Novel Approach to Personalized Physician Recommendations Using Semantic Features and Response Metrics: Model Evaluation Study.

BACKGROUND: The rapid growth of web-based medical services has highlighted the significance of smart triage systems in helping patients find the most appropriate physicians. However, traditional triage methods often rely on department recommendations and are insufficient to accurately match patients' textual questions with physicians' specialties. Therefore, there is an urgent need to develop algorithms for recommending physicians. OBJECTIVE: This study aims to develop and validate a patient-physician hybrid recommendation (PPHR) model with response metrics for better triage performance. METHODS: A total of 646,383 web-based medical consultation records from the Internet Hospital of the First Affiliated Hospital of Xiamen University were collected. Semantic features representing patients and physicians were developed to identify the set of most similar questions and semantically expand the pool of recommended physician candidates, respectively. The physicians' response rate feature was designed to improve candidate rankings. These 3 characteristics combine to create the PPHR model. Overall, 5 physicians participated in the evaluation of the efficiency of the PPHR model through multiple metrics and questionnaires as well as the performance of Sentence Bidirectional Encoder Representations from Transformers and Doc2Vec in text embedding. RESULTS: The PPHR model reaches the best recommendation performance when the number of recommended physicians is 14. At this point, the model has an F1-score of 76.25%, a proportion of high-quality services of 41.05%, and a rating of 3.90. After removing physicians' characteristics and response rates from the PPHR model, the F1-score decreased by 12.05%, the proportion of high-quality services fell by 10.87%, the average hit ratio dropped by 1.06%, and the rating declined by 11.43%. According to whether those 5 physicians were recommended by the PPHR model, Sentence Bidirectional Encoder Representations from Transformers achieved an average hit ratio of 88.6%, while Doc2Vec achieved an average hit ratio of 53.4%. CONCLUSIONS: The PPHR model uses semantic features and response metrics to enable patients to accurately find the physician who best suits their needs.

IL-37 possesses both anti-inflammatory and antiviral effects against Middle East respiratory syndrome coronavirus infection.

BACKGROUND: The aim was to elucidate the function of IL-37 in middle east respiratory syndrome coronavirus (MERS-CoV) infection, thereby providing a novel therapeutic strategy for managing the clinical treatment of inflammatory response caused by respiratory virus infection. METHODS: We investigated the development of MERS by infecting hDPP4 mice with hCoV-EMC (107 TCID50 [50% tissue culture infectious dose]) intranasally. We infected A549 cells with MERS-CoV, which concurrently interfered with IL-37, detecting the viral titer, viral load, and cytokine expression at certain points postinfection. Meanwhile, we administered IL-37 (12.5 µg/kg) intravenously to hDPP4 mice 2 h after MERS-CoV-2 infection and collected the serum and lungs 5 days after infection to investigate the efficacy of IL-37 in MERS-CoV infection. RESULTS: The viral titer of MERS-CoV-infected A549 cells interfering with IL-37 was significantly reduced by 4.7-fold, and the viral load of MERS-CoV-infected hDPP4 mice was decreased by 59-fold in lung tissue. Furthermore, the administration of IL-37 suppressed inflammatory cytokine and chemokine (monocyte chemoattractant protein 1, interferon-γ, and IL-17A) expression and ameliorated the infiltration of inflammatory cells in hDPP4 mice. CONCLUSION: IL-37 exhibits protective properties in severe pneumonia induced by MERS-CoV infection. This effect is achieved through attenuation of lung viral load, suppression of inflammatory cytokine secretion, reduction in inflammatory cell infiltration, and mitigation of pulmonary injury.

Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study.

