Objective:To construct a risk prediction model for the inter-hospital transfer of critically ill children using machine learning methods, identify key medical features affecting transfer outcomes, and improve the success rate of transfers.Methods:A prospective study was conducted on critically ill children admitted to the pediatric transfer center of Hunan Children's Hospital from January 2020 to January 2021. Medical data on critical care features and relevant data from the Pediatric Risk of Mortality (PRISMⅢ) scoring system were collected and processed. Three machine learning models, including logistic regression, decision tree, and Relief algorithm, were used to construct the risk prediction model. A back propagation neural network was employed to build a referral outcome prediction model to verify and analyze the selected medical features from the risk prediction model, exploring the key medical features influencing inter-hospital transfer risk.Results:Among the 549 transferred children included in the study, 222 were neonates (40.44%) and 327 were non-neonates (59.56%). There were 50 children in-hospital deaths, resulting in a mortality rate of 9.11%. After processing 151 critical care medical feature data points, each model selected the top 15 important features influencing transfer outcomes, with a total of 34 selected features. The decision tree model had an overlap of 72.7% with PRISMⅢ indicators, higher than logistic regression (36.4%) and Relief algorithm (27.3%). The training prediction accuracy of the decision tree model was 0.94, higher than the accuracy of 0.90 when including all features, indicating its clinical utility. Among the top 15 important features selected by the decision tree model, the impact on transfer outcomes was ranked as follows based on quantitative feature violin plots: base excess, total bilirubin, ionized calcium, total time, arterial oxygen pressure, blood parameters (including white blood cells, platelets, prothrombin time/activated partial thromboplastin time), carbon dioxide pressure, blood glucose, systolic blood pressure, heart rate, organ failure, lactate, capillary refill time, temperature, and cyanosis. Eight of these important features overlapped with PRISMⅢ indicators, including systolic blood pressure, heart rate, temperature, pupillary reflex, consciousness, acidosis, arterial oxygen pressure, carbon dioxide pressure, blood parameters, and blood glucose. The decision tree was used to select the top 15 medical features with high impact on the neonatal and non-neonatal datasets, respectively. A total of 19 features were selected, among which there were 8 differences and 11 overlap terms between the important features of the neonatal and non-neonatal.Conclusions:Machine learning models could serve as reliable tools for predicting the risk of inter-hospital transfer of critically ill children. The decision tree model exhibits superior performance and helps identify key medical features affecting inter-hospital transfer risk, thereby improving the success rate of inter-hospital transfers for critically ill children.

Objective:To investigate the application effect of simulation teaching in basic nursing practical teaching for undergraduates.Methods:A total of 271 nursing undergraduate intern students in the classes of 2018 and 2019 were selected as subjects, among whom 135 students in the class of 2018 were established as control group and 136 students in the class of 2019 were established as experimental group. The students in the control group received conventional practical training, and those in the experimental group received simulation teaching. The two groups were compared in terms of test scores and self-efficacy scores after practical teaching, and a questionnaire survey was conducted to investigate the degree of satisfaction with practical teaching among students. SPSS 20.0 was used for the t-test and the chi-square test. Results:Compared with the control group, the experimental group had significantly higher average scores of theoretical examination (88.78±5.17 vs. 82.04±4.36, P<0.05) and practical examination (96.90±5.05 vs. 90.48±5.34, P<0.05), as well as a significantly higher self-efficacy score (29.80±3.83 vs. 28.76±2.75, P<0.05). The experimental group had a significantly higher degree of satisfaction with clinical teaching than the control group ( P<0.05). Conclusion:Simulation teaching can effectively increase the practical score of nursing students, enhance their sense of self-efficacy, and improve their satisfaction with clinical teaching.

Objective: To compare and investigate the physicochemical characteristics and antibacterial effect of ZnO nanofilms prepared by atomic layer deposition(ALD) at different deposition cycles. Methods: According to different ALD cycles, four groups were set up (control group, 300, 600 and 1 200 cycles group). Using DEZn and water as precursors, ZnO nanofilms were prepared by ALD on the surface of pure titanium specimens. Surface morphology of the films was observed by scanning electron microscope (SEM); the element composition and crystal type of the films were observed by energy dispersive spectrometer (EDS) and X-Ray Diffraction (XRD); the hydrophilicity and thickness of the films were detected by water contact angle detector and ellipsometer. The cytotoxicity of the films was evaluated by CCK-8 assay. The antibacterial effect against S. aureus in vitro of the films was evaluated by optical density method. Results: The surface morphology of the films was uniform and compact as shown through SEM. The grain size increased with the increase of the number of ALD cycles. EDS results showed that the films were mainly composed of Zn and O elements. XRD results confirmed that the composition of the films was ZnO. Results of water contact angle showed that the films were hydrophobic. The thickness of the films was nanoscale and there was a linear relationship between the thickness and ALD cycles. All experimental groups showed no cytotoxicity. The 1 200 cycles group showed the highest antibacterial rate of 65.9% and 52.3% at 24 and 48 hours respectively, which was the best among all experimental groups. Conclusion The ZnO nanofilms prepared by ALD at different cycles on pure titanium surface are uniform and compact. Thickness of the films increases with the increase of ALD cycles. The films have good biocompatibility and anti-S. aureus effect in vitro. The 1 200 cycles group has the best antibacterial effect.

