Objective To propose a low-dose CT reconstruction algorithm across different scanners based on federated feature learning(FedCT)to improve the generalization of deep learning models for multiple CT scanners and protect data privacy.Methods In the proposed FedCT framework,each client is assigned an inverse Radon transform-based reconstruction model to serve as a local network model that participates in federated learning.A projection-domain specific learning strategy is adopted to preserve the geometry specificity in the local projection domain.Federated feature learning is introduced in the model,which utilizes conditional parameters to mark the local data and feed the conditional parameters into the network for encoding to enhance the generalization of the model in the image domain.Results In the cross-client,multi-scanner,and multi-protocol low-dose CT reconstruction experiments,FedCT achieved the highest PSNR(+2.8048,+2.7301,and +2.7263 compared to the second best federated learning method),the highest SSIM(+0.0009,+0.0165,and +0.0131 in the same comparison),and the lowest RMSE(-0.6687,-1.5956,and-0.9962).In the ablation experiment,compared with the general federated learning strategy,the model with projection-specific learning strategy showed an average improvement by 1.18 on Q1 of the PSNR and an average decrease by 1.36 on Q3 of the RMSE on the test set.The introduction of federated feature learning in FedCT further improved the Q1 of the PSNR on the test set by 3.56 and reduced the Q3 of the RMSE by 1.80.Conclusion FedCT provides an effective solution for collaborative construction of CT reconstruction models,which can enhance model generalization and further improve the reconstruction performance on global data while protecting data privacy.

Objective To propose a CT truncated data reconstruction model(DDTrans)based on projection and image dual-domain Transformer coupled feature learning for reducing truncation artifacts and image structure distortion caused by insufficient field of view(FOV)in CT scanning.Methods Transformer was adopted to build projection domain and image domain restoration models,and the long-range dependency modeling capability of the Transformer attention module was used to capture global structural features to restore the projection data information and enhance the reconstructed images.We constructed a differentiable Radon back-projection operator layer between the projection domain and image domain networks to enable end-to-end training of DDTrans.Projection consistency loss was introduced to constrain the image forward-projection results to further improve the accuracy of image reconstruction.Results The experimental results with Mayo simulation data showed that for both partial truncation and interior scanning data,the proposed DDTrans method showed better performance than the comparison algorithms in removing truncation artifacts at the edges and restoring the external information of the FOV.Conclusion The DDTrans method can effectively remove CT truncation artifacts to ensure accurate reconstruction of the data within the FOV and achieve approximate reconstruction of data outside the FOV.

Objective To assess the elderly health-related rehabilitation services(HRRS)needs from a community and population perspective and construct a community-based elderly HRRS framework. Methods The limitation of the elderly HRRS was analyzed,a community-based elderly rehabilitation service framework based on the International Classification of Functioning,Disability,and Health(ICF)was guided,and the imple-mentation path was proposed. Results This paper analyzed the evaluation,provision and models of existing community rehabilitation services both do-mestically and internationally.It combined the background and practical requirements of China's new era to eluci-date the connotation of HRRS for the elderly in the community.It proposed constructing a community-based el-derly HRRS framework guided by ICF.The paper also offered implementation strategies for promoting communi-ty-based elderly HRRS,focusing on enhancing leadership and policy,financing,human resources,service provi-sion,technology,and digital intelligence empowerment.It provided reference and insights for advancing the na-tional strategy of population aging and implementing the Healthy China strategy. Conclusion It is suggested to continue to accelerate the development of rehabilitation capacity,and increase the supply of HRRS,to meet the diverse needs of the masses of HRRS.

