Objective:To develop an economical,simple,and accessible method for early identification of high-risk pregnant women with gestational diabetes mellitus(GDM),this study developed and evaluated multiple machine learning models,identified the optimal prediction model,and constructed a clinical decision support sys-tem(CDSS)based on this model.Methods:A total of 464 pregnant women who visited the Second Affiliated Hospital of Dalian Medical University from January 1,2023 to December 30,2024 were included,of which 386 were used to establish a prediction model(231 in the training set and 155 in the testing set),and the remaining 78 were used as a validation.Adopting the methods of double-point sequence correlation and chi-square test,four machine learning models were constructed after selecting feature variables:Logistic Regression,Random Forest,Support Vector Machine,and eXtreme Gradient Boosting(XGBoost).Preliminary judgment of the maximum weight mod-el,further comparison of the discriminative ability,calibration ability,and clinical practicality of each model to evalu-ate and select the optimal model,develop its CDSS,and verify the accuracy of the model.Results:①Correlation analysis identified predictors of GDM:age,pre-pregnancy body mass index(BMI),systolic/diastolic blood pres-sure,white blood cell count,hemoglobin,lymphocyte ratio,fasting plasma glucose,uric acid,direct bilirubin,chronic hypertension complicating pregnancy,and assisted reproductive technology conception.②XGBoost dominated the ensemble model and demonstrated the best performance in discrimination(AUC 0.931,95%CI 0.910-0.967),cali-bration,and clinical utility among the four models.③The CDSS achieved an accuracy of 78.2%,sensitivity of 64.7%,and specificity of 82.0%in the XGBoost model.Conclusions:The XGBoost model has the highest ability to predict GDM in the early stage.Developing its CDSS not only facilitates doctors to quickly assess GDM risk,but also is suitable for promotion to remote areas,where high-risk population screening can be achieved through re-mote data.

Concepts are the cornerstone of the development of disciplines. The concepts of TCM present that a superior concept contains more subordinate concepts. The superordinate concepts are often used to refer to different subordinate concepts, which can refer to both superior concepts themselves and non-specific subordinate concepts, that is, the characteristics of subordinate coverage and indefinite reference, which cause confusion in concept meaning, concept relationships, reasoning logic, and other problems. Nowadays, the TCM scholars pay little attention to this characteristic. Therefore, this article analyzed this characteristic, discussed its impact on the inheritance and development of TCM, and proposed that starting from the anchoring of concepts and entities to clarify the connotation of concepts, looking forward to provide new ideas for the definition of the concepts of TCM and the development of the discipline.

Objective:To analyze the risk factors of anxiety and depression in elderly bronchiectasis patients and establish a nomogram model.Methods:A total of 90 elderly patients with bronchiectasis who were treated in Sichuan Santai County People′s Hospital from January 2020 to January 2023 were selected as the research subjects. The incidence of anxiety and depression in patients was observed, influencing factors were analyzed by univariate and multivariate Logistic regression analysis, and a predictive risk column chart model was established.Results:In 90 elderly patients, 40 patients experienced anxiety and depression, with an incidence rate of 44.44%. Univariate and multivariate Logistic regression analysis showed that hospitalization frequency, hemoptysis, educational level, arterial partial oxygen pressure (PaO 2), severity of the condition, copper green colonization, length of hospital stay, monthly family income, and family happiness index were risk factors for anxiety and depression in elderly patients with bronchiectasis ( P<0.05). A column line prediction model for anxiety and depression in elderly patients with bronchiectasis based on 9 independent risk factors was drawn. The calibration verification result show that the predicted values of the model had a high degree of fit with the measured values. The internal validation result of bootstrap showed that the C-index was 0.724 (95% CI 0.670 -0.779). Conclusions:The occurrence of anxiety and depression in elderly patients with bronchiectasis can be influenced by various factors. The model has high predictive performance.

Objective:To develop an economical,simple,and accessible method for early identification of high-risk pregnant women with gestational diabetes mellitus(GDM),this study developed and evaluated multiple machine learning models,identified the optimal prediction model,and constructed a clinical decision support sys-tem(CDSS)based on this model.Methods:A total of 464 pregnant women who visited the Second Affiliated Hospital of Dalian Medical University from January 1,2023 to December 30,2024 were included,of which 386 were used to establish a prediction model(231 in the training set and 155 in the testing set),and the remaining 78 were used as a validation.Adopting the methods of double-point sequence correlation and chi-square test,four machine learning models were constructed after selecting feature variables:Logistic Regression,Random Forest,Support Vector Machine,and eXtreme Gradient Boosting(XGBoost).Preliminary judgment of the maximum weight mod-el,further comparison of the discriminative ability,calibration ability,and clinical practicality of each model to evalu-ate and select the optimal model,develop its CDSS,and verify the accuracy of the model.Results:①Correlation analysis identified predictors of GDM:age,pre-pregnancy body mass index(BMI),systolic/diastolic blood pres-sure,white blood cell count,hemoglobin,lymphocyte ratio,fasting plasma glucose,uric acid,direct bilirubin,chronic hypertension complicating pregnancy,and assisted reproductive technology conception.②XGBoost dominated the ensemble model and demonstrated the best performance in discrimination(AUC 0.931,95%CI 0.910-0.967),cali-bration,and clinical utility among the four models.③The CDSS achieved an accuracy of 78.2%,sensitivity of 64.7%,and specificity of 82.0%in the XGBoost model.Conclusions:The XGBoost model has the highest ability to predict GDM in the early stage.Developing its CDSS not only facilitates doctors to quickly assess GDM risk,but also is suitable for promotion to remote areas,where high-risk population screening can be achieved through re-mote data.

