Clinical data and quantitative CT parameters combined with machine learning to predict short-term prognosis of severe COVID-19 in the elderly.

Rationale and objectives: This study aims to evaluate the effectiveness of integrating clinical data and quantitative CT parameters with machine learning techniques in forecasting the short-term outcomes of severe COVID-19 in elderly patients. Materials and methods: In this retrospective study, we analyzed the clinical profiles and chest quantitative CT parameters of 239 elderly patients with severe COVID-19 admitted for treatment. The cohort included 61 deceased patients (death group) and 178 who recovered and were discharged (survival group). The participants were randomly assigned into a training group (n = 167) and a validation group (n = 72). Quantitative CT parameters were measured using the 3D-Slicer software. Univariate and multivariate logistic regression analyses identified independent risk factors for mortality. Predictive models were developed employing four machine learning algorithms: Logistic Regression (LR), Random Forest (RF), Decision Tree (DT), and Support Vector Machine (SVM). Results: Both univariate and multivariate logistic regression analyses revealed age, hypersensitive C-reactive protein (hs-CRP), and solid organ volume percentage (SOV%) as independent predictors of mortality. The Area Under the Curve (AUC) values for the LR, RF, DT, and SVM models in the training group were 0.795, 0.726, 0.854, and 0.589, respectively; for the validation group, they were 0.817, 0.634, 0.869, and 0.754, respectively. The DT algorithm outperformed other models in both the training and validation groups, emerging as the most effective predictive model in this study. Conclusion: The combination of clinical data and quantitative CT parameters with machine learning approaches is highly valuable in predicting the short-term prognosis of severe COVID-19 in the elderly. Among the various models tested, the Decision Tree algorithm-based model proved to be the most accurate and reliable in this context.

Association of Gene Polymorphisms and Serum Levels of ALAS1 with the Risk of Anti-Tuberculosis Drug-Induced Liver Injury.

The accumulation of protoporphyrin IX in the liver caused by isoniazid and rifampicin through the disorder of heme biosynthesis was considered an important mechanism of anti-tuberculosis drug-induced liver injury (ATLI). Alanine synthase 1 (ALAS1) is a rate-limiting enzyme in the process of heme synthesis. This study aimed to investigate the association between ALAS1 gene polymorphism, serum ALAS1 level, and the risk of ATLI. This study was a case-control study including 58 ATLI cases and 192 controls. Four single nucleotide polymorphisms (SNPs) of the ALAS1 gene were selected for genotyping and serum ALAS1 concentrations were detected using ELISA kits. There was no significant difference in the genotype distribution of four SNPs between the ATLI cases and the controls under different genetic models. Patients carrying the GG genotype of SNP rs352163 in controls had higher baseline ALAS1 levels than those in ATLI cases (243.6 vs 290.2 ng/L, P = .034), and patients with baseline ALAS1 < 337.85 ng/L had a higher risk of ATLI than those with ALAS1 ≥ 337.85 ng/L (HR = 2.679, 95% CI: 1.360-5.278, P = .004). Our findings indicated that the serum ALAS1 concentrations in the ATLI cases were lower than those in the controls, and the lower baseline ALAS1 levels can be associated with higher ATLI risk.

Evaluation and analysis of influencing factors of placental mesenchymal dysplasia diagnosed using prenatal ultrasonography and pregnancy outcomes: case series.

