ObjectiveCleft palate (CP) is a common congenital deformity often associated with velopharyngeal insufficiency (VPI), which disrupts the physiological coupling between respiration and speech. Conventional clinical assessments, such as nasometry and spirometry, provide limited static data and fail to visualize the dynamic spatiotemporal distribution of lung ventilation during phonation. This study introduces spatiotemporal electrical impedance tomography (ST-EIT) to evaluate speech-respiratory functional features in CP patients compared to normal controls (NC). The aim is to characterize multi-domain respiratory patterns and to validate an interpretable machine learning framework for providing objective, quantitative evidence for clinical assessment. MethodsSeventy-five participants were enrolled in this study, comprising 37 patients with surgically repaired CP and 38 healthy volunteers matched for age, gender, and body mass index (BMI). All subjects performed standardized sustained phonation tasks while undergoing synchronous monitoring with a 16-electrode EIT system and a pneumotachograph. A comprehensive feature engineering pipeline was developed to extract physiological parameters across 3 complementary domains. (1) Temporal domain: including inspiratory/expiratory phase duration (tPhase), time constants (Tau), and inspiratory-to-expiratory time ratios (TI/TE); (2) airflow domain: comprising mean flow, peak flow, and instantaneous flow at 25%, 50%, and 75% of tidal volume; and (3) spatial domain: quantifying global and regional tidal impedance variation (TIV), global inhomogeneity (GI), and center of ventilation (CoV). Extreme Gradient Boosting (XGBoost) classifiers were trained using 5 distinct data sources (Spirometry, Nasometry, Inspiratory-EIT, Expiratory-EIT, and fused ST-EIT). Model performance was rigorously evaluated via stratified 5-fold cross-validation, and Shapley additive explanations (SHAP) were employed to quantify global and local feature contributions. ResultsThe CP group exhibited a distinct respiratory phenotype compared to controls. In the temporal domain, CP patients showed significantly shorter inspiratory (1.60 s vs.1.85 s, P<0.001) and expiratory phase durations (2.45 s vs. 3.95 s, P<0.001), indicating a rapid, shallow breathing rhythm. In the airflow domain, while inspiratory flows were comparable, the CP group demonstrated significantly elevated mean and peak flows during the expiratory phase (P<0.001), reflecting compensatory respiratory effort. Spatially, CP patients presented significant ventilation redistribution, characterized by higher regional TIV in the right-anterior (ROI1) and left-posterior (ROI4) quadrants, but lower TIV in the left-anterior (ROI2) quadrant. In terms of diagnostic accuracy, the multi-modal ST-EIT model achieved the highest performance (AUC: 0.915±0.012, Accuracy: 0.843±0.019, F1-score: 0.872±0.017), substantially outperforming models based on spirometry (AUC: 0.721) or nasometry (AUC: 0.625) alone. Interpretability analysis revealed that spatial domain features were the most critical, contributing 53.4% to the model’s decision-making, followed by temporal (25.0%) and airflow (21.6%) features. ConclusionST-EIT successfully captures the temporal, airflow, and spatial deviations in CP speech respiration that are undetectable by conventional methods—specifically, rapid phase transitions, hyperdynamic expiratory airflow, and regional ventilation heterogeneity. This study validates ST-EIT as a robust, non-invasive, and radiation-free tool for characterizing speech-respiratory dysfunction, offering high clinical value for bedside screening, rehabilitation planning, and longitudinal monitoring of patients with cleft palate.

