Objective:To investigate the value of CT quantitative parameters of tumor and spleen in predicting the clinical stage of gastric cancer (Ⅰ/Ⅱ stage and Ⅲ/Ⅳ stage).Methods:This study was a case-control study. The data of 145 patients with gastric cancer confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from February 2019 to June 2021 were retrospectively collected, including 70 cases of Ⅰ/Ⅱ stage and 75 cases of Ⅲ/Ⅳ stage. On the baseline CT images, the tumor related parameters, including tumor thickness, length of tumor, CT attenuation of tumor unenhanced phase, CT attenuation of tumor arterial phase, CT attenuation of tumor venous phase were measured. The spleen related parameters, including splenic thickness, CT attenuation of splenic unenhanced phase, CT attenuation of splenic arterial phase, CT attenuation of splenic venous phase, and standard deviation of CT attenuation (CTsd) in splenic unenhanced phase were also measured. The independent sample t test or Mann-Whitney U test was used to compare the parameters between the Ⅰ/Ⅱ stage and Ⅲ/Ⅳ stage patients. The multi-factor logistic regression analysis was used to find the independent predictors of gastric cancer clinical stage, and establish the combined parameters. The efficiency to the diagnosis of gastric cancer stage of single and combined parameters was evaluated using the operating characteristic curve, and the DeLong test was used to compare the differences of area under the curve (AUC). Results:There were significant differences in tumor thickness, length of tumor, CT attenuation of tumor venous phase, CT attenuation of splenic unenhanced phase, CT attenuation of splenic venous phase, CTsd in splenic unenhanced phase between the Ⅰ/Ⅱ stage and Ⅲ/Ⅳ stage of gastric cancer ( P<0.05). Multivariate analysis showed that tumor thickness ( OR=1.073, 95% CI 1.026-1.123, P=0.002), CT attenuation of splenic venous phase ( OR=1.040, 95% CI 1.011-1.070, P=0.006) and CTsd in splenic unenhanced phase ( OR=1.625, 95% CI 1.330-1.987, P<0.001) were independent risk factors for the clinical stage of gastric cancer and the combined parameters were established. The AUC values of tumor thickness, CT attenuation of splenic venous phase, CTsd in splenic unenhanced phase and combined parameters were 0.655, 0.614, 0.749 and 0.806, respectively. The AUC of combined parameters was higher than those of tumor thickness and CT attenuation of splenic venous phase, and the differences were statistically significant ( Z=3.37, 3.82, both P<0.001). Conclusion:Tumor thickness, CT attenuation of splenic venous phase and CTsd in splenic unenhanced phase are independent risk factors for the clinical stage of gastric cancer, and combined parameters can improve the diagnostic efficiency.

Objective:To establish a prediction model of risk factors for early Q-T interval prolongation after acute myocardial infarction (AMI), which helps prevent and reduce the occurrence of acute malignant events.Methods:This is a case-control study. A total of 100 patients with Q-T interval prolongation after AMI who received treatment at Heilongjiang Provincial Hospital from January 2018 to December 2022 were included in this study. An additional 100 patients without Q-T interval prolongation after AMI who concurrently received treatment in the same hospital were also included in this study. Two model groups, including model group 1 (with Q-T interval prolongation, n = 50) and model group 2 (without Q-T interval prolongation, n = 50), and two test groups, including test group 1 (with Q-T interval prolongation, n = 50) and test group 2 (without Q-T interval prolongation, n = 50), were designated. Logistic regression analysis was performed to construct a prediction model of risk factors for Q-T interval prolongation. The area under the receiver operating characteristic curve was determined to evaluate the prediction model. The value of the prediction model was validated in the test groups. Results:Multivariate logistic regression showed that female gender ( OR = 2.307, 95% CI: 0.09-0.91, P = 0.041) and heart failure ( OR = 3.087, 95% CI: 1.15-8.27, P = 0.025) were independent risk factors for early Q-T interval prolongation after AMI. The area under the receiver operating characteristic curve of the prediction model was 0.770, with a sensitivity of 84.0%, a specificity of 66.0%, the Jordan index of 0.44, and the corresponding optimal critical value of 0.43. This indicates good fit of the model. Conclusion:Female gender and heart failure are independent risk factors for early Q-T interval prolongation after AMI. The model constructed based on the above-mentioned risk factors fits well and has a high predictive value, which helps reduce the occurrence of early Q-T interval prolongation after AMI.

