Objective:This study aimed to assess the effects of Peer Balint-style group on the empathy ability of third-year long-term medical students and to provide a theoretical and practical reference for effectively improving their humanistic quality.Methods:Ninety third-year Chinese long-term medicine students participated. Volunteers received either ten sessions of 1.5-h Peer Balint-style group which were led by specially trained peers from June 2019 to August 2019. The College Students' Empathy Ability Questionnaire was used before the experiment and the second day after the experiment. The total score of the scale from the pre-test and post-test and the scores of each dimension conformed to a normal distribution, with equal variance, describing in the form of ( x± s). Paired t-tests were performed to compare the total score and each dimension score before and after the intervention, using SPSS 22.0. Semi-structured interviews were conducted with 7 peer-group leaders and group members after the clinical practice period. The interview materials were analyzed by traditional content analysis. The content of the qualitative research was open-coded to obtain 10 categories, suggesting the role and inadequacy of Peer Balint-style groups. Results:A total of 63 valid samples were obtained. There was no significant difference of ( t=-0.44, P=0.661, P>0.05) between the total score of the post-test (118.00±11.98) and the total score of the pre-test (117.38±12.36). In each dimension, the reverse comprehension score of post-test (9.06±1.97) was significantly different ( t=-2.08, P=0.041, P>0.05) from the pre-test's (8.57±2.15), which increased compared to the pre-test score. Conclusions:Peer Balint-style group had a positive effect on improving empathy among medical students. Compared with the traditional Balint group, it has wider coverage, higher affinity and greater mobility. However, the design of the Peer Balint-style group still needs to be further improved.

Purpose To evaluate the carotid artery elasticity and the influencing factors in the offspring of early-onset type 2 diabetes mellitus by RF-data based quantitative analysis on vessel stiffness.Materials and Methods We continuously encrolled 63 offspring of type 2 diabetes mellitus,depending on the parental diagnostic age of diabetes they were divided into two groups:32 cases of early-onset offspring group,31 cases of late-onset offspring group.32 healthy volunteers who were matched for age,gender and body mass index,were selected as controls.Real-time intima-media thickness and RF-data based quantitative analysis on vessel stiffness were employed to evaluate common carotid intima-media thickness,displacement,diameter,hardness coefficient and pulse wave velocity.The differences among the groups were compared.Results The intima-media thickness,pulse wave velocity and hardness coefficient in early-onset offspring group were higher than late-onset offspring group(t=0.054-1.228,P＜0.05),and displacement was lower than late-onset offspring group(t=0.048,0.109,both P＜0.05).Conclusion Carotid artery stiffness in the offspring of diabetes mellitus patients is significantly higher than the control group.And the carotid elasticity of early-onset offspring group decreased more obviously than late-onset group.

Objective:To construct a spatial radiomics model based on the spatial distribution characteristics of supratentorial pilocytic astrocytoma (PA) and ganglioglioma (GG) and to evaluate its differential diagnosis efficiency.Methods:The study was a cross-sectional study. A retrospective collection of 244 patients with episodic PA and GG who attended Beijing Tiantan Hospital of Capital Medical University (Center 1) from June 2016 to June 2022 and 116 patients with episodic PA and GG who attended General Hospital of Eastern Theater Command (Center 2) from March 2019 to October 2022 was performed. The patients in Center 1 were divided into a training set (171 patients) and a validation set (73 patients) in a 7∶3 ratio according to the random number table method, and the patients in Center 2 as a whole were regarded as test sets. All patients underwent MRI. Segmentation of tumor based on enhanced T 1WI and T 2WI images, alignment to standard space to generate a statistical parametric mapping of tumor locations and intergroup comparison was conducted. The Johns Hopkins University template was used to extract 189 tumor location features to construct a spatial model of tumor location; PyRadiomic 3.0.1 software was used to extract tumor radiomics features to construct a radiomics model; and the two models were fused to construct a spatial radiomics model. The efficacy of spatial radiomics model, spatial model, and radiomics model to discriminate PA from GG was analyzed using receiver operating characteristic curves and area under the curve (AUC). The generalization ability of the model was assessed by the difference in accuracy between the test sets and the validation sets (ΔACC). The clinical utility of the model was compared using clinical decision curves and calibration curves. Results:The statistical parametric mapping of lesions showed that supratentorial PA was vulnerable to medial structure areas such as suprasellar region, thalamus, basal ganglia and frontal lobe, temporal lobe, parietal lobe. GG was mainly distributed in bilateral temporal lobes, as well as frontal lobe, occipital lobe and parietal lobe. The AUCs of spatial radiomics model, radiomics model and spatial model to identify PA and GG in the test set were 0.876, 0.785, and 0.819, with accuracies of 77.59%, 72.41%, and 77.14%, respectively, and ΔACCs in the test set and validation set were 11.6%, 15.43%, and 6.94%, respectively. The clinical decision curves showed an overall greater clinical benefit of the spatial radiomics model compared with the conventional radiomics model and spatial model.Conclusion:Spatial radiomics model containing spatial information on lesion location can improve the diagnostic efficacy of supratentorial PA and GG, and enhance the generalization of the prediction model.