ObjectiveCleft palate (CP) is a common congenital deformity often associated with velopharyngeal insufficiency (VPI), which disrupts the physiological coupling between respiration and speech. Conventional clinical assessments, such as nasometry and spirometry, provide limited static data and fail to visualize the dynamic spatiotemporal distribution of lung ventilation during phonation. This study introduces spatiotemporal electrical impedance tomography (ST-EIT) to evaluate speech-respiratory functional features in CP patients compared to normal controls (NC). The aim is to characterize multi-domain respiratory patterns and to validate an interpretable machine learning framework for providing objective, quantitative evidence for clinical assessment. MethodsSeventy-five participants were enrolled in this study, comprising 37 patients with surgically repaired CP and 38 healthy volunteers matched for age, gender, and body mass index (BMI). All subjects performed standardized sustained phonation tasks while undergoing synchronous monitoring with a 16-electrode EIT system and a pneumotachograph. A comprehensive feature engineering pipeline was developed to extract physiological parameters across 3 complementary domains. (1) Temporal domain: including inspiratory/expiratory phase duration (tPhase), time constants (Tau), and inspiratory-to-expiratory time ratios (TI/TE); (2) airflow domain: comprising mean flow, peak flow, and instantaneous flow at 25%, 50%, and 75% of tidal volume; and (3) spatial domain: quantifying global and regional tidal impedance variation (TIV), global inhomogeneity (GI), and center of ventilation (CoV). Extreme Gradient Boosting (XGBoost) classifiers were trained using 5 distinct data sources (Spirometry, Nasometry, Inspiratory-EIT, Expiratory-EIT, and fused ST-EIT). Model performance was rigorously evaluated via stratified 5-fold cross-validation, and Shapley additive explanations (SHAP) were employed to quantify global and local feature contributions. ResultsThe CP group exhibited a distinct respiratory phenotype compared to controls. In the temporal domain, CP patients showed significantly shorter inspiratory (1.60 s vs.1.85 s, P<0.001) and expiratory phase durations (2.45 s vs. 3.95 s, P<0.001), indicating a rapid, shallow breathing rhythm. In the airflow domain, while inspiratory flows were comparable, the CP group demonstrated significantly elevated mean and peak flows during the expiratory phase (P<0.001), reflecting compensatory respiratory effort. Spatially, CP patients presented significant ventilation redistribution, characterized by higher regional TIV in the right-anterior (ROI1) and left-posterior (ROI4) quadrants, but lower TIV in the left-anterior (ROI2) quadrant. In terms of diagnostic accuracy, the multi-modal ST-EIT model achieved the highest performance (AUC: 0.915±0.012, Accuracy: 0.843±0.019, F1-score: 0.872±0.017), substantially outperforming models based on spirometry (AUC: 0.721) or nasometry (AUC: 0.625) alone. Interpretability analysis revealed that spatial domain features were the most critical, contributing 53.4% to the model’s decision-making, followed by temporal (25.0%) and airflow (21.6%) features. ConclusionST-EIT successfully captures the temporal, airflow, and spatial deviations in CP speech respiration that are undetectable by conventional methods—specifically, rapid phase transitions, hyperdynamic expiratory airflow, and regional ventilation heterogeneity. This study validates ST-EIT as a robust, non-invasive, and radiation-free tool for characterizing speech-respiratory dysfunction, offering high clinical value for bedside screening, rehabilitation planning, and longitudinal monitoring of patients with cleft palate.

Objective To propose a framework for risk assessment and stepwise management of pulmonary nodules based on existing guidelines and key studies, and to clarify the boundaries for triage, workup escalation, and referral in different detection scenarios. Methods A problem-oriented evidence synthesis approach was used, prioritizing Chinese expert consensus, Fleischner Society Guidelines, British Thoracic Society (BTS) Guidelines, and Lung-RADS. This was supplemented by studies on risk models, imaging measurements, liquid biopsy, tissue sampling, and surgical treatments. This paper is not presented as a formal consensus or a validated clinical pathway. Results A three-tiered framework consisting of basic non-invasive assessment, advanced assessment, and invasive diagnosis was established. It specified the applicable populations, boundaries for the use of risk models, imaging review, management of conflicting results, evaluation of histopathological consistency, and post-intervention follow-up. Liquid biopsy, genetic testing, and artificial intelligence were defined as investigational or adjunctive tools. Conclusion This framework can serve as a preliminary reference for multidisciplinary teams in developing local protocols. It cannot replace applicable guidelines, pathological diagnosis, shared decision-making with patients, or real-world validation.

