Objective:s To investigate the risk factors for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in patients with acute carbon monoxide poisoning (ACOP) and to develop predictive models based on machine learning algorithms.Methods:Patients with ACOP hospitalized at the First Affiliated Hospital of Zhengzhou University from August 2019 to October 2024 were included, with the occurrence of DEACMP as the outcome measure. The dataset was randomly divided into training and validation sets at a ratio of 7:3. Lasso regression was used to select features influencing the outcome in training sets. Nine machine learning models—including Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Support Vector Machine (SVM)—were constructed. Receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) calculated for each model. Calibration curves were used to assess accuracy, and decision curve analysis (DCA) was applied to evaluate clinical utility. The SHapley Additive exPlanations (SHAP) method was employed to visualize and interpret the best-performing model.Results:A total of 264 ACOP patients were included, of whom 54 (20.5%) developed DEACMP. Lasso regression identified eight key feature variables. Based on these factors, predictive models were constructed, showing good AUC stability across the nine machine learning models in both training (0.92–0.99) and validation sets (0.85–0.91). The RF model performed best, with an AUC of 0.99 in the training set and 0.90 in the validation set; its calibration curve and DCA curve also demonstrated excellent performance. SHAP analysis of the RF model revealed the importance ranking of factors from highest to lowest as follows: Glasgow Coma Scale (GCS) score, duration of coma, age, history of coronary heart disease, CK-MB level, monocyte count, diastolic blood pressure (DBP), and drinking history.Conclusions:The RF model exhibited the highest predictive performance for DEACMP occurrence in ACOP patients. The influencing factors, ranked in order of importance from highest to lowest, are as follows: GCS score, duration of coma, age, history of coronary heart disease, CK-MB level, monocyte count, DBP, and drinking history.

Objective To investigate the relationship between serum sorting protein(Sortilin),trimethyl-amine oxide(TMAO)and inflammatory factors and abdominal aortic calcification(AAC)in maintenance he-modialysis(MHD)patients.Methods A total of 197 MHD patients(MHD group)admitted to Department of Nephrology in the hospital from January 2021 to May 2023 and 150 physically examined healthy individuals(control group)during the same period were prospectively selected,and the MHD patients were classified into the moderate and severe AAC group(82 patients)and no or mild AAC group(115 patients)according to the AAC score.The serum of serum Sortilin,TMAO and inflammatory factors[interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α)]were measured using enzyme-linked immunosorbent assay.The correlation be-tween serum Sortilin,TMAO,and inflammatory factors in MHD patients was assessed using Spearman corre-lation analysis,and influencing factors associated with moderate and severe AAC in MHD patients were ex-plored using multivariate Logistic regression analysis.The predictive value of serum Sortilin and TMAO levels for moderate and severe AAC in MHD patients was analyzed using receiver operating characteristic curve.Re-sults The levels of serum Sortilin,TMAO,IL-1β,IL-6 and TNF-α in moderate and severe AAC group were higher than those in no or mild AAC group and control group(all P＜0.05).Serum Sortilin and TMAO were positively correlated with IL-1β,IL-6 and TNF-α levels in MHD patients(all P＜0.05).Prolonged dialysis age(OR=1.034,95％CI:1.010-1.060),increased levels of IL-6(OR=1.092,95％CI:1.034-1.152),Sortilin(OR=1.076,95％CI:1.043-1.110)and TMAO(OR=1.384,95％CI:1.150-1.664)were independent risk factors for moderate and severe AAC in MHD patients(P＜0.05).The area under the curve of serum Sortilin combined with TMAO levels in predicting moderate and severe AAC in MHD patients was 0.885(95％CI:0.831-0.926),which was greater than 0.785(95％CI:0.721-0.841)and 0.797(95％CI:0.734-0.850)predicted by serum Sortilin and TMAO levels alone(P＜0.05).Conclusion The levels of se-rum Sortilin and TMAO in MHD patients are increased,and are closely related to the elevation of inflammato-ry factors and AAC.Furthermore,the combination of serum Sortilin and TMAO levels shows certain predic-tive value for moderate and severe AAC in MHD patients.