Objective To propose a distribution feature extraction algorithm based on wavelet packet coefficients to reconstruct the signal energy sequence for effectively identifying the pathological features of heart sounds,thereby realizing the early screening of heart diseases.Methods The original heart sound signal was decomposed into 10 layers using wavelet packet decomposition algorithm.After obtaining the wavelet packet coefficients of each layer,each coefficient was reconstructed,and the energy of the reconstructed signal was calculated and arranged in the original order to form the energy sequence.The distribution characteristics of the energy sequence of the reconstructed signals at each layer were analyzed,and distribution features were taken as classification features.Support vector machine,K-nearest neighbor,and decision tree were used to classify and recognize normal heart sounds and the heart sound signals of various diseases.Results The combination of the distribution features of the reconstructed signal energy sequence and decision tree classifier had an accuracy of 93.6%for classifying 5 types of heart sounds on the public dataset,and the accuracy was 95.6%for identifying normal heart sounds and hypertrophic cardiomyopathy heart sounds.Conclusion The proposed algorithm can extract the effective pathological information of abnormal heart sounds,providing a reference for clinical cardiac auscultation.

Patients with overlap syndrome(OS)of autoimmune liver disease may present with more than one biochemical,immunological,histological or cholangiography features of autoimmune liver disease(AILD)and often require a combination of immunosuppressants for treatment.Pulmonary cryptococcosis is a type of invasive pneumomycosis caused by Cryptococcus neoformans or Cryptococcus gattii and has a relatively high incidence rate in immunocompromised patients.This case report presents a patient with OS who was found to have pulmonary cryptococcosis during immunosuppressive therapy and developed abnormal liver function during antifungal treatment.Based on the liver function of the patient,the feasibility of adjusting antifungal agents was assessed,and active treatment strategies for novel cryptococcal infection were developed under the close monitoring of liver function,which helped to avoid the progression of infection.It is suggested that before the initiation of immunosuppressive therapy,systemic foci of infection should be comprehensively evaluated,and suspicious foci of infection should be monitored continuously.

Objective To explore the relationship between alterations of neural network plasticity and spatial learning and memory functions in mouse models with depression-like behaviors.Methods C57Thy1-YFP/GAD67-GFP mice were randomized into control group(with no treatment)and chronic unpredictable mild stress(CUMS)group(n=15)subjected to CUMS for 8 weeks.Depression-like behaviors of the mice were assessed using sucrose preference test,open field test,and forced swimming test,and their spatial learning and memory abilities were evaluated using Morris water maze test.The changes in the firing patterns of different neuronal subtypes were detected in the central nucleus of the amygdala(CeA)and the prelimbic cortex(PrL)using whole-cell patch-clamp technique.Results Compared with the control mice,CUMS mice showed significantly decreased sucrose preference,total distance moved,number of grid-crossings,entries into the central area,and time spent in the central area in the open field test(P<0.01).In the forced swimming test,CUMS mice exhibited obviously shortened time of struggling,swimming,and climbing with increased immobility time.In Morris water maze test,CUMS mice showed significantly increased escape latency and path length,decreased percentage of distance and swimming time within the target quadrant,and increased first entry latency into the target zone and swimming time within the opposite quadrant.Exposure to CUMS resulted in significantly enhanced energy barrier and increased absolute refractory period and inter-spike interval of glutamatergic neurons in the CeA and GABAergic neurons in the PrL,while the opposite changes were observed in GABAergic neurons in the CeA and glutamatergic neurons in the PrL.Conclusion CUMS-induced depression may lead to plastic changes in the excitatory and inhibitory neuronal networks within the CeA and PrL to cause impairment of spatial learning and memory abilities in mice.

