Objective:To develop CNN-Dinov2, a deep learning-based automatic classification model for Gram-stained images, enabling rapid diagnosis of three prevalent Gram-negative bacilli in bloodstream infections: Escherichia coli ( E.coli), Klebsiella pneumoniae ( K.pneumoniae), and Pseudomonas aeruginosa ( P.aeruginosa). Methods:This evaluation study analyzed 1 425 Gram-stained microscopic images from patients with bloodstream infections at Houjie Hospital, in Dongguan City, collected between January 2023 and January 2024. The images, all positive for blood culture and identified as target strains, were categorized into Escherichia coli (419 images), Klebsiella pneumoniae (411 images), Pseudomonas aeruginosa (413 images), and other Gram-negative bacilli (182 images). They were randomly split into a training set (1 141 images), a validation set (141 images), and a test set (143 images) in an 8∶1∶1 ratio. A hybrid CNN-Dinov2 model was developed by integrating ResNet′s local feature extraction with Dinov2′s global pre-trained features, followed by a fully connected layer. The model was optimized by inputting the preprocessed images and adjusting parameters through loss calculation and backpropagation. AlexNet, Dinov2, and ResNet18 served as control models. The models′ classification performance was assessed using accuracy, precision, weighted F1 score, and recall rate, derived from the confusion matrix. The PR curve and AP value further evaluated each model′s classification capability across the four image categories. Results:The CNN-Dinov2 model achieved a training accuracy of 99.74%, a validation accuracy of 98.12%, and a validation loss of 0.070 6, demonstrating robust generalization without overfitting. Validation metrics revealed superior performance with an accuracy of 98.60%, precision of 98.65%, a weighted F1 score of 98.60%, and a recall rate of 98.60%, outperforming other models. The confusion matrix confirmed its strong classification capability, with the highest sum of diagonal values for identifying four types of bacteria. The macro average precision (AP) values under the precision-recall (PR) curves were all 1, indicating excellent discrimination across all categories. Overall, the CNN-Dinov2 model exhibited the best performance among the four models evaluated.Conclusion:This study successfully developed CNN-Dinov2, an automated classification model for Gram staining images. It offers valuable support for the rapid diagnosis of bloodstream infections caused by Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, demonstrating practical utility.

Objective:To develop CNN-Dinov2, a deep learning-based automatic classification model for Gram-stained images, enabling rapid diagnosis of three prevalent Gram-negative bacilli in bloodstream infections: Escherichia coli ( E.coli), Klebsiella pneumoniae ( K.pneumoniae), and Pseudomonas aeruginosa ( P.aeruginosa). Methods:This evaluation study analyzed 1 425 Gram-stained microscopic images from patients with bloodstream infections at Houjie Hospital, in Dongguan City, collected between January 2023 and January 2024. The images, all positive for blood culture and identified as target strains, were categorized into Escherichia coli (419 images), Klebsiella pneumoniae (411 images), Pseudomonas aeruginosa (413 images), and other Gram-negative bacilli (182 images). They were randomly split into a training set (1 141 images), a validation set (141 images), and a test set (143 images) in an 8∶1∶1 ratio. A hybrid CNN-Dinov2 model was developed by integrating ResNet′s local feature extraction with Dinov2′s global pre-trained features, followed by a fully connected layer. The model was optimized by inputting the preprocessed images and adjusting parameters through loss calculation and backpropagation. AlexNet, Dinov2, and ResNet18 served as control models. The models′ classification performance was assessed using accuracy, precision, weighted F1 score, and recall rate, derived from the confusion matrix. The PR curve and AP value further evaluated each model′s classification capability across the four image categories. Results:The CNN-Dinov2 model achieved a training accuracy of 99.74%, a validation accuracy of 98.12%, and a validation loss of 0.070 6, demonstrating robust generalization without overfitting. Validation metrics revealed superior performance with an accuracy of 98.60%, precision of 98.65%, a weighted F1 score of 98.60%, and a recall rate of 98.60%, outperforming other models. The confusion matrix confirmed its strong classification capability, with the highest sum of diagonal values for identifying four types of bacteria. The macro average precision (AP) values under the precision-recall (PR) curves were all 1, indicating excellent discrimination across all categories. Overall, the CNN-Dinov2 model exhibited the best performance among the four models evaluated.Conclusion:This study successfully developed CNN-Dinov2, an automated classification model for Gram staining images. It offers valuable support for the rapid diagnosis of bloodstream infections caused by Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, demonstrating practical utility.

