OBJECTIVE: This study examines utilizes the advantages of machine learning algorithms to discern key determinants in prognosticate postoperative circulatory complications (PCCs) for older patients. METHODS: This secondary analysis of data from a randomized controlled trial involved 1,720 elderly participants in five tertiary hospitals in Beijing, China. Participants aged 60-90 years undergoing major non-cardiac surgery under general anesthesia. The primary outcome metric of the study was the occurrence of PCCs, according to the European Society of Cardiology and the European Society of Anaesthesiology diagnostic criteria. The analysis metrics contained 67 candidate variables, including baseline characteristics, laboratory tests, and scale assessments. RESULTS: Our feature selection process identified key variables that significantly impact patient outcomes, including the duration of ICU stay, surgery, and anesthesia; APACHE-II score; intraoperative average heart rate and blood loss; cumulative opioid use during surgery; patient age; VAS-Move-Median score on the 1st to 3rd day; Charlson comorbidity score; volumes of intraoperative plasma, crystalloid, and colloid fluids; cumulative red blood cell transfusion during surgery; and endotracheal intubation duration. Notably, our Random Forest model demonstrated exceptional performance with an accuracy of 0.9872. CONCLUSION We have developed and validated an algorithm for predicting PCCs in elderly patients by identifying key risk factors.
Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Cardiovascular Diseases/etiology* ; Machine Learning ; Postoperative Complications/etiology* ; Risk Factors ; Randomized Controlled Trials as Topic ; Secondary Data Analysis

Objective:To construct a thyroid nodule segmentation model using ultrasound dynamic images and explore its potential for assisting in the screening of thyroid nodules.Methods:A total of 126 patients with thyroid nodules（comprising 150 nodules）who were diagnosed and treated at Xuzhou Cancer Hospital from April 2024 to December 2024 were prospectively enrolled. Two-dimensional ultrasound was performed to capture short-axis and long-axis video images of thyroid nodules，forming a dynamic ultrasound image dataset. The dataset was divided into training，validation，and test sets in a ratio of 6∶1∶3. After the training loss curve converged，the model that performed well on the validation set was selected for testing. Three-fold cross-validation was employed for training and testing. All 300 ultrasound videos were divided into three subsets. In each experiment，two subsets were used as the training set，and one subset was used as the test set to evaluate the model's generalization ability. A collaborative spatiotemporal diffusion model was established based on the dynamic trends and tissue texture details of thyroid nodules. Six widely used segmentation metrics were employed to evaluate the model's application capabilities.Results:The study included 126 patients with 150 thyroid nodules，300 dynamic ultrasound images，and video lengths of 3-4 seconds per nodule，resulting in 12 312 segmented images. The size of the thyroid nodules was（10.7 ± 10.6）mm（transverse diameter）×（8.4 ± 6.3）mm（anteroposterior diameter）. Among the nodules，62（41.3%）had clear boundaries，while 88（58.7%）had indistinct boundaries；61（40.7%）exhibited regular shapes，while 89（59.3%）were irregular；66（44.0%）had a taller-than-wide aspect ratio；and 70（46.7%）showed microcalcifications. The collaborative diffusion model based on dynamic ultrasound image segmentation achieved the following scores：a Jaccard score of（69.22 ± 0.03）%，a Dice score of（79.16 ± 0.18）%，a Precision score of（86.70 ± 0.17）%，a Recall score of（77.82 ± 0.04）%，an Sα score of（85.26 ± 0.01）%，and an Eθmn score of（90.58 ± 0.17）%. Compared to other models，this model demonstrated significant improvements across all evaluation metrics，achieving the highest values in each metric with increments of over 8% and 1%，respectively. Conclusions:The collaborative diffusion model with a dynamic controller，constructed based on dynamic ultrasound images of thyroid nodules，demonstrates excellent performance in ultrasound image segmentation. It improves the accuracy of thyroid nodule screening，thereby providing a valuable auxiliary diagnostic tool for clinical practice.

