Objective To develop an automatic segmentation network for thyroid nodules by integrating wavelet transform and CNN-Transformer in order to improve the efficiency and accuracy of ultrasound image segmentation.Methods A total of 1 371 sets of ultrasound images of thyroid nodules were collected from Department of Ultrasonography of Second Affiliated Hospital of Army Medical University between May 2023 and February 2024.After preprocessing and normalization,the data were divided into training,validation,and testing sets in a ratio of 8∶1∶1.Based on UNet,CNN and Swin-Transformer were used in parallel as the encoder,with a wavelet transform module inserted between the encoder and decoder to construct a thyroid nodule segmentation network.The performance of the segmentation model was evaluated on the collected internal dataset using accuracy,IoU,and Dice coefficient metrics.Results The finally verified 1 371 sets of ultrasonic thyroid nodules had an average Dice coefficient of 79.63%and an IoU of 67.30%.Compared with UNet,the segmentation accuracy was improved by 1.02%.The segmentation model obtained accurate location and smooth edges of thyroid nodules,and the segmentation was more consistent in thyroid nodule edge and morphology with those marked by doctors manually when compared with other segmentations.Compared with UNet,this segmentation method can learn the texture of nodules more fully and avoid the situation that nodules had been incorrectly divided into surrounding tissues.Conclusion Our developed segmentation model based on wavelet transform and CNN-Transformer demonstrates better segmentation accuracy in comparison to conventional UNet variants,such as UNet,Attention-UNet,and UNetv2,and medical segment anything models like SAM Med2D.This segmentation method enables accurate segmentation of ultrasound thyroid nodules,thereby enhancing clinical workflow efficiency through automated precise delineation.

Objective To investigate the clinical application value of MRI Radiomics score(Radscore)combined with clinicopatho-logical features in predicting postoperative progression-free survival(PFS)of patients with endometrial cancer(EC).Methods A total of 127 patients with EC were selected.The radiomic features of the lesions were extracted from T2 WI,diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)images.The features were screened by random forest model and Radscore was calcu-lated.Simultaneously,clinical and pathological characteristics of patients were collected and incorporated,and multivariate Cox regression analysis was used to screen the risk factors related to PFS.The MRI Radscore and clinicopathological features were mapped to the nomogram,and the performance of nomogram was evaluated by receiver operating characteristic(ROC)curve and calibration curve.Results Multivariate Cox regression analysis showed that progesterone receptor(PR),human epididymis protein 4(HE4)and MRI Radscore were independent risk factors for predicting PFS in patients with EC(P＜0.05).The area under the curve(AUC)of the predicted PFS at 1,3 and 5 years after surgery were 0.91,0.804 and 0.776,respectively.Calibration curves showed that nomogram had a good fit in predicting PFS in patients with EC 1,3 and 5 years after surgery.Conclusion The nomogram con-structed based on multi-sequence MRI Radscore and clinicopathological features has favorable accuracy and stability in predicting postoperative PFS in individuals diagnosed with EC.

Objective:To explore the relationship between the clinical outcome of emotional symptoms and cognitive performance and related cerebral oxygenated hemoglobin in adolescents with depression.Methods:Through subject recruitment, 46 adolescent patients with depression (patient group) from the First Hospital of Shanxi Medical University were selected as the subjects for this study from December 2020 to December 2021, including 8 males and 38 females, aged 12-18 (15.7±2.3) years old. All patients received sertraline treatment for 8 weeks and were further followed into responders ( n=24) and non-responders ( n=22) according to the outcome of emotional symptoms. In the meantime, 51 healthy controls (control group) were enrolled, including 7 males and 44 females, aged 12-18 (16.1±1.5) years old. The repeatable battery for the assessment of neuropsychological status (RBANS) was conducted to measure the multi-dimensional neurocognitive performance, and the functional near-infrared spectroscopy (fNIRS) was used to assess changes in the concentration of oxyhemoglobin (HBO) during the verbal fluency test. The differences were compared in multi-dimensional cognitive performance and cerebral HBO level between each patient group and control group and between responders and non-responders. The changes were analyzed in cognitive performance and cerebral HBO level after intervention in responders and non-responders. Results:At baseline, compared to the control group, the patient group performed decreased scores of RBANS, immediate memory, speech function, attention, and delayed memory (88.0 (82.8, 100.0) M ( Q1, Q3) vs. 100.0 (90.0, 110.0) scores; 78.0 (73.0, 87.8) vs.85.0 (78.0, 94.0) scores; (84.4±16.1) vs. (95.7±15.7) scores; 106.0 (99.5, 115.0) vs.118.0 (109.0, 128.0) scores; 94.0 (84.5, 99.0) vs.97.0 (91.0, 101.0) scores), and lower HBO levels in 7 channels (all P<0.05). Compared to responders, non-responders showed more severe impairment of visual-spatial and attention performance (103.9±11.0 vs. 94.4±16.7 scores; 112.5±12.1 vs. 98.0±21.2 scores) ( t=2.30 or 2.87; all P<0.05). After treatment, the scores of RBANS and immediate memory improved significantly in responders (98.8±11.2 vs. 93.0±9.7 scores; 95.2±13.8 vs.83.0±14.6 scores) ( t=-3.00 or-4.97; both P<0.05), but the scores of attention and the HBO level of two channels in the prefrontal cortex were still significantly lower than those of the control group (Z=2.27, 3.02 or 3.04; all P<0.05). Besides, there were no significant differences in the scores of immediate memory and the HBO levels of 3 channels in the temporal lobe between the no-responders and the control group (all P>0.05). Conclusion:Immediate memory injure, attention injure and HBO levels of frontal-temporal lobes may be independent of emotional symptoms among adolescents with depression.

