OBJECTIVE: To identify the optimal machine learning algorithm for predicting post-stroke epilepsy (PSE) within one year following acute stroke, establish a nomogram model based on this algorithm, and perform external validation to achieve accurate prediction of secondary epilepsy. METHODS: A total of 870 acute stroke patients admitted to the emergency department of Xiang'an Hospital of Xiamen University from June 2019 to June 2023 were enrolled for model development (model group). An external validation cohort of 435 acute stroke patients admitted to the Fifth Hospital of Xiamen during the same period was used to validate the machine learning algorithms and nomogram model. Patients were classified into control and epilepsy groups based on the development of PSE within one year. Clinical and laboratory data, including baseline characteristics, stroke location, vascular status, complications, hematologic parameters, and National Institutes of Health Stroke Scale (NIHSS) score, were collected for analysis. Nine machine learning algorithms such as logistic regression, CN2 rule induction, K-nearest neighbors, adaptive boosting, random forest, gradient boosting, support vector machine, naive Bayes, and neural network were applied to evaluate predictive performance. The area under the curve (AUC) of receiver operator characteristic curve (ROC curve) was used to identify the optimal algorithm. Logistic regression was used to screen risk factors for PSE, and the top 10 predictors were selected to construct the nomogram model. The predictive performance of the model was evaluated using the ROC curve in both the model and validation groups. RESULTS: Among the 870 patients in the model group, 29 developed PSE within one year. Among the nine algorithms tested, logistic regression demonstrated the best performance and generalizability, with an AUC of 0.923. Univariate logistic regression identified several risk factors for PSE, including platelet count, white blood cell count, red blood cell count, glycated hemoglobin (HbA1c), C-reactive protein (CRP), triglycerides, high-density lipoprotein (HDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen, creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), serum sodium, lactic acid, anion gap, NIHSS score, brain herniation, periventricular stroke, and carotid artery plaque. Further multivariate logistic regression analysis showed that white blood cell count, HDL, fibrinogen, lactic acid and brain herniation were independent risk factors [odds ratio (OR) were 1.837, 198.039, 47.025, 11.559, 70.722, respectively, all P < 0.05]. In the external validation group, univariate logistic regression analysis showed that platelet count, white blood cell count, CRP, triacylglycerol, APTT, D-dimer, fibrinogen, CK, CK-MB, LDH, NIHSS score, and cerebral herniation were risk factors for PSE one year after acute stroke. Further multiple logistic regression analysis showed that APTT and cerebral herniation were independent predictors (OR were 0.587 and 116.193, respectively, both P < 0.05). The nomogram model, constructed using 10 key variables-brain herniation, periventricular stroke, carotid artery plaque, white blood cell count, triglycerides, thrombin time, D-dimer, serum sodium, lactic acid, and NIHSS score-achieved an AUC of 0.908 in the model group and 0.864 in the external validation group. CONCLUSIONS The logistic regression-based prediction model for epilepsy one year after acute stroke, developed using machine learning algorithms, showed optimal predictive performance. The nomogram model based on the logistic regression-derived predictors showed strong discriminative power and was successfully validated externally, suggesting favorable clinical applicability and generalizability.