Objective To compare the effects of three nickel-titanium file systems,ProTaper Next,TruNatomy,and VDW.RO-TATE,on the morphology of the Danger Zone of the mesial buccal root of mandibular first molar after root canal preparation using Mi-cro-CT and 3D printing technology.Methods 3D-printed mandibular first molars were selected and designed for purpose.They were randomly divided into three groups according to the used NiTi files(n=20).Micro-CT was used to scan the cross-sectional images of the Danger Zone 2 mm below the furcation of the mesial buccal root before and after root canal preparation.The changes in the root ca-nal wall thickness,root canal volume,surface area,cross-sectional area,and root canal transportation in the Danger Zone were ob-served.Statistical analysis was performed using one-way ANOVA(P＜0.05).Results Statistically significant differences were observed before and after root canal preparation in the Danger Zone among the three groups(P＜0.05).Among the three groups,the PTN files caused the largest change before and after preparation,followed by VDW files,and the TRU files had the smallest change.Conclusion The study highlights TruNatomy's conservative shaping capacity,advocating its use in minimally invasive endodontics,whereas Pro-Taper Next may be reserved for cases requiring aggressive canal preparation.

Objective:To analyze the occurrence and relevant factors associated with non-curative resection following endoscopic submucosal dissection(ESD)in elderly patients with early gastric cancer(EGC), as well as to establish a predictive model.Methods:Elderly patients diagnosed with EGC and treated at the First Affiliated Hospital of Hebei North University between January 2019 and January 2023 were retrospectively selected for this study.All patients underwent ESD surgery and were categorized based on the occurrence of non-curative resection( n=44)versus curative resection( n=284).Relevant factors contributing to non-curative resection after ESD surgery in elderly EGC patients were analyzed using both univariate and multivariate analyses.A predictive model was developed, and the receiver operating characteristic(ROC)curve was generated to assess its efficacy. Results:In this study, we analyzed a cohort of 328 elderly patients diagnosed with EGC, aged between 60 and 88 years, with a mean age of 70.87±2.67 years, of which 211 were male.Non-curative resection was performed in 44 cases, accounting for 13.41% of the cohort.Compared to the curative group, the non-curative group exhibited a significantly larger lesion diameter, greater infiltration depth into the submucosa, a lower degree of differentiation, a higher prevalence of undifferentiated types, and an increased fold interruption ratio(all P<0.05).Multivariate logistic regression analysis identified increased lesion diameter( OR=2.380, 95% CI: 1.361-4.160), invasion depth into the submucosa( OR=1.824, 95% CI: 1.120-2.971), undifferentiated degree( OR=1.960, 95% CI: 1.286-2.987), and fold interruption( OR=2.094, 95% CI: 1.384-3.166)as significant predictors of non-curable resection following ESD in elderly patients with EGC(all P<0.05).These factors were incorporated into a predictive model represented by the equation: logit( P)=-6.307+ (lesion diameter × 0.867)+ (infiltration depth into submucosa × 0.601)+ (undifferentiated degree × 0.673)+ (fold interruption × 0.739).The ROC curve analysis yielded an area under the curve(AUC)of 0.859, with diagnostic sensitivity and specificity of 84.09% and 74.65%, respectively. Conclusions:There are numerous relevant factors influencing non-curable resection following ESD surgery in elderly patients with EGC.The prediction model developed herein can serve as a foundation for identifying high-risk patients and formulating effective clinical intervention strategies.

