Objective To establish and validate a prediction model for gastric cancer lymph node metastasis based on four machine learning(ML)algorithms.Methods A retrospective analysis was conducted on clinical data of 531 patients who underwent radical gastrectomy.The patients were ran-domly divided into training set(399 patients)and test set(132 patients)in a ratio of 3 to 1.Univari-ate analysis was used to screen for variables associated with gastric cancer lymph node metastasis,and Logistic regression,random forest,K-nearest neighbor algorithm,and support vector machine algo-rithm models were established to rank the importance of variables.All ML algorithm models were vali-dated in the test set,and receiver operating characteristic(ROC)curves were plotted.The optimal ML algorithm model was determined based on the area under the curve(AUC),sensitivity,specifici-ty,and accuracy.A nomogram model was constructed based on the variable importance ranking of the optimal ML algorithm model.The discrimination,calibration,and clinical applicability of the nomo-gram model were evaluated using ROC curves,calibration curves,and decision curves.Results The results of the comparison of the four ML algorithm models showed that the random forest model was the optimal algorithm model.The accuracy,sensitivity,and specificity of the random forest model in the training set were 72.7％,69.9％,and 75.0％,respectively,with an AUC of 0.803.The accuracy,sensitivity,and specificity of the random forest model in the test set were 64.4％,66.7％,and 62.5％,respectively,with an AUC of 0.751.A nomogram model was constructed based on the variables of the random forest algorithm model.The ROC curve showed that the AUCs of the nomogram model in the training set and test set were 0.721 and 0.776,respectively.Calibration curves and decision curves showed that the nomogram model had good calibration and clinical applicability in both the training set and test set.Conclusion The random forest model is the optimal algorithm model a-mong the four ML algorithm models.The nomogram model based on the random forest model can ac-curately predict the risk of gastric cancer lymph node metastasis,thereby better guiding clinical di-agnosis and treatment decisions.

Objective To establish and validate a prediction model for gastric cancer lymph node metastasis based on four machine learning(ML)algorithms.Methods A retrospective analysis was conducted on clinical data of 531 patients who underwent radical gastrectomy.The patients were ran-domly divided into training set(399 patients)and test set(132 patients)in a ratio of 3 to 1.Univari-ate analysis was used to screen for variables associated with gastric cancer lymph node metastasis,and Logistic regression,random forest,K-nearest neighbor algorithm,and support vector machine algo-rithm models were established to rank the importance of variables.All ML algorithm models were vali-dated in the test set,and receiver operating characteristic(ROC)curves were plotted.The optimal ML algorithm model was determined based on the area under the curve(AUC),sensitivity,specifici-ty,and accuracy.A nomogram model was constructed based on the variable importance ranking of the optimal ML algorithm model.The discrimination,calibration,and clinical applicability of the nomo-gram model were evaluated using ROC curves,calibration curves,and decision curves.Results The results of the comparison of the four ML algorithm models showed that the random forest model was the optimal algorithm model.The accuracy,sensitivity,and specificity of the random forest model in the training set were 72.7％,69.9％,and 75.0％,respectively,with an AUC of 0.803.The accuracy,sensitivity,and specificity of the random forest model in the test set were 64.4％,66.7％,and 62.5％,respectively,with an AUC of 0.751.A nomogram model was constructed based on the variables of the random forest algorithm model.The ROC curve showed that the AUCs of the nomogram model in the training set and test set were 0.721 and 0.776,respectively.Calibration curves and decision curves showed that the nomogram model had good calibration and clinical applicability in both the training set and test set.Conclusion The random forest model is the optimal algorithm model a-mong the four ML algorithm models.The nomogram model based on the random forest model can ac-curately predict the risk of gastric cancer lymph node metastasis,thereby better guiding clinical di-agnosis and treatment decisions.

OBJECTIVETo assess the association of neural precursor cell expressed developmentally down-regulated 4 (NEDD4) with schizophrenia.

METHODSFive single nucleotide polymorphisms (SNPs) of the NEDD4 gene were genotyped by TaqMan SNP genotyping assay in an independent sample of 464 individuals with schizophrenia and 487 healthy controls from eastern Han Chinese population. Clinical data were collected with a general information questionnaire and Positive and Negative Syndrome Scale (PANSS).

