Aim To explore the feasibility of using machine learning algorithms combined with coronary computed tomography(CT)derived perivascular fat attenuation index(FAI)and plaque information to evaluate myocardial ischemia in stable coronary heart disease patients.Methods A retrospective analysis was conducted on the clinical and imaging data of patients who underwent preoperative coronary CT angiography(CCTA),invasive coronary angiography(ICA),and flow reserve fraction(FFR)measurements at Zhongshan Hospital Affiliated to Fudan University from April 2019 to October 2021.206 patients with stable coronary heart disease were selected.The semi-automatic plaque analysis software was used for quantification of plaque and lumen parameters and perivascular FAI measurement,with man-ual delineation of a 40 mm segment of the coronary artery starting 10 mm from the ostium for perivascular FAI measure-ment.Differences in plaque characteristics,perivascular FAI,and coronary perivascular FAI between stable coronary heart disease patients with FFR≤0.8 and FFR＞0.8 were compared.The diagnostic performance of combining perivascu-lar FAI,coronary perivascular FAI,and plaque features using machine learning algorithms for myocardial ischemia in stable coronary heart disease patients was evaluated through ROC curves.Results 206 stable coronary heart disease patients were divided into FFR≤0.8 group(50 cases)and FFR＞0.8 group(156 cases).The mean periplaque FAI of patients with FFR≤0.8 was-69.28±5.65 HU,significantly higher than that of patients with FFR＞0.8 at-80.10±7.75 HU(P＜0.001).Further analysis was conducted using machine learning models,including XGBoost,random forest,and Logistic regression models,all of which had an accuracy rate of over 0.8 in diagnosing myocardial ischemia.Among them,the XGBoost model performed the best with an accuracy of 0.903,an F1 value of 0.774,and an AUC of 0.931,in-dicating its high effectiveness in diagnosing myocardial ischemia.Conclusion The combination of FAI and machine learning algorithm XGBoost model is a new method for diagnosing myocardial ischemia,which has better diagnostic value in evaluating myocardial ischemia in stable coronary heart disease patients.

Objective:To investigate the clinical infection status and trends in drug resistance of a rare pathogen Kluyveromyces marxianus ( Candida kefyr), and to provide experience for clinical diagnosis and treatment. Methods:Morphological and molecular biological identification tests and in vitro microdilution drug susceptibility test were conducted on a Kluyveromyces marxianus strain recently isolated from the midstream urine sample of a patient with urinary calculus in the Fungal Laboratory, Changhai Hospital. The ultrastructural damage of the strain caused by different antifungal drugs was observed by scanning electron microscopy. A retrospective analysis was conducted on clinical cases of Kluyveromyces marxianus infection in Changhai Hospital from 2009 to 2021. Results:The isolated strain formed smooth, soft, cheese-like yeast colonies on the Sabouraud′s agar medium, and ovoid or slender spores were observed under the microscope. Morphological analysis, mass spectrometry and sequencing analysis identified the strain as Kluyveromyces marxianus. The drug susceptibility test showed that minimum inhibitory concentrations (MICs) of amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, flucytosine, caspofungin, and micafungin were 0.5, 0.5, 0.03, ≤ 0.03, 0.06, 0.5, ≤ 0.016, and 0.06 μg/ml, respectively. Under the scanning electron microscope, the strain was ovoid to slender before antifungal drug treatment, with a size of (3.0 - 6.5) μm × (5.5 - 11.0) μm; after 24-hour treatment with antifungal drugs at the dose of 1 μg/ml, cell membrane shrinkage was more obvious under the treatment with posaconazole, which exhibited a stronger destructive effect on the strain compared with amphotericin B and voriconazole. From 2009 to 2021, 8 cases of Kluyveromyces marxianus infection were collected, including 6 males and 2 females; the Kluyveromyces marxianus strains were isolated from ascites in 3 cases, bronchoalveolar lavage fluid in 1 case, sputum in 2 cases, and midstream urine samples in 2 cases. Conclusion:For suspected Kluyveromyces marxianus infection, it is crucial to determine the pathogenic species as early as possible using various identification methods, and to collect strain as well as evaluate drug susceptibility, which will be beneficial for targeted clinical treatment.