BACKGROUND: After the implementation of 2- and 3-child policies, the rising proportion of high-age and high-risk pregnancies put enormous pressure on maternal and child health (MCH) services for China. This populous nation with an increasing population flow imperatively required the support of large-scale information systems for management. Municipal MCH information systems were commonly applied in developed cities of eastern provinces in China. However, implementation of provincial MCH information systems in relatively low-income areas is lacking. In 2020, the implementation of a regional maternal and child information system (RMCIS) in Inner Mongolia filled this gap. OBJECTIVE: This paper aimed to demonstrate the construction process and evaluate the implementation effect of an RMCIS in improving the regional MCH in Inner Mongolia. METHODS: We conducted a descriptive study for the implementation of an RMCIS in Inner Mongolia. Based on the role analysis and information reporting process, the system architecture design had 10 modules, supporting basic health care services, special case management, health support, and administration and supervision. Five-color management was applied for pregnancy risk stratification. We collected data on the construction cost, key characteristics of patients, and use count of the main services from January 1, 2020, to October 31, 2022, in Inner Mongolia. Descriptive analysis was used to demonstrate the implementation effects of the RMCIS. RESULTS: The construction and implementation of the RMCIS cost CNY 8 million (US $1.1 million), with a duration of 13 months. Between 2020 and 2022, the system recorded 221,772 registered pregnant women, with a 44.75% early pregnancy registry rate and 147,264 newborns, covering 278 hospitals and 225 community health care centers in 12 cities. Five-color management of high-risk pregnancies resulted in 76,975 (45.45%) pregnancies stratified as yellow (general risk), 36,627 (21.63%) as orange (relatively high risk), 156 (0.09%) as red (high risk), and 3888 (2.30%) as purple (infectious disease). A scarred uterus (n=28,159, 36.58%), BMI≥28 (n=14,164, 38.67%), aggressive placenta praevia (n=32, 20.51%), and viral hepatitis (n=1787, 45.96%) were the top factors of high-risk pregnancies (yellow, orange, red, and purple). In addition, 132,079 pregnancies, including 65,018 (49.23%) high-risk pregnancies, were registered in 2022 compared to 32,466 pregnancies, including 21,849 (67.30%) high-risk pregnancies, registered in 2020. CONCLUSIONS: The implementation of an RMCIS in Inner Mongolia achieved the provincial MCH data interconnection for basic services and obtained both social and economic benefits, which could provide valuable experience to medical administration departments, practitioners, and medical informatics constructors worldwide.

[Expression and significance of jumonji domain-containing protein 2B and hypoxia inducible factor-1α in non-Hodgkin lymphoma tissues in children]. / 含jumonji结构域的蛋白2Bå’Œç¼ºæ°§è¯±å¯¼å› å­1α在儿童非霍奇金淋巴瘤组织中的表达及意义.

OBJECTIVES: To investigate the expression and significance of jumonji domain-containing protein 2B (JMJD2B) and hypoxia-inducible factor-1α (HIF-1α) in non-Hodgkin's lymphoma (NHL) tissues in children. METHODS: Immunohistochemistry was used to detect the expression of JMJD2B and HIF-1α in lymph node tissue specimens from 46 children with NHL (observation group) and 24 children with reactive hyperplasia (control group). The relationship between JMJD2B and HIF-1α expression with clinicopathological characteristics and prognosis in children with NHL, as well as the correlation between JMJD2B and HIF-1α expression in NHL tissues, were analyzed. RESULTS: The positive expression rates of JMJD2B (87% vs 21%) and HIF-1α (83% vs 42%) in the observation group were higher than those in the control group (P<0.05). The expression of JMJD2B and HIF-1α was correlated with serum lactate dehydrogenase levels and the risk of international prognostic index in children with NHL (P<0.05). The expression of JMJD2B was positively correlated with the HIF-1α expression in children with NHL (rs=0.333, P=0.024). CONCLUSIONS: JMJD2B and HIF-1α are upregulated in children with NHL, and they may play a synergistic role in the development of pediatric NHL. JMJD2B can serve as a novel indicator for auxiliary diagnosis, evaluation of the severity, treatment guidance, and prognosis assessment in pediatric NHL.

Effect of intra-operative chemotherapy with 5-fluorouracil and leucovorin on the survival of patients with colorectal cancer after radical surgery: a retrospective cohort study.

