Objective To explore the impact of deep learning image reconstruction(DLIR)algorithms on image quality of chest CT,detection rate of lung nodule and reproducibility of lung nodule radiomics feature data compared with adaptive statistical iterative reconstruction V(ASIR-V)algorithms.Methods Seventy-five patients with 211 lung nodules who underwent both ultra-low-dose CT(ULD-CT)and standard-dose CT(SDCT)were prospectively enrolled.ULD-CT images were reconstructed using different algorithms,namely high-level DLIR(DLIR-H),medium-level DLIR(DLIR-M)and 50％ASIR-V(50％ASIR-V),while SDCT images were reconstructed by 50％ASIR-V.Image noise was represented by the standard deviation(SD)of lung parenchyma CT values within identical ROI in both ULD-CT and SDCT images,and signal-to-noise ratio(SNR)were calculated.The detection rate of lung nodule were obtained and compared among different images.Radiomics features of lung nodules in chest 50％ASIR-V SDCT and each ULD-CT were extracted based on automatic segmentation methods,and intra-class correlation coefficients(ICC)of each ULD-CT and 50％ASIR-V SDCT were calculated respectively,and then compared among different ULD-CT algorithms.Results Compared with SDCT images reconstructed with 50％ASIR-V algorithm,all ULD-CT images reconstructed by different algorithms showed higher SD and lower SNR(all P＜0.05).ULD-CT images reconstructed by DLIR-H,DLIR-M and 50％ASIR-V exhibited progressively increasing SD and decreasing SNR(all adjusted P＜0.05).Taken 50％ASIR-V SDCT images as standards,ULD-CT by DLIR-H,DLIR-M and 50％ASIR-V each detected 207 lung nodules(207/211,98.10％),respectively.In chest ULD-CT images,the reproducibility with 50％ASIR-V SDCT for texture feature data of lung nodules on ULD-CT reconstructed by 50％ASIR-V algorithm was lower than that by DLIR-H and DLIR-M(both adjusted P＜0.05),while no significant difference was found between the latter two with 50％ASIR-V SDCT(adjusted P＞0.05).The first order and shape feature data of lung nodules on ULD-CT reconstructed by all 3 algorithms showed good reproducibility with 50％ASIR-V SDCT(median ICC＞0.75),and no significant difference was detected among them(all P＞0.05).Conclusion Compared with 50％ASIR-V ULD-CT,both DLIR-H and DLIR-M ULD-CT could significantly reduce image noise and improve image quality,as well as maintain reproducibility of radiomics features in lung nodules in a certain degree,especially DLIR-H.

Objective To explore the impact of deep learning image reconstruction(DLIR)algorithms on image quality of chest CT,detection rate of lung nodule and reproducibility of lung nodule radiomics feature data compared with adaptive statistical iterative reconstruction V(ASIR-V)algorithms.Methods Seventy-five patients with 211 lung nodules who underwent both ultra-low-dose CT(ULD-CT)and standard-dose CT(SDCT)were prospectively enrolled.ULD-CT images were reconstructed using different algorithms,namely high-level DLIR(DLIR-H),medium-level DLIR(DLIR-M)and 50％ASIR-V(50％ASIR-V),while SDCT images were reconstructed by 50％ASIR-V.Image noise was represented by the standard deviation(SD)of lung parenchyma CT values within identical ROI in both ULD-CT and SDCT images,and signal-to-noise ratio(SNR)were calculated.The detection rate of lung nodule were obtained and compared among different images.Radiomics features of lung nodules in chest 50％ASIR-V SDCT and each ULD-CT were extracted based on automatic segmentation methods,and intra-class correlation coefficients(ICC)of each ULD-CT and 50％ASIR-V SDCT were calculated respectively,and then compared among different ULD-CT algorithms.Results Compared with SDCT images reconstructed with 50％ASIR-V algorithm,all ULD-CT images reconstructed by different algorithms showed higher SD and lower SNR(all P＜0.05).ULD-CT images reconstructed by DLIR-H,DLIR-M and 50％ASIR-V exhibited progressively increasing SD and decreasing SNR(all adjusted P＜0.05).Taken 50％ASIR-V SDCT images as standards,ULD-CT by DLIR-H,DLIR-M and 50％ASIR-V each detected 207 lung nodules(207/211,98.10％),respectively.In chest ULD-CT images,the reproducibility with 50％ASIR-V SDCT for texture feature data of lung nodules on ULD-CT reconstructed by 50％ASIR-V algorithm was lower than that by DLIR-H and DLIR-M(both adjusted P＜0.05),while no significant difference was found between the latter two with 50％ASIR-V SDCT(adjusted P＞0.05).The first order and shape feature data of lung nodules on ULD-CT reconstructed by all 3 algorithms showed good reproducibility with 50％ASIR-V SDCT(median ICC＞0.75),and no significant difference was detected among them(all P＞0.05).Conclusion Compared with 50％ASIR-V ULD-CT,both DLIR-H and DLIR-M ULD-CT could significantly reduce image noise and improve image quality,as well as maintain reproducibility of radiomics features in lung nodules in a certain degree,especially DLIR-H.