Objective:To correlate serum bone morphogenetic protein-2 (BMP-2) and cartilage oligomeric matrix protein (COMP) levels with joint function and systemic inflammatory response in patients with knee osteoarthritis (KOA) complicated by cartilage injury.Methods:This study is a retrospective analysis. It selected 258 patients with knee osteoarthritis who were treated at Yantai Yuhuangding Hospital from January 2022 to December 2023. All patients underwent arthroscopic examination. Based on the presence of cartilage injury, 118 patients with cartilage injury were included in the Group A, while 140 patients without cartilage injury were included in the Group B. Joint function (WOMAC Osteoarthritis Index, Lysholm Knee Function Score), serum levels of BMP-2 and COMP, and systemic inflammatory responses [levels of interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-α)] were compared between the two groups. Receiver Operating Characteristic (ROC) curves were drawn to analyze the diagnostic efficacy of serum BMP-2 and COMP levels for KOA complicated by cartilage injury. Pearson correlation analysis was used to assess the correlation between the aforementioned serum markers and the patients' WOMAC Osteoarthritis Index, Lysholm Knee Function Score, as well as serum levels of IL-1, IL-6, and TNF-α.Results:Group A had significantly lower serum BMP-2 levels and Lysholm Knee Function Scores compared with Group B [(9.18 ± 1.65) ng/L vs. (11.43 ± 2.51) ng/L, t = 8.34, P < 0.001; (80.06 ± 8.34) vs. (86.94 ± 7.21), t = 7.11, P < 0.001]. Group A exhibited higher serum levels of COMP, IL-1, IL-6, and TNF-α, as well as a higher WOMAC Osteoarthritis Index, with all differences being statistically significant [(6.88 ± 2.34) μg/L vs. (5.04 ± 1.01) μg/L, t = -8.34, P < 0.001; (43.18 ± 7.81) ng/L vs. (35.96 ± 5.02) ng/L, t = -8.96, P < 0.001; (34.03 ± 6.68) ng/L vs. (28.75 ± 5.61) ng/L, t = -6.90, P < 0.001; (13.17 ± 1.89) ng/L vs. (11.24 ± 1.01) ng/L, t = -10.44, P < 0.001; (137.18 ± 18.95) vs. (121.14 ± 13.58), t = -7.90, P < 0.001]. ROC curve analysis indicated that the area under the curve values for serum BMP-2 and COMP levels in diagnosing KOA complicated by cartilage injury were 0.773 and 0.811, respectively. Pearson correlation analysis revealed a negative correlation between serum BMP-2 levels and the WOMAC Osteoarthritis Index, as well as serum levels of IL-1, IL-6, and TNF-α ( r = -0.52, -0.42, -0.40, -0.57, all P < 0.05). Additionally, serum BMP-2 levels showed a positive correlation with the Lysholm Knee Function Score ( r = 0.51, P < 0.05). Serum COMP levels and the WOMAC Osteoarthritis Index were positively correlated with serum IL-1, IL-6, and TNF-α levels ( r = 0.48, 0.45, 0.37, 0.54, all P < 0.05) and were negatively correlated with the Lysholm Knee Function Score ( r = -0.51, P < 0.05). Conclusions:Serum BMP-2 and COMP levels have certain diagnostic value in patients with KOA complicated by cartilage injury. Moreover, these indicators are correlated with joint function and systemic inflammatory responses. Therefore, they hold promise as potential indicators for assessing disease progression in patients with KOA.

