Objective To assess the accuracy of pN staging prediction in papillary thyroid carcinoma (PTC) using ultrasound radiomics and deep neural networks (DNN). Methods A retrospective analysis was conducted on 375 patients with pathologically confirmed PTC, comprising 261 cases in the training set and 114 in the test set. Staging was categorized as pN0 (no cervical lymph node metastasis), pN1a (central neck lymph node metastasis), and pN1b (lateral neck lymph node metastasis). An ultrasound physician manually segmented the regions of interest (ROIs) for PTC, extracting 1899 radiomic features. Dimensionality reduction was performed using the least absolute shrinkage and selection operator (LASSO) regression. A DNN model for predicting PTC pN staging was developed using the H2O deep learning platform, trained on the training set, and validated on the test set to assess the accuracy of the optimal model. Results A total of 153 patients were in the pN0 stage, 131 patients in the pN1a stage, and 91 patients in the pN1b stage. LASSO regression selected 15 radiomic features for each PTC. The optimal DNN model, constructed using these 15 features, achieved accuracies of 85.82% on the training set and 81.57% on the test set. Conclusion Ultrasound radiomics of PTC demonstrates high accuracy in predicting pN staging and shows potential for automating N staging in patients.

Objective To develop a tiered training framework for operating room nurses in tertiary hospitals,provi-ding guidance for corresponding training curriculum development and clinical competency evaluation.Methods Delphi method was used to conduct two rounds of expert consultation on the preliminary training indicators,estab-lishing a comprehensive tiered training framework for operating room nurses.Results After two rounds of expert consultation,a tiered training framework for operating room nurses was constructed,which includes 6 primary indi-cators,19 secondary indicators and 62 tertiary indicators.The response rate of the two rounds of expert consultation for valid questionnaires were all over 99％and the expert authority coefficients were all over 0.87.Conclusions The consulted experts have good enthusiasm and authority;the developed framework comprehensively covers training content,laying a foundation for designing and implementing tiered training programs for operating room nurses.

ObjectiveTo explore the exposure-lag-response relationship between temperature and risk of varicella incidence，and to provide a scientific evidence for early warning and precise prevention and control of varicella epidemic. MethodsDaily varicella cases and daily meteorological data were collected in Minhang District， Shanghai from 2010 to 2022. A distributed lag nonlinear model was used to determine the exposure-lag-response relationship between temperature and risk of varicella incidence. Furthermore， effect of temperature on the incidence risk was determined across different age groups. ResultsIn 2010‒2022， the total number of notified varicella cases was 26 207 in Minhang District， with the highest incidence in the group aged 3‒14 years （50.35%）. The seasonal pattern of daily varicella cases showed a double peak. The large peak was found in November and December， followed by a smaller peak in May and June. Moreover， the distributed lag nonlinear model showed a unimodal curve in the relationship between temperature and varicella incidence. The RR value reached its maximum peak of 1.90 （95%CI： 1.25‒2.87） at 7 ℃. A reverse U-shape was found in the lag-response curves between temperature and varicella incidence. Furthermore， the effect of temperature on the varicella incidence showed a unimodal pattern in the varicella cases aged 3‒14 years. The RR value reached its peak at 11 ℃ （RR=2.89， 95%CI： 1.33‒6.24）. In contrast， the effect of temperature on the varicella incidence in the cases aged 15 years and above showed a unimodal pattern， with RR value reaching the peak at 5 ℃ （RR=2.14， 95%CI： 1.33‒3.44）. ConclusionThe unimodal curve is found in the relationship between temperature and varicella incidence. Low temperature is associated with increased risk of varicella incidence. Children aged 3‒14 years are more susceptible to the effect of temperature on the varicella incidence.

