Objective To investigate the preoperative predictive value of clinical-radiomics nomogram on N1-N2 lymph node metastasis in patients with stage Ⅰ to Ⅲ A primary lung adenocarcinoma(PL A).Methods A total of 164 PLA patients were divided into a training set(n=114)and an validation set(n=50).Three logistic regression models were created separately and the predictive efficacy of the model was evaluated using the receiver operating characteristic(ROC)curve and area under the curve(AUC)respectively.The AUC difference between models was tested by the DeLong test.The calibration degree was evaluated by the calibration curve.Decision curve analysis was performed to evaluate the benefits of clinical application.Results The radiomics model consisted of 8 imaging features[Radiomics score(Radscore)].The clinical model was composed of tumor type(central or peripheral)and tumor size.The tumor type,tumor size and Radscore formed the nomogram model.In the training set,the prediction of the nomogram model was more effective(AUC=0.909)than the clinical model(AUC=0.748)and the radiomics model(AUC=0.814),while the differences in AUC were statistically significant(P＜0.05).In the validation set,the prediction of the nomogram model was more effective(AUC=0.875)than the clinical model(AUC=0.682),and the difference in AUC was statistically significant(P＜0.05).The prediction of the nomogram model was also more effective than the radiomics model(AUC=0.799),but the difference in AUC was not statistically significant(P＞0.05).The calibration curve showed that the clinical-radiomics nomogram had a high level of calibration and the decision curve analysis showed good benefits from clinical application.Conclusion The clinical-radiomics nomogram is proven to be more effective than radiomics or clinical factors alone in the preoperative prediction of stage Ⅰ to Ⅲ A PLA N1-N2 lymph node metastasis.

Objective:To study the diagnostic value of artificial intelligence B-ultrasound image computer-aided diagnosis system (hereinafter referred to as intelligent ultrasound system) in adult goiter.Methods:In June 2022 and March 2023, two phases of thyroid disease survey were carried out in 4 cities in Anhui Province. One village was selected in each city, and 250 adults were selected as survey subjects in each village. Adult bilateral thyroid area was scanned by both intelligent ultrasound system and conventional ultrasound scanning equipment, and the effectiveness of intelligent ultrasound system in the diagnosis of goiter was analyzed based on the results of conventional ultrasound examination. Receiver operating characteristic (ROC) curve was drawn, and Kappa test was used to analyze the consistency between intelligent ultrasound system and conventional ultrasound examination in the diagnosis of goiter. At the same time, Spearman correlation analysis and Bland-Altman method were used to evaluate the consistency of the two methods in measuring thyroid volume.Results:After screening and removing outliers and missing values, a total of 910 adults were included, including 253 males (27.80%) and 657 females (72.20%). The age was (45.92 ± 10.20) years old, ranging from 18 to 60 years old. The sensitivity, specificity, and accuracy of the intelligent ultrasound system for diagnosing adult goiter were 80.00%, 99.67%, and 99.56%, respectively. The area under the ROC curve (AUC) was 0.996, which was consistent with the results of conventional ultrasound examination for diagnosing goiter ( κ = 0.67, P < 0.001). After controlling for variables such as gender, thyroid function, and thyroid nodules, the intelligent ultrasound system showed good consistency with conventional ultrasound examination in the diagnosis of goiter in females, adults with thyroid dysfunction, and adults without thyroid nodules ( κ = 0.66, 0.80, 0.80, P < 0.001). The consistency in the diagnosis of goiter in adults with thyroid nodules was moderate ( κ = 0.56, P < 0.001). Spearman correlation analysis showed a highly positive correlation between the measurement results of adult thyroid volume by intelligent ultrasound system and conventional ultrasound examination ( r = 0.88, P < 0.001). The Bland-Altman method results showed that only 4.62% (42/910) of points in adults were outside the 95% consistency limit, indicating good consistency between intelligent ultrasound system and conventional ultrasound examination in measuring thyroid volume (< 5%). The proportion of points outside the 95% consistency limit in males, adults with thyroid dysfunction, and adults with thyroid nodules was 6.72% (17/253), 5.83% (12/206), and 6.45% (12/186), respectively. Conclusions:The intelligent ultrasound system has certain diagnostic value for adult goiter and has good consistency with conventional ultrasound examination for thyroid volume measurement. However, the accuracy of diagnosis for males and adults with thyroid nodules still needs to be improved.

