1.Risk factors analysis and predictive model construction for atrial high-rate episodes after cardiac resynchronization therapy in patients with heart failure
Ping LI ; Xiaoyan LIU ; Yongming HE ; Xiaofeng CHENG
Chinese Journal of General Practitioners 2025;24(6):722-727
Objective:To analyze the risk factors for atrial high-rate episodes (AHRE) following cardiac resynchronization therapy (CRT) and construct a predictive model for the occurrence of AHRE.Methods:This was a case-control study. Patients who received CRT treatment for heart failure in the Second Affiliated Hospital of Second Affiliated Hospital of Army Military Medical University from January 2017 to December 2020 were selected and divided into AHRE group and non-AHRE group according to whether AHRE occurred during the follow-up period. Baseline clinical data were collected. Patients were followed up regularly after CRT or cardiac resynchronization therapy defibrillator (CRT-D) implantation until August 31, 2022. Logistic regression model was used to analyze the factors influencing the occurrence of AHRE in patients with heart failure treated with CRT, and a nomogram prediction model was established. The receiver operating characteristic (ROC) curve was used to evaluate the nomogram model, and the Hosmer-Lemeshow test was used to evaluate the consistency of the prediction model.Results:A total of 198 patients, aged (62±8) years, 138 (69.7%) males, were enrolled, of whom 52 (26.3%) patients developed AHRE (AHRE group) and 146 (73.7%) had no AHRE (non-AHRE group) during the follow-up period. Multivariate logistic regression analysis revealed that age, coronary heart disease, C-reactive protein, left atrial volume, and left ventricular ejection fraction (LVEF) were independent influencing factors of heart failure patients developing AHRE after CRT surgery (all P<0.05). A nomogram prediction model was constructed by combining 5 indicators: age, coronary heart disease, C-reactive protein, left atrial volume, and LVEF. In this model, a score of 4 was assigned for age ≥65 years, 4 for coronary heart disease, 4 for C-reactive protein ≥10 ng/ml, 20 for left atrial volume ≥35 ml, and 5 for LVEF ≤30%. The total score was obtained by accumulating the scores of each indicator, and the probability of heart failure patients developing AHRE after CRT surgery was predicted based on the total score. The area under the curve of the nomogram prediction model constructed in this study for predicting AHRE in heart failure patients after CRT surgery was 0.830 (95% CI: 0.795-0.866). The incidence of AHRE predicted by the model was basically consistent with the actual incidence of AHRE. The Hosmer-Lemeshow test indicated a good calibration of the model ( χ2=6.32, P=0.612). Conclusions:Age, coronary heart disease, C-reactive protein, left atrial volume, and LVEF are all independent risk factors for AHRE after CRT treatment. The nomogram prediction model based on the above factors can effectively predict the risk of AHRE in patients with heart failure after CRT, and the ROC curve and consistency test both show good prediction efficiency and consistency.
2.Consensus on informed consent for orthodontic treatment
Yang CAO ; Bing FANG ; Zuolin JIN ; Hong HE ; Yuxing BAI ; Lin WANG ; Haiping LU ; Zhihe ZHAO ; Tianmin XU ; Weiran LI ; Min HU ; Jinlin SONG ; Jun WANG ; Fang JIN ; Ding BAI ; Xianglong HAN ; Yuehua LIU ; Bin YAN ; Jie GUO ; Jiejun SHI ; Yongming LI ; Zhihua LI ; Xiuping WU ; Jiangtian HU ; Linyu XU ; Lin LIU ; Yi LIU ; Yanqin LU ; Wensheng MA ; Shuixue MO ; Liling REN ; Shuxia CUI ; Yongjie FAN ; Jianguang XU ; Lulu XU ; Zhijun ZHENG ; Peijun WANG ; Rui ZOU ; Chufeng LIU ; Lunguo XIA ; Li HU ; Weicai WANG ; Liping WU ; Xiaoxing KOU ; Jiali TAN ; Yuanbo LIU ; Bowen MENG ; Yuantao HAO ; Lili CHEN
Chinese Journal of Stomatology 2025;60(12):1327-1336
This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.
