Objective:To construct a machine-learning model for predicting the progression of pancreatic cystic lesions (PCLs) based on clinical and CT features, and to evaluate its predictive performance in internal/external testing cohorts.Methods:Baseline clinical and radiological data of 200 PCLs in 177 patients undergoing abdominal thin slice enhanced CT examination at Peking Union Medical College Hospital from July 2014 to December 2022 were retrospectively collected. PCLs were divided into progressive and non-progressive groups according to whether the signs indicated for surgery by the guidelines of the European study group on PCLs were present during three-year follow-up. 200 PCLs were randomly divided into training (150 PCLs) and internal testing cohorts (50 PCLs) at the ratio of 1∶3. 15 PCLs in 14 patients at Jinling Affiliated Hospital of Medical School of Nanjing University from October 2011 to May 2020 were enrolled as external testing cohort. The clinical and CT radiological features were recorded. Multiple feature selection methods and machine-learning models were implemented and combined to identify the optimal machine-learning model based on the 10-fold cross-validation method. Receiver operating characteristics (ROC) curve was drawn and area under curve (AUC) was calculated. The model with the highest AUC was determined as the optimal model. The optimal model's predictive performance was evaluated on testing cohort by calculating AUC, sensitivity, specificity and accuracy. Permutation importance was used to assess the importance of optimal model features. Calibration curves of the optimal model were established to evaluate the model's clinical applicability by Hosmer-Lemeshow test.Results:In training and internal testing cohorts, the progressive and non-progressive groups were significantly different on history of pancreatitis, lesions size, main pancreatic duct diameter and dilation, thick cyst wall, presence of septation and thick septation (all P value <0.05) In internal testing cohort, the two groups were significantly different on gender, lesion calcification and pancreatic atrophy (all P value <0.05). In external testing cohort, the two groups were significantly different on lesions size and pancreatic duct dilation (both P<0.05). The support vector machine (SVM) model based on five features selected by F test (lesion size, thick cyst wall, history of pancreatitis, main pancreatic duct diameter and dilation) achieved the highest AUC of 0.899 during cross-validation. SVM model for predicting the progression of PCLs demonstrated an AUC of 0.909, sensitivity of 82.4%, specificity of 72.7%, and accuracy of 76.0% in the internal testing cohort, and 0.944, 100%, 77.8%, and 86.7% in the external testing cohort. Calibration curved showed that the predicted probability by the model was comparable to the real progression of PCLs. Hosmer-Lemeshow goodness-of-fit test affirmed the model's consistency with actual PCLs progression in testing cohorts. Conclusions:The SVM model based on clinical and CT features can help doctors predict the PCLs progression within three-year follow-up, thus achieving efficient patient management and rational allocation of medical resource.

BACKGROUND:Stem cell transplantation is a new way to prevent and cure intervertebral disc degeneration.However,whether the transplanted stem cells can survive,proliferate,differentiate,and restore the function of nucleus pulposus cells after transplantation,is the key and difficult point to overcome. OBJECTIVE:To explore the effects of Bushenhuoxue decoction on survival,proliferation,and nucleus pulposus-like differentiation of adipose-derived stem cells. METHODS:A Transwell chamber was used to construct a co-culture model of human adipose-derived stem cells and human degenerative nucleus pulposus cells.The experiment was divided into control group,model group,drug-containing serum group,and drug-free serum group.Except for the control group,the co-culture system of other groups was treated with 50 μmol/L tert-butyl hydrogen peroxide for 24 hours.The drug-containing serum group and drug-free serum group were treated with DMEM low-glucose complete culture medium containing drug-containing serum of Bushenhuoxue decoction or drug-free serum with 20％volume fraction for 48 hours.The sublayer adipose-derived stem cells were taken.Toluidine blue staining was used to detect proteoglycan synthesis levels.Real-time PCR method was used to detect mRNA expression of type Ⅱ collagen,proteoglycan and SRY-box transcription factor 9.The protein expression of SOX9 was detected by western blot assay.Lactate dehydrogenase assay was used to detect cytotoxicity.Flow cytometry was used to detect reactive oxygen species,and β-galactosidase staining was used to detect cell senescence. RESULTS AND CONCLUSION:(1)Compared with the control group,the proportion of necrotic cells in the model group increased;toluidine blue staining became lighter,and the expression levels of type Ⅱ collagen,proteoglycan,SOX9 mRNA and SOX9 protein decreased(P<0.05).Compared with the model group,the drug-containing serum of Bushenhuoxue decoction could significantly reduce cell injury and promote the expression of type Ⅱ collagen,proteoglycan,SOX9 mRNA,and SOX9 protein(P<0.05),but the improvement in the drug-free serum group was not significant(P>0.05).(2)Compared with the control group,the contents of cytotoxicity,reactive oxygen species,and cell senescence in the model group were significantly increased.Compared with the model group,the microenvironment of the coculture system was significantly improved by drug-containing serum of Bushenhuoxue decoction(P<0.05),while drug-free serum had no significant effect on the microenvironment of the co-culture system(P>0.05).(3)The results show that Bushenhuoxue decoction can promote the survival,proliferation,and nucleus pulposus-like differentiation of adipose-derived stem cells.

