The ambiguity of symptom information in traditional Chinese medicine （TCM） syndrome differentiation can be amplified in the direct reasoning process from symptoms to syndromes in the absence of constraints， which affects the accuracy and stability of intelligent syndrome differentiation. TCM disease concepts， while historically rational， are structurally ambiguous in both their connotation and extension， making it difficult to serve as stable prior knowledge in intelligent modeling. In contrast， modern medical diseases， based on objective testing and quantifiable indicators， have relatively clear boundaries and reproducible standards. This study proposes a disease-syndrome combination model， adopting modern medical diseases as structural prior variables to reconstruct the hierarchical relationships among disease， symptoms， and syndromes. By applying disease constraints， effective screening of information from the four examinations and compressing the reasoning space are achieved. Furthermore， by integrating artificial intelligence technologies， such as multimodal fusion and knowledge graphs， an intelligent syndrome differentiation model driven by both prior knowledge and clinical data is constructed， providing a feasible path to enhance the accuracy of syndrome differentiation and realize the intelligentization of TCM diagnosis and treatment.

Objective:To explore the application and effectiveness evaluation of the "six thinking hats" thinking mode in nursing teaching rounds.Methods:A total of 65 surgical nursing interns from a tertiary hospital were selected as the research subjects. The control group received routine teaching rounds, while the observation group received teaching rounds based on the "six thinking hats" thinking mode intervention. General information, assessment results, critical thinking ability, job competence, and satisfaction with teaching effectiveness were compared between the two groups of nursing students. SPSS 22.0 statistical software was used for t-test and chi-square test. Results:Compared with the control group, the observation group showed significantly higher scores in operational skills [(92.50±2.20) vs. (89.53±2.08)] and theoretical knowledge [(89.21±1.51) vs. (86.81±2.71)] and medical record writing score [(93.17±4.05) vs. (85.20±3.19)]. The critical thinking ability score was significantly higher in the observation group than in the control group [(319.97±45.13) vs. (283.57±41.57)]. The competency score was significantly higher in the observation group than in the control group [(182.62±14.07) vs. (164.43±14.50)]. The observation group demonstrated a higher overall evaluation of teaching satisfaction.Conclusions:The "six thinking hats" thinking mode improves the ability of nursing students to analyze problems, stimulates their subjective initiative in learning, and has a positive impact on the cultivation of their comprehensive abilities, making it a feasible teaching mode.

Objective:To investigate the current status of teaching behavior of clinical nursing teachers and explore the mediation effect of organizational commitment between their work engagement and teaching behavior.Methods:This study included a total of 1 736 clinical nursing teachers who worked in grade A tertiary hospitals in Beijing City, Shanghai City, Henan Province, Hubei Province, Hebei Province, and Chongqing City from May 2022 to November 2022. Data were collected using a general information questionnaire, the Effective Teaching Behavior Scale, the Work Engagement Scale, and the Organizational Commitment Scale. Statistical description and correlation analysis were performed using SPSS 25.0 software, and mediation effect was analyzed using AMOS 25.0 software.Results:The total mean score of effective teaching behavior of 1 599 clinical nursing teachers was (4.19±0.66), the total mean score of work engagement was (5.09±1.36), and the total mean score of organizational commitment was (3.93±0.72). Pearson correlation analysis showed that work engagement and organizational commitment were positively correlated with teaching behavior ( r=0.560, 0.519, both P<0.01). Organizational commitment partially mediated the relationship between work engagement and teaching behavior, with a mediation effect value of 0.27, and the mediation effect accounted for 49.10% of the total effect. Conclusions:Work engagement is a direct predictor of the teaching behavior of clinical nursing teachers, and organizational commitment partially mediates the relationship between work engagement and teaching behavior. Administrators can promote the work engagement of clinical nursing teachers by adopting effective interventions to increase the level of organizational commitment, which in turn enhances teaching behavior.

