Objective To discuss the value of clinical radiomic nomogram(CRN)and deep convolutional neural network(DCNN)in distinguishing atypical pulmonary hamartoma(APH)from atypical lung adenocarcinoma(ALA).Methods A total of 307 patients were retrospectively recruited from two institutions.Patients in institu-tion 1 were randomly divided into the training(n=184:APH=97,ALA=87)and internal validation sets(n=79:APH=41,ALA=38)in a ratio of 7∶3,and patients in institution 2 were assigned as the external validation set(n=44:APH=23,ALA=21).A CRN model and a DCNN model were established,respectively,and the performances of two models were compared by delong test and receiver operating characteristic(ROC)curves.A human-machine competition was conducted to evaluate the value of AI in the Lung-RADS classification.Results The areas under the curve(AUCs)of DCNN model were higher than those of CRN model in the training,internal and external validation sets(0.983 vs 0.968,0.973 vs 0.953,and 0.942 vs 0.932,respectively),however,the differences were not statistically significant(p=0.23,0.31 and 0.34,respectively).With a radiologist-AI com-petition experiment,AI tended to downgrade more Lung-RADS categories in APH and affirm more Lung-RADS cat-egories in ALA than radiologists.Conclusion Both DCNN and CRN have higher value in distinguishing APH from ALA,with the former performing better.AI is superior to radiologists in evaluating the Lung-RADS classification of pulmonary nodules.

Objective To explore the value of combined prediction model based on clinical and CT radiomics features in discriminating atypical pulmonary hamartoma(APH)from atypical lung adenocarcinoma(ALA).Methods A total of 290 patients with APH and ALA confirmed by pathology were retrospectively selected.250 patients from the First Affiliated Hospital of Anhui Medical University were randomly assigned into a training set(APH=91,ALA=84)and an internal validation set(APH=39,ALA=36)at a ratio of 7∶3,and other 40 patients from the First Affiliated Hospital of USTC were assigned as an external validation set(APH=21,ALA=19).The independent model and multivariate logistic regression combined model were constructed using the selected clinical-CT features and radiomics features,respectively,and a nomogram was drawn.Receiver operating characteristic(ROC)curve and DeLong test were used to evaluate and compare the performances of the models.Results The area under the curve(AUC)of the combined model established by 3 clinical-CT features and 4 radiomics features in the training set was 0.980,which was higher than that of clinical-CT model(AUC=0.885,P＜0.001)and radiomics model(AUC=0.975,P=0.042).The AUC of the combined model in the internal and external validation sets(0.963 vs 0.917)were also higher than those of clinical-CT model(0.858 vs 0.774)and radiomics model(0.953 vs 0.897),respectively.Conclusion The combined prediction model based on clinical and CT radiomics features can improve the differential diagnosis ability of APH and ALA.

Flavonoid glycosides are the main active constituents of Epimedii Folium and its related plants. They can be divided into polyglycosides and low glycosides according to the number of glycosyl group. The polyglycosides of Epimedii Folium can be transformed into low glycosides after biotransformation ；pharmacological activities of low glycosides in anti-tumor ，tonifying kidney yang and anti-osteoporosis are stronger than those of polyglycosides. In this paper ， the research progress about biotransformation technology of flavonoid glycosides of Epimedii Folium was reviewed. It was found that the main biotransformation pathway of flavonoid glycosides of Epimedii Folium was to obtain low glycosides by removing glycosyl group ； related methods were mainly enzymatic hydrolysis and microbial transformation ，and also included plant cell transformation ，acid hydrolysis method and synthesis method.

To explore influence of exercise rehabilitation therapy on inflammatory factor levels and cardiac func‐tion in patients with chronic heart disease (CHD).Methods :A total of 92 CHF patients of our department from Jun 2016 to May 2018 were randomly and equally divided into routine treatment group and exercise rehabilitation group (received ex‐ercise rehabilitation training based on routine treatment group ) ,both groups were intervened for six months .Cardiac func‐tion ,6min walking distance (6MWD) ,levels of inflammatory factors ,quality of life (QOL) before and after treatment were observed and compared between two groups .Results :Compared with routine treatment group after six months ,there were significant reductions in left ventricular end diastolic volume [LVEDV ,(61.26 ± 8.03) ml vs.(55.77 ± 7.75) ml] , left ventricular end systolic volume [LVESV ,(54.89 ± 6.15) ml vs.(51.36 ± 4.99) ml] ,levels of CRP [(21.41 ± 4.14) ng／ml vs.(18.18 ± 4.22) ng／ml] ,TNF‐α [ (18.46 ± 4.69) ng／ml vs.(15.67 ± 3.37) ng／ml] ,IL‐6 [ (80.09 ± 14.47) ng／ml vs.(71.88 ± 16.16) ng／ml] ,score of Minnesota living with heart failure questionnaire [ (49.50 ± 6.91) scores vs. (46.74 ± 5.12) scores] ,and significant rise in LVEF [ (43.11 ± 4.59)% vs.(45.33 ± 5.58)%] and 6MWD [ (265.70 ± 12.37) m vs.(336.89 ± 11.23) m] in exercise rehabilitation group , P＜0.05 or ＜0.01. Conclusion :Exercise rehabilita‐tion therapy can significantly improve inflammatory factor levels ,cardiac function and QOL ,and reduce rehospitalization rate within six months in CHF patients .

