Purpose/Significance To explore the application and predictive accuracy of various models in predicting the risk of ather-osclerosis in diabetic patients.Method/Process Based on the biochemical data table from the"Diabetes Complications Warning Dataset"provided by the National Population Health Science Data Center,MATLAB software is used to construct risk prediction models for diabe-tes-induced atherosclerosis.The models are built by using k-nearest neighbors(KNN),decision trees,backpropagation(BP)neural networks,and Naive Bayes algorithms,and which are subjected to comparative analysis.Result/Conclusion In terms of effectiveness,the predictive accuracy of Naive Bayes algorithm is the highest(61.6％),followed by the decision tree model(58.2％),the KNN mod-el(57.7％),and the BP neural network model(55.9％).The results of the confusion matrix and the receiver operating characteristic(ROC)curve indicate that the Naive Bayes model performs best.When comparing the models in terms of effectiveness,performance and stability,the Naive Bayes model is superior.

BACKGROUND: Congenital heart disease (CHD) is one of the most common congenital malformations in humans. Inconsistent results emerged in the existed studies on associations between air pollution and congenital heart disease. The purpose of this study was to evaluate the association of gestational exposure to air pollutants with congenital heart disease, and to explore the critical exposure windows for congenital heart disease. METHODS: The nested case-control study collected birth records and the following health data in Tianjin Women and Children's Health Center, China. All of the cases of congenital heart disease from 2013 to 2015 were selected matching five healthy controls for each case. Inverse distance weighting was used to estimate individual exposure based on daily air pollution data. Furthermore, the conditional logistic regression with distributed lag non-linear model was performed to identify the association between gestational exposure to air pollution and congenital heart disease. RESULTS: A total of 8,748 mother-infant pairs were entered into the analysis, of which 1,458 infants suffered from congenital heart disease. For each 10 µg/m³ increase of gestational exposure to PM_2.5, the ORs (95% confidence interval, 95%CI) ranged from 1.008 (1.001-1.016) to 1.013 (1.001-1.024) during the 1^st-2^nd gestation weeks. Similar weak but increased risks of congenital heart disease were associated with O₃ exposure during the 1^st week and SO₂ exposure during 6^th-7^th weeks in the first trimester, while no significant findings for other air pollutants. CONCLUSIONS This study highlighted that gestational exposure to PM_2.5, O₃, and SO₂ had lag effects on congenital heart disease. Our results support potential benefits for pregnancy women to the mitigation of air pollution exposure in the early stage, especially when a critical exposure time window of air pollutants may precede heart development.
Infant ; Pregnancy ; Child ; Humans ; Female ; Air Pollutants/analysis* ; Case-Control Studies ; Prenatal Exposure Delayed Effects/epidemiology* ; Heart Defects, Congenital/etiology* ; China/epidemiology* ; Particulate Matter/adverse effects* ; Maternal Exposure/adverse effects*

Objective:To investigate the survival and prognosis of B-lineage acute lymphoblastic leukemia (B-ALL) patients with TP53 mutation.Methods:The clinical data of 479 newly diagnosed B-ALL patients treated in the First Affiliated Hospital of Soochow University from January 2016 to December 2019 were retrospectively analyzed.Results:Among 479 B-ALL patients, 34 cases (7.1%) were positive for TP53 gene mutation, and a total of 36 TP53 mutations were detected, including 10 frameshift gene mutations (27.8%) , 23 missense mutations (63.9%) and 3 nonsense mutations (8.3%) . A total of 34 (94.4%) mutations were located in the DNA binding domain (exons 5-8) .The average number of mutated genes in patients with TP53 gene mutation (2.3) and the group without TP53 gene mutation (1.1) were statistically different ( P<0.001) . The proportion of Ph positive and Ph-like positive patients in the TP53 gene mutation negative group was significantly higher than that of the TP53 mutation positive group, and the difference was statistically significant ( P<0.001) . The 3-year OS and EFS rates of the TP53 gene mutation negative group were significantly higher than those of the TP53 gene mutation positive group. The differences in OS and EFS rates between the two groups were statistically significant ( χ2= 4.694, P = 0.030; χ2= 5.080, P= 0.024) . In the multivariate analysis, failure to achieve remission (CR) after one course of induction chemotherapy was an independent adverse prognostic factor affecting OS.Of the 34 patients with TP53 mutation, 16 underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the CR 1 state, and 2 patients with recurrence after transplantation obtained CR 2 after infusion of donor-derived anti-CD19 chimeric antigen receptor T (CAR-T) cells. Among the 11 patients with TP53 gene mutation who relapsed during consolidation chemotherapy, 6 received anti-CD19 CAR T cell therapy, 4 patients achieved remission and minimal residual disease (MRD) turned negative, followed by bridging allo-HSCT, and 2 of them sustained CR. Conclusion:Missense mutations are the most common in B-ALL patients with TP53 gene mutation, and the majority of mutations were located in the DNA binding domain. B-ALL patients with TP53 gene mutation should undergo allo-HSCT as soon as possible after CAR-T cell therapy has cleared the MRD after recurrence. B-ALL patients with TP53 gene mutation still have a higher recurrence rate after allo-HSCT, and the infusion of donor-derived CAR-T cells can achieve better sustained remission.

