The development and validation of clinical prediction models based on artificial intelligence (AI) and machine learning methods have become increasingly widespread. However, the prediction model bias risk and applicability evaluation tool developed in 2019 (i.e., PROBAST-2019) has shown significant limitations. Therefore, an expanded and updated version of the PROBAST-2019 tool was released in 2025, known as the PROBAST+AI tool. The tool is divided into two parts including model development and model evaluation. It aims to comprehensively and systematically evaluate potential methodological quality issues in model development, bias risks in model evaluation, and the applicability of models, regardless of the modeling method used. This paper provides a systematic interpretation of the PROBAST+AI tool's items and case analyses, with the aim of guiding and assisting researchers engaged in related studies and promoting the high-quality development of clinical predictive model research.

Background::Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China.Methods::Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran’s I analysis. Results::The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603) of total cases and cirrhosis cases accounted for 11.23% (180/1603). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (Moran’s I <0) and percentage of urban population (Moran’s I <0), and positively correlated with the number of pediatric beds per million population (Moran’s I >0). Conclusion::The number of severe hepatitis B cases is low in areas with high gross domestic product levels and high urban population ratios, and health care costs have been declining over the years.

Background::Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China.Methods::Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran’s I analysis. Results::The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603) of total cases and cirrhosis cases accounted for 11.23% (180/1603). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (Moran’s I <0) and percentage of urban population (Moran’s I <0), and positively correlated with the number of pediatric beds per million population (Moran’s I >0). Conclusion::The number of severe hepatitis B cases is low in areas with high gross domestic product levels and high urban population ratios, and health care costs have been declining over the years.

Objective:To evaluate the prognostic value of plasma microRNA-30b-5p (miR-30b-5p) combined with extravascular lung water index (EVLWI) in patients with acute respiratory distress syndrome (ARDS).Methods:120 ARDS patients admitted to Danzhou People's Hospital from January 2016 to June 2019 were enrolled. The gender, age, body mass index (BMI), underlying diseases, etiology and baseline values of heart rate (HR), respiratory rate (RR), oxygenation index (OI), arterial partial pressure of carbon dioxide (PaCO 2) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were collected. According to the survival outcome during hospitalization, the patients were divided into survival group and death group. According to OI, the patients were divided into mild-moderate group (OI > 100 mmHg, 1 mmHg = 0.133 kPa) and severe group (OI ≤ 100 mmHg). The expression of plasma miR-30b-5p was detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR), and EVLWI was measured. The receiver operating characteristic (ROC) curve was drawn to analyze the value of plasma miR-30b-5p and EVLWI in predicting the death of patients with ARDS. Pearson correlation method was used to analyze the correlation between miR-30b-5p and EVLWI in ARDS patients with different prognosis during hospitalization. Results:120 patients with ARDS were enrolled in the analysis, with 42 patients in the death group, and 78 in the survival group; with 67 patients in the mild-moderate group, and 53 in the severe group. APACHE Ⅱ score in the death group was higher than that in the survival group, but there was no significant difference in gender, age, BMI, underlying diseases, etiology or baseline values of HR, RR, OI, or PaCO 2 between the two groups. The expression of plasma miR-30b-5p and EVLWI level in the death group were significantly higher than those in the survival group [miR-30b-5p (2 -ΔΔCt): 2.28±0.74 vs. 0.52±0.06, EVLWI (mL/kg): 15.38±4.60 vs. 10.24±2.15, both P < 0.01]. The expression of plasma miR-30b-5p, EVLWI and mortality during hospitalization in the severe group were significantly higher than those in the mild-moderate group [miR-30b-5p (2 -ΔΔCt): 2.05±0.65 vs. 0.93±0.17, EVLWI (mL/kg): 14.65±4.20 vs. 11.36±2.28, mortality during hospitalization: 58.5% (31/53) vs. 16.4% (11/67), all P < 0.01]. ROC curve analysis showed that the best cut-off value of plasma miR-30b-5p and EVLWI in predicting the death during hospitalization of ARDS patients were 1.62 and 13.28 mL/kg, respectively. Moreover, the area under ROC curve (AUC) of the combination of two parameters was significantly higher than that of the two alone (0.897 vs. 0.827, 0.785), with high sensitivity and specificity, 90.5% and 84.2%, respectively. Pearson correlation analysis showed that plasma miR-30b-5p in dead ARDS patients was significantly positively correlated with EVLWI ( r = 0.768, P < 0.01), but the correlation was not found in surviving patients ( r = 0.118, P > 0.05). Conclusion:The expression of plasma miR-30b-5p and EVLWI are related to the severity and prognosis of patients with ARDS, and the combination of the two has certain evaluation value for the prognosis of ARDS patients.

