images, and select the maximum value of T₂RT in the five layers for each extraocular muscle to represent the T₂RT of this extraocular muscle. Finally, select the maximum T₂RT values of the four extraocular muscles, expressed as extraocular muscle maximum T₂RT. Compare the differences of the above 5 indicators (superior rectus T₂RT, inferior rectus T₂RT, medial rectus T₂RT, lateral rectus T₂RT, extraocular muscle maximum T₂RT) between active group, inactive group and NC group. ROC curve was used to analyze the diagnostic value of the above 5 indicators for GO activity assessment, and the diagnostic threshold was obtained. Then, another 15 GO patients were performed for diagnostic tests evaluation to determine the indicators of high diagnostic efficacy and the threshold of diagnostic activity. Results The T₂RT of all extraocular muscles in active group were significantly higher than those in inactive group and NC group, the difference was statistically significant (P<0.001). The threshold value of the five indicators were obtained by ROC curve analysis. The maximum T₂RT cut-off values of superior rectus muscle, inferior rectus muscle, medial rectus muscle, lateral rectus muscle and extraocular muscles for judging activity were 80.200 ms, 97.045 ms, 94.355 ms, 85.750 ms and 101.385 ms respectively. Another 15 GO patients were performed for diagnostic tests, the indexes with relatively high sensitivity, specificity, positive predictive value and negative predictive value were inferior rectus T₂RT and extraocular muscle maximum T₂RT, the cut-off values of GO activity were 97.045 ms and 101.385 ms, respectively; the sensitivity were 91.7% and 93.8%, respectively; the specificity all were 80.0%. Conclusions MRI T₂-mapping sequence has a good value in assessment of GO activity. The inferior rectus T₂RT and extraocular muscle maximum T₂RT can be choosed to evaluate the activity of GO.

Objective To investigate the effect of antinuclear antibodies (ANAs) on hormone response in patients with autoimmune hepatitis (AIH)-primary biliary cholangitis (PBC) overlap syndrome (AIH-PBC OS) and AIH-only within half a year. Methods A retrospective analysis of 77 patients with autoimmune liver disease (AILD) admitted to First Clinical Medical College of Lanzhou University from January 2018 to December 2021, all of whom were confirmed by liver biopsy and receiving glucocorticoid treatment. Among them, 46 patients were in AIH-PBC OS group and 31 were in AIH-only group. The general clinical characteristics, liver puncture-related indexes, autoantibodies and immunoglobulin indexes of patients in each group at the time of diagnosis were collected and compared, and the biochemical and immunoglobulin indexes of patients at the time of hormone use and at the time of review within 6 months were also collected, and the hormone response within 6 months was evaluated according to the levels of glutamic transaminase (AST), glutamic alanine transaminase (ALT) and immunoglobulin G (IgG), and the effect of ANAs on hormone response outcomes in both groups over a six-month period was analyzed. Multifactorial ordered logistic analysis was performed to evaluate the effect of ANAs on hormone response between two groups. Results There was no statistically significant difference in the percentage of AIH-PBC OS and AIH-only patients among both ANAs-positive and -negative AILD patients (55.6% vs. 44.4% and 65.6% vs. 34.4%, P>0.05). Among 46 patients with AIH-PBC OS, there were 25 in ANAs-positive group and 21 in ANAs-negative group. The rate of complete hormone response within 6 months was lower than that of ANAs-negative group (44.0% vs. 76.2%), while the rate of hormone non-response was higher than that of ANAs-negative group (20.0% vs. 0), and the difference was statistically significant (P<0.05). There were 20 cases of ANAs-positive and 11 cases of ANAs-negative in the 31 AIH-only patients. There was no statistically significant difference in the results of hormone response within 6 months between the two groups (P>0.05). Multifactorial ordered logistic analysis showed that AIH-PBC OS patients were more likely to have a higher likelihood of 6-month hormone non-response rate in ANAs-positive patients, and the difference was statistically different (P<0.05). And there was no significant effect of ANAs type on hormone response outcome in AIH-only patients (P>0.05). Conclusion AIH-PBC OS ANAs-positive patients have a poor hormone response within half a year. In AIH-only patients, ANAs have no significant effect on hormone response results.

