Objective To observe the value of machine learning model based on MR T2WI and diffusion weighted imaging(DWI)radiomics for predicting perineural invasion(PNI)of rectal cancer.Methods Totally 343 patients with rectal cancer were retrospectively collected and divided into training set(n=275,92 PNI[+]and 183 PNI[-])and test set(n=68,23 PNI[+]and 45 PNI[-])at the ratio of 8∶2.Univariate and multivariate logistic regression(LR)were used to analyze clinical data and screen the independent predictors of PNI in rectal cancer,so as to construct a clinical model.The best radiomics features were extracted and screened based on preoperative T2WI and DWI.Then extremely randomized trees,multilayer perceptron,light gradient boosting machine,extreme gradient boosting,support vector machine(SVM),LR,K-nearest neighbor and random forest algorithms were used to construct ML models,respectively,and the optimal ML model was selected to establish a clinical-radiomics ML model combined with clinical relevant independent predictors.The predictive efficacy and clinical value of each model were evaluated.Results Patients' age was the independent predictor of PNI of rectal cancer(OR=0.988,P＜0.001),and the area under the curve(AUC)of the clinical model constructed based on it was 0.435 and 0.458 in training and test sets,respectively.SVM model was the best one among 8 ML models,with AUC in training and test set of 0.887 and 0.854,respectively.The AUC of clinical-radiomics ML model in training and test sets was 0.887 and 0.860,respectively,not different with AUC of SVM model(both P＞0.05).Decision curve analysis showed that when the threshold value was 0.20-0.45,clinical net benefit of SVM model was higher than that of other models.Conclusion SVM model based on T2WI and DWI radiomics could effectively predict PNI of rectal cancer.

Objective To observe the value of machine learning model based on MR T2WI and diffusion weighted imaging(DWI)radiomics for predicting perineural invasion(PNI)of rectal cancer.Methods Totally 343 patients with rectal cancer were retrospectively collected and divided into training set(n=275,92 PNI[+]and 183 PNI[-])and test set(n=68,23 PNI[+]and 45 PNI[-])at the ratio of 8∶2.Univariate and multivariate logistic regression(LR)were used to analyze clinical data and screen the independent predictors of PNI in rectal cancer,so as to construct a clinical model.The best radiomics features were extracted and screened based on preoperative T2WI and DWI.Then extremely randomized trees,multilayer perceptron,light gradient boosting machine,extreme gradient boosting,support vector machine(SVM),LR,K-nearest neighbor and random forest algorithms were used to construct ML models,respectively,and the optimal ML model was selected to establish a clinical-radiomics ML model combined with clinical relevant independent predictors.The predictive efficacy and clinical value of each model were evaluated.Results Patients' age was the independent predictor of PNI of rectal cancer(OR=0.988,P＜0.001),and the area under the curve(AUC)of the clinical model constructed based on it was 0.435 and 0.458 in training and test sets,respectively.SVM model was the best one among 8 ML models,with AUC in training and test set of 0.887 and 0.854,respectively.The AUC of clinical-radiomics ML model in training and test sets was 0.887 and 0.860,respectively,not different with AUC of SVM model(both P＞0.05).Decision curve analysis showed that when the threshold value was 0.20-0.45,clinical net benefit of SVM model was higher than that of other models.Conclusion SVM model based on T2WI and DWI radiomics could effectively predict PNI of rectal cancer.

The development of information technology in the medical industry is accelerating the construction of 3-level rehabilitation networks centering on community-based rehabilitation, which is based on the Internet and in combination with the Internet of things(IOT). A municipal rehabilitation hospital cooperated with the health centers of sub-district communities in the city to build a remote rehabilitation network based on IOT technology, for rehabilitation training of community stroke patients. The two sides worked out a cooperation scheme on project management, designed and built a remote community rehabilitation management model. Under the remote monitoring and equipment data IOT, the medical team of the municipal rehabilitation hospital could formulate the therapeutic plan according to the immediately obtained relevant functional evaluation data, and the medical team of the community health service center was responsible for the implementation of the plan. Fifty-three patients in the experimental group received the training of remote lower limb intelligent feedback system based on IOT together with routine rehabilitation training. After 8 weeks of treatment, the functional evaluation data of the two groups were improved in varying degrees( P< 0.05), but the improvement of the experimental group was significantly better than that of the control group( P < 0.05). Remote rehabilitation under the construction path of remote rehabilitation network based on IOT technology could significantly promote the improvement of post-functional rehabilitation of community stroke patients. This study can provide reference for the construction of three-level remote rehabilitation networks based on IOT and the implementation of home-based remote rehabilitation therapy in the future.

