Objective To analyze the structural and phylogenetic characteristics of the mitochondrial genome from Bulinus globosus, so as to provide a theoretical basis for classification and identification of species within the Bulinus genus, and to provide insights into understanding of Bulinus-schistosomes interactions and the mechanisms of parasite transmission. Methods B. globosus samples were collected from the Ruya River basin in Zimbabwe. Mitochondrial DNA was extracted from B. globosus samples and the corresponding libraries were constructed for high-throughput sequencing on the Illumina NovaSeq 6000 platform. After raw sequencing data were subjected to quality control using the fastp software, genome assembly was performed using the A5-miseq and SPAdes tools, and genome annotation was conducted using the MITOS online server. Circular maps and sequence plots of the mitochondrial genome were generated using the CGView and OGDRAW software, and the protein conservation motifs and structures were analyzed using the TBtools software. Base composition and codon usage bias were analyzed and visualized using the software MEGA X and the ggplot2 package in the R software. In addition, a phylogenetic tree was created in the software MEGA X after sequence alignment with the software MAFFT 7, and visualized using the software iTOL. Results The mitochondrial genome of B. globosus was a 13 730 bp double-stranded circular molecule, containing 2 ribosomal RNA (rRNA) genes, 22 transfer RNA (tRNA) genes, and 13 protein-coding genes, with a marked AT preference. The mitochondrial genome composition of B. globosus was similar to that of other species within the Bulinus genus. Phylogenetic analysis revealed that the complete mitochondrial genome sequence of B. globosus was clustered with B. truncatus, B. nasutus, and B. ugandae into the same evolutionary clade, and gene superfamily analysis showed that the metabolism-related proteins of B. globosus were highly conserved, notably the cytochrome c oxidase family, which showed a significant consistency. Conclusions This is the first whole mitochondrial genome sequencing to decode the compositional features of the mitochondrial genome of B. globosus from Zimbabwe and its evolutionary relationship within the Bulinus genus, which provides important insights for further understanding of the phylogeny and mitochondrial genome characteristics of the Bulinus genus.

Schizophrenia is a chronic and debilitating mental disorder.Around 20%to 40%of patients do not respond well to normal antipsychotic medication,and are ultimately diagnosed with treatment-resistant schizophrenia(TRS),representing the most severe and challenging form of schizophrenia.Currently,clozapine is the standard treatment for TRS.Early identification and standardized treatment can be beneficial to patients with TRS by controlling acute-phase symptoms as soon as possible,reducing suicidal rate and improving their quality of life.Under the guidance of the Steering Committee,this consensus was formed after multiple discussions by 30 psychiatric experts and anonymous Delphi surveys including 17 consensus opinions on treatment-resistant schizophrenia,which cover risk factors and prevention,diagnosis and evaluation,standardized clozapine treatment and management of adverse reactions,treatment regimens for clozapine resistance and intolerance,and psychosocial intervention,etc.The consensus-making process also incorporated evidence-based medicine to help standardize and guide diagnosis and treatment for adults with TRS in China.

Schizophrenia is a chronic and debilitating mental disorder.Around 20%to 40%of patients do not respond well to normal antipsychotic medication,and are ultimately diagnosed with treatment-resistant schizophrenia(TRS),representing the most severe and challenging form of schizophrenia.Currently,clozapine is the standard treatment for TRS.Early identification and standardized treatment can be beneficial to patients with TRS by controlling acute-phase symptoms as soon as possible,reducing suicidal rate and improving their quality of life.Under the guidance of the Steering Committee,this consensus was formed after multiple discussions by 30 psychiatric experts and anonymous Delphi surveys including 17 consensus opinions on treatment-resistant schizophrenia,which cover risk factors and prevention,diagnosis and evaluation,standardized clozapine treatment and management of adverse reactions,treatment regimens for clozapine resistance and intolerance,and psychosocial intervention,etc.The consensus-making process also incorporated evidence-based medicine to help standardize and guide diagnosis and treatment for adults with TRS in China.

The training of orthopedic residents in Taiwan, China includes post graduate year and specialist training, which contain continuous orthopedic specialist training, humanistic training, and holistic education to ensure the high post competency of orthopedic residents. The training process is oriented towards competency and outcome, emphasizing the cultivation of core competencies. Comprehensive quantitative standards have been established to comprehensively evaluate the post competency of residents through theoretical, technical, and clinical work assessments. In this paper, the literature on medical education and resident training in Taiwan was reviewed. The overall training system, assessment requirements, and humanistic training of orthopedic residents in Taiwan were introduced. In addition, the models of training orthopedic specialists were compared between Taiwan and Mainland of China represented by Peking University Medical Department to provide reference for the training program of orthopedic residents.

