The rapid development of artificial intelligence in the field of healthcare has greatly improved diagnosis accuracy, disease prediction, personalized treatment and healthcare resource management. However, with the widespread application of medical artificial intelligence, challenges has emerged in the aspects of medical data, model development and evaluation, and societal considerations. Therefore, this study aims to explore challenges in the application of artificial intelligence in healthcare and suggest a series of feasible solutions to improve medical professional and researchers' understanding of medical artificial intelligence and enhance the quality of healthcare in clinical practice

Objective:To investigate the factors related to child care environment and the association between child care environment and children′s early development.Methods:Using stratified cluster random sampling, a total of 22 509 children newly enrolled to kindergarten from 187 kindergartens of 16 districts in Shanghai in 2017 were enrolled. A survey was conducted by parent-reported questionnaire. The index of child care environment (ICCE) and the early human capacity index were used to evaluate family child care environment and children′s early development respectively. The sample was divided into four groups based on the ICCE score: the lowest family childcare environment (ICCE≤10 scores), lower middle (ICCE=11 scores), upper middle (ICCE=12 scores), and the highest (ICCE=13 scores). The linear regression model and Logistic regression model were used to analyze the factors related to child care environment and the association between child care environment and children′s early development respectively.Results:A total of 22 067 children aged (44±7) months, including 11 425 boys (51.8%) and 10 642 girls (48.2%), participated in this study. The multnomial linear regression revealed girls, higher maternal education, higher household annual income, single-child, non-divorced parents, and early breastfeeding experience were protective factors of child care environment for children newly enrolled to kindergarten ( β=0.064, 0.238, 0.119, 0.096, 0.113, and 0.032; 95% confidence interval ( CI): 0.020-0.108, 0.175-0.302, 0.058-0.180, 0.046-0.146, -0.012-0.242, and -0.051-0.116; all P<0.01). The multinomial Logistic regression revealed compared with the highest child care environment group, the odds ratio of children′s early development risks in upper midclle, lower middle, and the lowest child care environment groups were 1.543 (95% CI: 1.373-1.735, P<0.01), 2.537 (95% CI: 2.254-2.856, P<0.01), and 4.198 (95% CI: 3.757-4.690, P<0.01), respectively. Conclusions:The child care environment is not only significantly related to family structure and socioeconomic status, but also to early breastfeeding experience. The child care environment plays an important role in promoting childhood early development.

