ObjectiveTo develop a predictive model and application for spontaneous passage of common bile duct stones using automated machine learning algorithms given the complexity of treatment decision-making for patients with common bile duct stones， and to reduce unnecessary endoscopic retrograde cholangiopancreatography （ERCP） procedures. MethodsA retrospective analysis was performed for the data of 835 patients who were scheduled for ERCP after a confirmed diagnosis of common bile duct stones based on imaging techniques in Changshu First People’s Hospital （dataset 1） and Changshu Traditional Chinese Medicine Hospital （dataset 2）. The dataset 1 was used for the training and internal validation of the machine learning model and the development of an application， and the dataset 2 was used for external testing. A total of 22 potential predictive variables were included for the establishment and internal validation of the LASSO regression model and various automated machine learning models. The area under the receiver operating characteristic curve （AUC）， sensitivity， specificity， and accuracy were used to assess the performance of models and identify the best model. Feature importance plots， force plots， and SHAP plots were used to interpret the model. The Python Dash library and the best model were used to develop a web application， and external testing was conducted using the dataset 2. The Kolmogorov-Smirnov test was used to examine whether the data were normally distributed， and the Mann-Whitney U test was used for comparison between two groups， while the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsAmong the 835 patients included in the study， 152 （18.20%） experienced spontaneous stone passage. The LASSO model achieved an AUC of 0.875 in the training set （n=588） and 0.864 in the validation set （n=171）， and the top five predictive factors in terms of importance were solitary common bile duct stones， non-dilated common bile duct， diameter of common bile duct stones， a reduction in serum alkaline phosphatase （ALP）， and a reduction in gamma-glutamyl transpeptidase （GGT）. A total of 55 models were established using automated machine learning， among which the gradient boosting machine （GBM） model had the best performance， with an AUC of 0.891 （95% confidence interval： 0.859‍ ‍—‍ ‍0.927）， outperforming the extreme randomized tree mode， the deep learning model， the generalized linear model， and the distributed random forest model. The GBM model had an accuracy of 0.855， a sensitivity of 0.846， and a specificity of 0.857 in the test set （n=76）. The variable importance analysis showed that five factors had important influence on the prediction of spontaneous stone passage， i.e.， were solitary common bile duct stones， non-dilated common bile duct， a stone diameter of <8 mm， a reduction in serum ALP， and a reduction in GGT. The SHAP analysis of the GBM model showed a significant increase in the probability of spontaneous stone passage in patients with solitary common bile duct stones， non-dilated common bile duct， a stone diameter of <8 mm， and a reduction in serum ALP or GGT. ConclusionThe GBM model and application developed using automated machine learning algorithms exhibit excellent predictive performance and user-friendliness in predicting spontaneous stone passage in patients with common bile duct stones. This application can help avoid unnecessary ERCP procedures， thereby reducing surgical risks and healthcare costs.

Acute lung injury （ALI） is a common clinical inflammatory respiratory emergency with high morbidity and mortality， for which there is no effective and safe therapeutic drug. Nuclear factor-κB （NF-κB）， as a classic inflammatory signaling pathway， can interact with upstream and downstream regulatory factors such as Toll-like receptor 4 （TLR4）， mitogen- activated protein kinase （MAPK）， nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 （NLRP3）， high mobility group box-1 protein 1 （HMGB1）， to jointly affect ALI. This review summarizes the latest research findings in recent years regarding the treatment of ALI through traditional Chinese medicine （TCM） interventions targeting NF-κB signaling pathways. It has been found that a variety of TCM monomers （danshensu methyl ester， salidroside total glycosides， berberine， Codonopsis pilosula polysaccharides， ursolic acid， chrysophanol， and polyphenols from longan seed kernels， etc.） and compound formulas （Resolving-dampness and defeating-toxins formula， Jinyin qingre oral liquid， Xuebijing injection， Combined treatment of lung and intestine， Huangqi baihe decoction， etc.） can modulate NF-κB signaling pathway， and can prevent and control ALI by inhibiting inflammation， improving oxidative stress， reducing apoptosis and modulating the intestinal flora in a multi-pathway manner.