Objective To investigate the current status of nurses'knowledge,attitude and practice regarding sleep management of critically ill children in pediatric ICU,and to analyze its impact factors.Methods A self-designed questionnaire on general information and a questionnaire on knowledge and practical behaviors of pediatric ICU nurses on child's sleep management were used.In March 2023,902 pediatric ICU nurses from 24 hospitals in China were surveyed using a convenient sampling method,and the impact factors were analyzed using multiple stepwise linear regression.Results 893 valid questionnaires were collected and the recovery rate of valid questionnaires was 99.00％.Nurses in pediatric ICU scored(33.71±7.76)in knowledge dimension,(37.38±4.86)in attitude dimension and(80.60±16.78)in practice dimension,with a total score of(151.78±24.27).The scores of knowledge and attitude,knowledge and practice,attitude and practice are all positively correlated(r=0.393,P＜0.001;r=0.495,P＜0.001;r=0.320,P＜0.001).The results of multiple stepwise linear regression analysis showed that gender,region,whether they had received sleep management training were the influencing factors of pediatric ICU nurses'total score of knowledge,attitude and practice towards children's sleep management(P＜0.05).Conclusion Nurses in pediatric ICU are positive about sleep management for critically ill children,but their knowledge and practice levels need to improve.Nursing managers should strengthen the theoretical knowledge and practical behavioral training of pediatric ICU nurses on child sleep management,develop scientific sleep management plans,and guide nurses to make reasonable evaluation and interventions to improve children's sleep quality.

Uncovering the risk factors of pulmonary hypertension and its mechanisms is crucial for the prevention and treatment of the disease.In the current study,we showed that experimental periodontitis,which was established by ligation of molars followed by orally smearing subgingival plaques from patients with periodontitis,exacerbated hypoxia-induced pulmonary hypertension in mice.Mechanistically,periodontitis dysregulated the pulmonary microbiota by promoting ectopic colonization and enrichment of oral bacteria in the lungs,contributing to pulmonary infiltration of interferon gamma positive(IFNγ+)T cells and aggravating the progression of pulmonary hypertension.In addition,we identified Prevotella zoogleoformans as the critical periodontitis-associated bacterium driving the exacerbation of pulmonary hypertension by periodontitis,and the exacerbation was potently ameliorated by both cervical lymph node excision and IFNγ neutralizing antibodies.Our study suggests a proof of concept that the combined prevention and treatment of periodontitis and pulmonary hypertension are necessary.

Objective To analyze the status of the bacteria in the operative area of transnasal skull base surgery and its correlation with postoperative intracranial infection.Methods The procedure of transnasal skull base surgery was divided into three stages:nasal passage preparation(stage 1),tumor resection(stage 2),and skull base reconstruction(stage 3).Bacterial sampling was taken from the mucosa of the anterior wall of sphenoid sinus or clival recess of sellar floor at the beginning of each stage;and the positive rate of bacterial culture in different stages of operation and its correlation with postoperative intracranial infection were analyzed.Results A total of 105 patients were enrolled in this study,and 315 samples were taken.The average time point of sampling in the three stages was 20.3,45.1 and 131.3 min after the beginning of operation,respectively.The positive results were 9 cases(2.9％)in the stage 1,8 cases(2.5％)in the stage 2,and 23 cases(7.3％)in the stage 3,which were 24 cases of Staphylococcus epidermidis,7 cases of Staphylococcus aureus,3 cases of hemolytic streptococcus,2 cases of Klebsiella pneumonia,and 4 cases of Escherichia coli.There was no significant difference in the positive cases between stage 1 and stage 2(P=0.955),but there were significant differences between stage 1 or 2 and stage 3(P=0.013;P=0.007).There were 36(11.4％)patients with at least one positive result in the three stages,17(16.2％)with cerebrospinal fluid leakage,and 12(11.4％)with intracranial infection.The risk of intracranial infection was 3.1 times higher in patients with positive bacterial culture than patients with negative bacterial culture(OR=3.1,95％CI:0.9-10.6),which was not statistically significant;patients with CSF leakage were 61.4 times higher than those without CSF leakage(OR=61.4,95％CI:11.2-337.1),which was statistically significant(P＜0.001).The consistency rate of bacteria in nasal cavity and postoperative cerebrospinal fluid culture was 57.1％.Conclusion The positive rate of bacterial culture in the operative area of transnasal skull base surgery increases significantly with the extension of operation time,which is a potential risk index of postoperative intracranial infection.