3.Effects of Kanxin Powder on Neuroinflammation in APP/PS1 Mice Based on WDFY1/TLR4/NF-κB Signaling Pathway
Yali YANG ; Dongyu MIN ; Yongming LIU ; Changbin YUAN ; Yetao JU ; Yuanyu LIANG ; Meijia CHENG ; Xiaoming HE ; Changyang YU ; Li ZHANG
Chinese Journal of Information on Traditional Chinese Medicine 2025;32(5):90-97
Objective To observe the effect of Kaixin Powder on neuroinflammation in APP/PS1 mice by regulating WDFY1/TLR4/NF-κB signaling pathway;To explore its mechanism of intervening in Alzheimer disease(AD).Methods APP/PS1 transgenic mice were randomly divided into model group,donepezil hydrochloride group(0.66 mg/kg),and Kaixin Powder low-,medium-and high-dosage groups(1.625,3.25,6.5 g/kg),C57BL/6J mice were set as blank control group,with 8 mice in each group,and corresponding drug intervention was given to medicaction group for 24 weeks.Morris water maze,Y maze and novel object recognition experiments were conducted to assess the cognitive function and learning and memory abilities of mice,immunohistochemical staining was used to detect the deposition of β-amyloid protein(Aβ)in hippocampus,the morphology and Nissl bodies of hippocampal CA1 neurons were observed using HE staining and Nissl staining,ELISA was used to detect the serum contents of interleukin(IL)-6,IL-17,IL-1β and tumor necrosis factor-α(TNF-α),Western blot was used to detect the protein expression of calcium-binding adapter molecule 1(Iba1),glial fibrillary acidic protein(GFAP),WDFY1,Toll like receptor 4(TLR4),Toll like receptor associated molecule(TRAM),TIR domain adapter protein(TRIF),NF-κB p65 and p-NF-κB p65 in hippocampal tissue,RT-qPCR was used to detect the mRNA expression of WDFY1,TLR4,TRAM,TRIF and NF-κB p65 in hippocampal tissue.Results Compared with the blank control group,the model group had significantly prolonged escape latency,reduced platform crossings,decreased autonomous reaction alternation rate and relative recognition index(P<0.05,P<0.01),with increased deposition of Aβ in hippocampal tissue(P<0.01),damaged morphological structure of neurons,reduced number of neurons and Nissl bodies,the serum contents of IL-6,IL-17,IL-1β and TNF-α significantly increased,the expression of Iba1,GFAP,WDFY1,TLR4,TRAM,TRIF,p-NF-κB p65 protein and WDFY1,TLR4,TRAM,TRIF mRNA in hippocampal tissue significantly increased(P<0.01).Compared with the model group,Kaixin Powder groups and donepezil hydrochloride group had significantly shortened escape latency and increased platform crossings,autonomous reaction alternation rate and relative recognition index(P<0.05,P<0.01),hippocampal Aβ deposition reduced in Kaixin Powder medium-,high-dosage groups and donepezil hydrochloride group,the morphological structure of neurons recovered,the number of neurons and Nissl bodies increased,the serum contents of IL-6,IL-17,IL-1β and TNF-α significantly decreased(P<0.05,P<0.01),and the protein expression of Iba1,GFAP,WDFY1,TLR4,TRAM,TRIF,p-NF-κB p65 and the mRNA expressions of WDFY1,TLR4,TRAM and TRIF in hippocampal tissue significantly decreased(P<0.05,P<0.01).Conclusion Kaixin Powder can improve cognitive function and learning and memory abilities in AD model mice,alleviate hippocampal neuron damage and Aβ deposition,inhibit the activation of microglia and astrocytes,and thereby reduce serum inflammatory cytokine release.Its mechanism may be related to regulating the WDFY1/TLR4/NF-κB signaling pathway to inhibit neuroinflammation.