Purpose To evaluate the changes of carotid artery elasticity in children with type 1 diabetes mellitus (T1DM) via RF-data based quantitative analysis on vessel stiffness technique (R-VQS),and to detect its correlation with the duration of diabetes mellitus and blood sugar control. Materials and Methods A total of 75 children with T1DM from the Pediatrics Department of Henan Chest Hospital,the Pediatrics Department of Henan People's Hospital,and the Endocrinology,Genetics,and Metabolism Department of Henan Children's Hospital were prospectively collected from September 2019 to November 2021. According to the T1DM duration,all patients were divided into long course group (duration ≥5 years,n=30 cases) and short course group (duration<5 years,n=45 cases). And 30 age and sex matched controls were also collected. The systolic diameter (Diam),vascular displacement (Dist),pulse wave velocity (PWV),stiffness coefficient (HC) and intima-media thickness (IMT) of common carotid artery were measured by R-VQS. Fasting blood glucose (FBG),glycosylated hemoglobin (HbA1c),triglyceride (TG),serum total cholesterol (TC),high-density lipoprotein (HDL),low-density lipoprotein cholesterol (LDL) were collected to compared the differences of parameters among the three groups. Results The FBG,HbA1c and IMT of the long and short course groups were all significantly higher than those of control group (all P<0.05). There were statistically significant differences in PWV and HC among the three groups (F=22.854,P<0.001;F=16.811,P<0.001;H=33.214,P<0.001). The course of disease was moderately correlated with PWV and HC (r=0.621,0.517,respectively,P<0.001). HbA1c was moderately correlated with PWV (r=0.562,P<0.001). Conclusion Early onset of T1DM in children may lead to decreased carotid artery elasticity,and prolonged hyperglycemia can aggravate the degree of arterial elasticity damage. R-VQS is a simple,effective,and non-invasive method for assessing arterial elasticity,providing a basis for clinical diagnosis and treatment.

Purpose To evaluate the changes of carotid artery elasticity in children with type 1 diabetes mellitus (T1DM) via RF-data based quantitative analysis on vessel stiffness technique (R-VQS),and to detect its correlation with the duration of diabetes mellitus and blood sugar control. Materials and Methods A total of 75 children with T1DM from the Pediatrics Department of Henan Chest Hospital,the Pediatrics Department of Henan People's Hospital,and the Endocrinology,Genetics,and Metabolism Department of Henan Children's Hospital were prospectively collected from September 2019 to November 2021. According to the T1DM duration,all patients were divided into long course group (duration ≥5 years,n=30 cases) and short course group (duration<5 years,n=45 cases). And 30 age and sex matched controls were also collected. The systolic diameter (Diam),vascular displacement (Dist),pulse wave velocity (PWV),stiffness coefficient (HC) and intima-media thickness (IMT) of common carotid artery were measured by R-VQS. Fasting blood glucose (FBG),glycosylated hemoglobin (HbA1c),triglyceride (TG),serum total cholesterol (TC),high-density lipoprotein (HDL),low-density lipoprotein cholesterol (LDL) were collected to compared the differences of parameters among the three groups. Results The FBG,HbA1c and IMT of the long and short course groups were all significantly higher than those of control group (all P<0.05). There were statistically significant differences in PWV and HC among the three groups (F=22.854,P<0.001;F=16.811,P<0.001;H=33.214,P<0.001). The course of disease was moderately correlated with PWV and HC (r=0.621,0.517,respectively,P<0.001). HbA1c was moderately correlated with PWV (r=0.562,P<0.001). Conclusion Early onset of T1DM in children may lead to decreased carotid artery elasticity,and prolonged hyperglycemia can aggravate the degree of arterial elasticity damage. R-VQS is a simple,effective,and non-invasive method for assessing arterial elasticity,providing a basis for clinical diagnosis and treatment.

