Objective To construct a risk prediction model for post-stroke depression based on the neural network algorithm.Methods A prospective study was conducted on 260 stroke patients admitted in our center from March 2021 to March 2024.They were randomly divided into a train-ing set(80％,208 cases)and a verification set(20％,52 cases).According to the occurrence of post-stroke depression within 1 month after stroke,the training set was assigned into post-stroke depression group(62 cases)and non-post-stroke depression group(146 cases).The predictive fac-tors for post-stroke depression occurrence were screened through the training set,and the risk prediction models for post-stroke depression occurrence were constructed with multivariate logis-tic and neural network algorithms in the training set.The prediction efficiency of the two predic-tion models was compared and verified in the verification set.Results Within 1 month after stroke,76 cases(29.23％)experienced post-stroke depression(62 cases in training set and 14 in the validation set).Based on the data in the training set,the levels of CRP,FIB,IL-6,IL-lβ,TNF-αand IL-18,and neutrophil and lymphocyte ratio(NLR)were significant higher in the post-stroke depression group than the non-post-stroke depression group(P＜0.01).Multivariate logistic re-gression analysis showed that CRP(OR=1.494,95％CI:1.239-1.802),FIB(OR=1.924,95％CI:1.191-3.109),IL-6(OR=1.128,95％CI:1.001-1.272),TNF-α(OR=1.051,95％CI:1.010-1.093),IL-1β(OR=1.096,95％CI:1.006-1.194),IL-18(OR=1.019,95％CI:1.002-1.036),and NLR(OR=1.873,95％CI:1.027-3.418)were risk factors for post-stroke depression(P＜0.05,P＜0.01).ROC curve analysis indicated that the AUC value of the predictive model of the neural network algorithm was higher than that of the model of multivariate logistic regression(0.931 vs 0.855,Z=3.448,P＜0.05).Based on the validation set,the former model also had bet-ter accuracy than the latter one(92.31％vs 75.00％,P＜0.05).Conclusion Circulating inflam-matory factors CRP,FIB,IL-6,IL-1β,TNF-α and IL-18,and NLR are related to the risk of post-stroke depression.The prediction model based on above factors combined with neural network al-gorithm can more effectively predict the risk of post-stroke depression.

Objective To construct a risk prediction model for post-stroke depression based on the neural network algorithm.Methods A prospective study was conducted on 260 stroke patients admitted in our center from March 2021 to March 2024.They were randomly divided into a train-ing set(80％,208 cases)and a verification set(20％,52 cases).According to the occurrence of post-stroke depression within 1 month after stroke,the training set was assigned into post-stroke depression group(62 cases)and non-post-stroke depression group(146 cases).The predictive fac-tors for post-stroke depression occurrence were screened through the training set,and the risk prediction models for post-stroke depression occurrence were constructed with multivariate logis-tic and neural network algorithms in the training set.The prediction efficiency of the two predic-tion models was compared and verified in the verification set.Results Within 1 month after stroke,76 cases(29.23％)experienced post-stroke depression(62 cases in training set and 14 in the validation set).Based on the data in the training set,the levels of CRP,FIB,IL-6,IL-lβ,TNF-αand IL-18,and neutrophil and lymphocyte ratio(NLR)were significant higher in the post-stroke depression group than the non-post-stroke depression group(P＜0.01).Multivariate logistic re-gression analysis showed that CRP(OR=1.494,95％CI:1.239-1.802),FIB(OR=1.924,95％CI:1.191-3.109),IL-6(OR=1.128,95％CI:1.001-1.272),TNF-α(OR=1.051,95％CI:1.010-1.093),IL-1β(OR=1.096,95％CI:1.006-1.194),IL-18(OR=1.019,95％CI:1.002-1.036),and NLR(OR=1.873,95％CI:1.027-3.418)were risk factors for post-stroke depression(P＜0.05,P＜0.01).ROC curve analysis indicated that the AUC value of the predictive model of the neural network algorithm was higher than that of the model of multivariate logistic regression(0.931 vs 0.855,Z=3.448,P＜0.05).Based on the validation set,the former model also had bet-ter accuracy than the latter one(92.31％vs 75.00％,P＜0.05).Conclusion Circulating inflam-matory factors CRP,FIB,IL-6,IL-1β,TNF-α and IL-18,and NLR are related to the risk of post-stroke depression.The prediction model based on above factors combined with neural network al-gorithm can more effectively predict the risk of post-stroke depression.