RESULTSFrequencies of rs3088077 (allelic: χ2=18.024, P=0.000; genotypic: χ2=16.634, P=0.000), rs7162435 (allelic: χ2=6.771, P=0.009; genotypic: χ2=7.352, P=0.025) and rs2303579 (allelic: χ2=11.253, P=0.001; genotypic: χ2=12.248, P=0.002) were found to be significant different between the two groups. Moreover, TT of rs7162435 was significantly correlated with scores of factors of excitement and hostility (14.53±3.925, F=3.551, P=0.029).

CONCLUSIONrs3088077, rs7162435 and rs2303579 of the NEDD4 gene may be associated with schizophrenia. Moreover, the TT genotype of rs7162435 may increase the severity of excitement and hostility. Our results may provide a clue for delineating the connection between the glutamate hypothesis of schizophrenia and ubiquitination.

Adolescent ; Adult ; Aged ; Alleles ; Asian Continental Ancestry Group ; ethnology ; genetics ; China ; ethnology ; Endosomal Sorting Complexes Required for Transport ; genetics ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; Middle Aged ; Nedd4 Ubiquitin Protein Ligases ; Polymorphism, Single Nucleotide ; Schizophrenia ; enzymology ; ethnology ; genetics ; Ubiquitin-Protein Ligases ; genetics ; Young Adult

Objective:To investigate the value of delta radiomics based on longitudinal changes of dynamic contrast enhanced MRI (DCE-MRI) in predicting pathological complete response (pCR) after neoadjuvant therapy (NAT) for breast cancer.Methods:The clinicopathological and imaging data of 117 patients with breast cancer confirmed by surgical pathology from April 2019 to November 2021 at Jiangxi Cancer Hospital were analyzed retrospectively. All patients were female with 23?74 (48±10) years old. The patients were randomly divided into training (81 cases) and test sets (36 cases) at the ratio of 7∶3 according to the number of random seeds in the software. All patients underwent DCE-MRI before and after early NAT (2 courses). The maximum diameter relative regression value of breast tumors before and after early NAT (D%) was calculated and used to construct a conventional imaging model. The delta radiomic features were extracted based on pre-NAT and early-NAT (2 courses) DCE-MRI and selected by redundancy analysis and least absolute shrinkage and selection operator algorithm. A ten-fold cross-validation method was used to construct the delta radiomic model and Radscore was calculated for each patient. All patients were classified into pCR group and non-pCR group according to the surgical pathology after NAT. Significant clinicopathological variables were selected by univariate analysis and stepwise regression method. They were integrated with D% and Radscore to build the combined model and nomogram. The model performance in predicting pCR after NAT in breast cancer was evaluated by the receiver operating characteristic curve and the area under the curve (AUC), and the clinical utility of the models was compared by using clinical decision curves.Results:The combined model had the best diagnostic performance among the three models, with an AUC of 0.90 in the training set and 0.87 in the test set. The Radscore had the highest weight in the nomogram. In the training set, the diagnostic performance of the combined model and delta radiomics model were better than that of the conventional imaging model ( Z=?3.48, P=0.001; Z=2.54, P=0.011). The clinical decision curves showed an overall greater clinical benefit of the combined model compared with the conventional imaging model and delta radiomic model. Conclusions:The addition of significant clinicopathological variables and Radscore of delta radiomic model which represents the longitudinal changes in tumor heterogeneity to the conventional imaging model may improve the predictive ability of pCR. The delta radiomic may serve as a noninvasive biomarker for early prediction of NAT response.

