OBJECTIVE To construct and evaluate nomogram prediction model for refractory chemotherapy-induced nausea and vomiting （CINV）. METHODS The data of malignant tumor patients who received chemotherapy at the Third People’s Hospital of Zhengzhou from January 2017 to December 2023 were collected. These patients were categorized into the occurrence group and the non-occurrence group according to the occurrence of refractory CINV. Multivariate Logistic regression analysis was employed to screen predictive factors for refractory CINV and constructing a nomogram prediction model. Model performance was assessed via receiver operating characteristic curve analysis. Model calibration was evaluated using Bootstrap resampling. Decision curve analysis （DCA） was used to determine the clinical net benefit of three strategies under different risk thresholds. Clinical impact curves were utilized to assess the clinical value of the model at different risk thresholds. Shapley additive explanations （SHAP） analysis was performed to evaluate individual factor contributions to the predictive model. RESULTS A total of 388 patients were included， with 219 experiencing refractory CINV. Multivariate Logistic regression identified 11 predictive factors for refractory CINV， including gastrointestinal disease history， anticipated nausea and vomiting， chemotherapy-induced emetic risk classification， and electrolyte levels， etc. The model’s area under the curve was 0.80 [95% confidence interval （0.76， 0.84）]， with a mean error of 0.036. DCA demonstrated the prediction model had higher clinical net benefit when the risk threshold was between 0.05 and 0.85. SHAP analysis revealed the top three predictive factors as gastrointestinal disease history （0.924）， chemotherapy- induced emetic risk classification （0.866）， and electrolyte levels （0.581）. CONCLUSIONS Eleven factors， including gastrointestinal disease history， anticipated nausea and vomiting， chemotherapy-induced emetic risk classification， and electrolyte levels， are identified as predictors of refractory CINV. The model based on these factors has good predictive ability， which can be used to predict the risk of refractory CINV.

BACKGROUND: Over 20 million colonoscopies are performed in China annually. An automatic clinical decision support system (CDSS) with accurate semantic recognition of colonoscopy reports and guideline-based is helpful to relieve the increasing medical burden and standardize the healthcare. In this study, the CDSS was built under a hierarchical-label interpretable classification framework, trained by a state-of-the-art transformer-based model, and validated in a multi-center style. METHODS: We conducted stratified sampling on a previously established dataset containing 302,965 electronic colonoscopy reports with pathology, identified 2041 patients' records representative of overall features, and randomly divided into the training and testing sets (7:3). A total of five main labels and 22 sublabels were applied to annotate each record on a network platform, and the data were trained respectively by three pre-training models on Chinese corpus website, including bidirectional encoder representations from transformers (BERT)-base-Chinese (BC), the BERT-wwm-ext-Chinese (BWEC), and ernie-3.0-base-zh (E3BZ). The performance of trained models was subsequently compared with a randomly initialized model, and the preferred model was selected. Model fine-tuning was applied to further enhance the capacity. The system was validated in five other hospitals with 3177 consecutive colonoscopy cases. RESULTS: The E3BZ pre-trained model exhibited the best performance, with a 90.18% accuracy and a 69.14% Macro-F1 score overall. The model achieved 100% accuracy in identifying cancer cases and 99.16% for normal cases. In external validation, the model exhibited favorable consistency and good performance among five hospitals. CONCLUSIONS The novel CDSS possesses high-level semantic recognition of colonoscopy reports, provides appropriate recommendations, and holds the potential to be a powerful tool for physicians and patients. The hierarchical multi-label strategy and pre-training method should be amendable to manage more medical text in the future.
Humans ; Colonoscopy/methods* ; Deep Learning ; Decision Support Systems, Clinical ; Female ; Male

Objective: To assess the presence of vector-borne pathogens [including Zika virus (ZIKV), dengue virus (DENV), chikungunya virus (CHIKV), and Plasmodium (PLAS)] among voluntary blood donors in Wenshan Zhuang and Miao Autonomous Prefecture (referred to as Wenshan), so as to provide a basis for formulating blood safety-related strategies. Methods: Blood samples from voluntary blood donors in Wenshan from June to August 2022 to 2024 were selected. Real-time fluorescent quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to test 20 426 samples for ZIKV RNA, DENV RNA, and CHIKV RNA; and 19 765 samples were tested for PLAS DNA. Results: All 20 426 samples tested for ZIKV RNA, DENV RNA, and CHIKV RNA were negative; similarly, all 19 765 samples tested for PLAS DNA were negative. Conclusion: The risk of ZIKV, DENV, CHIKV, and PLAS infection among voluntary blood donors in Wenshan is relatively low. Routine surveillance for these pathogens as endemic diseases is not currently warranted. It is recommended to adjust the screening strategy based on the dynamic situation of local epidemiology control and prevention.

