Objective To explore the value of machine learning(ML)models based on ultrasonic texture features(TF)of coronary artery for predicting incomplete Kawasaki disease(IKD)in children.Methods Forty-eight children with IKD and 48 children without KD(non-KD)were enrolled with propensity score matching and divided into training set(n=67,34 cases of IKD and 33 cases of non-KD)and test set(n=29,14 of IKD and 15 of non-KD)at the ratio of 7∶3.Based on clinic-laboratory indicators(C-L)in training set and TF obtained with texture analysis of coronary artery ultrasound images,the optimal C-L-related features and TF were selected.Based on the optimal C-L correlated features,TF and their combinations,6 ML models,including random forest(RF),support vector machine(SVM),logistic regression(LR),gradient boosting decision tree(GBDT),decision tree(DT)and eXtreme gradient boosting(XGBoost)were respectively constructed for predicting IKD in children.The models were then trained in training set and validated in test set,and the best C-L ML,TF ML and C-L-TF ML models were selected.The area under the curve(AUC)of the best ML models were compared,and the clinical value of the best TF ML model was observed with decision curve analysis(DCA).Results Totally 3 optimal C-L related features and 8 optimal TF were selected.Among the constructed C-L ML,TF ML and C-L-TF ML models,C-L-LR model,TF-LR model and C-L-TF-SVM model were the optimal ones,with AUC in training set of 0.891,0.985 and 0.965,while in test set of 0.676,0.971 and 0.948,respectively.No significant difference of AUC was found between TF-LR model and C-L-TF-SVM model in both training set and test set(both P＞0.05),which were both greater than those of C-L-LR model(all P＜0.05).TF-LR model achieved higher clinical benefits in both training set and test set.Conclusion Ultrasound TF-LR model of coronary artery could be used to effectively predict IKD in children.

Objective:To develop the Hypoglycemia Prevention Knowledge, Attitude and Practice Questionnaire for Homebound Elderly Patients with Diabetes Mellitus to inform the development of targeted interventions for caregivers.Methods:The first draft of the questionnaire was formed through literature analysis, group discussion, semi-structured interviews, Delphi expert consultation and pre-testing based on the theory of knowledge, attitude and practice. Convenience sampling was applied to select homebound elderly diabetic patients within the Shangcheng District of Hangzhou City from August to September 2022, and the questionnaire was subjected to item analysis, reliability test and exploratory factor analysis. Patients within Gongshu District of Hangzhou City were selected from October to November 2022 for questionnaire survey and validation factor analysis.Results:The questionnaire included 31 entries in three dimensions of knowledge, attitude, and practice. The content validity index was 0.96 at the questionnaire level and 0.83 to 1.00 at the entry level. The overall Cronbach's α coefficient for the questionnaire was 0.933, the folded reliability was 0.836, and the retest reliability was 0.913. The exploratory factor analysis cumulative variance contribution was 68.917% and the validation factor analysis showed a good model fit.Conclusions:The Hypoglycemia Prevention Knowledge, Attitude and Practice Questionnaire for Homebound Elderly Patients with Diabetes Mellitus is scientific and practical and can be used to investigate the hypoglycemia prevention knowledge, attitude and practice among homebound elderly diabetic patients.

Objective:To develop the Hypoglycemia Prevention Knowledge, Attitude and Practice Questionnaire for Homebound Elderly Patients with Diabetes Mellitus to inform the development of targeted interventions for caregivers.Methods:The first draft of the questionnaire was formed through literature analysis, group discussion, semi-structured interviews, Delphi expert consultation and pre-testing based on the theory of knowledge, attitude and practice. Convenience sampling was applied to select homebound elderly diabetic patients within the Shangcheng District of Hangzhou City from August to September 2022, and the questionnaire was subjected to item analysis, reliability test and exploratory factor analysis. Patients within Gongshu District of Hangzhou City were selected from October to November 2022 for questionnaire survey and validation factor analysis.Results:The questionnaire included 31 entries in three dimensions of knowledge, attitude, and practice. The content validity index was 0.96 at the questionnaire level and 0.83 to 1.00 at the entry level. The overall Cronbach's α coefficient for the questionnaire was 0.933, the folded reliability was 0.836, and the retest reliability was 0.913. The exploratory factor analysis cumulative variance contribution was 68.917% and the validation factor analysis showed a good model fit.Conclusions:The Hypoglycemia Prevention Knowledge, Attitude and Practice Questionnaire for Homebound Elderly Patients with Diabetes Mellitus is scientific and practical and can be used to investigate the hypoglycemia prevention knowledge, attitude and practice among homebound elderly diabetic patients.

