Objective:To construct preeclampsia (PE) prediction models using information from the hospital electronic medical information and clinical laboratory data through logistic regression (LR) and machine learning algorithms, and to compare their predictive performance.Methods:The study was conducted based on the information from Rouji Pregnancy Test Database and the perinatal data of women who visited the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2012, to December 31, 2019. Drawing upon clinical treatment guidelines and related literature, 28 clinical indicators from 2 736 pregnant women at 24 to 28 weeks of gestation were selected after a thorough integration and used for the construction of the PE prediction model dataset. Patients diagnosed with PE comprised the PE group ( n=245), while another 255 cases from the rest who did not have PE were selected, with undersampling method, as the control group. The Random Forest algorithm (RF), eXtreme Gradient Boosting (XGB) algorithm, and LR model were each employed to develop predictive models for PE. Following the construction of the models, external validation of PE prediction accuracy was carried out using data acquired from an independent prospective cohort study on PE that was conducted from June 2019 to December 2022, in which 38 PE cases and 80 controls were chosen. The performance of predictive models were evaluated using metrics such as accuracy, sensitivity, specificity, and the area under the curve (AUC) of receiver operating characteristic. Results:Indicators included in the construction of the three predictive models suggested that uric acid, creatinine, maternal age, early pregnancy body mass index, urea, triglycerides, red blood cell count, eosinophil count, total cholesterol, neutrophil count, urine protein, alanine aminotransferase, and urine occult blood were influential in PE prediction models. The AUCs for RF, XGB, and LR models in the training and test sets were 0.851 (95% CI:0.730-0.891), 0.955 (95% CI:0.865-0.987), 0.884 (95% CI:0.767-0.923) vs. 0.845 (95% CI:0.723-0.868), 0.907 (95% CI:0.791-0.919), 0.851 (95% CI:0.755-0.893), respectively. In the test set, the accuracy, sensitivity, and specificity for RF, XGB, and LR models were 0.803, 0.607, 0.958, 0.864, 0.790, 0.927, and 0.832, 0.661, 0.971, respectively. In the external validation of the RF, XGB and LR predictive models, the accuracy were 0.822, 0.814, and 0.763; the sensitivity were 0.737, 0.789, and 0.605, and the specificity were 0.863, 0.825, and 0.838, respectively. Among them, XGB model showed the highest Youden's index (0.614). Conclusion:Compared to traditional methods of model construction, machine learning algorithms can establish more effective PE prediction models using real clinical data.

Objective:To investigate the radiation dose and fractionation regimens for limited stage small cell lung cancer (LS-SCLC) in Chinese radiation oncologists.Methods:Over 500 radiation oncologists were surveyed through questionnaire for radiation dose and fractionation regimens for LS-SCLC and 216 valid samples were collected for further analysis. All data were collected by online questionnaire designed by WJX software. Data collection and statistical analysis were performed by SPSS 25.0 statistical software. The differences in categorical variables among different groups were analyzed by Chi-square test and Fisher's exact test. Results:Among 216 participants, 94.9% preferred early concurrent chemoradiotherapy, 69.4% recommended conventional fractionation, 70.8% preferred a total dose of 60 Gy when delivering conventional radiotherapy and 78.7% recommended 45 Gy when administering hyperfractionated radiotherapy.Conclusions:Despite differences in LS-SCLC treatment plans, most of Chinese radiation oncologists prefer to choose 60 Gy conventional fractionated radiotherapy as the main treatment strategy for LS-SCLC patients. Chinese Society of Clinical Oncology (CSCO), National Comprehensive Cancer Network (NCCN) and Chinese Medical Association guidelines or expert consensus play a critical role in guiding treatment decision-making.