It is believed that dampness is a key pathological factor contributing to digestive dysfunction in chronic renal failure. Damp pathogens tend to be entangled with or transformed into other pathogenic factors， obstructing the flow of qi， disturbing the functions of the zang-fu organs， and impairing the spleen and stomach's transportation and transformation functions， ultimately leading to disease onset. Based on this understanding， the treatment principle emphasizes dispelling dampness， regulating qi， and harmonizing the five zang organs. For the syndrome of spleen and kidney qi deficiency with dampness， the self-formulated Buyuan Fengzang Decoction （补元封藏煎） is used to tonify the kidney， secure essence， strengthen the spleen， and eliminate dampness. For the syndrome of turbid dampness obstructing the lung and stomach， the self-formulated Sulian Xiexin Decoction （苏连泻心汤） is applied to open with acrid， descend with bitter， dry dampness， and discharge turbidity. For the syndrome of dampness stagnating and transforming into heat， with concurrent spleen deficiency and liver qi stagnation， the self-formulated Chailian Wendan Decoction （柴连温胆汤） is employed to soothe the liver， strengthen the spleen， and disperse the accumulation. For the syndrome of damp obstruction with qi stagnation and constrained yang， the self-formulated Caozhi Erchen Decoction （草知二陈汤） is used to resolve dampness， relieve constraint， raise yang， and promote the defensive qi.

Hepatic encephalopathy （HE） is a common severe liver disease syndrome in clinical practice and is one of the critical and severe diseases in internal medicine， and more than half of liver failure patients diagnosed with overt HE have a survival time of less than 1 year. A comprehensive analysis of the complex pathogenesis of HE and the development of diagnosis and treatment regimens based on evidence-based medicine are of great importance for alleviating high medical resource consumption， high medical expenses， and high incidence and mortality rates in clinical practice. The latest studies have shown that the intestinal tract and the central nervous system can perform bidirectional continuous interaction and signal transmission and regulate the function of inflammation signals， molecules， cells， and organs， which is known as neuroimmune communication and is highly consistent with the main pathological features of HE. With a focus on the mechanism of neuroimmune communication in HE， this article reviews the association between inflammation signal transduction via the gut-brain axis and neurotransmitter regulation and its role in neuroimmune communication in HE， which provides new ideas for the clinical diagnosis and treatment of HE and the research and development of related drugs.

Objective To investigate the feasibility of AccuLearning system for the auto-segmentation of target areas and organs-at-risk(OAR)for total marrow and lymphoid irradiation(TMLI)in children.Methods Thirty pediatric patients who underwent TMLI since 2018 to 2022 were selected.The patients were immobilized in the supine position,and their CT images were acquired on the Philips Brilliance Big Bore CT scanner.After the target areas and OAR were manually delineated and modified,the CT images and manually delineated contours were imported into AccuLearning system for training,validation,and testing of the auto-segmentation model.The auto-segmentation results in 6 TMLI patients in the test set were evaluated in terms of Dice similarity coefficient(DSC),95%Hausdorff distance and average surface distance.Results On the test set with 6 cases,except for the lens that was difficult to be delineated automatically,the DSC values was above 0.70 for all other target areas and OAR,with only one patient having a DSC value of 0.59 for the stomach.The average DSC value for the stomach in all 6 patients was 0.76,and the average DSC values for the other organs were above 0.80.Conclusion The target areas and OAR automatically delineated with the model can meet the requirements of clinical planning after simple modifications.

