Aiming at the problems of low accuracy and large difference of segmentation boundary distance in anterior cruciate ligament (ACL) image segmentation of knee joint, this paper proposes an ACL image segmentation model by fusing dilated convolution and residual hybrid attention U-shaped network (DRH-UNet). The proposed model builds upon the U-shaped network (U-Net) by incorporating dilated convolutions to expand the receptive field, enabling a better understanding of the contextual relationships within the image. Additionally, a residual hybrid attention block is designed in the skip connections to enhance the expression of critical features in key regions and reduce the semantic gap, thereby improving the representation capability for the ACL area. This study constructs an enhanced annotated ACL dataset based on the publicly available Magnetic Resonance Imaging Network (MRNet) dataset. The proposed method is validated on this dataset, and the experimental results demonstrate that the DRH-UNet model achieves a Dice similarity coefficient (DSC) of (88.01±1.57)% and a Hausdorff distance (HD) of 5.16±0.85, outperforming other ACL segmentation methods. The proposed approach further enhances the segmentation accuracy of ACL, providing valuable assistance for subsequent clinical diagnosis by physicians.
Humans ; Magnetic Resonance Imaging/methods* ; Anterior Cruciate Ligament/diagnostic imaging* ; Image Processing, Computer-Assisted/methods* ; Knee Joint/diagnostic imaging* ; Neural Networks, Computer ; Algorithms ; Deep Learning

Objective:To observe the efficacy and safety of combined lienal polypeptide injection therapy in the treatment of Mycoplasma pneumoniae pneumonia（MPP）in children aged 3 to 14 years old in multiple clinical centers.Methods:A randomized，controlled，multi-center clinical study design was adopted.A total of 240 hospitalized children aged 3 to 14 years old with MPP from 7 hospitals from September 1，2023 to January 31，2024 were included.According to the severity of pneumonia，they were divided into the mild MPP group with 80 cases and the severe MPP/refractory MPP（SMPP/RMPP）group with 160 cases，and then randomly divided into the control group and the experimental group at a ratio of 1 ∶1，using the random number table method.After screening，subjects entered a treatment period of 5 to 7 days.The control group was treated with azithromycin，while the experimental group was treated with azithromycin plus lienal polypeptide injection .The recovery of lung CT，length of hospital stay，duration of fever，cough score，whether mild cases developed into severe or refractory cases，duration of hormone use，use of intravenous immunoglobulin（IVIG），bronchoscopy treatment，and immune function were observed between the two groups to evaluate the efficacy of lienal polypeptide injection.Adverse events after medication，vital signs，blood routine，urine routine，liver function，myocardial enzymes，renal function，and electrocardiogram were observed to evaluate the safety. Results:A total of 231 subjects have completed the trial in the 7 hospitals，including 118 cases in the experimental group and 113 cases in the control group.Main observation index：the rate of lung CT aggravation in the experimental group was lower than that in the control group（2.6% vs 15.3%， P<0.01），and the difference was statistically significant.Secondary indexes：there were no statistically significant differences in the length of hospital stay，duration of fever，cough score，duration of hormone use，whether IVIG treatment was used，the number of bronchoscopy treatment cases，and immunoglobulin between the two groups（all P>0.05）.However，the rate of cases of plastic bronchitis（PB）found under bronchoscopy in the experimental group was lower than that in the control group（0 vs 18.8%， P=0.03），and the difference was statistically significant.Among the mild MPP（72 cases），there were no statistically significant differences in the length of hospital stay，duration of fever，cough score，duration of hormone use，whether IVIG treatment was used，the number of bronchoscopy treatment cases，and the improvement rate of lung CT between the two groups（all P>0.05）.However，compared with the control group，the rate of cases developing into SMPP/RMPP in the experimental group was less（24.3% vs 48.6%， P=0.03），and the difference in IgG before and after treatment was small［0.53（-0.04，1.18）g/L vs 1.33（0.48，2.25）g/L， P=0.01］.Among the SMPP/RMPP cases（159 cases），the rate of cases of PB found under bronchoscopy in the experimental group was less than that in the control group（0 vs 20%， P=0.04），and the rate of cases with aggravated lung CT in the experimental group was less than that in the control group（1.3% vs 19.5%， P<0.01），and the improvement rate of lung CT in the experimental group was higher than that in the control group（88.8% vs 75.3%， P=0.03），with statistically significant differences.There were no statistically significant differences in the length of hospital stay，duration of fever，cough score，duration of hormone use，whether IVIG treatment was used，the number of bronchoscopy treatment cases，and immunoglobulin between the two groups（all P>0.05）.Two cases in the experimental group developed rashes，which improved after the drug was discontinued.There were no serious adverse reactions such as abnormal vital signs like dyspnea and cyanosis due to the use of lienal polypeptide injection.There were no obvious changes in blood routine，liver function，myocardial enzymes，renal function，electrocardiogram，and urine routine values before and after medication compared with the baseline. Conclusion:The combined use of lienal polypeptide injection in the treatment of MPP in children can reduce the probability of the transformation from mild cases to SMPP/RMPP，reduce the rate of aggravation of the image findings，promote the absorption of lung inflammation，reduce the rate of PB found under bronchoscopy，and has good safety.