Objective:To explore the effect of improved skin cleaning method combined with Incontinence-Associated Dermatitis Intervention Tool (IADIT) in the treatment of incontinence-associated dermatitis in critically ill patients.Methods:By convenience sampling, we selected the patients in Peking University Third Hospital as subjects. A total of 92 critically ill patients with fecal incontinence from March 2017 to February 2018 were set as the control group while 63 critically ill patients with fecal incontinence from March 2018 to February 2019 were set as the experimental group. Patients in the control group received routine care, and those in the experimental group received IADIT care. The incidence, curative effects and healing time of incontinence-associated dermatitis were compared between the two groups.Results:After the intervention, the incidence of incontinence-associated dermatitis in the experimental group was 30.16% (19/63) , which was lower than 44.57% (41/92) in the control group, and the difference between the two groups was statistically significant ( P<0.05) . The effective rate of incontinence-associated dermatitis in the experimental group was 94.74% (18/19) , which was higher than 65.86% (27/41) in the control group, and the difference between the two groups was statistically significant ( P<0.05) . The healing time of incontinence-associated dermatitis in the experimental group was (6.33±3.14) d, which was lower than (11.55±3.41) d in the control group, and the difference between the two groups was statistically significant ( P<0.01) . Conclusions:Compared with traditional empirical nursing methods, targeted interventions based on IADIT for critically ill patients with fecal incontinence can effectively reduce the incidence of incontinence-associated dermatitis, improve the cure rate of incontinence-associated dermatitis and shorten the healing time.

Chronic obstructive pulmonary disease (COPD) is a global public health issue, and elderly COPD patients are at high risk of fall. Domestic and foreign clinical practice guidelines for fall prevention in the elderly emphasize that the identification of risk factors is the key to prevent fall. This article reviews the risk factors, risk assessment and fall intervention measures of elderly COPD patients, so as to provid a reference for fall prevention in elderly COPD patients.

ObjectiveTo explore the effect of Tanreqing injection combined with Ceftazide on the clinical efficacy， lung function， and laboratory inflammatory index of patients suffering from phlegm heat obstructing lung syndrome in acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. MethodFrom June 2021 to June 2023， 76 patients diagnosed with phlegm heat obstructing lung syndrome in AECOPD were enrolled in the respiratory and critical medical department of Jieshou Hospital of Traditional Chinese Medicine. They were randomly divided into a control group and an observation group with 38 cases each. The control group used Ceftazidime intravenous drip and other conventional oxygen inhalation and antispasmodic treatment measures of western medicine. The observation group received Tanreqing injection intravenous drip based on the treatment of the control group， with a course of 10 days. The changes of laboratory indicators such as hs-CRP， calcitonin （PCT）， and interleukin-6 （IL-6） before and after treatment were analyzed， and the improvement of forced expiratory volume in the first second （FEV₁）， forced vital capacity （FVC）， one second rate （FEV₁/FVC）， assessment and improvement of the British Medical Research Society’s dyspnea index （mMRC）， self-evaluation test of chronic obstructive pulmonary disease patients （CAT）， and traditional Chinese medicine syndrome score was compared. In addition， the total effective rate between the two groups after treatment was compared. ResultAfter treatment， the hs-CRP， PCT， IL-6， FEV₁， FVC， FEV₁/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation of both groups improved （P<0.01）. After treatment， compared with the control group， the observation group showed more significant improvements in hs-CRP， PCT， IL-6， FEV₁， FVC， FEV₁/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation， and the difference was statistically significant （P<0.05，P<0.01）. The total clinical effective rate of the control group was 86.84% （33/38）， while that of the observation group was 94.74% （36/38）. The therapeutic effect of the observation group was better than that of the control group （χ²=8.471， P<0.05）. ConclusionTanreqing injection combined with Ceftazidime has obvious efficacy in the treatment of phlegm heat obstructing lung syndrome in AECOPD， which is better than the treatment of Ceftazidime antibiotics alone. It can reduce the risk of acute exacerbation， alleviate clinical symptoms， and delay the decline of lung function.

