Objective To develop a three-dimensional(3D)deep neural network based preoperative classification model for coronary computed tomography angiography(CTA)in atrial fibrillation patients,and to explore the effects of transfer learning on the performance of medical image classification models,thereby providing preoperative decision support for catheter ablation to advance atrial fibrillation treatment toward precision and personalization.Methods Utilizing 3D ConvNet and 3D ResNet as backbone network,the three-dimensional classification features were extracted from coronary CTA sequences.The publicly available pre-trained weights were used for transfer learning.The model performance was evaluated through metrics such as confusion matrix,classification accuracy,and area under the curve(AUC).A comparative analysis was also conducted to evaluate the performance differences between the transfer learning model and the initialized training model.Results Transfer learning yielded significant performance improvements over the initialized training models,attaining AUC improvement of 9.1%-16.7%and accuracy enhancement of 6.2%-23.5%.Among all models,3D-ResNet18 model with MedicalNet pre-training weights performed the best,achieving an AUC of 0.77 and an accuracy of 0.71.Conclusion The proposed three-dimensional deep network enhanced by transfer learning can effectively identify atrial fibrillation patients requiring additional ablation besides pulmonary vein isolation through preoperative coronary CTA,which will assist clinicians in optimizing surgical strategies and improving treatment outcomes,thereby reducing long-term postoperative recurrence rates.

Objective To explore the mechanism through which dexmedetomidine(Dex)alleviates doxorubicin(Adr)-induced myo-cardial injury via regulating nuclear factor κB(NF-κB)expression.Methods Sprague-Dawley rats were divided into control,Adr,and Adr+Dex groups.Theirs hearts were harvested for hematoxylin and eosin(HE)staining,immunohistochemical staining,real-time polymerase chain reaction(PCR),and Western blotting anlyses.The rat primary cardiomyocytes,breast cancer cell line MDA-MB-23,lung cancer cell line H226,gastric cancer cell line AGS,and bladder cancer cell line 5637 were cultured and divided into control,Adr,Adr+Dex,Dex,and Adr+Dex+NF-κBi groups.CCK-8 and immunofluorescence staining were performed to detect the reactive oxygen species(ROS)contents.Results The myocardial arrangement of the rats in the Adr group was disordered,myocardial cell activity was lower,the mitochondrial membrane potential was lower,ROS production was higher,and NF-κB mRNA and protein contents were sub-stantially lower than those in the control group.The cardiomyocyte morphology was improved,cell activity was higher,mitochondrial mem-brane potential was increased,ROS production decreased,and NF-κB expression significantly increased in the Adr+Dex group compared with those in the control group.The mitochondrial membrane potential in the Adr+Dex+NF-κBi group was lower,and ROS generation was increased compared with the control group.The activity of the tumor cells in the Adr group was lower,and no statistically significant diffe-rences were found compared with that in the Adr+Dex group.Conclusion Treatment with Dex may not affect the chemotherapeutic effects of Adr.Dex administration may increase the myocardial mitochondrial membrane potential and reduce ROS generation by regu-lating NF-κB levels,thereby reducing Adr-induced myocardial damage.

Objective To explore the mechanism through which dexmedetomidine(Dex)alleviates doxorubicin(Adr)-induced myo-cardial injury via regulating nuclear factor κB(NF-κB)expression.Methods Sprague-Dawley rats were divided into control,Adr,and Adr+Dex groups.Theirs hearts were harvested for hematoxylin and eosin(HE)staining,immunohistochemical staining,real-time polymerase chain reaction(PCR),and Western blotting anlyses.The rat primary cardiomyocytes,breast cancer cell line MDA-MB-23,lung cancer cell line H226,gastric cancer cell line AGS,and bladder cancer cell line 5637 were cultured and divided into control,Adr,Adr+Dex,Dex,and Adr+Dex+NF-κBi groups.CCK-8 and immunofluorescence staining were performed to detect the reactive oxygen species(ROS)contents.Results The myocardial arrangement of the rats in the Adr group was disordered,myocardial cell activity was lower,the mitochondrial membrane potential was lower,ROS production was higher,and NF-κB mRNA and protein contents were sub-stantially lower than those in the control group.The cardiomyocyte morphology was improved,cell activity was higher,mitochondrial mem-brane potential was increased,ROS production decreased,and NF-κB expression significantly increased in the Adr+Dex group compared with those in the control group.The mitochondrial membrane potential in the Adr+Dex+NF-κBi group was lower,and ROS generation was increased compared with the control group.The activity of the tumor cells in the Adr group was lower,and no statistically significant diffe-rences were found compared with that in the Adr+Dex group.Conclusion Treatment with Dex may not affect the chemotherapeutic effects of Adr.Dex administration may increase the myocardial mitochondrial membrane potential and reduce ROS generation by regu-lating NF-κB levels,thereby reducing Adr-induced myocardial damage.

