Objective:To construct a combined radiomics model based on preoperative enhanced computed tomography (CT) examination for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC), and provide biological explanations for the radiomics model.Methods:The retrospective cohort study was conducted. The messenger RNA (mRNA) of 424 HCC patients, the clinicopathological data of 39 HCC patients entered into the Cancer Genome Atlas database from its establishment until January 2023, and the clinicopathological data of 53 HCC patients who were admitted to the Gansu Provincial People′s Hospital from January 2020 to January 2023 were collected. The 92 HCC patients were randomly divided into a training dataset of 64 cases and a test dataset of 28 cases with a ratio of 7∶3 based on a random number table method. The CT images of patients in the arterial phase and portal venous phase as well as the corresponding clinical data were analyzed. The 3Dslicer software (version 5.0.3) was used to register the CT images in the arterial phase and portal venous phase and delineate the three-dimensional regions of interest. The original images were preprocessed and the corresponding features were extracted by the open-source software FAE (version 0.5.5). After selecting features using the Least Absolute Shrinkage and Selection Operator, the radiomics model was constructed and the radiomics score (R-score) was calculated. The nomogram was constructed by integrating clinical parameters, imaging features and R-score based on Logistic regression. The gene modules related to radiomics model were obtained and subjected to enrichment analysis by conducting weighted gene co-expression network analysis and correlation analysis. Observation indicators: (1) comparison of clinical characteristics of patients with different MVI properties; (2) establishment of MVI risk model; (3) evaluation of MVI risk model; (4) clustering of gene modules; (5) functional enrichment of feature-correlated gene modules. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of count data was conducted using the chi-square test. The intra-/inter-class correlation coefficient (ICC) was used to assess the inter-observer consistency of radiomics feature extracted by different observers. ICC >0.75 indicated a good consistency in feature extraction. The Logistic regression model was used for univariate and multivariate analyses. The receiver operating characteristic curve was drawn, and the area under curve (AUC), the decision curve and the calibration curve were used to evaluate the diagnostic efficacy and clinical practicality of the model. Results:(1) Comparison of clinical characteristics of patients with different MVI properties. Of 92 HCC patients, there were 47 cases with MVI-positive and 45 cases with MVI-negative, and there were significant differences in hepatitis, tumor diameter, peritumoral enhancement, intratumoral arteries, pseudocapsule and smoothness of tumor margin between them ( χ2=5.308, 9.977, 47.370, 32.368, 21.105, 31.711, P<0.05). (2) Establishment of MVI risk model. A total of 1 781 features were extrac-ted from arterial and portal venous phases of the intratumoral and peritumoral regions. After feature dimension reduction, 8 radiomics features were selected from arterial and portal venous phases to construct the combined model. Results of multivariate analysis showed that peritumoral enhancement, intratumoral arteries, pseudocapsule, smoothness of tumor margins, and R-score were independent risk factors for MVI in patients with HCC [ hazard ratio=0.049, 0.017, 0.017, 0.021, 2.539, 95% confidence interval ( CI) as 0.005-0.446, 0.001-0.435, 0.001-0.518, 0.001-0.473, 1.220-5.283, P<0.05]. A nomogram model was constructed incorporating peritumoral enhancement, intratumoral arteries, pseudocapsule, smoothness of tumor margins, and R-score. (3) Evaluation of the MVI risk model. The AUC of radiomics model was 0.923 (95% CI as 0.887-0.944) and 0.918 (95% CI as 0.894-0.945) in the training dataset and test dataset, respectively. The AUC of nomogram model, incorpora-ting both the R-score and radiomics features, was 0.973 (95% CI as 0.954-0.988) and 0.962 (95% CI as 0.942-0.987) in the training dataset and test dataset, respectively. Results of decision curve showed that the nomogram had better clinical utility compared to the R-score. Results of calibration curve showed good consistency between the actual observed outcomes and the nomogram or the R-score. (4) Clustering of gene module. Results of weighted gene co-expression network analysis showed that 8 gene modules were obtained. (5) Functional enrichment of feature-related gene modules. Results of correlation analysis showed 4 gene modules were significantly associated with radiomics features. The radiomics features predicting of MVI may be related to pathways such as the cell cycle, neutrophil extracellular trap formation, and PPAR signaling pathway. Conclusions:The combined radiomics model based on preoperative enhanced CT imaging can predict the MVI status of HCC. By obtaining mRNA gene expression profiles associated with radiomics features, a biological interpretation of the radiomics model is provided.

