Objective To construct a machine learning prediction model for diabetic kidney disease(DKD)in type 2 diabetes mellitus(T2DM)patients in the plain-sand and loess hilly areas of Gansu Province,and analyze the interpretability of the model.Methods A multi-stage stratified random sampling method was used to collect the data of T2DM patients in the two areas.After key feature screening,eight ML prediction models were constructed for the risk of DKD in the two areas.The receiver operating characteristic(ROC)curve,accuracy and F1 index were used to evaluate the model,and Shapley additive explanation(SHAP)algorithm was used for model interpretation.Results A total of 1599 patients with T2DM were enrolled in this study.After feature screening,ten variables were selected for model construction in the plain-sand areas.Among the eight models,the gradient boosting decision tree(GBDT)model had the highest prediction efficiency.The area under the curve(AUC)of the test dataset was 0.972,the accuracy was 0.949,and the F1 index was 0.884.In the loess hilly region,12 variables were included in the model,and the best model was the random forest(RF).The AUC of the test set was 0.966,the accuracy was 0.951,and the F1 index was 0.861.SHAP analysis showed that in addition to serum creatinine,age,LDL-C,HbA1c,DM duration,serum uric acid and urinary microalbumin were also closely related to the high risk of DKD.Conclusions The GBDT and RF models have good predictive efficiency for the occurrence of DKD in the two areas,which can be used for the screening of DKD high-risk populations and the in-depth exploration of potential risk factors in the two areas.

Objective:To explore the categories and influencing factors of depression in mild cognitive impairment (MCI) patients, so as to provide a reference for formulating precise interventions for depression in MCI patients.Methods:A cross-sectional investigation was conducted. Patients with MCI admitted to the Department of Neurology, The First Affiliated Hospital of Nanchang University from December 2022 to December 2023 were selected as the investigation objects by convenience sampling method. The general data questionnaire, Hamilton Depression Rating Scale-17, Montreal Cognitive Assessment Scale and Lubben Social Network Scale-6 were used to conduct a survey. Latent profile analysis and multiple Logistic regression analysis were used to explore the categories and influencing factors of depression.Results:A total of 537 patients with MCI were included, including 335 females and 202 males, aged (65.72 ± 9.53) years old. MCI patients scored (22.67 ± 4.68) points on the Montreal Cognitive Assessment Scale, (13.27 ± 5.73) points on the Lubben Social Network Scale-6, and 9.00 (5.00, 13.00) points on the Hamilton Depression Rating Scale-17. The depression in MCI patients could be divided into three categories: low risk depression (67.8%, 364/537), low depression-sleep disorder (20.1%, 108/537), and high depression-anxiety (12.1%, 65/537). The multiple Logistic regression analysis showed that gender, education, living style, social isolation and cognitive function were the influencing factors for different categories of depression ( OR values were 0.443-2.921, all P<0.05). Conclusions:There are individual differences in depression in patients with MCI, and precise intervention should be implemented according to the characteristics of different categories of depression.

Objective To construct a machine learning prediction model for diabetic kidney disease(DKD)in type 2 diabetes mellitus(T2DM)patients in the plain-sand and loess hilly areas of Gansu Province,and analyze the interpretability of the model.Methods A multi-stage stratified random sampling method was used to collect the data of T2DM patients in the two areas.After key feature screening,eight ML prediction models were constructed for the risk of DKD in the two areas.The receiver operating characteristic(ROC)curve,accuracy and F1 index were used to evaluate the model,and Shapley additive explanation(SHAP)algorithm was used for model interpretation.Results A total of 1599 patients with T2DM were enrolled in this study.After feature screening,ten variables were selected for model construction in the plain-sand areas.Among the eight models,the gradient boosting decision tree(GBDT)model had the highest prediction efficiency.The area under the curve(AUC)of the test dataset was 0.972,the accuracy was 0.949,and the F1 index was 0.884.In the loess hilly region,12 variables were included in the model,and the best model was the random forest(RF).The AUC of the test set was 0.966,the accuracy was 0.951,and the F1 index was 0.861.SHAP analysis showed that in addition to serum creatinine,age,LDL-C,HbA1c,DM duration,serum uric acid and urinary microalbumin were also closely related to the high risk of DKD.Conclusions The GBDT and RF models have good predictive efficiency for the occurrence of DKD in the two areas,which can be used for the screening of DKD high-risk populations and the in-depth exploration of potential risk factors in the two areas.

