Objective:To explore the value of machine learning models based on multiple structural MRI features for diagnosis of Parkinson disease (PD).Methods:The clinical and imaging data of 60 PD patients (PD group) diagnosed in the Neurology Department of the Second Affiliated Hospital of Soochow University from November 2017 to August 2019 and 56 normal elderly people (NC group) recruited from the community were retrospectively analyzed. All subjects underwent brain MR imaging. Multiple structural MRI features were extracted from cerebellum, deep nuclei and of brain cortex based on different partition templates. The Mann-Whitney U test, as well as least absolute shrinkage and selection operator regression were used to select the most discriminating features. Finally, logistic regression (LR) and linear discriminant analysis (LDA) classifier combined with the 5-fold cross-validation scheme were used to construct the models based on structural features of cerebellum, deep nuclei and cortex, and a combined model based on all features. The receiver operating characteristic curves were drawn, and the diagnostic performance and clinical net benefit of each model were evaluated by the area under curve (AUC) and the decision curve analysis (DCA). Results:In total, four cerebellum (asymmetry index of Lobule Ⅵ volume, asymmetry index of Lobule ⅦB cortical thickness, asymmetry index of total gray matter volume and absolute value of right Lobule Ⅵ gray matter volume), 3 deep nuclei (absolute value of right nucleus accumbens volume, absolute and relative value of total nucleus accumbens volume) and 3 cortex features (local gyration index of left PFm, local fractal dimension of right superior frontal gyrus and sulcal depth of left superior occipital gyrus) were selected as the most discriminating features, and the related models were constructed. In validation set, the AUC of cerebellum, deep nuclei, cortex and combined models for diagnosis of PD based on LR classifier were 0.692, 0.641, 0.747 and 0.816; the AUC of cerebellum, deep nuclei, cortex and combined models for diagnosis of PD based on LDA classifier were 0.726, 0.610, 0.752 and 0.818. The diagnostic efficiency of the combined models based on LR and LDA classifiers were significantly better than those of other models ( P<0.05). The DCA curve demonstrated that the combined models based on LR and LDA classifiers showed the highest clinical net benefit. Conclusion:The combined models with all structural features of cerebellum, deep nuclei and cortex included based on LR and LDA classifiers showed favorable performance and clinical net benefit for diagnosis of PD, which have the potential application value in clinical diagnosis.

Objective:To evaluate the optimization efficacy of anterior quadratus lumborum block at supra-arcuate ligament (SA-AQLB) combined with general anesthesia for laparoscopic gynecological surgery.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 28-64 yr, weighing 52-78 kg, with height of 154-166 cm, scheduled for elective laparoscopic gynecological surgery, were divided into general anesthesia group (group G, n=40) and SA-AQLB combined with general anesthesia group (group SG, n=40) using a random number table method.In group SG, bilateral SA-AQLB was performed under ultrasound guidance before anesthesia induction, and 0.4% ropivacaine 25 ml plus dexamethasone 5 mg was injected into both sides.Combined intravenous-inhalational anesthesia was applied in both groups.Patient-controlled intravenous analgesia (PCIA) with sufentanil 2 μg/kg (in 150 ml of normal saline) was performed after surgery.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analogue scale (VAS) scores for abdomen, pelvis and shoulder pain were recorded at 1, 6, 12, 24 and 48 h after operation.Flurbiprofen was used for rescue analgesia when VAS score >4.The occurrence of intraoperative cardiovascular events and amount of sufentanil used during operation were recorded.The time to first pressing the analgesia pump, effective pressing times of PCA, requirement for rescue analgesia and consumption of sufentanil after operation were recorded.The extubation time, time to first flatus after operation, first ambulation time, length of hospital stay and development of postoperative adverse reactions such as nausea and vomiting, urinary retention and respiratory depression within 48 h after operation were recorded. Results:Compared with group G, the incidence of intraoperative hypertension and tachycardia was significantly decreased, the incidence of intraoperative hypotension and bradycardia was increased, the intraoperative consumption of sufentanil was reduced, the extubation time was shortened, the time to first pressing the analgesia pump was prolonged, the effective pressing times of PCA, requirement for rescue analgesia and postoperative consumption of sufentanil were reduced, the time to first flatus, first ambulation time and length of hospital stay were shortened, VAS scores for abdomen, pelvis and shoulder pain were decreased at each time point after operation, and the incidence of nausea and vomiting, urinary retention and respiratory depression after operation was decreased in group SG ( P<0.01). Conclusions:Compared with general anesthesia, the combination of SA-AQLB and general anesthesia can reduce the opioid consumption, inhibit intraoperative stress responses and postoperative hyperalgesia and promote early postoperative recovery when used for the patients undergoing laparoscopic gynecological surgery.

