A sandglass ladder residual network(SLRN)is proposed for multi-label chest X-ray classification,thereby improving the accuracy of clinical diagnosis.SLRN consists of 3 key modules:(1)a sandglass convolutional module to simultaneously extract inter-channel and spatial information;(2)a ladder self attention block to achieve different window divisions through shift operations,expand the receptive field,and realize multi-scale feature extraction and fusion;(3)class specific residual attention in the multi-label classification stage to capture the correlation between different labels and the importance of features for accomplishing more accurate classification by adjusting the weights of different features.The proposed model is validated using the IU X-Ray dataset collected by Indiana University and the publicly available Chest X-Ray14 dataset collected by the National Institutes of Health in the United States;and the results demonstrate that SLRN which combines the advantages of convolutional neural network and vision transformer enables the capture of local features and global correlations in images,better handles long-distance dependencies,and assists doctors in clinical diagnosis.

ObjectiveThis study aims to investigate the effect of Dictamni Cortex on intestinal barrier damage in rats and its mechanism by untargeted metabolomics and targeted metabolomics for short-chain fatty acids （SCFAs）. MethodsRats were randomly divided into a control group， a high-dose group of Dictamni Cortex （8.1 g·kg^-1）， a medium-dose group （2.7 g·kg^-1）， and a low-dose group （0.9 g·kg^-1）. Except for the control group， the other groups were administered different doses of Dictamni Cortex by gavage for eight consecutive weeks. Hematoxylin-eosin （HE） staining was used to observe the pathological changes in the ileal tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to detect the level of cytokines， including tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and interleukin-1β （IL-1β）， in the ileal tissue of rats. Quantitative real-time fluorescence polymerase chain reaction （Real-time PCR） technology was used to detect the expression level of tight junction proteins， including zonula occludens-1 （ZO-1）， Occludin， and Claudin-1 mRNAs， in the ileal tissue of rats to preliminarily explore the effects of Dictamni Cortex on intestinal damage. The dose with the most significant toxic phenotype was selected to further reveal the effects of Dictamni Cortex on the metabolic profile of ileal tissue in rats by non-targeted metabolomics combined with targeted metabolomics for SCFAs. ResultsCompared with the control group， all doses of Dictamni Cortex induced varying degrees of pathological damage in the ileum， increased TNF-α （P<0.01）， IL-6 （P<0.01）， and IL-1β （P<0.01） levels in the ileal tissue， and decreased the expression level of ZO-1 （P<0.05， P<0.01）， Occludin （P<0.01）， and Claudin-1 （P<0.05） in the ileal tissue， with the high-dose group showing the most significant toxic phenotypes. The damage mechanisms of the high-dose group of Dictamni Cortex on the ileal tissue were further explored by integrating non-targeted metabolomics and targeted metabolomics for SCFAs. The non-targeted metabolomics results showed that 21 differential metabolites were identified in the control group and the high-dose group. Compared with that in the control group， after Dictamni Cortex intervention， the level of 14 metabolites was significantly increased （P<0.05， P<0.01）， and the level of seven metabolites was significantly decreased （P<0.05， P<0.01） in the ileal contents. These metabolites collectively acted on 10 related metabolic pathways， including glycerophospholipids and primary bile acid biosynthesis. The quantitative data of targeted metabolomics for SCFAs showed that Dictamni Cortex intervention disrupted the level of propionic acid， butyric acid， acetic acid， caproic acid， isobutyric acid， isovaleric acid， valeric acid， and isocaproic acid in the ileal contents of rats. Compared with those in the control group， the level of isobutyric acid， isovaleric acid， and valeric acid were significantly increased， while the level of propionic acid， butyric acid， and acetic acid were significantly decreased in the ileal contents of rats after Dictamni Cortex intervention （P<0.05， P<0.01）. ConclusionDictamni Cortex can induce intestinal damage by regulating glycerophospholipid metabolism， primary bile acid biosynthesis， and metabolic pathways for SCFAs.