Objective:To explore the categories and influencing factors of depression in mild cognitive impairment (MCI) patients, so as to provide a reference for formulating precise interventions for depression in MCI patients.Methods:A cross-sectional investigation was conducted. Patients with MCI admitted to the Department of Neurology, The First Affiliated Hospital of Nanchang University from December 2022 to December 2023 were selected as the investigation objects by convenience sampling method. The general data questionnaire, Hamilton Depression Rating Scale-17, Montreal Cognitive Assessment Scale and Lubben Social Network Scale-6 were used to conduct a survey. Latent profile analysis and multiple Logistic regression analysis were used to explore the categories and influencing factors of depression.Results:A total of 537 patients with MCI were included, including 335 females and 202 males, aged (65.72 ± 9.53) years old. MCI patients scored (22.67 ± 4.68) points on the Montreal Cognitive Assessment Scale, (13.27 ± 5.73) points on the Lubben Social Network Scale-6, and 9.00 (5.00, 13.00) points on the Hamilton Depression Rating Scale-17. The depression in MCI patients could be divided into three categories: low risk depression (67.8%, 364/537), low depression-sleep disorder (20.1%, 108/537), and high depression-anxiety (12.1%, 65/537). The multiple Logistic regression analysis showed that gender, education, living style, social isolation and cognitive function were the influencing factors for different categories of depression ( OR values were 0.443-2.921, all P<0.05). Conclusions:There are individual differences in depression in patients with MCI, and precise intervention should be implemented according to the characteristics of different categories of depression.

Objective:To explore the surgical effects of continuous trapezoidal suture method between subcutaneous and subconjunctival tissue in buried-suture double-eyelid blepharoplasty.Methods:A retrospective study was conducted on patients who underwent the operation of continuous trapezoidal suture method between subcutaneous and subconjunctival tissue in buried-suture double-eyelid blepharoplasty at the Department of Plastic and Aesthetic Surgery of Qingdao Municipal Hospital from September 2021 to September 2023. Six points were marked on the skin surface of the designed double eyelid line on patient' s upper eyelid, 8 points were marked on the corresponding conjunctival surface of the designed double eyelid line. A 6-0 nylon thread attached with one needle on each end was used for suturing, with two ends running through and between the subcutaneous and subconjunctival layers alternatively, forming a " trapezoidal" shape of path. Finally, two ends exited at the same point on the most lateral side of the designed double eyelid line on skin surface and were tied together with the knot hidden within the orbicularis oculi muscle. The morphology of the double eyelids and postoperative complications were observed and evaluated after surgery, the follow-up period was at least 6 months. At the last time of follow-up, the satisfaction rates were evaluated by patients themselves. Four aspects of the surgical effects of the double eyelids were put into the evaluation system, which were radian, width, smoothness and symmetry, with score from 0-5 points for each. The total score was 0-20 points, of which 17-20 points indicated high satisfaction, score of 13-16 points indicated relative satisfaction, ≤ 12 points indicated dissatisfaction.Results:A total of 52 female patients were included, aged 18 to 29 years old, with an average age of 22.5 years. Among all patients, 33 cases had shallow double eyelid lines while 19 cases had single eyelids. All patients’ upper eyelids were relatively thin and without obvious looseness. The surgical procedures were all done smoothly and successfully, with an average operation time of (0.72±0.13) h. Immediately after surgery, the radian of the double eyelid lines on both sides looked smooth, the widths of the double eyelids were also basically symmetrical. During the follow-up period of 6-12 months postoperatively, the morphologies of the double eyelids were relatively natural and realistic, the double eyelid lines and widths remained deep and stable, and the incision scars were left unobvious for all patients. Besides, no complications such as ptosis, incomplete upper eyelid closure and ectropion were observed. Among the 52 patients, 45 cases were highly satisfied with the surgical result (17-20 points) , 7 were relatively satisfied (13-16 points) , while none of them required reoperation.Conclusions:The continuous trapezoidal suture method between subcutaneous and subconjunctival tissue in buried-suture double-eyelid blepharoplasty has advantages of short operation time, good and stable surgical effects such as natural and realistic morphology of double eyelids, few complications, and high patients' satisfaction rate.

Objective:To explore the surgical effects of continuous trapezoidal suture method between subcutaneous and subconjunctival tissue in buried-suture double-eyelid blepharoplasty.Methods:A retrospective study was conducted on patients who underwent the operation of continuous trapezoidal suture method between subcutaneous and subconjunctival tissue in buried-suture double-eyelid blepharoplasty at the Department of Plastic and Aesthetic Surgery of Qingdao Municipal Hospital from September 2021 to September 2023. Six points were marked on the skin surface along the designed double eyelid line on patient’s upper eyelid, 8 points were marked on the corresponding conjunctival surface along the designed double eyelid line. A 6-0 nylon thread attached with one needle on each end was used for suturing, with two ends running through and between the subcutaneous and subconjunctival layers alternatively, forming a "trapezoidal" shape of path. Finally, two ends exited at the same point on the most lateral side of the designed double eyelid line on skin surface and were tied together with the knot hidden within the orbicularis oculi muscle. The morphology of the double eyelids and postoperative complications were observed and evaluated after surgery, the follow-up period was at least 6 months. At the last time of follow-up, the satisfaction rates were evaluated by patients themselves. Four aspects of the surgical effects of the double eyelids were put into the evaluation system, which were radian, width, smoothness and symmetry, with score from 0-5 points for each. The total score was 0-20 points, of which 17-20 points indicated high satisfaction, 13-16 points indicated relative satisfaction, ≤12 points indicated dissatisfaction.Results:A total of 52 female patients were included, aged 18 to 29 years old, with an average age of 22.5 years. Among all patients, 33 cases had shallow double eyelid lines while 19 cases had single eyelids. All patients’ upper eyelids were relatively thin and without obvious looseness. The surgical procedures were all done smoothly and successfully, with an average operation time of (0.72±0.13) h. Immediately after surgery, the radian of the double eyelid lines on both sides looked smooth, the widths of the double eyelids were also basically symmetrical. During the follow-up period of 6-12 months postoperatively, the morphologies of the double eyelids were relatively natural and realistic, the double eyelid lines and widths remained deep and stable, and the incision scars were unobvious for all patients. Besides, no complications such as ptosis, incomplete upper eyelid closure and ectropion were observed. Among the 52 patients, 45 cases were highly satisfied with the surgical result, 7 cases were relatively satisfied, while none of them required reoperation.Conclusion:The continuous trapezoidal suture method between subcutaneous and subconjunctival tissue in buried-suture double-eyelid blepharoplasty has advantages of short operation time, good and stable surgical effects such as natural and realistic morphology of double eyelids, few complications, and high patients’ satisfaction rate.

