Objective:To investigate the enhancement effect of deep progressive reconstruction (DPR) algorithm on image quality and standardized uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in obese patients. Methods:The images of a total of 27 obese patients,who underwent 18F-FDG PET/CT in Affiliated Nanjing Hospital of Nanjing Medical University from September 2023 to May 2024,were retrospectively enrolled. The images of all patients were collected by using uMI 780 PET/CT. Ordered subset expectation maximization (OSEM) iterative algorithm and DPR algorithm were adopted to reconstruct PET images,and measure counting rate of scattering coincidence of PET/CT images,counting rate of true coincidence,noise equivalent counting rate (NECR) and scattering fraction (SF). The quality indicators of PET images included signal-to-noise ratio (SNR),the maximum SUV (SUVmax) of lesions,the tumor-to-background ratio (TBR),the contrast-to-noise ratio (CNR) and the visual scores of 18F-FDG PET/CT images on livers were evaluated. The differences and consistency of various indicators between DPR and OSEM reconstruction algorithms were further analyzed. Results:The average 18F-FDG PET/CT injection activity of 27 patients was (0.12±0.01) mCi (1 mCi=37 MBq)/kg,and the counting rate of true coincidence,NECR and SF of PET images were respectively (153.73±25.09),(44.81±8.47) kcps and (36.77±1.91)％. The SNR of liver obtained by DPR algorithm was (15.83±3.60),which was significantly higher than that (9.06±1.87) of OSEM algorithm,with statistically significant (t=20.6,P<0.05),and there was significantly correlation in liver SNR between two algorithms (R2=0.91,P<0.05). In 27 uptake 18F-FDG PET/CT lesions,the SUVmax,TBR and CNR of lesions that were obtained from OSEM algorithm were respectively (5.86±1.49),(1.95±0.49) and (17.74±4.77),which were lower than corresponding those of DPR algorithm,and the differences were significant (t=9.03,8.79,15.49,P<0.05),respectively. There were significant correlations in SUVmax,TBR and CNR between the two algorithms (R2=0.71,0.70,0.76,P<0.05),respectively. The visual scores of PET images obtained from the DPR algorithm was 4 (3,5) scores,which was significantly higher than 3 (2,4) scores of OSEM algorithm,and the difference of that between two algorithms was significant (U=396,P<0.05). Conclusion:The scattering effect of 18F-FDG PET/CT imaging is stronger in obese patients,whose counting rate of equivalent effect of noise is lower. The DPR reconstruction algorithm can significantly improve the SNR and lesion contrast of PET images than the OSEM algorithm,which has significant gain effect on the SUVmax of lesions,and it can significantly improve the quality of 18F-FDG PET/PET images in obese patients.

Objective:To construct and validate a depression risk prediction model for middle-aged and elderly patients with diabetes.Methods:Data were extracted from the fifth wave (2020) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 900 diabetic patients were identified, and after excluding those with missing data or invalid questionnaires, 769 patients were included in the analysis. Patients were randomly divided into a training set and a validation set in a 7∶3 ratio. Univariate analysis and logistic regression analysis were performed to screen the optimal predictors of depression in diabetic patients, and a nomogram model was developed. The predictive performance of the model was assessed by the area under the receiver operating characteristic curve ( AUC). Model calibration and accuracy were evaluated using bootstrap resampling, calibration plots, and the Hosmer-Lemeshow test. The clinical utility was further assessed by decision curve analysis (DCA) and clinical impact curves (CIC) . Results:Among the 769 patients, 366 (47.59%) had depression. Logistic regression analysis showed that place of residence, pain, difficulty in toileting, difficulty in bathing, sleep duration, physical exercise, life satisfaction, and children's satisfaction were independent predictors of depression in diabetic patients. A nomogram was constructed based on these variables, yielding an AUC of 0.775. At the optimal cutoff value of 0.557, the model demonstrated a sensitivity of 59.1% and a specificity of 84.8%, indicating good discriminative ability. The Hosmer-Lemeshow test showed (χ 2=15.821, P=0.105), suggesting good agreement between predicted and observed outcomes. In the validation set, the AUC was 0.778, with Hosmer-Lemeshow (χ 2=8.557, P=0.575). DCA and CIC indicated favorable clinical applicability of the model. Conclusions:The depression risk prediction model constructed in this study demonstrated good predictive performance. It can assist clinicians in early identification of high-risk individuals with diabetes and provide a theoretical basis for targeted interventions.

