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

Liver fibrosis is a vital cause of morbidity in patients with liver diseases and developing novel anti-fibrotic drugs is imperative. Isovalerylspiramycin I (ISP I) as a major component of carrimycin applied to upper respiratory infections, was first found to possess anti-fibrotic potential. The present study aims to evaluate the functions and mechanisms of ISP I in protecting against liver fibrosis. According to our results, ISP I not only reduced the expressions of fibrogenic markers in LX-2 cells but also appeared great protective effects on liver injury and liver fibrosis in bile duct ligation (BDL) rats and carbon tetrachloride (CCl₄) mice. We proved that nucleotide-binding protein 2 (NUBP2) was the direct target of ISP I. ISP I through targeting NUBP2, increased the amount of vascular non-inflammatory molecule-1 (VNN1) on the cell membrane, which will inhibit oxidative stress and fibrosis. Simultaneously, the original carrimycin's protective effect on liver damage and fibrosis was verified. Therefore, our study provides potential agents for patients with liver fibrosis-related diseases, and the clear mechanism supports wide application in the clinic.

Objective:To study positive rates and typing of oligoclonal bands (OCB) in patients with neurological disorders, and to reveal the clinical significance and applicational value of OCB test.Methods:A retrospective analysis was performed on the detection results of 3 217 patients with neurological disorders who undertook both serum and cerebrospinal fluid OCBs in the First Hospital of Peking University from January 2012 to August 2022. According to the final diagnosis, the patients were divided into 13 groups including multiple sclerosis (479 cases), neuromyelitis optica spectrum disorders (935 cases), autoimmune encephalitis (192 cases), viral encephalitis (94 cases), nervous system complication after HSCT (232 cases), Guillain-Barré syndrome (644 cases), chronic inflammatory demyelinating polyneuropathy (157 cases), etc. Cerebrospinal fluid and serum OCBs were detected using isoelectric focusing electrophoresis combining immunofixation, then classified into Ⅰ-Ⅴ types according to the morphology. Consequently, positive rates and types were analyzed for each group. χ2 test was used for comparison between groups. Results:The positive rates of cerebrospinal fluid OCB in multiple sclerosis, nervous system complication after hematopoietic stem cell transplantation (HSCT), autoimmune encephalitis, viral encephalitis, neuromyelitis optica spectrum disorders, Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy were respectively 66.8% (320/479), 48.7% (113/232), 46.4%(89/192), 19.1% (18/94), 17.6% (165/935), 9.9% (64/644), 5.1% (8/157). For patients with multiple sclerosis, neuromyelitis optica spectrum disorders, viral encephalitis, and autoimmune encephalitis, Type Ⅱ bands took the majority of cerebrospinal fluid OCB-positive cases with the rates of 94.1% (301/320), 78.7% (70/89), 77.8% (14/18), and 77.6% (128/165) respectively, indicating intrathecal IgG synthesis; for patients with nervous system complication after HSCT, Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy, type Ⅳ bands took the majority of cerebrospinal fluid OCB-positive cases with the rates of 94.7% (107/113), 82.8% (53/64) and 100% (8/8), indicating no obvious intrathecal IgG synthesis. The positive rates of cerebrospinal fluid oligoclonal bands were significantly different among all groups (χ 2=1 268.31, P<0.001). Conclusion:The positive rates of cerebrospinal fluid oligoclonal bands are different among different neurological disorders, in which the positive rate of cerebrospinal fluid OCB is higher with type Ⅱ bands as the majority type in multiple sclerosis, which indicates that the detection and typing of cerebrospinal fluid OCB are helpful for the diagnosis of various neurological diseases, especially for multiple sclerosis.

