ObjectiveTo investigate the value of predictive models established based on machine learning methods in predicting the risk of metabolic associated fatty liver disease （MAFLD）， and to analyze its key risk factors. MethodsA retrospective analysis was performed for the 50 variables of 2 168 healthy individuals who underwent physical examination in Department of Health Assessment， Xiyuan Hospital， China Academy of Chinese Medical Sciences， from January 2021 to December 2024， including body composition， past history， and laboratory tests， and according to whether they were diagnosed with MAFLD or not， they were divided into MAFLD group with 265 individuals and non-MAFLD group with 1 903 individuals. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. Randomly split the research data into a training set and a validation set in a 70% to 30% ratio. Predictive factors were screened from the training set data using univariate analysis， LASSO regression， and multivariate Logistic regression analysis. Predictive models were then constructed using seven machine learning methods： Logistic regression， decision tree， random forest （RF）， eXtreme gradient boosting， light gradient boosting machine， support vector machine， and artificial neural network. Model performance was evaluated by plotting receiver operating characteristic curve for the validation set and calculating the area under the curve （AUC）， sensitivity， specificity， and Youden index for each model. Furthermore， the SHapley Additive exPlanation （SHAP） method was used to analyze the contribution of variables in the optimal model. ResultsThe prevalence rate of MAFLD among the 2 168 subjects was 12.22% （265/2 168）. Smoking， diastolic blood pressure， phase angle， visceral fat area， muscle fat ratio， waist-to-hip ratio， aspartate aminotransferase， non-HDL-C/HDL-C ratio， triglyceride-glucose index， and gallstones were independent risk factors for MAFLD （all P<0.05）. The seven predictive models of support vector machine， eXtreme gradient boosting， decision tree， light gradient boosting machine， artificial neural network， RF， and Logistic regression had an AUC of 0.738， 0.754， 0.757， 0.786， 0.795， 0.796， and 0.815， respectively， in the validation set， among which the RF model had the best discriminatory ability （AUC=0.796， 95% confidence interval： 0.754 — 0.839）， with a sensitivity of 81.01%， a specificity of 63.16%， and a Youden index of 44.17%. The SHAP analysis showed that visceral fat area， waist-to-hip ratio， and diastolic blood pressure were the top three predictive factors in terms of importance. ConclusionThe RF model， constructed based on body composition and clinical indicators， has a good performance in predicting the risk of MAFLD， and its interpretability can help to identify high-risk individuals in the early stage in clinical practice.

Objective To investigate the acquisition of the"standard for intubation and maintenance of nasointestinal tube in adult patients"of Chinese Nursing Association,and its influencing factors,so as to provide a basis for targeted training programs.Methods A multi-centered,cross-sectional study was performed in 31 provinces from September to November 2023,and nurses from different departments which use nasointestinal tubes like intensive care units,gastroenterology,neurology,geriatrics were included by a convenient sampling method.The tool was a self-designed questionnaire based on the group standard and the survey was conducted.Multiple linear regression analysis was used to explore the influencing factors of nurses'knowledge of nasointestinal tubes intubation and maintenance.Results 1 350 valid questionnaires were collected.Only 61.63％of the respondents knew about the publishing of the standard.The score of knowledge of tube intubation and maintenance was(61.09±13.56).The results of multiple linear regression analysis showed the influencing factors of the score of knowledge of intubation and maintenance were as follows:education level,professional title,job position,intubation experience within half a year,and corresponding achievements(P＜0.05).Conclusion The acqui-sition level of nurses for the standard calls for continuous promotion.Nursing managers should establish targeted training programs based on the related influencing factors,so as to advance the implementation of the group standard.