A sandglass ladder residual network(SLRN)is proposed for multi-label chest X-ray classification,thereby improving the accuracy of clinical diagnosis.SLRN consists of 3 key modules:(1)a sandglass convolutional module to simultaneously extract inter-channel and spatial information;(2)a ladder self attention block to achieve different window divisions through shift operations,expand the receptive field,and realize multi-scale feature extraction and fusion;(3)class specific residual attention in the multi-label classification stage to capture the correlation between different labels and the importance of features for accomplishing more accurate classification by adjusting the weights of different features.The proposed model is validated using the IU X-Ray dataset collected by Indiana University and the publicly available Chest X-Ray14 dataset collected by the National Institutes of Health in the United States;and the results demonstrate that SLRN which combines the advantages of convolutional neural network and vision transformer enables the capture of local features and global correlations in images,better handles long-distance dependencies,and assists doctors in clinical diagnosis.

Objective:To analyze the epidemiological characteristics of respiratory syncytial virus (RSV) among children in Hebei from 2019 to 2023.Methods:A total of 46 576 lower respiratory tract specimens were collected from hospitalized children in the Children′s Hospital of Hebei Province from 2019 to 2023. Multiple RT-PCR and capillary electrophoresis were used to detect 13 common respiratory pathogens in the specimens, and the results were statistically analyzed.Results:The overall positive rate of RSV was 18.76%(8 739/46 576). The overall positive rates of RSV in male and female children were 18.84%(5 174/27 462) and 18.65%(3 565/19 114), respectively, showing no statistically significant difference between genders (χ 2=0.916, P=0.339). A linear relationship was found between the positive rate of RSV and age ( P<0.01). There was a significant difference in the positive rates of RSV in different years (χ 2=723.71, P<0.01). The positive rate of RSV peaked in the period from December to February from 2019 to 2021. In 2019 and 2020, the positive rates of RSV were very low from May to October, while the positive rate of RSV was above 10% throughout the whole year of 2021 and small off-season epidemics occurred in May and August. The positive rate of RSV was low in 2022, and no significant seasonal change was observed. The rate of RSV infections peaked from April to June in 2023. There were significant differences in the rates of RSV infections before, during and after the COVID-19 epidemic in each age group ( P<0.01). The rate of mixed infections was 29.20%(2 522/8 739), and the most common other respiratory pathogen was human rhinovirus (52.29%, 1 342/2 552 ). Conclusions:RSV is a common pathogen causing respiratory tract infections in children in Hebei, especially in children under 3 years old. After the COVID-19 epidemic, there are off-season RSV epidemics. Given the variations in the epidemiological features of RSV, it is necessary to carry out continuous monitoring of RSV to provide scientific data for the prevention and control of related diseases.

OBJECTIVE To establish an HPLC method for the separation of enantiomers of farrerol, and apply it to the determination of the content of enantiomers in Rhododendri Daurici Folium and Rhododendron Micranthum. METHODS HPLC was used to separate the farrerol enantiomers, and the chromatographic conditions of chiral column type, mobile phase ratio, flow rate, and column temperature were optimized. The thermodynamic separation of farrerol enantiomers was discussed. Thermodynamic parameters such as enthalpy change, entropy change, enthalpy change and entropy change were calculated. And the contents of two enantiomers in Rhododendri Daurici Folium and Rhododendron Micranthum were determined under the optimum resolution conditions. RESULTS The optimum separation conditions for two enantiomers of farrerol were determined as follows: Chiralcel OJ-RH(4.6 mm×150 mm, 5 μm), equilibrium elution of acetonitrile-water(40∶60), the flow rate of 0.5 mL·min–1, the column temperature of 25 ℃, and the detection wavelength of 295 nm. Under the optimum separation conditions, the resolution of farrerol enantiomers reached 1.5, indicating that the two enantiomers of the farrerol could be completely separated. When the column temperature was between 20 ℃ and 35 ℃, the separation factor decreased with the increase of temperature. The lnα of the two enantiomers of farrerol showed a good linear relationship with 1/T, and the chiral reselution process was controlled by enthalpy. The enantiomer separation method of farrerol was applied to the determination of farrerol enantiomer in Chinese medicinal materials of Rhododendri Daurici Folium and Rhododendron Micranthum. The linear relationship between the two enantiomers of farrerol were good in the range of 0.718–57.44 μg·mL–1 and 1.28–102.24 μg·mL–1, respectively. And the contents of the two enantiomers of farrerol in Rhododendri Daurici Folium were 0.228 2 and 0.466 2 mg·g–1, respectively. And the contents of the two enantiomers of farrerol in Rhododendron Micranthum were 0.416 8 and 0.707 3 mg·g–1, respectively. CONCLUSION This method is simple, efficient and suitable for the determination of farrerol enantiomers in traditional Chinese medicine.