The clinical data of one child with metanephric stromal tumor (MST) and BRAF V600E gene mutation admitted to the First Affiliated Hospital of Zhengzhou University in June 2022 was analyzed retrospectively.Literature was reviewed.The patient, a 2-year-old girl, was diagnosed with a tumor in the left abdomen.The maximum diameter of the tumor was 10.5 cm.A radical nephrectomy was performed on the left kidney, and postoperative pathology revealed MST.Microscopically, the tumor had no envelope and exhibited expansive growth.The tumor cells were fusiform or stellate, and nuclear division was visible in the cell-rich region.Dysplastic blood vessels were seen inside the tumor.The tumor cells around the blood vessels and invaginated renal tubules were arranged like onion skin.CD34 was detected positive by immunohistochemical staining, and BRAF V600E mutation was also detected positive by fluorescent polymerase chain reaction.A total of 21 relevant case reports were retrieved, including 16 in English and 5 in Chinese.Fifty-eight MST patients, including the one in this report were analyzed.These patients were aged 2 days to 15 years, with a median age of 2 years.Except for 2 patients with unknown sex, the ratio of male to female was about 1.4∶1.0.Most MST patients were asymptomatic, with an average tumor size of 5.3 cm.The tumor cell CD34 showed positive expression in different degrees.Eight patients received the BRAF V600E mutation detection, and the results were all positive.Fifty-eight patients underwent nephrectomy and were followed up for 0-156 months, of which 7 patients were assisted with radiotherapy and chemotherapy.During the follow-up, 1 patient died, and 1 patient had a relapse.MST is a rare benign renal stromal tumor. BRAF V600E mutations are detected in a variety of malignancies.This paper is the first to report MST with BRAF V600E mutation in China and points out the importance of molecular detection of BRAF mutation for accurate diagnosis of MST.

[Objective]To explore the clinical characteristics of neurobrucellosis in Kashi,Xinjiang Uygur Autono-mous Region,thus improve the diagnosis and treatment.[Methods]A retrospective analysis was conducted on the clinical data of 18 cases of neurobrucellosis who were admitted to the First People's Hospital of Kashi Prefecture between Decem-ber 2019 and January 2024.[Results]The study included 9 males and 9 females,with a median age of 36 years(range:17-54.5).A clear epidemiological history was found in all the 18 brucllosis patients,12 of whom presented with meningo-encephalitis,5 meningitis,and 1 encephalitis.Two comorbided with spinal meningitis,2 osteoarthritis and 1 epididymitis.Most frequently reported clinical symptoms were headache,fever and fatigue.The prevalence rates of brucellosis by rose bengal plate agglutination test(RBPT)and serum agglutination test(SAT)were 11/12 and 8/9,respectively.Two of 10 patients had positive blood cultures,four of 16 had positive cerebrospinal fluid(CSF)cultures and five of five were detect-ed to be positive by next-generation sequencing(NGS)for pathogens in CSF.CSF showed exudative changes and elevated number of leukocytes,with predominance of single nucleated cells.All patients were treated with the combined use of two to four from the drugs like doxycycline,rifampicin,ceftriaxone,cefixime,minocycline,levofloxacin and sulfanilamide.Most patients had a favorable prognosis.[Conclusions]Neurobrucellosis should be considered in all patients with central nervous system manifestations from endemic areas.If there are exudative changes in CSF,differential diagnoses can be made by serological testing,blood culture,CSF culture and NGS.NGS could significantly increase the accuracy for neuro-brucellosis diagnosis.

ObjectiveTo investigate the effects of acupuncture combined with Du-Moxibustion (ADM) on peripheral blood cell count and levels of immune factors in patients with occupational chronic benzene poisoning. Methods A total of 70 patients with occupational chronic benzene poisoning (leukopenia and neutropenia) were selected as the research subjects by judgement sampling method. They were randomly divided into a control group and an ADM group using a random number table method, with 35 cases in each group. Patients in the control group were treated with conventional Western medicine such as leukocyte boosting and symptomatic treatment. While patients in the ADM group were treated with ADM treatment in addition to treatments of the control group, once per week for five consecutive weeks. Peripheral blood samples of patients were collected before and after treatment from both groups, to detect cell counts and serum levels of immune factors. Results The white blood cell count, red blood cell count, absolute lymphocyte count, absolute neutrophil count, platelet count, and levels of hemoglobin, immunoglobulins (Ig) A, IgM, IgG, complement C3 and complement C4 of patients in both groups improved after treatment compared with those before treatment (all P<0.05). The white blood cell count, levels of IgA, IgM, IgG, complement C3 and complement C4 of patients in the ADM group were higher than those in the control group after treatment (all P<0.05). Conclusion ADM treatment can increase peripheral blood white blood cells and serum levels of immune factor in patients with occupational chronic benzene poisoning (leukopenia, neutropenia), which helps improve patient recovery and can be promoted clinically.