OBJECTIVE To study the improvement effects of different polar parts fro m total f lavonoids of Scutellaria amoena on non-alcoholic fatty liver disease （NAFLD）model rats. METHODS The total flavonoids of S. amoena （SAF）were extracted by reflux extraction with ethanol ，suspended with water ，and then extracted with ethyl acetate and n-butanol in order to obtain the extraction parts of SAF （recorded as SAFA and SAFB respectively ）. Thirty-six rats were randomly divided into normal group （n＝ 6）and modeling group （n＝30）. Modeling group was given high-lipid diet to induce NAFLD model. After modeling ，modeling group was randomly divided into model group （normal saline ），fenofibrate group （positive control ，20 mg/kg），SAF group （300 mg/kg），SAFA group （300 mg/kg）and SAFB group （300 mg/kg）；they were given relevant intragastical administration ，once a day，for consecutive 6 weeks. After last administration ，the liver index was calculated ；the levels of total cholesterol （TC）， triacylglycerol（TG），aspartate transaminase （AST），alanine transaminase （ALT），high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C） in serum ，the levels of superoxide dismutase （SOD），glutathione peroxidase （GSH-Px），malondialdehyde（MDA），interleukin-1β（IL-1β），IL-6 and tumor necrosis factor-α（TNF-α）in liver tissue were detected；the pathomorphological changes of liver tissue were observed. RESULTS Compared with normal group ，the liver index ， the levels of TC ，TG，AST，ALT，LDL-C，MDA，IL-1β， IL-6 and TNF-α in serum/liver tissue of model group were all increased significantly （P＜0.05）， while the levels of HDL-C，SOD and GSH-Px were all decreased significantly （P＜0.05）. Compared with model group ，except there was no statistical significance in the serum levels of HDL-C and ALT in SAFA group （P＞0.05），above indexes in serum/liver tissue of rats in groups of polar parts from total flavonoids of S. amoena were significantly improved （P＜0.05）；inflammatory cell infiltration and fatty vacuoles in liver tissue were significantly improved. Compared with SAF group and SAFA group ，the levels of TC，TG，AST，MDA，IL-6 and TNF-α were decreased significantly in SAFB group（P＜0.05），while the level of SOD was increased significantly （P＜0.05）；pathomorphological changes of liver tissue were improved more significantly. CONCLUSIONS Each polar part from total flavonoids of S. amoena can improve NAFLD by regulating oxidative stress and inhibiting the secretion of inflammatory factors. The n-butanol polar part has more obvious effect .

OBJECTIVE To investigate the improvement effect and mechanism of different extracts from Tylophora yunnanensis on non-alcoholic steatohepatitis （NASH）. METHODS Normal human liver LO2 cells were induced to steatosis by free fatty acid， then were divided into normal group， model group， silybin group （100 μmol/mL）， T. yunnanensis ethanol extracts （TYS） group （50 μg/mL）， T. yunnanensis ethyl acetate extracts （TYSA） group （50 μg/mL）， and T. yunnanensis n-butanol extracts （TYSB） group （50 μg/mL）. After 24 hours of drug intervention， the deposition of lipid droplets was observed in LO2 cells in each group. The contents of total cholesterol （TC）， triacylglycerol （TG）， malondialdehyde （MDA） and glutathione （GSH）， the activities of aspartate transaminase （AST）， alanine transaminase （ALT） and superoxide dismutase （SOD）， the mRNA expressions of Kelch-like ECH-associated protein 1（ Keap1）， nuclear factor E2-related factor 2（ Nrf2） and heme oxygenase 1（ HO- 1） were detected. NASH rat model was induced by a high-fat diet， and then divided into normal group， model group， silybin group （12.6 mg/kg）， TYS group （80 mg/kg）， TYSA group （80 mg/kg） and TYSB group （80 mg/kg）， with six rats in each group. The liver indexes of rats in each group were calculated after 6 weeks of drug intervention. The liver histopathological changes were observed， and the contents of TC， TG， HDL-C and LDL-C， AST and ALT activities in serum， the contents of MDA and GSH， SOD activities in liver tissue were detected. RESULTS Compared with model group， TYS， TYSA and TYSB could reduce lipid droplet deposition， intracellular TC， TG and MDA contents， AST and ALT activities， and increase SOD activity， GSH content， and Keap1， Nrf2， HO-1 mRNA expression levels in LO2 cells after steatosis to varying degrees， with some differences being statistically significant （P＜0.05）. They also significantly improved liver injury in NASH model rats， reduced their liver indexes， TC， TG， LDL-C and MDA contents， AST and ALT 1-042） activities， and increased HDL-C （except for TYS and TYSB）， GSH contents and SOD activity， with TYSA having the most significant effect （P＜0.05）. CONCLUSIONS TYS， TYSA and TYSB have a certain improvement effect on NASH， among which TYSA has the most obvious effect. Its mechanism of action may be related to upregulating the Keap1/Nrf2/HO-1 signaling pathway and inhibiting oxidative stress