OBJECTIVES: Programmed death 1 (PD-1) associated fulminant type 1 diabetes (PFD) is a rare acute and critical in internal medicine, and its clinical characteristics are still unclear. This study aims to analyze the clinical characteristics of PFD patients to improve clinical diagnosis and treatment. METHODS: We retrospectively analyzed the clinical data of 10 patients with PFD admitted to the Second Xiangya Hospital of Central South University, combined with the data of 66 patients reported in the relevant literature, analyzed and summarized their clinical and immunological characteristics, and compared the patients with PFD with different islet autoantibody status. RESULTS: Combined with our hospital and literature data, a total of 76 patients with PFD were reported, with the age of (60.9±12.1) years old, 60.0% male and body mass index of (22.1±5.2) kg/m2. In 76 patients, the most common tumors were lung cancer (43.4%) and melanoma (22.4%). Among PD-1 inhibitors, the most common drugs are nivolumab (37.5%) and pembrolizumab (38.9%). 82.2% of PFD patients developed diabetes ketoacidosis. The median onset time from PD-1 related inhibitor treatment to hyperglycemia was 95 (36.0, 164.5) d, and the median treatment cycle before the onset of diabetes was 6 (2.3, 8.0) cycles. 26% (19/73) of PFD patients had positive islet autoantibodies, and the proportion of ketoacidosis in the positive group was significantly higher than that in the negative group (100.0% vs 75.0%, P<0.05). The onset time and infusion times of diabetes after PD-1 inhibitor treatment in the autoantibody positive group were significantly lower than those in the autoantibody negative group (28.5 d vs 120.0 d; 2 cycles vs 7 cycles, both P<0.001). CONCLUSIONS After initiation of tumor immunotherapy, it is necessary to be alert to the occurrence of adverse reactions of PFD, and the onset of PFD with islet autoantibody positive is faster and more serious than that of patients with autoantibodies negative. Detection of islet autoantibodies and blood glucose before and after treatment with PD-1 inhibitors is of great value for early warning and prediction of PFD.
Humans ; Male ; Middle Aged ; Aged ; Female ; Diabetes Mellitus, Type 1 ; Programmed Cell Death 1 Receptor ; Immune Checkpoint Inhibitors/therapeutic use* ; Retrospective Studies ; Ketosis ; Autoantibodies

ObjectiveTo observe the lower limb muscle activation strategy of healthy middle-aged and old women during stair ascent and descent with surface electromyography. MethodsFrom August, 2021 to February, 2022, 20 healthy middle-aged and old women were measured the surface electromyography root mean square (RMS) and integrated electromyography (iEMG) of bilateral vastus lateral, rectus femoris, vastus medialis, biceps femoris and semitendinosus during stair ascent and descent, and co-contraction ratio was calculated. ResultsDuring stair ascent, the RMS of bilateral vastus lateral, rectus femoris and vastus medialis was higher at starting stage than at following stage (|t| > 6.650, P < 0.001), while the RMS of biceps femoris and semitendinosus was lower (t > 3.559, P < 0.01); and the co-contraction ratio of hamstrings/quadriceps was lower at starting stage than at following stage (t > 8.185, P < 0.001). During stair descent, the RMS of bilateral vastus lateral, vastus medialis, biceps femoris and semitendinosus was higher at following stage than at starting stage (t > 2.345, P < 0.05), as well as the co-contraction ratio of hamstrings/quadriceps (t > 2.405, P < 0.05). ConclusionThe activities of the muscles around the knees are almost symmetrical during stair ascent and descent for healthy middle-aged and old women. The activation and co-contraction ratio of quadriceps and hamstring are various at starting/following stages.

Objective:To analyze and summarize the experience and shortcomings of this case in the process of abortion diagnosis and treatment of early pregnancy patients with hysteromyoma.Methods:A case of early pregnancy complicated with huge hysteromyoma was reported. The patient was planned to perform assisted uterine curettage after drug flow.Results:On the second day after taking mifepristone, the patient suddenly suffered from severe lower abdominal pain and less to moderate amount of ascites in the abdominal cavity. "Blood abdomen to be investigated: ectopic pregnancy? Spleen rupture? Hemorrhagic shock". The shock was corrected and exploratory laparotomy was performed at the same time. Repeated exploration of the pelvis and abdomen revealed no obvious bleeding point. During the operation, a small amount of blood was found in the vagina, and the villi were discharged automatically, so the uterus was cleared. The final consideration was that the bleeding was caused by the backflow of intrauterine bleeding to the abdominal cavity.Conclusion:Early pregnancy with hysteromyoma belongs to the category of high-risk abortion, especially hysteromyoma larger than 5 cm. Such patients need to strictly grasp the indications of drug abortion, and strengthen monitoring and management to avoid serious complications such as hemorrhagic shock.

