Objective:To construct a machine learning model based on serum indicators and lung ultrasound features for the prediction of respiratory failure in children with severe pneumonia.Methods:Case-control study.The clinical data of 208 children with severe pneumonia admitted to the Pediatric Intensive Care Unit of Jiujiang Maternal and Child Health Hospital from January 2019 to January 2024 were analyzed.According to whether respiratory failure occurred 3 months after admission, the patients were divided into a respiratory failure group (131 cases) and a non-respiratory failure group (77 cases).Logistic regression, classification regression tree (CRT) and back propagation neural network (BPNN) algorithms based on machine learning were used to construct the prediction models of respiratory failure in children with severe pneumonia by SPSS software.The predictive value of models was analyzed by the receiver operating characteristic (ROC) curve.Results:The univariate analysis showed that there were significant differences in age, history of pulmonary infection, pediatric critical illness score (PCIS), congenital airway malformation, congenital heart disease, lung ultrasound score (LUS), Krebs von den Lungen-6 (KL-6) and soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) between the two groups (all P<0.05).The multivariate Logistic regression analysis showed that age, PCIS score, LUS, congenital heart disease, KL-6 and sTREM-1 were independent risk factors for respiratory failure in children with severe pneumonia (all P<0.05).The analysis results of the CRT model showed that age, congenital heart disease, KL-6 and congenital airway malformation were factors influencing the development of respiratory failure in children with severe pneumonia.The analysis results of the BPNN model indicated that KL-6 was the most important factor that affected the occurrence of respiratory failure in severe pneumonia, followed by age, sTREM-1, LUS, PCIS score, congenital heart disease, congenital airway malformation, and history of pulmonary infection successively.Among the models constructed by the three machine learning algorithms, the Logistic model had the best prediction performance, with an area under the ROC curve of 0.981, a sensitivity of 0.962, and a specificity of 0.909. Conclusions:The risk factors of respiratory failure in children with severe pneumonia include age, LUS, KL-6, sTREM-1, etc.Machine learning models based on serum indicators and lung ultrasound features are effective in predicting respiratory failure in children with severe pneumonia, especially the Logistic model, which has the best prediction efficiency.

Objective:To construct a machine learning model based on serum indicators and lung ultrasound features for the prediction of respiratory failure in children with severe pneumonia.Methods:Case-control study.The clinical data of 208 children with severe pneumonia admitted to the Pediatric Intensive Care Unit of Jiujiang Maternal and Child Health Hospital from January 2019 to January 2024 were analyzed.According to whether respiratory failure occurred 3 months after admission, the patients were divided into a respiratory failure group (131 cases) and a non-respiratory failure group (77 cases).Logistic regression, classification regression tree (CRT) and back propagation neural network (BPNN) algorithms based on machine learning were used to construct the prediction models of respiratory failure in children with severe pneumonia by SPSS software.The predictive value of models was analyzed by the receiver operating characteristic (ROC) curve.Results:The univariate analysis showed that there were significant differences in age, history of pulmonary infection, pediatric critical illness score (PCIS), congenital airway malformation, congenital heart disease, lung ultrasound score (LUS), Krebs von den Lungen-6 (KL-6) and soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) between the two groups (all P<0.05).The multivariate Logistic regression analysis showed that age, PCIS score, LUS, congenital heart disease, KL-6 and sTREM-1 were independent risk factors for respiratory failure in children with severe pneumonia (all P<0.05).The analysis results of the CRT model showed that age, congenital heart disease, KL-6 and congenital airway malformation were factors influencing the development of respiratory failure in children with severe pneumonia.The analysis results of the BPNN model indicated that KL-6 was the most important factor that affected the occurrence of respiratory failure in severe pneumonia, followed by age, sTREM-1, LUS, PCIS score, congenital heart disease, congenital airway malformation, and history of pulmonary infection successively.Among the models constructed by the three machine learning algorithms, the Logistic model had the best prediction performance, with an area under the ROC curve of 0.981, a sensitivity of 0.962, and a specificity of 0.909. Conclusions:The risk factors of respiratory failure in children with severe pneumonia include age, LUS, KL-6, sTREM-1, etc.Machine learning models based on serum indicators and lung ultrasound features are effective in predicting respiratory failure in children with severe pneumonia, especially the Logistic model, which has the best prediction efficiency.

