Objective To develop and validate a deep learning model for automatic identification of liver CT contrast-enhanced phases.Methods A total of 766 patients with liver CT contrast-enhanced images were retrospectively collected.A three-phase classification model and an arterial phase(AP)classification model were developed,so as to automatically identify liver CT contrast-enhanced phases as early arterial phase(EAP)or late arterial phase(LAP),portal venous phase(PVP),and equilibrium phase(EP).In addition,221 patients with liver CT contrast-enhanced images in 5 different hospitals were used for external validation.The annotation results of radiologists were used as a reference standard to evaluate the model performances.Results In the external validation datasets,the accuracy in identifying each enhanced phase reached to 90.50%-99.70%.Conclusion The automatic identification model of liver CT contrast-enhanced phases based on residual network may provide an efficient,objective,and unified image quality control tool.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To assess the effects of low-dose ionizing radiation on the thyroid of medical radiation workers.Methods:Based on the inclusion and exclusion criteria, 27 articles, involving 22 937 individuals, were screened finally from relevant literature published from 1996 to 2022. Meta-analysis was carried out using Stata 16.0 for serum levels of triiodothyronine (T 3), free triiodothyronine (FT 3), thyroid hormone (T 4), free thyroid hormone (FT 4), thyrotropin-stimulating hormone (TSH) and thyroid nodule rates. As well, subgroup analysis were carried out of thyroid function in different types of radiation workers. Results:The standardized mean difference (SMD) at T 3 and T 4 levels for radiation workers was -0.19 (-0.37, -0.01) and -0.34 (-0.38, -0.30), lower than that of control group ( Z=2.07, -16.06, P<0.05). The SMD at FT 4 levels for radiation workers was 0.22 (0.06, 0.39), higher than control group ( Z=2.61, P<0.05). The relative risk of thyroid nodules in radiation workers was 1.47 (1.19, 1.82), higher than that of control group ( Z=-3.58, P<0.05). The analysis result for subgroup showed that the SMD for T 3, T 4 and TSH levels in the interventional radiology workers were -0.29 (-0.51, -0.07), -0.31 (-0.47, -0.15) and -0.43 (-0.73, -0.13) ( Z=-2.55, -3.86, -2.82, P<0.05), respectively, and the SMD for T 4 levels in the nuclear medicine workers was -0.26 (-0.45, -0.07), which meaned a reduced risk compared to the control group ( Z=-2.70, P<0.05). Conclusions:Long-term low doses of ionising radiation may have adverse effects on thyroid hormone and thyroid nodule in radiation workers, particularly in interventional radiology workers, and attention should be focused on their radiation protection.

Objective : To investigate the effects of C-type lectin domain family 5，member A( CLEC5A) on the pro- liferation，apoptosis，and cell cycle of leukemia cell lines THP-1 and K562，and the underlying mechanism． Methods : The expression of CLEC5A in leukemia patients was investigated in the GEPIA database. Recombined plasmid containing CLEC5A was transfected into THP-1 and K562 cells for overexpression of CLEC5A．Small interfering RNA(siRNA) was used to knock down the endogenous CLEC5A in leukemia cells．CCK-8 and EdU assays were used to assess the leukemia cells proliferation．Flow cytometry was used to assess cell cycle．Flow cytometry was used to assess cell apoptosis under hydrogen peroxide( H2 O2 ) stress．The RNA sequencing( RNA-seq) and pathway enrichment analysis were used to analyze the signal pathways of significant enrichment of up-regulated or down-reg- ulated genes after knocking down CLEC5A gene．Protein expression levels of several members in AKT1 / mTOR and p53 signaling pathways were detected by Western blot assays. Results : CLEC5A was significantly up-regulated in bone marrow tissues of leukemia patients compared to the matched non-tumor tissues of healthy individuals．Knock- down of CLEC5A significantly reduced the proliferation(all P＜0. 01) and S phase progression(all P＜0. 05) ，and increased the apoptosis(all P＜0. 001) under H2 O2 stress，in THP-1 and K562 cells．Conversely，overexpression of CLEC5A significantly increased the proliferation(all P ＜0. 001) and S phase progression ( all P ＜0. 01) ，and re- duced the apoptosis(all P＜0. 01) under H2 O2 stress，in THP-1 and K562 cells．The uregulated genes were sig- nificantly enriched in AKT1-mTOR and other signal pathways after knocking down CLEC5A，while the down-regula- ted genes were significantly enriched in cell cycle signal pathways．CLEC5A in leukemia cells significantly reduced the genes expression levels of BAX and p53，and significantly induced the gene expression levels of BCL-2 and phosphorylation levels of AKT1 and mTOR proteins． Conclusion CLEC5A increases the cell cycle and proliferation and inhibits cells apoptosis in THP-1 and K562 cells，and the mechanism may be related to activating the AKT / mTOR and p53 signaling pathways.