Objective:To construct a training model for non-psychiatric psychological specialist nurses in general hospitals, providing reference for the selection, training, management, and evaluation of psychological specialist nurses.Methods:From November 2022 to April 2023, a preliminary draft of the training model for non-psychiatric psychological specialist nurses in general hospitals was developed through literature review and semi-structured interviews. From May to July 2023, the Delphi method was used to conduct two rounds of expert consultations with 29 experts from seven provinces and municipalities directly under the central government, including Shanxi, Beijing and Anhui, etc. Based on expert opinions, the final training model for non-psychiatric psychological specialist nurses in general hospitals was formed. The enthusiasm of experts was expressed by the questionnaire response rate, the degree of authority was expressed by the expert authority coefficient, and the degree of coordination of expert opinions was expressed by Kendall's coordination coefficient.Results:In two rounds of expert consultations, the questionnaire response rate was 100.00% (29/29) for both rounds, and the expert authority coefficients were 0.884 and 0.916, and Kendall's coordination coefficients were 0.085-0.203 and 0.084-0.228 (all P<0.05). The final training model for non-psychiatric psychological specialist nurses in general hospitals included five primary indicators of training objectives, training content, training methods, training process, and training evaluation, 22 secondary indicators, and 92 tertiary indicators. Conclusions:The training model for non-psychiatric psychological specialist nurses in general hospitals constructed is scientific and practical, and has guiding significance for the selection, training, assessment and evaluation of psychological specialist nurses in China.

Objective:To investigate the role and molecular mechanism of death receptor 5 (DR5) in early brain injury (EBI) after subarachnoid hemorrhage (SAH), as well as the neuroprotective effect of soluble DR5 (sDR5) on SAH.Methods:Experiment 1: SD rats were randomly divided into sham-operated group ( n=6) and SAH group (SAH model was established by carotid artery puncture, n=30), and the SAH group was further subdivided into post-SAH (6 h) group, post-SAH (12 h) group, post-SAH (24 h) group, post-SAH (48 h) group and post-SAH (72 h) group ( n=6); Western blotting was used to detect the expressions of tumor necrosis factor (TNF)-α and DR5; immunofluorescent DR5 and neuronal nuclear antigen (NeuN) double staining was used to evaluate the DR5 expression in neurons. Experiment 2: SD rats were randomly divided into sham-operated group, SAH group, Trail group (injected Trail agonist dordaviprone), and Trail+sDR5 group (injected dordaviprone+sDR5, n=6); at the 24 th h of successfully constructed SAH model, the caspase family protein levels were detected by Western blotting, and Tunel staining and immunofluorescent DR5 and Caspase-3 double staining were performed. Experiment 3: SD rats were divided into sham-operated group, SAH group, Trail group and Trail+sDR5 group ( n=6); long-term motor functions, by modified Gracia score, forelimb placement experiment, rotarod test and misstep experiment, were evaluated 5, 7 and 12 d after successfully constructed SAH model; and long-term learning and memory functions were detected by water maze experiment 14, 16, 18, 20 and 21 d after successfully constructed SAH model. Results:(1) Result of Experiment 1: the expressions of TNF-α and DR5 in sham-operated group, post-SAH (6 h) group, post-SAH (12 h) group, post-SAH (24 h) group, post-SAH (48 h) group and post-SAH (72 h) group were statistically different ( F=837.992, P<0.001; F=503.942, P<0.001), and these expressions peaked 24 h after SAH; immunofluorescent DR5 and NeuN double staining showed that DR5 was located in neurons after SAH. (2) Result of Experiment 2: compared with the SAH group and Trail group, the Trail+sDR5 group had significantly decreased levels of activated caspase-8, tBid and activated caspase-3, significantly decreased numbers of Tunel positive cells and DR5 and activated caspase-3 co-marked positive cells ( P<0.05). (3) Result of Experiment 3: compared with the SAH group and Trail group, the Trail+sDR5 group had significantly increased Garcia scores, decreased failure rate in forelimb placement experiment, prolonged duration of stick rotation, and decreased foot fault rate ( P<0.05), suggesting that sDR5 could improve the long-term motor function deficit after SAH; water maze experiment showed that 21 d after SAH, compared with the SAH group and Trail group, Trail+sDR5 group had significantly increased proportion of escape time in the original platform quadrat in total escape time and increased proportion of movement path in the original platform quadrat in total movement path after platform removal ( P<0.05), suggesting that sDR5 could improve long-term learning and memory impairment after SAH. Conclusion:The sDR5 can inhibit DR5-Trail-mediated neuronal apoptosis and improve long-term neurological functional deficits after SAH.