Objective To analyze the results of ultrasonic examinations of hip joints in preterm infants,clarify the developmental characteristics of hip joints across different gestational ages.Meth-ods A total of 881 preterm infants who attended the Child Healthcare Outpatient Clinic of Nanjing Maternity and Child Health Care Hospital between January 2023 and April 2024 were enrolled.The first ultrasonic examination of the hip joints was performed at a corrected gestational age of 4 to 6 weeks.The Graf classification method was employed to categorize the ultrasonic findings.Differences in hip joint development among preterm infants of varying gestational ages were compared,and rele-vant influencing factors were statistically analyzed.Results A total of 1,762 hip joints were exam-ined,with 30 cases of abnormal hip joints detected,yielding an abnormality detection rate of 3.4％(30/881).Among these,26 hips were classified as type Ⅱa and 8 as type Ⅱb.Statistically signifi-cant differences were observed in the detection of left-sided abnormal hip joints between preterm in-fants of other gestational age groups and late preterm infants(P＜0.05).A statistically significant difference was found in the classification of right-sided hip joints between preterm infants of different genders(P＜0.05),while no significant difference was observed for left-sided hip joints(P＞0.05).Statistically significant differences were noted in the detection rates of bilateral abnormal hip joints among preterm infants with varying birth weights(P＜0.05).Advanced maternal age was found to influence the development of left-sided hip joints inpreterm infants,whereas factors such as assisted reproductive technology,breech presentation,and nulliparity had no significant impacts on abnormal hip joint development in preterm infants.Conclusion Ultrasonic technology demonstrates signifi-cant advantages in screening for developmental dysplasia of the hip(DDH)in preterm infants.Dif-ferent gestational ages exert a notable influence on the development of left-sided hip joints in preterm infants.Female preterm infants exhibit a higher risk of right-sided hip joint abnormalities compared to the left side.Breech presentation,assisted reproductive technology,and nulliparity are not risk factors for DDH in preterm infants.However,higher birth weight in preterm infants and advanced maternal age are associated with abnormal hip joint development.Clinical attention should focus on high-risk factors,and enhanced dynamic ultrasonic monitoring of hip joints in preterm infants is war-ranted to facilitate early intervention and treatment.

Objective To explore an assessment model for multi-level integrated training in health service based on advanced intelligent trauma simulators in order to innovate health service training.Methods An assessment model for multi-level integrated training that involved advanced trauma simulators was adopted to assess chains of treatment and rescue that were composed of multi-hierarchy medical institutions.The assessment focused on trauma emergency response capabilities at each level and the overall therapeutic effect.Results In terms of capabilities for treatment and rescue,group B was the best one,followed by group C and group A.As for the overall therapeutic effect,group A was outstanding,followed by group B and group C.Based on the priorities of combat casualty care,the final results of assessment were as follows:group A was the best one,followed by group B and group C.Conclusion The analysis of processes and outcomes of assessment reveals the edge of this model,as evidenced by the continuity of treatment and rescue,integrity of overall effectiveness,and adaptability of this assessment model.

Objective:To construct a scientific and reasonable evaluation index system for the service capacity of integrated Traditional Chinese and Western medicine trauma rescue,providing a tool for assessing the synergistic efficacy of regional trauma rescue systems.Methods:Based on the collaborative governance theory framework,an initial indicator pool was developed through literature analysis and focus group discussions.Two rounds of Delphi expert consultation were conducted to screen indicators,and the analytic hierarchy process was used to determine weights.Results:The final system included 5 first-level indicators,19 second-level indicators,and 45 third-level indicators.Experts positive coefficients(0.923),authority coefficient(0.929)and coordination coefficient(0.24)met requirements.Conclusions:The index system demonstrates scientific rigor and operability,supporting the standardized construction and dynamic optimization of integrated Traditional Chinese and Western medicine trauma rescue services.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective:To investigate the enhancement effect of deep progressive reconstruction (DPR) algorithm on image quality and standardized uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in obese patients. Methods:The images of a total of 27 obese patients,who underwent 18F-FDG PET/CT in Affiliated Nanjing Hospital of Nanjing Medical University from September 2023 to May 2024,were retrospectively enrolled. The images of all patients were collected by using uMI 780 PET/CT. Ordered subset expectation maximization (OSEM) iterative algorithm and DPR algorithm were adopted to reconstruct PET images,and measure counting rate of scattering coincidence of PET/CT images,counting rate of true coincidence,noise equivalent counting rate (NECR) and scattering fraction (SF). The quality indicators of PET images included signal-to-noise ratio (SNR),the maximum SUV (SUVmax) of lesions,the tumor-to-background ratio (TBR),the contrast-to-noise ratio (CNR) and the visual scores of 18F-FDG PET/CT images on livers were evaluated. The differences and consistency of various indicators between DPR and OSEM reconstruction algorithms were further analyzed. Results:The average 18F-FDG PET/CT injection activity of 27 patients was (0.12±0.01) mCi (1 mCi=37 MBq)/kg,and the counting rate of true coincidence,NECR and SF of PET images were respectively (153.73±25.09),(44.81±8.47) kcps and (36.77±1.91)％. The SNR of liver obtained by DPR algorithm was (15.83±3.60),which was significantly higher than that (9.06±1.87) of OSEM algorithm,with statistically significant (t=20.6,P<0.05),and there was significantly correlation in liver SNR between two algorithms (R2=0.91,P<0.05). In 27 uptake 18F-FDG PET/CT lesions,the SUVmax,TBR and CNR of lesions that were obtained from OSEM algorithm were respectively (5.86±1.49),(1.95±0.49) and (17.74±4.77),which were lower than corresponding those of DPR algorithm,and the differences were significant (t=9.03,8.79,15.49,P<0.05),respectively. There were significant correlations in SUVmax,TBR and CNR between the two algorithms (R2=0.71,0.70,0.76,P<0.05),respectively. The visual scores of PET images obtained from the DPR algorithm was 4 (3,5) scores,which was significantly higher than 3 (2,4) scores of OSEM algorithm,and the difference of that between two algorithms was significant (U=396,P<0.05). Conclusion:The scattering effect of 18F-FDG PET/CT imaging is stronger in obese patients,whose counting rate of equivalent effect of noise is lower. The DPR reconstruction algorithm can significantly improve the SNR and lesion contrast of PET images than the OSEM algorithm,which has significant gain effect on the SUVmax of lesions,and it can significantly improve the quality of 18F-FDG PET/PET images in obese patients.

