Objective:To investigate the risk factors associated with mortality in patients with severe traumatic liver injury (TLI) and to establish and validate an early prediction model for mortality.Methods:A retrospective cohort study was conducted to analyze the clinical data of 273 patients with severe TLI admitted to the ICU from the medical information mart for the intensive care-IV (MIMIC-IV) database. The cohort consisted of 176 males and 97 females, with age ranging from 18 to 83 years [35.6 years(25.7,57.5)years]. The patients were divided into two groups based on in-hospital mortality: the survival group (253 patients, 92.7%) and the death group (20 patients, 7.3%). The two groups were compared with regards to gender, age, cause and type of injury, treatment method, massive blood transfusion, comorbidities as well as vital signs and laboratory tests measured within 24 hours of ICU admission. Univariate analysis was used to screen for risk factors associated with mortality in severe TLI patients. Independent risk factors for mortality were determined using multivariate Logistic regression analysis. Lasso regression was used to screen for predictors of mortality, and a nomogram prognostic model was then established through a multivariate Logistic regression analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discrimination of the model, while the Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to evaluate the calibration of the model. The model′s clinical applicability was evaluated through decision curve analysis (DCA). Internal validation was performed by the 200 Bootstrap samples, and external validation was performed by using 163 patients with severe TLI from the emergency ICU collaborative research database (eICU-CRD). Finally, the predictive efficacy of the nomogram model was compared to other trauma or severity scores.Results:Univariate analysis showed that the age, cause of injury, massive blood transfusion, chronic liver disease and laboratory tests measured within 24 hours of ICU admission, including temperature, systolic blood pressure, diastolic blood pressure, mean arterial pressure, shock index, platelets, red blood cell distribution width (RDW), mean red blood cell hemoglobin concentration (MCHC), blood glucose, blood urea nitrogen, creatinine, anion gap, bicarbonate, prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) were associated with the mortality of severe TLI patients ( P<0.05 or 0.01). Multivariate Logistic regression analysis revealed that age ( OR=1.08, 95% CI 1.03, 1.12, P<0.01), body temperature <36 ℃ ( OR=8.00, 95% CI 2.17, 29.53, P<0.01), shock index ( OR=9.59, 95% CI 1.76, 52.18, P<0.01) and anion gap ( OR=1.32, 95% CI 1.15, 1.53, P<0.01) were significantly associated with mortality in severe TLI patients. Lasso regression analysis selected 7 predictors, including age, body temperature<36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT. Based on these 7 predictors, a nomogram prediction model was developed. The AUC of the nomogram for predicting mortality was 0.96 (95% CI 0.94, 0.99), and the Hosmer-Lemeshow goodness-of-fit test indicated a good fit ( P>0.05). The calibration curve demonstrated excellent consistency between the predicted and actual probabilities, and DCA demonstrated that the model had good clinical net benefit at all risk threshold probability ranges. Internal validation confirmed the stability of the model ( AUC=0.96, 95% CI 0.92, 0.98), and external validation demonstrated good generalization ability ( AUC=0.95, 95% CI 0.91, 0.98). Moreover, the nomogram exhibited superior predictive efficacy compared with injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS), sequential organ failure score (SOFA), acute physiological score III (APS III), Logistic organ dysfunction score (LODS), Oxford acute severity of illness score (OASIS) and simplified acute physiological score II (SAPS II). Conclusions:Age, body temperature <36 ℃, shock index and anion gap are independent risk factors for mortality in severe TLI patients. A nomogram prognosis model based on 7 predictors, namely age, body temperature <36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT exhibits good predictive efficacy and robustness, and is contributive to accurately assess the risk of mortality in severe TLI patients at an early stage.

