Objective:To apply artificial intelligence（AI）in classifying ovarian tumors on ultrasound images，and compare the diagnostic results of several sonographers with varying seniority levels.Methods:A total of 645 patients diagnosed with adnexal masses via gynecological ultrasound examination at Qilu Hospital of Shandong University from January 2021 to December 2024 were enrolled. Three deep learning architectures，i.e.，Alexnet，Densenet121，and Resnet50 were developed and used to internally test the classification effectiveness of ovarian tumors，while the optimal model was selected for external testing. Two junior sonographers and two senior sonographers were recruited to independently diagnose ovarian tumors in the external test dataset. Subsequently，the benign and malignant results of the model's predictions were disclosed to each sonographer，and their revised diagnoses on the same external test data in combination with the best AI model were recorded.Results:The optimal model achieved an accuracy of 0.941，sensitivity of 0.936，and specificity of 0.944 on the internal test dataset，and maintained robust performance on the external test dataset with accuracy of 0.891，sensitivity of 0.880，and specificity of 0.907. Compared to junior sonographers，the optimal model demonstrated significantly higher sensitivity in discriminating benign from malignant ovarian tumors（0.880 vs. 0.723，0.602；all P<0.05）. No statistically significant difference was observed in diagnostic accuracy between the optimal model and senior sonographer 1（ P=0.05）. With assistance from the optimal model，junior sonographers achieved significant improvements in both sensitivity and specificity（sensitivity：0.723 vs. 0.843，0.602 vs. 0.819；specificity：0.778 vs. 0.833，0.685 vs. 0.741；all P<0.05）. Conclusions:The optimal model achieves comparable performance to that of senior sonographers in ovarian tumor classification. With model assistance，the diagnostic performance of junior sonographers is significantly improved.

Objective:To apply artificial intelligence（AI）in classifying ovarian tumors on ultrasound images，and compare the diagnostic results of several sonographers with varying seniority levels.Methods:A total of 645 patients diagnosed with adnexal masses via gynecological ultrasound examination at Qilu Hospital of Shandong University from January 2021 to December 2024 were enrolled. Three deep learning architectures，i.e.，Alexnet，Densenet121，and Resnet50 were developed and used to internally test the classification effectiveness of ovarian tumors，while the optimal model was selected for external testing. Two junior sonographers and two senior sonographers were recruited to independently diagnose ovarian tumors in the external test dataset. Subsequently，the benign and malignant results of the model's predictions were disclosed to each sonographer，and their revised diagnoses on the same external test data in combination with the best AI model were recorded.Results:The optimal model achieved an accuracy of 0.941，sensitivity of 0.936，and specificity of 0.944 on the internal test dataset，and maintained robust performance on the external test dataset with accuracy of 0.891，sensitivity of 0.880，and specificity of 0.907. Compared to junior sonographers，the optimal model demonstrated significantly higher sensitivity in discriminating benign from malignant ovarian tumors（0.880 vs. 0.723，0.602；all P<0.05）. No statistically significant difference was observed in diagnostic accuracy between the optimal model and senior sonographer 1（ P=0.05）. With assistance from the optimal model，junior sonographers achieved significant improvements in both sensitivity and specificity（sensitivity：0.723 vs. 0.843，0.602 vs. 0.819；specificity：0.778 vs. 0.833，0.685 vs. 0.741；all P<0.05）. Conclusions:The optimal model achieves comparable performance to that of senior sonographers in ovarian tumor classification. With model assistance，the diagnostic performance of junior sonographers is significantly improved.

Objective     To evaluate the early clinical outcomes of the Renatus® balloon-expandable valve in the treatment of severe aortic stenosis. Methods    From November 2021 to April 2022, a total of 38 patients who received Renatus® balloon-expandable valve for severe aortic stenosis in Guangdong Provincial People's Hospital were included. There were 22 males and 16 females, with an average age of 73.7±5.3 years. Mean aortic gradient and peak aortic jet velocity at baseline, post-procedure, and follow-up were compared. Clinical outcomes including all-cause mortality, perivalvular leakage, serious adverse cardiovascular events and the occurrence of permanent pacemaker implantation were assessed. Results    All patients completed the procedure successfully without conversion to thoracotomy or perioperative death. The post-implant mean aortic pressure gradient was decreased from 41.5 (27.8, 58.8) mm Hg to 6.0 (3.0, 8.0) mm Hg, and the peak aortic jet velocity was also decreased from 4.1±0.9 m/s to 1.7±0.4 m/s (P<0.001). Pacemakers were required in 2 (5.3%) patients. The median follow-up time was 27.5 (23.0, 87.5) d, with a follow-up rate of 100.0%. The mean aortic gradient was 8.0 (7.0, 10.8) mm Hg and peak aortic jet velocity was 2.0±0.3 m/s, showing significant improvement compared with those in the preoperative period (P<0.001). No severe aortic regurgitation or paravalvular leak was observed. There was no serious cardiovascular adverse event or reoperative event during the study period. Conclusion    Transcatheter aortic valve replacement with the domestic Renatus® balloon-expandable valve system is a safe and effective procedure for selected patients with severe aortic stenosis who are at high risk or not candidates for surgical aortic valve replacement.