Background: Placental mesenchymal dysplasia (PMD) is a rare placental vascular malformation of unknown etiology. PMD may coexist with a healthy fetus, and its ultrasound appearance is similar to that of a hydatidiform mole, especially the partial type. Prenatal ultrasonography is vital for accurate diagnosis of these conditions. This study aimed to summarize the characteristics of prenatal ultrasonographic images across different gestational weeks (W) for PMD and evaluate and analyze factors that influence pregnancy outcomes related to PMD. The goal is to improve the diagnosis of PMD, effectively assess fetal prognosis, and provide a reference for prenatal consultations and clinical management. Case Description: Of the 15 included patients, 4, 8, and 3 had PMD in early pregnancy (<13+6 W), mid-pregnancy (approximately 14-27+6 W), and late pregnancy (>28 W), respectively. Among the 15 patients, 5 successfully underwent delivery, thereby resulting in fetal survival; 3 experienced intrauterine death, 1 had a miscarriage, and 6 pregnancies were terminated. During early pregnancy, ultrasonographic manifestations of PMD included microscopic anechoic cystic areas in the placental parenchyma. In the second trimester, the placenta exhibited diffuse enlargement and thickening, with the placental parenchyma showing cellular anechoic cystic areas clearly separated from the surrounding normal placental tissue. As the pregnancy progressed, the cystic areas gradually reduced in the third trimester. Additionally, localized umbilical blood vessels showed tumorous lesions, sometimes accompanied by intravascular thrombosis. Some cases exhibited tortuosity and dilation in the umbilical vein. Conclusions: PMD exhibited varying ultrasonographic characteristics across different gestational stages and demonstrated regular disease evolution corresponding to gestational W. This condition is associated with adverse pregnancy outcomes, with the location, extent, and severity of lesions being crucial factors affecting fetal development in utero.

EHDPP induces proliferation inhibition and apoptosis to spermatocyte: Insights from transcriptomic and metabolomic profiles.

BACKGROUND: 2-ethylhexyldiphenyl phosphate (EHDPP) was used widespread in recent years and it was reported to impair reproductive behaviors and decrease fertility in male Japanese medaka. However, whether EHDPP causes spermatogenesis disturbance remains uncertain. OBJECTIVES: We aimed to study the male reproductive toxicity of EHDPP and its related mechanism. METHODS: Human spermatocyte cell line GC-2 was treated with 10 µM, 50 µM or 100 µM EHDPP for 24 h. Male CD-1 mice aged 6 weeks were given 1, 10, or 100 mg/kg/d EHDPP daily for 42 days and then euthanized to detect sperm count and motility. Proliferation, apoptosis, oxidative stress was detected in mice and cell lines. Metabolome and transcriptome were used to detect the related mechanism. Finally, anti-oxidative reagent N-Acetylcysteine was used to detect whether it could reverse the side-effect of EHDPP both in vivo and in vitro. RESULTS: Our results showed that EHDPP inhibited proliferation and induced apoptosis in mice testes and spermatocyte cell line GC-2. Metabolome and transcriptome showed that nucleotide metabolism disturbance and DNA damage was potentially involved in EHDPP-induced reproductive toxicity. Finally, we found that excessive ROS production caused DNA damage and mitochondrial dysfunction; NAC supplement reversed the side effects of EHDPP such as DNA damage, proliferation inhibition, apoptosis and decline in sperm motility. CONCLUSION: ROS-evoked DNA damage and nucleotide metabolism disturbance mediates EHDPP-induced germ cell proliferation inhibition and apoptosis, which finally induced decline of sperm motility.

[Professor ZHUANG Lixing's experience of integrated acupuncture and medication approach to treat motor complications in Parkinson's disease based on the alternation of "movement and stillness"].

This paper introduces Professor ZHUANG Lixing's experience in treating motor complications of Parkinson's disease (PD) with acupuncture combined with medication. Based on the characteristics of the alternation of "movement and stillness" in PD motor complications, Professor ZHUANG divides these complications into three distinct periods: "movement" stage, "stillness" stage and "alternation" stage, and proposes an integrated approach of acupuncture and medication, with staged treatment tailored to each period. The main acupoints include Jin's three needles to regulate spirit (four spirit needles, Shenting [GV 24], Yintang [GV 24+], Shenmen [HT 7], Sanyinjiao [SP 6]), along with hand tremor three needles (Hegu [LI 4], Quchi [LI 11], Dingchan), foot tremor three needles (Yinlingquan [SP 9], Yanglingquan [GB 34], Taichong [LR 3]), and Du's three needles (Dazhui [GV 14], Jinsuo [GV 8], Mingmen [GV 4]). The primary medicinal formulas include Lingjiao Gouteng decoction, Banxia Baizhu Tianma decoction, Bazhen decoction combined with Buzhong Yiqi decoction, Sini decoction combined with Yougui pills, and Xiaochaihu decoction. This integrated approach effectively alleviates the motor symptom fluctuations in PD patients, helping them maintain a stable life.