Objective:To evaluate right atrial (RA) volume and function in patients with hepatitis B cirrhosis by four-dimensional automatic quantitation analysis technique, and to explore its correlation with liver function grading.Methods:Ninety patients with hepatitis B cirrhosis who were clinically confirmed in Henan Provincial People′s Hospital from December 2020 to July 2021 were randomly enrolled as the research subjects. According to Child-Pugh liver function score criteria, the patients were divided into three groups: Child-Pugh A group ( n=31), Child-Pugh B group ( n=31), Child-Pugh C group ( n=28). Another 30 healthy volunteers with gender and age matched at the same period were selected as the control group. The RA maximum volume (RAVmax), RA minimum volume (RAVmin), RA presystolic volume (RAVpreA), RA maximum volume index (RAVImax), RA emptying volume (RAEV), RA ejection fraction (RAEF), RA reservoir longitudinal and circumferential strains (RASr, RASr-c), RA conduit longitudinal and circumferential strains (RAScd, RAScd-c), RA contraction longitudinal and circumferential strains (RASct, RASct-c) were obtained by four-dimensional automatic quantitation analysis technique. Spearman correlation analysis was used to explore the correlation between the volume and strain parameters of right atrium and liver function grading, and the independent correlation factors of RASr-c were analyzed by univariate and multivariate linear regression analyses. Results:Compared with the control group, Child-Pugh A and Child-Pugh B groups, RAVmax, RAVmin, RAVpreA, RAVImax, and RAEV were all increased in Child-Pugh C group (all P<0.05). Compared with control group, the absolute values of RASr, RASct, RASr-c and RASct-c were increased, and the absolute values of RAScd and RAScd-c were decreased in Child-Pugh A group (all P<0.05). Compared with control group, Child-Pugh A and Child-Pugh B groups, the absolute values of RASr, RAScd, RASct, RASr-c, RAScd-c and RASct-c were decreased in the Child-Pugh C group (all P<0.05). Correlation analysis showed that the volume and strain parameters of the right atrium were correlated with liver function grading. RASr-c was independently correlated with E/e, ALB and BNP(β=-0.543, 0.521, and -0.562 respectively, all P<0.05). Conclusions:During the compensatory stage in patients with hepatitis B cirrhosis, the RA functions of reservoir and contractile were increased, but the function of conduit was decreased. With the aggravation of liver cirrhosis, the RA functions of reservoir, conduit and contractile were all decreased. The four-dimensional volume and strain parameters of the right atrium were correlated with Child-Pugh liver function grading, and RASr-c was independently correlated with E/e, ALB and BNP.

Objective:To investigate the change of left atrial volume and function in patients with hypertensive disorders of pregnancy (HDPs) by four-dimensional automatic left atrial quantitative analysis (4D LAQ) and analyze the predictive value of risk stratification.Methods:A total of 60 patients diagnosed with hypertensive disorder of pregnancy in Henan Provincial People′s Hospital from March to December 2021 were randomly enrolled, which were divided into gestational hypertension group (low risk group, n=30) and preeclampsia group (medium and high risk group, n=30) according to the disease development and risk stratification method reported in the literature; another 30 healthy pregnant women matched for age, gestational weeks and body mass index were selected as the control group. Left atrial anteroposterior diameter (LAd), interventricular septum thickness (IVSd), left ventricular end diastolic diameter (LVd), left ventricular ejection fraction (LVEF), left ventricular myocardial mass index (LVMI), peak early diastolic (E) and late diastolic (A) velocities of mitral inflow, and e′ values on the septal and lateral mitral annulus sides were routinely measured to calculate E/A and E/e′ values. Left atrial volume and strain parameters were obtained using 4D LAQ technique, including left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial presystolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial inflation index (LAEI), left atrial stroke volume (LAEV), left atrial fraction (LAEF), longitudinal strain of left atrial reserve, conduit and systolic period (LASr, LAScd, LASct), circumferential strain of left atrial reserve, conduit and systolic period(LASr-c, LAScd-c, LASct-c). The differences among the three groups were compared. Multiple Logistics regression analysis was used to obtain the relevant indicators of risk stratification of HDPs and ROC curves were used for assessment. Results:Compared with the control group, E/e′, LAVmin, LAVpreA, LAScd, and LAScd-c increased, and LAEI, LAEF, LApEF, LASr, and LASr-c decreased in the gestational hypertension group (all P<0.05). Compared with the control group and gestational hypertension group, LAd, IVSd, LVd, LVMI, E/e′ LAVmin, LAVmax, LAVpreA, LAVImax, LAEV, LAScd, and LAScd-c increased, and LVEF, LAEF, LAEI, LApEF, LASr, and LASr-c decreased in the preeclamptic group, and the differences were statistically significant (all P<0.05). The results of multiple Logistics regression showed that LAVmax, LAScd-c and LASr were the indicators relevant to risk stratification of HDPs(β=0.344, 0.216 and -0.249, respectively, all P<0.05). ROC analysis showed when the cut-off value of left atrial strain parameter LASr was 30.5%, the AUC, sensitivity, and specificity were 0.725, 0.58, 0.90, respectively; when the cut-off value of LAVmax was 44.5 ml, the AUC, sensitivity, and specificity were 0.662, 0.80, and 0.56, respectively; and when the cut-off value of LAScd-c was -17.5%, the AUC, sensitivity, and specificity were 0.706, 0.56, and 0.78, respectively. Conclusions:Left atrial remodeling occured in pregnant women with hypertensive disorders, their reserve and conduit function were impaired, and aggravated with the progress of the disease. The four-dimensional parameters LASr, LAVmax, and LAScd-c were relevant indicators for risk stratification of HDPs. In predicting the severity of HDPs, LASr has high diagnostic value and good specificity; LAVmax and LAScd-c can be considered as supplementary parameters to predict the risk stratification of HDPs.

