Objective To assess the accuracy of pN staging prediction in papillary thyroid carcinoma (PTC) using ultrasound radiomics and deep neural networks (DNN). Methods A retrospective analysis was conducted on 375 patients with pathologically confirmed PTC, comprising 261 cases in the training set and 114 in the test set. Staging was categorized as pN0 (no cervical lymph node metastasis), pN1a (central neck lymph node metastasis), and pN1b (lateral neck lymph node metastasis). An ultrasound physician manually segmented the regions of interest (ROIs) for PTC, extracting 1899 radiomic features. Dimensionality reduction was performed using the least absolute shrinkage and selection operator (LASSO) regression. A DNN model for predicting PTC pN staging was developed using the H2O deep learning platform, trained on the training set, and validated on the test set to assess the accuracy of the optimal model. Results A total of 153 patients were in the pN0 stage, 131 patients in the pN1a stage, and 91 patients in the pN1b stage. LASSO regression selected 15 radiomic features for each PTC. The optimal DNN model, constructed using these 15 features, achieved accuracies of 85.82% on the training set and 81.57% on the test set. Conclusion Ultrasound radiomics of PTC demonstrates high accuracy in predicting pN staging and shows potential for automating N staging in patients.

Pulmonary sarcoidosis is an immune system disease with an unclear etiology. Guided by the yang-reinforcing method， it is believed that the fundamental pathogenesis of pulmonary sarcoidosis lies in the disharmony between water and fire and the reckless movement of the ministerial fire. The failure of the spleen and stomach to maintain warmth， leading to the production of phlegm and blood stasis， is an important pathogenesis. The invasion of external pathogenic toxins， deeply penetrating into the interior， is considered a triggering factor for the disease. The treatment focuses on supplementing the yang， consolidating the kidney， drawing fire back to its source， warming the yang， benefiting the kidney， and nourishing the spleen to generate metal. It also emphasizes unblocking the yang， transforming turbidity， and eliminating phlegm and blood stasis.

Objective:To explore the association between albumin-corrected serum calcium (ACSC) levels and 30-day all-cause mortality in patients hospitalized for community-acquired bacterial pneumonia (CABP).Methods:A secondary analysis was conducted on 1 899 patients with CABP from a Norwegian cohort study. The relationship between baseline ACSC levels and 30-day mortality was assessed using multivariable logistic regression models, adjusted for potential confounders.Results:A significant positive correlation was found between ACSC levels and 30-day mortality risk after adjusting for confounding variables ( OR=1.95, 95% CI=1.48-2.58). When ACSC levels were categorized into tertiles (T1-T3), a trend analysis revealed that the T2 and T3 groups had significantly higher mortality risks compared to the lowest tertile (T1), with odds ratios ( OR) and 95% confidence intervals ( CI) of 1.52(95% CI: 0.97-2.38) and 2.21 (95% CI: 1.44-3.39), respectively ( P for trend <0.001). Subgroup analyses demonstrated no significant interactions across predefined subgroups (all P for interaction > 0.05). Conclusions:In patients with CABP and admission ACSC levels of ≥8.6 mg/dL, higher ACSC levels were positively associated with an increased risk of 30-day mortality. These findings highlight the potential prognostic value of ACSC levels in CABP patients.

Objective:s To investigate the risk factors for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in patients with acute carbon monoxide poisoning (ACOP) and to develop predictive models based on machine learning algorithms.Methods:Patients with ACOP hospitalized at the First Affiliated Hospital of Zhengzhou University from August 2019 to October 2024 were included, with the occurrence of DEACMP as the outcome measure. The dataset was randomly divided into training and validation sets at a ratio of 7:3. Lasso regression was used to select features influencing the outcome in training sets. Nine machine learning models—including Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Support Vector Machine (SVM)—were constructed. Receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) calculated for each model. Calibration curves were used to assess accuracy, and decision curve analysis (DCA) was applied to evaluate clinical utility. The SHapley Additive exPlanations (SHAP) method was employed to visualize and interpret the best-performing model.Results:A total of 264 ACOP patients were included, of whom 54 (20.5%) developed DEACMP. Lasso regression identified eight key feature variables. Based on these factors, predictive models were constructed, showing good AUC stability across the nine machine learning models in both training (0.92–0.99) and validation sets (0.85–0.91). The RF model performed best, with an AUC of 0.99 in the training set and 0.90 in the validation set; its calibration curve and DCA curve also demonstrated excellent performance. SHAP analysis of the RF model revealed the importance ranking of factors from highest to lowest as follows: Glasgow Coma Scale (GCS) score, duration of coma, age, history of coronary heart disease, CK-MB level, monocyte count, diastolic blood pressure (DBP), and drinking history.Conclusions:The RF model exhibited the highest predictive performance for DEACMP occurrence in ACOP patients. The influencing factors, ranked in order of importance from highest to lowest, are as follows: GCS score, duration of coma, age, history of coronary heart disease, CK-MB level, monocyte count, DBP, and drinking history.