Objective:To investigate the effects of different radiotherapy regimens on the short-term and long-term prognosis of patients with limited-stage small cell lung cancer (SCLC).Methods:Sixty patients with limited-stage SCLC in the Third People′s Hospital of Yangquan City from September 2017 to September 2019 were selected. The patients who received concurrent radiotherapy and chemotherapy were in group A and the patients who received sequential radiotherapy and chemotherapy were in group B, 30 cases in each group. The short-term efficacy and adverse reactions of the two groups were compared, and the levels of neuron-specific enolase (NSE), gastrin release precursor (ProGRP), carcinoembryonic antigen (CEA), vascular endothelial growth factor (VEGF), endostatin (ES), circulating endothelial cells (CEC) were compared between the two groups. The survival status of the two groups were followed-up.Results:After treatment, the disease control rate in group A was higher than that in the group B : 80.00%(24/30) vs. 53.33%(16/30), the difference was statistically significant ( χ2 = 4.80, P<0.05). The levels of serum NSE, ProGRP and CEA in the group A after treatment were lower than those in the group B: (19.42 ± 3.31) pg/L vs. (24.58 ± 4.42) pg/L, (95.45 ± 10.33) ng/L vs. (115.54 ± 15.66) ng/L, (8.25 ± 1.02) μg/L vs. (10.33 ± 1.15) μg/L, the differences were statistically significant ( P<0.05). The levels of VEGF and CEC in the group A were lower than those in the group B after treatment and ES was higher than that in the group B: (356.62 ± 56.63) ng/L vs. (442.21 ± 55.38) ng/L, (65.56 ± 5.41) × 10 6/L vs. (99.28 ± 7.24) ×10 6/L, (52.65 ± 6.44) μmol/L vs. (31.85 ± 5.49) μmol/L, the differences were statistically significant ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). The survival rate in the group A was higher than that in the group B at 1 year after treatment: 82.14%(23/28) vs. 56.00%(14/25), the difference was statistically significant ( χ2 = 4.28, P = 0.038). Conclusions:Compared with sequential radiotherapy and chemotherapy, concurrent radiotherapy and chemotherapy is effective in treating limited-stage SCLC, which can adjust the level of tumor markers and angiogenesis indicators, and improve the treatment effect and survival rate.

The online version of the original article can be found at https://doi.org/10.1631/jzus.B1900468 The original version of this article (Liu et al., 2020) unfortunately contained some mistakes. 1. Figs. 7c and 7d in p.229 were incorrect. The upper left and bottom left pictures in Fig. 7c were accidentally duplicated with the pictures at the same position of Fig. 1a. The upper right and bottom right pictures were mistakenly placed in Fig. 7c. Therefore, the calculation results in Fig. 7d were also mistaken. The correct versions should be as follows: 2. Because of the wrong pictures of Fig. 7c, the calculated results of "42.5%" in Abstract, Sections 3.9 and 5 are also mistaken. The correct result should be "45.2%." (1) Lines 10-12 of Abstract in p.218: "CSO-ss-SA/siRNA could effectively transmit siRNA into tumor cells, reducing the expression of RAC1 protein by 38.2% and decreasing the number of tumor-induced invasion cells by 42.5%." was incorrect. The correct version should be "CSO-ss-SA/siRNA could effectively transmit siRNA into tumor cells, reducing the expression of RAC1 protein by 38.2% and decreasing the number of tumor-induced invasion cells by 45.2%." (2) Lines 23-26 of Section 3.9 in p.227: "It was shown that the number of invasive tumor cells induced by DOX was reduced by 42.5% since CSO-ss-SA/siRNA downregulated the expression of RAC1 protein." was incorrect. The correct version should be "It was shown that the number of invasive tumor cells induced by DOX was reduced by 45.2% since CSO-ss-SA/siRNA downregulated the expression of RAC1 protein." (3) Lines 4-8 of Section 5 in p.231: "CSO-ss-SA, as an efficient redox-sensitive carrier for delivering siRNA silencing RAC1 into tumor cells, reduced the expression of RAC1 by 38.2% and decreased DOX-induced tumor invasion cells by 42.5% in vitro." was incorrect. The correct version should be "CSO-ss-SA, as an efficient redox-sensitive carrier for delivering siRNA silencing RAC1 into tumor cells, reduced the expression of RAC1 by 38.2% and decreased DOX-induced tumor invasion cells by 45.2% in vitro."

Objective:To investigate the changes of plasma ghrelin levels and insulin(INS) sensitivity of full-term infants small for gestational age (SGA) and the effects of breast feeding on it.Methods:Full-term SGA hospitalised in the Department of Neonatology, Wuhan Children′s Hospital from October 2014 to April 2019 were re-cruited as the SGA group (120 cases), with full-term infants appropriate for gestational age (AGA) born in the same period as the AGA group (96 cases) in this study with recorded birth weight and length.The levels of fasting blood glucose (FG), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), INS and ghrelin were measured 7 days after birth.Homeostasis model assessment-insulin resistance (HOMA-IR) was calculated.The SGA group was subdivided into breast feeding group and formula feeding group.The above indexes were tracked and mea-sured in the 3 rd and 6 th month, respectively, and their growth parameters were recorded. Results:There were no diffe-rences in serum FG, TG, LDL and HDL levels between the SGA and the AGA group (all P>0.05). Compared with the AGA group, the serum INS[(4.21±0.83) mIU/L vs.(3.54±1.10) mIU/L], ghrelin levels[(0.80±0.23) μg/L vs.(0.69±0.19) μg/L] and HOMA-IR (0.85±0.25 vs.0.72±0.25) increased in the SGA group, the differences were statistically significant (all P<0.05). Serum INS, HOMA-IR and ghrelin levels changed with the duration of breast feeding, the differences were statistically significant( F=12.394, 9.810, 5.531, all P<0.05). Conclusions:The serum ghrelin levels of SGA infants increased and INS sensitivity decreased.Breastfeeding can decrease levels of serum INS, HOMA-IR and ghrelin, and can improve INS sensitivity of SGA infants.

