Objective:To develop and validate a predictive model of 28-day mortality in sepsis based on lactate dehydrogenase-to-albumin ratio (LAR).Methods:Sepsis patients diagnosed in the department of intensive care medicine of the First Affiliated Hospital of Soochow University from August 1, 2017 to September 1, 2022 were retrospective selected. Clinical data, laboratory indicators, disease severity scores [acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment (SOFA)] were collected. Patients were divided into death group and survival group according to whether they died at 28 days, and the difference between the two groups was compared. The dataset was randomly divided into training set and validation set according to 7∶3. Lasso regression method was used to screen the risk factors affecting the 28-day death of sepsis patients, and incorporating multivariate Logistic regression analysis (stepwise regression) were included, a prediction model was constructed based on the independent risk factors obtained, and a nomogram was drawn. The nomogram prediction model was established. Receiver operator characteristic curve (ROC curve) was drawn to analyze and evaluate the predictive efficacy of the model. Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA) were used to evaluate the accuracy and clinical practicability of the model, respectively.Results:A total of 394 patients with sepsis were included, with 248 survivors and 146 non-survivors at 28 days. Compared with the survival group, the age, proportion of chronic obstructive pneumonia, respiratory rate, lactic acid, red blood cell distribution width, prothrombin time, activated partial thromboplastin time, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, blood potassium, blood phosphorus, LAR, SOFA score, and APACHEⅡ score in the death group were significantly increased, while oxygenation index, monocyte count, platelet count, fibrinogen, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and blood calcium were significantly reduced. In the training set, LAR, age, oxygenation index, blood urea nitrogen, lactic acid, total cholesterol, fibrinogen, blood potassium and blood phosphorus were screened by Lasso regression. Multivariate Logistic regression analysis finally included LAR [odds ratio ( OR) = 1.029, 95% confidence interval (95% CI) was 1.014-1.047, P < 0.001], age ( OR = 1.023, 95% CI was 1.005-1.043, P = 0.012), lactic acid ( OR = 1.089, 95% CI was 1.003-1.186, P = 0.043), oxygenation index ( OR = 0.996, 95% CI was 0.993-0.998, P = 0.002), total cholesterol ( OR = 0.662, 95% CI was 0.496-0.865, P = 0.003) and blood potassium ( OR = 1.852, 95% CI was 1.169-2.996, P = 0.010). A total of 6 predictor variables were used to establish a prediction model. ROC curve showed that the area under the curve (AUC) of the model in the training set and validation set were 0.773 (95% CI was 0.715-0.831) and 0.793 (95% CI was 0.703-0.884), which was better than APACHEⅡ score (AUC were 0.699 and 0.745) and SOFA score (AUC were 0.644 and 0.650), and the cut-off values were 0.421 and 0.309, the sensitivity were 62.4% and 82.2%, and the specificity were 82.2% and 68.9%, respectively. The results of Hosmer-Lemeshow test and calibration curve showed that the predicted results of the model were in good agreement with the actual clinical observation results, and the DCA showed that the model had good clinical application value. Conclusion:The prediction model based on LAR has a good predictive value for 28-day mortality in patients with sepsis and can guide clinical decision-making.

Objective:To investigate the effects of transepithelial photorefractive keratectomy (TransPRK) and femtosecond small incision lenticule extraction (SMILE) on corneal biomechanics measured by the Ocular Response Analyzer in the early postoperative period.Methods:A cohort study was conducted.The right eyes of 56 patients who underwent TransPRK and 52 patients who underwent SMILE in Dalian Medical University Affiliated Dalian Third People's Hospital from November 2020 to June 2021 were continuously included.The postoperative follow-up was 3 months.The central corneal thickness (CCT) and keratometry (Km) were measured 1 month and 3 months after surgery.The corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF), corneal hysteresis (CH), and 19 repeatable mechanical infrared signal waveform parameters measured by the Ocular Response Analyzer were recorded before the surgery, 1 month and 3 months after the surgery, respectively.The measurement indexs at different time points between two groups were compared.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Dalian Medical University Affiliated Dalian Third People's Hospital (No.2019-KT-010). Written informed consent was obtained from each patient before surgery.Results:There was no significant difference in CCT, Km, and IOPcc between the two groups at 1 month and 3 months after the surgery (all at P>0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1, dive2 and mslew1 were decreased, while path1, path2, path11, and aplhf were increased at 1 month after the surgery compared with before surgery, showing statistically significant differences (all at P<0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1 decreased, while path1, path2, path11, and aplhf were increased at 3 months after the surgery in comparison with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, the dive2 were decreased at 3 months after the surgery compared with before surgery, and the difference was statistically significant ( P<0.01). At 1 month after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, dive1 and dive2 were higher, while CH, path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). At 3 months after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h2, h21, dive1 and dive2 were higher, while path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). Conclusions:Corneal biomechanics are weakened after both TransPRK and SMILE.In the early postoperative period, the mechanical infrared waveform parameters measured by the Ocular Response Analyzer are better after TransPRK than after SMILE.