Objective To observe the effect of Naoxintong capsule on blood lipid and hemorheology in the treatment of type 2 diabetes mellitus patients complicated with cerebral infarction with Qi deficiency and blood stasis type.Methods From February 2015 to February 2017,96 type 2 diabetes mellitus patients complicated with cerebral infarction with Qi deficiency and blood stasis type who treated in the Traditional Chinese Medicine Hospital of Tongxiang were selected in the research.The patients were randomly divided into two groups according to the digital table,with 48 cases in each group.The control group was treated with routine treatment scheme,while the observation group was added Naoxintong capsule.The blood lipids and hemorheology data before and after treatment were compared between the two groups.Results After treatment,the levels of LDL-C,TG,TC and HDL-C in the observation group were (1.8 ± 0.3) mmol/L,(0.9 ± 0.4) mmol/L,(2.1 ± 0.4) mmol/L,(1.6 ± 0.7) mmol/L,respectively,which were lower than those in the control group [(2.2 ± 0.4) mmol/L,(1.2 ± 0.6) mmol/L,(2.3 ± 0.3)mmol/L,(1.3 ±0.4) mmol/L] (t =5.54,2.88,3.18,2.58,all P ＜0.05).The HCT,ESR,EEP,Fig in the observation group were (41.5 ± 1.3) ％,(16.5 ± 2.1) mm/h,(292.1 ± 18.3) s,(7.6 ± 0.4) g/L,respectively,which were lower than those in the control group[(45.6 ± 1.4)％,(21.1 ± 3.2)mm/h,(332.3 ± 19.2)s,(8.2 ± 0.3) g/L] (t =14.87,8.33,10.50,8.31,all P ＜ 0.05).Conclusion Naoxintong capsule is effective in the treatment of type 2 diabetes mellitus patients complicated with cerebral infarction with Qi deficiency and blood stasis type,and can effectively improve the related indicators of blood lipids and hemorhelogy and stabilize the carotid artery plaque,it is worthy of clinical application.

Objective To explore the clinical value of combined detection of serum beta human chorionic gonadotropin (β-hCG),estradiol (E2),progesterone (P) and antiphospholipid antibodies (ACA) in predicting the outcomes of early threatened abortion.Methods 80 pregnant women were chosen from six to eight weeks singleton pregnancies,50 cases of threatened abortion and 30 cases of normal pregnancy.The serum levels of β-HCG,estradiol,progesterone and ACA-IgG,ACA-IgM and ACA-IgA were detected.The threatened abortion patients were given intramuscular progesterone 20 mg/day/time for 1 week,then,the pregnancy outcomes were analyzed and the serum levels of β-HCG,estradiol and progesterone were explored.Results The serum β-HCG,estradiol and progesterone of the threatened abortion group [(5 140.77 ± 2 365.47) IU/L,(680.28 ± 306.06) pg/mL,(15.59 ± 3.65) pg/L]were lower than those of the normal pregnant women [(14 520.4 ± 11 016.24) IU/L,(1 142.81 ± 670.57) pg/mL,(27.6 ± 4.78) pg/L] (t =3.224,P =0.003 ; t =2.43,P =0.022 ; t =7.72,P =0.001).According to pregnancy outcome,patients with threatened miscarriages were divided into the two groups,including 45 patients with continuing pregnancies and 5 patients with inevitable miscarriages.The serum levels of β-HCG,estradiol and progesterone in ongoing pregnancies group [(10 829.42 ± 6 926.28) IU/L,(832.9 ± 397.91) pg/mL,(25.62 ± 4.51) pg/L] were higher than those in inevitable miscarriages [(6 310.14 ± 2 593.19) IU/L,(487.14 ± 275.47) pg/mL,(13.6 ±4.84) pg/L] (P ＜ 0.05) ;The serum levels of ACA-IgG,ACA-IgM and ACA-IgA in 80 cases tested,only 2 cases who appeared in the threatened abortion group were detected with the positive of serum ACA-IgG,accounted for 4％ (2/50) (x2 =68.05,P =0.000),occurred spontaneous abortion in the end.Conclusion Combined detection of serum ACA,β-HCG,estradiol and progesterone may be helpful for prognosis of threatened abortion.However,the clinical predictive value of ACA needs further study in the early threatened abortion.