Objective:To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV) among medical staffs in pediatric intensive care unit(PICU) in China, and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods:The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12, 2020.The questionnaire was issued, collected and checked by the Children′s Hospital of Fudan University.Results:(1) PMV related settings: Nine out of eleven hospitals had established PMV multidisciplinary teams, respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7% and 36.4% of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques, induced spirometer exercise, external diaphragm pacemaker stimulation, transfer bed exercise, balloon blowing, hyperbaric oxygen therapy could be respectively executed in 100.0%, 9.1%, 9.1%, 9.1%, 27.3% and 27.3% of PICU, respectively.(2) The cognitive status quo of children′s PMV: The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases, and 62.7% of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3) The cognitive status quo of the children′s PMV management in PICU: Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+ pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7% of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment, bedside rehabilitation training, nutritional assessment, analgesia and sedation assessment for children with PMV.(4) The cognitive status quo of the children′s PMV management of transition from hospital to family: 54.5% of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5% of PICU would follow up these discharged children one month later.Conclusion:At present, PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis, treatment and management.

The fall armyworm (FAW), Spodoptera frugiperda, is a destructive pest native to America and has recently become an invasive insect pest in China. Because of its rapid spread and great risks in China, understanding of FAW genetic background and pesticide resistance is urgent and essential to develop effective management strategies. Here, we assembled a chromosome-level genome of a male FAW (SFynMstLFR) and compared re-sequencing results of the populations from America, Africa, and China. Strain identification of 163 individuals collected from America, Africa and China showed that both C and R strains were found in the American populations, while only C strain was found in the Chinese and African populations. Moreover, population genomics analysis showed that populations from Africa and China have close relationship with significantly genetic differentiation from American populations. Taken together, FAWs invaded into China were most likely originated from Africa. Comparative genomics analysis displayed that the cytochrome p450 gene family is extremely expanded to 425 members in FAW, of which 283 genes are specific to FAW. Treatments of Chinese populations with twenty-three pesticides showed the variant patterns of transcriptome profiles, and several detoxification genes such as AOX, UGT and GST specially responded to the pesticides. These findings will be useful in developing effective strategies for management of FAW in China and other invaded areas.
Animals ; China ; Genomics ; Humans ; Male ; Pesticides ; Spodoptera/genetics* ; Transcriptome

Objective: To investigate parent-child conflict among primary and secondary school students and their parents, and to promote family harmony and mental health of children and adolescents during the COVID-19 pandemic. Methods: An anonymous online survey was completed by 12 711 parents of primary and middle school students during mid-March, 2020. Emotional translation, coping style, parent-child conflict were collected and analyzed by grade. Results: The incidence of parent-child conflict was emotional opposition (62.3%), verbal conflict (52.6%) and physical conflict (20.5%), respectively. About 38.1% of parents and 23.6% of students experienced negative emotions, such as anxiety and anger, and the students used coping styles that were more uniform than those of their parents. About 77.9% of families reported that they experienced different levels of parent-child conflict, which was mainly caused by child learning difficulties(45.6%), daily arrangements(22.1%), and the use of electronic devices(10.2%); compared with the previous year, about 31.4% of families reported an increase in the frequency of parent-child conflicts in the last month. Conclusion Parent-child conflict is highly prevalent in the families of primary and middle school students, and such conflicts were affected by stress-related factors, which included COVID-19. It s necessary to improve the provision of relevant mental health education and psychological assistance.

