Objective To develop a classification tree algorithm to improve diagnostic performances of 99mTc-MIBI SPECT/CT fusion imaging in differentiating solitary pulmonary nodules (SPNs). Methods Forty-four SPNs, including 30 malignant cases and 14 benign ones that were eventually pathologically identified, were included in this prospective study. All patients received 99Tcm-MIBI SPECT/CT scanning at an early stage and a delayed stage before operation. Thirty predictor variables, including 11 clinical variables, 4 variables of emission and 15 variables of transmission information from SPECT/CT scanning, were analyzed independently by the classification tree algorithm and radiological residents. Diagnostic rules were demonstrated in tree-topology, and diagnostic performances were compared with Area under Curve (AUC) of Receiver Operating Characteristic Curve (ROC). Results A classification decision tree with lowest relative cost of 0.340 was developed for 99Tcm-MIBI SPECT/CT scanning in which the value of Target/Normal region of 99Tcm-MIBI uptake in the delayed stage and in the early stage, age, cough and specula sign were five most important contributors. The sensitivity and specificity were 93.33% and 78. 57e, respectively, a little higher than those of the expert. The sensitivity and specificity by residents of Grade one were 76.67% and 28.57%, respectively, and AUC of CART and expert was 0.886±0.055 and 0.829±0.062, respectively, and the corresponding AUC of residents was 0.566±0.092. Comparisons of AUCs suggest that performance of CART was similar to that of expert (P=0.204), but greater than that of residents (P<0.001). Conclusion Our data mining technique using classification decision tree has a much higher accuracy than residents. It suggests that the application of this algorithm will significantly improve the diagnostic performance of residents.

Objective To explore the status of emotional-social loneliness including emotional isolation,social isolation,emotional and social loneliness in patients with acute cerebral infraction,and to analyze the related factors.Methods A total of 122 patients with acute cerebral infraction admitted to the neurology department of 5 third-grade class-A hospitals from Jan.2017 to Oct.2017 were enrolled.Data was collected by self-reported questionnaires including patients' general data and the emotional-social loneliness questionnaire data.Results Among 122 patients with acute cerebral infraction,emotional isolation,social isolation,emotional loneliness and social loneliness were found in 48 cases(39.3％),60 cases(49.2％),40 cases(32.8％)and 36 cases(29.5％),respectively.The total average score for emotional isolation,social isolation,emotional loneliness and social loneliness were 8.3 ± 5.2,8.6 ± 5.1,7.5 ± 6.1,and 7.4 ± 5.5,respectively.The scores for emotional-social loneliness were associated with education level,monthly family income,occupations and the emotion state before disease,and were not associated with gender,marriage status and stroke history.Conclusions The prevalence of emotional-social loneliness is high in patients with acute cerebral infraction.Especially careful attention should be paid to patients with higher education level and retired with monthly family income ≥5 000 RMB.

Objective:To analyze the association between the Charlson Comorbidity Index(CCI)and the risk of early in-hospital death in cerebral hemorrhage inpatients.Methods:Basic personal and medical information about sex, age, surgery, frequency of hospitalization, days of hospitalization, and ICD-10 diagnosis code was collected for intracerebral hemorrhage patients aged 60 or above admitted to a tertiary general hospital from January 1, 2017 to December 31, 2019.The CCI score was calculated based on diagnoses at the time of discharge.Using the CCI score as the dependent variable and in-hospital death as the independent variable, univariate and multiple logistic regression analysis was conducted to examine the association between CCI and in-hospital death.The receiver operator characteristic curve(ROC)was used to assess the value of CCI in predicting death.Results:A total of 504 cerebral hemorrhage inpatients were included in the study, with an average age of 69.48±7.55 years, and 52 died during the period.Univariate Logistic regression showed that, compared with inpatients with CCI=3, the OR values(95% CI)for inpatients with CCI=4 and CCI≥5 were 2.145(1.056-4.355)and 4.769(2.168-10.494), respectively.Multiple Logistic regression showed that, compared with inpatients with CCI=3, the OR(95% CI)for inpatients with CCI≥5 was 4.453(1.474-13.456), The area under the ROC curve was 0.718, with 95% CI at 0.642-0.793( P<0.001). Conclusions:The CCI score was associated with the risk of early in-hospital death in elderly patients with cerebral hemorrhage and can be used to assess and predict the risk of early in-hospital death for these patients.

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.