Objective:To compare pregnancy outcomes between patients undergoing combined hysteroscopy and hysterosalpingo-contrast sonography (HyCoSy) versus hysteroscopy alone prior to intrauterine insemination, and to evaluate the safety and clinical value of the combined procedure in the diagnosis and treatment of infertility.Methods:A retrospective analysis was conducted on clinical data from 385 patients who underwent hysteroscopy at Peking University Third Hospital between October 1, 2020 and September 30, 2022, and subsequently received their first cycle of artificial insemination with donor sperm (AID) within six months. Pregnancy outcomes were compared between the group receiving combined hysteroscopy with four-dimensional HyCoSy (hysteroscopy+4D-HyCoSy group) and the group receiving hysteroscopy alone (hysteroscopy group). Multivariate logistic regression was used to analyze factors influencing pregnancy outcomes after AID.Results:Among the 385 patients included, 79 achieved clinical pregnancy. The clinical pregnancy rate (24.9%, 53/213) and live birth rate (21.1%, 45/213) in the hysteroscopy+4D-HyCoSy group were significantly higher than those in the hysteroscopy group [15.1% (26/172) and 12.8% (22/172), respectively; all P<0.05]. There was no significant difference in tubal patency between the two groups ( P>0.05); however, the time interval from tubal patency assessment to intrauterine insemination was significantly longer in the hysteroscopy group compared to the hysteroscopy+4D-HyCoSy group (median: 4.0 vs 2.0 months; P<0.001). Multivariate analysis showed that double insemination significantly increased clinical pregnancy rate compared to single insemination ( OR=2.42, 95% CI: 1.02-5.72; P=0.044). An interval exceeding 6 months between tubal patency assessment and intrauterine insemination was identified as a risk factor for reduced clinical pregnancy ( OR=0.35, 95% CI: 0.14-0.92; P=0.047). Additionally, neither the time interval from hysteroscopy to intrauterine insemination nor hysteroscopic findings and pathological diagnoses had significant effects on clinical pregnancy rates (all P>0.05). Conclusions:The combination of hysteroscopy and HyCoSy provides a safe and efficient approach for fertility assessment in infertile patients and improves clinical pregnancy rate and live birth rate in intrauterine insemination cycles. Hysteroscopy is recommended for patients with suspected endometrial or intrauterine abnormalities. If no previous tubal patency assessment has been performed or the last assessment was more than six months prior, combined hysteroscopy and HyCoSy may be considered to enhance the likelihood of clinical pregnancy.

Objective:To evaluate the effects of chlorinated organophosphate flame retardants (Cl-OPFRs) via respiratory and digestive tract exposure on multiple organs in mice.Methods:A short-term repeated exposure model of tris(2-chloroethyl) phosphate (TCEP), tris(1-chloro-2-propyl) phosphate (TCIPP) and tris(1, 3-dichloro-2-propyl) phosphate (TDCIPP) in mice was established through intratracheal instillation and oral gavage administration. The exposure doses were 0.7, 1 and 2 mg·kg -1·day -1, respectively, with continuous administration for 14 days. The organs of the heart, liver, spleen, lung, kidney, stomach, large intestine, small intestine, bladder and testis were collected and weighed to calculate the organ coefficients. The pathological and histological changes were observed by hematoxylin-eosin staining to quantitatively assess the effects of the three Cl-OPFRs on the various organs by using the pathology score. Results:Analysis of organ coefficients in tracheal drip-treated mice showed that the organ coefficients in the testes of the TCEP, TCIPP and TDCIPP groups were lower than those in the control group ( PTCEP-testis=0.045, PTCIPP-testis=0.012 and PTDCIPP-testis<0.001). The organ coefficients were lower in the lungs and small intestines of the TCEP group ( PTCEP-lung=0.006, PTCEP-small intestine=0.042). The organ coefficients for the stomach and large intestine were higher in the TDCIPP group ( PTDCIPP-stomach=0.014, PTDCIPP-large intestine=0.049). Analyses of gavage-contaminated mice showed that the organ coefficients for liver, stomach and small intestine in the TCEP and TDCIPP groups were higher than those in the control group ( PTCEP-liver=0.007, PTCEP-stomach=0.003, PTCEP-small intestine<0.001, PTDCIPP-liver=0.001, PTDCIPP-stomach=0.004, and PTDCIPP-small intestine<0.001). Histopathological analyses of the organs of tracheal drip dyed mice showed significant pathological damage in the lung tissue of the TCIPP group, mainly in the form of thickening of the interstitium, infiltration of inflammatory cells and alveolar collapse. The results of the analysis of gavage poisoned mice showed that TCIPP exposure could lead to blurring of the red and white medullary boundaries of spleen tissues, destruction of white medullary structures, etc., and induce small intestinal cryptitis. TDCIPP induced significant pathological damage to the liver tissues of mice, which mainly included cytoplasmic washout, infiltration of inflammatory cells, acute inflammation, and other injurious effects. Significant pathological damage to the intestinal tissues of mice was also observed. Conclusions:This study demonstrates that the toxic effects of Cl-OPFRs are significantly associated with exposure routes and compound specificity. Respiratory exposure predominantly induces TCIPP-mediated pulmonary injury, while digestive exposure causes TDCIPP-driven hepatointestinal toxicity. These findings provide preliminary evidence for the toxicity screening of Cl-OPFRs.

