Objective To investigate the prevalence of metabolic associated fatty liver disease(MAFLD)and its correlation with metabolic components among personnel on tropical islands.Methods The data of personnel who received health examination on islands in 2024 were analyzed,and they were grouped with the age limit of 30 years old to compare the detection rates of MAFLD and metabolic components in different age groups.In people aged≥ 30 years old,the age,gender,body mass index(BMI),waist circumference(WC),fasting blood glucose,blood lipids,liver function,kidney function and other indexes were compared between MAFLD and non-MAFLD groups.Univariate and multivariate logistic regression models were conducted to analyze the factors affecting the occurrence of MAFLD.The effects of various metabolic components on the risk of MAFLD in different age groups were analyzed by subgroup analyses.Results Among 1213 personnel,175(14.4％)cases had MAFLD,of which 141(80.6％)cases were mild,32(18.3％)were moderate,and 2(1.1％)were severe.The detection rates of MAFLD(25.6％[74/289]vs 10.9％[101/924])and overweight/obesity(55.7％[161/289]vs 37.7％[348/924])in age ≥ 30 years old were significantly higher than those in age＜30 years old(both P＜0.001).In people aged≥ 30 years old,compared with the non-MAFLD group,the BMI,WC,systolic blood pressure,diastolic blood pressure,triglyceride(TG),low density lipoprotein-cholesterol,alanine transaminase,aspartate transaminase,gamma glutamyltransferase and uric acid(UA)in the MAFLD group were significantly higher(all P＜0.05),and the high density lipoprotein-cholesterol(HDL-C)was significantly lower(P＜0.05).There were no significant differences in age,gender,fast blood glucose,total cholesterol,alkaline phosphatase,total bilirubin,serum creatinine,or blood urea nitrogen(all P＞0.05).Logistic regression analysis showed that WC was an independent risk factor for MAFLD(odds ratio[OR]=1.101,95％confidence interval[95％CI]1.030-1.176,P=0.004);HDL-C was an independent protective factor for MAFLD(OR=0.071,95％CI0.016-0.323,P=0.001);and BMI ≥24.0 kg/m2 and WC≥90 cm were positively correlated with MAFLD(both P＜0.01).In people aged≥30 years old,the risk of MAFLD was increased in those with overweight/obesity,arterial blood pressure≥ 130/85 mmHg(1 mmHg=0.133 kPa),TG≥1.7 mmol/L,HDL-C≤1.0 mmol/L and UA＞420 μmol/L(all P＜0.05),and the risk of MAFLD was most significantly increased in overweight/obesity people(hazard ratio[HR]=5.088,95％CI 2.724-9.504,P＜0.001).Among people aged＜30 years old,the risk of MAFLD was increased in those with overweight/obesity and UA＞420 μmol/L(both P＜0.01),and the risk of MAFLD was most significantly increased in overweight/obesity individuals(HR=6.305,95％CI3.973-10.006,P＜0.001).Conclusion The detection rates of MAFLD and various metabolic components are higher in the personnel on tropical islands,and the risk of MAFLD is higher in those with overweight/obesity,TG≥1.7 mmol/L and hyperuricemia.

Objective: To analyze the mediating effects of loneliness and depressive symptoms on family functioning and life satisfaction among rural elderly patients with chronic diseases, so as to provide the basis for improving the life satisfaction of this population. Methods: Rural elderly patients with chronic diseases aged ≥60 years in Qiannan Buyi and Miao Autonomous Prefecture, Guizhou Province were selected using a multi-stage stratified random cluster sampling method from June to September 2022. Basic information such as gender, age, and chronic diseases were collected. Family function, life satisfaction, loneliness and depressive symptoms were evaluated using Family Care Index Scale, the Satisfaction with Life Scale, the b-item Revised VCLA Loneliness Sale and the 15-item Geriatric Depression Scale, respectively. The structural equation model was constructed using Amos software to analyze the mediating effects of loneliness and depressive symptoms on the relationship between family function and life satisfaction. The Bootstrap method was employed to test the mediating effects. Results: A total of 1 145 rural elderly patients with chronic diseases were recruited, including 517 males (45.15%) and 628 females (54.85%). Among the participants, 657 individuals (57.38%) were aged 60-<71 years, and 540 individuals (47.16%) had three or more chronic diseases. The scores for family function, life satisfaction, loneliness, and depressive symptoms were (3.90±1.18), (18.88±5.25), (12.88±2.99), and (6.65±2.26), respectively. Mediating effect analysis showed that family function had a direct positive effect on life satisfaction (β=0.179, 95%CI: 0.126-0.231). It also indirectly positively influenced the life satisfaction of rural elderly patients with chronic diseases through the independent mediating effect of depressive symptoms (β=0.035, 95%CI: 0.021-0.054) and the chained mediating effect of loneliness and depressive symptoms (β=0.021, 95%CI: 0.013-0.030). The mediating effect of depressive symptoms accounted for 14.89% of the total effect, while the chained mediating effect of loneliness and depressive symptoms accounted for 8.94% of the total effect. Conclusion Good family function can directly enhance the life satisfaction of rural elderly patients with chronic diseases and can also indirectly improve their life satisfaction by reducing loneliness and depressive symptoms.

