Considering the complexity and diversity of breast ultrasound images,a deep learning model combining convolutional neural network and transfer learning is proposed to enhance the accuracy and efficiency of tumor discrimination.Specifically,a pre-trained convolutional neural network model is utilized to extract features from breast ultrasound images,and transfer learning is employed to adapt the pre-trained model to the breast ultrasound image dataset.The extracted features are then applied to multiple classification models to differentiate between benign and malignant tumors.Experimental results demonstrate that compared with traditional image processing and machine learning methods,the proposed deep learning model exhibits significant improvements in sensitivity,specificity,and precision.The deep learning-based feature extraction method for breast ultrasound images substantially enhances the accuracy and efficiency of discrimination between benign and malignant tumors,providing an effective technical tool for the early diagnosis and treatment of breast cancer and assisting clinicians in making more accurate clinical decisions.

Considering the complexity and diversity of breast ultrasound images,a deep learning model combining convolutional neural network and transfer learning is proposed to enhance the accuracy and efficiency of tumor discrimination.Specifically,a pre-trained convolutional neural network model is utilized to extract features from breast ultrasound images,and transfer learning is employed to adapt the pre-trained model to the breast ultrasound image dataset.The extracted features are then applied to multiple classification models to differentiate between benign and malignant tumors.Experimental results demonstrate that compared with traditional image processing and machine learning methods,the proposed deep learning model exhibits significant improvements in sensitivity,specificity,and precision.The deep learning-based feature extraction method for breast ultrasound images substantially enhances the accuracy and efficiency of discrimination between benign and malignant tumors,providing an effective technical tool for the early diagnosis and treatment of breast cancer and assisting clinicians in making more accurate clinical decisions.

Objective To revise the Inventory of Alienation Toward Parents(IAP)and test its reliability and validity in a military population in order to provide a scientific tool for assessing the level and grade of parent-child alienation among military personnel.Methods Whole-cluster stratified random sampling was used to subject 8 641 service members from 8 Army units.Then all participants were surveyed with 18-item adolescent IAP,Beck Depression Inventory-Ⅱ,and Generalized Anxiety Disorder-7.SPSS 27.0 and AMOS 26.0 were used to perform item analysis,exploratory factor analysis(EFA),and confirmatory factor analysis(CFA)to assess reliability and validity.Subsequently,our revised 16-item version of IAP was employed to develop means,percentiles,cut-off scores,and category norms.Results ①Items 3 and 12 were deleted in item analysis.②EFA extracted the original communication and emotional distance factors;CFA indicated that the two-factor model had good fitness,with the mother-child alienation scale:χ2/df=4.248,comparative fit index(CFI)=0.962,Tucker-Lewis index(TLI)=0.929,root mean square error of approximation(RMSEA)=0.028,standardized root mean squared residual(SRMR)=0.023;while the father-child alienation scale:χ2/df=5.41,CFI=0.939,TLI=0.901,RMSEA=0.032,SRMR=0.044.③The internal consistency reliability of the total IAP was good(0.744～0.888).④The total IAP score and scores of the mother-child and father-child subscales were positively correlated with depression and anxiety(r=0.395～0.493,P<0.01).⑤ The average total IAP score for military personnel was 17.27±4.21,and the scores of mother-child alienation and father-child alienation were 8.64±2.26 and 8.62±2.43,respectively.With percentiles of P75 and P90 as the cut-off points,the total IAP score can be stratified into 3 levels,that is,normal(≤16),moderate(17～19),and severe(≥20).Then,additional category norms were developed based on demographic characteristics.Conclusion Our revised 16-item military version of IAP shows good reliability and validity.A preliminary and representative norm is developed primarily,and can be used to assess the level and grade of military parental alienation.

