Objective To develop a deep learning model based on fundus retinal images to improve the detection rate of mild cognitive impairment(MCI)in patients with coronary heart disease,achieve early intervention and improve prognosis.Methods The study was a single-center cross-sectional study that retrospectively included patients diagnosed with coronary heart disease(CHD)by coronary angiography(≥50％ stenosis of at least one coronary vessel)from Beijing Anzhen Hospital between November 2021 and December 2022.The whole data set was randomly divided into the training set and the testing set according to the ratio of 8∶2 for model development.After that,the patient data of the same center from January 2023 to April 2023 were included in the time verification method to verify the model.The diagnostic criteria for MCI were MMSE＜27 or MoCA＜26.Four kinds of convolutional neural network(CNN)architectures were used to train fundus images,and a comprehensive vision model of MCI detection was established through model integration.The area under the curve(AUC),sensitivity and specificity of the receiver operating curve(ROC)were used to evaluate the performance of the AI model.Results We collected 5 880 eligible fundus images from 3 368 CHD patients.Based on the results of the MMSE scale,the algorithm was labeled,including 2 898 males and 527 MCI patients.The AUC of the deep learning model in the test group is 0.733(95％CI 0.688-0.778),and the sensitivity of the algorithm in the test group is 0.577(95％CI 0.528-0.625)by using the operating point with the maximum sum of sensitivity and specificity.With a specificity of 0.758(95％CI 0.714-0.802),corresponding to a validated AUC of 0.710(95％CI 0.601-0.818).Based on the results of the MoCA scale,the algorithm labels 2 437 males and 1 626 MCI patients.The AUC of the deep learning model in the test group was 0.702(95％CI 0.671-0.733).The operating point with the maximum sum of sensitivity and specificity was selected,and the sensitivity of the algorithm was 0.749(95％CI 0.719-0.778)and the specificity was 0.561(95％CI 0.527-0.595),corresponding to the AUC value of the verification group was 0.674(95％CI 0.622-0.726).Conclusions The deep learning algorithm model based on fundus images has good diagnostic performance,and may be used as a new non-invasive,convenient and rapid screening method for MCI in CHD population.

Objectives:To systematically evaluate the effects of spinal osteotomy and spinal cord blood flow(SCBF)on the spinal cord,and to explore the safe range of osteotomy.Methods:The relevant research liter-atures on spinal osteotomy shortening and SCBF in CNKI,Wanfang,VIP,PubMed,Cochrane Library,EM-BASE and CBM databases published before May 2024 were searched by computer.Two researchers indepen-dently conducted literature screening and extracted data(research design,sample size,and outcome indicators).The quality of the included literatures was evaluated by using the improved Jadad score scale and Newcastle-Ottawa scale(NOS)score.The Revman 5.3 software was used for meta-analysis.Results:A total of 8 litera-tures were included,and the risk of the included literatures mainly came from the allocation hiding and out-come blind methods after evaluated with the Cochrane risk bias assessment tool;The Jadad scale scores of the 6 randomized controlled studies and the NOS scores of the 2 cohort studies were all ≥ 5.A total of 170 subjects were included,including 91 dogs,50 rabbits,and 29 clinical patients;In the animal experiments of dogs,the SCBF increased when the spinal vertebrae were shortened by 2/4 compared with 1/3 or 1/4[OR=-24.10,95％CI(-35.96,-12.23),Z=3.98,P＜0.0001];The SCBF in dogs decreased when the spinal vertebrae were shortened by 2/3 or 3/4 compared with 2/4[OR=44.63,95％CI(19.16,70.09),Z=3.43,P=0.0006];Spinal cord evoked potentials(SCEP)was significantly abnormal when spinal vertebrae shortening was 2/3 or 3/4 compared with 1/3 or 1/4[OR=0.03,95％CI(0.00,0.21),Z=3.55,P=0.004];The dural sac tortuous angle in-creased significantly when the spinal vertebrae shortening in rabbits was more than 2/4[OR=53.51,95％CI(17.92,89.10),Z=2.95,P=0.003],which led to a sharp decrease in SCBF,and the difference was statistically significant.In clinical studies,the SCBF after spinal vertebrae shortening of less than 2/4,that was,about 2/4 of the resection space,was slightly higher than that after vertebral column resection(VCR)[OR=43.81,95％CI(20.40,67.21),Z=3.67,P=0.002],and the difference was statistically significant.Conclusions:In animal ex-periments in dogs and rabbits and clinical studies,spinal vertebrae shortening of less than 2/4 is the safe range of osteotomy;In the animal experiment of dogs,when the shortening is more than 2/3 or 3/4,it will lead to a sharp decrease in SCBF and cause obvious SCEP abnormalities.