Objective:To compare the effect of hearing improvement after canal wall down mastoidectomy and tympanoplasty(CWDM) and canal wall up mastoidectomy and tympanoplasty(CWUM).Methods:88 patients who underwent CWDM or CWUM in 2014-2017 with complete follow-up data were retrospectively studied. There were 45 males and 43 females, aged 12-68 years old, and the average follow-up time was 12.3 months. Among them, 42 cases underwent CWDM and 46 cases underwent CWUM. A series of improvements were made in the clinical practice of CWDM: (1) to expand the indications properly, including limited lesions with sclerotic mastoid and narrow tympanic sinus; (2) to form disciform cavity strictly during operation in order to retain the appropriate height of facial nerve crest; (3) to avoid the cleaning of mastoid cavity in the post-operation follow up, thus the operative cavity was effectively constricted; and (4) to transfer the temporal muscle flap in pneumatic mastoid to reduce the cavity. The condition of dry ear and the size of cavity were observed after operation. The average pure tone threshold (PTA) before/after operation and threshold changes of each frequency were compared between the two groups. SPSS 19.0 software was used to analyze the data.Results:The mastoid cavity of CWDM was significantly narrowed after operation and the width of the external auditory canal was close to the CWUM group. The postoperative PTA of the CWDM and CWUM group was reduced by 11.4 dB and 10.4 dB respectively, with no significant difference ( t=0.290, P=0.770). The average value of bone conduction threshold after operation was reduced by 1.8 dB and 1.9 dB respectively, with no significant difference ( t=-0.076, P=0.940). The mean value of ABG after operation was shortened by 9.6 dB and 8.4 dB respectively, with no significant difference ( t=-0.370, P=0.712). The threshold decrease of 1 000 Hz of CWUM was slightly better than that of CWDM, and the threshold decreases of the other frequencies of CWDM were slightly better than those of CWUM, however, the differences were not statistically significant ( P>0.05). Conclusion:Through the adjustment of indications and a series of intraoperative and postoperative improvements, CWDM can achieve the same effect of postoperative hearing improvement as CWUM.

OBJECTIVE: To develop a fiber Raman endoscopic probe that can be integrated in a gastroscope and evaluate its value in the diagnosis of gastric cancer. METHODS: The Raman spectra of gastric cancer tissues and normal tissues were obtained using the fiber Raman endoscopic probe and confocal microRaman spectroscopy. After preprocessing with smoothing, baseline elimination and normalization, the spectroscopic data were analyzed by the principle component analyses combined with stechiometry. Based on the pathological results, the diagnostic accuracy, sensitiveness and specificity of Raman spectroscopy combined with stechiometry were evaluated. RESULTS: The fiber Raman endoscopic probe and microRaman spectroscopy revealed significantly different Raman spectra between gastric cancer tissues and normal tissues. The diagnostic accuracy, sensitiveness and specificity of the fiber Raman endoscopic probe was 80.56%, 88.89%, and 84.72% for gastric cancer, respectively. CONCLUSIONS The fiber Raman endoscopic probe combined with stechiometry provides an effective modality for the diagnosis of gastric cancer and can well distinguish gastric cancer tissue from normal gastric tissues.
Endoscopy ; Fiber Optic Technology ; Humans ; Sensitivity and Specificity ; Spectrum Analysis, Raman ; Stomach Neoplasms