Objective:To explore the relationship between the clinical outcome of emotional symptoms and cognitive performance and related cerebral oxygenated hemoglobin in adolescents with depression.Methods:Through subject recruitment, 46 adolescent patients with depression (patient group) from the First Hospital of Shanxi Medical University were selected as the subjects for this study from December 2020 to December 2021, including 8 males and 38 females, aged 12-18 (15.7±2.3) years old. All patients received sertraline treatment for 8 weeks and were further followed into responders ( n=24) and non-responders ( n=22) according to the outcome of emotional symptoms. In the meantime, 51 healthy controls (control group) were enrolled, including 7 males and 44 females, aged 12-18 (16.1±1.5) years old. The repeatable battery for the assessment of neuropsychological status (RBANS) was conducted to measure the multi-dimensional neurocognitive performance, and the functional near-infrared spectroscopy (fNIRS) was used to assess changes in the concentration of oxyhemoglobin (HBO) during the verbal fluency test. The differences were compared in multi-dimensional cognitive performance and cerebral HBO level between each patient group and control group and between responders and non-responders. The changes were analyzed in cognitive performance and cerebral HBO level after intervention in responders and non-responders. Results:At baseline, compared to the control group, the patient group performed decreased scores of RBANS, immediate memory, speech function, attention, and delayed memory (88.0 (82.8, 100.0) M ( Q1, Q3) vs. 100.0 (90.0, 110.0) scores; 78.0 (73.0, 87.8) vs.85.0 (78.0, 94.0) scores; (84.4±16.1) vs. (95.7±15.7) scores; 106.0 (99.5, 115.0) vs.118.0 (109.0, 128.0) scores; 94.0 (84.5, 99.0) vs.97.0 (91.0, 101.0) scores), and lower HBO levels in 7 channels (all P<0.05). Compared to responders, non-responders showed more severe impairment of visual-spatial and attention performance (103.9±11.0 vs. 94.4±16.7 scores; 112.5±12.1 vs. 98.0±21.2 scores) ( t=2.30 or 2.87; all P<0.05). After treatment, the scores of RBANS and immediate memory improved significantly in responders (98.8±11.2 vs. 93.0±9.7 scores; 95.2±13.8 vs.83.0±14.6 scores) ( t=-3.00 or-4.97; both P<0.05), but the scores of attention and the HBO level of two channels in the prefrontal cortex were still significantly lower than those of the control group (Z=2.27, 3.02 or 3.04; all P<0.05). Besides, there were no significant differences in the scores of immediate memory and the HBO levels of 3 channels in the temporal lobe between the no-responders and the control group (all P>0.05). Conclusion:Immediate memory injure, attention injure and HBO levels of frontal-temporal lobes may be independent of emotional symptoms among adolescents with depression.

