Objective:To develop and validate a 30-day readmission risk prediction model for patients with chronic obstructive pulmonary disease (COPD) using multiple machine learning algorithms.Methods:Convenience sampling was used to select 1 450 COPD patients hospitalized at Tianjin Medical University General Hospital from January 2017 to December 2023 as study subjects. Twenty-nine variables associated with readmission were included. LASSO was used to screen for primary characteristic variables associated with 30-day readmission. The 1 450 patients were divided into a training set ( n=870) and a test set ( n=580) in a 6∶4 ratio. Ten machine learning methods, including random forest, AdaBoost, extreme radient Boosting (XGB), decision tree and so on, were used for model training and testing to identify the optimal prediction model. The optimal model and SHAP were employed to analyze key features and rank characteristic importance. Results:Among 1 450 COPD patients, the 30-day readmission rate was 24.48% (355/1 450). There were no significant differences in the general information between patients in test set and training set ( P>0.05). LASSO regression analysis identified seven variables with the highest predictive value, namely regular weekly exercise, hospital stay, mean arterial pressure, forced expiratory volume in one second/forced vital capacity (FEV1/FVC), C-reactive protein, body mass index, and medication adherence. Machine learning showed that in the training set, XGB had the highest area under the receiver operating characteristic curve ( AUC), sensitivity, and F1 score of 0.943, 0.926, and 0.930, respectively. In the test set, the AUC and accuracy of XGB were 0.882 and 0.858, respectively, and XGB's various scores showed that it had good generalization and predictive performance. XGB analysis showed that medication adherence, FEV1/FVC, and regular weekly exercise were negatively correlated with the 30-day readmission risk, while body mass index, C-reactive protein, mean arterial pressure, and hospital stay were positively correlated. The characteristics ranked in order of importance were medication adherence, body mass index, C-reactive protein, mean arterial pressure, FEV1/FVC, hospital stay and regular weekly exercise. Conclusions:The XGB model has strong predictive performance and good generalization ability, which can effectively predict the 30-day readmission risk of COPD patients, assist in clinical identification of high-risk patients, implement nursing interventions, and reduce readmission rates.

Objective:To develop and validate a 30-day readmission risk prediction model for patients with chronic obstructive pulmonary disease (COPD) using multiple machine learning algorithms.Methods:Convenience sampling was used to select 1 450 COPD patients hospitalized at Tianjin Medical University General Hospital from January 2017 to December 2023 as study subjects. Twenty-nine variables associated with readmission were included. LASSO was used to screen for primary characteristic variables associated with 30-day readmission. The 1 450 patients were divided into a training set ( n=870) and a test set ( n=580) in a 6∶4 ratio. Ten machine learning methods, including random forest, AdaBoost, extreme radient Boosting (XGB), decision tree and so on, were used for model training and testing to identify the optimal prediction model. The optimal model and SHAP were employed to analyze key features and rank characteristic importance. Results:Among 1 450 COPD patients, the 30-day readmission rate was 24.48% (355/1 450). There were no significant differences in the general information between patients in test set and training set ( P>0.05). LASSO regression analysis identified seven variables with the highest predictive value, namely regular weekly exercise, hospital stay, mean arterial pressure, forced expiratory volume in one second/forced vital capacity (FEV1/FVC), C-reactive protein, body mass index, and medication adherence. Machine learning showed that in the training set, XGB had the highest area under the receiver operating characteristic curve ( AUC), sensitivity, and F1 score of 0.943, 0.926, and 0.930, respectively. In the test set, the AUC and accuracy of XGB were 0.882 and 0.858, respectively, and XGB's various scores showed that it had good generalization and predictive performance. XGB analysis showed that medication adherence, FEV1/FVC, and regular weekly exercise were negatively correlated with the 30-day readmission risk, while body mass index, C-reactive protein, mean arterial pressure, and hospital stay were positively correlated. The characteristics ranked in order of importance were medication adherence, body mass index, C-reactive protein, mean arterial pressure, FEV1/FVC, hospital stay and regular weekly exercise. Conclusions:The XGB model has strong predictive performance and good generalization ability, which can effectively predict the 30-day readmission risk of COPD patients, assist in clinical identification of high-risk patients, implement nursing interventions, and reduce readmission rates.

