Radiomics of pericoronary adipose tissue on computed tomography angiography predicts coronary heart disease in patients with type 2 diabetes mellitus.

BACKGROUND: Diabetes is a common chronic metabolic disease. The progression of the disease promotes vascular inflammation and the formation of atherosclerosis, leading to cardiovascular disease. The coronary artery perivascular adipose tissue attenuation index based on CCTA is a new noninvasive imaging biomarker that reflects the spatial changes in perivascular adipose tissue attenuation in CCTA images and the inflammation around the coronary arteries. In this study, a radiomics approach is proposed to extract a large number of image features from CCTA in a high-throughput manner and combined with clinical diagnostic data to explore the predictive ability of vascular perivascular adipose imaging data based on CCTA for coronary heart disease in diabetic patients. METHODS: R language was used for statistical analysis to screen the variables with significant differences. A presegmentation model was used for CCTA vessel segmentation, and the pericoronary adipose region was screened out. PyRadiomics was used to calculate the radiomics features of pericoronary adipose tissue, and SVM, DT and RF were used to model and analyze the clinical data and radiomics data. Model performance was evaluated using indicators such as PPV, FPR, AAC, and ROC. RESULTS: The results indicate that there are significant differences in age, blood pressure, and some biochemical indicators between diabetes patients with and without coronary heart disease. Among 1037 calculated radiomic parameters, 18.3% showed significant differences in imaging omics features. Three modeling methods were used to analyze different combinations of clinical information, internal vascular radiomics information and pericoronary vascular fat radiomics information. The results showed that the dataset of full data had the highest ACC values under different machine learning models. The support vector machine method showed the best specificity, sensitivity, and accuracy for this dataset. CONCLUSIONS: In this study, the clinical data and pericoronary radiomics data of CCTA were fused to predict the occurrence of coronary heart disease in diabetic patients. This provides information for the early detection of coronary heart disease in patients with diabetes and allows for timely intervention and treatment.

LightGBM is an Effective Predictive Model for Postoperative Complications in Gastric Cancer: A Study Integrating Radiomics with Ensemble Learning.

Postoperative complications of radical gastrectomy seriously affect postoperative recovery and require accurate risk prediction. Therefore, this study aimed to develop a prediction model specifically tailored to guide perioperative clinical decision-making for postoperative complications in patients with gastric cancer. A retrospective analysis was conducted on patients who underwent radical gastrectomy at the First Affiliated Hospital of Nanjing Medical University between April 2022 and June 2023. A total of 166 patients were enrolled. Patient demographic characteristics, laboratory examination results, and surgical pathological features were recorded. Preoperative abdominal CT scans were used to segment the visceral fat region of the patients through 3Dslicer, a 3D Convolutional Neural Network (3D-CNN) to extract image features and the LASSO regression model was employed for feature selection. Moreover, an ensemble learning strategy was adopted to train the features and predict postoperative complications of gastric cancer. The prediction performance of the LGBM (Light Gradient Boosting Machine), XGB (XGBoost), RF (Random Forest), and GBDT (Gradient Boosting Decision Tree) models was evaluated through fivefold cross-validation. This study successfully constructed a model for predicting early complications following radical gastrectomy based on the optimal algorithm, LGBM. The LGBM model yielded an AUC value of 0.9232 and an accuracy of 87.28% (95% CI, 75.61-98.95%), surpassing the performance of other models. Through ensemble learning and integration of perioperative clinical data and visceral fat radiomics, a predictive LGBM model was established. This model has the potential to facilitate individualized clinical decision-making and the early recovery of patients with gastric cancer post-surgery.

Longitudinal changes in mental health among medical students in China during the COVID-19 epidemic: depression, anxiety and stress at 1-year follow -up.

This study aimed to evaluate the influence of COVID-19 on the mental health of Chinese medical students at 1-year of follow-up. From 2 February 2020 to 23 February 2021, we conducted three waves of research online (T1 = during outbreak, T2 = controlling period, T3 = 1 year after outbreak). The survey collected demographic data and several self reporting questionnaires to measure the depressive, anxiety and stress symptoms. A total of 4002 participants complete the whole research phases. The study major, grade level and gender were the main factors related to psychological distress caused by the COVID-19 crisis. Importantly, medical knowledge has a protective effect on medical students' psychological distress during the COVID-19 period.

