Machine learning-based identification of symptomatic carotid atherosclerotic plaques with dual-energy computed tomography angiography.

OBJECTIVE: This study aimed to develop and validate a machine learning model incorporating both dual-energy computed tomography (DECT) angiography quantitative parameters and clinically relevant risk factors for the identification of symptomatic carotid plaques to prevent acute cerebrovascular events. METHODS: The data of 180 patients with carotid atherosclerosis plaques were analysed from January 2017 to December 2021; 110 patients (64.03±9.58 years old, 20 women, 90 men) were allocated to the symptomatic group, and 70 patients (64.70±9.89 years old, 50 women, 20 men) were allocated to the asymptomatic group. Overall, five machine learning models using the XGBoost algorithm, based on different CT and clinical features, were developed in the training cohort. The performances of all five models were assessed in the testing cohort using receiver operating characteristic curves, accuracy, recall rate, and F1 score. RESULTS: The shapley additive explanation (SHAP) value ranking showed fat fraction (FF) as the highest among all CT and clinical features and normalised iodine density (NID) as the 10th. The model based on the top 10 features from the SHAP measurement showed optimal performance (area under the curve [AUC] .885, accuracy .833, recall rate .933, F1 score .861), compared with the other four models based on conventional CT features (AUC .588, accuracy .593, recall rate .767, F1 score .676), DECT features (AUC .685, accuracy .648, recall rate .667, F1 score .678), conventional CT and DECT features (AUC .819, accuracy .740, recall rate .867, F1 score .788), and all CT and clinical features (AUC .878, accuracy .833, recall rate .867, F1 score .852). CONCLUSION: FF and NID can serve as useful imaging markers of symptomatic carotid plaques. This tree-based machine learning model incorporating both DECT and clinical features could potentially comprise a non-invasive method for identification of symptomatic carotid plaques to guide clinical treatment strategies.

[Cardiac Structural and Functional Features in Patients With Type 2 Diabetes Mellitus and Heart Failure With Preserved Ejection Fraction:A Study Based on Propensity Score Matching].

Objective To investigate the cardiac structural and functional characteristics in the patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM),and predict the factors influencing the characteristics. Methods A total of 783 HFpEF patients diagnosed in the Department of Geriatric Cardiology,the First Hospital of Lanzhou University from April 2009 to December 2020 were enrolled in this study.Echocardiography and tissue Doppler technique were employed to evaluate cardiac structure and function.According to the occurrence of T2DM,the patients were assigned into a HFpEF+T2DM group (n=332) and a HFpEF group (n=451).Propensity score matching (PSM)(in a 1∶1 ratio) was adopted to minimize confounding effect.According to urinary albumin excretion rate (UAER),the HFpEF+T2DM group was further divided into three subgroups with UAER<20 µg/min,of 20-200 µg/min,and>200 µg/min,respectively.The comorbidities,symptoms and signs,and cardiac structure and function were compared among the groups to clarify the features of diabetes related HFpEF.Multivariate linear regression was conducted to probe the relationship of systolic blood pressure,blood glucose,glycosylated hemoglobin,and UARE with cardiac structural and functional impairment. Results The HFpEF+T2DM group had higher prevalence of hypertension (P=0.001) and coronary heart disease (P=0.036),younger age (P=0.020),and larger body mass index (P=0.005) than the HFpEF group,with the median diabetic course of 10 (3,17) years.After PSM,the prevalence of hypertension and coronary heart disease,body mass index,and age had no significant differences between the two groups(all P>0.05).In addition,the HFpEF+T2DM group had higher interventricular septal thickness (P=0.015),left ventricular posterior wall thickness (P=0.040),and left ventricular mass (P=0.012) and lower early diastole velocity of mitral annular septum (P=0.030) and lateral wall (P=0.011) than the HFpEF group.Compared with the HFpEF group,the HFpEF+T2DM group showed increased ratio of early diastolic mitral filling velocity to early diastolic mitral annular velocity (E/e') (P=0.036).Glycosylated hemoglobin was correlated with left ventricular mass (P=0.011),and the natural logarithm of UAER with interventricular septal thickness (P=0.004),left ventricular posterior wall thickness (P=0.006),left ventricular mass (P<0.001),and E/e' ratio (P=0.049). Conclusion The patients with both T2DM and HFpEF have thicker left ventricular wall,larger left ventricular mass,more advanced left ventricular remodeling,severer impaired left ventricular diastolic function,and higher left ventricular filling pressure than the HFpEF patients without T2DM.Elevated blood glucose and diabetic microvascular diseases might play a role in the development of the detrimental structural and functional changes of the heart.

