Objective To establish and validate a prediction model for gastric cancer lymph node metastasis based on four machine learning (ML) algorithms. Methods A retrospective analysis was conducted on clinical data of 531 patients who underwent radical gastrectomy. The patients were randomly divided into training set (399 patients) and test set (132 patients) in a ratio of 3 to 1. Univariate analysis was used to screen for variables associated with gastric cancer lymph node metastasis, and Logistic regression, random forest, K-nearest neighbor algorithm, and support vector machine algorithm models were established to rank the importance of variables. All ML algorithm models were validated in the test set, and receiver operating characteristic (ROC) curves were plotted. The optimal ML algorithm model was determined based on the area under the curve (AUC), sensitivity, specificity, and accuracy. A nomogram model was constructed based on the variable importance ranking of the optimal ML algorithm model. The discrimination, calibration, and clinical applicability of the nomogram model were evaluated using ROC curves, calibration curves, and decision curves. Results The results of the comparison of the four ML algorithm models showed that the random forest model was the optimal algorithm model. The accuracy, sensitivity, and specificity of the random forest model in the training set were 72.7%, 69.9%, and 75.0%, respectively, with an AUC of 0.803. The accuracy, sensitivity, and specificity of the random forest model in the test set were 64.4%, 66.7%, and 62.5%, respectively, with an AUC of 0.751. A nomogram model was constructed based on the variables of the random forest algorithm model. The ROC curve showed that the AUCs of the nomogram model in the training set and test set were 0.721 and 0.776, respectively. Calibration curves and decision curves showed that the nomogram model had good calibration and clinical applicability in both the training set and test set. Conclusion The random forest model is the optimal algorithm model among the four ML algorithm models. The nomogram model based on the random forest model can accurately predict the risk of gastric cancer lymph node metastasis, thereby better guiding clinical diagnosis and treatment decisions.

Objective To analyze the equity of the allocation of oral medical resources and the accessibility of health service capabilities in Wuhan. Methods The equity of oral medical resources was calculated with Gini coefficient and Theil index, accessibility was assessed by two-step floating catchment area model, and the spatial autocorrelation was used to study the high-low clustering of accessibility. Results The Gini coefficient of oral medical resources based on population level was around 0.3, and the Gini coefficient of oral medical resources based on geographic area was greater than 0.6. Theil index calculation results were similar. In terms of overall accessibility, the area with poor accessibility was 2,428 square kilometers, reaching 28.38% of the total area, while the area with better accessibility accounted for 14.18%. Conclusion The allocation of oral medical care resources based on population distribution was fairer and better than that based on geographic area. Moreover, the geographical accessibility varies greatly between regions, showing the characteristics of high-high cluster and low-low cluster.

Objective:To investigate the omics mechanism of SARS-related immune injury and predict targeted therapeutic drugs through clinical bioinformatics analysis of the transcriptome data of SARS virus in order to provide reference for clinical treatment of COVID-19.Methods:The transcriptome data of SARA virus were collected from the Gene Expression Oibus (GEO) and used to screen differential genes. Enrichment analysis and protein interaction analysis were performed to investigate the mechanism of immune damage associated with SARS. A platform of epigenetics in precision medicine (EpiMed) was established to predict potential therapeutic drugs.Results:The mechanism of SARS-related immune injury was complex, involving affecting the function of immune cells through signaling pathways such as Toll-like receptors, increasing cytokines in plasma through Th17 signaling pathway and inducing autoimmune responses after autoantibodies were generated by molecules such as IL-6, NF-κB, and TNF. Drugs such as Chuanqiong and Etanercept might have therapeutic effects on SARS-related immune damage.Conclusions:SARS virus could cause abnormal expression of many immune-related molecules and signaling pathways. Drugs such as Chuanqiong and Etanercept might have therapeutic effects on SARS-related immune damage. This study might provide reference for clinical treatment of COVID-19.

