Objective: Machine learning (ML) has been reported to have better predictive capability than traditional statistical techniques. The aim of this study was to assess the efficacy of ML algorithms and logistic regression (LR) for predicting depressive symptoms during the COVID-19 pandemic. Methods: Analyses were carried out in a national cross-sectional study involving 21,916 participants. The ML algorithms in this study included random forest (RF), support vector machine (SVM), neural network (NN), and gradient boosting machine (GBM) methods. The performance indices were sensitivity, specificity, accuracy, precision, F1-score, and area under the receiver operating characteristic curve (AUC). Results: LR and NN had the best performance in terms of AUCs. The risk of overfitting was found to be negligible for most ML models except for RF, and GBM obtained the highest sensitivity, specificity, accuracy, precision, and F1-score. Therefore, LR, NN, and GBM models ranked among the best models. Conclusion Compared with ML models, LR model performed comparably to ML models in predicting depressive symptoms and identifying potential risk factors while also exhibiting a lower risk of overfitting.

Purpose: The aim of this study was to investigate the feasibility of an intelligent handheld ultrasound (US) device for assisting non-expert general practitioners (GPs) in detecting carotid plaques (CPs) in community populations. Methods: This prospective parallel controlled trial recruited 111 consecutive community residents. All of them underwent examinations by non-expert GPs and specialist doctors using handheld US devices (setting A, setting B, and setting C). The results of setting C with specialist doctors were considered the gold standard. Carotid intima-media thickness (CIMT) and the features of CPs were measured and recorded. The diagnostic performance of GPs in distinguishing CPs was evaluated using a receiver operating characteristic curve. Inter-observer agreement was compared using the intragroup correlation coefficient (ICC). Questionnaires were completed to evaluate clinical benefits. Results: Among the 111 community residents, 80, 96, and 112 CPs were detected in settings A, B, and C, respectively. Setting B exhibited better diagnostic performance than setting A for detecting CPs (area under the curve, 0.856 vs. 0.749; P<0.01). Setting B had better consistency with setting C than setting A in CIMT measurement and the assessment of CPs (ICC, 0.731 to 0.923). Moreover, measurements in setting B required less time than the other two settings (44.59 seconds vs. 108.87 seconds vs. 126.13 seconds, both P<0.01). Conclusion Using an intelligent handheld US device, GPs can perform CP screening and achieve a diagnostic capability comparable to that of specialist doctors.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated death globally. Liver transplantation (LT) has emerged as a key treatment for patients with HCC, and the Milan criteria have been adopted as the cornerstone of the selection policy. To allow more patients to benefit from LT, a number of expanded criteria have been proposed, many of which use radiologic morphological characteristics with larger and more tumors as surrogates to predict outcomes. Other groups developed indices incorporating biological variables and dynamic markers of response to locoregional treatment. These expanded selection criteria achieved satisfactory results with limited liver supplies. In addition, a number of prognostic models have been developed using clinicopathological characteristics, imaging radiomics features, genetic data, and advanced techniques such as artificial intelligence. These models could improve prognostic estimation, establish surveillance strategies, and bolster long-term outcomes in patients with HCC. In this study, we reviewed the latest findings and achievements regarding the selection criteria and post-transplant prognostic models for LT in patients with HCC.

Intraoperative cell salvage (IOCS) has been widely applied as an important blood conservation measure in surgical operations. However, there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors. This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence. Data were derived from databases such as PubMed, Embase, the Cochrane Library and Wanfang. The guideline development team formulated recommendations based on the quality of evidence, balance of benefits and harms, patient preferences, and health economic assessments. This study constructed seven major clinical questions. The main conclusions of this guideline are as follows: 1) Compared with no perioperative allogeneic blood transfusion (NPABT), perioperative allogeneic blood transfusion (PABT) leads to a more unfavorable prognosis in cancer patients (Recommended); 2) Compared with the transfusion of allogeneic blood or no transfusion, IOCS does not lead to a more unfavorable prognosis in cancer patients (Recommended); 3) The implementation of IOCS in cancer patients is economically feasible (Recommended); 4) Leukocyte depletion filters (LDF) should be used when implementing IOCS in cancer patients (Strongly Recommended); 5) Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients (Recommended); 6) A careful assessment of the condition of cancer patients (meeting indications and excluding contraindications) should be conducted before implementing IOCS (Strongly Recommended); 7) Informed consent from cancer patients should be obtained when implementing IOCS, with a thorough pre-assessment of the patient's condition and the likelihood of blood loss, adherence to standardized internally audited management procedures, meeting corresponding conditions, and obtaining corresponding qualifications (Recommended). In brief, current evidence indicates that IOCS can be implemented for some malignant tumor patients who need allogeneic blood transfusion after physician full evaluation, and LDF or irradiation should be used during the implementation process.