New insight into the response and transport of nitrate in karst groundwater to rainfall events.

Although numerous studies focused on nitrate source, transformation and transport of river water in karst area have been reported, it's still unclear in understanding nitrate main source and transformation in karst groundwater system and how nitrate transport from soil to water during rainfall events in karst critical zone. In order to explore the response and transport of nitrate in karst groundwater to rainfall events, different depths of well water before, during and after rainfall event were sampled, and hillslope runoff, surface runoff of different land-use types during rainfall event were sampled synchronously at a typical karst agricultural catchment in Southwest China. Results showed that fluctuations of EC, pH and DO in deep borehole well (W1) and artesian well (W2) were small, on the contrary, variations of EC and DO in shallow well (W3) were large during sampling period. The nitrate concentrations and isotopic values indicated that nitrate in karst groundwater mainly originated from chemical fertilizer (CF), and influenced by denitrification process. High intensity of denitrification was observed in deep groundwater (87%) and artesian well water (almost 100%). Extremely high dual nitrate isotope values up to 46.8 ± 1.5‰ and 24.7 ± 0.5‰ were found in the deep artesian well. The small variation of water chemistry (EC, DO and pH), nitrate concentration and dual nitrate isotope values in deep wells during sampling period suggested that newly supplied nitrogen in deep groundwater during rainfall events also comes from deep groundwater. Low nitrogen concentrations in hillslope subsurface flow and surface runoff suggests that nitrogen transport process leading to increase of water nitrogen content mainly occur in depression. Nitrogen in depression soil is mainly transported to groundwater through fissures, fractures and conduits, rather than through vertical migration processes in the soil during rainfall events.

The prognostic value of soluble Klotho in patients with haemodialysis: a systematic review and meta-analysis.

AIM: The correlation between soluble Klotho (sKlotho) levels and clinical outcomes remains inconclusive for patients undergoing maintenance haemodialysis (MHD). We aimed to evaluate the potential predictive significance of sKlotho in this population by conducting a meta-analysis. METHODS: PubMed, Embase, Web of Science and Cochrane Library were comprehensively searched for studies concerning the association between sKlotho level and clinical outcomes including cardiovascular (CV) events and all-cause mortality. The pooled hazard ratios (HR) and 95% confidence intervals (CI) were generated using either random or fixed effects models. Sensitivity and subgroup analyses were used to explore heterogeneity sources. RESULTS: Eight prospective studies with 992 MHD participants were included and reduced sKlotho levels predicted more adverse outcomes in this meta-analysis. The pooled HRs and 95% CIs related to CV events, mortality, or composite outcomes were 1.73 (95% CI 1.08-2.76, p = 0.02), 2.34 (95% CI 1.34-2.07, p = 0.003) or 1.75 (95% CI 1.19-2.57, p = 0.005). Moderate heterogeneity was observed in the composite adverse outcomes (I 2 = 57%, p = 0.05). Age and sKlotho level were the main sources of heterogeneities in the subgroup analysis. CONCLUSION: Lower sKlotho levels were associated with more CV events and all-cause mortality, suggesting that sKlotho may have predictive value in CKD patients receiving haemodialysis.

Research and development of safety management information system for neonatal bathroom and its clinical application: (A STROBE-compliant article).