Objective To addresses the challenges arising from the rapid expansion of pharmaceutical clinical trials and the growing demands for quality management,this paper investigates the application of low-code technology in project management.Its goals are to enhance the operational efficiency and execution capabilities of clinical trial institutions,ensure trial quality and safety,and accelerate the translation of pharmaceutical scientific achievements.Methods A brainstorming session was conducted to analyze the technical and functional requirements for managing pharmaceutical clinical trial projects.Utilizing the ＂template design＂ and ＂decision analysis＂ functionalities of low-code technology,the study adopted a modular and visually driven data management approach to develop a system compliant with Good Clinical Practice(GCP)standards.This system integrates key functionalities,including project progress management,funding management,drug inventory management,and quality control.Its effectiveness was evaluated through real-world operation and performance validation.Results The system had demonstrated stable operation with substantial improvements in practical application.Compared with conventional management approaches,it significantly enhanced project management efficiency:the time required for project schedule management was reduced by 80%,the efficiency of financial processing increased by 95%,drug inventory management efficiency improved by 75%,and the time spent on quality control was shortened by 60%.Conclusion The pharmaceutical clinical trial project management system developed using low-code technology offers substantial advantages and promising application potential.It represents a critical practice in applying digital and intelligent tools to advance pharmaceutical productivity in the medical and healthcare sectors.

Objective To addresses the challenges arising from the rapid expansion of pharmaceutical clinical trials and the growing demands for quality management,this paper investigates the application of low-code technology in project management.Its goals are to enhance the operational efficiency and execution capabilities of clinical trial institutions,ensure trial quality and safety,and accelerate the translation of pharmaceutical scientific achievements.Methods A brainstorming session was conducted to analyze the technical and functional requirements for managing pharmaceutical clinical trial projects.Utilizing the ＂template design＂ and ＂decision analysis＂ functionalities of low-code technology,the study adopted a modular and visually driven data management approach to develop a system compliant with Good Clinical Practice(GCP)standards.This system integrates key functionalities,including project progress management,funding management,drug inventory management,and quality control.Its effectiveness was evaluated through real-world operation and performance validation.Results The system had demonstrated stable operation with substantial improvements in practical application.Compared with conventional management approaches,it significantly enhanced project management efficiency:the time required for project schedule management was reduced by 80%,the efficiency of financial processing increased by 95%,drug inventory management efficiency improved by 75%,and the time spent on quality control was shortened by 60%.Conclusion The pharmaceutical clinical trial project management system developed using low-code technology offers substantial advantages and promising application potential.It represents a critical practice in applying digital and intelligent tools to advance pharmaceutical productivity in the medical and healthcare sectors.