Prognostic mutations identified by whole-exome sequencing and validation of the Molecular International Prognostic Scoring System in myelodysplastic syndromes after allogeneic haematopoietic stem cell transplantation.

In this study, we used the whole-exome sequencing (WES) approach to obtain genomic profiles from 92 marrow samples of myelodysplastic syndrome (MDS) patients before haematopoietic stem cell transplantation. We identified 129 mutations in 45 driver genes. Fifty-five patients (59.8%) carried at least 1 driver mutation. The splicing factor U2AF1 was the most frequently mutated in the cohort (21 cases, 23%), followed by BCOR (9 cases, 10%), ASXL1 (8 cases, 9%), TET2 (6 cases, 7%), NPM1 (5 cases, 5%), RUNX1 (5 cases, 5%), and SETBP1 (5 cases, 5%). WES also identified 49 possible oncogenic variants in six genes (PIEZO1, LOXHD1, MYH13, DNAH5, DPH1, and USH2A) that were associated with overall survival (OS) or relapse-free survival (RFS) in MDS after transplantation. Multivariate analysis showed mutations in DNAH5 and USH2A to be independent risk factors for OS. Mutations in DNAH5 and LOXHD1 were risk factors for worse RFS. The Molecular International Prognostic Scoring System retained its independent prognostic significance for RFS after multivariate analysis.

Photoinduced oxidation of chromium picolinate to hexavalent chromium in the presence of ferric ions.

The occurrence of chromium picolinate (Cr(pic)3) in environment has attracted raising concerns on its fate and the associated risks. Herein, the photoinduced oxidation of Cr(pic)3 in the presence of ferric ions (Fe(III)) under simulated sunlight and natural solar light irradiation were investigated. Cr(pic)3 was stable under dark or without Fe(III). 87.9 % of Cr(pic)3 (C0 = 1.0 µM) was degraded in the presence of 50 µM Fe(III) after 90 min simulated sunlight irradiation at initial pH of 4.0. •OH was the main cause for Cr(pic)3 oxidation, it attacked the chromium center to generate hexavalent chromium (Cr(VI)) and picolinic acid (k = 5.9 ×108 M-1·s-1). Picolinic acid could be further oxidized to NH4+ and small organics. Relative higher Fe(III) content (25 - 75 µM) and Cr(pic)3 concentration (0.5 - 2.0 µM) promoted both of Cr(pic)3 degradation and Cr(VI) accumulation. While, the degradation of Cr(pic)3 decreased with pH at the range of 3.0 - 8.0, more Cr(VI) was accumulated at pH 5.0 and 6.0. The co-existence of inorganic ions and dissolved organic matter (DOM) in river water inhibited Cr(pic)3 oxidation by scavenging the •OH formed and shielding the light. 8.0 - 16.7 µg/L of Cr(VI) was accumulated after 9.0 h simulated sunlight irradiation of Cr(pic)3 in river water matrix ([Fe(III)]0 = 50 - 100 µM). The generation of Cr(VI) under solar light was slower than that under simulated sunlight due to the weaker light intensity (43.2 - 85.0 mW/cm2 vs. 750 - 1300 mW/cm2). These results consistently suggest photoinduced oxidation of Cr(pic)3 in environment generates the toxic Cr(VI), which deserves significant attention.

Conservation and specialization of the Ycf2-FtsHi chloroplast protein import motor in green algae.

The protein import motor in chloroplasts plays a pivotal role in their biogenesis and homeostasis by driving the translocation of preproteins into chloroplasts. While the Ycf2-FtsHi complex serves as the import motor in land plants, its evolutionary conservation, specialization, and mechanisms across photosynthetic organisms are largely unexplored. Here, we isolated and determined the cryogenic electron microscopy (cryo-EM) structures of the native Ycf2-FtsHi complex from Chlamydomonas reinhardtii, uncovering a complex composed of up to 19 subunits, including multiple green-algae-specific components. The heterohexameric AAA+ ATPase motor module is tilted, potentially facilitating preprotein handover from the translocon at the inner chloroplast membrane (TIC) complex. Preprotein interacts with Ycf2-FtsHi and enhances its ATPase activity in vitro. Integrating Ycf2-FtsHi and translocon at the outer chloroplast membrane (TOC)-TIC supercomplex structures reveals insights into their physical and functional interplay during preprotein translocation. By comparing these findings with those from land plants, our study establishes a structural foundation for understanding the assembly, function, evolutionary conservation, and diversity of chloroplast protein import motors.