Objective To understand the job well-being status of ICU nurses,and to explore the mediating role of psychological capital in job stress and job well-being.Methods ICU nurses'general data questionnaire,the Nurse Questionnaire Psychological Capital,Chinese Nurses' Work Stressor Scale and Work Well-Being Scale were used to investigate 224 ICU nurses in three grade a general hospitals.Results Total score of psychological capital for ICU nurses was(4.46±0.55)points,the total average working pressure was(2.14±0.37)points,the happiness score was(4.36±0.67)points.Psychological capital and job well-being were positively correlated(r=0.513,P＜0.01),job stress and job well-being was negatively correlated(r =-0.454,P＜ 0.05).The structural equation results showed that psychological capital played an intermediary role in the sense of ICU nurses job stress and job happiness.Conclusions Hospital nursing managers should pay more attention to the mental health of ICU nurses and lower their work stress,so as to improve the work well-being of ICU nurses and improve the quality of ICU nursing.

Objective To explore the effect of risk assessment tracking management in reducing unplanned extubation in patients with tracheal intubation.Methods From January to December 2015,120 patients with tracheal intubation in ICU were selected as the control group with routine nursing care of indwelling endotracheal intubation.From January to November 2016,120 patients with tracheal intubation were selected as the observation group,where the risk assessment and risk management were done on the basis of routine nursing as in the control group.The two groups were compared in terms of tracheal intubation and unplanned extubation related knowledge,the implementation of the risk assessment,the accuracy in risk assessment and the incidence of unplanned extubation.Result The tracheal intubation and unplanned extubation related knowledge in the observation group was lower than that of the control group (P＜0.001),The implementation rate of the risk assessment and the accuracy in risk assessment in the observation group were significantly higher than the control group,and the rate of unplanned extubation in the observation group was significantly lower than in the control group (all P＜0.01).Conclusion The implementation on risk assessment and extubation-preventing nursing quality tracing management can enhance the awareness and knowledge of preventing trachea cannula exodus,improve the quality of nursing and reduce the rate of unplanned extubation.

Objective To investigate the relationship between plasma docetaxel concentration and the efficacy as well as toxic and side effects in patients with breast cancer after chemotherapy.Methods Seventy -one patients with breast cancer who accepted AC sequential T chemotherapy regimen as first line treatment were selected from April 2015 to September 2015 in Hubei Provicial Tumor Hospital.The plasma concentration of docetaxel was detected by latex immunoturdidimetry after the docetaxel continuous infusion in each cycle.The three groups were assigned according to the concentration distribution of docetaxel:group A (plasma concentration docetaxel ≤ 2.0mg·h -1 · L -1 ),group B (2.1 -2.5mg·h -1 ·L -1 )and group C (≥2.6 mg·h -1 ·L -1 ).The relationship between the drug plasma concentration,therapeutic efficacy and adverse reactions in different docetaxel plasma concentration was analyzed retrospectively by Chi -square tests.Results The average plasma concentrations of docetaxel of the three groups were (1.55 ±0.36)mg·h -1 ·L -1 ,(2.28 ±0.13)mg·h -1 ·L -1 ,(2.87 ±0.38)mg· h -1 · L -1 respectively.The adverse reactions were enhanced with the increasing of docetaxel plasma concentration (χ2 =5.169, 4.463,3.630,P =0.023,0.035,0.047).The therapeutic efficacy of group C and group B was same(95.8%),which was higher than 87.0% of group A,but there was no statistically significant difference (χ2 =1.559,P =0.24). Conclusion Breast cancer patients whose plasma concentration of docetaxel is between 2.1 ~2.5mg·h -1 ·L -1 has a better prognosis,and its adverse reactions are controlled in a certain extent.