Objective To develop a deep learning model based on fundus retinal images to improve the detection rate of mild cognitive impairment(MCI)in patients with coronary heart disease,achieve early intervention and improve prognosis.Methods The study was a single-center cross-sectional study that retrospectively included patients diagnosed with coronary heart disease(CHD)by coronary angiography(≥50％ stenosis of at least one coronary vessel)from Beijing Anzhen Hospital between November 2021 and December 2022.The whole data set was randomly divided into the training set and the testing set according to the ratio of 8∶2 for model development.After that,the patient data of the same center from January 2023 to April 2023 were included in the time verification method to verify the model.The diagnostic criteria for MCI were MMSE＜27 or MoCA＜26.Four kinds of convolutional neural network(CNN)architectures were used to train fundus images,and a comprehensive vision model of MCI detection was established through model integration.The area under the curve(AUC),sensitivity and specificity of the receiver operating curve(ROC)were used to evaluate the performance of the AI model.Results We collected 5 880 eligible fundus images from 3 368 CHD patients.Based on the results of the MMSE scale,the algorithm was labeled,including 2 898 males and 527 MCI patients.The AUC of the deep learning model in the test group is 0.733(95％CI 0.688-0.778),and the sensitivity of the algorithm in the test group is 0.577(95％CI 0.528-0.625)by using the operating point with the maximum sum of sensitivity and specificity.With a specificity of 0.758(95％CI 0.714-0.802),corresponding to a validated AUC of 0.710(95％CI 0.601-0.818).Based on the results of the MoCA scale,the algorithm labels 2 437 males and 1 626 MCI patients.The AUC of the deep learning model in the test group was 0.702(95％CI 0.671-0.733).The operating point with the maximum sum of sensitivity and specificity was selected,and the sensitivity of the algorithm was 0.749(95％CI 0.719-0.778)and the specificity was 0.561(95％CI 0.527-0.595),corresponding to the AUC value of the verification group was 0.674(95％CI 0.622-0.726).Conclusions The deep learning algorithm model based on fundus images has good diagnostic performance,and may be used as a new non-invasive,convenient and rapid screening method for MCI in CHD population.

BACKGROUND:Adolescent idiopathic scoliosis is a common spinal deformity that seriously affects the physical and mental health of patients.Modal analysis will focus on analyzing the natural vibration characteristics of the thoracic spine and its stability and response under the influence of external vibration.This analysis is expected to not only enhance the understanding of the thoracic curvature of adolescent idiopathic scoliosis,but also provide new perspectives and methods for developing new treatment strategies,designing personalized braces,and evaluating surgical outcomes.OBJECTIVE:To create a three-dimensional finite element model to evaluate the response modes of the entire thoracic spine and intervertebral discs in adolescent idiopathic scoliosis patients at different vibration frequencies,and determine the potential frequency range of injury risk.METHODS:This study was jointly conducted at the Sixth Affiliated Hospital of Xinjiang Medical University and the School of Mechanical Engineering at the Boda Campus of Xinjiang University from June 2023 to June 2024.The research subject was a patient with severe spinal and thoracic curvature.CT images were obtained using Siemens dual source spiral CT scanning,and a fine T1-T12 three-dimensional finite element model was established using software such as Mimics,Geomagic Studio,Solidworks,and Hypermesh.Abaqus software was used to perform modal analysis on the model and obtain the maximum amplitude and corresponding vibration modes of the first 12 modes of the entire thoracic spine and intervertebral disc.RESULTS AND CONCLUSION:(1)The modal analysis results showed that the entire thoracic vertebrae and intervertebral discs mainly bent and twisted around the X and Y axes in the lower order modes,while increasing rotation around the Z axis in the higher order modes.(2)The T1-T3 and T6-T8 segments showed the most significant deformation and higher load burden,indicating that these regions played a crucial role in the development of scoliosis.(3)When the natural frequency was concentrated between 98.832 to 121.97 cycles/s for a long time,the vibration displacement of the entire thoracic vertebrae and intervertebral discs was large,which might lead to spinal injury.(4)Through finite element modal analysis,this study provides a scientific basis for understanding the response of the entire thoracic spine and intervertebral discs in adolescent idiopathic scoliosis patients under various vibration frequencies,thereby offering crucial insights into clinical treatment,prevention,and particularly,vibration-related protective strategies.Furthermore,by identifying the potential frequency range of injury risk,this study provides an important basis for developing vibration protection measures and optimizing spinal care strategies for adolescent idiopathic scoliosis patients.