The anterior cruciate ligament (ACL), anterolateral complex (ALC) and lateral meniscus (LM) maintain the anterolateral rotatory stability of the knee and control the internal rotation of the tibia. Anterolateral rotatory instability (ALRI) of the knee is not uncommon in clinic, and its main injury mechanism is non-contact injury. A pivot shift test or a tibial internal rotation test can indicate ALRI while X-ray, CT, MRI and ultrasound can assist in its diagnosis and differential diagnosis. For acute ALRI, good technique of ACL reconstruction is the basis to avoid postoperative residual ALRI, and anterolateral ligament reconstruction and extra-articular tenodesis are optional as appropriate. For chronic cases, however, both anterolateral ligament reconstruction and extra-articular tenodesis are effective. This article reviews the progress in research on the diagnosis and treatment of ALRI of the knee, hoping to provide references for its clinical diagnosis and treatment.

Objective To investigate the predictive value of combined plasma gluconic acid(GA),fumaric acid(FA),and pseudouridine levels at admission for acute kidney injury(AKI)in elderly patients with acute myocardial infarction(AMI).Methods A total of 78 elderly AMI patients transferred from Emergency Department to Coronary Care Unit in Fuwai Hospital during Decem-ber 2021 and July 2022 were enrolled in this prospective study.They were divided into AKI group(40 cases)and non-AKI group(38 cases)according to whether they developed AKI during hospi-talization.Plasma levels of GA,FA and pseudouridine were quantitatively detected with liquid chromatography-tandem mass spectrometry.ROC curve was plotted to assess the predictive value of these three plasma metabolites for AKI in AMI patients.Multivariate logistic regression analy-sis was applied to analyze the clinical risk factors for AKI.Results There were no statistical differences in the plasma levels of GA,FA and pseudouridine between the AKI group and the non-AKI group(P＞0.05).ROC curve analysis revealed that the plasma levels of the three indicators had no predictive value for the development of AKI in elderly AMI patients(AUC=0.576,95％CI:0.449-0.704,P=0.246;AUC=0.595,95％CI:0.467--0.721,P=0.154;AUC=0.563,95％CI:0.435-0.692,P=0.337).Multivariate logistic regression analysis revealed that left ventricu-lar ejection fraction(LVEF)was an independent predictor for AKI development in elderly AMI patients(OR=0.923,95％CI:0.870-0.978,P=0.007).Conclusion Plasma GA,FA and pseud-ouridine cannot predict the development of AKI in elderly AMI patients,while,LVEF is an inde-pendent predictor for the development.

This paper reports a case of reparing the tissue defect after resection of a malignant tumor in the glabellar nasion with bilateral modified horizontal advancement flaps. The patient, a 20-year-old female, was admitted to the hospital because of a mass on the nasion between the eyebrows for more than 5 years, with enlargement and ulceration for 5 months. Surgical resection of the tumor was performed. Intraoperative rapid frozen sections showed that the tumor was basal cell carcinoma, and there were no cancer cells at the margins. Bilateral modified horizontal advancement flap repair was performed. At three months after the operation, the incision area healed well, the appearance and eyelid function were normal, and there was no sign of recurrence of basal cell carcinoma. Bilateral modified horizontal advancement flap was effective in repairing the tissue defect after resection of glabellar nasal root basal cell carcinoma.

This paper reports a case of reparing the tissue defect after resection of a malignant tumor in the glabellar nasion with bilateral modified horizontal advancement flaps. The patient, a 20-year-old female, was admitted to the hospital because of a mass on the nasion between the eyebrows for more than 5 years, with enlargement and ulceration for 5 months. Surgical resection of the tumor was performed. Intraoperative rapid frozen sections showed that the tumor was basal cell carcinoma, and there were no cancer cells at the margins. Bilateral modified horizontal advancement flap repair was performed. At three months after the operation, the incision area healed well, the appearance and eyelid function were normal, and there was no sign of recurrence of basal cell carcinoma. Bilateral modified horizontal advancement flap was effective in repairing the tissue defect after resection of glabellar nasal root basal cell carcinoma.