Objective:To assess the performance of machine learning(ML),and integrate the clinical parameters with coronary artery calcium(CAC)score of computed tomography(CT)and quantification of automated epicardial adipose tissue(EAT),so as to predict the long-term risk of myocardial infarction(MI)and cardiogenic death in asymptomatic patients.Methods:A total of 1 058 subjects with cardiovascular risk factors and without symptoms of coronary heart disease who underwent physical examination at the Fifth Medical Center of Chinese PLA General Hospital from January 2013 to October 2015 were selected as this study subjects.A long-term follow-up was conducted on them after CAC score.EAT volume and density were quantified using a fully automated deep learning method.ML extreme gradient boosting was trained by using clinical data,risk score of atherosclerotic cardiovascular disease,CAC score and automated EAT measure,and the repeated 10-fold cross validation was used to verify the model.Results:During the 8-year follow-up period,61 cases of 1 058 subjects occurred events of MI and(or)cardiac death.The area under curve(AUC)value of ML was significantly higher than that of the atherosclerotic cardiovascular disease(ASCVD)risk and the predicting events of CAC score(ML:0.82,ASCVD:0.77,CAC:0.77).Compared with ML with only clinical variable,machine learning based on ASCVD,CAC and EAT had more predictive ability for MI and cardiac death[AUC 0.82(95%CI:77-87)vs.0.78(95%CI:0.72-0.84),P=0.02].The survival rate of subjects with high ML scores had a greater decline degree with the increasing of time,therefore,the subjects with higher ML scores were more likely to experience events.Conclusion:ML,which integrated clinical and quantitative imaging variables,can provide long-term risk prediction for patients with cardiovascular risk factors.

Objective:To summarise the clinical experience in replantation of the severed auricle distal to helix with microsurgical technique.Methods:From December 2018 to October 2021, a total of 5 patients with severed auricle injury were treated in the Department of Hand and Foot Surgery of The Affiliated Hospital of Qingdao University. They were 4 males and 1 female with 23-62 years old. After complete debridement of the auricular pinna, the retrograde replantation method was used. For arteries: a dorsal vein of the foot was used to bridge the posterior auricular artery. For veins: 2 patients had the veins directly anastomosed, 2 had the arteriovenous bridging to the posterior ear vein with dorsal foot veins, and the veins in 1 case were not anastomosed. Among the patients, 2 developed venous occlusions after severed auricle, and were treated with bloodletting through small incision at the skin margin. Two patients who received the arteriovenous of the severed auriclse achieved good blood supply. All the patients underwent treatments including anti-freezing, anti-spasm and anti-infection after the emergency surgery. The follow-ups were conducted regularly by telephone and by display photos via WeChat after surgery.Results:All 5 severed auricles were successfully replanted and survived. Postoperative follow-up ranged from 3 months to 2 years, with an average of 10 months. In the 2 cases with venous crisis, the auricles had mild atrophy. All auricles had no obvious pigmentation, and had the sensation recovery back to normal in 1 year after surgery.Conclusion:The pre-judgment of blood vessel quality and high-quality microsurgery skills are the necessary pre-conditions for auricle replantation. For replantation of severed auricle, it is the key to prevent vascular crisis by having the injured blood vessels thoroughly removed.

Taking full advantage of professional knowledge,clinical pharmacist involved in the whole treatment process of one case of mycobacterium infection by assisting doctors in determining and optimizing the anti-infective treatment plan, and performing pharmaceutical care. After the active, rational and effective anti-infective treatment, the patient's infection was controlled effectively. The active participation of clinical pharmacist gains clinical experience for the treatment of rare bacterial infections.