OBJECTIVE: To analyze the clinical manifestations of heart, liver and kidney damages in the early stage of COVID-19 to identify the indicators for these damages. METHODS: We analyzed the clinical features, underlying diseases, and indicators of infection in 12 patients with COVID-19 on the second day after their admission to our hospital between January 20 and February 20, 2020.The data including CK-MB, aTnI, BNP, heart rate, changes in ECG, LVEF (%), left ventricular general longitudinal strain (GLS, measured by color Doppler ultrasound) were collected.The changes of liver function biochemical indicators were dynamically reviewed.BUN, UCR, eGFR, Ccr, and UACR and the levels of MA, A1M, IGU, and TRU were recorded. RESULTS: The 12 patients included 2 severe cases, 8 common type cases, and 2 mild cases.Four of the patients presented with sinus tachycardia, ECG changes and abnormal GLS in spite of normal aTNI and LVEF; 1 patient had abnormal CKMB and BNP.On the first and third days following admission, the patients had normal ALT, AST and GGT levels.On day 7, hepatic function damage occurred in the severe cases, manifested by elevated ALT and AST levels.Abnormalities of eGFR, Ccr and UACR occurred in 8, 5 and 5 of the patients, respectively.Abnormal elevations of MA, A1M, IGU and TRU in urine protein were observed in 4, 4, 5, and 2 of the patients, respectively. CONCLUSIONS In patients with COVID-19, heart damage can be identified early by observing the GLS and new abnormalities on ECG in spite of normal aTNI and LVEF.Early liver injury is not obvious in these patients, but dynamic monitoring of the indicators of should be emplemented, especially in severe cases. In cases with normal CR and BUN, kidney damage can be detected early by calculating eGFR, Ccr and UACR and urine protein tests.
Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2

Objective To investigate the application of pulmonary ultrasound in the diagnosis of neonatal novel coronavirus pneumonia (COVID-19). Methods In this retrospective study, the clinical data of 5 infants, who were admitted to the Department of Neonatology in Wuhan Children's hospital from 31 th January to 25 th February 2020, were collected. Bedside pulmondary ultrasound was conducted on admission, during the hospitalization, and before discharge, and the result were compared with the chest X-ray or CT done at the same time. Results Among the 5 cases who aged 1-18 days, 3 were male. The main clinical manifestations were respiratory and gastrointestinal symptoms. The pulmonary ultrasonography on admission showed abnormal pleural line and pulmonary edema of different severity in all 5 cases, presented as increase and fusion of B-line, and pulmonary interstitial syndrome; among them, one case also had a small-range consolidation. The chest CT on admission showed no obvious parenchymal infiltration in 2 cases, small strip or patchy high-density shadow in 2 cases, and ground glass change in one case. The re-examination of ultrosound during the hospitalization and at discharge showed improvement in all cases and were consistent with the chest X-ray taken at the sametime. Conclusions The main changes on the pulmonary ultrasonography in neonates with COVID-19 pneumonia are increase and fusion of B-line, abnormal pleural line, and nalveolar interstitial syndrome, and may combined with small range of pulmonary consolidation. The sensitivity of pulmonary ultrasound is higher than chest X-ray and CT in the diagnosis of pulmonary edema, and could be used in monitoring and evaluation of the disease.