Objective:To analyze the risk factors of anxiety and depression in elderly bronchiectasis patients and establish a nomogram model.Methods:A total of 90 elderly patients with bronchiectasis who were treated in Sichuan Santai County People′s Hospital from January 2020 to January 2023 were selected as the research subjects. The incidence of anxiety and depression in patients was observed, influencing factors were analyzed by univariate and multivariate Logistic regression analysis, and a predictive risk column chart model was established.Results:In 90 elderly patients, 40 patients experienced anxiety and depression, with an incidence rate of 44.44%. Univariate and multivariate Logistic regression analysis showed that hospitalization frequency, hemoptysis, educational level, arterial partial oxygen pressure (PaO 2), severity of the condition, copper green colonization, length of hospital stay, monthly family income, and family happiness index were risk factors for anxiety and depression in elderly patients with bronchiectasis ( P<0.05). A column line prediction model for anxiety and depression in elderly patients with bronchiectasis based on 9 independent risk factors was drawn. The calibration verification result show that the predicted values of the model had a high degree of fit with the measured values. The internal validation result of bootstrap showed that the C-index was 0.724 (95% CI 0.670 -0.779). Conclusions:The occurrence of anxiety and depression in elderly patients with bronchiectasis can be influenced by various factors. The model has high predictive performance.

Urate oxidase (Uox) plays a pivotal role in uric acid (UA) degradation, and it has been applied in controlling serum UA level in clinical treatment of hyperuricemia (HUA). However, because Uox is a heterogenous protein to the human body, the immune rejections typically occur after intravenous administration, which greatly hampers the application of Uox-based agents. In this study, we used Lactococcus lactis NZ9000, a food-grade bacterium, as a host to express exogenous Uox genes, to generate the Uox-expressing engineered strains to treat HUA. Aspergillus flavus-derived Uox (aUox) and the "resurrected" human-derived Uox (hUox) were cloned into vector and expressed in NZ9000, to generate engineered strains, respectively. The engineered NZ9000 strains were confirmed to express Uox and showed UA-lowering activity in a time-dependent manner in vitro. Next, in an HUA mice model established by oral gavage of yeast paste, the UA levels were increased by 85.4% and 106.2% at day 7 and day 14. By contrast, in mice fed with NZ9000-aUox, the UA levels were increased by 39.5% and 48.3% while in mice fed with NZ9000-hUox were increased by 57.0% and 82.9%, suggesting a UA-lowering activity of both engineered strains. Furthermore, compared with allopurinol, the first-line agent for HUA treatment, mice fed with NZ9000-aUox exhibited comparable liver safety but better kidney safety than allopurinol, indicating that the use of engineered NZ9000 strains not only alleviated kidney injury caused by HUA, but could also avoided the risk of kidney injury elicited by using allopurinol. Collectively, our study offers an effective and safe therapeutic approach for HUA long-term treatment and controlling.
Animals ; Lactococcus lactis/metabolism* ; Urate Oxidase/genetics* ; Mice ; Uric Acid/blood* ; Hyperuricemia ; Humans ; Administration, Oral ; Aspergillus flavus/genetics* ; Male

Objective : To investigate the drug resistance and pathogenicity of six clinical isolates of Klebsiella pneu- moniae (Kp) ，and to provide a basis for prevention and treatment of Kp infection． Methods : The six strains from different hospitals were isolated ，cultured ，and identified by species-specific gene khe． Their whole genome se- quences (WGS) were obtained using next-generation sequencing technology (NGS) ．Based on the WGS，the cap- sular serotypes，sequence types (ST) and drug-resistance genes of six strains were identified．The capsular sero- type genes and virulence genes were validated or identified using PCR. Broth microdilution tests were conducted to validate their drug susceptibility，and mice were challenged with Kp aerosols by MicroSprayer aerosolizer to evaluate their pathogenicity. Results : The six strains were all serotype K2 but belonged to four ST types ( ST14 ，ST65， ST700，and ST86) ，and collectively carried six virulence genes and 23 drug-resistance genes．All the six strains were resistant to ampicillin，but only one strain was multidrug-resistant．Four strains exhibited high mucoid charac- teristics．Five strains could cause mortality in mice，which were preliminary identified as high virulence strains. Conclusion For the six Kp clinical isolates from different sources，only one strain named NY 13294 is both multi- drug-resistant and highly virulent，and other four highly virulent strains are resistant to one or two types of antibiot- ics.