Objective To evaluate the recognition capability of AI-enabled Cellsee CS-BM1 automatic cell morphology analyzer for pe-ripheral blood smears and its roles in assisting manual classification,and explore the application value of AI system in the diagnosis network of tiered primary medical units.Methods The blood samples which triggered the re-examination rules were collected from six primary medical units,including the Laboratory Department of Shanghai Jiahui International Hospital,and so on,from March to No-vember 2023.The smears of peripheral blood were prepared and AI analyzer was used for pre-classification to evaluate its recognition performance in identifying the samples with abnormal WBC and RBC.The sensitivity,specificity,and accuracy of WBC classification by six junior and intermediate technicians,both with and without AI assistance,were analyzed.Additionally,the roles of the AI system in tiered diagnosis of primary medical units were also evaluated.Results The sensitivity,specificity,and accuracy of AI system in recognizing malignant primitive cells were 92.86％,95.16％,and 95.10％,respectively.The sensitivities of AI system in recognizing immature granulocytes,reactive lymphocytes,and nucleated RBCs were all greater than 90％.The sensitivity of AI system in identif-ying abnormal morphology of RBCs reached 99.59％,along with rapid quantitative analysis for various anomalous types of RBCs.In AI-assisted mode,the sensitivity of recognition for all cell types was improved to varying degrees by junior and intermediate technicians,and the sensitivity for recognizing malignant primitive cells,reactive lymphocytes,and immature granulocytes increased to 58.24％,53.39％,and 62.37％for junior technicians,and to 92.06％,83.24％,and 83.12％for intermediate technicians,respectively.The improvements for junior technicians were particularly significant,with increases of 12.46％,10.61％,and 3.71％for each cell type,respectively.Both groups achieved higher specificity and accuracy.Through AI pre-classification and manual review,a variety of pe-ripheral blood cell-related diseases were accurately diagnosed in the tiered healthcare practice of primary medical units,including 339 cases(11.13％)of red blood cell diseases,5 cases(0.16％)of platelet diseases,2 343 cases(76.90％)of infection-related disea-ses,and 28 cases(0.92％)of malignant hematological diseases.In addition,332 cases(10.90％)which lacked an obvious related cause or required further examinations were identified as well.Conclusion AI pre-classification has demonstrated strong cell recogni-tion capabilities and may assist technicians in improving the sensitivity,specificity,and accuracy of blood cell classification.AI could en-hance the disease-screening capabilities in the tiered diagnosis network of primary medical units,presenting a broad application prospect.

Objective To evaluate the effect of Intravascular lithotripsy(IVL)in the treatment of calcified nodules,and to observe the presence of coronary dissection after IVL treatment.Methods A total of 106 patients with coronary atherosclerotic heart disease(coronary heart disease)admitted to the cardiovascular Department of Shougang Hospital,Peking University from March 2023 to July 2024 were retrospectively analyzed.A total of 106 patients with moderate to severe stenosis accompanied by calcification as detected by coronary angiography were treated with IVL after intravascular ultrasound(IVUS)examination.Patients were divided into two groups according to whether there were calcified nodules in the coronary lesions:39 cases in the calcified nodules group and 67 cases in the non-calcified nodules group.The occurrence of coronary dissection during surgery was observed between the two groups,and other perioperative related complications and major adverse cardiovascular events(MACE)within 1 month after percutaneous coronary intervention(PCI)were compared between the two groups.Results The levels of renal insufficiency(25.6％vs.9.0％,P=0.021)and creatinine[(119.71±134.75)μmol/L vs.(71.82±16.53)μmol/L,P=0.033]in the calcified nodule group were higher than those in the non-calcified nodule group,the difference was statistically significant,and there was no difference in other baseline data.The target vessels in the calcified nodule group were mainly left anterior descending branch and right coronary artery,while those in the non-calcified nodule group were mainly left anterior descending branch,with few circumflex branches in both groups,and there was statistical significance in the distribution of target vessels in the left anterior descending branch and right coronary artery between the two groups(P=0.020).In terms of eccentric calcification(P=0.048)and asymmetric calcification(48.7％vs.28.4％,P=0.035)between the two groups,the calcified nodule group was higher than the non-calcified nodule group,the difference was statistically significant(P＜0.05).In terms of whether more than 20 pulses were needed and whether there was slippage during IVL,the calcified nodule group was higher than the non-calcified nodule group,the difference was statistically significant(P=0.022).The success rate of interventional therapy was 100％in both groups.After IVL treatment,the calcified nodule group was higher than the non-calcified nodule group in terms of the occurrence of coronary artery dissection,the difference was statistically significant(P＜0.009).The MACE of the two groups within 1 month after PCI was slightly higher in the calcified nodule group than in the non-calcified nodule group,but the difference was not statistically significant(P=0.235).Conclusions IVL is feasible and effective for the treatment of calcified coronary nodules.However,in the course of treatment,the occurrence of coronary dissection should be vigilant,identified as early as possible,and treated in time.