Objective To explore the relationship between alterations of neural network plasticity and spatial learning and memory functions in mouse models with depression-like behaviors.Methods C57Thy1-YFP/GAD67-GFP mice were randomized into control group(with no treatment)and chronic unpredictable mild stress(CUMS)group(n=15)subjected to CUMS for 8 weeks.Depression-like behaviors of the mice were assessed using sucrose preference test,open field test,and forced swimming test,and their spatial learning and memory abilities were evaluated using Morris water maze test.The changes in the firing patterns of different neuronal subtypes were detected in the central nucleus of the amygdala(CeA)and the prelimbic cortex(PrL)using whole-cell patch-clamp technique.Results Compared with the control mice,CUMS mice showed significantly decreased sucrose preference,total distance moved,number of grid-crossings,entries into the central area,and time spent in the central area in the open field test(P<0.01).In the forced swimming test,CUMS mice exhibited obviously shortened time of struggling,swimming,and climbing with increased immobility time.In Morris water maze test,CUMS mice showed significantly increased escape latency and path length,decreased percentage of distance and swimming time within the target quadrant,and increased first entry latency into the target zone and swimming time within the opposite quadrant.Exposure to CUMS resulted in significantly enhanced energy barrier and increased absolute refractory period and inter-spike interval of glutamatergic neurons in the CeA and GABAergic neurons in the PrL,while the opposite changes were observed in GABAergic neurons in the CeA and glutamatergic neurons in the PrL.Conclusion CUMS-induced depression may lead to plastic changes in the excitatory and inhibitory neuronal networks within the CeA and PrL to cause impairment of spatial learning and memory abilities in mice.

L-asparaginase (L-ASN) is widely applied in the treatment of malignant tumor and low-acrylamide food production, however, the low expression level hampers its application. Heterologous expression is an effective strategy to increase the expression level of target enzymes, and Bacillus is generally used as the host for efficient production of enzymes. In this study, the expression level of L-asparaginase in Bacillus was enhanced through optimization of expression element and host. Firstly, five signal peptides (SP_SacC, SP_AmyL, SP_AprE, SP_YwbN and SP_WapA) were screened, among which SP_SacC showed the best performance, reaching an activity of 157.61 U/mL. Subsequently, four strong promoters (P43, P_ykzA-P43, P_Ubay and P_bacA) from Bacillus were screened, and tandem promoter P_ykzA-P43 showed the highest yield of L-asparaginase, which was 52.94% higher than that of control strain. Finally, three Bacillus expression hosts (B. licheniformis Δ0F3 and BL10, B. subtilis WB800) were investigated, and the maximum L-asparaginase activity, 438.3 U/mL, was reached by B. licheniformis BL10, which was an 81.83% increase compared with that of the control. This is also the highest level of L-asparaginase in shake flask reported to date. Taken together, this study constructed a B. licheniformis strain BL10/P_ykzA-P43-SP_SacC-ansZ capable of efficiently producing L-asparaginase, which laid the foundation for industrial production of L-asparaginase.
Bacillus licheniformis/metabolism* ; Asparaginase/genetics* ; Bacillus/genetics* ; Protein Sorting Signals ; Promoter Regions, Genetic/genetics* ; Bacillus subtilis/genetics* ; Bacterial Proteins

Objective:To evaluate the value of preoperative prediction of vessel invasion (VI) of locally advanced gastric cancer by machine learning model based on the venous phase enhanced CT radiomics features.Methods:A retrospective analysis of 296 patients with locally advanced gastric cancer confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from July 2011 to December 2020 was performed. The patients were divided into VI positive group ( n=213) and VI negative group ( n=83) based on pathological results. The data were divided into training set ( n=207) and test set ( n=89) according to the ratio of 7∶3 with stratification sampling. The clinical characteristics of patients were recorded, and the independent risk factors of gastric cancer VI were screened by multivariate logistic regression. Pyradiomics software was used to extract radiomic features from the venous phase enhanced CT images, and the minimum absolute shrinkage and selection algorithm (LASSO) was used to screen the features, obtain the optimal feature subset, and establish the radiomics signature. Four machine learning algorithms, including extreme gradient boosting (XGBoost), logistic, naive Bayes (GNB), and support vector machine (SVM) models, were used to build prediction models for the radiomics signature and the screened clinical independent risk factors. The efficacy of the model in predicting gastric cancer VI was evaluated by the receiver operating characteristic curve. Results:The degree of differentiation (OR=13.651, 95%CI 7.265-25.650, P=0.003), Lauren′s classification (OR=1.349, 95%CI 1.011-1.799, P=0.042) and CA199 (OR=1.796, 95%CI 1.406-2.186, P=0.044) were independent risk factors for predicting the VI of locally advanced gastric cancer. Based on the venous phase enhanced CT images, 864 quantitative features were extracted, and 18 best constructed radiomics signature were selected by LASSO. In the training set, the area under the curve (AUC) of XGBoost, logistic, GNB and SVM models for predicting gastric cancer VI were 0.914 (95%CI 0.875-0.953), 0.897 (95%CI 0.853-0.940), 0.880 (95%CI 0.832-0.928) and 0.814 (95%CI 0.755-0.873), respectively, and in the test set were 0.870 (95%CI 0.769-0.971), 0.877 (95%CI 0.788-0.964), 0.859 (95%CI 0.755-0.961) and 0.773 (95%CI 0.647-0.898). The logistic model had the largest AUC in the test set. Conclusions:The machine learning model based on the venous phase enhanced CT radiomics features has high efficacy in predicting the VI of locally advanced gastric cancer before the operation, and the logistic model demonstrates the best diagnostic efficacy.