Objective:To investigate the effects of Anhydroicaritin (AHI) , an isopentenylated flavo-noid compound, on proliferation, migration and apoptosis of human hepatocarcinoma cell line MHCC-97H.Methods:Human hepatocarcinoma cell line MHCC-97H and human normal liver cell line L02 were cultured in vitro. MHCC-97H cells were treated with 0, 20, 40, 80, 120, 160, 200 μg/ml of AHI respectively and L02 cells were treated with 0, 25, 50, 100, 150, 200, 400, 500 μg/ml of AHI respectively. CCK-8 and clone formation assay were used to detect cell proliferation. Scratch test was used to explore cell migration ability. Hoechst33342 assay and flow cytometer were used to detect cell apoptosis. The expressions of apoptosis-related proteins were detected by Western blotting. Results:The cell viabilities of MHCC-97H cells treated with 0, 20, 40, 80, 120, 160, 200 μg/ml of AHI for 24 h were (100.00±0.00) %, (97.41±2.10) %, (96.58±3.23) %, (87.72±4.85) %, (78.33±3.76) %, (56.97±2.61) % and (15.25±2.51) % respectively, and there was a statistically significant difference ( F=429.20, P<0.001) . There were statistically significant differences between 0 μg/ml and 80, 120, 160, 200 μg/ml of AHI treatment (all P<0.001) . The cell viabilities of L02 cells treated with 0, 25, 50, 100, 150, 200, 400, 500 μg/ml of AHI for 24 h were (100.00±0.00) %, (96.82±3.79) %, (95.36±3.43) %, (90.79±5.75) %, (77.67±5.66) %, (63.98±5.22) %, (34.22±4.01) % and (33.84±4.41) % respectively, and there was a statistically significant difference ( F=233.20, P<0.001) . There were statistically significant differences between 0 μg/ml and 100, 150, 200, 400, 500 μg/ml of AHI treatment (all P<0.05) . The 24 h half maximal inhibitory concentration (IC 50) value of AHI treated L02 cells was (300.20±17.10) μg/ml, which was significantly higher than that of MHCC-97H cells [ (158.60±5.50) μg/ml], and there was a statistically significant difference ( t=13.65, P<0.001) . The cell clone numbers of MHCC-97H cells treated with 0, 120, 160 and 200 μg/ml of AHI for 24 h were 1 993.00±46.29, 1 355.00±54.84, 998.33±21.03 and 218.33±35.95 respectively, and there was a statistically significant difference ( F=954.80, P<0.001) . There were statistically significant differences between 0 μg/ml and 120, 160, 200 μg/ml of AHI treatment (all P<0.001) . The healing rates of MHCC-97H cells treated with 0, 120, 160 and 200 μg/ml of AHI for 24 h were (51.68±1.93) %, (16.04±0.73) %, (8.88±0.31) % and (-6.94±0.46) % respectively, and there was a statistically significant difference ( F=1 616.00, P<0.001) . There were statistically significant differences between 0 μg/ml and 120, 160, 200 μg/ml of AHI treatment (all P<0.001) . Hoechst33342 experiment showed that MHCC-97H cells treated with 0 μg/ml AHI showed uniform dark blue with a complete nuclear state under inverted microscope. Compared with 0 μg/ml AHI treated cells, cells in the 120, 160, 200 μg/ml AHI treatment groups wrinkled and broken, and nuclei were also morphologically abnormal, with some nuclei stained bright blue, and the situation became more obvious with increasing dose. The apoptosis rates of MHCC-97H cells treated with 0, 120, 160 and 200 μg/ml AHI for 24 h were (10.51±0.56) %, (42.23±0.87) %, (61.92±0.52) % and (72.05±0.74) % respectively, and there was a statistically significant difference ( F=4 677.00, P<0.001) . There were statistically significant differences between 0 μg/ml and 120, 160, 200 μg/ml of AHI treatment (all P<0.001) . There were statistically significant differences among the different expression levels of Bax, Cleaved Caspase-3/Caspase-3, Cleaved Caspase-9/Caspase-9, and Bcl-2 proteins in MHCC-97H cells of 0, 120, 160, and 200 μg/ml of AHI treatment ( F=30.43, P<0.001; F=212.80, P<0.001; F=475.30, P<0.001; F=10.75, P=0.004) . The Bax protein expression of 160 and 200 μg/ml was significantly increased than that of 0 μg/ml AHI (both P<0.001) . The Cleaved Caspase-3/Caspase-3, Cleaved Caspase-9/Caspase-9 protein expressions of 120, 160 and 200 μg/ml were significantly increased than those of 0 μg/ml AHI (all P<0.001) . The Bcl-2 protein expression of 120, 160, 200 μg/ml was significantly decreased compared with that of 0 μg/ml AHI (all P<0.05) . Conclusion:AHI can inhibit the proliferation and migration of hepatocellular carcinoma cell line MHCC-97H, and promote its apoptosis.

The brain pericyte is a unique and indispensable part of the blood-brain barrier (BBB), and contributes to several pathological processes in traumatic brain injury (TBI). However, the cellular and molecular mechanisms by which pericytes are regulated in the damaged brain are largely unknown. Here, we show that the formation of neutrophil extracellular traps (NETs) induces the appearance of CD11b⁺ pericytes after TBI. These CD11b⁺ pericyte subsets are characterized by increased permeability and pro-inflammatory profiles compared to CD11b^- pericytes. Moreover, histones from NETs by Dectin-1 facilitate CD11b induction in brain pericytes in PKC-c-Jun dependent manner, resulting in neuroinflammation and BBB dysfunction after TBI. These data indicate that neutrophil-NET-pericyte and histone-Dectin-1-CD11b are possible mechanisms for the activation and dysfunction of pericytes. Targeting NETs formation and Dectin-1 are promising means of treating TBI.
Blood-Brain Barrier/metabolism* ; Brain/pathology* ; Brain Injuries, Traumatic/metabolism* ; Extracellular Traps/metabolism* ; Histones ; Humans ; Lectins, C-Type ; Pericytes/pathology*

