Objective To construct a MRI-based radiomics nomogram for predicting the Cyelin-Dependent Kinase Inhibitor 2A/B(CDKN 2A/B)homozygous deletion status in patients with isocitrate dehydrogenase(IDH)-mutant astrocytoma.Methods A total of 200 patients with IDH-mutant astrocytoma(103 CDKN 2A/B homozygous deletion and 97 CDKN 2A/B non-homozygous dele-tion)were enrolled in a training cohort(n=140)and a test cohort(n=60).A total of 1 946 features were respectively extracted in tumor edema area and tumor parenchyma area,and 3 892 features were extracted in overall tumor area.All features were extracted from T2 fluid attenuated inversion recovery(T2 FLAIR)and T1 WI contrast enhancement sequences.The t test and the least absolute shrinkage and selection operator(LASSO)model were used to select radiomics features,and a radiomics nomogram was constructed by using age,gen-der and the above radiomics features.Results The t test concluded that the overall tumor radiomics signature had the best perform-ance[area under the curve(AUC):training cohort=0.951,test cohort=0.779]and the radiomics nomogram had a good ability to pre-dict the CDKN 2A/B homozygous deletion in IDH-mutant astrocytoma.The clinical usefulness of the nomogram in predicting the CDKN 2A/B homozygous deletion was further confirmed by decision curve analysis(DCA).Conclusion The nomogram combined with age,gender,and the radiomics features provides a clinically useful approach to predict the CDKN 2A/B homozygous deletion and facilitated MRI-based clinical decision-making in patients with IDH-mutant astrocytoma.

The objective of this study is to assess the current status of vaccination against respiratory disease among the elderly aged ≥60 and analyze the factors influencing vaccination rates at both service provider and recipient levels in Zhejiang Province. Using a stratified random sampling method, a questionnaire survey was conducted from September 2022 to January 2023 among elderly people aged ≥60 in 30 townships/streets in Zhejiang Province, as well as immunization planning staff at the provincial, municipal, county/district, and township/street levels. Logistic regression models were used to analyze the factors related to vaccination among elderly people in Zhejiang Province. Based on the Zhejiang Provincial Comprehensive Management Information System for Vaccine and Vaccination, the systematic coverage rates of influenza vaccine and pneumonia vaccine for the elderly were 21.76% and 4.57%, respectively. Multivariate logistic regression analysis indicated that advanced age ( OR=1.74, 95% CI: 1.51-1.99), knowing that influenza is more severe than the common cold ( OR=1.67, 95% CI: 1.37-2.04) and having heard of the influenza vaccine ( OR=9.78, 95% CI: 7.03-13.59) were motivating factors for elderly to receive influenza vaccines. Advanced age ( OR=1.71, 95% CI: 1.43-2.06), knowing the serious consequences of pneumonia in the elderly ( OR=1.93, 95% CI: 1.47-2.55) and knowing that pneumonia vaccines can prevent pneumonia ( OR=6.36, 95% CI: 4.84-8.36) were motivating factors for elderly to receive pneumonia vaccines. Zhejiang Immunization Program staff believed that the main reasons why the elderly aged ≥60 would not be vaccinated against influenza or pneumonia were that they felt they would not get sick (55.52% and 56.35% respectively), it would not be serious if get sick (47.73% and 37.46% respectively), lacking trust in vaccine efficacy and safety (38.31% and 43.69% respectively). Vaccination rates for influenza and pneumonia vaccines among the elderly aged ≥60 in Zhejiang Province are suboptimal. Advanced age, awareness of the severity of respiratory diseases and awareness of vaccines against such diseases are related factors for elderly individuals to receive influenza and pneumonia vaccines.