Objective:To search, evaluate and summarize the evidence on prediabetes management in high-risk population with gestational diabetes mellitus (GDM).Methods:Two researchers independently screened the evidence according to the inclusion criteria and exclusion criteria. The quality of the included evidence was evaluated by the clinical guideline research and evaluation system (AGREE Ⅱ). The quality of the evidence and the strength of recommendation were graded by the GRADE system. According to the clinical nursing practice guidelines for gestational diabetes mellitus, the recommendations for GDM high-risk groups were extracted.Results:A total of 14 pieces of evidence were included, including 4 guidelines, 2 consensus, 5 practice guidelines and 3 diagnosis and treatment standards. 29 pieces of recommendations for prediabetes management of high-risk population with gestational diabetes mellitus were summarized from five aspects, including disease risk assessment, prenatal examination guidance, management objectives of gestational weight and blood glucose, diet guidance and exercise guidance.Conclusion:The evidence of prediabetes management of high-risk population with gestational diabetes mellitus is scientific and reliable.

This study aimed to evaluate the efficacy of Chinese herbal medicine (CHM) in patients with severe/critical coronavirus disease 2019 (COVID-19). In this retrospective study, data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20, 2020. All patients were divided into an exposed group (CHM users) and a control group (non-users). After propensity score matching in a 1:1 ratio, 156 CHM users were matched by propensity score to 156 non-users. No significant differences in seven baseline clinical variables were found between the two groups of patients. All-cause mortality was reported in 13 CHM users who died and 36 non-users who died. After multivariate adjustment, the mortality risk of CHM users was reduced by 82.2% (odds ratio 0.178, 95% CI 0.076-0.418; P < 0.001) compared with the non-users. Secondly, age (odds ratio 1.053, 95% CI 1.023-1.084; P < 0.001) and the proportion of severe/critical patients (odds ratio 0.063, 95% CI 0.028-0.143; P < 0.001) were the risk factors of mortality. These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.
Age Factors ; Aged ; COVID-19/therapy* ; China ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Odds Ratio ; Propensity Score ; Retrospective Studies ; Survival Rate

Objective: To investigate the levels of NK cells and their relevant cytokines (IL-10, TGF-β and IFN-γ) in patients with primary immune thrombocytopenia (ITP) . Methods: All samples were obtained from 42 patients (22 newly diagnosed and 20 in remission) and 20 healthy volunteers. The levels of IL-10 and IFN-γ in blood serum were detected by enzyme-linked immunosorbent assay (ELISA) . The percentage of CD3^- CD56⁺ NK cell, CD3^- CD56^bright CD16^- NK cell, CD3^- CD56^dim CD16⁺ NK cell in peripheral blood lymphocyte were detected by flow cytometry. The NK cells were isolated by immunomagnetic microbeads. The mRNA expression levels of IL-10, TGF-β, and IFN-γ in NK cells were detected by real-time fluorescent quantitative PCR. Correlation between the above measured results was analyzed. Results: ① The blood serum level of IFN-γ in newly diagnosed ITP patients [ (653.0±221.6) ng/L] was higher than that in remission ITP patients [ (484.4±219.5) ng/L] and healthy control [ (390.9±253.5) ng/L] (P=0.022, P=0.001) . The blood serum level of IL-10 in newly diagnosed ITP patients was lower than that in healthy control [ (52.09±26.66) ng/L vs (79.44±38.43) ng/L, P=0.007]. ②The percentage of NK cell in newly diagnosed and remission ITP patients [ (9.53±3.93) %, (9.03±3.78) %] were significantly lower than that in healthy control [ (13.72±7.42) %] (P=0.013, P=0.007) . The ratio of CD3^- CD56^bright CD16^- NK cell/total NK cells in newly diagnosed ITP patients was higher than that in healthy control [ (6.85±4.43) % vs (4.05±2.81) %, P=0.032]. The ratio of CD3^-CD56^dim CD16^- NK cell/total NK cells in newly diagnosed ITP patients was lower than that in healthy control [ (93.14±4.43) % vs (95.94±2.81) %, P=0.032]. ③ There was no significant difference in the mRNA expression level of IFN-γ in NK cells of ITP patients and healthy control (all P>0.05) . The mRNA expression levels of IL-10 and TGF-β in NK cells in newly diagnosed ITP patients were significantly higher than that in healthy control (1.82±1.32 vs 1.02±1.03, P=0.023; 2.80±2.31 vs 1.46±1.37, P=0.028) . The ratio of CD3^-CD56^bright CD16^- NK cell/total NK cells was positively correlated with the mRNA expression levels of IL-10, TGF-β in NK cells (r=0.424, P=0.001; r=0.432, P<0.001) . Conclusion NK cells may compensate for the deficiency of the number by enhancing the secretion of negative regulation cytokines, acting as "protective" roles in the disease.