Objective To evaluate the effectiveness of different non-pharmacological interventions in relieving post-transcatheter arterial chemoembolization(post-TACE)pain in patients with liver neoplasm.Methods A computerized retrieval of randomized controlled trials(RCT)concerning the non-pharmacological interventions for relieving post-TACE pain in patients with liver neoplasm from the Chinese and English databases of CNKI,VIP,Wanfang,CBM,PubMed,Embase,Web of Science,the Cochrane Library,etc.was conducted.The retrieval time period was from the establishment of the database to May,2024.Review Manager 5.4 software was used to make meta-analysis.Two investigators independently screened the literature,extracted the data and evaluated the quality of the included literature using the RCT risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Evaluation 5.1.0,and RevMan 5.3 software and Stata 17 software were used to perform traditional and network meta-analysis respectively.Results A total of 29 studies,including 2 866 patients and involving 10 non-pharmacologic intervention measures,were included in this analysis.The results of network meta-analysis showed that acupressure combined with music therapy was the most effective method for relieving post-TACE pain in patients with liver neoplasm.According to the area under the cumulative ranked probability map,the order of the effects of various intervention measures from best to poor was as follows:acupressure plus music therapy(88.9％),exercise rehabilitation therapy(76.8％),acupressure(76.0％),abdominal breathing training(66.4％),music therapy(54.5％),psychological relaxation therapy(47.9％),ear acupoint pressure bean(45.3％),systematic health education(35.2％),wrist and ankle needle therapy(25.7％),ear acupoint pressure bean plus acupressure(25.6％),and conventional nursing care(7.4％).Conclusion A variety of non-pharmacological intervention measures can effectively relieve post-TACE pain in patients with liver neoplasm,and acupressure plus music therapy is the best way for relieving pain.Due to the limitation of the quality and quantity of the collected literature,more high-quality,multicenter,large-sample studies need to be conducted before the pain-relief effect of non-pharmacological intervention measures can be further verified.

Objective To explore the effect of prominent cortical vein(PCV)sign on the clinical prognosis of patients undergoing endovascular recanalization for acute anterior circulation cerebral infarction.Methods A total of 102 patients with acute anterior circulation large-vessel occlusion in Zhongshan Municipal Hospital of Tradiontional Chinese Medicine from January 1,2020 to December 21,2022,who received endovascular recanalization,were enrolled in this study.The clinical data and radiographic materials were collected.According to whether PCV sign was present or not,the patients were divided into PCV group and non-PCV group.The clinical data were compared between the two groups.Logistic regression analysis was used to analyze the correlation between the postoperative 90-day mRS score and the occurrence of PCV.Results Compared with non-PCV group,in PCV group the incidence of atrial fibrillation was even higher,and the good rate of collateral compensation was even lower,and the postoperative(7±2)-day NIHSS score was even lower;the differences in above indexes between the two groups were statistically significant(all P＜0.05).Ninety days after treatment,the proportion of patients having modified Rankin Scale(mRS)score ≤2 points in the non-PCV group was 76.3％,which was higher than 58.6％in the PCV group,but the difference was not statistically significant(P=0.074).Logistic regression analysis indicated that a positive correlation existed between the presence of PCV sign and atrial fibrillation(OR=9.679,95％CI=1.264-74.364)and a negative correlation existed between the presence of PCV sign and good collateral compensation(OR=0.015,95％CI=0.033-0.331).No relationship existed between the postoperative 90-day good prognosis and the presence of preoperative PCV sign(OR=2.078,95％CI=0.680-6.348),but patient's age,preoperative intravenous thrombolysis were negatively correlated with the preoperative Alberta Stroke Program Early CT(ASPECT)score(P＜0.005).Conclusion In patients with anterior circulation acute ischemic stroke(AIS),the occurrence of PCV sign is associated with the impaired collateral compensation and atrial fibrillation,but its impact on the clinical outcomes of patients after receiving reperfusion therapy remains uncertain.PCV sign may be used as a potential evaluation indicator for inadequate cerebrovascular collateral compensation.

