Objective To evaluate the application value of artificial intelligence (AI) in the quality control of mammographic images and explore its feasibility for improving image quality. Methods A retrospective analysis was conducted on 500 mammographic images from 125 female patients. These images were acquired in December 2024 at the Department of Radiology, Obstetrics and Gynecology Hospital of Tongji University by two junior technologists with qualification certificate for junior radiologic technologists and ≤ 2 months of independent operation. The reference standard was the evaluation by a panel of senior experts comprising one associate chief radiologist and two intermediate radiologic technologists with over 10 years of experience in mammography. The evaluation was based on nine criteria within an AI quality control system. The correlation and consistency (Kappa test) of the assessment outcomes were compared among the junior technologist group, the AI quality control group, and the panel group. Additionally, the differences in the proportions of high-, medium-, and low-quality images rated by the three groups were analyzed. After one month of AI assistance, 200 images from 50 additional patients acquired by the same two junior technologists in January 2025 were collected. The area under the receiver operating characteristic curve and 95% confidence interval (95%CI) were calculated for the assessment performance of the junior technologist group before and after AI assistance. Differences were compared using the DeLong test. Changes in the disqualification rates for the nine criteria were analyzed. Results In consistency analysis, the AI quality control group showed high consistency with the panel group across multiple key criteria, with Kappa values ranging from 0.41 to 1.00. In contrast, the consistency between the junior technologist group and the panel group was generally low, with Kappa values ranging from 0.13 to 0.49. In comparison of image quality classification, no significant differences were observed in image quality classification between the AI group and the panel group (P>0.05). However, the proportion of images rated as high quality by the junior technologist group was significantly higher, while the proportions rated as medium and low quality were significantly lower, compared to those rated by the panel group (P<0.05). After AI assistance, the area under the receiver operating characteristic curve for the assessment performance of junior technologist group increased significantly from 0.56 (95%CI: 0.51-0.61) to 0.91 (95%CI: 0.87-0.94) (P<0.001). The disqualification rates for skin folds, incomplete inclusion of the pectoralis major muscle, and nipple not in profile decreased significantly. Conclusion AI demonstrates assessment capability comparable to the panel group in mammographic quality control. AI effectively enhances the quality of images acquired by junior technologists through real-time, objective feedback.

Objective To evaluate the application value of artificial intelligence (AI) in the quality control of mammographic images and explore its feasibility for improving image quality. Methods A retrospective analysis was conducted on 500 mammographic images from 125 female patients. These images were acquired in December 2024 at the Department of Radiology, Obstetrics and Gynecology Hospital of Tongji University by two junior technologists with qualification certificate for junior radiologic technologists and ≤ 2 months of independent operation. The reference standard was the evaluation by a panel of senior experts comprising one associate chief radiologist and two intermediate radiologic technologists with over 10 years of experience in mammography. The evaluation was based on nine criteria within an AI quality control system. The correlation and consistency (Kappa test) of the assessment outcomes were compared among the junior technologist group, the AI quality control group, and the panel group. Additionally, the differences in the proportions of high-, medium-, and low-quality images rated by the three groups were analyzed. After one month of AI assistance, 200 images from 50 additional patients acquired by the same two junior technologists in January 2025 were collected. The area under the receiver operating characteristic curve and 95% confidence interval (95%CI) were calculated for the assessment performance of the junior technologist group before and after AI assistance. Differences were compared using the DeLong test. Changes in the disqualification rates for the nine criteria were analyzed. Results In consistency analysis, the AI quality control group showed high consistency with the panel group across multiple key criteria, with Kappa values ranging from 0.41 to 1.00. In contrast, the consistency between the junior technologist group and the panel group was generally low, with Kappa values ranging from 0.13 to 0.49. In comparison of image quality classification, no significant differences were observed in image quality classification between the AI group and the panel group (P>0.05). However, the proportion of images rated as high quality by the junior technologist group was significantly higher, while the proportions rated as medium and low quality were significantly lower, compared to those rated by the panel group (P<0.05). After AI assistance, the area under the receiver operating characteristic curve for the assessment performance of junior technologist group increased significantly from 0.56 (95%CI: 0.51-0.61) to 0.91 (95%CI: 0.87-0.94) (P<0.001). The disqualification rates for skin folds, incomplete inclusion of the pectoralis major muscle, and nipple not in profile decreased significantly. Conclusion AI demonstrates assessment capability comparable to the panel group in mammographic quality control. AI effectively enhances the quality of images acquired by junior technologists through real-time, objective feedback.

