Objective To investigate the relationship between the expression levels of serum multiple epithelial growth factor like domains 6(MEGF6),sterile alpha motif(SAM)domain,scr homology 3(SH3)domain and nuclear localization signals 1(SAMSN1)and acute lung injury(ALI)in patients with sepsis.Methods A total of 182 patients with sepsis(sepsis group)who were admitted to Huazhong University of Science and Technology Union Jiangnan Hospital from February 2021 to February 2024 were selected and divided into ALI group(n=60)and non-ALI group(n=122)according to whether they were complicated with ALI or not.80 healthy people who underwent physical examination during the same period were selected as the control group.Serum MEGF6 and SAMSN1 levels were detected by enzyme-linked immunosorbent assay(ELISA).Pearson correlation analysis was used to analyze the correlation between serum MEGF6,SAMSN1 and clinical indicators.Multivariate Logistic re-gression analysis was used to analyze the risk factors of sepsis complicated with ALI.The receiver operating characteristic(ROC)curve was used to analyze the value of serum MEGF6 and SAMSN1 in the evaluation of sepsis complicated with ALI.Results Serum MEGF6(37.52±7.87 ng/L)and SAMSN1(24.26±7.45 ng/L)in the sepsis group were lower than those in the control group(78.17±15.26 ng/L,62.31±14.12 ng/L),and the differences were statistically significant(t=28.397,28.477,all P<0.001).Serum MEGF6(29.22±7.64 ng/L)and SAMSN1(13.28±7.12 ng/L)in the ALI group were lower than those in the non-ALI group(41.60±7.90 ng/L,29.66±7.67 ng/L),and the differences were statistically significant(t=10.045,13.961,all P<0.05).Se-rum MEGF6 and SAMSN1 in patients with sepsis complicated with ALI were negatively correlated with APACHE II score and SOFA score(r=-0.811～-0.728,all P<0.05),and positively correlated with oxygenation index(OI)(r=0.689,0.640,all P<0.05).APACHE II score and SOFA score were risk factors for sepsis complicated with ALI.Serum MEGF6(OR=0.769,95%CI:0.612～0.965)and SAMSN1(OR=0.778,95%CI:0.617～0.980)were protective factors(Wald χ2=5.140,4.525,all P<0.05).The area under the curve(AUC)of serum MEGF6,SAMSN1 alone and combined in the evaluation of sepsis complicated with ALI were 0.840,0.811 and 0.903,respectively.The combined detection was greater than the single detection,and the differences were statistically significant(Z=4.602,4.318,all P<0.05).Conclusion The serum levels of MEGF6 and SAMSN1 in patients with sepsis are decreased,which are the influ-encing factors of sepsis complicated with ALI.The combined detection of the two has a high evaluation value for sepsis complicated with ALI.

Objective To obtain measurements of fetal four-chamber view and left and right ventricular shapes using two-dimensional speckle tracking,and to explore the clinical quantification of cardiac shape remodeling in small for gestational age(SGA)fetuses.Methods In this study,we prospectively collected data on singleton pregnancies from 28 to 39 weeks that were established in the archives of Obstetrics and Gynecology Hospital,Fudan University from May 2020 to Jul 2021.Fetuses eligible for inclusion criteria were randomly matched according to the ratio of estimated fetal weight(EFW)≥10th percentile(P10)∶EFWP90 in the apical segments of the left ventricle was greater in normal UAPI fetuses than that in low-risk fetuses(24.2%vs.14.3%,P=0.005);the SI of left ventricle in UAPI-normal SGA fetuses was greater in segments S1 to S22 than that of right ventricle with statistically significant difference(all P<0.05),while no significant difference was found between the SI of left and right ventricles in segments S23 and S24.Conclusion About one-fourth of SGA fetuses with normal UAPI have abnormally increased apical segments of the left ventricular SI,suggesting that cardiac remodeling with a predominantly"elongated"apical segments of the left ventricle precedes Doppler anomalies.

