ObjectiveTo investigate the application value of a machine learning model based on preoperative clinical indicators in predicting the risk of hypoalbuminemia after partial hepatectomy. MethodsA retrospective analysis was performed for the clinical data of 700 patients who underwent partial hepatectomy in Nanfang Hospital， Southern Medical University， from January 2018 to January 2023， including demographic data， history of underlying diseases， tumor characteristics， preoperative laboratory markers， and perioperative indicators. The research data were divided into a training set and a test set at a ratio of 7∶3. The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups； the two-independent-samples Wilcoxon rank-sum test was used for comparison of continuous data with skewed distribution between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The least absolute shrinkage and selection operator （LASSO） regression analysis was used to identify characteristic variables， and 7 machine learning algorithms were used to construct predictive models， i.e.， logistic regression， decision tree， artificial neural network， K-nearest neighbors （KNN）， support vector machine， eXtreme gradient boosting， and light gradient boosting machine. The receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to assess the discriminatory ability of models， and the DeLong test was used for comparison of AUC. The calibration curve and decision curve analysis were used to assess the calibration and clinical practicability of models， and the models were compared with albumin-bilirubin （ALBI） score and Model for End-Stage Liver Disease （MELD） score. SHapley Additive exPlanations （SHAP） were used to interpret the key influencing factors for the optimal model. ResultsA total of 700 patients were finally enrolled， 283 （40.42%） developed hypoalbuminemia after surgery. The LASSO regression analysis identified 8 predictive factors of age， hepatitis B， fatty liver， blockade time， preoperative albumin （Alb）， time of operation， intraoperative blood loss， and preoperative aspartate aminotransferase （AST）. Among the 7 machine learning models， the KNN model showed the best overall predictive performance， with an AUC of 0.835 （95% confidence interval： 0.781 — 0.889）， a sensitivity of 84.0%， and a specificity of 65.5% in the test set. ALBI and MELD scores had an AUC of 0.652 and 0.524， respectively， and the KNN model had a better predictive performance than these two scores （Z=5.309 and 8.945， both P <0.001）. The calibration curve showed good consistency between predicted probabilities and actual incidence rates， and the decision curve analysis showed that the KNN model had net clinical benefit across a wide threshold range. The SHAP analysis showed that preoperative Alb， hepatitis B， time of operation， and age were the most significant influencing factors， and a synergistic effect was observed between hepatitis B and age/time of operation. ConclusionThe KNN machine learning model constructed based on preoperative clinical indicators can effectively predict the risk of hypoalbuminemia after partial hepatectomy and has a better performance than traditional scoring models， which provides a reference for the early identification of high-risk patients in clinical practice.

Obese type 2 diabetes belongs to the category of"consumptive thirst"in traditional Chinese medicine,and obesity is its main cause.This paper summarizes the pathogenesis of obese type 2 diabetes from three aspects:thirst caused by fat evil,deficiency caused by fat evil,and fat evil causing various pathogens.That is to say,the congestion of fat evil produces heat and hurts Yin,lead-ing to consumptive thirst.The accumulation of ointment and fat will damage Yang in the middle energizer and hinder spleen transport.Phlegm and dampness originate from spleen deficiency,which gather in veins and generate blood stasis and heat.The com-plicated combination of phlegm,blood stasis and heat leads to the relapse or development of consumptive thirst.Based on the theory of"maintaining the sweet and restoring the body fluids",this paper skillfully uses sweet herbs and cooperates with other nature and flavors to treat the pathogenesis of"thirst,deficiency and blood stasis"caused by fat evil injuring body fluids,to achieve the purposes of clear-ing away heat and nourishing Yin,strengthening spleen and protecting middle energizer,removing turbidity and blood stasis.Finally,the body fluid is continuously produced,transported smoothly,and the consumptive thirst is relieved.