Objective:To investigate the effect of 300 m saturation diving at sea on tremor intensity of divers’ finger.Methods:The finger tremor intensities of four divers were measured before entering pressurization chamber, during increasing pressurization, and at the stable stage of 300 m saturation pressurization.Results:The mean values of the tremor intensities of the divers’ fingers during the period from entering the chamber and starting pressurization to the stable stage of 300 m pressurization were higher than that before pressurization; specifically, the increases of tremor intensity of the divers’ fingers were the most significant at 250 m, 270 m, and 290 m pressurization ( P<0.05). However, there was no statistically significant difference in the mean value of the finger tremor intensities between that before pressurization and those at 195 m, 220 m, 250 m, 300 m pressurization, and during the 24 h-stay at the 300 m saturation pressurization ( P>0.05). Conclusion:The monitoring of finger tremor intensity in saturation diving at each pressurization stage can objectively and quantificationally evaluate the onset and development of high-pressure neurological syndrome (HPNS), which, combined with the traditional evaluation method, can provide a basis for improving the saturation diving pressurization rate and ensuring the safety of divers.

Objective:To investigate the effect of 300 m saturation diving at sea on tremor intensity of divers’ finger.Methods:The finger tremor intensities of four divers were measured before entering pressurization chamber, during increasing pressurization, and at the stable stage of 300 m saturation pressurization.Results:The mean values of the tremor intensities of the divers’ fingers during the period from entering the chamber and starting pressurization to the stable stage of 300 m pressurization were higher than that before pressurization; specifically, the increases of tremor intensity of the divers’ fingers were the most significant at 250 m, 270 m, and 290 m pressurization ( P<0.05). However, there was no statistically significant difference in the mean value of the finger tremor intensities between that before pressurization and those at 195 m, 220 m, 250 m, 300 m pressurization, and during the 24 h-stay at the 300 m saturation pressurization ( P>0.05). Conclusion:The monitoring of finger tremor intensity in saturation diving at each pressurization stage can objectively and quantificationally evaluate the onset and development of high-pressure neurological syndrome (HPNS), which, combined with the traditional evaluation method, can provide a basis for improving the saturation diving pressurization rate and ensuring the safety of divers.

BACKGROUND: Tumor microenvironment is a complex and dynamic community, which plays a crucial role in tumor progression via the co-evolution of cancer cells and tumor stroma. Among them, tumor-associated macrophages (TAMs) and tumor neo-vessels are two key components in the tumor microenvironment during cancer invasion. In addition, programmed cell death ligand 1/programmed cell death ligand 1 (PD-1/PD-L1) also plays an important role in tumorigenesis and development, and the clinical strategies to block PD-1/PD-L1 pathway could have great benefits for cancer patients. This study was aimed at analyzing the quantitative expression and prognostic significance of TAMs, tumor neo-vessels and PD-L1 in tumor microenvironment and exploring the relations between the expression of above components with the patients' prognosis of non-small cell lung cancer (NSCLC). METHODS: Clinico-pathological data and surgical specimens of 92 patients with NSCLC were collected, and immunohistochemistry was used to stain the expression of TAMs, tumor neo-vessels and PD-L1 on tumor tissue and peri-tumor tissues. The inverted microscopy was used to take pictures and Image-pro Plus 6.0 software was used for quantitative analysis. The clinicopathological characteristics and overall survival (OS) were analyzed. RESULTS: The median OS of 92 NSCLC cases was 22.5 month. The expression of TAMs, tumor neo-vessels and PD-L1 in tumor tissue and peri-tumor tissues were not statistically significant (P>0.05). According to the cutoff of above key three components in tumor microenvironment, all the cases could be classified into high, middle and low expression groups. The survival analysis demonstrated that the OS in high expression group of TAMs (P=0.016) and PD-L1 (P=0.002) was shorter than the other two groups, respectively, with statistical significance. The OS in high tumor neo vessels group was shorter than the other two groups. However, there was no statistical significance between these three group (P=0.626). Combined with above the three components, all the cases could be classified into low, middle and high density groups. The survival analysis demonstrated that the median OS of combined high density group was shorter than the other two groups (P=0.001). Multivariate analysis by Cox regression indicated that pathological type, TAMs and PD-L1 expression were the independent prognostic factors. CONCLUSIONS The key components of TAMs and PD-L1 in tumor microenvironment are closely related to the prognosis of NSCLC patients.

Objective:To optimize the decompression scheme of conventional air diving based on the data of 5 factors.Methods:Five factors, i. e. bottom material, water temperature, water current velocity, individual susceptibility to decompression sickness, and labor intensity, associated with decompression safety were calculated and analyzed, to select the most optimized decompression scheme.Results:A modified formula for the duration of underwater operation was proposed, and it was proved safe and reliable during the underwater construction of railway bridge pier.Conclusion:Based on synthetical consideration of various factors, i. e. bottom material, water temperature, water current velocity, individual susceptibility to decompression sickness, and labor intensity, an optimized decompression scheme was gained for balancing the decompression efficiency and the safety of divers by modifying the time duration of underwater operation.

