Objective To observe the value of residual neural network(ResNet)-101-feature pyramid network(FPN)model based on CT for differentiating benign and malignant lung nodules.Methods Totally 2 040 lung nodules in 2 000 patients were retrospectively enrolled,including 1 150 benign and 890 malignant nodules.The nodules were divided into training set(n=1 632)and test set(n=408)at the ratio of 8∶2,the former including 881 benign and 751 malignant ones,while the latter including 269 benign and 139 malignant ones,respectively.Taken ResNet-101 as the backbone network,combined with FPN,a classification model was established based on chest CT,and the efficiency of this model alone and combined with evaluation of physicians for differentiating benign and malignant lung nodules were evaluated.Results Among 269 benign lung nodules in test set,ResNet-101-FPN model alone correctly diagnosed 214 nodules(214/269,79.55%),while combined with evaluation of physicians correctly diagnosed 230 ones(230/269,85.50%).For 139 malignant nodules in test set,ResNet-101-FPN model alone correctly diagnosed 124 nodules(124/139,89.21%),while combined with evaluation of physicians correctly diagnosed 131 ones(131/139,94.24%).The sensitivity,accuracy and precision of ResNet-101-FPN model combined with evaluation of physicians for distinguishing benign and malignant lung nodules were all higher,while the specificity of the combination was lower than those of ResNet-101-FPN model alone,but the differences were not significant(all P＞0.05).Conclusion ResNet-101-FPN model could be used to distinguish benign and malignant lung nodules based on CT.Combining with evaluation of physicians could improve diagnostic efficiency of this model.

Objective To observe the incidence of pericardial tamponade(PT)after left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF),and to explore its related factors and outcomes.Methods NVAF patients who were hospitalized and treated with LAAC in Department of Cardiology of our hospital from August 2014 to March 2023 were selected for the study.The general clinical data,preoperative transthoracic echocardiography and transesophageal echocardiography data,results of routine preoperative laboratory tests,intraoperative data and follow-up data of the patients were collected through the hospital medical record management system.The enrolled patients were classified into the non-PT group(n=8)and the PT group(n =1184)according to whether PT occurred after LAAC or not.The incidence of PT,related risk factors and outcomes were statistically analyzed.Results This study included 639 males(53.6%)and 553 females(46.4%),with an average age of 68.1±9.65 years.The CHA2 DS2-VASc score was 4.51±1.72,and the HAS-BLED score was 3.36±1.09.PT occurred in 8 cases(0.67%),among them,6 cases occurred 1 to 33 h after LAAC,and 2 cases occurred on day 19 and day 27 after LAAC.As for the results of transesophageal echocardiography(TEE)and LAA angiography,compared with the non-PT group,the PT group had the significantly larger maximum caliber of the LAA(P=0.025,P=0.015),smaller maximum depth of the LAA(P=0.028,P=0.031),and lower success rate of one-time placement of the occluder(P=0.031);The occluder compression rate of the PT group was significantly greater than that of the non-PT group(P=0.046).Multivariate analysis showed that larger maximum diameter of LAA,smaller average effective depth of LAA and larger compression rate of occluder were the main risk factors for PT.All the 8 PT patients were cured by stopping antithrombotic drugs,pericardiocentesis or surgical drainage.During a mean follow-up of 39±27 months,there were no device-related thrombosis(DRT),ischemic stroke,systemic embolism and other complications in the PT group.Conclusion The incidence of PT after LAAC is low,which is related to the large diameter of LAA,the relatively insufficient depth of the LAA and the large compression rate of the occlude.PT can be cured by stopping antithrombotic drugs and pericardiocentesis/surgical drainage.