Objective To investigate a cluster of healthcare-associated infection(HAI)of carbapenem-resistant Klebsiella pneumoniae(CRKP)in intensive care unit(ICU)of a traditional Chinese medicine hospital,and provide evidence for the prevention and control of multidrug-resistant organisms in hospitals.Methods From January to Ju-ly 2023,multiple cases of CRKP infection in the ICU of a traditional Chinese medicine hospital occurred,surpassing the number in the same period of previous years.Through collection of patients'clinical information,epidemiologi-cal investigation and environmental hygiene monitoring,the isolated CRKP strains were identified by pulsed-field gel electrophoresis(PFGE),possible causes of transmission were found out,and corresponding control measures were taken.Results During the study period,a total of 13 patients were confirmed to have developed CRKP infection,mainly respiratory tract infection,bloodstream infection,and abdominal infection.Environmental monitoring showed that only 2 out of 131 environmental object surfaces specimens and staff's hand specimens tested positive for CRKP.PFGE identification showed that the 2 CRKP strains isolated from the sink specimens were highly homolo-gous to the strains isolated from 2 recently admitted patients.Some strains isolated from patients were highly ho-mologous,indicating a possibility of cross transmission.Conclusion CRKP is prone to be cross-transmission among ICU patients and contaminates the environment.Early warning and investigation should be conducted to prevent the occurrence of HAI outbreaks.

Objective:To evaluate the clinical efficacy of Tianma Xionglin Zhixuan Tablets in treating hypertension patients with liver yang hyperactivity or comorbid phlegm-stasis syndrome and explore its therapeutic mechanisms through plasma metabolomics.Methods:Thirty-six hypertension patients(4 dropouts)diagnosed with liver yang hyperactivity or phlegm-stasis syndrome were enrolled as the treatment group from June 2022 to September 2023 at the First Affiliated Hospital of Hunan University of Chinese Medicine,while 30 healthy volunteers with balanced constitutions were recruited as the blank group.Plasma samples were collected from patients pre-and post-treatment and from healthy volunteers.Clinical outcomes,including syndrome scores,office blood pressure(BP),and 24-hour ambulatory BP,were recorded.Plasma metabolomic profiling was performed using liquid chromatography-mass spectrometry(LC-MS).Results:Compared with baseline,Tianma Xionglin Zhixuan Tablets significantly reduced traditional Chinese medicine syndrome scores(P＜0.01),office systolic/diastolic BP(P＜0.01),and 24-hour ambulatory BP parameters(24-hour mean BP,daytime/nighttime mean BP;all P＜0.01).Metabolomic analysis identified 45 differential metabolites between the blank group and pretreatment patients,and 64 metabolites altered post-treatment(VIP＞1,P＜0.05).Enrichment analysis of 16 overlapping endogenous metabolites revealed that Tianma Xionglin Zhixuan Tablets primarily modulated arachidonic acid metabolism and sphingolipid metabolism pathways.Conclusion:Tianma Xionglin Zhixuan Tablets demonstrates significant clinical efficacy in hypertension patients with liver yang hyperactivity or phlegm-stasis syndrome,potentially mediated through regulation of arachidonic acid and sphingolipid metabolism.

Objective:To evaluate the clinical efficacy of Tianma Xionglin Zhixuan Tablets in treating hypertension patients with liver yang hyperactivity or comorbid phlegm-stasis syndrome and explore its therapeutic mechanisms through plasma metabolomics.Methods:Thirty-six hypertension patients(4 dropouts)diagnosed with liver yang hyperactivity or phlegm-stasis syndrome were enrolled as the treatment group from June 2022 to September 2023 at the First Affiliated Hospital of Hunan University of Chinese Medicine,while 30 healthy volunteers with balanced constitutions were recruited as the blank group.Plasma samples were collected from patients pre-and post-treatment and from healthy volunteers.Clinical outcomes,including syndrome scores,office blood pressure(BP),and 24-hour ambulatory BP,were recorded.Plasma metabolomic profiling was performed using liquid chromatography-mass spectrometry(LC-MS).Results:Compared with baseline,Tianma Xionglin Zhixuan Tablets significantly reduced traditional Chinese medicine syndrome scores(P＜0.01),office systolic/diastolic BP(P＜0.01),and 24-hour ambulatory BP parameters(24-hour mean BP,daytime/nighttime mean BP;all P＜0.01).Metabolomic analysis identified 45 differential metabolites between the blank group and pretreatment patients,and 64 metabolites altered post-treatment(VIP＞1,P＜0.05).Enrichment analysis of 16 overlapping endogenous metabolites revealed that Tianma Xionglin Zhixuan Tablets primarily modulated arachidonic acid metabolism and sphingolipid metabolism pathways.Conclusion:Tianma Xionglin Zhixuan Tablets demonstrates significant clinical efficacy in hypertension patients with liver yang hyperactivity or phlegm-stasis syndrome,potentially mediated through regulation of arachidonic acid and sphingolipid metabolism.