We reported a 26-year-old male who was diagnosed with apical hypertrophic cardiomyopathy with left ventricular aneurysm. The location of the hypertrophic myocardium and the extent of resection were accurately assessed preoperatively using 3D modeling and printing technology. Myectomy was performed via transapical approach, and the intraoperative exploration was consistent with the description of the preoperative 3D modeling. The patient underwent the surgery successfully without any complications during the hospitalization, and the cardiopulmonary bypass time was 117 min, the aortic cross-clamping time was 57 min, and the hospital stay time was 7 d. The postoperative echocardiography demonstrated left ventricular cavity flow patency. This case provides a reference for the management of patients with apical hypertrophic cardiomyopathy.

Objective? To?Study?the?changes?of?short-chain?acyl-CoA?dehydrogenase?(SCAD)?in?heart?failure?(HF)?after?myocardial?infarction?(MI),?and?the?effect?of?aerobic?exercise?on?SCAD.? Methods? Healthy?male?Sprague-Dawley?(SD)?rats?were?divided?into?sham?operation?group?(Sham?group),?sham?operation?swimming?group?(Sham+swim?group),?HF?model?group?(LAD?group)?and?HF?swimming?group?(LAD+swim?group)?by?random?number?table?method,?with?9?rats?in?each?group.?The?left?anterior?descending?branch?of?coronary?artery?(LAD)?was?ligated?to?establish?a?rat?model?of?HF?after?MI.?In?Sham?group,?only?one?loose?knot?was?threaded?under?the?left?coronary?artery,?and?the?rest?operations?were?the?same?as?those?in?LAD?group.?Rats?in?Sham+swim?group?and?LAD+swim?group?were?given?swimming?test?for?1?week?after?operation?(from?15?minutes?on?the?1st?day?to?60?minutes?on?the?5th?day).?Then?they?were?given?swimming?endurance?training?(from?the?2nd?week?onwards,?60?minutes?daily,?6?times?weekly,?10?weeks?in?a?row).?Tail?artery?systolic?pressure??(SBP)?was?measured?before?swimming?endurance?training?and?every?2?weeks?until?the?end?of?the?10th?week.?Ten?weeks?after?swimming?training,?echocardiography?was?performed?to?measure?cardiac?output?(CO),?stroke?volume?(SV),?left?ventricular?ejection?fraction?(LVEF),?shortening?fraction?(FS),?left?ventricular?end-systolic?diameter?(LVESD),?left?ventricular?end-diastolic?diameter?(LVEDD),?left?ventricular?end-systolic?volume?(LVESV),?and?left?ventricular?end-diastolic??volume?(LVEDV).?Morphological?changes?of?heart?were?observed?by?Masson?staining.?Apoptosis?of?myocardial?cells?was?detected?by?transferase-mediated?deoxyuridine?triphosphate-biotin?nick?end?labeling?stain?(TUNEL)?and?apoptosis?index?(AI)?was?calculated.?Reverse?transcription-polymerase?chain?reaction?(RT-PCR)?and?Western?Blot?were?used?to?detect?the?mRNA?and?protein?expression?of?myocardial?SCAD?respectively.?In?addition,?the?enzyme?activity?of?SCAD,?the?content?of?adenosine?triphosphate?(ATP)?and?free?fatty?acid?(FFA)?in?serum?and?myocardium?were?detected?according?to?the?kit?instruction?steps.? Results? Compared?with?Sham?group,?Sham+swim?group?showed?SBP?did?not?change?significantly,?with?obvious?eccentric?hypertrophy?and?increased?myocardial?contractility,?and?LAD?group?showed?persistent?hypotension,?obvious?MI,?thinning?of?left?ventricle,?and?decreased?myocardial?systolic/diastolic?function.?Compared?with?LAD?group,?SBP,?systolic/diastolic?function?and?MI?in?LAD+swim?group?were?significantly?improved?[SBP?(mmHg,?1?mmHg?=?0.133?kPa):?119.5±4.4?vs.?113.2±4.5?at?4?weeks,?120.3±4.0?vs.?106.5±3.7?at??6?weeks,?117.4±1.3?vs.?111.0±2.3?at?8?weeks,?126.1±1.6?vs.?119.4±1.9?at?10?weeks;?CO?(mL/min):?59.10±6.31?vs.?33.19±4.76,?SV?(μL):?139.42±17.32?vs.?84.02±14.26,?LVEF:?0.523±0.039?vs.?0.309±0.011,?FS:?(28.17±2.57)%?vs.?(15.93±3.64)%,?LVEDD?(mm):?8.80±0.19?vs.?9.35±0.30,?LVESD?(mm):?5.90±0.77?vs.?7.97±0.60,?LVEDV?(μL):?426.57±20.84?vs.?476.24±25.18,?LVESV?(μL):?209.50±25.18?vs.?318.60±16.10;?AI:?(20.4±1.4)%?vs.?(31.2±4.6)%;?all?P??0.05).? Conclusion? The?expression?of?SCAD?in?HF?was?significantly?down-regulated,?and?the?expression?was?significantly?up-regulated?after?aerobic?exercise?intervention,?indicating?that?swimming?may?improve?the?severity?of?HF?by?up-regulating?the?expression?of?SCAD.