Objective To propose a low-dose CT reconstruction algorithm across different scanners based on federated feature learning(FedCT)to improve the generalization of deep learning models for multiple CT scanners and protect data privacy.Methods In the proposed FedCT framework,each client is assigned an inverse Radon transform-based reconstruction model to serve as a local network model that participates in federated learning.A projection-domain specific learning strategy is adopted to preserve the geometry specificity in the local projection domain.Federated feature learning is introduced in the model,which utilizes conditional parameters to mark the local data and feed the conditional parameters into the network for encoding to enhance the generalization of the model in the image domain.Results In the cross-client,multi-scanner,and multi-protocol low-dose CT reconstruction experiments,FedCT achieved the highest PSNR(+2.8048,+2.7301,and +2.7263 compared to the second best federated learning method),the highest SSIM(+0.0009,+0.0165,and +0.0131 in the same comparison),and the lowest RMSE(-0.6687,-1.5956,and-0.9962).In the ablation experiment,compared with the general federated learning strategy,the model with projection-specific learning strategy showed an average improvement by 1.18 on Q1 of the PSNR and an average decrease by 1.36 on Q3 of the RMSE on the test set.The introduction of federated feature learning in FedCT further improved the Q1 of the PSNR on the test set by 3.56 and reduced the Q3 of the RMSE by 1.80.Conclusion FedCT provides an effective solution for collaborative construction of CT reconstruction models,which can enhance model generalization and further improve the reconstruction performance on global data while protecting data privacy.

Objective To propose a CT truncated data reconstruction model(DDTrans)based on projection and image dual-domain Transformer coupled feature learning for reducing truncation artifacts and image structure distortion caused by insufficient field of view(FOV)in CT scanning.Methods Transformer was adopted to build projection domain and image domain restoration models,and the long-range dependency modeling capability of the Transformer attention module was used to capture global structural features to restore the projection data information and enhance the reconstructed images.We constructed a differentiable Radon back-projection operator layer between the projection domain and image domain networks to enable end-to-end training of DDTrans.Projection consistency loss was introduced to constrain the image forward-projection results to further improve the accuracy of image reconstruction.Results The experimental results with Mayo simulation data showed that for both partial truncation and interior scanning data,the proposed DDTrans method showed better performance than the comparison algorithms in removing truncation artifacts at the edges and restoring the external information of the FOV.Conclusion The DDTrans method can effectively remove CT truncation artifacts to ensure accurate reconstruction of the data within the FOV and achieve approximate reconstruction of data outside the FOV.

OBJECTIVE To systematically evaluate the real-world effectiveness and safety of belimumab in the treatment of lupus nephritis （LN） in Chinese adult patients. METHODS Retrieved from PubMed， Embase， Web of Science， Cochrane Library， Wanfang data， CNKI， VIP and CBM， real-world studies on belimumab in the treatment of LN in Chinese adult patients were collected from the inception to July 7th， 2023. Two reviewers independently screened the literature， extracted data， and assessed the quality of the included studies. Meta-analysis was then performed using RevMan 5.3 software. RESULTS A total of 10 real- world studies were included， involving 253 Chinese adult patients with LN. The results of the meta-analysis demonstrated that the complete renal response rate， partial renal response rate， and the incidence of adverse reaction rate in Chinese adult patients with LN treated with belimumab were 61% （95%CI was 46%-76%， P＜0.000 01）， 23%（95%CI was 2%-44%， P＝0.03）， and 30% （95%CI was 16%-43%， P＜0.000 01）， respectively. Belimumab could reduce the 24-hour urinary protein （MD＝－1.71， 95%CI was －3.02-－0.40， P＝0.01）， urine protein-creatinine ratio （MD＝－1.76，95%CI was －2.06-－1.46，P＜0.000 01）， the systemic lupus erythematosus disease activity index （MD＝－8.63， 95%CI was －12.12-－5.13， P＜0.000 01）， and glucocorticoids dosage （MD＝－18.65， 95%CI was －31.82-－5.48， P＝0.006）. In addition， it could elevate the levels of complement C3 （MD＝0.19， 95%CI was 0.08-0.30， P＝0.000 6） and complement C4 （MD＝0.06， 95%CI was 0.02-0.09， P＝0.001）. However， belimumab could not improve the levels of serum creatinine and estimated glomerular filtration rate （P＞0.05）. CONCLUSIONS Belimumab has good efficacy and safety in Chinese adult patients with LN.