A molecular imprinted ratiometric fluorescence sensor based on blue/orange MXene quantum dots for visual detection of histamine.

Histamine is a highly toxic biogenic amine in food, making its sensitive and rapid detection methods vital for the assurance of edible safety and human health. Here, we explored for the first time a smartphone-enabled ratiometric imprinted fluorescence sensor based on blue/orange MXene quantum dots (MQDs) for fluorescence and visual detection of histamine. A linear relationship between the concentration of histamine and the fluorescence response of the sensor was found in the range of 1-60 µM with a limit of detection (LOD) of 21.9 nM for fluorescence detection and 92.2 nM for visual detection. In addition, the method was validated for the detection of real samples with excellent recoveries from 96.52% to 105.32%. Therefore, this work greatly expands the application of MQDs in the fluorescence sensing field, as well as provides a visual strategy for in-situ detection of histamine in food.

Application of psychological intervention in intensive care unit nursing for patients with severe acute pancreatitis.

BACKGROUND: Severe acute pancreatitis (SAP) is a familiar critical disease in the intensive care unit (ICU) patients. Nursing staff are important spiritual pillars during the treatment of patients, and in addition to routine nursing, more attention needs be paid to the patient's psychological changes. AIM: To investigate the effects of psychological intervention in ICU patients with SAP. METHODS: One hundred ICU patients with SAP were hospitalized in the authors' hospital between 2020 and 2023 were selected, and divided into observation and control groups per the hospitalization order. The control and observation groups received routine nursing and psychological interventions, respectively. Two groups are being compared, using the Self-rating Anxiety Scale (SAS), Self-Determination Scale (SDS), Acute Physiology and Chronic Health Evaluation (APACHE) II, and 36-item Short Form Health Survey (SF-36) scores; nursing satisfaction of patients; ICU care duration; length of stay; hospitalization expenses; and the incidence of complications. RESULTS: After nursing, the SDS, SAS, and APACHE II scores in the experimental group were significantly lower than in the control group (P < 0.05). The SF-36 scores in the observation group were significantly higher than those in the control group (P < 0.05). The nursing satisfaction of patients in the experimental group was 94.5%, considerably higher than that of 75.6% in the control group (P < 0.05). The ICU care duration, length of stay, and hospitalization expenses in the observation group were significantly lower than those in the control group, and the incidence of complications was lower (P < 0.05). CONCLUSION: For patients with SAP, the implementation of standardized psychological intervention measures can effectively alleviate adverse psychological conditions.

Prediction of pathological complete response and prognosis in locally advanced rectal cancer.

BACKGROUND: Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide. Neoadjuvant chemoradiotherapy (nCRT) is standard for locally advanced rectal cancer (LARC). Except for pathological examination after resection, it is not known exactly whether LARC patients have achieved pathological complete response (pCR) before surgery. To date, there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes. AIM: To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC. METHODS: Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed. Patients were categorized into pCR and non-pCR groups. Univariate analysis (using the χ 2 test or Fisher's exact test) and logistic multivariate regression analysis were used to study clinical predictors affecting pCR. The 5-year disease-free survival (DFS) and overall survival (OS) rates were calculated using Kaplan-Meier analysis, and differences in survival curves were assessed with the log-rank test. RESULTS: Univariate analysis showed that pretreatment carcinoembryonic antigen (CEA) level, lymphocyte-monocyte ratio (LMR), time interval between neoadjuvant therapy completion and total mesorectal excision, and tumor size were correlated with pCR. Multivariate results showed that CEA ≤ 5 ng/mL (P = 0.039), LMR > 2.73 (P = 0.023), and time interval > 10 wk (P = 0.039) were independent predictors for pCR. Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates (94.7% vs 59.7%, P = 0.002) and 5-year OS rates (95.8% vs 80.1%, P = 0.019) compared to the non-pCR group. Tumor deposits (TDs) were significantly correlated with shorter DFS (P = 0.002) and OS (P < 0.001). CONCLUSION: Pretreatment CEA, LMR, and time interval contribute to predicting nCRT efficacy in LARC patients. Achieving pCR demonstrates longer DFS and OS. TDs correlate with poor prognosis.