BACKGROUND:In recent years, with the in-depth research on thecharacteristics and functions of stem cells,stem cell research has become a hot research targeting thetreatment of a variety of diseases.OBJECTIVE:To summarize the research progress of human amnioticmesenchymal stem cells in the treatment of acute lung injury.METHODS:The PubMed and CNKI databases were searched by computerfor relevant literatures published from January 2000 to January 2017. The key words were mesenchymal stem cells, acute lung injury in Chinese and English,respectively.RESULTS AND CONCLUSION:As an important member of adult stem cells, human amniotic mesenchymal stem cells not only have the advantages and characteristics of most other stem cells, but also have unique advantages, such as these cells can be extracted from a vast of sources, require only non-invasive operations, and involve no violation of ethics. Human amniotic mesenchymal stem cells can be driven by inflammation reaction and homing to the damaged tissue, and be activated by inflammatory factors to secrete a variety of cytokines in a paracrine fashion, which inhibit neutrophils, macrophages and other immune cell migration and inhibit dendritic cell maturity, and reduce the proliferation of NK cells, B lymphocytes and T lymphocytes, and up-regulate anti-inflammatory cytokines and down-regulate proinflammatory cytokines, and alleviate alveolar inflammatory injury through anti-oxidation and anti-apoptotic processes. Human amniotic mesenchymal stem cells can also assist in the repair or homing to the damaged tissue to directionally differentiate to replace the apoptotic and necrotic cells. All of these characteristics of human amniotic mesenchymal stem cells provide new insight into the treatment of acute lung injury. As acute lung injury is caused by many pathogenic factors and its pathophysiological process is very complicated, human amniotic mesenchymal stem cell transplantation in the treatment of acute lung injury has many issues to be resolved.

Objective Methodsof meta-analysis was used to investigate the clinical characteristics, related factors of ocular diseases caused by Tamoxifen.MethodsThe literature and key words in the literature search strategy were used to search the literatures related to the toxicity of tamoxifen in the treatment of breast cancer from 1980 to 2016.Refer to the literature, and extract the data information, use revman 5.1.7 statistical analysis.Results Tamoxifen was taken after t unilateral breast cancer resection by the patient,a sharp decline in visual acuity was found at the third month of taking Tamoxifen, and then the hospital diagnosed it was neuropapillitis.The analysis results show that the ocular toxicity of Tamoxifen was generally appeared after taking 1month to 100months.The most common eye diseases that result in Tamoxifen were macular edema and macular crystallization, although the cure rate was high, but if not treated ocular disease in time, blindness rate was high too.Ocular toxicity may be positive correlated with the cumulative dose of Tamoxifen and Tamoxifen concentration.The incidence rate may also positive correlated with age.Adverse reactions may be related to the metabolic rate, eye disease history and so on.Conclusion The clinical treatment of breast cancer treated with Tamoxifen, should pay attention to the ocular toxicity, replace drugs timely when there is any ADR that could not be tolerate.

Objective To explore the relations of the doctor-patient relationship to psychological security and stress.Methods Totally 430 operation patients were selected and followed-up.A survey was performed using the Security Questionnaire (SQ),the Patient Doctor Relationship Questionnaire 13-Item Version (PDRQ-13),the Hospital Stress Rating Scale (HSRS) Results The average score of SQ was lower than medium value in operation patients.The SQ scores of operation patients with emergency operation were 39.50±10.51,lower than those of selective operation which were 49.02±10.37 and limited operation which were 47.67±10.29 (P ＜ 0.05).The SQ scores of operation patients who didn't provided themselves were 37.33±10.10,lower than those of basically which were 40.10±10.83 and partly provided for themselves which were 43.50±10.51 (P＜ 0.05).The SQ scores of operation patients in severe group according severity of illness were 37.13±10.40,lower than those of them in mild group which were 39.19±10.24 and moderate group which were 41.38±10.01 (P＜ 0.01).The SQ scores of post-operation patients were 44.32±9.96,higher than post-operation patients which were 40.36±10.81 (P ＜ 0.01).The lack of comforts (LC),lack of information (LI) and risks of serious disease (RSD) scores of post-operation patients were 49.23±30.62,30.46±21.42,52.84±31.22,lower than those of post-operation patients which were 52.37±32.06,35.25±20.14,80.12±33.18 (P ＜ 0.05).The path analysis showed that the regression relationship between SQ scores and PDRQ scores,RSD scores was established (β=0.40,-0.26,P ＜ 0.01),and the PDRQ-13 scores was a mediator between the scores of LC,LI,RSD and the SQ scores (β=0.40,P＜0.01).The PDRQ-13 scores was a adjustor between the RSD scores and the SQ scores (β=-0.34,P ＜ 0.01).Conclusions The operation patients have a low level of the sense of security which is statistically significant with surgical types,the ability to care for themselves and severity of illness.The sense of security of post-operation patients were higher than those of pre-operation patients.The recognition of physician-patient relationship may be play a mediating and adjusting role between the sense of security and stress.The surgical stress affect patient security and physician-patient relationship.

OBJECTIVETo analyze the proportion and associated factors of taking subsequent confirmation test among men who have sex with men (MSM) after being tested positive in oral fluid HIV antibody test.