Objective To evaluate the application value of artificial intelligence (AI) in the quality control of mammographic images and explore its feasibility for improving image quality. Methods A retrospective analysis was conducted on 500 mammographic images from 125 female patients. These images were acquired in December 2024 at the Department of Radiology, Obstetrics and Gynecology Hospital of Tongji University by two junior technologists with qualification certificate for junior radiologic technologists and ≤ 2 months of independent operation. The reference standard was the evaluation by a panel of senior experts comprising one associate chief radiologist and two intermediate radiologic technologists with over 10 years of experience in mammography. The evaluation was based on nine criteria within an AI quality control system. The correlation and consistency (Kappa test) of the assessment outcomes were compared among the junior technologist group, the AI quality control group, and the panel group. Additionally, the differences in the proportions of high-, medium-, and low-quality images rated by the three groups were analyzed. After one month of AI assistance, 200 images from 50 additional patients acquired by the same two junior technologists in January 2025 were collected. The area under the receiver operating characteristic curve and 95% confidence interval (95%CI) were calculated for the assessment performance of the junior technologist group before and after AI assistance. Differences were compared using the DeLong test. Changes in the disqualification rates for the nine criteria were analyzed. Results In consistency analysis, the AI quality control group showed high consistency with the panel group across multiple key criteria, with Kappa values ranging from 0.41 to 1.00. In contrast, the consistency between the junior technologist group and the panel group was generally low, with Kappa values ranging from 0.13 to 0.49. In comparison of image quality classification, no significant differences were observed in image quality classification between the AI group and the panel group (P>0.05). However, the proportion of images rated as high quality by the junior technologist group was significantly higher, while the proportions rated as medium and low quality were significantly lower, compared to those rated by the panel group (P<0.05). After AI assistance, the area under the receiver operating characteristic curve for the assessment performance of junior technologist group increased significantly from 0.56 (95%CI: 0.51-0.61) to 0.91 (95%CI: 0.87-0.94) (P<0.001). The disqualification rates for skin folds, incomplete inclusion of the pectoralis major muscle, and nipple not in profile decreased significantly. Conclusion AI demonstrates assessment capability comparable to the panel group in mammographic quality control. AI effectively enhances the quality of images acquired by junior technologists through real-time, objective feedback.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective To compare the effects of main artery clamping(MAC)and selective artery clamping(SAC)strategies on postoperative renal function in patients with chronic renal insufficiency undergoing robot-assisted partial nephrectomy.Methods A retrospective cohort study was conducted on 231 patients with preoperative chronic renal insufficiency[eGFR<90 mL/(min·1.73 m2)with renal injury markers or eGFR<60 mL/(min·1.73 m2)]who underwent robot-assisted partial nephrectomy in the Department of Urology of the First Affiliated Hospital of Army Medical University from February 2018 to February 2024.According to intraoperative renal artery clamping strategy,they were divided into a MAC group(n=129)and a SAC group(n=102).Preoperatively,individualized renal artery clamping strategies were developed using a machine learning-based multimodal holographic 3-D reconstruction technique.Serum creatinine(Scr)level was measured at 3 d and 3 months after surgery,and estimated glomerular filtration rate(eGFR)was calculated using the chronic kidney disease epidemiology collaboration equation(CKD-EPI)formula.Renal dynamic imaging with 99mTc-DTPA or 99mTc-MAG3 was used to assess the GFR of the affected kidney.Results At 3 d after surgery,the decrease in GFR of the affected kidney was significantly lower[(8.3±7.7)vs(16.0±10.2)mL/(min·1.73 m2),95%CI:-10.2～-5.2,P<0.001]in the SAC group than the MAC group.Scr increment analysis showed that the SAC group exhibited notably lower Scr increase[8.2(2.5,18.7)vs 15.5(5.8,28.3)μmol/L,95%CI:-12.3～-1.8,P=0.027],and milder eGFR decline[3.0(0.5,7.8)vs 7.5(2.0,14.3)mL/(min·1.73 m2),95%CI:-6.2～-0.8,P=0.015].And,in 3 months after surgery,the SAC group had lower Scr level[(89.2±23.1)vs(95.3±22.1)μmol/L,95%CI:-11.9～-0.3,P=0.042],and higher GFR of the affected kidney[(33.5±10.5)vs(26.1±10.9)mL/(min·1.73 m2),95%CI:4.6～10.2,P<0.001].Conclusion For patients with chronic renal insufficiency undergoing robot-assisted partial nephrectomy,SAC strategy is superior to MAC strategy in protecting postoperative renal function without increasing surgical risk.