Objective To investigate the effect of Cyclocarya paliurus(Batal.)lljinskaja polysaccharides on insulin resistance in type 2 diabetic rats by regulating glucose transporter 4(GLUT4)translocation in islet and liver.Methods High-fat diet combined with low-dose streptozotocin(35 mg·kg-1)to induce type 2 diabetes model,all the rats were randomly divided into model control group,Cyclocarya paliurus polysaccharides groups(5,10 g·kg-1)and metformin group(0.25 g·kg-1),and treated for eight weeks(n=9 in each group).Fasting glucose and lipid were determined.Histopathology of rat islet and liver were observed by hematoxylin and eosin staining.Protein expressions of phosphorylated phosphoinositide-3-kinase(p-PI3K),phosphorylated serine-threonine kinase 1(p-Akt1),and GLUT4 in islet were measured by immunohistochemistry staining.GLUT4 translocation in the islet and liver was detected by immunofluorescence.Results Compared with the model control group,the Cyclocarya paliurus polysaccharides group and metformin group had declined fasting glucose levels and increased high-density lipoprotein(P＜0.05).The structure of the islets and liver was relatively complete.The content of p-PI3K,p-Akt1 and GLUT4 in the islet increased(P＜0.05).GLUT4 translocation in the liver and islet enhanced(P＜0.05).Conclusions Cyclocarya paliurus polysaccharides alleviate glucose and lipid metabolism disorders.The mechanism may lay in it activating protein expressions of p-PI3K,p-Akt1,and GLUT4 in islet cells.GLUT4 translocation to the islet and liver cell membrane are increased to regulate peripheral islet resistance.

Objective:To describe the characteristics, etiology and patterns of outpatients and inpatients patients with moderate or severe valvular heart disease (VHD).Methods:This is a cross-sectional study. Outpatients and inpatients with moderate or severe VHD who underwent transthoracic echocardiography for first examination from 1 st January 2001 to 1 st January 2020 in Southwest Hospital, Army Medical University were enrolled. Data were collected from medical records and big data platform of Southwest Hospital. Characteristics of age and gender, etiology and types of VHD were descriptively analysed. Results:A total of 68 354 patients with moderate or severe VHD were enrolled. The age was 63 (50, 72) years. And 35 706 (52.24%) patients were female. (1) Age characteristics: There was similar age trend between male and female patients with moderate or severe VHD. The number of patients increased firstly and then decreased and reached its peak in the age group of 65-69 years old. The peak age of mitral stenosis patients was 45-49 years, which was earlier than that of whole patients with moderate or severe VHD. The median age of patients with bicuspid aortic valve was 42 years. (2) Gender characteristics: The proportion of tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, mitral stenosis and valve surgery in female patients with moderate or severe VHD were higher than those in male patients. The proportion of aortic regurgitation, aortic stenosis and bicuspid aortic valve in male patients with moderate or severe VHD were significantly higher than those in female patients (all P<0.05). (3) Etiology: The proportion of rheumatic VHD was 13.07% (8 934/68 354), which was higher than that of degenerative VHD (0.67% (458/68 354)). (4) Types of VHD: Tricuspid regurgitation made contribution to the largest proportion with 60.72% (41 503/68 354), followed by mitral regurgitation, aortic regurgitation, mitral stenosis, pulmonary regurgitation and aortic stenosis. Conclusions:There are certain regional characteristics in the prevalence of moderate or severe VHD in southwest China, suggesting different attention should be paid on the whole process of refined management of moderate or severe VHD.

Objective　To investigate the changes in expression and diagnostic value of miRNA-424-5p and interleukin-6 (IL-6) in patients with latent tuberculosis (LTBI) and active tuberculosis (ATB). Methods Data from the miRNA expression microarray GSE25435 and GSE29190 were downloaded from the U.S. National Center for Biotechnology Information Gene Expression Omnibus (GEO) database, and differentially expressed miRNA were obtained using the GEO2R tool. A total of 30 cases, including LTBI and ATB patients, were selected from the Sixth People's Hospital of Nantong between July 2022 to July 2023, with healthy controls (HC) being concurrent healthy individuals. The expression of miRNA and IL-6 in peripheral blood mononuclear cells (PBMCs) among three groups was verified by real-time fluorogenic quantitative PCR (qPCR). The diagnostic efficacy of candidate miRNA and IL-6 was evaluated by receiver operating characteristic (ROC) curves. Results By GEO2R analysis, three differential miRNAs were obtained: miRNA-424-5p, miRNA-21-3p, and miRNA-144-3p. qPCR experiments verified the levels of these three miRNAs and IL-6, showing that miRNA-21-3p and miRNA-144-3p exhibited no significant difference in relative expression in PBMCs of ATB patients compared to the LTBI group (F=6.53, P>0.05; F=3.21, P>0.05). However, the expression levels of miRNA-424-5p and IL-6 in PBMCs were significantly increased, with statistically significant differences (F=5.35, P<0.01; F=8.77, P<0.01). ROC curve analysis showed that the maximum AUC of miRNA-424-5p and IL-6 for distinguishing ATB from LTBI was 0.70 and 0.76 respectively, and their combined diagnostic AUC could reach 0.84. Conclusions The combined diagnosis of miRNA-424-5p and IL-6 has the potential to distinguish LTBI from ATB patients, providing a certain reference for the rapid differential diagnosis of latent infection and active tuberculosis.

