Objective To identify the pathogenic bacteria such as Staphylococcus aureus and Enterococcus faecalis in bloodstream infec-tions with high confidence based on three deep learning models such as GoogleNet,ResNet101,and Vgg19,compare the performance and classification ability of these models,and explore the feasibility of applying the deep learning models for the rapid identification of pathogenic bacteria in bloodstream infections.Methods The preprocessed Gram-stained bacterial images,including 1 682 images for Staphylococcus aureus and 1 723 for Enterococcus faecalis,and 688 blank control microscopic images were input into three models for training and validation,respectively.Among them,1 344 images for Staphylococcus aureus,1 376 for Enterococcus faecalis,and 544 blank control images were used for training,and the remaining images were used for validation.The model with the best performance was identified according to the classification parameters between the models.Results The ResNet101 model had the lowest cross-en-tropy loss value(0.008 710 3),the largest Epoch value(93),and the highest accuracy rate(99％)for identifying the three types of validation set images.The cross-entropy loss value,Epoch value,and accuracy rate of the GoogleNet model were 0.063 89,86 and 98.6％,respectively,for identifying the three types of validation set images.Those of the Vgg19 model were 0.035 682,86 and 97.7％,respectively.Conclusion The ResNet101 model has the best performance in the classification of three kinds of images.The deep learning model may accurately,reliably and rapidly identify the Gram-stained images of pathogenic bacteria such as Staphylococcus aureus and Enterococcus faecalis in bloodstream infections.

Objective:To systematically evaluate the effect of cognitive behavioral therapy (CBT) in elderly patients with depression.Methods:The randomized controlled trials on the effect of CBT in elderly patients with depression, published until December 15, 2022, were searched in PubMed, CINHAL, Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, WanFang Data, and VIP. Two researchers independently screened the literature, extracted data, and used the revised Cochrane risk of bias tool for randomized trials (ROB 2.0) to evaluate the quality of the included studies. Statistical analysis was conducted using Stata 16.0, and the quality of evidence was rated using Appraisal of Guidelines for Research and Evaluation (GRADE) predictor software.Results:A total of 11 randomized controlled trials were included, with a total of 833 elderly patients with depression. Randomized effect models were used to analyze outcome indicators such as depression, anxiety, and quality of life by combining effect quantities. Meta-analysis and GRADE evidence quality showed that compared to the control group, medium quality evidence showed that CBT could relieve depression in elderly depression patients with a statistical difference [ SMD=-1.58, 95% CI (-2.16, -0.99), P<0.05]. Low quality evidence suggested that CBT could alleviate anxiety in elderly depression patients also with a statistical difference [ SMD=-2.25, 95% CI (-4.04, -0.47), P<0.05]. Very low quality evidence indicated that CBT did not significantly improve the quality of life in elderly depression patients compared to conventional or pharmacological treatment [ SMD=-0.09, 95% CI (-2.07, 1.88), P>0.05] . Conclusions:Existing evidence suggests that CBT can alleviate depression and anxiety in elderly depression patients, but its improvement in quality of life is not yet significant. Treatment feedback and forms of CBT may become a research focus in recent years on intervention for elderly depression patients.

Acute skin failure is a common condition of skin damage in critically ill patients, which seriously affects the prognosis of patients. This article summarizes the evaluation indicators, techniques, and comparison of evaluation indicators and techniques for acute skin failure, in order to provide references for the development of acute skin failure evaluation tools and the formulation of nursing measures.

Objective To analyze the current status and influencing factors of demoralization syndrome in patients with liver cirrhosis at the decompensated stage. Methods A total of 444 patients with liver cirrhosis at the decompensated stage were selected as study subjects from four tertiary hospitals in Changsha, Hunan Province using a convenient sampling method. The survey was conducted using a general information questionnaire, the Chinese version of the Demoralization Scale, the Social Support Rating Scale, the Chinese version of the Brief Illness Perception Questionnaire, and the Simplified Coping Style Questionnaire. Results The incidence of demoralization syndrome in patients with liver cirrhosis at the decompensated stage was 71.62%, with a mean total score of (38.21±14.34) for the Demoralization Scale. Multiple linear regression analysis showed that primary disease, the number of complications, Child-Pugh classification, coping style, illness perception, and social support were influencing factors of demoralization syndrome in patients with liver cirrhosis at the decompensated stage (P < 0.05). Conclusion The demoralization syndrome in patients with decompensated cirrhosis is at a severe level, and its main influencing factors are primary disease, the number of complications, Child-Pugh classification, social support, illness perception, and coping style. Healthcare professionals should regularly assess the level of demoralization syndrome in patients with liver cirrhosis at decompensated stage and adopt targeted interventions to improve their psychological status.

