Objective To investigate the early dynamic changes of biomarkers associated with capillary leak syndrome(CLS)in patients with severe acute pancreatitis(SAP)and their correlation with multiple organ failure(MOF).Methods A total of 171 SAP patients admitted to the West China Centre of Excellence for Pancreatitis,West China Hospital,Sichuan University between September 1,2019 and December 31,2020 were enrolled for this study.The patients were divided into MOF and non-MOF groups based on the occurrence of MOF in the first 5 days of hospitalization,and were further divided into subgroups based on the presence of moderate-to-severe intra-abdominal hypertension(IAH).We performed dynamic monitoring of the blood biomarkers(hematocrit[HCT].blood urea nitrogen[BUN].and creatinine[Cr]),plasma proteins(albumin[Alb].total protein[TP].and non-albumin plasma proteins[NAPP]),and intra-abdominal pressure.Trends in these indicators across groups were analyzed comprehensively.Results No significant differences in baseline data between the two groups were observed.The baseline data of the 2 groups were comparable.The MOF group had significantly higher rates of persistent systemic inflammatory response syndrome(SIRS)lasting 48 hours(91.3％vs.71.8％),ICU admission(70.4％vs.17.6％),and length-of-stay([32±17.7]days vs.[19.0±12.2]days)compared to those of the non-MOF group(P＜0.05).The incidences of respiratory,circulatory,and renal failures were higher in the MOF group than those in the non-MOF group,showing significant differences in circulatory failure(69％vs.3.5％)and renal failure(65.5％vs.3.5％)(P＜0.05).In the first 5 days of hospitalization,the MOF group showed significantly elevated BUN and Cr levels,while Alb and TP levels dropped rapidly upon admission and then gradually recovered.The NAPP level of the MOF group continued to decrease after admission,and on the third day after admission,the NAPP level was lower than that of the Non-MOF group,showing statistically significant difference(P＜0.001).The Alb/NAPP ratio of the MOF group decreased significantly on day 1 and then rapidly increased,showing significant differences between the groups on days 3 and 4(P=0.001).Subgroup analysis of MOF patients with moderate-to-severe IAH revealed similar trends in the dynamic changes and the overall changes in the indicators,and the difference was even more pronounced.The mixed linear model showed that the average levels of HCT,BUN,Alb/NAPP,and Alb/TP were higher and increased over time in the MOF combined with IAP subgroup(P＜0.001).Conclusion The CLS model of SAP patients is validated,confirming that CLS is a key factor in the progression from SIRS to MOF.The loss of NAPP is an early and important indicator of CLS persistence and progression to MOF.Additionally,moderate-to-severe IAH accelerates the deterioration of MOF.These findings provide valuable insights into the potential mechanisms of MOF and warrant further validation through large-scale prospective studies.

Purpose To explore the feasibility and validity of radiomics combined with blind/referenceless image spatial quality evaluator(Brisque)for automated assessment of arterial-phase image quality in hepatic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)dynamic enhanced MRI examinations.Materials and Methods A total of 326 arterial phase images from January 2020 to March 2024 in the First Affiliated Hospital of Henan University of Chinese Medicine for liver Gd-EOB-DTPA dynamic enhancement MRI examination were retrospectively collected.A 4-level(1-4 points)Likert scale was used for subjective image quality scoring,and then binary classification was used to divide the images into clinically acceptable group(166 images with a score of 2-4)and clinically unacceptable group(160 images with a score of 1).All images were randomly divided into a training set(227 images)and a test set(99 images)in a 7∶3 ratio.Brisque images were created based on arterial-phase images,and subsequently Brisque image features,image histologic features of the original arterial-phase images and combined features of the two were extracted.The extracted data were reduced in dimension and the optimal features of radiomics were selected.Based on the Logistic regression algorithm,radiomics models,Brisque models and combined models of the two were constructed.The receiver operating characteristic curve was drawn for each subject,and the area under the curve(AUC),threshold,sensitivity,specificity,accuracy,negative predictive value and positive predictive value were calculated to analyze the diagnostic performance of each model,and the net benefit of the models was evaluated by decision curve analysis.Results The AUC values of the radiomics model,Brisque model and combined model in the training set were 0.942(95%CI 0.914-0.969),0.722(95%CI 0.655-0.788)and 0.967(95%CI 0.947-0.987),respectively.In the test set,the AUC values were 0.904(95%CI 0.848-0.960),0.684(95%CI 0.579-0.789)and 0.920(95%CI 0.866-0.972),respectively.There was statistically significant difference between two of the three models in the training set(Z=6.493,3.397,7.427;all P<0.05);in the test set,there was statistically significant difference between the combined model and the Brisque model,and between the radiomics model and the Brisque model(Z=4.137,3.740,both P<0.05),but no statistically significant difference between the combined model and the radiomics model(P>0.05).The diagnostic performance was higher in the combined model in both the training set and the test set.The decision curve analysis curve suggested that the net benefit of the combined model was greater than that of the other two models.Conclusion Radiomics combined with Brisque can be applied in the assessment of the quality of arterial-phase images in Gd-EOB-DTPA dynamic-enhanced MRI examinations of the liver to automatically detect clinically unacceptable arterial-phase images of the liver with high diagnostic efficacy,which contributes to the improvement of the quality of the images at the time of acquisition,leading to a reduction in the number of duplicate scans and an increase in the accuracy of the diagnosis.