Objective: To investigate the location, size, ultrasonic characteristics and clinical significances of normal parathyroid glands. Methods: A total of 350 healthy subjects with no relevant diseases in Shanxi Provincial Cancer Hospital from January 2017 to December 2017 were selected. The age ranged from 9 to 83 years old. They were divided into seven groups according to age, with 50 in each group. The position, size, shape, echo, boundary, and blood flow signal characteristics of the normal parathyroid glands in these healthy subjects examined by ultrasound were retrospectively analyzed, and the differences among the different groups were compared. Results: The detection rate of normal parathyroid glands in 350 subjects was 95.4% (1 335/1 400). The normal parathyroid glands were oval, fusiform or irregular shape hyperechoic or isoechoic nodules, with homogeneous echoes and clear borders. There was no obvious blood flow signal in most glands. The proportion of fusiform shape in upper parathyroid glands (24.4%, 161/659) was higher than that in lower parathyroid glands (18.4%, 125/676), the difference was statistically significant (χ ² = 6.99, P < 0.05). The superior parathyroid gland was mainly located in the superior thyroid region, while the inferior parathyroid gland was mainly located in the inferior thyroid region, especially within the range of 2 cm from the inferior thyroid pole. In the age ≤ 20 years old group, the proportion of patients with upper parathyroid gland in the upper thyroid region (80.4%, 74/92) was higher than that in the other age groups, and the proportion of patients with lower parathyroid gland in the subthyroid region (30.6%, 30/98) was higher than that in the other age groups, the difference was statistically significant (χ ² = 3.35, P < 0.05). There was no significant difference in the size of parathyroid gland among different age groups (P > 0.05). Conclusions The detection rate of normal parathyroid glands is high, and they mainly located in the upper and lower thyroid regions within 2 cm from the lower margin of the thyroid. Ultrasound images are mainly characterized by the clear elliptical shape and the uniform high echo. The ultrasonic characteristics of normal parathyroid glands are conducive to preoperative localization of parathyroid glands and provides a reliable basis for finding and retaining parathyroid glands in thyroid surgery.

Objective To study the effect of gastrin, motilin of chronic atrophic gastritis model in rats by acupuncturing at back-shu points. Methods 60 SD rats were randomly divided into blank control group, model control group, omeprazole group, back-shu points group, with 15 rats in each group, and to establish the model of chronic atrophic gastritis by irregular diet that given rats odd and even days. The blank control group, model control group were fed with normal saline, 2ml/time, 1 time/day. The omeprazole group was given oral gavage(Omeprazole 0.44 mg/kg, Clarithromycin 6.92 mg/kg, Metronidazole 7.6 mg/kg), 1 time/day. Back-shu points group received acupuncture at “Geshu”“Ganshu”“Pishu”“Weishu”“Shenshu”, retaining 15 min, 1 time/day. After 30 days, the content of ELSIA was used to detect the serum gastrin, motilin. Results ①GAS of model control group(54.25±5.70)pg/ml was significantly decreased compared with blank control group(66.63± 5.99)pg/ml, the difference was statistically significant (P<0.05). Compared with the model control group, GAS content of omeprazole group(62.70±8.55)pg/ml and back-shu Points group(66.27±3.79)pg/ml were higher, showed significant differences(P<0.05). ②MOT of model control group(223.60±17.83)pg/ml was significantly increased compared with the blank control group(188.45 ± 8.90)pg/ml, the difference was statistically significant(P<0.05). MOT of omeprazole group(200.16 ± 4.38)pg/ml and back-shu Points group(190.11±10.04)pg/ml were lower than those in the model control group, there was statistically significant difference(P<0.05). Conclusion Acupuncturing at back-shu acupoints can increase the content of GAS, reduce content of MOT, regulate gastrointestinal hormone in rats of chronic atrophic gastritis model.