Objective To develop a three-dimensional(3D)deep neural network based preoperative classification model for coronary computed tomography angiography(CTA)in atrial fibrillation patients,and to explore the effects of transfer learning on the performance of medical image classification models,thereby providing preoperative decision support for catheter ablation to advance atrial fibrillation treatment toward precision and personalization.Methods Utilizing 3D ConvNet and 3D ResNet as backbone network,the three-dimensional classification features were extracted from coronary CTA sequences.The publicly available pre-trained weights were used for transfer learning.The model performance was evaluated through metrics such as confusion matrix,classification accuracy,and area under the curve(AUC).A comparative analysis was also conducted to evaluate the performance differences between the transfer learning model and the initialized training model.Results Transfer learning yielded significant performance improvements over the initialized training models,attaining AUC improvement of 9.1%-16.7%and accuracy enhancement of 6.2%-23.5%.Among all models,3D-ResNet18 model with MedicalNet pre-training weights performed the best,achieving an AUC of 0.77 and an accuracy of 0.71.Conclusion The proposed three-dimensional deep network enhanced by transfer learning can effectively identify atrial fibrillation patients requiring additional ablation besides pulmonary vein isolation through preoperative coronary CTA,which will assist clinicians in optimizing surgical strategies and improving treatment outcomes,thereby reducing long-term postoperative recurrence rates.

Objective To evaluate the effectiveness and safety of Yiyang Pill in preventing and treating cardiovascular adverse reactions in patients with traditional Chinese medicine(TCM)syndrome with qi and yin deficiency and thyroid stimulating hormone(TSH)inhibition after differentiated thyroid cancer(DTC)resection.Methods A randomized,double-blind,placebo-controlled clinical trial was conducted,and 120 patients with TSH inhibition after DTC surgery were enrolled and randomized into two groups in a 1∶1 ratio using SAS 9.4 software generated random tables.The control group received a placebo and TSH suppression therapy,whereas the treatment group received the Yiyang Pill and TSH suppression therapy.The treatment period was 3 months.The incidence of cardiovascular adverse reactions,blood pressure,blood lipids,thyroid function,the dosage of levothyroxine,the efficacy of TCM syndrome,and safety indicators were compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of cardiovascular adverse reactions.Results The incidence of cardiovascular adverse reactions in the treatment group was lower than that in the control group(P<0.05),and the efficacy of TCM syndrome treatment was significantly higher than in the control group(P<0.05).The free tetraiodothyronine level in the treatment group was higher than that before treatment(P<0.05),and the systolic and diastolic blood pressure in the control group increased compared to those before treatment(P<0.05).No severe adverse events were observed in either group.Compared with the control group,the cardiovascular incidence in the treatment group was lower,and the cardiovascular incidence in the<100 μg/d group was lower than that in the group with≥100 μg/d before treatment.Conclusion The Yiyang Pill can reduce the incidence of cardiovascular adverse reactions in patients after DTC surgery,effectively improve TCM syndromes,and be safe to use.Yiyang Pill treatment is a protective factor for cardiovascular adverse reactions,and the dosage of levothyroxine≥100 μg/d was a risk factor.

OBJECTIVES: Clinical research plays a vital role in disease research and population health. The public is the main source of clinical research volunteers. Understanding the public's cognition of clinical research plays a decisive role in the development of clinical research. This study aims to understand the Chinese public's cognition for clinical research and the influencing factors. METHODS: The questionnaire based on Chinese-translated Public Awareness of Research for Therapeutic Advancements through Knowledge and Empowerment (PARTAKE) was used to investigate the public's cognition for clinical research. RESULTS: Of the 2 513 valid respondents, 91.84% had heard of "clinical research", 91.76% of the respondents believed that clinical research was beneficial to society, 65.90% were willing to participate in clinical research, 87.50% believed that confidentiality was a very important thing, 73.70% believed that their personal information had been protected when participating in clinical research, and, 46.40% did not know whether volunteers participating in clinical research could receive adequate compensation. Educational levels, employment status, and annual income impacted in public perceptions of willingness to participate in clinical research, especially in privacy protection, informed consent, whether clinical research is intended for society, compensation for clinical research, and safety of clinical research (all P<0.01). CONCLUSIONS The Chinese public's cognition level for clinical research is acceptable, but there is still a lot of room for improvement in privacy protection, informed consent, and compensation. By designing a reasonable knowledge training program for clinical research and using the multimedia, improving access to the relevant knowledge, more public will know about clinical research recruitment information, which is of great significance for the development of clinical research in China.
Humans ; China ; East Asian People ; Educational Status ; Surveys and Questionnaires ; Public Opinion ; Knowledge ; Biomedical Research