Objectives To investigate the relationship of sex difference with serum bisphenol-A (BP-A),adiponectin and metabolic syndrome (MetS)in elderly patients with isolated systolic hypertension(EISH).Methods A retrospective study of the clinical data was conducted in 540 subjects from the Cardiology and Geriatric Department in the Affiliated Hospital of Shanxi Medical University,Changzhi Municipal People,s Hospital and the Department of Cardiology of Shanxi Medical University,First Clinic Hospital from January 2010 to December 2013.Elderly patients with EISH were divided into male group(n=270)and female group(n=270).Meanwhile 560 older health persons were severed as controls,including 300 females and 260 males.The changes of BP-A and adiponectin (Ad) concentration were measured.The blood lipid,insulin resistance index (HOMA-IR),blood pressure,body mass index,heart rate variability and ultrasonic change of heart and blood vessel were tested regularly.Results The level of serum BP-A[(0.89±0.10)ng/L vs.(0.57±0.04)ng/L]and [(0.64±0.10)ng/L vs.(0.55 ± 0.08)ng/L] were higher in male EISH vs in male control,and in female EISH than in female control (F =23.76,23.86,all P ＜ 0.01),respectively.The levels of adiponectin were lower in male EISH vs control[(4.9±1.4)ng/L vs.(10.5±2.7)ng/L and in female EISH vs control(6.0±1.3) ng/L vs.(11.5±3.3)ng/L),F=13.10,16.20,all P＜0.01.Root mean sequare of the successive normal sinus RR interval difference(rMSSD)were lower in male/ female EISH than control groups(F=13.10、13.70,P ＜0.01).Serum BP-A level was positively correlated with the bocly mass index and systolic pressure (r =0.38,0.54,P ＜ 0.01),and was negatively correlated with serum Ad and rMSSD(r=-0.46,-0.42,P＜0.01).Conclusions Obvious gender difference in changes of serum BP-A exists in older patients with EISH.Network cytokines may take part in the pathophysiological process of the obesity related hypertension.

Objective The aim of this study was to investigate the value of ultrasound in diagnosis of benign and malignant thyroid nodules with rim calcification. Methods Sixty thyroid nodules with rim calcifications from Sun Yat-sen University Cancer center which were detected on ultrasound from January 2008 to December 2015 were included in this study, and all the thyroid nodules had pathological results. Ultrasonic features of thyroid nodules, including the size, border, internal echo, growth pattern, rear echo, interruption or inner sink of the rim calcification and hypoechoic soft tissue extrusion around rim calcification were analyzed. Results Thirty-seven nodules (61.7%) were confirmed to be benign, and twenty-three nodules (38.3%) were malignant. The ultrasonic features of interruption or inner sink of rim calcifications and hypoechoic soft tissue extrusion around rim calcification, were more often in malignant nodules than benign nodules. The sensitivity, specificity, the positive predictive values and the negative predictive values for interruption or inner sink of rim calcifications were 85.7%, 89.4%, 85.7% and 89.4%, respectively. The sensitivity, specificity, the positive predictive values and the negative predictive values for hypoechoic soft tissue extrusion around rim calcification were 81.3%, 94.4%, 92.9% and 85.0%, respectively. Internal hypoechogenicity was more frequently observed in the malignant nodules (82.6%) than in benign nodules (40.5%). The longitudinal growth pattern of thyroid was more frequently observed in malignant nodules (30.4%) than in benign nodules (2.7%). The differences of this two ultrasound features were statistically significant(χ2=9.958 and 9.440,both P<0.01).There were no significant differences in size,border and the rear echo between malignant and benign nodules (all P>0.05). Conclusion The interruption or inner sink of the rim calcification could be useful in differential diagnosis of thyroid nodules with rim calcification.

Objective To explore the effects of sertraline combined with attribution retraining in post-stroke depression and recovery of neurological function.Methods A total of seventy-eight patients with post-stroke depression were randomly divided into research group and control group.The research group was treated by sertraline combined with attribution retraining and the control group was treated by sertraline only for 8 weeks.Depressive symptoms were assessed using the Hamilton Depression Rating Scale (HAMD) and recovery of neurological functions using the National Institute of Health Stroke Scale (NIHSS) at baseline and at the end of the 24,44,64 and 84 week.Results Repeated measure ANOVA for the total scores of HAMD showed that the main effect of time,the main effect of group and the interactive effect of time and group were significant (P＜0.05).Total scores of HAMD in the research group were significantly lower than those in the control group at the end of the 2nd,44,64 and 84 week [(18.25±4.27) vs.(20.81±4.63),(15.94±3.47)vs.(18.12±4.51),(12.85±3.12) vs.(16.54±3.70),(10.42±3.66) vs.(13.09±3.59),P＜0.05].HAMD Total scores in two groups were showed significantly decreased on each time point after treatment (P＜0.01).Effective rates (using reduction rate of HAMD total scores as evaluation) were more significant in the research group than those in the control group at the end of the 8th week (77.5％ vs.52.6％,P＜0.05).The repeated measure ANOVA showed that the main effect of time in NIHSS total scores was significant (P＜0.01).The main effect of group and the interactive effect of time and group in NIHSS total scores were not significant (P＞0.05).Total scores of NIHSS in two groups significantly decreased on each time point after treatment (P＜0.01).Conclusions Sertraline combined with attribution retraining can significantly relieve post-stroke depression and attribution training does not have obvious effects on the recovery of neurological function.