【Objective】  To study the composition and function of tongue coating (TC) and gastrointestinal tract (GIT) microbiota in participants with yellow-greasy tongue coating (YGTC), and to explore the representative metabolite markers and pathways in this group. 【Methods】  Subjects with YGTC or thin-white tongue coating (TWTC) were recruited from December 1, 2021 to October 30, 2022, and the TC and fecal samples were collected. Samples were subjected to both whole-genome shotgun (WGS), and 16S rRNA gene sequencing. The α-diversity analysis, principal component analysis (PCA), and Spearman correlation analysis were performed for two groups. Ultra-performance liquid chromatography combined with tandem mass spectrometry (UPLC–MS/MS) analysis was used to analyze metabolomics and enrichment of metabolic pathways. 【Results】  The results revealed 20 YGTC participates and 19 TWTC participates. At the genus level, the dominant bacterial species of TC flora and intestinal flora in the two groups were roughly the same, but the relative kurtosis difference was marked, and the abundance of potentially pathogenic bacteria in TC and fecal samples of YGTC subjects was higher. There were 9 down-regulated microorganisms in the TC samples, 26 down-regulated microorganisms, and 6 up-regulated microorganisms in YGTC subjects. The α-diversity analysis indicated that the Chao and abundance-based coverage estimator (ACE) indices of TC bacteria in the YGTC subjects showed a decreasing trend, but the difference was not statistically significant (P > 0.05). The α-diversity of fecal samples and the Chao and ACE indices decreased significantly (P < 0.05). PCA showed that the microflora structure of TC and fecal samples were significantly different between the two groups. Spearman correlation analysis showed that there was no correlation between TC and fecal microorganisms at phyla and genus levels in the same subjects (P > 0.05). The metabolomics results demonstrated that fumarate reductase, V/A ATPase, and phosphatidylethanolamine were increased, and glycerate-3p, UDP-glucose, and quinone oxidoreductase metabolites were decreased in YGTC TC samples. Inosine monophosphate (IMP), uridine monophosphate (UMP), and gamma-aminobutyric acid(GABA) were increased in YGTC fecal samples, while the contents of ribo-5P, histidine, biotin,and cobalamin were decreased. Metabolic pathway analysis indicated that the abundance of the TC and fecal samples of the YGTC subjects was relatively low in various metabolic pathways, including amino acid metabolism, carbohydrate metabolism, nitrogen metabolism, and energy metabolism. 【Conclusion】  Structural and functional changes in TC and GIT microbiota or metabolite markers could be potential biological bases of YGTC formation.

Objective:To provide evidence for the selection of fixation devices and CTV to PTV margins (M ptv) in precision radiotherapy for pelvic tumors by analyzing three fixation devices in precision radiotherapy for prostate cancer. Methods:From April 2015 to December 2020, 133 prostate cancer patients treated with pelvic drainage area irradiation in our center were retrospectively analyzed. The patients were fixed with 1.2m vacuum bag (n=39), 1.8m vacuum bag (n=44) and personalized prone plate by our center (n=50). Each patient was asked to complete our bowel and bladder preparation process before positioning and radiotherapy. The registration of CBCT to planned CT before each treatment adopted the same registration box and algorithm. Setup errors in the SI, LR and AP directions under qualified bowel and bladder conditions were recorded. Setup errors in three directions under three fixation devices and corresponding M ptv values were analyzed. The correlation between setup errors with age and body mass index (BMI) was analyzed. Results:Analysis of 3333 setup errors data showed: in the SI and LR directions, the mean setup errors of 1.2m vacuum bag (3.26mm, 2.34mm) were greater than those of 1.8m vacuum bag (2.51mm, P<0.001; 1.90mm, P<0.001), and personalized prone plate (3.07mm, P=0.066; 2.10 mm, P=0.009). In the AP direction, the mean setup errors of 1.2m vacuum bag (supine)(2.20mm) were smaller than those of 1.8m vacuum bag (3.33mm, P<0.001) and personalized prone plate (3.61mm, P<0.001). The setup errors of 1.8m vacuum bag in all directions were smaller than those of personalized prone plate (P≤0.028). According to Van Herk's expansion formula, the M ptv of 1.2m vacuum bag in three directions was approximately 4 mm. The M ptv of 1.8m vacuum bag and personalized prone plate in the SI and LR directions was approximately 3 mm, and more than 5 mm in the AP direction. The setup errors were not correlated with age or BMI. Conclusions:From the setup errors results of three devices, 1.8m vacuum bag is the best, followed by personalized prone plate. And supine position is better than prone position in the AP direction.