Objective:To explore the effect of network medication guidance on anticoagulation management of warfarin.Methods:The study was designed as the retrospective cohort study. Study subjects were selected from patients who underwent cardiac valve replacement during January 2018 and April 2019 in the Department of Cardiovascular Surgery of Xiangya Hospital, Central South University, and took oral warfarin for 3 months or more after operation. According to the mode of revisit, the patients were divided into 4 groups: 1-month post-operation network group (INR review results were uploaded online for more than 2 times within 1 month after operation), 1-month post-operation control group (INR was reviewed in Xiangya Hospital 1 month after the operation and INR data was recorded), 3-month post-operation network group (INR review results were uploaded online for more than 4 times within 3 months after operation), and 3-month post-operation control group (INR was reviewed in Xiangya Hospital 3 months after the operation and INR data was recorded). The gender and age distribution of patients in the network group and the control group, as well as INR and INR compliance rate at 1 or 3 months after operation were compared.Results:A total of 420 patients underwent cardiac valve replacement in Xiangya Hospital during the study period, and all of them were prescribed warfarin for anticoagulation. Among the 420 patients, 266 patients (63.3%) had network or Xiangya Hospital revisit records 1 month after operation, 71 of which were included in the 1-month post-operation network group and 178 of which in the 1-month post-operation control group; 132 (31.4%) patients had network or Xiangya Hospital revisit records 3 month after operation, 46 of which were included in the 3-month post-operation network group and 77 of which in the 3-month post-operation control group. Patients in the 1-month post-operation network group had lower age, higher INR compliance rate, and lower incidence of insufficient anticoagulation than those in the 1-month post-operation control group, and the differences were all statistically significant [(49±10) years vs. (53±11) years, P=0.009; 64.8%(46/71) vs. 45.5%(81/178), P=0.006; 21.1%(15/71) vs. 46.6%(83/178), P<0.001]. Patients in the 3-month post-operation network group had higher INR, higher INR compliance rate, and lower incidence of insufficient anticoagulation than those in the 3-month post-operation control group, and the differences were all statistically significant [(2.05±0.45) vs. (1.84±0.62), P=0.044; 67.4% (31/46) vs. 30.9% (30/97), P=0.002; 30.4% (14/46) vs. 54.5% (42/77), P=0.009]. Conclusions:Network medication guidance is helpful to improve the effect of warfarin anticoagulation management and improve the INR compliance rate of patients after cardiac valve replacement. The main manifestation of substandard anticoagulation is insufficient anticoagulation, which should be paid attention to.

Objective:To explore the effect of network medication guidance on anticoagulation management of warfarin.Methods:The study was designed as the retrospective cohort study. Study subjects were selected from patients who underwent cardiac valve replacement during January 2018 and April 2019 in the Department of Cardiovascular Surgery of Xiangya Hospital, Central South University, and took oral warfarin for 3 months or more after operation. According to the mode of revisit, the patients were divided into 4 groups: 1-month post-operation network group (INR review results were uploaded online for more than 2 times within 1 month after operation), 1-month post-operation control group (INR was reviewed in Xiangya Hospital 1 month after the operation and INR data was recorded), 3-month post-operation network group (INR review results were uploaded online for more than 4 times within 3 months after operation), and 3-month post-operation control group (INR was reviewed in Xiangya Hospital 3 months after the operation and INR data was recorded). The gender and age distribution of patients in the network group and the control group, as well as INR and INR compliance rate at 1 or 3 months after operation were compared.Results:A total of 420 patients underwent cardiac valve replacement in Xiangya Hospital during the study period, and all of them were prescribed warfarin for anticoagulation. Among the 420 patients, 266 patients (63.3%) had network or Xiangya Hospital revisit records 1 month after operation, 71 of which were included in the 1-month post-operation network group and 178 of which in the 1-month post-operation control group; 132 (31.4%) patients had network or Xiangya Hospital revisit records 3 month after operation, 46 of which were included in the 3-month post-operation network group and 77 of which in the 3-month post-operation control group. Patients in the 1-month post-operation network group had lower age, higher INR compliance rate, and lower incidence of insufficient anticoagulation than those in the 1-month post-operation control group, and the differences were all statistically significant [(49±10) years vs. (53±11) years, P=0.009; 64.8%(46/71) vs. 45.5%(81/178), P=0.006; 21.1%(15/71) vs. 46.6%(83/178), P<0.001]. Patients in the 3-month post-operation network group had higher INR, higher INR compliance rate, and lower incidence of insufficient anticoagulation than those in the 3-month post-operation control group, and the differences were all statistically significant [(2.05±0.45) vs. (1.84±0.62), P=0.044; 67.4% (31/46) vs. 30.9% (30/97), P=0.002; 30.4% (14/46) vs. 54.5% (42/77), P=0.009]. Conclusions:Network medication guidance is helpful to improve the effect of warfarin anticoagulation management and improve the INR compliance rate of patients after cardiac valve replacement. The main manifestation of substandard anticoagulation is insufficient anticoagulation, which should be paid attention to.