Objective To explore the application effect of the dual-track nursing intervention model in the treatment process of children with lobar pneumonia.Methods A total of 186 children with lobar pneumonia were selected and randomly divided into control group and intervention group u-sing a double-blind method,with 93 cases in each group.The control group received conventional nursing intervention,while the intervention group implemented the dual-track nursing intervention model on the basis of conventional nursing.This model included the establishment and training of nurs-ing teams,personalized nursing plans,health education,and psychological support.Outside the hos-pital,it emphasized family support,regular follow-up guidance,and community-based collaborative ed-ucation.Both groups received a 3-week intervention.The improvement times of clinical symptoms,hos-pital stay,pulmonary function indicators before and after nursing,treatment compliance,and family members' satisfaction with nursing were compared and analyzed between the two groups.Results The fever resolution time[(3.89±0.96)d],cough relief time[(6.21±1.34)d],disappearance time of pulmonary rales[(7.89±1.56)d],and hospital stay duration[(9.45±1.89)d]in the intervention group were all shorter than those in the control group[(5.23±1.14),(7.45±1.67),(9.32±2.01),and(11.28±2.35)d,respectively],with statistically significant differences(P＜0.05).After nursing,the forced expiratory volume in one second(FEV1)[(1.51±0.22)L],forced vital capacity(FVC)[(1.75±0.25)L],and FEV1/FVC[(94.12±5.65)％]in the intervention group were all higher than those in the control group[(1.42±0.15)L,(1.66±0.22)L,and(85.73±8.41)％,respectively],with statistically significant differences(P＜0.05).The scores for exami-nation cooperation[(23.91±3.82)points],nursing cooperation[(24.19±4.03)points],standardized medication use[(24.26±3.94)points],and rational diet[(23.77±3.62)points]in the intervention group were higher than those in the control group[(20.16±3.53),(19.64±3.46),(23.05±3.68),and(18.85±3.41)points,respectively],with statistically significant differences(P＜0.05).The satisfaction rate of family members with nursing work in the intervention group was higher than that in the control group,with a statistically significant difference(98.92％versus 89.25％,P＜0.05).Conclusion The dual-track nursing intervention model has a signifi-cant application effect in children with lobar pneumonia.It can accelerate their recovery process,improve treatment compliance,promote pulmonary function improvement,and enhance family mem-bers' satisfaction.

Objective:To investigate the different expression levels of programmed cell death 1 ligand 1 (PD-L1) in non-small cell carcinoma (NSCLC) of distribution characteristics of TCM constitutions and prognosis.Methods:The clinical data of 355 NSCLC patients who had been treated with immune checkpoint inhibitors (ICIs) from January 2019 to June 2023 in the Cancer Medical Center of the First Affiliated Hospital of Hunan University of Chinese Medicine were retrospectively analyzed, and their TCM constitutions were determined. According to the expression level of PD-L1, they were divided into three groups: low expression group (TPS≤1%), medium expression group (1% < TPS < 49%) and high expression group (TPS≥50%). Overall survival (OS) of patients was followed up, and the median OS were compared. Kaplan-Meier method was used to draw survival curves, and Log-rank test was used to compare the difference of survival curves. The independent risk factors of OS were analyzed by COX regression.Results:The distribution of different TCM constitutions showed statistical significance across the three groups ( P<0.05). The median OS for the medium and high expression groups were 21.082 months and 25.714 months, respectively, both significantly higher than the 14.437 months for the low expression group ( P<0.05). The survival curve of TCM constitutions showed that the constitutions significantly correlated with the prognosis of ICIs treatment were qi deficiency, phlegm dampness, and blood stasis ( P<0.05 or P<0.01). The median OS from high to low was 44.971 months for phlegm-dampness constitution, 23.297 months for qi-deficiency constitution, and 11.763 months for blood-stasis constitution. COX regression analysis indicated that medium PD-L1 expression ( HR=0.622, 95% CI=0.459,0.844, P=0.002), high PD-L1 expression ( HR=0.509, 95% CI=0.361,0.718, P<0.001), phlegm-dampness constitution ( HR=0.556, 95% CI=0.335,0.924, P=0.024), and blood-stasis constitution ( HR=2.952, 95% CI=1.929,4.518, P<0.001) were independent prognostic factors. Conclusions:The higher the expression level of PD-L1 in NSCLC patients, the better the prognosis of ICIs treatment. The prognosis of ICIs treatment is better for people with phlegm-dampness constitution and poor for those with blood stasis constitution.