[Characterization and identification of chemical components from Euodiae Fructus based on UHPLC-Q-TOF-MS].

A sensitive and efficient ultra-high performance liquid chromatography/quadrupole time-of-flight mass spectrometry(UHPLC-Q-TOF-MS) approach was established. Based on the self-developed information library, the chemical components from Euodiae Fructus were systematically characterized and identified. The chromatographic separation conditions(e. g., stationary phase,mobile phase, column temperature, and elution gradient) and MS detection conditions(nozzle voltage, capillary voltage, fragmentor,and collision energy) were optimized. Ultimately, an HSS T3 column(2. 1 mm×100 mm, 1. 8 µm) maintained at 35 ℃ was used,and 0. 1% formic acid water-acetonitrile at the flow rate of 0. 4 m L·min~(-1) was used as the mobile phase. Electrospray ionization was adopted to collect the positive and negative ion mass spectrometry data in Auto MS/MS mode. According to the reference compound comparison, fragment ion information interpretation, literature, and retrieval in the self-developed information library, 92 compounds were characterized or derived from the decoction of Euodiae Fructus, including 33 alkaloids, 23 flavonoids, 12 terpenoids, 12phenylpropanoids, and 12 others. Among them, 17 compounds were identified by comparison with the reference compounds, and 11compounds were unreported from Euodiae Fructus. This study realizes the rapid characterization and identification of multi-class chemical components in the decoction of Euodiae Fructus and provides a reference for the studies regarding its effective substances and quality control.

Management of infected bone defects of the femoral shaft by Masquelet technique: sequential internal fixation and nail with plate augmentation.

BACKGROUND: To evaluate the effectiveness of a sequential internal fixation strategy and intramedullary nailing with plate augmentation (IMN/PA) for bone reconstruction in the management of infected femoral shaft defects using the Masquelet technique. METHODS: We performed a retrospective descriptive cohort study of 21 patients (mean age, 36.4 years) with infected bone defects of the femoral shaft treated by the Masquelet technique with a minimum follow-up of 18 months after second stage. After aggressive debridement, temporary stabilisation (T1) was achieved by an antibiotic-loaded bone cement spacer and internal fixation with a bone cement-coated locking plate. At second stage (T2), the spacer and the locking plate were removed following re-debridement, and IMN/PA was used as definitive fixation together with bone grafting. We evaluated the following clinical outcomes: infection recurrence, bone union time, complications, and the affected limb's knee joint function. RESULTS: The median and quartiles of bone defect length was 7 (4.75-9.5) cm. Four patients required iterative debridement for infection recurrence after T1. The median of interval between T1 and T2 was 10 (9-19) weeks. At a median follow-up of 22 (20-27.5) months, none of the patients experienced recurrence of infection. Bone union was achieved at 7 (6-8.5) months in all patients, with one patient experiencing delayed union at the distal end of bone defect due to screws loosening. At the last follow-up, the median of flexion ROM of the knee joint was 120 (105-120.0)°. CONCLUSIONS: For infected femoral shaft bone defects treated by the Masquelet technique, sequential internal fixation and IMN/PA for the reconstruction can provide excellent mechanical stability, which is beneficial for early functional exercise and bone union, and does not increase the rate of infection recurrence.

The effect of Toxoplasma gondii infection on galectin-9 expression in decidual macrophages contributing to dysfunction of decidual NK cells during pregnancy.