Objective:To summarize the clinical data of single-center juvenile dermatomyositis（JDM）complicated with interstitial lung disease（ILD），and provide experience for pediatricians.Methods:Data of 61 children with JDM who were admitted to Children's Hospital affiliated to Xi'an Jiaotong University from January 2016 to May 2023 were collected. General data，clinical symptoms，chest high-resolution CT，laboratory examination and myositis antibody spectrum of the children were recorded.Results:Among the 61 children with JDM，there were 30 cases（13 males and 17 females）without ILD. The age of onset was 5.96（3.50，8.92）years and the course of disease was（11.79±20.00）months. There were 31 cases with ILD（14 males and 17 females），the age of onset was 7.42（4.50，10.08）years，and the duration of ILD was（5.47±8.09）months. There was statistical difference in the course of disease between the two groups（ P<0.05），but no statistical difference in gender and age between the two groups（ P>0.05）. Among 61 children with JDM，there were statistical differences in fever between the two groups（ P<0.05），but no statistical differences in heliotrope discoloration，gottron’s papules，calcinosis and myasthenia between the two groups（ P>0.05）. AST and FER showed statistical difference between the two groups（ P<0.05），while CK，LDH，CK-MB，ESR，C3 and C4 showed no statistical difference（ P>0.05）. All 61 cases of children were tested for myositis antibody spectrum，and there was statistical difference in anti-MDA5 antibody between the two groups（ P<0.05），but no statistical difference in the rest（ P>0.05）. There were statistical differences between the two groups in the treatment of methotrexate，hydroxychloroquine and cyclophosphamide（ P<0.05）. A total of 11 cases（36.67%）in the without ILD group were treated with biologics（8 adalimumab，2 infliximab and 1 tofacitinib），and 23 cases（74.19%）in the ILD group were treated with biologics（11 adalimumab，9 tofaciib，2 infliximab and 1 tocilizumab）. All 61 cases with JDM were followed up. Among the 30 children without ILD，1 case was lost to follow-up 2 months after treatment，and the rest were treated effectively without death. Among the 31 children with ILD，3 cases died of severe pulmonary infection with multidrug-resistant bacteria during treatment，of which 1 case was positive for anti-MDA5 antibody and 2 cases were negative for myositis specific antibody. Conclusion:JDM is more likely to be complicated with ILD，fever is more likely to occur in ILD group，and children with positive anti-MDA5 antibody are more likely to occur ILD. Biologic agents such as adalimumab and tofacitinib are effective in combination therapy. In the course of treatment，multi-drug resistant bacteria infection should be guarded against to reduce mortality.

Developmental dysplasia of hip(DDH)usually occurs in children,and delayed diagnosis of DDH might lead to serious complications and influence long-term prognosis.The application of artificial intelligence(AI)in medical images helps to quantitatively individualize image data,reduce bias generated by manual analysis and achieve early and accurate diagnosis of children DDH.The research progresses of AI in imaging diagnosis of children DDH were reviewed in this article.

Objective To investigate the value of morphological and hemodynamic parameters of CT angiography(CTA)for predicting recurrence of intracranial aneurysms(IA)after endovascular embolization.Methods Totally 205 patients with ruptured IA who underwent endovascular embolization were retrospectively collected and divided into recurrence group(n=35)and non-recurrence group(n=170)according to follow-up results after embolization.The morphological and hemodynamic parameters of IA in CTA before treatment were compared between groups.Variance inflation factor(VIF)was used to explore whether there was collinearity between morphological and hemodynamic parameters,and those without collinearity were included in univariate and multivariate logistic regression analysis to screen predictors of recurrence of IA after endovascular embolization.Two prediction models were constructed based on morphological parameters(model 1)and combination with hemodynamic parameters(model 2).Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of models.Results The maximum diameter,aneurysm neck width,maximum height,maximum vertical height and size ratio(SR)of IA in recurrence group were all higher than those in non-recurrence group(all P＜0.05),while gradient oscillatory number(GON)in recurrence group was lower than that in non-recurrence group(P＜0.05).The neck width,SR,pressure at IA neck plane,intra-aneurysm time-averaged wall shear stress(TAWSS),oscillatory shear index(OSI)and GON had no significant collinearity(all VIF＜10),among which the neck width,SR and TAWSS were all independent predictors(all P＜0.05).AUC of model 1 and model 2 for predicting recurrence of IA after endovascular embolization was 0.668 and 0.723,respectively,which of model 2 was higher than which of model 1(integrated discrimination improvement index was 0.055,P=0.025).Conclusion CTA morphological parameters combined with hemodynamic parameters of IA could be used to predict its recurrence after endovascular embolization.

