ObjectiveTo develop a predictive model and application for spontaneous passage of common bile duct stones using automated machine learning algorithms given the complexity of treatment decision-making for patients with common bile duct stones， and to reduce unnecessary endoscopic retrograde cholangiopancreatography （ERCP） procedures. MethodsA retrospective analysis was performed for the data of 835 patients who were scheduled for ERCP after a confirmed diagnosis of common bile duct stones based on imaging techniques in Changshu First People’s Hospital （dataset 1） and Changshu Traditional Chinese Medicine Hospital （dataset 2）. The dataset 1 was used for the training and internal validation of the machine learning model and the development of an application， and the dataset 2 was used for external testing. A total of 22 potential predictive variables were included for the establishment and internal validation of the LASSO regression model and various automated machine learning models. The area under the receiver operating characteristic curve （AUC）， sensitivity， specificity， and accuracy were used to assess the performance of models and identify the best model. Feature importance plots， force plots， and SHAP plots were used to interpret the model. The Python Dash library and the best model were used to develop a web application， and external testing was conducted using the dataset 2. The Kolmogorov-Smirnov test was used to examine whether the data were normally distributed， and the Mann-Whitney U test was used for comparison between two groups， while the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsAmong the 835 patients included in the study， 152 （18.20%） experienced spontaneous stone passage. The LASSO model achieved an AUC of 0.875 in the training set （n=588） and 0.864 in the validation set （n=171）， and the top five predictive factors in terms of importance were solitary common bile duct stones， non-dilated common bile duct， diameter of common bile duct stones， a reduction in serum alkaline phosphatase （ALP）， and a reduction in gamma-glutamyl transpeptidase （GGT）. A total of 55 models were established using automated machine learning， among which the gradient boosting machine （GBM） model had the best performance， with an AUC of 0.891 （95% confidence interval： 0.859‍ ‍—‍ ‍0.927）， outperforming the extreme randomized tree mode， the deep learning model， the generalized linear model， and the distributed random forest model. The GBM model had an accuracy of 0.855， a sensitivity of 0.846， and a specificity of 0.857 in the test set （n=76）. The variable importance analysis showed that five factors had important influence on the prediction of spontaneous stone passage， i.e.， were solitary common bile duct stones， non-dilated common bile duct， a stone diameter of <8 mm， a reduction in serum ALP， and a reduction in GGT. The SHAP analysis of the GBM model showed a significant increase in the probability of spontaneous stone passage in patients with solitary common bile duct stones， non-dilated common bile duct， a stone diameter of <8 mm， and a reduction in serum ALP or GGT. ConclusionThe GBM model and application developed using automated machine learning algorithms exhibit excellent predictive performance and user-friendliness in predicting spontaneous stone passage in patients with common bile duct stones. This application can help avoid unnecessary ERCP procedures， thereby reducing surgical risks and healthcare costs.

【Objective】 To explore the clinicopathological characteristics and comprehensive treatment strategies of prostate mucosa adenocarcinoma under multidisciplinary diagnosis and treatment (MDT) mode. 【Methods】 Data of two patients with typical prostate mucosa adenocarcinoma treated in our hospital during Sep.2020 and Apr.2023 were retrospectively analyzed. 【Results】 In case 1, the clinical manifestation was macroscopic hematuria; multiparametric magnetic resonance imaging (mpMRI) indicated solid prostatic nodules, clinical stage T4N1Mx; initial prostate specific antigen (PSA) was 1.2 ng/mL; ⁶⁸68Ga-prostate specific membrane antigen PET/CT (⁶⁸Ga-PSMA PET/CT) suggested abnormal uptake of nuclear lesions in the prostate (SUV4.2-5.3); biopsy results indicated invasive mucinous adenocarcinoma.After prostate and pelvic field radiotherapy + androgen deprivation therapy (ADT) + antihypertensive treatment, lesions were significantly reduced, and hematuria symptoms were relieved.In case 2, the clinical manifestation was dysuria; initial PSA was 91.78 ng/mL; mpMRI suggested invasion of prostate mass into the bladder and clinical stage of T4N1M1b; ⁶⁸Ga-PSMA PET/CT indicated prostate and pelvic lymph nodes, and multiple bone lesions showed increased nuclide uptake; biopsy results indicated prostate adenocarcinoma with mucinous adenocarcinoma.Initial endocrine treatment was performed.After 3 months, PSA was reduced to 0.083 ng/mL, and imaging showed the tumor was significantly reduced.Robotic-assisted laparoscopic tumor prostatectomy with extended pelvic lymph node dissection was performed, and endocrine adjuvant therapy was continued after surgery. 【Conclusion】 Prostate mucosa adenocarcinoma has different clinicopathological characteristics and prognosis from conventional acinar adenocarcinoma, and the whole-process management under MDT mode is of great value in the diagnosis and treatment of this disease.