Objective To obtain measurements of fetal four-chamber view and left and right ventricular shapes using two-dimensional speckle tracking,and to explore the clinical quantification of cardiac shape remodeling in small for gestational age(SGA)fetuses.Methods In this study,we prospectively collected data on singleton pregnancies from 28 to 39 weeks that were established in the archives of Obstetrics and Gynecology Hospital,Fudan University from May 2020 to Jul 2021.Fetuses eligible for inclusion criteria were randomly matched according to the ratio of estimated fetal weight(EFW)≥10th percentile(P10)∶EFWP90 in the apical segments of the left ventricle was greater in normal UAPI fetuses than that in low-risk fetuses(24.2%vs.14.3%,P=0.005);the SI of left ventricle in UAPI-normal SGA fetuses was greater in segments S1 to S22 than that of right ventricle with statistically significant difference(all P<0.05),while no significant difference was found between the SI of left and right ventricles in segments S23 and S24.Conclusion About one-fourth of SGA fetuses with normal UAPI have abnormally increased apical segments of the left ventricular SI,suggesting that cardiac remodeling with a predominantly"elongated"apical segments of the left ventricle precedes Doppler anomalies.

Objective To investigate the relationship between the expression levels of serum multiple epithelial growth factor like domains 6(MEGF6),sterile alpha motif(SAM)domain,scr homology 3(SH3)domain and nuclear localization signals 1(SAMSN1)and acute lung injury(ALI)in patients with sepsis.Methods A total of 182 patients with sepsis(sepsis group)who were admitted to Huazhong University of Science and Technology Union Jiangnan Hospital from February 2021 to February 2024 were selected and divided into ALI group(n=60)and non-ALI group(n=122)according to whether they were complicated with ALI or not.80 healthy people who underwent physical examination during the same period were selected as the control group.Serum MEGF6 and SAMSN1 levels were detected by enzyme-linked immunosorbent assay(ELISA).Pearson correlation analysis was used to analyze the correlation between serum MEGF6,SAMSN1 and clinical indicators.Multivariate Logistic re-gression analysis was used to analyze the risk factors of sepsis complicated with ALI.The receiver operating characteristic(ROC)curve was used to analyze the value of serum MEGF6 and SAMSN1 in the evaluation of sepsis complicated with ALI.Results Serum MEGF6(37.52±7.87 ng/L)and SAMSN1(24.26±7.45 ng/L)in the sepsis group were lower than those in the control group(78.17±15.26 ng/L,62.31±14.12 ng/L),and the differences were statistically significant(t=28.397,28.477,all P<0.001).Serum MEGF6(29.22±7.64 ng/L)and SAMSN1(13.28±7.12 ng/L)in the ALI group were lower than those in the non-ALI group(41.60±7.90 ng/L,29.66±7.67 ng/L),and the differences were statistically significant(t=10.045,13.961,all P<0.05).Se-rum MEGF6 and SAMSN1 in patients with sepsis complicated with ALI were negatively correlated with APACHE II score and SOFA score(r=-0.811～-0.728,all P<0.05),and positively correlated with oxygenation index(OI)(r=0.689,0.640,all P<0.05).APACHE II score and SOFA score were risk factors for sepsis complicated with ALI.Serum MEGF6(OR=0.769,95%CI:0.612～0.965)and SAMSN1(OR=0.778,95%CI:0.617～0.980)were protective factors(Wald χ2=5.140,4.525,all P<0.05).The area under the curve(AUC)of serum MEGF6,SAMSN1 alone and combined in the evaluation of sepsis complicated with ALI were 0.840,0.811 and 0.903,respectively.The combined detection was greater than the single detection,and the differences were statistically significant(Z=4.602,4.318,all P<0.05).Conclusion The serum levels of MEGF6 and SAMSN1 in patients with sepsis are decreased,which are the influ-encing factors of sepsis complicated with ALI.The combined detection of the two has a high evaluation value for sepsis complicated with ALI.