Objective To compare the value of intrarectal filling with water and filling in rubber sheath with water in endoluminal uhrasonography for preoperative staging of rectal tumors. Methods 215 cases of rectal tumors were divided into two groups. 120 cases using the method of filling in rubber sheath with water and 95 cases using intrarectal filling with water were diagnosed with uhrasonography. The results were compared with corresponding pathologic results for the judgment of their accuracy. Results The accuracy for the diagnosis of infiltration depth was 60.0 % in the first group and was 73.7 % in the second. The difference was statistically significant (P <0.05). The accuracy for diagnosis of metastases of perirectal lymph nodes was 82.5 % in the first group and was 80.0 % in the second. The difference has no statistical significance (P >0.50). Conclusion Intrarectai filling with water is better than filling in rubber sheath with water in the diagnosis of infiltration depth of rectal tumors, while there is no difference in the diagnosis of metastasis of perirectal lymph nodes.

Objective To investigate the endoluminal ultrasonographie characteristics of adenoearcinoma and mucous adenocareinoma of the rectum. Methods The ultrasonographie characteristics of thirty eases of advanced adenoeareinoma of the rectum and twenty-eight eases of rectal mucous adenoearcinoma were analyzed retrospectively in comparison with their eorresponding pathologic images. Results In advanced adenocareinoma of the rectum, 28 eases manifested rough endoluminal surface, of which 19 marked by thickened changes without arrangement of layers, 10 had indistinct arrangement of layers in some areas and one had clear arrangement of layers. In the deepest margin of infiltration, 17 eases manifested sentus, homed or knot-like protuberance, while 5 marked by wavy margins, and 8 cases had clear and fiat margins. In 25 eases of rectal mucous adenocareinoma, 20 manifested smooth endoluminal surface. With regard to infiltration of tumors to rectal wall, 6 cases manifested clear arrangement of layers, while 13 had clear arrangement of layers in part and 6 had no clear arrangement. In the deepest part of infiltration, 8 eases manifested slippery and fiat margins and 10 manifested wavy margins and 7 had a few sentus, homed or knot-like protuberance locally. According to ultrasonic results of the depth of infiltration to rectal wall in comparison with pathologic findings, 25 eases were diagnosed accurately, while in two cases the diagnosis was too shallow and in three eases it was too deep. In rectal mucous adenocarcinoma, 10 cases got correct diagnosis and 14 were diagnosed superficially and one got too deep. The accuracy of ultrasonic diagnosis on rectal mueoas adenoearcinoma was apparently lower than that of adenoeareinoma and most of the misdiagnosis were too superfieiai. Conclusion There are different ultrasonographie characteristics of rectal adenoeareinoma and rectal mucous adenoeareinoma, which can be helpful for the typing of rectal carcinoma and avoiding excessively superficial misdiagnosis.

Objective To discuss the characteristics of ultrasonic images obtained by color Doppler per rectum after intrarectal pouring and the advantages of this method.Methods 40 cases who were diagnosed as rectal carcinoma prior to surgeries were investigated.The rectum was cleand and then was poured with normal saline before examination.Color Doppler ultrasonography per rectum was performed with intrarectal probe touching the inferior edge of the tumor.The 2-dimensional images and color Doppler images were then analyzed.Results The accurate typing of rectal tumors(detailedly,the ulcerative,intumescent,and confined types)can be obtained with this method.Within the 40 cases,24 were ulcerative,12 were intumescent and 4 were confined.Only one case with ulcerative tumor was misdiagnosed as intumescent.The total accuracy rate was 97.5%.As with rectal tumors less than 5cm,there was no significant difference between the measurement by ultrasonography and that by pathologic methods (P＞0.05).While for tumors larger than 5cm,the measurement by ultrasonography was significantly different from that by pathologic methods (P＜0.05).There was no significant correlation between the bloodstream signal of color Doppler and pathological grading(P＞0.05).The method can be applied for patients who have a narrow rectal duct or are suffering from agonies which prevent the passage of the colonoscope.For cases failing to detect the margin and surface of the tumor with routine method,or ultrasonic probe failing to pass the confined area leading to illegible 2-dimensional images,This method is competent as well.Conclusion Color Doppler ultrasonography per rectum after intrareetal pouring can be applied for the diagnosis of rectal tumors of all types.