Objective To observe the effect of hyperbaric oxygen therapy (HBOT) on the improvement of executive function of the patients with traumatic brain injury (TBI) by using resting state functional magnetic resonance (rs-fMRI).Methods Fifty patients with executive disorder after traumatic brain injury were randomly divided into the HBO group (n =25) and the control group (n =25).The patients of the control group received routine treatment and executive function rehabilitation training,while the patients of the HBO group were supplemented with HBOT in addition to the treatment received by the control group.The applied HBO pressure was 2.0 MPa,one session a day with a duration of 105 minutes,five days a week,for a total of 20 sessions.Both before and after treatment,all the subjects received executive function assessment and rs-fMRI examination by using the drawing of clock test,the Chinese version Stroop color word test and the Wechsler adult intelligence scale similarity subtest.In the study,we closely observed the effects of HBOT on the intensity of metabolic activities in the brain,changes in neuron cell synchronization and coordination in TBI patients through the approach of rs-fMRI technique combined with ReHo and ALFF analysis methods.At the same time,the correlation between imaging data and neuropsychological assessment results was also analyzed in the study.Results (1) After intervention,Stroop-A time-consumption and Stroop-C time-consumption,correct reading scores,as well as interference scores of the HBO group were all significantly better than those of the control group,and statistical significance could be found when comparisons were made between the 2 groups (P ＜ 0.05).(2) Following intervention with different methods,obvious differences in the ALFF value of superior parietal lobe in the common brain regions of the TBI patients in the 2 groups could be seen,with statistical significance (P ＜ 0.05).Correlation analysis revealed that there was a positive correlation between the superior parietal lobe and interference time in the HBO group (P ＜ 0.05).(3) There was also a positive correlation between correct readings of Stroop-A in the middle frontal gyrus of the HBO group (P ＜ 0.05).Conclusion Executive function rehabilitation training,HBO therapy combined with executive function rehabilitation training could improve the executive function of TBI patients to various degrees.HBO therapy combined with executive function rehabilitation training was more beneficial to further improvement of executive function in patients with TBI.The improvement of executive function in TBI patients by HBO therapy might be achieved through the regulation of spontaneous activity and regional homogeneity of neurons in the middle frontal gyms,and superior parietal lobe.

Objective To observe the effect of hyperbaric oxygen therapy (HBOT) on the improvement of executive function of the patients with traumatic brain injury (TBI) by using resting state functional magnetic resonance (rs-fMRI).Methods Fifty patients with executive disorder after traumatic brain injury were randomly divided into the HBO group (n =25) and the control group (n =25).The patients of the control group received routine treatment and executive function rehabilitation training,while the patients of the HBO group were supplemented with HBOT in addition to the treatment received by the control group.The applied HBO pressure was 2.0 MPa,one session a day with a duration of 105 minutes,five days a week,for a total of 20 sessions.Both before and after treatment,all the subjects received executive function assessment and rs-fMRI examination by using the drawing of clock test,the Chinese version Stroop color word test and the Wechsler adult intelligence scale similarity subtest.In the study,we closely observed the effects of HBOT on the intensity of metabolic activities in the brain,changes in neuron cell synchronization and coordination in TBI patients through the approach of rs-fMRI technique combined with ReHo and ALFF analysis methods.At the same time,the correlation between imaging data and neuropsychological assessment results was also analyzed in the study.Results (1) After intervention,Stroop-A time-consumption and Stroop-C time-consumption,correct reading scores,as well as interference scores of the HBO group were all significantly better than those of the control group,and statistical significance could be found when comparisons were made between the 2 groups (P ＜ 0.05).(2) Following intervention with different methods,obvious differences in the ALFF value of superior parietal lobe in the common brain regions of the TBI patients in the 2 groups could be seen,with statistical significance (P ＜ 0.05).Correlation analysis revealed that there was a positive correlation between the superior parietal lobe and interference time in the HBO group (P ＜ 0.05).(3) There was also a positive correlation between correct readings of Stroop-A in the middle frontal gyrus of the HBO group (P ＜ 0.05).Conclusion Executive function rehabilitation training,HBO therapy combined with executive function rehabilitation training could improve the executive function of TBI patients to various degrees.HBO therapy combined with executive function rehabilitation training was more beneficial to further improvement of executive function in patients with TBI.The improvement of executive function in TBI patients by HBO therapy might be achieved through the regulation of spontaneous activity and regional homogeneity of neurons in the middle frontal gyms,and superior parietal lobe.