Objective To study the predictive value of hemodynamic monitoring in the responsiveness of fluid therapy in neonatal septic shock.Method The 96 neonates with septic shock admitted to the NICU from Wuhan Children's Hospital and Tongji Hospital between March 2014 to May 2017 were enrolled.Hemodynamics parameters of neonates pre-,1 hour and 6 hour post-fluid therapy were supervised by ultrasonic cardiac output monitor.The hemodynamics parameters included cardiac index (CI),systemic vascular resistance (SVR),stroke volume (SV),stroke volume variation (SVV),stroke volume index (SVI) and corrected flow time (FTc).The SVI variation (△ SVI) were calculated based on the SVI among pre-and post-fluid therapy.According to the △ SVI,these samples were assigned into two groups,responsive group with a △ SVI ≥10％,and the other was nonresponsive group respectively.T-test was applied to analyze the differences of hemodynamic parameters between two groups.The associations between SVV、FTc and △ SVI were evaluated by bivariate correlation.Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of SVV and FTc in fluid responsiveness.All statistical analyses were performed by SPSS 19.0,P＜0.05 was considered as statistically significant.Result A total of 96 cases were enrolled,of which 54 were fluid responsive group,while 42 were nonresponsive group.(1) Before fluid resuscitation,the FTc in responsive and nonresponsive groups were (317.1±22.2) ms and (326.8± 21.2) ms (P＜0.05) respectively,SVV were(18.3±2.0)％ and (15.0±2.6)％ (P＜0.05).SVV was significantly associated with △ SVI (r=0.542,P＜0.05).(2) There were statistically significant differences in heart rate,mean arterial pressure,cardiac output,cardiac index,stroke volume and systemic vascular resistance index before treatment,1 h and 6 h after treatment (P＜0.05).(3) The area under the ROC of SVV (AUC) was 0.838 (95％CI 0.749～0.906).A sensitivity of 98.2％,and specificity 73.8％ when SVV defined as 15.5％,with a significant difference when compared with FTc (AUC=0.642,95％CI 0.538～0.737) (P＜0.01).Conclusion SVV could be a reliable predictive index in estimating fluid responsiveness of neonatal septic shock and could be helpful parameter in clinic diagnosis.

Objective To discuss the safety and the application of the self-designed multifunctional inflatable pelvis and hip-joint fixator (MIPHF) in damage control in pelvic fracture patients.Methods The MIPHF was subjected to pressure test and quality inspection.From September 2016 to June 2017,61 pelvic-fracture patients were treated with our self-designed MIPHF as pre-hospital first-aid care according to the concept of damage control orthopedics (DCO) (MIPHF group).The control group consisted of 69 pelvic-fracture patients who had not received pre-hospital first-aid care with the self-designed MIPHF from December 2015 to August 2016.There were no statistically significant differences between the two groups in gender,age,types of pelvic fracture,and preoperative injure severity score (ISS).The study compared the two groups for the case fatality rate,volume of blood transfused during surgeries,early complication rates,fracture reduction (Matta standards),and long-term efficacy (Cole scores).Results The pressure test showed that the MIPHF had a good fixation effect on the pelvis.And the quality inspection showed that the material used for the MIPHF was in line with national standards and the safety was guaranteed.The MIPHF group had 1 death (1.6％) and the control group had 8 deaths (11.6％),which was a significant difference (x2=4.979,P=0.026).All survival patients in both groups were followed up.The MIPHF group (61 cases) received 3.0 to 18.0 months follow-up,with an average of 9.0 months.And the control group (69 cases) had 18.0 to 30.0 months follow-up,with an average of 21.9 months.In the MIPHF group,23 cases were treated conservatively,and 37 cases were treated with surgery.Among them,3 cases were fixed with external fixator,20 cases with anterior open reduction and internal fixation,9 cases with posterior open reduction and internal fixation,and 5 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 20 days after injury,with an average of 4.1 days.The volume of blood transfused in the MIPHF group during surgery was 200 to 1500 ml,with an average of 628.6 ml.In the control group,27 patients were treated conservatively,and 42 patients were treated with surgery.Among them,2 cases were fixed with external fixator,24 cases with anterior open reduction and internal fixation,10 cases with posterior open reduction and internal fixation,and 6 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 15 days after injury,with an average of 3.l days.The volume of blood transfused in the control group during surgery was 200 to 4000 ml,with an average of 1 707.1 ml.There was a significant difference between the two groups in intraoperative blood transfusion(Z=-2.330,P=0.020).The MIPHF group had 10 (16.4％) cases of early serious complications and the control group had 22 (31.9％) cases,which had a significant difference (x2=4.187,P=0.041).According to the criteria proposed by Matta et al.,the good rate of results for treating fractures was 82.0％ in the MIPHF group and 60.9％ in the control group,which got a significant difference (x2=6.967,P=0.008).The MIPHF group and the control group also differed significantly in their mean long-term Cole scores (27.2±4.0 versus 25.1 ±5.6,t=2.457,P=0.015).Conclusion MIPHF,which reflects the DCO concept,may be recommended as pre-hospital first-aid care for patients with pelvic fracture because it can lessen bleeding and prevent secondary pelvic injury,thus reduce case fatality rate and the incidence of complications.It can also improve the success rate of treating pelvic fracture,which will positively affect long-term outcomes.