The TGF-β signaling pathway affects various biological processes of cancers, including proliferation, invasion, metastasis, angiogenesis, and immune escape. Currently, multiple drugs targeting this pathway are in clinical trial stage, which involve three aspects of TGF-β, namely, production, activation, and signal transduction. Based on current evidence, the therapeutic effect of TGF-β monotherapy on advanced solid tumors is limited. Combination therapies that show promising results include combination with PD-1 antibodies, and combination with radiotherapy and chemotherapy. New combination therapies, such as CAR-T therapy modified with TGF-βRII, are also emerging in clinical research. This article systematically reviews the therapeutic strategies targeting TGF-β to provide research basis and ideas for the development of drugs targeting the TGF-β pathway.

Objective To compare the mid- and long-term clinical results of mitral valve plasty (MVP) and mitral valve replacement (MVR) in the treatment of functional mitral regurgitation (FMR). Methods Patients with FMR who underwent surgical treatment in the Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command from 2012 to 2021 were collected. The patients who underwent MVP were divided into a MVP group, and those who underwent MVR into a MVR group. The clinical data and mid-term follow-up efficacy of two groups were compared. Results Finally 236 patients were included. There were 100 patients in the MVP group, including 53 males and 47 females, with an average age of (61.80±8.03) years. There were 136 patients in the MVR group, including 72 males and 64 females, with an average age of (61.29±8.97) years. There was no statistical difference in baseline data between the two groups (P＞0.05). There was no statistical difference between the two groups in the extracorporeal circulation time, aortic occlusion time, postoperative hospital and ICU stay, intraoperative blood loss, or hospitalization death (P＞0.05), but the time of mechanical ventilation in the MVP group was significantly shorter than that in the MVR group (P=0.022). The total follow-up rate was 100.0%, the longest follow-up was 10 years, and the average follow-up time was (3.60±2.55) years. There were statistical differences in the left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac function between the two groups compared with those before surgery (P<0.05). The postoperative left ventricular ejection fraction in the MVP group was statistically higher than that before surgery (P=0.002), but there was no statistical difference in the MVR group before and after surgery (P=0.658). The left atrial diameter in the MVP group was reduced compared with the MVR group (P=0.026). The recurrence rate of mitral regurgitation in the MVP group was higher than that in the MVR group, and the difference was statistically significant (10.0% vs. 1.5%, P=0.003). There were 14 deaths in the MVP group and 19 in the MVR group. The cumulative survival rate (P=0.605) and cardiovascular events-free survival rate (P=0.875) were not statistically significant between the two groups by Kaplan-Meier survival analysis. Conclusion The safety, and mid- and long-term clinical efficacy of MVP in the treatment of FMR patients are better than MVR, and the left atrial and left ventricular diameters are statistically reduced, and cardiac function is statistically improved. However, the surgeon needs to be well aware of the indications for the MVP procedure to reduce the rate of mitral regurgitation recurrence.