Objective To retrieve,evaluate and summarize the best pertinent evidence on the placement and management of peripheral arterial catheters in critically ill children at home and abroad for clinical references.Methods A systematic search was conducted in related databases on the evidence of the placement and management of peripheral arterial catheters in critically ill children.The spectrum of eligible documents included clinical decisions,guidelines,evidence summaries,systematic reviews,expert consensuses,and norms.The search period was from the establishment of the databases to April 30,2023.The included literature was limited to English and Chinese languages.The quality of the literature was independently evaluated by evidence-based trained investigators and combined with professional judgment to extract information from the literature that met the quality standards.Results A total of 18 articles were included,including 3 guidelines,3 clinical decisions,8 evidence summaries,3 systematic reviews and 1 expert consensus.The best evidence included a total of 27 pieces of evidence in 4 areas,namely the assessment of indwelling peripheral arterial catheters,placement of peripheral arterial catheters,maintenance during the duration of indwelling peripheral arterial catheters,and removal.Conclusion This study summarized the most robust evidence pertaining to the management of peripheral arterial catheters in critically ill children,and provided an evidence-based basis for the standardized placement and management of peripheral arterial catheters in critically ill children.Nursing staff should carefully select and apply evidence according to the actual clinical situation,the wishes of children and parents.

Objective To analyze the relationship between soluble α-Klotho(SKL)levels and continuous glucose monitoring(CGMS)-derived measures of glycemic management in diabetic kidney disease(DKD)patients.Methods A total of 140 T2DM patients admitted to the Department of General Medicine Affiliated Hospital of Yan'an University from May 2020 to May 2022 were selected and divided into two groups according to the levels of UACR:T2DM group(UACR<30 mg/g,n=60),DKD group(UACR≥30 mg/g,n=80)and 45 healthy persons(NC group)who received physical examination in the hospital during the same period were the NC group.Results The SKL level of DKD group was lower than that of T2DM group and NC group(P<0.05).Spearman correlation analysis showed that SKL was positively correlated with eGRF and TIR(P<0.01),and negatively correlated with Scr,UACR,CysC,β2-MG,FPG,HbA1c,MG,TAR and GMI(P<0.01).Multiple linear regression analysis showed that HbA1c and GMI were the influencing factors of SKL.Conclusion The level of SKL in DKD patients is correlated with HbA1c and GMI.

Objective To evaluate the feasibility,reliability and validity of the symptom identification scale for kidney yang deficiency syndrome.Methods The symptom identification scale for kidney yang deficiency syndrome developed in previous research was administered to 200 vascular cognitive impairment patients from September 2020 to September 2022 to assess feasibility through recall rate,completion rate,and completion time;reliability was measured using retest reliability,split-half reliability,homogeneity reliability,and inter-rater reliability;and validity was evaluated based on discriminant and structural validity.Results A total of 200 scales were sent out,and all of them cooperated and were completed and retrieved within 20 min.The results of reliability analysis showed that the retest reliability of the scale was 0.828 for the dimension of yang deficiency and 0.718 for the dimension of kidney qi deficiency;the Spearman-Brown coefficient of split-half reliability was 0.784;the Cronbach coefficient of the dimension of yang deficiency was 0.799,and the Cronbach coefficient of the dimension of kidney qi deficiency in the homogeneity reliability was 0.670.The results of the analysis showed that the differences between the kidney yang deficiency syndrome group and the non-kidney yang deficiency syndrome group in the yang deficiency dimension,kidney qi deficiency dimension scores and total scale scores in the discriminant validity were statistically significant(P<0.001);the KMO value in the structural validity was 0.842,and a total of two factors with eigenvalues greater than 1 were extracted,with a cumulative variance contribution rate of 58.227%.Conclusion The symptom identification scale for kidney yang deficiency syndrome demonstrates adequate reliability and validity,potentially enhancing the prediction of kidney yang deficiency in vascular cognitive impairment.However,the validity of the scale is somewhat limited and requires further refinement for clinical application.