Developmental dysplasia of hip(DDH)usually occurs in children,and delayed diagnosis of DDH might lead to serious complications and influence long-term prognosis.The application of artificial intelligence(AI)in medical images helps to quantitatively individualize image data,reduce bias generated by manual analysis and achieve early and accurate diagnosis of children DDH.The research progresses of AI in imaging diagnosis of children DDH were reviewed in this article.

Objective To investigate the value of morphological and hemodynamic parameters of CT angiography(CTA)for predicting recurrence of intracranial aneurysms(IA)after endovascular embolization.Methods Totally 205 patients with ruptured IA who underwent endovascular embolization were retrospectively collected and divided into recurrence group(n=35)and non-recurrence group(n=170)according to follow-up results after embolization.The morphological and hemodynamic parameters of IA in CTA before treatment were compared between groups.Variance inflation factor(VIF)was used to explore whether there was collinearity between morphological and hemodynamic parameters,and those without collinearity were included in univariate and multivariate logistic regression analysis to screen predictors of recurrence of IA after endovascular embolization.Two prediction models were constructed based on morphological parameters(model 1)and combination with hemodynamic parameters(model 2).Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of models.Results The maximum diameter,aneurysm neck width,maximum height,maximum vertical height and size ratio(SR)of IA in recurrence group were all higher than those in non-recurrence group(all P＜0.05),while gradient oscillatory number(GON)in recurrence group was lower than that in non-recurrence group(P＜0.05).The neck width,SR,pressure at IA neck plane,intra-aneurysm time-averaged wall shear stress(TAWSS),oscillatory shear index(OSI)and GON had no significant collinearity(all VIF＜10),among which the neck width,SR and TAWSS were all independent predictors(all P＜0.05).AUC of model 1 and model 2 for predicting recurrence of IA after endovascular embolization was 0.668 and 0.723,respectively,which of model 2 was higher than which of model 1(integrated discrimination improvement index was 0.055,P=0.025).Conclusion CTA morphological parameters combined with hemodynamic parameters of IA could be used to predict its recurrence after endovascular embolization.

Objective To explore the value of dynamic contrast-enhanced(DCE)-MRI quantitative parameters based on differential sub-sampling with Cartesian ordering(DISCO)technology for differentiating high-and low-grade breast cancer.Methods A total of 80 patients with single breast cancer confirmed by biopsy pathology were retrospectively enrolled,including 40 cases of low-grade(L group)and 40 cases of high-grade breast cancer(H group).Then quantitative parameters obtained from DISCO-DCE-MRI before treatment were compared between groups,including extravascular extracellular volume fraction(Ve),rate constant(Kep),contrast enhancement ratio(CER),maximum slope(MaxSlope)and volume transfer constant(Ktrans),and their correlations with histological grade were analyzed.Receiver operating characteristic(ROC)curves of DISCO-DCE-MRI quantitative parameters being significantly different between groups were plotted,and the area under the curves(AUC)were calculated to evaluate their efficacy for differentiating high-and low-grade breast cancer.Results Ve(0.91[0.59,0.99]),CER(2.76±0.54)and MaxSlope(0.02[0.01,0.03])in L group were all higher than those in H group(0.52[0.34,0.73],[2.31±0.74],0.01[0.01,0.02],all P＜0.05),and no significant difference of Kep nor Ktrans was found between groups(both P＞0.05).Ve,CER and MaxSlope of breast cancer were all negatively correlated with histological grade(rs=-0.43,-0.39,-0.35,all P＜0.05),while Kep andKtranshad no significant correlation with histological grade(both P＞0.05).The AUC of Ve,CER and MaxSlope for differentiating high-and low-grade breast cancer was 0.749,0.725 and 0.700,respectively.Conclusion Among DISCO-DCE-MRI quantitative parameters,Ve,CER and MaxSlope could be used for differentiating high-and low-grade breast cancer.