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) in improving early enteral nutrition tolerance in patients with acute pancreatitis (AP) under the concept of accelerated rehabilitation, and to explore the related mechanism based on the changes in autonomic nerve characteristics. METHODS: A total of 42 patients with AP were randomized into an observation group (21 cases, 1 case dropped out) and a control group (21 cases, 1 case dropped out). The control group received standard basic treatment for AP. On the basis of the treatment in the control group, EA was applied in the observation group, bilateral Zusanli (ST36), Yixian point (Extra), Tianshu (ST25), Neiguan (PC6) and Zhongwan (CV12) were selected as the main points, and the supplementary points were selected according to syndrome differentiation. Ipsilateral Zusanli (ST36) and Yixian point (Extra) were connected to EA, using discontinuous wave, in frequency of 2 Hz, 30 min a time, once a day for 6 continuous days. The enteral nutrition tolerance score was observed before treatment and after 3 and 5 days of treatment; the visual analogue scale (VAS) score for abdominal pain was observed before treatment and after 3 days of treatment; the time of reaching the feeding goal and hospital stay was recorded; the levels of C-reactive protein (CRP) and amylase were measured before treatment and after 5 days of treatment; the heart rate variability (HRV) indexes (standard deviation of NN intervals [SDNN], average standard deviation of NN intervals [SDANN], root mean square of successive NN interval differences [rMSSD], low frequency [LF] and high frequency [HF], ratio of low frequency to high frequency [LF/HF]) were monitored in the two groups. RESULTS: After 3 and 5 days of treatment, the enteral nutrition tolerance scores were decreased compared with those before treatment in both groups (P<0.01), the reductions in the observation group were larger than those in the control group (P<0.01). After 3 days of treatment, the VAS scores for abdominal pain were decreased compared with those before treatment in both groups (P<0.01), the reduction in the observation group was larger than that in the control group (P<0.01). The time of reaching the feeding goal and hospital stay in the observation group was shorter than that in the control group (P<0.05). After 5 days of treatment, the CRP and amylase levels were decreased compared with those before treatment in both groups (P<0.01), the reduction of CRP level in the observation group was larger than that in the control group (P<0.01). In the observation group, SDNN, SDANN and LF/HF were lower than those in the control group (P<0.05, P<0.01), while rMSSD was higher than that in the control group (P<0.01). SDNN, SDANN and LF/HF were positively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.05), while rMSSD was negatively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.01). CONCLUSION Electroacupuncture can improve enteral nutrition tolerance in patients with AP by regulating autonomic nervous function, alleviating the inflammation, promoting accelerated recovery, and reducing the length of hospital stay.
Humans ; Electroacupuncture ; Male ; Female ; Enteral Nutrition ; Middle Aged ; Adult ; Pancreatitis/physiopathology* ; Aged ; Acupuncture Points ; Young Adult ; Acute Disease/therapy* ; Autonomic Pathways/physiopathology*

