ObjectiveTo establish a risk recognition model for coronary artery stenosis by using a machine learning method and to identify the key causative factors. MethodsPatients aged ≥18 years，diagnosed with coronary heart disease through coronary angiography from January 2013 to May 2020 in two prominent hospitals in Shanxi Province， were continuously enrolled. Logistic regression，back propagation neural network （BPNN）， and random forest（RF）algorithms were used to construct models for detecting the causative factors of coronary artery stenosis. Sensitivity （TPR）， specificity （TNR）， accuracy （ACC）， positive predictive value （PV+）， negative predictive value （PV-）， area under subject operating characteristic curve （AUC）， and calibration curve were used to compare the discrimination and calibration performance of the models. The best model was then employed to predict the main risk variables associated with coronary stenosis. ResultsThe RF model exhibited superior comprehensive performance compared to logistic regression and BPNN models. The TPR values for logistic regression，BPNN，and RF models were 75.76%， 74.30%， and 93.70%， while ACC values were 74.05%， 72.30%， and 79.49%， respectively. The AUC values were：logistic regression 0.739 9； BPNN 0.723 1； RF 0.752 2. Manifestations such as chest pains，abnormal ST segments on ECG，ventricular premature beats with hypertension， atrial fibrillation， regional wall motion abnormalities（RWMA） by color echocardiography， aortic regurgitation（AR）， pulmonary insufficiency （PI）， family history of cardiovascular diseases，and body mass index（BMI）were identified as top ten important variables affecting coronary stenosis according to the RF model. ConclusionsRandom forest model shows the best comprehensive performance in identification and accurate assessment of coronary artery stenosis. The prediction of risk factors affecting coronary artery stenosis can provide a scientific basis for clinical intervention and help to formulate further diagnosis and treatment strategies so as to delay the disease progression.

Objectives:To analyze the consistency of evaluating left ventricular hemodynamics (HDF) based on single plane and multi plane cine sequences of magnetic resonance mitral valve orifice.Methods:A prospective study was conducted on 48 healthy adults, and two methods were used to measure the mitral valve diameter and calculate HDF parameters. The first method was to measure the diameter of the mitral valve opening in the left ventricular three chamber cine sequence; The second method is to measure the mitral valve diameter using cine sequences of two chamber, three chamber, and four chamber hearts, and then take the average value. Paired t-tests were used to compare the differences in HDF measured by two methods, and Pearson correlation coefficient ( r), intra group correlation coefficient ( ICC), and Bland-Altman analysis were used to test the consistency and reproducibility of the two methods. Results:The root mean square (RMS) of longitudinal HDF calculated using single plane and multi plane mitral valve diameters were [(17.28±4.41)% vs (17.21±4.61)%] ( P=0.379) for the entire cardiac cycle, [(21.45±5.54)% vs (21.49±5.68)%] ( P=0.646) for systolic phase, and [(12.78±4.10)% vs (12.54±4.24)%] ( P=0.106) for diastolic phase, respectively. The difference in the calculation results of HDF parameters related to ventricular function was not statistically significant (all P>0.05), and there was good consistency ( r=0.924-0.996, ICC=0.924-0.995). The two HDF parameters related to atrial function were sensitive to the measurement method of mitral valve orifice diameter [RMS of longitudinal HDF during active atrial emptying: (3.26±1.51)% vs (3.32±1.55)%, P=0.006; longitudinal HDF pulse during active atrial emptying: (-2.60±1.28)% vs (-2.76±1.30)%, P<0.001]. Conclusions:The ventricular function related HDF parameters obtained from the analysis of mitral valve orifice diameter using single plane and multi plane methods have good consistency, and can be evaluated using relatively simple single plane methods for left ventricular HDF.