The objective of this study is to assess the current status of vaccination against respiratory disease among the elderly aged ≥60 and analyze the factors influencing vaccination rates at both service provider and recipient levels in Zhejiang Province. Using a stratified random sampling method, a questionnaire survey was conducted from September 2022 to January 2023 among elderly people aged ≥60 in 30 townships/streets in Zhejiang Province, as well as immunization planning staff at the provincial, municipal, county/district, and township/street levels. Logistic regression models were used to analyze the factors related to vaccination among elderly people in Zhejiang Province. Based on the Zhejiang Provincial Comprehensive Management Information System for Vaccine and Vaccination, the systematic coverage rates of influenza vaccine and pneumonia vaccine for the elderly were 21.76% and 4.57%, respectively. Multivariate logistic regression analysis indicated that advanced age ( OR=1.74, 95% CI: 1.51-1.99), knowing that influenza is more severe than the common cold ( OR=1.67, 95% CI: 1.37-2.04) and having heard of the influenza vaccine ( OR=9.78, 95% CI: 7.03-13.59) were motivating factors for elderly to receive influenza vaccines. Advanced age ( OR=1.71, 95% CI: 1.43-2.06), knowing the serious consequences of pneumonia in the elderly ( OR=1.93, 95% CI: 1.47-2.55) and knowing that pneumonia vaccines can prevent pneumonia ( OR=6.36, 95% CI: 4.84-8.36) were motivating factors for elderly to receive pneumonia vaccines. Zhejiang Immunization Program staff believed that the main reasons why the elderly aged ≥60 would not be vaccinated against influenza or pneumonia were that they felt they would not get sick (55.52% and 56.35% respectively), it would not be serious if get sick (47.73% and 37.46% respectively), lacking trust in vaccine efficacy and safety (38.31% and 43.69% respectively). Vaccination rates for influenza and pneumonia vaccines among the elderly aged ≥60 in Zhejiang Province are suboptimal. Advanced age, awareness of the severity of respiratory diseases and awareness of vaccines against such diseases are related factors for elderly individuals to receive influenza and pneumonia vaccines.

AIM:To compare the recovery of psy-chomotor function after intravenous anesthesia with remazolam or propofol compound alfentanil in patients undergoing painless gastrointestinal en-doscopy.METHODS:78 patients undergoing pain-less gastrointestinal endoscopy were randomly di-vided into group RA and group PA.Remiazolam or propofol combined with alfentanil were given intra-venously in group RA or group PA.The blood pres-sure,heart rate,respiratory rate and saturation of puls oxygen were recorded before procdure(T1),during checking(T2),awaking from anaesthesia(T3)and at discharging from PACU(T4).Psychomo-tor function,as measured by the Trieger's dot test(TDT)and digit symbol substitution test(DSST),were evaluated before anesthesia(T1),at discharg-ing from PACU(T4),1 h(T5)and 2 h(T6)after checking.RESULTS:From assessment of the TDT,number of dots missed(NDM),maximum distance of dots missed(MDDM)and average distance of dots missed(ADDM)at T4,T5 were significantly lower than those at T1 in two groups.The comple-tion rates and accuracy rates of DSST at T4,T5 were significantly lower than those at T1.Results of TDT and DSST at T6 were not significantly differ-ent to those at T1.The results of NDT,MDDM and ADDM at T4,T5 in group RA were significantly low-er than those in group PA.The completion rates and accuracy rates of DSST at T4,T5 in group RA increased significantly compared with group PA.Compared to group PA,the incidence of hypoten-sion was significantly lower in group RA.There was no significant difference in the incidence of respira-tory depression between the two groups.CONCLU-SION:Psychomotor function was fully recovered 2 h after surgery when remazolam compound alfent-anil was used for painless gastrointestinal endosco-py.Compared with propofol,psychomotor function recovery in the remazolam group was faster and there were fewer adverse effects after surgery in group RA.