Objective To investigate the neuroprotective effect of Tibetan medicine 70 Wei Pearl Pill(RNSP)on 6-hydroxydopamine(6-OHDA)induced Parkinson's disease model rats and its related mechanism.Methods Totally 48 male SD rats were randomly divided into control group,model group,model plus low-dose RNSP group(90 mg/kg),model plus medium-dose RNSP group(180 mg/kg),model plus high-dose RNSP group(360 mg/kg),and model plus madopar group(50 mg/kg),with 8 rats in per group.Except for the control group,the other rats were treated with 6-OHDA single injection into the striatum to establish the PD model.Each group was given intragastric administration after modeling and the control group and model group were given an equal volume of saline once a day for 4 weeks.The rats were subjected to apomorphine-induced rotation,experiments at the 2nd and 4th week after the completion of modeling,and the open field experiment was conducted the next day after the last rotation experiment to observe the animal behavior.After the behavioral experiment,the rats were stained with tyrosine hydroxylase(TH)in the substantia nigra pars compacta by immunohistochemical method and the positive neurons were counted.The protein levels of Bcl-2,BAX,Caspase-3 in substantia nigra and P38,P-P38,ERK,P-ERK,JNK,P-JNK in the striatum were detected by Western blotting.Results Compared with the control group,the rotation frequency and percentage of rotating rats in the model group increased significantly at the 2nd and 4th weeks after modeling;the open field active distance,average speed and times of crossing the grid were significantly decreased;and the rest time was significantly increased.While the number of TH positive neurons in the substantia nigra was significantly decreased,the BAX and Caspase-3 protein levels were increased significantly,Bcl-2 was decreased significantly,the ratios of P-P38/P38,P-JNK/JNK and P-ERK/ERK in the striatum were significantly increased in PD group.Compared with the model group,the rotation frequency and percentage of rotating rats in the low-,medium-and high-dose groups of RNSP had no significant changes after 2 weeks of administration,the rotation frequency in the high-dose group and percentage of rotating rats in the low-and medium-dose RNSP groups significantly decreased after 4 weeks of administration.The open field active distance,average speed,and times of crossing the grid were significantly increased;the rest time was significantly decreased.The number of TH positive neurons in the substantia nigra was significantly increased,the Bax and Caspase-3 protein levels were decreased significantly while the Bcl-2 was significantly increased.The ratios of P-P38/P38,P-JNK/JNK and P-ERK/ERK in the striatum were significantly decreased.Conclusion Tibetan medicine RNSP can improve the motor ability and reduce the loss of DA neurons in PD rats,and its mechanism may be related to inhibiting P38/JNK/ERK signaling pathway and reducing the apoptosis of midbrain neurons.