Objective To investigate the effect of closed-chain exercise training on hemiplegic shoulder pain and shoulder joint sta-bility in stroke patients,and to explore the relationship between hemiplegic shoulder pain and shoulder joint sta-bility.Methods A total of 52 stroke patients with hemiplegic shoulder pain in Jiangsu Province Hospital from October,2020 to January,2023 were selected,and were randomly divided into control group(n=26)and experimental group(n=26).Both groups received conventional rehabilitation therapy,while the experimental group additionally under-went closed-chain exercise training for shoulder joint.Pain severity and motor function were assessed using Visu-al Analog Scale(VAS)and Fugl-Meyer Assessment-Upper Extremities(FMA-UE)before and after intervention.Musculoskeletal ultrasound was used to measure acromion-greater tuberosity distance(AGT),acromion-lesser tu-berosity distance(ALT),acromiohumeral distance(AHD)and supraspinatus thickness(SST)to evaluate shoulder joint stability.Correlation analysis was conducted on the improvements in shoulder pain and shoulder joint stabil-ity in the experimental group.Results Two cases in the control group and two in the experimental group dropped down.Both groups showed signifi-cant improvements in VAS and FMA-UE scores after intervention(|t|>5.214,P<0.001),and the scores im-proved more in the experimental group than in the control group(|t|>2.087,P<0.05).The experimental group also showed significant improvements in AGT,ALT,AHD and SST(|t|>4.187,P<0.001),with AGT,ALT and AHD being superior to those in the control group(|t|>2.155,P<0.05).The difference of VAS score in the exper-imental group was correlated with the difference of FMA-UE,AGT and ALT after intervention(r>0.434,P<0.05).Conclusion Closed-chain shoulder exercise training can significantly improve shoulder joint stability while alleviating shoulder pain,and effectively enhancing upper limb function in stroke patients with hemiplegic shoulder pain.Hemiplegic shoulder pain is correlated with shoulder joint stability.

Objective:To investigate the pathogen of an acute gastroenteritis outbreak in a school in Taizhou, and to understand the epidemiological characteristics and patterns of the outbreak and the etiology of the pathogen.Methods:Twelve anal swab samples from patients who met the suspected case definition during the outbreak in March 2024 were collected. FilmArray GI was used to screen 22 common pathogens in the 12 samples, and the real-time fluorescent RT-PCR was performed for verification. Nested RT-PCR was used to amplify and sequence the nucleotide sequence of the viral capsid region VP1, and the variability of the sequence sites was analyzed. Based on the sequence relationship, a molecular phylogenetic tree was constructed and the viral genotypes were determined. Molecular transmission network analysis was conducted by integrating field epidemiological information.Results:The VP1 gene sequences were obtained from 8 of the 12 specimens. Systematic evolution showed that the molecular typing of the 8 strains of Sapoviuses (SaV) was all GI.6 genotype, and there was a C/T mutation at position 1236 in the VP1 gene. The inferred molecular transmission network was largely consistent with the information from the field epidemiological investigation, such as the initial infected person being the earliest case of the outbreak, and there was a closer transmission link between the two teachers.Conclusions:This article reported a school outbreak caused by a SaV GI.6 type. We speculated a more reliable molecular transmission network, estimated the rate of gene mutation and provided a reasonable elaboration for the C/T mutation at position 1236 of the VP1 gene.

Objective To investigate the effect of closed-chain exercise training on hemiplegic shoulder pain and shoulder joint sta-bility in stroke patients,and to explore the relationship between hemiplegic shoulder pain and shoulder joint sta-bility.Methods A total of 52 stroke patients with hemiplegic shoulder pain in Jiangsu Province Hospital from October,2020 to January,2023 were selected,and were randomly divided into control group(n=26)and experimental group(n=26).Both groups received conventional rehabilitation therapy,while the experimental group additionally under-went closed-chain exercise training for shoulder joint.Pain severity and motor function were assessed using Visu-al Analog Scale(VAS)and Fugl-Meyer Assessment-Upper Extremities(FMA-UE)before and after intervention.Musculoskeletal ultrasound was used to measure acromion-greater tuberosity distance(AGT),acromion-lesser tu-berosity distance(ALT),acromiohumeral distance(AHD)and supraspinatus thickness(SST)to evaluate shoulder joint stability.Correlation analysis was conducted on the improvements in shoulder pain and shoulder joint stabil-ity in the experimental group.Results Two cases in the control group and two in the experimental group dropped down.Both groups showed signifi-cant improvements in VAS and FMA-UE scores after intervention(|t|>5.214,P<0.001),and the scores im-proved more in the experimental group than in the control group(|t|>2.087,P<0.05).The experimental group also showed significant improvements in AGT,ALT,AHD and SST(|t|>4.187,P<0.001),with AGT,ALT and AHD being superior to those in the control group(|t|>2.155,P<0.05).The difference of VAS score in the exper-imental group was correlated with the difference of FMA-UE,AGT and ALT after intervention(r>0.434,P<0.05).Conclusion Closed-chain shoulder exercise training can significantly improve shoulder joint stability while alleviating shoulder pain,and effectively enhancing upper limb function in stroke patients with hemiplegic shoulder pain.Hemiplegic shoulder pain is correlated with shoulder joint stability.