BACKGROUND: The effect of intra-operative chemotherapy (IOC) on the long-term survival of patients with colorectal cancer (CRC) remains unclear. In this study, we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection. METHODS: 1820 patients were recruited, and 1263 received IOC and 557 did not. Clinical and demographic data were collected, including overall survival (OS), clinicopathological features, and treatment strategies. Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models. A regression model was developed to analyze the independent effects of IOC. RESULTS: Proportional hazard regression analysis showed that IOC (hazard ratio [HR]=0.53, 95% confidence intervals [CI] [0.43, 0.65], P  < 0.001) was a protective factor for the survival of patients. The mean overall survival time in IOC group was 82.50 (95% CI [80.52, 84.49]) months, and 71.21 (95% CI [67.92, 74.50]) months in non-IOC group. The OS in IOC-treated patients were significantly higher than non-IOC-treated patients ( P  < 0.001, log-rank test). Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model (HR=0.53, 95% CI [0.43, 0.65], P  < 0.001), model 2 (adjusted for age and gender, HR=0.52, 95% CI [0.43, 0.64], P  < 0.001), and model 3 (adjusted for all factors, 95% CI 0.71 [0.55, 0.90], P  = 0.006). The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II (HR = 0.46, 95% CI [0.31, 0.67]) or III disease (HR=0.59, 95% CI [0.45, 0.76]), regardless of pre-operative radiotherapy (HR=0.55, 95% CI [0.45, 0.68]) or pre-operative chemotherapy (HR=0.54, 95% CI [0.44, 0.66]). CONCLUSIONS: IOC is an independent factor that influences the survival of CRC patients. It improved the OS of patients with stages II and III CRC after radical surgery. TRIAL REGISTRATION: chictr.org.cn, ChiCTR 2100043775.

Comparison of the replication and neutralization of different SARS-CoV-2 Omicron subvariants in vitro.

BACKGROUND: New Omicron subvariants are emerging rapidly from BA.1 to BA.4 and BA.5. Their pathogenicity has changed from that of wild-type (WH-09) and Omicron variants have over time become globally dominant. The spike proteins of BA.4 and BA.5 that serve as the target for vaccine-induced neutralizing antibodies have also changed compared to the previous subvariants, which is likely to cause immune escape and the reduction of the protective effect of the vaccine. Our study addresses the above issues and provides a basis for formulating relevant prevention and control strategies. METHODS: We collected cellular supernatant and cell lysates and measured the viral titers, viral RNA loads, and E subgenomic RNA (E sgRNA) loads in different Omicron subvariants grown in Vero E6 cells, using WH-09 and Delta variants as a reference. Additionally, we evaluated the in vitro neutralizing activity of different Omicron subvariants and compared it to the WH-09 and Delta variants using macaque sera with different types of immunity. RESULTS: As the SARS-CoV-2 evolved into Omicron BA.1, the replication ability in vitro began to decrease. Then with the emergence of new subvariants, the replication ability gradually recovered and became stable in the BA.4 and BA.5 subvariants. In WH-09-inactivated vaccine sera, geometric mean titers of neutralization antibodies against different Omicron subvariants declined by 3.7~15.4-fold compared to those against WH-09. In Delta-inactivated vaccine sera, geometric mean titers of neutralization antibodies against Omicron subvariants declined by 3.1~7.4-fold compared to those against Delta. CONCLUSION: According to the findings of this research, the replication efficiency of all Omicron subvariants declined compared with WH-09 and Delta variants, and was lower in BA.1 than in other Omicron subvariants. After two doses of inactivated (WH-09 or Delta) vaccine, cross-neutralizing activities against various Omicron subvariants were seen despite a decline in neutralizing titers.

Predictive value of combining maternal peripheral blood count indicators for early-onset sepsis in preterm infants: A retrospective cohort study.

To assess the early predictive value of maternal parameters for early-onset sepsis (EOS) in preterm infants, especially including the maternal neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV). The retrospective cohort study examined a total of 231 preterm infants (69 with EOS) from May 2017 to October 2021 of the Fourth Hospital of Hebei Medical University, randomly divided (7:3) into the training set group (n = 162) and validation set group (n = 69). Thirteen clinical variables (including MPV, NLR, and PLR) were included as the research objects. By logistic regression, the factors significantly associated with EOS were distinguished. Additionally, a nomogram was constructed based on the independent risk factors, the validation of which relied on the concordance index, calibration curves, receiver operating characteristic curves, and decision curve analyses. Multivariate logistic regression proved that NLR (OR = 1.67, 95% CI = 1.18-2.36, P = .004), PLR (OR = 1.03, 95% CI = 1.01-1.04, P = .001), and MPV (OR = 1.75, 95% CI = 1.15-2.66, P = .009) were independent risk factors for EOS. The AUC of the nomogram for the training set group was 0.872 (0.814, 0.931) and 0.889 (0.843, 0.935) in the validation set group. The P values of Hosmer-Lemeshow test for the training set and validation set groups were .903 and .752, respectively. The decision curve analyses outcome indicated good clinical practicability. The C-index for the training set and validation set groups were 0.872 and 0.889, respectively. The maternal NLR, PLR, and MPV levels had good predictive value for EOS in premature infants. The nomogram in our study could help clinicians predict the occurrence of EOS.

miR-93-5p suppresses ovarian cancer malignancy and negatively regulate CCND2 by binding to its 3'UTR region.

