Objective This study aimed to identify differentially methylated genes (DMGs) associated with natural killer cells in patients with autoimmune thyroiditis (AIT),focusing on the influence of varying water iodine exposure levels. Methods Participants were divided into categories based on median water iodine (MWI) concentrations:iodine-fortified areas (IFA,MWI<10 μg/L),iodine-adequate areas (IAA,40 ≤ MWI ≤ 100μg/L),and iodine-excessive areas (IEA,MWI>300 μg/L). A total of 176 matched AIT cases and controls were recruited and divided into 89,40,and 47 pairs for IFA,IAA,and IEA,respectively. DMGs were identified using 850K BeadChip analysis for 10/10 paired samples. Validation of DNA methylation and mRNA expression levels of the DMGs was conducted using MethylTarget? and QRT-PCR for 176/176 paired samples. Results KLRC1,KLRC3,and SH2D1B were identified as significant DMGs. Validation revealed that KLRC1 was hypomethylated and highly expressed,whereas KLRC3 was hypermethylated and highly expressed in individuals with AIT. Furthermore,KLRC1 was hypomethylated and highly expressed in both IFA and IEA. Conclusion The DNA methylation status of KLRC1 and KLRC3 may play crucial roles in AIT pathogenesis. Additionally,DNA methylation of KLRC1 seems to be influenced by different iodine concentrations in water.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.

Objective:To establish HPLC fingerprint spectra and multi-component content determination methods for 20 batches of Mori Ramulus from different origins; To evaluate the quality of Mori Ramulus from different producing areas with similarity evaluation, CA, PCA, PLS-DA and other chemical pattern recognition methods.Methods:The chromatography was performed on Wondasil C18 column (4.6 mm×250 mm, 5 μm) at the detection wavelength of 254 nm, with acetonitrile (A) -0.2% glacial acetic acid (B) as the mobile phase at the flow rate of 0.8 ml/min. The fingerprint was established through the "TCM chromatographic Fingerprint Similarity Evaluation System", the similarity was calculated, and the chemical pattern recognition was carried out by SPSS 26.0 and SIMCA 14.1 software.Results:The similarity calculation results of fingerprint spectra showed that the similarity of the production areas in Fujian, Zhejiang, and Hebei was>0.830, while the similarity of other production areas was>0.900; a total of 14 common peaks were identified, and 8 components of mulberroside A, chlorogenic acid, polydatin, oxyresveratrol, resveratrol, morin, kuwanone G and morusin were identified; CA, PCA analysis divided Mori Ramulus from different producing areas into two categories, extracted four principal components, and the cumulative variance contribution rate was 89.247%. PLS-DA analysis was based on a VIP value greater than 1, and three quality difference criteria of mulberroside A, kuwanone G and morusin were selected.Conclusions:The established HPLC fingerprint and content determination method is simple, reproducible, stable, accurate and reliable. Combined with the chemical stoichiometric analysis methods, the quality evaluation of Mori Ramulus from different origins can be complete, and provide a reference for the quality control of mulberry branches.

Objective:To optimize the technology of Zhangbang wine moistening bran stir-fried Mori Ramulus.Methods:Using the total contents of 8 components including mulberry bark glycoside A, chlorogenic acid, resveratrol, resveratrol glycoside, oxidized resveratrol, mulberry pigment, mulberry ketone G, and mulberry saponin as the examination indicators, single factor investigation of five influencing factors of Zhangbang wine moistening bran stir-fried Mori Ramulus: wheat bran dosage, yellow wine dosage, frying temperature, soaking time, and processing time was conducted. Box Behnken response surface methodology was used for experimental design, to optimize processing technology for Zhangbang wine moistening bran stir-fried Mori Ramulus.Results:The optimal processing technology of the response surface method was: soaking time 116 min, wheat bran amount 19%, rice wine amount 10%, roasting time 7 min, and roasting temperature 237 ℃. Under these conditions, the average total content of eight components in the prepared Mori Ramulus decoction pieces was 787.8 μg/g, and RSD was 0.98%. Conclusion:The optimal processing technology of Zhangbang wine moistening bran stir-fried Mori Ramulus is stable, reliable and repeatable, which can better guarantee the quality of Zhangbang wine moistening bran stir-fried Mori Ramulus.