ObjectiveExploring the role of microRNA126 （miRNA126） in chronic kidney disease combined with atherosclerosis （CKD AS） by regulating the phosphatidylinositol-3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway and the mechanism of Shenshuai Xiezhuo decoction in the intervention of CKD AS rats with 5/6 nephrectomy combined with high-fat feeding. MethodA total of 60 SD rats were randomly divided into sham operation group， model group， losartan group， and low， medium， and high dose groups of Shenshuai Xiezhuo decoction. The CKD AS rat model was established by 5/6 nephrectomy combined with high-fat feeding for 10 weeks. The low， medium， and high dose groups （6.0， 12.0， 24.0 g·kg^-1·d^-1） of Shenshuai Xiezhuo decoction and the losartan group （20 mg·kg^-1·d^-1） were gavaged， and the corresponding intervention was carried out for eight weeks. Then， the rats were killed， and samples were collected for corresponding detection. Fully automated biochemical analyzers were used to detect kidney function and blood lipids in rats： blood creatinine （SCr）， blood urea nitrogen （BUN）， total cholesterol （TC）， triglyceride （TG）， and low-density lipoprotein cholesterol （LDL-C） levels. Hematoxylin-eosin （HE） and Masson staining of aortic tissue and pathological observation under a light microscope were carried out， and autophagosomes and autophagy lysosomes were observed by transmission electron microscopy. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to determine the mRNA levels of miRNA126， PI3K， Akt， and mTOR in rats， and Western blot was used to determine the protein expression levels of phosphorylated （p）-PI3K， PI3K， p-Akt， Akt， p -mTOR， mTOR， benzyl chloride 1 （Beclin-1）， and microtubule-associated protein light chain 3Ⅱ/Ⅰ （LC3Ⅱ/LC3Ⅰ）. ResultCompared with the sham operation group， the serum SCr， BUN， TC， TG， and LDL-C in the model group were significantly increased （P<0.01）. Compared with the model group， the SCr， BUN， TC， TG， and LDL-C were decreased in the losartan group and low， medium， and high dose groups of Shenshuai Xiezhuo decoction （P<0.05）. Compared with the sham operation group， thickening plaques， infiltration of mononuclear macrophages， a small number of foam cells， disordered arrangement of smooth muscle fibers in the tunica media， and increased collagen fibers were observed in the model group， and the lesions in the losartan group and Shenshuai Xiezhuo decoction groups were alleviated compared with those in the model group. Compared with the model group， the number of autophagosomes and autophagy lysosomes increased in the medium and high dose groups of Shenshuai Xiezhuo decoction. Compared with the sham operation group， the expression of miRNA126 in the aortic tissue of the model group was significantly decreased （P<0.01）， and the mRNA expressions of PI3K， Akt， and mTOR were significantly increased （P<0.01）. Compared with the model group， the expression of miRNA126 in the aortic tissue of rats in high， medium， and low dose groups of Shenshuai Xiezhuo decoction and losartan group was significantly increased （P<0.01）， while the mRNA expressions of PI3K， Akt， and mTOR were significantly decreased （P<0.01）. Compared with the sham operation group， the protein expressions of p-PI3K， PI3K， p-Akt， Akt， p-mTOR， and mTOR in the model group were significantly increased （P<0.01）， while the protein levels of Beclin-1， LC3Ⅰ， and LC3Ⅱ were significantly decreased （P<0.01）. Compared with the model group， the protein expressions of p-PI3K， PI3K， p-Akt， Akt， p-mTOR， and mTOR in the losartan group and low， medium， and high dose groups of Shenshuai Xiezhuo decoction were decreased （P<0.05）， while the protein levels of Beclin-1 and LC3Ⅱ/LC3Ⅰ were increased （P<0.05）. ConclusionThe expression of miRNA126 is decreased in the aortic tissue of CKD AS rats， and the PI3K/Akt/mTOR pathway is activated to inhibit autophagy flux. Shenshuai Xiezhuo decoction regulates the PI3K/Akt/mTOR signaling pathway through miRNA126， restores the autophagy of aortic endothelial cells， protects the damage of CKD vessels， reduces the formation of As plaques， and slows the development of cardiovascular complications.

Objective:To investigate the pathway of self-disclosure to posttraumatic growth in patients after cervical cancer surgery, and to provide reference for improving the level of posttraumatic growth in patients.Methods:A convenient sampling method was used to investigate 300 patients with cervical cancer after surgery in Shandong Provincial Hospital Affiliated to Shandong First Medical University from June to November 2022 by using general data questionnaire, Distress Disclosure Index (DDI), Connor-Davidson Resilience Scale (CD-RISC), the Shortened Chinese Version of the Family Resilience Assessment Scale (FRAS-C) and the Posttraumatic Growth Inventory (PTGI) in a cross-section study.Results:A total of 290 valid questionnaires were collected, with an effective recovery rate of 96.7%. The patients were aged 23-70(48.13 ± 10.39) years. The scores of self-disclosure, resilience, family resilience and posttraumatic growth were (46.41 ± 9.82), (67.06 ± 14.63), (108.18 ± 11.06) and (58.24 ± 17.86) respectively. The results of pathway analysis showed that self-disclosure could not only directly predict posttraumatic growth, but also indirectly predict posttraumatic growth through the mediating role of resilience and family resilience, and the chain mediating role of resilience and family resilience, respectively. The direct effect of self-disclosure on posttraumatic growth was 0.236(95% CI 0.138-0.335), and the chain mediating effect of family resilience and resilience between self-disclosure and posttraumatic growth was 0.036(95% CI 0.018-0.060). Conclusions:Medical staff should not only consider the direct influence of self-disclosure on posttraumatic growth, but also pay attention to improve the resilience and family flexibility of patients after cervical cancer surgery, so as to promote their posttraumatic growth.