Fatigue Tests and Analysis on Welded Joints of Weathering Steel.

To investigate the fatigue performance of vertical web stiffener to deck plate welded joints in weathering steel box girders, six specimens of the weathering steel (WS) Q345qNH, four specimens of WS Q420qNH, and four specimens of the plain carbon steel (CS) Q345q for comparison were tested by a vibratory fatigue testing machine, considering different steel grades, yield strengths, stiffener plate thicknesses, and weld types. The fatigue strength was evaluated based on S-N curves and the crack propagation was analyzed by linear elastic fracture mechanics (LEFM). The results show that the fatigue crack of the welded joints was initiated from the end weld toe of the deck plate and subsequently propagated both along the thickness of the deck plate and in the direction perpendicular to the stiffener plate. The fatigue crack initiation and propagation life of WS Q345qNH specimens were longer than those of CS Q345q specimens. The fatigue crack propagation life of WS Q345qNH specimens was longer than that of WS Q420qNH specimens, while the initiation life bore little relationship to the yield strength. Increasing the stiffener plate thickness effectively delayed crack initiation and slowed down its propagation. Compared with fillet welds, full penetration welds extended the fatigue crack propagation life, while no significant improvement was implied for the initiation life. The WS and CS specimens could be classified as having the same fatigue strengths by nominal stress, hot spot stress, and effective notch stress approaches, which were FAT 50, FAT 100, and FAT 225, respectively. Meanwhile, their material constants for LEFM were relatively close to each other.

The analysis of differential diagnosis of benign and malignant thyroid nodules based on ultrasound reports.

BACKGROUND: Thyroid cancer is a common endocrine tumor, the incidence of which is increasing each year. Early diagnosis and treatment can effectively prevent thyroid cancer. This article uses Chinese's ultrasound reports to determine the value of early diagnosis. METHODS: The clinical data center of the First Affiliated Hospital of Nanjing Medical University was screened for patients diagnosed with a thyroid nodule, who had undergone a thyroid function test, ultrasound records and pathological assessment. A total of 811 patients with a total of 1,290 pathologically confirmed nodules (506 benign and 784 malignant) were enrolled. Logistic regression was used to analyze the variables that significantly affected malignant nodules. The sensitivity and specificity of ultrasound thyroid imaging-reporting and data system (TI-RADS) classification results for benign and malignant tumors were calculated. RESULTS: The age of the patients had a very significant difference in the classification of benign and malignant nodules (P<0.001), and the marital status was significantly different (P<0.05). Gender and medical insurance had no significant effect (P>0.05). Thyroglobulin (TG), free thyroxine (FT4), and free triiodothyronine (FT3) had significant effects (P=0.003) on the incidence of malignant nodules in patients, while thyroid-stimulating hormone (TSH) had no significant effect (P>0.05). Ultrasound analysis showed a Youden's index of 78.97%, a positive predictive value of 93.20%, and a negative predicted value of 84.10% at the most excellent classification effect. The sensitivity was 89.0%, the specificity was 89.9%; much greater than the classification model based on the thyroid function test (sensitivity =80.6%, specificity =55.8%). CONCLUSIONS: The present study verifies the effectiveness of using TI-RADS classification for diagnosis of benign and malignant thyroid nodules, and explores the use of new analysis methods for clinical data. To reduce dependence on the doctors, ultrasound image data and clinical phenotypic data can be further used to assist clinical decision making.

Risk Factors for the Relapse of Graves' Disease Treated With Antithyroid Drugs: A Systematic Review and Meta-analysis.