Humans ; Machine Learning ; Stroke/complications* ; Nomograms ; Epilepsy/etiology* ; Algorithms ; Male ; Female ; Logistic Models ; Middle Aged ; Aged ; Risk Factors ; Bayes Theorem

Objective:To construct a risk classification model for adverse events of medical consumables,so as to achieve automatic evaluation for risk level of such events,and enhance the capability for risk management of adverse events of medical consumables,and ensure the safety of medical apparatuses.Methods:The data of adverse events of medical consumables of 370 cases of 148 types that were reported by Shandong Provincial Third Hospital from 2020 to 2023 were selected,and they were divided into high-risk and low-risk types.Eight key factors of them,which included the number of cases,injury level,type of registration certificate,with source and without source,high-value and low-value,domestic and imports,product classification,and risk levels,were counted to form a dataset.K-nearest neighbor(KNN),support vector machine(SVM)and decision tree algorithms in machine learning were used to construct a risk classification model for adverse events of medical consumables.The data of 12 adverse events of medical consumables of 5 types of our hospital,which were newly reported in 2024,were integrated for their parameters.Then,the accuracy rate and prediction performance of the model were further analyzed.Results:By comparing the KNN,SVM and decision tree algorithm models,the effect of SVM algorithm model was better,and its accuracy rate was 90.54%,and its area under curve(AUC)value of the receiver operating characteristic(ROC)curve was 0.944,and its Kolmogorov-Smirnov(KS)test value was 0.808.The model had favorable predictive performance.The results,that invoked SVM algorithm model to conduct verification of actual prediction for 12 adverse events of medical consumables of 5 types,indicated it was same between predictive outcomes and risk levels of manual evaluation.Conclusion:The risk classification model of adverse events of medical consumables has established an operational model for assessing the risk level of such events,which can assist monitoring personnel for adverse event of medical apparatuses to quickly and accurately find risk signals of adverse events of medical consumables,and improve the monitoring capability of them for these adverse events.

Objective To learn the current status of informational development in public TCM hospitals in China,and to provide references for promoting the informational development.Methods It makes a comprehensive assessment of the informational level in 2 539 public TCM hospitals nationwide with comprehensive index method,and then analyse the index.Results(1)The construction rate of telemedicine systems in tertiary public TCM hospitals reached 76.96%,and the rate in secondary hospitals is 57.63%.(2)In terms of functional level of electronic medical record application,34.42%of tertiary public TCM hospitals failed to meet the requirement of Level 4,and 40.92%of secondary hospitals failed to meet the requirement of Level 3.In terms of Interconnection standardization maturity level,86.72%of tertiary public TCM hospitals failed to meet the requirement of Level 4.(3)The informational level is not balanced among different typesand different regions in tertiary public TCM hospitals.In secondary public TCM hospitals,there are differences among types of hospitals.Conclusion There are advantages on the development of Internet consultation and telemedicine systems in public TCM hospitals.The standardization of information may be a key factor that affect the lack of data connectivity and smart hospital management.There are differences in the level of informatization among different types of hospitals.So TCM hospitals is recommended to explore the way of development that suit for them.Some hospitalswell-developed should lead the way of development.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

Objective:To investigate the clinical features and prognosis of neonatal patients with congenital idiopathic vocal cord paralysis (VCP).Methods:A retrospective analysis was conducted on the general condition,clinical manifestations,auxiliary examinations,complications,treatment,and follow-up of 41 cases of congenital idiopathic VCP at the Neonatal Center,Xi'an Children's Hospital,from January 2018 to June 2023.Patients were divided into unilateral vocal cord paralysis (UVCP) and bilateral vocal cord paralysis (BVCP) groups based on the side of the affected vocal cord.The Fisher exact test or Mann-Whitney U test was employed to compare the follow-up indicators between the two groups. Results:A total of 41 cases (26 males,15 females) were included.All were full-term infants with a mean birth weight of (3 240.0±553.9) g.The median age at first visit was 3.0 (1.0,12.5) days.All 41 cases exhibited varying degrees of hoarseness,with 33 (80.5%) experiencing inspiratory stridor,10 (24.4%) having feeding difficulties,and 9 (22.0%) presenting with dyspnea and cyanosis.Serum vitamin D levels were found to be deficient or insufficient in 19 of 24 (79.2%) cases.Eighteen (43.9%) cases were misdiagnosed,and 4 (9.8%) cases were missed.Seven (17.1%) cases were complicated by laryngomalacia.Among the 33 (80.5%) cases in the UVCP group,30 (73.2%) exhibited left VCP and 3 (7.3%) had right VCP.Eight (19.5%) cases were classified in the BVCP group.Nine patients required respiratory support,with 2 undergoing tracheotomy.Ten patients with feeding difficulties received tube feeding,and some underwent swallowing and sucking training.A total of 37 (90.2%) cases were followed up for a median of 2 (1,5) months; 29 (78.4%) had no symptoms,4 (10.8%) showed symptom improvement,2 (5.4%) had persistent symptoms,and 2 (5.4%) died due to treatment interruption.The rates of symptom disappearance and improvement in the UVCP group were significantly higher than those in the BVCP group,while the rate of symptom persistence and mortality were significantly lower in the UVCP group (83.3% vs.57.1%,13.3% vs.0,0 vs.28.6%,3.3% vs.14.3%, P<0.05).No statistically significant difference was found between the two groups regarding the age of symptom disappearance ( P>0.05). Conclusion:Neonatal congenital idiopathic VCP is more prevalent among full-term infants,with most cases presenting hoarseness,vitamin D deficiency,and some associated with laryngomalacia.The condition is often misdiagnosed or missed,but most cases demonstrate a favorable prognosis.