Purpose To investigate the fusion model based on MRI radiomics and deep learning to predict the telomerase reverse transcriptase promoter(TERTp)mutation status in isocitrate dehydrogenase-wildtype diffuse astrocytoma.Materials and Methods A retrospective analysis of 175 patients with isocitrate dehydrogenase-wildtype diffuse astrocytoma(122 in the training group and 53 in the test group)from January 2019 to June 2021 in the First Affiliated Hospital of Chongqing Medical University.The Cancer Genome Atlas and The Cancer Imaging Archive were performed to assess TERTp mutation status.The edema and tumor regions were outlined on T1c and T2f images,deep learning model were constructed using the SE-Net model,radiomics features of different regions(edema region,tumor region and overall lesion)were extracted,and 11 features were screened by the least absolute shrinkage and selection operator to build radiomics model.Finally,the radiomics model,deep learning model and clinical model containing Visually Accessible Rembrandt Images features were combined as fusion model,and the model was evaluated using calibration curves and decision curves.Results Six predictive models were eventually built,with an area under curve(AUC)of 0.815(95%CI 0.738-0.892)and 0.645(95%CI 0.494-0.796)for the training and test groups of the clinical model;the AUC for the training and test groups of the deep learning model was 0.860(95%CI 0.798-0.922)and 0.735(95%CI 0.614-0.856);the fusion radiomics model had better predictive performance than the edema or tumor region radiomics models alone,with AUC of 0.906(95%CI 0.856-0.955)and 0.867(95%CI 0.769-0.964)in the training and test groups;the fusion model showed the best performance,with AUC of 0.964(95%CI 0.929-1.000)and 0.905(95%CI 0.818-0.991)in the training and test groups.Conclusion The clinical fusion model of radiomics combined with deep learning performed well in predicting TERTp mutation status in isocitrate dehydrogenase-wildtype diffuse astrocytoma.

Objective To evaluate the value of chromosomal microarray analysis (CMA) for genetic evaluation of fetal ultrasound abnormality. Methods A total of 180 pregnant women with fetal abnormality detected by prenatal ultrasound diagnosis in the first trimester during the period from January 2020 through May 2022 were enrolled as the study subjects. All prenatal fetal screening samples were subjected to G-band karyotyping and CMA. Results G-band karyotyping detected normal karyotypes in 168 samples (93.85%) and abnormal karyotypes in 11 samples (6.15%), and CMA detected 17 positive samples (9.44%) and 163 negative samples (90.56%). The seventeen positive samples included 11 pathogenic copy number variations (CNVs) and 6 variants of unknown significance (VOUS), and there were 11 CMA-positive results consistent with G-band karyotyping, and 6 additional pathogenic CNVs mainly included microdeletion and microduplication syndromes. The detection rates of pathogenic CNVs were 11.11%, 2.63%, 2.78%, 4.00%, 0, 0, 11.11% and 0 among the fetuses with abnormal structure of the cardiovascular system, the lymphatic system, the nervous system, the digestive system, the cranial and face system, the skeletal system, the urinary system, and other system (χ² =8.188, P = 0.316). All eleven fetuses with pathogenic CNVs detected by CMA were all induced for abortion. Conclusion CMA improves the detection of genetic abnormality among fetuses with ultrasound abnormality in relative to G-band karyotyping, which is feasible for prenatal cytogenetic diagnosis among fetuses with ultrasound abnormality

Objective:To explore the effect of post-pyloric feeding by spiral nasoenteric tubes on the prognosis of critically ill patients with acute gastrointestinal injury (AGI) grade Ⅱ.Methods:A retrospective study was performed to analyze the clinical data of critically ill adult patients with AGI grade Ⅱ, who were enrolled in three randomized controlled trials conducted by Guangdong Provincial People's Hospital for post-pyloric tube placement between April 2012 and May 2019. Data including demographic characteristics, serological indicators of nutrition, the tube tip position confirmed by abdominal X-ray 24 h after tube insertion, and intensive care unit (ICU), 28-day and hospital mortality were collected. Patients were divided into the post-pyloric feeding group and gastric feeding group according to the tube tip position. Propensity score matching method was used to perform 1:1 matching, and the differences of each index between the two groups were compared after matching. Then the influencing factors of P<0.1 were included in multivariate logistic regression analysis to investigate the potential ICU mortality risk factors of critically ill patients with AGI gradeⅡ. Factors with 0.1 level of significance from the univariate analysis were considered in the multivariate analysis. Results:There were 90 patients in post-pyloric feeding group and 90 patients in the gastric feeding group. Demographics and clinical characteristics of study population were well balanced between the two groups after matching. ICU, 28-day and hospital mortality in the post-pyloric feeding group were significantly lower than those in the gastric feeding group (4.4% vs 15.6%, 14.4% vs 27.8%, 6.7% vs 17.8%, all P < 0.05). Multivariate logistic regression analysis indicated that post-pyloric feeding was an independent protective factor [odds ratio ( OR)=0.295, 95% confidence internal (95% CI): 0.091-0.959, P=0.042] and APACHEⅡ score was an independent risk factor ( OR=1.111, 95% CI: 1.025-1.203, P=0.010) for ICU mortality of critically ill patients with AGI gradeⅡ. Conclusions:Post-pyloric feeding for critically ill patients with AGI grade Ⅱ could decrease ICU mortality and is an independent protective factor against mortality.