Objective Given that psychosocial stress can contribute to a series of diseases,such as inflammatory bowel disease and irritable bowel syndrome,we aimed to establish an experimental chronic restraint mouse intestinal stress injury model as a basis for exploring the pathogenic mechanism of chronic restraint stress-induced gastrointestinal diseases,and for developing preventive and curative measures.Methods Eighteen male SPF-grade BALB/c mice were acclimatized for 7 days and then divided into a control group and a chronic restraint stress group according to body weight,using a randomized numerical table method.The mice were subjected to restraint stress for 3 hours per day for 14 days to establish an intestinal injury model.The model was evaluated by observing body weight,pathological changes in intestinal histomorphology,expression of tight junction proteins,apoptosis of intestinal epithelial cells,and mRNA expression levels of inflammatory cytokines.Results After 14 days of chronic restraint stress,model mice showed weight loss,shortened duodenal villus height,abnormal crypt structure,a decreased villus/crypt ratio,colonic mucosal inflammatory cell infiltration,and irregular crypt structure.Protein immunoblotting,immunohistochemistry,and immunofluorescence staining showed that the expression levels of the duodenal and colonic tight junction proteins Occludin and Claudin-1 were significantly decreased in mice after chronic restraint stress(P＜0.05),while expression levels of the apoptotic protein cleaved-caspase-3 in intestinal epithelial cells were significantly increased(P＜0.05).Regarding the mRNA expression levels of intestinal inflammatory factors and chemokines,chronic restraint stress for 14 days significantly increased the gene expression levels of interleukin(IL)-1β,IL-6,monocyte chemoattractant protein-1(MCP-1),tumor necrosis factor-α,and IL-10 in the duodenum of mice(P＜0.05),and significantly increased the gene expression levels ofIL-1β,IL-6,and MCP-1 in the colon(P＜0.001).Conclusions The use of a behavioral restriction device to restrain mice continuously for 14 days led to abnormal intestinal tissue structure,intestinal barrier dysfunction,and intestinal epithelial cell apoptosis,and triggered an intestinal inflammatory response in the stressed mice,indicating successful establishment of a mouse model of intestinal injury by chronic restraint stress.

Objective To investigate the correlation between brain injury and spleen damage in a rat model of acute ischemic stroke and stasis interaction,and its effect on the MCP-1/CCR2 axis,and to provide an experimental basis for the mechanism of brain-spleen inflammatory coupling in spleen lesions caused by acute ischemic stroke.Methods Forty male SD rats were randomly divided into a sham group,carrageenan/yeast stasis syndrome group(carrageenan/yeast,CA/Y),middle cerebral artery occlusion group(MCAO),and middle cerebral artery stasis syndrome group(MCAO CA/Y)with 10 rats in each group.CA/Y and MCAO CA/Y groups were injected with 10 mg/kg carrageenan and 10 mg/kg intraperitoneally on the first day of modeling.2 mg/kg of dry yeast suspension were injected subcutaneously on the second day.MCAO and MCAO CA/Y groups were established by wire embolism on the second day.At 24 h after cerebral infarction modeling,the neurological deficit score was calculated in each group,the percentage of the cerebral infarction area was determined by TTC staining,the spleen weight was measured,and the correlation between the percentage of the cerebral infarction area and spleen weight was analyzed by the Spearman correlation coefficient.Furthermore,the pathological morphology of brain and spleen tissues was observed by hematoxylin-eosin(HE)staining,and chemotactic protein 1(MCP-1)and interferon-γ(IFN-γ)contents were measured in rat plasma by enzyme-linked immunosorbent assays.Western blot was used to detect chemokine C-C-motif receptor 2(CCR2)protein expression in the ischemic side of brain tissue.Results Compared with the sham group,the neurological deficit score,cerebral infarction area,and MCP-1 and IFN-γ contents in plasma were significantly increased(P＜0.01),spleen weight was decreased significantly(P＜0.01),and CCR2 protein expression in brain tissue was significantly upregulated(P＜0.05)in MCAO and MCAO CA/Y groups.Moreover,the area of cerebral infarction was increased significantly(P＜0.01),the spleen weight was decreased significantly(P＜0.01),and CCR2 protein expression in brain and spleen tissues was significantly upregulated(P＜0.05)Compared with the MCAO group,the area of cerebral infarction in the MCAO CA/Y group was significantly increased(P＜0.01)and the spleen weight was decreased significantly(P＜0.05).Spearman correlation analysis showed that the spleen weight was negatively correlated to the percentage of the cerebral infarction area(P＜0.01,r=-0.9711).Pathological morphology observation revealed that the pathological changes in the MCAO CA/Y group were the most serious,cerebral liquefaction necrosis foci were seen in the brain tissue cortex,arrangement of neuronal cells in the lesions was sparse and disordered with volume atrophy and a small number of vacuoles and nuclear solidification,most neuronal cells were degenerated and necrotic,microglia hyperplasia was obvious,small blood vessels were significantly increased,and interstitial lipid degeneration was severe.The density of periarterial lymph sheath cells in some of the spleen tissue was reduced and the marginal area is widened.Conclusions A correlation between brain and spleen injury was found after acute ischemic stroke with stasis and toxin syndrome,and the chemokine signaling axis of MCP-1/CCR2 might be involved in the mechanism of brain-spleen inflammation coupling.