Helicobacter pylori (H. pylori), creating a global infection rate over 50%, presents great challenges in clinical therapies due to its complex pathological microenvironment in vivo. To improve the eradication efficacy, herein we fabricated a pharmaceutical vesicle RHL/Cl-Ch-cal where cholesterol-PEG, calcitriol and first-line antibiotic clarithromycin were co-loaded in the rhamnolipid-composed outer lipid layer. RHL/Cl-Ch-cal could quickly penetrate through gastric mucus layer to reach H. pylori infection sites, and then effectively destroyed the architecture of H. pylori biofilms, killed dispersed H. pylori and inhibited the re-adhesion of residual bacteria (called biofilms eradication tetralogy). Moreover, RHL/Cl-Ch-cal activated the host immune response to H. pylori by replenishing cholesterol to repair lipid raft on the cell membrane of host epithelial cells. Finally, RHL/Cl-Ch-cal killed the intracellular H. pylori through recovering the lysosomal acidification and assisting degradation. In experiments, RHL/Cl-Ch-cal demonstrated prominent anti-H. pylori efficacy in the classical H. pylori-infected mice model. Therefore, the study provides a "comprehensive attack" strategy for anti-H. pylori therapies including biofilms eradication tetralogy, immune activation and intracellular bacteria killing.

Nursing education emphasizes the cultivation of high-quality talents, and high-fidelity simulation has been applied to the training and evaluation of nursing staff. This article summarizes the status quo of nursing education evaluation at home and abroad and the application of high-fidelity simulation in education evaluation, in order to apply high-fidelity simulation to the evaluation of nursing professionals and provide ideas for the reform of nursing education.

Objective To analyze the Oncomelania hupensis snail distribution and the changes of snail situation in Chang-zhou City from 2013 to 2016,so as to provide the evidence for formulating the schistosomiasis prevention and control interven-tions. Methods The data of snail monitoring in Changzhou City from 2013 to 2016 were collected and statistically analyzed. Re-sults The total area with snails was 40.17 hm2 and the newly discovered area was 30.63 hm2 in Changzhou City from 2013 to 2016. In the four years,3454 snails were dissected,and no schistosome infected snails were found. There were totally 51 spots with snails,and the areas with snails of different types of marshland,inland and mountain were 12.13(30.19％),25.54 hm2 (63.57％)and 2.51 hm2(6.24％),respectively. In the newly discovered snail environment,the areas of types of marshland and inland were 8.00 hm2(26.12％)and 22.63 hm2(73.88％),respectively. The main causes for snail existence were external input and adjacent diffusion. In the past four years,the total snail control area with molluscicides was 71.74 hm2,the consolidated snail control area with molluscicides was 155.15 hm2,and the total environmental modification areas in the current snail spots and historic snail spots were 15.90 hm2 and 11.30 hm2 respectively. Conclusion The diffusion of snails in inland rivers is the key of the newly discovered snail areas in Changzhou City in recent years,and the snail monitoring and control measures should be strengthened in the future.