Goiter is a kind of non-inflammatory and non-neoplastic hyperplasia and enlargement. Many studies have shown that substances such as thiocyanates and isothiocyanates can prevent the development of a variety of tumors. However, some studies have also found that such substances can lead to goiter. In this article, relevant information on common goitrogen in food are collected to explore their mechanism of action, laying a foundation for guiding residents to maintain a healthy and balanced diet.

Objective:To observe the regulatory effect of microRNA-10b(miR-10b)on the immune effect of glioma cells and explore its mechanism.Methods:Human glioma cell U251 was cultured to obtain cells in logarithmic growth stage.The cell suspen-sion was prepared according to the concentration of 1.0×105 cells/ml,and the control group,overexpression group,low expression group and blank group were set up,with 6 wells in each group.The negative control,miR-10b mimics and miR-10b inhibitor were transfected by liposome transfection in control group,overexpression group and low expression group,respectively.The blank group was given the same amount of sterile normal saline.Natural killer(NK)cells from peripheral blood of a healthy volunteer was isolated and cultured.The killing activity of NK cells was detected by MTT method.The expression of NK cell activated receptor(NKG2D)on the surface of NK cells in each group were detected by flow cytometry,and the expression of major histocompatibility complex class Ⅰ chain-related gene A(MICA),UL16 binding protein 2(ULBP2)and UL16 binding protein 3(ULBP3)on the surface of U251 hu-man glioma cells in each group were detected.Results:The transfection efficiency of control group,overexpression group and low ex-pression group were(93.55±2.05)％,(95.67±3.14)％,(94.18±3.26)％,respectively.Compared with control group and blank group,the expression of miR-10b increased in overexpression group and decreased in low expression group,and the difference were statisti-cally significant(P<0.05).There was no significant difference in the expression of miR-10b between control group and blank group(P>0.05).Compared with control group and blank group,the killing activity of NK cells with different effect target ratios in overex-pression group decreased,the expression of NKG2D decreased,the killing activity of NK cells with different effect target ratios in low expression group increased,and the expression of NKG2D increased,and the difference were statistically significant(P<0.05).The killing activity of NK cells in each group increased with the increase of effect target ratio,and the difference were statistically signifi-cant(P<0.05),and there was no significant difference in NK cell killing activity and NKG2D expression between control group and blank group(P>0.05).Compared with control group and blank group,the expression of MICA,ULBP2 and ULBP3 on the surface of human glioma cell U251 in overexpression group decreased,and the expression of MICA,ULBP2 and ULBP3 on the surface of human glioma cell U251 in low expression group increased,the difference were statistically significant(P<0.05),and there was no signifi-cant difference in the expression of MICA,ULBP2 and ULBP3 on the surface of U251 glioma cells between control group and blank group(P>0.05).Conclusion:Inhibiting the expression of miR-10b can increase the expression of NKG2D on the surface of NK cells and MICA,ULBP2 and ULBP3 on the surface of human glioma cell U251,and enhance the killing activity of NK cells against human glioma cell U251.