Total knee arthroplasty， as a common treatment option for advanced knee osteoarthritis， can alleviate the clinical symptoms of patients. Deep vein thrombosis of the lower extremity is the most common complication of total knee arthroplasty. Previous studies have shown that the occurrence of deep vein thrombosis after total knee arthroplasty is mostly related to the overexpression of inflammatory factors in vivo. Nuclear transcription factor-κB， Toll-like receptor 4， phosphatidylinositol 3-kinase/protein kinase B， tumor necrosis factor， and nuclear transcription factor E₂-related factor 2 are typical signaling pathways related to inflammation. Regulating the expression of the signaling pathways can intervene the formation of inflammatory factors. Inhibiting the formation of inflammatory factors can help suppress the activation of platelets， thereby blocking thrombosis. According to previous research， Chinese medicine monomers， Chinese medicine extract， and compound Chinese medicine prescriptions all directly or indirectly inhibit the expression of inflammatory factors by regulating the above signaling pathways， thereby suppressing the occurrence of deep vein thrombosis after total knee arthroplasty. Therefore， Chinese medicine can reduce postoperative complications and promote postoperative recovery of patients at low cost with small side effects. This article summarizes the research on Chinese medicine intervention on deep vein thrombosis-related signaling pathways after total knee arthroplasty， which is expected to lay a basis for the in-depth study and clinical application of Chinese medicine in deep vein thrombosis.

Objective:To investigate the ultrasonographic features and evolution of thyroid shrinking nodules in order to improve the differential diagnosis and management strategy and avoid unnecessary biopsy.Methods:A total of 245 patients with old bleeding of benign thyroid nodules diagnosed via fine needle aspiration cytology (FNAC) from May 2015 to July 2020 in the southern part of the Shanghai General Hospital Affiliated to the Medical College of Shanghai Jiaotong University, including 263 nodules. The sonographic parameters such as size, shape, aspect ratio, echo, edge, boundary, periphery, halo, calcification, posterior echo enhancement and posterior acoustic attenuation of nodules were analyzed retrospectively, and the ultrasonic appearances of nodules were classified; 41 nodules from 40 patients, who did ultrasound examinations more than twice and had both complete ultrasonographic data, were compared and then classified in order to explore the evolution rules of the nodules.Results:Two hundred and sixty-three thyroid shrinking nodules in 245 cases were classified into 4 types: "cystic wall shrinkage sign" type(71.48%, 188/263), "carcinoma-like" type (22.05%, 58/263), "inflammation-like" type(3.04%, 8/263) and "undefined atypical solid nodules" type(3.42%, 9/263). Of the 41 consecutive follow-up nodules, 37 cases showed obvious cystic wall shrinkage sign, and 7 of them developed into "carcinoma-like" type and 6 cases into "inflammation-like" type.Conclusions:The ultrasonographic appearance of thyroid shrinking nodules is a dynamic process, which can be divided into 4 types: "cystic wall shrinkage sign" , "carcinoma-like" , "inflammation-like" and "undefined atypical solid nodules" types. The "cystic wall shrinkage sign" type is typical and common. The "cystic wall shrinkage sign" type can develope into the "carcinoma-like" type or the "inflammation-like" type.

Objective To investigate the efficacy of transcatheter selective cystic arterial infusion chemotherapy embolization in the treatment of invasive bladder cancer with hemorrhage.Methods 81 cases of with invasive bladder cancer and hemorrhage treated by superselective intervention in hospital were selected,as well as postoperative complications and tumor volume changes were recorded in followG up.Results The success rate of intubation and embolization was 100%,the immediate hemostasis rate was 97.53%,and the preoperative bladder tumor volume (4.08±1.66)cm was significantly larger than that of the six months after surgery (3.45±1.33)cm.Conclusion Superselective cystic arterial perfusion embolization is a safe and effective treatment for patients with invasive bladder cancer complicated with hemorrhage.