BACKGROUND: Toxoplasma gondii infection causes adverse pregnancy outcomes by affecting the expression of immunotolerant molecules in decidual immune cells. Galectin-9 (Gal-9) is widely expressed in decidual macrophages (dMφ) and is crucial for maintaining normal pregnancy by interacting with the immunomodulatory protein T-cell immunoglobulin and mucin domain-containing molecule 3 (Tim-3). However, the effects of T. gondii infection on Gal-9 expression in dMφ, and the impact of altered Gal-9 expression levels on the maternal-fetal tolerance function of decidual natural killer (dNK) cells, are still unknown. METHODS: Pregnancy outcomes of T. gondii-infected C57BL/6 and Lgals9-/- pregnant mice models were recorded. Expression of Gal-9, c-Jun N-terminal kinase (JNK), phosphorylated JNK (p-JNK), and Forkhead box protein O1 (FOXO1) was detected by western blotting, flow cytometry or immunofluorescence. The binding of FOXO1 to the promoter of Lgals9 was determined by chromatin immunoprecipitation-polymerase chain reaction (ChIP-PCR). The expression of extracellular signal-regulated kinase (ERK), phosphorylated ERK (p-ERK), cAMP-response element binding protein (CREB), phosphorylated CREB (p-CREB), T-box expressed in T cells (T-bet), interleukin 10 (IL-10), and interferon gamma (IFN-γ) in dNK cells was assayed by western blotting. RESULTS: Toxoplasma gondii infection increased the expression of p-JNK and FOXO1 in dMφ, resulting in a reduction in Gal-9 due to the elevated binding of FOXO1 with Lgals9 promoter. Downregulation of Gal-9 enhanced the phosphorylation of ERK, inhibited the expression of p-CREB and IL-10, and promoted the expression of T-bet and IFN-γ in dNK cells. In the mice model, knockout of Lgals9 aggravated adverse pregnancy outcomes caused by T. gondii infection during pregnancy. CONCLUSIONS: Toxoplasma gondii infection suppressed Gal-9 expression in dMφ by activating the JNK/FOXO1 signaling pathway, and reduction of Gal-9 contributed to dysfunction of dNK via Gal-9/Tim-3 interaction. This study provides new insights for the molecular mechanisms of the adverse pregnancy outcomes caused by T. gondii.

Overexpression of REC8 induces aberrant gamete meiotic division and contributes to AML pathogenesis - a multiplexed microarray analysis and mendelian randomization study.

Acute myeloid leukemia (AML) is a notably lethal disease, characterized by malignant clonal proliferation of hematopoietic stem cells in the bone marrow. This study seeks to unveil potential therapeutic targets for AML, using a combined approach of microarray analysis and Mendelian randomization (MR). We collected data samples from the Gene Expression Omnibus (GEO) database and extracted pQTL data from genome-wide association studies (GWAS) to identify overlapping genes between the DEGs and GWAS data. Gene enrichment and pathway annotation analyses were performed on these genes. Furthermore, we validated gene expression levels and assessed their clinical relevance. By taking the intersection of these gene sets, we obtained a list of co-expressed genes, including four upregulated genes (REC8, TPM2, ZMIZ1, CD82) and two downregulated genes (IFNAR1, TMCO3). MR analysis demonstrated that genetically predicted protein levels of CD82, REC8, ZMIZ1, and TPM2 were significantly associated with increased odds of AML, while IFNAR1 and TMCO3 showed a protective effect. Gene ontology and KEGG pathway analyses revealed significant enrichment in functions related to female gamete generation, meiosis, p53 signaling pathway, and cardiac muscle contraction. Differences in immune cell profiles were observed between AML survivors and those with poor prognosis, including lower levels of neutrophils and higher levels of follicular helper T cells in the latter group. This study identifies a causal relationship between gene expression and AML and highlights the potential role of REC8 in leukemogenesis, possibly through its impact on gametocyte meiotic abnormalities. The findings provide new insights into the prevention and treatment of leukemia.

Artesunate inhibits vasculogenic mimicry in choroidal melanoma through HIF-1 α/ VEGF/PDGF pathway.

Choroidal melanoma (CM), a highly metastatic eye tumor, exhibits vasculogenic mimicry (VM) facilitated by hypoxia-induced angiogenesis. This study explored the inhibitory impact of the anti-malarial drug Artesunate (ART) on CM VM through modulation of the HIF-1α/VEGF/PDGF pathway. Immunohistochemistry (IHC) confirmed VM in CM with elevated VEGF and PDGF expression. Hypoxia promoted CM proliferation, upregulating HIF-1α, VEGF and PDGF. VEGF and PDGF enhanced CM migration, invasion and VM, with HIF-1α playing a crucial role. ART mitigated VM formation by suppressing the HIF-1α/VEGF/PDGF pathway, highlighting its potential as an anti-tumor agent in CM.

Deep learning in the precise assessment of primary Sjögren's Syndrome based on ultrasound images.