Purpose To evaluate the diagnostic value of an abbreviated protocol MRI(AP-MRI)based on first post-contrast subtracted(FAST)images for breast cancer detection.Materials and Methods This study included imaging data from 160 female patients with solid breast lesions who underwent breast MRI in the First Affiliated Hospital of Henan University of Chinese Medicine from April 2021 to January 2024.Two AP-MRI protocols were extracted from the full diagnostic protocol(FDP),including:dynamic contrast-enhanced MRI(DCE-MRI)A protocol:FAST and maximum-intensity projection(MIP)images,and DCE-MRI B protocol:FAST+MIP+diffusion-weighted imaging(DWI).Lesions categorized as breast imaging reporting and data system(BI-RADS)1-3 were classified as negative,and those categorized as BI-RADS 4-5 were classified as positive.Pathological findings served as the diagnostic gold standard.Two radiologists independently evaluated the lesions as negative/positive and compared with the gold standard.The sensitivity,specificity and accuracy of the three protocols were compared.Receiver operating characteristic curves were generated for each protocol,and the area under the curve(AUC)was compared.Results The accuracy of the three protocols showed statistically significant differences(Cochran's Qreader1=6.000,P=0.050;Cochran's Qreader2=10.909,P=0.012).The accuracy of the DCE-MRI A protocol was significantly lower than that of the FDP protocol(Z=2.449,Preader1=0.043;Z=2.858,Preader2=0.013).There were no statistically significant differences in sensitivity(Cochran's Qreader1=3.000,P=0.223;Cochran's Qreader2=2.667,P=0.264)or specificity(Cochran's Qreader1=3.000,P=0.223;Cochran's Qreader2=2.800,P=0.247)between the two AP-MRI protocols and the FDP protocol.There were no statistically significant differences in AUC between the DCE-MRI B protocol and the FDP protocol(Z=1.390-1.719,all P>0.05),while the AUC of the DCE-MRI A protocol had lower AUCs than the FDP protocol(Z=1.980,2.441;both P<0.05).Conclusion The AP-MRI protocol combining FAST,MIP and DWI shows diagnostic accuracy comparable to that of the FDP and greatly saves time and cost,suggesting its potential as an alternative imaging strategy for women with dense breasts and as a new diagnostic approach for high-risk populations.

Under the background of the in-depth implementation of the Healthy China initiative,the high-quality devel-opment of public hospitals has become a key link in deepening the reform of the medical and health system.This research,focu-sing on public hospitals in Tianjin,systematically investigates innovative approaches to operational management through literature review and field research methods.Typical case analysis illustrates the status of construction of operational management depart-ments of Tianjin's public hospitals.Meanwhile the study explores the issues such as underdeveloped management infrastructure,inadequate intelligentization,and challenges in inter-departmental coordination.Consequently,it proposes countermeasures and suggestions such as establishing a data-driven real-time monitoring systems and improving cross-departmental governance frame-works.This research offers theoretical insights for optimizing the operational and management system of public hospitals,provides replicable practical experience for healthcare reforms in similar cities,and contributes to achieving the synergistic alignment of so-cial benefits and operational quality of public hospitals.