4.Mechanism of Action of Kaixinsan in Ameliorating Alzheimer's Disease
Xiaoming HE ; Xiaotong WANG ; Dongyu MIN ; Xinxin WANG ; Meijia CHENG ; Yongming LIU ; Yetao JU ; Yali YANG ; Changbin YUAN ; Changyang YU ; Li ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(1):20-29
ObjectiveTo investigate the mechanism of action of Kaixinsan in the treatment of Alzheimer's disease (AD) based on network pharmacology, molecular docking, and animal experimental validation. MethodsThe Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP) and the Encyclopedia of Traditional Chinese Medicine(ETCM) databases were used to obtain the active ingredients and targets of Kaixinsan. GeneCards, Online Mendelian Inheritance in Man(OMIM), TTD, PharmGKB, and DrugBank databases were used to obtain the relevant targets of AD. The intersection (common targets) of the active ingredient targets of Kaixinsan and the relevant targets of AD was taken, and the network interaction analysis of the common targets was carried out in the STRING database to construct a protein-protein interaction(PPI) network. The CytoNCA plugin within Cytoscape was used to screen out the core targets, and the Metascape platform was used to perform gene ontology(GO) functional enrichment analysis and Kyoto encyclopedia of genes and genomes(KEGG) pathway enrichment analysis. The “drug-active ingredient-target” interaction network was constructed with the help of Cytoscape 3.8.2, and AutoDock Vina was used for molecular docking. Scopolamine (SCOP) was utilized for modeling and injected intraperitoneally once daily. Thirty-two male C57/BL6 mice were randomly divided into blank control (CON) group (0.9% NaCl, n=8), model (SCOP) group (3 mg·kg-1·d-1, n=8), positive control group (3 mg·kg-1·d-1 of SCOP+3 mg·kg-1·d-1 of Donepezil, n=8), and Kaixinsan group (3 mg·kg-1·d-1 of SCOP+6.5 g·kg-1·d-1 of Kaixinsan, n=8). Mice in each group were administered with 0.9% NaCl, Kaixinsan, or Donepezil by gavage twice a day for 14 days. Morris water maze experiment was used to observe the learning memory ability of mice. Hematoxylin-eosin (HE) staining method was used to observe the pathological changes in the CA1 area of the mouse hippocampus. Enzyme linked immunosorbent assay(ELISA) was used to determine the serum acetylcholine (ACh) and acetylcholinesterase (AChE) contents of mice. Western blot method was used to detect the protein expression levels of signal transducer and activator of transcription 3(STAT3) and nuclear transcription factor(NF)-κB p65 in the hippocampus of mice. ResultsA total of 73 active ingredients of Kaixinsan were obtained, and 578 potential targets (common targets) of Kaixinsan for the treatment of AD were screened out. Key active ingredients included kaempferol, gijugliflozin, etc.. Potential core targets were STAT3, NF-κB p65, et al. GO functional enrichment analysis obtained 3 124 biological functions, 254 cellular building blocks, and 461 molecular functions. KEGG pathway enrichment obtained 248 pathways, mainly involving cancer-related pathways, TRP pathway, cyclic adenosine monophosphate(cAMP) pathway, and NF-κB pathway. Molecular docking showed that the binding of the key active ingredients to the target targets was more stable. Morris water maze experiment indicated that Kaixinsan could improve the learning memory ability of SCOP-induced mice. HE staining and ELISA results showed that Kaixinsan had an ameliorating effect on central nerve injury in mice. Western blot test indicated that Kaixinsan had a down-regulating effect on the levels of NF-κB p65 phosphorylation and STAT3 phosphorylation in the hippocampal tissue of mice in the SCOP model. ConclusionKaixinsan can improve the cognitive impairment function in SCOP model mice and may reduce hippocampal neuronal damage and thus play a therapeutic role in the treatment of AD by regulating NF-κB p65, STAT3, and other targets involved in the NF-κB signaling pathway.
5.Differential expression of microRNAs in seminal plasma with high viscosity
Yongming WU ; Zhengli YU ; Siyuan HE
Chinese Journal of Clinical Laboratory Science 2025;43(6):416-422
Objective To investigate the expression profiles of microRNAs(miRNAs)in seminal plasma of the patients with hypervis-cous semen and explore their possible roles in the formation of seminal hyperviscosity.Methods Ten semen samples,including 5 with hyperviscosity(hyperviscosity group)and the other 5 without hyperviscosity(control group),were collected,and the seminal plasmas were obtained by centrifugation after completing semen analysis.The miRNAs in seminal plasma were extracted and performed sequen-cing using high-throughput sequencing technology based on the Illumina platform.The differences in miRNA expression between the two groups were compared.The differentially expressed miRNAs were validated by real-time fluorescence quantitative-PCR(qRT-PCR).The differentially expressed miRNAs were screened to predict their target genes.The Gene Ontology(GO)and KEGG Pathway were used for the enrichment analysis of functional significance.Results A total of 82 significantly differentially expressed miRNAs were found between the hyperviscosity group and the control group,of which 76 were up-regulated and 6 were down-regulated.The results of qRT-PCR validation showed that the expression trends of the differentially expressed miRNAs(miR-449a,miR-517a-3p,and miR-1257)were largely consistent with the high-throughput sequencing results.The GO functional classification annotation showed that their target genes were mainly enriched in ubiquitin-like protein ligase binding,kinase activity,and ion transmembrane transport activi-ty in molecular functions.They mainly participated in the regulation of neuronal apoptosis and ion transmembrane transport in biological processes,and the formation of cell membranes,Golgi membranes and phagocytic vesicles in cellular components.KEGG pathway en-richment analysis showed that the target genes were mainly enriched in signaling pathways,such as ErbB,neurotrophin,interaction with signaling molecules,signal transduction,and cancer-related signal pathways.Conclusion Various differentially expressed miRNAs existed in hyperviscous semen,which may provide a basis for finding a molecular marker or a group of markers in the diagno-sis and evaluation of the treatment for hyperviscous semen.