Objective ToexploretheeffectofTIPS+GCVEcombinedwithPSEonhemodynamicsinpatientswithlivercirrhosis,portal hypertensionandsplenomegaly.Methods 56patientswereincludedfromJanuary2015toDecember2016 whounderwentTIPS+GCVEcombinedwithPSE.Patientswerefollowed-upon1month,3months,6monthsand1yearaftersurgery,andstatisticanalysis weredoneonportalveinhemodynamicindex:portalveintrunkdiameter(PVD),portalveinvelocity(PVV),portalvenousbloodflow (PVF),splenicveintrunkdiameter(SVD)andvelocityofbloodflowinsplenicvein(SVV).Results Thereweresignificantdifferencesinportal veinpressurebeforeandafterthebypassinall56patients.PVDandPVV weresignificantlydifferentbetween3and6 monthsafter surgeryandpre-surgery.PVF wassignificantlydifferentcomparing6 monthsand1yearaftersurgery withpre-surgery.SVDand SVV weresignificantlydifferentbetween3 months,6 monthsand1yearaftersurgeryandpre-surgery.Conclusion TIPS+GCVE combinedwithPSEcouldeffectivelyreduceportalveinpressure,improveportalveinandspleenveinbloodflow,increaseportalvenousblood flow,andimprovepatients’liverfunction.

Objective To investigate the effect of CareDose 4D combined with Care kV on CT pulmonary ground glass nodule ( GGN) with respect to quality and radiation dose. Methods The thoracic model containing 6 GGN was performed by using 7 low-dose schemes. The CareDose 4D + Care kV was adopted in scheme 1. In schemes 2, 3 and 4, the tube voltage was 120 kV, and the tube current 30, 20 and 10 mAs respectively. In schemes 5, 6 and 7, the tube voltage was 100 kV, and the tube current was 30, 20 and 10 mAs, respectively. The image quality [ CT value, contrast noise ratio ( CNR) , noise value (SD) and subjective score] and effective dose (E) were compared. Results There was no statistically significant difference in CT value of GGN among different schemes (P>0. 05). The SD of scheme 1 was higher than those of schemes 2, 3 and 5, but lower than those f scheme 7, while the CNR of scheme 1 was lower than those of schemes 2, 3 and 5, but higher than that of scheme 7 ( t=13. 020, 9. 560, 8. 120,-5. 720, -7. 849, -5. 192, -4. 130, 1. 361,P<0. 05). SD and CNR of scheme 1 were not significantly different from those of scheme 4 and 6 ( P>0. 05) . The subjective scores of each GGN of schemes 1, 2, 3, 5 and 6 was over 3 points, but and the subjective scores of one GGN of each of schemes 4 and 7 were below 3 points. The value E of the scheme 1 was reduced by 63. 0％, 44. 4％, 38. 8％, and 9. 1％, compared with the schemes 2, 3, 5 and 6, respectively. Conclusions CareDose 4D combined with Care kV in low-dose lung CT scan can ensure the image quality of GGN and reduce the radiation dose effectively.

Objective To investigate the clinical curative effect and significance of partial splenic artery embolization (PSE) for the treatment of patients with hypersplenism at high altitude region. Methods The clinical data of 66 patients with cirrhosis complicated by portal hypertension and hypersplenism, who lived in Xining City of Qinghai Province, the high altitude region in China, and were admitted to authors' hospital during the period from March 2015 to December 2016 to receive PSE, were retrospectively analyzed. White blood cell (WBC) count, red blood cell (RBC) count and platelet (PLT) count were calculated at one day before operation as well as at one, 7, 30 and 90 days after operation. Results The technical success rate of PSE was 100％. The mean WBC count determined at one, 7, 30 and 90 days after PSE was obviously different from that determined at one day before PSE, the differences were statistically significant (P＜0. 05). Conclusion For the treatment of patients with cirrhosis complicated by portal hypertension and hypersplenism, who live at high altitude region, PSE has reliable curative effect, therefore, this therapy is worth promoting in clinical practice. (J Intervent Radiol, 2018, 27: 271-273)