Objective:To optimize the decompression scheme of conventional air diving based on the data of 5 factors.Methods:Five factors, i. e. bottom material, water temperature, water current velocity, individual susceptibility to decompression sickness, and labor intensity, associated with decompression safety were calculated and analyzed, to select the most optimized decompression scheme.Results:A modified formula for the duration of underwater operation was proposed, and it was proved safe and reliable during the underwater construction of railway bridge pier.Conclusion:Based on synthetical consideration of various factors, i. e. bottom material, water temperature, water current velocity, individual susceptibility to decompression sickness, and labor intensity, an optimized decompression scheme was gained for balancing the decompression efficiency and the safety of divers by modifying the time duration of underwater operation.

OBJECTIVE: observe the changes of localization and expression of acetylated tubulin alpha( Ac-tubulin α) in fibroblasts of silicosis fibrosis. METHODS: i) A total of 22 autopsy case with coal workers' pneumoconiosis( CWP) was selected as CWP group( autopsy lesion lung tissue) and their adjacent normal lung tissues surrounding fibrotic regions were selected as the control group using typical sampling method. ii) Specific pathogens free healthy male rats were randomly divided into control group and 5 dust-exposed groups with 10 rats in each group. In dust-exposed group,the rats were exposed to 2 000 mg/m~3 of silica dust for 0,2,4,8,12 and 16 weeks respectively by dynamic inhalation. The rats in control group were given no treatment. iii) Primary cultured rat lung fibroblasts were induced by Ang Ⅱ at a concentration of 100 nmol/L at different time points( 0,5,15 and 30 min,1,3,6,12,24 and 48 hours). iv) The expression of Ac-tubulin α and α-smooth muscle actin( α-SMA) were detected by immunohistochemical staining. The expression of Ac-tubulinα/Vimentin and Ac-tubulin α/α-SMA were observed by immunofluorescence staining. The relative expression ofα-SMA and Ac-tubulin α protein was detected by Western blot. RESULTS: The positive expression of Ac-tubulin α in lung tissue of CWP group was down-regulated while that of α-SMA was up-regulated compared with the control group( P < 0. 01). Immunofluorescence results showed that Vimentin positive expression in the CWP group was significantly increased in the lesion fibrosis area,while Ac-tubulin α expression was absent. The co-expression of Ac-tubulin α and Vimentin was detected in normal lung tissue of control group. The animal experiment results showed that the expression of Ac-tubulin αin lung tissue of rats was down-regulated and that of α-SMA was up-regulated with the prolongation of dust exposure time( P < 0. 01). The Ang Ⅱ induced the differentiation of fibroblasts into myofibroblasts,and the expression of Ac-tubulin α in fibroblasts gradually decreased and the expression of α-SMA gradually increased with the prolongation of Ang Ⅱ induction time( P < 0. 05). CONCLUSION: The lack of expression of Ac-tubulin α may be involved in the occurrence and development of silicotic fibrosis.

Purpose To explore the feasibility of denoising algorithm-PixelShine algorithm based on deep learning to enhance the quality of abdominal arterial phase CT images rebuilt by 70 kVp combined with adaptive statistical iterative reconstruction-Veo (ASiR-V). Materials and Methods Abdominal arterial phase images of 33 patients [body mass index (BMI) BMI≤20 kg/m2] scanned by GE Revolution CT were retrospectively analyzed (group A) using 70 kVp tube voltage and 50% ASiR-V technique. PixelShine algorithm B2 mode was applied to post-process group A images to obtain PixelShine image (group B). Two observers rated the image quality of the two groups via a 5-point rating system. The consistency of the rating was analyzed. The difference in ratings, noise, virtual signal-to-noise ratio (SNR) of liver and pancreas and contrast noise ratio (CNR) were compared between the two groups of images. Results The image quality rating of group A and B were(3.12±0.33) scores and(3.97±0.53) scores respectively,noise value(14.50±1.42)HU vs(10.05±1.80)HU, liver virtual SNR 4.51±0.53 vs 6.78.±1.27,liver virtual CNR 0.89±0.55 vs 1.42±0.81,pancreatic virtual SNR 9.51±1.69 vs 13.87±3.26, and pancreatic virtual CNR 5.83±1.66 vs 8.48±2.46.The quality rating of images,liver and pancreas virtual SNR,CNR in group B were all higher than those in group A, and the image noise of group B decreased about 31% compared with that of group A, the difference was statistically significant (P<0.05). Conclusion Post-processing with PixelShine algorithm can improve the image quality of 70 kVp abdominal arterial phase, significantly reduce image noise, and increase image SNR and CNR.