Objective:To investigate the epidemiological characteristics of human parainfluenza virus (HPIV) in hospitalized children with acute respiratory tract infection in Hebei region, providing reference for the diagnosis and prevention of children with respiratory tract infection.Methods:A retrospective analysis was performed on 20 577 children hospitalized with acute respiratory tract infection in Hebei Children′s Hospital from January 2022 to September 2023. Multiple PCR and capillary electrophoresis were used to detect HPIV and 12 other common respiratory viruses and atypical pathogens. The data from January to September 2022 were taken as the normalized epidemic prevention and control period, and the data from January to September 2023 were taken as the normalized epidemic control period. The epidemiological characteristics of HPIV were analyzed.Results:The overall HPIV-positive rate was 13.65% (2 808/20 577). There was no statistical difference in the total detection rate of HPIV [14.24%(1 236/8 679) and 14.35%(1 447/10 087)] at the same time before and after the novel coronavirus normalization prevention and control was lifted(χ 2= 0.041, P=0.839), while the detection rate of single infection [8.96%(778/8 679) and 7.58%(765/10 087)] decreased, while mixed infection [5.28%(458/8 679) and 6.76%(682/10 087)] increased, with statistically significant differences(χ 2= 11.776 and 18.008, P<0.01). The HPIV positive rate in the <1 year [18.53%(378/2 040) and 17.08%(369/2 161)] decreased after the release of normalized prevention and control, and the difference was statistically significant(χ 2= 5.932, P<0.05). The HPIV positive rate [13.03%(382/2 932) and 14.82%(529/3 570)] in the 3-5 years increased after the normalized prevention and control was lifted, and the difference was statistically significant(χ 2= 7.177, P<0.05). The rate of mixed infection of HPIV with other respiratory pathogens was 43.13% (1 211/2 808), among which double infection was 34.40% (966/2 808), triple infection was 7.55% (212/2 808), and quadruple infection was 1.18% (33/2 808). Mixed detection of HPIV and HRV (38.65%, 468/1 211) was the most common. Conclusions:HPIV is one of the respiratory pathogens in children in Hebei region and more prevalent in spring and summer. The susceptible population of HPIV is mainly children under the age of 3 years old. After the normal prevention and control of novel coronavirus was lifted, the detection rate of HPIV combined with other pathogens increased.

Objective:To analyze the clinical and pathological data of 15 patients with light chain amyloidosis initially diagnosed with other kidney diseases, and identify possible misdiagnosis reasons.Methods:It was a retrospective observational study. The clinical and pathological data of 15 patients, whose initial kidney biopsies failed to diagnose light chain-amyloidosis but were confirmed by a subsequent kidney biopsy or pathology consultation at Peking University First Hospital from January 2010 to December 2022 were collected. The results of immunofluorescence, Congo red staining, and electron microscopy of two renal biopsies were analyzed.Results:The median age of 15 patients was 56 years old, with a male-to-female ratio of 7∶8. The main clinical manifestation was massive proteinuria with normal kidney function, and there were 10 cases presenting as nephrotic syndrome. The initial diagnosis based on the first kidney biopsy included minimal change disease (8 cases), IgA nephropathy (3 cases), membranous nephropathy (3 cases), and type Ⅲ collagen glomerulonephritis (1 case). M proteinemia was not evaluated in 13 patients during the first kidney biopsy. Light chain immunofluorescence staining was not performed in 12 cases. Congo red staining was not performed in 13 cases. All fifteen patients received glucocorticoids combined with immunosuppressive therapy after their initial diagnosis, and 5 patients developed severe infection. After 12.0 (7.5, 20.0) months of treatment, none of them achieved clinical remission. Thirteen had evidences for M protein before the second kidney biopsy. The renal tissues of all patients underwent immunofluorescence light chain examination, Congo red staining, and immunoelectron microscopy examination when necessary. The repeat kidney biopsies of 14 cases and pathology consultation of one case consistently indicated light chain-amyloidosis. The kidney tissues in 13 cases were confirmed to be light chain restricted, 11 cases by immunofluorescence, and 2 cases by immune electron microscopy. After diagnosis of light chain-amyloidosis, all patients received targeted plasma cell therapy except for 1 patient lost to follow-up, 6 patients achieved hematologic remission, 5 patients achieved renal remission, 1 patient entered end-stage renal disease, and 3 patients died.Conclusions:In middle and elderly-aged patients with nephrotic syndrome, if conventional immunosuppressive therapy yields unsatisfactory results, it is crucial to focus on identifying evidences of monoclonal immunoglobulinemia, if necessary, kidney biopsy should be actively repeated. Kidney biopsy pathology should include comprehensive examinations such as light chain immunofluorescence, Congo red staining, and electron microscopy to avoid misdiagnosis of light chain-amyloidosis.