Objective:To report the clinical, electrophysiological, and genetic mutation characteristics of a family with paramyotonia congenita, to enhance clinical understanding of ion channelopathies, provide better guidance for clinical diagnosis, and optimize treatment plans.Methods:The clinical data, nerve conduction studies, needle electromyography, long exercise test, short exercise test, and whole-exome sequencing results of the proband with paramyotonia congenita and his family members admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, in August 2023 were collected and analyzed.Results:The proband was a 15-year-old male who presented with episodic muscle weakness for 1 year, accompanied by elevated creatine kinase during episodes. Between the ages of 3 and 4, he exhibited facial and bilateral hand myotonia triggered by cold exposure. His mother, sister, maternal grandmother, maternal aunt and uncle also displayed similar cold-induced facial and hand myotonia during childhood. Additionally, his cousin exhibited walking difficulties, frequent falls, mild difficulty in opening eyes after closure, and mild chewing and swallowing difficulties at the age of 1. Electromyography of the proband showed widespread myotonic discharges and myopathic impairment, while the electromyography of his mother and sister revealed only widespread myotonic discharges. The proband′s long exercise test results were consistent with periodic paralysis, while the short exercise test results aligned with paramyotonia congenita. His sister′s long exercise test results were within normal range, while the short exercise test results of his mother and sister were consistent with paramyotonia congenita. Genetic testing of the family revealed that all tested patients carried a heterozygous SCN4A mutation, c.4343G>A (R1448H). Conclusions:The R1448H mutation in the SCN4A gene is the genetic cause of this family. Patients carrying the SCN4A R1448H mutation may exhibit clinical features of cold-induced myotonia with or without episodic muscle weakness. In addition to widespread myotonic discharges on electromyography, certain patients may also show myopathic impairment. The long and short exercise tests can further assist in differentiating various types of myotonia and periodic paralysis for clinical diagnosis.

Objective To explore the application of Wechat platform step-by-step management in the health behavior of stroke patients.Methods A total of 69 stroke patients admitted to Department of Neurology,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from January to March 2022,who met the inclusion and exclusion criteria,were selected as research subjects.The quasi-experimental study method was used to divide them into control group and intervention group,the patients of control group received routine health education,while the patients of intervention group implemented micro-platform step-by-step management.The health behaviors of two groups of patients were compared at four time points(1 month,3 months,6 months,and 12 months after stroke onset).Results The analysis results of the generalized estimation equation showed that there were statistically significant differences in the total scores of the health behavior scale,as well as in the dimensions of exercise,medication adherence,instruction following,and sense of responsibility at the four time points for both groups(P＜0.05).The nutritional dimension at 3 months,6 months,and 12 months after onset,and the smoking and drinking dimension at 12 months after onset,showed statistically significant differences between two groups(P＜0.05).Conclusion The Wechat platform step-by-step management helps to improve the health behavior of stroke patients,and enhance the health management effects of stroke patients.