By combing out the historical development logic of sports and health integration and the current development achievement, the underlying logic of sports and health integration is described systematically in multiple dimensions, and the prominent dilemmas in development are analyzed as follows: lack of residents' health literacy, excessive dependence on medical treatment, low bridging of talent team construction, lack of the guidance of funds centralization, insufficient financial support, imperfect management system and mechanism, and unspecific departmental collaboration.The strategies for solving the problems are as follows: strengthening the integration of sports science and clinical medicine, consolidating the technical integration of sports prescription and clinical standardization process, further improving the business integration of exercise intervention and clinical treatment, and enhancing the industrial integration of sports products and medical treatment.

Objective:To compare the laboratory diagnostic methods of Mycoplasma pneumonia(MP) and evaluate its clinical value.Methods:A prospective study.Throat swabs and double sera of children with MP infection were collected from December 2016 to January 2017 in Shengjing Hospital Affiliated to China Medical University; throat swab samples of healthy children aged 3 to 5 in Chaoyang District, Beijing were collected from March to May 2017.Passive agglutination (PA) was used to detect the double serum.Taking the 4-fold increase or decrease of the specific antibody titer of the double serum as the gold standard, the receiver operating characteristic curve (ROC) was drawn, and the laboratory methods for detecting MP infection were compared and evaluated.Results:(1)A total of 93 children with MP infection were clinically diagnosed, including 42 males (45.2%) and 51 females (54.8%), with an average age of 5.5 years.Sixty cases (64.5%) of MP infection were diagnosed.There were 349 healthy children, 198 males and 151 females, with an average age of 4.3 years.The positive rate of throat swab culture was 0.6% (2 cases), and the positive rate of fluorescent quantitative PCR(qPCR) was 18.9% (66 cases). (2) The culture specificity was the highest (100.0%) and the sensitivity was the lowest (65.0%). PA and enzyme linked immunosorbent assay (ELISA) were used to detect a single serum in the acute phase, the sensitivity was 71.7% and 86.5% respectively.ROC curve suggested that the current clinical diagnostic threshold MP specific antibody IgM ≥ 1∶160 was not the best diagnostic threshold.Molecular biological diagnostic methods were the most sensitive, RNA simultaneous and testing (SAT) was 85.0% and qPCR was 93.0%; while the specificity was low, 75.7% (SAT) and 63.6% (qPCR), respectively.(3) At the same time, MP nucleic acid (SAT, PCR) of throat swabs and a single serum (ELISA, PA) of children in acute phase were detected, the sensitivity was increased to 95.0%-100.0%, and the specificity was 63.6%-75.7%.Conclusions:Molecular biology is highly sensitive in diagnosing MP infection.It has asymptomatic infection or is carried after infection.Whether it needs treatment needs to be combined with clinical practice, when MP detection is positive.The detection of a single serum in the acute phase with a course of about 1 week has high sensitivity and is of reference value for the diagnosis of MP infection, but the diagnosis needs to be combined with clinical practice.The sensitivity and accuracy of detecting MP infection by single serological test combined with SAT in acute phase are higher than that by single application.