6.Consensus on informed consent for orthodontic treatment
Yang CAO ; Bing FANG ; Zuolin JIN ; Hong HE ; Yuxing BAI ; Lin WANG ; Haiping LU ; Zhihe ZHAO ; Tianmin XU ; Weiran LI ; Min HU ; Jinlin SONG ; Jun WANG ; Fang JIN ; Ding BAI ; Xianglong HAN ; Yuehua LIU ; Bin YAN ; Jie GUO ; Jiejun SHI ; Yongming LI ; Zhihua LI ; Xiuping WU ; Jiangtian HU ; Linyu XU ; Lin LIU ; Yi LIU ; Yanqin LU ; Wensheng MA ; Shuixue MO ; Liling REN ; Shuxia CUI ; Yongjie FAN ; Jianguang XU ; Lulu XU ; Zhijun ZHENG ; Peijun WANG ; Rui ZOU ; Chufeng LIU ; Lunguo XIA ; Li HU ; Weicai WANG ; Liping WU ; Xiaoxing KOU ; Jiali TAN ; Yuanbo LIU ; Bowen MENG ; Yuantao HAO ; Lili CHEN
Chinese Journal of Stomatology 2025;60(12):1327-1336
This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.
7.Effects of Kanxin Powder on Neuroinflammation in APP/PS1 Mice Based on WDFY1/TLR4/NF-κB Signaling Pathway
Yali YANG ; Dongyu MIN ; Yongming LIU ; Changbin YUAN ; Yetao JU ; Yuanyu LIANG ; Meijia CHENG ; Xiaoming HE ; Changyang YU ; Li ZHANG
Chinese Journal of Information on Traditional Chinese Medicine 2025;32(5):90-97
Objective To observe the effect of Kaixin Powder on neuroinflammation in APP/PS1 mice by regulating WDFY1/TLR4/NF-κB signaling pathway;To explore its mechanism of intervening in Alzheimer disease(AD).Methods APP/PS1 transgenic mice were randomly divided into model group,donepezil hydrochloride group(0.66 mg/kg),and Kaixin Powder low-,medium-and high-dosage groups(1.625,3.25,6.5 g/kg),C57BL/6J mice were set as blank control group,with 8 mice in each group,and corresponding drug intervention was given to medicaction group for 24 weeks.Morris water maze,Y maze and novel object recognition experiments were conducted to assess the cognitive function and learning and memory abilities of mice,immunohistochemical staining was used to detect the deposition of β-amyloid protein(Aβ)in hippocampus,the morphology and Nissl bodies of hippocampal CA1 neurons were observed using HE staining and Nissl staining,ELISA was used to detect the serum contents of interleukin(IL)-6,IL-17,IL-1β and tumor necrosis factor-α(TNF-α),Western blot was used to detect the protein expression of calcium-binding adapter molecule 1(Iba1),glial fibrillary acidic protein(GFAP),WDFY1,Toll like receptor 4(TLR4),Toll like receptor associated molecule(TRAM),TIR domain adapter protein(TRIF),NF-κB p65 and p-NF-κB p65 in hippocampal tissue,RT-qPCR was used to detect the mRNA expression of WDFY1,TLR4,TRAM,TRIF and NF-κB p65 in hippocampal tissue.Results Compared with the blank control group,the model group had significantly prolonged escape latency,reduced platform crossings,decreased autonomous reaction alternation rate and relative recognition index(P<0.05,P<0.01),with increased deposition of Aβ in hippocampal tissue(P<0.01),damaged morphological structure of neurons,reduced number of neurons and Nissl bodies,the serum contents of IL-6,IL-17,IL-1β and TNF-α significantly increased,the expression of Iba1,GFAP,WDFY1,TLR4,TRAM,TRIF,p-NF-κB p65 protein and WDFY1,TLR4,TRAM,TRIF mRNA in hippocampal tissue significantly increased(P<0.01).Compared with the model group,Kaixin Powder groups and donepezil hydrochloride group had significantly shortened escape latency and increased platform crossings,autonomous reaction alternation rate and