Purpose To explore the value of three-dimensions densely connected convolutional networks(3D-DenseNet)in the differential diagnosis of high-grade gliomas(HGGs)and single brain metastases(BMs)via MRI,and to compare the diagnostic performance of models built with different sequences.Materials and Methods T2WI and T1WI contra-enhanced(T1C)imaging data of 230 cases of HGGs and 111 cases of BMs confirmed by surgical pathology in Lanzhou University Second Hospital from June 2016 to June 2021 were retrospectively collected,and the volume of interest under the 3D model was delineated in advance as the input data.All data were randomly divided into a training set(n=254)and a validation set(n=87)in a ratio of 7∶3.Based on the 3D-DenseNet,T2WI,T1C and two sequence fusion prediction models(T2-net,T1C-net and TS-net)were constructed respectively.The predictive efficiency of each model was evaluated and compared by the receiver operating characteristic curve,and the predictive performance of models built with different sequences were compared.Results The area under curve(AUC)of T1C-net,T2-net and TS-net in the training and validation sets were 0.852,0.853,0.802,0.721,0.856 and 0.745,respectively.The AUC and accuracy of the validation set of T1C-net were significantly higher than those of T2-net and TS-net,respectively,and the AUC and accuracy of the validation set of TS-net were significantly higher than those of T2-net.There was a significant difference between T1C-net and T2-net models(P<0.05),while there were no statistical differences between the models of TS-net and T2-net,T1C-net and TS-net(P>0.05).The T1C-net model based on 3D-DenseNet had the best performance,the accuracy of the validation set was 80.5%,the sensitivity was 90.9%,the specificity was 62.5%.Conclusion The 3D-DenseNet model based on MRI conventional sequence has better diagnostic performance,and the model built by T1C-net sequence has better performance in differentiating HGGs and BMs.Deep learning models can be a potential tool to identify HGGs and BMs and to guide the clinical formulation of precise treatment plans.

Objective:To explore the clinical value of the relative size of gestational sac and serum progesterone levels in predicting early pregnancy outcomes.Methods:Retrospective cohort study selected patients who underwent early pregnancy ultrasound examination at the Ultrasound Medicine Department of Shanghai Changning Maternity and Infant Health Hospital from April 2020 to June 2023. Transvaginal two-dimensional ultrasound was used to measure the three diameters of the gestational sac (longitudinal diameter, transverse diameter, anterior-posterior diameter) and fetal pole length. Serum progesterone levels were tested in 3 d. All patients were followed up until 12 weeks of gestation to estimate the early pregnancy outcomes. Gestational age was calculated based on the gestational sac diameter line (Hellman's formula) and embryo length (Hadlock's formula), and the patients were divided into the gestational sac deviation group (deviation group, n=100) and the gestational sac normal group (normal group, n=500) based on the relative size of gestational age. The relative size of the gestational sac and progesterone level were compared between the two groups, and the effectiveness of predicting early pregnancy outcomes for statistically significant indicators was calculated with receiver operating characteristic curve. Results:1) The relative size of gestational sac in the normal group and the deviation group were 3.24±1.06 and 1.65±0.56, respectively, and the difference between the two groups was statistically significant ( P=0.004). The positive predictive value of ultrasound gestational sac size for predicting adverse pregnancy outcome in the first trimester was 97.00% (97/100) and the negative predictive value was 94.2% (471/500). 2) The levels of progesterone in the normal group and the deviation group were (68.4±37.2) nmol/L and (29.6±11.8) nmol/L, respectively, with a statistically significant difference ( P<0.001). 3) The areas under receiver operating characteristic curves of the relative size of gestational sac, progesterone levels and the both combined in predicting early pregnancy outcomes were 0.804, 0.818 and 0.847, respectively, and the cut-off values of the relative size of pregnancy sac and progesterone was 2.40 and 37.6 nmol/L, respectively. 4) The accuracy of the relative size of gestational sac in predicting adverse outcomes in early pregnancies was 76.98% (97/126). The accuracy of progesterone in predicting adverse outcomes in early pregnancy was 78.57% (99/126). When the both combined, the predicting accuracy was increased to 84.92% (107/126). Conclusion:It is easy to measure and calculate the relative size of pregnancy sac by ultrasound, which provided a good predictive value for the outcomes of early pregnancies. The relative size of pregnancy sac combined with progesterone levels showed better predictive efficacy.