Objective To analyze the effects of Hual qi huang granules on children with mycoplasma pneumoniae pneumonia.Methods A randomized,multicenter parallel controlled clinical trial was carried out.A total of 3 000 cases of hospitalized children with mycoplasma pneumoniae pneumonia were selected.All of them were given treatment for mycoplasma pneumoniae pneumonia with macrolide antibiotics and symptomatic treatment.They were randomly divided into 2 groups:research group and control group.The children of research group were give oral Huai qi huang granules for three months.According to the classification of pneumonia,these two groups were divided into:lobar pneumonia research group,lobar pneumonia control group,lobular pneumonia research group,lobular pneumonia control group.The hospitalization duration of fever,length of hospital stay,the absorption area of lung inflammation and pneumonia severity sores were observed.The frequency of upper respiratory infections,bronchitis,pneumonia were observed in 3 months after discharge.Results 2 378 cases were investigated.The hospitalization duration of fever,length of hospital stay of research group were significantly shorter than that of in control group (P ＜ 0.001).The children with lobar pneumonia,2 weeks after treatment,the absorption of consolidation of the lobar pneumonia research group is significantly better than lobar pneumonia control group (P ＜0.001).After two weeks treatment,the pneumonia scores of lobar pneumonia research group is lower than lobar pneumonia control group (P ＜ 0.05).Followup of 3 months after hospital discharge,frequency of upper respiratory infection and bronchitis of research group,were significantly lower than that of control.In addition,appetite increased significantly in research group than control (P ＜ 0.001).There are 21 cases with drug associated adverse reactions (mild diarrhea),including 12 cases of research group,9 cases of control group,and there was no statistical significance (P ＞0.05).Conclusion Standard treatment combined with oral Huai qi huang granules in the treatment of mycoplasma pneumoniae pneumonia,can significantly shorten hospitalization duration of fever,length of hospital stay and reduce the severity score of pneumonia.Three months oral Huai qi huang granules can significant reduce the frequency of respiratory infections and bronchitis,also can increase patients appetite,and be safe.

Objective To explore the interaction of streptococcus suis serotype 2 recombinant suilysin ( SLY ) with platelets, and provide the theoretical basis for clinic treatment of patients infected with S.suis.Methods The nickel column affinity chromatography was used to purify the recombinant SLY.The hemolytic acivity was identified by optical density before the platelets aggregation induced by a SLY was detected by a platelet aggregometer or electron microscope and the effect of aspirin on platelets aggregation was analyzed.The impact of wild type 05ZYH33 and sly-deficient mutant strainΔSLY on platelets of mice was compared to predict the interaction of the SLY with platelets in vivo.Results and Conclusion Hemolytic activity of recombinant SLY was 2000 hemolytic units( HU) and platelets aggregation was induced at 1 μg/ml.The aggregation can be inhibited by aspirin in 5 mmol/L.SLY can also increase the volume and reduce the amount of platelets in mice.

Objective To analyze the efficacy and prognosis of different antiviral agents on compensated hepatitis B cirrhosis.Methods Eight hundred and sixty-five cases of Hepatitis B patients with compensated cirrhosis were randomly divided into five groups:A group(n =143,subcutaneous injection interferon 3 million U every other day for 48 weeks),B group(n =171,orally treatment with lamivudine 100 mg/d for 48weeks),C group(n =137,orally treatment with adefovir 10 mg/d for 48 weeks),D group(n =83,oral treatment with entecavir O.5 mg/d,for 48 weeks) and E group(n =331,treated with general hepatoprotective drugs).Clinical symptoms and signs,changes in liver function were observed and prothrombin time activity degrees (PTA),quantitative HBV-DNA,HBeAg seroconversion and HBeAg/HBeAb conversion situation were detected.Results There were significant differences on HBeAg seroconversion between A group and other four groups after treated for48 weeks(31.5％ vs 13.5％,22.6％,18.1％,5.7％,x2 =58.56,P ＜0.01) and at the end of follow up (33.1％ vs 14.2％,23.3 ％,23.6％,6.4％,x2 =52.87,P ＜ 0.01).Patients' condition in A,B,C,D groups progressed slowly,and their incidence rates of decompensate cirrhosis were significantly lower than that in group E(x2 =122.41,P ＜ 0.01).The incidence rate of liver cancer in group A was significantly lower than that in B,C,D,E groups (x2 =19.61,P ＜ 0.01).Conclusion Antiviral therapy of interferon and nucleoside drugs can slow the progression of compensated Hepatitis B cirrhosis and reduce the incidence rates of decompensate cirrhosis.And interferon can significantly reduce the incidence rate of liver cancer.

Objective To evaluate the effects of simulated family nursing on the cognitive function and activity of daily living in patients with Alzheimer's disease.Methods Sixty-eight patients with Alzheimer's disease were assigned to routine nursing condition and simulated family nursing condition.The patients were assessed with Mini-Mental State Examination (MMSE) and Activity of Daily Living Scale (ADL) before intervention,and 3 months and 6 months after intervention.Results Compared with the control group,the patients' cognitive function (t=2.31,P=0.026) and activity of daily living (t=2.59,P=0.012) were improved significantly in the experimental group.Conclusion The simulated family nursing can improve the cognitive function and activity of daily living in patients with Alzheimer's disease.