Objective:To investigate the differences in protein profile expression in serum samples from children with corona virus disease 2019（COVID-19）related encephalopathy and to explore the underlying mechanisms.Methods:From December 1,2022 to January 31,2023,28 children with COVID-19 who were admitted to the Department of Pediatric Intensive Medicine at Shandong Provincial Hospital Affiliated to Shandong First Medical University were collected,including 21 patients with encephalopathy(COVID-19 with encephalopathy group) and seven patients without encephalopathy(COVID-19 without encephalopathy group).Three children from each group were selected for serum proteomic analysis using tandem mass spectrometry labeling proteomics technology.Proteins were considered significantly different if the fold change was >1.2 or <0.8，with P<0.05.Bioinformatics analysis，including Gene Ontology and Kyoto Encyclopedia of Genes and Genomes Pathway Enrichment were performed on differentially expressed proteins.Protein-protein interaction networks were analyzed using the STRING database.Selected proteins were further validated by enzyme-linked immunosorbert assay. Results:A total of 41 differentially expressed proteins were identified between the two groups.Among these，14 proteins were upregulated and 27 proteins were downregulated in COVID-19 patients with encephalopathy compared to those without encephalopathy.Bioinformatics analysis revealed that these proteins were primarily enriched in critical signaling pathways，including complement and coagulation regulation，neutrophil degranulation and activation，and platelet degranulation.Enzyme-linked immunosorbert assay validation confirmed significant differences in key coagulation-regulating proteins(von willebrand factor upregulated，serpin family F member 2 downregulated in COVID-19 patients with encephalopatly）between the two groups.Conclusion:Coagulation dysfunction may play a role in the development of COVID-19 associated encephalopathy in children，providing valuable insights for future research.

Objective To analyze the therapeutic effect and mechanism of Neferine(Nef)on psoriasis mice based on the nuclear factor E2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathway.Methods A mouse model of psoriasis was constructed.The 50 mice with successful modeling were divided into the model group,the L-Nef group,the M-Nef group,the H-Nef group,and the H-Nef+ML385 group,with 10 mice in each group according to random number table method.Additionally,10 normal mice were selected as the control group.The L-Nef group,M-Nef group and H-Nef group were respectively administered 5,10 and 20 mg/kg Nef by gavage.The H-Nef+ML385 group was administered 20 mg/kg Nef by gavage and intraperitoneally injected with 30 mg/kg Nrf2/HO-1 signaling pathway inhibitor ML385.The control group and the model group were given the same amount of normal saline.The changes of skin lesions in each group of mice were observed and the psoriasis area and severity index(PASI)scoring was conducted.HE staining and toluidine blue staining were used to observe the pathological changes of the skin and the number of mast cells in each group,and immunohistochemical staining was used to observe the expression of Ki-67 in the lesion sites of mice in each group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of inflammation and oxidative stress factors in the skin lesion tissues of mice in each group,and Western blot was used to detect the expression of Nrf2/HO-1 signaling pathway-related proteins in the skin lesion tissues of mice in each group.Results Compared with the control group,the mice in the model group presented symptoms such as skin erythema and scales,and the pathological changes of the skin lesion tissue were severe.The PASI score,the number of mast cells,Ki-67,tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),interleukin-6(IL-6),interleukin-17A(IL-17A),and malondialdehyde expressions were increased,while the expressions of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),Nrf2 and HO-1 were decreased(P<0.05).Compared with the model group,the symptoms such as skin erythema and scales and the pathological changes of skin lesion tissues in mice of the L-Nef group,M-Nef group and H-Nef group were alleviated,and the PASI score,the number of mast cells,the expressions of Ki-67,TNF-α,IFN-γ,IL-6,IL-17A and malondialdehyde were significantly reduced;however,the expressions of SOD,GSH-Px,Nrf2 and HO-1 were significantly increased(P<0.05).Compared with the H-Nef group,the symptoms such as skin erythema and scales and the pathological changes of skin lesion tissues in the H-Nef+ML385 group of mice were more severe.The PASI score,the number of mast cells,and the expressions of Ki-67,TNF-α,IFN-γ,IL-6,IL-17A,and malondialdehyde were significantly increased.while the expressions of SOD,GSH-Px,Nrf2 and HO-1 were significantly decreased(P<0.05).Conclusion Nef may have therapeutic effects by activating the Nrf2/HO-1 signaling pathway to improve the inflammation and oxidative stress responses in the lesion tissues of mice with psoriasis.

