Objective To explore the prediction efficiency of Ki-67 expression status in pituitary adenoma(PA)based on a joint model of siamese network and transfer learning.Methods The preoperative MR T1WI enhanced sequence images of 370 patients with PA diagnosed by surgery and pathology were retrospectively collected.According to the results of immunohistochemical,all patients were divided into high proliferation index group(Ki-67≥3,n=97)and low proliferation index group(Ki-67＜3,n=273),and all the sample data were randomly divided into training set and test set according to the ratio of 7∶3.Two single predictive models,ResNet-50 and VGGNet-16 and combined them with the siamese network and transfer learning were built.The prediction efficiency of different models were evaluated via accuracy rate,precision rate,recall rate,F1 score and receiver operating characteristic(ROC)curve as the main criteria.Results Compared with a single predictive model,the model combined with siamese network and transfer learning showed a better performance for predicting the Ki-67 of PA.Additionally,the ResNet-50 joint model exhibited the superior predictive performance.The accuracy rate was 0.872 7,the precision rate was 0.812 5,the recall rate was 0.764 7,the F1 score was 0.787 9,and the area under the curve(AUC)was 0.841 6.Conclusion The joint model based on siamese network and transfer learning exhibits a higher efficiency for predicting the Ki-67 expression status in PA,which can help the clinicians to formulate more personalized treatment for the patients.

OBJECTIVE To explore the mechanism of improvement effect of Chanbao zhichuang suppository(CBZCS)on hemorrhoids in rats through network pharmacology and metabolomics.METHODS A hemorrhoid model was established by subcutaneous injection of rhododendron oil to induce anal swelling.SD rats were divided into blank group(NC group,0.32 g/kg vaseline),model group(Model group,0.32 g/kg vaseline),CBZCS low-,medium-,and high-dose groups(CBZCS-L,CBZCS-M,CBZCS-H groups,with dosages of 0.16,0.32,and 0.64 g/kg respectively),and Mayinglong musk hemorrhoids suppository group(Positive group,0.32 g/kg),with 9 rats in each group.Anal administration was performed at 6,12,24,48,and 72 hours after modeling.After the last administration,the pathological changes of the anal tissues in rats were observed,and the serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in rats were detected.Differential metabolite analysis and enrichment analysis were conducted by metabolomics methods,and the target proteins of CBZCS in treating hemorrhoids were obtained by network pharmacology.The core metabolic pathways were screened by interaction and enrichment analysis of differential metabolites and proteins,and the core proteins were experimentally verified.RESULTS Compared with the NC group,the anal tissues of the Model group showed obvious lesions,and the levels of IL-6 and TNF-α in the serum were significantly increased(P＜0.05);compared with the Model group,the pathological damage of the anal tissues in the treatment groups was alleviated to varying degrees,and serum levels of IL-6 in CBZCS-H group,CBZCS-M group,and Positive group as well as serum levels of TNF-α in CBZCS-H group were significantly reduced(P＜0.05).The metabolomics results showed that 34 differential metabolites were screened from the anal tissues of rats,and 22 of them showed a return after CBZCS administration.The differential metabolites mainly enriched in arachidonic acid metabolism,histidine metabolism,and glycerophospholipid metabolism.Through the network pharmacology,138 intersection genes of CBZCS against hemorrhoids were determined.The analysis results showed that differential metabolites and target proteins were mainly enriched in the arachidonic acid metabolism pathway,and the regulation of this pathway might be related to cyclooxygenase-2(COX-2),Myc proto-oncogene protein(c-MYC),cytochrome P450 1B1(CYP1B1),interleukin-1β(IL-1β),and IL-6 protein expression.The experimental verification results showed that the expression levels of key proteins(COX-2,c-MYC,CYP1B1,IL-6,IL-1β)in the anal tissues of the Model group were significantly higher than those in the NC group(P＜0.05),and the levels of the above proteins in the anal tissues of CBZCS-H group and Positive group were significantly lower than those in the Model group(P＜0.05).CONCLUSIONS The mechanism of CBZCS in treating hemorrhoids may be to inhibit the expression of COX-2,c-MYC and CYP1B1 proteins,thereby inhibiting arachidonic acid metabolism and reducing the release of inflammatory factors IL-6 and IL-1β.