Objective To explore aging effect on healthy cerebral white matter using fixel-based analysis(FBA)on diffusion tensor imaging.Methods Eighty-seven healthy participants were divided into younger group and older group according to their ages,and all of whom were examined with diffusion tensor imaging at 3.0T.The fractional anisotropy(FA)of two groups was compared using whole brain voxel-based analysis(VBA).Then,FBA was used to calculate complexity(CX),fiber density(FD),fiber cross-section(FC)and fiber density and fiber cross-section(FDC)in voxels where older group exhibited significantly lower FA values than younger group.Finally,certain tracts of interest were chosen for tract-specific analyses.Results Compared with younger group,older group had significantly lower FA values in the genu of corpus callosum,splenium of corpus callosum,fornix,and posterior limb of internal capsule(P<0.05).Besides the above regions,older group showed significantly lower FD,FC and FDC in the anterior thalamic radiation,anterior limb of internal capsule,cerebral peduncle,superior longitudinal fasciculus,inferior longitudinal fasciculus,cingulum gyrus,forceps-minor and uncinate fasciculus(P<0.05).In voxels where FA values of older group were significantly lower than those of younger group,strong negative correlation was observed between average CX and average FA,while positive correlation was observed between average FD/FDC and average FA.Quantitative tract-specific analyses showed that older group had showed lower FD,FC and FDC in regard of superior longitudinal fasciculus,inferior longitudinal fasciculus,cingulum,anterior thalamic radiation,forceps-minor and uncinate fasciculus(P<0.05).Conclusion FBA reveals the characteristics of specific fibers and can be used to perform comprehensive and effective evaluation of aging effect on healthy cerebral white matter.

Aim To explore the effect mechanism of Jiangzhi Ligan decoction decoction treating non-alco-holic fatty liver disease(NAFLD),based on network pharmacology and molecular docking technology,com-bined with cell experiment verification.Methods The active ingredients and potential targets of JZLGD in the treatment of NAFLD were obtained from the network pharmacology-related database,and the"drug-ingredi-ent-target"relationship network map was constructed,and the intersection genes were enriched by GO and KEGG.And the core components and the core target of molecular docking.Then,HepG2 cells were induced by palmitic acid(PA)to establish NAFLD model,and the cytotoxicity of JZLGD drug-containing serum was detected by MTT.The levels of intracellular total cho-lesterol(TC)and triglycerides(TG)were measured by the kit.Lipid degeneration was detected by oil red O staining.The expressions of p62,a key target of au-tophagy,and microtubule-associated proteinlight-chain-3(LC3),AMPKα and p-AMPKα were detected by Western blot.AMPK inhibitor(compound C,CC)and autophagy inhibitor chloroquine(CQ)intervention groups were set up to detect intracellular TC and TG content,and further verify the efficacy and mechanism of JZLGD.Results A total of 64 active components of JZLGD were screened,involving 373 targets and 109 intersection targets with NAFLD.The first four core targets were INS,AKT1,TNF and PPARγ,respective-ly.KEGG analysis showed that JZLGD treatment of NAFLD mainly concentrated in insulin resistance,AMPK,mTOR,autophagy and other signaling path-ways.Molecular docking results showed that cryptotan-shinone,lotus leaf,quercetin,aloe emodin and other core components were well bound to core targets and autophagy related protein receptors.The results showed that JZLGD intervention could significantly decrease the contents of TG and TC in PA-induced HepG2 cells,down-regulate the expression of p62 protein,up-regulate the expression of LC3 Ⅱ protein,and increase the phosphorylation degree of AMPK.However,the in-tervention of CC and CQ largely reversed the effect of JZLGD on improving lipid accumulation.Conclusion JZLGD regulates AMPK signaling pathway to activate autophagy,thereby treating NAFLD.

