Objective To investigate the 30-day mortality risk factors in elderly patients with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly (≥70 years) HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024 was performed. Simple random sampling in R software was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. Results A total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training set, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065-11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269-67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057-46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997-6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000-2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: area under the curve (AUC) in the training set was 0.898 (95%CI 0.831-0.966) and in the validation set was 0.912 (95%CI 0.805-1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.

Objective:To investigate the feasibility of deep learning reconstruction (DLR) algorithm combined with a dual-low protocol (low radiation dose and low contrast medium dose) for thoracoabdominal aortic CT angiography (CTA).Methods:This cross-sectional study prospectively enrolled 56 patients suspected of aortic diseases who underwent aortic CTA at China-Japan Friendship Hospital from June 2023 to June 2024. All patients were randomly divided into two groups: Group A (28 cases) underwent CTA with a tube voltage of 100 kVp, automatic tube current modulation (noise index=10), and a contrast agent dose of 80 ml (flow rate 5 ml/s), with images reconstructed using the three-dimensional adaptive iterative dose reduction algorithm (AIDR). Group B (28 cases) underwent CTA with a tube voltage of 80 kVp, automatic tube current modulation (noise index=25), and a contrast agent dose of 40 ml (flow rate 3.5 ml/s), with images reconstructed using either the deep learning reconstruction algorithm-Advanced intelligent Clear-IQ Engine (AiCE subgroup) or the AIDR (AIDR subgroup). Two physicians evaluated the image quality of the three groups subjectively and objectively. Objective evaluation metrics included CT values, image noise (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) at the ascending aorta, carina-level descending aorta, celiac trunk-origin abdominal aorta, and common iliac bifurcation abdominal aorta carina. Subjective evaluation metrics included image quality and noise scores. Comparisons among the three datasets (Group A, AiCE subgroup, AIDR subgroup) were performed using one-way ANOVA or the Kruskal-Wallis test, with appropriate post-hoc tests for pairwise comparisons.Results:No significant differences were observed in CT values of the ascending aorta, descending aorta, and abdominal aorta between Group A and the AiCE subgroup or the AIDR subgroup ( P0.05). However, significant overall differences were found in SD, SNR, and CNR values for the ascending aorta, descending aorta, and abdominal aorta ( P0.05). Pairwise comparisons revealed that, except for no significant differences in SD, SNR, and CNR values of the ascending and descending aorta between Group A and the AiCE subgroup, and no significant difference in SNR values of the ascending and abdominal aorta between Group A and the AIDR subgroup ( P0.05), all other intergroup comparisons showed statistically significant differences ( P0.05). Significant overall differences were also observed in image quality and noise scores between Group A and the AiCE and AIDR subgroups ( P0.05). Except for no significant differences in image quality and noise scores between Group A and the AiCE subgroup ( P0.05), all other pairwise comparisons showed statistically significant differences ( P0.05). Conclusions:The application of deep learning reconstruction algorithm combined with a dual-low protocol in thoracoabdominal aortic CTA can reduce radiation dose and contrast agent dose while maintaining diagnostic image quality, demonstrating significant clinical value for widespread adoption.

The cultivation of innovation ability is not only the essential requirement of graduate education,but also the strate-gic demand of the development of the communist party and our country,and is of great significance to the realization of the Chinese dream of the great rejuvenation of the Chinese nation.Curriculum ideology and politics should run through the whole process of post-graduate innovation ability training.However,the curriculum ideology and politics and postgraduate innovation ability training lack deep integration.It's important for postgraduates'growth and scientific research innovation that the curriculum ideology and politics covers the whole process of scientific research activities.Therefore,this paper focuses on the design and specific implementation schemes of the curriculum ideology and politics on the postgraduate innovative ability training at the respiratory disease research team in the department of medical immunology.It makes a basis for optimizing postgraduate curriculum ideology and politics teaching in the future,which also provides ideas for cultivating innovative talents with both morality and ability in medical specialty.