Objective To explore the value of machine learning(ML)models based on ultrasonic texture features(TF)of coronary artery for predicting incomplete Kawasaki disease(IKD)in children.Methods Forty-eight children with IKD and 48 children without KD(non-KD)were enrolled with propensity score matching and divided into training set(n=67,34 cases of IKD and 33 cases of non-KD)and test set(n=29,14 of IKD and 15 of non-KD)at the ratio of 7∶3.Based on clinic-laboratory indicators(C-L)in training set and TF obtained with texture analysis of coronary artery ultrasound images,the optimal C-L-related features and TF were selected.Based on the optimal C-L correlated features,TF and their combinations,6 ML models,including random forest(RF),support vector machine(SVM),logistic regression(LR),gradient boosting decision tree(GBDT),decision tree(DT)and eXtreme gradient boosting(XGBoost)were respectively constructed for predicting IKD in children.The models were then trained in training set and validated in test set,and the best C-L ML,TF ML and C-L-TF ML models were selected.The area under the curve(AUC)of the best ML models were compared,and the clinical value of the best TF ML model was observed with decision curve analysis(DCA).Results Totally 3 optimal C-L related features and 8 optimal TF were selected.Among the constructed C-L ML,TF ML and C-L-TF ML models,C-L-LR model,TF-LR model and C-L-TF-SVM model were the optimal ones,with AUC in training set of 0.891,0.985 and 0.965,while in test set of 0.676,0.971 and 0.948,respectively.No significant difference of AUC was found between TF-LR model and C-L-TF-SVM model in both training set and test set(both P＞0.05),which were both greater than those of C-L-LR model(all P＜0.05).TF-LR model achieved higher clinical benefits in both training set and test set.Conclusion Ultrasound TF-LR model of coronary artery could be used to effectively predict IKD in children.

Objective To analyze the hotspots and frontiers of researches related to pain in Parkinson's disease. Methods The literatures on pain in Parkinson's disease were retrieved from CNKI,VIP,Wanfang data,CBM and Web of Science Core Collection from inception to November,2023,and were analyzed with CiteSpace 6.1.R6. Results A total of 926 literatures were included with 293 in Chinese and 633 in English,respectively.Chinese high-fre-quency keywords were quality of life,sleep disorders and depression,while English high-frequency keywords were nonmotor symptom,quality of life and levodopa.The latest bursting word in Chinese was pathogenesis,while the latest bursting words in English were exercise and management. Conclusion Number of researches related to pain in Parkinson's disease is gradually rising,and the characteristics,patho-genesis,quality of life,rehabilitation interventions and clinical efficacy have become research hotspots.The mechanism of pain in Parkinson's disease and rehabilitation management program will be the main research top-ics in the future.