METHODSBy using successive sampling, 1 003 MSM, who were tested positive in oral fluid HIV antibody test in China-Bill & Melinda Gates Foundation AIDS prevention Program (Extension program) in Beijing during May 1 to December 31, 2013, were recruited. The inclusion criteria included: the objects were men who reported having sex with men; the objects aged more than 18 years old; the objects were tested positive in oral fluid HIV antibody test; the objects had not been reported as HIV positives in China Information System for Disease Control and Prevention previously. According to the program strategy, MSM grassroots organizations transferred the respondents to seek subsequent confirmation tests in specific Center for Disease Control and Prevention (CDCs) or hospitals. The subsequent confirmation tests included: fingertip blood HIV antibody rapid test, venous blood Enzyme Linked Immunosorbent Assay (ELISA) HIV antibody test and venous blood Western Blot (WB) HIV antibody test. Chi-square test was adopted to compare the proportion of taking subsequent confirmation tests in different groups. Nonconditional multivaritae binarylogistic regression analysis was taken to identify the associated factors with whether taking subsequent confirmation tests and to calculate the OR (95% CI) values.

RESULTSThe 1 003 respondents were (30.9 ± 9.1) years old. Among all objects, 87.8% (881/1 003) of them took fingertip blood HIV antibody rapid tests and the positive rate was 85.4% (752/881). 98.0% (737/752) of those who were identified as positive in fingertip blood HIV rapid tests took ELISA and WB tests, and the positive rate was 94.4% (696/737). Comparing with those who were expected to seek subsequent confirmation tests in CDCs, the OR (95% CI) value of those who were expected to seek tests in hospitals was 5.10 (1.69-15.36). The OR (95% CI) values of those who used condom sometimes and those who never used condom in anal sex were 5.81 (2.14-15.77) and 3.45 (2.00-5.97) respectively, in comparison with those who reported not having anal sex or using condom consistently in anal sex during the past 6 months. Comparing with the respondents recruited from the internet, the OR (95% CI) values of those recruited in bathrooms, parks/toilets and bars were 0.17 (0.05-0.53), 0.10 (0.04-0.29) and 0.22 (0.06-0.79) respectively. The likelihood of taking subsequent confirmation test decreased with the increase of number of male sexual partners in the past 3 months, and the OR (95% CI) value was 0.92 (0.86-0.99).

CONCLUSIONThe potential HIV positive MSM in the bathroom, park/toilet and bars are less likely to take subsequent confirmation test. Those who do not use condom consistently during anal sex are more likely to seek subsequent confirmation test. Medical organization conducting subsequent confirmation tests is more likely to increase the confirmation test rate of potential HIV positive MSM. The number of male sexual partners has negative correlation with whether to accept the subsequent confirmation test.

Beijing ; Condoms ; HIV Antibodies ; analysis ; HIV Seropositivity ; diagnosis ; Homosexuality, Male ; Humans ; Male ; Mass Screening ; Patient Acceptance of Health Care ; Risk-Taking ; Sexual Behavior ; Sexual Partners ; Surveys and Questionnaires

Objective To explore the status and influencing factors of the rescue posttraumatic growth of Chinese people' s armed forces soldiers in order to provide a new point of view for psychological intervention.Methods 424 soldiers who had executed earthquake rescue task were assessed with Posttraumatic Growth Inventory (PTGI),and the growth status between different groups were compared.Results (1) The average score of PTGI 21 items ranged from 2.72-3.72,and the score of most items were above 3,which implied the growth degree was between middle change and more change.8 items with highest score were focused on three dimensions which were labeled interpersonal relationship,appreciation of life and personal strength.(2) There was no significant difference between the total score of different rank groups (F=0.885,P＞0.05),which score were 3.43±0.66,3.50±0.62,3.50±0.79,3.30±1.11 respectively.The was significant difference in 4 dimensions and total score of PTGI between the group which had executed rescue task for more than 14 days and the other which had executed rescue task for less than 14 days,and the scores of the group which had executed rescue task for more than 14 days were higher (P＜0.05 or 0.01).Conclusion Almost all rescue soldiers perceives mental growth,such as the changes of interpersonal relationship,attitude of life,and personal strength particularly.The duration of rescue task might be a influencing factor of posttraumatic growth.