Objectives:To investigate the clinical feasibility of three-dimensional(3D)high-resolution late gadolinium enhancement(LGE)MRI in accessing left atrial myocardial fibrosis in patients with atrial fibrillation(AF). Methods:A total of 34 AF patients referred for hybrid surgical ablation were retrospectively enrolled in this study.3D-LGE-MRI images were acquired by Siemens 3.0 T machine and analyzed by ADAS post-processing software by two experienced radiologists to obtain parameters such as the area and the area percentage of LGE.Regional analysis was performed by one of the two radiologists at ten left atrial segments.The Kappa test was used to assess the agreement for scoring image quality,and the interclass correlation coefficient(ICC)was used to evaluate the interobserver agreement of LGE parameters.The parameters of left atrial morphology,area(and area percentage)of LGE,and location of LGE were compared between patients with persistent AF and paroxysmal AF. Results:Images of all 34 patients were considered to have diagnostic value.The scores of the overall image quality and the clarity of the left atrial wall evaluated by two radiologists were(2.88±0.64)points and(3.26±0.75)points(radiologist 1),(2.97±0.58)points and(3.24±0.70)points(radiologist 2),respectively.The corresponding Kappa values were 0.724 and 0.859.Both the area and the area percentage of LGE showed good consistency among observers,and the ICCs were 0.969 and 0.950,respectively.The difference in the area of LGE and the area percentage of LGE between patients with paroxysmal and persistent atrial fibrillation was similar(both P＞0.05).Compared with patients with paroxysmal AF,patients with persistent AF had a higher Utah stage and more severe myocardial fibrosis in the right inferior pulmonary vein antrum and the left atrial septum(all P＜0.05). Conclusions:3D high-resolution LGE-MRI provides a non-invasive way to visualize and quantify left atrial myocardial fibrosis.The extent of left atrial fibrosis in patients with persistent AF is more severe than that in patients with paroxysmal AF,with a preferential distribution in the right inferior pulmonary vein antrum and the left atrial septum.

Objective·To explore the efficacy and safety of compound amino acid capsules in the treatment of malnutrition and calcium and phosphorus metabolism disorders in maintenance hemodialysis patients.Methods·In this prospective,randomized,controlled,single-center study,forty maintenance hemodialysis patients from Renji Hospital,Shanghai Jiao Tong University School of Medicine were randomly divided into two groups,the treatment group(n=21)and the control group(n=19).The treatment group was given oral compound amino acid capsules on the basis of regular hemodialysis treatment,while the control group received no special nutritional intervention.Serum albumin,prealbumin,hemoglobin,ferritin,calcium,phosphorus,1,25-(OH)2-D3 and intact parathyroid hormone levels were analyzed every 3 months,and the incidence of adverse events including death,cardio-cerebrovascular accidents and vascular access failure was recorded.The total follow-up period was 9 months.Results·Serum albumin and prealbumin in the treatment group at 6-month and 9-month were significantly higher than the baseline parameters(albumin,t=3.574,5.599,both P<0.05;prealbumin,t/Z=-2.485,2.921,both P<0.05).Albumin in the control group increased at 9-month with a lower amplification compared to the treatment group(t=3.877,P=0.001),while the difference of prealbumin showed no statistical significance during follow-up.Hemoglobin and serum ferritin in the treatment group started to increase at 3-month(hemoglobin,t=2.192;ferritin,t=2.994;both P<0.05).Phosphorus in treatment group decreased at 3-month and 9-month(t/Z=-2.743,-2.103,both P<0.05),while phosphorus in the control group remained relatively stable during the first 6 months and increased at 9-month(Z=-2.178,P=0.029).Calcium and 1,25-(OH)2-D3 in the treatment group at 3-month and 6-month were significantly higher than the baseline parameters(calcium,t=4.581,4.922,both P=0.000;1,25-(OH)2-D3 t/Z=4.504,-2.374,both P<0.05),while the increase in blood calcium in the control group was significantly smaller than that in the treatment group during the same period.1,25-(OH)2-D3 in the control group showed no significant improvement.There was no significant difference in intact parathyroid hormone level,incidence of adverse events and other laboratory examination results between the two groups.Conclusion·Compound amino acid capsules can ameliorate the nutrition status and regulate calcium and phosphorus metabolism effectively and safely in maintenance hemodialysis patients.