Objective:To understand the lens condition of radiation workers in a city, explore the factors affecting lens opacity, and provide basis for strengthening the radiation protection management of radiation workers.Methods:In December 2020, according to the national radiation health monitoring project, the occupational health examination data of radiation workers in an occupational health examination institution in a city from December 2018 to November 2020 were collected, including the basic information of radiation workers and ophthalmic examination results. The lens conditions of radiation workers in different subgroups were analyzed, and the influencing factors of lens opacity were analyzed by multifactor logistic regression.Results:A total of 4452 radiation workers were included, of which 439 (9.9%) had lens opacity. The lens opacity rate of male radiation workers was higher than that of female radiation workers ( P<0.05) . With the increase of age and length of service, the lens abnormalities of radiation workers increased ( rs=0.269, 0.212, P<0.01) . The lens opacity rate of radiation workers engaged in nuclear medicine was high (12.7%, 9/71) . The rate of lens opacity in off-the-job medical examination radiation workers was high (18.3%, 26/142) . By multivariate logistic regression analysis, the risk of lens opacification in the age ≤30-year-old group and the >30-<50-year-old group were 0.087 times (95% CI: 0.058-0.132) and 0.076 times (95% CI: 0.054-0.107) that in the age ≥50-year-old group, respectively. The risk of lens opacification in the age ≤10-year-old group, >10-<20-year-old group and 20-30-year-old group were 0.293 (95% CI: 0.189-0.456) , 0.413 (95% CI: 0.256-0.666) and 0.318 (95% CI: 0.204-0.497) times, respectively. Conclusion:The lens opacity rate of radiation workers is related to age and working age.Attention should be paid to high-age and long-term radiation workers to ensure their health.

Objective:To understand the lens condition of radiation workers in a city, explore the factors affecting lens opacity, and provide basis for strengthening the radiation protection management of radiation workers.Methods:In December 2020, according to the national radiation health monitoring project, the occupational health examination data of radiation workers in an occupational health examination institution in a city from December 2018 to November 2020 were collected, including the basic information of radiation workers and ophthalmic examination results. The lens conditions of radiation workers in different subgroups were analyzed, and the influencing factors of lens opacity were analyzed by multifactor logistic regression.Results:A total of 4452 radiation workers were included, of which 439 (9.9%) had lens opacity. The lens opacity rate of male radiation workers was higher than that of female radiation workers ( P<0.05) . With the increase of age and length of service, the lens abnormalities of radiation workers increased ( rs=0.269, 0.212, P<0.01) . The lens opacity rate of radiation workers engaged in nuclear medicine was high (12.7%, 9/71) . The rate of lens opacity in off-the-job medical examination radiation workers was high (18.3%, 26/142) . By multivariate logistic regression analysis, the risk of lens opacification in the age ≤30-year-old group and the >30-<50-year-old group were 0.087 times (95% CI: 0.058-0.132) and 0.076 times (95% CI: 0.054-0.107) that in the age ≥50-year-old group, respectively. The risk of lens opacification in the age ≤10-year-old group, >10-<20-year-old group and 20-30-year-old group were 0.293 (95% CI: 0.189-0.456) , 0.413 (95% CI: 0.256-0.666) and 0.318 (95% CI: 0.204-0.497) times, respectively. Conclusion:The lens opacity rate of radiation workers is related to age and working age.Attention should be paid to high-age and long-term radiation workers to ensure their health.