PURPOSE: Antithyroid drugs (ATDs) are the first-line treatment for Graves' disease (GD). A common problem with ATD treatment is the high relapse rate after drug withdrawal. The goal of this study was to analyze the influencing factors for the relapse of GD patients treated with ATD by using a systematic review and meta-analysis, provide some predictive indexes for the susceptibility of GD recurrence, and then further explore some useful methods to decrease the GD relapse rate after ATD treatment. METHODS: Articles published in PubMed, EMBASE, The Cochrane Library, China National Knowledge Infrastructure, Wan Fang, and Chinese Biomedical Literature databases before January 2019 were collected. Patients newly diagnosed with GD, who were aged >16 years, were treated with ATD. Follow-up was then conducted for at least 12 months after ATD withdrawal. Only prospective or retrospective studies were eligible. The primary end point was the recurrence of GD during follow-up. All the data from the trials were analyzed via meta-analysis and meta-regression. p values < 0.05 were considered statistically significant, and statistical heterogeneity was assessed by using I2 statistics. FINDINGS: A total of 20 studies and 3242 patients were involved in this meta-analysis, with 1681 patients relapsed (incidence rate, 51.9%) during the follow-up time. Analysis of risk factors suggested that younger age (weighted raw mean difference [RMD], -3.51; 95% CI, -5.74 to -1.29), larger thyroid volume (RMD, 4.38; 95% CI, 1.68 to 7.08), bigger goiter size (1.94% risk; 95% CI, 0.43 to 3.46), higher free triiodothyronine level (RMD, 5.09; 95% CI, 4.42 to 5.77), and higher free thyroxine level (RMD, 4.21; 95% CI, 0.54 to 7.89) were associated with the higher relapse rate of GD. The block-replace ATD regimen (a fixed high dose of an ATD with levothyroxine supplementation to maintain euthyroidism) (risk ratio, 0.64; 95% CI, 0.52 to 0.78) exhibits a lower relapse rate than the titration regimen (an ATD used alone and dose adjusted according to thyroid function tests). IMPLICATIONS: This analysis revealed that certain risk factors were associated with GD relapses such as younger age, larger goiter size or thyroid volume, and the higher free triiodothyronine or free thyroxine level in the diagnosing phase of GD. For patients with these clinical characteristics, early definitive treatment with radioactive iodine or surgery should be offered to those who are unlikely to achieve remission with ATDs only. In addition, more prospective cohort studies with different ATD regimens would help to determine the optimum ATD treatment for patients with GD. PROSPERO identifier: CRD 42019146825.

Estimation of work-related injury and economic burden attributable to heat stress in Guangzhou, China.

BACKGROUND: Climate change has exacerbated the health effects of high ambient temperatures on occupational health and safety; however, to what extent heat stress can induce workplace injuries and economic costs is poorly studied. This study aimed to quantify the attributable fractions of injury claims and subsequent insurance payouts using data from work-related injury insurance system in Guangzhou, China. METHODS: Individual workers' injury claims data were collected for the period of 2011-2012, including demographic characteristics and work-related information. Daily maximum wet bulb globe temperature (WBGT, °C) was calculated from meteorological data. To examine the association between WBGT index and work-related injury, we fit a quasi-Poisson regression with distributed lag non-linear model. Then we calculated the numbers of injury claims and costs of insurance compensations attributable to days with WBGT above the heat stress limit according to the national occupational health standards. RESULTS: There were 9550 work-related injury claims, resulting in an insurance payout of 282.3 million Chinese Yuan. The risks of injury claims increased with rising WBGT. 4.8% (95% eCI: 2.9%-6.9%) of work-related injuries and 4.1% (95% eCI: 0.2%-7.7%) of work-related injury insurance payouts were attributed to heat exposure for WBGT threshold above the heat stress limit. Male workers, those in small enterprises and with low educational attainment were especially sensitive to the effects of heat exposure. CONCLUSIONS: Heat stress can contribute to higher risk of work-related injury and substantial economic costs. Quantified the impacts of injuries and related economic costs should be considered to develop targeted preventive measures in the context of climate change.

Effect of traffic legislation on road traffic deaths in Ningbo, China.