Hereditary gingival fibromatosis (HGF) is a rare inherited condition with fibromatoid hyperplasia of the gingival tissue that exhibits great genetic heterogeneity. Five distinct loci related to non-syndromic HGF have been identified; however, only two disease-causing genes, SOS1 and REST, inducing HGF have been identified at two loci, GINGF1 and GINGF5, respectively. Here, based on a family pedigree with 26 members, including nine patients with HGF, we identified double heterozygous pathogenic mutations in the ZNF513 (c.C748T, p.R250W) and KIF3C (c.G1229A, p.R410H) genes within the GINGF3 locus related to HGF. Functional studies demonstrated that the ZNF513 p.R250W and KIF3C p.R410H variants significantly increased the expression of ZNF513 and KIF3C in vitro and in vivo. ZNF513, a transcription factor, binds to KIF3C exon 1 and participates in the positive regulation of KIF3C expression in gingival fibroblasts. Furthermore, a knock-in mouse model confirmed that heterozygous or homozygous mutations within Zfp513 (p.R250W) or Kif3c (p.R412H) alone do not led to clear phenotypes with gingival fibromatosis, whereas the double mutations led to gingival hyperplasia phenotypes. In addition, we found that ZNF513 binds to the SOS1 promoter and plays an important positive role in regulating the expression of SOS1. Moreover, the KIF3C p.R410H mutation could activate the PI3K and KCNQ1 potassium channels. ZNF513 combined with KIF3C regulates gingival fibroblast proliferation, migration, and fibrosis response via the PI3K/AKT/mTOR and Ras/Raf/MEK/ERK pathways. In summary, these results demonstrate ZNF513 + KIF3C as an important genetic combination in HGF manifestation and suggest that ZNF513 mutation may be a major risk factor for HGF.
Animals ; Humans ; Mice ; Fibromatosis, Gingival/pathology* ; Gingiva ; Kinesins/genetics* ; Mutation/genetics* ; Phosphatidylinositol 3-Kinases/genetics*

Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disease with the highest incidence rate, and the elderly are the high incidence population. Particle repositioning maneuver, simple and practicable, and has good clinical effects, is recognized as the preferred treatment method for BPPV. However, the elderly patients have a higher prevalence rate, often suffer from multiple chronic diseases, and their various bodily functions have entered a declining stage, with poor response to treatment and a tendency to recur. Based on these, medical staff should continuously improve their professional abilities, and pay attention to and implement some comprehensive and multi-dimensional humanistic care measures from physiological to psychological aspects such as verbal encouragement, behavioral support, and spiritual integration during the diagnosis and treatment process, to improve the quality of life of elderly BPPV patients, reduce medical disputes, and save medical resources.

Objective:To investigate the malignant imaging characteristics of non-palpable Breast Imaging-Reporting and Data System 3 breast lesions (NPBL BI-RADS 3 breast lesions) with ultrasound-guided core needle biopsy.Methods:From February 2016 to February 2018, the ultrasound characteristics of 161 NPBL BI-RADS 3 breast lesions in Beijing Friendship Hospital, Capital Medical University were retrospectively collected with ultrasound-guided core needle biopsy and pathological examination. According to the pathological results, the patients were divided into two groups: benign group (153 cases) and malignant group (8 cases). Associated risk factors were analyzed retrospectively according to general characteristics and characteristics of the ultrasound report. The Fisher exact probability test was used for single-factor comparative analysis. Significant variables based on univariate analysis were included in multivariate regression analysis, and then logistic regression was used to search for clinical risk parameters and ultrasound malignant signs. The receiver operating characteristic (ROC) curve was plotted with statistically significant factors to evaluate the diagnostic efficacy. In combination with the area under the curve (AUC), the parameter integral critical value, sensitivity and specificity were analyzed.Results:The age≥45 years ( OR=35.036, P=0.012), the maximum lesion diameter of 1-1.3 cm ( OR=25.047, P=0.008) and a aspect ratio of the lesion of 0.56-0.72 ( OR=19.860, P=0.013) could significantly affect the benign and malignant nature of the lesions, could be independent risk factors. The AUCs for constructing ROC curves to assess the diagnostic values of the above-mentioned indices were 0.732, 0.724 and 0.751, respectively; the sensitivity was 87.5%, 62.5% and 75%; the specificity was 58.8%, 82.4% and 75.2%; the positive predictive values was 10.0%, 15.6% and 13.6%; the negative predictive values was 98.9%, 97.7% and 98.3%, respectively. Conclusion:Of the NPBL BI-RADS 3 breast lesions, the malignant risk of lesions with an age≥45 years, maximum diameter of 1-1.3 cm and aspect ratio of 0.56-0.72 is high.