Objective: To evaluate the association between NLRP2(NLR Family Pyrin Domain Containing 2) gene polymorphisms and classical type 1 diabetes mellitus(T1DM) in Chinese Han population. Methods: A case-control study was conducted in 510 classical T1DM patients from the Department of Metabolism and Endocrinology in the Second Xiangya Hospital affiliated to Central South University and 531 healthy controls in this region. The polymorphisms of rs1043673 in NLRP2 gene were analyzed by MassARRAY. Mann-Whitney U test and χ² test were used to compare the differences between patients and controls. Logistic regression analysis and χ² test were performed to compare the distributions of the alleles and genotypes between T1DM patients and controls. Kruskal-Wallis H test was used to compare the clinical characteristics of different genotypes in T1D patients. Results: The differences of the allele and genotype distributions in rs1043673 of NLRP2 gene were not significant between patients and controls. The polymorphisms of rs1043673 were associated with fasting C-peptide(P=0.029), postprandial 2-h C-peptide(P=0.017), and titer of GADA(P=0.043) in T1DM patients. Conclusion The polymorphisms of NLRP2 gene were associated with the characteristics of T1DM patients.

Objective To improve the diagnosis and treatment of infective endocardits(IE)by exploring the causes,pathogenic microorganism,clinical characteristics and therapeutic results of patients with IE.Methods From January 2006 to January 2016,89 cases with IE in Ganzhou People's Hospital were collected,and the clinical charac-teristics were analyzed retrospectively.Results Among the IE patients,40.5%had congenital heart diseases,33.7%had rheumatic heart diseases,18.0% were post－PCI or operative endocarditis,and patients without basic cardiac diseases accounted for 7.9%.The most common clinical manifestations were fever (86.5%),followed by anemia (85.4%).The blood culture positive rate was 63.4%.Streptococci viridians were the most common causative organ-isms(44.2%),followed by coagulase －negative staphylococci(21.2%).Eighty－six patients received echocardio-graphy examination,vegetation was observed in 61cases (68.5%).The hospital mortality rate was 10.1%,mostly due to refractory congestive heart failure and sepsis.Conclusion Congenital heart disease showed an upward trend, rheumatic heart disease decreased significantly.Intermittent fever,anemia are the main clinical manifestations.Blood culture positive rate is not high,Streptococcus viridians is the most common causative organism.Echocardiography is the main basis for the diagnosis.

Aim To study the effect of high salt diet during pregnancy on the development of renal vessels in offspring rats and its mechanism.Methods Natural pregnant Sprague-Dawley rats were randomly divided into high-salt group and control group.The pregnant rats in the high-salt group were given high-salt diet of 8% NaCl content , while the control group normal diet with 1% NaCl content.In both groups, pregnant rats were given normal drinking water.After delivery, all mothers returned to normal diet and all neonatal rats were breast-fed until one month old.The adult male off springs were used as experimental animals.The vessel tone of renal interlobar arteries and electrophysiological behavior of single vascular smooth muscle cells (VSMCs) were detected respectively.Results The contractile response of renal arteries to phenylephrine(Phe) in high-salt group was stronger than that in the control group(P<0.05).The effect of protein kinase C(PKC) non selective blocker GF109203X on Phe-induced contraction in two groups also showed significant difference(P<0.05).In electrophysiology experiments, Phe inhibited high-conductance Ca2+-activated K+ channel(BK channel) currents in renal arteriolar smooth muscle cells in two groups, and the inhibitory effect was more pronounced in high-salt offsprings (P<0.05).GF109203X could eliminate the response of Phe on BK currents in both groups(P>0.05).Conclusions High-salt diet during pregnancy could increase the sensitivity of renal interlobar arterial contractile response to Phe in adult male offsprings, which is associated with PKC-mediated BK channels pathway.Maternal high-salt diet during pregnancy may increase the risk of renal vascular diseases in adult offsprings.