Objective The purpose of this study was to evaluate the degree of skin thickening of patients with systemic sclerosis (SSc) by high-frequecy ultrasound,as well as the value of ultrasound.Methods Thirty-one patients with SSc and 31 age-matched and sex-matched healthy control subjects were enrolled.Skin thickness,modified Rodnan skin score (mRss),disease activity index (DA1) and other clinical parameters within and between groups were compared using SPSS 21 software.Student's t test,x2 test or nonparametric testing was performed to compare between groups.The Pearson or Spearman methods were used to test correlation.Sensitivity and specificity of skin thickness detection by high-frequecy ultrasound were evaluated by using receiver operating characteristic (ROC) curve analysis.Results Total thickness of skin (TST) of patientswith SSc were positively correlated to the total mRss (r=0.416,P=0.020) and DAI (r=0.436,P=0.014).The skin thickness of patients with mRss 0,1,2 was higher than CNT [1.45(0.60),1.70(0.30) mm,1.60 (0.30) mm vs 1.30 (0.35) mm,Z=-3.242,-6.577,-5.090,P＜0.01].The cut-off value of TST used as the evaluation of skin change was 7.4 mm by ROC curve analysis,and the sensitivity and specificity of them was 77.40％ and 87.10％ respectively,and patients with thickened skin were more likely to suffer interstitial lung disease (ILD) (16 vs 1,x2=26.004,P=0.014),higher mRss [10(6) vs 4(5),Z=-2.499,P=0.031],DAI [(5.2±2.4) vs (2.3±1.7),t=-3.104,P＜0.01)] and CRP [(8.60 (10.48) mg/L vs 3.52 (4.93) mg/L,Z=-2.276,P=0.038].Conclusion US combined with mRss are helpful to evaluate the changes of skin and disease activity of patients in SSc.US can identify the early and subclinical skin involvement that may precede mRss,providing a more reliable tool for diagnosis,treat efficacy and prediction of organ damage.

Objective To explore the application value of chromosomal microarray analysis(CMA)technolo-gy in children with abnormal development at the endocrine clinic,and to summarize the data of diagnosis and treatment. Methods A retrospective analysis of 15 children with abnormal development was performed at the endocrinology clinic of Guangzhou Women and Childrenˊs Medical Center from January 2015 to December 2017. The whole genome CMA was applied according to the standard operation procedure of CytoScan 750 arrays of Affymetrix,USA. The results were analyzed by chromosome analysis suite( CHAS)software and related bioinformatics methods. Results The report on CMA showed that the genomes of 15 children had the pathogenic copy number variation(CNVs)or variants of uncer-tain significance. The chromosomal abnormalities were consistent with the clinical manifestations of all children. There were deletions in 14 cases and duplications in 3 cases. Among the 15 cases,loss of heterozygosity was found in 2 cases, uniparental disomy in 1 case,trisomy in 2 cases,Turner syndrome in 2 cases,Smith-Magenis syndrome in 1 case,and wolf Hirschhorn syndrome in 1 case. Only 2 of 15 children were diagnosed as chromosomal abnormalities by routine kar-yotype analysis. Conclusions The whole genome high resolution CMA can significantly improve the rate of diagnosis in children with abnormal development at endocrinology clinic,and is worthy of recommendation.