Objectives:To investigate the predictive factors of stroke associated-pneumonia (SAP) in patients with acute stroke, develop nomogram and neural network prediction models and verify their predictive performance.Methods:Patients with acute stroke admitted to the First Affiliated Hospital of Kunming Medical University and Zhenxiong County People's Hospital were included retrospectively. Multivariate logistic regression analysis was used to determine the independent predictive factors of SAP, and develop nomogram and neural network prediction models. Receiver operating characteristic curve (ROC) curves were used to validate and compare the predictive performances. Results:A total of 450 patients with acute stroke were enrolled, including 286 males (63.6%), aged 64.28±13.24 years; 344 patientss (76.4%) had ischemic stroke and 106 (23.6%) had hemorrhagic stroke; 128 patients (28.4%) experienced SAP. According to the random number method, they were divided into a modeling cohort ( n=300) and a validation cohort ( n=150). Multivariate logistic regression analysis in the modeling cohort showed that a higher baseline National Institutes of Health Stroke Scale (NIHSS) score, gastric tube placement, use of proton pump inhibitors, heart failure, and higher neutrophil/lymphocyte ratio (NLR) were the independent predictive factors of SAP. ROC curve analysis showed that the area under the ROC curve of the nomogram model for predicting SAP in the modeling cohort and validation cohort was 0.841 (95% confidence interval [ CI] 0.795-0.880) and 0.863 (95% CI 0.798-0.914), respectively. The sensitivity for predicting SAP were 75.00% and 70.45%, respectively, and the specificity was 81.94% and 92.45%, respectively. The area under the ROC curve of the neural network model for predicting SAP in the modeling cohort and validation cohort was 0.847 (95% CI 0.802-0.866) and 0.862 (95% CI 0.796-0.913), respectively. The sensitivity for predicting SAP were 76.19% and 72.73%, and the specificity was 79.17% and 89.62%, respectively. Conclusions:Higher NIHSS score, gastric tube placement, use of proton pump inhibitors, heart failure, and higher NLR are the independent risk factors for SAP in patients with acute stroke. The nomogram and neural network prediction model developed using the above risk factors have higher predictive value for SAP.

Objective:To investigate the radiation dose and detection efficiency of artificial intelligence (AI) system for solid nodules in chest phantom with different scanning protocols.Methods:A total of 60 simulated nodules with different CT values and diameters were uniformly placed in each lung lobe and lung segment of the anthropomorphic chest phantom. GE Revolution evo CT was used to scan the chest phantom. 64 groups of images with different scanning parameters were collected at the tube voltage of 80, 100, 120, 140 kV, different noise indexes (NI 10-40 with interval 2), and other fixed parameters. The detection result of simulated nodules were recorded on AI software, and the detection rate and false detection rate were calculated, respectively, for different shapes of nodules. The mean volume CT dose index (CTDI vol) and dose length product (DLP) of each scan were recorded. Results:There were no statistically significant differences in the detection rate and false detection rate of spherical nodules and irregular nodules at different tube voltages( P > 0.05), but there were and statistically significant with different noise indices ( F=10.57, 17.77, 9.33, P < 0.001). Different tube voltages had no statistical significance for CTDI vol and DLP ( P > 0.05), while different noise indices had statistical significance for CTDI vol and DLP ( F=59.87, 60.92, P < 0.001). The detection rates of nodules were moderately or weakly correlated with noise indices, CTDI vol and DLP ( r=0.43, 0.56, -0.58, -0.78, P<0.05), but no correlation with tube voltage ( P>0.05). Conclusions:Scanning protocol has an impact on AI detection efficiency of pulmonary nodules. Reasonable scanning parameters should be selected according to different image quality requirements in clinical practice.