Objective:To investigate the changes of the epidemiology and clinical characteristics of human metapneumovirus (hMPV) among children with acute lower respiratory tract infection (ALRTI) before and after the discontinuation of non-pharmaceutical interventions (NPI) during coronavirus disease 2019 epidemic.Methods:This was a retrospective cohort study. Children hospitalized at The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University between January 2021 and December 2023, who were diagnosed with ALRTI by nasopharyngeal secretion testing for respiratory pathogens nucleic acid were enrolled. Clinical and laboratory data were collected. Children admitted between January 1, 2021 and January 7, 2023 were classified as the pre-NPI withdrawal group (abbreviated as pre-withdrawal group), while those admitted from January 8, 2023 afterward were classified as the post-NPI withdrawal group (abbreviated as post-withdrawal group). Nasopharyngeal secretions from the enrolled children were tested for 13 respiratory pathogens using polymerase chain reaction-capillary electrophoresis fragment analysis, and bacterial cultures were also performed. Statistical analyses were performed using the Mann-Whitney U test or chi-square test. Results:A total of 30 855 ALRTI cases were enrolled, with 1 679 of hMPV-positive. In the pre-withdrawal group, there were 861 cases with an age of onset of 2.0(1.0, 3.0) years, and the highest proportion was in the 1 to <3 years age group, accounting for 35.3%(304/861). In the post-withdrawal group, there were 818 cases with an age of onset of 3.0(2.0, 4.0) years, and the highest proportion was in the 3 to <5 years age group, accounting for 39.2%(321/818).The age of onset in the post-withdrawal group was significantly older than that in the pre-withdrawal group ( Z=7.69, P<0.001) .The hMPV detection rate was higher in the pre-withdrawal group than that in post-withdrawal group (5.75%(861/14 984) vs 5.15%(818/15 871); χ2=5.25, P=0.022). In the pre-withdrawal group, the epidemic peaks occurred in winter and spring, with the highest rates in January 2022(25.2%(224/890)) and March 2022 (21.6%(186/860)). In the post-withdrawal group, the epidemic peak shifted to spring and summer, and the detection rate became increased since April 2023(10.8%(136/1 258)). The post-withdrawal group showed lower rates of wheezing, shortness of breath, cyanosis, respiratory support, severe pneumonia, intensive care unit admission, and shorter hospital stays compared to the pre-withdrawal group ( χ2=69.09, 31.63, 12.97, 57.96, 55.73, 5.48 and Z=7.11, respectively, all P< 0.05).In the pre-withdrawal group, 412 cases (47.9%(412/861)) had other pathogens detected, compared to 445 cases (54.4%(445/181)) in the post-withdrawal group, indicating a significantly higher rate of co-infections in the post-withdrawal group ( χ2=7.20, P<0.05). The most commonly detected pathogens in both groups were Mycoplasma pneumoniae (MP), rhinovirus, and Streptococcus pneumoniae. However, the post-withdrawal group showed significantly higher detection rates of MP and influenza virus, but lower bacterial detection rates compared to the pre-withdrawal group ( χ2=39.41, 9.70, 5.63, respectively, all P<0.05). The detection rate of Haemophilus influenzae was 2.1%(17/818) in the post-withdrawal group which lower than that (6.7%(58/861)) in the pre-withdrawal group, and the difference was statistically significant ( χ2=21.32, P<0.001). Conclusions:In 2023, following the withdrawal of NPI, the epidemic peak of hMPV in Wenzhou area is delayed to spring and summer. The age of children with hMPV-associated ALRTI increases, with the majority being 3 to <5 years old. The overall severity of the disease decreases. However, the detection of mixed pathogens increases, with MP being the most common, while bacterial detection decreases.