Objective? To explore the correlations among learning outcome, learning belief, professional identity and learning satisfaction in nursing undergraduates, so as to build the structural equation model among them. Methods In March 2018, we selected 335 nursing undergraduates from grade 1 to grade 3 in school of nursing of China Medical University as subjects by cluster sampling. All of them were investigated with the learning outcome questionnaire, learning belief questionnaire, professional identity questionnaire and learning satisfaction questionnaire to analyze the correlations among learning outcome, learning belief, professional identity and learning satisfaction. AMOS 17.0 was used to build the structural equation model among them. Results? In this study, a total of 335 questionnaires were sent out and 284 valid questionnaires were collected. Among 284 nursing undergraduates, the averages of learning outcome, learning belief, professional identity and learning satisfaction were (4.45±0.53), (3.87±0.45), (3.53±0.44) and (3.58±0.52). There were positive correlations among learning outcome, learning belief, professional identity and learning satisfaction (P＜0.01). Learning belief had the strongest direct effects on learning outcome (β=0.46, P＜0.05). Professional identity had bidirectional relationship with learning satisfaction and learning belief (β=0.69, 0.56;P＜0.05). Conclusions? Learning outcome of nursing undergraduates was influenced by learning belief, professional identity and learning satisfaction. Besides, learning belief has the strongest direct effects on learning outcome followed by professional identity, and learning satisfaction had the weakest effects. We should strengthen learning belief of nursing undergraduates, improve their professional identity and learning satisfaction, so as to make them gather more learning outcome.

Objective To explore the influence of self-acceptance and academic achievement on career adaptability, and the mediating effect of academic achievement between self-acceptance and career adaptability among nursing undergraduates. Methods In September 2017, we selected 281 nursing undergraduates from Grade 1 to 3 of School of Nursing at China Medical University as subjects by convenience sampling. All of the patients were investigated with the College Students' Career Adaptability Questionnaire (CSCAQ), Unconditional Self-acceptance Questionnaire (USAQ) and Academic Achievement Scale. Results The average score of CSCAQ, USAQ and academic achievement scale of nursing undergraduates were (3.70±0.39), (3.64±0.51) and (3.51±0.46) respectively. Nursing undergraduates' career adaptability had positive correlations with self-acceptance and academic achievement (r=0.395, 0.382; P＜ 0.05). Three-step mediating regression analysis showed academic achievement played a partial mediating effect in the influence of self-acceptance on career adaptability with a significant mediating effect (P＜0.01). The mediating effect accounted for 27.94% of the total effect. Conclusions Nursing undergraduates' academic achievement has effects on their career adaptability. Their self-acceptance not only has effects on career adaptability directly, but also has effects on career adaptability by the mediating effect of academic achievement indirectly.

Objective Through detecting the expression of chemokine CCL21 and its receptor CCR7 in thyroiditis of NOD mice induced by excessive iodine and thyroglobulin (Tg) immunization,to explore the mechanism of lymphocytic infiltration.Methods Seven to eight weeks old female NOD (non-obese diabetic) mice were used,the mice were divided into four groups by random number table,7 mice for each group.Control group:intoke distilled water;,Tg group:intoke'distilled water,use pig Tg emulsified in Freund's complete adjuvant subcutaneous injection to immunization,0.10 mg Tg for each mouse at 8 weeks old,strengthened immunity at 11 and 15 weeks old (0.05 mg Tg for each mouse,and emulsified by Freund's incomplete adjuvant); iodine excess (HI) group:intoke 0.05％ NaI water; iodine excess combined with Tg (HI + Tg) group:intoke 0.05％ NaI water,Tg immunization method was same to Tg group; all mice were raised in specific pathogen free (SPF) environment.All mice were executed at 16 weeks old,and removed the thyroid tissue.Morphologic change in thyroid was observed by HE staining.Immunofluorescence (IF) staining was used to observe CD3,CD22,CCL21 and CCR7 expression in thyroid.Real-time PCR was used to detect CCL21 mRNA expression in thyroid.Results The morphologic change of thyroid was observed under the light microscope,in HI group,thyroid follicle distended,colloid accumulation,lymphocytes accumulate together and disorganization was seen; Tg group thyroid had scatted lymphocytes; HI + Tg group enhanced inflammation response and disorganization.IF staining showed that lymphocytes infiltrated in thyroid were almost CD3+ T cells,only few scatted CD22+ B cells; CCL21 and CCR7 were negative in control group,CCR7 positive cells were scatted in Tg group but no CCL21 expression,in HI and HI + Tg groups,we could see CCL21 strong positive expression in inflammation area and also had CCR7 positive cells there.CCL21 mRNA relative expression in thyroid:Tg group (3.20 ± 0.18),HI group (1.72 ± 0.31),and HI ± Tg group (9.94 ± 0.32) increased compared to control group (1.00 ± 0.17,all P ＜ 0.01).Conclusion CCL21 and its receptor CCR7 have improved lymphocytic infiltration in autoimmune thyroiditis