Objective:Multidrug-resistant tuberculosis(MDR-TB)has a high mortality and is always one of the major challenges in global TB prevention and control.Analyzing the factors that may impact the adverse outcomes of MDR-TB patients is helpful for improving the systematic management and optimizing the treatment strategies for MDR-TB patients.For follow-up data,the Cox proportional hazards regression model is an important multifactor analysis method.However,the method has significant limitations in its application,such as the fact that it is difficult to deal with the impacts of small sample sizes and other practical issues on the model.Therefore,Bayesian and conventional Cox regression models were both used in this study to analyze the influencing factors of death in MDR-TB patients during the anti-TB therapy,and compare the differences between these 2 methods in their application. Methods:Data were obtained from 388 MDR-TB patients treated at Lanzhou Pulmonary Hospital from November 1,2017 to March 31,2021.Survival analysis was employed to analyze the death of MDR-TB patients during the therapy and its influencing factors.Conventional and Bayesian Cox regression models were established to estimate the hazard ratios(HR)and their 95% confidence interval(95% CI)for the factors affecting the death of MDR-TB patients.The reliability of parameter estimation in these 2 models was assessed by comparing the parameter standard deviation and 95% CI of each variable.The smaller parameter standard deviation and narrower 95% CI range indicated the more reliable parameter estimation. Results:The median survival time(1st quartile,3rd quartile)of the 388 MDR-TB patients included in the study was 10.18(4.26,18.13)months,with the longest survival time of 31.90 months.Among these patients,a total of 12 individuals died of MDR-TB and the mortality was 3.1%.The median survival time(1st quartile,3rd quartile)for the deceased patients was 4.78(2.63,6.93)months.The majority of deceased patients,accounting for 50%,experienced death within the first 5 months of anti-TB therapy,with the last mortality case occurring within the 13th month of therapy.The results of the conventional Cox regression model showed that the risk of death in MDR-TB patients with comorbidities was approximately 6.96 times higher than that of patients without complications(HR=6.96,95% CI 2.00 to 24.24,P=0.002)and patients who received regular follow-up had a decrease in the risk of death by approximately 81% compared to those who did not receive regular follow-up(HR=0.19,95% CI 0.05 to 0.77,P=0.020).In the results of Bayesian Cox regression model,the iterative history plot and Blue/Green/Red(BGR)plot for each parameter showed the good model convergence,and parameter estimation indicated that the risk of death in patients with a positive first sputum culture was lower than that of patients with a negative first sputum culture(HR=0.33,95% CI 0.08 to 0.87).Additionally,compared to patients without complications,those with comorbidities had an approximately 6.80-fold increase in the risk of death(HR=7.80,95% CI 1.90 to 21.91).Patients who received regular follow-up had a 90% reduction in the risk of death compared to those who did not receive regular follow-up(HR=0.10,95% CI 0.01 to 0.30).The comparison between these 2 models showed that the parameter standard deviations and corresponding 95% CI ranges of other variables in the Bayesian Cox model were significantly smaller than those in the conventional model,except for parameter standard deviations of receiving regular follow-up(Bayesian model was 0.77;conventional model was 0.72)and pulmonary cavities(Bayesian model was 0.73;conventional model was 0.73). Conclusion:The first year of anti-TB therapy is a high-risk period for mortality in MDR-TB patients.Complications are the main risk factors of death in MDR-TB patients,while patients who received regular follow-up and had positive first sputum culture presented a lower risk of death.For data with a small sample size and low incidence of outcome,the Bayesian Cox regression model provides more reliable parameter estimation than the conventional Cox model.

Objective: To understand the current situation and trends of anemia among kindergarten children in urban area of Suzhou from 2018 to 2022, so as to provide a theoretical basis for prevention and intervention in anemia among kindergarten children. Methods: From March 2023, a total of 24 178 person times of children from 59 kindergartens selected by random number table method were enrolled, and their physical examination data from 2018 to 2022 were collected, including hemoglobin (Hb), height, gender, weight. The period of 2018-2019 was defined as before the COVID-19 epidemic, and period of 2020-2022 was defined as the COVID-19 epidemic. Data were analyzed using the Mann Whitney U test, χ 2 test and Spearman s correlation analysis. Results: From 2018 to 2019, the M ( P 25 ， P 75 ) of Hb levels of children in nursery, middle, and senior class were 118 (112, 129), 120 (112, 132) and 122 (113, 134)g/L, respectively, which were higher than that of during 2020-2022 [116(110, 123), 117(111, 124) , 119(112, 126)g/L, Z =-10.7, -12.7, -12.9, P <0.05]. A total of 4 584 person times of children were anemic, with a detection rate of 19.0%. The overall anemia detection rate of kindergarten children during 2018-2019 was lower than that in 2020-2022 (15.3% vs 20.7%, χ 2=100.8, P <0.05). The anemia detection rate of kindergarten children in 2022 (24.5%) was higher than that in 2020 (20.6%) and in 2021 (17.0%) ( χ 2=93.9, P <0.05). The anemia prevalence of children in the nursery, middle, and senior class were 13.9%, 14.7% and 17.1% during 2018-2019, 19.3%, 15.9% and 26.6% during 2020-2022, and 17.6%, 15.5% and 23.6% during 2018-2022, respectively ( χ 2=10.7, 204.6, 186.8, P <0.01). There was no statistically significant correlation between Hb values and body mass index (BMI) in boys and girls with anemia, and all children in kindergarten ( r=0.03, 0.03, 0.09, P ＞0.05). Conclusion The prevalence of anemia among kindergarten children in the urban area of Suzhou is relatively high. The COVID-19 pandemic may have increased the risk of anemia among children.