Objective To investigate the antibacterial effect of Fusidic acid on Mycoplasma pneumoniae and antibiotic resistant Mycoplasma pneumoniae in vitro.Methods Twenty-eight clinical strains of Mycoplasma pneumoniae isolated from patients with respiratory tract infection at Beijing Friendship Hospital Affiliated to the Capital University of Medical Sciences from January to December 2016 and 2 Mycoplasma pneumoniae reference strains were enrolled.The minimum inhibitory concentration (MIC) of Fusidic acid and Azithromycin were determined by using micro-dilution ration method.The chessboard method was used to check the antibacterial effect of combination between Fusidic acid and Azithromycin.The antibacterial activity of the Fusidic acid was evaluated by measuring the antibacterial rate of different concentrations.Results One isolate showed no mutation in 23SrRNA,26 isolates had one point mutation in loci 2063 and 1 isolate had one point mutation in loci 2064 among the 28 clinical isolates.The findings by micro-dilution method results showed that the MIC values of all the clinical isolates with mutations associated with macrolide resistance to Azithromycin were ＞ 1.000 0 mg/L,and the MIC values of all the clinical isolates with no mutations to azithromycin were ＜ 0.500 0 mg/L.The findings by micro-dilution method results showed that the MIC value of Fusidic acid for Mycoplasma pneumonia and drug resistance Mycoplasma pneumoniae was 1.000 0 mg/L.The Fractional Inhibitory Concentration index of Fusidic acid and Azithromycin combination was ≤0.500 0 mg/L.When the concentration of the Fusidic acid was lower than or equal to 32 MIC,the antibacterial effect of Fusidic acid against Mycoplasma pneumoniae increased with its higher concentration.When the concentration of the Fusidic acid was lower than or equal to 8 MIC,the longer the strain was exposed to the drug,the stronger antibacterial effect was against Mycoplasma pneumoniae.Conclusion If the treatment of Mycoplasma pneumoniae infection is not effective or the infection of patient is combined with bacteria,the application or combination of Fusidic acid may inhibit pathogenic bacteria effectively.Of course,how to use Fusidic acid in clinical treatment needs further study and discussion.

Objective: To explore the function and molecular mechanism of Timeless in promoting hepatocellular carcinoma (HCC) growth. Methods: The expression of Timeless in HCC and paracancer tissues were analyzed by using the public data of HCC. Timeless was overexpressed in MHCC97L cells and silenced in MHCC97H cells, respectively, and the expression of Timeless and its downstream molecules were detected by real-time PCR and western blot. The effects of Timeless on cell glycolysis, oxidative phosphorylation and proliferation were detected by the glucose uptake experiment, lactic acid detection experiment, the extracellular fluid pH detection experiment, cell oxygen consumption test and cell viability assay, respectively. Results: The level of Timeless in HCC tissue was significantly higher than that of paracancer tissue (P<0.05). The relative cellular glucose uptake levels in the groups of Timeless knockdown, including siTimeless-1 and siTimeless-2 group were 0.510±0.119 and 0.508±0.099, respectively, significantly different from that of control group (P<0.05); The relative cellular uptake level of Timeless overexpressed group was 1.953±0.324, significantly different from that of vector transfected group (P<0.05). The relative levels of lactic acid production in the siTimeless-1 and siTimeless-2 group were 0.579±0.096 and 0.550±0.120, respectively, significantly different from that of control group (P<0.05); The relative production level of lactic acid in the Timeless overexpressed group was 1.463±0.179, significantly different that of vector transfected group (P<0.05). The extracellular pH values of siTimeless-1 and siTimeless-2 group were 7.390±0.035 and 7.370±0.060, respectively, significantly different from that of control group (P<0.05); the extracellular pH value of Timeless overexpressed group was 7.130±0.031, significantly different than vector transfected group (P<0.05). Oxygen consumption rate of siTimeless-1 and siTimeless-2 group were 3.686±0.389 and 3.955±0.431, respectively, significantly higher than 1.690±0.297 of control group (P<0.05); Oxygen consumption rate of Timeless overexpressed group was 1.302±0.336, significantly lower than 3.185±0.262 of vector transfected group (P<0.05) Timeless inhibited the expression of p53. The cell glucose uptake, lactic acid production, the pH of extracellular culture medium and cell oxygen consumption of control group were not significantly different from that of Timeless and p53 co-silenced group [(si-Timeless+sip53) group] (P>0.05); the glucose uptake, the production of lactic acid, the pH of the extracellular culture medium and the oxygen consumption of Timeless co-transfected with p53 (Timeless+p53) group were not significantly different from those of vector transfected group (P>0.05). Timeless promoted the proliferation of HCC cells through inhibiting the expression of p53. Conclusion Timeless promotes reprogramming of glucose metabolism and proliferation of HCC cells by inhibiting the p53-dependent signaling pathway.