Objective To investigate the prevalence of Toxoplasma gondii infection and related knowledge and behavior among special population in Changzhou City,so as to provide the evidence for formulating effective measures of toxoplasmosis prevention. Methods The pregnant women and patients with neoplasia in Changzhou hospitals,and livestock and poultry breeding or processing workers were selected as the subjects of the study. Venous blood samples were collected from each partici-pant for detecting IgG and IgM antibodies against T. gondii by ELISA. A questionnaire investigation on knowledge and behavior about T. gondii infection was conducted. Results Among the total 300 respondents investigated from March to May,2015,the prevalence of T. gondii infection was 16.3％(49/300). Totally 52 respondents knew the knowledge about the prevention and con-trol of T. gondii infection with an awareness rate of 17.3％(52/300). The proportion of participants who frequently contacted with cats/dogs(25.0％,13/52)in the group who knew the knowledge about the prevention and control of T. gondii infection was lower than that of participants(50.8％,126/248)in the group who did not know the knowledge about the prevention and control of T. gondii infection,and the difference was statistically significant(X2=11.51,P<0.05). The proportion of participants sepa-rating chopping boards for raw and cooked food(61.5％,32/52)in the group who knew the knowledge about the prevention and control of T. gondii infection was statistically higher than that of the participants(9.3％,23/248)in the group who did not know the knowledge about the prevention and control of T. gondii infection,and the difference was statistically significant (X2=78.43,P<0.001). There was a negative correlation between the awareness rate of the knowledge about the prevention and con-trol of T. gondii infection and the infection rate of T. gondii. The infection rate of T. gondii(5.8％,3/52)in the group who knew the knowledge about the prevention and control of T. gondii infection was lower than that(18.5％,46/248)of the group who did not know the knowledge about the prevention and control of T. gondii infection,and the difference was statistically significant (X2=5.14,P<0.05). Conclusions The awareness rate of the knowledge about the prevention and control of T. gondii infec-tion among special population in Changzhou City is low. The health education on the knowledge of the prevention and control of toxoplasmosis should be strengthened,in order to improve the awareness of personal hygiene and change the unhealthy lifestyles and dietary habits.

Objective To understand the status of knowledge,attitude,and practice of schistosomiasis prevention and con-trol and infection status in Armed Police Forces stationed along the Yangtze River,so as to provide the reference for formulating the schistosomiasis prevention and control measures in Armed Police Forces. Methods A questionnaire survey was conducted in the Armed Police Forces along the Yangtze River in Jiangsu Province,and the investigation content included social demo-graphic data,schistosomiasis prevention knowledge,attitude and behavior. All the subjects were examined for Schistosoma ja-ponicum infection. Results Totally 376 soldiers were investigated in 2 sites. The total passing rate of schistosomiasis knowl-edge was 72.87%. The passing rate among different age groups had no significant difference( χ2 =0.26,P > 0.05). The passing rate of soldiers from endemic areas was significantly higher than that of the soldiers from non-endemic areas( χ2 =4.71,P <0.05). The passing rate of officers was significantly higher than that of the soldiers(χ2 = 4.21,P <0.05). The passing rate of sol-diers with the education levels of junior school,high school,college,undergraduate and above increased gradually,with a sig-nificant difference( χ2 =8.16,P < 0.05). The soldiers with positive attitude accounted for 93.88%. Among the water contact be-haviors,training accounted for 17.55% and participating in the task(such as flood fighting and water work)accounted for 86.44%. When launching,the rate of taking protective measures was 52.93%. The rate of taking protective measures in the knowledge passing group was much higher than that in the knowledge failed group( χ2 =10.55,P < 0.05). The stool was harm-lessly treated in the two camps. Among 376 soldiers,the positive rate of blood examinations was 0.53%,but the stool examina-tions were all negative. Conclusions The overall level of knowledge and correct behavior of schistosomiasis prevention in the Armed Police Forces along the Yangtze River still should be improved. The better health education and behavior intervention are crucial to schistosomiasis prevention in the army.