Objective To analyze the therapeutic effect and mechanism of Neferine(Nef)on psoriasis mice based on the nuclear factor E2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathway.Methods A mouse model of psoriasis was constructed.The 50 mice with successful modeling were divided into the model group,the L-Nef group,the M-Nef group,the H-Nef group,and the H-Nef+ML385 group,with 10 mice in each group according to random number table method.Additionally,10 normal mice were selected as the control group.The L-Nef group,M-Nef group and H-Nef group were respectively administered 5,10 and 20 mg/kg Nef by gavage.The H-Nef+ML385 group was administered 20 mg/kg Nef by gavage and intraperitoneally injected with 30 mg/kg Nrf2/HO-1 signaling pathway inhibitor ML385.The control group and the model group were given the same amount of normal saline.The changes of skin lesions in each group of mice were observed and the psoriasis area and severity index(PASI)scoring was conducted.HE staining and toluidine blue staining were used to observe the pathological changes of the skin and the number of mast cells in each group,and immunohistochemical staining was used to observe the expression of Ki-67 in the lesion sites of mice in each group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of inflammation and oxidative stress factors in the skin lesion tissues of mice in each group,and Western blot was used to detect the expression of Nrf2/HO-1 signaling pathway-related proteins in the skin lesion tissues of mice in each group.Results Compared with the control group,the mice in the model group presented symptoms such as skin erythema and scales,and the pathological changes of the skin lesion tissue were severe.The PASI score,the number of mast cells,Ki-67,tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),interleukin-6(IL-6),interleukin-17A(IL-17A),and malondialdehyde expressions were increased,while the expressions of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),Nrf2 and HO-1 were decreased(P<0.05).Compared with the model group,the symptoms such as skin erythema and scales and the pathological changes of skin lesion tissues in mice of the L-Nef group,M-Nef group and H-Nef group were alleviated,and the PASI score,the number of mast cells,the expressions of Ki-67,TNF-α,IFN-γ,IL-6,IL-17A and malondialdehyde were significantly reduced;however,the expressions of SOD,GSH-Px,Nrf2 and HO-1 were significantly increased(P<0.05).Compared with the H-Nef group,the symptoms such as skin erythema and scales and the pathological changes of skin lesion tissues in the H-Nef+ML385 group of mice were more severe.The PASI score,the number of mast cells,and the expressions of Ki-67,TNF-α,IFN-γ,IL-6,IL-17A,and malondialdehyde were significantly increased.while the expressions of SOD,GSH-Px,Nrf2 and HO-1 were significantly decreased(P<0.05).Conclusion Nef may have therapeutic effects by activating the Nrf2/HO-1 signaling pathway to improve the inflammation and oxidative stress responses in the lesion tissues of mice with psoriasis.