Objective Ultrasound diagnosis and treatment is easy to perform and takes little time.It is widely used in clinical practice thanks to its non-invasive,real-time,and dynamic characteristics.In the process of ultrasound diagnosis and treatment,the probe may come into contact with the skin,the mucous membranes,and even the sterile parts of the body.However,it is difficult to achieve effective real-time disinfection of the probes after use and the probes are often reused,leading to the possibility of the probes carrying multiple pathogenic bacteria.At present,the processing methods for probes at home and abroad mainly include probe cleaning,probe disinfection,and physical isolation(using probe covers or sheaths).Yet,each approach has its limitations and cannot completely prevent probe contamination and infections caused by ultrasound diagnosis and treatment.For example,when condoms are used as the probe sheath,the rate of condom breakage is relatively high.The cutting and fixing of cling film or freezer bags involves complicated procedures and is difficult to perform.Disposable plastic gloves are prone to falling off and causing contamination and are hence not in compliance with the principles of sterility.Furthermore,the imaging effect of disposable plastic gloves is poor.Therefore,there is an urgent need to explore new materials to make probe covers that can not only wrap tightly around the ultrasound probe,but also help achieve effective protection and rapid reuse.Based on the concept of physical barriers,we developed in this study a heat sealing system for the rapid reuse of ultrasound probes.The system uses a heat sealing device to shrink the protective film so that it wraps tightly against the surface of the ultrasound probe,allowing for the rapid reuse of the probe while reducing the risk of nosocomial infections.The purpose of this study is to design a heat sealing system for the rapid reuse of ultrasound probes and to verify its application effect on the rapid reuse of ultrasound probes.Methods 1)The heat sealing system for the rapid reuse of ultrasound probes was designed and tested by integrating medical and engineering methods.The system included a protective film(a multilayer co-extruded polyolefin thermal shrinkable film)and a heat sealing device,which included heating wire components,a blower,a photoelectric switch,temperature sensors,a control and drive circuit board,etc.According to the principle of thermal shrinkage,the ultrasound probe equipped with thermal shrinkable film was rapidly heated and the film would wrap closely around the ultrasound probe placed on the top of the heat sealing machine.The ultrasound probe was ready for use after the thermal shrinkage process finished.Temperature sensors were installed on the surface of the probe to test the thermal insulation performance of the system.The operation procedures of the system are as follows:placing the ultrasound probe covered with the protective film in a certain space above the protective air vent,which is detected by the photoelectric switch;the heating device heats the thermal shrinkable film with a constant flow of hot air at a set temperature value.Then,the probe is rotated so that the thermal shrinkable film will quickly wrap around the ultrasound probe.After the heat shrinking is completed,the probe can be used directly.2)Using the convenience sampling method,90 patients from the Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Xi'an Jiaotong University were included as the research subjects.All patients were going to undergo arterial puncture under ultrasound guidance.The subjects were divided into 3 groups,with 30 patients in each group.Three measures commonly applied in clinical practice were used to process the probes in the three groups and water-soluble fluorescent labeling was applied around the puncture site before use.In the experimental group,the probes were processed with the heat sealing system.The standard operating procedures of the heat sealing system for rapid reuse of ultrasonic probes were performed to cover the ultrasonic probe and form a physical barrier to prevent probe contamination.There were two control groups.In control group 1,disinfection wipes containing double-chain quaternary ammonium salt were used to repeatedly wipe the surface of the probe for 10-15 times,and then the probe was ready for use once it dried up.In the control group 2,a disposable protective sheath was used to cover the front end of the probe and the handle end of the sheath was tied up with threads.Comparison of the water-soluble fluorescent labeling on the surface of the probe(which reflected the colony residues on the surface of the probe)before and after use and the reuse time(i.e.,the lapse of time from the end of the first use to the beginning of the second use)were made between the experimental group and the two control groups.Results 1)The temperature inside the ultrasound probe was below 40℃and the heat sealing system for rapid reuse did not affect the performance of the ultrasound probe.2)The reuse time in the heat sealing system group,as represented by(median[P25,P75]),was(8.00[7.00,10.00])s,which was significantly lower than those of the disinfection wipe group at(95.50[8.00,214.00])s and the protective sleeve group at(25.00[8.00,51.00])s,with the differences being statistically significant(P<0.05).No fluorescence residue was found on the probe in either the heat sealing system group or the protective sheath group after use.The fluorescence residue in the heat sealing system group was significantly lower than that in the disinfection wipes group,showing statistically significant differences(χ2=45.882,P<0.05).Conclusion The thermal shrinkable film designed and developed in this study can be cut and trimmed according to the size of the equipment.When the film is heated,it shrinks and wraps tightly around the equipment,forming a sturdy protective layer.With the heat sealing system for rapid reuse of ultrasonic probes,we have realized the semi-automatic connection between the thermal shrinkable film and the heating device,reducing the amount of time-consuming and complicated manual operation.Furthermore,the average reuse time is shortened and the system is easy to use,which contributes to improvements in the reuse and operation efficiency of ultrasound probes.The heat sealing system reduces colony residues on the surface of the probe and forms an effective physical barrier on the probe.No probes were damaged in the study.The heat sealing system for rapid reuse of ultrasonic probes can be used as a new method to process the ultrasonic probes.