We developed a bathroom safety management information system to decrease adverse nursing events, and observed the application of the self-developed safety management information system in neonatal bathroom.A total of 3482 newborns receiving neonatal bath and rooming in between May 2015 and May 2017, were enrolled in this study. Of the 3482 newborns, 1727 that did not use the safety management information system from May 1, 2015 to May 31, 2016, were considered as control group; and other 1755 that used the safety management information system from June 1, 2016 to May 31, 2017 were entered in observation group. The accident rate of adverse nursing events, the duration to check wristbands, response time of urgency call, quantitative data recording for nursing procedures, and pregnant women's and their families' satisfaction degree were compared between the 2 groups.The management information system possesses 4 functions including personal identification, nursing operation quantification, monitoring alarm and music function, and guidance on specialized knowledge and skills. The accident rate of adverse nursing events was significantly lower in the observation than in the control group (P < .05). The duration to check wristbands and the response time of urgency call were all significantly shorter in the observation group than in the control group (all P < .05). Quantitative data recording was significantly better in the observation than in the control group (P < .05). Satisfaction degree was significantly higher in the observation group (96.47%) than in the control group (89.69%) (P < .05). The wireless transmission information was exact and safe, and the system was sensitive and reliable.The system not only is clinically practical but also can enhance the safety of newborns and improve pregnant women's and their families' satisfaction degree.

[Microscopic Raman spectral characteristics and diagnostic value of pathological lip minor salivary glands affected in primary Sjögren's syndrome].

OBJECTIVE: To investigate the Raman spectral characteristics of the pathological lip minor salivary glands affected in primary Sjögren's syndrome. METHODS: Thirty pathological samples and 30 normal samples were collected in this study. The samples were examined by Raman microscope.Support vector machine(SVM) was employed to analyze the data and establish the classification model. RESULTS: The spectra of pathological tissues was different from the controls in proteins, nucleic acids, lipids and glycogen skeleton. The sensitivity, specificity and accuracy of the model established by SVM on the training sets were all 92.0% (92/100), but the sensitivity, specificity and accuracy of the model established by SVM on the testing sets were 69.2% (37/53), 100.0% (37/37) and 82.0% (73/89) respectively. CONCLUSIONS: There was significant difference in Raman spectra between the pathological and normal lip salivary glands, and the classification model established by SVM could discriminate the pathological glands from the normal ones.

[Gingival retraction paste versus gingival retraction cord for fixed prosthodontics: a systematic review].

PURPOSE: To assess the efficacy of gingival retraction paste versus gingival retraction cord in fixed prosthodontics on gingiva protection, tooth preparation, clarity of the impression and plaster model, and aptness of the prosthesis. METHODS: Chinese BioMedical Literature Database, VIP, China National Knowledge Infrastructure (CNKI) and Wangfang database were searched on November 15th 2012 for eligible studies. Hand-searching included references of the included studies and Chinese dental journals. Risk of bias of the included studies was assessed by 2 reviewers independently using Cochrane Collaboration's tool, and data extraction was done by the 2 reviewers. Meta analysis was performed with Revman 5.1 software. RESULTS: Nine randomized controlled trials, involving 1153 participants, were included. All of them had moderate risk of bias. Meta analysis revealed that gingival retraction paste had better effect on gingival health [RR=1.05, 95%CI (1.00, 1.11), P=0.04], tooth preparation [RR=1.17, 95%CI (1.07, 1.28), P=0.0008] and clarity of the impression and plaster model [RR=1.08, 95%CI (1.03, 1.13), P=0.0009] than gingival retraction cord, and the aptness of the prosthesis was as good as the cord [RR=1.07, 95%CI (0.96, 1.19), P=0.21]. CONCLUSIONS: The gingival retraction paste has better effect on gingival health, tooth preparation and clarity of the impression and plaster model, while the aptness of the prosthesis is as good as the cord and can be considered as a good candidate of the gingival retraction cord, but more randomized controlled trials are needed.