Objective:To evaluate the clinical efficacy of Jianpi-Huazhuo Decoction in the treatment of complication patients with phlegm-dampness in type 2 diabetes mellitus (T2DM) and Diabetic nephropathies (DN). Methods:A total of 72 patients with with phlegm dampness T2DM and DN in Huaibei Traditional Chinese Medicine Hospital of Anhui Province from June 2018 to June 2020 were randomly divided into two groups with 36 in each group. The control group were treated with oral metformin sustained-release tablets on the basis of diabetes propaganda. The observation group was treated with Jianpi-Huazhuo Decoction on the basis of the control group. Both groups were treated for 4 weeks. The blood glucose (plasma, enzyme method), HbA1c (whole blood, high performance liquid chromatography) and fasting insulin (serum, chemiluminescence method) were measured, and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Plasma BUN, SCR and urinary albumin excretion rate (UAER) were measured by automatic biochemical analyzer. The plasma laminin (LN), procollagen Ⅲ (PC Ⅲ) and collagen type Ⅳ (Ⅳ-c) were detected by ELISA. The adverse events during treatment were observed and the clinical efficacy was evaluated. Results:The total effective rate was 86.1% (31/36) in the observation group and 58.3% (21/36) in the control group ( χ2 =6.923, P=0.009). After treatment, the levels of FBG, 2 hPG, HbA1c, FINS and HOMA-IR in the observation group were significanlty lower than those in the control group ( t values were 4.242, 2.751, 3.565, 3.613 and 4.512, respectively, all Ps<0.05). After treatment, the plasma levels of LN, PC Ⅲ and Ⅳ-c were significanlty lower than those in the control group ( t values were 3.612, 1.864 and 2.046, respectively, all Ps<0.05). After treatment, the levels of serum creatinine and urinary albumin excretion rate in the control group were significanlty lower than those in the control group ( t values were 5.864 and 3.286, respectively, all Ps<0.05). Conclusion:The Jianpi-Huazhuo Decoction can reduce the blood glucose level and renal fibrosis related factors in patients with phlegm dampness T2DM complicated with DN, improve the clinical symptoms and improve the clinical curative effect.

Objective:To evaluate the changes of fetal renal artery blood flow parameters in fetuses with isolated borderline oligohydramnios (IBO) in the middle and third trimesters by Doppler ultrasound, and to assess its correlations with maternal and infant pregnancy outcomes.Methods:Twenty-seven IBO fetuses (IBO group) and 27 gestational age-matched normal fetuses (control group) from April to October 2019 in the Second Xiangya Hospital of Central South University underwent prenatal ultrasound examination during the middle and third trimesters. Renal artery blood flow parameters, including renal artery pulsatility index (RAPI), volume corrected renal artery pulsatility index (vcRAPI) and pregnancy outcomes were measured and compared between the two groups. Once diagnosed IBO, patients were recommended to the obstetric clinic for consultation and intervention. The correlation between RAPI, vcRAPI measured before intervention and prepartum amniotic fluid volume and pregnancy outcomes was analyzed, the ROC curve was plotted to find the better predictor.Results:The vcRAPI of the IBO group was higher than that of the control group ( P=0.015). In the IBO group, the vcRAPI measured before intervention was higer in those fetuses who were still IBO before delivery( P=0.048). In the IBO group, the correlation of the vcRAPI measured before intervention and IBO before delivery was statistically significant ( OR=2.41, 95% CI=1.06-5.43, P=0.035). The ROC curve showed that the sensitivity of vcRAPI to IBO was 0.67, the specificity was 0.75( P=0.002). Conclusions:Compared with RAPI, The vcRAPI may reflect the increase in fetal renal artery perfusion resistance of IBO group more timely. The higher vcRAPI before intervention in the IBO group have difficulty in recovering amniotic fluid volume before delivery.Increased vcRAPI is a better predictor of IBO before delivery.