With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

AIM:To detect the expression levels of miR-744-5p and E3 ubiquitin protein ligase(PELI3)in conjunctival epithelial cells of perimenopausal patients with dry eye, and analyze their correlation with sex hormone level, inflammatory factor level and tear secretion function.METHODS: A total of 60 perimenopausal patients with dry eye admitted to our hospital from February 2020 to February 2022 were selected as the observation group, in addition, 60 perimenopausal subjects with no abnormal eye examination were included as a control group. The tear film break-up time(BUT), Schirmer I test(SⅠt)and corneal fluorescein staining(FL)scores of perimenopausal patients with dry eye were collected. The conjunctival epithelial cells of the two groups were obtained by impression cytology, the expression level of miR-744-5p was detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR), the PELI3 levels of conjunctival epithelial cells and serum levels of follicle stimulating hormone(FSH), estradiol(E2), luteinizing hormone(LH), interleukin-1(IL-1), interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay; correlation analysis was conducted by Pearson and Spearman methods.RESULTS: The expression level of miR-744-5p in conjunctival epithelial cells of patients in the observation group was higher than that in the control group, and the expression level of PELI3 was lower than that in the control group(all P<0.05). Compared with the control group, the expression levels of FSH, IL-1, IL-6 and TNF-α in serum of patients increased in the observation group, and the expression levels of E2 and LH in serum decreased(all P<0.05). Correlation analysis showed that miR-744-5p was negatively correlated with PELI3 in conjunctival epithelial cells of perimenopausal dry eye patients(r=-0.476, P<0.01); miR-744-5p was negatively correlated with LH, E2, BUT and SⅠt(all P<0.05), while it was positively correlated with FSH, IL-1, IL-6, TNF-α and FL scores(all P<0.05); PELI3 was negatively correlated with FSH, IL-1, IL-6, TNF-α and FL scores, while it was positively correlated with E2, BUT and SⅠt(all P<0.05).CONCLUSION: The level of miR-744-5p increased and PELI3 decreased in conjunctival epithelial cells of perimenopausal patients with dry eye. PELI3 and miR-744-5p were closely related to the sex hormones level, inflammatory factor level and the function of tear secretion in perimenopausal patients with dry eye.

AIM:To detect the expression levels of miR-744-5p and E3 ubiquitin protein ligase(PELI3)in conjunctival epithelial cells of perimenopausal patients with dry eye, and analyze their correlation with sex hormone level, inflammatory factor level and tear secretion function.METHODS: A total of 60 perimenopausal patients with dry eye admitted to our hospital from February 2020 to February 2022 were selected as the observation group, in addition, 60 perimenopausal subjects with no abnormal eye examination were included as a control group. The tear film break-up time(BUT), Schirmer I test(SⅠt)and corneal fluorescein staining(FL)scores of perimenopausal patients with dry eye were collected. The conjunctival epithelial cells of the two groups were obtained by impression cytology, the expression level of miR-744-5p was detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR), the PELI3 levels of conjunctival epithelial cells and serum levels of follicle stimulating hormone(FSH), estradiol(E2), luteinizing hormone(LH), interleukin-1(IL-1), interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay; correlation analysis was conducted by Pearson and Spearman methods.RESULTS: The expression level of miR-744-5p in conjunctival epithelial cells of patients in the observation group was higher than that in the control group, and the expression level of PELI3 was lower than that in the control group(all P<0.05). Compared with the control group, the expression levels of FSH, IL-1, IL-6 and TNF-α in serum of patients increased in the observation group, and the expression levels of E2 and LH in serum decreased(all P<0.05). Correlation analysis showed that miR-744-5p was negatively correlated with PELI3 in conjunctival epithelial cells of perimenopausal dry eye patients(r=-0.476, P<0.01); miR-744-5p was negatively correlated with LH, E2, BUT and SⅠt(all P<0.05), while it was positively correlated with FSH, IL-1, IL-6, TNF-α and FL scores(all P<0.05); PELI3 was negatively correlated with FSH, IL-1, IL-6, TNF-α and FL scores, while it was positively correlated with E2, BUT and SⅠt(all P<0.05).CONCLUSION: The level of miR-744-5p increased and PELI3 decreased in conjunctival epithelial cells of perimenopausal patients with dry eye. PELI3 and miR-744-5p were closely related to the sex hormones level, inflammatory factor level and the function of tear secretion in perimenopausal patients with dry eye.