Objective To investigate the role of Toll-like receptor 4(TLR4)in the regulation of homocys-teine(Hcy)-induced ferroptosis in macrophages.Methods Mouse macrophage cells RAW264.7 were cultured and divided into control group,Hcy intervention group(Hcy group),and Hcy plus ferroptosis inhibitor group(Hcy+Fer-1 group).After transfection with interference fragments,macrophages were treated with Hcy,and then divided into control group,Hcy intervention group(Hcy group),TLR4 interference negative control plus Hcy intervention group(si-NC+Hcy group),and TLR4 interference plus Hcy intervention group(si-TLR4+Hcy group).Macrophages were transfected with overexpression lentivirus and treated with Hcy,then were divided into control group,Hcy intervention group(Hcy group),a TLR4 overexpression negative control plus Hcy intervention group(OE-NC+Hcy group),and a TLR4 overexpression plus Hcy intervention group(OE-TLR4+Hcy group).After 48 hours of intervention,real-time fluorescent quantitative PCR and western blot were used to detect the expression levels of TLR4 in macrophages treated with Hcy;western blot was used to detect the expression levels of ferroptosis-related proteins ACSL4,GPX4,and FTH1 in macrophages,and ferrous ion assay kit to detect the concentration of Fe2+in macrophages;reactive oxygen species(ROS)assay kit and laser confocal microscopy were used to detect the content of intracellular reactive oxygen species.Results Compared with those in the control group,the expression level of the pro-ferroptosis protein ACSL4 was increased in the Hcy group(P<0.05),while the expression levels of anti-ferroptosis proteins GPX4 and FTH1 were decreased(P<0.05);the concentration of Fe2+was increased(P<0.05),and the content of ROS was increased.Meanwhile,the protein and mRNA expres-sion levels of TLR4 were both increased in the Hcy group(P<0.05).After macrophages were transfected with TLR4 interference fragments,compared with those in the si-NC+Hcy group,the expression levels of GPX4 and FTH1 were increased(P<0.05);the expression level of ACSL4 was decreased(P<0.05);the concentration of Fe2+was decreased(P<0.05),and the content of ROS was reduced in the si-TLR4+Hcy group.After macro-phages were transfected with TLR4 overexpression lentivirus,compared with those in the OE-NC+Hcy group,the expression levels of GPX4 and FTH1 were decreased(P<0.05),and the expression level of ACSL4 was increased(P<0.05)in the OE-TLR4+Hcy group.Conclusion Hcy induces the occurrence of ferroptosis in macrophages,and Toll-like receptor 4 has a positive feedback regulatory effect on ferroptosis in macrophages.

Objective:To investigate the construction and existing problems of radiotherapy departments in non-public hospitals in Beijing, and to propose improvement suggestions.Methods:An electronic questionnaire survey of 2023 medical education and research situation of the radiotherapy departments of 8 non-public hospitals in Beijing was conducted from March 2024 to June 2024, and on-site quality control supervision and inspection were conducted. The survey covered the equipment allocation, the educational background, professional title, age, working experience of radiotherapy-related personnel, and the operation of the hospital, etc. The questionable questionnaires were reviewed by telephone. The quality control method of entry was double entry and cross-checking. Frequency and composition ratio were used for statistical description. Results:The radiation oncology departments of 8 non-public hospitals in Beijing were mainly located in the main urban areas and suburbs. There were 105 radiotherapy practitioners, including 37 radiation oncologists, 19 medical physicists (14 with intermediate titles) and 49 radiotherapists (42 with junior titles, accounting for 86%). The medical teams of 5 hospitals lacked of a 3-level professional title echelon. A total of 67% (33/49) of radiotherapists had ≤ 5 years of working experience. There were 10 medical linear accelerators, 2 sets of after-loading radiotherapy equipment, 8 sets of CT simulation positioning equipment, 1 X-ray simulation positioning machine, and 35 sets of radiotherapy quality control instruments. Conformal intensity-modulated radiotherapy and volumetric arc-modulated radiotherapy could be simultaneously carried out in 8 hospitals. In 2023, 5010 patients were treated with medical linear accelerators and 171 patients were treated with after-loading radiotherapy. Two hospitals carried out scientific research, 1 hospital accepted trainees, and 2 hospitals provided teaching for interns. The results of quality control supervision and inspection showed that the equipment from 8 non-public hospitals could basically meet the needs of radiotherapy and daily equipment quality control.Conclusions:The organizational structure of radiotherapy departments in non-public hospitals in Beijing are generally reasonable, with relatively complete equipment and personnel configurations. However, multiple issues such as an insufficient number of personnel, unbalanced personnel structures, lack of work experience, low professional titles, and inadequate research and teaching capabilities still exist, which require further improvements.