Objective:To explore the changes of brain excitation/inhibition balance and gray matter volume (GMV) and their correlations with clinical features in benign childhood epilepsy with centrotemporal spikes (BECTS).Methods:A cross-sectional study was performed; 83 BECTS children enrolled from Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2015 to January 2024 were selected as BECTS group. During the same period, 101 age- and gender-matched healthy children were recruited as healthy control group through advertisements in local primary schools. Data of conventional MRI and resting-state functional MRI (rs-fMRI) of the two groups were collected. Whole brain GMV was analyzed by voxel-based morphometry (VBM), and Hurst index was calculated based on time series data of blood oxygen level dependent (BOLD) signal of rs-fMRI. Correlations of GMV and Hurst index with disease duration and onset age in children with BECTS were explored by Pearson correlation analysis.Results:Compared with the healthy control group, the BECTS group had significantly increased GMV and decreased Hurst index in the bilateral Rolandic region ( P<0.05). Pearson correlation analysis showed that in the BECTS group, GMV in bilateral Rolandic region was negatively correlated with onset age ( r=-0.267, P=0.015) and positively correlated with disease course ( r=0.267, P=0.015); Hurst index in bilateral Rolandic region was positively correlated with onset age ( r=0.323, P=0.003) and negatively correlated with disease course ( r=-0.240, P=0.029); Hurst index was negatively correlated with GMV in bilateral Rolandic region ( r=-0.328, P=0.003). Conclusion:BECTS children have excitation/inhibition imbalance in epilepsy-related regions and cortical structural delay, and both of them are related to onset age and disease course.

Objective To explore the prediction efficiency of Ki-67 expression status in pituitary adenoma(PA)based on a joint model of siamese network and transfer learning.Methods The preoperative MR T1WI enhanced sequence images of 370 patients with PA diagnosed by surgery and pathology were retrospectively collected.According to the results of immunohistochemical,all patients were divided into high proliferation index group(Ki-67≥3,n=97)and low proliferation index group(Ki-67＜3,n=273),and all the sample data were randomly divided into training set and test set according to the ratio of 7∶3.Two single predictive models,ResNet-50 and VGGNet-16 and combined them with the siamese network and transfer learning were built.The prediction efficiency of different models were evaluated via accuracy rate,precision rate,recall rate,F1 score and receiver operating characteristic(ROC)curve as the main criteria.Results Compared with a single predictive model,the model combined with siamese network and transfer learning showed a better performance for predicting the Ki-67 of PA.Additionally,the ResNet-50 joint model exhibited the superior predictive performance.The accuracy rate was 0.872 7,the precision rate was 0.812 5,the recall rate was 0.764 7,the F1 score was 0.787 9,and the area under the curve(AUC)was 0.841 6.Conclusion The joint model based on siamese network and transfer learning exhibits a higher efficiency for predicting the Ki-67 expression status in PA,which can help the clinicians to formulate more personalized treatment for the patients.

Objective:To explore the changes of brain excitation/inhibition balance and gray matter volume (GMV) and their correlations with clinical features in benign childhood epilepsy with centrotemporal spikes (BECTS).Methods:A cross-sectional study was performed; 83 BECTS children enrolled from Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2015 to January 2024 were selected as BECTS group. During the same period, 101 age- and gender-matched healthy children were recruited as healthy control group through advertisements in local primary schools. Data of conventional MRI and resting-state functional MRI (rs-fMRI) of the two groups were collected. Whole brain GMV was analyzed by voxel-based morphometry (VBM), and Hurst index was calculated based on time series data of blood oxygen level dependent (BOLD) signal of rs-fMRI. Correlations of GMV and Hurst index with disease duration and onset age in children with BECTS were explored by Pearson correlation analysis.Results:Compared with the healthy control group, the BECTS group had significantly increased GMV and decreased Hurst index in the bilateral Rolandic region ( P<0.05). Pearson correlation analysis showed that in the BECTS group, GMV in bilateral Rolandic region was negatively correlated with onset age ( r=-0.267, P=0.015) and positively correlated with disease course ( r=0.267, P=0.015); Hurst index in bilateral Rolandic region was positively correlated with onset age ( r=0.323, P=0.003) and negatively correlated with disease course ( r=-0.240, P=0.029); Hurst index was negatively correlated with GMV in bilateral Rolandic region ( r=-0.328, P=0.003). Conclusion:BECTS children have excitation/inhibition imbalance in epilepsy-related regions and cortical structural delay, and both of them are related to onset age and disease course.

ObjectiveTo construct an evaluation index system for the development of district-level disease prevention and control centers according to the requirements of the modernization of Shanghai’s disease control system and public health work practices， and to comprehensively assess the construction and development of district-level disease prevention and control institutions. MethodsAccording to the national and municipal requirements for the development of disease prevention and control institutions， an index framework was proposed through literature search and expert interviews. 39 representative experts in the field of public health at the national， provincial， and municipal （district） levels were selected to participate in the consultation and construction of the index system. The authority coefficient， the coefficient of variation， etc. were used to carry out quality control and determination of each index on the Delphi method. ResultsThe questionnaire response rate was 100%， the expert authority coefficient was 0.86，the degree of familiarity was 0.79， and the judgment basis was 0.92. The coefficients of variation of the necessary indicators in the index system were all <0.25 in the dimension of importance， and there were statistical differences in the statistical test of Kendall’s W coordination coefficients at all levels and dimensions （all P<0.001）. After multiple rounds of consultation， experts reached a consensus， forming a development evaluation index system of district-level CDCs with 6 first-level indicators， 24 second-level indicators， and 105 third-level indicators （including 63 necessary indicators and 42 recommended indicators）. ConclusionThe evaluation index system of Shanghai district-level CDCs based on the Delphi method has good authority， reliability， sensitivity and operability. This indicator system can effectively support the development of Shanghai district-level CDCs， and can be used for evaluation at multiple levels and in an all-round way in the future. The evaluation results can provide an evidence-based basis for the modernization of the disease prevention and control system and the continuous and dynamic updating of the development goals in the future.

Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.

Objective:To know the current situation of kinesiophobia in patients after cardiac surgery under cardiopulmonary bypass, and to clarify its influencing factors, so as to provide reference for developing intervention strategies to improve kinesiophobia level.Methods:This was a cross-sectional study. From February 2022 to September 2022, the patients after cardiac valve surgery under cardiopulmonary bypass in the Second Affiliated Hospital Zhejiang University School of Medicine were investigated by convenience sampling methods. The survey was conducted using the General Information Questionnaire, The Tampa Scale for Kinesiophobia Heart, Exercise Self-Efficacy Scale, Pain Catastrophizing Scale, and Adaptation, Partnership, Growth, Affection and Resolve(APGAR) as research tools, and the influencing factors were analyzed using univariate and binary Logistic regression analysis.Results:A total of 219 patients were included, of which 97 patients (44.3%) had kinesiophobia. The results of binary Logistic regression analysis showed that monthly family income level, first time out of bed after operation, fear of falling, the family APGAR, and pain catastrophizing were significant influencing factors of kinesiophobia in patients after heart valve surgery under cardiopulmonary bypass (all P<0.05). Conclusions:The prevalence of kinesiophobia is high among patients after heart valve surgery under cardiopulmonary bypass. Clinicians should pay attention to patients with low monthly family income level, late first time out of bed after surgery, and fear of falling, as well as strengthen communication with patients and families, focus on the management of acute postoperative pain. In order to reduce or avoid the occurrence of kinesiophobia and enable patients to benefit from early ambulation.

Objective:To describe the treatment strategies in children with septic shock in China.Methods:A questionnaire was prepared and 368 pediatric intensivists from the Pediatric Critical Care Physician Branch of Chinese Medical Doctor Association were surveyed about the treatment of pediatric septic shock from April to June 2017.Results:Surveys were received from 87.2%(68/78) institutions and 368 questionnaires (response-rate 45.1%) were included.59.2% and 77.7% of the respondents chose debridement surgery and fluid drainage as source control intervention.Antibiotics were used within 1 hour of shock in 90.8% of respondents.98.4% of respondents chose normal saline, 72.3% of respondents chosen albumin, and 53.8% of respondents chosen plasma for fluid resuscitation.When no venous access was available during shock resuscitation, 57.1% of respondents preferred intraosseous access.79.3% and 83.2% of the respondents used the adjuvant therapy such as glucocorticoids and intravenous immunoglobulin.96.7%, 85.3% and 22.0% of respondents were likely to provide oxygen and mechanical ventilation, continuous renal replacement, and extracorporeal membrane oxygenation as organ support, respectively.Additionally, 322 (88.7%), 188 (51.1%), and 85 (23.1%) respondents chose the "best advice" options to simulated clinical cases of fluid resuscitation, inotropic agents, and vasoactive agents, respectively.In the simulated cases of vasoactive drugs and inotropic drugs, 69.3% and 24.2% of the respondents chose fluid resuscitation strategy, respectively.In cases of fluid resuscitation, 49.7% (183/368) of respondents reported performing fluid responsiveness and volume status assessment, and instruments used in the assessment included bedside echocardiography[39.4% (145/368)], bioreactance[10.3% (38/368)], transpulmonary thermodilution devices[6.3% (23/368)]. Pediatricians who received advanced life support courses for children ( P=0.006) and intensive care specialist training center training ( P=0.002) were more likely to choose the " best recommendation" option than those who did not attend the training. Conclusion:The current status of pediatric septic shock treatment strategies in China are active source control intervention, antibiotic use and organs support, and increased awareness of non-invasive hemodynamic monitoring.However, there may be excessive fluid infusion and inappropriate use of plasma, glucocorticoids and intravenous immunoglobulin.Different training and continuing education may improve rational treatment strategies.

The ketogenic diet(KD) treatment program planned for a 2 years old and 5 months boy suffered from severe cerebral complications after ependymoma operation in the Children′s Hospital of Nanjing Medical University at December 2018 was analyzed retrospectively.The patient developed various complications, including cerebral hemorrhage, hydrocephalus and hernia after the operation of ependymoma, with coma, fever and convulsion, and 1 month of anti-infection and antiepileptic treatment was ineffective.After 2 weeks of 4∶1 KD, fever and convulsion were effectively relieved without obvious side effects.One month later, the patient regained consciousness, demonstrating that KD can be applied to treat severe cerebral complications after ependymoma operation.