Objective:To investigate the clinical features and prognosis of neonatal patients with congenital idiopathic vocal cord paralysis (VCP).Methods:A retrospective analysis was conducted on the general condition,clinical manifestations,auxiliary examinations,complications,treatment,and follow-up of 41 cases of congenital idiopathic VCP at the Neonatal Center,Xi'an Children's Hospital,from January 2018 to June 2023.Patients were divided into unilateral vocal cord paralysis (UVCP) and bilateral vocal cord paralysis (BVCP) groups based on the side of the affected vocal cord.The Fisher exact test or Mann-Whitney U test was employed to compare the follow-up indicators between the two groups. Results:A total of 41 cases (26 males,15 females) were included.All were full-term infants with a mean birth weight of (3 240.0±553.9) g.The median age at first visit was 3.0 (1.0,12.5) days.All 41 cases exhibited varying degrees of hoarseness,with 33 (80.5%) experiencing inspiratory stridor,10 (24.4%) having feeding difficulties,and 9 (22.0%) presenting with dyspnea and cyanosis.Serum vitamin D levels were found to be deficient or insufficient in 19 of 24 (79.2%) cases.Eighteen (43.9%) cases were misdiagnosed,and 4 (9.8%) cases were missed.Seven (17.1%) cases were complicated by laryngomalacia.Among the 33 (80.5%) cases in the UVCP group,30 (73.2%) exhibited left VCP and 3 (7.3%) had right VCP.Eight (19.5%) cases were classified in the BVCP group.Nine patients required respiratory support,with 2 undergoing tracheotomy.Ten patients with feeding difficulties received tube feeding,and some underwent swallowing and sucking training.A total of 37 (90.2%) cases were followed up for a median of 2 (1,5) months; 29 (78.4%) had no symptoms,4 (10.8%) showed symptom improvement,2 (5.4%) had persistent symptoms,and 2 (5.4%) died due to treatment interruption.The rates of symptom disappearance and improvement in the UVCP group were significantly higher than those in the BVCP group,while the rate of symptom persistence and mortality were significantly lower in the UVCP group (83.3% vs.57.1%,13.3% vs.0,0 vs.28.6%,3.3% vs.14.3%, P<0.05).No statistically significant difference was found between the two groups regarding the age of symptom disappearance ( P>0.05). Conclusion:Neonatal congenital idiopathic VCP is more prevalent among full-term infants,with most cases presenting hoarseness,vitamin D deficiency,and some associated with laryngomalacia.The condition is often misdiagnosed or missed,but most cases demonstrate a favorable prognosis.

Objective:To investigate the differences in protein profile expression in serum samples from children with corona virus disease 2019（COVID-19）related encephalopathy and to explore the underlying mechanisms.Methods:From December 1,2022 to January 31,2023,28 children with COVID-19 who were admitted to the Department of Pediatric Intensive Medicine at Shandong Provincial Hospital Affiliated to Shandong First Medical University were collected,including 21 patients with encephalopathy(COVID-19 with encephalopathy group) and seven patients without encephalopathy(COVID-19 without encephalopathy group).Three children from each group were selected for serum proteomic analysis using tandem mass spectrometry labeling proteomics technology.Proteins were considered significantly different if the fold change was >1.2 or <0.8，with P<0.05.Bioinformatics analysis，including Gene Ontology and Kyoto Encyclopedia of Genes and Genomes Pathway Enrichment were performed on differentially expressed proteins.Protein-protein interaction networks were analyzed using the STRING database.Selected proteins were further validated by enzyme-linked immunosorbert assay. Results:A total of 41 differentially expressed proteins were identified between the two groups.Among these，14 proteins were upregulated and 27 proteins were downregulated in COVID-19 patients with encephalopathy compared to those without encephalopathy.Bioinformatics analysis revealed that these proteins were primarily enriched in critical signaling pathways，including complement and coagulation regulation，neutrophil degranulation and activation，and platelet degranulation.Enzyme-linked immunosorbert assay validation confirmed significant differences in key coagulation-regulating proteins(von willebrand factor upregulated，serpin family F member 2 downregulated in COVID-19 patients with encephalopatly）between the two groups.Conclusion:Coagulation dysfunction may play a role in the development of COVID-19 associated encephalopathy in children，providing valuable insights for future research.