Objective:To investigate CK19 and COX-2 expression in papillary thyroid carcinoma (PTC) and their relationship with clinicopathologic parameters.Methods:Retrospective study of 120 consecutive patients with PTC who underwent resection from May. 2017 to Dec. 2020 was conducted. The expression of CK19 and COX-2 in 120 pieces of primary PTC tissue and 30 pieces of adjacent carcinoma tissue were detected by EliVision TM plus two-step immunohistochemical method. The relationship between the expression of CK19 and COX-2 and the clinicopathologic parameters including patient age, TI-RADS classification, TNM staging, carcinomatous infiltration, lymph node metastasis was studied. The analysis was performed using SPSS 22.0 software. The numerical data were presented as numbers and percentages, and chi-test ( χ2 test) and Pearson’s correlation were used to analyze the difference and association between two groups. P<0.05 was considered statistically significant. Results:The positive immunostaining of CK19 and COX-2 were mainly localized in the cytoplasm. The positive rates of CK19 and COX-2 were 87.50% (105/120) and 72.50% (87/120) in cancer tissues and 10.00% (3/30) and 3.33% (1/30) in paracancerous tissues, respectively, with statistically significant differences (both P<0.05 by χ2 test) . In the groups with patients aged <45 years versus ≥45 years, the CK19 positive rates were 88.16% (67/76) and 86.36% (38/44) , and the COX-2 positive rates were 69.74% (53/76) and 77.27% (34/44) , respectively. In the groups of TI-RADS (grade 4 and 5) versus grade 6, the CK19 positive rates were 85.26% (81/95) and 96.00% (24/25) , and the COX-2 positive rates were 69.47% (66/95) and 84.00% (21/25) , respectively, with no statistically significant differences between the two groups (both P>0.05) . In the groups of TNM (stage T1 and T2) versus stage T3, the CK19 positive rates were 82.28% (65/79) and 97.56% (40/41) , and the COX-2 positive rates were 65.82% (52/79) and 85.36% (35/41) , respectively. In the groups with versus without cancer infiltration, the CK19 positive rates were 94.44% (68/72) and 77.08% (37/48) , and the COX-2 positive rates were 83.33% (60/72) and 56.25% (27/48) , respectively. In the groups with versus without lymph node metastasis, the CK19 positive rates were 95.59% (65/68) and 76.92% (40/52) , and the COX-2 positive rates were 83.82% (57/68) and 57.69% (30/52) , respectively, and the differences between the above groups were statistically significant (all P<0.05 by χ2 test) . The co-positive and co-negative expression rates of CK19 and COX-2 in 120 patients were 70.83% (85/120) and 10.83% (13/120) , respectively, with a positive correlation ( r=0.45, P<0.05 by Pearson’s correlation) . Conclusions:The positive rates of CK19 and COX-2 expressions are not related to patient’s age or TI-RADS classification, but closely related to TNM stage, cancer invasion and lymph node metastasis. The up-regulation of both CK19 and COX-2 expressions predicts higher tumor stage, more aggressive invasion and more prone to lymph node metastasis.

Objective:To compare the prediction efficiency of traditional linear regression model and four machine learning models on the learning behavior of clinical medical postgraduates, and to explore the pros and cons and applicability of different prediction models.Methods:A total of 6,922 clinical medical postgraduates were surveyed, their comprehensive learning behavior scores were obtained through the learning behavior scale. In the training set, Lasso linear regression and artificial neural network, decision tree, Bootstrap random forest, and lifting tree were used to build prediction models respectively. The above models were used to predict the validation set data and compare the prediction efficiency.Results:The comprehensive learning behavior score of clinical medical postgraduates was (3.31±0.54) points, and the overall compliance rate was 74.02%. In the linear regression model, the influence of age, school level, degree type, learning interest, pressure and satisfaction on learning behavior were statistically significant. In the prediction of validation set, the sensitivity, specificity, and accuracy of the linear regression model were 0.484, 0.914, and 0.801, respectively. The indexes of the four machine learning models were higher than those of the traditional linear regression model, and the Bootstrap random forest had the highest elevation.Conclusion:The linear regression model has a good prediction effect on learning behavior, and machine learning is superior to linear regression model in terms of accuracy of prediction. However, traditional linear regression models are superior to machine learning models in computational efficiency and interpretability.