Objective To construct a prediction model for the risk of peripherally inserted central venous catheter(PICC)-related bloodstream infection(CRBSI)in preterm infants,and evaluate the effect of the model.Methods 1 295 preterm infants admitted to the neonatal intensive care unit(NICU)in a hospital and received PICC intrave-nous infusion from January 2019 to October 2023 were selected as the study subjects,including 1 080 preterm in-fants from January 2019 to December 2022 in the modeling set and 215 premature infants from January to October 2023 in the validation set.Risk factors of cases were analyzed based on 24 clinical characteristics,optimized charac-teristics was selected by LASSO regression,independent risk factors for CRBSI of preterm infants during PICC in-dwelling period were identified by multiple logistic regression analysis,and nomogram model was constructed with R software.Discrimination and fitting of the model were evaluated by the area under the curve(AUC)of the receiver operating characteristic(ROC)as well as Hosmer-Lemeshow test and calibration curve,and clinical practicality of the model was evaluated by decision curve analysis(DCA).Results Multivariate logistic analysis showed that birth weight ≥1 500 g,sterile protection during catheter maintenance,and sterile cloth wrapped joints were protective factors for CRBSI during PICC indwelling period in preterm infants(OR=0.172,0.187,0.063,respectively,all P＜0.05),while puncture frequency＞2 times,catheter indwelling period＞14 days,and use of tees were inde-pendent risk factors for CRBSI during PICC indwelling period in premature infants(OR=2.533,14.128,13.256,respectively,all P＜0.05).The AUC of ROC of the modeling set was 0.953(95％CI:0.936-0.969),and that of the validation set was 0.930(95％CI:0.885-0.974),indicating good discriminability of the model.The calibra-tion curve and Hosmer-Lemeshow goodness of fit test showed that the model had good accuracy and consistency,with high net profit value,indicating that the predictive value of the model was high and with good clinical practica-lity.The statistical test result in the rationality analysis of the model was P＜0.001.Conclusion The nomogram model based on the general clinical characteristics of preterm infants as well as the basic prevention and control measures of the catheter can provide a visual and simple evaluation tool for early identification of high risk factors for CRBSI in preterm infants.

Objective This study aims to explore the application effect of a multidisciplinary teaching model(MDT)combined with problem-based learning(PBL)and case-based learning(CBL)in the standardized training of radiation oncology residents.The study aims to highlight its innovative teaching reform characteristics and enhance students'comprehensive quali-ties.Methods This study included 80 residents who underwent radiation oncology training in our hospital from October 2018 to October 2021.The participants were divided into a research group(n=40)that received MDT combined with PBL+CBL multi-track teaching and a control group(n=40)that received traditional lecture-based teaching(LBL).General information of the residents,including age,gender,and entrance exam scores,was collected.The total scores of the two groups in theoretical knowledge,case analysis,and skill operation after training were statistically analyzed.The comprehensive qualities of the resi-dents were evaluated in terms of self-learning ability,comprehension ability,thinking ability,practical ability,and learning in-terest.The scoring system ranged from 0 to 10,with higher scores indicating stronger comprehensive qualities.A questionnaire was used to assess the satisfaction of the residents with the teaching courses,categorized as very satisfied,satisfied,or dissatis-fied,and the overall satisfaction was calculated.Results The research group had significantly higher scores in theoretical knowl-edge,case analysis,skill operation,and total scores compared to the control group(P＜0.05).The research group also had higher scores in self-learning ability,comprehension ability,thinking ability,practical ability,and learning interest(P＜0.05).The overall satisfaction evaluation of the research group was significantly higher(P＜0.05).Conclusion In the teaching of ra-diation oncology,the MDT combined with PBL+CBL model,which focuses on the cultivation of practical and applied talents,can greatly enhance the enthusiasm and interest of residents in training,significantly improve teaching outcomes,and strengthen the comprehensive qualities of clinical physicians.