Toxic Chinese materia medica has been highly valued by its specialized and effective effects， but its safe application has become an urgent clinical problem to be solved. Compatibility for toxic attenuation is an important method for the rational clinical application of toxic Chinese materia medica as well as the promotion of its therapeutic advantages. The theory of “heterogeneous medicinals mutual restriction” elaborated in this article has been formed through long-term clinical practice and cognition， and refinement of clinical experience， which means that the nature partiality of toxic Chinese materia medica can be adjusted， and the toxicity can be suppressed through reasonable combination with herbal medicinalsof different properties， flavors， and effects. This theory covers the modes of compatibility for toxicity attenuation and the interaction relationships， like the restriction of medicinals with different properties and flavors， restriction of medicinals with different effects， and inhibiting toxins by reinforcing healthy qi. The opposite and complementary effects of various medicinals combinations are an extension of the connotations of this theory， and the principles can be explained from material basis and mechanism of action. Under the guidance of this theory， it is possible to optimize the compound prescription strategies of toxic Chinese materia medica， and provide new strategies for the clinical combinations of toxic Chinese materia medica， thereby achieving the reduction of toxicity and enhancement of effectiveness of the compound formulas.

OBJECTIVE: To investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study. METHODS: The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups ( P>0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated. RESULTS: All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time ( P>0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values ( P<0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant ( P<0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups ( P<0.05). The 2-PD gradually improved over time, showing significant difference ( P<0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant ( P<0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation ( P>0.05). CONCLUSION Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient's quality of life.
Humans ; Diabetic Foot/surgery* ; Microcirculation ; Prospective Studies ; Quality of Life ; Treatment Outcome ; Diabetes Mellitus

Objective:To investigate the value of event-related potential (ERP) P3 in the assessment of visual attention impairment in patients with cerebral small vessel disease (CSVD).Methods:Twenty-five patients with CSVD diagnosed in the Shandong Provincial Hospital Affiliated to Shandong First Medical University from July 2019 to December 2020 were selected as the CSVD group, while 25 healthy subjects who underwent physical examination in the same period were selected as the control group.The neuropsychological evaluation of CSVD group and control group was carried out by Montreal cognitive assessment (MoCA), 7-items generalized anxiety disorder (GAD-7) and patient health questionnaire-9 (PHQ-9). Magnetic resonance imaging brain white matter high signal of CSVD group and control group was carried out by Fazekas score.The amplitude and latency of ERP component P3 were measured by visual tristimulation Oddball experimental paradigm.SPSS 23.0 software was used for statistical analysis.The differences of amplitude and latency between the two groups were compared by repeated measurement analysis of variance.Pearson or Spearman correlation analysis were used to explore the correlation between P3 amplitude, latency and related scale scores.Results:(1)In the amplitude of P3, the interaction effect between group and stimulation was significant( F(2, 96)=3.922, P=0.023). The main effect between groups was significant( F(1, 46)=15.976, P<0.01). The main effect of stimulation was significant( F(2, 96)=86.212, P<0.01). Further simple effect analysis showed that compared with the control group((9.82±5.14)μV, (11.12±4.72)μV) the P3 amplitude induced by target stimulation ((6.59±4.22)μV, F(1, 48)=7.363, P=0.009) and novel stimulation ((7.08±3.91)μV, F(1, 48)=13.907, P=0.001) in CSVD group decreased significantly.(2)In the latency of P3, the main effect between groups was significant( F(1, 48)=4.870, P=0.032). The main effect of stimulation was significant( F(2, 96)=86.212, P<0.01). The interaction effect between group and stimulation was significant( F(2, 96)=4.561, P=0.013). The main effect of stimulation was significant( F(2, 96)=16.299, P<0.01). Further simple effect analysis showed that the P3 latency induced by novel stimulation in CSVD group was longer than that in control group( F(1, 48)=17.124, P<0.01). (3)P3 amplitude induced by target stimulation was positively correlated with MoCA score ( r=0.255, P=0.027). The P3 amplitude ( r=-0.502, P<0.01) and P3 latency ( r=-0.265, P=0.022) induced by novel stimulation were negatively correlated with Fazekas score. Conclusion:The speed and ability of patients with CSVD to process visual spatial information are impaired, especially for rare stimulation.ERP examination may be a rapid, objective and sensitive method for the diagnosis of visual attention impairment in patients with CSVD.

