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: This study investigates the efficacy and mechanisms of Qingjie Fuzheng Granules (QFG) in inhibiting colitis-associated colorectal cancer (CAC) development via RNA sequencing (RNA-seq) and 16S ribosomal RNA (rRNA) correlation analysis. METHODS: CAC was induced in BALB/c mice using azoxymethane (AOM) and dextran sulfate sodium (DSS), and QFG was administered orally to the treatment group. The effects of QFG on CAC were evaluated using disease index, histology, and serum T-cell ratios. RNA-seq and 16S rRNA analysis assessed the transcriptome and microbiome change. Key pharmacodynamic pathways were identified by integrating these data and confirmed via Western blotting and immunofluorescence. The link between microbiota and CAC-related markers was explored using linear discriminant analysis effect size and Spearman correlation analysis. RESULTS: Long-term treatment with QFG prevented AOM/DSS-induced CAC formation, reduced levels of interleukin (IL)-1β, tumor necrosis factor-alpha (TNF-α), IL-6, and interferon γ (IFN-γ), and increased CD3⁺ and CD4⁺/CD8⁺ T cells ratio, without causing hepatic or renal toxicity. A 16S rRNA analysis revealed that QFG rebalanced the Firmicutes/Bacteroidetes ratio and mitigated AOM/DSS-induced microbiota disturbances. Transcriptomics and Western blotting analysis identified the nucleotide-binding oligomerization domain-containing protein 2 (NOD2)/nuclear factor kappa-B (NF-κB) pathway as key for QFG's treatment against CAC. Furthermore, QFG decreased the abundance of Bacilli, Bacillales, Staphylococcaceae, Staphylococcus, Lactobacillales, Aerococcus, Alloprevotella, and Akkermansia, while increasing Clostridiales, Lachnospiraceae, Lachnospiraceae_NK4A136_group, Ruminococcaceae, and Muribaculaceae, which were highly correlated with CAC-related markers or NOD2/NF-κB pathway. CONCLUSION By mapping the relationships between CAC, immune responses, microbiota, and key pathways, this study clarifies the mechanism of QFG in inhibiting CAC, highlighting its potential for clinical use as preventive therapy.

The inappropriate utilisation of the agricultural insecticide lambda-cyhalothrin (LCT) has the potential to result in residues that compromise food safety and human health. Respiratory exposure represents a major route of LCT contact in humans. Nevertheless, its deleterious effects on the respiratory system remain inadequately characterized. It is imperative to elucidate the potential relationship and mechanisms by which lung cancer, a significant malignant neoplasm of the respiratory system, is associated with exposure to LCT. The objective of this study is to utilise bioinformatics methodologies to screen and analyse the key target molecules affected by LCT in the occurrence of lung cancer, and their mechanisms of action. Specifically, network toxicology methods were employed to identify core targets of LCT-induced lung cancer. Subsequently, functional annotation to delineate associated cellular pathways, and finally, molecular docking to simulate binding modes between LCT and shared core targets. Core target screening identified 50 targets for large cell lung cancer, 54 for small cell lung cancer, 29 for lung squamous cell carcinoma, and 28 for lung adenocarcinoma, with EGFR, HSP90AA1, JUN, CCL2, MYC, CXCL8, and HSPA4 shared in all subtypes. Functional annotation revealed that LCT-triggered oncogenic pathways predominantly involved ubiquitination, chemotaxis, and tumor immune signaling. Molecular docking demonstrated spontaneous binding of LCT to core targets mediated by hydrogen bonds and π-cation interactions. These results establish a theoretical framework for evaluating LCT-associated risks of lung cancer and respiratory system damage.
Lung Neoplasms/metabolism* ; Pyrethrins/toxicity* ; Humans ; Insecticides/toxicity* ; Nitriles/toxicity* ; Molecular Docking Simulation