Objective:To explore the effect of kangaroo mother care (KMC) on lactation, uterine involution of parturients and neonatal pain.Methods:A total of 200 parturients who gave birth at full term in our hospital from January 2019 to June 2019 and their newborns were selected as the research objects, they were randomly divided into control group and observation group of 100 pairs each. The control group received routine obstetric postpartum care and the observation group received KMC. The KMC cognition, postpartum lactation and uterine involution, neonatal pain during neonatal heel blood collection were compared between the two groups.Results:The cognition of KMC in the observation group was significantly better than that in the control group, and the difference was statistically significant ( χ 2 value was 24.700, P<0.01). The first lactation time of parturients in the observation group was (41.25±3.20) hours after birth, which was earlier than (54.17±2.20) hours in the control group, there was significant difference between the two groups ( t value was 2.378, P value was 0.019). The breast pain Ⅰ degree (20 cases), Ⅱ degree (56 cases), Ⅲ degree (24 cases) in observation group were significantly lighter than those in control group (62, 27, 11 cases respectively) 72h after delivery, the differences were statistically significant ( t value was 12.166, P value was 0.011). The parturients of sufficient lactation in the observation group (73 cases) were more than those in the control group (34 case),the differences was statistically significant ( χ 2 value was 30.570, P value was 0.000). The uterine fundus of the observation group decreased by (3.06±1.26) cm and (1.67 ±0.43) cm at 24h and 48h postnatally, which were better than those of the control group (1.97±0.92) cm and (1.23±0.18) cm,the differences were statistically significant ( t value was 3.162, P value was 0.002; t value was 2.689, P value was 0.009). In the process of heel blood collection after 72h of delivery in both groups, the pain scores of the observation group during and after blood collection were 4.92±0.33 and 2.37±1.27 respectively, which were lower than those of the control group (5.57±1.37 and 5.01±1.09), and the differences were statistically significant ( t value was 2.035, P value was 0.046; t value was 2.579, P value was 0.011). The heart rates of the observation group during and after blood collection were (121.36±22.13) and (142.55±23.91) beats/min, respectively, which were lower than (152.64±18.21) and (156.79±17.37) beats/min of the control group, the difference were statistically significant ( t value was 2.375, P value was 0.018; t value was 2.126, P value was 0.037). The blood oxygen saturation of the observation group during and after blood collection were 0.967 2±0.013 7 and 0.985 5 ±0.022 4 respectively, which were significantly higher than 0.891 7±0.116 5 and 0.914 5±0.137 8 of the control group ( t value was 2.036, P value was 0.046; t value was 2.017, P value was 0.047). Conclusions:The implementation of KMC can promote lactation, accelerate uterine involution, and relieve the pain of neonats during neonatal heel blood collection; Strengthening the health education of KMC can improve the cognition of parturients and their families about KMC, which has positive significance in promoting maternal and infant health and is worthy of clinical application.

OBJECTIVE：To study the effects of Calpeptin inhibitor Calpeptin on the transformation and stemness markers expression induced by estradiol（E2），and to investigate its mechanism. METHODS ：Taking human mammary epithelial cells MCF-10A as research object ，transformed cells were induced by E 2 treatment. Cells were divided into control group （0.1％DMSO）， E2-transformed group （50 nmol/L），E2-transformed+Calpeptin group （50 nmol/L E 2+1 μmol/L Calpeptin），then continuously treated with corresponding drug-containing culture medium for 15 generations. Then ，MTT assay was used to determine the proliferation rate of cells （24，48 h）；plate colony test was used to detect the Clone formation rate of cells ；the number of sphere-forming cells was measured by suspension spheroidization test ；mRNA expressions of stemness marker （CD44，Nanog，OCT4）and extracellular sigal-regulated kinase （ERK）were detected by RT-qPCR ，and protein expressions of CD 44，Nanog，OCT4 ，ERK and p-ERK were detected by Western blotting assay. Another E 2-transformed cells were divided into control group （0.1％DMSO）and U0126 （ERK inhibitor ）group（10 μmol/L）. Clone formation rate ，the number of sphere-forming ，protein expressions of CD 44，Nanog， OCT4，ERK and p-ERK were determined with above methods ，and to validate the relationship of ERK inhibition with transformed cell behavior and the expression of stemness markers. RESULTS ：Compared with control group ，proliferation rate and clone formation rate of E 2 transformed group were increased significantly （P＜0.01），and the number of sphere-forming was increased significantly（P＜0.01）；mRNA expression levels of CD 44，Nanog，OCT4，ERK and protein expression levels of CD 44，Nanog， OCT4 and p-ERK in cells were increased significantly （P＜0.01）. Compared with E 2-transformed group ，proliferation rate （24，48 h）and clone formation rate of E 2-transformed + Calpeptin group were decreased significantly （P＜0.01），and the number of sphere-forming was decreased significantly （P＜0.05）；mRNA expression levels of CD 44，Nanog，OCT4 ，ERK and protein expression levels of CD 44，Nanog，OCT4，p-ERK in cells were decreased significantly （P＜0.05 or P＜0.01）. After treated with ERK inhibitor U 0126，clone formation rate of E 2-transformed cells ，the number of sphere-forming ，protein expression levels of CD44，Nanog，OCT4 and p-ERK were increased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS ：Calpeptin can inhibit the transformation and the expression of stemness markers of human mammary epithelial cells MCF- 10A，and the mechanism of it may be associated with inhibiting the activation of Calpain-ERK signaling pathway.