Objective:Four cases with NLRP3-related autoinflammatory diseases were reported to summarize the clinical characteristics, genotype, and treatment responses of the disease, and to improve clinical pediatricians' understanding of the disease.Methods:A retrospective analysis was performed on 4 cases with NLRP3-related autoinflammatory diseases diagnosed in Children's Hospital of Anhui Province in 2016—2021, and the clinical features and treatment progress of NLRP3-related autoinflammatory diseases were retrospectively analyzed based on the clinical features, gene reports, and literature review.Results:① All 4 cases were male. Cases 1, 2, and 3 had the disease onset after birth, and case 4 had the disease onset 6 months after birth. All showed periodic fever, repeated urticaria-like rash, protruding forehead, and saddle nose. White blood cells count, erythrocyte sedimentation rate, and C-reactive protein were increased during the attack period, and those in the interval period were normal, and antibiotic treatment was ineffective. ② The genetic test of all these 4 children showed NLRP3 mutation. Children 1, 2, and 3 were heterozygous mutations, and their parents were wild-type. The mutation was located at chromosome Chr1: 247587658, exon c913 (exon3). G>A, the 305th aspartic acid (Asp) of the protein was changed to asparagine (Asn) in child 1. The mutation was located at the chromosomal Chr1: 247588072, the nucleic acid was changed to c1327(exon3)T>C, and the amino acid was changed to p.Y443H in cases 2 and 3. Somatic heterozygous mutation was found in case 4, and the child's parents were wild-type. In this case, the mutation was located at chromosomal Chr1: 247587658, exon3 G>A, and the 305th Asp of the protein was changed to Asn. ③Children in cases 1, 2, and 3 were treated with glucocorticoids and non-steroidal anti-inflammatory drugs at the initial stage, but the effects were limited. After receiving IL-1 antagonist treatment fever, skin rash, joint swelling and pain disappeared, and the inflammatory indexes were returned to normal. The child 4 received non-steroidal anti-inflammatory drugs and methotrexate, but he failed to respond to the treatment. Treatment with tocilizumab was not effective, however, fever, skin rash, or joint pain disappeared after treated with Khanna.Conclusion:①NLRP3-related autoinflammatory diseases can cause periodic fever, urticaria, joint involvement, and severe involvement of the central nervous system and organ amyloidosis. Which are early misdiagnosis is prone to systemic juvenile idiopathic arthritis. ②The disease was an inflammatory disease mediated by interleukin-1. At present, non-steroidal anti-inflammatory drug, glucocorticoid and chronic anti-rheumatic drugs have limited effects. IL-1 antagonists are effective and safe in the treatment of the disease.

Objective: To investigate the prevalence of postmenopausal osteoporosis (PMOP) and analyze its influencing factors among women at ages of 50 to 59 years in Dali Bai Autonomous Prefecture, Yunnan Province, so as to provide insights into the prevention of PMOP among menopausal women. Methods: Bai Ethnic menopausal women at ages of 50 to 59 years who received healthy examination at the Center of Healthy Examination, Dali Prefecture People's Hospital from June 2017 to May 2021 were selected as the study subjects, and subjects' demographic characteristics, living habits, history of diseases, family history of osteoporosis and history of parturition were collected using self-designed questionnaires. The height, body weight and bone density were measured, and fasting blood glucose, vitamin D3, blood lipids and liver functions were detected. The factors affecting the development of PMOP were identified using a multivariable logistic regression model. Results: Totally 2 000 questionnaires were allocated, and 1 584 valid questionnaires were recovered, with an effective recovery rate of 79.20%. The respondents had a mean age of ( 56.22±2.61 ) years, and mean body mass index ( BMI ) of ( 24.62±2.35 ) kg/m2. There were 497 respondents ( 31.38% ) with a family history of osteoporosis, and the prevalence of PMOP was 20.64%. Multivariable logistic regression analysis identified age ( OR=1.135, 95%CI: 1.074-1.196 ), age of menarche ( OR=1.138, 95%CI: 1.059-1.217 ), duration of menopause (OR=1.425, 95%CI: 1.228-1.622), number of parturition ( >2, OR=5.036, 95%CI: 2.972-7.101 ), smoking ( OR=2.594, 95%CI: 1.767- 3.421 ), alcohol consumption ( OR=2.051, 95%CI: 1.503-2.598 ), family history of osteoporosis ( OR=2.540, 95%CI: 1.769-3.311 ), hypertension ( OR=1.492, 95%CI: 1.406-1.578 ), diabetes ( OR=1.774, 95%CI: 1.581-1.967 ), total cholesterol ( OR=1.483, 95%CI: 1.251-1.716 ), triacylglycerol ( OR=1.801, 95%CI: 1.576-2.026 ), low-density lipoprotein cholesterol ( OR=1.614, 95%CI: 1.498-1.731 ), fasting blood glucose ( OR=1.192, 95%CI: 1.077-1.307 ), BMI ( OR=0.934, 95%CI: 0.862-0.993 ), outdoor activity ( ≥1 time/week, OR: 0.413-0.549, 95%CI: 0.329-0.637 ), age of menopause ( OR=0.909, 95%CI: 0.841-0.977 ), daily intake of calcium ( ≥600 mg, OR: 0.493-0.644, 95%CI: 0.389-0.786 ), vitamin D3 level ( ≥20 ng/mL, OR: 0.604-0.719, 95%CI: 0.523-0.853 ) and high-density lipoprotein cholesterol ( OR=0.658, 95%CI: 0.550-0.767 ) as factors affecting the development of PMOP. Conclusions The prevalence of PMOP in Dali Bai Autonomous Prefecture is similar to the nationwide level in China, and old age, smoking, alcohol consumption, a family history of osteoporosis and high blood lipid levels may increase the risk of PMOP.