Objective To develop a three-dimensional(3D)deep neural network based preoperative classification model for coronary computed tomography angiography(CTA)in atrial fibrillation patients,and to explore the effects of transfer learning on the performance of medical image classification models,thereby providing preoperative decision support for catheter ablation to advance atrial fibrillation treatment toward precision and personalization.Methods Utilizing 3D ConvNet and 3D ResNet as backbone network,the three-dimensional classification features were extracted from coronary CTA sequences.The publicly available pre-trained weights were used for transfer learning.The model performance was evaluated through metrics such as confusion matrix,classification accuracy,and area under the curve(AUC).A comparative analysis was also conducted to evaluate the performance differences between the transfer learning model and the initialized training model.Results Transfer learning yielded significant performance improvements over the initialized training models,attaining AUC improvement of 9.1%-16.7%and accuracy enhancement of 6.2%-23.5%.Among all models,3D-ResNet18 model with MedicalNet pre-training weights performed the best,achieving an AUC of 0.77 and an accuracy of 0.71.Conclusion The proposed three-dimensional deep network enhanced by transfer learning can effectively identify atrial fibrillation patients requiring additional ablation besides pulmonary vein isolation through preoperative coronary CTA,which will assist clinicians in optimizing surgical strategies and improving treatment outcomes,thereby reducing long-term postoperative recurrence rates.

Objective To develop a three-dimensional(3D)deep neural network based preoperative classification model for coronary computed tomography angiography(CTA)in atrial fibrillation patients,and to explore the effects of transfer learning on the performance of medical image classification models,thereby providing preoperative decision support for catheter ablation to advance atrial fibrillation treatment toward precision and personalization.Methods Utilizing 3D ConvNet and 3D ResNet as backbone network,the three-dimensional classification features were extracted from coronary CTA sequences.The publicly available pre-trained weights were used for transfer learning.The model performance was evaluated through metrics such as confusion matrix,classification accuracy,and area under the curve(AUC).A comparative analysis was also conducted to evaluate the performance differences between the transfer learning model and the initialized training model.Results Transfer learning yielded significant performance improvements over the initialized training models,attaining AUC improvement of 9.1%-16.7%and accuracy enhancement of 6.2%-23.5%.Among all models,3D-ResNet18 model with MedicalNet pre-training weights performed the best,achieving an AUC of 0.77 and an accuracy of 0.71.Conclusion The proposed three-dimensional deep network enhanced by transfer learning can effectively identify atrial fibrillation patients requiring additional ablation besides pulmonary vein isolation through preoperative coronary CTA,which will assist clinicians in optimizing surgical strategies and improving treatment outcomes,thereby reducing long-term postoperative recurrence rates.

ObjectiveTo investigate the inhibitory effect of hederasaponin B on gastric cancer HGC-27 cell and the mechanism. MethodMethyl thiazolyl tetrazolium （MTT） assay， hematoxylin-eosin （HE） staining， 4'，6-diamidino-2-phenylindote （DAPI） staining， colony formation assay， scratch assay， and flow cytometry were employed for the analysis of apoptosis and cell cycle. Thereby， the inhibitory effect of hederasaponin B on gastric cancer HGC-27 cell was investigated. Then the Pharm Mapper， UniProt， Swissdock， STRING， and Metascape were used for target screening， gene annotation， molecular docking， protein-protein interaction （PPI） network construction， Gene Ontology （GO） term and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway analysis to explore the mechanism. ResultHederasaponin B （15， 30， 60， 120 μmol·L^-1） can significantly reduce the survival rate of HGC-27 cell （P<0.01） in a time-dependent and dose-dependent manner compared with the blank group. It had no significant toxicity to normal GES-1 cell at concentration below 120 μmol·L^-1. Compared with the blank group， hederasaponin B （30， 60， 120 μmol·L^-1） induced cytoplasmic vacuolization， and nuclear deformation and karyopyknosis， inhibited the migration of HGC-27 cell （P<0.01）， and brought about the apoptosis （P<0.05， P<0.01） and cell cycle arrest of HGC-27 cell （P<0.05， P<0.01）. Hederasaponin B （10， 20， 30 μmol·L^-1） also suppressed the independent survival ability and proliferation ability of HGC-27 cell （P<0.01）. The possible action targets were kinesin-like protein KIF11， cGMP-specific 3，5 cyclic phosphodiesterase， caspase-3， serine/threonine protein kinase Chk1， proto-oncogene tyrosine protein kinase， epidermal growth factor receptor， and mitogen-activated protein kinase （MAPK） 8. The mechanism may be related to MAPK signaling pathway （pathways in cancer）， adhesion connection， focal adhesion and proteoglycans in cancer （epithelial cell signaling pathways in Helicobacter pylori infection）. ConclusionHederasaponin B exerts significant inhibitory effect on gastric cancer HGC-27 cell through multiple targets and multiple pathways.