Objective: To explore the relationship between visual acuity and physical fitness of university freshmen, so as to provide reference for myopia prevention and control for freshmen. Methods: From October to November 2022, 2 160 college freshman without majoring in public safety administration, selected from Guangxi Police College in 2022 by using the stratified cluster random sampling method, were reviewed for the results of visual acuity test and physical fitness scores. The physical fitness indices were evaluated by using the Z scores of physical fitness test scores, and the strength of association between the level of physical fitness index and myopia was analyzed by using Logistic regression model. Results: Among 2 160 college freshman without majoring in public safety administration, 917 (42.5%) students were diagnosed screening myopia, including 66 (3.1%) cases of high myopia, 383 (17.7%) cases of moderate myopia and 468 (21.7%) cases of mild myopia. The differences in the distribution of visual acuity tests among students with different physical fitness indices, body mass index, and gender were statistically significant ( Z/H=54.50, 49.53, 15.51, P <0.01). Low level and low middle level physical fitness indices were associated with screening myopia among freshmen[ OR (95% CI )=2.81(1.93-4.08),1.87(1.38-2.54)], and low level physical fitness indexes were associated with high myopia [ OR (95% CI )=7.22(2.33-22.32)] ( P <0.01). Conclusions Screening myopia among college freshman without majoring in public safety administration is related to physical fitness, and low level and low middle level physical fitness index are risk factors for myopia. Improving the level of physical fitness might be effective in preventing myopia.

ObjectiveThis study leverages structural data from antigen-antibody complexes of the influenza A virus neuraminidase (NA) protein to investigate the spatial recognition relationship between the antigenic epitopes and antibody paratopes. MethodsStructural data on NA protein antigen-antibody complexes were comprehensively collected from the SAbDab database, and processed to obtain the amino acid sequences and spatial distribution information on antigenic epitopes and corresponding antibody paratopes. Statistical analysis was conducted on the antibody sequences, frequency of use of genes, amino acid preferences, and the lengths of complementarity determining regions (CDR). Epitope hotspots for antibody binding were analyzed, and the spatial structural similarity of antibody paratopes was calculated and subjected to clustering, which allowed for a comprehensively exploration of the spatial recognition relationship between antigenic epitopes and antibodies. The specificity of antibodies targeting different antigenic epitope clusters was further validated through bio-layer interferometry (BLI) experiments. ResultsThe collected data revealed that the antigen-antibody complex structure data of influenza A virus NA protein in SAbDab database were mainly from H3N2, H7N9 and H1N1 subtypes. The hotspot regions of antigen epitopes were primarily located around the catalytic active site. The antibodies used for structural analysis were primarily derived from human and murine sources. Among murine antibodies, the most frequently used V-J gene combination was IGHV1-12*01/IGHJ2*01, while for human antibodies, the most common combination was IGHV1-69*01/IGHJ6*01. There were significant differences in the lengths and usage preferences of heavy chain CDR amino acids between antibodies that bind within the catalytic active site and those that bind to regions outside the catalytic active site. The results revealed that structurally similar antibodies could recognize the same epitopes, indicating a specific spatial recognition between antibody and antigen epitopes. Structural overlap in the binding regions was observed for antibodies with similar paratope structures, and the competitive binding of these antibodies to the epitope was confirmed through BLI experiments. ConclusionThe antigen epitopes of NA protein mainly ditributed around the catalytic active site and its surrounding loops. Spatial complementarity and electrostatic interactions play crucial roles in the recognition and binding of antibodies to antigenic epitopes in the catalytic region. There existed a spatial recognition relationship between antigens and antibodies that was independent of the uniqueness of antibody sequences, which means that antibodies with different sequences could potentially form similar local spatial structures and recognize the same epitopes.