Objective: In order to understand the current situation and influencing factors of teaching quality in a Medical University in Yunnan, thus improving the teaching quality of the teachers. Methods: The self-made evaluation forms for teachers' teaching quality which include 9 first-level indicators were adopted. In December 2016, a survey was conducted on some students from grade 2013 to 2016 about the teachers who gave them lectures from September to December 2016, involving 7 different majors, 23 teachers and 18 courses. SPSS 21.0 was used for data analysis. Enumeration data were described by frequencies and percentages. Univariate and multivariate Logistic regression analyses were used for satisfaction. Results: There were 1 542 valid questionnaires collected in this survey. Univariate Logistic regression analysis showed that there were 6 factors related to the overall satisfaction of teachers' classroom teaching quality, which were "whether the courses are professional (OR=1.430)", "curriculum difficulty (OR=1.731)", "curriculum progression (OR=1.620)", "learning time after class (OR=1.141)", "interest before class (OR=1.565)", and "interest after class (OR=2.291)", respectively. Conclusion "courses are professional", "courses are too easy", and "the progression of courses is slow " are favorable factors for high satisfaction degree, while "courses are set up by the departments that the students belong", "learning time used after class is too short", and "interest for study is decreased after class" may be unfavorable factors for high satisfaction degree.

Objective To discuss the dosimetric differences in the planning methods between physical and biological optimization during thehypofractionated radiotherapy for lung cancer.MethodsTen cases of non-small cell lung cancer (NSCLC) receiving radiotherapy were selected in this retrospective study.The VMAT plans for all patients were re-designed by physical functions (DV group),biological combined with physical functions (DV+EUD group and EUD+DV group) and biological functions (EUD group).The constrained functions were different,whereas the constrained conditions and optimized parameters were identical among four groups.The dosimetric differences among four optimization methods during thehypofractionated radiotherapy for lung cancer were evaluated through calculating and analyzing each dosimetry parameter.Results For the target area,the equivalent uniform dose was approximate between the EUD and EUD+DV groups.The EUD in these two groups was approximately 2.8％-3.6％ and 3.2％-3.7％ higher than those in the DV and DV+EUD groups.The average tumor control probability (TCP) in the EUD and EUD +DV groupswas considerably higher than those in the other two groups (both P＜0.05).The homogeneity index (HI) significantly differed (all P＜0.05),whereas the conformity index (CI) did not differ (all P＞0.05).For the organ at risk (OAR) area,the differences of EUD,V5,V1o,V20,V30 of normal lung tissues and the difference of dosimetry parameters in heart and spinal cord were not statistically significant (all P＞0.05).The mean dose of all lungs in the EUD and EUD+DV groupswas slightly lower than those in the other two groups.ConclusionsBiological optimization method has certain advantages in increasing EUD and TCP in the target area and decreasing the irradiation dose of normal lung tissues,which provides references for selecting the optimization method with biological functions in clinical practice.

To address the controversial issue of the toxicity of dental alloys and silver nanoparticles in medical applications, an in vivo-like LO2 3-D model was constructed within polyvinylidene fluoride hollow fiber materials to mimic the microenvironment of liver tissue. The use of microscopy methods and the measurement of liver-specific functions optimized the model for best cell performances and also proved the superiority of the 3-D LO2 model when compared with the traditional monolayer model. Toxicity tests were conducted using the newly constructed model, finding that four dental castings coated with silver nanoparticles were toxic to human hepatocytes after cell viability assays. In general, the toxicity of both the castings and the coated silver nanoparticles aggravated as time increased, yet the nanoparticles attenuated the general toxicity by preventing metal ion release, especially at high concentrations.
Cells, Cultured ; Dental Casting Technique ; Hepatocytes/drug effects* ; Humans ; Metal Nanoparticles/toxicity* ; Silver/toxicity* ; Toxicity Tests

Objective Treatment and histopathological observation of demodex canis in beagle dogs .Methods Using the method of direct smear for microscopic examination of demodex canis.Histopathological observation on the skin of the parasitic parts after routine paraffin section and HE staining .Results (1) Clinical observation: The red spots and hair removal was appeared on limbs , eyes, lower abdomen and other parts of the skin of canine patients .The skin of the limbs becomes thicker and wrinkles .(2) Blood routine examination:Basically normal.(3) Microscope observation:The results showed that a large number of worms and eggs of small demodex canis could be found .(4) Histopathological observation:Hair follicles showed a large number of demodex mites and eggs.The sebaceous glands and sweat glands have normal morphology and no mites was found .A large number of eosinophils and neutrophil infiltration were seen around the hair follicles.It was also found that the formation of multifocal granuloma:the granuloma was oval shaped .(5) Treatment programme:The combination of medication and the strengthening of environmental control has been shown to be effective . Conclusions Granuloma caused by demodex canis can be divided into immune granuloma .It may not be possible to destroy the sebaceous glands after infection with small demodex canis.Whether the sebaceous gland is infected with the demodex canis may be associated with the worm species or course of disease .