Objective:To explore the clinical effect of repairing interphalangeal joint defect of hand with free transfer of part of the 2nd metatarsophalangeal joint tissue flap precisely cut with the aid of digital 3D printing technology.Methods:From December 2016 to December 2020, 7 patients with partial joint defects of proximal interphalangeal joints of fingers were treated in Department of Hand and Foot Surgery, Shunde Hospital Affiliated to Guangzhou Medical University(Foshan Shunde Lecong Hospital). Before surgery, three-dimensional data of hand and foot bones were collected, and the 3D printing model was used to simulate the operation in vitro. During the operation, the first dorsal metatarsal artery-the 2nd dorsal metatarsal artery was used as the pedicle, and the 2nd metatarsophalangeal joint composite tissue flap with a required size was harvested with the assistance of the navigation template to tranfer and repair the small joint defects of hand. All 7 cases entered follow-up at outpatient and telephone. Results:All 7 cases survived. Postoperative follow-up was 3-24(mean 9.5) months, Range of motion of the repaired interphalangeal joint was (56 ± 6)°; According to the Evaluation Standard of Thumb and Finger Reconstruction Function of the Society of Hand Surgery of the Chinese Medical Association, 2 cases were excellent, 4 cases were good, and 1 case was poor.Conclusion:Transfer of the free 2nd metatarsophalangeal joint tissue flap assisted by 3D printing technology in repair of the small joint defect of the hand can accurately harvest the tissue flap, which is clinically reliable.

Objective:To explore the clinical effect of a modified single-trunk arterialised venous flap in reconstruction of soft tissue defect in hand and foot.Methods:From January 2019 to June 2022, 25 patients with soft tissue defect in hand and foot were treated in the Department of Hand and Foot Plastic Surgery of Lecong Hospital of Shunde in Foshan. The soft tissue defects were reconstructed with a venous flap, of which a single trunk of vein was ligated and then a blood flux of the flap was re-established via a modified single vein trunk. One patient had soft tissue defect in dorsal foot and toes, 3 patients had defects in dorsal hand, 3 patients had defects in 2 digits and 18 patients had defects in single-digit. The sizes of defects were 2.0 cm×1.0 cm-10.0 cm×4.5 cm. The sizes of flaps were 2.0 cm×1.0 cm-12.0 cm×5.5 cm. Donor sites of the 19 cases were directly sutured and 6 were covered by skin grafts. The postoperative follow-ups were conducted at outpatient clinics and via telephone reviews to observe the survival of flaps. Functional recovery of 23 cases whose soft tissue defects in hand were evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. The sensory recovery of flaps was evaluated according to the comprehensive flap scale.Results:All 25 single-trunk venous flaps survived successfully. There were small number of blisters on 5 flaps, due to tissue oedema. One patient lost in follow-up. The other 24 patients had 2-18 months of follow-up. The appearance of flaps was soft and thin, with wear-resistant. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the function recovery were excellent in 12 cases, good in 9 cases and poor in 2 cases. Sensations of the flaps were 90-99 point with an average of 97 point according to the comprehensive flap scale, of which 22 flaps were in excellent and 2 in good.Conclusion:The method of ligation of single vein-trunk to make a arterialised venous flap is a simple surgical procedure. There are many selections of donor site with minimum damage. It is an effective method and with satisfactory outcomes.