Objective To study the effectiveness of pro-abdominal exercise in improving the quality of gastroscopy,and provide patients with a better preoperative preparation for gastroscopy.Methods 307 patients who underwent painless gastroscopy from March to July 2023 were selected and divided into three groups according to the random number table method.There were 106 cases in the abdominal massage group,103 cases in the bed turning group and 98 cases in the control group.On the basis of routine medication,different preoperative activity guidance was used to compare and analyze the preoperative preparation time,examination time and gastric mucosal visual field clarity score in each group.Results The gastroscopy time in the abdominal massage group and the bed-turning group was significantly shorter than that in the control group,and the clarity score of the gastric mucosal visual field was significantly lower than that of the control group,with statistically significant differences(P<0.05).However,there were no statistically significant differences in the gastroscopy time or visual field clarity score for gastric body,gastric fundus,and gastric antrum between the abdominal massage group and the bed-turning group(P>0.05).The satisfaction rate of endoscopists in the abdominal massage group and the bed turning group was higher than that in the control group,and the differences were statistically significant.Conclusion Abdominal massage and turning over in bed as preoperative preparation methods for gastroscopy can improve the quality of gastroscopy,while abdominal massage can shorten the preparation time before gastroscopy,which is helpful for the efficient operation of digestive endoscopy center and is worthy of clinical application.

Objective To compare the analgesic effect and the effect on the success rate of reduc-tion of three doses of remifentanil combined with dexmedetomidine in the clamping reduction of cricoarytenoid joint dislocation.Methods Fifty-one patients with cricoarytenoid joint dislocation,30 males and 21 females,aged 18-80 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were selected from April 2021 to December 2022 in the department of otolaryngology,head and neck surgery.The patients were randomly divided into three groups according to remifentanil dose:remifentanil 0.5 μg·kg-1·min-1 group(group A,n=17),remifentanil 1.0 μg·kg-1·min-1 group(group B,n=18),and remifentanil 1.5 μg·kg-1·min-1 group(group C,n=16).After admission,dexmedetomidine 0.6 μg·kg 1·h-1 was injected intravenously,and an ear,nose and throat anesthetic spray(2％lidocaine 2 ml)was used to administer surface anesthesia to the base of the tongue.A second surface anesthesia was administered to the throat at 5 minutes,and dexmedetomidine was stopped at 10 minutes.The supraglottic and periarticular cri-coarytenoid joints were subjected to superficial anesthesia for a third time under visual laryngoscope,and then remifentanil at corresponding doses was injected intravenously in three groups for 5 minutes,and the reduction operation began after the pumping was stopped.The success of the first reduction,the anesthesia quality satisfaction score of the surgeon and the recovery of remifentanil during the operation were recorded.VAS pain scores were recorded at the time of entry,3 minutes,30 minutes,and 6 hours after operation.The adverse reactions during operation and recovery were recorded.Results Compared with group B,the success rate of first reduction and the score of anesthesia quality satisfaction were significantly decreased in groups A and C(P＜0.05).Compared with group A,the ratio of additional remifentanil supplementation in groups B and C was significantly reduced,and the VAS pain score 3 minutes after surgery was significant-ly decreased(P＜0.05).Compared with group C,the proportion of mandibular manipulation ventilation in groups A and B was significantly reduced(P＜0.05).There was no significant difference in the incidence of bradyheart rate,nausea and vomiting,agitation,delirium and laryngeal spasm between the three groups.Conclusion Compared with remifentanil 0.5 and 1.5 μg·kg-1·min-1,remifentanil 1.0 μg·kg-1·min-1 combined with dexmedetomide sequential pumping provided good analgesic effect for the clamping reduction of cricoarytenoid joint dislocation,improved the success rate of the first reduction,more stable respiratory circulation and fewer perioperative adverse reactions.