DiGeorge(DGS)syndrome is an autosomal dominant disorder caused by 22q11.2 microdeletions,most patients developed the disease in childhood.22q11.2 deletion syndrome,and the mutation types are dominated by haploid deletion of this gene.We report a young patient with hypoparathyroidism(parathyroidism)induced by DGS syndrome combined with hypocalcemic heart failure.Genetic testing revealed pathogenic copy number variants associated with the clinical phenotype of the subject.About 2 674 kb of deletion variation was detected at q11.21 position on chromosome 22,which contained the TBX1 gene and was a pathogenic mutation.This paper discusses the clinical features,pathogenesis and current treatment of DGS,and emphasizes the importance of early screening,early diagnosis and treatment,and regular follow-up of heart failure,aiming to enhance the awareness of clinicians and geneticists on DGS syndrome.

Obese type 2 diabetes belongs to the category of"consumptive thirst"in traditional Chinese medicine,and obesity is its main cause.This paper summarizes the pathogenesis of obese type 2 diabetes from three aspects:thirst caused by fat evil,deficiency caused by fat evil,and fat evil causing various pathogens.That is to say,the congestion of fat evil produces heat and hurts Yin,lead-ing to consumptive thirst.The accumulation of ointment and fat will damage Yang in the middle energizer and hinder spleen transport.Phlegm and dampness originate from spleen deficiency,which gather in veins and generate blood stasis and heat.The com-plicated combination of phlegm,blood stasis and heat leads to the relapse or development of consumptive thirst.Based on the theory of"maintaining the sweet and restoring the body fluids",this paper skillfully uses sweet herbs and cooperates with other nature and flavors to treat the pathogenesis of"thirst,deficiency and blood stasis"caused by fat evil injuring body fluids,to achieve the purposes of clear-ing away heat and nourishing Yin,strengthening spleen and protecting middle energizer,removing turbidity and blood stasis.Finally,the body fluid is continuously produced,transported smoothly,and the consumptive thirst is relieved.

DiGeorge(DGS)syndrome is an autosomal dominant disorder caused by 22q11.2 microdeletions,most patients developed the disease in childhood.22q11.2 deletion syndrome,and the mutation types are dominated by haploid deletion of this gene.We report a young patient with hypoparathyroidism(parathyroidism)induced by DGS syndrome combined with hypocalcemic heart failure.Genetic testing revealed pathogenic copy number variants associated with the clinical phenotype of the subject.About 2 674 kb of deletion variation was detected at q11.21 position on chromosome 22,which contained the TBX1 gene and was a pathogenic mutation.This paper discusses the clinical features,pathogenesis and current treatment of DGS,and emphasizes the importance of early screening,early diagnosis and treatment,and regular follow-up of heart failure,aiming to enhance the awareness of clinicians and geneticists on DGS syndrome.

Objective:To investigate the clinical characteristics and next generation sequencing (NGS) results of acute myeloid leukemia (AML) patients dying early.Methods:A retrospective case series study was performed. The clinical data of 49 AML patients dying early in the Affiliated Yuebei People's Hospital of Shantou University Medical College from January 2016 to May 2021 were retrospectively analyzed. All patients were divided into 10 cases in the very early death group (death occurred within 3 d after diagnosis) and 38 cases in the non-very early death group (death occurred within 4-30 d after diagnosis). NGS was used to detect 196 mutant genes related to hematological malignancies.Results:The white blood cell count, creatinine level, lactate dehydrogenase level, bone marrow original cells proportion in the very early death group were higher than those in the non-very early death group, and the differences were statistically significant (all P < 0.05). Among 48 AML patients dying early, 34 cases had NGS results, among which the very early death occurred in 5 cases and the non-very early death occurred in 29 cases. Gene mutations were detected in 34 patients; finally 32 mutant genes were detected and 33 cases (97.06%) harbored more than 2 gene mutations, and the median number [ M ( Q1, Q3)] of gene mutations was 3 (2, 4). Conclusions:AML patients dying early harbor more than 2 gene mutations involving multiple signaling pathways. The clinical characteristics of AML patients in the very early death group are different from those of patients in the non-very early death group.