Objective:To explore the clinical value of the relative size of gestational sac and serum progesterone levels in predicting early pregnancy outcomes.Methods:Retrospective cohort study selected patients who underwent early pregnancy ultrasound examination at the Ultrasound Medicine Department of Shanghai Changning Maternity and Infant Health Hospital from April 2020 to June 2023. Transvaginal two-dimensional ultrasound was used to measure the three diameters of the gestational sac (longitudinal diameter, transverse diameter, anterior-posterior diameter) and fetal pole length. Serum progesterone levels were tested in 3 d. All patients were followed up until 12 weeks of gestation to estimate the early pregnancy outcomes. Gestational age was calculated based on the gestational sac diameter line (Hellman's formula) and embryo length (Hadlock's formula), and the patients were divided into the gestational sac deviation group (deviation group, n=100) and the gestational sac normal group (normal group, n=500) based on the relative size of gestational age. The relative size of the gestational sac and progesterone level were compared between the two groups, and the effectiveness of predicting early pregnancy outcomes for statistically significant indicators was calculated with receiver operating characteristic curve. Results:1) The relative size of gestational sac in the normal group and the deviation group were 3.24±1.06 and 1.65±0.56, respectively, and the difference between the two groups was statistically significant ( P=0.004). The positive predictive value of ultrasound gestational sac size for predicting adverse pregnancy outcome in the first trimester was 97.00% (97/100) and the negative predictive value was 94.2% (471/500). 2) The levels of progesterone in the normal group and the deviation group were (68.4±37.2) nmol/L and (29.6±11.8) nmol/L, respectively, with a statistically significant difference ( P<0.001). 3) The areas under receiver operating characteristic curves of the relative size of gestational sac, progesterone levels and the both combined in predicting early pregnancy outcomes were 0.804, 0.818 and 0.847, respectively, and the cut-off values of the relative size of pregnancy sac and progesterone was 2.40 and 37.6 nmol/L, respectively. 4) The accuracy of the relative size of gestational sac in predicting adverse outcomes in early pregnancies was 76.98% (97/126). The accuracy of progesterone in predicting adverse outcomes in early pregnancy was 78.57% (99/126). When the both combined, the predicting accuracy was increased to 84.92% (107/126). Conclusion:It is easy to measure and calculate the relative size of pregnancy sac by ultrasound, which provided a good predictive value for the outcomes of early pregnancies. The relative size of pregnancy sac combined with progesterone levels showed better predictive efficacy.

OBJECTIVE: To explore the risk factors for poor prognosis in sepsis-associated acute kidney injury (SA-AKI) and establish a nomogram predictive model. METHODS: The clinical data of patients with SA-AKI admitted to the department of critical care medicine of Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2019 to September 2022 were retrospectively analyzed, including demographic information, worst values of blood cell counts and biochemical indicators within 24 hours of SA-AKI diagnosis, whether the patient received renal replacement therapy (RRT), mechanical ventilation, vasopressor therapy during hospitalization, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), fibrinogen-to-albumin ratio (FAR) within 24 hours of diagnosis, acute kidney injury (AKI) staging, total length of hospital stay, length of intensive care unit (ICU) stay, and others. According to the 28-day outcome, the patients were divided into survival group and death group, and the indicators between the two groups were compared. Univariate and multivariate Logistic regression analyses were used to screen for risk factors associated with mortality in SA-AKI patients. A nomogram predictive model for SA-AKI prognosis was constructed based on the identified risk factors. Receiver operator characteristic curve (ROC curve) and calibration plots were generated to evaluate the predictive value of the nomogram model for SA-AKI prognosis. RESULTS: A total of 113 SA-AKI patients were included, with 67 in the survival group and 46 in the death group. The 28-day mortality among SA-AKI patients was 40.7%. The comparison between the two groups showed that there were statistically significant differences in age ≥ 65 years, AKI stage, mechanical ventilation, vasopressors, RRT, length of ICU stay, and laboratory indicators cystatin C (Cys C), fibrinogen (Fib), and FAR. Multivariate Logistic regression analysis showed that age ≥ 65 years [odds ratio (OR) = 7.967, 95% confidence interval (95%CI) was 1.803-35.203, P = 0.006], cystatin C (OR = 7.202, 95%CI was 1.756-29.534, P = 0.006), FAR (OR = 2.444, 95%CI was 1.506-3.968, P < 0.001), and RRT (OR = 7.639, 95%CI was 1.391-41.951, P = 0.019) were independent risk factors for mortality in SA-AKI patients. ROC curve analysis showed that the area under the ROC curve (AUC) for age ≥ 65 years, cystatin C, FAR, and RRT in predicting SA-AKI patient mortality were 0.713, 0.856, 0.911, and 0.701, respectively. A nomogram predictive model for SA-AKI patient prognosis was constructed based on age ≥ 65 years, cystatin C, FAR, and RRT, with an AUC of 0.967 (95%CI was 0.932-1.000) according to ROC curve analysis. The calibration plot indicated good consistency between predicted and actual probabilities. CONCLUSIONS Age ≥ 65 years, cystatin C, FAR, and RRT are independent risk factors for mortality in SA-AKI patients. The nomogram predictive model based on these four factors can accurately predict SA-AKI patient prognosis, helping physicians adjust treatment strategies in a timely manner and improve patient outcomes.
Humans ; Aged ; Cystatin C ; Retrospective Studies ; Intensive Care Units ; Sepsis/diagnosis* ; Acute Kidney Injury/therapy* ; Prognosis ; ROC Curve ; Fibrinogen