Purpose To investigate the independent risk factors for early recurrence of solitary hepatocellular carcinoma after radiofrequency ablation based on gadoxetic acid disodium(Gd-EOB-DTPA)-enhanced MRI combined with clinical features.Materials and Methods Clinical and imaging data of hepatocellular carcinoma patients who underwent radiofrequency ablation at the First Affiliated Hospital of Henan University of Chinese Medicine from January 2019 to June 2022 were retrospectively collected.All patients underwent preoperative Gd-EOB-DTPA-enhanced MRI and were followed up for up to two years post-surgery.Univariate and multivariate Cox proportional hazards regression were performed to identify independent risk factors for recurrence after radiofrequency ablation.Results A total of 58 patients were finally included,including early recurrence group(n=22)and non-early recurrence group(n=36).Multivariate Cox regression analysis revealed that preoperative alpha-fetoprotein(AFP)levels(HR=1.103,95%CI 1.008-1.206,P=0.033),arterial-phase irregular margin enhancement(HR=4.647,95%CI 1.527-14.110,P=0.007),peritumoral arterial-phase enhancement(HR=11.575,95%CI 3.575-37.478,P=0.001)and peritumoral hepatobiliary phase hypointensity(HR=5.058,95%CI 1.129-22.668,P=0.034)were independent risk factors for early recurrence.The area under the curve for AFP combined with arterial-phase irregular margin enhancement,peritumoral arterial-phase enhancement and peritumoral hepatobiliary phase hypointensity were 0.896,0.842 and 0.860,with accuracy rates of 81.0%,84.5%and 82.8%,respectively.Conclusion Preoperative serum AFP levels,arterial-phase irregular margin enhancement,peritumoral arterial-phase enhancement and peritumoral hepatobiliary phase hypointensity are independent risk factors for early recurrence after radiofrequency ablation in hepatocellular carcinoma patients.The combination of AFP and any of these MRI features significantly improves predictive efficacy.

Purpose To achieve intelligent detection of acute pulmonary embolism(APE)in CT pulmonary angiography based on the Res2Net attention mechanism network.Materials and Methods Retrospectively included patients with suspected of APE who underwent CT pulmonary angiography examination and were diagnosed as APE at the First Affiliated Hospital of Henan University of Chinese Medicine from February 2015 to May 2023.The dataset was randomly divided into training,validation and test set in a ratio of 7∶2∶1.The model was trained based on the Res2Net network,combined with atrous spatial pyramid pooling and attention mechanism modules,and was performed five-fold cross internal validation.Using the area under the receiver operator characteristic curve,sensitivity and specificity to assess the diagnostic performance of the model.Dice similarity coefficient,precision and intersection over union(IOU)were used to assess the segmentation performance of thrombus on the test set and plot the corresponding curves.The performance of the Res2Net attention mechanism network was compared with the classic U-Net and CE-Net model.Results A total of 303 patients with APE were included in this study.There were 212,61 and 30 cases in the training set,validation set and test set,respectively.The model's area under the curve was 0.95,sensitivity was 0.90,specificity was 1.00,Dice similarity coefficient was 0.86,precision was 0.90,Pos-IOU was 0.78 and Neg-IOU was 1.00,respectively.The parameter curves and radar chart showed that the Res2Net attention mechanism network performed better than the U-Net and CE-Net models.The visualization results of the segmentation comparison showed that the Res2Net attention mechanism network achieved higher precision in segmenting pulmonary artery thrombus.Conclusion The Res2Net attention mechanism network has good performance for detection of APE.

Under the background of the in-depth implementation of the Healthy China initiative,the high-quality devel-opment of public hospitals has become a key link in deepening the reform of the medical and health system.This research,focu-sing on public hospitals in Tianjin,systematically investigates innovative approaches to operational management through literature review and field research methods.Typical case analysis illustrates the status of construction of operational management depart-ments of Tianjin's public hospitals.Meanwhile the study explores the issues such as underdeveloped management infrastructure,inadequate intelligentization,and challenges in inter-departmental coordination.Consequently,it proposes countermeasures and suggestions such as establishing a data-driven real-time monitoring systems and improving cross-departmental governance frame-works.This research offers theoretical insights for optimizing the operational and management system of public hospitals,provides replicable practical experience for healthcare reforms in similar cities,and contributes to achieving the synergistic alignment of so-cial benefits and operational quality of public hospitals.