Objective To evaluate effectiveness of guideline-oriented training for community healthcare workers (HCWs) with The Applied Standards for Hypertension Prevention and Control at the Grassroots to provide guidance to hypertension management in communities. Methods In 2003, four community health-care service centers in Beijing were selected and assigned as intervention (one at urban and one at rural) and control (one at urban and one at rural ) groups, respectively. HCWs in the intervention group received guideline-oriented training based on The Applied Standards for Hypertension Prevention and Control at the Grassroots, while HCW in the control group did not. All HCWs participated in tests of the knowledge of hypertension management using the same questionnaire before and after the training to analyze their changes in awareness scores with a full of 32. Results There were 39 and 33 HCWs in the intervention group and 15 and 16 HCWs in the control group, respectively at urban, and 30 and 33 HCWs in the intervention group and 21 and 22 HCWs in the control group, respectively at rural before and after the training were involved in the tests, respectively. After training, overall knowledge scores of hypertension prevention and control in HCWs in the intervention group at urban increased obviously, with an average score of 26 of 32 ( 81.0% ) after training from 15 of 32 (45. 6% ) before it ( P ＜ 0. 01 ) , with a net increase of 28.5% (9/32), as compared to HCWs in the control group. Those at rural increased to 6. 6% (20/32) after training from 40. 7% (13/32) before it ( P ＜ 0.01 ), with a net increase of 22. 2 percent (7/32), as compared to HCWs in the control group. Their awareness of knowledge of hypertension prevention and control significantly improved, with the most obviously in the target of blood pressure control (51.7% vs. 31.5% ) and principles of pharmaceutical therapy (42. 2% vs. 27. 6% ). Conclusions Guideline-oriented training based on The Applied Standards for Hypertension Prevention and Control at the Grassroots can effectively improve community HCWs' awareness of knowledge of hypertension management and should be widely promoted in communities.

Quantification of right ventricular (RV) volume and function remains a challenge because of RV complex geometry by conventional echocardiography. The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot (TOF) by 2-dimensional ultrasound speckle tracking imaging (STI). Thirty-eight patients with TOF were enrolled in this study and divided into child group (n=25) and adult group (n=13) according to age. Thirty-eight age- and sex-matched normal subjects were selected as control groups including child control group (n=25) and adult control group (n=13). RV global longitudinal peak systolic strain (GLS), strain rate (GLSR(s)), early diastolic strain rate (GLSR(e)) and late diastolic strain rate (GLSR(a)) were measured in all subjects by STI from the apical 4-chamber view and compared between groups. Furthermore, the main factors affecting the RV global longitudinal functional parameters were assessed. Compared with those in controls, RV GLS, GLSR(s) and GLSR(e) were significantly reduced in patients with TOF (P<0.05 for all). RV GLSR(s) was significantly decreased in adult patients with TOF as compared with that in child patients (P<0.05). There was no significant difference in RV GLS, GLSR(e) and GLSR(a) between child and adult TOF groups (P>0.05). The diameter of right ventricle, main pulmonary artery and ventricular septum defect had correlations with RV GLSR(s) (r ( 1 )=-0.490, r ( 2 )=0.580, r ( 3 )=-0.528, respectively, P<0.05 for all). Tricuspid annular plane peak systolic velocity (Sm) was the independent predictor of RV global strain and strain rate (beta(1)=0.355, P (1)=0.031, beta(2)=0.307, P (2)=0.021). RV global longitudinal function is decreased in patients with TOF, especially in adult patients. STI is a sensitive and accurate technique in RV global functional assessment.

Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot(TOF)by 2-dimensional ultrasound speckle tracking imaging(STI).Thirty-eight patients with TOF were enrolled in this study and divided into child group(n=25)and adult group(n=13)according to age.Thirty-eight age-and sex-matched normal subjects were selected as control groups including child control group(n=25)and adult control group(n=13).RV global longitudinal peak systolic strain(GLS),strain rate(GLSPs),early diastolic strain rate(GLSRe)and late diastolic strain rate(GLSRa)were measured in all subjects by STI from the apical 4-chamber view and compared between groups.Furthermore,the main factors affecting the RV global longitudinal functional parameters were assessed.Compared with those in controls,RV GLS,GLSRs and GLSPe were significantly reduced in patients with TOF(P<0.05 for all).RV GLSRs was significantly decreased in adult patients with TOF as compared with that in child patients(P<0.05).There was no significant difference in RV GLS,GLSRe and GLSRa between child and adult TOF groups(P>0.05).The diameter of right ventricle,main pulmonary artery and ventricular septum defect had correlations with RV GLSRs(r1=-0.490,r2=0.580,r3=-0.528,respectively,P<0.05 for all).Tricuspid annular plane peak systolic velocity(Sm)was the independent predictor of RV global strain and strain rate(β1=0.355,P1=0.031,β2=0.307,P2=0.021).RV global longitudinal function is decreased in patients with TOF,especially in adult patients.STI is a sensitive and accurate technique in RV global functional assessment.

Objective To assess right ventricular systolic function in normal subjects and patients with pulmonary arterial hypertension (PAH) by using 2-dimensional strain (2DS) and tissue Doppler imaging(TDI), and to investigate the feasibility of 2DS for quantitative assessment of myocardial longitudinal systolic function. Methods Longitudinal peak systolic velocity (V), peak systolic strain(ε), peak systolic strain rate(SRS) were measured in right ventricular free wall for basal,mid and apical segment in 42 patients with PAH and 31 healthy controls by 2DS and TDI from the apical 4-chamber view and compared between 2DS and TDI. Results ①Compared with controls,ε and SRS of the mid segment of the right ventricular free wall by TDI were significantly reduced in patients with PAH (P<0.05),but these of the basal and apical segment were normal (P>0.05). ε and SRS of all segments by 2DS were markedly reduced in patients with PAH (all P<0.05), V of all segments by TDI and 2DS were not decreased (P>0.05). ②In normal subjects,values(V,ε,SRS) of basal and apical segment of right ventricular free wall measured by 2DS were significantly different from those by TDI (P<0.05), Values of mid segment by 2DS and TDI were not significantly different (P>0.05); In patients with PAH, values (V, ε, SRS) of apical segment of right ventricular free wall by 2DS were significantly different from those by TDI,values of basal and mid segment by 2DS and TDI were not significantly different. ③ There were good correlations between 2DS and TDI in patients with PAH (r = 0.406～0.760, P<0.05 for all). Conclusions Right ventricular longitudinal systolic function in patients with PAH was decreased, 2DS is more accurate and objective than TDI in assessment of right ventricular longitudinal systolic function.

Objective To analyze the left ventricular(LV) rotation and twist by two-dimensional ultrasound speckle-tracking imaging(STI),and evaluate the correlation between twist and other components of LV contraction in uremia patients. Methods Twenty-nine uremia patients and twenty-nine healthy volunteers were included. High frame rate two-dimensional images were recorded from the left ventricular short-axis views both of the basal and apical planes. Segmental and global LV rotation were recorded at both The peak systolic LV twist was significantly decreased in uremia patients(P <0. 001). The loss of LV twist occurred mainly by the impairment of maximal global counterclockwise apical rotation(P <0. 001),and was augmented by somewhat less reduction in global clockwise basal rotation although the differences was not significantly reduced(P<0.01), while only the posterior and inferior of the basal plane was significantly fraction(r=0.645,P=0.000), LV end-diastolic volume (r=-0.549,P=0.002), LV end-systolic volume(r=-0.673, P = 0.000) in uremia patients. Conclusions STI enables quantification of segmental and global LV rotation in an objective manner in uremia patients,and provides a new method for evaluation of segmental and global LV systolic function.