OBJECTIVE: To explore the risk factors affecting the prognosis of patients with sepsis complicated with acute pulmonary embolism, and to construct and validate a nomogram predictive model for in-hospital mortality risk. METHODS: Based on the American Medical Information Mart for Intensive Care (MIMIC-III, MIMIC-IV) databases, the data were collected on patients with sepsis complicated with acute pulmonary embolism from 2001 to 2019, including baseline characteristics, and vital signs, disease scores, laboratory tests within 24 hours of admission to the intensive care unit (ICU), and interventions. In-hospital mortality was the outcome event. The total samples were divided into training and testing sets in a 7:3 ratio by random sampling. Univariate Cox regression analysis was used to verify the impact of all variables on the risk of in-hospital mortality, thereby screen potential influencing factors. Subsequently, a stepwise bi-directional regression method was applied to select factors one by one, leading to the construction of a nomogram prediction model. Collinearity testing was used to demonstrate the absence of strong multicollinearity among the influencing factors in the nomogram prediction model. The discrimination of the nomogram model, sequential organ failure assessment (SOFA), and simplified pulmonary embolism severity index (sPESI) was evaluated using C-index in the test set. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of various models for in-hospital mortality in patients with sepsis complicated with acute pulmonary embolism. RESULTS: A total of 562 patients with sepsis complicated with acute pulmonary embolism were included, including 393 in the training set and 169 in the testing set. Univariate Cox regression analysis showed that 30 factors associated with in-hospital mortality in patients with sepsis complicated with acute pulmonary embolism. Through stepwise bi-directional regression, 12 variables were ultimately selected, including gender, presence of malignant tumors, body temperature, red cell distribution width (RDW), blood urea nitrogen (BUN), serum potassium, prothrombin time (PT), 24-hour urine output, mechanical ventilation, vasoactive drugs, warfarin use, and sepsis-induced coagulopathy (SIC). Collinearity testing indicated no strong multicollinearity among the influencing factors [all variance inflation factor (VIF) > 10]. A nomogram model was constructed using the 12 variables mentioned above. The nomogram model predicted the C-index and its 95% confidence interval (95%CI) of in-hospital mortality in patients with sepsis complicated with acute pulmonary embolism better than SOFA score and sPESI [0.771 (0.725-0.816) vs. 0.579 (0.519-0.639), 0.608 (0.554-0.663)]. The ROC curve showed that the area under the curve (AUC) and its 95%CI of the nomogram model were higher than those of the SOFA score and sPESI [0.811 (0.766-0.857) vs. 0.630 (0.568-0.691), 0.623 (0.566-0.680)]. These findings were consistently replicated in the internal validation of the testing set. In both the training and testing sets, Delong's test showed that the AUC of the nomogram model was significantly higher than the SOFA score and sPESI (both P < 0.05). CONCLUSION The nomogram model demonstrated good predictive effectiveness for the risk of in-hospital mortality in patients with sepsis complicated with acute pulmonary embolism, enabling clinicians to predict mortality risk in advance and take timely interventions to reduce mortality.
Humans ; Pulmonary Embolism/mortality* ; Hospital Mortality ; Nomograms ; Sepsis/complications* ; Prognosis ; Risk Factors ; Intensive Care Units ; Male ; Female ; Middle Aged ; Aged

Objective To analyze the clinical and pathogenic characteristics,as well as influencing factors for the prognosis of patients with Candida bloodstream infection(CBSI).Methods Clinical data of 47 CBSI patients in a hospital from January 2015 to September 2024 were collected.Distribution of departments and infection strains,an-timicrobial resistance,and influencing factors for the poor prognosis of patients were analyzed.Results A total of 51 strains of Candida were detected from 47 CBSI patients,mainly from the intensive care unit(ICU;n=25,53.2％),department of intestinal fistula surgery(n=8,17.0％),and department of respiratory medicine(n=4,8.6％),et al.The main detected pathogens were Candida albicans(n=29,56.9％),Candida tropicalis(n=7,13.7％),Candida glabrata(n=6,11.8％),and Candida parapsilosis(n=6,11.8％).Resistance rate of Candida albi-cans to fluconazole was 11.5％(3/26).According to the prognosis results,patients were divided into a good prog-nosis group(n=26,55.3％)and a poor prognosis group(n=21,44.7％).Univariate analysis showed statistically significant differences between patients in the good prognosis group and the poor prognosis group in terms of abso-lute neutrophil count,ICU admission,mechanical ventilation,tracheal intubation,gastrointestinal hemorrhage/per-foration,and surgical treatment(lesion clearance,drainage or unblocking for obstruction)(all P＜0.05).Prelimi-nary multivariate logistic regression analysis showed that gastrointestinal hemorrhage/perforation was a potential risk factor for the poor prognosis in CBSI patients(OR=11.156,95％CI:1.434-86.809,P=0.021).Conclusion The detected CBSI strains are mainly Candida albicans,and gastrointestinal hemorrhage/perforation may be one of the potential risk factors affecting the prognosis of CBSI patients.These patients are generally in critical condition and should be detected and treated as early as possible to improve their prognosis.Due to the small amount of speci-mens,further research is still needed for confirmation.