Objective:To explore the effect of network medication guidance on anticoagulation management of warfarin.Methods:The study was designed as the retrospective cohort study. Study subjects were selected from patients who underwent cardiac valve replacement during January 2018 and April 2019 in the Department of Cardiovascular Surgery of Xiangya Hospital, Central South University, and took oral warfarin for 3 months or more after operation. According to the mode of revisit, the patients were divided into 4 groups: 1-month post-operation network group (INR review results were uploaded online for more than 2 times within 1 month after operation), 1-month post-operation control group (INR was reviewed in Xiangya Hospital 1 month after the operation and INR data was recorded), 3-month post-operation network group (INR review results were uploaded online for more than 4 times within 3 months after operation), and 3-month post-operation control group (INR was reviewed in Xiangya Hospital 3 months after the operation and INR data was recorded). The gender and age distribution of patients in the network group and the control group, as well as INR and INR compliance rate at 1 or 3 months after operation were compared.Results:A total of 420 patients underwent cardiac valve replacement in Xiangya Hospital during the study period, and all of them were prescribed warfarin for anticoagulation. Among the 420 patients, 266 patients (63.3%) had network or Xiangya Hospital revisit records 1 month after operation, 71 of which were included in the 1-month post-operation network group and 178 of which in the 1-month post-operation control group; 132 (31.4%) patients had network or Xiangya Hospital revisit records 3 month after operation, 46 of which were included in the 3-month post-operation network group and 77 of which in the 3-month post-operation control group. Patients in the 1-month post-operation network group had lower age, higher INR compliance rate, and lower incidence of insufficient anticoagulation than those in the 1-month post-operation control group, and the differences were all statistically significant [(49±10) years vs. (53±11) years, P=0.009; 64.8%(46/71) vs. 45.5%(81/178), P=0.006; 21.1%(15/71) vs. 46.6%(83/178), P<0.001]. Patients in the 3-month post-operation network group had higher INR, higher INR compliance rate, and lower incidence of insufficient anticoagulation than those in the 3-month post-operation control group, and the differences were all statistically significant [(2.05±0.45) vs. (1.84±0.62), P=0.044; 67.4% (31/46) vs. 30.9% (30/97), P=0.002; 30.4% (14/46) vs. 54.5% (42/77), P=0.009]. Conclusions:Network medication guidance is helpful to improve the effect of warfarin anticoagulation management and improve the INR compliance rate of patients after cardiac valve replacement. The main manifestation of substandard anticoagulation is insufficient anticoagulation, which should be paid attention to.