Objective:To anaylyze the influencing factors of peripheral arterial catheter-related bloodstream infection (CRBSI), and provide theoretical basis for clinical medical staff to control CRBSI.Methods:Adopting cross-sectional survey method. Convenient sampling method was used to select 331 patients with arterial catheterization in Tianjin Beichen Hospital from January 2021 to January 2022. The general status, catheter related infections,local skin abnormalities and catheterization status of the subjects were collected. The positive microbial culture at the tip of the catheter after extubation was taken as the outcome index, the influencing factors of peripheral arterial CRBSI were analyzed.Results:The incidence of CRBSI was 8.15% (27/331). Adjusted Logistic regression showed that age ( OR=3.013, 95% CI 1.158-14.365), local abnormality ( OR=3.357, 95% CI 1.670-9.269), number of days of catheterization ( OR=2.338, 95% CI 1.127-4.183) and location of catheterization (lower limb) ( OR=3.325, 95% CI 1.007-3.954) were the risk factors of peripheral artery CRBSI (all P<0.05). Conclusions:Peripheral artery CRBSI is more likely to occur in ICU patients aged ≥65 years, with local skin abnormalities, catheterization days ≥14 d and catheterization site in lower extremity. Paying attention to the elderly, paying attention to the integrity of the sterile barrier at the puncture site, shortening the catheterization days and avoiding lower extremity puncture can reduce the occurrence of peripheral artery CRBSI.

Cholangiocarcinoma is a malignant tumor originating from the bile duct epithelium, with the increasing incidence year by year. Its early symptoms are atypical and the diagnosis rate is low. Most of the patients are already in advanced stage when they are diagnosed, losing the best surgery period. Currently, the conservative treatments for unresectable extrahepatic cholangiocarcinoma include stent placement, radiofrequency ablation, radiotherapy and chemotherapy, targeted and immunotherapy and other systemic treatments. But due to the high malignancy of biliary tract tumors, the tendency to develop drug resistance and the limited population benefited from the emerging treatment modalities, we urgently need to explore new treatment strategies to break this bottleneck. As a new treatment for cholangiocarcinoma, photodynamic therapy has attracted much attention for its clinical application and therapeutic effects. In this paper, we summarize the principles of photodynamic therapy, the combination of photodynamic and other therapeutic modalities, especially the combination of photodynamic with emerging immune and targeted therapies, and describe the current hotspot directions of photodynamic therapy research at home and abroad to provide reference for clinical treatment and research.

【Objective】 To reveal possible mechanisms of miRNA in diabetic hepatopathy through bioinformatics method. 【Methods】 Subset data of miRNA and their matched mRNAs in the liver of STZ-induced diabetic mice and the normal liver tissues of congenial mice by detecting on microarrays were collected from GEO database； information from the database and bioinformatics analysis were applied to mine a batch of miRNAs in diabetic hepatopathy and targeted mRNAs regulated. Then qRT-PCR was used to verify the expressions of miRNAs in diabetic liver from 20 STZ-treated Kunming mice and 10 normal homologous mice. 【Results】 Via detection and analysis， miRNAs differentially expressed （including 96 up-regulated and 77 down-regulated） were significantly obtained. Groups of miRNAs and their effectors （mRNAs） that may be related to the pathological process of diabetic liver disease in mice were screened by GO and KEGG enrichment analyses， combined with relevant protein annotations in the databases and references. The expressions of miR-200a-3p， miR-200b-3p and miR-222-3p in the mice’s liver tissue detected by qRT-PCR were significantly down-regulated. In addition， the expressions of related effector genes CERS6， MYBL1， SCD2， SLCO1A4 and PLK2 were up-regulated， while the expressions of ACSS2， BCL6 and SLC10A2 were down-regulated. 【Conclusion】 The variation trend of those candidate miRNAs in mouse diabetic liver compared with that in control livers was consistent with that of the previous studies and prediction， which revealed their potential molecular regulation in this disease process.