Objective:To determine the relationship between tibial plateau stresses and malunion by exploring the changes in mechanical conduction in the knee joint after malunion of Hoffa fracture of the tibial plateau.Methods:This study selected 28 knee joint specimens treated with formalin for preservation, half of which were from male and half from female individuals with an age of (51.4±9.5) years. Their structures were intact, and flexion-extension activities normal. X-ray examinations excluded osteoporosis, tuberculosis, and diseases that could have potentially affected bone quality. The knee specimens were divided into a control group (intact tibia) ( n=4) and 6 groups of tibial plateau Hoffa fracture malunion model: 3 vertical malunion groups (groups V1, V2, and V3, with a vertical displacement of 1, 2, and 3 mm, respectively, n=4) and 3 separation malunion groups (groups S3, S5, and S7, with a separation displacement of 3, 5, and 7 mm, respectively), with half males and half females in each group. After a 600N vertical load was applied at passive knee flexions at 0°, 30°, 60°, 90°, and 120°, the stress levels in the medial and lateral compartments of the knee joint were measured using pressure-sensitive films. Results:Under a vertical load of 600 N, when the knee joint was in a neutral position (flexion of 0°), the differences in the medial and lateral tibial plateau stress values were not statistically significant between the malunion models groups and the control group ( P>0.05). When the knee flexion increased to 30°, the medial tibial plateau stress in the V3 and S7 groups was significantly greater than that in the control group ( P<0.05). At a knee flexion of 60°, the medial plateau stress was significantly greater in the V3, S5 and S7 groups than that in the control group, and the differences were significantly greater than the comparisons at a knee flexion of 30° (all P<0.05). When the knee flexion was 90°, the medial plateau stress in the V2, V3, S5 and S7 groups was significantly greater than that in the control group ( P<0.05), but the lateral tibial plateau stress in the V3 group was significantly smaller than that in the control group ( P<0.05). When the knee flexion was further increased to 120°, the differences in the medial and lateral plateau stress values were statistically significant between all the malunion groups and the control group ( P<0.05), and the differences significantly greater than the comparisons at a knee flexion of 90° (all P<0.05). Under a vertical load of 600 N, the differences in the stresses on the medial and lateral plateaus were not statistically significant between the control group and all the malunion groups at a knee flexion of 0° ( P>0.05). When the knee flexion increased to 30°, the difference between the medial and lateral stresses was not statistically significant in the control group ( P>0.05), but was statistically significant in the V3 and S7 groups ( P<0.05). When the knee flexion reached 60°, 90°, and 120°, the differences between the medial and lateral tibial plateau stresses in all the groups were statistically significant ( P<0.05). Conclusions:The peak knee stresses after malunion of Hoffa fracture of the tibial plateau correlate with the severity of malunion and knee flexion angles. The mechanical properties are not significantly different between a mild malunion knee and a normal knee, but a significant displacement (vertical displacement >2 mm and separation displacement ≥5 mm) may increase the peak knee stresses to increase the risk of knee osteoarthritis. When the severity of malunion is certain, an increase in knee flexion angle increases the difference in the peak stress between the medial and lateral tibial plateaus, thus increasing the risk of knee osteoarthritis.

Objective The study analyzed and identified the components in Shangketianshao Gel by LC-Q-TOF/MS.Methods The analysis was performed on Agilent Eclipse Plus C18(250 mm×4.6 mm,5 μm)column was applied with methanol and 0.1%formic acid as mobile phase for gradient elution,flow rate was 1 mL·min-1 and column temperature was 30℃.The analytes were determined by positive and negative ion modes with electro-spray ionization source,combined message of standard reference and the literature.Results 103 constituents were identified,all compounds were classified to their medicinal materials derivation.22 compounds from Paeoniae Radix Rubra,33 compounds from Rhei Radix et Rhizoma,20 compounds from Angelicae Dahuricae,23 compounds from Cortex Phellodendr and 14 compounds from Trichosanthes kirilowii Maxim.9 components were jointly owned.Conclusion The study provided a suitable way for Chemical fundamentals and quality control of Shangketianshao Gel and laid a foundation for in depth studies of its pharmacodynamics and the quality control.