Objective:To investigate the feasibility of deep learning reconstruction (DLR) algorithm combined with a dual-low protocol (low radiation dose and low contrast medium dose) for thoracoabdominal aortic CT angiography (CTA).Methods:This cross-sectional study prospectively enrolled 56 patients suspected of aortic diseases who underwent aortic CTA at China-Japan Friendship Hospital from June 2023 to June 2024. All patients were randomly divided into two groups: Group A (28 cases) underwent CTA with a tube voltage of 100 kVp, automatic tube current modulation (noise index=10), and a contrast agent dose of 80 ml (flow rate 5 ml/s), with images reconstructed using the three-dimensional adaptive iterative dose reduction algorithm (AIDR). Group B (28 cases) underwent CTA with a tube voltage of 80 kVp, automatic tube current modulation (noise index=25), and a contrast agent dose of 40 ml (flow rate 3.5 ml/s), with images reconstructed using either the deep learning reconstruction algorithm-Advanced intelligent Clear-IQ Engine (AiCE subgroup) or the AIDR (AIDR subgroup). Two physicians evaluated the image quality of the three groups subjectively and objectively. Objective evaluation metrics included CT values, image noise (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) at the ascending aorta, carina-level descending aorta, celiac trunk-origin abdominal aorta, and common iliac bifurcation abdominal aorta carina. Subjective evaluation metrics included image quality and noise scores. Comparisons among the three datasets (Group A, AiCE subgroup, AIDR subgroup) were performed using one-way ANOVA or the Kruskal-Wallis test, with appropriate post-hoc tests for pairwise comparisons.Results:No significant differences were observed in CT values of the ascending aorta, descending aorta, and abdominal aorta between Group A and the AiCE subgroup or the AIDR subgroup ( P0.05). However, significant overall differences were found in SD, SNR, and CNR values for the ascending aorta, descending aorta, and abdominal aorta ( P0.05). Pairwise comparisons revealed that, except for no significant differences in SD, SNR, and CNR values of the ascending and descending aorta between Group A and the AiCE subgroup, and no significant difference in SNR values of the ascending and abdominal aorta between Group A and the AIDR subgroup ( P0.05), all other intergroup comparisons showed statistically significant differences ( P0.05). Significant overall differences were also observed in image quality and noise scores between Group A and the AiCE and AIDR subgroups ( P0.05). Except for no significant differences in image quality and noise scores between Group A and the AiCE subgroup ( P0.05), all other pairwise comparisons showed statistically significant differences ( P0.05). Conclusions:The application of deep learning reconstruction algorithm combined with a dual-low protocol in thoracoabdominal aortic CTA can reduce radiation dose and contrast agent dose while maintaining diagnostic image quality, demonstrating significant clinical value for widespread adoption.

Objective:To investigate the clinical efficacy of compound sabal berry tablets on overactive bladder symptoms in patients with benign prostatic hyperplasia after transurethral laser enucleation of the prostate.Methods:This study was a prospective study. Eighty patients with benign prostatic hyperplasia who underwent laser enucleation at Tongliao People's Hospital from January 2024 to December 2024 were included in this study. The patients were randomly divided into a study group and a control group using the random number table method, with 40 patients per group. The control group received 0.2 mg of tolterodine tartrate tablets twice a day after surgery. The study group was given compound sabal berry tablets (0.5 g orally three times a day) in addition to the treatment provided to the control group. Both groups of patients were treated for 4 weeks after surgery. The clinical efficacy of the two groups was compared, including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Maximum Postoperative Urinary Flow Rate (Qmax), Post-Void Residual (PVR), and the incidence of postoperative bladder irritative symptoms.Results:The differences in the preoperative indicators, including IPSS, OABSS, Qmax, and PVR, between the two groups were not statistically significant (all P > 0.05). Preoperatively, in the control group, Qmax was (8.64 ± 2.83) mL/s, IPSS was (25.10 ± 4.37), OABSS was (10.52 ± 1.87), and PVR was (80.70 ± 6.34) mL; in the study group, the respective values were (9.12 ± 2.95) mL/s, (24.60 ± 4.53), (10.83 ± 1.73), and (80.10 ± 5.61) mL. Postoperatively, in the control group, Qmax was (20.30 ± 3.65) mL/s, IPSS was (8.50 ± 1.58), OABSS was (4.09 ± 0.52), and PVR was (9.70 ± 2.48) mL, while in the study group, the respective values were (21.40 ± 4.38) mL/s, (7.40 ± 1.76), (1.71 ± 0.36), and (9.00 ± 1.75) mL. Postoperatively, both groups showed a significant increase in Qmax, while IPSS, OABSS, and PVR all significantly decreased (all P < 0.05). Postoperatively, the IPSS and OABSS in the study group were significantly lower than those in the control group ( t = -3.28, -25.89, both P < 0.05). However, there were no statistically significant differences in Qmax and PVR between the two groups (both P > 0.05). The incidence of bladder irritative symptoms in the study group [12.50% (5/40)] was significantly lower than that in the control group [35.00% (14/40), χ2 = 8.64, P < 0.05]. Conclusions:Compound sabal berry tablets can reduce postoperative prostate symptoms and overactive bladder symptoms in patients undergoing transurethral laser enucleation of the prostate for benign prostatic hyperplasia, demonstrating a certain clinical efficacy.