With the rise of digital healthcare in recent years, digital tools, as a new type of health management tool, are expected to become a feasible tool for rehabilitation exercise in stroke patients. The aim of this article is to review the current status of the application of digital tools in self-management of stroke recovery. In addition, the concept, function and application effect of digital tools are introduced, and the existing problems and future research directions are pointed out, in order to provide reference for the self-management of stroke patients in China.

With the rise of digital healthcare in recent years, digital tools, as a new type of health management tool, are expected to become a feasible tool for rehabilitation exercise in stroke patients. The aim of this article is to review the current status of the application of digital tools in self-management of stroke recovery. In addition, the concept, function and application effect of digital tools are introduced, and the existing problems and future research directions are pointed out, in order to provide reference for the self-management of stroke patients in China.

Rheumatoid arthritis (RA) is an autoimmune disease with a complex etiology. Monocyte-derived macrophages (MDMs) infiltration are associated with RA severity. We have reported the deletion of G-protein-coupled receptor kinase 2 (GRK2) reprograms macrophages toward an anti-inflammatory phenotype by recovering G-protein-coupled receptor signaling. However, as more GRK2-interacting proteins were discovered, the GRK2 interactome mechanisms in RA have been understudied. Thus, in the collagen-induced arthritis mouse model, we performed genetic GRK2 deletion using GRK2^f/fLyz2-Cre^+/- mice. Synovial inflammation and M1 polarization were improved in GRK2^f/fLyz2-Cre^+/- mice. Supporting experiments with RNA-seq and dual-luciferase reporter assays identified peroxisome proliferator-activated receptor γ (PPARγ) as a new GRK2-interacting protein. We further confirmed that fms-related tyrosine kinase 1 (Flt-1), which promoted macrophage migration to induce angiogenesis, was inhibited by GRK2-PPARγ signaling. Mechanistically, excess GRK2 membrane recruitment in CIA MDMs reduced the activation of PPARγ ligand-binding domain and enhanced Flt-1 transcription. Furthermore, the treatment of mice with GRK2 activity inhibitor resulted in significantly diminished CIA pathology, Flt-1⁺ macrophages induced-synovial inflammation, and angiogenesis. Altogether, we anticipate to facilitate the elucidation of previously unappreciated details of GRK2-specific intracellular signaling. Targeting GRK2 activity is a viable strategy to inhibit MDMs infiltration, affording a distinct way to control joint inflammation and angiogenesis of RA.