Purpose To investigate the independent risk factors for early recurrence of solitary hepatocellular carcinoma after radiofrequency ablation based on gadoxetic acid disodium(Gd-EOB-DTPA)-enhanced MRI combined with clinical features.Materials and Methods Clinical and imaging data of hepatocellular carcinoma patients who underwent radiofrequency ablation at the First Affiliated Hospital of Henan University of Chinese Medicine from January 2019 to June 2022 were retrospectively collected.All patients underwent preoperative Gd-EOB-DTPA-enhanced MRI and were followed up for up to two years post-surgery.Univariate and multivariate Cox proportional hazards regression were performed to identify independent risk factors for recurrence after radiofrequency ablation.Results A total of 58 patients were finally included,including early recurrence group(n=22)and non-early recurrence group(n=36).Multivariate Cox regression analysis revealed that preoperative alpha-fetoprotein(AFP)levels(HR=1.103,95%CI 1.008-1.206,P=0.033),arterial-phase irregular margin enhancement(HR=4.647,95%CI 1.527-14.110,P=0.007),peritumoral arterial-phase enhancement(HR=11.575,95%CI 3.575-37.478,P=0.001)and peritumoral hepatobiliary phase hypointensity(HR=5.058,95%CI 1.129-22.668,P=0.034)were independent risk factors for early recurrence.The area under the curve for AFP combined with arterial-phase irregular margin enhancement,peritumoral arterial-phase enhancement and peritumoral hepatobiliary phase hypointensity were 0.896,0.842 and 0.860,with accuracy rates of 81.0%,84.5%and 82.8%,respectively.Conclusion Preoperative serum AFP levels,arterial-phase irregular margin enhancement,peritumoral arterial-phase enhancement and peritumoral hepatobiliary phase hypointensity are independent risk factors for early recurrence after radiofrequency ablation in hepatocellular carcinoma patients.The combination of AFP and any of these MRI features significantly improves predictive efficacy.

Purpose To explore the feasibility and validity of radiomics combined with blind/referenceless image spatial quality evaluator(Brisque)for automated assessment of arterial-phase image quality in hepatic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)dynamic enhanced MRI examinations.Materials and Methods A total of 326 arterial phase images from January 2020 to March 2024 in the First Affiliated Hospital of Henan University of Chinese Medicine for liver Gd-EOB-DTPA dynamic enhancement MRI examination were retrospectively collected.A 4-level(1-4 points)Likert scale was used for subjective image quality scoring,and then binary classification was used to divide the images into clinically acceptable group(166 images with a score of 2-4)and clinically unacceptable group(160 images with a score of 1).All images were randomly divided into a training set(227 images)and a test set(99 images)in a 7∶3 ratio.Brisque images were created based on arterial-phase images,and subsequently Brisque image features,image histologic features of the original arterial-phase images and combined features of the two were extracted.The extracted data were reduced in dimension and the optimal features of radiomics were selected.Based on the Logistic regression algorithm,radiomics models,Brisque models and combined models of the two were constructed.The receiver operating characteristic curve was drawn for each subject,and the area under the curve(AUC),threshold,sensitivity,specificity,accuracy,negative predictive value and positive predictive value were calculated to analyze the diagnostic performance of each model,and the net benefit of the models was evaluated by decision curve analysis.Results The AUC values of the radiomics model,Brisque model and combined model in the training set were 0.942(95%CI 0.914-0.969),0.722(95%CI 0.655-0.788)and 0.967(95%CI 0.947-0.987),respectively.In the test set,the AUC values were 0.904(95%CI 0.848-0.960),0.684(95%CI 0.579-0.789)and 0.920(95%CI 0.866-0.972),respectively.There was statistically significant difference between two of the three models in the training set(Z=6.493,3.397,7.427;all P<0.05);in the test set,there was statistically significant difference between the combined model and the Brisque model,and between the radiomics model and the Brisque model(Z=4.137,3.740,both P<0.05),but no statistically significant difference between the combined model and the radiomics model(P>0.05).The diagnostic performance was higher in the combined model in both the training set and the test set.The decision curve analysis curve suggested that the net benefit of the combined model was greater than that of the other two models.Conclusion Radiomics combined with Brisque can be applied in the assessment of the quality of arterial-phase images in Gd-EOB-DTPA dynamic-enhanced MRI examinations of the liver to automatically detect clinically unacceptable arterial-phase images of the liver with high diagnostic efficacy,which contributes to the improvement of the quality of the images at the time of acquisition,leading to a reduction in the number of duplicate scans and an increase in the accuracy of the diagnosis.