Objective:To investigate the pathogen of an acute gastroenteritis outbreak in a school in Taizhou, and to understand the epidemiological characteristics and patterns of the outbreak and the etiology of the pathogen.Methods:Twelve anal swab samples from patients who met the suspected case definition during the outbreak in March 2024 were collected. FilmArray GI was used to screen 22 common pathogens in the 12 samples, and the real-time fluorescent RT-PCR was performed for verification. Nested RT-PCR was used to amplify and sequence the nucleotide sequence of the viral capsid region VP1, and the variability of the sequence sites was analyzed. Based on the sequence relationship, a molecular phylogenetic tree was constructed and the viral genotypes were determined. Molecular transmission network analysis was conducted by integrating field epidemiological information.Results:The VP1 gene sequences were obtained from 8 of the 12 specimens. Systematic evolution showed that the molecular typing of the 8 strains of Sapoviuses (SaV) was all GI.6 genotype, and there was a C/T mutation at position 1236 in the VP1 gene. The inferred molecular transmission network was largely consistent with the information from the field epidemiological investigation, such as the initial infected person being the earliest case of the outbreak, and there was a closer transmission link between the two teachers.Conclusions:This article reported a school outbreak caused by a SaV GI.6 type. We speculated a more reliable molecular transmission network, estimated the rate of gene mutation and provided a reasonable elaboration for the C/T mutation at position 1236 of the VP1 gene.

Objective:To investigate the clinicopathological features and prognosis of patients with penile cancer.Methods:The clinical data of 362 patients with penile cancer who underwent surgery in Fudan University Shanghai Cancer Center from January 2005 to December 2020 were retrospectively analyzed. The mean age was (57.0±0.7) years. According to the clinical N stage classification, 239 patients were in N 0 stage, 57 patients in N 1 stage, 37 patients in N 2 stage, and 29 patients in N 3 stage. All these patients had no metastasis. Based on tumor size and location, 50 patients underwent extended circumcision, 283 patients underwent partial penectomy, and 29 patients underwent total penectomy. One hundred and eighty-three patients underwent inguinal lymphadenectomy and 47 patients underwent pelvic lymphadenectomy. Tumor pathology, tumor size, HPV subtype, postoperative pathological stage, overall survival (OS) and prognosis were analyzed. The Kaplan-Meier analysis and multivariate Cox regression analysis were used to analyse the factors which could affect the survival of patients. 5-year OS rate of these patients were also calculated. Results:In the pathological T classification, 137 cases were in T 1a stage, 24 cases in T 1b stage, 51 cases in T 2 stage, 136 cases in T 3 stage, and 14 cases in T 4 stage. In the pathological N classification, 235 cases were in N 0 stage, 54 cases in N 1 stage, 31 cases in N 2 stage and 42 cases in N 3 stage. The most common tumor type was squamous cell carcinoma (300 cases, 83%), followed by verrucous carcinoma (40 cases, 11%), sarcomatoid carcinoma(7 cases), carcinoma in situ (6 cases), basal-like carcinoma (6 cases), and adenosquamous carcinoma (3 cases). The most common tumor grade was mild (160 cases, 44%), followed by moderate differentiation (130 cases, 36%), poor differentiation (46 cases, 13%), and unclear differentiation (26 cases). The tumor sizes were < 3 cm in 135 patients and ≥ 3 cm in 142 patients. The tumor size was unclear in 85 patients. 173 cases (48%) were HPV positive and 189 cases (52%) were HPV negative. The Kaplan-Meier analysis showed the 5-year OS rate of HPV-positive group was higher than that of HPV-negative group (79% vs. 72%) but no significant difference was found ( P=0.09). The 5-year OS rate of patients whose tumor ≥ 3 cm (69%) was lower than those tumor < 3 cm (85%) and significant difference could be found ( P = 0.02). The 5-year OS rate of wild and moderate and poor grade were 85%, 70% and 58%, and significant difference could be found in the three groups ( P<0.01). The 5-year OS rates of patients with stage T 1a, T 1b, T 2, T 3and T 4 were 90%, 67%, 71%, 68% and 37% respectively( P<0.01). The 5-year OS rates of patients with stage N 0, N 1, N 2, and N 3 were 91%, 62%, 57%, and 30%, respectively( P<0.01). N stage could significantly affect the prognosis. The 5-year OS rate of T 1b patients was lower than that of T 1a and T 2 stage (67% vs. 90% vs. 71%, P=0.003). Of the 24 patients with T 1b stage, 17 cases received inguinal lymphadenectomy and 7 cases not. The 5-year OS rate of T 1b who received lymphadenectomy, who not and T 2 group were 73%, 57% and 71% respectively ( P=0.22). Multivariate Cox analysis showed that N stage ( HR =4.55, 95% CI 2.64-7.85, P<0.01) and tumor grade ( HR =2.09, 95% CI 1.09-4.02, P=0.03) were independent factors which could affect the prognosis. Conclusions:N stage and tumor grade were independent factors which could affect the prognosis. The poorer the tumor grade, the worse the prognosis. Inguinal lymphadenectomy could improve the prognosis of patients with T 1b stage.