Objective: To investigate the effects of mindfulness relaxation training on stress response and postoperative rehabilitation of patients undergoing general surgery. Methods: A total of 110 patients who underwent general surgery were randomly divided into study group and control group, with 55 cases in each group. The control group received routine peri-operational period nursing, and the study group carried out mindfulness relaxation training on the basis of control group for 4 weeks. The levels changes of serum insulin, cortisol were detected between two groups. The psychological stress of two groups were evaluated with Symptom Checklist 90 (SCL-90). The off-bed activity time, anus exhaust time, bowel sounds recovery time and hospital stay time were recorded to evaluate the quality of patients′ postoperative rehabilitation. Results: The levels of insulin, cortisol were at minimum on admission in two groups, and then increased, the highest level was at 2 hours after operation. There was no significant difference in insulin, cortisol level on admission in two groups (P>0.05), however, the insulin [(120.15±22.63) μg/L, (122.34±15.75) μg/L], cortisol [(10.41±3.07) mmol/L, (12.69±4.50) mmol/L] levels were significantly decreased in the study group compared to the control group [(129.85±15.43) μg/L, (131.34±22.79) μg/L and (11.69±2.99) mmol/L, (14.84±4.04) mmol/L] before anesthesia and at 2 hours after operation (t value was 2.206-2.638, P<0.05). After intervention, the total scores of SCL-90 (120.91±11.84), somatization (1.26±0.13), compulsion (1.43±0.08), depression (1.18±0.12), anxiety (1.14±0.10) and fear (1.34±0.08) were all lower in the study group than those in the control group (130.47±14.13, 1.83±0.53, 1.65±0.58, 1.71±0.12, 1.76±0.13, 1.41±0.12), and the differences were statistically significant (t value was 2.828-28.277, all P<0.05). Besides, off-bed activity time [(1.55±0.18) d] and hospital stay time[ (6.51±2.20) d] in the study group were significantly less than in the control group [(1.73±0.25) d and (7.65±2.19 d)] (t value was 2.737,4.592, P<0.05). Conclusion The mindfulness relaxation training in nursing general surgery patients during peri-operational period is helpful to ameliorate the patients′ degree of physiological and psychological stress reactions, and this mode has important significance in promoting the quality of patients' postoperative rehabilitation.

Objective:To investigate the independent predictors for malignancy in colorectal laterally spreading tumors (LSTs) by therapeutic endoscopy.Methods:Data of consecutive patients with colorectal LSTs who underwent endoscopic treatment in Beijing Friendship Hospital between June 2013 and March 2019 were collected for retrospective analysis. Patients′ gender, age, body mass index, smoking history, and endoscopic and histological results were reviewed. Univariate analysis was used to identify the associated factors for malignancy of colorectal LSTs. Factors with statistical significance in univariate analysis were used in multivariate logistic regression to determine the independent predictors.Results:A total of 323 patients with 341 colorectal LSTs were involved in the study. The rate of malignancy was highest in non-granular pseudo depressed (NG-PD) subtype [85.48% (53/62)], followed by granular nodular mixed (G-NM) subtype [76.97% (117/152)]. Both of the above rates were significantly higher than that of granular homogenous (G-H) subtype [29.51% (18/61), P<0.001] and non-granular flat elevated (NG-FE) subtype [24.24% (16/66), P<0.001]. Univariate analysis showed that NG-PD subtype ( P<0.001, OR=18.40, 95% CI: 7.46-45.42), G-NM subtype ( P<0.001, OR=10.45, 95% CI: 5.30-20.58), rectosigmoid location ( P<0.001, OR=2.33, 95% CI: 1.47-3.69) and size ≥2 cm ( P<0.001, OR=2.60, 95% CI: 1.60-4.00) associated with malignancy for colorectal LSTs. In multivariate logistic regression, NG-PD subtype ( P<0.001, OR=17.51, 95% CI: 7.06-43.43), G-NM subtype ( P<0.001, OR=8.25, 95% CI: 4.07-16.73) and size ≥2 cm ( P=0.032, OR=1.80, 95% CI: 1.05-3.08) remained to be independent predictors. Conclusion:LSTs of NG-PD subtype, G-NM subtype or size ≥2 cm are high risk factors of malignancy, in which cases, en bloc resection is required.