Objective To investigate the clinical features of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant infection and abnormal liver function in Guangdong Province, China. Methods The patients with SARS-CoV-2 Delta variant infection who belonged to the same chain of transmission in Guangdong Province (Guangzhou and Foshan) and were admitted to Guangzhou Eighth People's Hospital, Guangzhou Medical University from May 21 to June 18, 2021 were enrolled in this study, and the judgment criteria for liver function were alanine aminotransferase (male/female) > 50/40 U/L, aspartate aminotransferase > 40 U/L, total bilirubin > 26 μmol/L, gamma-glutamyl transpeptidase > 60 U/L, and alkaline phosphatase (ALK) > 125 U/L. Abnormality in any one item of the above criteria was defined as abnormal liver function, and such patients were included in analysis (the patients, aged < 18 years, who had a mild or moderate increase in ALP alone were not included in analysis). Clinical data were compared between the patients with normal liver function and those with abnormal liver function, and the etiology and prognosis of abnormal liver function were analyzed. The Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Results Among the 166 patients with SARS-CoV-2 Delta variant infection, 32 (19.3%) had abnormal liver function with mild-to-moderate increases in liver function parameters, and compared with the normal liver function group, the abnormal liver function group had a significantly higher proportion of critical patients ( χ 2 =38.689, P < 0.001) and significantly higher age and inflammatory cytokines [C-reactive protein type, serum amyloid A, and interleukin-6 (IL-6)](all P < 0.05). Among the 32 patients with abnormal liver function, 13 patients had abnormal liver function on admission (defined as primary group), while 19 patients had normal liver function on admission but were found to have abnormal liver function by reexamination after treatment (defined as secondary group). For the primary group, the evidence of abnormal liver function was not found for 3 patients (3/13, 23.1%), and the possibility of toxic liver injury directly associated with SARS-CoV-2 infection was considered. Among the 19 patients in the secondary group, 9 (47.4%) had mild/common type and 10 (52.6%) had critical type, and all critical patients had the evidence of liver injury indirectly caused by the significant increases in C-reactive protein type, serum amyloid A, and IL-6 and hypoxemia; the evidence of abnormal liver function was not found for only 1 patient (1/19, 5.3%), and the possibility of toxic liver injury directly associated with SARS-CoV-2 infection was considered. All 32 patients with abnormal liver function had [JP2]significant reductions in liver function parameters after treatment including liver protection. Conclusion As for the patients with SARS-CoV-2 Delta variant infection who belong to the same chain of transmission in Guangdong Province, the critical patients show a significantly higher proportion of patients with abnormal liver function than the patients with other clinical types, and other factors except SARS-CoV-2 infection and indirect injury caused by SARS-CoV-2 infection are the main cause of liver injury.