Objective To address the quality problems caused by high porosity in the preparation of dental cobalt-chrome alloy prosthetics based on selective laser melting(SLM)technology,we investigated the influence mechanism of different forming process parameters on the microstructure and properties of the materials.Moreover,the range of form-ing process parameters that can effectively reduce defects was precisely defined.Methods The effects of laser power,scanning speed,and scanning distance on the pore properties,surface roughness,and hardness of dental cobalt-chrome al-loy were investigated by adjusting the printing parame-ters in the process of SLM.Through metallographic anal-ysis,image analysis,and molten pool simulation,the pore formation mechanism was revealed,and the relation-ship between the porosity and energy density of SLM dental cobalt-chrome alloy was elucidated.Results When the linear energy density was higher than 0.18 J/mm,the po-rosity defect easily appeared at the bottom of the molten pool.When the laser energy density was lower than 0.13 J/mm,defects occurred in the gap of the molten pool due to insufficient melting of powder.In particular,when the linear energy density exceeded the threshold of 0.30 J/mm or was below 0.12 J/mm,the porosity increased significantly to more than 1%.In addition,we observed a negative correlation between free surface roughness and energy density and an inverse re-lationship between macroscopic hardness and porosity.Conclusion On the basis of the conditions of raw materials and molding equipment used in this study,the key process parameters of SLM of molding parts with porosity lower than 1%were successfully determined.Specifically,these key parameters included the line energy density,which ranged from 0.13 J/mm to 0.30 J/mm,and the scan spacing should be strictly controlled below 90 μm.

Objective:To explore surgical strategies for acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries.Methods:From January 2019 to March 2023, a total of 29 patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries were included in the study. All patients underwent emergency surgery, with simultaneous intraoperative neck incision and replacement of the unilateral or bilateral carotid arteries. Among them, there were 19 males with a mean age of(49.57±2.14)years old. Preoperative brain CT indicated abnormalities in 15 cases, transient neurological dysfunction occurred in 5 cases, and syncope in 1 case.Results:Procedures included ascending aorta replacement in 10 cases, Bentall procedure in 18 cases, and Wheat procedure in 1 case. Arch operations involved partial arch replacement in 3 cases and Sun’s procedure in 26 cases. Simple left carotid artery replacement was performed in 6 cases, simple right carotid artery replacement in 19 cases, and bilateral carotid artery replacement in 4 cases. Cerebral protection measures during circulatory arrest included unilateral cerebral perfusion in 24 cases and bilateral cerebral perfusion in 5 cases. The mean operation time was(7. 6±0. 3) h, with a mean cardiopulmonary bypass time of(196. 3±8. 7) min, aortic cross-clamp time of(113.2±6.4) min, ischemic time 12(5-16.5) min, and lowest temperature of(26.3±0.4)°C. One patient experienced in-hospital mortality. Postoperatively, new neurological dysfunction occurred in 2 cases, including 1 case with coma and permanent neurological deficit.Conclusion:In patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries, simultaneous carotid artery replacement via neck incision during aortic surgery is a safe and reliable surgical approach.

miR-135 is a highly conserved miRNA in mammals and includes miR-135a and miR-135b.Recent studies have shown that miR-135b is a key regulatory factor in cardio-cerebrovascular diseases.It is involved in regulating the pathological process of myocardial infarction,myocardial ischemia/reperfusion injury,cardiac hypertrophy,atrial fibrillation,diabetic cardiomyopathy,atherosclerosis,pulmonary hyperten-sion,cerebral ischemia/reperfusion injury,Parkinson's disease,and Alzheimer's disease.Obviously,miR-135b is an emerging player in cardio-cerebrovascular diseases and is expected to be an important target for the treatment of cardio-cerebrovascular diseases.However,the crucial role of miR-135b in cardio-cerebrovascular diseases and its underlying mechanism of action has not been reviewed.Therefore,in this review,we aimed to comprehensively summarize the role of miR-135b and the signaling pathway mediated by miR-135b in cardio-cerebrovascular diseases.Drugs targeting miR-135b for the treatment of diseases and related patents,highlighting the importance of this target and its utility as a therapeutic target for cardio-cerebrovascular diseases,have been discussed.