OBJECTIVES: This study aimed to investigate the value of a deep learning (DL) model based on greyscale ultrasound (US) images for precise assessment and accurate diagnosis of primary Sjögren's syndrome (pSS). METHODS: This was a multicentre prospective analysis. All pSS patients were diagnosed according to 2016 ACR/EULAR criteria. 72 pSS patients and 72 sex- and age-matched healthy controls recruited between January 2022 and April 2023, together with 41 patients and 41 healthy controls recruited from June 2023 to February 2024 were used for DL model development and validation, respectively. DL model was constructed based on the ResNet 50, input with preprocessed all participants' bilateral submandibular glands (SMGs), parotid glands (PGs), and lacrimal glands (LGs) greyscale US images. Diagnostic performance of the model was compared with two radiologists. The accuracy of prediction and identification performance of DL model were evaluated by calibration curve. RESULTS: 864 and 164 greyscale US images of SMGs, PGs, and LGs were collected for development and validation of the model. The AUCs of DL model in the SMG, PG, and LG were 0.92, 0.93, 0.91 in the model cohort, and were 0.90, 0.88, 0.87 in the validation cohort respectively, outperforming both radiologists. Calibration curves showed the prediction probability of DL model were consistent with the actual probability in both model cohort and validation cohort. CONCLUSION: DL model based on greyscale US images showed diagnostic potential in the precise assessment of pSS patients in the SMG, PG, and LG, outperforming conventional radiologist evaluation.

Construction and Application of Autonomy Theory of Rehabilitation Program for Bronchiectasis Patients.

Objective: The autonomy theory holds that the autonomy of individuals in the rehabilitation process is crucial to the success of rehabilitation. To explore the use of autonomous rehabilitation programs in patients with bronchiectasis, This study was conducted through the construction of a stable family rehabilitation program for bronchiectasis patients and the application of patients self-determination theory. To further explore the value of autonomy theory in rehabilitation therapy. Method: The experimental group used self-determination theory as the guide for intervention on the basis of the control groups. The two groups of observation indexes included St. George's Respiratory Questionnaire, FEV1 and FEV1 values, lung capacity, V25, V50, maximal ventilation, compliance questionnaire, anxiety self-assessment scale, and depression self-assessment scale. Results: (1) The lung capacity of the experimental group patients (3.01 ± 0.82) L was higher than that of the control group (2.86 ± 0.36) L, and the V25 value (2.63 ± 0.31) L/s, V50 value (4.31 ± 1.01) L/s, and maximum ventilation volume (71.63 ± 18.35) L/min were all higher than those of the control group, with P < .05; (2) After intervention, the SGRO score of patients in the experimental group (38.66 ± 8.67)score was lower than that of the control group (56.48 ± 9.86)score. The FEV1 score of patients in the experimental group (9.35 ± 2.36)L was higher than that of the control group (1.04 ± 0.29)L. After intervention, the FEV1 score of patients in the experimental group was% (56.83 ± 9.21)% higher than that of the control group (46.37 ± 7.67)%, with P < .05; (3) Comparison of compliance scores between two groups of patients before and after intervention: the experimental group had scores for timed medication (4.89 ± 0.64)score, moderate exercise (4.61 ± 1.04)score, and dietary regulation (4.72 ± 0.87)score after intervention, all of which were higher than those of the control group (P < .05); (4) The comparison of anxiety and depression between two groups of patients showed that the anxiety score (10.16 ± 3.03)score of the experimental group after intervention was lower than that of the control group (13.03 ± 3.67)score, and the depression score (9.35 ± 2.36)score of the experimental group after intervention was lower than that of the control group (12.34 ± 3.01)score, with P < .05. Conclusion: Using the theory of autonomy to construct and apply the rehabilitation program in the home stabilization stage of bronchiectasis patients can improve respiratory and lung function. At the same time, it has a certain degree of promoting effect on improving patients' treatment compliance, and can improve patients' emotional state and reduce the occurrence of anxiety and depression. The results of this study will provide a certain theoretical basis for the construction of the treatment and rehabilitation program of clinically related diseases. In the future clinical treatment, personalized treatment intervention can be carried out according to the autonomy of patients to improve the clinical prognosis.