Objective:To explore the correlation between the initial estimated glomerular filtration rate (eGFR) and all-cause mortality in end-stage renal disease (ESRD) patients undergoing urgent-start peritoneal dialysis (USPD).Methods:The clinical data of 380 ESRD patients undergoing USPD from January 2013 to June 2023 in Affiliated Hospital of Jining Medical University were retrospective analyzed. According to the median initial eGFR of 6.25 ml/(min·1.73 m 2), the patients were divided into low eGFR group with eGFR<6.25 ml/(min·1.73 m 2) and high eGFR group with eGFR ≥6.25 ml/(min·1.73 m 2), with 190 patients in each group. The baseline characteristics and hematological indexes within 48 h before USPD were compared between the two groups. The patients were followed up until death or until June 30, 2023, and all-cause mortality was recorded. The Kaplan-Meier survival curve was used to evaluate the accumulated survival rate. Multivariate Cox regression analyses were used to identify the independent risk factors for all-cause mortality in ESRD patients undergoing USPD, with subgroup analyses based on age, gender and diabetes. Results:The median follow-up time was 40.7 (21.7, 59.0) months, 112 patients died, with a total mortality rate of 29.5% (112/380). The blood potassium, blood phosphorus, urea nitrogen, uric acid, parathyroid hormone and dialysis age in high eGFR group were significantly lower than those in low eGFR group: (4.1 ± 0.7) mmol/L vs. (4.5 ± 0.8) mmol/L, (1.6 ± 0.4) mmol/L vs. (1.9 ± 0.6) mmol/L, (21.8 ± 7.2) mmol/L vs. (29.7 ± 11.0) mmol/L, (359.8 ± 99.4) μmol/L vs. (429.4 ± 116.9) μmol/L, 242.2 (151.5, 398.3) ng/L vs. 281.7 (189.1, 487.2) ng/L and 36.1 (18.8, 54.0) months vs. 43.7 (28.8, 68.2) months, the diabetes rate, hemoglobin, platelet count, blood chloride, fasting blood glucose and mortality rate were significantly higher than those in low eGFR group: 20.0% (38/190) vs. 11.6% (22/190), (100.6 ± 18.2) g/L vs. (96.1 ± 20.0) g/L, (207.7 ± 72.6) × 10 9/L vs. (192.4 ± 65.6) × 10 9/L, (100.6 ± 4.1) mmol/L vs. (99.4 ± 4.7) mmol/L, (5.9 ± 2.3) mmol/L vs. (5.5 ± 1.9) mmol/L and 34.2% (65/190) vs. 24.7% (47/190), and there were statistical differences ( P<0.01 or< 0.05). Kaplan-Meier survival curve analysis result showed that the all-cause mortality rate in high eGFR group was significantly higher than that in low eGFR group, and there was statistical difference (log-rank χ2 = 6.64, P<0.01). After adjusting for gender, age and confounding factors, multivariate Cox regression analysis result showed that elevated eGFR, increased mean corpuscular volume and elevated fasting blood glucose were independent risk factors for all-cause mortality in ESRD patients undergoing USPD ( HR = 1.14, 1.04 and 1.15; 95% CI 1.04 to 1.26, 1.01 to 1.08 and 1.03 to 1.29; P<0.01 or<0.05), while female was an independent protective factor ( HR = 0.59, 95% CI 0.38 to 0.92, P<0.05). Subgroup analysis result showed a consistent effect of eGFR on mortality in ESRD patients undergoing USPD. Conclusions:Higher initial eGFR in ESRD patients undergoing USPD is associated with an increased risk of all-cause mortality.