Objective:To analyze the inflammatory mechanism and potential intervention drugs related to angiotensin converting enzyme 2 (ACE2) inhibitory mutations in order to provide reference for the treatment of corona virus disease 2019 (COVID-19).Methods:The data of lung adenocarcinoma with ACE2 mutations were screened from the cancer genome atlas (TCGA) database. The data were analyzed by R program language edgeR package and cluster Profiler package, gene ontology (GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Using String online analysis website for protein-protein interaction (PPI) network analysis, screening out the core genes, and finally using the Epigenomic Precision Medicine Prediction Platform (EpiMed) for multi-group association analysis of key genes, and drug candidates prediction.Results:A total of 1 005 differential genes were obtained, of which 91 were up-regulated and 914 down-regulated. A total of 71 GO were enriched, including 45 items related to biological processes, 16 items related to cell components, and 10 items related to molecular function. A total of 13 KEGG pathways were enriched, mainly in inflammatory pathways, various viral infectious diseases, transcriptional regulation, drug metabolism and protein digestion and absorption pathways. The differentially expressed genes were introduced into String online analysis website for PPI network analysis, a total of 252 proteins were obtained, and 10 core genes were H2A clustered histone 16(HIST1H2AL), H3 clustered histone 2 (HIST1H3B), H3 clustered histone 7 (HIST1H3F), H3 clustered histone 11 (HIST1H3I), H3 clustered histone 3 (HIST1H3C), H2B clustered histone 3 (HIST1H2BB), H2B clustered histone 6 (HIST1H2BI), H4 clustered histone 2 (HIST1H4B), H1-4 linker histone (HIST1H1E), H2A clustered histone 4 (HIST1H2AB). Interferon-α, resveratrol, celecoxib, heartleaf houttuynia herb, weeping forsythia capsule, dexamethasone, Chinese pulsatilla root, tumor necrosis factor-α inhibitors, liquorice root and famciclovir might be drugs for the treatment of ACE2 mutation-related inflammation.Conclusions:Inflammation associated with ACE2 inhibitory mutations is similar to the pathogenesis of COVID-19, which could lead to disease by promoting the activation of inflammatory pathways such as mitogen-activated protein kinase (MAPK), the Janus kinase signal transducer and activator of transcription (JAK/STAT), mammalian target of rapamycin (mTOR). Celecoxib, interferon and resveratrol may have the potential therapeutic effects on COVID-19.

Objective:To compare the effect of posterolateral plate and anterolateral locking plate in surgical treatment for extra-articular distal humeral shaft fractures.Methods:A retrospective case-control study was made on 52 patients with extra-articular distal humeral shaft fractures admitted in Tianjin Hospital from January 2014 to October 2016. There were 32 males and 20 females, with the age from 18 to 56 years [(36.9±10.9)years]. According to the AO/OTA classification, there were 15 patients with type A, 32 type B, and 5 type C. Twenty-three patients were treated with osterolateral locking plate (Group A) and 29 with anterolateral locking plate (Group B). Operation time, bone union time, range of motion of the elbow, Mayo elbow performance score and complication rate were evaluated.Results:All patients were followed up for 12-20 months [(13.7±2.2)months]. Operation time was (79.8±9.6)minutes in Group A and (85.0±11.6)minutes in Group B ( P>0.05). Bone union time was (4.1±1.0)months in Group A and (4.1±1.0)months in Group B ( P>0.05). Degrees of elbow extension was 3.9°(0.0°, 5.0°) in Group A, and 4.4°(0.0°, 5.0°) in Group B ( P>0.05). Degrees of elbow flexion was 127.4°(125.0°, 132.50°) in Group A and 128.5°(122.5°, 132.5°) in Group B ( P>0.05). Mayo elbow performance score was 91.0 (90.0, 93.5) points in Group A and 90.2 (90.0, 92.5)points in Group B ( P>0.05). Radial nerve damage was noted after operation, showing no significant difference between two groups [2 patients (9%) in Group A and 3 patients (10%) in Group B] ( P>0.05), and the symptoms were recovered in all patients within 3 months. Conclusions:Both the posterolateral and anterolateral locking plate are effective in surgical treatment for extra-articular distal humeral shaft fractures. However, the posterolateral plate can be placed closer to the distal end of the humerus and the multi-directional locking design is more stable, which has advantages for the patient with fracture line close to the elbow joint.

Objective:To analyze the mechanism and potential intervention drugs of acute lung injury caused by severe acute respiratory syndrome coronavirus (SARS-CoV) infection in order to provide reference for the treatment of COVID-19.Methods:Gene Expression Omnibus (GEO) announcement database was used to screen coronavirus transcriptome data, and R language package was used for differential expression analysis and Kyoto Gene and Genome Encyclopedia (KEGG) and Gene Ontology (GO) enrichment analysis. A protein-protein interaction (PPI) network analysis was carried out by using STRING online analysis website, and the key genes were screened. Then the Epigenomic Precision Medicine Prediction Platform (EpiMed) was used to analyze the association of key genes and predict potential therapeutic drugs.Results:Based on the whole genome expression profile data of SARS-CoV, a total of 3 606 differential genes were screened, including 2 148 up-regulated and 1 458 down-regulated. GO enrichment is mainly related to viral infection, leukocyte migration and adhesion, acute inflammation and collagen secretion. KEGG enrichment is mainly related to signal transduction, acute inflammation, immune response and so on. Ten key genes related to lung injury, such as PTPRC, TIMP1, ICAM1 and IL1B, were screened by protein interaction network analysis. EpiMed platform predicted that pulsatilla chinensis, polygonum cuspidatum, tumor necrosis factor-α inhibitors, famciclovir, fluvastatin and other drugs have potential therapeutic effects.Conclusions:SARS-CoV infection can cause lung injury by activating a series of inflammation-related molecules. Drugs that may be effective in the treatment of coronavirus infections, including pulsatilla chinensis, polygonum cuspidatum, tumor necrosis factor-α inhibitors, famciclovir and fluvastatin.