Objective To investigate the semen quality and the influence of urogenital Ureaplasma urealyticum infection in pre‐conception males in Shanghai .Methods From Jan ,2014 to Nov ,2015 ,5 306 preconception males in our andrology department were received semen analysis .The difference of semen index between ages and urogenital Ureaplasma urealyticum infected or not were analyzed .Results The average pH value was(7 .27 ± 0 .14) ,the average volume was(3 .15 ± 1 .42)mL ,the average sperm concen‐trationwas(57.51±40.22)×106/mL,theaverageoftotalspermcountwas(172.83±134.90)×106 ,theaveragevitalityratioof grade(A+B) sperm was(38 .50 ± 17 .54)% ,the average motile sperm ratio was(46 .36 ± 20 .08)% ,the average of total motile sperm count was(89 .86 ± 92 .82) × 106 .Motile sperm ratio of preconception males from twenty to twenty nine was(49 .60 ± 20 .70)% ,total motile sperm count was(93 .40 ± 95 .83) × 106 ,which was greater than other ages .Ureaplasma urealyticum turned to positive in 2 311 cases was (43 .55% ) .There were statistically significant differences in total sperm count ,total motile sperm count ,sperm concentration ,vitality ratio of grade A sperm ,vitality ratio of grade(A+B) sperm ,motile sperm ratio ,seminal acid phosphatase ,seminalα‐glucosidase and seminal plasma fructose between positive and negative samples(P<0 .01) .There was differ‐ence in pH and seminal plasma zinc between positive and negative samples(P<0 .05) .Conclusion The sperm quality of preconcep‐tion males in Shanghai is not encouraging ,urogenital Ureaplasma urealyticum infection in preconception men is very important .

Objective To study the effects of different temporal resolution of spiral computed tomography (CT)on perfusion parameters and perfusion curve of cervical cervical cancer.Methods Ten cases of cervical cancer were clinically confirmed with CT perfusion scanning.The original data were acquired using temporal resolution of 0.75 s.Then the original data were grouped according to different temporal resolution,namely,1.5 s group,2.25 s group,3 s group,3.75 s group,4.5 s group,5.25 s group,and 6 s group (experiment group). According to the same mathematical model and ROI of the same part,perfusion parameters (BF,BV,MTT,and PS)in each group were calculated respectively and compared with the original data.Results BF and MTT were relatively sensitive to the change of temporal resolution.When the temporal resolution was 3 s,it had a significant impact.PS and BV were not so sensitive to the change of temporal resolution.Temporal resolution of 4.5 s had a significant effect on PS. There was a significant effect on BV until the temporal resolution was 5.25 s. Conclusion Changing the temporal resolution will lead to corresponding changes of perfusion curve and perfusion parameters.Under the premise that it does not affect the diagnosis,properly decreasing temporal resolution (circu-lar scanning temporal ≤2.25 s)of CT perfusion scanning of cervical cancer can reduce the radiation dose effectively.