Purpose To investigate the multi-slice spiral CT (MSCT) features ofchromophobe renal cell carcinoma (CCRC),renal oncocytoma (RO) and clear-cell renal cell carcinoma (CCRCC) for the improvement of its diagnostic accuracy.Materials and Methods The MSCT data of 15 CCRC cases,8 RO cases,and 29 CCRCC cases confirmed by surgery or pathology at Dong H ua Hospital from October 2012 to April 2016 were retrospectively studied.The CT signs of different tumors were compared.Results Most CCRCC cases had cystic degenerations,which showed significant difference with CCRC and RO cases (P＜0.05);RO cases were found mostly with star-shaped scars,which had significant difference with CCRCC cases (P＜0.05);the enhanced scanning showed most of CCRC were enhanced homogeneously,which presented significant difference from CCRCC (P＜0.05).The lesion-kidney-ration (LKR) of CCRCC at cortical phase,parenchymal phase or excretory phase was significantly different from that of CCRC (P＜0.05);the LKR of CCRCC at cortical phase was significantly different from that of RO (P＜0.05);the LKR of CCRC at the three phases were all significantly different from that of RO (P＜0.05).The average △ LKR value of CCRCC was significantly different from that of CCRC and RO (P＜0.05);there was a certain degree of difference distribution of their △ LKR among the three kinds of cases.Taking CCRCC as object,when the LKR at cortical phase was 0.693 or △ LKR was 0.068,the sensitivity reached 93.3％ and the specificity reached 72.2％ or 88.9％ respectively in evaluating the differential diagnosis of CCRC and RO.Taking RO as object,when the LKR was 0.656 at cortical phase or was 0.595 at parenchymal phase,the sensitivity reached 83.3％ and 91.7％ respectively,and the specificity was 75.0％ and 58.3％ respectively,in evaluating the differential diagnosis of CCRC.Conclusion Enhanced MSCT at different phases,especially the calculation of LKR and △ LKR value,can benefit the diagnosis of CCRC,RO and CCRCC.

Objective To evaluate the value of bone marrow imaging by third-generation dual-source dual-energy CT(DSDECT) using virtual noncalcium(VNCa) technique for the assessment of diffuse infiltrative lesions of multiple myeloma(MM). Methods From December 2015 to June 2016,31 patients with plasma disorders at our center were prospectively recruited and received whole-body imaging with third-generation DSDECT and MRI. CT numbers of vertebrae were measured on VNCa images as well as regular CT images. Correlation between VNCa CT numbers and MRI signal intensities of the vertebrae was evaluated. The diagnostic ability of VNCa for MM infiltrative lesions was assessed by ROC analysis,using MRI as the reference standard. Results The mean VNCa CT numbers of vertebrae with MM diffuse infiltration (n=62) were (-13.27±18.96)HU,which were significantly higher than those of non-infiltrated vertebrae[(-63.31±26.75)HU,(n=117)] (Z=-9.731,P=0.000). VNCa CT numbers of vertebrae were negatively correlated with T1WI signal intensity normalized by non-degenerative vertebral discs (r=-0.592,P=0.000). ROC analysis showed the area under the curve of VNCa for the diagnosis of infiltrative lesions was 0.943. With the cut-off value of-37 HU,the sensitivity and specificity of VNCa were 90.32% and 87.18%,respectively. Conclusion Bone marrow imaging by third-generation DSDECT using VNCa technique is a valuable tool for assessing diffuse infiltrative lesions of MM.
Bone Marrow ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Multiple Myeloma ; diagnostic imaging ; ROC Curve ; Sensitivity and Specificity ; Spine ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