Objective Retrospectively analysis of our hospital thoracoscopic lobectomy cases in infants and children.This study evaluates the safety and efficacy of thoracoscopic lobectomy in infants and children.Methods Retrospective analysis of our hospital from April 2015 to August 2016,50 consecutive patients were plans to implement thoracoscopic lobectomy,excluding extralobar isolated,lung bullae,lung biopsies.35 males and 15 females,aged 2 months and 13 years,the average (5.94 ±3.94) years,3.25-59.00 kg body weight,average(22.15 ± 12.54) kg.11 cases of prenatal ultrasound to confirm.21 cases have a history of recurrent pneumonia.3 patients had a history of hemoptysis,are leaf-type isolation within the lung.Results 50 patients were successful in 46 cases by thoracoscopic surgery,4 patients underwent thoracotomy,transit rate of 8％.Transfer 4 cases,2 cases of left upper lobe,13 year-old and 15 year old children,preoperative recurrent pneumonia,pleural adhesions.1 case of right lower lobe,right lower pulmonary artery surgery damage the basal segments,bleeding.1 case of left lower lobe,the upper and lower leaf division stunted.VATS 40-300 minutes,an average of 120 minutes.There was no operative mortality,postoperative bleeding reoperation case who,as a transit cases thoracotomy.Lesion distribution right upper lobe in 5 cases,1ease of right middle lower,19 cases of right lower lobe,left upper lobe in 7 cases,18 cases of left lower lobe.Histological examination showed bronchial pulmonary cyst in 4 cases,leaf-type isolation within the lung in 15 cases,cystic adenomatoid malformation in 30 cases(type I 17 eases,type Ⅱ 13 cases).Indwelling chest tube after 2-3 days in hospital after 5-10 days,an average of 7 days.Postoperative follow-up 1-12 months,no recurrence and thoracic collapse,the remaining lung well compensated.Conclusion VATS lobectomy with less trauma,quicker recovery after surgery.However,due to the small chest in children,one lung difficulties,thoracoscopic operation requires a longer learning curve.Preoperative recurrent infections,pleural adhesions,fissure dysplasia will increase the rate of conversion to open.

Objective To investigate the expression of Aire,Foxp3,AchR and other immune factors in human thymoma tissue and plasma and explore their role in myasthenia gravis with thymoma.Methods T lymphocyte subsets,immunoglobulin and other immune factors in plasma were compared,and the Expression of Aire,Foxp3 and AchR were examined in thymoma by reverse transcriptional polymerase chain reaction and immunohistochemical staining,and the results were analyzed by SPSS statistics software.Results The ratio of CD4 + to CD8 + T lymphocyte was much higher in plasma,while the expressions of Aire,Foxp3 and AchR at mRNA and protein level were much lower in thymoma patients with myasthenia gravis,and related to Ossermann subtype,WHO subgroup and Masaoka stage.The differences were statistically significant (P ＜ 0.05).Conclusion The ratio of CD4 + to CD8 + T lymphocyte and the abnormal expressions of Aire and Foxp3could used as an indicator of immune state in thymoma patient with myasthenia gravis and play an important role in the development of thymoma with myasthenia gravis,but the mechanism is indefinite.