Purpose To investigate the clinicopathologic features,molecular changes,treatment and prognosis of pulmo-nary artery intimal sarcoma.Methods Ten cases of pulmonary artery intimal sarcoma were collected and the clinical features analyzed,by using HE,immunohistochemistry EnVision meth-od,FISH,and review of relevant literature.Results There were 4 males and 6 females,with a male to female ratio of 1∶1.5.The patients were 33-75 years old with an average age of 55.7 years.The main clinical symptoms were chest tightness,shortness of breath(6/10),chest pain(5/10)and cough(3/10),hemoptysis(2/10),syncope(1/10),heart murmur(1/10).1 patient had a history of bilateral breast cancer,bilateral papillary thyroid carcinoma and invasive lung adenocarcinoma,1 patient had bilateral breast cancer and 1 patient had pulmonary embolism and cardiac myxoma.Preoperative imaging showed pulmonary embolism or lung tumor.Histological morphology showed that the tumor cells were fusiform or epithelioid,with ob-vious atypia.Some tumors differentiated into rhabdomyosarco-ma,angiosarcoma and leiomyosarcoma,and giant cells were seen in 2 cases.The tumor lacked specific immune markers,and the tumor cells expressed vimentin,Fli-1,SMA,MyogD1,Myoglobin,BCL-2,ERG,etc.Ki-67 proliferation index was a-bout 30％-70％.Fluorescence in situ hybridization was used to detect MDM2(4/5)and CDK4(1/1).All cases received surgical treatment,7 cases were followed up from 1 month to 17 months,and 4 cases of them had recurrence or distant metasta-sis.Conclusion Pulmonary artery intimal sarcoma is rare,without specific immune markers and with complicated gene changes.There is no standard treatment,and the prognosis is poor.

Review article is an important part of medical journals. It provides readers with the latest progress and cutting-edge ideas of medical research, which is of great interests for medical workers. An excellent review is not a simple literature listing. The author not only needs to summarize the important findings and highlights in the literature, but also needs to make a fair evaluation of the current research situation, deeply analyze the deficiencies and put forward his/her own unique views. The purpose is to enable readers to fully and accurately understand the research progress in this field, and inspire the readers to explore ideas, grasp the future direction and carry out innovative research. This paper will focus on how to improve the writing level of medical literature review in the process of topic selection, literature collection and screening, data analysis and evaluation.

Objective:To investigate the clinical value of serum cystatin C(Cys C) and neutrophil gelatinase associated lipocalin(NGAL) combined with cardiac biomarkers in the evaluation of sepsis with renal injury in children.Methods:The clinical data of 130 children with sepsis(67 cases in sepsis non AKI group and 63 cases in septic AKI group)admitted to pediatric intensive care unit(PICU) at Hunan Children′s Hospital from May 2018 to December 2019 were retrospectively analyzed.The differences of serum Cys C, NGAL and cardiac related biomarkers between sepsis and septic kidney injury were analyzed and compared.Results:The levels of serum Cys C, NGAL and amino-terminal pro-brain natriuretic peptide(NT-proBNP) in children with septic AKI were significantly higher than those in children of sepsis non AKI group(all P<0.01). There were no significant differences in creatine kinase isoenzyme(CK-MB)and high-sensitivity troponin T(cTnT-hs) between two groups (all P>0.05). The levels of CK-MB, cTnT-hs, NT-proBNP, Cys C and NGAL in the dead children were significantly higher than those in the surviving children ( P<0.05). In terms of predicting of AKI, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.724, 0.759 and 0.747, respectively.Regarding predicting the survival and death of sepsis, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.719, 0.722 and 0.769, respectively.In predicting the prognosis of children with sepsis and kidney injury, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.683, 0.651 and 0.682, respectively.The binary Logistic regression equation was established by Cys C, NGAL and NT-proBNP, Y=0.970 NGAL+ 0.9441 BNP+ 1.815 Cys C-2.944.In predicting kidney injury, evaluating prognosis of sepsis and predicting prognosis of sepsis with kidney injury, the area under ROC curve of new variable Y were 0.882, 0.802 and 0.808, respectively. Conclusion:NGAL, Cys C and NT-proBNP can be used to judge sepsis and sepsis with kidney injury alone.The evaluation value of combined detection of three indexes is better than that of single index.Therefore, the combined use of the three indicators may be better to judge the condition of children with sepsis and kidney injury.