Objective:To explore application values of action research practice in the out-of-hospital health management of patients with rectal cancer stoma.Methods:According to the convenience sampling method, 46 patients with rectal cancer stoma who were admitted to Nanyang Central Hospital of Henan Province from March 2017 to March 2018 before the implementation of the action research practice were selected as the control group and 46 patients with rectal cancer stoma who were admitted from April 2018 to April 2019 after the implementation of the action research practice were selected as the observation group. The control group was given routine nursing after surgery while the observation group was given action research practice nursing after surgery. Hamilton Anxiety Scale (HAMA) , Hamilton Depression Scale (HAMD) , Exercise of Self-Care Agency Scale (ESCA) and MOS 36-Item Short-Form Health Survey (SF-36) were used before and after implementation to compare the implementation effects between the two groups.Results:After nursing, scores of HAMA and HAMD in the observation group were respectively (15.65±10.31) points and (17.41±9.25) points, both lower than those in the control group and the differences were statistically significant ( t=2.181, 2.384; P<0.05) . After nursing, the total score of ESCA of the observation group and the control group were respectively (114.96±20.45) points and (100.28±16.80) points and the difference was statistically significant ( t=3.762, P<0.05) . After nursing, the overall health of SF-36 scale was (19.11.±5.08) points in the observation group and (17.11±4.12) points in the control group and the difference was statistically significant ( t=2.074, P<0.05) . Conclusions:Carrying out action research practice for out-of-hospital health management of patients with rectal cancer stoma can alleviate negative emotions and improve self-care ability and quality of life of patients, which has relatively high clinical application value.

Objective To investigate the learning curve of contrast-enhanced ultrasonography ( CEUS) in sentinel lymph node( SLN ) of breast cancer and provide a theoretical basis for leaners to learn SLN CEUS . Methods The multi-center study of SLN CEUS in breast cancer" was planned by Sichuan Cancer Hospital . According to the uniform inclusion and exclusion criteria , 511 patients with complete clinical data and follow-up results from 9 hospitals in Multi-center were included in this study . According to the inspection time ,the patients were divided into 3 groups named as group A ( 170 patients) ,group B ( 170 patients) and group C ( 171 patients ) ,respectively . The basic clinical data ,ultrasound imaging data , intraoperative and postoperative pathological findings of all patients were recorded . With the accumulation of cases examined ,analysis was performed to find the learning curve of the SLN CEUS examination time , SLN CEUS detection rate ,SLN CEUS surface marking accuracy rate and SLN CEUS diagnosis rate ,the learning curve was analyzed . Results ① There was no statistical significant difference in patients ages , tumors sizes ,tumors locations ,SLNs numbers and LCs numbers among the three groups( all P > 0 .05) . ②As the number of cases examined increases ,the examination time was reduced gradually ,but SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate were increased gradually( F = 151 .75 , 1 .96 ,7 .49 ,5 .50 ; P = 0 .000 ,0 .143 ,0 .001 ,0 .005 ) . Conclusions The skill of the doctor is improved gradually when learning SLN CEUS . With the number of the cases increase ,the operating time of SLN CEUS is shorted ,and the SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate of SLN-CEUS are gradually increased . It has an important clinical significance for beginners to learn the SLN CEUS technology .