PURPOSE: Road safety is a major public health concern in China. However, the effectiveness of traffic laws in China is not known. We investigated the effect of traffic legislation on traffic deaths using data in Ningbo, China. METHODS: We obtained traffic fatality data from 2002 to 2014 from the Ningbo Municipal Center for Disease Control and Prevention. An interrupted time series was used to look for change points in fatalities over time. We first used multiple change-point analysis to identify whether change points existed. Then, we checked if the identified change points corresponded to major changes in traffic legislation. Finally, we used a generalized additive model to examine the magnitude of those changes on fatalities. RESULTS: A total of 12,412 traffic fatalities occurred in the study period. We detected two change points in traffic fatalities, which corresponded to the road safety law in 2004 and the Criminal Law Amendment criminalizing risky driving in 2011. The fatalities showed an 18.9% reduction (relative risk = 0.81, 95% confidence interval, 0.74-0.89) after the first change point and a further 19.2% reduction (relative risk = 0.80, 95% confidence interval, 0.74-0.89) after the second change point. CONCLUSIONS: Traffic legislation might improve road safety by spurring behavioral changes that reduce traffic deaths in China. These laws may provide a sound model for other similar countries.

Does hot weather affect work-related injury? A case-crossover study in Guangzhou, China.

BACKGROUND: Despite increasing concerns about the health effects of climate change, the extent to which workers are affected by hot weather is not well documented. This study aims to investigate the association between high temperatures and work-related injuries using data from a large subtropical city in China. METHODS: We used workers' compensation claims to identify work-related injuries in Guangzhou, China during 2011-2012. To feature the heat effect, the study period was restricted to the warm seasons in Guangzhou (1 May-31 October). We conducted a time-stratified case-crossover study to examine the association between ambient outdoor temperatures, including daily maximum and minimum temperatures, and cases of work-related injury. The relationships were assessed using conditional Poisson regression models. RESULTS: Overall, a total of 5418 workers' compensation claims were included over the study period. Both maximum and minimum temperatures were significantly associated with work-related injuries, but associations varied by subgroup. One °C increase in maximum temperature was associated with a 1.4% (RR = 1.014, 95%CIs 1.012-1.017) increase in daily injury claims. Significant associations were seen for male and middle-aged workers, workers in small and medium-sized enterprises, and those working in manufacturing sector. And 1 °C increase in minimum temperature was associated with 1.7% (RR = 1.017, 95%CIs 1.012-1.021) increase in daily injury claims. Significant associations were observed for female and middle-aged workers, workers in large-sized enterprises, and those working in transport and construction sectors. CONCLUSIONS: We found a higher risk of work-related injuries due to hot weather in Guangzhou, China. This study provides important epidemiological evidence for policy-makers and industry that may assist in the formulation of occupational safety and climate adaptation strategies.

Assessment of the Public Health Risks and Impact of a Tornado in Funing, China, 23 June 2016: A Retrospective Analysis.

(1) Background: Tornadoes are one of the deadliest disasters but their health impacts in China are poorly investigated. This study aimed to assess the public health risks and impact of an EF-4 tornado outbreak in Funing, China; (2) Methods: A retrospective analysis on the characteristics of tornado-related deaths and injuries was conducted based on the database from the Funing's Center for Disease Control and Prevention (CDC) and Funing People's Hospital. A change-point time-series analysis of weekly incidence for the period January 2010 to September 2016 was used to identify sensitive infectious diseases to the tornado; (3) Results: The 75 to 84 years old group was at the highest risk of both death (RR = 82.16; 95% CIs = 19.66, 343.33) and injury (RR = 31.80; 95% CI = 17.26, 58.61), and females were at 53% higher risk of death than males (RR = 1.53; 95% CIs = 1.02, 2.29). Of the 337 injuries, 274 injuries (81%) were minor. Most deaths occurred indoors (87%) and the head (74%) was the most frequent site of trauma during the tornado. Five diseases showed downward change-points; (4) Conclusions: The experience of the Funing tornado underscores the relative danger of being indoors during a tornado and is successful in avoiding epidemics post-tornado. Current international safety guidelines need modification when generalized to China.