Objective: To assess the associations of indoor fine particulate matter (PM_2.5) from outdoor and indoor sources with heart rate (HR) and heart rate variability (HRV) in patients with chronic obstructive pulmonary disease (COPD) of Beijing. Methods: A total of 40 male patients in a stable stage of COPD were recruited from a hospital in a panel study in Beijing with 5 consecutive days of measurement for each subject. General information and disease history of the participants from questionnaires were obtained prior to the study. HR and HRV were repeatedly examined using dynamic electrocardiograph. HRV included standard deviation of all NN intervals (SDNN), root mean square of successive differences between adjacent NN intervals (rMSSD), total power (TP) power in the low-frequency band (LF) and the high-frequency band (HF). Iron was used as tracer element to separate indoor-originated PM_2.5 and outdoor-originated PM_2.5. Mixed-effect models were applied to assess the associations of outdoor-originated PM_2.5 or indoor-originated PM_2.5 and health effects. Results: The P₅₀ (P₂₅, P₇₅) values of daily indoor PM_2.5, indoor-originated PM_2.5 and outdoor-originated PM_2.5 were 50.9 (26.8, 122.7), 16.0 (1.9, 43.7) and 27.3 (13.5, 61.8) μg/m³, respectively. The mean±SD of concentrations of real-time indoor PM_2.5, indoor-originated PM_2.5 and outdoor-originated PM₂.5 were (61.5±58.8), (25.3±39.1) and (36.2±42.7) μg/m³, respectively. Compared with outdoor-originated PM_2.5, indoor-originated PM_2.5 had significant associations with HRV and HR. Each 10 μg/m³ increase at 4 h indoor-originated PM_2.5 and outdoor-originated PM_2.5 moving average was associated with 3.4% (95%CI: -4.7%, -2.1%) and 0.6% (95%CI: -2.0%, -0.8%) reduction in TP (P<0.001). Each 10 μg/m³ increase at 12 h indoor-originated PM_2.5 moving average was associated with 7.6% (95%CI: -10.1%, -5.1%), 4.7% (95%CI: -6.7%, -2.7%), 3.3% (95%CI: -4.2%,-2.4%) and 3.0% (95%CI: -4.5%, -1.5%) reduction in HF, LF, SDNN and rMSSD, respectively. Each 10 μg/m³ increase at 12 h outdoor-originated PM_2.5 moving average was associated with 0.7% (95%CI: -2.7%, -1.4%), 0.2% (95%CI: -1.9%, 1.4%), 0.7% (95%CI: -1.4%, -0.1%) and 0.2% (95%CI: -1.3%, 0.9%) reduction in HF, LF, SDNN and rMSSD, respectively (P<0.001). Each 10 μg/m³ increase at 8 h indoor-originated PM_2.5 and outdoor-originated PM_2.5 moving average was associated with 0.7% (95%CI: 0.4%, 1.0%) and 0.4% (95%CI: 0.2%, 0.6%) increase in HR. Conclusion Exposure to indoor-originated PM_2.5 was more strongly associations with HRV indices and HR compared with outdoor-originated PM_2.5 in male COPD patients.

Objective:To analyze the effects of enhanced recovery after surgery(ERAS) concept on anesthetic agents in our hos-pital in order to provide evidence for rational drug use. Methods:The patients received ERAS care and surgery from departments of o-torhinolaryngology,gynecology and urology during June and December in 2016 were selected into ERAS group. Meanwhile, the pa-tients received usual care and routine operation were selected into the traditional group. Anesthetic agents of the two groups were then analyzed. Results:The anesthetic agents costs, the usage rate and expenses of patient controlled analgesia pump and the total drug costs of ERAS groups were significantly lower than those of the traditional groups(P<0.05 or P<0.01). Conclusion:With the de-velopment of ERAS concept, the patients can receive good diagnosis and treatment. Meanwhile, anesthetic agents costs, total drug costs and drug proportion decrease as well.

In the past decades, people's work and life styles have dramatically changed during the rapid economic development and urbanization in China. A national survey reported that Chinese adults spend an average of 81% of daily time in indoor environment. Exposure to indoor air pollution plays key roles for human health but is likely to be neglected due on the relatively lower concentration levels and lower awareness among common people. Till now, published studies focus more on the pollution levels or the toxicological effects of indoor air pollutants but there is a lack of disease burden assessment attributable to indoor air pollution. In this review, several international studies were introduced on the disease burden estimation attributable to indoor air pollution, as well as the estimation methods. The current situation of national study was also reviewed. The strengths and limitations of the representative international studies were discussed. This review is helpful in providing data to guide the research on disease burden assessment attributable to indoor air pollution in China, and further helps to prioritize the indoor air pollution control based on disease burden ranking among pollutants and motivate public policies to protect the public health.