Objective: To explore the differences in the gut microbiota of primary school students with different levels of sugar sweetened beverage intake, so as to provide scientific evidence for better identification of health risks in children and the development of targeted health policies. Methods: In June 2022, a total of 192 healthy primary school students from Chengdu were selected using a stratified cluster random sampling method. The sugar sweetened beverage intake was assessed through a dietary frequency questionnaire. Based on the median daily sugar sweetened beverage intake, primary school students were categorized into a low intake group ( n =96) and a high intake group ( n =96). The gut microbiota in fresh fecal samples from the two groups of primary school students was analyzed using 16S rRNA high throughput sequencing, and the diversity and community structure differences in the gut microbiota were compared. Results: Children in the low intake group had a sugar sweetened beverage intake of (21.3±1.6) mL/d, while the high intake group had an intake of (269.6±37.3) mL/d. Diversity analysis results showed that there were no statistically significant differences between the low intake and the high intake group in terms of α diversity metrics: Observed_otus index [298.50 (259.75, 342.25), 305.50 (244.25, 367.75)], Goods_coverage index [1.00 (1.00, 1.00), 1.00 (1.00, 1.00)], Chao index [304.18 (260.75, 348.78), 305.88 (245.68, 370.88)], Shannon index [5.88 (5.29, 6.45), 5.71 (4.89, 6.28)] and Simpson index [0.95 (0.91, 0.97), 0.94 (0.88, 0.97)] ( Z =-0.64, -0.76, -0.54, -1.76, -1.67, P >0.05). Furthermore, no statistically significant difference was observed in β diversity between the two groups ( R 2=0.006, P >0.05). At the genus level, the abundance of Blautia [0.033 (0.018, 0.055)] and Fusicatenibacter [0.009 (0.005, 0.015)] were higher in the low intake group compared to the high intake group [0.024 (0.013, 0.041),0.006 (0.003, 0.011)]and differences were statistically significant ( Z =-2.52, -2.81, P <0.05). LEfSe analysis highlighted intergroup differences primarily in Blautia, Fusicatenibacter and Sarcina( LDA= 3.56,3.12,3.53, P <0.05). Conclusions There is no significant difference in the diversity and overall structure of the gut microbiota in primary school students with different levels of sugar sweetened beverage intake. However, there are species variations at the genus level. The information can serve as a scientific basis for identifying health risks in primary school students and formulating targeted health strategies.

Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Objective This study aims to discuss the research hotspot and development trend in the field of polycystic ovary syndrome(PCOS)through bibliometric statistics and visual analysis of long noncoding RNA(lncRNA)related studies.Methods Utilizing the Web of Science core database as the literature data source,we searched for PCOS lncRNA-related literature from 2015 to 2023.CiteSpace software was used to conduct a visual analysis,including the annual distribution,citation trends,countries,institutions,funding sources and key words,as well as co-occurrence and cluster analysis of key words.Results The visual analysis of 108 PCOS lncRNA literature revealed that China was the country with the highest number of publications.The first contributing institution was the Shandong University.The national natural science fund of China gave the biggest funding.The keyword cluster analysis suggested that PCOS lncRNA signal pathway regulation,related receptor activators,and the expression of regulatory factors were the research hotspots in ovary syndrome lncRNA research.Conclusion LncRNA related regulatory factors,bioinformatics analysis,and gene transcription in PCOS are new targetsfor PCOS treatment,providing valuable insights for clinical therapy and new strategies for the development of PCOS-related pharmaceuticals.

Aim To study the distribution of CYP2C19,ABCB1,and PON1 genotypes and their correlation with clopidogrel resistance in patients with coronary heart disease in Tai'an.Methods A total of 594 patients with coronary heart disease who were treated with clopidogrel during hospitalization in Tai'an Central Hospital from January 2019 to March 2020 were selected.Fluorescence in situ hybridization was used to detect CYP2C19*2(rs4244285),CYP2C19*3(rs4986893),CYP2C19*17(rs12248560),ABCB1(rs1045642)and PON1(rs662)gene types.Results CYP2C19*2,CYP2C19*3,CYP2C19*17 genotypes in patients with coronary heart disease in Tai'an were mainly with homozygous(GG).The frequencies of CYP2C19*2 GG,CYP2C19*3 GG,CYP2C19*17 CC,ABCB1 CT and PON1 AG were 48.0％,89.6％,97.0％,46.8％and 47.1％respectively.There was no significant difference in CYP2C19*2,CYP2C19*3,CYP2C19*17,ABCB1,PON1 genotype distribution and allele distribution between male and female patients(P＞0.05).Significant regional differences in the frequency of CYP2C19 alleles and the distribution of metabolic types were found in patients with coronary heart disease in Tai'an.Among 594 patients included in the study,there were 287 patients with a risk level of clopidogrel resistance ≥ 2 in the composite evaluation of patients,approximately 48.3％of the total number of patients.This indicated that clopidogrel resistance was present in 48.3％of patients on the regular dose of clopidogrel.Of the 287 people with a risk level ≥2,46 had a normal CYP2C19 metabolic type,representing approxi-mately 7.7％of the total number of patients.Conclusion There were gene polymorphisms observed in CYP2C19*2,CYP2C19*3,CYP2C19*17,ABCB1 and PON1 distribution in patients with coronary heart disease in Tai'an,and ABCB1 and PON1 gene polymorphisms would had an impact on the outcome of medication guidance in approximately 7.7％.