Objective:To investigate clinical features of congenital triangular alopecia.Methods:Clinical data were collected from 10 children with congenital triangular alopecia, who were diagnosed and treated in Xiamen Children′s Hospital from August 2020 to June 2021, and their clinical and dermoscopic features were analyzed.Results:All the 10 patients were males, aged from 2 months to 6 years and 4 months. Hair loss occurred at birth or within 1 month after birth in 6 children, and occurred between the age of 4 months and 6 years in 4. The alopecic area was located in the left frontotemporal region in 5 patients, in the right frontotemporal region in 3, and in the vertex region in 2. In all the patients, thin vellus hair could be seen in the alopecic areas, and the hair pull test was negative, while in 1 patient showed some normal terminal hair scattered in the alopecic area. Dermoscopy showed a lot of vellus hair surrounded by normal terminal hair in the alopecic area with a clear boundary, and no yellow or black dots, or 'exclamation mark’ hair was observed. Seven patients had visited department of dermatology due to hair loss, of whom 5 were diagnosed with alopecia areata, and 2 with sebaceous nevus.Conclusions:Congenital triangular alopecia is common in children, and mostly occurs in the left frontotemporal region. It is characterized by the replacement of normal terminal hair by thin vellus hair in the alopecic area. Dermoscopy is helpful in its diagnosis and differential diagnosis.

Objective To compare the therapeutic effect of postprandial and preprandial injection of glulisine.Methods Sixty hospitalized patients with T2DM receiving one dose of glargine and three doses of glulisine were recruited.They were randomly divided into two groups:group A and group B when the glycemic state and insulin dosages had been stable for more than seven days.Two-stage cross design:stage 1:group A (n=30):glulisine was injected before meal;Group B (n=30):glulisine was injected after meal.Blood glucose was monitored for three days.Stage 2:glulisine was injected after meal in group A while before meal in group B without dosages adjustment,and blood glucose was monitored continuously for three days.Then standard deviation of blood sugar (SDBG),blood glucose fluctuation after meal (PPGE),maximum blood glucose fluctuation range (LAGE) during 24 hour and satisfaction values of insulin treatment (SVIT) were compared.Results There was no significant differences between group A and group B in terms of age((50.70±13.29)years vs (55.63±13.05) years,P=0.152),diabetes course((36.23±29.20)months vs (43.63±32.19) months,P=0.355),HbA1c ((10.05％± 1.46％)vs (9.81％±2.08％,P=0.612),daily insulin dose((35.67±8.64)U vs (34.83±8.24) U,P=0.704),SDBG ((2.63±0.58 vs (2.84±0.64)) before operation.There was no significant differences of SDBG(F=0.432,P=0.73),PPGE (F=1.216,P=0.31),LAGE (F=0.431,P=0.73) or SVIT (F=0.685,P=0.56) between glulisine injected before and after meal.Conclusion Postprandial glulisine administration can provide the same effect in lowering glucose,satisfaction values and reducing glucose fluctuation as preprandial injection.