AIM: To investigate the effects of poly (I:C) as virus mimics on iodine excess-induced chronic lymphocytic thyroiditis in NOD mouse. METHODS: Female, 32 NOD mice were randomly divided into 4 groups: (1) control;(2) high iodine;(3) poly (I:C);(4) high iodine+poly (I:C). Nine weeks after administration, mice were sacrificed. The following parameters were determined: body weight, thyroid weight and anatomic form. Thyroid hormone (T_4) in serum was measured by radioimmunoassay, the thyroid morphology was observed through HE staining, apoptosis was detected by TUNEL, the mRNA expression levels of TRAIL, TRAIL-sR1, ICAM-1 and CXCL10 were determined by the method of real time RT-PCR. RESULTS: Compared to control group and poly (I:C) group, the thyroid absolute weight and relative weight in high iodine group were increased (P<0.01), the level of total T_4 in serum was decreased (P<0.05), inflammation and apoptosis were obviously observed, the mRNA expressions of TRAIL, TRAIL-sR1, CXCL10 and ICAM-1 were upregulated (P<0.05). Compared to high iodine group, thyroid absolute weight and relative weight in high iodine+poly (I:C) group were further increased, the level of total T_4 in serum was further decreased (P<0.05), the ratio of inflammatory degree Ⅳ increased to 50.0%, the numbers of apoptosis cells were further enhanced, the mRNA expressions of TRAIL, TRAIL-sR1, ICAM-1 and CXCL10 were further upregulated (P<0.05). Otherwise, the tendency of all parameters in poly (I:C) group was similar to that in control group (P>0.05). CONCLUSION: Poly (I:C) aggravates chronic lymphocytic thyroiditis induced by excess of iodine associated with increase in infiltration of lymphocytes and induction of apoptosis.

Objective To observe the pathological characteristics of thyroiditis induced by iodine excess and thyroglobulin (Tg) immunization and to explore the mechanism of thyroiditis induced by iodine excess. Methods NOD mice were used for intaking 0.05% Nal water and(or) Tg immunization. Morphologic change in thyroid and apoptosis were observed. The levels of serum TT4, TSH, thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were measured. Responding to Tg, lymphocytic proliferation of lymph node and spleen, interleukin-4(IL-4)and γ-interferon(IFN-γ) levels in culture medium of splenocytes were detected. Real-time PCR Was used to detect mRNA expressions of IL-4, IFN-γ, chemokine ligand 10 (CXCL10) and intercellular adhesion molecular-1(ICAM-1) in thyroid. Results Distended thyroid follicles,colloid accumulation, intense lymphocytic infiltration and disorganization were seen in thyroid of iodine excess group, along with increased apoptosis of thyroid cells(34.66～ 2.78 vs 5.11±0.62 ,P<0.01). The levels of TT4 were lowered while TSH raised ,but no production of thyroid-specific autoantibodies was revealed. Lymph node and spleen cells showed positive respornse under stimulation of Tg. The level of IFN-γ[(1. 272±0.049 vs 1. 139±0. 025)ng/L,P<0. 01] was raised in culture medium of splenocytes but not IL-4. The expression of IFN-γ, CXCLI0 and ICAM-1 mRNA were increased in thyroid. But in Tg group, some lymphocytes were scattered in thyroid, autoantibodies emerged ,and the level of IL-4 was increased in cuhure medium of splenocytes[(18. 508±0. 113 vs 13. 368±0. 016)ng/L, P<0. 01]. ledine excess combined with Tg enhanced these inflammatory reaction. Conclusion Iodine excess induced thyroiditis in NOD mice. The process seems to be Th1 response dominant organ-specific autoimmune diseases. Iodine excess and Tg immunizatiou play a synergistic role in inducing experimental autoimmune thyroiditis.