Objective:To explore the clinical effect of vitamin A in the adjuvant treatment of bronchial asthma in children and its influence on serum transforming growth factor-β1 (TGF-β1), eosinophils (EOS) and interleukin-17 (IL-17) levels.Methods:A prospective study was conducted on 110 children with bronchial asthma who received treatment in Department of Pediatrics, Xi'an Central Hospital from January 2022 to December 2023. Based on the principle of balanced and comparable baseline characteristics between groups, they were randomly divided into a control group and an observation group, with 55 cases in each group, using a random number table method. The control group was treated with routine pediatric bronchial asthma therapy, while the observation group was added with vitamin A adjuvant therapy on the basis of the control group. After 15 days of continuous treatment, the scores of asthma control condition (Childhood-Asthma Control Test (C-ACT), Asthma Control Questionnaire (ACQ)) in the two groups were evaluated. The pulmonary ventilation function (forced expiratory volume in one second (FEV 1), forced expiratory volume in one second/forced vital capacity (FEV 1/FVC), peak expiratory flow (PEF)), serum inflammatory factors (TGF-β1, EOS, IL-17) and immune function indicators (T helper 17 cell (Th17), T helper 2 cell (Th2), regulatory T cell (Treg) ) were compared between groups of children before treatment and after 15 days of treatment. Measurement data with normal or approximate distribution were expressed as xˉ± s, and independent sample t test was used for comparison between groups. Enumeration data were expressed as percentage, and chi-square test was adopted for between-group comparison. Results:After 15 days of treatment, the C-ACT score with (16.20±3.14) points in observation group was higher than (14.80±2.62) points in control group while the ACQ score with (30.30±4.14) points was lower than (34.60±6.23) points in control group, with statistical differences between groups (t values were 2.54 and 4.26; P values were 0.012 and <0.001). The pulmonary ventilation function indicators in observation group and control group after 15 days of treatment (FEV 1: (1.76±0.34) L与(1.54±0.32) L, FEV 1/FVC:(76.89±5.76)%与(70.25±6.42)%, PEF(2.89±0.35) L/s与(2.68±0.39) L/s) were higher than those before treatment (FEV 1:(1.12±0.31) L与(1.20±0.33) L, FEV 1/FVC:(56.96±4.35)%与(58.12±3.48)%, PEF(2.15±0.66) L/s与(2.34±0.56) L/s), and the differences were statistically significant ( t values were 10.32, 5.49, 20.48, 10.43, 7.35, 3.70, respectively; all P<0.001), and the indicators in observation group were higher compared to control group, the differences were statistically significant ( t values were 3.49, 5.71, and 2.97; P values were 0.001, <0.001, and 0.004). After 15 days of treatment, the levels of serum inflammatory factors (TGF-β1:(6.32±1.36) ng/L与(8.75±1.81) ng/L, EOS:(3.56±0.65)%与(4.28±0.82)%, IL-17:(5.53±1.22) ng/L与(6.42±1.51) ng/L) and CD4 + T lymphocyte immune function indicators (Th17:(0.97±0.26) ng/L与(1.23±0.35) ng/L, Th2:(2.32±0.64) ng/L与(3.15±0.52) ng/L, Treg:(5.41±0.76) ng/L与(5.86±0.23) ng/L ) were lower in observation group and control group than those before treatment (TGF-β1: (14.35±2.23)与(15.26±3.05) ng/L, EOS: (6.32±1.33)%与(6.41±1.27)%, IL-17:(8.86±1.68)与(9.03±1.89) ng/L, Th17:(1.82±0.75)与(1.67±0.68) ng/L, Th2:(4.15±1.49)与(3.98±1.28) ng/L, Treg: (7.26±1.35)与(6.92±1.72) ng/L), and the differences were statistically significant ( t values were 22.80, 13.61, 13.83, 10.45, 11.90, 8.08, 7.94, 4.27, 8.37, 4.46, 8.86, 4.58, respectively; all P<0.001). However, the above indicators in the observation group were lower than those in the control group ( t values were 7.96, 5.10, 3.40, 4.42, 7.47, 4.20, and P-values were <0.001, <0.001, 0.001, <0.001, <0.001, and <0.001 respectively). Conclusion:Vitamin A adjuvant therapy is helpful to the control of bronchial asthma, and it can effectively improve the pulmonary function, reduce the inflammatory reaction and enhance the body's immunity.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.