Objective:To investigate the effect of Snyder's hope theory intervention on mental resilience and quality of life in elderly patients with nonvalvular atrial fibrillation(NVAF).Methods:This randomized controlled study enrolled 128 elderly NVAF patients admitted in Second Affiliated Hospital of Chinese People's Liberation Army Air Force Military Medical University between October 2018 and June 2022.They were divided into control group(n=64,routine nursing)and intervention group(n=64,additional Snyder's hope theory intervention).After 3-month intervention,mental resilience,quality of life and satisfaction were compared between two groups.Results:After 3-month intervention,compared with patients in control group,those in intervention group had significant higher total scores of Connor-Davidson Resilience Scale(CD-RISC)[(45.41±6.07)points vs.(35.40±4.96)points],the MOS 36-Item Short-Form Health Survey(SF-36)[(90.69±6.16)points vs.(75.71±4.31)points]and total satisfaction(95.31％vs.81.25％)(P＜0.05 or＜0.01).Conclusion:Snyder's hope theory intervention could significantly improve their mental resilience and quality of life,as well as satisfaction,in elderly patients with non-valvular atrial fibrillation.

Objectives:To systematically evaluate the effects of spinal osteotomy and spinal cord blood flow(SCBF)on the spinal cord,and to explore the safe range of osteotomy.Methods:The relevant research liter-atures on spinal osteotomy shortening and SCBF in CNKI,Wanfang,VIP,PubMed,Cochrane Library,EM-BASE and CBM databases published before May 2024 were searched by computer.Two researchers indepen-dently conducted literature screening and extracted data(research design,sample size,and outcome indicators).The quality of the included literatures was evaluated by using the improved Jadad score scale and Newcastle-Ottawa scale(NOS)score.The Revman 5.3 software was used for meta-analysis.Results:A total of 8 litera-tures were included,and the risk of the included literatures mainly came from the allocation hiding and out-come blind methods after evaluated with the Cochrane risk bias assessment tool;The Jadad scale scores of the 6 randomized controlled studies and the NOS scores of the 2 cohort studies were all ≥ 5.A total of 170 subjects were included,including 91 dogs,50 rabbits,and 29 clinical patients;In the animal experiments of dogs,the SCBF increased when the spinal vertebrae were shortened by 2/4 compared with 1/3 or 1/4[OR=-24.10,95％CI(-35.96,-12.23),Z=3.98,P＜0.0001];The SCBF in dogs decreased when the spinal vertebrae were shortened by 2/3 or 3/4 compared with 2/4[OR=44.63,95％CI(19.16,70.09),Z=3.43,P=0.0006];Spinal cord evoked potentials(SCEP)was significantly abnormal when spinal vertebrae shortening was 2/3 or 3/4 compared with 1/3 or 1/4[OR=0.03,95％CI(0.00,0.21),Z=3.55,P=0.004];The dural sac tortuous angle in-creased significantly when the spinal vertebrae shortening in rabbits was more than 2/4[OR=53.51,95％CI(17.92,89.10),Z=2.95,P=0.003],which led to a sharp decrease in SCBF,and the difference was statistically significant.In clinical studies,the SCBF after spinal vertebrae shortening of less than 2/4,that was,about 2/4 of the resection space,was slightly higher than that after vertebral column resection(VCR)[OR=43.81,95％CI(20.40,67.21),Z=3.67,P=0.002],and the difference was statistically significant.Conclusions:In animal ex-periments in dogs and rabbits and clinical studies,spinal vertebrae shortening of less than 2/4 is the safe range of osteotomy;In the animal experiment of dogs,when the shortening is more than 2/3 or 3/4,it will lead to a sharp decrease in SCBF and cause obvious SCEP abnormalities.