Objective To explore the clinical application value and feasibility of contrast-enhanced ultrasonography (CEUS) in rapid diagnosis for bleeding of hepatocellular carcinoma. Methods From January 2009 to December 2012, 58 patients from the 302nd Hospital of the People′s Liberation Army underwent CEUS and conventional ultrasound, who were suspicioused primary bleeding of liver cancer or secondary bleeding of liver cancer after percutaneous radiofrequency ablation (RFA). The change of effusion volume in front of liver and in abdominal cavity, the perfusion time, range and characteristics of contrast agent, tumor vessel and the characteristic manifestation of active bleeding within the tumor and subcapsular were evaluated. Theχ2 test was used to compare the show rates of lesion boundary and the bleeding point by conventional ultrasound and CEUS. The t test was used to compare the change of effusion in front of liver and in abdominal cavity from 0 min to 30 min after bleeding were diagnosis by CEUS. Results For 58 cases of suspicious rupture and bleeding of liver cancer, 34 cases were conifrmed by clinical and imaging ifndings. The bleeding points were detected by conventional ultrasound in 5 cases. The bleeding points in 30 cases (including 4 cases of rapid bleeding, 7 cases of medium bleeding and 19 cases of slow bleeding) were detected by CEUS. The detection rate of lesion boundary, tumor vessel and bleeding point of CEUS were higher than those of conventional ultrasound, and the differences were statistically significant (χ2=10.350, P=0.001; χ2=4.300, P=0.034;χ2=36.790, P=0.0007). CEUS showed that contrast agent continuously concentrated at the bleeding point of lesions, and different degrees of bleeding were shown as′jet-like′,′linear′or′intermittent′spillover. The volume of effusion in front of the liver and in abdominal cavity at 30 min was more than those at 0 min after bleeding were diagnosis by CEUS, and the differences were statistically significant (the volume of effusion in abdominal cavity:t=-3.467, P=0.026;t=-12.895, P=0.000;t=-3.055, P=0.007;the volume of effusion in front of the liver:t=-8.110, P=0.001;t=-5.642, P=0.002;t=-5.981, P=0.000). Conclusions CEUS can show direct signs of rupture and bleeding of liver cancer, and the degree of bleeding can be evaluated according to the extravasation characteristics of contrast medium and the changes of lfuid volume. Therefore, CEUS can provid an objective basis for rapid diagnosis of ruptured hepatocellular carcinoma in the emergency scene and bedside.

Objective To study the detection rate of contrast-enhanced ultrasound (CEUS) with different perfusion methods on rabbit VX2 small hepatocellular carcinoma less than 10.0 mm. Methods VX2 tumor cells were inoculated into the subcutaneous tissue of New Zealand rabbit′s thigh. Then the plant tumor were cut into small blocks under sterile conditions and transplanted into hepatic parenchyma in 30 New Zealand rabbits. The contrast media was injected through peripheral vein by single and double perfusion methods. The detection rate of two methods were compared. Results There were 41 hepatocellular carcinoma lesions in the 30 rabbits. There were 15 lesions with size between 3.0 mm and 5.0 mm, and 26 lesions between 5.0 mm and 10.0 mm in diameter. On CEUS, the VX2 tumor presented fast-in and fast-out pattern. In arterial phase, the lesion was enhanced rapidly. In portal venous phase, contrast began to wash out from the carcinoma. In delay phase, the enhancement of lesion was signiifcantly lower than the surrounding normal liver parenchyma. A total of 32 lesions were detected by single perfusion method, including 7 lesions ranging 3.0-5.0 mm and 25 lesions ranging 5.0-10.0 mm. A total of 39 lesions were detected by double perfusion method, including 13 lesions ranging 3.0-5.0 mm and 26 lesions ranging 5.0-10.0 mm. The detection rate of micro-hepatocellular carcinoma by single and double perfusion method was 78% and 95% respectively. The difference was statistically signiifcant (χ2=5.150, P=0.023). The detection rate of 3.0-5.0 mm lesions by single and double perfusion method was 47%and 87%, respectively. The difference was statistically signiifcant ( χ2=5.400, P=0.025). The detection rate of 5.0-10.0 mm lesions by single and double perfusion method was 96% and 100%, respectively. There was no statistically signiifcant difference (χ2=1.020, P=0.500). Conclusion The double perfusion method greatly promotes the detection of micro hepatocellular carcinoma, especially for the lesions less than 5.0 mm in diameter.