Objective:To analyze the epidemiological and clinical characteristics of respiratory syncytial virus (RSV) infection in children in Jiangsu Province from 2014 to 2023.Methods:The acute respiratory infection cases in children aged 0-14 years were selected from outpatient/emergency or inpatient departments in 2 surveillance sentinel hospitals, respectively, in Nanjing, Suzhou and Taizhou of Jiangsu from 1 July 2014 to 31 December 2023, and RSV nucleic acid test was conducted and the intensity of the RSV infection was accessed by WHO influenza epidemiological threshold method, and case information and clinical data were collected. χ2 test was used to compare the differences between groups, and the Bonferroni method was used for pairwise comparisons between groups. Results:In 4 946 cases of acute respiratory infections, the RSV positive rate was 8.21% (406/4 946), and the age M( Q1, Q3) of the cases was 1 (0, 3) years. The RSV positive rate was 10.92% (258/2 362) during 2014-2019 and 6.06% (118/1 948) during 2019-2023, the difference was significant ( χ2=31.74, P<0.001). RSV infection mainly occurred from October to March during 2014-2019, with the incidence peak in December and moderate or higher intensity. The seasonality of RSV infection was not obvious during 2019-2023, with low intensity. The RSV positive rate was highest in children in age group 0- years (17.85%, 151/846), and the positive rate declined gradually with age ( χ2=184.51, P<0.001). The RSV positive rate was higher in inpatient cases (9.84%, 244/2 480) than in outpatient/emergency cases (6.57%, 162/2 466) ( χ2=17.54, P<0.001). In the 155 RSV infection cases with complete clinical data, the clinical symptoms mainly included cough (99.35%, 154/155), fever (55.48%, 86/155), and shortness of breath (45.16%, 70/155). In the cases aged <6 months, the proportion of those with fever was low, but the proportion of those with shortness of breath, transferred to intensive care units, and receiving oxygen therapy were higher (all P<0.05). Children aged <6 months and those with underlying diseases were more likely to have severe RSV infection (all P<0.05). Conclusions:RSV infection in children in Jiangsu Province showed seasonal prevalence in winter from 2014 to 2019. Since 2020, the seasonal characteristics of the epidemic have changed, the epidemic period has been dispersed and the epidemic intensity has decreased. Infants <1 year old were at high risk for RSV infection, and those <6 months old and with underlying diseases might have severe infection.

Objective To investigate the application value of ultrafast pulse wave velocity (ufPWV) technique in the assessment of carotid artery elasticity decline in the patients with simple hypertriglyceridemia (TG).Methods The patients visiting the cardiology outpatient department of Jiangsu Provincial Hospital of Traditional Chinese Medicine/Affiliated Hospital of Nanjing University of Chinese Medicine from January 2020 to March 2022 were selected,the serum lipid satisfied:TG≥1.7 mmol/L,moreover total cholesterol (TC)<5.2 mmol/L,low density lipoprotein cholesterol (LDL-C)<3.4 mmol/L and high density lipoprotein cholesterol (HDL-C)>1.0 mmol/L,they were included into the simple high TG group (n=63).Sixty-eight healthy subjects undergoing physical examination in this hospital were selected as the normal blood lipid group and their blood lipid indicators TG,TC,LDL-C and HDL-C all were within the normal range.The clinical data of all subjects were collected.The ufPWV technique was used to detect the common carotid artery pulse wave velocity of beginning systole (PWV-BS),pulse wave velocity of ending systolic (PWV-ES) and carotid intima-media thickness (cIMT).Results The body mass index (BMI),systolic blood pressure,diastolic blood pres-sure,TG,fasting blood glucose (FBG),cIMT and PWV-ES value had statistical differences between the sim-ple high TG group and normal blood lipid group (P<0.05);PWV-BS,PWV-ES and cIMT were positively correlated with age,and the PWV-ES correlation was the highest (r=0.607,P<0.001),followed by cIMT (r=0.590,P<0.001),and PWV-BS (r=0.325,P<0.001) was the lowest;the Logistic regression analysis showed that PWV-ES could serve as a predictive factor of carotid artery elasticity decline in the population with simple TG,moreover which was independent of the factors such as age,gender,BMI,systolic blood pres-sure,diastolic blood pressure and FBG (OR=1.449,P<0.005).Conclusion The ufPWV technique could e-valuate the decline phenomenon of carotid artery elasticity in the population with simple high TG,and the ele-vated PWV-ES is an independent risk factor for carotid artery elasticity decline in this population.