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic pulmonary infection that commonly occurs in immunocompromised children. We report a case of infantile leukemia complicated by PJP and review the relevant literature. A summary and analysis of 10 infantile leukemia patients with PJP infection (9 cases reported in the literature and 1 case from our center) showed that PJP mostly occurred in the early stages of chemotherapy (80%, 8/10). The main clinical manifestations were dyspnea (100%, 10/10) and hypoxemia (50%, 5/10), while pulmonary imaging findings lacked specificity. In most cases (50%, 5/10), diagnosis was established by identifying pathogens in bronchoalveolar lavage fluid under microscopy. In our case, diagnosis was confirmed using targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid. Treatment with intravenous sulfamethoxazole complex was administered in 8 patients, all of whom eventually recovered. PJP may occur in the early stages of chemotherapy for infantile leukemia, thus early prevention is necessary. tNGS facilitates early diagnosis of PJP, and sulfamethoxazole complex remains an effective therapeutic option.
Humans ; Infant ; Bronchoalveolar Lavage Fluid/microbiology* ; Immunocompromised Host ; Leukemia/complications* ; Pneumocystis carinii/isolation & purification* ; Pneumonia, Pneumocystis/diagnosis* ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use*

Objective:To investigate the training needs of general practitioners in community health center in health care and management of older patients for developing a curriculum for the Extension for Community Health Outcomes (ECHO) project accordingly.Methods:This was a qualitative study. The semi-structured interviews were conducted with 20 community health center general practitioners (GPs) using focus groups between March 2024 and April 2024. The interview data were collated using Nvivo12 software and coded using thematic analysis. The focus of the interviews was on the challenges GPs face in health care of older people in the community and relevant training needs.Results:Three male and 17 female GPs took part in the interviews. The interviews showed that GPs in comminity health service centers faced multiple challenges in the helth management of older patients, including implementation of holistic treatment plans, time-consuming comprehensive patient assessment, lack of standardized medication selection, unclear referral processes and difficulties in establishing a trusting doctor-patient relationship. The study suggested that the design and development of training programs should encompass eight core components: differentiated end-of-life care for patients, nutritional advice, positive psychological intervention, software data-based health assessment, systematic geriatric medicine, updated clinical research findings, medication selection and treatment guidelines, and insulin resistance management.Conclusion:Through qualitative investigation, this study explored the challenges faced by general practitioners in providing health care for older patients and relevant training needs, which provids evidence for designing and developing corresponding curricula for ECHO projects.

Objective:To investigate the training needs of general practitioners in community health center in health care and management of older patients for developing a curriculum for the Extension for Community Health Outcomes (ECHO) project accordingly.Methods:This was a qualitative study. The semi-structured interviews were conducted with 20 community health center general practitioners (GPs) using focus groups between March 2024 and April 2024. The interview data were collated using Nvivo12 software and coded using thematic analysis. The focus of the interviews was on the challenges GPs face in health care of older people in the community and relevant training needs.Results:Three male and 17 female GPs took part in the interviews. The interviews showed that GPs in comminity health service centers faced multiple challenges in the helth management of older patients, including implementation of holistic treatment plans, time-consuming comprehensive patient assessment, lack of standardized medication selection, unclear referral processes and difficulties in establishing a trusting doctor-patient relationship. The study suggested that the design and development of training programs should encompass eight core components: differentiated end-of-life care for patients, nutritional advice, positive psychological intervention, software data-based health assessment, systematic geriatric medicine, updated clinical research findings, medication selection and treatment guidelines, and insulin resistance management.Conclusion:Through qualitative investigation, this study explored the challenges faced by general practitioners in providing health care for older patients and relevant training needs, which provids evidence for designing and developing corresponding curricula for ECHO projects.