Objective To investigate the rate of hippocampus injury during whole brain radiotherapy for intracranial metastasis and explore the effect of whole brain radiotherapy in reducing the radiotherapy induced neurocognitive dysfunction of hippocampu and provide reference for the treatment of intracranial metastatic tumors. Methods The intracranial metastases in 123 patients from January 2015 to December 2016 were enrolled in this study. The MRI image data before and after radiotherapy were analyzed retrospectively.The anatomical position of tumor and the hippocampus in patients with intracranial metastasis was outlined.According to outlined position, the relationship between location of intracranial metastatic tumor and the hippocampus was analyzed, and the probability of the hippocampal damage by tumor radiotherapy was calculated in the treatment of intracranial metastatic brain. Neurocognitive dysfunction improvement by protective irradiation of hippocampus was compared between different radiotherapy methods. Results Four hundred and seventeen intracranial metastatic tumors were observed in 123 patients, among which the sites of 15 tumors(3.60%) were within the 5mm of hippocampus, the sites of 146 tumors(35.01%)were 5-10 mm from the hippocampus, and the sites of 256 tumors(61.39%) were beyond 10 mm of hippocampus. The distribution of 417 metastatic tumors in the brain was as followings: 137 tumors (32.85%) were in frontal lobe, 98 tumors(23.50%) were in temporal lobe, 59 tumors(14.15%)were in parietal lobe, 46 tumors(11.03%)were in occipital lobe, 41 tumors (9.83%) were in cerebellum and 36 tumors (8.63%) were in basal ganglia. Using helical tomotherapy, intracranial metastasis radiotherapy and volumetric modulated arc radiotherapy, the rate of patients with cognitive dysfunction induced by hippocampal injury was 1.96%(1/51), 10.26%(4/39)and 18.18% (6/33), and there was significant difference (χ2= 6.595, P = 0.000). Conclusions The hippocampus injury possibility is very small, when whole brain radiotherapy is used in the treatment of intracranial metastatic tumors. Avoiding the hippocampus in radiation therapy of intracranial metastasis has high feasibility, among which the helical tomotherapy can effectively reduce hippocampus injury and improve patients'cognitive function.

ObjectiveTo investigate the influence of olsalazine on tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) in patients with chronic ulcerative colitis.MethodsSixty patients with chronic ulcerative colitis(observation group),including 22 chronic recurrent cases and 38 chronic persistent cases,were enrolled and treated with olsalazine.Meanwhile,60 healthy volunteers without disease history of ulcerative colitis were selected as control group.The concentrations of TNF- α and IL-10 in serum of the two groups were detected by ELISA and compared.ResultsBefore treatment,the concentration of TNF- α in serum of the observation group was significantly higher than that of control group [ (57.2 ± 10.1 )ng/L vs.(27.2 ± 6.9) ng/L],while IL-10 was significantly lower than that of control group[ (9.2 ± 2.1 ) ng/L vs.(17.3 ±2.9) ng/L] (P ＜0.05).Before treatment,the concentration of TNF-α in serum in chronic persistent patients and chronic recurrent patients[ (56.9 ± 9.9),(57.3 ± 9.7) ng/L ] were significantly higher than that in control group,and serum IL-10 in chronic persistent patients and chronic recurrent patients [ (9.1 ± 2.3 ),(8.4 ± 2.5 ) ng/L ] was significantly lower than that in control group (P＜ 0.05 ).The concentration of TNF- α in serum in observation group after treatment was obviously lower than that before treatment [(28.1 ±8.9) ng/L vs.(57.2 ± 10.1 ) ng/L],and IL-10 was obviously higher than that before treatment [(13.4 ± 10.7) ng/L vs.(9.2 ±2.1 )ng/L] (P ＜ 0.05).The concentration of serum TNF-αand IL-10 in chronic persistent and chronic recurrent patients before and after treatment had statistical significance (P＜0.05 ).ConclusionsOlsalazine can significantly decrease the concentration of TNF- α and increase the concentration of IL-10 in serum in patients with chronic ulcerative colitis.It is worthy of application in clinic.