Objective:To explore the changes of left atrial volume and function in patients with early diabetic nephropathy by four-dimensional auto left atrial quantification (4D Auto LAQ).Methods:Forty patients with early diabetic nephropathy (early diabetic nephropathy group), 40 patients with type 2 diabetes (diabetes group) in Henan Provincial People′s Hospital from March 2020 to April 2021 were selected, and 36 healthy volunteers (control group) were collected during the same period. The parameters of conventional echocardiography were measured, and the four-dimensional volume probe was used to obtain the complete left atrial volume image in 5 cardiac cycles. The 4D Auto LAQ software on the EchoPAC workstation was used for analysis to obtain the left atrial volume and strain indicators: left atrial (LA) maximum volume (LAVmax), left atrial minimum volume (LAVmin), pre-systolic volume (LAVpreA), left atrial volume index (LAVImax), left atrial emptying volume (LAEV), left atrial emptying fraction (LAEF), and long axis and circumferential strains in left atrial reserve phase, pipeline phase and systolic phase (LASr, LASr-c; LAScd, LAScd-c; LASct, LASct-c). The differences of these parameters among 3 groups were analyzed.Results:There were no significant differences in interventricular septum end-diastolic thickness(IVSd), left ventricular posterior wall end-diastolic thickness(LVPWd), left ventricular end-diastolic dimension(LVIDd), left ventricular ejection fraction(LVEF), and E/A (ration of early to late diastolic peak flow velocity of mitral orifice) among 3 groups (all P>0.05), and left atrial diameter(LAD), relative wall thickness(RWT), and E/e′ (ration of early diastolic peak flow velocity of mitral orifice to early diastolic velocity of lateral mitral annulus) among 3 groups were significantly different (all P<0.05). Further pairwise comparison results showed that LAD was only significantly different between the early diabetic nephropathy group and control group ( P=0.001 2), and the differences in RWT and E/e′ were statistically significant among 3 groups (all P<0.05). There were no significant differences in LAEV, LAScd-c, and LASct-c among 3 groups (all P>0.05), and LAVmin, LAVmax, LAVpreA, LAVImax, LAEF, LASr, LAScd, LASct, and LASr-c among the 3 groups were significantly different (all P<0.05). The pairwise comparison showed that, compared with the control group and the diabetes group, LAVmin, AVpreA, and LAVImax in the early diabetic nephropathy group were increased, and LAEF, LAScd, LASct, and LASr-c were decreased (all P<0.05). Compared with the control group, LAVmax, LAVImax and LASct in the diabetes group were increased, and LAEF, LAScd, and LASr-c were decreased (all P<0.05). Conclusions:4D Auto LAQ technology can quantitatively evaluate the changes in left atrium volume and function in patients with early diabetic nephropathy. Patients with early diabetic nephropathy have an increase in left atrium volume and a decrease in strain value.

Objective:To observe the morphological characteristics of urogenital hiatus in patients with gestational diabetes mellitus (GDM) after vaginal delivery.Methods:This study included 192 pregnant patients from Henan Provincial People′s Hospital who met the conditions between Jan.2020 and Aug.2021. All participants were screened for GDM by oral glucose tolerance test (OGTT) or fasting blood glucose at 24-28 weeks of pregnancy, and were divided into GDM group (34 cases) and non-GDM group (158 cases) based on the presence or absence of GDM. All participants underwent pelvic floor ultrasonography at the first trimester (6-8 gestational weeks), 3 days postpartum, 6 weeks postpartum, 6 months postpartum, and 1 year postpartum. Area of urogenital hiatus (AUH), transversal diameter of urogenital hiatus (TDUH) and anteroposterior diameter of urogenital hiatus (APDUH) were measured using Smart Pelvic. The Logistic regression model was used to calculate and match the propensity score between the GDM group and the non-GDM group.Results:In the non-GDM group, TDUH during rest maneuver at 6 weeks postpartum( P=0.319), the indicators during rest and contract maneuver at 6 months postpartum( P=0.586, 0.877, 0.164, 0.226, 0.465, 0.097), and TDUH during tension maneuver at 1 year postpartum( P=0.643) returned to the level of early pregnancy. In the GDM group, the indicators during rest maneuver and TDUH during contract maneuver at 6 months postpartum recovered to the level of early pregnancy ( P=0.647, 0.584, 0.376, 0.440), while APDUH and AUH during contract maneuver ( F=7.784, 9.785; P=0.005, <0.001) and the indicators during tension maneuver at 1 year postpartum( F=15.343, 11.974, 17.981; P<0.001) did not recover to the level of early pregnancy. After propensity score matching, APDUH and AUH during tension maneuver at 1 year postpartum in the GDM group were significantly greater than those in the non-GDM group( t=2.810, 2.926; P=0.006, 0.004). Conclusions:The pelvic floor muscles of GDM patients after vaginal delivery are more severely damaged, and the recovery speed is slower. Pelvic floor muscle exercise during pregnancy and enhanced postpartum follow-up are needed to prevent, diagnose and treat pelvic floor dysfunction early.