Objective:To compare the effect on scar in donor area of small-and medium-sized anterolateral thigh perforator flap(ALTPF) harvested from superficial and deep layer of the superficial fascia.Methods:A retrospective analysis was performed on 31 patients who had small-and medium-sized soft tissue defects in the extremities and admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from January 2020 to February 2021. All the patients were repaired with ALTPFs. The sizes of defect ranged from 5.0 cm×3.5 cm to 17.0 cm×6.0 cm, and the flaps sized from 6.0 cm×4.0 cm to 20.0 cm×6.0 cm. Fifteen ALTPFs were harvested from superficial layer of superficial fascia (modified group), and 16 harvested from deep layer of superficial fascia (traditional group). The flap donor sites were sutured directly using the "Zunyi suture method". Appearance of scars was assessed within the Vancouver Scar Scale (VSS) and in addition the width of scars was been recorded. The data of the 2 groups were statistically analyzed. There was statistically significant difference when P<0.05. Results:All flaps were successfully viable. All wounds healed in Ⅰ stage and donor incisions healed in Ⅰ stage at 2-3 weeks after the surgery. All patients entered postoperative follow-up for 6 to 26 months, with a mean of 10.7 months. There was no ischaemic necrosis at the donor margin. There was no significant difference between circumference of thighs between the modified group and traditional group [ (0.10±0.40) cm and (0.03±0.39) cm, respectively]( P>0.05). VSS were found lower in the modified group (2.00±1.46) than that in the traditional group (3.06±1.61)( t=2.132, P=0.039), as well as the scars were found smaller at the widest point[(6.67±3.85) cm and(16.06±6.63) cm, respectively. t=2.807, P=0.005]. The differences were statistically significant( P<0.05). Conclusion:Small-and medium-sized ALTPFs, harvested in the superficial layer of superficial fascia, can reduce the width of the donor scar, improve the surgical outcome and increase patient satisfaction.

Objective:To disclose the molecular genetic differences of Culex flavivirus among mosquitoes in Gansu province in 2011 and 2019.Methods:Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to obtain the nucleotide sequences of Culex flavivirus genomes from mosquitoes in Gansu province in 2011 and 2019, and viral molecular biology and bioinformatics method were used to analyze the genetic differences of the viruses.Results:Nucleotide sequences of 10 strains of Culex flavivirus were obtained, including 8 strains (all from Culex pipiens pallens) obtained in 2011 and 2 strains ( from Culex tritaeniorhynchus and Anopheles sinensis) in 2019. Homology analysis of nucleotide and amino acid sequences of virus E gene showed that the nucleotide sequence similarity and amino acid similarity of viruses isolated from Gansu in 2019 and 2011 ranged from 98.3%-100% and 95.4%-97.3%, respectively. Phylogenetic analysis of Culex flavivirus E gene sequence showed that two strains of Culex flavivirus isolated in Gansu province in 2019 (GS1975 and GS1976) and eight strains of Culex flavivirus isolated in 2011 all belonged to group B of genotype 1 of Culex flavivirus. Further analysis found that GS1975 virus isolated in 2019 was in a common evolutionary cluster with viruses isolated from Liaoning (2010 and 2011) and Inner Mongolia (2018), while GS1976 virus isolated in 2019 formed a coevolutionary cluster with viruses isolated from Inner Mongolia (2018) and Gansu (2011). Conclusions:Although both Culex flaviviruses isolated in Gansu province in 2011 and 2019 are genotype 1 virus, the two viruses isolated in 2019 distributed in two different evolutionary clusters, suggesting that the local mosquito virus genome changes over time, therefore, long-term monitoring of molecular differences is needed to carry out.