Background and purpose: AMP-activated protein kinase (AMPK) plays an important role in the regulation of cell metabolism and energy balance and is associated with cell proliferation, survival and multiple signaling pathways. Recent reports found that AMPK is involved in tumor suppression and drug resistance. The aim of this study was to explore the effect of AMPK on the anti-tumor effect of adriamycin and underlying mechanism in breast cancer MCF-7/adr cells. Methods:The anti-proliferative effects of adriamycin was detected by methyl thiazolyl tetrazolium (MTT) assay in MCF-7/adr, MCF-7/adr-vector and MCF-7/adr-AMPKαcells. The cell morphology in each group was stained with the lfuorescent dye Hoechst 33528, and the effects on apoptosis induction were examined by lfow cytometry (FCM). The intracellular concentration of adriamycin was detected by lfuorescence assay. The resis-tance-and apoptosis-related proteins were analyzed by Western blot. Results:The growth of breast cancer MCF-7/adr cells was inhibited by adriamycin in a dose-and time-dependent manner. The IC50 values at 24 and 48 h were (36.8±2.1) and (28.8±1.3) μg/mL, respectively. AMPKαover-expression enhanced the cytotoxic effect of adriamycin in MCF-7/adr-AMPKαcells in a dose-and time-dependent manner. Its IC50 values at 24 and 48 h were (16.0±0.7) and (4.2±0.2) μg/mL, respectively. Fluorescent morphological assay showed that AMPKαoverexpression contributed to adriamycin induced apoptosis in MCF-7/adr-AMPKαcells. After treatment with 1.0 μg/mL adriamycin for 48 h, the apoptosis rates of MCF-7/adr, MCF-7/adr-vector and MCF-7/adr-AMPKα cells were (12.0±1.4)%, (12.7±1.6)% and (32.0±4.2)%, respectively, indicating that overexpression of AMPKα enhanced the adriamycin-induced apoptosis in MCF-7/adr cells. Fluorescence microplate assay showed that over expression of AMPKαsigniifcantly increased the intracellular accumulation of adriamycin, in a concentration dependent manner. Western blot analysis showed that, compared with MCF-7/adr and MCF-7/adr-vector cells, the expressions of Bax, caspase-3 and cleaved PARP proteins were increased. Meanwhile, Bcl-2 and P-gp protein expressions were decreased in MCF-7/adr-AMPKαcells. Furthermore, the release of cytochrome c from mitochondria into the cytosol was also observed in MCF-7/adr-AMPKαcells. Conclusion:AMP-Kαoverexpression can enhance the chemosensitivity of breast cancer MCF-7/adr cells to adriamycin through inhibiting the drug effux transporter and regulating the expression of apoptosis-related proteins.

BACKGROUND:Multimodal analgesia provides sufficient analgesia in renal recipients and appears to be associated with the recovery of renal function after transplantation. OBJECTIVE:To investigate the effect of multimodal analgesia with dezocine on postoperative immunity after renal transplantation, and discuss the appropriate analgesic drugs and methods for patients with renal transplantation. METHODS:Forty patients undergoing renal transplantation were randomly divided into two groups. They al received general anesthesia combined with epidural blockage. Control group received intramuscular injection of analgesic drugs when needed, while dezocine group received multimodal analgesia:preemptive anaIgesia with dezocine+patient-control ed epidural analgesia. The heart rate, mean arterial pressure, and saturation of blood oxygen were detected before anesthesia, 12, 24, 48 hours after transplantation. T lymphocyte subsets, interleukin-2, interleukin-6 and interleukin-10 levels in venous blood were measured before anesthesia, 12, 24, 48 hours after transplantation. RESULTS AND CONCLUSION:Compared with before anesthesia, the CD4+, CD8+cellsubset counts, CD4+/CD8+ratio, the levels of interleukin-2 and interleukin-6 were decreased significantly (P<0.05), and the levels of interleukin were significantly increased after transplantation in the control group (P<0.05). The postoperative CD4+cellsubset counts, the levels of interleukin-2 and interleukin-6 were significantly lower at 12 hours after transplantation than that before anesthesia (P<0.05), then recovered to normal levels at 24 hours in dezocine group. The postoperative CD8+cellsubset counts, CD8+and CD4+/CD8+ratio were not changed before and after transplantation in the dezocine group. The levels of interleukin-10 in the dezocine group were significantly increased at 48 hours after transplantation compared with before anesthesia (P<0.05), which was stil lower than that in control group (P<0.05). Multimodal analgesia with dezocine can effectively protect the immune system, promote short-term turnover of renal function, and prolong graft survival for patients with renal transplantation.