Objective To evaluate the clinical efficacy of artificial intelligence(AI)-assisted imaging diagnostic trials using multi-reader multi-case(MRMC)design,so as to provide a scientific basis for clinical evaluation of imaging diagnostic trials.Methods The MRMC design,widely used in imaging diagnostic trials,was adopted in this study.The Obuchowski-Rockette(OR)method of MRMC design was detailed,including model construction and test methods.A case study was conducted,collecting imaging data of 200 subjects from 3 hospitals,with 133 cases of rib fractures and 68 cases of non-rib fractures.Three radiologists reviewed all CT images of the subjects.The area under curve(AUC)value,sensitivity and specificity in detecting rib fractures between 2 reading modalities(radiologists with AI assistance vs radiologists reading independently)were compared.Results The AI-assisted reading group had an AUC value of 0.958,while the radiologist-independent reading group had an AUC value of 0.902,showing a significant difference(P＜0.001).The overall sensitivity and specificity of the AI-assisted reading group were 0.970 and 0.946,respectively;while the sensitivity and specificity of the radiologist-independent reading group were 0.838 and 0.966,respectively.The difference of sensitivity between groups was 0.131(95％confidence interval[CI]0.091-0.171),and the difference of specificity was-0.020(95％CI-0.059-0.020),indicating a significant difference in sensitivity but not in specificity between AI-assisted and radiologist-independent reading groups.Both groups had positive likelihood ratios(+LR)greater than 10 and negative likelihood ratios(-LR)less than 0.2,with positive predictive values approaching 1,suggesting that the diagnostic accuracy of the AI-assisted imaging diagnostic trials was high.Conclusion The AI-assisted reading method demonstrates a significant advantage in enhancing diagnostic efficiency,not only improving the diagnostic accuracy and detection rate of rib fractures,but also improving the work efficiency of radiologists and optimizing hospital services.

Objective To estimate the sample size of radiological diagnostic tests in multireader multicase(MRMC)design,and to explore the numbers of readers and cases under 3 different inference situations:random-reader random-case,fixed-reader random-case,and random-reader fixed-case.Methods The images of 114 participants(45 cases diagnosed as aortic coarctation by the gold standard)in the Van Dyke dataset were used,and 5 radiologists read these images under 2 different magnetic resonance imaging(MRI)sequences(Spin-echo and Cine MRI)to obtain the pre-experiment data.Then Obuchowski-Rockette method was used to estimate sample size.Results The mean area under curve(AUC)of aortic coarctation determined by radiologists was 0.941(95%confidence interval[CI]0.899-0.983)with the Spin-echo MRI sequence,and 0.897(95%CI 0.837-0.957)with the Cine MRI sequence.When the effect size was 0.044 and the number of readers was 5,we needed 337 participants for random-reader random-case,162 participants for fixed-reader random-case,and 282 participants for random-reader fixed-case.Conclusion In MRMC design,we need both the number of readers and cases;the larger the number of readers,the smaller the cases required.We need more samples under the situation of random-reader random-case,when the number of readers is≥5.

Ureteropelvic junction obstruction, as a common urological disorder, not only affects the renal function of patients, but also seriously reduces their quality of life. Pyeloplasty, as the first-line therapy for ureteral stricture at present, is a key approach to eliminating hydronephrosis and improving renal function. The quality of life of postoperative patients, as an important criterion for measuring the therapeutic effect, has also attracted increasing attention. Therefore, this article reviews the evaluation tools, research status and influencing factors of the postoperative quality of life of ureteropelvic junction obstruction patients, aiming to provide a reference for the formulation of relevant nursing intervention measures in clinical practice.