Objective:To explore the isolation and culture methods of mouse parietal epithelial cells (PECs) of Bowman′s capsule, so as to provide a cell tool for further study.Methods:Mouse renal corpuscles were isolated by cell sieving combined with magnetic separation. After primary culture, identified parietal epithelial cells were induced to differentiate into podocytes. Immunofluorescence staining, real-time quantitative PCR and Western blotting were used to detect specific markers of parietal epithelial cells and podocytes.Results:Primary cultured PECs grew like paving stone and expressed Claudin-1 (PECs specific marker), CD133 (stem cell marker) and CD24 (stem cell marker), without the expression of tubular epithelial cell proteins, mesangial cell and podocyte specific proteins. Cultured to 6 generations in vitro, the PECs still expressed Claudin-1, CD133 and CD24. After incubated with differentiation medium, PECs were able to express podocyte markers WT-1 and Synaptopodin. Conclusion:The renal corpuscles are extracted by cell sieving combined with magnetic separation, and the mouse PECs successfully cultured in vitro can be induced to express podocytes′ markers.

Objective:To compare the curative effect of hematoma removal and minimally invasive puncture drainage in hypertensive intracerebral hemorrhage (HICH) under neuroendoscope.Methods:The clinical data of 118 patients with HICH admitted to our hospital from February 2017 to November 2019 were retrospectively analyzed. According to the different surgical methods, the patients were divided into group A ( n=59, minimally invasive puncture and drainage) and group B ( n=59, neuroendoscopic hematoma removal). The perioperative indexes, complications and neurological function indexes [neuron specific enolase (NSE), neurotrophic factor (NGF), substance P (SP)], inflammatory factor index [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] and related scale scores [National Institutes of Health Stroke Scale (NIHSS), modified Barthel Index (mBI)] were compared between the two groups. Results:The operation time, cerebrospinal fluid recovery time, hematoma removal time and hospitalization time of group B were shorter than those of group A ( P<0.05). On the 7th day after operation, the NSE, SP, IL-6, TNF-α in the two groups were decreased, and the levels of NSE, SP, IL-6 and TNF-α in group B were lower than those in group A ( P<0.05); on the 7th day after operation, the levels of NGF in two groups were increased, and those in group B were higher than those in group A ( P<0.05). 6 months after operation, the NIHSS decreased and mBI increased in both groups ( P<0.05), and NIHSS in group B was lower than that in group A, but mBI was higher than that in group A ( P<0.05). There was no difference in the incidence of complications between the two groups ( P>0.05). Conclusions:Compared with minimally invasive puncture and drainage, neuroendoscope hematoma removal for HICH patients can effectively improve perioperative indicators, reduce neurological damage and body inflammatory stimulation, and improve the self-care ability of patients, which is safe and reliable.

Objective To investigate the effect of the mirror therapy (MT) combined with motor imagery therapy (MIT) on the lower limb motor performance,balance and ability in the activities of daily living of ischemic stroke patients soon after a stroke.Methods Forty hospitalized ischemic stroke patients were randomly allocated to an MT+MIT group (n=20) or an MIT only group (n=20).In addition to routine rehabilitation,the MIT group exercised practicing knee extension and ankle dorsiflexion 30 minutes a day,five days a week for 8 weeks following motor imagery therapy protocols,while the MT+MIT group accepted MIT combined with mirror therapy.The Fugl-Meyer lower extremity assessment (FMALE),Berg Balance scores (BBSs) and the Modified Barthel index (MBI) were used to evaluate the effects of the treatment before the treatment and after 4 and 8 weeks of therapy.Results Before the intervention there was no significant difference between the two groups in terms of their average FMA,BBS and MBI ratings.After 4 weeks of treatment a significant improvement was observed in the MT+MIT group's average FMA-LE and BBS scores and in the flat walking component of the MBI.In the MIT group only the average bed/wheelchair transfer and flat walking scores in the MBI were significantly improved.After 8 weeks the MT+MIT group's average FMA-LE and BBS scores had improved significantly,along with its average scores in the feeding,dressing,grooming,bathing,urination,bed/wheelchair transfer,walking up and down stairs and flat walking components of the MBI.In the MIT group the average FMA-LE and BBS scores had improved significantly,along with those for bed/wheelchair transfer,walking up and down stairs and flat walking in the MBI.After both 4 and 8 weeks,the MT+MIT group's average scores were consistently significantly better than those of the MT group.Conclusion Mirror therapy can significantly enhance the effectiveness of motor imagery therapy when they are combined in the rehabilitation of ischemic stroke patients in the early post-stroke stage.