Objective To investigate the clinical application value of MRI Radiomics score(Radscore)combined with clinicopatho-logical features in predicting postoperative progression-free survival(PFS)of patients with endometrial cancer(EC).Methods A total of 127 patients with EC were selected.The radiomic features of the lesions were extracted from T2 WI,diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)images.The features were screened by random forest model and Radscore was calcu-lated.Simultaneously,clinical and pathological characteristics of patients were collected and incorporated,and multivariate Cox regression analysis was used to screen the risk factors related to PFS.The MRI Radscore and clinicopathological features were mapped to the nomogram,and the performance of nomogram was evaluated by receiver operating characteristic(ROC)curve and calibration curve.Results Multivariate Cox regression analysis showed that progesterone receptor(PR),human epididymis protein 4(HE4)and MRI Radscore were independent risk factors for predicting PFS in patients with EC(P＜0.05).The area under the curve(AUC)of the predicted PFS at 1,3 and 5 years after surgery were 0.91,0.804 and 0.776,respectively.Calibration curves showed that nomogram had a good fit in predicting PFS in patients with EC 1,3 and 5 years after surgery.Conclusion The nomogram con-structed based on multi-sequence MRI Radscore and clinicopathological features has favorable accuracy and stability in predicting postoperative PFS in individuals diagnosed with EC.

The automatic detection of tuberculosis lesions based on medical imaging has become a research hotspot in medical image processing.A comprehensive review of relevant researches and applications pertaining to deep learning in tuberculosis lesion detection is provided,which elucidates the experimental benchmarks in tuberculosis analysis,covering public datasets of pulmonary medical images and recent research advancements in tuberculosis detection and classification competitions,introduces emerging trends in deep learning methods and applications in tuberculosis detection,and analyzes the challenges existing in tuberculosis diagnosis using deep learning.The review summarizes and provides insights into the research advances and challenges of these technologies from the aspects of technical characteristics,performance advantages,and application prospects.

Taking the reform of payment methods based on diagnosis related groups as an opportunity, implementing performance management based on disease groups is an important lever to promote the improvement of hospital diagnosis and treatment level and high-quality development. In 2023, a tertiary comprehensive hospital introduced benchmarking management into performance management, using the average days of stay, drug costs, and consumables costs of the disease group as cost benchmark indicators. The cost benchmark values for each disease group was determined based on the big data of the disease group of the tertiary comprehensive hospital in the region and the clinical pathway management goals of the hospital. Through multidimensional and multi-level comparative analysis of the hospital′s historical values and regional big data distribution values of the benchmark indicators for each disease group, the cost benchmark values for each disease group was determined. The hospital has established a performance reward and punishment mechanism based on the benchmark value of disease group costs, and at the same time, established a performance management communication mechanism to promote relevant departments and medical groups to improve their management against the benchmark. In addition, with changes in the external environment and internal practices, the cost benchmark value of the disease group was dynamically optimized, forming a closed-loop management system that included establishing benchmarks, comparing benchmarks, achieving benchmarks, and optimizing benchmarks. Since the implementation of performance management based on disease group cost benchmarking in March 2023, the hospital′s case mix index has increased from 1.52 in March to 1.54 in September; The average days of stay decreased from 6.22 days to 5.90 days; The monthly payment weight has increased from 18 103 to 18 558; The average hospitalization cost has decreased from 16 724 yuan/person to 15 278 yuan/person, mainly due to the decrease in drug and consumables costs. The proportion of drug costs has decreased from 27.45% to 26.32%, the proportion of consumables costs has decreased from 28.75% to 26.85%, and the proportion of medical service revenue has increased from 24.64% to 26.08%; The proportion of low magnification cases decreased from 9.09% to 8.24%; The medical insurance payment rate has increased from 99.3% to 107.0%; The job satisfaction of physicians has increased from 70.00% in 2022 to 76.77% in 2023, which can provide reference for performance management practices in other hospitals.

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.