Objective To construct a training program for retuming to work after delivery based on Morrison's job adaptation theory in operating room nurses and to explore its application effect.Methods On the basis of literature research and Delphi expert consultation method,a training program of postpartum return of operating room nurses was constructed.From August 2021 to December 2022,the preliminary application of this research program was carried out,with 6 cases in an experimental group and 5 cases in a control group.The differences between the 2 groups were compared by Job Adaptation Scale,Psychological Resilience Scale and satisfaction evaluation,and the application effect was evaluated.Results After 2 rounds of correspondence,a training program for postpartum return of operating room nurses was formed,which included 4 first-level indicators(role adaptation,task adaptation,environment adaptation and cultural adaptation),and 32 second-level indicators.The authority coefficients of the 2 rounds of correspondence consultation were 0.908 and 0.917,and the Kendall W coefficients were 0.224 and 0.206,respectively(both P＜0.001).The preliminary application results showed that there were statistically significant differences in job adaptation and satisfaction evaluation between the 2 groups(both P＜0.05).There was no significant difference in psychological resilience score between groups(P＞0.05).Conclusion The postpartum retum training program for operating room nurses established in this study is scientific and practical to a certain extent.In the future,samples can be expanded and multi-center studies can be carried out to further test the practicability and effectiveness of the program.

Objective:To explore the clinical data of patients with metastatic pheochromocytoma/paraganglioma (PPGL).Methods:The clinical data of 57 patients with metastatic pheochromocytoma/paraganglioma diagnosed and treated at Peking Union Medical College Hospital from January 2016 to June 2022 were reviewed, including 28 cases of pheochromocytoma(PCC) and 29 cases of paraganglioma(PGL). The clinical manifestations, biochemical indexes, tumour characteristics, and metastatic characteristics of the 57 patients were analysed.Results:There were 34 males and 23 females. The median age at the time of initial diagnosis was 34 (20, 54) years, 17 (29.3%) presented with concurrent metastases, and 40 (70.7%) with heterochronous metastases. The median time to presentation of metastases was 2.2 (0, 5.0) years (range 0-22 years). Adrenergic symptoms were present in 45 cases (78.6%) at the time of initial diagnosis, and the median size of the primary tumour was 6.7 (5.0, 9.0) cm. Excessive catecholamine secretion was present in 48 cases (81.4%). The most common locations of metastasis were lymph nodes (71.9%, 41/57), bone (47.3%, 27/57), lung (38.6%, 20/57), and liver (35.1%, 20/57). Metastatic PGL had more multifocal metastases than PCC [10 (34.5%) vs. 2 (7.1%), P=0.011)], was more frequently associated with SDHB mutations [13 (42.9%) vs. 3 (10.7%), P=0.008], and was more likely to have concurrent metastases [12 (41.3%) vs. 5 (17.9%), P=0.005]. Metastatic PCC primary tumours were larger compared to PGL [median length 8.9 (4.0, 17.0) cm vs. 6.1 (1.0, 15.8) cm, P=0.020]. Conclusions:Patients with PGL present with metastases over an extremely wide time span, and patients diagnosed with PPGL should be followed throughout their lives. PGL is more prone to multifocal metastases and simultaneous metastases than PCC, and PGL is more highly correlated with the SDHB mutation.