Objective:To investigate the short-term pulmonary function outcomes in children with congenital diaphragmatic hernia (CDH) following surgery and analyze the influencing factors of poor outcomes.Methods:This study retrospectively enrolled 81 children who had undergone surgery for CDH and were discharged after recovery at the Department of Neonatal Surgery, Children's Hospital of Capital Institute of Pediatrics from January 2020 to June 2023. All children had pulmonary function tests before discharge, 6 months to 2 year after discharge. Changes in the pulmonary function parameters at different time points were compared. Based on the results of the final pulmonary function test after discharge, these patients were categorized into a favorable outcome group (32 cases) with normal pulmonary function and an unfavorable outcome group (49 cases) with pulmonary dysfunction. Clinical data of the two groups were compared using two independent samples t-test, rank-sum test, Chi-square test, or Fisher's exact test. Logistic regression analysis was used to explore the factors influencing pulmonary function outcomes. Results:A total of 81 cured and discharged CDH children were included in this study, comprising 34 males (42.0%) and 47 females (58.0%). The first two pulmonary function tests were performed at a mean postnatal age of (30.1±14.1) d (14-75 d) and (8.3±1.3) months (4 months and 14 d to 12 months), respectively. Pre-discharge pulmonary function tests revealed that 13 cases (16.0%) had nearly normal pulmonary function, while 68 cases (84.0%) showed pulmonary function abnormalities with seven cases of restrictive ventilatory dysfunction, 56 cases of obstructive ventilatory dysfunction, and five cases of mixed ventilatory dysfunction. In the children with abnormal pulmonary function before discharge, their second pulmonary function tests showed that some parameters including tidal volume [(7.49±1.35) ml/kg vs. (8.02±2.21) ml/kg], the ratio of time to peak tidal expiratory flow and expiratory time [(23.21±4.95)% vs. (26.50±5.48)%], the ratio of volume to peak expiratory flow and expiratory volume [(26.41±5.79)% vs. (27.55±5.20)%], respiratory system compliance per kg body weight during single occlusion [(0.93±0.22) ml/(cmH 2O·kg) vs. (0.96±0.25) ml/(cmH 2O·kg), 1 cmH 2O=0.098 kPa], functional residual capacity [(52.18±17.83) ml vs. (126.39±26.73) ml], and respiratory system resistance in single occlusion condition [(0.06±0.02) cmH 2O/(ml·s) vs. (0.05±0.01) cmH 2O/(ml·s)] improved after discharge ( t values were－2.41,－6.14,－7.68,－2.26,－18.94, and 4.87, all P<0.05). Eight children with obstructive ventilatory dysfunction were followed up for two years after surgery, of which three had normal lung function and five still showed mild to moderate obstructive ventilatory dysfunction. Logistic regression analysis indicated that liver herniation, severe pulmonary hypertension (PH), low observed-to-expected lung-to-head ratio (o/e LHR), grade C/D diaphragmatic defect, and prolonged invasive ventilation were risk factors for poor pulmonary outcomes [ OR(95% CI) were 5.655(1.410-22.676), 5.610 (1.589-19.804),4.183 (1.234-14.180) and 1.195(1.074- 1.329), all P<0.05]. Conclusions:Although lung function parameters of CDH patients show certain improvement after surgery, many children still have mild to moderate obstructive ventilatory dysfunction, requiring long-term follow-up. Prenatal and postnatal indicators such as liver herniation, severe PH, and low o/e LHR can predict the pulmonary outcomes of children with CDH.