Objective To evaluate the image quality and radiation exposure in multidetector computed tomography (MDCT) with automated topogram-based tube potential selection,compared to fixed tube potential,in patients with solid pancreatic lesions. Methods The preoperative pancreatic dual-source CT images of 113 patients who were confirmed as solid pancreatic lesions by postoperative pathology in the Peking Union Medical College Hospital from January 2014 to August 2016 were retrospectively analyzed.Among them,53 patients were examined on fixed tube potential at 120 kV,and tube current was automatically modulated (group 1). Sixty patients underwent topogram-based automatic tube potential selection (Tube voltage step:90,100 kV) and automated mA modulation (group 2). Two experienced radiologists measured the body sizes,assessed subjective and objective image quality of arterial phase and portal phase,and recorded radiation parameters including CT dose index volume (CTDI) and dose-length product (DLP). Results Of 60 patients in group 2,45 patients were scaned at 90 kV,15 patients were scaned at 100 kV.The average body diameter [(287±24) mm] in 90 kV group was significantly lower than that [(328±22) mm] in 100 kV group(t=0.731,P=0.0008). The mean CTDI[(3.9±1.0) mGy] in group 2 was significantly lower than in group 1 [(9.0±1.9) mGy],reduced by 56.7% (t=17.5,P=0.0003). The average DLP [(109±38) mGy·cm] in group 2 was significantly lower than that in group 1 [(276±83) mGy·cm],reduced by 60.5% (t=14.0,P=0.0007). In group 2,the standard deviations of images background noise in arterial and portal phase were (6.4±0.9) and (6.4±1.0)HU,respectively,which were significantly higher than those in group 1 [(5.6±1.4)HU,t=-3.757,P=0.0003;(5.5±1.4)HU,t=-3.828,P=0.0006]. In group 2,the signal to noise ratios of pancreatic lesions, abdominal aorta in arterial phase and pancreatic lesions, the portal vein in portal phase were 18.8±9.3,76.0±19.3 and 17.4±6.7,33.1±7.2,which were significantly higher than those in group 1 (13.1±8.7,t=-3.379,P=0.001;56.5±22.6,t=-2.268,P=0.025;14.1±8.1,t=-2.283,P=0.024;28.9±8.8,t=-2.613,P=0.009). Conclusion Compared with fixed tube voltage on the second-generation dual-source CT techniques,topogram-based automatic tube potential selection on third-generation dual-source CT can reduce radiation dose without decreasing image quality in imaging solid pancreatic lesions.
Humans ; Multidetector Computed Tomography ; methods ; Pancreas ; diagnostic imaging ; pathology ; Radiation Dosage ; Retrospective Studies ; Signal-To-Noise Ratio

Objective To investigate the dynamic changes of three types of anti-poliovirus neutralizing antibodies and anti-hepatitis A virus (HAV) IgG antibody in children who were immunized with inactivated enterovirus 71 (EV71) vaccine (human diploid cell).Methods Serum samples were collected from the subjects immunized with inactivated EV71 vaccine.Neutralizing antibodies against EV71 and poliovirus were detected by micro-cytopathic effect neutralization test.Enzyme linked immunosorbent assay (ELISA) was used to detect IgG antibody against HAV.Results The geometric mean titers (GMTs) of anti-EV71 neutralizing antibody increased to 4.85 following the first-dose injection of inactivated EV71 vaccine.A significant increase of GMTs (up to 64.37) could be observed 28 days after the second-dose vaccination.Meanwhile, results of the dynamic monitor showed that there were slight fluctuations in the neutralizing antibodies against three types of poliovirus on day 28 (28 days after the first-dose vaccination) compared with those on day 0 (before vaccination) (P<0.05);types Ⅰ and Ⅲ anti-poliovirus neutralizing antibodies on day 56 (28 days after the second-dose vaccination) remained slightly different from those on day 0 (P<0.05), but type Ⅱ anti-poliovirus neutralizing antibody on day 56 had restored to normal level (P>0.05).The level of anti-HAV IgG antibody was stable and no significant difference was found during the observation period (P>0.05).Conclusion This study shows that inactivated EV71 vaccine has no impact on anti-HAV IgG antibody in Children during the two-dose vaccination and in anti-EV71 antibody-producing period, but has slight influence on the anti-poliovirus antibodies.In general, changes in antibody profile do not affect the clinical efficacy of immune response.