Objective:To explore the effect of educational intervention based on timing theory on mothers of premature infants.Methods:Using the convenience sampling method, 80 mothers of premature infants hospitalized in the Neonatology Department of Affiliated Hospital of Youjiang Medical University for Nationalities from May 2019 to October 2020 were included in this study. According to the time of admission, they were divided into the control group (42 cases) and the observation group (38 cases). The mothers in the control group were given routine educational guidance during the hospitalization of premature infants, while the mothers in the observation group were given comprehensive educational intervention based on timing theory on the basis of the control group. The mothers′ caring ability during the transition period, breastfeeding self-efficacy and breastfeeding rate at a month after discharge, and mother′s coping ability at 3 months after discharge were compared between the two groups.Results:There were 35 cases in each group completed the study. The observation group scored (100.86 ± 6.22) on the maternal care ability of premature infants in transition period, and the control group scored (89.51 ± 4.17), the difference between the two groups was statistically significant ( t=-8.97, P<0.05). The breastfeeding self-efficacy score of the observation group a month after discharge from hospital was (47.83 ± 2.54) points, which was higher than (41.20 ± 1.97) points of the control group, and the difference was statistically significant ( t=-12.21, P<0.05). The breastfeeding rate a month after discharge in the observation group was 62.9% (22/35), which was higher than 37.1% (13/35) in the control group, and the difference was statistically significant ( χ2=4.63, P<0.05). The maternal coping ability scores of the premature infants in the observation group and control group 3 months after discharge were (119.29 ± 6.03) and (113.66 ± 6.59) points respectively, and the difference between the two groups was statistically significant ( t=-3.73, P<0.05). Conclusions:The educational intervention based on timing theory can help mothers of premature infants master the nursing knowledge and skills, strengthen the mother′s transitional care ability and post-discharge coping ability, improve the breastfeeding self-efficacy and breastfeeding rate of premature infants, promote and development the growth of premature infants, worthy of clinical application.

ObjectiveTo explore the intervention effect and molecular mechanism of Dabufei decoction in Dunhuang formula combined with cisplatin on Lewis lung adenocarcinoma-bearing mice. MethodFifty C57BL/6J mice were used， with 10 randomly assigned to the blank group （without modeling）， and 40 subcutaneously inoculated with Lewis cells to establish a Lewis lung adenocarcinoma-bearing mouse model. These 40 mice were randomly divided into the following four groups （with 10 mice in each group）： Model group （equal volume of physiological saline）， cisplatin group （5 mg·kg^-1）， Dabufei decoction group （14.35 g·kg^-1·d^-1）， and Dabufei decoction combined with cisplatin group （Dabufei decoction 14.35 g·kg^-1·d^-1 + cisplatin 5 mg·kg^-1）. Each group was treated continuously for 14 days. The general condition of the mice was observed， body weight changes were recorded， and the tumor inhibition rate， spleen index， and thymus index were calculated. Peripheral blood white blood cell （WBC）， platelet （PLT）， and hemoglobin （HGB） were detected by routine blood tests. Flow cytometry was used to detect the expression of CD4⁺CD25⁺FoxP3⁺ regulatory T cells （Treg） and natural killer （NK） cells in the spleen. Western blot and real-time quantitative polymerase chain reaction （Real-time PCR） were used to determine the expression of proteins and mRNA related to the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway in tumor tissues. ResultCompared with the blank group， the model group showed decreased body weight （P<0.05）， spleen index， and thymus index （P<0.05）， decreased percentage of NK cells in the spleen （P<0.05）， increased percentage of Treg cells （P<0.05）， and decreased counts of WBC， PLT， and HGB （P<0.05）. Compared with the model group， the Dabufei decoction group exhibited significant tumor growth inhibition， increased body weight， and reduced tumor weight （P<0.05）， increased percentage of NK cells （P<0.05）， decreased proportion of Treg cells （P<0.05）， and increased counts of WBC， PLT， and HGB （P<0.05）. In the cisplatin group， tumor growth was significantly inhibited， body weight significantly decreased （P<0.05）， and tumor weight significantly reduced （P<0.05）. The spleen index and thymus index decreased （P<0.05）， and the percentage of Treg cells significantly decreased （P<0.05）. The counts of WBC， PLT， and HGB significantly decreased （P<0.05）. In the Dabufei decoction combined with cisplatin group， tumor growth was significantly inhibited， and tumor weight significantly reduced （P<0.05）. The levels of phosphorylated PI3K， Akt， and mTOR proteins and mRNA in tumor tissues were significantly reduced in all medication groups （P<0.05）. Compared with the cisplatin group， the Dabufei decoction combined with cisplatin group showed significantly inhibited tumor growth， reduced tumor weight （P<0.05）， increased body weight （P<0.05）， increased spleen index and thymus index （P<0.05）， increased percentage of NK cells （P<0.05）， decreased percentage of Treg cells （P<0.05）， significantly increased counts of WBC， PLT， and HGB （P<0.05）， and reduced levels of phosphorylated PI3K， Akt， and mTOR and their mRNA （P<0.05）. ConclusionDabufei decoction combined with cisplatin has a synergistic effect with reduced toxicity， effectively regulating immune function， increasing the proportion of NK cells， reducing the proportion of Treg cells， improving bone marrow suppression， and downregulating the PI3K/Akt/mTOR signaling pathway to inhibit tumor growth in Lewis lung adenocarcinoma-bearing mice.