Objective To analyze the effect of needle arrangement on the lung dose in interstitial brachytherapy for lung cancer. Methods For 15 patients undergoing interstitial brachytherapy for lung cancer, a virtual radiotherapy plan in which needle arrangement was not restricted by the ribs was designed and compared with the original plan. For the two plans, V5, V20, V30, and mean lung dose(MLD)of the whole lung were determined when the prescribed doses were 10,30, 60, and 120 Gy, respectively. The data were analyzed by Wilcoxon signed-rank test. Results The lung V5,V20, V30, and MLD were significantly smaller in the virtual plan than in the actual plan(all P<0.05). Conclusions Irregular needle arrangement prevents a further reduction in the lung dose in interstitial brachytherapy for lung cancer. In the implantation surgery, therefore, the needles should be arranged as regularly as possible.

Objective To analyze and discuss the status of fighter pilots' centrifuge training,to investigate the pilots' G tolerance and to provide reference for training program improvement.Methods One thousand and one hundred ninety-nine fighter pilots' human centrifuge training data were collected and analyzed by cross-sectional study.Pilots were classified by the training purposes that were for aeromedical qualification and competitive assessment.The up-to-standard rates were compared upon the analysis of pilots' training performance.Results In 877 pilots for aeromedical qualification,594 completed the runs of 8 G for 10 s,106 completed 9 G for 10 s.The qualification rate was 79.1％.In 180 high performance fighter pilots selected for competitive assessment,141 completed the runs of 9 G for 10 s.The qualification rate was 78.3％.In 142 second generation fighter pilots selected for competitive assessment,140 completed the runs of 7 G for 10 s.The qualification rate was 98.6％ which was significantly greater than that of the pilots for aeromedical qualification (x 2 =31.141,P ＜ 0.01) and high performance fighter pilots selected for competitive assessment (x 2 =29.318,P＜0.01).There was no difference on qualification rate between the latter two groups (x2 =0.058,P ＞0.05).The incidence of G-LOC and A-LOC was 5.0％ and 2.7％ respectively.The incidences of G-LOC (x2 =4.983,P＜0.05) and A-LOC (x2 =7.528,P＜0.05) of the pilots selected for competitive assessment were significantly greater than those of the pilots for aeromedical qualification.In 1 199 pilots,only 2 pilots (0.17％) had severe acute lumbar sprain.Conclusions Advanced anti-G methods have been adopted in our centrifuge training.The incidences of G-LOC and spinal injury induced by centrifuge training are low.The training program still needs further development and the training effectiveness should be improved.

Objective To analyze and discuss the status of fighter pilots' centrifuge training,to investigate the pilots' G tolerance and to provide reference for training program improvement.Methods One thousand and one hundred ninety-nine fighter pilots' human centrifuge training data were collected and analyzed by cross-sectional study.Pilots were classified by the training purposes that were for aeromedical qualification and competitive assessment.The up-to-standard rates were compared upon the analysis of pilots' training performance.Results In 877 pilots for aeromedical qualification,594 completed the runs of 8 G for 10 s,106 completed 9 G for 10 s.The qualification rate was 79.1％.In 180 high performance fighter pilots selected for competitive assessment,141 completed the runs of 9 G for 10 s.The qualification rate was 78.3％.In 142 second generation fighter pilots selected for competitive assessment,140 completed the runs of 7 G for 10 s.The qualification rate was 98.6％ which was significantly greater than that of the pilots for aeromedical qualification (x 2 =31.141,P ＜ 0.01) and high performance fighter pilots selected for competitive assessment (x 2 =29.318,P＜0.01).There was no difference on qualification rate between the latter two groups (x2 =0.058,P ＞0.05).The incidence of G-LOC and A-LOC was 5.0％ and 2.7％ respectively.The incidences of G-LOC (x2 =4.983,P＜0.05) and A-LOC (x2 =7.528,P＜0.05) of the pilots selected for competitive assessment were significantly greater than those of the pilots for aeromedical qualification.In 1 199 pilots,only 2 pilots (0.17％) had severe acute lumbar sprain.Conclusions Advanced anti-G methods have been adopted in our centrifuge training.The incidences of G-LOC and spinal injury induced by centrifuge training are low.The training program still needs further development and the training effectiveness should be improved.

Objective:To provide clinical evidence-based prognosis for patients with postpartum HEELP syndrome complicated with acute renal failure. Methods:The clinical question was proposed. Some database was searched to assess the evidence. Results:A total of 4 studies were included,however,the quality of the studies was low. The results of the studies was suitable for our patients. The death of patients with postpartum HEELP syndrome complicated with acute renal failure was attributed to multiple organ failure. The risk factors for poor prognosis was primipara, delivery after twin pregnancy, absence of typical symptoms, rapid clinical progression, high blood pressure, epigastric pain. Early assessment and diagnosis for maternal and infant, positive in intervention and be caution for the DIC and multiple organ failure, using plasmapheresis can improve the prognosis. Conclusion:Patients with postpartum HEELP syndrome complicated with acute renal failure have an acute process and poor prognosis, especially for patients without typical symptoms.