Objective:To integrate implicit templates with deep learning techniques, a novel neural network, the tooth-deformable deep implicit network (T-DDIN), was constructed to achieve high-precision shape completion of tooth defects in a personalized manner.Methods:A total of 550 intraoral scan models were collected from patients treated at the Department of Orthodontics and Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University (500 for training and 50 for testing), between March 2022 and March 2024. T-DDIN reconstructed defective tooth morphology using an implicit template and a latent encoding prediction network. During model evaluation, Class Ⅱ cavity defects and occlusal wear defects were simulated in the test set. Morphological restoration was performed using both traditional computer aided design (CAD) methods and the T-DDIN deep learning approach. The two methods were compared based on three-dimensional deviation, occlusal adjustment volumes, cusp angle deviation, and restoration time.Results:The T-DDIN group demonstrated significantly lower three-dimensional deviation for Class Ⅱ cavity defects and occlusal wear restoration [(0.14±0.05) and (0.16±0.09) mm], occlusal adjustment volumes [(0.44±0.03) and (0.49±0.03) mm 3], and difference value of the tooth cusp angles (5.69°±1.90° and 6.04°±0.53°) compared to the traditional CAD group (both P<0.001). No significant differences were observed within the T-DDIN group between the two defect types in terms of three-dimensional deviation ( P=0.098) or occlusal adjustment volume ( P=0.154) or difference value of the tooth cusp angles ( P=0.196). However, in the traditional CAD group, three-dimensional deviation, occlusal adjustment volume and difference value of the tooth cusp angles was significantly higher in occlusal wear restorations than in Class Ⅱ cavity defects restorations ( P<0.001). The T-DDIN group, which involved Class Ⅱ cavity defects and occlusal wear, demonstrated significantly less recovery time of morphology (37.2±7.7) and (39.4±6.2) s compared to the traditional CAD group ( P<0.001). Conclusions:T-DDIN demonstrated superior stability and accuracy in morphological reconstruction for various types of dental defects while significantly reducing restoration time.

With rapid development of artificial intelligence(AI)technology,AI is reshaping new ecology in field of educa-tion.With promotion of AI,AI digital teaching materials will further clearly present knowledge context and build a new paradigm and new form of digital teaching materials.In context of general health,integration of medicine and prevention has become an important trend in medical and health field.However,at present,there is a lack of medical and preventive integration resources,and a single paper textbook cannot achieve depth and breadth of knowledge system of medical and preventive integration,which is difficult to adapt to development trend of AI enabling education.Therefore,it is urgent to use AI technology to develop and expand digital teaching materials for medical and prevention integration and realize resource penetration.Immune system is an important defense line of physi-cal diseases,and there is a close relationship between integration of medical and prevention.This paper aims to explore application path of developing digital teaching materials in medical education by AI technology.This concept of medical integration runs through every chapter and case analysis of AI textbooks,strengthening shift from"treatment-centered"to"health-centered"concept.Taking immune system as an example,this paper conducts in-depth analysis,develops and shares digital teaching materials by integrating medical knowledge,prevention strategies and AI technology,and provides new ideas and methods for medical education.

Objective:To integrate implicit templates with deep learning techniques, a novel neural network, the tooth-deformable deep implicit network (T-DDIN), was constructed to achieve high-precision shape completion of tooth defects in a personalized manner.Methods:A total of 550 intraoral scan models were collected from patients treated at the Department of Orthodontics and Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University (500 for training and 50 for testing), between March 2022 and March 2024. T-DDIN reconstructed defective tooth morphology using an implicit template and a latent encoding prediction network. During model evaluation, Class Ⅱ cavity defects and occlusal wear defects were simulated in the test set. Morphological restoration was performed using both traditional computer aided design (CAD) methods and the T-DDIN deep learning approach. The two methods were compared based on three-dimensional deviation, occlusal adjustment volumes, cusp angle deviation, and restoration time.Results:The T-DDIN group demonstrated significantly lower three-dimensional deviation for Class Ⅱ cavity defects and occlusal wear restoration [(0.14±0.05) and (0.16±0.09) mm], occlusal adjustment volumes [(0.44±0.03) and (0.49±0.03) mm 3], and difference value of the tooth cusp angles (5.69°±1.90° and 6.04°±0.53°) compared to the traditional CAD group (both P<0.001). No significant differences were observed within the T-DDIN group between the two defect types in terms of three-dimensional deviation ( P=0.098) or occlusal adjustment volume ( P=0.154) or difference value of the tooth cusp angles ( P=0.196). However, in the traditional CAD group, three-dimensional deviation, occlusal adjustment volume and difference value of the tooth cusp angles was significantly higher in occlusal wear restorations than in Class Ⅱ cavity defects restorations ( P<0.001). The T-DDIN group, which involved Class Ⅱ cavity defects and occlusal wear, demonstrated significantly less recovery time of morphology (37.2±7.7) and (39.4±6.2) s compared to the traditional CAD group ( P<0.001). Conclusions:T-DDIN demonstrated superior stability and accuracy in morphological reconstruction for various types of dental defects while significantly reducing restoration time.