relative recognition index(P<0.05,P<0.01),hippocampal Aβ deposition reduced in Kaixin Powder medium-,high-dosage groups and donepezil hydrochloride group,the morphological structure of neurons recovered,the number of neurons and Nissl bodies increased,the serum contents of IL-6,IL-17,IL-1β and TNF-α significantly decreased(P<0.05,P<0.01),and the protein expression of Iba1,GFAP,WDFY1,TLR4,TRAM,TRIF,p-NF-κB p65 and the mRNA expressions of WDFY1,TLR4,TRAM and TRIF in hippocampal tissue significantly decreased(P<0.05,P<0.01).Conclusion Kaixin Powder can improve cognitive function and learning and memory abilities in AD model mice,alleviate hippocampal neuron damage and Aβ deposition,inhibit the activation of microglia and astrocytes,and thereby reduce serum inflammatory cytokine release.Its mechanism may be related to regulating the WDFY1/TLR4/NF-κB signaling pathway to inhibit neuroinflammation.
8.Differential expression of microRNAs in seminal plasma with high viscosity
Yongming WU ; Zhengli YU ; Siyuan HE
Chinese Journal of Clinical Laboratory Science 2025;43(6):416-422
Objective To investigate the expression profiles of microRNAs(miRNAs)in seminal plasma of the patients with hypervis-cous semen and explore their possible roles in the formation of seminal hyperviscosity.Methods Ten semen samples,including 5 with hyperviscosity(hyperviscosity group)and the other 5 without hyperviscosity(control group),were collected,and the seminal plasmas were obtained by centrifugation after completing semen analysis.The miRNAs in seminal plasma were extracted and performed sequen-cing using high-throughput sequencing technology based on the Illumina platform.The differences in miRNA expression between the two groups were compared.The differentially expressed miRNAs were validated by real-time fluorescence quantitative-PCR(qRT-PCR).The differentially expressed miRNAs were screened to predict their target genes.The Gene Ontology(GO)and KEGG Pathway were used for the enrichment analysis of functional significance.Results A total of 82 significantly differentially expressed miRNAs were found between the hyperviscosity group and the control group,of which 76 were up-regulated and 6 were down-regulated.The results of qRT-PCR validation showed that the expression trends of the differentially expressed miRNAs(miR-449a,miR-517a-3p,and miR-1257)were largely consistent with the high-throughput sequencing results.The GO functional classification annotation showed that their target genes were mainly enriched in ubiquitin-like protein ligase binding,kinase activity,and ion transmembrane transport activi-ty in molecular functions.They mainly participated in the regulation of neuronal apoptosis and ion transmembrane transport in biological processes,and the formation of cell membranes,Golgi membranes and phagocytic vesicles in cellular components.KEGG pathway en-richment analysis showed that the target genes were mainly enriched in signaling pathways,such as ErbB,neurotrophin,interaction with signaling molecules,signal transduction,and cancer-related signal pathways.Conclusion Various differentially expressed miRNAs existed in hyperviscous semen,which may provide a basis for finding a molecular marker or a group of markers in the diagno-sis and evaluation of the treatment for hyperviscous semen.