Objective:To perform virological and molecular biological identification of the virus (SX1943) isolated from specimens of Culex tritaeniorhynchus in Shaanxi province in 2019. Methods:Mosquito ground fluid was inoculated into tissue culture cells, and isolates were made virological and molecular genetic analysis.Results:A virus isolate (SX1943) was obtained from a specimen of Culex tritaeniorhynchus collected in Shaanxi province in 2019, which developed significant cytopathic effect (CPE) on day 3 after inoculation into C6/36 cells, manifested as cell pyknosis, aggregation and shedding, and the isolate could be stably passaged. However, no significant CPE was observed after three consecutive passages in BHK-21 cells. Electron microscopy (negative staining) of C6/36 cells inoculated with SX1943 virus showed a large number of round virus particles, about 25 nm in diameter. The result of amplification and sequencing of the SX1943 viral genome showed that the total length of the viral genome sequence was 3 594 nt, encoding a total of three proteins, which were non-structural proteins (NS1 and NS2) and capsid proteins (VP), and the gene lengths of the three proteins were 2 376 nt, 1 098 nt and 1 136 nt, respectively. Phylogenetic analysis of the virus revealed that the SX1943 virus were in the same evolutionary clade as Culex pipiens pallens Densovirus (CppDNV) in the genus Brevidensovirus in the subfamily Densovirus, and the above result suggested that SX1943 virus was CppDNV. Conclusions:CppDNV was isolated from Culex tritaeniorhynchus in Shaanxi province.

Objective To evaluate the safety and efficacy of botulinum toxin type A for injection in the treatment of post-stroke upper limb spasticity (dosage was 200 U,or 240 U if combined with thumb spasticity).Methods The study was a multi-center,stratified block randomized,double-blind,placebocontrolled trial.All the qualificd subjects were from 15 clinical centers from September 2014 to February 2016.They were randomized (2∶1) to injections of botulinum toxin type A made in China (200-240 U;n =118) or placebo (n =60) in pivotal phase after informed consent signed.The study was divided into two stages.The pivotal trial phase included a one-week screening,12-week double-blind treatment,followed by an expanded phase which included six-week open-label treatment.The tone of the wrist,finger,thumb flexors was assessed at baseline and at weeks 0,1,4,6,8,12,16 and 18 using Modified Ashworth Scale (MAS),disability in activities of daily living was rated using the Disability Assessment Scale and impaction on pain,muscle tone and deformity was assessed using the Global Assessment Scale.The primary endpoint was the score difference between botulinum toxin type A and placebo groups in the tone of the wrist flexor using MAS at six weeks compared to baseline.Results Muscle tone MAS score in the wrist flexor of botulinum toxin type A and placebo groups at six weeks changed-1.00 (-2.00,-1.00) and 0.00 (-0.50,0.00) respectively from baseline.Botulinum toxin type A was significantly superior to placebo for the primary endpoint (Z =6.618,P ＜ 0.01).The safety measurement showed 10 subjects who received botulinum toxin type A had 13 adverse reactions,with an incidence of 8.47％ (10/118),and three subjects who received placebo had three adverse reactions,with an incidence of 5.00％ (3/60) during the pivotal trial phase.All adverse reactions were mild to moderate,none serious.There was no significant difference in adverse reactions incidence between the botulinum toxin type A and the placebo groups.During the expanded phase three subjects had four adverse reactions and the incidence was 1.95％.All adverse reactions were mild,none serious.Conclusion Botulinum toxin type A was found to be safe and efficacious for the treatment of post-stroke upper limb spasticity.Clinical Trial Registration:China Drug Trials,CTR20131191

Aim To establish a cell model targeting on GLP-1 R,and evaluate its function by the cAMP assay,for screening the new class of GLP-1 analogues as anti-diabetic candidates. Methods An eukaryotic expression vector pEGFP-GLP-1 R was constructed and transfected into HEK293A cells.After selecting with G41 8,a cell line stably expressing GLP-1 R-GFP was estab-lished.The expression and the cellular distribution of GLP-1 R-GFP fusion protein were investigated by Western blot and fluo-rescence microscopy.Then,the activity of GLP-1 analogue Lira-glutide was evaluated by monitoring the content of cAMP via HTRF using this cell model.Results GLP-1 R-GFP-293A cell line was successfully established.GLP-1 R-GFP fusion proteins were mainly distributed in the cell membrane.The dose-respon-sive relationship experiments revealed that cAMP could be effec-tively stimulated by Liraglutide using this cell model.Conclu-sion This cell model could be used to detect the bioactivity of GLP-1 analogues in vitro,which lays a foundation for the screen-ing of GLP-1 analogues and small GLP-1 R agonists.