The current linear economy model relies on fossil energy and increases CO₂ emissions, which contributes to global warming and environmental pollution. Therefore, there is an urgent need to develop and deploy technologies for carbon capture and utilization to establish a circular economy. The use of acetogens for C1-gas (CO and CO₂) conversion is a promising technology due to high metabolic flexibility, product selectivity, and diversity of the products including chemicals and fuels. This review focuses on the physiological and metabolic mechanisms, genetic and metabolic engineering modifications, fermentation process optimization, and carbon atom economy in the process of C1-gas conversion by acetogens, with the aim to facilitate the industrial scale-up and carbon negative production through acetogen gas fermentation.
Fermentation ; Gases/metabolism* ; Carbon Dioxide/metabolism* ; Metabolic Engineering ; Carbon/metabolism*

OBJECTIVE: To compare the prevalence of chromosomal aneuploidies and pregnancy outcomes of D5 and D6 blastocysts subjected to preimplantation genetic testing for aneuploidy (PGT-A). METHODS: Clinical and laboratory data of 268 couples who underwent PGT-A at the Reproductive Center of the First Affiliated Hospital of Zhengzhou University from September 2018 to September 2020 were collected. The prevalence of chromosomal aneuploidies and pregnancy outcomes of D5/D6 biopsied blastocysts were compared. RESULTS: Compared with D6 blastocysts, the euploidy rate of D5 blastocysts was significantly higher (49.1% vs. 41.1%, P = 0.001 1), whilst their aneuploidy rate was significantly lower (50.9% vs. 58.9%, P = 0.001 1). The rate of numerical abnormalities of D6 blastocysts was significantly higher than that of D5 blastocysts (27.9% vs. 20.2%, P = 0.000 5). For patients under 35 years old, the euploidy rate of D5 blastocysts was significantly higher than that of D6 blastocysts (53.8% vs. 44.3%, P = 0.001), whilst the numerical abnormality rate was significantly lower (16.3% vs. 23.9%, P = 0.001). For both D5 and D6 blastocysts, the euploidy rates for patients <= 35 were significantly higher than those for > 35. The elder group had the lowest rates for aneuploidies and live births. Compared with those receiving D6 blastocysts transplantation, the pregnancy rate, implantation rate and live birth rate for those receiving thawed D5 blastocysts transplantation were significantly higher (60.2% vs.37.0%, P = 0.000 3; 59.1% vs.37.0%, P = 0.000 6; 47.7% vs. 28.3%, P = 0.002). CONCLUSION For patients undergoing PGT-A, the chromosomal euploidy rate for D5 blastocysts is higher than that for D6 blastocysts, and the clinical outcome of D5 blastocysts with normal signal is better than that of D6 blastocysts. Elder patients have a higher rate of aneuploidies.
Female ; Pregnancy ; Humans ; Aged ; Adult ; Pregnancy Outcome ; Aneuploidy ; Blastocyst ; Genetic Testing ; Laboratories

Abstract: Objective　The study aims to investigate the diagnosis quality and accuracy of syphilis cases reported by medical facilities in Inner Mongolia, understand possible problems and influencing factors in reporting and diagnosis, providing evidence for the better formulation of syphilis control and prevention. Methods　Cross-sectional survey was conducted with 2 counties sampled randomly from 12 municipals of Inner Mongolia, different medical facilities were covered. Syphilis cases reported from July 2019 to June 2020 in medical institutions of different categories were sampled and checked. The quality and accuracy of syphilis case reporting were evaluated according to the identifiers in "Syphilis Diagnosis (WS 273-2018)" and "National STD Case Reporting Quality Management Scheme (2018)". In addition, the basic information of medical institutions and the implementation of syphilis detection in laboratories were investigated, and the physicians who reported the case first were interviewed to understand their mastery of syphilis diagnosis and reporting, thus analyzing the major factors influencing the accuracy of reports. Results　The reporting rate of syphilis in medical institutions in Inner Mongolia was 99.04% (311/314), the missing-report rate was 0.96% (3/314), the timely reporting rate was 98.05% (1 659/1 692), the completeness rate was 99.64% (1 686/1 692), the correct rate was 99.35% (1 681/1 692), the accuracy rate of internet-based input was 84.63% (1 432/1 692). There were statistical differences in the quality (χ2=13.95, P<0.05; χ2=11.40, P<0.05) and accuracy （χ2=30.06, P<0.05; χ2=44.93, P<0.05) of reports among different municipals and different types of medical facilities. The accuracy rate of syphilis reporting by medical institutions was 86.17% (1 458/1 692), the correct rate for classifying diagnosis was 87.06% (1 473/1 692), and the accuracy rate of staging was 90.25% (1 527/1 692). Multivariate logistic regression results showed that whether the first-clinic physician attended training in the past three years [OR=6.26, 95%CI: (2.12-18.46)] and whether they grasped the key points of syphilis classification standard [OR=2.79, 95%CI: (1.21-6.46)] influenced report accuracy. Conclusions　The quality of reports in Inner Mongolia medical institutions is generally high, but the accuracy rate of reporting and correctness of network input have not yet reached the target requirement of 95%. There is still room for improvement in reporting and diagnostic capabilities. It is suggested to further strengthen the training frequency and coverage for physicians on syphilis diagnosis standard.