Objective To investigate the prompt value of abnormal vaginal morphology on diagnosing pelvic organ prolapse . Methods Forty eight pelvic organ prolapse female patients diagnosed by pelvic organ prolapse quantification were enrolled in the pelvic organ prolapse group and 51 normal female volunteers were enrolled in the control group in this study. Pelvic MRI T2WI were performed in all cases. The vaginal shape were evaluated according to Delancey Ⅱ level on the transverse images, which were divided into two categories:normal morphology (H-shaped) and abnormal morphology(non H-shaped). The vaginal shape distribution of different prolapse degree(0,Ⅰ,Ⅱ,Ⅲ,Ⅳstage) and types(anterior,middle, posterior pelvic prolapse) were recorded. Chi-square test was used to analyse distribution difference of vaginal shape between the two groups. The ROC curve was used to analyse the diagnostic efficiency of abnormal vaginal morphology for diagnosing pelvic organ prolapse. Results In the control group, there were 40 cases with normal vaginal morphology and 11 cases with abnormal morphology mainly including W-shaped and U-shaped abnormal morphology. In the prolapse group, there were 5 cases with normal vaginal morphology and 43 cases with abnormal morphologymainly including U-shaped (13 cases), W-shaped (26 cases) and O-shaped(4 cases) abnormal morphology. There was significant difference between the two groups(c2=46.137,P<0.01). The area under the curve (AUC) was 0.800. The sensitivity and specificity of abnormal vaginal shape for diagnosing pelvic organ prolapse were 89.6% and 78.4%respectively.The distribution of vaginal morphology in different degrees and types of prolapse were different:vaginal morphology of 0 stage prolapse showed H-typed mainly (40/51, 78.4%), Ⅰ stage prolapse showed W-shaped (16/28 57.1%), Ⅱ,Ⅲ stage prolapse all showed non H-shaped (20/20, 100%), Ⅱstage mainly showed W-shaped (9/14), Ⅲ stage mainly showed O-shaped (3/6). Anterior pelvic organ prolapse were manifested mainly with W-shaped vaginal morphology (4/9) and middle pelvic organ prolapse mainly showed O-shaped vaginal morphology (4/7). Conclusions The abnormal vaginal morphology has the prompt value on diagnosing pelvic organ prolapse.Moreover, the different shape probably indicates the different degrees and types of pelvic organ prolapse.

Objective To investigate MR T2-mapping in evaluating birth-related levator ani muscle injury.Methods 25 primiparas at 6 weeks after first vaginal delivery as primiparous group and 12 nulliparous volunteers as control group were prospectively studied. All the subjects underwent pelvic MRI including T2-mapping,mDIXON-T2 WI sequences.Levator ani muscle were divided into two subgroups:levator ani muscle injury group and non-injury group according to if there were edema,avulsion,or rupture in each levator ani muscle subdivisions[puborectal muscle(PRM);iliococcygeal muscle(ICM)],which were showed on mDIXON-T2 WI images.Two radiologists evaluated T2 values of PRM,ICM and observed artificial color images respectively.The consistency between two observers for T2 values of PRM,ICM were evaluated using the intraclass correlation coefficient (ICC ),the difference of T2 values in each levator ani muscle subdivisions among control group,non-injury group and muscle injury group were analyzed using ANOVA .Results There were 26 PRM injury cases and 24 non-injury cases in primiparous group on mDIXON-T2 WI images,and no ICM injured cases in our study.Inter-rater reliability for T2 values between two observers were good(ICC >0.75).T2 values in PRM injury group,non-injury group and control group were(62.78±1.23)ms,(49.75±3.17)ms,(49.96±4.37)ms respectively and the difference was significant. There were significant difference between PRM injury group and non-injury group,control group respectively(P =0.000,P =0.000). The T2 values of ICM in PRM injury group,non-injury group and control group were(70.80±6.50)ms,(62.41±7.32)ms,(62.78±6.91)ms and there were significant difference(P =0.000),meanwhile the difference between PRM injury group and non-injury group,control group were significant respectively(P =0.000,P =0.000).The color gradation of PRM in PRM injury group were mixed with blue, green,and yellow,and tone were lightened on T2-mapping artificial color images;ICM color gradation were uneven with green and yellow, a d tone were higher than those of control group and non-injurygroup.Conclusion T2-mapping can quantitatively assess birth-related levator ani muscle injury and T2-mapping artificial color images show the range and degree of levator ani muscle injury visually.It is hopeful to find micro lesions that T2 WI images are difficult to find.

Chronic Disease ; Cresols ; toxicity ; Humans ; Multiple Organ Failure ; chemically induced