Objective:To study the risk factors for ipsilateral severe hearing impairment in patients with hemifacial spasm (HFS) after microvascular decompression (MVD).Methods:MVD was performed in 3700 patients with HFS, admitted to our hospital from October 2007 to August 2020; according to the existence of ipsilateral severe hearing impairment, these patients were divided into severe hearing impairment group and non-severe hearing impairment group. The clinical data of these patients were compared. Multivariate linear regression analysis was used to determine the independent influencing factors for ipsilateral severe hearing impairment.Results:Forty-five patients (1.2%) had ipsilateral severe hearing impairment after MVD; no one got recovery of hearing impairment during the follow-up period (0.6-11.8 years, 6.3 years in average). As compared with those in the non-severe hearing impairment group, patients in the severe hearing impairment group had significantly older age, significantly higher percentages of male patients, and patients with left HFS, hypertension, and diabetes mellitus, statistically higher percentage of patients having small posterior fossa volume, arachnoid thickening and adhesion, and vertebral artery compression, significantly lower percentage of patients with anterior inferior cerebellar artery compression, significantly higher percentage of patients with arteriosclerosis of offending arteries and difficult decompression ( P<0.05). Multivariate linear regression analysis revealed that hypertension, vertebral artery compression, arteriosclerosis of offending artery and difficult decompression were independent risk factors for severe hearing impairment in patients with HFS after MVD. Conclusion:It's difficult to get recovery for severe hearing impairment in patients with HFS after MVD; this complication is much common in patients with hypertension, vertebral artery compression, arteriosclerosis of offending artery or difficult decompression.

Objective:To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81 st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results:Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM ( P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM ( P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95% CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95% CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95% CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions:NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.

Objective:To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81 st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results:Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM ( P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM ( P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95% CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95% CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95% CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions:NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.

Objective:To evaluate the effect of standardized bowel preparation and nursing procedures in patients with colon disease underwent full abdominal CT examination.Methods:A total of 281 inpatients who were diagnosed as "colon tumors" and underwent full-abdominal CT examinations from January 2016 to December 2017 were selected. From January to December 2016, 153 patients were included in the study, which is the pre-implementation group; from January to December 2017, 128 patients were included in the study, all of whom received standardized bowel preparation and nursing procedures, and were the post-implementation group. Compare and observe the differences in the cleanliness, intestinal filling and CT image quality of patients before and after the intervention measures.Results:After the implementation of standardized nursing procedures, the proportion of patients with good intestinal cleanliness was 71.09% (91/128), which was higher than the pre-implementation of 33.33% (51/153) ( χ2 value was 40.79, P<0.001). The proportion of patients with sub-intestinal preparations also decreased ( P<0.05). The proportion of patients with good intestinal filling in the post-implementation group was 75.00% (96/128), which was higher than 42.48% (65/153) in the pre-implementation group ( χ2 value was 42.63, P<0.001). After the implementation of standardized nursing procedures, the image quality rate of patients with whole abdominal CT was 90.63% (116/128), which was higher than the pre-implementation 32.68% (50/153) ( χ2 value was 98.34, P<0.001). Conclusion:The standardized nursing process can improve the quality of bowel preparation and significantly improve the image quality of abdominal CT examination.

Schisandra chinensis, a traditional Chinese medicine (TCM), has been used to treat sleep disorders. Zebrafish sleep/wake behavioral profiling provides a high-throughput platform to screen chemicals, but has never been used to study extracts and components from TCM. In the present study, the ethanol extract of Schisandra chinensis and its two main lignin components, schisandrin and schisandrin B, were studied in zebrafish. We found that the ethanol extract had bidirectional improvement in rest and activity in zebrafish. Schisandrin and schisandrin B were both sedative and active components. We predicted that schisandrin was related to serotonin pathway and the enthanol extract of Schisandra chinensis was related to seoronin and domapine pathways using a database of zebrafish behaviors. These predictions were confirmed in experiments using Caenorhabditis elegans. In conclusion, zebrafish behavior profiling could be used as a high-throughput platform to screen neuroactive effects and predict molecular pathways of extracts and components from TCM.
Animals ; Behavior, Animal ; drug effects ; Caenorhabditis elegans ; Central Nervous System Agents ; chemistry ; isolation & purification ; pharmacology ; Cyclooctanes ; analysis ; isolation & purification ; pharmacology ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Lignans ; analysis ; isolation & purification ; pharmacology ; Plant Extracts ; chemistry ; isolation & purification ; pharmacology ; Polycyclic Compounds ; analysis ; isolation & purification ; pharmacology ; Schisandra ; chemistry ; Zebrafish ; physiology