The study is to explore the diagnostic value of magnetic resonance imaging (MRI) for endometrial carcinoma. Clinical data of 199 patients with endometrial cancer confirmed by diagnostic uterine curettage in the Second Hospital of Jilin University and the People′s Hospital of Xinjiang Uygur Autonomous Region from June 2017 to December 2019 were reviewed retrospectively. The data were analyzed by SPSS 21.0 software. MRI scan was performed before operation, the diagnostic accuracy of MRI for the preoperative staging of endometrial carcinoma was 85.9%(171/199) with postoperative pathological results as gold standard. The Kappa values of muscular infiltration, cervical infiltration and lymph node metastasis were 0.353, 0.574 and 0.573, respectively ( P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for myometrial invasion on MRI were 45.2%(19/42), 88.5%(139/157), 51.4%(19/37), 85.8%(139/162) and 79.4%(158/199), respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for cervical invasion on MRI were 58.3% (14/24), 96.0%(168/175), 66.7% (14/21), 94.4%(168/178)and 91.5%(182/199), respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for lymph node metastasis on MRI were 12/18, 95.6%(173/181), 60.0%(12/20), 96.6%(173/179)and 93.0%(185/199), respectively. The results indicate that MRI has high accuracy and negative predictive rate in evaluation of preoperative staging of endometrial cancer.

Objective:To construct a drug knowledge base based on drug instructions.Methods:Six hundred randomly selected drug instructions were labeled manually and divided into training set and test set. The training was based on bidirectional long short-term memory(Bi-LSTM) and conditional random fields(CRF) model to complete the recognition of medical entities. The extracted entities were standardized by the hybrid model of " similarity calculation and rule mapping table" , and then the drug information was imported into the Access database.Results:In the task of named entity recognition based on Bi-LSTM and CRF model, except for the crowd entities, the other entities had achieved good results with an F-value higher than 85%. Based on the hybrid model of " similarity calculation and rule mapping table" , the accuracy of entity standardization was 88.23%.Conclusions:The effect of the machine learning model in this study is similar to that of other named entity recognition and entity standardization studies, which can complete the task of drug knowledge base construction satisfactorily.

Objective:To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit (ICU) with different admission methods, in order to make more effective and rational use of ICU resources.Methods:A retrospective study was conducted. The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed. According to the admission mode to ICU, the pregnant women were divided into emergency admission group (transferred to ICU on the same day or the next day due to critical illness) and planned admission group (transferred to ICU 2 days after admitting in obstetric ward). The clinical characteristics of ICU critical pregnant women, such as the incidence, causes of admission, severity of the disease, main treatment measures, mortality, and medical expenses were collected, and a comparative analysis between the two groups was performed.Results:During the nearly 14 years, a total of 576 critical pregnant women in ICU were enrolled, accounting for 0.8% (576/71 790) of the total number of obstetric inpatients and 4.6% (576/12 412) of the total number of ICU inpatients. Seven maternal deaths accounted for 1.2% of all critically pregnant women transferred to ICU, and the overall mortality of pregnant women was 10/100 thousand. Of the 576 critically pregnant women, there were 327 patients (56.8%) in the emergency admission group and 249 patients (43.2%) in the planned admission group. Compared with the planned admission group, the proportion of elective cesarean section in the emergency admission group was significantly lower (17.7% vs. 94.0%, P < 0.01), and the proportion of emergency cesarean section was significantly higher (65.1% vs. 2.4%, P < 0.01), the acute physiology and chronic health evaluation (APACHE Ⅱ, APACHE Ⅲ) scores, simplified acute physiology score Ⅱ (SAPS Ⅱ) and Marshall score were significantly higher [APACHE Ⅱ score: 6.0 (4.0, 9.8) vs. 4.0 (3.0, 7.0), APACHE Ⅲ score: 14.0 (11.0, 20.3) vs. 12.0 (9.0, 16.0), SAPS Ⅱ score: 8 (0, 12) vs. 3 (0, 8), Marshall score: 2 (1, 4) vs. 1 (1, 3), all P < 0.01]. The length of ICU stay in the emergency admission group was significantly longer than that in the planned admission group [days: 2 (1, 5) vs. 2 (1, 3), P < 0.01], and the total length of hospital stay was significantly shorter [days: 9 (7, 13) vs. 13 (10, 18), P < 0.01]. Both in the emergency admission group and the planned admission group, obstetric factors were the main reason for admission, 60.9% (199/327) and 70.3% (175/249), respectively. The proportion of postpartum hemorrhage was the highest [35.2% (115/327) and 57.0% (142/249)], followed by preeclampsia/eclampsia [7.0% (23/327) and 7.6% (19/249)]. Only 7 of the 19 critically pregnant women with puerperal infection were planned admission. All 21 patients with acute fatty liver of pregnancy (AFLP) during pregnancy were emergency admission. Among the emergency and planned admission patients, 73 patients (22.3%) and 42 patients (16.9%) required mechanical ventilation (duration of mechanical ventilation > 24 hours), 99 patients (30.3%) and 35 patients (14.1%) needed vasoactive agents, 67 patients (20.5%) and 20 patients (8.0%) received hemodynamic monitoring, and 123 patients (37.6%) and 154 patients (61.8%) were given anticoagulation therapy, respectively. In terms of severity score of critical pregnant women, there were significant differences in APACHE Ⅱ, APACHE Ⅲ, SAPS Ⅱ and Marshall scores of pregnant women with different diseases. Among them, the APACHE Ⅲ, SAPS Ⅱ and Marshall scores of AFLP were the highest [21.0 (15.0, 32.5), 12.0 (6.0, 16.5) and 6.0 (3.5, 8.0), respectively]. The APACHE Ⅱ and APACHE Ⅲ scores of postpartum hemorrhage were the lowest [4.0 (3.0, 7.0), 12.0 (10.0, 16.0)]. The SAPS Ⅱ score of pneumonia was the lowest [2.0 (0, 14.0)]. The Marshall score for puerperal infection was the lowest [1.0 (0, 3.0)]. In terms of the total medical expenses, the cost in the emergency admission group was significantly lower than that in the planned admission group [10 thousand Yuan: 3.1 (2.0, 4.7) vs. 4.1 (2.9, 5.8), P < 0.05]. Conclusions:Compared with the critically ill pregnant women who planned to be admitted to ICU, the patients emergency admitted to ICU were more complicated and urgent, and the severity of the condition was scored higher. At present, the severity scoring system commonly used in ICU can only partly evaluate the severity of critically ill pregnant women, therefore, it is necessary to design the specific severity scoring system for critically ill pregnant women to effectively and rationally use the precious ICU resources.