Objective:To explore the efficacy of online pulmonary rehabilitation (PR) management among community-dwelling patients with stable chronic obstructive pulmonary disease (COPD).Methods:This study was a single-center randomized controlled trail with an unblinded design. A total of 130 patients with stable COPD who visited Zhuanqiao Community Health Service Center in Shanghai Minhang District from October 2020 to March 2022 were randomly divided into study group and control group with 65 cases in each group. Both groups received conventional treatment, while patients in study group attended online rehabilitation management, including face-to-face rehabilitation instruction and multiple online guidance. Pulmonary ventilation function including forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1) and percentage of forced expiratory volume in the first second to forced expiratoty volume (FEV 1%pred), modified British Medical Research Council Dyspnea Scale (mMRC), chronic obstructive pulmonary disease assessment test (CAT), score of 6 minutes walking distance (6MWD) and DOSE (dyspnea, degree of airflow obstruction, smoking status, the number of exacerbation) index were measured at baseline and after 8 weeks of rehabilitation, and compared between two groups. Results:The baseline data of the two groups were comparable. After 8 weeks of management, FVC, FEV 1, FEV 1%pred, mMRC, CAT, 6MWD and DOSE index of both groups were improved compared with the baseline level(control group: t=-7.799, -7.581, -9.010, 3.565, 9.887, -16.677, 3.795; study group: t=-12.623, -13.914, -17.644, 7.404, 22.457, -26.826, 7.968; all P<0.05). The FEV 1%pred, CAT and 6MWD in the study group were better than those in the control group ( t=-2.939, 2.277,-2.130, all P<0.05); while there were no significant differences in FVC, FEV 1, mMRC and DOSE index between the two groups( t=-0.162, -1.280, 0.925, 1.939,all P>0.05). Conclusions:The online pulmonary rehabilitation management can better improve lung function, dyspnea symptoms and exercise tolerance of patients with stable COPD, which can be used for rehabilitation training and management of community-dwelling patients.

BACKGROUND:Endothelial injury is one of the causes of cardiovascular diseases.Human induced pluripotent stem cells are easy to obtain,have strong differentiation ability,and have less exclusiveness,and their endothelial differentiated cells can be used as ideal cells for cardiovascular disease research. OBJECTIVE:To investigate the effect and mechanism of calycosin on endothelial differentiation of human induced pluripotent stem cells and to provide technical support for microvascular regeneration. METHODS:Human induced pluripotent stem cells were divided into control group and calycosin group(1.25,2.5 μg/mL),and growth factors were added to induce single-layer endothelial differentiation.After the induction of differentiation for 8 days,the positive rate of endothelial cell marker CD144 was detected by flow cytometry.Fluorescent expressions of CD144 and CD31 were detected by the immunofluorescence method.Lentivirus RNAi GFP puromycin was used to silence human-induced pluripotent stem cell Piezo1 mRNA followed by endothelial directed differentiation.After 8 days of differentiation,the positive rate of CD144 in differentiated cells was detected by flow cytometry.The mRNA expression levels of CD144,Piezo1 and MEK were detected by qPCR. RESULTS AND CONCLUSION:(1)Compared with the control group,the positive rate of CD144 was significantly increased in the 1.25 and 2.5 μg/mL calycosin groups(P<0.05).The expressions of CD144,Piezo1,and MEK mRNA were increased in the 2.5 μg/mL calycosin group(P<0.05).The fluorescence expressions of CD144(P<0.01)and CD31(P<0.001)were significantly increased in the 2.5 μg/mL calycosin group.(2)Compared with the shNT group,CD144 positive rate and CD144,Piezo1,MEK mRNA expressions were significantly increased in the shNT + calycosin 1.25,2.5 μg/mL groups(P<0.05).Compared with the shPiezo1 group,the positive rate of CD144 and mRNA expressions of CD144,Piezo1 and MEK had no significant changes in the shPiezo1+calycosin 1.25,2.5 μg/mL groups(P>0.05).(3)It is concluded that 2.5 μg/mL calycosin promotes the differentiation of human-induced pluripotent stem cells into endothelial lineages.Calycosin promotes the downstream MEK expression,thereby promoting the endothelial differentiation of human induced pluripotent stem cells by targeting the expression level of Piezo1.

Objective:To assess the validity and reliability of the depression and somatic symptoms scale among patients with coronary heart disease.Methods:Totally 246 patients with coronary heart disease were assessed with depression and somatic symptoms scale (DSSS), Hamilton depression rating scale for depression (HAMD) and patients’ health questionnaire depression scale-9 item (PHQ-9). The structural validity was evaluated with exploratory factor analysis and confirmatory factor analysis. The validity as a screening tool was evaluated with the gold standard diagnosed by psychiatrists who were trained with the mini international neuropsychological interview (MINI) according to ICD-10. Receiver operating characteristic (ROC) curve was used to identify cutoff scores for depression. Cronbach α coefficient was used to evaluate the internal consistency.Results:Exploratory factor analysis yielded two factors: depression factor and somatic factor, and the cumulative variance was 51.8%. The fitting indexes of confirmatory factor analysis were as follows: χ2/ df=3.636, RMR=0.077, RMSEA=0.104, IFI=0.804, TLI=0.781, CFI=0.802. The intraclass correlation coefficient of DSSS and HAMD was 0.54. The area under ROC curve (AUC) was 0.828, and the best boundary value was 17 points (sensitivity and specificity: 81% and 75%, respectively). The total scores and subscale scores for internal consistency of DSSS were higher in the depression group than those in the non-depression group ( P<0.01). Cronbach α coefficient for internal consistency of DSSS was 0.917. Conclusion:The DSSS has good validity and reliability among patients with coronary heart disease for screening depression, and can be used to screen depression among patients with coronary heart disease in general hospital.