Objective:To investigate the changes in thyroid hormone levels and inflammatory markers in critically ill children，analyze their correlation with disease severity，and explore their potential impact on prognosis,providing references for clinical management and prognosis assessment in critical illness.Methods:A retrospective cohort study was conducted involving 394 pediatric patients admitted to the ICU of the Capital Pediatric Institute Affiliated Children's Hospital from 2019 to 2023.Based on the pediatric critical illness score,patients were divided into three groups:the extremely critical group (score ≤ 70, n=81),the critical group (score 71–80, n=150),and the non-critical group (score>80, n=163).Data collected included thyroid function indicators，inflammatory markers[C-reactive protein（CRP)，procalcitonin(PCT),tumor necrosis factor(TNF)-α，interleukin (IL)，etc.]，clinical information，and outcomes.The correlation between thyroid function indicators and inflammatory markers were analyzed.The predictive value of thyroid function indicators and inflammatory markers for prognosis in critically ill pediatric patients was assessed. Results:Of the 394 children,non-thyroidal disease syndrome occurred in 321 cases,with an overall incidence of 81.5%,which increased with disease severity.Thyroid hormone [total triiodothyronine (TT3),free triiodothyronine (FT3),and total tetraiodothyronine (TT4)] levels were significantly lower in the extremely critical group than in the other groups ( P<0.05).Inflammatory markers such as CRP,PCT,TNF-α,IL-6,IL-8,and IL-10 were significantly higher in the extremely critical group than in the other groups ( P<0.05).Thyroid hormones were negatively correlated with inflammatory markers,and the receivor operating characteristic curves analysis indicated that TT3,FT3,IL-6 and IL-8 levels,could effectively differentiate disease prognosis.Univariate regression model showed significant associations between TT3,FT3,TT4,PCT,IL-8,and IL-10 and disease prognosis.The multivariate Logistic regression model showed IL-6 and IL-8 were independent predictors of disease prognosis. Conclusion:Significant reductions in thyroid hormone levels are closely related to disease severity and poor prognosis.Changes in inflammatory markers reflect the inflammatory state and severity of the disease and impact prognosis.Monitoring thyroid function and inflammatory status is important in clinical management，which provids new insights into prognosis assessment and treatment strategies for critically ill children.

ObjectiveTo explore the epidemic levels and epidemiological characteristics of influenza-like illness (ILI) in Hongkou District of Shanghai, to track the trends in virus mutations, so as to offer a scientific foundation for precisely predicting influenza epidemic trends, providing early alerts, and implementing prompt prevention and control measures. MethodsData on ILI and etiological surveillance from Hongkou District between 2015 and 2024 were collected and statistically analyzed. ResultsThe consultation percentage of ILI (ILI%) in Hongkou District from 2015 to 2024 was 0.58%, and the differences were statistically significant between different years (χ²=19 280.500, P<0.001), with winter and summer being the prevalence peaks. The highest proportion of ILI cases was observed in the 25‒<60 years age group, and the proportion of cases aged ≥60 years showed an increasing trend. The positive rate for influenza viruses was 17.60%, with seasonal influenzaA (H3N2) subtype (49.78%) and influenza A(H1N1) (30.03%) being the predominant strains,and the positive rate was different by years. There was a correlation between ILI% and the positive rate of influenza viruses (r=0.260, P<0.001). The median intensity of influenza activity in 2023‒2024 was 23.09, which was significantly higher than that in 2015‒2019 (H=37.052, P<0.001) and that in 2020‒2022 (H=40.436, P<0.001). ConclusionFrom 2015 to 2022, the ILI% in Hongkou District, Shanghai remained at a relatively low level, but it significantly increased in 2023‒2024, with peaks observed in winter and summer. The predominant influenza virus strains varied and alternated by years. The 2023‒2024 period witnessed an intensified influenza activity. It is necessary to continuously monitor the impact of other respiratory pathogens on influenza epidemic, so as to provide a scientific basis for early warning and prevention and control of influenza.

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

This paper reviews the published articles of recent years on the application of deep learning methods in automatic localization of acupoint, and summarizes it from 3 key links, i.e. the dataset construction, the neural network model design, and the accuracy evaluation of acupoint localization. The significant progress has been obtained in the field of deep learning for acupoint localization, but the scale of acupoint detection needs to be expanded and the precision, the generalization ability, and the real-time performance of the model be advanced. The future research should focus on the support of standardized datasets, and the integration of 3D modeling and multimodal data fusion, so as to increase the accuracy and strengthen the personalization of acupoint localization.
Deep Learning ; Acupuncture Points ; Humans ; Neural Networks, Computer