Objective:To explore the effect of network medication guidance on anticoagulation management of warfarin.Methods:The study was designed as the retrospective cohort study. Study subjects were selected from patients who underwent cardiac valve replacement during January 2018 and April 2019 in the Department of Cardiovascular Surgery of Xiangya Hospital, Central South University, and took oral warfarin for 3 months or more after operation. According to the mode of revisit, the patients were divided into 4 groups: 1-month post-operation network group (INR review results were uploaded online for more than 2 times within 1 month after operation), 1-month post-operation control group (INR was reviewed in Xiangya Hospital 1 month after the operation and INR data was recorded), 3-month post-operation network group (INR review results were uploaded online for more than 4 times within 3 months after operation), and 3-month post-operation control group (INR was reviewed in Xiangya Hospital 3 months after the operation and INR data was recorded). The gender and age distribution of patients in the network group and the control group, as well as INR and INR compliance rate at 1 or 3 months after operation were compared.Results:A total of 420 patients underwent cardiac valve replacement in Xiangya Hospital during the study period, and all of them were prescribed warfarin for anticoagulation. Among the 420 patients, 266 patients (63.3%) had network or Xiangya Hospital revisit records 1 month after operation, 71 of which were included in the 1-month post-operation network group and 178 of which in the 1-month post-operation control group; 132 (31.4%) patients had network or Xiangya Hospital revisit records 3 month after operation, 46 of which were included in the 3-month post-operation network group and 77 of which in the 3-month post-operation control group. Patients in the 1-month post-operation network group had lower age, higher INR compliance rate, and lower incidence of insufficient anticoagulation than those in the 1-month post-operation control group, and the differences were all statistically significant [(49±10) years vs. (53±11) years, P=0.009; 64.8%(46/71) vs. 45.5%(81/178), P=0.006; 21.1%(15/71) vs. 46.6%(83/178), P<0.001]. Patients in the 3-month post-operation network group had higher INR, higher INR compliance rate, and lower incidence of insufficient anticoagulation than those in the 3-month post-operation control group, and the differences were all statistically significant [(2.05±0.45) vs. (1.84±0.62), P=0.044; 67.4% (31/46) vs. 30.9% (30/97), P=0.002; 30.4% (14/46) vs. 54.5% (42/77), P=0.009]. Conclusions:Network medication guidance is helpful to improve the effect of warfarin anticoagulation management and improve the INR compliance rate of patients after cardiac valve replacement. The main manifestation of substandard anticoagulation is insufficient anticoagulation, which should be paid attention to.

The training of residents majoring in ultrasound needs not only to pay attention to the teaching of speculative knowledge,but also to "look at pictures and talk",which is based on a large number of diagnostic ultrasound cases,training the residents to find,discover and discriminate the lesions from the ultrasonic images to finally form a sharp recognition and diagnosis ability.This study used the instant messaging tool WeChat to establish a virtual learning platform and implement a case based teaching process through this platform,which can avoid the limitations of time and space,and make the communication between teachers and students faster.According to the questionnaire survey,residents generally believed that the training mode can effectively improve learning efficiency and professional ability and hope to add this training mode to the basis of traditional teaching mode.The results of resident case analysis showed that the diagnostic accuracy of residents gradually increased during the training process.The model of WeChat platform combined with case teaching can provide new ideas and methods for standardized training of resident doctors in ultrasound specialty.

Objective:To adjust the wording and to examine the validity and reliability of the Chinese traditional version of the Body Image Scale (BIS) in patients with rectal cancer.Methods:Totally 180 patients pathologically diagnosed with rectal cancer were selected.The obtained data were divided equally into two parts.Half of them was for item analysis and exploratory factor analysis, and the other half was for confirmatory factor analysis and internal consistency reliability.The criterion validity was tested with the Quality of Life Questionnare-Core30 (QLQ-C30).Twenty-five patients were retested for test-retest reliability with 2 week interval.Results:Two factors were retained after exploratory factor analysis, which could explain 69.1％ of the total variation.And the result of confirmatory factor analysis was that the structure of the scale was stable and achieved goodness of fit (χ2/df=2.32, CFI=0.96, NFI=0.93, IFI=0.96, TLI=0.94, RMSEA=0.078).The scores of total scale and two factors were negatively correlated with the scores of five function domains and overall quality of life of QLQ-C30 (r=-0.27——0.54, Ps＜0.05).In total scale, Cronbach' s α coefficient of total scale was 0.92, while test-retest reliability was 0.88.Conclusion:The Chinese version of BIS showed good validity and reliability for assessment of body image in Chinese patients with rectal cancer.

Objective:In order to apply the index system for clinical evaluation of implementation effect in hospitals.Methods:A total of 862 patients with vaginal delivery from 9 hospitals were randomly divided into an clinical pathway group (n=496) and a control group (n=366).The patients in the control group received traditional treatment procedure while the patients in the clinical pathway group experienced procedure of the clinical treatment.The index system was used for clinical evaluation of implementation effect.Results:There were obvious advantages in 15 indicators in the clinical pathway group than those in the control group (P＜0.05).The comprehensive score of the clinical pathway group was higher than the control group of the corresponding grade and nature of the hospital.The comprehensive score for secondary hospitals (Ci=0.7967) were higher than that for the tertiary hospitals (Ci=0.2033).The comprehensive score for the general hospitals (Ci=0.8948) were higher than that for the specialized hospitals (Ci=0.1052).As for clinical implementation effect,the secondary hospitals were better than the tertiary hospital,and the general hospitals were better than the specialized hospitals.Conclusion:The index system for clinical evaluation could quantify the implementation effect,and compare the implementation effect in different hospitals,which provides reference for the management of clinical pathway.