Objective To study the therapeutic effect of phages on extensively drug-resistant Acinetobacter baumannii-induced sepsis in mice.Methods (1) Sixty BALB/c mice were divided into blank control group,sepsis control group,antibiotics treatment group,phage treatment group,and phage control group according to the random number table,with 12 mice in each group.Mice in blank control group were intraperitoneally (the same injection position below) injected with 1 mL normal saline.Mice in sepsis control group,antibiotics treatment group,and phage treatment group were injected with 1 mL extensively drug-resistant Acinetobacter baumannii (the strain was isolated from the blood of a severely burned patient hospitalized in our unit) in the concentration of 5 × 107 colony-forming unit/mL to reproduce sepsis model.Two hours later,mice in sepsis control group,antibiotics treatment group,and phage treatment group were injected with 1 mL saline,1 mg/mL imipenem/cilastatin,and 1 × 108 plaque-forming unit (PFU)/mL phages screened based on above-mentioned Acinetobacter baumannii (the same phages below) respectively.Mice in phage control group were injected with 1 mL phages in the titer of 1 × 108 PFU/mL.The injection was performed continuously for 7 days in each living mouse,and the survival situation of mice was observed each day to calculate the survival ratio in one week.(2) Another 60 BALB/c mice were grouped and treated as in experiment (1),and the injection was performed continuously for 5 days in each living mouse.On experiment day 2,4,and 6,3 mice from each group were selected (if the number of survived mouse in any group was less than 3 at sample collecting,all the survived mice were selected),and blood was drawn to determine white blood cell count (WBC,with 3 samples at each time point in each group).On experiment day 2,blood was drawn from the mice that had their blood taken earlier for bacterial culture,and lung,liver,kidney,and spleen tissue was collected from the same mice.The tissue samples were added to the LB solid medium after being homogenized and diluted for bacterial culture.The content of bacteria was calculated after the bacterial colony number was counted.Data were processed Wilcoxon rank sum test,one-way analysis of variance,LSD test and Kruskal-Wallis rank sum test.Results (1) On experiment day 7,there were 12,8,10,and 12 mice survived in blank control group,antibiotics treatment group,phage treatment group,and phage control group respectively,while no mouse survived in sepsis control group.Compared with that in sepsis control group,the survival ratio of mice was significantly higher in the other four groups (with Z values from 55.635 to 106.593,P values below 0.05).The survival ratio of mice in phage treatment group was slightly higher than that in antibiotics treatment group,without statistically significant difference (Z =2.797,P ＞0.05).(2) On experiment day 2,WBC data of mice in blank control group,phage treatment group,and phage control group were close [respectively (5.60 ± 0.94) × 109/L,(5.16 ±0.36) × 109/L,and (5.26 ± 1.89) × 109/L],all significantly lower than the datum in sepsis control group [(8.64 ±0.64) × 109/L,P ＜0.05 orP ＜0.01],and the WBC data in the latter two groups were significantly lower than the datum in antibiotics treatment group [(7.80 ± 1.76) × 109/L,with P values below 0.05].On experiment day 4,WBC data of mice in antibiotics treatment group,phage treatment group,and phage control group were close,all significantly lower than the datum in blank control group (P ＜ 0.05 or P ＜ 0.01),and WBC data in the above-mentioned four groups were all lower than the datum in sepsis control group (with P values below 0.01).On experiment day 6,there was no statistically significant difference in WBC among blank control group,antibiotics treatment group,phage treatment group,and phage control group (x2 =4.128,P ＞0.05).On experiment day 2,respectively 12,7,and 2 mice were detected as blood bacterial culture-positive in sepsis control group,antibiotics treatment group,and phage treatment group,while no positive result was detected in the other two groups.Positive ratios of blood bacterial culture of mice in blank control group,phage treatment group,phage control group were significantly lower than the ratio in sepsis control group (with x 2 values from-30.000 to 30.000,P values below 0.01).Positive ratio of blood bacterial culture of mice in antibiotics treatment group was significantly higher than that in blank control group or phage control group (withx 2 values respectively 17.500 and-17.500,P values below 0.05).On experiment day 2,except for the kidney tissue of mice in phage treatment group,the bacteria load in each viscus of mice in blank control group,phage treatment group,and phage control group was significantly lower than that in sepsis control group (withx 2 values from-9.000 to 9.000,P values below 0.01).The bacteria load in kidney of mice in antibiotics treatment group was significantly higher than that in blank control group or phage control group (withx2 values respectively-7.500 and 7.500,P values below 0.05).Conclusions Phages can significantly improve survival ratio,control inflammation response,and effectively clean bacteria in lung,liver,spleen,and kidney in treating extensively drug-resistant Acinetobacter baumannii-induced sepsis in mice.

Regional odontodysplasia(ROD)is a localized developmental anomaly involving deciduous and perma-nent dentition,with a significant impact on patients.The affected teeth display unique ghost-like radiological characteris-tics,clinically manifesting as delayed tooth eruption,abnormal tooth morphology,and recurrent swelling of gingiva.In this paper,we report a case of a 2-year-old patient with ROD whose chief complaint was facial cellulitis.We analyze the medical history,clinical examination,radiographic findings,and histologic findings,and review the pathological fea-tures,pathogenesis,multidisciplinary diagnosis,and treatment of ROD.This rare case,which offers clinical samples for its further study,can provide a deeper study of ROD.