Objective:To explore the asymmetry of neonatal brain white matter using fractional anisotropy (FA) parameter generated from diffusion tensor imaging (DTI).Methods:From January 2011 to June 2013, 88 neonates with normal cranial MRI performance, aged 1-14 (7.7±0.3) days and gestational age 31-42 (37.5±0.3) weeks, were retrospectively collected from the First Affiliated Hospital of Xi′an Jiaotong University. According to the gestational age at birth, the neonates were divided into preterm group (37 cases) and term group (51 cases). DTI was processed to generate FA parametric maps. Tract-based spatial statistics (TBSS) was used to analyze the asymmetry in neonatal white matter. Regions of interest were placed in bilaterally symmetrical white matter tracts. The white matter tracts included the bilateral anterior thalamic radiation, corticospinal tract-posterior limb of the inner capsule (CST-IC), corticospinal tract-corona radiata, cingulum hippocampus part (CGH), inferior frontal occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF), uncinate fasciculus, superior longitudinal fasciculus temporal part (SLF-temp). The FA value was measured and asymmetry index (AI) was calculated. The independent-sample t test or Mann-Whitney U test was used to compare the AI of each tract between the preterm and term groups. Partial correlation was used to analyze the effects of neonatal gestational age and birth anthropometric measures on the asymmetry of neonate at birth. Results:The results of TBSS showed that the left lateralized areas of brain white matter in the neonatal period were mainly located in the corticospinal tract, external capsule and genu of corpus callosum. The right lateralized areas of brain white matter in the neonatal period were mainly located in the optic radiation and splenium of corpus callosum. In both the preterm and term groups, the tracts related to motor (CST-IC) and language function (ILF, SLF, SLF-temp) were left asymmetry. The CGH of the preterm and the term neonates were right asymmetry, and AI was -0.086±0.114 and -0.140±0.108 respectively, with a statistically significant difference ( t=2.27, P=0.026), while the differences of AI in the remaining tracts were not statistically significant ( P>0.05). Only gestational age was correlated with the AI of ILF ( r=0.234, P=0.033), SLF ( r=0.259, P=0.018), SLF-temp ( r=0.252, P=0.022), CST-IC ( r=0.235, P=0.033). No significant correlation was found between birthweight, head circumference, body length and AI. Conclusions:The asymmetries of brain white matter already exist in neonates aged less than two weeks. The tracts associated with motor and language function are predominantly left asymmetry.

Objective:To investigate the prognosis and risk factors for children diagnosed with all types of subaortic stenosis(SAS) who developed recurrent left ventricular outflow tract obstruction after surgical treatment.Methods:The study retrospectively included patients aged 0-18 years old who underwent open heart SAS surgery at Fuwai Hospital from 2016-2019. Children with hypertrophic obstructive cardiomyopathy were excluded. Detailed operative notes, medical records and ultrasound information, and follow-ups were extracted. Recurrent SAS was defined as left ventricular outflow tract gradient 30 mmHg(1 mmHg=0.133 kPa) 1 month after SAS surgical treatment.Results:A total of 137 children were included in this study. The medium age of children at the time of SAS surgery was 4.6 years old(3 months-17.8 years old). After a median follow-up of 4.36 years(3.2-5.7 years), a total of 30 patients developed recurrent LVOTO, with a recurrence rate of 21.9%, and 7(5.1%) underwent a second surgery. Compared to the non-recurrent group, children in the recurrent group were younger at the time of surgery( P=0.0443), had a smaller body surface area( P=0.0485), and a longer length of stay( P=0.0380). In Cox analysis, when only considering preoperative variables, the independent risk factor for LVOTO recurrence were a peak left ventricular outflow tract gradient higher than 50 mmHg( HR=5.25, P=0.001), a BSA less than 0.9( HR=2.5, P=0.023), and a length of SAS 5 mm( HR=2.29, P=0.050). When both preoperative and intraoperative variables were considered, preoperative peak left ventricular outflow tract gradient 50 mmHg( HR=4.91, P=0.002) and peeling from the aortic valve( HR=3.23, P=0.010) were independent risk factors for postoperative recurrence. Conclusion:Recurrent LVOTO after SAS surgical repair is common, and regular postoperative follow-up is crucial to evaluate whether a secondary intervention is required. Regular postoperative follow-up is needed for children at high risk.