AIM: To investigate the effects of transient receptor potential channel 6 (TRPC6) on the proliferation of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) induced by IL-1β.METHODS: The mRNA expression of TRPC6 in synovial tissues from RA or OA patients was studied by RT-qPCR.RA-FLS were cultured by enzyme digestion and tissue adhesion methods.The method of flow cytometry was applied to identify the RA-FLS.RA-FLS were treated with different concentrations (0, 0.25, 0.5, 1, 2, 4, 8 and 16 μg/L) of IL-1β for 36 h.The cell viability was examined by CCK-8 assay.RA-FLS were incubated with IL-1β (16 μg/L) for different time (12, 24, 36, 48, 60 and 72 h), and the cell viability was measured by CCK-8 assay.The interference efficiency of TRPC6-siRNA was determined by RT-qPCR and Western blotting.After incubation in the presence or absence of IL-1β medium, the cell viability, the percentage of EdU-positive cells and the percentage of (G2/M+S) phase were measured by CCK-8 assay, EdU labeling assay and flow cytometry, respectively.RESULTS: The mRNA expression of TRPC6 was found in synovial tissue with higher levels in RA patients than that in OA patients.TRPC6-siRNA significantly decreased the mRNA and protein expression of TRPC6 (P<0.05).When RA-FLS were treated with IL-1β, the proliferation of RA-FLS was increased (P<0.05).The differences of the cell viability, the percentage of EdU-positive cells and the (G2/M+S) phase percentage between TRPC6-siRNA group and blank control group or NC-siRNA group were significant, in the presence of IL-1β (P<0.05).However, they were not significant in the absence of IL-1β.CONCLUSION: TRPC6 is involved in the proliferation of RA-FLS induced by IL-1β.Silencing of TRPC6 gene inhibits the growth of RA-FLS induced by IL-1β.

Objective To investigate the endemic fluorosis of drinking water type in 3 counties in the northwest of Shandong Province,and to provide scientific basis for prevention and control of endemic fluorosis.Methods Seven villages in 3 counties of Ningjin,Xiajin and Wucheng were investigated to achieve the results including fluoride of drinking water,8-12 year-old children's dental fluorosis incidence rate,the fluoride of urine,prevalence of skeletal fluorosis by clinical and X-ray diagnosis in adults over 30-year old,and the bone mineral density.At the same time,set up a control point to detect the adult bone density in non-ward village of each investigated county,The water and urine fluoride were checked by selective electrode method,dental fluorosis was diagnosed by Dean method (WS/T 208-2011) and the diagnosis of adult fluorosis was performed in accordance with the diagnostic criteria of endemic fluorosis (WS 192-2008),and bone mineral density was measured by EXA-3000.Results The villages in Ningjin and Wucheng had finished defluoridation,where the water fluoride was at normal level.In the 7 villages,the total detection rate of 8-12 year-old children's dental fluorosis was 85.09％ (411/483),dental fluorosis index was 1.88;the dental fluorosis detection rate in Wucheng,Xiajin and Ningjin was 92.48％ (295/319),88.76％ (79/89) and 49.33％ (35/75),respectively,the difference was statistically significant (x2 =90.26,P ＜ 0.01).The average urine fluoride geometric mean of children (206) and adults (298) was 3.29 and 3.41 mg/L,respectively.The urine fluoride of Xiajin was the highest in the 3 counties,and the average urine fluoride geometric mean of the two groups was as high as 5.11 and 6.30 mg/L,respectively.The total detection rate of clinical and radiographic skeletal fluorosis in adults was 30.07％ (92/306) and 14.38％ (44/306),respectively.The osteoporosis detection rate of adults in endemic fluorosis area and non-endemic fluorosis area was 33.11％ (100/302) and 8.99％ (17/189),respectively.The difference was statistically significant (x2 =37.25,P ＜ 0.01);the average bone mineral density in endemic area and non-endemic area was 0.416 and 0.475 g/cm2,respectively,the difference was statistically significant (t =8.508,P ＜ 0.01).Conclusions The endemic fluorosis in the 3 counties in the northwest of Shandong Province is still existed.The defluoridation has not been completed in Xiajin County.Therefore,it is necessary to implement defluoridation measures of the drinking water as soon as possible and strengthen the water fluoride monitoring so as to prevent and control endemic fluorosis.