Objective:To evaluate the levels and source of cadmium exposure by dietary pathway among middle-aged and elderly people ≥40 in cadmium-contaminated areas of China.Methods:A total of 7 193 people aged 40-89 years from four typical cadmium-contaminated areas in China were selected as the study subjects. Food Frequency Questionnaire (FFQ), Total Diet Study (TDS) and a 3-day-24-hour dietary recall survey were conducted. Dietary cadmium intake and food sources through dietary pathways were assessed based on cadmium content in foods, consumption amounts and intake frequencies.Results:The mean age of the participants was 63.39±12.21 years, with 50.05% being males. The average monthly dietary cadmium intake was 7.39 μg/(kg·BW). Staple foods and vegetables were the primary sources of dietary cadmium intake, accounting for 57.51% and 32.48%, respectively. The monthly dietary cadmium intake in all surveyed regions did not exceed the Provisional Tolerable Monthly Intake (PTMI) recommended by the Joint FAO/WHO Expert Committee on Food Additives (JECFA).Conclusion:The monthly dietary cadmium intake among middle-aged and elderly people in cadmium-contaminated areas of China is relatively low, with the risk remaining at an acceptable level. Staple foods and vegetables are the most significant contributors to dietary cadmium intake.

Objective:To investigate the effect of Snyder's hope theory intervention on mental resilience and quality of life in elderly patients with nonvalvular atrial fibrillation(NVAF).Methods:This randomized controlled study enrolled 128 elderly NVAF patients admitted in Second Affiliated Hospital of Chinese People's Liberation Army Air Force Military Medical University between October 2018 and June 2022.They were divided into control group(n=64,routine nursing)and intervention group(n=64,additional Snyder's hope theory intervention).After 3-month intervention,mental resilience,quality of life and satisfaction were compared between two groups.Results:After 3-month intervention,compared with patients in control group,those in intervention group had significant higher total scores of Connor-Davidson Resilience Scale(CD-RISC)[(45.41±6.07)points vs.(35.40±4.96)points],the MOS 36-Item Short-Form Health Survey(SF-36)[(90.69±6.16)points vs.(75.71±4.31)points]and total satisfaction(95.31％vs.81.25％)(P＜0.05 or＜0.01).Conclusion:Snyder's hope theory intervention could significantly improve their mental resilience and quality of life,as well as satisfaction,in elderly patients with non-valvular atrial fibrillation.

Objective:To explore the value of non-invasive habitat imaging (HI) multi-parametric MRI (mpMRI) in predicting the risk of prostate cancer (PCa).Methods:In this cross-sectional study, 220 patients with PCa confirmed by radical prostatectomy (RP) who underwent multi-parametric MRI (mpMRI) scanning at Xijing Hospital, Air Force Military Medical University from January 2018 to May 2024 were retrospectively collected. Patients were divided into a training set (154 cases) and a test set (66 cases) by simple random sampling in a 7∶3 ratio. Based on mpMRI imaging, the apparent diffusion coefficient (ADC), perfusion fraction (f), and mean kurtosis (MK) of each voxel were integrated. The K-means clustering algorithm was used to divide the PCa target lesions into habitat subregions, generate habitat maps, and calculate the proportion of each habitat subregion in the entire lesion. According to the 2019 International Society of Urological Pathology (ISUP) guidelines, patients were categorized into a low-risk group (ISUP≤2, 65 cases) and a high-risk group (ISUP≥3, 155 cases). The RP specimens were matched with the habitat map to identify corresponding habitat subregions, and the ISUP grade of each subregion was individually evaluated to calculate the detection rate of high-risk PCa patients. The logistic regression analysis was applied to identify the independent risk factors associated with PCa risk, and the HI-clinical imaging model and clinical imaging model were constructed. The efficacy of the models was assessed using receiver operating characteristic curve.Results:Based on the optimal cluster number, the habitat was divided into three subregions. Habitat 1 had lower ADC and f values and higher MK values, while habitat 2 had the opposite characteristics, and habitat 3 was intermediate. The proportion of habitat 1 in the high-risk group was 28.8%, in the low-risk group was 8.9%. In the training set, the comparison of habitat subregions with pathological results showed that the detection rate of high-risk lesions was 66.9% (103/154) in habitat 1, 25.3% (39/154) in habitat 2, and 47.4% (73/154) in habitat 3. The logistic regression analysis indicated that the proportion of habitat 1 ( OR=3.03, 95% CI 1.77-5.18, P<0.001), prostate-specific antigen ( OR=1.66, 95% CI 1.04-2.66, P=0.034), and the prostate imaging reporting and data system score ( OR=1.65, 95% CI 1.00-2.70, P=0.048) as independent risk factors for high-risk PCa. In the training set, the area under the curve (AUC) for predicting PCa risk was 0.854 (95% CI 0.789-0.920) for the HI-clinical imaging model and 0.779 (95% CI 0.701-0.856) for the clinical imaging model. In the test set, the AUC values were 0.809 (95% CI 0.693-0.895) and 0.738 (95% CI 0.619-0.856), respectively. Conclusion:HI based on mpMRI can effectively predict the risk of PCa.