Objective To investigate the effects of laparoscopic radiofrequency ablation(LRFA)and percutaneous radiofrequency ablation(PRFA)on anti-tumor immunity,complication rate and recurrence rate in patients with primary liver cancer.Methods A total of 81 patients with primary liver cancer treated in Dazhou Central Hospital from January 2020 to August 2022 were selected and divided into observation group(LRFA,n=42)and control group(PRFA,n=39)according to the treatment plan.Compare the total ablation rate,postoperative complication rate,recurrence rate of the two groups,as well as tumor necrosis factor-α(TNF-α),carbohydrate antigen 199(CA199),interleukin-6(IL-6),Golgi protein 73(GP73),C-reactive protein(CRP),alpha-fetoprotein(AFP)and peripheral blood T lymphocyte subpopulation levels before and after surgery.Results There was no significant difference between the observation group(95.24％)and the control group(92.31％)(P＞0.05).At 1 d postoperatively,IL-6 was(124.63±45.41)pg/ml and(168.28±51.26)pg/ml,CRP was(19.14±5.03)ng/L and(28.26±7.47)ng/L,and TNF-α was(94.32±18.49)pg/ml and(108.41±20.11)pg/ml;at 3 d postoperatively,IL-6 was(92.37±24.11)pg/ml and(105.83±27.45)pg/ml in the observation group and the control group,respectively,CRP was(14.87±4.37)ng/L and(17.25±5.06)ng/L,and TNF-α was(75.41±12.10)pg/ml and(82.64±16.83)pg/ml,which were all higher than that of preoperative period(P＜0.05).At 7 d postoperatively,CD3+in the observation group and control group were(66.27±7.82)％and(65.14±7.63)％,AFP was(156.23±30.27)μg/mland(160.84±32.33)μg/ml,GP73 was(65.21±10.26)μg/L and(67.44±11.03)μg/L,CA199 was(44.89±11.41)U/L and(45.12±13.07)U/L,CD4 was(32.02±6.03)％and(31.53±6.11)％,and CD4+/CD8+was(1.31±0.39)and(1.29±0.37)respectively;at 14 d postoperatively,CD3+was(71.25±6.83)％and(70.89±6.76)％,AFP was(48.52±18.31)μg/ml and(50.11±19.12)μg/ml,GP73 was(48.25±8.46)μg/L and(49.12±10.12)μg/L,CA199 was(19.27±5.16)U/L and(20.07±5.39)U/L,and CD4 was(38.25±7.7)U/L and(20.07±5.39)U/L,respectively,in the observation and control groups.g/L,CA199 was(19.27±5.16)U/L and(20.07±5.39)U/L,CD4 was(38.25±7.45)％and(37.61±7.92)％,and CD4+/CD8+was(1.49±0.42)and(1.47±0.45),respectively,which were higher than that of preoperative period(P＜0.05),but the difference between the two groups was not statistically significant(P＞0.05).The postoperative complication rate of 42.86％and recurrence rate of 2.38％in the observation group were lower than 66.67％and 17.95％in the control group(P＜0.05).The 12-month postoperative survival rate of 97.62％in the observation group was not statistically significant compared with 94.87％in the control group(P＞0.05).Conclusion The efficacy of LRFA and PRFA in the treatment of primary hepatocellular carcinoma is comparable,which can effectively improve the body's anti-tumor immunity and reduce the release of serum tumor markers;however,LRFA has less stressful reaction,reduces the occurrence of postoperative complications,and has a lower recurrence rate,which is especially advantageous in the treatment of hepatocellular carcinoma at special sites.

Objective To evaluate the cost-effectiveness of enzalutamide in the treatment of metastatic prostate cancer from the perspective of healthcare in China.Methods Based on the published phase Ⅲ randomized controlled trial(ENZAMET),the disease process of metastatic prostate cancer was classified into three states:progression-free survival,progression survival and death,and the model period was defined as 28 days,and the study period was lifelong,and a Markov model was established to evaluate the cost-effectiveness of the treatment of enzalutamide versus standard antiandrogen drugs in metastatic prostate cancer.Setting the willingness-to-pay(WTP)threshold at 3 times our 2022 gross domestic product(GDP)per capita and the robustness of the model analysis was verified by sensitivity analysis.Results Compared to the control group standard antiandrogen therapy,the incremental effect of enzalutamide was 0.92 quality-adjusted life years(QALYs),the incremental cost was 311 863.30 yuan,and the incremental cost-effectiveness ratio(ICER)was 338 981.85 yuan/QALY,which was higher than WTP threshold(257 094 yuan/QALY).The results of univariate sensitivity analyses showed that the total cost of the enzalutamide group,the PFS utility value,the cost of the PD status of enzalutamide group,and the unit price of enzalutamide had a greater impact on the model results.The results of the probabilistic sensitivity analysis suggested that the enzalutamide treatment regimen was not economical within the willingness-to-pay threshold of 3 times our 2022 GDP per capita.Conclusion Compared with the standard anti-androgen drugs,enzalutamide does not offer a cost-effectiveness advantage in the treatment of metastatic prostate cancer.