Objective: To investigate the postoperative prognosis and the related factors of patients with stage pT2N0-1M0 of thoracic esophageal carcinoma(EC). Methods: From 2008 to 2011, clinical data of 275 cases with stage pT2N0-1M0 of thoracic EC treated by esophagectomy were enrolled. These cases includ 180 male and 95 female. Among them, 32 cases were upper thoracic EC, 186 cases were middle thoracic EC and 57 cases were lower thoracic EC. Alternatively, 205 cases were stage pN0, 70 cases were stage pN1. 155 cases received esophagectomy alone and 120 cases received esophagectomy and postoperative adjuvant therapy. Results: The end of follow-up time was on September 30th, 2014. The 1-, 3-, 5-year overall survival (OS) rates were 91.6%, 70.2% and 63.7%, respectively. The 1- 3-, 5-year progression-free survival (PFS) rates were 83.9%, 64.0% and 60.0%, respectively. The result of univariate analysis showed that the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with OS (all of P<0.05). Moreover, the gender, the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with PFS (all of P<0.05). Cox multivariate analysis showed that the location of primary tumor and pN stage were the independent factors of OS (both P<0.05). The gender, pN stage and postoperative adjuvant therapy were the independent factors of PFS (all of P<0.05). Conclusion Among the patients with pT2N0~1M0 stage of thoracic EC, patients with upper thoracic EC or pN1 stage have poorer postoperative prognosis compared with others, and postoperative adjuvant treatment is recommended for these patients.

INTRODUCTIONAn accurate assessment of peer victimisation (i.e. bullying) is a necessary precondition for research and intervention. Most assessment instruments use the 'list of acts' measurement strategy, which does not account for the actual physical and psychological damage inflicted by bullying. To resolve this limitation, this study developed a peer victimisation scale (PVS) that includes harmful consequences for judgement and measurement of peer victimisation.

METHODSThe PVS is a 40-item self-report questionnaire designed to assess the four aspects of peer victimisation: physical, verbal, relational, and interference and control. A total of 1,469 Grade 3-8 students (49.9% male) were recruited to test the psychometric properties of the PVS. Another 420 Grade 3-8 students were examined by a modified PVS supplemented with a semi-structured interview for scale validation and establishment of the cut-off points for severe bullying. Incidence, age and gender distribution of peer victimisation were also analysed.

RESULTSThe PVS demonstrated good internal consistency reliability (Cronbach's alpha 0.73-0.83) and test-retest reliability two weeks later (correlation coefficient [r] = 0.71-0.80). The scores for each dimension were significantly and positively correlated with the scores from the questionnaire-interview sample (r = 0.73-0.78), and modestly correlated with the scores for symptoms of anxiety and depression (r = 0.36-0.54).

CONCLUSIONThe results were consistent with the measurement constructs, demonstrating that the PVS is a reliable and effective instrument for assessing peer victimisation in children. It may enable more reliable longitudinal studies assessing the impact of peer victimisation to be conducted.

Behavior Therapy ; methods ; Bullying ; prevention & control ; Child ; Depression ; diagnosis ; Factor Analysis, Statistical ; Female ; Humans ; Male ; Peer Group ; Psychometrics ; methods ; standards ; Reproducibility of Results ; Social Behavior ; Students ; Surveys and Questionnaires

Objective To investigate the effect of different endoscopic sclerotherapy for esophageal variceal bleed-ing caused by rupture. Methods 66 cases of liver cirrhosis with esophageal variceal bleeding were randomly divided into treatment group A, endoscopic lauromacrogol sclerotherapy group B and endoscopic aethoxysklerol 1% German agents in treatment of group C, then observe the successful hemostasis, the curative effect and follow-up of patients with varices, bleeding, fever and other adverse conditions. Results Group B and group C with success rate of hemostasis has obvious advantages compared with group A, <0.05, the difference was statistically significant;total effective rate of group B was significantly higher than that in group A, < 0.05, the difference was statistically sig-nificant; early period of rebleeding, delayed again bleeding in group B was occurred less than that of group C, >0.05, the difference was not statistically significant; adverse conditions such as fever, ulcers, pain in group B was less than that in group C, <0.05, the difference was statistically significant. Conclusion Endoscopic lauromacrogol injection sclerotherapy for esophageal variceal bleeding is a safe, fast speed, timely, effective and repeatable treat-ment, it is worthy of promoting clinical application.