Objective:To explore the clinical features and survival of newly diagnosed follicular lymphoma (FL) patients with diffuse large B-cell lymphoma (DLBCL) component.Methods:1845 newly diagnosed FL patients aged ≥ 18 years with grades 1-3a in 11 medical centers in China from 2000 to 2020 were included, and patients with DLBCL component were screened. The clinical data and survival data of the patients were retrospectively analyzed, and the prognostic factors were screened by univariate and multivariate analysis.Results:146 patients (7.9% ) with newly diagnosed FL had DLBCL component. The median age was 56 (25-83) years, 79 males (54.1% ) . The pathology of 127 patients showed the proportion of DLBCL component. Patients were divided into two groups according to whether the proportion of DLBCL component was ≥ 50% . The study found that patients with DLBCL component ≥ 50% had higher grade 3 ratio (94.3% vs 91.9% , P=0.010) , Ki-67 index ≥ 70% ratio (58.5% vs 32.9% , P=0.013) and PET-CT SUVmax ≥ 13 ratio (72.4% vs 46.3% , P=0.030) than patients with DLBCL component<50% . All patients received CHOP or CHOP like ± rituximab chemotherapy. The overall response rate (ORR) was 88.2% , and the complete response (CR) rate was 76.4% . In the groups with different proportions of DLBCL component, there was no significant difference in the remission rate after induction treatment and the incidence of disease progression within 2 years after initiation of treatment (POD24) ( P<0.05) . The overall estimated 5-year progression free survival (PFS) rate was 58.9% , and the 5-year overall survival (OS) rate was 90.4% . The 5-year OS rate of POD24 patients was lower than that of non POD24 patients (70.3% vs 98.5% , P<0.001) . Compared with non maintenance treatment of rituximab, maintenance treatment of rituximab could not benefit the 5-year PFS rate (57.7% vs 58.8% , P=0.543) , and the 5-year OS rate had a benefit trend, but the difference was not statistically significant (100% vs 87.8% , P=0.082) . Multivariate analysis showed that failure to reach CR after induction treatment was an independent risk factor for PFS ( P=0.006) , while LDH higher than normal was an independent risk factor for OS ( P=0.031) . Conclusion:FL patients with DLBCL component ≥50% have more invasive clinical and pathological features. CHOP/CHOP like ± rituximab regimen can improve the clinical efficacy of patients. Rituximab maintenance therapy can not benefit the PFS and OS of patients. Failure to reach CR after induction therapy was the independent unfavorable factor for PFS.

Objective:To explore the feasibility of prenatal ultrasound in predicting delivery mode of full-term primipara.Methods:The study prospectively enrolled primiparas with gestational age ≥37 weeks, singleton, cephalic and no contraindications to vaginal delivery who underwent routine prenatal examination in the Third Affiliated Hospital of Sun Yat-sen University from September 2020 to February 2021.In addition to routine fetal ultrasound examination, the transperineal ultrasound examination was performed to assess the angle of progression (AOP), head perineum distance (HPD), the angle of pubic arch and the anteroposterior diameter, left and right diameter, area and perimeter of levator ani hiatus of pregnant women in different states were measured; Cervical length (CL) was examined by transvaginal ultrasound. The delivery mode was tracked, and the indicators related to natural delivery were screened out. Receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of relevant indicators in predicting natural delivery.Results:A total of 142 cases were included in this study, including 112 cases of natural delivery and 30 cases of manual intervention delivery. There were no significant differences in age, gestational weeks, biparietal diameter, head circumference, body mass index (BMI) and neonatal weight between the natural delivery group and the manual intervention delivery group (all P>0.05). Multivariate regression analysis showed that AOP was associated with natural delivery( OR=1.048, P=0.008). ROC curve analysis showed that the area under the curve was 0.648 with AOP 96.92° as the node, and the specificity and positive predictive values were 83.33% and 0.909 1 respectively. Conclusions:It is feasible to predict the mode of delivery by prenatal ultrasound in full-term primiparas. AOP is related to the mode of delivery, which can provide more reference information for clinical practice.