Objective: To analyze the clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S. pyogenes) in the third trimester to improve clinical awareness of this disease. Methods: A retrospective study was conducted to analyze the clinical data of two patients with STSS caused by S. pyogenes in Jinan Maternal and Child Health Care Hospital and nine reported cases of healthy pregnant women infected with S. pyogenes at 28-42 gestational weeks with detailed data retrieved from Chinese National Knowledge Infrastructure and PubMed database from January 1997 to December 2018. Results: The two cases admitted to our hospital were both multiparas, with onset in winter and no specific symptoms in early stage. Disseminated intravascular coagulation (DIC) was developed in both cases on admission. In one case, the fetal heart rate was reduced and disappeared soon after admission. The other patient was diagnosed as stillbirth on admission. Both patients died and blood culture revealed infection of group A streptococcus. Nine previous cases were reported in one Chinese and five English articles. No high-risk pregnancy or premature rupture of membranes was reported in these 11 cases. Among the 11 cases, ten were positive for S. pyogenes indicated by blood or tissue culture and one was positive for streptococcal toxin. Ten cases had high fever and three presented with respiratory symptoms in early stage. Abdominal pain and watery diarrhea were common symptoms and all patients developed multiple organ dysfunction and DIC. Cases occurred in winter or spring were more common. Nine women died within 36 h after the onset of fulminant symptoms. Only two survived and hospitalized for 90 d and 25 d, respectively, after emergent cesarean section indicated by reduced fetal heart rate. Unfortunately, both neonates died after birth. For the babies, there were seven intrauterine fetal deaths, one stillbirth and three live births, but only one survived (whose mother developed respiratory cardiac arrest 90 min after delivery). Conclusions STSS caused by S. pyogenes in pregnant women exacerbates rapidly with a high mortality. Early identification of clinical manifestations and rapid progress of the disease are crucial for early diagnosis and treatment, which may help improve maternal and fetal outcomes.

Objective To investigate the predictive value of cervical length (CL) measured by transvaginal ultrasound for preterm birth<32 weeks,＜34 weeks in twin pregnancies in the second and the third trimester of pregnancy. Methods A total of 490 twin pregnant women with CL measured by transvaginal ultrasound during the second trimester of pregnancy (20-24 weeks) and the third trimester of pregnancy (28-32 weeks) delivered in Peking University Third Hospital, and Tongzhou Maternal and Child Health Hospital from January 2014 to December 2017 were collected, and 161 cases out of which were measured by CL during both the second trimester and the third trimester of pregnancy. Based on the measured gestational weeks, 427 cases were in the second trimester group and 224 cases in the third trimester group. The predictive value of CL for preterm birth was evaluated by calculating the optimal cut-off point with sensitivity and specificity. Logistic regression analysis was used to assess the relationship between CL and preterm birth after adjusting for confounding factors (age of pregnant women, chorionic status, mulipara, assisted reproductive pregnancy and pre-pregnancy body mass index). Results (1) The median CL of pregnant women in the second trimester group and the third trimester group were 36 mm (33-40 mm) and 28 mm (18-33 mm) respectively. In the second trimester group, 151 cases (35.4%, 151/427) were preterm birth and 276 cases (64.6%, 276/427) were full-term birth; the median CL of preterm and full-term pregnant women were 34 mm (30-37 mm) and 37 mm (34-40 mm), respectively, with significant difference (P<0.01). In the third trimester group, 100 cases (44.6%, 100/224) were preterm birth and 124 cases (55.4%, 124/224) were full-term birth; the median CL of preterm and full-term pregnant women were 22 mm (15-30 mm) and 31 mm (23-34 mm), respectively, with significant difference (P<0.01). (2) Prediction of preterm birth<32 weeks and<34 weeks was performed with CL in the second trimester group. The area under the receiver-operating characteristics curve were 0.78 (95% CI : 0.70-0.86) and 0.71 (95% CI : 0.64-0.79), respectively. The optimal cut-off points were 36.5 mm and 33.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth<32 weeks and<34 weeks of gestation. (3) Prediction of preterm birth <32 weeks and <34 weeks were performed with CL in the third trimester group. The area under the receiver-operating characteristics curve were 0.86 (0.75-0.96) and 0.75 (0.67-0.84), respectively. The optimal cut-off points were 17.5 mm and 18.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth at<32 weeks and<34 weeks of gestation. Conclusions CL measured by transvaginal ultrasound in the second and the third trimester is a good predictor for preterm birth of twin pregnancy. CL≤36.5 mm and≤33.5 mm at 20-24 weeks of gestation could predict preterm birth<32 weeks and<34 weeks respectively. CL≤17.5 mm and≤18.5 mm at 28-32 weeks of gestation could predict preterm birth<32 weeks and<34 weeks respectively.