Objective:To evaluate the role of silent information regulator-1 (SIRT1)/nucleotide-binding domain (NOD)-like receptor protein-3 (NLRP3) signaling pathway in sevoflurane postconditioning-induced attenuation of oxygen-glucose deprivation and restoration (OGD/R) injury in mouse hippocampal neuronal cell line (HT22) cells.Methods:The HT22 cells were seeded in a culture plate (96-well plate, 100 μl/well; 6-well plate, 2 ml/well) at the density of 5×10 4 cells/ml or in a culture dish (6 cm in diameter) and then divided into 4 groups ( n=24 each) using a random number table method: control group (Control group), OGD/R group, sevoflurane postconditioning group (SPC group), and SIRT1 small interfering RNA group (si-SIRT 1 group). In Control group, cells were cultured at 37 ℃ in normal culture atmosphere. In OGD/R group, the culture medium was replaced with glucose-free serum-free culture medium, and cells were exposed to 95% N 2+ 5% CO 2 for 4 h in an incubator at 37 ℃, and then the glucose-free serum-free culture medium was replaced with the primary culture medium, and cells were cultured for 24 h at 37 ℃ in normal culture atmosphere. In SPC group, the glucose-free serum-free culture medium was replaced with the primary cell culture medium after 4-h oxygen and glucose deprivation, the cells were put into the hypoxia incubator chamber which was filled with 2% sevoflurane immediately after start of reoxygenation, then the chamber was placed in an incubator and the cells were cultured for 1 h at 37 ℃ in normal culture atmosphere, and finally the cells were removed from the chamber and cultured for 23 h at 37 ℃ in normal culture atmosphere. In si-SIRT1 group, SIRT1 small interfering RNA 150 pmol was added at 24 h before surgery, cells were then incubated, and the other procedures were the same as those previously described in group SPC. The cell survival rate was determined using MTT assay. TUNEL assay was used to detect cell apoptosis, and the apoptosis rate was calculated. The expression of SIRT1, NLRP3, IL-1β and IL-18 mRNA was determined using polymerase chain reaction. The expression of SIRT1, NLRP3, interleukin-1beta (IL-1β) and IL-18 was detected using Western blot. Results:Compared with Control group, the cell survival rate was significantly decreased, the apoptosis rate was increased, the expression of SIRT1 protein and mRNA was down-regulated, and the expression of NLRP3, IL-1β and IL-18 protein and mRNA was up-regulated in OGD/R group ( P<0.05). Compared with OGD/R group, the cell survival rate was significantly increased, the apoptosis rate was decreased, the expression of SIRT1 protein and mRNA was up-regulated, and the expression of NLRP3, IL-1β and IL-18 protein and mRNA was down-regulated in SPC group ( P<0.05). Compared with SPC group, the cell survival rate was significantly decreased, the apoptosis rate was increased, the expression of SIRT1 protein and mRNA was down-regulated, and the expression of NLRP3, IL-1β and IL-18 protein and mRNA was up-regulated in si-SIRT1 group ( P<0.05). Conclusions:Activation of SIRT1-NLRP3 signaling pathway is involved in sevoflurane postconditioning-induced attenuation of OGD/R injury in HT22 cells.

Objective:To establish a convenient preoperative nomogram prediction model for early diagnosis of hepatocellular carcinoma (HCC)with microvascular invasion (MVI), and to evaluate the model through internal and external validations for use informulating reasonable and individualized treatment strategies for patients with early-staged HCC.Methods:The clinical data of 294 patients who underwent hepatectomy at the General Hospital of Ningxia Medical University from January 2017 to December 2020 were retrospectively collected and analyzed. Based on the different admission times, they were divided into the training group ( n=231) and the validation group ( n=63). Based on the results from previous published literatures and our relevant clinical experience, risk factors including γ-glutamyltranspeptidase (GGT), platelet-lymphocyte ratio (PLR), fibrinogen albumin ratio (FAR), lymphocyte monocyte count ratio (LMR) and ALT-platelet ratio (APRI) were subjected to multi-factor logistic regression analysis to determine independent risk factors of HCC with MVI, and a nomogram prediction model was then constructed. The validation group was applied to the model for validation. Results:Of 294 patients who were enrolled in this study, there were 231 patients in the training cohort, with an average age of (55.1±10.9) years. In the training group, 95 patients were MVI positive and 136 patients were MVI negative. In the validation group, 38 patients were MVI positive and 25 patients were MVI negative. Logistic regression analysis showed that FAR>0.06, GGT>50 U/L, APRI>0.16, tumor diameter>5 cm, LMR>3.57 and PLR>98.75 were independent risk factors ( P<0.05), and a nomogram prediction model was established. The correction curve of the nomogram showed that the actual prediction result was close to the ideal result of the prediction model. The internal validated results showed the C-indexes to be between 0.71 and 0.90, and the prediction model had good discrimination. DCA curve was used to evaluate the clinical net benefit of the predictive model. When the net benefit rate was above zero, the threshold of the prediction model was 4%-77%, indicating that the prediction model had good clinical practicability. Conclusion:The established nomogram prediction model based on preoperative clinical indexes of GGT, APRI, LMR, PLR, FAR and diameter of tumor could be used to predict early diagnosis of HCC with MVI. The nomogram has good clinical application values.