Objective:To analyze and summarize the experience and shortcomings of this case in the process of abortion diagnosis and treatment of early pregnancy patients with hysteromyoma.Methods:A case of early pregnancy complicated with huge hysteromyoma was reported. The patient was planned to perform assisted uterine curettage after drug flow.Results:On the second day after taking mifepristone, the patient suddenly suffered from severe lower abdominal pain and less to moderate amount of ascites in the abdominal cavity. "Blood abdomen to be investigated: ectopic pregnancy? Spleen rupture? Hemorrhagic shock". The shock was corrected and exploratory laparotomy was performed at the same time. Repeated exploration of the pelvis and abdomen revealed no obvious bleeding point. During the operation, a small amount of blood was found in the vagina, and the villi were discharged automatically, so the uterus was cleared. The final consideration was that the bleeding was caused by the backflow of intrauterine bleeding to the abdominal cavity.Conclusion:Early pregnancy with hysteromyoma belongs to the category of high-risk abortion, especially hysteromyoma larger than 5 cm. Such patients need to strictly grasp the indications of drug abortion, and strengthen monitoring and management to avoid serious complications such as hemorrhagic shock.

Objective:To investigate the predictive value of serum soluble urokinase-type plasminogen activator receptor (suPAR) combined with alpha-fetoprotein (AFP) and model for end-stage liver disease (MELD) score in short-term prognosis assessment of patients with chronic hepatitis B (CHB) related acute-on-chronic liver failure (ACLF).Methods:From January 2018 to May 2020, 66 patients with CHB related ACLF from Fuzhou First People′s Hospital were enrolled. After 90 days of follow-up, the patients with CHB related ACLF were divided into death group and survival group according to the outcome. Meanwhile, 30 patients with CHB were enrolled by simple random sampling method. The differences of serum suPAR in patients with CHB related ACLF and patients with CHB were analyzed. The values of suPAR, AFP and MELD score were compared between death group and survival group in patients with CHB related ACLF. The predictive value of suPAR, AFP, MELD score, Child-Turcotte Pugh score (CTP score) and suPAR combined with AFP and MELD score in the short-term prognosis of patients with CHB related ACLF were analyzed by area under the receiver operator characteristic curve (AUROC). Data were analyzed by two independent sample t test or non-parametric test. Results:The serum suPAR level of patients with CHB related ACLF was (9.6±0.8) ln ng/L, which was higher than that of patients with CHB ((8.0±0.3) ln ng/L). The difference was statistically significant ( t=14.533, P<0.01). The suPAR and MELD score of patients with CHB related ACLF in the death group were (9.9±0.7) ln ng/L and 29.6 (7.1) points, respectively, which were higher than those in the survival group ((9.4±0.7) ln ng/L and 21.0 (5.0) points, respectively). The AFP level in the death group was 45.9 (108.1) μg/L, which was lower than that in the survival group (209.3 (187.1) μg/L). There were significant differences in suPAR ( t=2.895, P=0.005), MELD score ( Z=4.708, P<0.01) and AFP ( Z=3.051, P<0.01) between the death group and the survival group. AUROC of suPAR (0.741, P=0.001), AFP (0.724, P=0.002) and MELD score (0.885, P<0.01) had predictive value for death in patients with CHB related ACLF. The sensitivities of suPAR, AFP, MELD score, CTP score and suPAR combined with AFP and MELD score were 84.6%, 73.1%, 88.5%, 96.2% and 84.6%, respectively, and the specificities were 75.0%, 72.5%, 70.0%, 52.5% and 92.5%, respectively. The AUROC of suPAR combined with AFP and MELD score was 0.871 ( P<0.01), which was higher than that of CTP score (0.793, P<0.01). Conclusions:Serum suPAR is increased in patients with CHB related ACLF. SuPAR combined with AFP and MELD score could apply in the prognostic value for patients with CHB related ACLF.