9.Risk factors analysis and predictive model construction for atrial high-rate episodes after cardiac resynchronization therapy in patients with heart failure
Ping LI ; Xiaoyan LIU ; Yongming HE ; Xiaofeng CHENG
Chinese Journal of General Practitioners 2025;24(6):722-727
Objective:To analyze the risk factors for atrial high-rate episodes (AHRE) following cardiac resynchronization therapy (CRT) and construct a predictive model for the occurrence of AHRE.Methods:This was a case-control study. Patients who received CRT treatment for heart failure in the Second Affiliated Hospital of Second Affiliated Hospital of Army Military Medical University from January 2017 to December 2020 were selected and divided into AHRE group and non-AHRE group according to whether AHRE occurred during the follow-up period. Baseline clinical data were collected. Patients were followed up regularly after CRT or cardiac resynchronization therapy defibrillator (CRT-D) implantation until August 31, 2022. Logistic regression model was used to analyze the factors influencing the occurrence of AHRE in patients with heart failure treated with CRT, and a nomogram prediction model was established. The receiver operating characteristic (ROC) curve was used to evaluate the nomogram model, and the Hosmer-Lemeshow test was used to evaluate the consistency of the prediction model.Results:A total of 198 patients, aged (62±8) years, 138 (69.7%) males, were enrolled, of whom 52 (26.3%) patients developed AHRE (AHRE group) and 146 (73.7%) had no AHRE (non-AHRE group) during the follow-up period. Multivariate logistic regression analysis revealed that age, coronary heart disease, C-reactive protein, left atrial volume, and left ventricular ejection fraction (LVEF) were independent influencing factors of heart failure patients developing AHRE after CRT surgery (all P<0.05). A nomogram prediction model was constructed by combining 5 indicators: age, coronary heart disease, C-reactive protein, left atrial volume, and LVEF. In this model, a score of 4 was assigned for age ≥65 years, 4 for coronary heart disease, 4 for C-reactive protein ≥10 ng/ml, 20 for left atrial volume ≥35 ml, and 5 for LVEF ≤30%. The total score was obtained by accumulating the scores of each indicator, and the probability of heart failure patients developing AHRE after CRT surgery was predicted based on the total score. The area under the curve of the nomogram prediction model constructed in this study for predicting AHRE in heart failure patients after CRT surgery was 0.830 (95% CI: 0.795-0.866). The incidence of AHRE predicted by the model was basically consistent with the actual incidence of AHRE. The Hosmer-Lemeshow test indicated a good calibration of the model ( χ2=6.32, P=0.612). Conclusions:Age, coronary heart disease, C-reactive protein, left atrial volume, and LVEF are all independent risk factors for AHRE after CRT treatment. The nomogram prediction model based on the above factors can effectively predict the risk of AHRE in patients with heart failure after CRT, and the ROC curve and consistency test both show good prediction efficiency and consistency.
10.A preliminary exploration of a deep learning-based artificial intelligence model for automatic quantification of echocardiographic left ventricular ejection fraction
Lan HE ; Yang LU ; Zhigang XIA ; Xiaoyi XIE ; Lili DU ; Shulian GU ; Lan MA ; Yongming HE ; E SHEN
Journal of Clinical Medicine in Practice 2024;28(9):9-14
Objective To construct a deep learning-based artificial intelligence model to automatically quantify left ventricular ejection fraction (LVEF) using static views of echocardiography. Methods The study included data of 1, 902 adults with left ventricular multi-slice echocardiographic views at end-systole and end-diastole. The collected dataset was divided into development set (1, 610 cases, with 1, 252 cases for model training and 358 cases for parameter adjustment), internal test set (177 cases for internal validation), and external test set (115 cases for external validation and generalization testing). The model achieved left ventricular segmentation and automatic quantification of LVEF through precise identification of the left ventricular endocardial boundary and inspection of key points. The Dice coefficient was employed to evaluate the performance of the left ventricular segmentation model, while the Pearson correlation coefficient and the intraclass correlation coefficient were used to assess the correlation and consistency between the automatically measured LVEF and the reference standard. Results The left ventricular segmentation model performed well, with Dice coefficients ≥ 0.90 for both the internal and external independent test sets; the agreement between the automatically measured LVEF and the cardiologists' manual measurements was moderate, with Pearson correlation coefficients ranging from 0.46 to 0.71 and intragroup correlation analysis agreements from 0.39 to 0.57 for the internal test set; and Pearson correlation coefficients for the independent external test set were 0.26 to 0.54 and intra-group correlation analysis agreement of 0.23 to 0.50. Conclusion In this study, a left ventricular segmentation model with better performance is constructed, and initial application of the model for automatic quantification of LVEF for two-dimensional echocardiography has general performance, which requires further optimisation of the algorithm to improve the model generalisation.


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