OBJECTIVE To investigate the acute lung injury effects of pulmonary phospholipids and their phospholipase A2(PLA2)decomposition products-lysophospholipids and fatty acids-on mice.METHODS Mice were randomly assigned to the following groups:① solvent control(PBS)and PLA2;② solvent control and glycerol phospholipid groups:1,2-dioleoyl-sn-glycero-3-phosphoserine(DOPS),1,2-dipalmitoyl-sn-glycero-3-phosphoserine(DPPS),1,2-dioleoyl-sn-glycero-3-phosphoethanol-amine(DOPE),1,2-dipalmitoyl-sn-glycero-3-phosphoethanolamine(DPPE),1,2-dipalmitoyl-sn-glycero-3-phosphocholine(DPPC),and 1-stearoyl-2-oleoyl-sn-glycero-3-phosphocholine(SOPC);③ solvent con-trol and fatty acid groups:palmitic acid(PA),oleic acid;④ solvent control and lysophospholipid groups:1-oleoyl-2-hydroxy-sn-glycero-3-phosphoserine(18∶1 LysoPS),1-stearoyl-sn-glycero-3-phosphoserine(18∶0 LysoPS),1-palmitoyl-sn-glycero-3-phosphoserine(16∶0 LysoPS),1-palmitoyl-sn-glycero-3-phos-phoethanolamine(16∶0 LysoPE),1-palmitoyl-sn-glycero-3-phosphocholine(16∶0 LysoPC);⑤ solvent control,PLA2,DPPC,PA,16∶0 LysoPC,16∶0 LysoPS,and 18∶1 LysoPS.Following anesthesia,mice were administered nebulized PBS in the solvent control group,2.1 ug·kg-1 PLA2 in PBS in the PLA2 group and 2.5 mg·kg-1 of the corresponding substance in PBS in other experimental groups.For group①,survival times were recorded and survival curves were plotted.At 1 h post-treatment,lung tissues from groups ①②③④ were collected,photographed to obtain white light images,and subjected to HE staining to assess histopathological changes and pathological scoring.At 2 h post-treatment,pulmonary blood flow in group ⑤ was assessed using laser speckle contrast imaging,arterial blood gas was analyzed with a blood gas analyzer,and lung function was evaluated using whole-body pleth-ysmography.At 6 hours post-treatment,blood cells from group ⑤ were analyzed using an automated hematology analyzer.RESULTS Compared with the solvent control group,severe pathological changes were observed in lung tissues of the PLA2 group,accompanied by extensive inflammatory infiltration and interstitial thickening,with all mice succumbing within 240 min.In mice treated with glyc-erol phospholipids,alveolar structures remained clear,alveolar walls were intact and continuous,and alveolar spaces were translucent,with only occasional minor inflammatory cell infiltration in the septa.No significant pathological alterations were detected in the fatty acid groups.Minor inflammatory cell infiltration was seen in the 16∶0 LysoPE and 16∶0 LysoPC groups.However,such pathological changes as patchy hemorrhage,alveolar interstitial edema,increased alveolar wall thickness,and elevated neutrophil counts were observed in the 18∶1 LysoPS,18∶0 LysoPS,and 16∶0 LysoPS groups.Pathological scores based on HE staining were significantly increased in the 16∶0 LysoPS and 18∶1 LysoPS groups com-pared with the solvent control.The percentage of the lung tissue injury area was also markedly higher in the 16∶0 LysoPS group.A significant decrease in the mean fluorescence intensity of blood flow was observed in the 16∶0 LysoPS group.Arterial partial pressure of oxygen(pO2)was significantly reduced in the PLA2 group,while arterial partial pressure of carbon dioxide(pCO2)was markedly elevated in the 16∶0 LysoPS and 18∶1 LysoPS groups.Lung function tests revealed that the 16∶0 LysoPS group exhibited significant increases in expiratory time,end-expiratory pressure,and enhanced pause,in contrast to significant decreases in tidal volume,expired volume,and minute volume.The 18∶1 LysoPS group also exhibited a significant decline in minute volume.No significant changes in inflammatory cell concentrations were detected in blood,with the exception of neutrophils in the 16∶0 LysoPS group,which showed a significant but physiologically normal increase.CONCLUSION Pulmonary phospholipids and their PLA2-derived fatty acid metabolites do not induce severe lung injury in mice while the lyso-phospholipid metabolites,particularly lysophosphatidylserine,are found to cause significant lung injury.