Objective:To investigate the compliance of statins and influencing factors in population with cardiovascular risks in the community.Methods:One hundred and eighty-six residents with cardiovascular disease risks in a community of Tianjin were recruited from June 2017 to October 2017. The Chinese revised version of the compliance Morisky scale was used to assess the compliance, and the influencing factors were analyzed.Results:Among all subjects 119 were prescribed with statins (64.0%,119/186) , of whom 7.6% (9/119) did not take the drug. According to the risk assessment of arteriosclerotic cardiovascular disease (ASCVD) in the next 10 years, among the 110 subjects taking the medicine, there were 18 subjects with intermediate risk and 92 with high risk. The subjects with good compliance accounted for 30.0% (33/110), and those with poor compliance accounted for 70.0% (77/110). Univariate analysis showed that education level, occupation, and drug types were significantly associated with statin compliance ( P<0.05). Multivariate logistic regression analysis showed that higher education level and fewer total drug users were correlated with better compliance ( OR=3.530 and 0.388, P<0.05) . The reasons for subjects not taking medicine were fearing of adverse reactions ( n=6, 6/9) , and thinking no symptoms and no need to have medication ( n=3, 3/9).The reasons of poor medication adherence were thinking no symptoms and no need to have medication ( n=31, 40.2%), thinking ineffectiveness of medication ( n=28, 36.4%), fearing of adverse reactions ( n=16, 20.8%), and economic pressure ( n=2, 2.6%). Conclusions:The proportion of residents with poor compliance of statins is high in the community. It is suggested that targeted interventions and standardized management for subjects with cardiovascular risks should be conducted based on the related factors found in the study.

BACKGROUND: Benvitimod cream, a novel synthetic small molecule, was effective in treating mild-to-moderate plaque psoriasis. We conducted a phase III clinical trial to assess the efficacy and safety of benvitimod cream in patients with mild-to-moderate plaque psoriasis. METHODS: We randomly assigned 686 patients (2:1:1) to receive 1% benvitimod cream, 0.005% calcipotriol ointment or placebo twice a day for 12 weeks. The primary efficacy end points were the percentage of patients with a 75% or greater reduction from baseline in the psoriasis area and severity index (PASI 75) score and with a score of 0 or 1 in static physician's global assessment (sPGA) at week 12. RESULTS: The results showed that 50.4% of patients in the benvitimod group achieved PASI 75, which was significantly higher than that in the calcipotriol (38.5%, P < 0.05) and placebo (13.9%, P < 0.05) groups. The proportion of patients achieving an sPGA score 0 or 1 was 66.3% in the benvitimod group and 63.9% in the calcipotriol group, which were both significantly higher than that in the placebo group (34%, P < 0.05). In the long-term follow-up study, 50.8% of patients experienced recurrence. After retreatment with 1% benvitimod, 73.3% of patients achieved an sPGA score of 0 or 1 again at week 52. Adverse events included application site irritation, follicular papules, and contact dermatitis. No systemic adverse reactions were reported. CONCLUSION: During this 12-week study, benvitimod cream was demonstrated with high effectiveness and safety in patients with mild-to-moderate plaque psoriasis. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), ChiCTR-TRC-13003259; http://www.chictr.org.cn/showprojen.aspx?proj=6300.
Double-Blind Method ; Follow-Up Studies ; Humans ; Ointments ; Psoriasis/drug therapy* ; Resorcinols ; Severity of Illness Index ; Stilbenes ; Treatment Outcome

Objective To investigate the clinical value of serum lipoprotein associated phospholipase A 2 (Lp-PLA2)as a biomarker for benign prostatic hyperplasia(BPH).Methods A total of 65 serum samples of BPH patients were selected as BPH group,64 serum samples of healthy male as control group.The serum lev-el of Lp-PLA2,total prostate specific antigen(tPSA)and free prostate specific antigen(fPSA)in both groups were detected,and the specificity and sensitivity of Lp-PLA2,F/T ratio and combine both were analyzed by ROC curve.Results The serum level of Lp-PLA2,tPSA and fPSA in BPH group were significantly higher than those in control group,the different were significant(P<0.05).ROC curve analyze shown that the area under the curve(AUC)of Lp-PLA2 was 0.763,95% confidence interval(CI)was 0.680-0.833;AUC of F/T ratio was 0.715,95% CI 0.633 -0.795;AUC of Lp-PLA2 combined with F/T ratio was 0.832,95% CI 0.756-0.892.Conclusion The serum level of Lp-PLA2 could be used as a potential diagnostic marker for BPH,and the diagnostic value of Lp-PLA2 combined with F/T ratio was better than ther single indicator. Key words:benign prostatic hyperplasia; lipoprotein associated phospholipase A 2; total prostate spe-cific antigen; free prostate specific antigen; F/T ratio