The correlations of global/local properties of brain networks with gambling behavioral scales in depression are explored.The task-state brain functional magnetic resonance imaging data of 24 patients with gambling behavior and depression and 24 healthy controls are analyzed,and preprocessed by SPM software.Graph theory analysis method is used to establish the functional brain networks in which local and global properties are calculated.Two sets of local attribute index including node degree and node efficiency are used to make edge analysis in different depression groups(major,moderate and mild depression groups,with 8 patients in each group)and healthy control group,and the changes in global properties are also discussed.Additionally,the correlations of scoring scale related to gambling behavior with 3 criteria on the global properties(small world attribute,global efficiency and local efficiency)are analyzed.The two-sample t-tests on depression groups and healthy control group confirm the significant connections among brain regions(P＜0.05),and reveal the significant negative correlations between the global brain network attribute indexes and different behavioral scales,which fully verifies the correlation between gambling behavior and depression,and provides the basis for further exploring correlation between the individual behavior attribute and depression,thereby assisting clinical diagnosis and treatment of depression patients.

Objective:To investigate the epidemiological characteristics of human parainfluenza virus (HPIV) in hospitalized children with acute respiratory tract infection in Hebei region, providing reference for the diagnosis and prevention of children with respiratory tract infection.Methods:A retrospective analysis was performed on 20 577 children hospitalized with acute respiratory tract infection in Hebei Children′s Hospital from January 2022 to September 2023. Multiple PCR and capillary electrophoresis were used to detect HPIV and 12 other common respiratory viruses and atypical pathogens. The data from January to September 2022 were taken as the normalized epidemic prevention and control period, and the data from January to September 2023 were taken as the normalized epidemic control period. The epidemiological characteristics of HPIV were analyzed.Results:The overall HPIV-positive rate was 13.65% (2 808/20 577). There was no statistical difference in the total detection rate of HPIV [14.24%(1 236/8 679) and 14.35%(1 447/10 087)] at the same time before and after the novel coronavirus normalization prevention and control was lifted(χ 2= 0.041, P=0.839), while the detection rate of single infection [8.96%(778/8 679) and 7.58%(765/10 087)] decreased, while mixed infection [5.28%(458/8 679) and 6.76%(682/10 087)] increased, with statistically significant differences(χ 2= 11.776 and 18.008, P<0.01). The HPIV positive rate in the <1 year [18.53%(378/2 040) and 17.08%(369/2 161)] decreased after the release of normalized prevention and control, and the difference was statistically significant(χ 2= 5.932, P<0.05). The HPIV positive rate [13.03%(382/2 932) and 14.82%(529/3 570)] in the 3-5 years increased after the normalized prevention and control was lifted, and the difference was statistically significant(χ 2= 7.177, P<0.05). The rate of mixed infection of HPIV with other respiratory pathogens was 43.13% (1 211/2 808), among which double infection was 34.40% (966/2 808), triple infection was 7.55% (212/2 808), and quadruple infection was 1.18% (33/2 808). Mixed detection of HPIV and HRV (38.65%, 468/1 211) was the most common. Conclusions:HPIV is one of the respiratory pathogens in children in Hebei region and more prevalent in spring and summer. The susceptible population of HPIV is mainly children under the age of 3 years old. After the normal prevention and control of novel coronavirus was lifted, the detection rate of HPIV combined with other pathogens increased.