In the past ten years, the research and application of microbiome has continued to increase. The microbiome has gradually become the research focus in the fields of life science, environmental science, and medicine. Meanwhile, many countries and organizations around the world are launching their own microbiome projects and conducting a multi-faceted layout, striving to gain a strategic position in this promising field. In addition, whether it is scientific research or industrial applications, there has been a climax of research and a wave of investment and financing, accordingly, products and services related to the microbiome are constantly emerging. However, due to the rapid development of microbiome sequencing and analysis related technologies and methods, the research and application from various countries have not yet unified on the standards of technology, programs, and data. Domestic industry participants also have insufficient understanding of the microbiome. New methods, technologies, and theories have not yet been fully accepted and used. In addition, some of the existing standards and guidelines are too general with poor practicality. This not only causes obstacles in the integration of scientific research data and waste of resources, but also gives related companies unfair competition opportunity. More importantly, China still lacks national standards related to the microbiome, and the national microbiome project is still in the process of preparation. In this context, the experts and practitioners of the microbiome worked together and developed the consensus of experts. It can not only guide domestic scientific research and industrial institutions to regulate the production, learning and research of the microbiome, the application can also provide reference technical basis for the relevant national functional departments, protect the scale and standardized corporate company's interests, strengthen industry self-discipline, avoid unregulated enterprises from disrupting the market, and ultimately promote the benign development of microbiome-related industries.
China ; Consensus ; Humans ; Industry ; Microbiota

OBJECTIVE：To compare the protective effects of different effective components of Astragali radix against DNA damage of human bone marrow mesenchymal stem cells （BMSCs）induced by ionizing radiation. METHODS ：2 Gy X-rays were used to directly irradiate BMSCs to establish a radiation model. CCK- 8 method was used to detect the effects of different mass concentrations（25，50，75，100 μg/mL）of astragalus polysaccharide ，astragalus saponin and astragalus flavonoids for 1 day before radiation + 1 to 5 days after radiation on the proliferation of BMSCs. The dose concentration and the duration of intervention after radiation were selected. The irradiated BMSCs were divided into radiation group ，astragalus polysaccharide group ，astragalus saponin group and astragalus flavonoids group. The last three groups were treated with appropriate dosage of corresponding drugs before and 2 days after radiation ，and a blank groupwas set for comparison. Cytoplasmic division arrest qq.com micronucleus method was used to detect micronucleus cell rate and cell micronucleus rate after appropriate time of was used to detect th e number of 53BP1 foci in cells after appropriare time of intervention following radiation ；the number of 53BP1 foci were compared among different time points （0.5，2，12，24 h）. RESULTS ：Compared with blank group ，OD values of BMSCs were decreased significantly in radiation group （P＜0.05 or P＜0.01）. Compared with radiation group ，the OD values of BMSCs were significantly increased when 50 μ g/mL astragalus polysaccharide，astragalus saponin and astragalus flavonoids continuously intervened radiation for 2-3 days，there was significant difference in other groups at some time point （P＜0.05 or P＜ 0.01）. After consideration ，drug concentration was determined to be 50 μg/mL，and the continuous intervention time was 2 days after radiation. Compared with blank group ，the micronucleus cell rate and cell micronucleus rate of radiation group ，astragalus polysaccharide group ，astragalus saponin group and astragalus flavonoids group increased significantly ，and the number of 53BP1 focus cluster in radiation group and astragalus polysaccharide group increased significantly （P＜0.01）. Compared with radiation group and astragalus flavonoids group ，the micronucleus cell rate ，cell micronucleus rate and the number of 53BP1 focus cluster （continued intervention for 0.5，2，12 h）in the astragalus polysaccharide group and astragalus saponin group were significantly reduced，and the micronucleus cell rate and cell micronucleus rate in the astragalus polysaccharide group were significantly lower than astragalus saponin group （P＜0.05）. 53BP1 focus cluster could not be detected 24 h later （P＜0.05）. CONCLUSIONS ： Astragalus polysaccharide and astragalus saponin both have protective effects on BMSCs DNA damage induced by radiation ，and the protective effect of astragalus polysaccharide is better than that of astragalus saponin ；astragalus flavonoids has no protective effect on radiation-induced DNA damage.