Objective:Using three dimensional magnetic resonance imaging to investigate the differences in velopharyngeal structures and motion between normal resonance adults with repaired cleft palate and without cleft palate, to guide the surgical method of cleft palate repair surgery.Methods:Twelve male adults, including 6 adults with repaired cleft palate (cleft group: age 18-26 years old, average 21.8 years old) and 6 adults without cleft palate (noncleft group: age 19-28 years old, average 23.3 years old) were examined with dynamic and static 3D MRI in midsagittal. 32 velopharyngeal measures including soft palate length, effective soft palate length, pharynx ratio, palate height, levator veli palatini muscle length and thickness were obtained on midsagittal, coronal, and levator veli palatine image plane(oblique coronal image plane)and compared between groups. The correlation test of two times data were carried out by Pearson product-moment correlation coefficient to determine the error size of the measurement result. Two separate sample t-tests was used to compare the two sets of data. Results:All the subjects had no speech abnormalities, and velopharyngeal competence. Two measurements of the r value is 0.789 to 0.925 ( P<0.05), which is twice the measurement error is within the acceptable range. The noncleft group of levator veli palatini muscle form is more fluid, while the cleft group is irregular, the middle line can be observed discontinuous phenomenon, and the levator veli palatini muscle insertion soft palate angle is obviously different. Compared to those without cleft palate, participants with repaired cleft palate had a significantly bigger pharynx wide(23.83±3.48) mm, pharynx deep(29.94±3.52) mm, bone pharynx deep(39.68±3.63) mm, palate length ratio(1.18±0.16), pharynx ratio(0.87±0.91), PVU angle (movement)(105.68±20.54)°, the intravelar segment of the levator veli palatini muscle(13.13±1.00) mm, insertion spacing(13.13±1.00) mm. and the starting angle of the levator muscle(58.0±3.3)°. In contrast, the width of the hard palate(37.5±1.43) mm, soft thicknes(9.48±1.03) mm, soft palate relative extension length (/ts/)(1.09±0.05) mm, the thickness of the levator veli palatini muscle(4.07±0.25) mm, APV angle (movement)(180.51±8.55)° and the starting distance of the levator muscle(52.27±7.08) mm are larger in the normal group, The differences are statistically significant( P<0.05). Conclusions:Measuring the pharyngeal structure with three-dimensional magnetic resonance is feasible, and there are significant differences in the pharynx structure, soft palate and levator veli palatini muscle morphological structure of the adults with repaired cleft palate and without cleft palate. Attention to the anatomical reset of the levator muscle, especially the protection and extension of the the extravelar segment of the levator veli palatini muscle, and the extension of the effective soft palate when the soft flap is separated, should be noted in the early repair of the cleft palate.