Objective To explore the efficacy and safety of ticagrelor de-escalation and nicorandil therapy in elderly patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods A total of 300 elderly patients with ACS were selected from the Sixth and Seventh Medical Center of Chinese PLA General Hospital and Beijing Chaoyang Integrative Medicine Emergency Rescue and First Aid Hospital from November 2016 to June 2019, including 153 males and 147 females, aged>65 years old. All the patients received PCI, and all had double antiplatelet therapy (DAPT) scores ≥2 and a new DAPT (PRECISE-DAPT) score of ≥25. All patients were divided into two groups by random number table method before operation: ticagrelor group(n=146, ticagrelor 180 mg load dose followed by PCI, and ticagrelor 90 mg bid after surgery) and ticagrelor de-escalation + nicorandil group (n=154, ticagrelor 180 mg load dose followed by PCI, ticagrelor 90 mg bid+nicorandil 5 mg tid after surgery, changed to ticagrelor 60 mg bid+ nicorandil 5 mg tid 6 months later). Follow-up was 12 months. The composite end points of cardiovascular death, myocardial infarction and stroke, the composite end points of mild hemorrhage, minor hemorrhage, other major hemorrhage and major fatal/life-threatening hemorrhage as defined by the PLATO study, and the composite end points of cardiovascular death, myocardial infarction, stroke and bleeding within 12 months in the two groups were observed. Results The comparison of general baseline data between the two groups showed no statistically significant difference (P>0.05). There was also no significant difference in the composite end points of cardiovascular death, myocardial infarction and stroke between the two groups (P>0.05). The cumulative incidence of bleeding events in ticagrelor de-escalation + nicorandil group was significantly lower than that in ticagrelor group (P<0.05), while the composite end points of cardiovascular death, myocardial infarction, stroke and bleeding were also significantly lower than those in tecagrelor group (P<0.05). Conclusion In elderly patients with ACS, the treatment of ticagrelor de-escalation + nicorandil after PCI may not increase the incidence of ischemic events such as cardiovascular death, myocardial infarction or stroke, and it may reduce the incidence of hemorrhagic events.

Objective To identify the clinical characteristics and prognostic factors of young patients with sporadic rectal cancer liver metastasis (RCLM). Methods The clinical data of young RCLM patients at 45 years or under (n=40, as younger patient group) in Peking University First Hospital from January 2016 to January 2021 were reviewed, meanwhile, elder RCLM patient group were comprised of 82 patients older than 45-year-old in a 1:2 ratio. Proportions of categorical variables were compared between young patients and old patients. The clinicopathologic parameters were analyzed with univariate and multivariate Cox regression models and Kaplan-Meier method for demonstrating survival differences between the maximum diameter of liver metastasis and local therapy. Results One hundred and twenty-two RCLM patients were identified, the 1-, 3- and 5-year survival rates of young patient group were 97.5%, 47.5%, 15.0%, those of elder patient group were 84.1%, 26.8%, 9.8%, respectively. The differences in BMI (P=0.008), primary tumor with obstruction and bleeding (P=0.006), synchronous rectal cancer liver metastases (P=0.005), the maximum diameter of liver metastasis >3 cm (P=0.019) were statistically significant between the two groups. And univariate and multivariate analyses showed that age (P=0.003), N stage (P=0.007), local therapy for liver metastases (P=0.047) and the maximum diameter of liver metastasis (P=0.030) were independent risk factors for influencing the prognosis of RCLM patients; curative resection or not of primary tumor (P=0.035) and the maximum diameter of liver metastasis (P=0.041) were independent risk factors for influencing the prognosis of young RCLM patients. Kaplan-Maier curve demonstrated survival differences between the maximum diameter of liver metastasis and local therapy for liver metastasis in RCLM patients (log-rank P=0.000). Conclusions Although with later staging of initial tumor station, young RCLM patients may obtain better survival benefit compared with old patients. Higher degree of lymph node metastasis, local therapy for liver metastases and the maximum diameter of liver metastasis >3 cm indicates poor prognosis in RCLM patients, and without curative resection of primary tumor and maximum diameter of liver metastasis are also considered as the independent poor prognostic factors of young RCLM patients. Local therapy for liver metastases appears to play an important role in the treatment strategy of RCLM patients.