Objective:To analyze the target signaling pathway of histone H3K27 methylation-induced podocyte injury, verify the regulatory effect of histone H3K27 methylation on podocyte injury in focal segmental glomerulosclerosis (FSGS) mice through target signaling pathway, and explore the mechanism of abnormal methylation of histone H3K27-induced podocyte injury in FSGS mice.Methods:(1) Cell experiments: primary cultured immortalized mouse podocytes MPC5 were cultured in vitro, and divided into control group, adriamycin (ADR) group, ADR+GSK-J4 (histone demethylase, KDM6B inhibitor) group, ADR+coumarin A1 (C-A1, JAK2 agonist) group and ADR+GSK-J4+C-A1 group. The transmission electron microscope was used to observe ultrastructure of podocytes. Immunofluorescence was used to detect the protein expression of H3K27me3 and nephrin in podocytes. The whole genome sequence of podocytes was obtained, the differentially expressed genes were screened, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were used for enrichment analysis. Real time-quantitative PCR and Western blotting were used to detect the gene and protein expression of JAK2-STAT3 signaling pathway in podocytes respectively. Enzyme-linked immunosorbent assay was used to detect interleukin 6 (IL-6), monocyte chemotactic protein 1 (MCP-1), α-smooth muscle actin (α-SMA) and transforming growth factor β1 (TGF-β1). (2) Animal experiments: EZH2 gene knock out ( EZH2podKo)-FSGS (tail vein injection of ADR) mouse models were established, and divided into EZH2ctrl+control group ( n=20), EZH2ctrl+FSGS ( n=20), EZH2podKo+control group ( n=30) and EZH2podKo+FSGS group ( n=30). HE staining was used to observe the morphology of kidney tissues. Immunohistochemistry was used to detect the H3K27me3 protein expression in podocytes. Real time-quantitative PCR and Western blotting were used to verify the gene and protein expression of JAK2-STAT3 signaling pathway respectively. Enzyme-linked immunosorbent assay was used to detect IL-6, MCP-1, α-SMA and TGF-β1 of kidney tissues. Results:(1) Cell experiments: Compared with control group, the nucleus shrank and ruptured, the cytoplasm showed vacuole, and mitochondria and endoplasmic reticulum swelled in ADR group, which verified that the podocyte injury model of ADR nephropathy was successfully established. Compared with control group, the protein expression level of H3K27me3 in ADR group was significantly lower ( P<0.05). Compared with ADR group, the protein expression level of H3K27me3 in podocytes in ADR+GSK-J4 group was significantly higher ( P<0.05), and there were 502 increased genes and 443 decreased genes. GO enrichment analysis showed that the differentially enriched peaks were mainly in ribonucleoprotein complex biogenesis, ribosome biogenesis, establishment of protein localization to organelle, and involved in regulation of receptor signaling pathway via JAK-STAT and receptor signaling pathway via JAK-STAT. Differential expressed genes were Irf1, Tnfrsf1a, S ocs1, Notch1, Gadd45a, Hes1 and Socs3, involving in the regulation of JAK-STAT signaling pathway. KEGG enrichment analysis showed that the differentially enriched peaks were mainly in amyotrophic lateral sclerosis, and the target genes were Mcl1, Egfr, Socs1, Cdkn1a, Pdgfa and Socs3, involving in the regulation of JAK-STAT signaling pathway. Compared with ADR group, the mRNA and protein expression levels of JAK2 and STAT3 in the ADR+GSK-J4 group were significantly lower, and the downstream inflammatory factors of IL-6, MCP-1 and α-SMA were significantly higher (all P<0.05). Compared with ADR group, the protein expression level of nephrin in ADR+GSK-J4 group was higher ( P<0.05), and the protein expression level of nephrin in ADR+C-A1 group was lower ( P<0.05). Compared with ADR+GSK-J4 group, the protein expression level of nephrin in ADR+GSK-J4+C-A1 group was lower ( P<0.05). (2) Animal experiments: Compared with EZH2ctrl+FSGS group, EZH2podKo+FSGS group showed obvious renal tissue damage, matrix hyperplasia in mesangial area with massive homogeneous substance deposition, apoptosis and necrosis of renal tubular epithelial cells, obvious thickening and extensive fusion of glomerular epithelial cells, basement membrane collapse, and compression and narrowing of capillary structure. Compared with EZH2ctrl+FSGS group, the protein expression level of H3K27me3 in EZH2podKo+FSGS group was significantly lower, and the mRNA and protein expression levels of JAK2 and STAT3, and the levels of IL-6, MCP-1, α-SMA and TGF-β1 were higher (all P<0.05). Conclusions:Abnormal methylation modification of H3K27 leads to change of target gene expression, activation of JAK2-STAT3 signaling pathway, podocyte injury, glomerulosclerosis and renal tubular injury, participating in the development of FSGS.