Objective:To investigate the clinicopathological characteristics and molecular variants of chromophobe renal cell carcinoma with small cell components/neuroendocrine-like features (ChRCC-SC/ND-L).Methods:There were 7 cases of ChRCC-SC/ND-L diagnosed by light microscopy and immunohistochemical staining were collected from the Affiliated Hospital of Qingdao University (5 cases) and 971 Hospital of the People′s Liberation Army Navy (2 cases) between January 2010 and December 2023. The clinical data, histological characteristics, and immunohistochemical staining results of the patients were summarized. Among them, 4 cases underwent whole exome sequencing.Results:Among the 7 cases, 5 cases were male and 2 cases were female. The mean age was 53 (43,58)years,with a range of 36 to 76 years. Gross examination showed that the mean maximum tumor diameter was 7.9 (6.0,9.0) cm,with a range of 5.5 to 13.0 cm. The tumors were nodular, well-defined, gray, red or yellow in color with a solid cut surface, except for 1 case with cystic and solid on cut surface. One case showed visible necrosis, and 1 case invaded the renal pelvis and sinus. Microscopically, the tumors had clear boundaries. Typical ChRCC components (5 cases of classical type, 2 cases of eosinophilic type) were found in all cases, accompanied by varying amounts of small cell components (5%-90%). The two components were mixed in 6 cases or directly adjacent to each other in 1 case. The small cell components were arranged in clusters, dense acinar and nest-like structures, beam-like, fence-like, chrysanthemum-shaped clusters, and ribbon-like patterns. Three cases exhibited patchy necrosis. Intravascular tumor thrombus was found in 1 case. Immunohistochemically, EMA was expressed consistently in the small cell and typical ChRCC components (7/7); whilst both CK7 and CD117 were negative in 1 case with typical ChRCC component (6/7). Small cell components in 3 cases were positive for CD56, whereas all 7 cases were negative for CgA, Syn, and INSM1. The Ki-67 proliferation index was less than 1% in both components. Whole exome sequencing revealed that the 4 cases exhibited different genetic aberrations including 1 case with multiple chromosomal deletions, while 2 cases showed amplification of chromosome 12 and deletion of chromosome 11, respectively. The 7 cases were followed up for 25 to 172 months. Except for 1 patient that died with unknown causes 25 months after surgery, the remaining 6 cases were still alive (average 103.8 months, median 101 months).Conclusions:ChRCC-SC/ND-L is a very rare subtype of ChRCC. The small cell component does not represent true neuroendocrine differentiation and might indicate a morphological heterogeneity of the tumor. The presence of typical chromophobe cell carcinoma components is helpful for the diagnosis of ChRCC-SC/ND-L and they do not have consistent molecular characteristics. ChRCC-SC/ND-L has a good prognosis and the small cell components/neuroendocrine-like components might not have a significant impact on the outcome of patients with the tumor.

Objective:To assess the current status of geriatrics department development in public general hospitals at or above the second grade in Shandong province.Methods:A cross-sectional survey was conducted from October 27 to November 3, 2023 using a web-based electronic questionnaire to investigate the current status of geriatrics department development in all public general hospitals at or above the second grade across 16 prefecture-level cities in Shandong province.The survey included participation from medical department staff and managers of geriatric medicine departments.Results:Shandong province has 355 public general hospitals at or above the second grade, of which 337 completed the questionnaire.Among these 337 hospitals, 92.28%(311/337)have established geriatric departments, 83.09%(280/337)have set up geriatric clinics, 69.14%(233/337)have independent geriatric wards, and 71.51%(241/337)have implemented comprehensive geriatric assessments(CGA).Regarding the configuration of geriatric departments, 60.24%(203/337)of hospitals met the requirement of having at least 20 ward beds, 34.42%(116/337)met the doctor-to-bed ratio requirement of at least 0.3, and 22.26%(75/337)met the nurse-to-bed ratio requirement of at least 0.6.Only 13 hospitals met all the requirements for geriatric wards, beds, doctors, and nurses, accounting for 3.86%(13/337)of the participating hospitals.Conclusions:The establishment of geriatrics departments in second-grade or higher public general hospitals in Shandong province has surpassed the national target in China ahead of schedule.Most hospitals have established geriatric clinics and wards and have implemented CGA.However, significant challenges remain, including a shortage of ward beds and a lack of medical staff.