Objective:To explore the protective effect and safety of RotaTeq vaccine on children with rotavirus gastroenteritis (RVGE) in high mortality areas in the world and guide the correct use of RotaTeq vaccine.Methods:The literature on RotaTeq vaccine in high mortality areas in the world published from February 2006 to December 2021 was searched, screened and sorted out according to the exclusion and inclusion criteria, and the data were analyzed by RevMan 5.3, Stata 14.0 and SPSS 26.0 softwares.Results:A total of 5 reports were enrolled, including 63 974 subjects, including 32 092 subjects in the vaccine group and 31 882 subjects in the placebo group. In high mortality areas, the protection rates of RotaTeq vaccine against RVGE, severe rotavirus gastroenteritis (SRVGE) and very severe rotavirus gastroenteritis (VSRVGE) were VE RVGE=35% (95% CI: 28%-41%), VE SRVGE=51% (95% CI: 33%-65%) and VE VSRVGE=64% (95% CI: 41%-78%). The protection rates of SRVGE in Asia and Africa are VE SRVGE=43% (95% CI: 28%-55%) and VE SRVGE=57% (95% CI: 17%-77%), respectively. There was no significant difference in the incidences of serious adverse events (SAEs) between RotaTeq vaccine group and placebo group ( χ2=2.05, P=0.152). Conclusions:RotaTeq vaccine has a certain protective effect on severe and above RVGE with good safety in high mortality areas in the world.

Objective:To investigate the epidemiological and clinical characteristics of G2P[4] group A rotavirus (RVA) in hospitalized children with diarrhea in China from 2016 to 2019, and to provide data support for the prevention and control of G2P[4] RVA.Methods:The data of viral diarrhea surveillance network in China from January 2016 to December 2019 were collected. A total of 19 667 specimens of hospitalized children with diarrhea under 5 years old were collected from all monitoring provinces, including 5 437 RVA positive specimens. EpiData 3.0 software and Excel 2010 were used for data collection and collation of viral diarrhea monitoring network, and SPSS 26.0 software was used for data analysis.Results:200 G2P[4] RVA specimens were detected from 5 437 RVA positive specimens, and the constituent rate of G2P[4] RVA was 3.68% (200/5 437) There is a statistically significant difference in the constituent ratio of G2P [4] RVA among RVA positive children in different years ( χ2=38.35, P<0.001), months ( χ2=62.69, P<0.001), and ages ( χ2=9.53, P=0.049). There is a statistically significant difference in the constituent ratio of G2P [4] RVA between rural and urban RVA positive children ( χ2=4.01, P=0.045). Compared with non-G2P[4] RVA hospitalized children, G2P[4] RVA hospitalized children had less proportion of respiratory tract infection ( χ2=6.07, P=0.014), G2P[4] RVA hospitalized children had higher proportion of fever ( χ2=6.68, P=0.010), there was no significant differences in diarrhea ( χ2=0.88, P=0.643), vomiting ( χ2=0.23, P=0.629), extraintestinal neurological symptoms ( χ2=0.18, P=0.668), and no significant difference in rash, sepsis and other complications ( χ2=0.45, P=0.504). Conclusions:The epidemic trend of G2P[4] RVA in China gradually decreased from 2016 to 2019, and the autumn and winter were G2P[4] RVA seasonal peaks. And the peak age was 24-36 months. There were a higher infection risk in rural areas, and fever was more than other genotypes.

Objective:To investigate the sequence characteristics and evolutionary pattern of a strain of G1P[8] genotype group A rotvirus (RVA) SC18511073 in China and to determine the differences between SC18511073 and the antigenic epitopes of RotaTeq? and Rotarix? vaccines.Methods:RT-PCR amplification of 11 segments of SC18511073 was performed using reverse transcription-polymerase chain reaction (RT-PCR), and the typing was conducted by online RVA automatic typing tool. DNAstar5.1 and Mega11.0 software were used to analyze the homology and genetic evolution of the 11 segments.Results:The genotype constellation of SC18511073 is G1P[8]-I1-R1-C1-M1-A1-N1-T1-E2-H1, and NSP4 is the E2 genotype. The VP7 and NSP3 segments of SC18511073 had high homology with the 2018 Sichuan epidemic G1P[8]-E1 strain, and the phylogenetic tree showed that they were located in the same branch. The remaining nine gene segments all had high homology with the G9P[8]-E2 type prevalent in China and were attributed to the same evolutionary branch. SC18511073 differs from RotaTeq? and Rotarix? by a total of 5 amino acid sites on 7-1a and 7-2 of VP7, and differences in the 8-1 and 8-3 regions of VP8 * antigen epitopes. Conclusions:The 2018 RVA strain SC18511073 in China is a rare G1P[8]-E2 type, which is a new strain generated by re-assortment of VP7 and NSP3 segments during the co-infection process of G1P[8]-E1 and G9P[8]-E2 RVA strains. SC18511073 has amino acid site changes in antigenic epitopes on VP7 and VP4 with RotaTeq? and Rotarix?.