Objective: To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL). Methods: Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People′s Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases. Results: This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma. Conclusions BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.

We tried to explore the value of contrast echocardiography (CEcho) on evaluating hypertrophic cardiomyopathy (HCM) with the inferior wall hypertrophy. A total of 114 patients with HCM were investigated. All the patients received CEcho and routine echocardiography (Echo), and 45 of them received cardiac magnetic resonance (CMR) and 47 of them received Holter. The frequency and percentage of inferior wall hypertrophy were analyzed in HCM patients, as well as the structure and function. The results showed that: (1) Inferior wall hypertrophy was detected in 55 patients (48%) by Echo, while 68 patients (60%) by CEcho. (2) There was no significant difference between CMR and CEcho in the measurement of inferior wall at end-diastole and end-systole. Thickness of inferior wall by CEcho tended to be higher than CMR. However, the inferior wall thickness measured by Echo was obviously lower than that by CMR ( < 0.05) and CEcho ( < 0.05). (3) Bland-Altman plot suggested good consistency between CEcho and CMR in measuring inferior wall thickness. 95% CI of mean differences in inferior wall thickness between CEcho and CMR were smaller in HCM patients as compared with that between Echo and CMR. Unary linear regression analysis showed good degree of fitting between CEcho and CMR. (4) Holter showed that HCM patients with inferior wall hypertrophy were likely to have higher incidence of premature ventricular complexes (PVC) ≥ 500/24 h. We demonstrate that CEcho is rather sensitive in detecting inferior wall hypertrophy. Echo may underestimate the inferior wall thickness. The risk of ventricular premature beats may increase in HCM patients with inferior hypertrophy.

Objective Decline in cognitive function caused by diabetes has become a research hotpots.The article aims to explore the relationship between serums regulated upon activation normal T cell expressed and secreted(RANTES) and cognitive dysfunction of newly diognosed T2DM patients, and provide a new way of prevention and treatment for newly diagnosed T2DM patients with cognitive dysfunction.Methods We retrospectively analyzed the general information and clinical biochemical indexes of the 123 patients who were first diagnosed of T2DM from March 2015 to September 2016 in Tangshan Worker''s Hospital.The levels of serum RANTES were measured by enzyme-linked immunosorbent assay (ELISA), and the cognitive function of all patients was assessed by Mini-mental State Examinatlon(MMSE)and Repeatable Battery for the Assessment of Neuropsyehologic Status(RBANS).Finally, newly diognosed T2DM patients were divided into T2DM non-cognitive disorder group and T2DM cognitive disorder group according to the MMSE score.We analyzed whether there are differences among general information,serum RANTES level and RBANS cognitive function score of two group patients.The correlations of RANTES with general information and cognitive scores were analyzed by single factor correlation and multiple stepwise regression analysis.Results ①The level of serum RANTESin T2DM cognitive disorder group[(2.62±0.37)mmol/L] was significantly higher compared to that in T2DM noncognitive disorder group[(2.29±0.36)mmol/L], and there was significant difference(P<0.001).②The instant memory,visual span,attention,delayed memory score and RBANS score of T2DM cognitive disorder group were(70.90±14.71)、(92.90±15.50)、(87.80±16.45)、(88.02±14.28)、(82.92±11.07), which were significant declined compared to those of T2DM non-cognitive disorder group [(85.28±13.97),(104.18±12.69),(101.51±12.94),(96.42±10.30),(95.84±9.94)], and there was significant difference (P≤0.05).There was no statistically significant difference between the two groups′ verbal function score [(96.08±7.87),(99.31±9.83)] (P=0.056).③The RANTES was negatively correlated with the total score of instant memory, visual span, verbal function, delayed memory score and RBANS score in T2DM patients(the valuue of r were-3.48、-2.35、-2.01、-3.02、-4.17).Conclusion There was a significant correlation between serum RANTES level and cognitive dysfunction, and elevated serum RANTES level could be used as an important indicator for monitoring newly diognosed T2DM patients with cognitive dysfunction.