Purpose To analyze the precursor lesions,clinicopathological features and prognosis of mucinous carcinoma(MC).Methods A total of 303 MC cases diagnosed by surgi-cal specimens were included,including 193 pure mucinous car-cinomas(PMC)and 110 mixed mucinous carcinomas(MMC).PMC included 163 cases of type A(hypocellular type)and 30 cases of type B(hypercellular type).The histomorphological characteristics,surrounding breast tissue morphology,and im-mune markers were evaluated to analyze the clinicopathological features related to MC precursor lesions and prognosis.Results The median age at diagnosis of MC was 50 years,and the me-dian tumor size was 2.5 cm.Compared to PMC,MMC had more lymph node(LN)involvement,more grade Ⅲ-Ⅳ and Ki67＞20％tumors(P＜0.05).There were no significant differences in tumor size,LN involvement and clinical stage between type A and type B PMC.55 cases of MC(49 PMC and 6 MMC)with precursor lesions of mucocoele-like lesions(MLL)were all grade 1 to 2,most of them(54/55,98.2％)were T1-T2,and the proportions of MC component in all 6 MMCs were all ≥ 50％.There were 119 cases of MC whose precursor lesions were ductal carcinoma in situ(DCIS),of which 28.6％of cases(34/119)had LN involvement,and 16.8％(20/119)of cases showed high proliferative activity(Ki67＞20％).The precursor lesions of MC in 16 cases were solid papillary carcinoma(SPC)in situ,inclu-ding 7 cases of type BPMC and 9 cases of MMC.The median age of these patients was 67 years and no recurrence or metastasis was observed during follow-up.The disease-free survival(DFS)and overall survival(OS)of the 303 cases of MC was 93.5％and 98.6％,respectively.PMC had a better prognosis than MMC(DFS:95.2％vs.90.6％;OS:99.5％vs.97.2％),but there was no significant difference between type A and type B PMC.The prognosis of patients with LN involvement and clinical stage Ⅲ-Ⅳ was worse(P＜0.05).Conclusion MC of the breast is a kind of heterogeneous malignant tumors.Our findings support that MC with specific precursor lesions have different ev-olutionary pathways,that MC with precursor lesions of MLL and SPC have a good prognosis,and MC associated with high-grade DCIS are more aggressive.LN involvement,higher clinical grade,and younger age are associated with poor prognosis.Focu-sing on precursor lesions and high risk clinicopathological fea-tures can contribute to providing more effective treatments for these patients.

The rehabilitation compliance of stroke patients is generally low.Evaluating the rehabilitation motivation of patients is helpful to promote the rehabilitation management of patients,enhance the rehabilitation enthusiasm and compliance of patients,and improve the rehabilitation outcome.This paper reviews the existing stroke patients rehabilitation motivation assessment tools,and expounds the main contents,application status,characteristics and limitations of stroke patients rehabilitation motivation assessment tools,in order to provide references for the appropriate selection of clinical assessment tools,the rehabilitation management of stroke patients and the development of domestic localized stroke rehabilitation motivation assessment tools.

Objective To investigate the correlation of serum calmodulin(CaM)level with the con-dition and prognosis of patients with severe traumatic brain injury(sTBI).Methods A total of 208 elderly sTBI patients admitted to the Geriatric Hospital and Puren Hospital Affiliated to Wuhan University of Science and Technology from January 2021 to June 2023 were enrolled,and after 3 months'follow-up,192 cases were finally included in this study.According to their progno-sis,they were divided into poor prognosis group(n=56)and good prognosis group(n=136).Their general data were collected,and serum CaM level was measured by ELISA.Pearson correla-tion analysis was used to study the correlation between the level and the disease condition.Multi-variate logistic regression model was employed to screen the prognosis related factors of sTBI pa-tients,and restricted cubic spline was applied to fit the relationship between serum CaM level and prognosis of sTBI patients.Results Midline shift,significantly lower CaM level and acute physi-ology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,and obviously higher Glasgow Coma Scale(GCS)score and albumin level were observed in the good prognosis group than the poor prognosis group(P＜0.05,P＜0.01).Pearson correlation analysis showed that serum CaM level was negatively correlated with condition of sTBI(r=-0.804,P＜0.05).Multivariate logistic analysis indicated that APACHE Ⅱ score(OR=1.248,95％CI:1.076-1.447,P=0.003)and ser-um CaM level(OR=1.030,95％CI:1.017-1.044,P=0.001)were risk factors for prognosis,while,GCS score(OR=0.730,95％CI:0.536-0.994,P=0.045)and serum albumin level(OR=0.730,95％CI:0.649-0.822,P=0.001)were protective factors for poor prognosis in sTBI pa-tients.Restricted cubic spline revealed that there was a linear dose-response relationship between serum CaM level and prognosis of sTBI patients(X2=27.080,P＜0.01).Conclusion Serum CaM level is correlated with sTBI disease and prognosis.