Objective: To explore whether Angiopoietin-like protein 3 (ANGPTL3) is involved in podocyte actin rearrangement, and to analyze whether integrin β3 signal pathway is a key in ANGPTL3 inducing actin rearrangement. Methods: The cultured podocytes were divided into six groups: wild type, ADR treated, ADR+Dex, MOCK, ANGPTL3-cDNA, miRNA, and AD+miRNA group. (1) We observed actin cytoskeleton using Invitrogen reagents with confocal microscopy; (2) Actin cytoskeleton after blocking β3 on podocytes was; (3) The expression of total FAK and p-FAK was through Western blotting. Results: (1) The wild type podocyte's cytoskeleton is arranged orderly. After ADR treatment, podocyte's actin are rearranged and weaken (P<0.05). There was no significant difference in actin arrangement between knock-down and MOCK group. In ANGPTL3-cDNA group the podocyte actin was also significantly rearranged; on the contrary, in miRNA+ADR group, the actin rearrangement never obviously happened (P<0.05). (2) Over-expression of ANGPTL3 podocytes blocked integrin β3 did not happen actin rearrangement. (3) The expression of p-FAK significantly increased in over-expression ANGPTL3 podocytes. Conclusion ANGPTL3 is a key in inducing actin rearrangement. Intergrin β3 maybe a central pathway in ANGPTL3's role with podocytes.

Frailty is a geriatric syndrome that has been implicated as a causative and prognostic factor for cardiovascular disease (CVD).Frailty and CVD are often concurrent and mutually promotive.The prevalence of frailty ranges from 10％ to 60％ in patients with CVD,depending on different tools and cutoffs chosen to define frailty.Short-and long-term prognosis of CVD are both affected by frailty.The presence of frailty is correlated with an increase in complications,outpatient and emergency department visits,hospital admissions and stays,and mortality in patients with CVD.Early prevention and clinical intervention can delay or even reverse the development of frailty,thus improving the prognosis for CVD.

Objective To observe the efficacy and safety of pigolitazone/metformin fixed-dose combination therapy replacing metformin alone or combined with other anti-diabetes drugs in type 2 diabetes with poor glycemic control.Methods 80 cases were recruited,with an average age of (54.79±13.99)years,diabetes history of (9.76±6.59) and baseline HbA1c (9.06±1.34)％.All participants received pigolitazone/metformin instead of metformin without other treatment changes.Glycemic control (level of fast blood glucose,HbA1c) was evaluated at 12 weeks,as well as lipid profiles,liver and renal function,adverse events and body weight.Results 8 cases were lost to visit,4 cases were withdrawn for edema,only 68 subjects finished the study.Compared to the baseline,after 12-week treatment,FPG decreased for (2.06+0.16) mmol/L,HbA1c decreased for (0.84+0.23)％,both of the differences were statistically significant (P＜0.001,P＜0.001).Body weight increased (0.34+1.13)kg,with no difference compared to the baseline.The lipid profile presented elevated high density lipoprotein cholesterol (P=0.012)and decreased total cholesterol,low density lipoprotein cholesterol,triglyceride,while the latter three items showed no differences (P＞0.05,P＞0.05,P＞0.05).Indexes reflecting liver and renal function,such as ALT,AST,TBIL,DBIL,Urea,UA,Cr showed no differences compared with the baseline.Adverse events analysis showed at the end of the study,no severe hypoglycemia and serious cardiovascular events occurred,6 cases suffered edema,among whom 4 patients exited the study for severe lower limb edema.No extra gastrointestinal symptom happened.Conclusion Pigolitazone/metformin fixed-dose combination exhibits an excellent efficacy and safety for T2DM,with satisfying tolerability and compliance,which is a selection for those patients with poor glycemic control.

Objective To explore the correlation between circadian clock gene clock circadian regulator (CLOCK) and attention-deficit/hyperactivity disorder (ADHD) and the role of CLOCK and sleep problems on inhibition in male children with ADHD. Methods Two single nucleotide polymorphisms (SNPs) of CLOCK were genotyped in 854 male ADHD children and 320 male controls. Sleep problems were assessed using parent symptom questionnaire. In ADHD cases, the main effects and interaction of CLOCK SNPs and sleep problems on inhibition assessed by using Stroop Color and Word Test, were analyzed using the analysis of covariance (ANCOVA). Results No significant differences of allele and genotype frequencies were found for rs6832769 and rs11932595 in all case-control groups (P>0.05). In ADHD cas?es, the main effects of rs6832769 and rs11932595 genotypes and sleep problems on inhibition were not significant (P>0.05). However, the interaction of rs6832769 genotype and sleep problems was significant (F=6.71, P=0.01). When ac?companied with sleep problems, ADHD cases carrying the AA&AG genotype showed the longest time of word interfer? ence (F=6.63, P=0.01). Conclusions Inhibition of male ADHD children can be modulated by the interaction of CLOCK rs6832769 and sleep problems.