Objective:To explore the correlation between the expression of fucosylated proteins in colonic epithelium (abbreviated as colonic fucosylation level) and the clinical efficacy of ustekinumab (UST) in patients with Crohn′s disease (CD).Methods:From January 2022 to November 2023, CD patients who were hospitalized at Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University and received the treatment of UST ≥24 weeks (CD group) and patients with colon polyps (colon polyps control group) were retrospectively enrolled. Baseline data of the patients were collected. Harvey-Bradshaw index for Crohn′s disease (HBI) and simple endoscopic score for Crohn′s disease (SES-CD) were applied to assess clinical and endoscopic disease activities, respectively. The colonic fucosylation level was detected by immunofluorescence staining in the CD group at weeks 0 and 24 after UST treatment and at diagnosis in the colon polyps control group (baseline). The levels of C-reactive protein (CRP) and fecal calprotectin (FC) were also assessed. A linear regression model was performed to analyze the correlation between the baseline colonic fucosylation levels and the clinical characteristics in CD patients. At week 24, the clinical efficacy of UST treatment was evaluated, clinical remission was defined as HBI ≤4, biological remission was defined as CRP<5 mg/L and(or) FC≤250 μg/g, and mucosal healing was defined as SES-CD≤2.Based on the efficacy of UST treatment, the CD group was further divided into clinical remission subgroup and clinical non-remission subgroup, biological remission subgroup and biological non-remission subgroup, and mucosal healing subgroup and mucosal non-healing subgroup. The differences in colonic fucosylation level between the subgroups were compared. Multivariate binary logistic regression model was used to analyze the impacts of the baseline clinical characteristics on clinical efficacy at week 24 of UST treatment in the CD group. Mann-Whitney U test and Wilcoxon matched-pair test were used for statistical analysis. Results:A total of 60 patients in the CD group and 72 patients in the colon polyps control group were enrolled. The baseline colonic fucosylation level of CD group was lower than that of the colon polyps control group (25.81 (15.55, 29.70) vs. 29.57 (27.32, 32.96)), and the difference was statistically significant ( Z=-5.02, P<0.001). The results of multiple linear regression analysis showed that the baseline colonic fucosylation level of the CD group was negatively correlated with the baseline FC level ( β=-13.80, 95% confidence interval (95% CI): -20.59 to -7.00, P<0.001). The colonic fucosylation level at week 24 of the CD group was higher than that at week 0 (28.53 (24.54, 32.32) vs. 25.81 (15.55, 29.70)), and the difference was statistically significant ( Z=4.75, P<0.001). The colonic fucosylation levels at week 24 of the clinical remission subgroup, the biological remission subgroup, and the mucosal healing subgroup were higher than those of the clinical non-remission subgroup, the biological non-remission subgroup, and the mucosal non-healing subgroup, respectively (29.1 (27.9, 33.0) vs. 19.6 (16.3, 31.9), 29.5 (27.3, 33.0) vs. 19.6 (17.5, 27.5), 29.6 (28.4, 33.0) vs. 23.4 (17.5, 28.4)), and the differences were statistically significant ( Z=3.35, 3.78, 4.63; all P<0.001). The results of multivariate binary logistic regression analysis showed that the baseline colonic fucosylation level was the independent influencing factor of the rate of clinical remission, biological remission and mucosal healing at week 24 after UST treatment in the CD group ( OR=1.30 (95% CI: 1.05 to 1.61), 1.24 (95% CI: 1.01 to 1.52), 1.57 (95% CI: 1.16 to 2.12); P=0.018, 0.037 and 0.003). Conclusion:The baseline level of colonic fucosylation in CD patients is correlated with the clinical efficacy at week 24 of UST treatment, suggesting its potential utility in predicting the efficacy of UST treatment in CD patients.