Objective:To summarize the clinical characteristics, causes of misdiagnosis and preventive measures of infectious mononucleosis (IM) in children, and to improve the ability of clinicians in early diagnosis of IM in children.Methods:The clinical data of 468 children with IM in Xi′an Children′s Hospital from January 2018 to December 2021 were retrospectively analyzed, including general situation, disease onset, diagnosis and misdiagnosis.Results:Among the 468 children, 33 cases were clinically diagnosed and 435 cases were a definitely diagnosed; 281 males (60.04%) and 187 females (39.96%); the incidence rate was highest in preschool children (43.80%, 205/468) and in autumn (33.12%, 155/468). The first symptoms were fever (52.99%, 248/468), eyelid edema (15.38%,72/468) and neck mass (14.96%, 70/468). The fever rate was 90.38% (423/468), and the median time of first fever appearance was on the first (first, second) day of disease course, and the median duration of fever was 6 (4, 8) d. The median time of first visit was on the third (first, fifth) day of disease course, and the time of diagnosis was on the seventh (fifth, ninth) day of disease course. Blood routine examination showed that the proportion of white blood cell count increased was 51.92% (243/468), the proportion of lymphocytes increased was 61.75% (289/468), and the proportion of abnormal lymphocytes increased (≥10%) in peripheral blood was 58.97% (276/468). The lymphocyte subsets of 364 children were detected, the rate of helper T lymphocytes (Th cells) decreased was 80.22% (292/364), the rate of suppressor T lymphocytes (Ts cells) increased was 99.45% (362/364), the value and decreased rate of Th cells/Ts cells were 0.24 (0.16, 0.40) and 100.00% (364/364), rate of B lymphocytes decreased was 93.96% (342/364), rates of natural killer cells decreased and increased were 35.16% (128/364) and 0.55% (2/364). The misdiagnosis rate was 55.13% (258/468), and the misdiagnosis time was on the fifth (fourth, seventh) day of disease course. Among the 258 misdiagnosed children, 105 cases (40.70%) were misdiagnosed as upper respiratory tract infection, 65 cases (25.19%) as acute suppurative tonsillitis, 27 cases (10.47%) as acute cervical lymphadenitis or neck mass.Conclusions:Due to the complex and diverse clinical manifestations of IM in children, it is easy to be misdiagnosed in the early stage of the disease. So, it is necessary for clinicians to master the clinical characteristics of IM in children, constantly improve the level of diagnosis and treatment, and reduce the misdiagnosis rate.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Objective:To analyze the sensitivity and specificity of SARS-CoV-2 nucleic acid testing in 20 348 close contacts of COVID-19 cases in different prevention and control stages in Guangzhou and to provide scientific evidence for optimizing epidemic response strategies.Methods:A total of 20 348 close contacts of COVID-19 cases in Guangzhou were traced between February 21 and September 22,2020. All the close contacts were tested for the nucleic acid of SARS-CoV-2. The sensitivity and specificity of nucleic acid testing and diagnosis in the different prevention and control stages were compared.Results:In 20 348 close contacts, 12 462 were males (61.24%), the median ( P 25, P 75) of age of them was 31.0 years (23.0,43.0), the median number ( P 25, P 75) of nucleic acid testing for them was 2.0 (1.0,3.0), and the median ( P 25, P 75) of their quarantine days was 12.0 (8.0,13.0) days, respectively. A total of 256 COVID-19 cases were confirmed in the close contacts after seven nucleic acid tests. In the 1 st, 2 nd, 3 rd and 7 th nucleic acid testing, the sensitivity and specificity were 69.14% and 99.99% (177 cases confirmed), 89.84% and 99.99% (230 cases confirmed), 97.27% and 99.99% (249 cases confirmed), and 100.00% and 99.98%, respectively. In the three stages of COVID-19 prevention and control in China: domestic case stage, imported case stage, and imported case associated local epidemic stage, the sensitivity of the 1 st nucleic acid testing was 70.68%, 68.00% and 67.35%, and the specificity was 99.98%, 100.00% and 100.00%, respectively. Conclusions:The sensitivity of nucleic acid testing in the close contacts at the different stages were consistent with slight decrease, which might be related to the increased proportion of asymptomatic infections in the late stage of epidemic prevention and control with COVID-19 in Guangzhou. It is suggested to give three nucleic acid tests to improve the sensitivity and reduce false negative risk.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.