Objective To explore the diagnosis and treatment of cystic dilatation of the cystic duct in adults.Method Clinical data of 25 cases of the cystic dilatation of cystic duct in adults in 3 hospitals in Songhuajiang river drainage area from 1991 to 2012 confirmed by surgery were analyzed retrospectively.Results The 25 cases were with manifestations of chronic cholecystitis,and 14 patients with right upper quadrant recurrent biliary colic and nausea,vomiting and other gastrointestinal symptoms,9 patients with yellowish discoloration of sclera and skin,and fever.Ultrasonography was done in 25 cases,ERCP in 16 cases and MRCP in 9 cases,displaying liquid dark area of diameter from 1.6 cm × 1.6 cm to 2.5 cm ×2.5 cm in the gallbladder tube suspective of calculi,and characteristic dumbbell shape image.Preoperative diagnosis was cystic duct cyst with stones or gallstones which was confirmed by surgery.Gallbladder and cyst resection was performed in all 25 cases,and bile duct jejunum Roux-en-Y anastomosis was done in 2 of these cases because of introgenic bile duct injury.Conclusions Cysts of the cystic duct is the special type (Ⅵ type) of choledochocele,and its prognosis is good after surgical treatment.

Objective To study the etiology,diagnosis and treatment of xanthogranulomatous cholecystitis (XGC).Methods Clinical data of 78 cases with xanthogranulomatous cholecystitis (confirmed by postoperative pathology) from January 1985 to December 2012 were reviewed retrospectively.Results All 78 cases underwent ultrasonography,50 cases did CT scan.Preoperative diagnosis included chronic calculous cholecystitis in 60 cases,gallbladder carcinoma with cholelithiasis in 8 cases,gallbladder space-occupying lesions in 10 cases.Among those 68 cases of tentative gallstone disease,67 cases were with gallbladder neck incarcerated stones.Surgery were performed in all 78 cases including cholecystectomy in 48 cases,partial cholecystectomy or subtotal resection in 13 eases,cholecystectomy with partial hepatic wedge resection in 12 cases.Intraoperatively 5 cases were misdiagnosed as the carcinoma of the gallbladder and underwent partial liver resection along with cholecystectomy.17 cases underwent choledocholithotomy.2 cases suffered from hepatic duct injury and received Roux-en-Y hepatojejunal anastomosis.Conclusions XGC is a special type of chronic cholecystitis,and accompanied by yellow granuloma formation.Preoperative diagnosis of XGC is often difficult,the definite diagnosis depends on intraoperative fiozen and postoperative paraffin pathology.

AIM: To investigate the role of N-cadherin in the delamination of neural crest cells. METHODS: The normal expression of N-cadherin in neural tube was identified using in situ hybridization. The cells with N-cadherin over expression were obtained by transfection of wild-type N-cadherin (wt-N-cadherin) ,and the cells with N-cadherin silencing expression were obtained by transfection of dominant-negative N-cadherin (dn-N-cadherin). The migration of cranial neural crest cells was determined by the technique of immunohistochemistry. RESULTS: Either overexpression or down-regulation of N-cadherin significantly affected the migration of cranial neural crest cells. CONCLUSION: Delamination and migration of the cranial neural crest cells rely on the relative N-cadherin expression in the neural tube during neurulation.

ObjectiveTo summarize our experience on the diagnosis and surgical treatment of hepatocellular adenoma (HCA).MethodsClinical data of 47 HCA cases managed from 1989 to 2009 were analyzed retrospectively. ResultsAll were single lesions.Preoperative correct diagnosis was established in only 7 cases ( 14.9％ ).Tentative malignant space-occupying lesions was diagnosed in other 40 cases (85.1％),including hepatocellular carcinoma in 11 cases,liver hemangioma in 10 cases,liver focal nodular hyperplasia in 14 cases and miscellaneous in the remaining 5 cases.Local resection,segmental hepatectomy,hepatic lobectomy and hemiheptectomy were performed according to the size and location of the lesions.To prevent recurrence or malignant transformation,not less than 1.0 cm safe margin was allowed in all cases.Final diagnosis was made by fast frozen pathology or postoperative pathology.Postoperatively 45 cases were followed up to 6 years without recurrence.ConclusionsPreoperative misdiagnosis of HCA is common.Surgical resection is the only effective treatment,and the prognosis of HCA is favorable.