Objective To analyze hemolysin and virulence -related genes in incomplete hemolytic Staphylococcus aureus.Methods Fifty strains of incomplete hemolytic Staphylococcus aureus were isolated from patients admitted in the Second Affiliated Hospital of Soochow University during 2013 and 2014, and the isolates with complete hemolytic phenotype were also collected at the same period as the control strains . All the strains were inoculated and subcultured on four kinds of sheep blood agar plates supplied by different manufacturers to compare their hemolytic phenotype .The relative mRNA expressions of hemolysin genes (hla, hlb, hlc, hld) in standard strain, complete and incomplete hemolytic phenotype strains were detected by real-time quantitative polymerase chain reaction (RT-qPCR), and valued by 2 -△△Ct method.t test was used to compare mRNA expressions of hemolysin genes .Western blot was performed to analyze the expression of α-hemolysin.Antibiotic susceptibility test of incomplete hemolytic strains was performed using broth microdilution method.Resistant gene mecA and virulence genes pvl, tst were detected by PCR.Results The steady and hereditary incomplete hemolysis was observed in 50 strains of incomplete hemolytic Staphylococcus aureus on the sheep blood agar plates from different suppliers .Taking mRNA expression of hla, hlb, hlc, hld in standard strain as 1, the relative mRNA expressions of hemolysin genes in incomplete hemolytic strains were 0.02, 7.51, 0.06 and 0.12 respectively, there were statistical differences between standard strain and incomplete hemolytic strains (t =8.46, -56.40, 8.12 and 7.61, all P <0.05).And the expression of α-hemolysin was decreased in incomplete hemolytic strains .All the strains were identified as methicillin resistant Staphylococcus aureus (MRSA).Three strains exhibited different minimum inhibitory concentrations of teicoplanin and linezolid after subcultured , but the differences had no impact on the final results of antibiotic susceptibility test .mecA, pvl and tst genes were positive in incomplete hemolytic strains . Conclusion Staphylococcus aureus with incomplete hemolytic phenotype is methicillin resistant with higher expression of β-hemolysin and lower expressions of α-hemolysin, γ-hemolysin and δ-hemolysin.It carries plv and tst virulence genes and is of high virulence .

Objective To investigate the effect of autophagy on the proliferation and migration of cervi-cal cancer cells ,as well as the underlining mechanisms .Methods Rapamycin was used to induce the autophagy in HeLa cells,formation of autophagosomes was observed by staining with acridine orange under fluorescence mi -croscope.Western blot was used to detect the expression of LC 3 and PI3K/Akt/mTOR in HeLa cells.The LC3 plasmid was transfected into HeLa cells .The distribution of LC3 in cells and the expression of LC3 was identified by fluorescence microscope and Western blot ,respectively.The autophagy was inhibited with 3-methyladenine(3-MA )in HeLa cells.The cell proliferation was monitored by RTCA real -time instrument.Transwell chamber was carried out to assess cell migration .Results After 6h of rapamycin treatment ,the expression of LC3B was in-creased in HeLa cells ( P<0 .05 ) .The proliferative and migration ability were weakened compared to wild type HeLa cells(P<0.05).The same results in the presence of 3-MA.The expression of PI3K/AKT/mTOR path-way proteins were activated by rapamycin treatment and LC 3 overexpression(P<0.05).Conclusion Autophagy can suppress the proliferation and migration in cervical cancer cells ,which may relate to PI3K/Akt/mTOR path-way.