Objective To investigate the role of the percentage of the total cross-sectional area of small pulmonary vessels for the lung area (%CSA) from multi-slice CT (MSCT) in evaluating the severity of chronic obstructive pulmonary disease (COPD). Methods One hundred and sixty-six COPD patients and 166 normal subjects underwent chest MSCT scans and all data were analyzed retrospectively. COPD patients underwent pulmonary function tests (PFT), including forced expiratory volume in one second (FEV1%) and FEV1/forced vital capacity (FEV1/FVC), and were classified into mild (n=32), moderate (n=65), severe (n=69) groups according to pulmonary function results, respectively. The%CSA less than 5 mm2 and 5—10 mm2 for the lung area (%CSA<5 and %CSA5-10) of small pulmonary vessels were measured with Image J image-processing program. Comparison of%CSA<5 and%CSA5-10 between the COPD and control groups was perfomred using t test, and the comparison between the 3 COPD subgroups and control group were carried out using ANOVA test. The correlation between %CSA and PFT was evaluated by the Spearman rank correlation test. The sensitivity and specificity of %CSA to diagnose COPD and the best cutoff were calculated from areas under the ROC curves. Results %CSA<5 of COPD patients and control group were (0.56 ± 0.19)%and (0.82 ± 0.15)%(t=12.80, P<0.001), respectively.%CSA5-10 of the two groups were (0.19 ± 0.09)%and (0.33 ± 0.16)%(t=8.93,P<0.001), respectively. The AUC values of%CSA<5 and%CSA5-10 were 0.866 and 0.790, respectively. When the cut-off values of%CSA<5 and%CSA5-10 were 0.65%and 0.24%, the sensitivities and specificities were 88%and 71%, 76%and 81%, respectively. The mean values of%CSA<5 in mild, moderate and severe groups were (0.67±0.20)%, (0.61±0.16)%and (0.44±0.14)%, respectively (P<0.05). The mean values of %CSA5-10 in the three groups were (0.19 ± 0.06)%, (0.19 ± 0.10)% and (0.20 ± 0.08)%, respectively.%CSA5-10 in the three groups were of no significant difference (P>0.05). FEV1%and FEV1/FVC in COPD patients were (60.38±15.52)%and 57.95±22.27.%CSA<5 in COPD patients correlated positively with both FEV1%and FEV1/FVC (r=0.609 and 0.721, P<0.01, respectively).%CSA5-10 in COPD patients correlated positively with both FEV1%and FEV1/FVC (r=0.271 and 0.288, P<0.01, respectively). Conclusion The measurement of%CSA<5 and%CSA5-10 in MSCT images correlated with PFTs and%CSA<5, which may play an important role in evaluating the severity of COPD.

Objective To investigate the prognostic value of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with sepsis.Methods A total of 162 patients was enrolled with consecutive pediatric intensive care unit (PICU) admissions during the study period of Jan 1st,2013 to June 30th,2013 at Hunan Children's Hospital.The 162 septic patients were divided into sepsis group and severe sepsis group,sepsis group and septic shock group,and survival group and death group.NT-proBNP was tested in the first and third day after 162 septic patients in hospital.Pediatric critical illness score (PCIS) score was assessed in all patients.NT-proBNP was compared between groups.The change of NT-proBNP was summarized between groups.The relationship between NT-proBNP and PCIS was analyzed.Results (1) The plasma NT-proBNP level of the first day after admission in the severe sepsis group and septic shock group was higher than sepsis group,the PCIS in the sepsis group was higher than severe sepsis group and septic shock group,with significant difference (P ＜ 0.05).(2) The plasma NT-proBNP level of the first day after admission in the death group was higher than the survival group,the PCIS in the death was lower than the survivor group,with significant difference (P ＜ 0.05).In the death group,the plasma NT-proBNP level of the third day after admission was higher than the NT-proBNP of the first day after admission (P =0.037) ; contrarily,the plasma NT-proBNP level of the third day after admission was lower than the NT-proBNP of the first day after admission in the survival group (P =0.023).Conclusions NT-proBNP could be used to assess the condition of septic patients,and dynamic test NT-proBNP can help to predict septic patient’s prognosis.