Ovarian cancer is the most fatal gynecological cancer worldwide, yet the fundamental mechanism of malignancy acquisition in ovarian cancer remains unknown. miRNA has been implicated to a variety of diseases, including cancer initiation and progression. Cyclin-D2 (CCND2) is ubiquitously implicated in cancer uncontrol cell proliferation. Bioinformatic research revealed that CCND2 is a candidate gene for miR-93-5p with a binding site in its 3'UTR region in the current study. Using our ovarian cancer sample, we verified that miR-93-5p is negatively correlated with CCND2 mRNA and protein levels. Luciferase report assay revealed miR-93-5p inhibits CCND2 production through binding to the 3'UTR region. The expression of miR-93-5p in ovarian cancer patient samples was then determined, and a survival analysis was performed. Our findings showed that miR-93-5p is downregulated in ovarian cancer and is a favorable predictive factor in ovarian cancer patient. CCK8 assay, wound healing assay and flow cytometry-based cell cycle and apoptotic cell analyses were employed here. We found that miR-93-5p suppresses ovarian cancer cell proliferation and migration while enhances cell death. Our research certified that miR-93-5p reduces ovarian cancer malignancy by targeting CCND2.

Levels of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 are related to cardiopulmonary injury in fetal inflammatory response syndrome.

OBJECTIVES: To evaluate the diagnostic value of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), and the MMP-9/TIMP-1 ratio in fetal inflammatory response syndrome (FIRS), and determine a possible association with the incidence of bronchopulmonary dysplasia (BPD) and myocardial injury. METHODS: Overall, 61 cases of preterm infants with FIRS were divided into the FIRS group 1 (≤32 weeks) and FIRS group 2 (32 to 37 weeks). Similarly, 57 cases of normal preterm infants were divided into Control group 1 and Control group 2. Levels of interleukin-6 (IL-6), MMP-9, and TIMP-1 were detected by enzyme-linked immunosorbent assay. Spearman's linear correlation was used to analyze the relationship between dependent variables. Pathological changes were examined by hematoxylin and eosin (HE) staining and in amniotic fluid smears. RESULTS: Levels of IL-6, MMP-9, and TIMP-1, and the MMP-9/TIMP-1 ratio were significantly higher in the FIRS group than in the Control groups. IL-6 was positively correlated with MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio. Areas under the curve (AUC) of MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio were 0.92, 0.90, and 0.95, respectively. HE staining and amniotic fluid smears showed the aggregation of inflammatory cells. MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio were closely related to the incidence of BPD (≤32 weeks) and myocardial injury (<37 weeks) in preterm infants. CONCLUSION: MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio revealed a certain diagnostic value for FIRS; combined with gestational age, these parameters were effective for predicting cardiopulmonary injury.

Levels of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 are related to cardiopulmonary injury in fetal inflammatory response syndrome

OBJECTIVES: To evaluate the diagnostic value of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), and the MMP-9/TIMP-1 ratio in fetal inflammatory response syndrome (FIRS), and determine a possible association with the incidence of bronchopulmonary dysplasia (BPD) and myocardial injury. METHODS: Overall, 61 cases of preterm infants with FIRS were divided into the FIRS group 1 (≤32 weeks) and FIRS group 2 (32 to 37 weeks). Similarly, 57 cases of normal preterm infants were divided into Control group 1 and Control group 2. Levels of interleukin-6 (IL-6), MMP-9, and TIMP-1 were detected by enzyme-linked immunosorbent assay. Spearman's linear correlation was used to analyze the relationship between dependent variables. Pathological changes were examined by hematoxylin and eosin (HE) staining and in amniotic fluid smears. RESULTS: Levels of IL-6, MMP-9, and TIMP-1, and the MMP-9/TIMP-1 ratio were significantly higher in the FIRS group than in the Control groups. IL-6 was positively correlated with MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio. Areas under the curve (AUC) of MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio were 0.92, 0.90, and 0.95, respectively. HE staining and amniotic fluid smears showed the aggregation of inflammatory cells. MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio were closely related to the incidence of BPD (≤32 weeks) and myocardial injury (<37 weeks) in preterm infants. CONCLUSION: MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio revealed a certain diagnostic value for FIRS; combined with gestational age, these parameters were effective for predicting cardiopulmonary injury.