Objective To explore the factors imfluencing the prognosis of patients with renal cell carcinoma after laparoscopic partial nephrectomy.Methods Clinical data from 593 renal cell carcinoma patients underwent laparoscopic partial nephrectomy in our institution from December 2010 to December 2015 were retrospectively collected..Tbere were 396 males and 197 females,aged 35 to 72 years old(mean 55.4 years).There were 181 cases of smoking history,206 cases of hypertension and 105 cases of diabetes.Before operation,98 cases of liver function were damaged and 122 cases were anemia.There were 521 cases with PLT ＜ 450 × 109/L,72 cases PLT≥ 450 × 109/L.Thc tumor of 292 cases on the left and 301 cases on the right.The Kaplan-Meier method log-rank test was used for survival analysis.Univariate analysis and factors which were significantly associated with survival in the univariate analysis were conducted into the multivariate analysis with Cox proportional hazards model.Results The operative time was 88.0-120.6 min,mean 104.3 min,the blood loss during operation was 47.2-157.8 ml,mean 102.5 ml. Pathological tumor stage revealed that 398 cases were T1 and 195 cases were T2 . Fuhrman classification revealed that 29 cases were grade Ⅰ,411 cases were grade Ⅱ,150 cases grade Ⅲ,3 cases grade Ⅳ . The median follow-up time was 36 months(ranged 6 to 99 months) . Five cases (1.3％) in the T1 patients relapsed,recurrencefree survival (RFS) rate was 98.7％;In the T2 patients,7 cases (3.6％) relapsed,1 of them had local recurrence and died of lung metastasis,and the RFS rate was 96.4％.Univariate analysis revealed that T stage,Fuhrman grade,tunor necrosis,tumor pseudocapsule,lymphovascular invasion,collection system violation,anemia,and high platelet were significantly associated with RFS of patients.Multivariate analysis found that T stage (HR =1.524,95 ％ CI 1.326-1.926,P =0.001),Fuhrman grade (HR =1.600,95 ％ CI 1.035-2.364,P =0.022),tumor necrosis (HR =2.315,95％ CI 1.523-3.624,P =0.001) were independent risk factors for the RFS of patients with renal cell carcinoma after retroperitoneal laparoscopic partial nephrectomy.Conclusion High T stage,high Fuhrman grade and tumor necrosis were independent risk factors for the RFS of patients with renal cell carcinoma after retroperitoneal laparoscopic partial nephrectomy.

Objective:To explore the efficacy and adverse reaction of TOMOX regimen combined with three dimensional conformal radiotherapy in the treatment of middle and advanced esophageal cancer. Methods:51 cases of hospitalized patients with esophageal cancer were selected from January 2013 to December 2015 in our hospital who were divided into observation group (n=27) and control group (n=24) by random number table method. The control group was treated with three dimensional conformal radiotherapy, and the observation group was added with the TOMOX scheme based on the control group. Compare the efficacy of the two groups, the control period, the survival period, the toxicity and side effects.Results: The rate of complete response(CR)and partial response (PR) in the observation group was significantly higher than that in the control group, the difference was statistically significant (P<0.05). The total effective rate of the observation group was 96.30%, which was significantly higher than that of the control group 58.33% (P<0.001). The 2 year control rate and 2 years survival rate of the observation group was significantly higher than that of the control group (P<0.05). The incidence of acute radiation pneumonia and gastrointestinal reaction in observation group was lower than the control group, the difference was statistically significant (P<0.05).The neuritis rate and leukopenia of observation group was lower than the control group, but the difference was not statistically significant (P>0.05). The rate of acute esophagitis in the observation group group was higher than that in the control group, the difference was statistically significant (P<0.05).Conclusion: TOMOX combined with three-dimensional conformal radiation therapy can effectively improve the short-term efficacy and long-term survival rate, reduce adverse reactions.