OBJECTIVE：To explore the therap eutic effects and its mech anism of Jianpi yiqi decoction on diethylnitrosamine （DEN）induced liver cancer model rats. METHODS ：Totally 80 male SD rats were divided into normal group ，model group ， Nod-like receptor family 3（NLRP3）inhibition group （MCC950，4.5 mg/kg），caspase-1 inhibitory group （VX-765，4.5 mg/kg）， Jianpi yiqi decoction low-dose ，medium-dose and high-dose groups （5.25，10.5，21 g/kg），with 10 rats in each group except for 20 rats in model group （10 of them were only used to judge whether modeling was successful ）. Rats in each group were intraperitoneally injected with DEN （70 mg/kg）to induce liver cancer model ，except for the rats in normal group which were replaced by normal saline. After modeling ，normal group and model group were given normal saline intragastrically ；inhibitor groups were given relevant medicine intraperitoneally ；Jianpi yiqi decoction groups were given relevant medicine intragastrically ， once a day ，for consecutive 4 weeks. After last administration ，histopathological morphology of liver tissue was observed. The contents of serum inflammatory factors TNF-α and IL-1β were detected. The expression of NLRP3 and programmed cell necrosis associated protein （ASC，pro-caspase-1，RIP1，RIP3 and MLKL ）in liver tissue were detected. RESULTS ：Compared with the normal group ，the hepatocytes of model group showed varying， degrees of steatosis ，enlarged nuclei ，lumpy，bleeding and necrosis，accompanied by proliferative foci and nodules. Liver 198086， tissue injury index ，serum content of TNF-α and IL-1β as well as the protein expression of NLRP 3，ASC，pro-caspase-1，RIP1，RIP3 and MLKL in liver tissue were significantly increased （P＜0.05 or P＜0.01）. Compared with model 防治。E-mail：sherwin_zhuo@126.com group，there were still a large number of inflammatory cell infiltration in the liver tissue of rats in Jianpi yiqi decoction low-dose and medium dose groups ，while the inflammatory cell infiltration of rats in high-dose group and inhibitor groups decreased significantly ；the liver tissue injury index and above indexes levels in serum and liver tissue were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS ：Jianpi yiqi decoction shows therapeutic effect on liver cancer model rats ，the mechanism of which may be associated with down-regulating the expression of NLRP3 inflammasome and inhibiting programmed cell necrosis.

ObjectiveTo study the relationship between the exposure to two kinds of phthalate esters （PAEs） ［Di-N-butyl phthalate，（DBP） and Di-（2-ethylhexyl）phthalate （DEHP）］ and estrogen homeostasis in pregnant women. MethodsIn 2021， we classified the Jiading District of Shanghai into five geographical areas， east， west， south， north and central. A total of 151 pregnant women from each area were selected for questionnaire survey， with random urine samples during first， second， and third trimesters collected. A DBP metabolite ［Mono-N-butyl phthalate （MBP）］ and two DEHP metabolites ［Mono（2-ethylhexyl） phthalate （MEHP）， Mono（2-ethyl5-oxohexyl） phthalate， （MEOHP）］ and three estrogens ［estrone （E₁）， 17β -estradiol （E₂）， and estriol （E₃）］ in urine were determined by ultra-performance liquid chromatography tandem quadrupole time-of-flight mass spectrometry. After a natural logarithmic transformation of PAEs metabolite levels and estrogen concentration， multivariable linear regression was used to control potential confounders and determine the relationship between PAEs metabolite levels and estrogen concentration. ResultsThe detection rates of three PAEs metabolites in urine of pregnant women were more than 98%. The median corrected concentrations of MBP， MEHP and MEOHP were 5.18， 0.59 and 4.23 mg·kg^-1， respectively. During the whole pregnancy， MEOHP was positively correlated with E₁ （β=0.450， 95%CI： 0.057‒0.844）， and MBP was positively correlated with E₃ （β=0.250， 95%CI： 0.034‒0.465）. Stratified by trimesters， MBP was positively correlated with E₃ in the first trimester （β=0.428， 95%CI： 0.103‒0.752）. MEOHP was positively correlated with E₁ in the second trimester （β=0.734， 95%CI： 0.130‒0.752）， and had a possitive trend with E₁ in the third trimester （β=0.744， 95%CI： -0.140‒1.629）. In addition， MEHP had a negative correlation with E₁ in the second trimester （β=-0.498， 95%CI： -1.063‒0.066）. MEOHP had a positive correlation trend with E₂ （β=0.628， 95%CI： -0.101‒1.356） in the third trimester. ConclusionPAEs exposure may interfere with estrogen homeostasis during pregnancy and differs by trimesters. Given the cross-sectional nature of this study， it warrants further study to validate the findings.