Objective:To assess the predictive value of the percentage of Gleason pattern 4 (G4%) in prostate biopsy for adverse pathology and biochemical recurrence.Methods:We retrospectively analyzed consecutive patients who underwent radical prostatectomy in our institution between January 2019 and December 2023, and included those who were diagnosed with ISUP 2-3 cancer at biopsy. A total of 109 patients were included in this study. The average age of patients was (67.40±6.11) years, and the average BMI of patients was (25.36±2.97) kg/m 2. 49 Cases (45.0%) had a PI-RADS score of 5, and the median prostate volume was 32.60 (24.57, 45.63) ml. The median of most recent tPSA before biopsy was 9.76 (6.89, 12.95) ng/ml, the median PSAD was 0.28 (0.17, 0.44) ng/ml 2, and the median f/tPSA was 0.11 (0.08, 0.16). Clinical T 2b or higher stage was found in 84 cases (77.1%). The total biopsy core length was (22.91±5.18) cm, with a median of 24 (20, 24) biopsy cores and a median of 6 (4, 9) positive cores. Gleason score 3+ 4 was found in 52 cases (47.7%), and Gleason score 4+ 3 in 57 cases (52.3%). Cribriform was present in 30 cases (27.5%). G4% was calculated based on the proportion of Gleason grade 4 tumor relative to total tumor, tumor proportion relative to total tissue, and tissue length. Patients were divided into high-G4% (≥2.45%) and low-G4% (<2.45%) groups based on the median G4% value, with 55 and 54 cases, respectively. No significant differences were observed in baseline characteristics between the two groups ( P>0.05). The main risk factor of adverse pathology was analyzed by logistic regression, and receiver operating characteristic (ROC) curve and area under curve (AUC) were performed. Patients were further stratified by the G4% cutoff value from ROC, and Kaplan-Meier survival curves were plotted to compare biochemical recurrence free survival (BCRFS) between groups. The main risk factor affecting BCRFS was analyzed by Cox regression. Adverse pathology was defined as postoperative Gleason score ≥4+ 3 or pathological stage ≥T 3a. Results:Adverse pathology occurred in 44 (80.0%) high-G4% and 16 (29.6%) low-G4% patients ( P<0.01). Multivariate analysis identified G4% as an independent risk factor for adverse pathology ( OR=1.23, 95% CI 1.02-1.50, P=0.033). The highest ROC AUC value was seen for G4% (0.799), significantly outperforming Gleason score (0.799 vs. 0.641, P=0.003), tPSA (0.799 vs. 0.615, P=0.003), PSAD (0.799 vs. 0.679, P=0.038), positive cores (0.799 vs. 0.677, P=0.009), clinical T stage (0.799 vs. 0.607, P=0.001) and cribriform (0.799 vs. 0.639, P=0.001). The G4% cutoff value for predicting biochemical recurrence was 10.97%. The median BCRFS was significantly higher in the low G4% (<10.97%) group than that in the high G4% (≥10.97%) group (55 vs. 28 months, P=0.002). Cumulative recurrence free survival rates at 1 and 3 years were 94.6% vs. 74.1% and 78.0% vs. 47.6%, respectively. Multivariate Cox regression analysis indicates that G4% was an independent risk factor affecting BCRFS ( HR=1.11, 95% CI 1.00-1.23, P=0.041). Conclusions:For patients with ISUP 2-3 nmPCa, a higher G4% in biopsy specimens demonstrates strong predictive ability for adverse pathology and biochemical recurrence, outperforming traditional clinical indicators such as Gleason score and PSA.