Objective To evaluate the protective effect of Schistosoma japonicum cystatin(rSj-Cystatin)in a mouse mode of"two-hit"sepsis.Methods Sixty male C57BL/6 mice randomized equally into sham-operated group,protein group,"two-hit"modeling group,and protein intervention group.In the former two groups,the mice received an intraperitoneal injection of 100 μL PBS followed by exposure of the cecum and then by intraperitoneal injection of 100 μL PBS or 25 μg rSj-Cystatin 30 min later;In the latter two groups,100 μL PBS containing LPS(5 mg/kg)was injected intraperitoneally 24 h before cecal ligation and puncture(CLP),and 100 μL PBS or 25 μg rSj-Cystatin were injected 30 min after CLP.At 12 h after rSj-Cystatin treatment,6 mice from each group were sacrificed for detection of TNF-α,IL-6,IL-10,TGF-β,iNOS and Arg-1 in the serum,spleen,liver,lung and kidney tissues using ELISA,for examinations of liver,lung and kidney pathologies with HE staining,and for analysis of CD3+CD4+CD25+Foxp3+T cell percentage in the spleen using flow cytometry.The remaining mice were observed for general condition and 72-h survival.Results The 72-h survival rates in the 4 groups were 100％,100％,0％and 20％,respectively,showing significant differences between the latter two groups.The mouse models of"two-hit"sepsis exhibited obvious tissue pathologies and significant elevations of TNF-α and IL-6 in both the serum and tissue homogenate,which were significantly ameliorated by rSj-Cystatin treatment.Treatment with rSj-Cystatin also increased IL-10 and TGF-β levels and spleen CD3+CD4+CD25+Foxp3+T cell percentage.The septic mouse models also showed increased iNOS levels in all the detected tissues and a decreased Arg-1 level in the kidney,and these changes were obviously improved by rSj-Cystatin treatment.Conclusion rSj-Cystatin has a protective effect against"two-hit"sepsis in mice by regulating the inflammatory microenvironment.

OBJECTIVES: To evaluate the protective effect of Schistosoma japonicum cystatin (rSj-Cystatin) in a mouse mode of "two-hit" sepsis. METHODS: Sixty male C57BL/6 mice randomized equally into sham-operated group, protein group, "two-hit" modeling group, and protein intervention group. In the former two groups, the mice received an intraperitoneal injection of 100 μL PBS followed by exposure of the cecum and then by intraperitoneal injection of 100 μL PBS or 25 μg rSj-Cystatin 30 min later; In the latter two groups, 100 μL PBS containing LPS (5 mg/kg) was injected intraperitoneally 24 h before cecal ligation and puncture (CLP), and 100 μL PBS or 25 μg rSj-Cystatin were injected 30 min after CLP. At 12 h after rSj-Cystatin treatment, 6 mice from each group were sacrificed for detection of TNF-α, IL-6, IL-10, TGF-β, iNOS and Arg-1 in the serum, spleen, liver, lung and kidney tissues using ELISA, for examinations of liver, lung and kidney pathologies with HE staining, and for analysis of CD3⁺CD4⁺CD25⁺Foxp3⁺ T cell percentage in the spleen using flow cytometry. The remaining mice were observed for general condition and 72-h survival. RESULTS: The 72-h survival rates in the 4 groups were 100%, 100%, 0% and 20%, respectively, showing significant differences between the latter two groups. The mouse models of "two-hit" sepsis exhibited obvious tissue pathologies and significant elevations of TNF-α and IL-6 in both the serum and tissue homogenate, which were significantly ameliorated by rSj-Cystatin treatment. Treatment with rSj-Cystatin also increased IL-10 and TGF-β levels and spleen CD3⁺CD4⁺CD25⁺Foxp3⁺ T cell percentage. The septic mouse models also showed increased iNOS levels in all the detected tissues and a decreased Arg-1 level in the kidney, and these changes were obviously improved by rSj-Cystatin treatment. CONCLUSIONS rSj-Cystatin has a protective effect against "two-hit" sepsis in mice by regulating the inflammatory microenvironment.
Animals ; Mice ; Sepsis/drug therapy* ; Male ; Schistosoma japonicum/chemistry* ; Mice, Inbred C57BL ; Cystatins/therapeutic use* ; Interleukin-10/metabolism* ; Interleukin-6/blood* ; Tumor Necrosis Factor-alpha/blood* ; Disease Models, Animal ; Transforming Growth Factor beta/metabolism*