Objective To understand the quality of blood smears for Plasmodium detection in Changzhou City,so as to pro?vide the technical support for malaria surveillance in the post?elimination period. Methods The blood smears of fever patients from each cities(districts)in Changzhou City in 2014,including more than 3%of the negatives and all the positives,were se?lected. The quality of the blood smear making,dyeing,cleanliness and results were reviewed by the experts from the municipal malaria microscopy station,and the data were analyzed statistically. Results Totally 996 negative blood smears were reviewed in 2014,with a review rate of 4.52%. The qualified rates of blood smear making,dyeing and cleanliness were 92.87%,93.27%and 94.48%,respectively. A total of 34 positive blood smears were reviewed,and there were no false detections and leak detec?tions. The qualified rates of blood smear making and dyeing were more than 90%in all the seven cities(districts). As for quali?fied rate of cleanliness,except the rate in Qishuyan District(81.36%),those in the other six cities(districts)were all above 90%. The qualified rates of blood smear making,dyeing and cleanliness were all more than 90%in first?class,second?class and third?class hospitals. The major quality defects of the blood smears were sediment,abnormal making and thick membrane shed?ding,and the proportions were 25.91%,21.76%and 19.17%,respectively. Conclusions The quality of blood smears for Plas?modium detection in Changzhou City is satisfying. In the future,the training and supervision still should be strengthened to guar?antee the capacity of microscopic examinations for Plasmodium detection in the surveillance of post?elimination period.

Objective To evaluate the effect of comprehensive schistosomiasis control in Changzhou City in recent 10 years, so as to provide the evidences for formulating the future prevention and control strategy. Methods The work reports and the da?ta of the schistosomiasis comprehensive control projects in Changzhou City from 2004 to 2014 were collected,the infection sta?tus of residents and livestock as well the Oncomelania hupensis snail situation were analyzed,and the implementation effect of the comprehensive control projects was evaluated. Results From 2004 to 2014,totally 215 368 person?times were examined, and the positive rate of the blood examinations of the population was 0.24%(478/198 356),and there were no positive cases de?tected out by using the miracidium hatching method. Totally 11 935 domestic animals were detected and no positives were found. From 2004 to 2014,the total area with snails was 92.27 hm2,and marshland,inland and mountain environments accounted for 34.75%,34.82%and 30.43%,respectively. The newly discovered area with snails was 34.40 hm2,and marshland,inland and mountain environments accounted for 2.62%,71.22% and 26.16%,respectively. Totally 8 511 snails were dissected and no schistosome infected snails were found. From 2004 to 2014,a total of 242 600 harmless toilets were built,2 704 700 domestic animals were reared in pens,5.82 km?long rivers were dredged,2 250.11 hm2 of protective forests were constructed,a total area of 625.79 hm2 were controlled with molluscicides,and an area of 149.58 hm2 were environmentally transformed. Totally 5.4 mil?lion people received health education. The awareness rate of knowledge on schistosomiasis control of residents was 96.00% in 2014. Conclusions There exists the risks of snails import and diffusion and schistosomiasis resurrection in Changzhou City, but under the condition of continuous implementation of comprehensive control measures,the endemic situation of schistosomia?sis is stable and the control achievement is consolidated in this city.

Objective To understand the prevalence of Toxoplasma gondii infection and related factors among special popu?lation in Changzhou City,so as to provide the evidence for formulating toxoplasmosis prevention measures. Methods The ve?nous blood was collected from participants in Changzhou City for detecting IgG and IgM antibodies against T. gondii by ELISA;and an epidemiological questionnaire investigation was also conducted. Results Among the total 400 respondents detected,the prevalence of T. gondii infection was 15.0%and the positive rates of IgG and IgM were 15.0%and 0.8%,respectively. The T. gondii infection rates of pregnant women,HIV/AIDS patients,patients with neoplasia,and livestock and poultry breeding and processing workers were 11.0%,11.0%,24.0%and 14.0%,respectively. As the age increased,the infection rate of T. gondii showed an upward trend,with the highest infection rate(21.6%)among the group of respondents aged above 50 years. The in?fection rates of groups with different education levels were statistically different(χ2=11.443,P<0.05),and there was a trend that the infection rate decreased with the increase of education level. The prevalence of T. gondii infection in pregnant women was not significantly associated with the number of pregnancies and gestational age. The infection rate of T. gondii in the live?stock and poultry breeding and processing workers increased with the length of their working years. Conclusions The preva?lence of T. gondii infection among the special population in Changzhou City is high. Therefore,it is necessary to enhance the health education on the knowledge and information of prevention and control of toxoplasmosis,and to improve the awareness of personal protection,the hygiene practices and diet habits. In addition,more attention should be paid to T. gondii monitoring in the special population.