Objective : To investigate the effect of different concentrations of MTA on the proliferation and differentiation of stem cells from the apical papilla (SCAP) and the potential of the SCAP to differentiate into odontoblasts. Methods: SCAP were cultured in different concentrations of mineral trioxide aggregate（MTA）. MTA experimental group with concentration of 0.01 mg/mL, 0.02 mg/mL, 0.1 mg/mL, 0.2 mg/mL, 1 mg/mL, 2 mg/mL, 10 mg/mL and 20 mg/mL were prepared. The number of cells at 1 day, 3 days, 5 days and 7 days were measured via a CCK-8 assay to observe the effect of MTA on SCAP proliferation. Real-time PCR was used to detect the gene expression changes. Cells cultured in alpha MEM culture containing 15% FBS without MTA were set as the control group. Results : When cultured for 1 d, statistically significant differences in the promotion of in vitro proliferation of SCAP were not observed between each MTA experimental group and the control group (P>0.05). When cultured for 3 d, 5 d and 7 d, the 0.01 mg/mL MTA group presented obvious promotion of SCAP proliferation compared with the control group (P<0.05), whereas the 0.02 mg/mL, 0.1 mg/mL, 0.2 mg/mL, 1 mg/mL groups did not presented differences with the control group (P>0.05). The in vitro proliferation of the 2 mg/mL, 10 mg/mL and 20 mg/mL groups was lower than that of the control group (P<0.05). Real-time PCR detection showed that the expression levels of DSPP (t=-11.12, P < 0.05) and Runx2 (t=-10.62, P < 0.05) in the experimental group treated with 0.01 mg/mL MTA for 7 days were higher than those in the control group. Conclusion The 0.01 mg/mL concentration of MTA significantly promotes the proliferation of SCAP and shows the best ability to induce osteogenic and odontoblast differentiation in the SCAP, whereas high concentrations of MTA inhibited the proliferation of SCAP.

Objective Transient brain function inhibition is a common symptom after mild brain injury,but some patients show persistent post-concussional syndrome (PCS).The aims of this study are to assess functional and causal connectivity of attention and default mode network using resting-state functional MR imaging (fMRI) to investigate the abnormal connectivity and its significance in PCS patients.Methods Resting-state fMRI data were collected from 23 PCS patients with attention disorders,admitted to our hospital from November 2015 to October 2016 and 21 age-,gender,and education-matched healthy controls recruited at the same period.The fMRI data were analyzed by group independent component analysis (ICA) toolbox to attention networks and default mode network (DMN).The components of the selected networks were compared in PCS and healthy controls to explore the changes of functional connectivity (FC).Granger causality analysis (GCA) was performed by taking the above significant brain areas as regions of interest (ROIs) to calculate bivariate coefficient of each pair of ROIs.Comparisons were performed to find the significant different causal connectivity of the two groups.Results In attention networks,the FC value of left frontal eye field (FEF),bilateral intraparietal sulcus (IPS),bilateral ventral prefrontal cortex (vPFC) and bilateral temporo-parietal junction (TPJ) was decreased.In DMN,the FC value of bilateral medial prefrontal cortex (mPFC) was reduced and bilateral precuneus (PCUN) was enhanced.Correlating GCA value,it was increased significantly from left FEF to left PCUN and IPS,while it was reduced from left PCUN and IPS to left FEF;and it was decreased from left IPS to left vPFC and increased from left TPJ to left PCUN.Conclusion The attention networks are restrained in resting state,which may influence the attention function in PCS patients;and the causal connection is altered in the above ROIs,and these changes may be related to inhibition of activation of default network to compensate for the loss of attention function by antagonistic effects in PCS patients.